Predictors of fertility quality of life (FertiQoL) in infertile women: analysis of confounding factors

OBJECTIVE

Infertility may adversely influence quality of life (QoL). The aim of this study was to compare QoL in women with primary and secondary infertility, and identify factors associated with poor and good QoL.

STUDY DESIGN

Quality of life was measured using the FertiQoL tool in 273 patients attending an infertility clinic, and demographic and clinical characteristics of the patients were recorded. Patients with primary and secondary infertility were compared for QoL subscales, and other confounding factors were investigated using multiple regression analysis.

RESULTS

Women with secondary infertility obtained higher scores in emotional, mind/body, and social domains of the core subscale, tolerability domain of the treatment subscale, and total QoL (p<0.05). Women desiring psychological support showed lower scores in all domains except environment. Prolonged duration of infertility was associated with lower scores of mind/body, social, tolerability domains and total QoL score (p<0.05). Multiple regression analysis showed that the status of education and secondary infertility had a positive impact, whereas prolonged duration of infertility and desire for psychological support had a negative impact on total QoL scores.

CONCLUSION

QoL scores were better in patients with secondary infertility and higher educational status, whereas scores were negatively affected by prolonged duration of infertility and desire for psychological support.

(Male) infertility: what does it mean to men? New evidence from quantitative and qualitative studies

Scientific knowledge of the emotional repercussions of infertility on men remains limited and has only recently become the focus of social science research. Firstly, the current developments in research on the psychosocial impact of infertility on men through a search of the literature over the last 10 years are outlined in this paper. In the second section, issues raised in pretreatment counselling for men and their partner who consider donor insemination are described as this treatment typically raises many emotional issues. The results of more recent studies with sophisticated methodological design show that the emotional impact of infertility may be nearly balanced, suggesting that men do suffer as well and that they have to be addressed in infertility counselling too. The emotional and clinical aspects of donor insemination support the hypothesis that the emotional repercussions of infertility affect both sexes. In general, male factor infertility seems to be more stigmatized than other infertility diagnoses. Forthcoming studies have to differentiate between the psychological impact of infertility on women and men and their respective abilities to communicate easily about this distress. More studies on infertile men in non-Western societies need to be conducted in order to understand the cultural impact on infertility.

Differences in quality of life and emotional status between infertile women and their partners

STUDY QUESTION

Do the quality of life (QoL) and the risk factors for emotional problems during and after treatment of infertile women differ from their partners?

SUMMARY ANSWER

Women have lower levels of fertility-related QoL, and more and differing risk factors for emotional problems during and after treatment than their partners. WHAT IS KNOWN ALREADY?: The psychological impact of infertility in patients negatively affects their QoL and is also related to increased discontinuation of treatment. Moreover, psychological factors might positively affect pregnancy rates. However, it is still unclear if differences in QoL and emotional status exist between infertile women and their partners. So far, research mainly focused on generic instruments to measure patients' QoL in the area of fertility care.

STUDY DESIGN, SIZE, DURATION

A cross-sectional study of infertile couples within 32 Dutch fertility clinics.

PARTICIPANTS/MATERIALS, SETTING, METHODS

We included infertile women and their partners (both heterosexual and lesbian couples) under any treatment and at any stage of treatment in one of the 32 participating clinics. Per clinic, 25-75 patients were randomly selected depending on clinic size. In total, 1620 women and their partners were invited separately to complete the FertiQoL and SCREENIVF questionnaires to measure their level of QoL and risk factors for emotional problems during and after treatment, respectively.

MAIN RESULTS AND THE ROLE OF CHANCE

A total of 946 women (response rate 58%) and 670 partners (response rate 41%) completed the questionnaire set. As 250 women and 150 partners were already pregnant, questionnaires from 696 women and 520 partners could be analysed. Women scored significantly lower on the FertiQoL total scores [B = -6.31; 95% confidence interval (CI) = -7.63 to 4.98] and three of the FertiQoL subscales (Emotional, Mind-Body and Social) than their partners, indicating lower QoL. Scores on the SCREENIVF questionnaire were significantly higher for women (B = 0.22; 95% CI = 0.06-0.38), indicating that women are more at risk for developing emotional problems (and these factors differed from those of their partners) during and after fertility treatment than their partners.

LIMITATIONS, REASONS FOR CAUTION

Although the number of participants is high (n = 1216), the relatively low response rate, especially for partners (41%), may have influenced the results through selection bias. An analysis of non-responders could not be performed. The FertiQoL and SCREENIVF questionnaires, which have been validated only in women starting a first IVF cycle, should also be validated for studying partners. In addition, the SCREENIVF questionnaire has been validated in Dutch women only and further research in an international setting is also required.

WIDER IMPLICATIONS OF THE FINDINGS

Our study results represent the Dutch infertile population as more than one-third of all Dutch clinics participated in the study. As the FertiQoL questionnaire is an internationally validated questionnaire already, these results can be put in a more broader and international perspective.

STUDY FUNDING/COMPETING INTEREST(S)

This work was supported by Merck Sharp & Dohme (MSD), The Netherlands. There are no competing interests.

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.

Psychological disturbances and quality of life in obese and infertile women and men

Anovulatory cycles and endometriosis are the main causes of female infertility. The most frequently anovulatory cycles are related to polycystic ovary syndrome (PCOS) commonly associated with obesity and hormonal disturbances in the course of obesity. Recently published studies revealed that infertility affects about one in six couples during their lifetime and is more frequent in obese. Obesity is also associated with male infertility related to erectile dysfunction, hormonal disturbances and lower semen quality. Any of these above mentioned disorder is the important risk factor of psychological disturbances and poor quality of life among women and men in the reproductive age. On the other hand the mood disorders may exacerbate the hormonal disturbances and worsen the effectiveness of infertility management. Infertility, its therapy with accompanying psychological disturbances may also significantly affect the partners relationships. The review summarize the results described in the current literature on the association between obesity and infertility and psychological disturbances as well as their impact on quality of life and sexual functioning in women and men. Moreover, the impact of infertility and psychological disturbances on partners relationships is discussed.

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

OBJECTIVE

To examine the extent to which men and women seeking treatment for infertility were able to accurately perceive their partners' ratings of their quality of life (QOL).

DESIGN

Cross-sectional prospective study. Quality of life was measured as a multidimensional construct.

SETTING

Assisted reproduction clinic of a university hospital.

PARTICIPANTS

One hundred and sixty-two couples participated. The men's and women's mean ages were 36.1 and 32.1 years, respectively. Most participants had no children, and no previous assisted reproduction attempts.

METHODS

Men and women completed the World Health Organization-Quality of Life-Brief (WHOQOL-Brief) and the Beck Depression Inventory independently. Paired t tests were used to explore men's perceptions of their wives' QOL ratings and wives' perceptions of their husbands' ratings. Multiple regression and repeated-measures ANCOVA were used to examine the role of depression.

RESULTS

Proxy assessments were consistently lower than self-reports on the domains of QOL. The influence of depression on agreement was minimal, and no gender effect was observed.

CONCLUSION

Findings indicated little agreement in perceptions of the partner's QOL, with each partner tending to underrate the other's view. Practitioners need to consider the differences between partners to enable partners to better understand and support each other.

Investigating quality of life and health-related quality of life in infertility: a systematic review

OBJECTIVE

To review the findings on quality of life (QOL) and health-related quality of life (HRQOL) among infertile women, men and couples.

DESIGN

Systematic review.

METHODS

Publications between January 1980 and July 2009 in Medline, PsycInfo, Embase and Health and Psychosocial Instruments were compiled using the following inclusion criteria: papers published in peer-reviewed journals; written in English, French, Spanish or Portuguese; presented original findings; assessed quality of life or health-related quality of life as an outcome; included infertile subjects without other clinical conditions; used validated measures.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Quality of life and health-related quality of life.

RESULTS

Fourteen studies were included in the review. Educational level, will to have children, poor marital relationship, previous in-vitro fertilisation attempt and duration of the infertility were predictors of lower mental health scores in infertile men. Women had significant lower scores on mental health, social functioning and emotional behaviour. Among infertile subjects, women had lower scores in several QOL or HRQOL domains in comparison to men.

CONCLUSIONS

Evidences indicate important QOL or HRQOL impairments in infertile women. Among men, it does not appear to be intense. There is scarce knowledge regarding the impact of infertility on couples.

Demographic characteristics and clinical profile of poor responders in IVF / ICSI: A comparative study

BACKGROUND

Ovarian response varies considerably among individuals and depends on various factors. Poor response in IVF yields lesser oocytes and is associated with poorer pregnancy perspective. Cycle cancellation due to poor response is frustrating for both clinician and the patient. Studies have shown that women conceiving after poor ovarian response have more pregnancy complications like PIH and preeclampsia than women with normal ovarian response. In addition, poor ovarian response could be a predictor of early menopause. This paper studies various demographic and clinical profiles of poor responders and tries to look at the known and unknown factors which could contribute to poor ovarian response in IVF.

MATERIALS AND METHODS

Data were collected retrospectively from 104 poor responders who had less than four oocytes at retrieval and compared with 324 good responders for factors like age, BMI, type of sub fertility, duration of sub fertility, environmental factors like stress at work, smoking, pelvic surgery, chronic medical disorder, indication of IVF, basal FSH, mean age of menopause in their mothers etc.

RESULTS

Among the poor responders, 60.57% were above 35 years of age compared to 36.41% in control group, which is statistically significant. Mean age of menopause in mother was found to be four years earlier in poor responder group. Male factor and unexplained infertility were significantly (P<0.05) higher in good responders (P<0.05). Significant proportion (31.73%) of women in study group had undergone some pelvic surgery (P<0.05).

CONCLUSION

Apart from age, prior pelvic surgery also could be used as predictors for poor ovarian response. Heredity also plays a major role in determining ovarian response.