A review of the psychometric properties and implications for the use of the fertility quality of life tool

A Secondary Analysis of a Cross-Sectional Study to Examine Factors Associated with Marital Benefit Among U.S. Women with Infertility

Infertility in women causes profound psychological distress and may affect the coupled relationship. Few studies have considered the strengthening of the relationship, or marital benefit, of women with infertility. This study sought to investigate factors associated with marital benefit, such as infertility-related stress, partner communication, sexual satisfaction, coping strategies, and quality of life satisfaction. We used a descriptive cross-sectional study design to recruit 197 U.S. women with infertility who were undergoing fertility treatments from infertility-related Facebook support groups to complete an online survey. We used SPSS 28 to conduct descriptive statistics, Pearson correlations, and multiple linear regression. Partner communication, sexual satisfaction, primary infertility, meaning-based coping, marital stress, quality of life satisfaction, and attending a support group were significantly associated with marital benefit. The multiple linear regression model accounted for 43% of the variance in marital benefit, and six variables had a significant relationship with marital benefit: meaning-based coping (p <.001), marital stress (p = .003), partner communication (p <.003), primary infertility (p = .014), active-avoidance coping (p = .020), and attending a support group (p = .006). Interventions to decrease marital stress and improve coping and partner communication could be beneficial to facilitating marital benefit in women with infertility.

Quality of life, spiritual needs, and well-being of people affected by infertility and its treatment: quantitative results of a mixed-methods study

PURPOSE

Infertility is a growing global health issue that significantly affects quality of life (QoL). Understanding its impact on QoL is essential for developing effective healthcare interventions. This study explored QoL, well-being, and spiritual needs among individuals affected by infertility, with implications for healthcare provision.

METHODS

Standardized questionnaire data from an anonymous mixed-methods study that was conducted from October 2022 to January 2023 in Switzerland and addressing QoL (FertiQoL), spiritual needs (SpNQ-20), and psychological well-being (WHO-5) of individuals undergoing fertility treatments.

RESULTS

The analysis included 326 participants. FertiQoL scores were lowest in the emotional domain (M = 46.35) and highest in the relational domain (M = 68.51), with a mean overall score of 56.69, indicating moderate QoL impacts. Participants without children reported significantly lower FertiQoL and WHO-5 well-being scores than those with children (p < 0.05). The WHO-5 mean score indicated moderate well-being (M = 13.89). SpNQ-20 results showed the highest needs in inner peace (M = 1.82), followed by generativity (M = 1.09) and existential needs (M = 0.86), with religious needs scoring the lowest (M = 0.43). Participants without children had significantly higher spiritual needs (p < 0.05).

CONCLUSION

This study highlights the emotional and spiritual challenges of infertility, revealing differences in experiences between individuals with and without children. It emphasizes the importance of addressing mental health and well-being in infertility care. Further research should focus on the psychological impacts of fertility treatments, including depressive mood states.

Type D personality, and quality of life in couples undergoing in vitro fertilization treatment:the role of dyadic coping

There is limited research on the relationship between type D personality, dyadic coping, and quality of life (QoL), with most studies focusing on the individual perspective rather than the dyadic perspective. Additionally, evidence for the systemic-transaction model (STM) is limited, and research on infertile couples is scarce. This study investigated the relationship between type D personality and QoL in couples with infertility through the mediation of dyadic coping mechanisms. The present descriptive cross-sectional study recruited 452 infertile couples (N = 904) receiving in vitro fertilization (IVF) treatment from a tertiary hospital in Hefei, China, between January and May of 2022. Information on sociodemographic and clinical characteristics, type D personality, dyadic coping, and the QoL of the dyads was collected. The dyadic data were examined using the Actor-Partner Interdependence Mediation Model approach (APIMeM). The results suggest that type D personality, dyadic coping, and QoL in infertile couples have Actor-Partner Interdependence effects. The negative impact of Type D personality can spill over from individuals to the dyadic domain of couples. In the later stage, the negative impact of type D personality on QoL can be reduced by enhancing the dyadic coping level of both members of the infertile couple.

Epidemiological disease burden and annual, nationwide health insurance treatment cost of female infertility based on real-world health insurance claims data in Hungary

BACKGROUND

Infertility affects more than 50 million couples worldwide, resulting in a significant burden on individuals and society. Its prevalence ranges from 8-12% among developed countries. The growing number of patients poses an increasing challenge to the healthcare system and its funding. Our quantitative, descriptive, and cross-sectional study aimed to analyze the prevalence and annual nationwide health insurance treatment cost of female infertility in Hungary in 2019.

METHODS

We used claims data obtained from the Hungarian National Health Insurance Fund Administration (NHFIA). The number of patients, total and age-specific prevalence, annual health insurance expenditure, and the distribution of costs by age group were evaluated. Infertility was determined according to the World Health Organization International Classification of Diseases codes (N.97.0, N97.1, N97.2, N97.3, N97.4, N97.8, and N97.9) and the utilization of each healthcare service type. During the study descriptive statistics, correlation analysis and t-test were used.

RESULTS

In 2019, the NHIFA spent a total of 7.2 billion HUF (22.2 million EUR) on female infertility treatment in Hungary (33,151 women in outpatient care). The most significant costs were related to inpatient care (4.1 billion HUF, 12.7 million EUR). The highest number of patients and prevalence (650.4 per 100,000 women) were found in outpatient care. In inpatient care, the prevalence is substantially lower (206.7 per 100,000 women). Regardless of its type, female infertility mainly affects patients in the 30-39 years age group (number of patients: 18,156 women). The average annual health insurance expenditure per capita was 1,083 EUR.

CONCLUSIONS

Reproductive health education, prevention, and medical screening play inevitable roles in the early stages of reproductive life to reduce the risk of infertility and decrease treatment costs.

The impact of infertility on the mental health of women undergoing in vitro fertilization treatment

BACKGROUND & PROBLEM

Infertility affects a substantial number of couples, posing physical, emotional, and psychological challenges. Infertile women experienced a sense of loss of control and planning of life with high stress and anxiety and they must deal with the uncertainty of treatment. The evolution of assisted reproductive techniques has provided hope for couples that struggle with infertility. The implementation of questionnaires assessing the mental health of women with infertility before, during, and after the IVF procedure proved to be useful tool to evaluate women who needs psychological support.

AIM

This study aims to explore the impact of infertility on the mental health of women undergoing IVF treatment.

METHODS

For the assessment of infertility on women's mental health, the CES-D Scale, the State-Trait Anxiety Inventory for Adults, and the Fertility Problem Inventory scale were given before or during the diagnostic evaluation of the infertility and before the initiation of infertility treatment (ovulation induction). To assess the effect of ART on the mental health of the participants, the fertility quality of life tool was applied at the end of the procedure.

FINDINGS

The current study found that the greater age, the greater educational level and not having experienced a miscarriage were significantly associated with better quality of life and decreased stress during the IVF procedure.

CONCLUSIONS

The application of psychological interventions can assist all women undergoing infertility treatment as a way to cope with the challenges associated with infertility treatment. IVF couples may need additional support during the procedure.

Quality of life and its determinants in women with delayed conception in low-mid socioeconomic neighbourhoods of Northern India: a cross-sectional study

Background

The inability to conceive or delay in conception has negative and multidimensional effects on health and well-being, daily functioning and societal interactions. This study assesses the impact of delayed conception on quality of life (QoL) among Indian women with delayed conception and evaluates the Fertility Quality of Life (FertiQoL) questionnaire's reliability and construct validity in this population.

Methodology

A cross-sectional study of 1530 women aged 18-30, who had not conceived over a period of 18 months, was conducted in low-to-mid-socioeconomic neighbourhoods in Delhi, India. The 24-item core module of the FertiQoL questionnaire was used to assess participants' QoL. Researchers analysed data to identify factors associated with QoL scores and evaluated FertiQoL's internal consistency and validity. Data were collected between July 2020 and August 2021.

Result

The average FertiQoL score was 31.71 out of 100, indicating a moderately low QoL. Among the subscales, emotional (mean: 29.0) and mind-body domains (mean: 25.4) scored the lowest, while the relational domain scored the highest (mean: 50.7). Factors negatively associated with QoL included a longer duration of delayed conception (β=-0.3, 95% CI: -0.5 to -0.1), husbands fathering children with other partners (β=-1.1, 95% CI: -1.7 to -0.38), domestic violence-emotional (β=-3.5, 95% CI: -4.5 to -2.4), verbal (β=-3.2, 95% CI: -4.7 to -1.7), physical abuse by family (β=-3.6, 95% CI: -5.5 to -1.6), lack of financial support (β=-3.2, 95% CI: -5.2 to -1.2), social pressures (β=-1.6, 95% CI: -2.3 to -0.9) and physical health issues (β=-0.9, 95% CI: -1.7 to -0.2). The FertiQoL tool demonstrated acceptable reliability (Cronbach's alpha=0.64) and good construct validity (confirmatory factor analysis), confirming its utility in this population.

Conclusion

Indian women experiencing delayed conception have reduced QoL, particularly in emotional and mind-body domains, due to various psychosocial and socioeconomic challenges. The FertiQoL questionnaire proved to be a reliable and valid tool for assessing QoL in this context. Psychosocial interventions addressing emotional, social and economic stressors are urgently needed to improve their well-being. Future research should include men to better understand the holistic challenges faced by couples struggling to conceive.

Dysmenorrhea and Its Impact on Patients' Quality of Life-A Cross-Sectional Study

Background: Dysmenorrhea is a common condition that may have negative effects on social life, couples' relationships and professional activities. The objectives of this study were to evaluate the prevalence, risk factors and characteristics of dysmenorrhea and its impact on patients' quality of life using a specific self-questionnaire named "DysmenQoL questionnaire". We also checked the validity and reliability of this questionnaire in our population. Methods: We conducted a cross-sectional study that included 504 participants of reproductive age between 18 and 45 years of age. The data were collected with an original form divided into three sections. The last section (DysmenQoL questionnaire) included 20 statements scored from 1 ("never") to 5 ("every time") that evaluates the effects of menstrual pain on health and feelings, daily activities, relationships and professional activity. We calculated the sum of the scores for each statement and we called it the "DysmenQoL score". Results: The prevalence of dysmenorrhea was 83.7%. The presence of dysmenorrhea was statistically significant associated with the degree of menstrual bleeding (p = 0.017), the presence of infertility (p = 0.034) and dyspareunia (p = 0.002), but also with the presence of premenstrual syndrome and a family history of dysmenorrhea (p < 0.001). Among the participants with dysmenorrhea, 73.9% considered that this symptom affected their quality of life, and this was correlated with pain intensity and the DysmenQoL score (p < 0.001). A significant difference regarding the DysmenQoL score depending on the pain intensity, frequency and duration of dysmenorrhea and the methods used to reduce the pain was observed. Conclusions: Dysmenorrhea had a high prevalence among the participants included in the study, and its presence was associated with a series of risk factors. Most women considered that dysmenorrhea affected their quality of life. The DysmenQoL questionnaire proved to be a reliable and valid method for evaluating the impact of dysmenorrhea on quality of life.

Enhancing cultural sensitivity in the implementation of the Fertility Quality of Life Tool in Sudan: a science diplomacy perspective

Background

Infertility is a global health challenge impacting quality of life, particularly in low and middle-income countries such as Sudan. The Fertility Quality of Life (FertiQoL) tool, a standardized questionnaire, is pivotal in assessing fertility-related quality of life. However, existing research on its utility has primarily been conducted in Global North and High-Income Countries, highlighting the need to shift away from neocolonialism to promote truly inclusive research and effective healthcare practices. Science diplomacy, through the adaptation and culturally sensitive implementation of research tools, can serve as a catalyst for addressing health disparities on a global scale. This study aims to assess methodological and cultural considerations that impact the implementation of the FertiQoL tool in Sudan, framed within the context of science diplomacy and neocolonialism. By investigating the challenges and opportunities of utilizing this tool in a non-Western cultural setting, we seek to contribute to the broader discussion on decolonizing global health research.

Methods

Utilizing an explanatory sequential design involving surveys and interviews, we conducted a study in a Sudanese fertility clinic from November 2017 to May 2018. A total of 102 participants were recruited using convenience sampling, providing socio-demographic, medical, and reproductive history data. The Arabic version of FertiQoL was administered, with 20 participants interviewed and 82 surveyed (40 self-administered and 42 provider-administered). We applied descriptive statistics, one-way ANOVA, thematic analysis, and triangulation to explore methodological and cultural nuances.

Results

Most participants were educated women who lived in urban areas. While the ANOVA results revealed no statistically significant differences in FertiQoL scores based on the mode of administration [core score (F(2,99) = 1.58, p = 0.21, η 2 = 0.03) and domain scores: emotional (F(2,99) = 1.85, p = 0.16, η 2 = 0.04); mind/body (F(2,99) = 1.95, p = 0.15, η 2 = 0.04); relational (F(2,99) = 0.18, p = 0.83, η 2 = 0.04); and social (F(2,99) = 1.67, p = 0.19, η 2 = 0.03)], qualitative insights unveiled vital cultural considerations. Interpretation challenges related to concepts like hope and jealousy emerged during interviews. Notably, the social domain of FertiQoL was found to inadequately capture the social pressures experienced by infertile individuals in Sudan, underscoring the importance of region-specific research. Despite these challenges, participants perceived FertiQoL as a comprehensive and valuable tool with broader utility beyond assessing fertility-related quality of life.

Conclusion

Our findings emphasize the significance of incorporating cultural sensitivity into the interpretation of FertiQoL scores when implementing it globally. This approach aligns with the principles of science diplomacy and challenges neocolonial structures by acknowledging the unique lived experiences of local populations. By fostering cross-cultural understanding and inclusivity in research, we can enhance the implementation of FertiQoL and pave the way for novel interventions, increased funding, and policy developments in the Global South, ultimately promoting equitable global health.

The SCREENIVF Hungarian version is a valid and reliable measure accurately predicting possible depression in female infertility patients

Infertility patients, often in high distress, are entitled to being informed about their mental status compared to normative data. The objective of this study was to revalidate and test the accuracy of the SCREENIVF, a self-reported tool for screening psychological maladjustment in the assisted reproduction context. A cross-sectional, questionnaire-based online survey was carried out between December 2019 and February 2023 in a consecutive sample of female patients (N = 645, response rate 22.9%) in a university-based assisted reproduction center in Hungary. Confirmatory factor analysis and cluster and ROC analyses were applied to test validity, sensitivity and specificity in relation to Beck Depression Inventory (BDI) scores. Model fit was optimal (chi-square = 630.866, p < 0.001; comparative fit index = 0.99; root-mean-square error of approximation = 0.018 (90% CI 0.013-0.023); standardized-root-mean-square-residual = 0.044), and all dimensions were reliable (α > 0.80). A specific combination of cutoffs correctly predicted 87.4% of BDI-scores possibly indicative of moderate-to-severe depression (χ2(1) = 220.608, p < 0.001, Nagelkerke R2 = 0.462, J = 66.4). The Hungarian version of the SCREENIVF is a valid and reliable tool, with high accuracy in predicting BDI-scores. Low response rate may affect generalizability. The same instrument with different cutoffs can serve various clinical goals.

Depression, anxiety, quality of life, and infertility: a global lens on the last decade of research

We aimed to review the global literature in the past 10 years regarding the impact of infertility on depression, anxiety, stress, and quality of life while exploring the potential clinical utility of psychosocial fertility questionnaires. PubMed, Scopus, and CINAHL were searched for English-published articles since 2013 on key search terms related to infertility, assisted reproductive technologies, and psychological terms such as depression, anxiety, mood disorders, and quality of life. The search yielded 7,947 articles, of which 366 articles were independently deemed relevant by the 3 reviewers. Anxiety, depression, and diminished quality of life are prevalent in the infertility experience of both men and women. Studies from around the world show similar experiences independent of culture.

Efficacy of Dry Cupping versus Counselling with Mindfulness-based Cognitive Therapy Approach on Fertility Quality of Life and Conception Success in Infertile Women due to Polycystic Ovary Syndrome: A Pilot Randomized Clinical Trial

Background

Physical and psychological interventions could affect the quality of life (QoL) of women with infertility. The purpose of this study was to compare the effectiveness of dry cupping and counselling with the mindfulness-based cognitive therapy (MBCT) approach on fertility QoL and conception success in infertile women due to polycystic ovary syndrome (PCOS).

Methods

This was a two-arm pilot randomized clinical trial from first January 2021 to the end of November 2022. In this regard, 19 women with infertility who were referred to the health centers affiliated with Shiraz University of Medical Sciences and met the inclusion criteria were enrolled in the study. Participants were randomly divided into two groups (10 in the virtual MBCT group and 9 in the cupping group). All participants completed the fertility quality of life (FertiQol) tool before the intervention and three months after the end of the intervention. In addition, after the end of the intervention, a human chorionic gonadotropin test was performed monthly for three months, too. We used ANOVA/ANCOVA and its related effect sizes, including mean difference (MD) and standard mean difference (SMD: Hedges's g), and chi-square tests to compare the study group outcomes in Stata 14.2. P-values equal to or less than 0.10 were considered significant.

Results

The intervention resulted in significant differences in the mean overall scores of FertiQol between the counseling and cupping groups (61.76±14.28 and 50.65±12.53, respectively) [P=0.091, MD=11.11 (90% CI: 0.33 to 21.89), SMD=1.07 (90% CI: 0.279 to 1.84)]. No significant difference was found in conception rates between the groups after the intervention.

Conclusion

This pilot study found that MBCT improved the fertility QoL in PCOS-related infertility patients better than cupping therapy.

Trial registration

IRCT201706110334452N1.