Agreement on perceptions of quality of life in couples dealing with 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.

A Systematic Review and Meta-analysis of the Psychiatric Morbidities and Quality of Life Differences Between Men and Women in Infertile Couples

Infertility is often associated with diverse psychiatric morbidities and quality of life impairments. Hence, this meta-analysis aimed to compare stress, depression, anxiety and quality of life (QoL) among infertile men and women. We retrieved the relevant articles from multiple databases. For the statistical analyses, we used Comprehensive Meta-Analysis software v. 3.7 (Biostat Inc., Englewood, NJ). Standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated and displayed in forest plots. Among the 4123 articles identified, 35 studies met the inclusion criteria. Our results revealed that stress, depression, and anxiety were higher in infertile women compared to men. Similarly, infertile women presented a lower QoL than infertile men. Subgroup analysis revealed that the assessment tool used, study design, and geographical origin were a source of heterogeneity. This meta-analysis showed that psychological disturbances were higher in infertile women compared to men. Physicians need to consider this difference to enable couples to better understand and support each other.

Striving for motherhood after uterus transplantation: a qualitative study concerning pregnancy attempts, and the first years of parenthood after transplantation

STUDY QUESTION

How do women experience attempts to become pregnant, and the first years of motherhood, after uterus transplantation (UTx)?

SUMMARY ANSWER

Women who try to become pregnant after UTx experience the general strains typically associated with infertility and childlessness, such as failure of embryo transfer (ET), and specific worries about graft survival but when they become mothers they essentially feel like other mothers, with the associated rewards and stresses.

WHAT IS KNOWN ALREADY

UTx has proven to be a successful treatment for absolute uterine factor infertility (AUFI). Although UTx seems to have a positive effect on self-image there is a lack of knowledge about how women who have received uterine grafts experience pregnancy attempts, pregnancy itself and the first years of motherhood.

STUDY DESIGN, SIZE, DURATION

This prospective cohort study included the seven participants in the first UTx trial who had experienced surgically successful grafts. Pregnancy was attempted using ET 12 months after transplantation. Structured interviews were performed once a year for 5 years after transplantation.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Six of the seven participants (mean age 29.3 years at UTx) had AUFI owing to the congenital absence of the uterus, while the seventh woman had undergone a hysterectomy. Post-transplantation, yearly interviews (2013-2018) were performed, comprising a total of 34 interviews. Interview data were analysed thematically.

MAIN RESULTS AND THE ROLE OF CHANCE

All seven participants achieved pregnancy during the study period and six became mothers. Experiencing the previously unimaginable was classed as an overarching theme with the following underlying themes: The yoke of childlessness; Going through the impossible and Motherhood as surreal and normal. The results showed that the women who try to achieve motherhood after UTx generally describe their situation as manageable and present strains comparable to other women undergoing infertility treatments.

LIMITATIONS, REASONS FOR CAUTION

The fact that all participants came from one centre is a limitation.

WIDER IMPLICATIONS OF THE FINDINGS

There are real psychological strains in motherhood after UTx, such as the concern the women expressed relating to health of the child and the effects of immunosuppressants. These findings are in line with those of other women who became pregnant after transplantation of organs other than the uterus. The results show that extra psychological support and attention should be given to those with repeated pregnancy failures or unsuccessful outcomes. In the cases where women became mothers, attention needs to be given to the possible worries connected to the UTx, but in other respects, they should be treated like any mother-to-be.

STUDY FUNDING/COMPETING INTEREST(S)

Funding was received from the Jane and Dan Olsson Foundation for Science; Knut and Alice Wallenberg Foundation. A.L.F. grant from the Swedish state under an agreement between the government and the county councils; Swedish Research Council. The authors have no competing interests.

TRIAL REGISTRATION NUMBER

NCT01844362.

The Etiology of Infertility Affects Fertility Quality of Life of Males Undergoing Fertility Workup and Treatment

This panel study explored the effects of male, female, mixed, or idiopathic factor of infertility on the fertility quality of life (FertiQoL) in involuntarily childless males undergoing fertility workup for the first time. A convenience sample of 255 married males (age range = 22–51 years, mean = 30.24 years), 254 (99.6%) of whom suffered from primary infertility were assessed (1) at the baseline, before their initial fertility evaluation (T1); (2) before their second andrological appointment, 2–3 months after diagnostic disclosure (T2); and (3) before subsequent treatment-related/ follow-up appointments (T3, T4). The timing of psychological assessment was strictly related to andrological appointments and routine medical procedures. Respondents completed Emotional, Mind–Body, Relational, and Social subscales of the Polish version of FertiQoL and a baseline demographic survey. The research demonstrated that the FertiQoL scores across the Emotional, Mind–Body, and Relational subscales markedly decreased after the diagnostic disclosure, particularly in the subgroups with male and concurrent male and female factor. Social subscale scores in all subgroups remained stable after the diagnostic disclosure (at T2) but significantly decreased in the follow-up (at T3 and T4). Significant differences in FertiQoL scores associated with respondents’ infertility factor could be demonstrated at each time point. The study identifies the FertiQoL in unintentionally childless males is significantly affected by their factor of infertility and evolves across the pathway of treatment-related/follow-up appointments.

Effects of Irrational Parenthood Cognition, Post Traumatic Stress Disorder and Spousal Support on Quality of Life of Infertile Women

PURPOSE

This study examined degrees of irrational parenthood cognition, post traumatic stress disorder (PTSD), spousal support, and quality of life and investigated factors that influence the quality of life of infertile women.

METHODS

Research design was a cross sectional correlational survey with a total of 113 female patients receiving treatment for infertility. Data were collected from August 1 to November 30, 2015. The collected data were analyzed using t-test, ANOVA, Pearson's correlation, and multiple regression analysis.

RESULTS

The mean score of the quality of life was 59.0±14.8. The quality of life was significantly associated with irrational parenthood cognition (r=-.70), post traumatic stress disorder (r=-.65), and spousal support (r=.56). The factors significantly affecting the quality of life in infertile women were irrational parenthood cognition (β=-.45), post traumatic stress disorder (β=-.34), and spousal support (β=.32). The explained variance by these factors was 70.4%, and the regression model was valid (F=89.81, p<.001).

CONCLUSION

This study may contribute to the development of nursing intervention program to improve the quality of life of infertile women.

Marital Intimacy and Predictive Factors Among Infertile Women in Northern Iran

INTRODUCTION

Infertility is a stressful state that may decrease attachment between spouses. Marital intimacy is a real need in infertile women.

AIM

The aim of this study was to evaluate marital intimacy and predictive factors among infertile women in Northern Iran.

MATERIALS AND METHODS

This cross-sectional study was conducted at Fatemeh Zahra Infertility and Reproductive Health Center of Babol Medical Sciences University in 2014. A total of 221 infertile women participated in this study. The instrument used in this research was Marital Intimacy Need Questionnaire (MINQ). Statistical analyses was performed using linear and logistic regression with p<0.05 indicating statistical significance.

RESULTS

An 88.5% of infertile women had good marital intimacy. The mean and standard deviation of the marital intimacy was 349.11±49.26 and in marital intimacy domains including: emotional (42.28±7.23), psychological (41.84±7.59), intellectual (42.56±7.46), sexual (42.90±7.41), physical (43.59±6.96), spiritual (51.61±8.06), aesthetic (42.66±6.75), and social intimacy (42.59±6.89). The highest mean of marital intimacy domains is related to spirituality in infertile women. Physical and sexual domains had the high mean in infertile women. The lowest mean in marital intimacy domains was psychological intimacy. There was a significant correlation between the domains of marital intimacy. The strongest correlation was between the physical and sexual intimacy (r=0.85). There was a significant inverse association in marital intimacy with the age difference of spouses (p<0.01), and tobacco use (p<0.02). There was a statistically significant association in the marital intimacy with husband's occupation, and cause of infertility (p<0.02).

CONCLUSION

Early screening and psychosocial intervention strategies suggest in the setting of female infertility to identify and prevent the predictive factors that may cause marital conflict.

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.

Family and professionals underestimate quality of life across diverse cultures and health conditions: systematic review

OBJECTIVES

To examine how accurately proxies evaluate quality of life (QoL) in people they know, using cross-cultural data from the multidimensional, multilingual World Health Organization Quality of Life assessment short-form (the WHOQOL-BREF) and whether accuracy varies by health condition or proxy type (eg, family/professional).

STUDY DESIGN AND SETTING

Systematic review with meta-analysis: We searched five databases for reports of proxy-completed WHOQOL-BREF scores and aggregated results using a random-effects model. Minimal clinically important difference values were calculated.

RESULTS

Analyses included nine studies (1980 dyads) of physical (n = 762) or mental (n = 604) health conditions, or intellectual disability (n = 614), in 10 countries. Mean person-proxy correlations ranged from 0.28 (social QoL) to 0.44 (physical QoL). Proxy measures were underestimates (ie, significantly lower than persons reported for themselves) for social [mean difference (MD) = 4.7, 95% confidence interval (CI): 1.8, 7.6], psychological (MD = 3.7, 95% CI: 0.6, 6.8), and physical (MD = 3.1, 95% CI: 0.6, 5.6) QoL. Underestimates varied significantly between health conditions for social (P < 0.001), psychological (P = 0.009), and physical (P = 0.02) QoL. Family members assessed psychological and environmental QoL better than professionals.

CONCLUSION

Proxies tend to be imprecise, underestimating QoL, and should be aware of this tendency. Where health care is decided for others, family members' views about QoL should be prioritized.

[Characteristics of infertility-specific quality of life in Hungarian couples]

INTRODUCTION

Experiencing involuntary childlessness has a great impact on couples' quality of life.

AIM

The aim of the authors was to examine the correlations among infertility-specific quality of life and depression on the level of individuals and couples.

METHOD

126 couples in five fertility centers in Hungary filled out the FertiQoL and Beck Depression Inventory and answered some sociodemographic questions.

RESULTS

In gender comparison, women reported about more depressive symptoms and poorer quality of life than men. Both in men and women, the higher depression level correlated with lower level of quality of life. Moreover, the presence of more depressive symptoms in women was related to men's poorer quality of life.

CONCLUSIONS

The results show that differences may exist in affective responses to infertility between women and men and that female affective problems take effects on the level of the couple relationship. These findings may be useful in psychosocial support of the couples facing infertility, especially in couple counselling or couple therapy.

Effects of gender roles, child wish motives, subjective well-being, and marital adjustment on infertility-related stress: a preliminary study with a Hungarian sample of involuntary childless men and women

PURPOSE

The aim of the study is to investigate the infertility-related stress in a Hungarian infertile population and examine the effects of gender roles, child wish motives, subjective well-being, and marital relationship on the experience of infertility according to our self-constructed conceptual framework.

METHODS

Validated self-report questionnaires measuring the factors of the conceptual framework were taken in the study carried out in a sample of 53 people attending the fertility unit of a Hungarian clinic.

RESULTS

Infertility-related global stress, infertility-related social concerns, and general health problems have more intensive effect on women than on men (all p < 0.05). Women from the infertile group scored higher their femininity (p < 0.001) and lower their general health (p < 0.05) than the reference population. Infertile men believe deeper in meaning of life than women (p < 0.05) or reference population (p < 0.01). Femininity (β = 0.460, p < 0.05), traditional gender role concepts (β = -0.248, p < 0.05), general health (β = -0.474, p < 0.05), and marital relationship (β = -0.251, p < 0.05) play the strongest role to predict stress caused by infertility.

CONCLUSIONS

The current study emphasizes the importance of interrelations of gender role attitudes, gender role identification, general health, and satisfaction in couple relationship with infertility-related stress. In further investigations, both social and personal aspects and their effect on experiencing infertility need to be measured in infertile people, particularly in different cultural settings.