Quality of life in women with infertility via the FertiQoL and the Hospital Anxiety and Depression Scales

Psychometric properties of the Spanish version of the FertiQoL measure in couples undergoing infertility treatment

BACKGROUND

Both the diagnosis and the process of undergoing fertility treatment have a considerable negative effect on a person's quality of life (QoL). The evaluation of this effect is essential to offer comprehensive and high-quality care. The FertiQoL questionnaire is the most widely used instrument to evaluate QoL in people with fertility issues.

OBJECTIVE

This study is aimed at examining the dimensionality, validity and reliability of the Spanish version of the FertiQoL questionnaire in a sample of Spanish heterosexual couples undergoing fertility treatment.

METHODS

FertiQoL was administered to 500 people (50.2% women; 49.8% men; average age 36.1 years) recruited from a public Assisted Reproduction Unit in Spain. In this cross-sectional study, Confirmatory Factor Analysis (CFA) was used to analyse the dimensionality, validity and reliability of FertiQoL. Discriminant and convergent validity were assessed using the Average Variance Extracted (AVE), and model reliability was shown by Composite Reliability (CR) and Cronbach's alpha.

RESULTS

CFA's results support the 6-factor solution of the original FertiQoL (RMSEA and SRMR <0.09; CFI and TLI >0.9). However, several items had to be eliminated due to their low factorial weights - in particular, items Q4, Q5, Q6, Q11, Q14, Q15 and Q21. Moreover, FertiQoL showed good reliability (CR >0.7) and validity (AVE >0.5).

CONCLUSION

The Spanish version of FertiQoL is a reliable and valid instrument in measuring QoL in heterosexual couples undergoing fertility treatment. The CFA confirms the original 6-factors model but indicates that by eliminating some items the psychometric properties could improve. However, further research is recommended to address some of the measurement issues.

Examining the association between coping strategies and perceived social support among Vietnamese infertile women undergoing IVF treatment

The purpose of the study was to examine the association between coping strategies and perceived social support among women diagnosed with infertility and undergoing IVF treatment. A total of 383 Vietnamese women were invited to participate in this study. Participants completed a questionnaire consisting of The Multidimensional Scale of Perceived Social Support, the Copenhagen Multi-centre Psychosocial Infertility coping scales and the Fertility Problem Inventory, and other relevant questions. The results reveal that coping strategies significantly predict some specific types of perceived social supports among women undergoing IVF treatment. Specifically, passive-avoidance coping (PAC) and active-avoidance coping (AAC) predicts a decrease in receiving support from family and friends, whereas active-confronting coping (ACC) predicts an increase in receiving support from these two sources of support. Women who demonstrate increased meaning-based coping (MBC) received all three sources of support including family, friends, and significant others support. Despite some limitations, this study is useful in understanding how coping strategies among women undergoing IVF treatment affects the social support received in the Vietnamese social context. It also emphasizes the importance of psychological support for women facing IVF treatment distress.

Comparing infertility-related stress, coping, and quality of life among assisted reproductive technology and non-assisted reproductive technology treatments

Women who undergo assisted reproductive technology (ART) treatments experience infertility-related stress and have low quality of life (QOL). However, there is limited understanding of infertility-related stress, coping, or QOL among women who undergo non-ART treatments. The purpose of this study was to examine infertility-related stress, coping, and QOL among women who undergo ART and non-ART infertility treatments. Using a descriptive correlational cross-sectional design, we recruited 200 women who underwent infertility treatments. Participants completed the Copenhagen Multi-centre Psychosocial Infertility (COMPI) Fertility Problem Stress Scale, COMPI Coping Styles Scale, Fertility Quality of Life tool, and a demographic infertility survey. Data analysis included descriptive statistics, independent t-test, chi-square, and hierarchical multiple regression. Women who underwent non-ART had more personal stress, used more active-avoidance coping, and had lower emotional, social, and treatment environment QOL compared to those in ART treatment. Women who underwent ART treatments used more meaning-based coping but had lower treatment tolerability QOL. Stress and coping contribute to core QOL differently among infertility treatment groups. Both treatment groups report low satisfaction with emotional services. Regardless of the treatment type, women who undergo infertility treatments may need care to address their psychological health.

Psychometric Measurement of Fertility-related Quality of Life across Gender in Primary Infertile Couples

Background

Infertility is a crucial global public health issue that affects millions of people of reproductive age. Fertility-related stress can negatively impact infertile couples' quality of life (QoL).

Aims

This study aimed to assess and compare the psychometric properties of fertility QoL between primary infertile couples' male and female partners.

Settings and Design

This cross-sectional study included 114 primary infertile couples visiting the Andrology Laboratory referred from the Gynaecology and Obstetrics Department, AIIMS, Patna.

Materials and Methods

Data were collected using the Fertility QoL (FertiQoL) tool, an internationally validated questionnaire to measure the reproductive QoL, demographic information and medical history. The FertiQoL questionnaire responses were recorded and analysed.

Statistical Analyses Used

Statistical analyses used were performed using the SPSS 20.0 version. Descriptive statistics, Kolmogorov-Smirnov test, Cronbach's alpha and Student's independent t-tests were used. Statistical significance was set at P < 0.05.

Results

In our study, the overall estimated Cronbach's α was 0.83, and males had a significantly better fertility-related QoL in all domains of the FertiQoL, such as emotional (P < 0.000), mind-body (P < 0.000), social (P < 0.004) and tolerability (P < 0.000), except relational and environmental domains, which were lower in them. However, between the groups, the relational domain was significant (0.000) and the environmental domain was non-significant (0.592). Overall, males had a significantly better total core score, total treatment score and overall total FertiQoL score, while females had lower scores.

Conclusion

Amongst infertile couples, the reproductive QoL was poorer in females than in males. Our study suggests psychological counselling and mental support for females during infertility management.

Quality of life and associated factors among infertile women attending infertility clinic at Mnazi Mmoja Hospital, Zanzibar

BACKGROUND

Worldwide, it is estimated at least 50 million couples are affected by infertility with the prevalence of infertility being 16% in Tanzania. Psychological impact of infertility in patients negatively affects women's Quality of Life (QoL) defined as a person`s perception of where they are in life in terms of culture and value in the emotional, mind-body, relational, social, environment and tolerability of treatment aspects. Poor Quality of Life is related to increased treatment discontinuation. The aim of this study was to determine the Quality of Life and associated factors among infertile women attending infertility clinic at Mnazi Mmoja Hospital, Zanzibar.

METHODS

A hospital based cross-sectional study was conducted among 340 infertile women attending infertility clinic at Mnazi Mmoja Hospital, Zanzibar. Data was collected using FertiQoL tool. The factors associated with Quality of Life using FertiQoL tool in infertile women were estimated in a multivariable linear regression model at 95% confidence interval and 5% level of significance.

RESULTS

Quality of life of infertile women at Mnazi Mmoja infertility clinic was 70.6 ± 10.0 on a scale of 0 to 100. It increased significantly with increase in educational level (p = 0.009). Women with female individual causes on average had 5.07 (B=- 5.07, 95%CI: -7.78, -2.35) and women with individual and respective male partner causes of infertility had on average 4.95 (B= -4.95, 95% CI: -7.77, -2.12) respective decrease in the FertiQoL scores compared to those who had their male partner with problems as reason for infertility. There was an average 4.50 (B=-4.50, 95% CI: 2.30, 6.70) decrease in quality of life in women with secondary infertility compared to women with primary infertility. Every month increase in duration of infertility led to an average of 0.04 (B=-2.57, 95%CI: -0.07, -0.01) decrease in FertiQoL scores.

CONCLUSION

The overall quality of life in this population was positively associated with level of education but negatively affected with reason for infertility, type of infertility and duration of infertility.

Differences in Fertility-Related Quality of Life and Emotional Status Among Women Undergoing Different IVF Treatment Cycles

Objective

The present study aimed to provide more insight into the possible differences in the fertility-related quality of life (FertiQoL) and emotional status of women undergoing different cycles of in vitro fertilization (IVF) treatments.

Methods

A prospective cohort study was performed, and a total of 432 women undergoing IVF treatment were recruited. FertiQoL scale, self-rating anxiety scale (SAS), self-rating depression scale (SDS), and perceived social support scale (PSSS) were used to analyze fertility-related QoL and emotional status. Data were analyzed comparing women undergoing different cycles of IVF treatments.

Results

A significant decrease in FertiQoL scores occurred in women with increased cycles of IVF treatment. Both anxiety and depression scores significantly increased with increased cycles of attempting IVF treatment. There was no significant difference detected in perceived social support among groups.

Conclusion

With the increase in the number of IVF treatment cycles, women's FertiQoL gradually decreased, while the risk of anxiety and depression gradually increased.

Psychosocial correlates of fertility-related quality of life among infertile women with repeated implantation failure: The mediating role of resilience

OBJECTIVE

This study aimed to examine associations between psychosocial factors and fertility-related quality of life (FertiQoL) among infertile women with repeated implantation failure (RIF), and to identify the possible role of resilience in mediating the effect of social support on FertiQoL.

MATERIALS AND METHODS

A cross-sectional study was conducted with 234 infertile women with RIF in total. Fertility quality of life scale (FertiQoL), perceived social support scale (PSSS), and Connor-Davidson Resilience Scale (CD-RISC) were used to evaluate the patients. Data were described by univariate and multivariate analyses. Stepwise regression method was performed to analyse the mediating effect of resilience.

RESULTS

Social support had a positive predictive effect on FertiQoL (β = 0.757, P < 0.001), also positive on resilience (β = 0.847, P < 0.001). After both variables were added to the regression equation, resilience was found to have a significant positive predictive effect on FertiQoL (β = 0.798, P < 0.001), while the predictive effect of social support on FertiQoL was no longer significant (β = 0.081, P > 0.05). The results indicated that resilience played a complete mediating role between social support and FertiQoL.

CONCLUSION

This study preliminarily verified the mediating role of resilience between social support and FertiQoL among infertile women with RIF. Interventions that consider enhancing resilience and building social support will likely improve their FertiQoL.

The Relation Between Religious Coping, Adjustment to Fertility, Being Affected by Infertility, and Satisfaction with Life in Turkish Women with Infertility

Religion has been an important tool in treating the difficulties expereinced by infertile females. This study was conducted to determine the relationship between religious coping styles and infertility adjustment, infertility distress, and satisfaction with life in a group of women with infertility problems. The study was a cross-sectional study that involved a convenience sample of 168 women with infertility living in Turkey. A weak negative correlation was found between women's positive religious coping and infertility distress. There was no significant correlation between women's negative religious coping and their infertility adjustment, infertility distress, and satisfaction with life.

Quality of life of Sudanese patients attending a fertility clinic: a mixed methods study

BACKGROUND

Infertility affects over 50 million people globally, the burden is disproportionately borne by women, especially in low and middle-income countries (LMIC). The impact of infertility on quality of life (QoL) has not been well documented or assessed qualitatively in LMIC like Sudan, where infertility is a pervasive problem. Therefore, the purpose of this mixed-methods study was to assess the fertility-related QoL of infertile individuals in Sudan using the fertility quality of life (FertiQoL) tool.

METHODS

We used explanatory sequential design (surveys and interviews) in a fertility clinic in Sudan (January 2017-May 2018). We collected socio-demographic information, medical/reproductive history and used Arabic FertiQoL. We generated descriptive statistics of FertiQoL (core, domain) scores and independent variables; multiple linear regression models to assess the relationship between FertiQoL and dependent variables; and t-tests to compare mean core/domain scores. We conducted thematic analysis on qualitative data about the subjective experience of being infertile.

RESULTS

The study included 102 participants (72 women), 70 educated beyond secondary school, mean age 33.89 years (SD = 7.82) and mean duration of infertility was 4.03 years (SD 3.29). Mean FertiQoL core score 76.02 (SD = 16.26), domain scores: emotional 71.61 (SD = 22.04), relational 78.06 (SD = 16.62), mind/body 74.06 (SD 22.53) and social 78.88 (SD = 18.24). Men had better fertility-related QoL.

FOUR THEMES EMERGED

A sense of something missing because of childlessness; social pressure from peoples' questions; impact on the spousal relationship (which differed amongst participants) and coping (faith-based and non-faith-based) which was necessary when the lived experience led to internal distress.

CONCLUSIONS

Infertility negatively impacted the QoL of participants in this study, and women were worse off. Cognitive appraisal, social support and pressure may be key factors influencing the QoL of infertile individuals, therefore they should be encouraged to seek social and professional support. FertiQoL is a useful tool to assess fertility QoL in LMIC like Sudan.

The dyadic interaction model of relationship quality and the impact of attachment orientation and empathy on infertile couples in China

AIM

The study was conducted to examine the effect of attachment orientation and empathy on the relationship quality of infertile couples and assess the inter-dependency model of these factors.

DESIGN

A cross-sectional survey.

METHOD

In this study, 168 infertile couples (336 individuals) were enrolled and asked to finish the following questionnaires: the revised Adult Attachment Scales, the Interpersonal Response Index questionnaire and the Relationship Quality sub-scale of the Fertility Quality of Life (FertiQol). Hierarchical regression and path analysis were used to analyse the unique and combined contribution of the independent variables to relationship quality of couples.

RESULTS

The attachment orientation of infertile couples can influence their relationship quality, and empathetic wives and husbands have actor and partner effects on the infertile couples' relationship quality. Empathetic infertile couples are conducive to the harmony of the relationship.

Fertility quality of life (FertiQoL) among Chinese women undergoing frozen embryo transfer

Background

Women undergoing infertility treatment have poor quality of life. This may cause them to withdraw from or refuse treatment. Women undergoing frozen embryo transfer have a treatment interval. The aim of this study was to investigate the status quo of the fertility quality of life in women undergoing frozen embryo transfer and analyse its predictors.

Methods

A cross-sectional survey was conducted from August 2019 to August 2020 among women undergoing frozen embryo transfer in a tertiary hospital reproductive centre in Beijing, China. The survey collected demographic characteristics and treatment data and included the fertility problem inventory, the fertility quality of life scale (FertiQoL) and the state-trait anxiety scale. Multiple linear stepwise regression was used to explore the predictors of fertility quality of life.

Results

In total, 1062 women completed the survey. Participants reported that they had high levels of fertility-related stress and anxiety during treatment. They also had lower fertility-related quality of life, and the Treatment FertiQoL scored the lowest. The regression results showed that social concern, trait anxiety, duration of treatment and age were risk factors for diminished fertility quality of life.

Conclusion

Chinese women undergoing frozen embryo transfer have relatively poor quality of life. The potential predictors of fertility quality of life include social concern, trait anxiety, duration of treatment and age.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-021-01325-1.

Quality of life among infertile women with endometriosis undergoing IVF treatment and their pregnancy outcomes

OBJECTIVE

We assessed the quality of life (QoL) and pregnancy outcomes of in vitro fertilization (IVF) treatment among infertile women with endometriosis, as compared to infertile women without endometriosis.

STUDY DESIGN

Eighty-one (81) endometriosis women (with 142 embryo transfer [ET] cycles) and 605 non-endometriosis women (with 1063 ET cycles) were included. QoL was measured by FertiQoL at the date before ET. Pregnancy outcomes included biochemical pregnancy, ongoing pregnancy and live birth. Generalized estimating equation analyses were performed to assess the association between QoL and IVF pregnancy.

RESULTS

Endometriosis-affected women had significantly lower QoL, as indicated by mind/body, treatment environment and total treatment scores, and total scores of FertiQoL (p < .05), compared to those without endometriosis. Among non-endometriosis women, QoL scores were significantly associated with successful IVF pregnancy; with one unit increase in QoL scores as measured by emotional domain of FertiQoL, the probabilities of ongoing pregnancy and live birth significantly increased by 2.5% and 2.8%, respectively (p < .05). This association was also observed among endometriosis women but it did not reach statistical significance.

CONCLUSIONS

Lower QoL among women with endometriosis versus non-endometriosis during IVF treatment highlights the importance of developing strategies to improve their QoL, which may enhance following pregnancy rates in this population.

The analysis of fertility quality of life and the influencing factors of patients with repeated implantation failure

Background

The objective of this study was to investigate the current status of fertility quality of life (QoL) and explore the influencing factors for infertile women with repeated implantation failure (RIF).

Methods

The sample consisted of 137 infertile women with RIF who were under treatment from January 2019 to December 2019 in the Reproductive Medical Center of Ruijin Hospital, affiliated with Shanghai Jiaotong University School of Medicine in China. A general information questionnaire, FertiQoL scale, perceived social support scale (PSSS), self-rating anxiety scale (SAS), and self-rating depression scale (SDS) were used to analyse the fertility QoL and related factors of RIF patients.

Results

The total fertility QoL score of RIF patients was 60.44 ± 11.60. The results of multivariate regression analysis showed that residence, financial difficulties, male infertility, BMI index, depression, and family social support were the main factors that influenced the fertility QoL of RIF patients (adjusted R² = 0.762).

Conclusion

Based on the results of this study, RIF patients’ psychological status must be addressed. Corresponding interventions such as building a sound family and social support system, creating a good medical environment and offering diverse health education should be provided to improve the fertility QoL of RIF patients.

The Four-item Patient Health Questionnaire for Anxiety and Depression: A Validation Study in Infertile Patients

Background

The most common mental disorders in infertile patients are depression and anxiety. The four-item Patient Health Questionnaire-4 (PHQ-4) is a widely used tool that consists of the PHQ-2 depression and Generalized Anxiety Disorder-2 (GAD-2) scales. Given that PHQ-4 has not been validated in infertile patients, this study aimed to examine its reliability and validity in this population.

Materials and Methods

Participants in this cross-sectional study consisted of 539 infertile patients from a referral fertility centre in Tehran, Iran. The PHQ-4, Hospital Anxiety and Depression Scale (HADS), World Health Organi- sation-Five Well-Being Index (WHO-5), Penn State Worry Questionnaire (PSWQ) and demographic/infertility ques- tionnaires were administered to all participants. Factor structure and internal consistency of PHQ-4 were evaluated via confirmatory factor analysis (CFA) and Cronbach’s alpha, respectively. The convergent validity of this scale was examined by its relationship with HADS, WHO-5 and PSWQ.

Results

CFA results provided support for a two-factor model of PHQ-4. Internal consistency of the PHQ-4 and its subscales both were elevated with Cronbach’s alpha coefficients of 0.767 (PHQ-4), 0.780 (PHQ-2) and 0.814 (GAD-2). Inter-item correlations were between 0.386 and 0.639, and corrected item-total correlations were between 0.576 and 0.687. PHQ-4, PHQ-2 and GAD-2 showed positive correlations with measures of HADS-anxiety, HADS-depression, and PSWQ and neg- ative correlations with WHO-5, which confirmed convergent validity. Among demographic/fertility variables, we observed that gender, infertility duration, and failure in previous treatment were correlated with PHQ-4 and its subscales scores.

Conclusion

The PHQ-4 is a reliable and valid ultra-brief screening instrument for measuring both anxiety and depres- sive symptoms in infertile patients.

Quality of life with pregnancy outcomes: Further evaluating item properties for refined Taiwan's FertiQoL

PURPOSE

We assessed the reliability and validity of Taiwan's version of FertiQoL, with a focus on the association between quality of life (QoL) and in-vitro-fertilization (IVF) pregnancy.

METHODS

410 women undergoing IVF treatment were included. QoL measured by Taiwan's version of FertiQoL was assessed before embryo transfer. Item properties were examined using corrected item-total correlation, Rasch mean-square (MnSq), and internal consistency. Known-group validity was assessed using IVF pregnancy (i.e., chemical pregnancy, ongoing pregnancy, live birth) as the outcomes of interest.

RESULTS

Five FertiQoL items, namely Q4, Q5, Q15, Q21, and T5, had low corrected item-total correlation (i.e., -0.146-0.290) in their embedded domains; three other items, namely Q11, Q14, and T2, did not have acceptable MnSq values in the Rasch analysis (i.e., infit MnSq: 1.31-2.28; outfit MnSq: 1.95-4.57). These items were removed and a refined Taiwan's FertiQoL was generated. The internal consistency for the refined Taiwan's FertiQoL was improved (α = 0.928) with the capability of distinguishing women who had successful live birth from those who had failed live birth (i.e., 72.40 ± 12.71vs. 69.21 ± 13.26; p = 0.019).

CONCLUSION

The study results demonstrate that the refined Taiwan's FertiQoL is valid and reliable, suggesting that this FertiQoL should refined to be culturally and language appropriate for Taiwanese population.

Quality of life and related constructs in a group of infertile Hungarian women: a validation study of the FertiQoL

Quality-of-life measurement is a basic prerequisite for psychologically sensitive fertility care and the FertiQoL is a psychometrically sound outcome measure in this field. The aim of the present research was to investigate the reliability and validity of the Hungarian Core FertiQoL. Two independent samples of infertile women were merged (n = 320). While the model fit of the four-factor Confirmatory Factor Analysis was under the level of acceptability (χ²(246) = 626.36, p < 0.001, RMSEA = 0.070 [CI₉₀ = 0.063-0.076], CFI = 0.878, SRMR = 0.071), the four-factor Exploratory Structural Equation Model showed much improved model fit (χ²(186) = 395.63, p < 0.001, RMSEA = 0.059 [CI₉₀ = 0.051-0.067], CFI = 0.933, SRMR = 0.035). Good internal consistency (Cronbach's Alphas 0.77-0.92) and construct reliability (0.75-0.95) were found for both factor structures. Depression correlated negatively with fertility-specific quality of life. Almost a quarter of the sample suffered from moderate-to-severe depression. Multivariate analysis of variance indicated that Beck Depression Inventory categories (mild, moderate etc.) co-occurred with significantly distinct FertiQoL score ranges, leading to a possible, clinically meaningful threshold on the Core FertiQoL. Pearson coefficients showed secondary infertility, rural residency and pre-treatment status to be associated with better fertility quality of life.

The novel use of fertility quality of life (FertiQoL) treatment subscale to assess treatment acceptability in social egg freezing

This is the first study to assess the impact of social egg freezing (SEF) on quality of life. This cross-sectional survey utilised the FertiQoL treatment module in women who underwent SEF between January 2008 and October 2019 (n = 94). The mean treatment score was 65.5, whereas the tolerability and environment scores were 62.4 and 68 respectively. Being married or in a relationship was associated with higher, albeit not statistically significant, scores (69.2) when compared to single women (66.3; p = 0.49). However, being separated or divorced was associated with significantly worse scores compared to married women, women in a relationship and single women (43.3 vs. 67.0; p = 0.001). There were no significant differences in scores between younger and older women, low and high number of oocytes stored, duration of stimulation cycles, or in those who had single or multiple cycles. These data suggest SEF is largely tolerable, with favourable FertiQoL scores compared to infertile women undergoing IVF. However, whilst such women are physiologically fertile, their situation renders them socially infertile. As such, women undergoing SEF should be identified as a population that requires additional support, who should be offered extensive counselling, active monitoring throughout the process and additional support if required.

Patient-centered care in Israeli IVF units: divergent perceptions of patients and providers

Background

Patient-centered care is particularly important for patients undergoing fertility treatment because of their emotional involvement and their constant contact with providers. To the best of our knowledge, to date, there have been no rigorous studies of the discrepancies between the patients’ perceptions of the care they received and the providers’ perceptions of the care that they provided, in specific dimensions and elements of patient-centered care.

Objective

To compare provider and patient perceptions of the extent to which care in Israeli IVF units is patient-centered.

Methods

A previously validated survey instrument was used to assess the patient and provider perceptions of ten dimensions of patient-centered care: accessibility of providers, provision of information and of explanations, communication skills of providers, patient involvement in the treatment, respect for patient values and needs, continuity and transition in treatment, professional competence, care organization, physical comfort, and emotional support. The patient survey and the provider survey were conducted in 2016–2017; both surveys were carried out in 8 of 25 hospital-based IVF units in Israel. Seventy-six providers and 524 patients (response rate 79%) participated in the surveys.

Findings

The perceptions of patients and providers were similar regarding seven of the ten dimensions of patient-centered care, although there were some differences in patient vs. provider scores by unit. There were three dimensions with substantial provider-patient score differences: Moderate-sized gaps were found relative to the provision of information and explanations (1.96 vs. 2.38, on a 0–3 scale) and respect for patient values and needs (1.92 vs. 2.47). A large gap was observed relative to emotional support (0.96 vs. 2.54).

Conclusions

Providers appear to underestimate the needs of fertility treatment patients for information, respect, and emotional support. The observed differences between what patients feel about their care and what providers assume they provide, especially regarding emotional support, indicates a need for ongoing, specific feedback to providers as to the patient-centeredness of the care they provide. The particularly large patient – provider gap relative to the provision of emotional support highlights the importance of increasing the attention paid to the psychological impact of fertility treatment and of giving patients an opportunity to consult a counselor who is familiar with problems associated with fertility treatments.

Policy recommendations

Efforts to improve the patient-centeredness in FT should begin by establishing a national ongoing feedback mechanism, involving all 25 IVF units operating in Israel working in collaboration with the Ministry of Health. The findings from this joint effort should be shared with the public. In addition, we recommended appointing one professional in each IVF unit to be in charge of promoting improvements in the patient-centered care for that unit. Assigning a mental health professional (psychologist or social worker) to each and every IVF unit is also of crucial importance.

The relationship between quality of life, perceived stress, marital satisfaction in women conceived through ART

BACKGROUND

The stress experienced during pregnancy and the decrease in marital satisfaction affects the quality of life of the woman negatively.

OBJECTIVE

This study conducted to determine the quality of life and the relationship with perceived stress and marital satisfaction in pregnant women with ART.

METHODS

This study is a descriptive and corelational study. The study sample consisted of 120 pregnant women with ART. The patient descriptive form, the Married Life Scale (SWML), The Perceived Stress Scale (PSS) and The Fertility Quality of Life (FertiQoL) were used for data collection in this study.

RESULTS

The mean of the total score of PSS was 16.38 ± 4,721, the mean score of SWML was 23.03 ± 4.42 and the mean of the total score of FertiQoL was 81,25 ± 17,56. There was a moderate negative correlation (r = -0,551, p = 0,001) between the total score of the FertiQol and the total score of PSS and there was a moderate positive correlation (r = 0,452, p = 0,001) between FertiQol total score and SWML.

CONCLUSION

This study found that the rate of perceived stress affected the quality of life negatively and marital satisfaction affected the quality of life positively in pregnant women with ART.

Success of assisted reproductive technology treatment and couple relationship: A pilot study on the role of romantic attachment

Infertility is a deeply distressing experience, which can threaten important personal and martial goals, frequently affecting the psychophysical health. A supportive relationship and a secure romantic attachment appear to reduce infertility stress, as well as play a relevant role in the success of assisted reproductive technology treatments. The principal aim of the study is to investigate the predictive effect of romantic attachment, couple characteristics, quality of life and age on assisted reproductive technology outcome. A total of 88 infertile women, enrolled in an assisted reproductive technology Centre of Rome, completed the Experience in Close Relationship-Revised, the Couple Relationship Inventory, the Fertility Quality of Life and a socio-demographic questionnaire. The participants completed the questionnaires at the beginning of the medical treatment. Data analyses showed significant associations among Experience in Close Relationship-Revised dimensions, Couple Relationship Inventory and Fertility Quality of Life Scales. Assisted reproductive technology outcome was negatively correlated to Experience in Close Relationship-Revised Avoidance and positively related to Couple Relationship Inventory Dependence. A multi-variable logistic regression revealed that Experience in Close Relationship-Revised Avoidance decreased the probability of pregnancy. The present findings partially confirmed the study hypotheses since several associations among couple characteristics, attachment anxiety and avoidance dimensions, infertility-related quality of life in infertile women were found. Furthermore, according to a definition of Avoidance, assisted reproductive technology positive outcome appears to be associated to lower levels of fear of dependence and interpersonal intimacy, and to a low need both for self-reliance and for reluctance to self-disclose within the romantic relationship. Further investigations are needed both to confirm this preliminary finding and for promoting focused therapeutic interventions for couples facing assisted reproductive technology.

Adaptive coping strategies in male infertility, paramedical counselling as a way of support

Aims: In the last decades, the number of infertile males increased worldwide which gained more focus. The extent to which a person or a couple is able to cope adaptively with the problem of infertility depends on the combined effect of several variables. Our aim was to apply counselling among males suffering from infertility problems. During the therapy - besides providing information - we aim to elaborate the effects of the treatment and experiences, to process information, to develop adaptive coping strategies against stress and to indirectly or directly change health behaviours influencing reproduction.Methods: Only patients with male factor infertility were involved. They were divided into an observed group (n = 57) and a control (n = 51) group after a thorough physical examination and assessment of their reactions to, and awareness of, the disease.Results: The group that received the interventions had an intense awareness of the diagnosis and aims and nature of the indicated treatment. They employed purposeful problem-solving coping strategies, reported being satisfied with the infertility treatment.Conclusions: The counselling of clients with infertility problems a more favourable mental well-being can be established by the active participation of professional helpers. Patients might receive effective, targeted and problem-specific help.Abbreviations: ART: Assisted Reproductive Technology.

A Comparison of Postpartum Depression in Mothers Conceived by Assisted Reproductive Technology and Those Naturally Conceived

Background

It is thought that mothers who conceive via assisted reproductive technology (ART) may be at greater risk of postpartum depression (PPD) because of the problems and psychological stresses associated with ART treat- ment. The aim of the present study is to determine the occurrence of PPD among mothers who conceive by ART in comparison with mothers who naturally conceive. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess PPD.

Materials and Methods

This historical cohort study investigated 406 mothers with infants aged 3-9 months. Three hundred and eight women with natural pregnancies were selected as the control group from mothers who referred to Tehran healthcare centres for infant vaccinations. The ART group consisted of 98 women who conceived via ART at Royan Institute. Participants completed a general questionnaire that asked about education, occupation, number of children, delivery method, history of infant hospitalization, breastfeeding, mothers’ and infants’ ages, cause of infertil- ity (ART group), and history of depression. A validated Persian version of the EPDS was used to measure depressive symptoms.

Results

The mean EPDS score in mothers who naturally conceived was 8.38 ± 0.35 in comparison with mothers who conceived via ART (7.59 ± 0.63). The proportions of women who reported PPD were 26.0% for the control group and 20.4% for the ART group. There was no statistically significant difference in PPD between the control and ART groups (P=0.26).

Conclusion

The occurrence of PPD in mothers who conceived via ART was similar to those who conceived naturally.

The effects of an expressive writing intervention on pregnancy rates, alexithymia and psychophysical health during an assisted reproductive treatment

Objective: World Health Organization reported that in developed countries one in four couples experience infertility with serious implications for the psychophysical well-being. Aim of this study was to evaluate the effects of Pennebaker's writing technique on pregnancy rates, alexithymia and psychophysical health during an assisted reproductive treatment (ART).Method: 91 women admitted for an ART were randomly divided into two groups: an experimental one (n = 46), where women wrote about their thoughts and emotions concerning the infertility experience, and a control group (n = 45) where women did not write. All subjects completed a socio-demographic questionnaire, the 20-item Toronto Alexithymia Scale and the Symptoms Checklist-90-R before and after the writing sessions.Results: A significant difference in pregnancy rates between the experimental group (n = 13) and the control group (n = 5) was found (χ² = 4.216; p < .04). A significant difference was also found between women who participated in the study (experimental + control= 91) and women who declined to participate, in the direction of more ART successes (n = 18 vs. n = 0) in the group of women who participated (χ² = 10.17; p < .01).Conclusions: The findings support the usefulness of the writing technique during ART in promoting treatment success.

Fertility quality of life tool: update on research and practice considerations

The 36-item Fertility Quality of Life (FertiQoL) tool is increasingly used in research and practice. It measures quality of life in four personal domains (emotional, social, relational, mind/body) and two treatment domains (tolerability, environment). A literature review of published empirical research using FertiQoL was undertaken to provide an overview of this research base. Five databases were searched using 'FertiQoL' and its variant. In total, 41 published articles from 35 independent samples in 23 countries involving 16,315 participants, mainly in clinical settings, were reviewed. FertiQoL was used for three main purposes: (i) to assess quality of life and FertiQoL measurement properties (especially Core FertiQoL) using cross-sectional designs; (ii) to identify correlates, predictors, and consequences of fertility quality of life (some of which included international comparisons); (iii) to assess the effect of psychological interventions on fertility quality of life. The range of median FertiQoL Core, Treatment and subscale (scaled) scores in 31 samples was between 60 and 75. Poorer fertility quality of life was consistently associated with being a woman, longer duration of infertility, poorer psychological functioning and lower patient-centred care. Some FertiQoL subscale scores improved after psychological interventions. Future research should address measurement issues and examine reported associations with fertility quality of life.

Quality of life in Indian women with fertility problems as assessed by the FertiQoL questionnaire: a single center cross sectional study

PURPOSE

Infertility and its treatment can significantly impact an individual's physical and psychological health; however, this has not been well-studied in the Indian population. This study aimed to assess the quality of life in women with infertility at a teaching hospital in Hyderabad, India.

METHODS

In this cross sectional study of women with infertility, the quality of life was measured using the 'FertiQoL International' questionnaire (English/Hindi).

RESULTS

The age ranged from 20 to 38 years and polycystic ovary syndrome was the most common cause of infertility. Core FertiQoL scores were analyzed in 215 women and Treatment FertiQoL in 156. The mean Total FertiQoL score in the study population was 66.1 (SD 13.0) and this overall score was not influenced by socio-demographic or infertility-specific factors. However, on subscale analysis, women who had living children and were university-educated had significantly better emotional scores while obese (≥35 kg/m²) women and those on ovulation induction treatment had poorer mind body and relational scores, respectively. Women with associated co-morbidities had worse quality of life on the Treatment Environment scale than those without.

CONCLUSIONS

The results provide a baseline quality of life score in these women. Infertility had the greatest impact on the emotional domain.

[Ovarian stimulation with gonadotrophins in patients with polycystic ovary syndrome]

OBJECTIVES

The main objective of this study was to describe the ovulation rate in patients with polycystic ovary syndrome, treated with ovulation induction/intra-uterine insemination and follitropin alfa by gonadotrophins at a second attempt.

METHODS

An observational, national and multicentre study was carried out: 51 French physicians (endocrinologists, gynaecologists) participated. Eligible patients were followed according to the usual clinical practices. The primary endpoint was the number of ovulations (spontaneous or triggered). Quality of life evaluation (by FertiQoL), compliance, and patient satisfaction were secondary endpoints.

RESULTS

A total of 202 patients (mean age: 29.9 years; mean infertility: 2.9 years) were included: 78.4% met the Rotterdam definition. The ovulation rate was 93.3% (95% confidence interval [89.8; 96.8]%). At 12 weeks of gestation, 38 patients had an ongoing pregnancy. A difference of 10 points of the mean total FertiQoL score was observed between the two attempts. No patient reported missing injection. More than 9 in 10 patients said they were satisfied to very satisfied with the use of the pen injector for administration of follitropin alfa. Eight patients (4.0%) had hyperstimulation leading to cycle cancellation, and two patients (1.1%) reported ovarian hyperstimulation syndrome.

CONCLUSIONS

At the second cycle of follitropin alfa stimulation, a high rate of ovulations, satisfactory compliance and tolerance profile associated with a change in quality of life were reported.

Lifestyle and fertility: the influence of stress and quality of life on female fertility

There is growing evidence that lifestyle choices account for the overall quality of health and life (QoL) reflecting many potential lifestyle risks widely associated with alterations of the reproductive function up to the infertility. This review aims to summarize in a critical fashion the current knowledge about the potential effects of stress and QoL on female reproductive function. A specific literature search up to August 2017 was performed in IBSS, SocINDEX, Institute for Scientific Information, PubMed, Web of Science and Google Scholar. Current review highlights a close relationship in women between stress, QoL and reproductive function, that this association is more likely reported in infertile rather than fertile women, and that a vicious circle makes them to have supported each other. However, a precise cause-effect relationship is still difficult to demonstrate due to conflicting results and the lack of objective measures/instruments of evaluation.

Can a quality-of-life assessment assist in identifying women at risk of prematurely discontinuing IVF treatment? A prospective cohort study utilizing the FertiQoL questionnaire

PURPOSE

This study aimed at assessing quality of life (QoL) by means of a validated measurement tool (FertiQoL) in German infertile patients before a first IVF/ICSI cycle with ancillary assessment of changes in FertiQoL scores after a failed first cycle and the predictive capacity of FertiQoL scores for treatment discontinuation.

METHODS

The validated FertiQoL tool consisting of 24 questions regarding fertility-specific aspects of QoL was used for this prospective cohort study conducted at a university affiliated IVF center in Germany. Female patients (n = 119) filled out the FertiQoL form and questionnaire on sociodemographic variables on initiation of a first- and second-cycle IVF/ICSI treatment, respectively.

RESULTS

On initiation of a first IVF/ICSI cycle, the mean scores (± standard deviation) for subscales emotional, mind-body, relational, and social items were 62 (± 19), 75 (± 17), 82 (± 13), and 78 (± 14), respectively; the total FertiQoL score was 73 (± 12). The mean total FertiQoL score at initiation of a first treatment cycle did not differ between patients who continued vs. discontinued treatment in case of no pregnancy achievement in the first cycle (73) (± 10) vs. 74 (± 14), p = 0.46). Furthermore, the mean total FertiQoL score did not change after an unsuccessful first IVF cycle (74 vs. 76, p = 0.46).

CONCLUSIONS

There was no statistical difference in a small sample size for FertiQoL scores between all groups. In this study, FertiQoL scores were, therefore, not usable to predict withdrawal from infertility treatment.

The effect of depression on quality of life in infertile couples: an actor-partner interdependence model approach

Background

Infertility can cause psychological distress and has a negative impact on quality of life (QoL). There have been no studies investigating the effect of depression on QoL in infertile couples at the dyadic level. This study aimed to investigate the effects of actors’ and partners’ depression on QoL in male-female dyads experiencing infertility using an innovative dyadic analysis approach, the Actor–Partner Interdependence Model (APIM).

Methods

We conducted this cross-sectional study on 180 infertile couples in Tehran, Iran, during August-September 2017. Quality of life and depression were assessed using Fertility Quality of Life and Patient Health Questionnaire-9, respectively. Dyadic data were analyzed by the APIM approach. In this method, actor effect is the impact of a person’s depression on his/her own QoL. Partner effect is the impact of a person’s depression on his/her partner’s QoL.

Results

Results from APIM revealed that both males and females’ depression exuded an actor effect on their own QoL (β = − 0.589, p < 0.001; β = − 0.588, p < 0.001, respectively). Furthermore, males’ depression exuded a significant partner effect on their wives’ QoL (β = − 0.128, p = 0.030). Although the partner effect of females’ depression on males’ QoL was not statistically significant (β = − 0.108, P = 0.070), males whose wives had higher depression were more to indicate their own QoL was poorer. Based on equality constraint test, both actor and partner effects of depression on QoL were similar between males and females.

Conclusions

The findings suggest that QoL in infertile patients was influenced by not only their own depression but also their spouses’ depression; therefore, interventions to improve QoL should include both males and females.

The impact of complementary therapies on psychosocial factors in women undergoing in vitro fertilization (IVF): A systematic literature review

AIM

This review evaluates the impact of complementary therapies on psychosocial factors in women undergoing IVF.

BACKGROUND

According to the CDC, nearly 7% of married women in the United States face infertility. Approximately 1.5% of all infants born in the U.S. annually are conceived through assisted reproductive technologies (ART), such as IVF. Women undergoing ART report distress, anxiety, and depression related to their treatment. Stress has been cited as the top reason why women terminate treatment. Complementary therapies, such as mind-body techniques, have been associated with decreasing stress and anxiety.

METHODS

CINAHL and PubMED databases were searched for studies 1) published from January 2010 to 2017, 2) written in English, 3) that examined the effect of an complementary therapy on the psychological well-being of women undergoing, or about to be undergoing a cycle of IVF.

RESULTS

The search revealed 11 studies published between 2010 and 2015 from a variety of countries. The most common research design was a randomized controlled trial (n=7). The psychosocial factor most frequently measured was anxiety (n=8). The forms of complementary therapy varied, with the most common being Hatha yoga, cognitive behavioral interventions, and mind-body therapies (n=2 each).

CONCLUSIONS

Utilizing complementary therapies appears to be a positive way to decrease women's anxiety, depression, distress, and stress, and to increase fertility quality of life. This review informs providers that incorporating complementary therapies into the plan of care can lead to improved psychosocial health outcomes for women undergoing IVF.

Quality of life in Turkish infertile couples and related factors

Infertility is a major life crisis affecting couples' psychosocial and physical health. We aimed to assess the quality of life in Turkish infertile couples. This cross-sectional survey was carried out in 127 infertile couples admitted to a University Hospital. The quality of life was measured using the fertility quality of life tool (FertiQoL) scale. Women had lower overall quality of life than men. Women and men who were married for fewer than 10 years had a significantly lower emotional score. Women who had a history of infertility treatment, men who have lived in the town or village men with primary infertility and men who have had primary education or lower, had lower scores for mind/body subscale. Social scores were found lower in women under the age of 30, women with middle or low income, men who were married for fewer than 10 years, men who did not have children for 5 years or more and men with primary infertility. The tolerability and environment scores were significantly higher in women who had been married more than once. We conclude that health care providers should be aware of the factors affecting the quality of life (QoL) and give counselling to improve couples' quality of life at infertility clinics.

A review of patient-reported outcome measures to assess female infertility-related quality of life

BACKGROUND

Infertility has a negative impact on quality of life (QoL) and well-being of affected individuals and couples. A variety of patient-reported outcome (PRO) measures to assess infertility-related QoL are available; however, there is a concern regarding potential issues with their development methodology, validation and use. This review aimed to i) identify PRO measures used in infertility interventional studies ii) assess validation evidence to identify a reliable, valid PRO measure to assess changes in QoL or treatment satisfaction in clinical studies with female patients following treatment with novel therapies iii) identify potential gaps in evidence for validity.

METHODS

A structured literature search of Medline, Embase, and the Cochrane Library (accessed in September 2015) was conducted using pre-defined search terms. The identified publications were reviewed applying eligibility criteria to select interventional female infertility studies using PROs. Infertility-specific PRO measures assessing QoL, treatment satisfaction or psychiatric health, and included in studies by ≥2 research groups were selected and critically reviewed in light of scientific and regulatory guidance (e.g. FDA PRO Guidance for Industry) for evidence of content validity, psychometric strength, and patient acceptability.

RESULTS

The literature search and hand-searching yielded 122 publications; 78 unique PRO measures assessing QoL, treatment satisfaction or psychiatric health were identified. Five PRO measures met the selection criteria for detailed review: Fertility Quality of Life (FertiQoL); Fertility Problem Inventory (FPI); Fertility Problem Stress (FPS); Infertility Questionnaire (IFQ); Illness Cognitions Questionnaire adapted for Infertility (ICQ-I). None of the PRO measures met all validation criteria. The FertiQoL was the most widely used infertility-specific PRO measure to assess QoL in interventional studies, with reasonable evidence for adequate content validity, psychometric strength, and linguistic validation. However, gaps in evidence remain including test-retest reliability and thresholds for interpreting clinically important changes. While the FPI demonstrated reasonable evidence for content and psychometric validity, its utility as an outcome measure is limited by a lack of recall period.

CONCLUSION

The FertiQoL and the FPI are potentially useful measures of infertility-related QoL in interventional studies. Further research is recommended to address gaps in evidence and confirm both PRO measures as reliable assessments of patient outcomes.

A review of patient-reported outcome measures to assess female infertility-related quality of life

BACKGROUND

Infertility has a negative impact on quality of life (QoL) and well-being of affected individuals and couples. A variety of patient-reported outcome (PRO) measures to assess infertility-related QoL are available; however, there is a concern regarding potential issues with their development methodology, validation and use. This review aimed to i) identify PRO measures used in infertility interventional studies ii) assess validation evidence to identify a reliable, valid PRO measure to assess changes in QoL or treatment satisfaction in clinical studies with female patients following treatment with novel therapies iii) identify potential gaps in evidence for validity.

METHODS

A structured literature search of Medline, Embase, and the Cochrane Library (accessed in September 2015) was conducted using pre-defined search terms. The identified publications were reviewed applying eligibility criteria to select interventional female infertility studies using PROs. Infertility-specific PRO measures assessing QoL, treatment satisfaction or psychiatric health, and included in studies by ≥2 research groups were selected and critically reviewed in light of scientific and regulatory guidance (e.g. FDA PRO Guidance for Industry) for evidence of content validity, psychometric strength, and patient acceptability.

RESULTS

The literature search and hand-searching yielded 122 publications; 78 unique PRO measures assessing QoL, treatment satisfaction or psychiatric health were identified. Five PRO measures met the selection criteria for detailed review: Fertility Quality of Life (FertiQoL); Fertility Problem Inventory (FPI); Fertility Problem Stress (FPS); Infertility Questionnaire (IFQ); Illness Cognitions Questionnaire adapted for Infertility (ICQ-I). None of the PRO measures met all validation criteria. The FertiQoL was the most widely used infertility-specific PRO measure to assess QoL in interventional studies, with reasonable evidence for adequate content validity, psychometric strength, and linguistic validation. However, gaps in evidence remain including test-retest reliability and thresholds for interpreting clinically important changes. While the FPI demonstrated reasonable evidence for content and psychometric validity, its utility as an outcome measure is limited by a lack of recall period.

CONCLUSION

The FertiQoL and the FPI are potentially useful measures of infertility-related QoL in interventional studies. Further research is recommended to address gaps in evidence and confirm both PRO measures as reliable assessments of patient outcomes.

Psychometric Properties of The Fertility Quality of Life Instrument in Infertile Iranian Women

BACKGROUND

Infertility and its treatment can have a considerable effect on a person's quality of life (QoL). The Fertility QoL (FertiQoL) questionnaire is currently the most frequently used instrument to measure QoL in people with fertility problems. This study aims to examine the reliability and validity of the FertiQoL in infertile Iranian women.

MATERIALS AND METHODS

This cross-sectional study included 155 women with fertility problems in a referral fertility clinic in Tehran, Iran from January to March 2014. A battery of instruments was used: FertiQoL, Satisfaction with Life Scale (SWLS), Hospital Anxiety and Depression Scale (HADS), and a demographic questionnaire. Construct validity of the scale was evaluated using confirmatory factor analysis (CFA). We assessed internal consistency with Cronbach's alpha and convergent validity was examined by correlating the FertiQoL with SWLS and HADS.

RESULTS

The results of the CFA generally supported the four-factor model of Core FertiQoL and two-factor model of Treatment FertiQoL. Both FertiQoL modules and their subscales revealed acceptable internal consistency that ranged from 0.643 to 0.911. However, the FertiQoL might be improved if Q15 and T2 items were removed from the scale. These items had low loadings on the Relational and Environment factors which decreased their internal consistency. The FertiQoL and their subscales significantly correlated with both SWLS and HADS, which confirmed convergent validity.

CONCLUSION

The Persian version of the FertiQoL is a valid, reliable instrument to measure QoL in infertile women and seems to perform as well as the original English Version.

Fertility-related quality of life from two RCT cohorts with infertility: unexplained infertility and polycystic ovary syndrome

STUDY QUESTION

Does fertility-related quality of life (FertiQOL) differ by infertility diagnosis between women with polycystic ovary syndrome (PCOS) and their partners, compared with couples with unexplained infertility (UI)?

SUMMARY ANSWER

Women with PCOS report lower QOL than those with UI, whereas males with UI report lower QOL than males with PCOS partners.

WHAT IS KNOWN ALREADY

The fertility-specific QOL survey, FertiQOL, has been used to examine fertility-related QOL in a number of worldwide cohorts. Few data have addressed fertility-related QOL as a function of infertility diagnosis. Overall, men report better QOL than women with infertility, and there is variation in FertiQOL scores across different samples from different countries.

STUDY DESIGN, SIZE, DURATION

This was a prospective, cohort study derived from two concurrent, randomized clinical trials, and designed to examine QOL in infertile females with PCOS and UI at the time of enrollment compared with each other and their male partners; to compare concordance FertiQOL scores in this study across other worldwide cohorts; and to determine if baseline FertiQOL was associated with pregnancy outcome.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Women with PCOS and their partners (n = 733 and n = 641, respectively), and couples with UI (n = 865 women and 849 men) completed a validated fertility-specific QOL survey (FertiQOL) at the time of the study screening visit. PCOS women were randomized to either clomiphene citrate or letrozole treatment; couples with UI were randomized to clomiphene citrate, letrozole or gonadotrophin plus IUI. FertiQOL results were compiled by diagnosis (PCOS or UI) and compared by diagnosis and sex using Wilcoxon Rank-Sum testing. Relationships between baseline FertiQOL and pregnancy outcomes were examined using logistic regression. Multivariable models were performed to assess the association between FertiQOL scores and key participant characteristics.

MAIN RESULTS AND THE ROLE OF CHANCE

Women with PCOS had lower total FertiQOL scores (72.3 ± 14.8) than those with UI (77.1 ± 12.8; P < 0.001); this was true for each domain (except Relational). These differences were largely explained by variation in BMI, hirsutism, household income and age. Women had lower overall FertiQOL scores than their male partners. Males with PCOS partners had higher scores than males with UI (84.9 ± 10.2 versus 83.3 ± 10.8; P = 0.003). Scores were not consistently associated with conception or pregnancy outcome.

LIMITATIONS, REASONS FOR CAUTION

The use of multiple tests of association may have resulted in spurious statistically significant findings. Inherent sociodemographic differences between women with PCOS and those with UI largely account for the lower QOL in women with PCOS. Our study was unable to assess if changes in QOL affected pregnancy outcome as FertiQOL data were collected prior to treatment. Finally, the participants for both studies represent their local communities, but are not a population-based sample and thus firm conclusions about how representative these couples are to the general population must be made with caution.

WIDER IMPLICATIONS OF THE FINDINGS

Women with PCOS with elevated BMI and hirsutism scores and with lower socioeconomic status may require more, targeted psychosocial support than those with other diagnoses. Possible attribution of infertility to the male partner appears to result in a lower QOL. There appears to be substantial national variation in FertiQOL scores, with US-based cohorts reporting overall higher QOL.

STUDY FUNDING/COMPETING INTERESTS

This work was supported by National Institutes of Health (NIH)/Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Grants U10 HD39005 (to M.D.), U10 HD38992 (to R.S.L.), (to C.C.), U10 HD38998 (to R.A.), U10 HD055942 (to R.D.R.), HD055944 (to P.C.), U10 HD055936 (to G.C.), U10HD055925 (to H.Z.); and U10 U54-HD29834 (to the University of Virginia Center for Research in Reproduction Ligand Assay and Analysis Core of the Specialized Cooperative Centers Program in Reproduction and Infertility Research). Most importantly, this research was made possible by the funding by American Recovery and Reinvestment Act. N.S., E.E., J.C.T., C.G., H.H., R.A., P.C., G.C., C.C., M.D., S.J., W.D.S. and H.Z. report no conflicts of interests/disclosures. L.B.C. reports research support from Ferring Pharmaceuticals and Roche Diagnostics; R.S.L. reports receipt of consulting fees from AstraZeneca, Euroscreen, Sprout Pharmaceuticals, Taken, Kindex, Clarus and Bayer, Inc., and research support from AstraZeneca and Ferring Pharmaceuticals. R.D.R. reports research support from AbbVie.

TRIAL REGISTRATION NUMBER

Pregnancy in Polycystic Ovary Syndrome II (PPCOS II), NCT00719186; Assessment of Multiple Intrauterine Gestations in Ovulation Stimulation (AMIGOS) NCT01044862, clinicaltrials.gov.

TRIAL REGISTRATION DATE

PPCOS II 17 July 2008; AMIGOS 7 January 2010.

DATE OF FIRST PATIENT'S ENROLMENT

PPCOS II 19 February 2009; AMIGOS 2 August 2010.

Factors associated with poor quality of life among Iranian infertile women undergoing IVF

Infertility is a medical and social condition and has a considerable impact on a person's quality of life (QoL). The aim of the study was to determine the QoL of women with fertility problem, and identify factors associated with poor QoL. This cross-sectional study included 155 women with fertility problems undergoing IVF in a referral fertility center in Tehran, Iran. The Fertility Quality of Life, the Hospital Anxiety and Depression Scale and demographic and fertility information questionnaire were administered to all women. The mean total QoL score was 62.57 ± 16.89. Multivariate analysis showed that the anxiety (β = -1.59, p < 0.001) and depression (β = -2.09, p < 0.001) had a negative impact on QoL. Cause of infertility and failure in previous treatment were also significant factors of poorer QoL. The findings indicate that the QoL was worse in women with high depression and anxiety level, failure in previous treatment and unknown cause of infertility. Thus, a comprehensive approach, including psychosocial interventions and support, is absolutely essential to improve the QoL in these women.