P-509 Evolution of quality of life, sexual function and marital agreement in long term infertile couples: a 10-year prospective cohort study

Study question

Comparing the sexual function, marital adjustment, and quality of life of long-term infertile and parenting couples after a history of ART

Summary answer

Long time infertility alters the sexual function in women but does not impact negatively the quality of life and the marital adjustment of the couples

What is known already

The short-term impact of the diagnosis of infertility and its treatments on heterosexual couples has been investigated. But very little literature exists regarding the evolution of the quality of life, marital agreement, and the sexual function of long-term infertile couples. After ART, parenthood is considered to impact the quality of life and thus the conjugal life of the couples in a short time. But there are very few studies comparing the quality of life of couples who underwent ART in regard to the success or not of their parenthood project in the long term.

Study design, size, duration

This is a prospective, cohort-type analytical study where each patient is their own control over time. Patients were recruited at the Fertility Treatment Unit of our department, over a 10-year period (2009-2018). An interview was held with each partner at the 1st consultation and 10 years later. The recruitment phase took place from January 1st, 2009, and May 31, 2009.

Participants/materials, setting, methods

We included all heterosexual married couples with women under 40 and men under 45. The evaluation of the quality of life was standardized by the Medical Outcomes Study Short Form 36 (SF-36) and the Fertility Quality Of Life (FertiQol). The female sexual function was evaluated with the Female Sexual Function Index (FSFI). The male sexual function was evaluated through the International Index of Erectile Function (IIEF). The marital adjustment Test (MAT) evaluated the conjugal life.

Main results and the role of chance

We included 100 couples (100 women and 100 men) of whom only 44 were still together after 10 years:18 were still childless, 8 had adopted, and 18 had live births. The divorce rate in our study population was 56%. There were no significant differences in the socio-demographic features of the parenting and childless couples. Men's sexual function was not different between fathers and childless men. Childless women's sexual function was impaired compared with mothers either regarding the global function (p = 0.003) or all its components (Desire (p = 0,025), excitation (p = 0,001), lubrification (p = 0,007), orgasm (p = 0,017), pain (p = 0,008), and satisfaction (p = 0,006)). There is no difference in terms of marital adjustment (p = 0.479) and in terms of quality of life when applying the SF36. In the 18 long-term infertile women, the core FertiQol emotional scores and the FertiQol treatment tolerance scores were lower than in men (respectively, p = 0.02 and 0.003).

Limitations, reasons for caution

The small size of the sample of our study is the main limitation of the study. It is mainly related to the high rate of divorce in this specific population and the long period of the study.

Wider implications of the findings

Health care professionals need to emphasize the information of the couples of the potential effects of long-term infertility on the couple's marital life, the sexual life, and the quality of life, especially among women. They also need to help the patients seek the help and counseling they need.

Trial registration number

not applicable

[Interest of laparoscopy in infertile couple with normal hysterosalpingography]

OBJECTIVES

The diagnostic laparoscopy has long been the key consideration in the export of female infertility. This place is being reconsidered, especially in the case of normal hysterosalpingogrophy (HSG), because of the advent of assisted reproductive technologies which are more efficient, and because of the improvement of medical imaging techniques which are more sensitive and specific. We wanted to clarify the place of the diagnostic laparoscopy in the balance of female infertility in normal HSG.

PATIENTS AND METHODS

It is a retrospective study on a series of 100 observations of infertile patients with a normal HSG and having a diagnostic laparoscopy in the department of Gynecology and Obstetrics at Farhat Hached hospital in Sousse (Tunisia) from 1st January 1993 to 1st March 2003.

RESULTS

The mean age was 32.3years; the mean duration of infertility was 70.47months. Laparoscopy revealed pelvic abnormalities in 45% of cases, dominated by disease tubo-adhesions (23%), endometriosis was found in 6% of cases. These anomalies are considered major in 23% of cases and minor in 22% of cases. Conducting a surgical procedure in the same operating time (adhesiolysis, tubal plastic surgery, electrocoagulation of endometriosis implants) could improve the prognosis of fertility. Only 20 patients were followed among the 45 with pelvic abnormalities, seven pregnancies have been completed (35% of cases).

DISCUSSION AND CONCLUSION

Laparoscopy has improved the prognosis for the fertility of our patients by treating abnormalities involved in infertility. It is estimated that the prognosis can be improved by selecting patients with risk factors for pelvic abnormalities.