Impact of infertility on quality of life, marital adjustment, and sexual function

Reversible infertility associated with testosterone therapy for symptomatic hypogonadism in infertile couple

PURPOSE

Androgen replacement therapy has been shown to be safe and effective for most patients with testosterone deficiency. Male partners of infertile couples often report significantly poorer sexual activity and complain androgen deficiency symptoms. We report herein an adverse effect on fertility caused by misusage of androgen replacement therapy in infertile men with hypogonadal symptoms.

MATERIALS AND METHODS

The study population consisted of 8 male patients referred from a local clinic for azoospermia or severe oligozoospermia between January 2008 and July 2011. After detailed evaluation at our andrology clinic, all patients were diagnosed with iatrogenic hypogonadism associated with external androgen replacement. We evaluated changes in semen parameters and serum hormone level, and fertility status.

RESULTS

All patients had received multiple testosterone undecanoate (NebidoR) injections at local clinic due to androgen deficiency symptoms combined with lower serum testosterone level. The median duration of androgen replacement therapy prior to the development of azoospermia was 8 months (range: 4-12 months). After withdrawal of androgen therapy, sperm concentration and serum follicle-stimulating hormone level returned to normal range at a median 8.5 months (range: 7-10 months).

CONCLUSION

Misusage of external androgen replacement therapy in infertile men with poor sexual function can cause temporary spermatogenic dysfunction, thus aggravating infertility.

Effect of lifestyle on quality of life of couples receiving infertility treatment

This study investigated the effect of lifestyle on the quality of life among couples undergoing infertility treatment. The research universe consisted of 200 couples undergoing infertility treatment in Akdeniz University's Center of Reproductive Endocrinology and Assisted Reproductive Techniques. The data collection tools the authors used were a personal information form requesting sociodemographic characteristics and history of infertility, the SF-36 Quality of Life Scale, and the Healthy Lifestyle Behaviors Scale. This study revealed that the quality of life of the women in the study was lower than that of the men. The authors also found that the couples' quality of life was reduced by variables such as advanced age, low education level, unemployment status, lower income, long duration of infertility, high body mass index, history of andrological surgery, and previous experience of assisted reproduction techniques three or more times. Last, it was determined that the couples' quality of life improved as their healthy lifestyle behaviors increased. Demonstrating positive health behavior is likely to improve the quality of life of couples undergoing infertility treatment.

Quality of life and predictive factors in patients undergoing assisted reproduction techniques

OBJECTIVES

To evaluate the quality of life (QOL) of a cohort of women undergoing assisted reproduction techniques (ART), to compare two QOL questionnaires [Short Form 36 (SF36) and FertiQoL], and to identify the predictive factors related to QOL.

STUDY DESIGN

Women who received infertility medication from a hospital pharmacist during a one-year period were included in this study. Two standardized validated questionnaires - FertiQoL and SF36 - were used. Multivariate analyses were used to assess predictive factors for QOL.

RESULTS

Sixty-one women participated in this study. Median QOL scores ranged from 58 to 100. Comparisons between the two questionnaires revealed lower QOL scores when using FertiQoL. Most correlations between the questionnaires were positive, and significant for the majority of SF36 mental dimensions. The major predictors of QOL were: accompanied to the pharmacist's visit by partner, nationality, ART (in vitro fertilization or artificial insemination), employment status (employed or unemployed), tobacco consumption, age, number of cycles, infertility factor and treatment results (pregnancy, no pregnancy or treatment cancellation).

CONCLUSIONS

FertiQoL examines dimensions such as partner and social relationships. As such, it is recommended that FertiQoL should be used together with a short version of SF36 to investigate QOL among patients undergoing ART.

Prevalence and risk factors of the female sexual dysfunction in a sample of infertile Iranian women

BACKGROUND

Infertility has a major impact on women's quality of life and emotional well-being. The resulting interpersonal problems extend to women's sexual relationships, with a high proportion of infertile women reporting sexual problems.

AIM

To determine the prevalence and identify the potential risk factors of female sexual dysfunction (FSD) among infertile Iranian women.

METHODS

Using a cross-sectional study design including 12 infertility clinics in five Iranian cities, FSD was assessed in 604 infertile women using the culturally adapted, multidimensional Female Sexual Function Index (IV-FSFI). Depression, anxiety and health-related quality of life (HRQL) were also assessed for all infertile patients. Depression and anxiety were assessed with the Hospital Anxiety and Depression Scale (HADS) while HRQL was measured using the Short Form 36 (SF-36).

MAIN OUTCOME MEASURE

Prevalence of FSD in infertile women and associated factors.

RESULTS

Infertile women reported significantly lower scores on the FSFI domains in comparison with healthy women. Risk factors for FSD as determined by multilevel analyses were older age and self-reported depression. Furthermore, secondary infertility, lower educational level and higher partner education put women at increased risk for FSD.

CONCLUSIONS

Among infertile women, sexual dysfunctions seem to be prevalent higher than previously published in Iran. This finding may have implications on the clinical assessment of sexual function and the role of demographic and psychological factors in infertile women.

Procreative sex in infertile couples: the decay of pleasure?

BACKGROUND

Infertility represents a major challenge to the emotional balance and sexual life of couples, with long-lasting and gender-specific effects. The objective of this study is to explore personality features of infertile patients and detect possible sexual disorders in couples undergoing infertility treatment.

MATERIALS AND METHODS

In this prospective study 60 infertile couples and 52 fertile control couples were asked to complete standardized and validated questionnaires: the Adjective Check List (ACL) to enquire about personality features and the Female Sexual Function Index (FSFI) or the International Index of Erectile Function (IIEF) to assess sexual functioning of female and male partners. The study population was divided into 3 groups: Group A (N = 30, recently diagnosed infertile couples) Group B (N = 30, infertile couples already undergoing Intrauterine Insemination) and Group C (N = 52, fertile control group).

RESULTS

Infertile patients did not display any distinguishing personality features. Regarding sexual function, men of all the three groups scored higher in both questionnaires (sexual satisfaction, desire and orgasm) than their female partners. Comparing results between groups, Group A male partners obtained lower scores in all the subscales. Women belonging to Group A and Group B showed an impairment of sexual arousal, satisfaction, lubrification and orgasm when compared to fertile controls.

CONCLUSIONS

Even if at the very first stages of infertility treatment no personality disturbances can be detected, the couples' sexual life is already impaired with different sexual disorders according to gender.

[How to manage a woman with a sexual complaint in clinical practice?]

OBJECTIVE

To describe the main female sexual dysfunctions, their mechanisms, and the broad outlines of their therapeutic management.

MATERIAL AND METHODS

Review of consensus conferences and published guidelines on this subject and a reflexion from our own clinical experience, in urogynaecological practice.

RESULTS

Female sexual dysfunction is frequent and can present in different ways; pain, problems concerning desire and satisfaction. These symptoms can be associated with concomitant male sexual dysfunction. These symptoms can be managed by a gynaecologist if he/she is trained accordingly. Knowledge of this is essential for a gynaecologist in daily practice but also for an urologist treating both female urinary incontinence or pelvic prolapse and male sexual dysfunction.

CONCLUSION

Women's sexual disorders can considerably affect the quality of life of the partner and the couple. As the patients hesitate to speak of such matters the clinician should begin the dialogue with simple open questions.

Reassured or fobbed off? Perspectives on infertility consultations in primary care: a qualitative study

BACKGROUND

Infertility affects 9% of couples in the UK. Most couples who visit their GP because they are worried about their fertility will ultimately conceive, but a few will not. Treatment usually happens in secondary care, but GPs can have an invaluable role in starting investigations, referring, and giving support throughout treatment and beyond.

AIM

To inform clinical practice by exploring primary care experiences of infertility treatment among females and males, and discussing findings with a reference group of GPs to explore practice experience.

DESIGN AND SETTING

A qualitative patient interview and GP focus group study. Interviews were conducted in patients homes in England and Scotland; the focus group was held at a national conference.

METHOD

An in-depth interview study was conducted with 27 females and 11 males. A maximum variation sample was sought and interviews were transcribed for thematic analysis. Results were discussed with a focus group of GPs to elicit their views.

RESULTS

Feeling that they were being taken seriously was very important to patients. Some felt that their concerns were not taken seriously, or that their GP did not appear to be well informed about infertility. The focus group of GPs highlighted the role of protocols in their management of patients who are infertile, as well as the difficulty GPs faced in communicating both reassurance and engagement.

CONCLUSION

Simple things that GPs say and do, such as describing the 'action plan' at the first consultation, could make a real difference to demonstrating that they are taking the fertility problem seriously.

Efeitos da infertilidade no relacionamento dos cônjuges

Trata-se de um estudo sobre os efeitos da infertilidade no relacionamento dos cônjuges, com os objetivos de descrever o perfil da população de estudo e analisar os efeitos da infertilidade na vida emocional, sexual e conjugal. Para tal, foi realizado um estudo transversal e prospectivo em instituição especializada. A amostra foi constituída por 50 casais inférteis com seis anos de infertilidade em média. As mulheres manifestaram sentimentos negativos perante a infertilidade, enquanto os homens assumiram uma postura de suporte e apoio. Os efeitos na vida sexual foram mais expressivos nas mulheres, e o tratamento da infertilidade levou a mudanças positivas para ambos os cônjuges. Ao comparar os efeitos da infertilidade sobre os indivíduos que haviam realizado mais de um tratamento com aqueles no primeiro tratamento, observamos que não houve diferenças entre as mulheres; entre os homens houve diferenças no aspecto emocional (frustração e alívio) e no relacionamento conjugal (fortalecimento e amadurecimento).

Psychological disturbances and quality of life in obese and infertile women and men

Anovulatory cycles and endometriosis are the main causes of female infertility. The most frequently anovulatory cycles are related to polycystic ovary syndrome (PCOS) commonly associated with obesity and hormonal disturbances in the course of obesity. Recently published studies revealed that infertility affects about one in six couples during their lifetime and is more frequent in obese. Obesity is also associated with male infertility related to erectile dysfunction, hormonal disturbances and lower semen quality. Any of these above mentioned disorder is the important risk factor of psychological disturbances and poor quality of life among women and men in the reproductive age. On the other hand the mood disorders may exacerbate the hormonal disturbances and worsen the effectiveness of infertility management. Infertility, its therapy with accompanying psychological disturbances may also significantly affect the partners relationships. The review summarize the results described in the current literature on the association between obesity and infertility and psychological disturbances as well as their impact on quality of life and sexual functioning in women and men. Moreover, the impact of infertility and psychological disturbances on partners relationships is discussed.

Effects of Surgical Excision of Endometriosis regarding Quality of Life and Psychological Well-Being: A Review

The aim of the present work is to give a critical and detailed reflection on the effects of surgical resection of deep infiltrating endometriosis regarding reduction of symptoms, psychological well-being and quality of life. The current evidence strongly supports the effectiveness of radical laparoscopic resection in relieving endometriosis-associated symptoms and enhancing psychological well-being. In addition, studies suggest a general improvement of quality of life, however, further studies are needed to support this observation.

Comparison of dysfunctional attitudes and social adjustment among infertile employed and unemployed women in Iran

This study aims to compare dysfunctional attitudes and social adjustment in infertile employed and unemployed females. Due to the stresses of infertility, infertile females are faced with a variety of sexual and psychological problems, as well as dysfunctional attitudes that can lead to depression. Moreover, infertility problems provoke women into maladjustment and inadvertent corruption of relationships. In this regard, our goal is to consider the effects of employment in conjunction with education on dysfunctional attitudes and social adjustment among infertile women in Iran. In this work, we employed the survey method. We recruited 240 infertile women, utilizing the cluster random sampling method. These women filled out the Dysfunctional Attitudes Scale and the social adjustment part of the California Test of Personality. Next, multivariate analysis of variance was performed to test the relationship of employment status and education with dysfunctional attitudes and social adjustment. Our results indicated that dysfunctional attitudes were far more prevalent in infertile unemployed women than in infertile employed women. Also, social adjustment was better in infertile employed women than in infertile unemployed women. It was shown that education level alone does not have significant effect on dysfunctional attitudes and social adjustment. However, we demonstrated that the employment status of infertile women in conjunction with their education level significantly affects the two dimensions of dysfunctional attitudes (relationships, entitlements) and has insignificant effects on social adjustment. It was revealed that in employed infertile women in Iran, the higher education level, the less dysfunctional were attitudes in relationships and entitlements, whereas in unemployed infertile women, those with a college degree had the least and those with master's or higher degrees had the most dysfunctional attitudes in terms of relationships and entitlements.

Testing the psychometric properties of Mandarin version of the fertility problem inventory (M-FPI) in an infertile Chinese sample

The Fertility Problem Inventory (FPI) is an instrument to measure infertility-related stress, and has been widely used in a range of clinical settings. It has been translated into several languages, however there is no validated Mandarin version. The present study tests the psychometric properties of the Mandarin version of FPI (M-FPI). A hospital sample of 223 infertile Chinese couples (223 men and 223 women) completed the M-FPI along with other measures including demographics, Hospital Anxiety and Depression Scale, and Marlowe-Crowne Social Desirability Scale, which were used to assess the reliability and validity of the Mandarin version of FPI. Results showed that the M-FPI was best reduced to a five? factor solution, and all 46 items of the M-FPI showed moderate to high internal consistency. In addition, the test of convergent and discriminant validity from this study indicated satisfactory results. These results indicate that the M-FPI as an instrument is reliable and valid for use with infertile Chinese couples in clinical assessment.

Assessing infertility stress: re-examining the factor structure of the Fertility Problem Inventory

BACKGROUND

Research has documented that fertility problems can negatively affect the life of infertile patients, by imposing an obstacle to one important life goal: the achievement of parenthood. The Fertility Problem Inventory (FPI) proposes a comprehensive approach in assessing infertility stress, by measuring the impact on social, marital and sexual life dimensions and the importance of parenthood in infertile patients' life. This study examined the factor structure of the FPI, testing two alternative models using confirmatory factor analysis.

METHODS

A sample of 209 infertile patients was recruited in two public hospital departments of assisted reproduction technology. Measures included the FPI, the Brief Symptom Inventory and the ENRICH Marital Inventory.

RESULTS

Results confirmed the original measurement model of the instrument but suggested that the inclusion of an intermediate conceptual level resulted in a better fit to the model (χ²₈₄= 147.89, P< 0.001) i.e. the instrument assesses infertility stress by assessing two main conceptual domains: the impact of infertility in infertile patients' life and representations about the importance of parenthood. The instrument revealed measurement and structure invariance and construct validity by correlating with other measures assessing similar constructs.

CONCLUSIONS

This approach to the FPI has important contributions for research and clinical practice by distinguishing between the impact of infertility on different dimensions of a couple's' life and representations about the importance of parenthood, therefore extending the utility of the FPI in research and clinical practice.

An evaluation of the effect of infertility on marital, sexual satisfaction indices and health-related quality of life in women

BACKGROUND:

The effect of infertility on marital and sexual functioning, health-related quality of life (QoL) and the acceptability of the treatment modalities is a poorly researched area in India.

AIMS AND OBJECTIVES:

To measure and compare the impact of infertility on marital adjustment, sexual functioning, QoL and the acceptability of various treatment modalities in infertility.

DESIGN AND SETTING:

Hospital-based cross-sectional controlled study.

MATERIALS AND METHODS:

Data regarding infertility, socio-demographic characteristics and treatment acceptability was obtained via a semi-structured questionnaire. validated, standardized scales were used to measure marital adjustment (abbreviated dyadic adjustment scale), sexual functioning (abbreviated sexual functioning questionnaire) in cases and controls, and quality of life (FertiQol) in cases. Data from 106 women attending tertiary infertility centers who met the definition of primary infertility and 212 controls attending the medical outpatient department in the same centers was obtained.

RESULTS:

Body mass index and socioeconomic status were significant (P < 0.006 and < 0.0001 respectively) for infertility. Fertility-enhancing regimens and adoption had the highest acceptability with a wide dispersion of range for adoption and least acceptance for sperm, egg, embryo donation and surrogate motherhood. Logistic regression analysis revealed a significant effect size of infertility on marital adjustment (Nagelkerke R² 0.725, Cohen's D 0.86) and sexual functioning (Nagelkerke R² 0.73, Cohen's D 0.815). QoL showed a decrease in mean scores on the FertiQol scale similar to normative data.

CONCLUSIONS:

Effective counseling, reassurance and measures to reduce the impact of the condition on marital and sexual life, overall QoL are needed to impart a holistic treatment in infertility.

An evaluation of the effect of infertility on marital, sexual satisfaction indices and health-related quality of life in women

BACKGROUND

The effect of infertility on marital and sexual functioning, health-related quality of life (QoL) and the acceptability of the treatment modalities is a poorly researched area in India.

AIMS AND OBJECTIVES

To measure and compare the impact of infertility on marital adjustment, sexual functioning, QoL and the acceptability of various treatment modalities in infertility.

DESIGN AND SETTING

Hospital-based cross-sectional controlled study.

MATERIALS AND METHODS

Data regarding infertility, socio-demographic characteristics and treatment acceptability was obtained via a semi-structured questionnaire. validated, standardized scales were used to measure marital adjustment (abbreviated dyadic adjustment scale), sexual functioning (abbreviated sexual functioning questionnaire) in cases and controls, and quality of life (FertiQol) in cases. Data from 106 women attending tertiary infertility centers who met the definition of primary infertility and 212 controls attending the medical outpatient department in the same centers was obtained.

RESULTS

Body mass index and socioeconomic status were significant (P < 0.006 and < 0.0001 respectively) for infertility. Fertility-enhancing regimens and adoption had the highest acceptability with a wide dispersion of range for adoption and least acceptance for sperm, egg, embryo donation and surrogate motherhood. Logistic regression analysis revealed a significant effect size of infertility on marital adjustment (Nagelkerke R(2) 0.725, Cohen's D 0.86) and sexual functioning (Nagelkerke R(2) 0.73, Cohen's D 0.815). QoL showed a decrease in mean scores on the FertiQol scale similar to normative data.

CONCLUSIONS

Effective counseling, reassurance and measures to reduce the impact of the condition on marital and sexual life, overall QoL are needed to impart a holistic treatment in infertility.

Differences in prevalence of sexual dysfunction between primary and secondary infertile women

OBJECTIVE

To examine the impact of type of infertility on female sexual function.

DESIGN

Comparison of female sexual function index and prevalence in primary infertile women and secondary infertile women.

SETTING

Hospital.

PATIENT(S)

One hundred twenty-two primary infertile and 51 secondary infertile women.

INTERVENTION(S)

Questionnaires (Female Sexual Function Index [FSFI] and Beck Depression Inventory).

MAIN OUTCOME MEASURE(S)

Prevalence of dysfunction in primary and secondary infertile women.

RESULT(S)

The prevalence of female sexual dysfunction was 64.8% (n = 79) and 76.5% (n = 39) in primary infertile and secondary infertile women, respectively. In analyses of mean overall and subgroup scores of FSFI, there were significant differences between primary and secondary infertile women in the mean scores of orgasm, satisfaction, and total FSFI. Backward logistic regression identified a model with four significant predictors of sexual dysfunction (group, age, income level, and educational level). Secondary infertile women had a 9.5-fold higher risk of sexual dysfunction than primary infertile women after adjustment for confounding factors.

CONCLUSION(S)

There was a higher prevalence of sexual dysfunction in secondary infertile women. Secondary infertile women have decreased sexual desire, orgasm, and satisfaction compared with primary infertile women.

Infertility treatment and fertility-specific distress: A longitudinal analysis of a population-based sample of U.S. women

Because research on infertile women usually uses clinic-based samples of treatment seekers, it is difficult to sort out to what extent distress is the result of the condition of infertility itself and to what extent it is a consequence of the experience of infertility treatment. We use the National Survey of Fertility Barriers, a two-wave national probability sample of U.S. women, to disentangle the effects of infertility and infertility treatment on fertility-specific distress. Using a series of ANOVAs, we examine 266 infertile women who experienced infertility both at Wave 1 and at Wave 2, three years later. We compare eight groups of infertile women based on whether or not they have received treatment and on whether or not they have had a live birth. At Wave 1, infertile women who did not receive treatment and who had no live birth reported lower distress levels than women who received treatment at Wave 1 only, regardless of whether their infertility episode was followed by a live birth. At Wave 2, women who received no treatment have significantly lower fertility-specific distress than women who were treated at Wave 1 or at Waves 1 and 2, regardless of whether there was a subsequent live birth. Furthermore, fertility-specific distress did not increase over time among infertile women who did not receive treatment. The increase infertility-specific distress was significantly higher for women who received treatment at Wave 2 that was not followed by a live birth than for women who received no treatment or for women who received treatment at Wave 1 only. These patterns suggest that infertility treatment is associated with levels of distress over and above those associated with the state of being infertile in and of itself.

Variation in distress among women with infertility: evidence from a population-based sample

BACKGROUND

We examine variation in fertility-specific distress (FSD) and general distress according to different experiences of infertility among 1027 US women who have experienced infertility within the previous 10 years.

METHODS

General distress was measured by a short form of the Center for Epidemiological Studies-Depression. Multiple regression analysis was conducted on self-report data (based on a telephone interview) from a probability-based sample of US women aged 25-45 years. We compare women with infertility who have had a prior pregnancy (secondary infertility, n = 628) to women with infertility with no prior pregnancies (primary infertility, n = 399). We further distinguish between women with infertility who were actually 'trying' to become pregnant (the infertile with intent) with those who met the medical definition of infertile but did not describe themselves as trying to become pregnant (infertile without intent).

RESULTS

Both types of infertility (primary versus secondary) (β = 0.31*) and intentionality (infertile with and without intent) (β = 0.08*) are associated with FSD. These associations persist when we control for resource and demographic variables, life course variables, social support and social pressure variables. General distress does not vary by infertility type or intentionality.

CONCLUSIONS

Results reveal variation in women's recalled experiences of infertility and that FSD is more sensitive to effects of different experiences than general distress. Women with primary infertility who were explicitly trying to become pregnant at the time of the infertility episode stand out as a particularly distressed group. Caregivers should be aware that the emotional needs of women with primary infertility may differ from those with secondary infertility.

'Mama and papa nothing': living with infertility among an urban population in Kigali, Rwanda

BACKGROUND

Not being able to procreate has severe social and economic repercussions in resource-poor countries. The purpose of this research was to explore the consequences of female and/or male factor infertility for men and women in Rwanda.

METHODS

Both quantitative and qualitative methods were used. Couples presenting with female and/or male factor infertility problems at the infertility clinic of the Kigali University Teaching Hospital (n = 312), and fertile controls who recently delivered (n = 312), were surveyed about domestic violence, current and past relationships and sexual functioning. In addition, five focus group discussions were held with a subsample of survey participants, who were either patients diagnosed with female- or male-factor fertility or their partners.

RESULTS

Domestic violence, union dissolutions and sexual dysfunction were reported more frequently in the survey by infertile than fertile couples. The psycho-social consequences suffered by infertile couples in Rwanda are severe and similar to those reported in other resource-poor countries. Although women carry the largest burden of suffering, the negative repercussions of infertility for men, especially at the level of the community, are considerable. Whether the infertility was caused by a female factor or male factor was an important determinant for the type of psycho-social consequences suffered.

CONCLUSIONS

In Rwanda, as in other resource-poor countries, infertility causes severe suffering. There is an urgent need to recognize infertility as a serious reproductive health problem and to put infertility care on the public health agenda.

Perceived negative consequences of donor gametes from male and female members of infertile couples

OBJECTIVE

To determine the views toward donor sperm and eggs of both men and women. The use of donor sperm or ova becomes an option for some infertile couples.

DESIGN

Prospective cohort of infertile couples.

SETTING

Eight California reproductive endocrinology practices.

PATIENT(S)

Infertile couples (n=377) were recruited after an initial infertility clinic visit.

MAIN OUTCOME MEASURE(S)

From questionnaires administered at recruitment, ratings concerning the impact of the use of donor gametes were assessed. Differences between men and women in attitudes toward donor gametes were compared with analysis of variance (ANOVA). Linear regression was used to identify independent predictors of attitudes toward gametes.

RESULT(S)

Women's attitudes toward donor sperm were significantly more negative than their attitudes toward donor eggs (5.1+/-1.4 vs. 4.7+/-1.6). Similarly, male donor gamete attitude scores were higher for donor sperm compared with donor eggs (4.9+/-1.6 vs. 4.1+/-1.6). Both men and women agreed that the use of donor sperm was more likely to have negative effects on their relationship and negative societal ramifications. Female donor gamete attitude scores were predicted by marital status, race, and education, whereas men's scores were independent of all measured factors.

CONCLUSION(S)

Both men and women view the use of donor sperm with more skepticism compared with the use of donor eggs, suggesting a unique underlying perception regarding the use of male donor gametes.

Differences in quality of life between infertile women and men in Turkey

OBJECTIVE

To examine potential differences in quality of life between infertile women and men.

DESIGN

A descriptive, cross-sectional design.

METHOD

A questionnaire was used to collect individuals' sociodemographic data; the World Health Organization Quality of Life-BREF (WHOQOL-BREF) tool was used to collect information about quality of life.

PARTICIPANTS

The research sample comprised 248 infertile individuals (141 women and 107 men) admitted to the clinic for the first time for diagnosis and treatment between January 1 and June 30, 2007, and who voluntarily agreed to participate.

SETTING

The research was conducted at the Ege University Family Planning and Infertility Research and Training Center Infertility Clinic in Izmir, Turkey.

RESULTS

Physical health, psychological health, and social relations domain score means did not show significant differences between infertile women and infertile men (p>.05). However, score means for the environment domain were significantly higher (p<.05) for infertile women than for infertile men. Unemployed infertile men had significantly lower score means in the physical health and social relation domains (p<.01). No such significant differences were found for the other quality of life domain scores for infertile women or infertile men (p>.05).

CONCLUSION

In the environmental domain, the quality of life of infertile women was greater than that of infertile men. Variables affecting quality of life of infertile individuals were seen to affect women and men in similar ways. Nurses and health care professionals caring for infertile individuals should be aware of the factors that affect quality of life and should plan to meet their care needs accordingly.

Investigating quality of life and health-related quality of life in infertility: a systematic review

OBJECTIVE

To review the findings on quality of life (QOL) and health-related quality of life (HRQOL) among infertile women, men and couples.

DESIGN

Systematic review.

METHODS

Publications between January 1980 and July 2009 in Medline, PsycInfo, Embase and Health and Psychosocial Instruments were compiled using the following inclusion criteria: papers published in peer-reviewed journals; written in English, French, Spanish or Portuguese; presented original findings; assessed quality of life or health-related quality of life as an outcome; included infertile subjects without other clinical conditions; used validated measures.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Quality of life and health-related quality of life.

RESULTS

Fourteen studies were included in the review. Educational level, will to have children, poor marital relationship, previous in-vitro fertilisation attempt and duration of the infertility were predictors of lower mental health scores in infertile men. Women had significant lower scores on mental health, social functioning and emotional behaviour. Among infertile subjects, women had lower scores in several QOL or HRQOL domains in comparison to men.

CONCLUSIONS

Evidences indicate important QOL or HRQOL impairments in infertile women. Among men, it does not appear to be intense. There is scarce knowledge regarding the impact of infertility on couples.

Psychological distress as predictor of quality of life in men experiencing infertility: a cross-sectional survey

BACKGROUND

Infertility is associated with impairment in human life. The quality of life (QOL) construct allows measuring the impact of health conditions in a broader way. The study aimed to explore the impact of the psychological distress on QOL's dimensions in men experiencing infertility.

METHODS

162 men were completed a socio-demographic form, SF-36, WHOQOL-BREF, Beck Anxiety Inventory and Beck Depression Inventory. Hierarchical regressions included demographic and clinic variables, and subsequently depression and anxiety were added.

RESULTS AND DISCUSSION

Model 1 was not accurate in predicting QOL. R2 values ranged from 0.029 (Social Functioning) to 0.149 (Mental Health). Eight domains were not associated with any of the predictors. In the second model, a R2increase was observed in all domains. R2 of QOL scores ranged from .209 (Role Physical) to .406 (Social Functioning). The intensity of the depression was a significant predictor for all outcomes. The load of depression was higher than the ones of the socio-demographic and clinical variables. Anxiety levels have also presented the same effect, but with less intensity.

CONCLUSION

Subthreshold depression and anxiety were major predictors of QOL in men experiencing infertility. Health professionals need to include assessment of psychological symptomatology to plan more efficient interventions to infertile patients.

The impact of a diagnosis of couple subfertility on male sexual function

AIM

The aim was to study: a) the prevalence of sexual dysfunction in male partners of subfertile couples; b) the possible correlation between sexual dysfunction and seminal profile.

SUBJECTS AND METHODS

Male partners (no.=171) of subfertile couples were studied, aged between 25 and 40 yr, attending the Andrology Unit of Sant'Andrea Hospital. All the subjects responded to a modified International Index of Erectile Function (IIEF) questionnaire, made up of 5 questions: 2 regarding erectile function, 1 concerning orgasmic function, 1 question on sexual desire, and 1 on satisfaction with intercourse. The questionnaire investigated both spontaneous sex for pleasure and sex intended to lead to pregnancy. The subjects underwent standard semen analysis, according to World Health Organization guidelines.

RESULTS

The data showed a disorder in sexual intercourse for reproductive purposes in 37 subjects (23.7%). Of these, only 14 (8.9%) also had problems with sex for pleasure. On the other hand, there was no significant variation in the prevalence of sexual dysfunction related to seminal profile.

CONCLUSIONS

A diagnosis of subfertility represents a stressful situation which can reduce the pleasure of sex, especially in intercourse intended for reproductive purposes; this disorder in sexual activity does not seem to be directly correlated with awareness of the severity of the semen alterations.

The experience of infertility: a review of recent literature

About 10 years ago Greil published a review and critique of the literature on the socio-psychological impact of infertility. He found at the time that most scholars treated infertility as a medical condition with psychological consequences rather than as a socially constructed reality. This article examines research published since the last review. More studies now place infertility within larger social contexts and social scientific frameworks although clinical emphases persist. Methodological problems remain but important improvements are also evident. We identify two vigorous research traditions in the social scientific study of infertility. One tradition uses primarily quantitative techniques to study clinic patients in order to improve service delivery and to assess the need for psychological counselling. The other tradition uses primarily qualitative research to capture the experiences of infertile people in a sociocultural context. We conclude that more attention is now being paid to the ways in which the experience of infertility is shaped by social context. We call for continued progress in the development of a distinctly sociological approach to infertility and for the continued integration of the two research traditions identified here.

Sexual, marital, and social impact of a man's perceived infertility diagnosis

INTRODUCTION

Male factor infertility is a relatively common problem. This diagnosis may increase sexual, marital, and relationship strain in male partners of infertile couples.

AIM

To measure the personal, social, sexual, and marital impacts of a male factor infertility diagnosis among men in couples evaluated for infertility.

METHODS

Cross-sectional analysis of 357 men in infertile couples from eight academic and community-based fertility clinics. Participants completed written surveys and face-to-face and telephone interviews at study enrollment. This interview queried each participant's perception of their infertility etiology to determine the primary study exposure (i.e., male factor only, male and female factors, female factor only, unknown).

MAIN OUTCOME MEASURES

Personal Impact, Social Impact, Marital Impact, and Sexual Impact scales.

RESULTS

Among the 357 men, no male factor was reported in 47%, isolated male factor was present in 12%, combined male and female factors were present in 16%, and unexplained infertility was present in 25% of couples. Male factor infertility was independently associated with worse Sexual (mean 39 vs. 30, standard deviation [SD] 2.7, P = 0.004) and Personal (mean 37 vs. 29, SD 3.8, P = 0.04) Impact scores relative to men in couples without male factor infertility. These differences remained statistically significant after controlling for male age, partner age, race, religion, educational level, employment status, prior pregnancy, duration of infertility, and prior paternity.

CONCLUSIONS

Male partners in couples who perceive isolated male factor infertility have a lower sexual and personal quality of life compared with male partners of couples without perceived male factor infertility. Social strain is highest among couples without a clear etiology for infertility. These findings highlight the clinically significant negative sexual, personal, and social strains of a perceived infertility diagnosis for men.

Evaluation of marital and sexual interactions of Polish infertile couples

INTRODUCTION

The World Health Organization defines infertility as inability to conceive despite regular sexual intercourse sustained for a period exceeding 12 months with no contraceptive methods.

AIM

The aim of this study was to evaluate the effect of infertility on marital and sexual interactions among infertile couples.

METHODS

Two hundred six infertile couples were qualified to the study as the research group. The control group consisted of 190 fertile couples.

MAIN OUTCOME MEASURES

A specific questionnaire was used as a research tool in this study. It included the sociodemographic part, infertility status, and validated scales: Polish version of Index of Marital Satisfaction and Index of Sexual Satisfaction. Statistica 6.0 (Medical University of Silesia; Katowice, Poland) was used in the statistical analysis. The statistical analysis made use of: Mann-Whitney U-test, chi-square with Yates' continuity correction, ancova log-linear analysis of covariance, and logistic regression analysis.

RESULTS

The study showed a significantly better partner relationship in female infertile as compared with female fertile. Clinically significant disorders of partnership stability were observed in 11.65% of studied women and in 20% of controls. Marital adjustment and sexual satisfaction were comparable among male groups. The probability of marital disorders increased with: age above 30 (odds ratio [OR] = 1.6), female sex (OR = 1.5), and lower education (OR = 1.7) among the study population. Diagnosed male factor and infertility duration of 3-6 years were connected with the highest relationship instability and the lowest sexual satisfaction both in female and male infertile.

CONCLUSIONS

The risk factors of marital dissatisfaction in infertility include: female sex, age over 30, lower education level, diagnosis of male infertility, and infertility duration of 3-6 years.

Medical decision analysis for the management of unifocal, flat, low-grade dysplasia in ulcerative colitis

BACKGROUND

Management of unifocal, flat, low-grade dysplasia (LGD) in ulcerative colitis (UC) remains controversial.

OBJECTIVE

To compare the relative costs and effectiveness of immediate colectomy and enhanced colonoscopic surveillance for the management of LGD.

DESIGN AND SETTING

Medical decision analysis by using state-transition Markov models. Transition probabilities and health utilities were derived from the literature, and costs were derived from national hospital data sets and Medicare and/or Medicaid reimbursement schedules.

PATIENTS

Two simulated cohorts of 10,000 patients with longstanding UC who were newly diagnosed with unifocal, flat LGD on initial surveillance colonoscopy.

INTERVENTIONS

Immediate colectomy or enhanced surveillance (repeated colonoscopy at 3, 6, and 12 months, and then annually).

MAIN OUTCOME MEASUREMENTS

Costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios.

RESULTS

Immediate colectomy dominated over enhanced surveillance and yielded higher QALYs (20.1 vs 19.9 years) and lower costs ($75,900 vs $83,900). These findings were robust to variations in model parameters, with immediate colectomy remaining dominant in 90% of simulations in sensitivity analysis. Varying postcolectomy health utility outside the range in the probabilistic sensitivity analysis rendered enhanced surveillance cost effective. When the health utility was below 0.77, the incremental cost-effectiveness ratio was $50,000 per QALY.

LIMITATIONS

Data based on observational studies and analyses rely on model assumptions.

CONCLUSIONS

Our analysis showed that immediate colectomy was preferable to enhanced surveillance. Health preference toward the postcolectomy state is, however, an influential factor. This decision analysis model provides a conceptual framework for physicians and patients to understand the relative benefits and costs of both interventions.

Prevalence of low serum cobalamin in infertile couples

A high prevalence of low levels of cobalamin had been found in a survey of multi-ethnic normal individuals in Israel. The purpose of this study was to investigate the incidence of cobalamin deficiency among Israeli couples suffering from infertility. All couples seen at the in vitro fertilization clinic at an urban hospital (Shaare Zedek Medical Center) in Jerusalem for a 6-month period were invited. Mean cobalamin levels were 259.2 pg ml(-1) in males and 275.1 pg ml(-1) in females (normal >200 pg ml(-1)), 35.5% of 172 men and 23.3% of 223 females had cobalamin deficiency (P = 0.01). There were 171 couples with complete demographic questionnaires and cobalamin values for each partner. In 74 couples (43.3%), one partner was cobalamin deficient, with no significant difference between those with unexplained infertility versus those with explained infertility; and in 13 couples, both partners were cobalamin deficient. Thirty-nine per cent of all men with an abnormal semen analysis had cobalamin deficiency, a finding that requires further investigation. This study questions whether higher rates of male infertility in Israel are partially ascribable to cobalamin deficiency. Recommendation for supplementation in both males and females to achieve high-normal levels of cobalamin would be prudent.

Polycystic ovary syndrome and its impact on women's quality of life: More than just an endocrine disorder

In the past, polycystic ovary syndrome has been looked at primarily as an endocrine disorder. Studies now show that polycystic ovary syndrome is a metabolic, hormonal, and psychosocial disorder that impacts a patient’s quality of life. It is extremely important to holistically treat these patients early on to help them deal with the emotional stress that is often overlooked with polycystic ovary syndrome. Early diagnosis and long term management can help control polycystic ovary syndrome so that women can still live a healthy active life and avoid long-term complications such as metabolic syndrome and cardiovascular diseases.

[Impact of infertility and assisted reproductive techniques on sexuality]

OBJECTIVE

We studied the impact of infertility and all the more Assisted Reproductive Techniques on marital relations and sexuality.

MATERIAL AND METHOD

Our study is based on a questionnaire distributed in our centre and on a review of literature.

RESULTS

Our inquest shows that both partners keep a good relationship in their couple and support each other. But, whereas pleasure during intercourse is little affected, many couples feel a reduction of their desires.

DISCUSSION AND CONCLUSION

This diminution of sexual desires, also noted in literature, can be explained by medical requirements intrusive for intimacy and also by strategies settled by the couples themselves during intercourse in order to optimise the chance of pregnancy. Medical staffs should take into consideration eventual sexual difficulties of the couples. Making them aware that their intimate life must remain or become again an end in itself, and not only a way of procreation, often permits a beneficial change of behaviour.

Psychological factors in male partners of infertile couples: relationship with semen quality and early miscarriage

In this study we sought to evaluate whether psychological factors in males affect semen quality and pregnancy. In 1076 men of infertile couples, psychological factors, i.e. exposure to acute stress, coping with stress, the WHO (five) Well-Being Index and the Zung's Anxiety Scale Inventory scores were assessed by a questionnaire at the time of semen analysis. Relationships between psychological factors and semen quality (sperm concentration, rapid and progressive motility and normal morphology) were assessed. In 353 men with infertility duration of < or =1.5 years, sperm concentration > or =5 x 10(6) sperm/mL and a female partner with a laparoscopically confirmed tubal patency, we looked prospectively for relations between psychological factors and the occurrence of a natural pregnancy at a 6-month follow-up (n = 124), and first-trimester loss (n = 18). Anxiety trait, found in 19% of men, was related to previous in vitro fertilization/intracytoplasmic sperm injection attempts (p = 0.014), cigarette intake (p = 0.006), alcohol intake (p = 0.026) and sexual difficulties (p < 0.001). Regression analyses indicated a significant positive relationship between the level of sperm concentration and the WHO (five) Well-Being Index score, each successive score number accounting for a 7.3% increase in sperm concentration (p = 0.039), whereas no correlation was found between psychological factors and sperm rapid progressive motility and normal morphology. Poorer coping with stress was related to the occurrence of a first-trimester miscarriage (p = 0.016) in the female partner. Possible depression in males is related to decreased sperm concentration, and poor coping with stress is associated with increased occurrence of early miscarriage.

Sexual function and quality of life in the male partner of infertile couples: prevalence and correlates of dysfunction

PURPOSE

We prospectively collected data on mental and physical health related quality of life as well as sexual and relationship function in couples presenting for the treatment of infertility.

MATERIALS AND METHODS

Infertile couples were invited to complete a demographic survey, the Short Form 36 and the Center for Epidemiological Studies Depression Inventory. Male partners completed the International Index of Erectile Function and the Self-Esteem and Relationship Quality scale. Female partners completed the Female Sexual Function Index and a version of the Self-Esteem and Relationship Quality Scale modified for women. Multiple regression analysis was conducted to assess for associations between partner responses.

RESULTS

A total of 121 couples were enrolled at 2 sites. Male partners reported significantly lower standardized scores on the Mental Health subscale of the Short Form 36 (mean 47.6, p <0.05) compared to normative values. Of the men surveyed 11% and 12% reported moderate or severe depression, respectively. There were 18% who had mild erectile dysfunction and 4% had moderate erectile dysfunction. The mean transformed score for the Self-Esteem and Relationship Quality Scale in our subjects was 29.44 (range 0 to 100). In multivariate analysis white race and partner Female Sexual Function Index score were significant predictors of International Index of Erectile Function Erectile Function Domain scores (p <0.01). Relationship duration and partner Self-Esteem and Relationship Quality Scale scores were significantly associated with male Self-Esteem and Relationship Quality Scale score on multivariate analysis.

CONCLUSIONS

Depression, erectile dysfunction and sexual relationship problems are prevalent among male partners of infertile couples. Partner sexual function is a significant predictor of male partner sexual function. Relationship duration and female partner assessment of relationship health are predictive of men's assessment of their relationship status.