Thank you for providing us the opportunity to respond to the recent letter to the editor regarding our article titled "If by exercising I can conceive; I would like to exercise". Exploring knowledge, perception, and practices about exercise among women with infertility: A qualitative study. We appreciate the authors’ efforts in analyzing our work and expressing their opinions and suggestions.
We want to begin by providing a brief background about our study. Women irrespective of their Body Mass Index (BMI), who have issues with ovulation, and who seek consultation with the Artificial Reproductive center attached to a tertiary care hospital in Southern India are referred to physical therapy for exercises. However, we found that the adherence to exercises in this population belonging to various cultural, religious, and socio-economic backgrounds is poor. Hence, we planned a study to explore their perception of exercises, and this was conducted in two phases. Phase I was a qualitative explorative study, and based on the themes obtained from this phase, we developed a questionnaire, which was used to conduct a cross-sectional survey (n = 332) in Phase II. These results are published elsewhere.1
The current publication is the outcome of Phase I of our study.2 Because the objective of this qualitative explorative study was to explore the perspectives of all women, we did not exclude them based on their BMI; we included our participants based on the screening criteria mentioned in the article. Please refer to the Strengths and Limitations section of the article, where we acknowledge this as our limitation and propose this as a future scope for further studies.
We would also like to point out the difference between the sample size of quantitative and qualitative study designs. Qualitative exploratory study designs are conducted to understand the in-depth lived experiences and perspectives of the population and the data are collected until no more new themes emerge in the discussion and data saturation is attained.3 In our article, we have indicated this in the Data Collection section under Methods and we attained the data saturation at 20 interviews. We have followed the seven stages of the framework approach for our data analysis and this has been explained in the data analysis section of the article.4
We would also like to indicate that we did not include our participants based on any specific existing comorbidities such as thyroid disorders, polycystic ovarian syndrome, etc., as through this study, we also intended to explore the knowledge of our participants about the causes of infertility. We included women who were yet to undergo infertility treatment, which is indicated in the inclusion criteria, as we did not want the women to have a biased opinion about exercise if the previous IVF treatment was not successful. We excluded those diagnosed with psychiatric conditions as we believed that this could have potentially affected the authenticity of the information provided by the participants during the interview. As we have clearly stated in the researcher characteristics, the interview was conducted by a qualified physical therapist, without the necessary training to address emotional breakdowns potentially associated with diagnosed psychiatric condition.
As we have clearly stated in the Results and Discussion section of our article, our participants belonged to diverse sociocultural and economic backgrounds. Factors such as lack of time, space, and family support could play a major role in their adherence to exercise programs. We could have included elaborate personal quotations by the participants to clarify this, however, we adhered to the journal guidelines about word count.
Further, we did not include the perspectives of women based on the type of infertility treatment (e.g., IVF, IUI) as that was not the objective of this study. We are happy to know that our study has ignited the scope of future research in this population as reflected in the authors’ comments regarding future directions.
We acknowledge that this qualitative exploratory study design has its limitations owing to the uniqueness of the study design and hence the knowledge, perception, and practices about exercise in this article are unique to the population we studied and cannot be generalized to populations across the globe. However, through this study, we articulate the necessity to understand and implement education programs among women with infertility to improve their awareness about the benefits of exercise and that physical therapists must identify the potential facilitators and barriers while prescribing the exercises that could facilitate adherence to the prescribed exercise programs.
