Psychosocial response of Chinese infertile husbands and wives

Relationship between marital satisfaction and defeat in IVF-ET: based on actor-partner interdependence model approach

OBJECTIVE

A person's marital satisfaction is a strong predictor of their own mental health outcomes. However, marital satisfaction results from both spouses' experiences, so a partner's marital satisfaction also affects his or her mental health outcomes. This study adopted the actor-partner interdependence model approach (APIM) to evaluate the relationship between marital satisfaction and sense of defeat in vitro fertilization-embryo transfer (IVF-ET) couples.

METHODS AND MEASURES

In this cross-sectional study, 181 infertile couples undergoing IVF-ET treatment were recruited using the Marital Satisfaction Scale of the ENRICH Marital Quality Questionnaire and Defeat Scale. Through APIM and Pearson analysis, the path relationship between marital satisfaction and defeat was analyzed.

RESULTS

The varying degrees of defeat in IVF-ET couples, are closely related to actors' and partners' marital satisfaction. In terms of actor effects, the Marital Satisfaction of both husbands (β = -0.71, p < 0.001) and wives (β = -0.46, p = 0.001) have a significant effect on individual Defeat. With regard to partner effects, husbands' Marital Satisfaction (β = -0.23, p = 0.038) has a significant impact on wives' Defeat and the wives' Marital Satisfaction (β = -0.45, p = -0.005) has a significant impact on husbands' Defeat.

CONCLUSION

IVF-ET couples must be looked at as a whole, and it is critical to include couples and not just men or women when studying infertility. The importance of their interaction is essential to improve the psychosocial adaptation of infertile couples in IVF-ET treatment.

Psychological consequences of a diagnosis of infertility in men: a systematic analysis

Almost half of infertility cases involve male infertility. Understanding the consequence of a diagnosis of male infertility, as a sole or partial contributor to the couples' infertility, to the mental health of men is required to ensure clinical care meets their psychological needs. The aim of this systematic analysis was to synthesize the evidence regarding whether men diagnosed with male factor infertility experience greater psychological distress than (1) men described as fertile and (2) men in couples with other infertility diagnoses. Online databases were searched using a combination of Medical Subject Headings (MeSH) headings and keywords relating to male infertility and psychological distress. The search yielded 1016 unique publications, of which 23 were included: 8 case-control, 14 prospective cohort, and 1 data linkage studies. Seven aspects of psychological distress were identified depression, anxiety, self-esteem, quality of life, fertility-related stress, general psychological stress or well-being, and psychiatric conditions. Case-control studies reported that men with male factor infertility have more symptoms of depression, anxiety and general psychological distress, worse quality of some aspects of life, and lower self-esteem than controls. When men with male factor infertility were compared to men in couples with other causes of infertility, there were few differences in the assessed aspects of psychological distress. Despite methodological limitations within the studies, this systematic analysis suggests that the experience of infertility, irrespective of its cause, negatively affects men's mental health and demonstrates the need for assisted reproduction technology (ART) providers to consider men undergoing assisted reproduction as individuals with their own unique support needs.

Factors affecting self-esteem and disease acceptance in patients from infertile couples

Introduction

Infertility has been diagnosed in millions of people around the world and is described as a complex medical, mental, and social problem that affects many aspects of life. The aim of the study was to extract the determining factors and the level of self-esteem and the degree of acceptance of the disease in infertile patients and to find differences between women and men in this aspect.

Methods

A total 456 patients (235 women and 221 men) from infertile couples participated in a cross-sectional study. To collect data a Personal Information Form (PIF), Rosenberg Self-Esteem Scale (SES), and Acceptance of Illness Scale (AIS) were used.

Results

The overall self-esteem score for the whole sample was 30.50 (15 ± 30) points and for acceptance of the disease 32.4 (8 ± 40) points. In the study group, men obtained a slightly higher level of self-esteem than women (31.00 vs. 30.04 points). Additionally, men had a higher level of acceptance of the disease (33.12 vs. 31.80) than women. Socio-demographic factors such as age and level of education had impact on scores SES and AIS. Clinical factors did not determine the results of SES and AIS, both in the overall sample and in the female and male groups.

Conclusion

Self-esteem in patients from infertile couples increases with age and level of education. There are also significant differences between women and men, i.e., positive correlations between the level of education and self-esteem in men and the degree of acceptance of the disease in women.

The Relationship between Attachment, Dyadic Adjustment, and Sexuality: A Comparison between Infertile Men and Women

Infertility impacts several life dimensions. Among them, sexuality is particularly affected; yet studies have mainly focused on infertile women. We aimed to explore infertile men's and women's experiences in sexual satisfaction, internal control, and anxiety, and the relationship between attachment, dyadic adjustment, and sexuality. The sample consisted of 129 infertile people (47.3% females, 52.7% males, Mage = 39 years) who fulfilled an ad hoc questionnaire, the Multidimensional Sexuality Questionnaire (MSQ), the Experiences in Close Relationship-Revised (ECR-R), and the Dyadic Adjustment Scale (DAS). We found a significant effect of type of infertility and infertility factors on sexual anxiety only in infertile men. As regards infertile women, dyadic adjustment predicted sexual satisfaction, anxious attachment decreased sexual internal control, and avoidant attachment reduced sexual anxiety. As regards infertile men, high dyadic adjustment increased sexual satisfaction and a high avoidant attachment predicted high levels of sexual internal control. There was no relationship between attachment, dyadic adjustment, and sexual anxiety for infertile men. From the results, it emerges how important is to consider both dyadic adjustment and attachment in studying how infertility impacts women's and men's lives.

Sexual dysfunction and disorders as a consequence of infertility: a systematic review and meta-analysis

BACKGROUND

Sexuality has a key impact on quality of life and on reproductive health. Infertility often results in sexual dysfunction. Despite this close association, addressing sexuality is not a standard component of infertility counselling, especially since in most countries sexual medicine is not a core element of specialist training. Even today, many doctors and patients consider discussing sexuality to be more challenging than other aspects of reproductive medicine. The present review addresses the complex consequences of infertility on sexuality.

OBJECTIVE AND RATIONALE

Our goals were: (i) to identify the prevalence of sexual problems resulting from infertility, (ii) to evaluate characteristics of sexual difficulties and disorders resulting from infertility and (iii) to analyse factors involved in the complex association between sexual problems and infertility.

SEARCH METHODS

A systematic search for publications containing keywords related to sexual disorders and infertility was performed via PubMed, Web of Science and Psyndex. A total of 170 manuscripts published between January 1966 and April 2021 were identified after verification of inclusion and exclusion criteria. The reference lists in these manuscripts were searched for further relevant literature. Studies were reviewed for quality-related methodological details.

OUTCOMES

Couples diagnosed with infertility have an increased risk of sexual disorders. Loss of sexual desire and erectile dysfunction are among the most frequent sexual disorders resulting from infertility. Currently available literature reflects only fragmentarily the complexity of the diverse interactions. Sexuality plays out against the backdrop of interactions among personal, cultural, infertility-related and sexuality-related factors. Considering this complexity, it is crucial to evaluate individual profiles as well as partnership interactions to avoid a negative impact of infertility on a couple's sexual life.

WIDER IMPLICATIONS

Identifying sexual disorders as relevant considerations in the context of infertility and exploring their impact during the entire course of diagnosis and treatment constitute an important contribution to comprehensively care for the couples concerned. Counselling should focus on preventing the onset and aggravation of sexual disorders. As sexuality represents a major component of quality of life and of partnership, such support may improve not only the current overall wellbeing but also the chances of a satisfactory long-term partnership and family life.

Changes in Life Satisfaction in Couples after Successful In vitro Fertilization and Natural Pregnancy

BACKGROUND

Previous research suggested reduced well-being and quality of life in couples with an unfulfilled desire to have a child. However, changes in psychological variables in infertile couples after successful in-vitro fertilization (IVF) have been scarcely investigated.

PURPOSE

This prospective study explored changes in life satisfaction, stress burden and habitual worry related to the birth of a child in couples undergoing IVF, and in those experiencing natural pregnancy.

METHODS

In total, 77 couples with successful IVF and 50 couples with natural pregnancy completed the Life Satisfaction Questionnaire, Perceived Stress Questionnaire and Penn State Worry Questionnaire; data were recorded before pregnancy (baseline) and 6 and 12 months after childbirth. Multi-level models were applied for data analysis.

RESULTS

Couples with IVF reported lower life satisfaction, and higher stress burden and worry, than those with natural pregnancy at baseline. Moreover, they showed a steep increase in life satisfaction at 6 and 12 months after childbirth, and decreased stress and worry. In couples with natural pregnancy, life satisfaction scores decreased, and those of stress and worry increased, at month 6 after childbirth and returned to initial state at month 12.

CONCLUSIONS

The group difference at baseline underlines the psychosocial burden of infertility. However, the increase in life satisfaction and decreases in stress and worry suggest that the burden is lessened after the birth of a child. The changes in couples with natural pregnancy reflect the impact of the typical challenges posed by childbirth and successful readjustment during the first year of the child´s life.

Sexual Function, Self-Esteem, and Quality of Life in Infertile Couples Undergoing in vitro Fertilization: A Dyadic Approach

Purpose

Infertility has adverse effects on the quality of life (QoL) of infertile couples. Previous studies found important associations between sexual function, self-esteem and QoL, but mainly focused on one individual’s approach rather than both partners. This study adopted a dyadic approach to evaluate the relationship between sexual function and QoL in couples with infertility through mediation and improving self-esteem.

Patients and Methods

Between October 2020 and January 2021, 428 couples with infertility (n=856) undergoing in-vitro fertilization (IVF) at a tertiary hospital in Hefei, China, were registered for the current descriptive cross-sectional research. The dyads’ sociodemographic and clinical features, as well as their sexual function, self-esteem, and QoL were evaluated. The Fertility quality of life scale (FertiQoL), Rosenberg Self-Esteem Scale (RSES), Female Sexual Function Index (FSFI), and International Index of Erectile Function-15 (IIEF-15) were used to evaluate the participants. The Actor-Partner Interdependence Mediation Model (APIMeM) was utilized to examine data from the dyadic relationships.

Results

According to the APIMeM analysis, sexual function of individuals with infertility was directly and indirectly connected with their QoL, mediated through their self-esteem. The women’s sexual function was found to be positively associated with their partner’s QoL, with the women’s self-esteem acting as a complete mediator. The men’s sexual function was found to be positively associated with partner’s QoL, with the men’s self-esteem acting as a complete mediator.

Conclusion

The findings suggest that boosting participants’ self-esteem can help them and their partners have a better QoL. Also, therapies aimed at improving and sustaining self-esteem of couples with infertility could help mitigate the negative influence of low sexual function on their QoL.

The negative impact of timed intercourse in infertile couples: A prospective cohort study

Objective:

To study the differences in sexual dysfunction and time to pregnancy (TTP) between infertile couples pursuing timed intercourse (TI – around the time of ovulation) and regular intercourse (RI – at least twice a week).

Methods:

In this prospective cohort study, we recruited all infertile couples presenting to the regional infertility clinics from January 2016 to December 2018, pursuing TI ( n = 283) or RI ( n = 88), and having no pre-existing sexual or psychiatric illness, and no medical contraindications to frequent intercourse. Sexual dysfunction was assessed using the Arizona Sexual Experience Scale and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. The couples for whom natural conception was possible were followed up to determine TTP using Kaplan–Meier analysis.

Results:

TI significantly increased the risk of sexual dysfunction than RI for both males and females, even after adjusting for age, medical disorders, obesity, smoking, cause of infertility, and previous assisted reproductive techniques. TI increased the risk of erectile dysfunction, premature ejaculation, male hypoactive sexual dysfunction, female sexual interest-arousal disorder, and female orgasmic disorder. The TTP for natural conception was similar between them.

Conclusion:

TI increased the risk of sexual dysfunction without accelerating the time to achieve pregnancy, compared with RI.

Level of evidence:

Not applicable

Individual and Relational Well-Being at the Start of an ART Treatment: A Focus on Partners' Gender Differences

Infertility and ART treatments represent stressful experiences for the couples, impacting on the overall psychological well-being of partners as well as on their couple adjustment. Several variables were analyzed as risk factors for infertility-related distress. The impact of these experiences has been well-documented in both women and men, reporting important gender differences. The aim of this study was to assess gender differences in individual and relational well-being in infertile couples. Gender differences for psychological and medical variables predicting psychological distress were investigated. Two hundred and thirty couples who entered an ART program at a public hospital in Milan were recruited. Each partner completed the following scales: ScreenIVF, Dyadic Adjustment Scale, and Experience in Close Relationship Questionnaire. Findings revealed several gender differences with women reporting higher levels of both anxiety and depressive symptoms, anxiety and avoidance attachment, and helplessness, but lower levels of acceptance than men. Differences emerged also in factors predicting well-being: poor support predicted anxiety in men and depression in women. Furthermore, individual well-being was predicted only for men by attachment anxiety and previous treatment. Finally, in the women subsample, couple's adjustment was predicted by anxiety attachment, while in men predictors were helplessness and type of diagnosis. These results suggest the importance of implementing support interventions for couples which take into consideration the specific needs and fragility of each partner as well as focusing on enhancing a sense of partnership.

Evaluation of the Psychological Status, Infertility-Associated Factors, and Erectile Function in Patients with Timely Ovulatory Intercourse Failure in China: Evidence from a Cross-Sectional Study

Results

A total of 1128 patients were enrolled, and 264 of them (23.40%) suffered from TOIF. TOIF was positively associated with smoking, drinking, hypertension, diabetes, anxiety, unknown cause of infertility, lower semen concentration, lower frequency of intercourse, and decreased erectile function. The total IIEF-15 scores, erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction were significantly decreased in patients with TOIF.

Conclusion

TOIF is associated with lower semen concentration, anxiety, and other comorbidities such as hypertension and diabetes. Clinicians are required to focus on these associated factors in addition to improve the erectile function.

Gender differences in factors associated with depression in infertility patients

AIMS

To clarify gender differences in the demographic variables and infertility problems associated with depression among men and women undergoing infertility treatment.

DESIGN

A cross-sectional study.

METHODS

We surveyed 380 women and 360 men undergoing infertility treatment at the reproductive medicine center of a hospital in China's Ningxia Province from March - September 2016.

RESULTS

For women, ethnicity, the number of clinic visits, social concern, and sexual concern were factors linked with depression symptoms. For men, treatment cost pressure and social concern were significantly associated with depression symptoms.

CONCLUSION

Psychological counseling and intervention programs should be integrated into in-vitro fertilization treatments and interventions should be targeted based on gender differences.

IMPACT

The provision of treatment-related sexual knowledge by nurses is indispensable for infertile participants. Mental health policies should be developed to facilitate the implementation of psychological services. Psychological counseling and intervention programs should be integrated into in vitro fertilization treatment to help men and women with infertility cope with psychological distress.

Examining the Role of Dyadic Coping on the Marital Adjustment of Couples Undergoing Assisted Reproductive Technology (ART)

A couple is considered to be infertile if unable to conceive after 12 months of unprotected sexual intercourse. An extended body of literature supports that infertility and infertility treatments contribute to emotional, social, sexual, and relational issues that can have a negative impact on each partner's well-being and on the couple relationship. Recent findings suggest that a dyadic approach should be used when working with couples coping with these stressors. However, most research to date has focused on the association between infertility and individual's psychological outcomes, rather than on the experience of infertility-related stress and coping from a relational perspective. Consequently, assuming that infertility is a dyadic stressor and that the ability of the partners to cope with this experience is the result of both individual and relational coping strategies, this study aimed to investigate dyadic coping and marital adjustment among couples at the beginning of an Assisted Reproductive Technology (ART) treatment. A sample of 167 heterosexual couples (N = 334) undergoing ART treatment at the fertility clinic of a large hospital in Milan from January to December 2017 was recruited. Each participant completed self-reported questionnaires examining marital adjustment (Dyadic Adjustment Scale) and dyadic coping (Dyadic Coping Questionnaire). Demographics and clinical variables were also collected. Data were analyzed using the Actor Partner Interdependence Model (APIM), testing the effect of each partner's dyadic coping style on their own and their partner's marital adjustment. Results revealed that both women and partners' scores on positive dyadic coping styles (common, emotion-focused, problem-focused, and delegated dyadic coping) contributed to higher marital adjustment. This result suggests that couples unable to engage in this type of reciprocal supportive behaviors and those unsatisfied with their coping efforts may be more vulnerable while undergoing ART treatments. Furthermore, findings highlighted some gender differences for stress communication and negative dyadic coping suggesting the presence of specific dynamics within couples facing an ART treatment. Implications for clinical practice and future research are discussed.

Sexual satisfaction, intimacy and relationship of couples undergoing infertility treatment

OBJECTIVE

To explore the infertility-related sexual and relationship concerns, sexual satisfaction and perceived intimacy of infertile couples.

BACKGROUND

Infertility is known to affect the psychosocial well-being of couples. Fertility treatment and the scheduled regime of sexual activities places further pressure on infertile couples.

METHODS

This was a cross-sectional study. Infertile couples who attended fertility clinics for treatment between November 2015 and March 2016 were invited. A total of 113 pairs of infertile women and men participated in the study as couples.

RESULTS

A significantly higher proportion of women than men reported that their partner did not understand how the problem of fertility affected them and had worries that they were drifting apart in their relationship. Significantly more men than women considered their sex life to be lacking in quality. In terms of perceived intimacy, more women than men reported that they had disclosed their feelings and negative emotions to their partner. The correlation analysis revealed significant positive correlations between sexual (dis)satisfaction and infertility-related sexual and relationship concerns in couples.

CONCLUSIONS

The results show that infertile couples suffer from infertility-related sexual and relationship concerns. An intervention study should be conducted to help these couples overcome such concerns.

FREQUENCY AND DETERMINANTS OF DEPRESSIVE ILLNESS AMONG INFERTILE WOMEN

Background: Depression is much more common among infertile women as compared to the general population. The objectives of our study were to determine the frequency of depression among infertile women and association of depression among infertile women with age groups, level of education, and duration of infertility. Materials & Methods: This cross-sectional study was conducted at Department of Psychiatry, Gomal Medical College, D.I.Khan, Pakistan from 1st January 2018 to 31st December 2018. Sample size was 145 women with primary infertility selected through consecutive sampling technique. The demographic variables were; age groups, level education, duration of primary infertility and research variables was presence of depression. Observed and expected frequency for depression was analyzed by chi-square goodness-of-fit test. Association of depression with age groups, level of education and infertility duration were analyzed by chi-square test of independence. Results: Out of 145 infertile women. 122(84.1%;78.15-90.05%) had depression whereas 23(15.9%;9.95-21.85%) had no depression. Thirty seven out of 145(25.52%) women in the age group

Psychological Adjustment of Infertile Men Undergoing Fertility Treatments: An Association With Sperm Parameters

BACKGROUND

The difficulties in the psychological adaptation to the infertility diagnosis and assisted reproductive technology (ART) treatments have shown influence on the sperm quality. The biological and psychological aspects of infertility seem not to be independent.

OBJECTIVE

To analyze the impact of depressive symptoms, anxiety, dyadic adjustment and infertility stress on the sperm quality of the men proposed to ART first or repeated experience.

MATERIALS AND METHODS

This transversal study was conducted in the Medically Assisted Reproduction Unit of Centro Hospitalar de São João, in Porto, Portugal. 112 men with infertility diagnosis were included to initiate an ART cycle. Participants completed the Inventory State-Trait Anxiety-Form Y (STAI-Y), the Beck Depression Inventory-II (BDI-II), the Dyadic Adjustment Scale (DAS) and the Inventory of Fertility Problems (IFP) before the beginning of the treatment.

RESULTS

The state-anxiety had a negative linear impact on the slow progressive motility (p<0.05). However, depressive symptoms assumed a suppressor effect on this variable, enhancing its importance as a predictor.

CONCLUSION

Results show that psychopathological symptoms before an ART cycle can influence the sperm motility. However, this association seems to only be present in men undergoing first experience ART treatments. Thus, this research shows the need for mental health professionals to respond to emotional difficulties of the male gender, through the development of psychological interventions adjusted, so as to minimize the impact of exposure to ART treatments.

A Review of Supportive Interventions Targeting Individuals or Couples Undergoing Infertility Treatment: Directions for the Development of Interventions

The purpose of this systematic review is to explore the types, content, and outcomes of different psychosocial approaches used in existing interventions for infertile individuals or couples. Relevant intervention studies published in English between 2000 and 2014 were searched using the electronic databases MEDLINE, PsycINFO, and CINHAL Plus. A total of 23 articles were identified and included in this review. Cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), and counseling were the most commonly adopted psychosocial interventions for infertile individuals or couples. After reviewing the various approaches, directions are given on the development of interventions for couples suffering from infertility.

Differences in psychophysical well-being and signs of depression in couples undergoing their first consultation for assisted reproduction technology (ART): an Italian pilot study

OBJECTIVE

The data we refer to belong to a longitudinal research project starting at the first contact of individual couples with the Infertility Unity; they were then followed-up till pregnancy or failure of treatments. The study aims at investigating in depth the emotional state of patients admitted for first consultation. Specifically, we investigated the emotional state of the two members of an infertile couple, considering also their biomedical and socio-demographic characteristics.

STUDY DESIGN

This is a cross-sectional study evaluating a consecutive series of 309 couples, consulting for the first time our Infertility Unit for a multidisciplinary diagnostic evaluation in relation to their infertility. The multidisciplinary equip is composed of a gynaecologist, an andrologist and a clinical psychologist. Two standardized instruments were administered by the clinical psychologist to the two members of the couple: the Edinburgh Depression Scale (EDS) and the General Health Questionnaire-form 12 (GHQ-12), for screening of non-somatic signs of depression and psychophysical well-being, respectively. Couples were eligible for the study if they had not received any prior ART treatment in our Unit and were able to read and understand Italian. In addition, they had to agree to provide informed consent for the study.

RESULTS

We obtained a response in 62% of all eligible couples. There were two major unexpected findings:

CONCLUSION

Psychological and counselling services dedicated to ART should consider also socio-demographic data and always specifically consider gender differences, not only a couple's psychology and its dynamics.

Female sexual distress in infertile Turkish women

Objective:

To evaluate the effect of infertility on sexual distress in women attending the infertility clinic.

Materials and Methods:

In a cross-sectional study we evaluated sexual distress among 88 women who attended the infertility clinic in our institute between January and June 2015. All women who were experiencing primary or secondary infertility during the study sampling were included in the sudy. Sexual distress was measured using the Female sexual distress scale-revised (FSDS-R), a cross-validated patient-reported outcomes measure. Correlations of FSDS-R with patient characteristics and laboratory measurements were calculated using Spearman’s rank correlation tests.

Results:

With the exceptions of the age of couples and serum anti-mullerian hormone (AMH) levels, no predictor of high sexual distress was found in the univariate analysis when comparing groups with regard to the FSDS-R cut-off score. The mean age of the sexually distressed women (33.6±5.8 years vs. 29.3±5.1 years) and their partners (35.4±4.8 years vs. 31.6±4.2 years) was significantly higher than those of the non distressed women, according to a FSDS-R score over 11 (p<0.05). The serum level of AMH was significantly lower in infertile women with high total sexual distress scores (1.4 vs. 7.6 ng/mL (p<0.001)).

Conclusion:

In infertile women, age of woman, age of partner, and serum AMH levels are related with the hope of women to have a child despite an association with sexual distress. Serum AMH, which is perceived as necessary for fertility, had a significant inverse correlation with levels of sexual stress.

Sexual dysfunction and depression among Turkish women with infertile husbands: the invisible part of the iceberg

PURPOSE

To determine the effect of male infertility on the sexual functions and level of depression among Turkish women.

METHODS

Fifty-six women with an infertile partner (exposed) and 48 women who conceived and gave birth without treatment (unexposed) were included in this study. The Female Sexual Function Index (FSFI) and Beck Depression Inventory (BDI) were used to determine sexual function and depression status. Statistical analyses were performed by independent samples t, Fischer's exact, and Mann-Whitney U tests.

RESULTS

There were no significant differences in terms of demographic characteristics between groups except that unexposed women had received education for longer period of time (11.6 vs. 7.1 years, p = 0.001). Mean FSFI scores were 19.1 ± 5.5 for the exposed and 20.0 ± 3.4 for the unexposed group. The scores of sexual desire domain (3.4 ± 1.2 vs. 2.7 ± 1.2, p < 0.05), sexual dysfunction in the axis of lubrication (3.6 ± 1.4 vs. 4.0 ± 0.2, p = 0.039), and pain (4.1 ± 1.9 vs. 5.4 ± 0.8, p = 0.001) were found to be significantly higher in women with an infertile partner. According to BDI scores, these women were feeling more depressed (9.7 ± 7.3 vs. 1.4 ± 2.8, p = 0.001) than the unexposed group.

CONCLUSION

Comparison of these groups indicated similar levels of sexual dysfunction. Nonetheless, we found that women with infertile partners experienced sexual problems related to lubrication and pain, even though they were in the initial stages of the treatment process for infertility. Exposed group had also higher level of depression than the unexposed group.

Investigating the Relationships among Stressors, Stress Level, and Mental Symptoms for Infertile Patients: A Structural Equation Modeling Approach

Objective

Patients with infertility are a high risk group in depression and anxiety. However, an existing theoretically and empirically validated model of stressors, stress, and mental symptoms specific for infertile patients is still a void. This study aimed to determine the related factors and their relational structures that affect the level of depressive and anxiety symptoms among infertile patients.

Methods

A cross-sectional sample of 400 infertility outpatients seeking reproduction treatments in three teaching hospitals across Taiwan participated in the structured questionnaire survey in 2011. The hypothesized model comprising 10 latent variables was tested by Structural Equation Modeling using AMOS 17.

Results

Goodness-of-fit indexes, including χ²/DF = 1.871, PGFI = 0.746, PNFI = 0.764, and others, confirmed the modified model fit the data well. Marital stressor, importance of children, guilt-and-blame, and social stressor showed a direct effect on perceived stress. Instead of being a factor of stress, social support was directly and positively related to self-esteem. Perceived stress and self-esteem were the two major mediators for the relationships between stressors and mental symptoms. Increase in social support and self-esteem led to decrease in mental symptoms among the infertile patients.

Conclusions

The relational structures were identified and named as the Stressors Stress Symptoms Model, clinically applied to predict anxiety and depression from various stressors. Assessing sources and level of infertility-related stress and implementing culturally-sensitive counseling with an emphasis on positive personal value may assist in preventing the severity of depression and anxiety.

Factors Associated With Marital Satisfaction in Infertile Couple: A Comprehensive Literature Review

Background:

Many factors impact on marital satisfaction. Related factors include demographic factors, assisted reproductive techniques, psychological health, quality of life, psychological, socioeconomic and family support, and sexual function.

Methods:

This study is a literature review of research studies conducted on factors associated with marital satisfaction in infertile couples. The current literature review search was undertaken using multiple databases selected from articles pertinent to the study. The selection of subjects was undertaken from1990 through 2015. The methodological quality was analyzed based on a checklist adopted from a systematic review. Quality assessment of full text studies was finally carried out by two reviewers.

Results:

The initial search yielded a list of 445 papers, and then reviewers studied titles and abstracts. Thereafter, 69 papers were incorporated, and researchers reviewed summaries of all of the searched articles. Finally, the researchers utilized the data gained from 64 full articles so as to compile this review paper. Reviewing the studies conducted on marital satisfaction, they classified related findings into 6 categories: demographic factors, using fertility assisting methods, psychological health, life quality, economic, social, and family support, and sexual function.

Conclusion:

The results of this review article depicted that various factors play role in creating marriage life satisfaction in an infertile couple, so that paying attention to them can play an important role in continuing their treatment. Thus, to identify such factors is considered essential in their treatment protocol highly based on culture. Of the drawbacks of this research is that it has tried at best to employ the studies belonging to diverse countries with different cultures. Also, the number of the papers was considerably limited.

Effect of Infertility on Sexual Function: A Cross-Sectional Study

INTRODUCTION

Sexual dysfunction is an important psychological disorder that may increase in infertile couples.

AIM

To evaluate the effect of infertility on sexual function in women attending in private and public institutions in Ilam during 2013.

MATERIALS AND METHODS

In a cross - sectional study evaluated the sexual function among 384 women attending in health care centers of Ilam western of Iran during 2013. Participants were divided in two groups, fertilities and infertilities women. Data was collected by trained research midwives using demographic and FSFI questionnaires. SPSS software Package 16 was used to analyse the data of this project. Differences were regarded statistically significant with an alpha error of 0.05.

RESULTS

The mean age was 29.29 ± 6.7 years in fertile and 31.74 ± 8.07 in infertile women. Significant difference was reported in mean age between fertile and infertile women (p=0.014). The Mean± SD of all demissions of female sexual function was difference between fertile and infertile women. Sexual function was lower in infertile women.

CONCLUSION

All dimensions of sexual function were lower in infertile women in compared with fertile women. Further research should be done on this subject and ways to address such problems should be found.

The Impact of Infertility on the Psychological Well-Being, Marital Relationships, Sexual Relationships, and Quality of Life of Couples: A Systematic Review

The purpose of this systematic review was to identify, with supporting evidence, the effect of infertility on couples. MEDLINE, PsycINFO, and CINHAL Plus articles were searched for relevant studies (2000-2014) published in English. Twenty articles were included in this review. The results showed that infertility affected couples in the following four aspects of their life: psychological well-being, marital relationships, sexual relationships, and quality of life. There is evidence that infertility has a negative effect on the psychological well-being and sexual relationships of couples, but the evidence is inconclusive for the effect on marital relationships and quality of life.

Development of a scale for determining violence against infertile women: a scale development study

Background

To develop a scale to evaluate violence experienced among infertile women.

Method

Three steps were followed in the development of the scale: Literature review and deep interviews to generate item pool, content validity testing, and administration of draft. Content validity was evaluated by experts. The draft scale was pilot-tested with a convenience sample of 30 women during their treatment. After the pilot-test, 166 infertile females filled the scale in the infertility clinic of a university hospital in Istanbul.

Results

For evaluation of construct validity, Kaiser-Mayer Olkin was 0.91. Bartlett test was statistically significant (p = 0.00). According to the results of analysis, 5 domains were determined: “domestic violence”, “social pressure”, “punishment”, “exposure to traditional practices” and “exclusion”. The values of correlation of item were between 0.50 and 0.82. Item-total and subscale-total correlation varied between 0.57-0.91. The scale had good internal reliability, with Cronbach’s Alpha coefficient of 0.96. The other coefficients of subscales varied between 0.80-0.94.

Conclusions

The scale called “Infertile Women’s Exposure to Violence Determination Scale” indicates high reliability, good content and construct validity. Routine screening for domestic violence in infertility clinics is necessary to give affected women an opportunity to access appropriate health care and support services. On the other hand, common use of Infertile Women’s Exposure to Violence Determination Scale in infertility clinics provides increased sensitivity and awareness by caregivers.

A preliminary study of the psychological differences in infertile couples and their relation to the coping styles

BACKGROUND

Studies from Western countries have observed that couples undergoing infertility treatment suffer various physical and psychological difficulties at a higher frequency than the comparable general population. These relate to treatment challenges and other psychosocial stressors, often influenced by coping style, personality factors and available support systems. There is paucity of studies in non-Western populations.

OBJECTIVE

The aim of this pilot investigation was to evaluate characteristics and gender differences in perceived psychological difficulties reported by infertile Malaysian couples. In particular, depression, anxiety and stress, along with correlated coping styles, were examined between spouses.

METHODS

Demographic information, including age, ethnicity and duration and causes of infertility, were collected from participants treated within a fertility clinic. The Depression, Anxiety and Stress Scale (DASS) and Coping Inventory for Stressful Situation (CISS) were completed to measure psychological distress and coping styles.

RESULTS

Depression, anxiety and stress-related difficulties were reported at significantly higher frequency by wives than husbands (p<0.05). There were no significant differences in coping styles between wives and husbands. However, emotional-oriented coping style was associated with significantly higher levels of depression, anxiety and stress (p<0.05) within the overall sample with odds ratios of 2.5, 3.0 and 1.5, respectively.

CONCLUSION

The study confirms that, as with Western subjects, Malaysian infertile couples demonstrate the vulnerability to psychological distress that occurs more frequently among wives than husbands. As anticipated, emotional coping style was associated with greater distress in both genders.

General psychopathology, anxiety, depression and self-esteem in couples undergoing infertility treatment: a comparative study between men and women

OBJECTIVE

To compare measures of psychological distress between men and women undergoing ART in the Unit of Reproductive Medicine "UMR" in the Department of Obstetrics and Gynecology at "Farhat Hached" Hospital in Sousse, Tunisia.

STUDY DESIGN

We conducted a gender comparative study of psychological profile in infertile couples. Recruitment was done during period from January to May 2009. 100 infertile couples with primary infertility were recruited. Scores of general psychopathology, depression, anxiety and self-esteem were evaluated. We administrated questionnaires on psychological factors among infertile couples before starting a new infertility treatment cycle. Psychological factors included the symptom check-list (SCL-90-R), the hospital anxiety and depression scale (HAD-S) and the Rosenberg self-esteem scale (RSE).

RESULT(S)

Infertile women had higher scores than their spouses in the three global scores of the SCL-90-R and in several items such as somatisation, obsessive symptoms, interpersonal sensitivity and phobias. Scores of HADS were higher among women for both depression and anxiety. Scores of self-esteem were lower among women.

CONCLUSION(S)

Women endorsed higher psychological distress than men across multiple symptoms domains: general psychopathology, anxiety, depression and self esteem.

Effect of counseling on quality of marital relationship of infertile couples: a randomized, controlled trial (RCT) study

BACKGROUND

Infertility is a major cause of marital problems and sexual dissatisfaction. This study was conducted to determine the effects of counseling on infertile couple's marital relationship and sexual satisfaction.

MATERIALS AND METHODS

This study was performed as a randomized controlled trial (RCT) in which 100 infertile couples (200 participants) who visited Reproductive Health Research Center Tehran, Iran were randomly assigned into two groups: intervention (n = 50 couples, 50 wives and 50 husbands) and control (n = 50 couples, 50 wives and 50 husbands). Intervention was defined as three counseling sessions per week, each lasting 60-90 min. Counseling in the intervention group was conducted separately for each couple. Demographic characteristics and marital and sexual satisfaction were investigated using three questionnaires through interviews. The outcomes, including changes in marital satisfaction and sexual satisfaction, were compared between the two groups 3 months later.

RESULTS

Based on the data collected 3 months after the intervention period, the mean scores of marital and sexual satisfaction in intervention and control groups for wives were 49.62 ± 11.09 versus 54.97 ± 12.64 (P = 0.036) and 36.00 ± 8.37 versus 40.04 ± 7.69 (P = 0.019), respectively. Respective scores for husbands were 45.48 ± 9.55 versus 50.08 ± 11.43 (P = 0.042) and 33.37 ± 7.09 versus 36.63 ± 6.52 (P = 0.025), respectively. It should be noted that higher scores in questionnaires inspecting marital and sexual satisfaction indicate lower satisfaction.

CONCLUSIONS

Infertility counseling improves marital and sexual satisfaction in infertile couples.

Differences in quality of life between infertile women and men in Turkey

OBJECTIVE

To examine potential differences in quality of life between infertile women and men.

DESIGN

A descriptive, cross-sectional design.

METHOD

A questionnaire was used to collect individuals' sociodemographic data; the World Health Organization Quality of Life-BREF (WHOQOL-BREF) tool was used to collect information about quality of life.

PARTICIPANTS

The research sample comprised 248 infertile individuals (141 women and 107 men) admitted to the clinic for the first time for diagnosis and treatment between January 1 and June 30, 2007, and who voluntarily agreed to participate.

SETTING

The research was conducted at the Ege University Family Planning and Infertility Research and Training Center Infertility Clinic in Izmir, Turkey.

RESULTS

Physical health, psychological health, and social relations domain score means did not show significant differences between infertile women and infertile men (p>.05). However, score means for the environment domain were significantly higher (p<.05) for infertile women than for infertile men. Unemployed infertile men had significantly lower score means in the physical health and social relation domains (p<.01). No such significant differences were found for the other quality of life domain scores for infertile women or infertile men (p>.05).

CONCLUSION

In the environmental domain, the quality of life of infertile women was greater than that of infertile men. Variables affecting quality of life of infertile individuals were seen to affect women and men in similar ways. Nurses and health care professionals caring for infertile individuals should be aware of the factors that affect quality of life and should plan to meet their care needs accordingly.

The experience of infertility: a review of recent literature

About 10 years ago Greil published a review and critique of the literature on the socio-psychological impact of infertility. He found at the time that most scholars treated infertility as a medical condition with psychological consequences rather than as a socially constructed reality. This article examines research published since the last review. More studies now place infertility within larger social contexts and social scientific frameworks although clinical emphases persist. Methodological problems remain but important improvements are also evident. We identify two vigorous research traditions in the social scientific study of infertility. One tradition uses primarily quantitative techniques to study clinic patients in order to improve service delivery and to assess the need for psychological counselling. The other tradition uses primarily qualitative research to capture the experiences of infertile people in a sociocultural context. We conclude that more attention is now being paid to the ways in which the experience of infertility is shaped by social context. We call for continued progress in the development of a distinctly sociological approach to infertility and for the continued integration of the two research traditions identified here.

Health concordance within couples: A systematic review

Research has consistently linked marriage and positive health outcomes. In addition, many researchers have found that couples often have similar or concordant health statuses. However, concordance research has been conducted in many fields for decades without a concise review of the literature, nor has one theory of health concordance been established. A systematic review was performed implementing rigorous identification strategies, and 103 health concordance research articles were identified and reviewed to understand what research has been conducted in mental health, physical health, and health behavior concordance among couples. The research overwhelmingly suggests evidence for concordant mental and physical health, as well as health behaviors among couples. Each area of health concordance research offers room for greater research and deeper understanding for the causes of health concordance.

Psychological characteristics and marital quality of infertile women registered for in vitro fertilization-intracytoplasmic sperm injection in China

OBJECTIVE

To assess the psychological health status and marital quality of Chinese women who were referred for IVF-intracytoplasmic sperm injection (ICSI), to compare the results with a control group, and to test the impact of clinical and sociodemographic determinants on psychological health status and marital quality in this cohort.

DESIGN

A descriptive study of psychological health status and marital relationships, comparing infertile women who are registered for IVF or IVF-ICSI with fertile controls.

SETTING

An assisted reproductive center of a science and technology institute of family planning.

PATIENT(S)

Two groups of infertile women (100 registered for IVF, and 100 registered for ICSI), and a control group of 100 women attending a gynecology clinic, who have no known history of infertility.

INTERVENTION

Psychometric tests were administered at the first visit of the treatment cycle.

MAIN OUTCOME MEASURE(S)

Psychological status measured by the Hopkins Symptom Checklist-90 (SCL-90), and marital quality measured by the ENRICH (Evaluating & Nurturing Relationship Issues, Communication & Happiness) marital inventory.

RESULT(S)

Infertile Chinese women planning to undergo IVF-ICSI scored significantly higher on all subscales of the SCL-90 than did controls. In addition, women in the IVF subgroup had significantly higher scores on depression scales than those in the ICSI subgroup. The study group displayed unstable relationships compared to the control group. Age, yearly income, duration of infertility, and history of unsuccessful IVF treatment had a negative correlation with psychological health status and marital quality.

CONCLUSION(S)

The stresses associated with infertility and IVF treatment had a negative impact on Chinese women's psychological health status and marital quality. These findings emphasize the need to include psychological and sociocultural considerations with any medical interventions for infertility.

L'impact de l'infertilité et de ses traitements sur la vie sexuelle et la relation de couple : revue de la littérature

This paper reviews the literature on the psychosocial impact of infertility and its treatments by the ART on the marital sexuality, by paying special attention to the relationship between gender and the infertility experience. It is convenient to divide this literature into articles that explore the sexual life of the infertile couples on the one hand, and those focusing on the couple relationship - marital satisfaction and marital adjustment-, on the other hand. The literature on the infertile couples' sexuality and sexual satisfaction, mostly descriptive, presents infertility as a deleterious experience for both women and men even if the repercussion differ according to gender, with correlative dynamic effects within the couple. The contributions to the investigation of the couple relationship, mostly quantitative Anglo-Saxon studies, have produced equivocal or contradictory results concerning the satisfaction with the relationship, the closeness between the two partners so that it is difficult to assume a trend in this field. This situation is largely due to the problems of sampling. In this view, future research should perform its methodological apparatus to take into account the processual nature of the infertility experience, at both levels of couple history and its involvement in the ART process.

Impact of infertility on quality of life, marital adjustment, and sexual function

OBJECTIVES

To evaluate the hypothesis that infertility may result in a decrease in quality of life and an increase in marital discord and sexual dysfunction. The burden of infertility is physical, psychological, emotional, and financial.

METHODS

Couples seeking treatment for infertility were asked to complete standardized validated questionnaires assessing quality of life (Quality of Well-Being Scale-Self Administered, version 1.04), marital adjustment (Locke-Wallace Marital Adjustment Test), and sexual function (Brief Index of Sexual Functioning for Women and International Index of Erectile Function for men). Couples seeking elective sterilization served as the control subjects.

RESULTS

Eighteen infertile couples and 12 couples seeking elective sterilization participated in the study. The mean age, years together, and household income were comparable. Infertile couples had made a mean of 14.5 office visits for infertility, and 83% of couples reported feeling societal pressures to conceive. The Marital Adjustment Test scores for the women of the infertile couples were significantly lower than the scores of the controls (P = 0.01); however no difference was noted in the men. A trend toward lower quality-of-life scores was noted in women (P = 0.09) but not in the men of infertile couples. No statistically significant impact on sexual functioning in women was noted; however, the men in the infertile couples had lower total International Index of Erectile Function scores (P = 0.05) and intercourse satisfaction scores (P = 0.03).

CONCLUSIONS

Women in infertile couples reported poor marital adjustment and quality of life compared with controls. Men may experience less intercourse satisfaction, perhaps because of the psychological pressure to try to conceive or because of the forced timing of intercourse around the woman's ovulatory cycle.

Psychiatric symptoms in Turkish infertile women

The aims of this study were to determine the psychiatric symptoms which may develop because of infertility in Turkish women and to find out the precipitating factors. Fifty women with primary infertility and 50 health controls were evaluated using the Beck Depression Inventory, Spielberger Stait-Trait Anxiety Inventory, Rosenberg self-esteem scale and Symptom Checklist scale. They were also asked to describe the reactions received from their husband, husbands' families and social group because of infertility. Psychiatric symptoms were not significantly different between the two groups. However, within the infertile group, depression and anxiety were more frequent in the women who received negative reactions from their husband, their husbands' families and social group. Depression, anxiety and self-esteem were improved in the infertile women as age and the duration of infertility increased. In conclusion, our findings indicate that the reactions the infertile women are faced with play an important role in the development of certain psychiatric symptoms.

Ejaculatory duct obstruction

PURPOSE OF REVIEW

We surveyed the growing literature on ejaculatory duct obstruction and provide suggestions regarding its diagnosis and management.

RECENT FINDINGS

Ejaculatory duct obstruction is a rare cause of male infertility. With the advent of the high resolution transurethral ultrasound (TRUS) technology, there has been an increase in diagnosis of this disorder. As for the treatment, it appears that central cystic lesions and partial obstructions respond best to transurethral resection of the ejaculatory ducts (TURED).

SUMMARY

Ejaculatory duct obstruction is a rare but surgically correctable cause of male infertility. Although there are no pathognomonic findings associated with ejaculatory duct obstruction, the diagnosis should be suspected in an infertile male with oligospermia or azoospermia with low ejaculate volume, normal secondary sex characteristics, testes, and hormonal profile, and dilated seminal vesicles, midline cyst, or calcifications on TRUS. In select cases, TURED has resulted in marked improvement in semen parameters, and pregnancies have been achieved. More studies are needed in the areas of diagnosis and long-term surgical outcome.