Psychogenic infertility--myths and facts

A new quality-of-life measure for men experiencing involuntary childlessness

BACKGROUND

Infertility may considerably reduce quality-of-life. Many of the existing generic quality-of-life measures, which often focus on physical impairments, do not represent the specific complaints of infertile patients. In this article, we report on the development and validation of the TLMK (Tübinger Lebensqualitätsfragebogen für Männer mit Kinderwunsch), an instrument for measuring quality-of-life in male patients with involuntary childlessness.

METHODS

The first version of the questionnaire, which consisted of 91 items, was administered to 275 men who attended andrology and gynaecology clinics for fertility evaluations. After the questionnaires were scored, item analysis and reduction, principal component analysis and internal consistency analyses were conducted.

RESULTS

The final version of the TLMK consists of 35 items in four scales and provides an internally consistent quality-of-life profile for men experiencing involuntary childlessness. Convergent and discriminant validity was supported through the correlation of the TLMK scales with established questionnaires on life satisfaction (FLZ) and partnership (PFB).

CONCLUSION

The TLMK provides information about the quality-of-life in men experiencing involuntary childlessness and was found to be easy to administer and acceptable to patients. It may be used to assess patients' baseline and ongoing quality-of-life during fertility treatment and as an outcome variable in the evaluation of integrated psychological counselling.

The effect of stress on menstrual function

Historically difficult to define, stress is, in one sense, the factor that stressors have in common in their impact on the body. Menstrual function is disrupted by stressors that activate the hypothalamic-pituitary-adrenal (HPA) axis; this activation is part of a catabolic response of the whole body that mobilizes metabolic fuels to meet energy demand. Functional menstrual disorders are associated with an increase in cortisol and with a broad spectrum of other symptoms of energy deficiency. Recent experiments suggest that exercise and other stressors have no disruptive effect on reproductive function beyond the impact of their energy cost on energy availability. These studies suggest that treatments for functional menstrual disorders should aim at dietary reform and that stress is simply low energy availability. Future experiments should carefully test this hypothesis.