1. Conclusion
1.1. The world of test-tube baby making in EGYPT is fraught with layer upon layer of stigma:
1.1.1. First, infertility spoils the identity of both men and women in ways that are deeply felt, moreover among women it strains social relationships who are stigmatized by fertile others
1.1.2. Second, infertile couples who choose to seek IVF services are doubly stigmatized by their association with a morally questionable technology:
1.1.2.1. Hence, they feel compelled to enact elaborate cover-ups to protect themselves
1.1.2.2. One associated in Egyptians minds with illicit sex, illegitimate offspring, and enduring sin
1.1.2.3. They fear stigmatization and kalam (gossip)
1.1.3. Third, the stigma of IVF is complicated by the stigma of psychological support, IVF seekers unable to access potentially beneficial psychological services because of the stigma that inheres to psychotherapy itself
1.1.3.1. The stigma of IVF is complicated by the stigma of psychological support. Infertile couples have no outlets to help them through an extremely difficult time
1.2. In Egypt, making a baby "in a test-tube" is not a natural act, according the moral majority
1.2.1. For this reason, the infertile minority continue to fear the chastisement & moral disregard that public disclosure may arouse (anticipating the negative judgements)
1.2.1.1. The question is whether this stigma and secrecy will eventually dissipate over time?
1.3. After more than a decade of IVF practice, Egyptian's views of the NRT can be characterized as deeply ambivalent, even hostile
1.3.1. In Egypt, the dominant view of these technologies has so far been resistant to such facile Western narratives of technological progress
1.4. Finally, IVF engenders shame in a society where ayb, or shame, devolves upon those who have done something morally questionable
2. The Stigma of Support
2.1. Issues of support, or rather , to the lack of support that is a striking feature
2.1.1. The Egyptian public clearly associated mental health professionals with "craziness"
2.1.1.1. Even highly educated elites shun psychotherapists
2.2. Emotional isolation at a time of heighten psychological distress is a consequence of two major factors:
2.2.1. First, the pervasive secrecy surrounding IVF, which militates against the formation of patient support groups
2.2.1.1. The notion of "patient empowerment" through organized support groups has yet to take hold, for infertility patients as well as for those with other serious health conditions
2.2.2. Second, the stigmatization of psychological support itself in a society where mental illness and all forms of professional psychotherapy are stigmatizing
2.2.2.1. Infertility and IVF treatment are deemed deeply personal and sensitive matters, not to be shared with others, especially strangers
2.2.2.2. Couples aren't up for participating in such programs they are "humiliating and embarrassing"
2.3. Women worry about the lack of anonymity in a cultural setting where gossip is rampant
2.3.1. In addition, many women fear that patient support groups would exacerbate rather than alleviate their suffering
2.3.1.1. "Fear of destroying their hope" as infertile women worry about their own emotional responses to other women's IVF success and failures, and hurting their feelings
2.4. The constraints on the use of psychotherapy by infertile patients are probably more pronounced than the constraints on IVF itself
3. Dilemmas of Disclosure
3.1. Perceived secrecy on the part of IVF patients leads to what might best be described as "dilemmas of disclosure"
3.1.1. "To tell or not to tell"
3.1.1.1. In Egypt, where all forms of third-party donations are strictly prohibited, disclosure of dilemmas are nonetheless tied indirectly to the issue of donation
3.2. DI (donor insemination), this belief in the like-hood of donation taking place on Egyptian soil has, in effect, tainted the reputation of this technology
3.2.1. The public believes the donation occurs--either intentionally by unscrupulous physicians and their desperate patients or through careless accidents that happen in IVF labs
3.2.1.1. Although IVF patients often "lament" the "mentality" of the Egyptian masses regarding IVF, they nonetheless are usually unwilling to be publicly associated with this morally disreputable technology
3.3. Avoid potential damaging effects of public knowledge by limiting their actual disclosures to a trusted few
3.3.1. "limited disclosers" decided to tell at least one family member, particularity the wife's mother
3.3.1.1. The discrepancy between disclosure to wives' versus husbands' families was quite pronounced
3.3.1.2. It reflects women's emotional connectivity to their families of origin, but also men's sensitivity over revelation of male infertility, even to their own family members
3.3.1.3. Half of them men felt as if their families can't be trusted
3.4. For men the decision to underatke ICSI is a lonely one, not to be shared even within the family
3.4.1. Many women feel they should not tell their children about IVF, but only a few would (but when they had become mature adults who can handle the psychological implications)
3.4.1.1. Many couples worried about the future stigmatization of their children, who their means of conception were generally known, might be ridiculed for their test-tube origins or even questioned about their status as "potential bastards"
3.5. Choose disclose over secrecy:
3.5.1. "Apprise their adult children of its worth or the miracle of their birth", so they would never take the meaning of their own lives for granted
3.5.1.1. But most importantly remind their children of the suffering, physical, emotional, and financial, that their parents had to endure in order to have them
3.5.2. " The inherent value of a test-tube child and the significant debt that it owed its parents for its difficult conception"
3.5.2.1. Egyptian parents of all social backgrounds worry about the fate of an only child and are often determined to have a second child in order to give the first a sibling
4. The "Top Secret" Stigma
4.1. "IVF in Egypt, IVF performs a kind of double stigmatization"
4.1.1. The already "secret stigma" of infertility, and especially male infertility, is intensified into a "top secret stigma"
4.1.1.1. Feelings of "failure," "defective," "weak," "not a real man," "loser,""missing, motherhood, such feelings of spoiled identity among both men and women of all social classes are almost inevitable part of the infertility experience
4.2. Crucial gender difference between "FELT" vs "ENACTED" stigma:
4.2.1. Felt stigma involves the internalization of the societal evaluation of their condition on the part of the stigmatized, and their resultant sense that they have failed to live up to the standards of normality
4.2.1.1. Felt stigma: experienced by men who feel stigma
4.2.1.2. Women may be extremely unkind to infertile women, justified by cultural concerns surrounding hasad, or envy
4.2.1.3. The belief that an infertile women is uncontrollably envious and may therefore cast the "evil eye," causing childhood illness or even death
4.2.1.3.1. Fear of other's envy: Ironically, infertile women, who know that they are considered envious by others, are nonetheless extremely concerned about not attracting envy of other infertile women
4.2.2. Enacted stigma or the stigma that stems from intentional discrimination against the stigmatized
4.2.2.1. Although infertile men may be feel diminished & emasculated, they are rarely discriminated. WHY?
4.2.2.1.1. Infertile men are typically able to keep their infertility a secret, through their own denial & dissimulation
4.2.2.1.2. Active collusion of wives, who protect their infertile husbands by accepting the blame for their infertility
4.2.2.1.3. Infertile men rarely feel under martial threat; women married to infertile men rarely seek divorce. Families typically don't interfere when male is infertile
4.2.2.1.4. Infertile men are rarely reminded or taunted by others-- men are simply freer from the kind of "fertility scrutiny"
4.2.2.2. Enacted stigma: It is experienced almost exclusively by women
4.3. Among elites such enacted stigma in the form of frank social discrimination against infertile women, is often less pronounced than among women from lower social classes
4.3.1. Elites attempt to resist this stigmatization by shielding themselves from interference and negative scrutiny by invoking their rights to privacy in a culture where privacy is not inherently valued
4.3.1.1. By politely dissembled, often telling others,"Both of us are right, & this is up to God"
4.3.1.1.1. By shrouding their own infertility in mystery thus become a "secret stigma"
4.4. Those who seek IVF, however, they open themselves up to accusations of shame and dishonor in a society where honor is highly valorized
4.4.1. "Top secret stigma" is surrounded by shame, paranoia, fear, dishonesty, and elaborate cover-ups, gossip
4.4.1.1. The result is IVF is hidden from public view in Egypt
5. The Woman with the Secrets
5.1. Maisa is a 39 and her husband in 46 years old. They have been involuntarily childless for over 17 years
5.2. Maisa views their quest for finding a child has left them down a path with pain, suffering, sorrow and a stigma
5.2.1. Maisa has blocked Fallopian tubes because of an unnecessary surgery
5.2.2. Her husband has a low sperm count and low motility