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Salari N, Babajani F, Hosseinian-Far A, Hasheminezhad R, Abdoli N, Haydarisharaf P, Mohammadi M. Global prevalence of major depressive disorder, generalized anxiety, stress, and depression among infertile women: a systematic review and meta-analysis. Arch Gynecol Obstet 2024; 309:1833-1846. [PMID: 38459997 DOI: 10.1007/s00404-024-07444-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/16/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND In recent years, the global prevalence of infertility has increased among women (Talmor and Dunphy, Best Pract Res Clin Obstet Gynaecol 29(4):498-506, 2015) and is considered as a public health concern. One of the impacts of infertility is mental health problems in the patients, which can lead to complications such as stress, anxiety, and depression. The aim of this study is to investigate the global prevalence of major depressive disorder, general anxiety, stress, and depression in infertile women through a systematic review and meta-analysis. METHODS To identify studies that have reported the prevalence of major depressive disorder, generalized anxiety, stress, and depression in infertile women, the PubMed, Scopus, Web of Science, Embase, ScienceDirect, and Google Scholar repositories were systematically searched. Articles published up until February 2023 were included, while no lower time limit was imposed in the search strategy. Heterogeneity of studies was examined using the I2 test and, thus, random-effects model was used to perform the analysis. Data analysis was conducted within the Comprehensive Meta-Analysis (v.2) software. RESULTS In the review of 44 studies with a sample size of 53,300 infertile female patients, the overall prevalence of major depressive disorder (clinical depression), generalized anxiety, stress, and depression was found to be 22.9%, 13.3%, 78.8%, and 31.6% respectively. It was also found that mental health complications are more prevalent among infertile women in Asia (continent). CONCLUSION Considering the prevalence of mental disorders among infertile women, health policymakers can use the results of the present meta-analysis to pay more attention to the mental health of infertile women and devise suitable interventions and programs to reduce and prevent the spread of psychological disorders among infertile women.
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Affiliation(s)
- Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Fateme Babajani
- Department of Clinical Psychology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Amin Hosseinian-Far
- Department of Business Systems and Operations, University of Northampton, Northampton, UK
| | - Razie Hasheminezhad
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nasrin Abdoli
- Department of Psychiatry, Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Parisa Haydarisharaf
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Mohammadi
- Cellular and Molecular Research Center, Gerash University of Medical Sciences, Gerash, Iran.
- Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.
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Saadedine M, Faubion SS, Kling JM, Kuhle C, Shufelt CL, Mara K, Enders F, Kapoor E. History of infertility and sexual dysfunction in midlife women: Is there a link? J Sex Med 2023; 20:1188-1194. [PMID: 37537692 PMCID: PMC10472170 DOI: 10.1093/jsxmed/qdad097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/16/2023] [Accepted: 06/26/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Infertility has been linked with an increased risk of sexual dysfunction in reproductive-aged women, with longer periods of infertility associated with a greater risk. AIM The study's aim was to examine whether a history of infertility treatment in women is linked to sexual dysfunction during midlife. METHODS The cross-sectional study was conducted among sexually active women, between the ages of 45 and 65 years, who sought consultation at the women's health clinics at a US tertiary care center. History of infertility treatment was assessed with a single question that asked participants if they were treated for infertility in the past. The association between a history of infertility treatment and sexual dysfunction-which was diagnosed by a combination of Female Sexual Function Index score ≤26.55 and Female Sexual Distress Scale-Revised score ≥11-was assessed in a multivariable logistic regression model that adjusted for multiple confounders. OUTCOMES The primary outcome was sexual dysfunction in midlife women. RESULTS The analysis included 5912 women, with a mean age of 54.1 years. Nearly 16% of women reported receiving treatment for infertility. More than half the women (55%) had sexual dysfunction: 56.3% of those with previous fertility treatments and 54.4% of those without any fertility treatment (P = .3). Receiving treatment for infertility in the younger years did not significantly increase the odds of sexual dysfunction in midlife in univariate (odds ratio, 1.08; 95% CI, 0.94-1.24; P = .3) and multivariable analyses (odds ratio, 1.11; 95% CI, 0.96-1.29; P = .17). CLINICAL IMPLICATIONS While infertility is known to be predictive of sexual dysfunction in women during their reproductive years, there was no association between a history of infertility treatment and sexual dysfunction in midlife women in the current study. STRENGTHS AND LIMITATIONS The study used validated questionnaires accounting for sexual complaints and distress and adjusted for multiple confounding factors. Limitations include the selection bias introduced by the study of women presenting for evaluation of sexual dysfunction, which may have been a result of factors stronger than the influence of infertility. Other limitations include the study's cross-sectional nature with suboptimal racial and ethnic representation. CONCLUSION Although infertility is commonly associated with female sexual dysfunction in women of reproductive age, the association was not present in midlife women in the current study.
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Affiliation(s)
- Mariam Saadedine
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL, 32224, United States
- Center for Women’s Health, Mayo Clinic, Rochester, MN, 55905, United States
| | - Stephanie S Faubion
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL, 32224, United States
- Center for Women’s Health, Mayo Clinic, Rochester, MN, 55905, United States
| | - Juliana M Kling
- Center for Women’s Health, Mayo Clinic, Rochester, MN, 55905, United States
- Division of Women’s Health Internal Medicine, Mayo Clinic, Scottsdale, AZ, 85259, United States
| | - Carol Kuhle
- Center for Women’s Health, Mayo Clinic, Rochester, MN, 55905, United States
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, 55905, United States
| | - Chrisandra L Shufelt
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL, 32224, United States
- Center for Women’s Health, Mayo Clinic, Rochester, MN, 55905, United States
| | - Kristin Mara
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, 55905, United States
| | - Felicity Enders
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, 55905, United States
| | - Ekta Kapoor
- Center for Women’s Health, Mayo Clinic, Rochester, MN, 55905, United States
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, 55905, United States
- Women’s Health Research Center, Mayo Clinic, Rochester, MN, 55905, United States
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, 55905, United States
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Impact of assisted reproduction treatment on sexual function of patients diagnosed with infertility. Arch Gynecol Obstet 2022; 305:1595-1604. [DOI: 10.1007/s00404-021-06367-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 12/09/2021] [Indexed: 11/26/2022]
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Patel A, Sharma PSVN, Kumar P. "When Love Does not bear a Fruit": Patterns and Prevalence of Sexual Difficulties in Infertile Men and Women as Predictors of Emotional Distress. J Hum Reprod Sci 2021; 14:307-312. [PMID: 34759622 PMCID: PMC8527079 DOI: 10.4103/jhrs.jhrs_70_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/28/2021] [Accepted: 08/08/2021] [Indexed: 11/04/2022] Open
Abstract
Background Self-identity, sexuality, and subfertility have multidirectional effects on each other. Subfertility is known to alter sexual esteem, threaten identity, body image, sexual attractivness, coital pleasure, and sexual satisfaction. Objective This study aimed to evaluate sexual difficulties as predictors of infertility-specific stress in patients undergoing fertility treatments and to assess the profile of sexual dysfunctions in participants. Study Setting and Design This cross-sectional study was conducted in a tertiary hospital setup of a medical college. Methods Three hundred married men and women diagnosed with infertility participated. The psychological evaluation test, international classification of diseases (10th, CDDG), female sexual functioning index, and international index of erectile functioning were used as measures. Statistical Analysis Data were analyzed using SPSS (version 15, Chicago, USA). Chi-square test was used for univariate analysis between stress and presence of sexual dysfunctions in men and women. Medians, quartile, and cutoff scores were used to profile the sexual issues in participants. Results Prevalence of sexual dysfunctions since marriage was higher in women (75%) than men (60%). Ninety-two percent of women and 86% of men experienced emergence of sexual difficulties after the couple started treatments. Conclusions Sexual dysfunctions appear to be a consistent psychosocial concern for those awaiting conception. These appear to worsen during the treatments. Our findings suggest the need to sensitively approach and explore sexual anamnesis with the couple before recourse to medically assisted reproductive treatments. Psychological interventions for sexual issues in distressed patients before, during, and after treatments such as controlled ovarian hyperstimulation, intrauterine insemination, in vitro fertilization, and intracytoplasmic sperm injection are most needed.
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Affiliation(s)
- Ansha Patel
- Department of Psychiatry & Psychology, MB Hospital, RNT Government Medical College, Shantiraj Hospitals and Paras JK Hospital, Udaipur and Post Doc Fellow at Mahe Faimer Manipal, India.,Department of Psychiatry and Surgery, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - P S V N Sharma
- Department of Psychiatry, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Pratap Kumar
- Reproductive Medicine and Surgery, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
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Luca G, Parrettini S, Sansone A, Calafiore R, Jannini EA. The Inferto-Sex Syndrome (ISS): sexual dysfunction in fertility care setting and assisted reproduction. J Endocrinol Invest 2021; 44:2071-2102. [PMID: 33956331 PMCID: PMC8421318 DOI: 10.1007/s40618-021-01581-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 04/19/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE Infertility represents a peculiar social burden affecting more than 15% of couples, provoking it a real threat to the general quality of life and to the sexual health. The medicalization (diagnosis, therapy and follow up) of the lack of fertility is frequently a challenge in term of personal and couple's involvement. In particular, while the Assisted Reproductive Technology (ART) has allowed many infertile couples to achieve pregnancy, the therapeutic process faced by the couple bears a strong psychological stress that can affect the couple's quality of life, relationship and sexuality. Despite infertility affects both female and male sexual health, only recently the interest in the effects of ART on the couple's sexuality has grown, especially for women. METHODS A literature research on the sexual dysfunction in fertility care and particularly in ART setting was performed. RESULTS Literature largely found that intimacy and sexuality appear specifically impaired by intrusiveness of treatments and medical prescriptions. Moreover, there is a close relationship between emotional, psychological and sexual aspects, which can be integrated in the new concept of Inferto-Sex Syndrome (ISS) that can impair the ART treatment outcomes. Evidence demonstrates that the assessment of sexual function is necessary in couples undergoing diagnosis of infertility and ART. CONCLUSION A close relationship between infertility and sexuality, both in the female and male partners, was detected. ART treatments may heavily impact on the couple's psychosexual health. A couple-centred program for the integrated management of psychological and sexual dysfunction should be considered in the context of ART programs.
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Affiliation(s)
- G Luca
- Unit of Andrology and Endocrinology of Reproduction, Department of Experimental Medicine, University Medical School, 06129, Perugia, Italy
| | - S Parrettini
- Section of Endocrinology and Metabolism, Department of Medicine, Perugia, University Medical School, 06129, Perugia, Italy
| | - A Sansone
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier, 1, E Tower South. Floor 4, Room E413, 00133, Rome, Italy
| | - R Calafiore
- Section of Endocrinology and Metabolism, Department of Medicine, Perugia, University Medical School, 06129, Perugia, Italy
| | - E A Jannini
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier, 1, E Tower South. Floor 4, Room E413, 00133, Rome, Italy.
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Starc A, Trampuš M, Pavan Jukić D, Rotim C, Jukić T, Polona Mivšek A. INFERTILITY AND SEXUAL DYSFUNCTIONS: A SYSTEMATIC LITERATURE REVIEW. Acta Clin Croat 2019; 58:508-515. [PMID: 31969764 PMCID: PMC6971809 DOI: 10.20471/acc.2019.58.03.15] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
This study aimed to investigate whether infertility and its treatment affect couple sexuality. A systematic literature review was performed, focusing on female and male sexual dysfunctions due to infertility. The method was descriptive, using a meta-synthesis of scientific research published between 2012 and 2017 in the English language. The search for suitable studies was carried out with the research databases Medline, CINAHL, PubMed and ScienceDirect using the following keywords: infertility, sexual dysfunctions, couple. It can be concluded that infertility negatively affects the sexuality of an infertile couple, which is further proven by a high percentage of sexual dysfunctions (43%-90% among women and 48%-58% among men). Couples report less satisfaction with sexuality. Since lower satisfaction and dysfunctions are closely connected with infertility and its treatment, couples might benefit from sexual therapy and support during the process of infertility treatment. Further research should focus on the evaluation of different psychological interventions that would address sexuality in couples when diagnosed and treated for infertility.
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Affiliation(s)
| | - Manca Trampuš
- 1Department of Public Health, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia; 2Jesenice General Hospital, Department of Pediatrics, Jesenice, Slovenia; 3Department of Gynecology and Obstetrics, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4Dr Andrija Štampar Teaching Institute of Public Health, Zagreb, Croatia; 5Department of Internal Medicine, Family Medicine and History of Medicine, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 6Department of Midwifery, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - Doroteja Pavan Jukić
- 1Department of Public Health, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia; 2Jesenice General Hospital, Department of Pediatrics, Jesenice, Slovenia; 3Department of Gynecology and Obstetrics, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4Dr Andrija Štampar Teaching Institute of Public Health, Zagreb, Croatia; 5Department of Internal Medicine, Family Medicine and History of Medicine, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 6Department of Midwifery, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - Cecilija Rotim
- 1Department of Public Health, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia; 2Jesenice General Hospital, Department of Pediatrics, Jesenice, Slovenia; 3Department of Gynecology and Obstetrics, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4Dr Andrija Štampar Teaching Institute of Public Health, Zagreb, Croatia; 5Department of Internal Medicine, Family Medicine and History of Medicine, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 6Department of Midwifery, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - Tomislav Jukić
- 1Department of Public Health, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia; 2Jesenice General Hospital, Department of Pediatrics, Jesenice, Slovenia; 3Department of Gynecology and Obstetrics, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4Dr Andrija Štampar Teaching Institute of Public Health, Zagreb, Croatia; 5Department of Internal Medicine, Family Medicine and History of Medicine, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 6Department of Midwifery, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - Ana Polona Mivšek
- 1Department of Public Health, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia; 2Jesenice General Hospital, Department of Pediatrics, Jesenice, Slovenia; 3Department of Gynecology and Obstetrics, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4Dr Andrija Štampar Teaching Institute of Public Health, Zagreb, Croatia; 5Department of Internal Medicine, Family Medicine and History of Medicine, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 6Department of Midwifery, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
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Impact of Infertility on the Sexuality of Couples: an Overview. CURRENT SEXUAL HEALTH REPORTS 2018. [DOI: 10.1007/s11930-018-0182-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Sahebalzamani M, Mostaedi Z, Farahani H, Sokhanvar M. Relationship between Health Literacy and Sexual Function and Sexual Satisfaction in Infertile Couples Referred to The Royan Institute. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2018; 12:136-141. [PMID: 29707930 PMCID: PMC5936611 DOI: 10.22074/ijfs.2018.5185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 09/17/2017] [Indexed: 11/24/2022]
Abstract
Background Health science and technology today is a rapidly growing field. Health is a multifaceted concept influ-
enced by several factors, and health literacy is essential to deal properly with the current situation. In this study, the
association between health literacy and sexual function and sexual satisfaction were investigated in 2016. Materials and Methods This descriptive and correlational study was conducted on 193 couples in the Royan Insti-
tute, Tehran. Data collection instruments were three standard questionnaires which included the Test of Functional
Health Literacy, the Female Sexual Function Index (FSFI) and the International Index of Erectile Function, and the
Iranian version of the Sexual Satisfaction Scale. The data were analyzed using SPSS-v23 software at a significance
level of 0.05. Results Marginal health literacy, 49.7% among men and 44.1% among women, was more common than adequate
or inadequate health literacy. Erectile function for the majority of men was appropriate (53.3%), compared to 16.6%
who had perfect function and 30.1% for whom function was less than appropriate. The majority of women (57.0%)
had sexual dysfunction. One hundred and three (53.3%) men had appropriate sexual function and 57% of women had
normal sexual function. The greater proportion of men (50.8%) and women (46.1%) had good, rather than very good
or less than good, sexual satisfaction. The results of chi-square tests indicated that greater health literacy was associ-
ated with higher levels of sexual function and sexual satisfaction among men and women. However, application of the
Cramer’s V test indicates that the strength of these associations is moderate to weak. Conclusion Health literacy was marginal among most couples and its adverse impacts on sexual function and sexual
satisfaction were confirmed. Accordingly, it is recommended that plans be developed to promote health literacy among
infertile couples.
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Affiliation(s)
- Mohammad Sahebalzamani
- Department of Management, Tehran Medical Sciences Branch Islamic Azad University, Tehran, Iran
| | - Zahra Mostaedi
- Department of Nursing and Midwifery, Tehran Medical Sciences Branch Islamic Azad University, Tehran, Iran
| | - Hojjatollah Farahani
- Department of Psychology, Tehran Medical Sciences Branch Islamic Azad University, Tehran, Iran. Electronic Address:
| | - Mobin Sokhanvar
- Iranian Center of Excellence in Health Management (IceHM), Tabriz University of Medical Sciences, Tabriz, Iran
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