Marital Relationship and Quality of Life Among Couples with Infertility

Violence against infertile women in an Iranian setting

BACKGROUND

Infertility as a distressing condition, is associated with numerous psychological and social consequences for couples. In addition, there is evidence to suggest that infertility may contribute to the occurrence of violence against women. The aim of the study is to determine the prevalence and factors associated with violence against Iranian women with infertility.

METHODS

A cross-sectional study was carried out in 2020, involving 310 infertile women who sought treatment at an infertility clinic in a referral women's hospital in Tehran. The eligible participants were selected using the consecutive sampling method. The Infertile Women's Exposure to Violence Determination Scale (IWEVDS) was used to collect data on violence. Data were analyzed using descriptive (Mean, frequency) and inferential statistics (Independent sample t-test, Chi-square, regression logistic) through the SPSS version 25.

RESULTS

The average score on the IWEVDS was found to be 43.89 ± 18.23, indicating a moderate level of violence. Out of the 310 participating infertile women, 84.2% reported experiencing violence. Among abused women, 67% experienced domestic violence, 76.2% encountered social pressure, 85.4% faced punishment, 88.9% were exposed to traditional practice, and 57.5% experienced exclusion. The main risk factors associated with violence were a low number of children, low economic status, and an increased duration of infertility.

CONCLUSIONS

This study's findings underline a high rate of violence experienced by infertile women. Therefore, it is crucial to screen women with infertility for violence and provide them with adequate support.

"The biggest disappointment": women's expectations from sex are ignored, from the perspective of infertile women

OBJECTIVE

The aim of this study is to determine the attitudes, behaviours and experiences of infertile women towards sexuality.

METHODS

This study was carried out in the infertility outpatient clinic of a state hospital in Istanbul of Turkey. Fifteen infertile women who had been receiving primary infertility treatment for at least two years and were actively continuing infertility treatment were included in the study. Data were collected by means of an detailed information form and a semi-structured interview. Content analysis was applied to the data obtained from semi-structured interviews. Consistency percentage calculation was made between the codes and themes determined by 4 researchers who are experts in their fields.

RESULTS

Results based on the interviews with the participants, 2 main themes, 6 sub-themes and 27 codes related to sub-themes were determined as 'Factors Affecting Sexual Life' and 'Overview of Sexual Health and Sexuality'. 'Disappointment' was determined as the most commonly defined code in the determined main theme and sub-themes.

CONCLUSION

It was determined that the majority of infertile women base their sexual lives on reproductive functions, experience serious sexual health problems, feel worthless, and describe their sexual life as a great disappointment.

A Dyadic Study of Attachment, Coping, and Quality of Life in Couples Seeking Fertility Treatment

This study examined attachment insecurities, infertility-specific coping strategies, and quality of life (QoL) in 87 couples seeking fertility treatment. Partners completed self-report measures. Path analyses showed that women's and men's attachment anxiety were associated with their own lower QoL, whereas attachment avoidance was associated with their own and their partner's lower QoL. Adaptive coping in men and women were associated with women's higher QoL. Non-adaptive coping was associated with men and women's lower QoL. Coping strategies explained the associations between attachment and QoL. This highlights the importance of individual and dyadic factors for understanding QoL in couples seeking fertility treatment.

Addressing the Rehabilitation Needs of Women Experiencing Infertility in Ethiopia: Time for Action

The psychological, social, and financial disabilities caused by infertility are significant for women, particularly those living in low- and middle-income countries such as Ethiopia. Although rehabilitation can be an important form of support for such women, infertility is frequently overlooked as a disability or potential target of rehabilitation interventions. This study aimed to determine what rehabilitation-related services and supports are available for women experiencing infertility in Ethiopia. We used an Interpretive Description design. We purposefully selected fourteen rehabilitation, medical, and policy service providers from diverse institutions across three geographical locations. We used semi-structured questions during our in-person and telephone interviews. The data were analyzed using reflexive thematic analysis with the assistance of NVivo. We identified five main themes, including (a) policies related to infertility, (b) the concept that disabilities are physically visible fails to recognize infertility, (c) the need for rehabilitation services for women with infertility, (d) the importance of wellness services for women experiencing infertility, and (e) the role of religion in rehabilitation services. In conclusion, it is essential to strengthen the policies around infertility, incorporate rehabilitation services in fertility care, and view infertility as a disabling condition for women who experience it in Ethiopia.

Deafening Silence of Male Infertility

Think about 6 loved ones of reproductive age in your life. Now imagine that 1 of these 6 individuals is suffering from infertility. Perhaps they feel alone and isolated, unable to discuss their heartbreak with their closest friends, family, and support network. Suffering in silence. In this editorial, we discuss the infertility journey through the lens of the patients, the providers, and the scientists who struggle with infertility each and every day. Our goal is to open a dialogue surrounding infertility, with an emphasis on dismantling the longstanding societal barriers to acknowledging male infertility as a disease. Through education, communication, compassion, and advocacy, together we can all begin to break the deafening silence of male infertility.

Psychometric properties of the Arabic version of the Fertility Quality of Life (FertiQoL) questionnaire tested on infertile couples in Jordan

BACKGROUND

The Fertility Quality of Life (FertiQoL) questionnaire assesses the quality of life of people with fertility problems. The present study aimed to assess the psychometric properties of the Arabic version of the FertiQoL in infertile couples in Jordan.

METHODS

This study used a cross-sectional design among 212 participants with infertility problems. An exploratory factor analysis (EFA) and a confirmatory factor analysis (CFA) were conducted to investigate the underlying structure of the novel Arabic version of the FertiQoL tool.

RESULTS

The Cronbach's alpha values for the FertiQoL core domain, the FertiQoL treatment domain, and the total FertiQoL scale were 0.93, 0.74, and 0.92, respectively. The EFA indicated a two-domain model, with the first factor having 24 items and measuring "Core QoL". The second factor has 10 items and measures "Treatment QoL" in the context of infertility. The EFA and the CFA supported a two-factor model whereby the two factors explained 48% of the shared covariance between the analyzed quality of life indicators. The indices of goodness-of-fit of the model showed acceptable fit as follows: the chi-squared test (χ2) = 7.943, the comparative fit index (CFI) = 0.999, the root mean square error of approximation (RMSEA) = 0.001, and the Tucker-Lewis index (TLI) = 0.989.

CONCLUSION

The study's findings demonstrated the reliability and validity of the Arabic version of the FertiQoL for assessing the quality of life of infertile couples or those in Jordan with no pregnancy or childlessness.

The Late Effects of Cancer Treatment on Female Fertility and the Current Status of Fertility Preservation-A Narrative Review

Fertility counseling should be offered to all individuals of young reproductive age early in the patient's trajectory following a cancer diagnosis. Systemic cancer treatment and radiotherapy often have an inherent gonadotoxic effect with the potential to induce permanent infertility and premature ovarian failure. For the best chances to preserve a patient's fertility potential and to improve future quality of life, fertility preservation methods should be applied before cancer treatment initiation, thus multidisciplinary team-work and timely referral to reproductive medicine centers specialized in fertility preservation is recommended. We aim to review the current clinical possibilities for fertility preservation and summarize how infertility, as a late effect of gonadotoxic treatment, affects the growing population of young female cancer survivors.

The Relationship between Attachment, Dyadic Adjustment, and Sexuality: A Comparison between Infertile Men and Women

Infertility impacts several life dimensions. Among them, sexuality is particularly affected; yet studies have mainly focused on infertile women. We aimed to explore infertile men's and women's experiences in sexual satisfaction, internal control, and anxiety, and the relationship between attachment, dyadic adjustment, and sexuality. The sample consisted of 129 infertile people (47.3% females, 52.7% males, Mage = 39 years) who fulfilled an ad hoc questionnaire, the Multidimensional Sexuality Questionnaire (MSQ), the Experiences in Close Relationship-Revised (ECR-R), and the Dyadic Adjustment Scale (DAS). We found a significant effect of type of infertility and infertility factors on sexual anxiety only in infertile men. As regards infertile women, dyadic adjustment predicted sexual satisfaction, anxious attachment decreased sexual internal control, and avoidant attachment reduced sexual anxiety. As regards infertile men, high dyadic adjustment increased sexual satisfaction and a high avoidant attachment predicted high levels of sexual internal control. There was no relationship between attachment, dyadic adjustment, and sexual anxiety for infertile men. From the results, it emerges how important is to consider both dyadic adjustment and attachment in studying how infertility impacts women's and men's lives.

The effect of e-health interventions on meeting the needs of individuals with infertility: a narrative review

Background

The mental health and well-being of millions of people worldwide are negatively impacted by infertility. A promising solution to meet the needs of people suffering from infertility is e-health interventions, such as online counseling and support groups. This study aims to review the current literature on e-health interventions and how they impact people with infertility.

Main body of the abstract

Relevant studies were searched in PubMed, Web of Science, and Scopus databases. Articles were entered into the EndNote software and screened for duplicates and relevance. Two authors then reviewed full-text articles independently, with a third person resolving any disagreements. Thirteen studies conducted between 2007 and 2022 were identified. The interventions aimed to meet various needs, including training on drug use (n = 23), lifestyle modifications (n = 1), periconceptional behavior modifications (n = 1), drug management (n = 1), IVF training (n = 4), psychological support to reduce distress (n = 4), and promoting a positive sexual self-concept (n = 1).

Short conclusion

The limited number of e-health interventions for infertile patients, the heterogeneity of interventions, and the lack of long-term effectiveness data make it challenging to compare e-health interventions to nonelectronic alternatives. However, the increasing use of technology in healthcare, especially during and after the Covid-19 pandemic, suggests that e-health educational interventions such as those using the Internet, psychological support, and patient interaction will continue to play a crucial role in healthcare.

Supplementary Information

The online version contains supplementary material available at 10.1186/s43043-023-00137-7.

Infertility-related stress and sexual satisfaction: a dyadic approach

PURPOSE OF THE STUDY

to examine whether women's and men's infertility-related stress, and specifically its sexual concerns aspect, is related to their and their partner's sexual satisfaction.

MATERIALS AND METHODS

In a cross-sectional study, 94 couples experiencing infertility filled out the New Sexual Satisfaction Scale and Fertility Problem Inventory, which measures infertility-related stress with dimensions of social, sexual and relationship concerns, rejection of childfree lifestyle, and need for parenthood. Dyadic analyses were performed following the Actor-Partner Interdependence Model (APIM).

RESULTS

The dyadic analysis revealed that women's and men's greater infertility-related stress contributed to their lower levels of sexual satisfaction (actor effect). Moreover, women's and men's greater sexual concerns (as the aspect of infertility-related stress) contributed to their own and their partner's lower levels of sexual satisfaction (actor and partner effect).

CONCLUSIONS

The findings suggest that both individual and relational processes are important in the association between the specific dimension of infertility-related stress and sexual satisfaction. These findings could guide the psychosocial support for couples experiencing infertility.

The effect of date palm on sexual function in infertile couples: a double-blind controlled clinical trial

Objective

Infertility has a significant impact on the sexual function of couples. The use of herbal medicine has been highly important throughout the history of medicine. The present study was conducted to evaluate the effect of date palm on sexual function of infertile couples.

Results

The present study was a double-blind, placebo-controlled clinical trial conducted on infertile women and their husbands who referred to infertility clinics in Iran in 2019. The intervention group was given a palm date capsule and the control group was given a placebo. Data were collected through female sexual function index and International Index of Erectile Function. The total score of sexual function of females in the intervention group increased significantly from 21.06 ± 2.58 to 27.31 ± 2.59 (P < 0.0001). Also, other areas of sexual function in females (arousal, orgasm, lubrication, pain during intercourse, satisfaction) in the intervention group showed a significant increase compared to females in the control group, which was statistically significant (P < 0.0001). All areas of male sexual function (erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall satisfaction) significantly increased in the intervention group compared to the control group (P < 0.0001). The present study revealed that 1-month consumption of date palm has a positive impact on the sexual function of infertile couples.

Trial registration The trial was retrospectively registered in the Iranian registry of clinical trials at 2020-10-07 (https://www.irct.ir/trial/51339; registration number: IRCT20200925048834N1)

Perceived Partner's Self-Control and Social Support Effects on Relationship Satisfaction in Couples Experiencing Infertility or Miscarriage: Dyadic Analyses

The process that infertile couples and those after a miscarriage go through is unpredictable and difficult to control; therefore, it is associated with a lowered sense of control for both partners. Uncontrolled stress creates a higher level of anxiety, which is associated not only with a lower quality of life but also with worse results from infertility treatment and higher risks of miscarriage. The aim of this study was to analyze the relationship between the partner’s perceived self-control and marital satisfaction in the context of the partners’ coping strategies. The actor-partner interdependence model was applied to 90 heterosexual married couples. Our results show that men who perceive their wives as being more self-controlled and women who are perceived by their husbands as being more self-controlled feel more satisfied in their relationships. The effect of a partner’s perceived self-control on satisfaction with the relationship was weaker when controlled for the length of marriage. It also appeared to be moderated through the spouses’ use of social support. We conclude that the effects of the partner’s perceived self-control and social support are strong for marital satisfaction in the context of infertility and miscarriage.

Segmentation of human spermatozoa using improved Havrda-Chavrat entropy-based thresholding method

The assisted method of fertilization has required an identification of sperm cells with normal morphological structure. The abnormal sperm cells cannot provide successful result in artificial fertilization. Nowadays the assessment of morphology of sperm cells is subjective and error prone hence creating automatic evaluation method for morphology assessment, it will improve the success ratio in infertility treatment. The first step in our proposed system is pre-processing where noise removal process is applied on microscopic medical images. In second step, adaptive alpha valued Havrda-Chavrat entropy-based threshold technique is proposed where the maximum probability distribution of foreground pixels or background pixels is assigned to alpha value. Further, existing state-of-art threshold-based segmentation methods are implemented and obtained results on the input images. These segmentation results are compared with the proposed method in terms of supervised and unsupervised evaluation metrics, in which our proposed thresholding method has given optimum threshold value for the segmentation of spermatozoa cells. The outcome of the segmented images and their metric values are indicating better segmentation by our proposed method. Furthermore, this proposed method can be implemented in the mobile applications for diagnosis with artificial intelligence techniques.

Study on the Interdependent Relationship between the Marital Satisfaction Variable and the Psychosocial Impact of Infertility and Anxiety Disposition, According to Gender

This study assessed the relationship between the marital satisfaction variable and the psychosocial impact of infertility and anxiety disposition, testing for possible gender-based differences. Comparisons performed on 87 couples did reveal differences and analyses disclosed that depression, anxiety and quality of life can influence the assessment each partner makes of their relationship, through an interdependent process. One partner's marital satisfaction can be influenced by those variables in the other partner. These findings indicate that psychosocial care for infertile couples must involve both partners and that they should be made aware of the effect of interdependence on marital satisfaction.

Sexual Function and Satisfaction in Couples with Infertility: A Closer Look at the Role of Personal and Relational Characteristics

BACKGROUND

Research to date suggests that couples undergoing assisted reproductive technology (ART) are at a high risk of experiencing sexual difficulties.

AIM

This dyadic cross-sectional study aimed to provide a better understanding of the infertility-specific personal (ie, emotional, mind-body) and relational stressors associated with the sexual desire, orgasm, arousal, and sexual satisfaction of infertile couples seeking ART.

METHODS

The sample included 185 mixed-sex infertile couples seeking ART. Participants completed online the Fertility Quality of Life tool and either the Female Sexual Function Index or the International Index of Erectile Function. Data were analyzed using path analyses based on the Actor-Partner Interdependence Model.

OUTCOMES

Individuals' own and their partners' sexual function (desire, orgasm, arousal domains) and sexual satisfaction.

RESULTS

For men and women, infertility-related emotional stressors were associated with their own and their partner's lower sexual desire. For women, experiencing greater infertility-related emotional stressors was also associated with their partner's lower sexual satisfaction. While experiencing greater infertility-related mind-body stressors was not associated with men and women's own sexual desire, arousal, orgasm, and satisfaction, for women, it was associated with their partner's lower sexual arousal. Lastly, for men and women, infertility-related relational stressors were associated with their own lower sexual arousal, as well as with their own and their partner's lower sexual satisfaction. For women, experiencing greater relational stressors was also associated with their own lower sexual desire and orgasm.

CLINICAL IMPLICATIONS

Interventions addressing the emotional, mind-body, and relational spheres of infertile couples seeking ART may help facilitate improvements in sexual function and satisfaction and better serve their needs.

STRENGTHS & LIMITATIONS

This study included a large sample of couples. Our sample was heterogeneous with regards to couples' cause of infertility and treatment stage. The use of an infertility-related measure allowed us to better capture personal and relational stressors specific to couples seeking ART. Given the cross-sectional design of our study, causality between infertility-related stressors and sexual function and satisfaction cannot be inferred. Our sample included predominantly White, mixed-sex individuals with a high level of education, which may reduce the generalizability of our findings.

CONCLUSION

Couples' subjective experience of infertility and treatment (personal and relational stressors) seems to be strongly associated with their sexual health, allowing us to identify potential targets of intervention with couples seeking ART. S.E. Amiri, A Brassard, N.O. Rosen, et al. Sexual Function and Satisfaction in Couples with Infertility: A Closer Look at the Role of Personal and Relational Characteristics. J Sex Med 2021;18:1984-1997.

Comparison of various aspects of women's lives between infertile and women with and without tubal ligation: a comparative cross-sectional study

Background

The aim of this study is to compare anxiety, depression, body image, self-esteem, sexual function, and quality of life (QoL) between infertile women and control fertile women undergoing tubal ligation (TL) and using condom.

Methods

This cross-sectional study was conducted on 600 women in three groups of infertile and control fertile women with or without TL (200 women in each group), who met the inclusion criteria. They were selected from Royan Institute and a number of health care centers in Tehran (Iran) from May 2017 to February 2019. The subjects were asked to fill out the Short Form Health Survey (SF-12), Female Sexual Function Index (FSFI), Hospital Anxiety and Depression Scale (HADS), Body Image Concern Inventory (BICI), and Rosenberg’ Self-Esteem Scale (RSES). One-way ANOVA was used to identify the possible statistical differences between the three groups of participants.

Results

The mean scores of all FSFI domains were lower in the control TL women, and the differences between the three groups in all dimensions were statistically significant. In addition, the TL group had more female sexual dysfunction (FSD) comparing to the infertile and condom group (22.43 ± 5.30, 24.79 ± 4.74, and 28.03 ± 3.29, respectively P <  0.001). There was a significant difference between the three groups in SF-12 scores (76.59 ± 13.14, 68.49 ± 14.47, and 78.87 ± 12.62, respectively P < 0.001). Also there was a significant difference between the three groups in anxiety, depression, and total scores of HADS (P  < 0.001). Furthermore, infertile women had lower body image (P  < 0.05) and the TL group had lower self-esteem comparing to the two other groups (P  < 0.05).

Conclusions

The findings revealed the adverse effects of using TL on the anxiety, depression, sexual life, body image, and QoL of women. It is recommended that health-care professionals should increase their awareness and knowledge regarding the side-effects of using TL on women’s lives and share this information with the patients.

The social and psychological consequences of women getting pregnant with fertility treatment: A qualitative study

PURPOSE

This study focuses on psychological and social problems of women getting pregnant with fertility before and after pregnancy. This study to gain a more in-depth understanding of the processes in which infertility affected the kinds of psychological and social consequences they experienced.

DESIGN AND METHODS

A qualitative descriptive design was used in the study. The descriptive and thematic content analysis methods were used for the analysis of the data obtained for the study.

FINDINGS

The identified themes are as follows: (1) society's social and psychological pressure, (2) isolation from the "fertile" world, (3) effects on marital relationship, (4) perspectives of family members, (5) experiencing pregnancy.

IMPLICATIONS FOR NURSING PRACTICE

Supportive counseling provided by nurses can be an integral component of treatment in infertile women.

Quality of life among infertile women living in a paradox of concerns and dealing strategies: A qualitative study

AIM

The current work investigated the issues that cause apprehension in infertile women, the effects of this disquiet on their quality of life and the strategies that they adopt in dealing with their concerns.

DESIGN

The qualitative research.

METHOD

This qualitative research sampled participants from a training centre in Mazandaran University of Medical Sciences and a privately owned infertility centre in Mazandaran Province, north of Iran. Purposive sampling continued until data saturation was reached. We conducted a conventional content analysis of the responses of 30 individuals (15 women with female infertility and 15 key informants) to in-depth and semi-structured in-person interviews on May to November 2019 .

RESULTS

The results uncovered two themes subsuming four categories of issues: The first theme revolves around "infertility concerns," under which "concerns" and "the difficulty and vagueness of treatment" belonged. The second theme was "dealing with infertility," which covered "adaptive strategies" and "inhibitors of reconciliation with perceived infertility."

Resilience as the predictor of quality of life in the infertile couples as the most neglected and silent minorities

Background: It has been demonstrated that infertility can affect quality of life (QoL) in infertile couples. Resilience is considered a protective factor against the distress caused by infertility and the quality of life status. There is a new definition for Fertility Quality of Life that evaluates particularly the impact of infertility on various aspects of life.Material and methods: In this couple-based study, the main objective was investigating the quality of life based on the gender and resilience of infertile couples. Measurement tools were three questionnaires including a demographic one, a quality of life of infertile couples questionnaire and the Connor-Davidson Resilience Scale. Data analysis was done through paired t-test and linear multiple regressions test.Results: Overall the difference of mean score for QoL is statistically significant (P > 0.001) between men and women (69.48% vs 58.87%), which means that QoL status was positive in men and neutral in women. In addition, the mean score of male resilience was more than female resilience (P = 0.009). The results showed there was a significant and positive correlation between the QoL status and resilience score (P = 0.008, r = 0.13) (P < 0.1), and resilience (β = 0.04 and P = 0.04) had a significant protective effect on the quality of life.Conclusion: Low resilience status in infertile couples is better to be considered as a risk factor compromising the quality of life and infertility consolers should keep in mind this issue and provide a comprehensive and holistic approach for a better outcome of infertility treatment.Abbreviations: QoLICQ: Quality of Life in Infertile Couple Questionnaire; CD-RISC: Connor-Davidson Resilience Scale; IVF: in vitro fertilisation; ART: assisted reproductive technique; PTSD: posttraumatic stress disorder; IUI: intrauterine insemination; ICSI: intracytoplasmic sperm injection.

Success of assisted reproductive technology treatment and couple relationship: A pilot study on the role of romantic attachment

Infertility is a deeply distressing experience, which can threaten important personal and martial goals, frequently affecting the psychophysical health. A supportive relationship and a secure romantic attachment appear to reduce infertility stress, as well as play a relevant role in the success of assisted reproductive technology treatments. The principal aim of the study is to investigate the predictive effect of romantic attachment, couple characteristics, quality of life and age on assisted reproductive technology outcome. A total of 88 infertile women, enrolled in an assisted reproductive technology Centre of Rome, completed the Experience in Close Relationship-Revised, the Couple Relationship Inventory, the Fertility Quality of Life and a socio-demographic questionnaire. The participants completed the questionnaires at the beginning of the medical treatment. Data analyses showed significant associations among Experience in Close Relationship-Revised dimensions, Couple Relationship Inventory and Fertility Quality of Life Scales. Assisted reproductive technology outcome was negatively correlated to Experience in Close Relationship-Revised Avoidance and positively related to Couple Relationship Inventory Dependence. A multi-variable logistic regression revealed that Experience in Close Relationship-Revised Avoidance decreased the probability of pregnancy. The present findings partially confirmed the study hypotheses since several associations among couple characteristics, attachment anxiety and avoidance dimensions, infertility-related quality of life in infertile women were found. Furthermore, according to a definition of Avoidance, assisted reproductive technology positive outcome appears to be associated to lower levels of fear of dependence and interpersonal intimacy, and to a low need both for self-reliance and for reluctance to self-disclose within the romantic relationship. Further investigations are needed both to confirm this preliminary finding and for promoting focused therapeutic interventions for couples facing assisted reproductive technology.

Demographics and the correlation between irrational parenthood cognitions and marital relationship quality in infertile women in Zanjan province in 2016

PURPOSE

The study determined the correlation between Irrational Parenthood Cognitions (IPC) and marital quality by demographic variables in infertile women.

METHODS

A correlational study with a census method was conducted on all primary infertile women, who had a file in Zanjan, Iran.

FINDINGS

A 47% significant positive correlation was showed between IPC and marital quality (p < 0.001). The highest correlation was observed in the subsets of women aged 31-40 years, with high level of education, those at third socioeconomic classes, those with less than 10 years of married life, and women whose husband had no children from their previous marriage (all ps < 0.05).

PRACTICE IMPLICATIONS

Providing counseling services to women with primary infertility, especially high-risk women may help to reduce IPC and to improve marital quality.

The Human Responses and Nursing Diagnoses of Those Living With Infertility: A Qualitative Systematic Review

OBJECTIVE

To systematically retrieve, critique, and synthesize patients' human responses about living with infertility and identify possible related nursing diagnoses according to NANDA-I.

METHODS

Systematic review of qualitative nursing studies.

FINDINGS

A total of 39 papers were included, 49 human responses, and 77 potential infertility-related nursing diagnoses were identified across three themes. Main foci matching nursing diagnosis were related to spiritual well-being, spiritual distress, and resilience.

CONCLUSIONS

Patients respond to infertility in a variety of ways and this raises the need for a more effective, holistic, and accurate nursing diagnosis.

IMPLICATIONS FOR PRACTICE

The accuracy of the nursing diagnosis is critical in raising the quality of the nursing process and in meeting infertile patients' circumstances and care expectations.

Whose fault is it? Blame predicting psychological adjustment and couple satisfaction in couples seeking fertility treatment

Infertility bears psychological and relational consequences for couples who face this problem. Few studies have examined the role of self- and partner blaming to explain psychological and relationship adjustment in couple presenting with a fertility problem. This study used a dyadic approach to explore the links between blaming oneself and one's partner and both partners' symptoms of depression and anxiety, and couple satisfaction in 279 couples enrolled in fertility treatments. Partners were questioned about the extent to which they blamed themselves and their partner for the fertility problem. They also completed the Dyadic Adjustment Scale and the Index of Psychological Symptoms. Path analyses based on the Actor-Partner Interdependence Model showed that self-blame predicted anxiety and depression symptoms in both men and women. Men's self-blame also predicted their own lower relationship satisfaction, whereas women's self-blame predicted more depression and anxiety in their partner. Partner blame in women predicted their own and their partner lower relationship satisfaction. Women's tendency to blame their partner also predicted their own depression symptoms. Clinical implications of these findings are discussed.

Spirituality, infertility-related stress, and quality of life in Brazilian infertile couples: Analysis using the actor-partner interdependence mediation model

Infertility has a stressful impact on both partners, with adverse effects on the quality of life of infertile couples. Spirituality is a meaning-based strategy that can protect couples against infertility's negative impact on quality of life, but analysis of this mediator relationship in infertile couples has not been reported. We adopted a dyadic approach and used the actor-partner interdependence mediation model to examine whether and how women's and men's spirituality was associated with their own and their partners' infertility-related stress and quality of life. In 2014, 152 infertile couples starting their first fertility treatment at a private clinic in Brazil were recruited and completed self-reports of spirituality, infertility-related stress, and quality of life. Results indicated that women's and men's level of spirituality was positively associated with their own quality of life directly and indirectly, by reducing their own infertility-related stress. Their spirituality was associated with an increase in their partners' quality of life only indirectly, by reducing their partners' infertility-related stress. Findings highlight the importance of assessing and promoting spirituality as a coping resource that infertile women and men might use to deal with the stress of infertility and reduce its adverse effects on quality of life.

Factor structure and psychometric properties of the Fertility Problem Inventory-Short Form

The study analyses factor structure and psychometric properties of the Italian version of the Fertility Problem Inventory–Short Form. A sample of 206 infertile couples completed the Italian version of Fertility Problem Inventory (46 items) with demographics, State Anxiety Scale of State-Trait Anxiety Inventory (Form Y), Edinburgh Depression Scale and Dyadic Adjustment Scale, used to assess convergent and discriminant validity. Confirmatory factor analysis was unsatisfactory (comparative fit index = 0.87; Tucker-Lewis Index = 0.83; root mean square error of approximation = 0.17), and Cronbach’s α (0.95) revealed a redundancy of items. Exploratory factor analysis was carried out deleting cross-loading items, and Mokken scale analysis was applied to verify the items homogeneity within the reduced subscales of the questionnaire. The Fertility Problem Inventory–Short Form consists of 27 items, tapping four meaningful and reliable factors. Convergent and discriminant validity were confirmed. Findings indicated that the Fertility Problem Inventory–Short Form is a valid and reliable measure to assess infertility-related stress dimensions.

Sexual satisfaction among involuntarily childless women: A cross-cultural study in Italy and Brazil

Infertility has been negatively associated with sexual satisfaction. This study aimed to estimate the relation of infertility to sexual satisfaction from a cross-cultural perspective, comparing Italian and Brazilian women. Between June 2012 and January 2013, 528 women seeking assisted reproduction technology (ART) treatment in Italy (39%) or Brazil (61%) completed self-reports of sexual satisfaction (ISS) and infertility-related stress in the marital domain (IRS). IRS was the same across countries. ISS differed, with 34.31% of the Italians and 43.52% of the Brazilians being sexually dissatisfied at a clinical level (ISS score >30). Multiple logistic regression models showed that being sexually dissatisfied at a clinical level was associated with lower education and higher IRS among Italian women, regardless of having a diagnosed cause of infertility. It was instead associated with higher IRS only among the Brazilian women who had a diagnosed cause of infertility. These findings suggest that, regardless of nationality, sexual satisfaction and infertility-related stress need to be addressed in the treatment of infertile women turning to ART. However, as factors associated with these dimensions vary across countries, interventions to promote sexual satisfaction among infertile women should be adapted to their specific socio-cultural context.

A Dyadic Approach to Infertility Stress, Marital Adjustment, and Depression on Quality of Life in Infertile Couples

Purpose: This study was conducted to examine the level of infertility stress, marital adjustment, depression, and quality of life in infertile couples and assess the actor and partner effects in these areas using the actor–partner interdependence model. Design: Cross-sectional study. Method: Participants were 121 infertile couples. After pilot study, data were collected from November 2012 to March 2013 using the following questionnaires: the Fertility Quality of Life, Fertility Problem Inventory, Revised Dyadic Adjustment Scale, and Beck Depression Inventory. Findings: There was a gender difference in infertility stress, depression, and quality of life. Infertility stress had actor and partner effects on the quality of life. Marital adjustment had an actor effect on the quality of life for the wives. Depression had actor and partner effects on quality of life for the wives, but only an actor effect for the husbands. Conclusion: This study found that there were actor and partner effects of infertility stress, marital adjustment, and depression on the quality of life in infertile couples. These findings may help nurses be aware of such effects and can be used as a baseline data in the development of nursing interventions for infertile couples.

Gender differences in perception of psychosocial distress and coping mechanisms among infertile men and women in Saudi Arabia

The objective of the study was to evaluate the differences in psychosocial distress and coping mechanisms among infertile men and women in Saudi Arabia (SA). We performed a cross-sectional study of infertile patients (206 women and 200 men) attending infertility clinics in three referral hospitals in Riyadh, SA. A semi-structured questionnaire was developed to assess socio-demographic, clinical and psychosocial variables. Infertility-related psychosocial pressures were reported in 79 (39.7%) male and 97 (47.3%) female participants (p = 0.123). Males suffered more from intrusive questions and pressure to conceive, remarry or get divorced, while females were stressed more from psychological and emotional exhaustion, marital discord, attitudes of mothers-in-law or society, and persistent desire by the husband to have children. To cope with infertility, females engaged more in religious activities (p < 0.001) and spoke more to someone regarding their problems (p < 0.001). To solve their infertility problems, 50% tried to find solutions via the internet, and 38.5% of males and 51% of females reported using alternative medicines (p = 0.012). The patients with infertility in SA face multiple psychosocial stressors related to their infertility, and cope differently based on the gender and culture-specific knowledge of infertility. The female participants were significantly more affected from psychosocial stressors and the persistent desire by their spouse to have children.

The Partnership and Coping Enhancement Programme for couples undergoing in vitro fertilization treatment: the development of a complex intervention in China

PURPOSE

Couples as dyads suffer from the diagnosis of infertility and related treatment. These couples commonly experience emotional and physical pain and tension in their marital lives. The purpose of this study is to report on the process of developing a potentially feasible and effective complex intervention for couples undergoing in vitro fertilization treatment in China.

METHODS

The Medical Research Council (MRC) framework for developing and evaluating the complex intervention was adopted to guide the development of the Partnership and Coping Enhancement Programme (PCEP). In developing the PCEP, three steps were taken, namely, (1) identifying evidence by conducting literature reviews, a concept analysis and a qualitative study; (2) identifying/developing a theory-in this case, a preliminary Endurance with Partnership Conceptual Framework (P-EPCF) was proposed; and (3) modelling the process and outcomes of the PCEP.

RESULTS

The PCEP that was developed is targeted mainly at the domains of the partnership mediators of stress in the P-EPCF. It consists of two sections-partnership and coping-and will be delivered to infertile couples on the day of embryo transfer. The main focuses of the programme are to facilitate mutual sharing and support in infertile couples, and to improve their individual and dyadic coping strategies while undergoing IVF treatment, especially in the period when they are waiting for the results of a pregnancy test and after the disclosure of a negative treatment outcome. The programme is couple-based, consisting of experience sharing, psychoeducation, meditation exercise, skill practise and supplemental written materials.

CONCLUSIONS

The Partnership and Coping Enhancement Programme (PCEP) for couples undergoing in vitro fertilization treatment was developed according to the guideline of the MRC framework. It is recommended that a pilot study be conducted to evaluate its feasibility and to model the process and outcomes of the programme.

Experiences of Spanish women undergoing hysterosalpingography as part of the infertility process: a phenomenological study

AIMS AND OBJECTIVES

To describe and understand the experiences and perceptions of women who undergo hysterosalpingography as part of the infertility process.

BACKGROUND

Nurses and midwives should conduct research into the emotional aspects of caring for patients undergoing infertility treatment. The hysterosalpingography is considered to be the most feared test in the infertility process and the one about which very little is known.

DESIGN

A phenomenological qualitative study.

METHODS

Ten Spanish women who had undergone hysterosalpingography participated in this study. In-depth interviews were carried out between October 2012-May 2013. Data analysis was performed with the help of atlas.ti software to identify emerging themes.

RESULTS

The experience of the participants who underwent hysterosalpingography during the infertility process is represented by the following three themes: (1) becoming a mother to feel complete as a person and as a woman, with the subthemes 'maternity as a life objective' and 'maternity in terms of gender identity'; (2) infertility--an intimate experience which provokes negative feelings, with the subthemes 'negative feelings regarding own infertility' and 'infertility as an experience that is little shared with others'; (3) Undergoing hysterosalpingography, with the subthemes 'feelings regarding hysterosalpingography', 'treatment by medical providers' and 'areas for improvement regarding the service given by the providers'.

CONCLUSION

For women who undergo hysterosalpingography, maternity may be seen as a life objective that could identify them as women. Results suggest that although infertility is experienced with negative feelings such as anxiety, frustration and sadness, hysterosalpingography seems to be related with both hope and fear when facing the test.

RELEVANCE TO CLINICAL PRACTICE

Knowing the experiences of these women could help nurses, midwives and physicians to provide better patient-centred care.

Automatic detection and segmentation of sperm head, acrosome and nucleus in microscopic images of human semen smears

BACKGROUND AND OBJECTIVE

Manual assessment of sperm morphology is subjective and error prone so developing automatic methods is vital for a more accurate assessment. The first step in automatic evaluation of sperm morphology is sperm head detection and segmentation. In this paper a complete framework for automatic sperm head detection and segmentation is presented.

METHODS

After an initial thresholding step, the histogram of the Hue channel of HSV color space is used, in addition to size criterion, to discriminate sperm heads in microscopic images. To achieve an improved segmentation of sperm heads, an edge-based active contour method is used. Also a novel tail point detection method is proposed to refine the segmentation by locating and removing the midpiece from the segmented head. An algorithm is also proposed to separate the acrosome and nucleus using morphological operations. Dice coefficient is used to evaluate the segmentation performance. The proposed methods are evaluated using a publicly available dataset.

RESULTS

The proposed method has achieved segmentation accuracy of 0.92 for sperm heads, 0.84 for acrosomes and 0.87 for nuclei, with the standard deviation of 0.05, which significantly outperforms the current state-of-the-art. Also our tail detection method achieved true detection rate of 96%.

CONCLUSIONS

In this paper we presented a complete framework for sperm detection and segmentation which is totally automatic. It is shown that using active contours can improve the segmentation results of sperm heads. Our proposed algorithms for tail detection and midpiece removal further improved the segmentation results. The results indicate that our method achieved higher Dice coefficients with less dispersion compared to the existing solutions.

The effects of psychosocial interventions on the mental health, pregnancy rates, and marital function of infertile couples undergoing in vitro fertilization: a systematic review

PURPOSE

The purpose of this study was to examine the effects of psychosocial interventions on the mental health, pregnancy rates, and marital function of infertile couples undergoing in vitro fertilization (IVF), as determined through RCT studies.

METHODS

Using the electronic databases PubMed, EMBase, Cochrane Library, CINAHL, PsycInfo, and CAJ, a systematic literature search was conducted in July 2015. MeSH terms, key words, and free words such as "infertility," "fertilization in vitro," "psychotherapy," "intervention," "anxiety," "depression," and "marital satisfaction" were used to identify all potential studies. The quality of the studies that were included was assessed using the risk of bias assessment tool developed by the Cochrane Back Review Group. Descriptive analysis was adopted to synthesize the results.

RESULTS

A total of 20 randomized controlled trials were included in this review. There were reports of positive effects on the anxiety levels, pregnancy rates, or marital function of infertile couples in six studies that adopted different psychosocial approaches, including mind body intervention (Eastern body-mind-spirit, Integrative body-mind-spirit, and Mind/body intervention), cognitive behavioral therapy, group psychotherapy, and harp therapy. However, there were methodological or practical issues related to measurement points and attrition rates in these studies. None of these interventions were found to be efficacious in relieving the depression or stress of individuals or couples undergoing IVF treatment. None of the included studies tackled or measured the mental health status of the couples during the most stressful time of waiting for the pregnancy results of their treatment.

CONCLUSIONS

A complex intervention, based on sound evidence, should be developed targeting both females and males of infertile couples undergoing IVF treatment, particularly during the stressful period of waiting for the results of the pregnancy test result and after failed cycles.

An Analysis of the Concept of Partnership in the Couples Undergoing Infertility Treatment

The elements of a partnership in the couples undergoing infertility treatment are not well understood. This article aims to fill the gap by using Rodger's evolutionary method of concept analysis. The attributes of the concept partnership that were identified are a process of joint hardship, sharing, intracouple communication, and mutual support. The antecedents are love and attraction for each other, agreement, and interpersonal skills. The consequences are marital benefit, improvement in psychological status, and quality of life. A middle-range model for partnership in relationship to infertile couples is proposed. The understanding of the phenomenon of partnership will enable the researchers to develop interventions, identify the appropriate assessment instruments, and to determine directions for future research on effort to support infertile couples through their hardship.

The experience of women affected by polycystic ovary syndrome: a qualitative study from iran

BACKGROUND

Polycystic ovary syndrome (PCOS) is the most common chronic endocrine disorder. It has significant and diverse clinical consequences including reproductive, metabolic, and psychological morbidities as well as predisposition to malignancies. It is unclear how women with PCOS experience symptoms of this syndrome.

OBJECTIVES

The aim of this study was to clarify the dimensions and components of quality of life in iranian women with PCOS.

PATIENTS AND METHODS

This study was a qualitative study to explore and document perceptions of women with PCOS about their disorder and quality of life. Semi-structured interviews with open ended questions were conducted with 23 women with PCOS. The interviews were continued to reach data saturation. The study was conducted in the Reproductive Endocrinology Research Center of Shahid Beheshti University of Medical Sciences. All the interviews were recorded and transcribed. Constant comparative analysis of the data was conducted manually according to the Strauss and Corbin analysis method.

RESULTS

The study revealed that the most important factors affecting quality of life in women with PCOS were the role functioning items as well as physical, mental, emotional, cognitive, and social dimensions.

CONCLUSIONS

Comprehensive cares concerning various mental, emotional, cognitive, and social dimensions of quality of life should be planned for women with PCOS.

Development of a scale for determining violence against infertile women: a scale development study

Background

To develop a scale to evaluate violence experienced among infertile women.

Method

Three steps were followed in the development of the scale: Literature review and deep interviews to generate item pool, content validity testing, and administration of draft. Content validity was evaluated by experts. The draft scale was pilot-tested with a convenience sample of 30 women during their treatment. After the pilot-test, 166 infertile females filled the scale in the infertility clinic of a university hospital in Istanbul.

Results

For evaluation of construct validity, Kaiser-Mayer Olkin was 0.91. Bartlett test was statistically significant (p = 0.00). According to the results of analysis, 5 domains were determined: “domestic violence”, “social pressure”, “punishment”, “exposure to traditional practices” and “exclusion”. The values of correlation of item were between 0.50 and 0.82. Item-total and subscale-total correlation varied between 0.57-0.91. The scale had good internal reliability, with Cronbach’s Alpha coefficient of 0.96. The other coefficients of subscales varied between 0.80-0.94.

Conclusions

The scale called “Infertile Women’s Exposure to Violence Determination Scale” indicates high reliability, good content and construct validity. Routine screening for domestic violence in infertility clinics is necessary to give affected women an opportunity to access appropriate health care and support services. On the other hand, common use of Infertile Women’s Exposure to Violence Determination Scale in infertility clinics provides increased sensitivity and awareness by caregivers.

Female Gender Scheme is Disturbed by Polycystic Ovary Syndrome: A Qualitative Study From Iran

Background:

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy affecting up to one in every five women of reproductive age. The majority of researches on PCOS focus on its biomedical aspects, often overlooking and neglecting women’s own perceptions and experiences.

Objectives:

This study aimed to explore women’s perception and experiences that influence their personal gender role.

Patients and Methods:

This research is a qualitative study by conventional content analysis. Semi-structured interviews were conducted with 23 reproductive aged women with PCOS, recruited from the reproductive endocrinology research center. , in-depth interviews were continued to reach data saturation. The study was carried out at the reproductive endocrinology research center of Shahid Beheshti University in Tehran All the interviews were recorded and transcribed, and qualitative content analysis of the data was conducted manually.

Results:

Four themes were identified. Content analysis of the interviews revealed these women mainly perceived themselves with lack of physical attractiveness, loss of womanhood, interruption of sexual role and disruption of fertility potential, feelings were related to symptoms e.g. ‘excess’ hair; absent or disrupted menstrual cycle, obesity and infertility commonly experienced by women with PCOS.

Conclusions:

Women with PCOS are challenged in their perceptions of themselves as “feminine” because of their hairy appearance, irregular menses and lack of fertility and this influences their gender roles. Medical practitioners must understand how PCOS precisely affects women’s roles and initiate management aimed at reconstructing their “womanhood”, along with their medical treatment.

A preliminary study of the psychological differences in infertile couples and their relation to the coping styles

BACKGROUND

Studies from Western countries have observed that couples undergoing infertility treatment suffer various physical and psychological difficulties at a higher frequency than the comparable general population. These relate to treatment challenges and other psychosocial stressors, often influenced by coping style, personality factors and available support systems. There is paucity of studies in non-Western populations.

OBJECTIVE

The aim of this pilot investigation was to evaluate characteristics and gender differences in perceived psychological difficulties reported by infertile Malaysian couples. In particular, depression, anxiety and stress, along with correlated coping styles, were examined between spouses.

METHODS

Demographic information, including age, ethnicity and duration and causes of infertility, were collected from participants treated within a fertility clinic. The Depression, Anxiety and Stress Scale (DASS) and Coping Inventory for Stressful Situation (CISS) were completed to measure psychological distress and coping styles.

RESULTS

Depression, anxiety and stress-related difficulties were reported at significantly higher frequency by wives than husbands (p<0.05). There were no significant differences in coping styles between wives and husbands. However, emotional-oriented coping style was associated with significantly higher levels of depression, anxiety and stress (p<0.05) within the overall sample with odds ratios of 2.5, 3.0 and 1.5, respectively.

CONCLUSION

The study confirms that, as with Western subjects, Malaysian infertile couples demonstrate the vulnerability to psychological distress that occurs more frequently among wives than husbands. As anticipated, emotional coping style was associated with greater distress in both genders.

Sexual disorders in infertile couples: an update

PURPOSE OF REVIEW

The aim of this review is to examine the medical literature published in 2011-2012 on reports of sexual disorders in infertile couples.

RECENT FINDINGS

Ten articles on sexual disorders in infertile couples were traced. The results were very inconsistent, and the response rates of the studies were low.

SUMMARY

Divergent samples and assessment instruments, together with low or unknown responder rates, mean that there are no valid findings about sexual disorders in infertile couples. Further research will have to find an appropriate way of addressing these methodological shortcomings. Recent studies on infertile men and their sexuality are definitely underrepresented.