Barriers and facilitators experienced by South Korean women undergoing fertility treatment: A qualitative socioecological study

The purpose of this qualitative study was to use interview data to identify and describe the intrapersonal, interpersonal, community, and policy barriers and facilitators experienced by South Korean women undergoing fertility treatment. The researchers conducted one-on-one interviews with 14 women who had undergone fertility treatment and then completed a thematic content analysis on the collected interview data. Guided by the socioecological model, the researchers explored the barriers and facilitators women experienced during fertility treatment. The participants described their struggles and -emotional distress as well as their coping mechanisms: addressing their physical and emotional stress; soliciting support from their husband, personal network, online peers, and healthcare team; and seeking government financial assistance. The information gained from this study can help healthcare providers and government agencies design effective psychosocial and national policies and interventions for this population.

Development of an infertility perception scale for women (IPS-W)

PURPOSE

The purpose of this study was to develop an Infertility Perception Scale for Women (IPS-W).

METHODS

Initial items were based on an extensive literature review and in-depth interviews with five infertile women and fifteen women not diagnosed with infertility. Forty-one items were derived from a pilot survey. Data were collected from 203 women who had experienced intrauterine insemination (IUI) and in-vitro fertilization (IVF) more than once. The data were analyzed to verify the reliability and validity of the scale.

RESULTS

Four factors containing 21 items were extracted from the exploratory factor analysis (EFA) to verify the construct validity. The four factors of infertility perception scale were perceived feelings, personal stigma, social stigma, and acceptance. These factors explained 59.3% of the total variance. The confirmatory factor analysis (CFA) confirmed a four-factor structure of the 21-item IPS-W. All fit indices were satisfactory (χ2/df ≤ 3, RMSEA < 0.08). These items were verified through convergent, discriminant, known group validity, concurrent validity testing. The internal consistency reliability was acceptable (Cronbach's α = 0.90).

CONCLUSION

The scale reflects the perception of infertility within the cultural context of Korea. The findings can help nurses provide support that is appropriate for individual circumstances by examining how women experiencing infertility perceive infertility.

Efficacy of psychosocial interventions for pregnancy rates of infertile women undergoing in vitro fertilization: a systematic review and meta-analysis

PURPOSE

This study aimed to analyze the efficacy of psychosocial interventions for improving pregnancy rates in infertile women undergoing in vitro fertilization (IVF) treatment through a systematic review and meta-analysis.

METHODS

Twelve studies were included in the meta-analysis. To estimate the effect size, a meta-analysis of the studies was performed using RevMan 5.3. The possibility of publication bias was evaluated using funnel plots and Egger's method.

RESULTS

A statistically significant effect size (standardized mean difference [SMD] = 1.39; 95% confidence interval [CI] = 1.11-1.71; p = 0.004; I² = 19%) was found for the 12 studies that investigated the effects of psychosocial interventions on clinical pregnancy rates. The psychosocial interventions that had a significant effect on pregnancy rates were mind-body interventions (SMD = 1.37; 95% CI = 1.01-1.85; p = 0.040; I² = 0%) and cognitive behavioral therapy (SMD = 2.19; 95% CI = 1.17-4.13; p = 0.010).

CONCLUSIONS

The results suggest that psychosocial interventions affect pregnancy rates. Moreover, they indicate that mind-body interventions and cognitive behavioral therapy are beneficial for improving the pregnancy outcome in infertile women undergoing IVF.

[The Reliability and Validity of Korean Version of the Infertility Stigma Scale (K-ISS)]

PURPOSE

This study aimed to translate the Infertility Stigma Scale (ISS) into Korean and to evaluate its reliability and validity in the Korean context.

METHODS

Data were collected from 350 women who underwent in vitro fertilization (IVF). Data were analyzed using SPSS WIN 25.0 and AMOS 22.0. Content validity was analyzed using the item-level content validity index (I-CVI) and scale-level content validity index/averaging (S-CVI/Ave). The preliminary survey was conducted on 20 women who had experienced IVF at least once to check the level of understanding of the tool and the time required to fill out the questionnaire. Exploratory and confirmatory factor analyses were used to test construct validity. Additionally, hypothesis-testing construct validity were tested. Cronbach's α was used to assess the reliability.

RESULTS

The Korean-ISS (K-ISS) consists of 25 items, excluding two items from the original ISS questionnaire. Exploratory factor analysis identified four factors, which explained 75.6% of the total variance. The four distinct factors were infertility stigma with self-devaluation (56.8%), public stigma (8.1%), social withdrawal (6.5%), and family stigma (4.2%). In the confirmatory factor analysis, the 25 items in the four-factor structure were validated (χ²/df ≤ 3, RMSEA ≤ 10). The hypothesis-testing construct validity of K-ISS against FPI (r = .58~.71, p < .001) and FQI (r = -.49~-.65, p < .001) was tested and found to be significant. The internal consistency reliability of the K-ISS, assessed using Cronbach's α, was .97.

CONCLUSION

The K-ISS has satisfactory construct validity and reliability; therefore, it can help minimize the negative impact of stigma by measuring the stigma associated with women experiencing infertility.

Associations of Symptoms of Depression, Social Support, and Quality of Life Among Korean Women Who Experience Infertility

OBJECTIVE

To describe the quality of life (QOL) of Korean women experiencing infertility based on sociodemographic and infertility characteristics and to examine the associations among symptoms of depression, social support, and QOL.

DESIGN

Cross-sectional, descriptive study.

SETTING

Participants were recruited from July to August 2019 on one of the largest South Korean websites where individuals share pregnancy and parenthood experiences.

PARTICIPANTS

Adult women (N = 186) who received infertility treatment.

METHODS

Participants completed an online survey using the Korean version of the Patient Health Questionnaire 9 to measure symptoms of depression, the Multidimensional Scale of Perceived Support, and the Fertility Quality of Life (FertiQOL) scale. Data were analyzed using descriptive statistics, correlation, analysis of variance, and multiple regression.

RESULTS

There was a significant negative relationship between scores on the Patient Health Questionnaire 9 and FertiQOL (r = -0.557) and a significant positive relationship between scores on the Multidimensional Scale of Perceived Support and FertiQOL (r = 0.404). The length of time from diagnosis of infertility to data collection, past and current treatments, cost burden, and degree of inhibition of daily life due to infertility also significantly affected participants' FertiQOL scores. Symptoms of depression, the burden of treatment, and inhibition of daily life activities explained 46% of the variance in QOL.

CONCLUSION

Women experiencing infertility and symptoms of depression had lower FertiQOL scores. Health care providers, who are most familiar with and attentive to patients, could provide a first line of defense against poor QOL in this population. By continuously assessing the levels of psychosocial stress in women with infertility, nurses could provide timely resources and design interventions to improve women's QOL.

Effect of an Infertility Counseling Education Program on Education Satisfaction and Counseling Competency of Nurses

The purpose of this study is to investigate the effects of an infertility counseling education program on education satisfaction and counseling competency of nurses. The study used a one-group pretest-posttest design. Participants were 135 nurses in Korea. Data on demographic characteristics on education satisfaction, and counseling competency were collected. After participating in the infertility counseling education program, the level of counseling competency increased significantly over that before participating in the infertility counseling education program. The infertility counseling education program improved the counseling competency of the participating nurses. Use of such an infertility counseling education program is recommended when nurses counsel patients facing infertility. It is necessary to repeat this study in the future to clarify the effects of these counseling education programs.

Development and Application of a Web-based Integrated Support Service Program for Infertile Women

Online-based infertility education provides a health management system to patients using electronic information and technology and no face-to-face interaction with patients and experts. This is a study to develop a web-based integrated support service system to meet the health care and nursing needs of infertile women. To develop a system that is most suitable and practically helpful to infertile women, who are end users of this system, research was conducted. This education system consists of introduction to women's health care, information on women's health, information on organizations for women, community for infertile women, and request for consultation for health management and nursing education of infertile women. This study introduced and applied a user-centered design that maximizes the value of use by first understanding the user's convenience and needs when developing a program.

[Development of a Coping Scale for Infertility-Women (CSI-W)]

PURPOSE

The purpose of this study was to develop a Coping Scale for Infertility-Women (CSI-W).

METHODS

The initial items were based on an extensive literature review and in-depth interviews with seven infertile women. Forty-three items were derived from a pilot survey. Data were collected from 216 women who had experienced intrauterine insemination (IUI) and in-vitro fertilization (IVF) more than once. The data were analyzed to verify the reliability and validity of the scale.

RESULTS

Seven factors containing 28 items (four factors containing 17 items for active coping and three factors containing 11 items for passive coping) were extracted from the exploratory factor analysis to verify the construct validity. The four factors of active coping were confrontation, self-control, seeking social support (spouse), and seeking social support (colleagues and experts). The three factors of passive coping were distancing, escape, and avoidance. These items were verified through convergent, discriminant, and concurrent validity testing. The internal consistency reliability was acceptable (active coping: Cronbach's α = .78; passive coping: Cronbach's α = .81).

CONCLUSION

As its validity and reliability have been verified through various methods, the CSI-W can contribute to assessing the coping strategies of infertile women.

Experiences of Women with Male Factor Infertility under In Vitro Fertilization

Purpose: This study attempts to explore the experiences of infertility among women with male factor infertility. Methods: From April to July 2018, nine women with experience of male factor infertility and assistant reproductive technology were interviewed. The transcribed data were qualitatively analyzed to identify major themes and sub-themes representing participants' experiences with male factor infertility. Results: The analysis indicated that the women's infertility experiences were structured into five theme clusters: "Difficult to accept the situation", "Confused inside", "Destroyed relationships due to blaming and anger", "Desire social support", and "Embracing hurt feelings and regaining strength". Conclusions: Intervention programs are needed to closely investigate the psychological status of women with male factor infertility and help with their physical and psychological well-being. Efforts to address infertility through effective governmental support for infertility, a strategy for promoting the social recognition of infertility, and the health professional's persistent interest and collaboration, are discussed.

[Nursing needs assessment scale for women with infertility: development and validation]

Purpose

High-quality nursing care must be provided for women with infertility, and their nursing care needs must be identified. Although scales have been developed to assess infertility-related stress, quality of life, and psychosocial status, there is a lack of scales that assess the nursing care needs of women with infertility. The purpose of this study was to develop a needs assessment scale for nursing care in women with infertility and to verify its reliability and validity.

Methods

The 250 subjects in this study were women with infertility recruited from four hospitals. The scale was developed following the framework of DeVellis, through a literature review, in-depth interviews, development of preliminary items, verification of content validity, development of secondary items, verification of construct validity, and extraction of the final items. Date were analyzed using item analysis, factor analysis, confirmatory factor analysis, Pearson correlation coefficients, and Cronbach's alpha. Reliability was tested using Cronbach's alpha, and validity was evaluated using item analysis, exploratory factor analysis, and criterion validity.

Results

The final version of the nursing needs assessment scale for woman with infertility consisted of 18 items. Four factors (physical and psychological nursing needs, needs for information regarding treatment, needs for infertility-related understanding and concern, and supportive needs) explained 66.0% of the total variance. Cronbach's alpha was .92 for the overall instrument and ranged from .88 to .91 for the subscales.

Conclusion

These results suggest that this needs assessment scale for nursing care in women with infertility demonstrated acceptable validity and reliability and contained items suitable for assessing the level of nursing care needed by women with infertility.

[Effects of uncertainty and spousal support on infertility-related quality of life in women undergoing assisted reproductive technologies]

Purpose

The purpose of this study was to investigate the effects of uncertainty and spousal support on infertility-related quality of life (QoL) in women undergoing assisted reproductive technologies.

Methods

In this correlational survey study, 172 infertile women undergoing assisted reproductive technologies for infertility treatment at M hospital in Seoul participated. Data collection took place at the outpatient department of M hospital using a self-report questionnaire from July to August 2019. Data were analyzed using SPSS for Windows version 28.0.

Results

The mean scores for uncertainty, spousal support, and infertility-related quality of life (QoL) were 28.35 (out of 50), 86.67 (out of 115), and 57.98 (out of 100), respectively. Infertility-related quality of life (QoL) was positively correlated with spousal support and negatively correlated with uncertainty. According to the regression analysis, infertility-related quality of life (QoL) was significantly affected by uncertainty, total number of assisted reproductive technology treatments, marriage duration, subjective health status, the financial burden of infertility testing, and the presence of a burdensome person. These variables had an explanatory power of 35.0% for infertility-related quality of life (QoL).

Conclusion

Uncertainty was an important factor influencing infertility-related quality of life (QoL) among women undergoing assisted reproductive technologies. It is necessary to develop and implement a nursing intervention program focused on reducing various forms of uncertainty during assisted reproductive procedures and to consider other factors affecting infertility-related quality of life (QoL) in the clinical setting.

The Relationship between Fatigue, Health-Promoting Behavior, and Depression among Infertile Women

PURPOSE

As the number of infertile couples has grown, many infertile women have experienced depression during the diagnosis and treatment of their infertility. This study aimed to identify the factors related to depression in infertile women who underwent reproductive treatments.

METHODS

The study subjects were 149 infertile women who underwent reproductive treatments. The data were collected by self-administered questionnaires from August 1 to December 24, 2018. The questionnaire consisted of questions about fatigue, health-promoting behavior, and depression. Analyses of the descriptive statistics, t-tests, one-way analysis of variance, correlation, and multiple regression were conducted using the SPSS 25.0 Windows program.

RESULTS

Thirty-six of the women in the study (24.2%) were in the probably depressed group and 113 (75.8%) were in the definitely depressed group and 100% of the subjects experienced symptoms of depression. Depression was positively correlated with fatigue and negatively correlated with health-promoting behavior. Multiple regression analysis revealed that fatigue and interpersonal relationships were factors significantly related to depression in the model (p<.001), with an explanatory power of 42.6%.

CONCLUSION

The results confirmed that fatigue and interpersonal relationships, which is a subfactor of health-promoting behavior, were factors related to depression. To alleviate depression in infertile women, efforts should be made to identify and reduce psychological and physical fatigue. In addition, minimizing relational difficulties that they experience during an infertility diagnosis and treatment and strengthening positive interpersonal relationships can be positive strategies to alleviate depression.

Health-care Needs of High-risk Pregnant Women Hospitalized in Maternal-Fetal Intensive Care Units: A Mixed-methods Design

PURPOSE

To identify the characteristics and health-care needs of high-risk pregnant women in maternal-fetal intensive care units (MFICU).

METHODS

mixed-methods design was adopted. Data were collected from 78 high-risk pregnant women admitted to the MFICU. Qualitative data included ten participants' experiences with hospitalization and childbirth, which were analyzed using mixed content analysis. Quantitative data were analyzed using at-test and one-way ANOVA testing.

RESULTS

The average score for pregnancy and childbirth health-care needs was 3.54 points. Average score by area was before-admission health care (3.70), health care of baby (3.67), health of childbirth (3.61), postpartum health (3.51), and pregnancy health care during hospitalization (3.48). Qualitative results showed diverse feelings and experiences of high-risk pregnant women and their need for health care, which was expressed in three themes and 11 sub-themes.

CONCLUSION

Nurses should recognize high-risk mothers' feelings and needs for pregnancy and childbirth-focused health care to help patients accept their vulnerability and cope positively.

A Phenomenological Study on the Spontaneous Abortion Experiences of Women

PURPOSE

The purpose of this study was to explore essences and meaning in experiences of women who have had spontaneous abortion.

METHODS

A phenomenological methodology was used for the study. A total of five women with the spontaneous abortion participated in the study. In-depth interviews were done for data collection, and the data were analyzed using Colaizzi's method.

RESULTS

Five theme clusters, along with 32 sub-themes and 13 themes. The five theme clusters were: 'Waiting and expecting pregnancy', 'Desire to overcome the spontaneous abortion', 'My baby makes me cry and laugh', 'My precious baby', and 'Want to hear with sympathy and talk with you'.

CONCLUSION

The women who have had the spontaneous abortion experiences can prevent potential physical and psychological complications after miscarriage by getting education and intervention in nursing. Moreover, they may experience that negative factors of the spontaneous abortion can be turned into positive things through emotional support of family and medical teams.

Factors Influencing Infertility-related Quality of Life in Women Undergoing Assisted Reproductive Techniques: Focusing on Depression and Resilience

PURPOSE

The purpose of this study was to investigate factors affecting on infertility-related quality of life in women undergoing assisted reproductive techniques focusing on depression and resilience.

METHODS

With correlational survey design, 125 infertile women who were receiving inpatient and outpatient treatment in K university hospital in D city completed a structured questionnaire.

RESULTS

There was a significant negative correlation between depression and resilience and between the depression and the quality of life. There was a significant positive correlation between resilience and the quality of life. The factors affecting on infertility-related quality of life were depression, burden of expenses, and relationship with husband which explained 48% in the quality of life.

CONCLUSION

It is necessary to develop and apply nursing programs that include individual counseling and education for infertile couple. Social support including financial support and better environment for these women will be also essential.

Stress, Depression, and Fetal Attachment in Pregnant Women having Infertility Treatments

PURPOSE

The purpose of this study was to determine the stress, depression, and fetal attachment of pregnant women who underwent infertility treatment, and to identify factors associated with fetal attachment.

METHODS

As a correlation survey design, data were collected from 136 pregnant women who underwent infertility treatment. Data were analyzed using chi2-test, t-test, ANOVA, Pearson correlation coefficients, and stepwise multiple regression.

RESULTS

Stress, depression, and fetal attachment averaged 3.01+/-0.60 (range of scale 1~5), 10.02+/-6.51 (out of a possible 63), and 3.64+/-0.55 (range of scale 1~5), respectively. Level of fetal attachment was higher when mother's age was less than 35, having other children, and having prenatal education experience. Lower score of depression and client's age less than 35 were significant factors affecting fetal attachment.

CONCLUSION

Infertility is a life-affecting trauma for the individual, and personal and social changes due to infertility cause physical and psychological difficulties even after a successful pregnancy with infertility treatment. Therefore, prenatal management programs need to be developed giving consideration to the emotional and physical changes in order to promote physical and psychological stability in the women pregnant following infertility treatment.