The Social Consequences of Infertility among Iranian Women: A Qualitative Study

Complementary, supportive and traditional practice experiences of infertile women in Türkiye: a qualitative study

BACKGROUND

In many societies, infertile couples use traditional practices.

OBJECTIVE

This study aimed to determine the complementary, supportive and traditional (CST) practices used by infertile women and their attitudes toward these practices.

METHODS

In this qualitative study, data were collected through individual interviews using a semi-structured form in December 2021. A total of 25 infertile women who applied to the in-vitro fertilization center of a hospital in Türkiye participated in the study. The findings were evaluated by thematic analysis.

RESULTS

The ages of the participants ranged from 25 to 49 years. Three main themes were obtained by the data analysis; "Reasons for using CST practices," "Complementary, supportive and traditional practices used" and "Opinions on the effect of CST practices."

CONCLUSION

Women resorted to complementary and supportive practices for economic reasons, seeking hope, and environmental pressure. Various herbal cures, dietary practices, and religious methods such as praying and prayer amulets, hacamat (cupping), leeches, and various bodily applications were identified as methods commonly used by women. Women were using these methods with the recommendations of people who are not health professionals. It is important to determine the beneficial methods and increase women's awareness of harmful practices. Additionally, although women use many methods for infertility treatment, it should also be noted that infertility is not a female-only problem. Consequently, childless women should be empowered with healthy coping skills.

Muslim Women's Experiences with Infertility: A Literature Review

OBJECTIVE

Infertility affects one in six women worldwide, playing a large role on an individual's psychosocial wellbeing and quality of life. The purpose of this review was to examine the experiences of Muslim women with infertility.

METHODS

A Prisma-guided literature review was conducted in Scopus, CINAHL, PubMed, Embase, PsychInfo, and Google Scholar. Sample inclusion criteria included research that examined the psychosocial consequences of infertility in women, used a qualitative design, were from a Muslim majority country or specified participants were Muslim, and were published in the English-language since 2013. Thematic analysis was used to synthesize the findings into themes.

RESULTS

Fourteen qualitative studies that explored the experiences of Muslim women with infertility were included for analysis. Women's responses were categorized into three focus areas: (1) emotional responses, (2) interpersonal relationships, and (3) social relationships. From these focus points, six overarching themes were identified that illustrated the challenges faced by Muslim women experiencing infertility: (1) identity crisis, (2) low self-esteem and depression, (3) abuse and harassment, (4) a weakened marital bond, (5) stigma, and (6) social exclusion and isolation .

CLINICAL IMPLICATIONS

Review of the literature provided an initial entrée into understanding the experiences of Muslim women with infertility. Understanding the unique role of infertility within a religious community equips nurses and other providers with the knowledge that discussions surrounding infertility must be conducted with cultural sensitivity. Further research should be conducted to explore and offer culturally tailored educational materials that align with the religious preferences of Muslim women.

Infertility-related stress and its relationship with emotional divorce among Iranian infertile people

BACKGROUND

Infertility affects different aspects of couples' lives, so it may cause problems in couples' emotional relationships by increasing marital conflicts. This study aimed to determine Infertility-related stress and its relationship with emotional divorce among Iranian infertile people.

METHODS

We conducted a cross-sectional observational study on 200 infertile people. The research environment was one of the well-equipped infertility centers in Tehran, Iran. Continuous sampling was employed. The data collection tools included a general information form, the Fertility Problem Inventory (FPI), and the Emotional Divorce Scale (EDS).

RESULTS

The findings revealed a significant direct relationship between infertility-related stress and all its subscales with emotional divorce in both infertile women and men. In infertile women, the most concern was the need for parenthood, while the lowest concerns were the relationship and sexual concerns. Multiple linear regression analysis indicated that social and relationship concerns predicted 44% of emotional divorce, with social concern being the more influential factor. In infertile men, the need for parenthood was the most significant concern, while relationship and social concerns were less prominent. Multiple linear regression analysis showed that relationship concern predicted 50% of emotional divorce in infertile men. In both infertile men and women, social and relationship concerns explained 45% of the variance in emotional divorce. Among these two variables, relationship concern had a more impact in predicting emotional divorce. Also, there was no statistically significant difference between women and men regarding infertility-related stress and its subscales, except for sexual concern.

CONCLUSION

The study highlights the importance of the need for parenthood as a main concern among infertile individuals. Increased infertility-related stress and its subscales contribute to higher levels of emotional divorce among this population. Additionally, relationship concern was the lowest concern in infertile people. But it significantly predicts emotional divorce among infertile individuals.

The role of men's forgiveness in marital satisfaction and coping strategies of infertile iranian women

BACKGROUND

Infertility and its related problems create tensions in infertile women, which may lead to reduced marital satisfaction and the use of ineffective coping strategies. Considering the important role of forgiveness, marital satisfaction and effective coping strategies in the quality of life of infertile couples, and taking into account the growing number of Iranian infertile couples, this study was conducted to determine the relationship between men's forgiveness, marital satisfaction, and coping strategies of infertile Iranian women.

METHODS

This cross-sectional study included 200 Iranian infertile couples. The research environment was the most equipped infertility center in the west of Iran. Sampling was continuous. Data collection tools used included a self-generated demographic and fertility questionnaire, the Family Forgiveness Scale (FFS), the Index of Marital Satisfaction (IMS), and the Ways of Coping Questionnaire-revised (WOCQ-R).

RESULTS

Husbands' forgiveness had a significant direct relationship with the marital satisfaction of infertile women (r = -0.27, p < 0.001). However, there was no significant correlation between Husbands' forgiveness, emotion-focused, and problem-focused coping of infertile women. Among the subscales of forgiveness, only the subscale of recognition had inversely correlated with the emotional coping of infertile women.

CONCLUSION

The results showed that the higher the forgiveness of husbands, the higher the marital satisfaction of infertile women. Also, with the increase of husbands' forgiveness in the recognition subscale, the use of emotion-focused coping decreased in infertile women. Based on the results with empowering the husbands of infertile women with forgiveness skills, it is possible to take a step towards marital satisfaction and thus improve the quality of life of infertile women.

The value of motherhood and psychological distress among infertile women: The mediating role of coping strategies

Introduction

The present study investigated psychological distress and coping strategies among infertile women during the COVID-19 pandemic using a multi-dimensional model of infertility-related stress. We explored the associations between individual (i.e., age) and situational characteristics related to infertility (i.e., duration of infertility, cause of infertility, number of lost pregnancies, and assisted reproductive techniques [ART] status), and perceived-infertility-related factors (i.e., the perceived importance of motherhood).

Methods

Our total sample consisted of 193 women aged 20 to 46 (M= 33.23, SD = 4.58), out of which 102 were undergoing ART procedures (M = 33.60, SD = 4.23), and 91 were not (M= 32.81, SD = 4.94). Participants filled in questionnaires measuring psychological distress, coping strategies, and the importance of motherhood.

Results

Correlation analyses suggested that the importance of motherhood was positively associated with psychological distress and negative coping strategies. Mediation analysis results indicated that both in the overall sample and in the sample of women undergoing ART procedures, the negative self-perception fully mediated the link between the importance of motherhood on psychological distress. In the non-ART sample, we found a significant mediation effect of denial on the link between the importance of motherhood and psychological distress.

Discussion

We discuss the theoretical and practical implications of the present findings, focusing on the mental health-related consequences of the social stigma of infertility heightened by the pressure of parenthood.

Marital satisfaction in Iranian infertile women: A systematic review and meta-analysis

Background

Infertility is a severe crisis in life that, in addition to creating psychological problems and disrupting a parent's identity and role, negatively impacts couples' marital satisfaction. Different studies in this field have reported different results, so this systematic review and meta-analysis was conducted to estimate the marital satisfaction standard score among infertile Iranian women.

Method

The databases of PubMed, Scopus, Web of Science, Embase, Scientific Information Database, and MagIran were searched without a time limit. We used the meta-analysis and a random-effects model to estimate the marital satisfaction pooled score. The heterogeneity of studies was examined with the I ² index and Cochrane's Q test. The correlation between the pooled score with the publication year and the mean age of women was evaluated using meta-regression. We assessed the publication bias by the Egger test.

Results

Seventeen studies with a sample size of 2,421 people were analyzed. The marital satisfaction pooled score of infertile women was 49% (95% CI: 39-60%). The marital satisfaction score in region 1 of the country (54, 95% CI: 42.7-65.3%) was higher than in other regions (45, 95% CI: 40-58%). Also, the marital satisfaction pooled score based on the Enrich scale (54, 95% CI: 39-69%) was higher than the score reported on other scales (45, 95% CI: 29-61%). Publication bias was not significant.

Conclusion

Infertile women have moderate to low marital satisfaction, rooted in the culture and context of Iranian society. It seems necessary to provide measures to strengthen marital satisfaction, strengthen family relationships and prevent family disintegration in these women.

The Infertility-Related Stress Scale: Validation of a Brazilian-Portuguese Version and Measurement Invariance Across Brazil and Italy

Infertility constitutes an essential source of stress in the individual and couple's life. The Infertility-Related Stress Scale (IRSS) is of clinical interest for exploring infertility-related stress affecting the intrapersonal and interpersonal domains of infertile individuals' lives. In the present study, the IRSS was translated into Brazilian-Portuguese, and its factor structure, reliability, and relations to sociodemographic and infertility-related characteristics and depression were examined. A sample of 553 Brazilian infertile individuals (54.2% female, mean aged 36 ± 6 years) completed the Brazilian-Portuguese IRSS (IRSS-BP), and a subsample of 222 participants also completed the BDI-II. A sample of 526 Italian infertile individuals (54.2% female, mean aged 38 ± 6 years) was used to test for the IRSS measurement invariance across Brazil and Italy. Results of exploratory structural equation modeling (ESEM) indicated that a bifactor solution best represented the structure underlying the IRSS-BP. Both the general and the two specific intrapersonal and interpersonal IRSS-BP factors showed satisfactory levels of composite reliability. The bifactor ESEM solution replicated well across countries. As evidence of relations to other variables, female gender, a longer duration of infertility, and higher depression were associated with higher scores in global and domain-specific infertility-related stress. The findings offer initial evidence of validity and reliability of the IRSS-BP, which could be used by fertility clinic staff to rapidly identify patients who need support to deal with the stressful impact of infertility in the intrapersonal and interpersonal life domains, as recommended by international guidelines for routine psychosocial care in infertility settings.

Assessment of Impact of Infertility & its Treatment on Quality of Life of Infertile Couples using Fertility Quality of Life Questionnaire

Background:

With rising trends of infertility in India, it is no longer just a medical concern, but is rapidly becoming a public health issue due to its social and interpersonal ramifications. Limited data is available regarding quality of life of the infertile couples.

Aim:

The aim of this study was to understand the quality of life (QOL) of Indian infertile couples using the fertility QOL (FertiQoL) tool and to find the correlation between the values of the core and treatment FertiQoL and various sociodemographic and clinical factors.

Study Setting and Design:

This cross-sectional study was conducted at fertility clinic at an urban tertiary care center.

Materials and Methods:

Over a period of 12 months, 274 completed questionnaires obtained from 137 couples were selected for the analysis. Demographic and clinical characteristics of all the patients were recorded. Data analysis was performed using the Statistical Package for the Social Sciences software version 25:0. IBM Chicago, USA.

Results:

Women had worse QOL than their male partners. They scored lower than men on emotional and mind body subscales. Women showed positive and uniform trend in mean scores of all core FertiQoL subscales with age and education. Rural population had poorer QOL. Patients with primary infertility had poorer QOL except in the relational domain. Couples, in whom both partners had some pathology, had the worse QOL compared to female factor, male factor or unexplained infertility.

Conclusion:

Our study is a step in the direction to establish the baseline QOL objectively in Indian couples with infertility.

The prevalence of depression symptoms among infertile women: a systematic review and meta-analysis

BACKGROUND

Infertile women's mental health problems, including depression, are key fertility health issues that affect infertile women more severely than infertile men. Depression may threaten the health of individuals and reduce the quality of their lives. Considering the role and impact of depression on responses to infertility treatments, a systematic review and meta-analysis were conducted to investigate the prevalence of depression symptoms among infertile women.

METHODS

International databases (PubMed, Cochrane Library, Web of Sciences, Scopus, Embase, and PsycINFO), national databases (SID and Magiran), and Google Scholar were searched by two independent reviewers for articles published from 2000 to April 5, 2020. The search procedure was performed in both Persian and English using keywords such as "depression," "disorders," "infertility," "prevalence," and "epidemiology." The articles were evaluated in terms of their titles, abstracts, and full texts. The reviewers evaluated the quality of the articles using the Newcastle-Ottawa Scale, after which they analyzed the findings using STATA version 14. The I² and Egger's tests were performed to examine heterogeneity and publication bias, respectively.

RESULTS

Thirty-two articles were subjected to the meta-analysis, and a random effects model was used in the examination given the heterogeneity of the articles. The samples in the reviewed studies encompassed a total of 9679 infertile women. The lowest and highest pooled prevalence rates were 21.01% (95% confidence interval [CI]: 15.61-34.42), as determined using the Hospital Anxiety and Depression Scale, and 52.21% (95% CI: 43.51-60.91), as ascertained using the Beck Depression Inventory, respectively. The pooled prevalence values of depression among infertile women were 44.32% (95% CI: 35.65-52.99) in low- and middle-income countries and 28.03% (95% CI: 19.61-36.44) in high-income countries.

CONCLUSION

The prevalence of depression among infertile women was higher than that among the general population of a given country. Especially in low- and middle-income countries, appropriate measures, planning, and policy that target the negative effects of depression on infertile women's lives should be established to reduce related problems.

Partner's emotional reaction to pregnancy mediates the relationship between pregnancy planning and prenatal mental health

Background

An unplanned pregnancy may be followed by increased depression and anxiety. The aim of the present study was to evaluate the mediating role of partner’s emotional reaction to pregnancy (PERP) on the relationship between pregnancy planning and prenatal mental health.

Methods

This cross-sectional study was conducted on 303 healthy Iranian pregnant women during their third trimester. The levels of depression and anxiety were measured using the Edinburgh Postnatal Depression Scale and the State-Trait Anxiety Inventory. The PERP score was also measured using a researcher-made questionnaire. The data were analyzed using the plug-in application PROCESS macro.

Results

The results showed that PERP score was reversely related to pregnancy planning and prenatal depression and anxiety. The direct effect of the pregnancy planning on depression (c = −.05) and anxiety levels (c = −.02) were not significant; but the indirect effect of pregnancy planning on depression (Point Estimate = −.379, CI: −.523 to −.250) and anxiety levels (Point Estimate = −.560, CI: −.741 to −.385) with the mediating role of PERP were significant.

Conclusions

The results indicated that the effect of pregnancy planning on prenatal mental health is mediated by PERP, and in unplanned pregnancy women need to receive positive reaction of their partners toward pregnancy so that they can preserve their mental health.

Sexual Self-Concept in Fertile and Infertile Women: A Comparative Study

Background

Sexual self-concept has a considerable impact on mental and sexual health. However, the relationship between sexual self-concept and infertility is unknown. This study aimed to compare sexual self-concept between fertile and infertile women.

Materials and Methods

This cross-sectional study was conducted on a sample of 250 fertile and 250 infertile women who had referred to 9 health centers affiliated to Medical universities in Tehran and Royan infertility treatment clinics in Tehran, Iran in 2017. Sexual self-concept was measured using the Multidimensional Sexual Self-Concept Questionnaire (MSSCQ) consisting of 20 subscales. Analysis of covariance (ANCOVA) was performed to compare sexual self-concept between the two groups.

Results

The mean age of fertile and infertile women was 34 ± 5.62 and 29.74 ± 5.29 years, respectively. The high- est score in both groups was for the sexual self-schemata subscale (mean score for fertile=3.21 ± 0.68 and for infer- tile=3.42 ± 0.62). The lowest score was for sexual-depression subscale (mean score for fertile=0.59 ± 0.81 and for infertile=0.61 ± 0.76). After adjustment for the age of each subject, the husband's age, duration of marriage, and wom- en’s education, we analyzed the sexual-satisfaction, the power-other sexual control, and the fear-of-sex subscales, which were found to be significantly lower in infertile women (P<0.05). No other significant differences between the fertile and infertile groups were observed.

Conclusion

We observed significant differences between fertile and infertile women in terms of sexual-satisfaction, the power-other sexual control, and the fear-of-sex, but not in other sexual self-concept subscales. These findings sug- gest that there is need to improve sexual self-concept among both fertile and infertile women. Indeed implementation of educational and counseling programs by reproductive health specialists might play an important role in enhancing sexual self-concept among these populations.

Quality of life among infertile women living in a paradox of concerns and dealing strategies: A qualitative study

Aim

The current work investigated the issues that cause apprehension in infertile women, the effects of this disquiet on their quality of life and the strategies that they adopt in dealing with their concerns.

Design

The qualitative research.

Method

This qualitative research sampled participants from a training centre in Mazandaran University of Medical Sciences and a privately owned infertility centre in Mazandaran Province, north of Iran. Purposive sampling continued until data saturation was reached. We conducted a conventional content analysis of the responses of 30 individuals (15 women with female infertility and 15 key informants) to in-depth and semi-structured in-person interviews on May to November 2019 .

Results

The results uncovered two themes subsuming four categories of issues: The first theme revolves around "infertility concerns," under which "concerns" and "the difficulty and vagueness of treatment" belonged. The second theme was "dealing with infertility," which covered "adaptive strategies" and "inhibitors of reconciliation with perceived infertility."

The relationship between gender perception levels and infertility distress of infertile women in a university hospital, Turkey

Purpose

This study was conducted to analyze the correlation between gender perception and infertility distress of infertile women.

Design/methodology/approach

This was a descriptive-analytical study conducted with 255 women receiving treatment in the in vitro fertilization unit of a medical faculty hospital in Turkey. Study data were collected using sociodemographic questions as well as the Perception of Gender Scale (PGS) and the Infertility Distress Scale (IDS).

Findings

It was found that the PGS mean score was 69.65 and the IDS mean score was 53.1. It was determined that there was a negative, moderate and significant correlation between gender perception and infertility distress levels of women in the infertility treatment process (r = −0.263, p < 0.001).

Originality/value

As a result of the study, a negative, moderate, significant correlation was detected between gender perception and infertility distress.

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.

Infertility policy analysis: a comparative study of selected lower middle- middle- and high-income countries

BACKGROUND

Infertility has recently become a salient but neglected global issue. Policies to address the sexual and reproductive health and rights (SRHR) are vital, especially in lower middle and middle-income countries (LMICs). Hence, the aim of this study was to compare the national infertility policies in the selected countries (LMICs comparing with high-income) to determine gaps or to confirm desirable policies in the given health systems.

METHODS

This study has executed a comparative policy analysis of infertility services using the universal health coverage framework (financial protection, population coverage, and service features) in three scopes (prevention, treatment, and supportive care). Seven countries that had infertility programs in their health sectors were selected.

RESULTS

The results showed that financial protection was good in high and middle-income countries, but in a lower middle income, and in one high-income country was poor. The findings also showed that health systems in the same countries had no infertility services for men. Preventive and supportive care services were neglected in LMICs by governments.

CONCLUSION

The findings indicate that income is not the only factor that fulfills universal health coverage for infertility care services. Perhaps to achieve equity in infertility care services, it should be seen as a universal human right to accomplish the right to have a child and to have a life with physical and mental health for all men and women.

Development and psychometric evaluation of a quality of life questionnaire for infertile women: a mixed method study

Background

Infertility is one of the most important issues that negatively influences women’s quality of life, especially when the cause is associated with females. Given that no instruments have been designed to assess quality of life among infertile women with focus on female factors, this study was conducted to develop and evaluate the psychometric properties of a female-centric quality of life questionnaire for infertile women.

Method

This sequential exploratory study was conducted in two stages. First, the concept of quality of life and its dimensions as they relate to infertile women were elucidated through a qualitative inquiry accompanied with a content analysis. Accordingly, infertile women and key informants from a teaching hospital affiliated with the Mazandaran University of Medical Sciences and a private center for infertility treatment in Sari (north of Iran) were screened through purposive sampling until data saturation. Those who satisfied the inclusion criteria and exhibited maximum variance in terms of age, educational level, employment status, infertility duration, treatment type, and social class were recruited. The conventional content analysis was carried out in accordance with the steps proposed by Graneheim and Lundman, and the accuracy and robustness of the data were verified using Lincoln and Guba’s criteria (credibility, transferability, dependability, confirmability and authenticity). Second, the psychometric properties of the instrument developed in the qualitative stage were evaluated using a quantitative method and on the basis of the results of a literature review. The content, face, and construct validity of the instrument was determined, and its test–retest reliability and stability were ascertained using internal correlation and Cronbach’s alpha. The collected data were entered into the Statistical Package for the Social Sciences (version 22) for analysis, and descriptive statistics were calculated.

Discussion

Developing and evaluating the psychometric properties of a valid and reliable female factor-centric instrument that measures quality of life among infertile women will be very useful in the assessment of their future status.

Level of depression, anxiety and stress in patients with intrauterine adhesions in Hunan Province, China: A cross-sectional study

Background

The incidence of intrauterine adhesions has been increasing in recent years, seriously affecting women’s health. This study aimed to investigate the psychological status and identify risk factors associated with high psychological distress in patients with intrauterine adhesions.

Methods

A cross-sectional study was conducted in Hunan Province, China. A total of 258 patients who presented with intrauterine adhesions between February and May 2018 were included. Data were collected by a questionnaire packet that included the Depression Anxiety Stress Scale, the Medical Coping Mode Questionnaire, and demographic and clinical information. Descriptive statistics, t-tests, one-way ANOVA, Pearson’s correlations and multiple linear stepwise regression were employed in this study.

Results

Among 258 participants, the detection rates of mild depression and moderate to extremely severe depression were 10.1% and 10.5%, respectively; the detection rates of mild anxiety and moderate to extremely severe anxiety were 11.2% and 20.2%, respectively; the detection rates of mild stress and moderate to extremely severe stress were 9.3% and 10.2%, respectively. Avoidance and resignation coping were positively correlated with the overall scores of general distress which represents the total scores of the Depression Anxiety Stress Scale (r = 0.171, 0.475, P < 0.01). Multiple linear stepwise regression results showed that husband-wife relationships and avoidance and resignation coping strategies were the main factors predicting general distress levels.

Conclusions

Patients with intrauterine adhesions have psychological distress in a certain extent. Target interventions should be taken to improve the mental health level of patients.

Analysis and exploration of infertility policies in Iran: a study protocol

BACKGROUND

Infertility is a complex and neglected reproductive health issue of global proportions, with varying effects on couples and their relationships. Therefore, international organisations and several countries have been compelled to consider infertility policies. In recent years, a shift in population policy trends toward increasing birth rates in Iran have set infertility policies in the health sector's agenda. Since infertility and its associated problems are multifactorial, all health systems, including that of Iran, need to have a comprehensive policy package that covers all of its dimensions. Policy analysis is necessary to formulate such policies. This project will therefore analyse the infertility policies in Iran's health sector and clarify the multilateral effects of their different components.

METHODS

This multidisciplinary study outlines the conceptual framework of infertility policies and consists of three stages. Stage I will involve the review of infertility policies in selected countries and Iran for the operational model of infertility programmes, rules and policies. Stage II will consist of a documentary infertility policy analysis of Iran. At this stage, Iran's infertility policies will be analysed using the Walt and Gilson framework in four areas, namely content, context, process and actors. Stage III will involve the analysis of infertility policies in Iran. At this stage, a qualitative study will be conducted to understand and provide in-depth explanations of the existing policies. Finally, the concepts and outcomes obtained from the first stage will be combined with the content of the qualitative analysis of the second and third stages for exploration of Iran's infertility policies, and a package including a framework for infertility policies will be proposed.

DISCUSSION

The findings of this study can be used by the Ministry of Health and public health policy-makers to determine which policies, in view of socio-cultural and economic contexts and actors' roles in each country, can be used to reach the goals defined by international organisations, on the prevention of infertility and reproductive health.

Iranian infertile couples' strategies to manage social interactions after unsuccessful treatment with assisted reproductive technologies

Many infertile couples feel vulnerable after failed treatment cycles and find insensitive remarks or inappropriate support distressing. They fear that the stress of failed treatment cycles may affect their marriage and lead to marriage breakdown. This study explored the strategies a sample of infertile couples used to manage social interactions after unsuccessful treatment with assisted reproductive technologies. A descriptive qualitative study was conducted with 34 participants including nine infertile couples, nine infertile women and two infertile men with primary infertility, two relatives, and three fertility clinic staff. The participants were selected through purposive sampling at an infertility centre in Iran, between 2016 and 2017. Data were collected using semi-structured face-to-face interviews and analysed by qualitative content analysis approach. Participants found some social interactions after failed assisted reproductive treatment cycles to be distressing and painful. They described tolerating painful emotions which cause them sadness and sorrow as well as feeling embarrassed. As a result, they found they needed to maintain their adopting concealment strategies with their families through not permitting speculation, selective disclosure, not giving details and hiding the truth. This study showed that social interactions following failed assisted reproductive cycles can be upsetting for infertile couples. Couples use different strategies to manage potentially distressing social interactions. Healthcare providers and psychologists may provide a space for safe social interactions in order to help couples to use appropriate strategies in these circumstances.

Psychological empowerment strategies in infertile women: A systematic review

Infertility requires long-term care and treatments which would influence different aspects of health including the mental health of infertile women. The present study was conducted to determine strategies for psychological empowerment of infertile women. This systematic review was performed on previously conducted clinical trials. To achieve the intended studies, databases of Magiran, Scientific Information Database, Google Scholar, Scopus, PubMed, ProQuest, ScienceDirect, and Web of Science and also Iranian Registry of Clinical Trials website were searched using "infertility and infertile women" as the keywords. The inclusion criteria were being an interventional study and assessing the psychological status of infertile women. Performed studies in Iran with no time limitations were evaluated. Based on the Jadad criteria, studies with a score of 3 or more were enrolled in the systematic review. After assessing the quality of the studies, 21 studies were enrolled in the review for final evaluation. Reviewing the conducted studies showed that educational and counseling interventions could be effective in improving the aspects of psychological well-being of infertile women. Existing evidence revealed that applying coping strategies is effective in improving the quality of life in infertile women, which consequently lead to the improvement of psychological empowerment of infertile women.

The Effect of Stress Management Based on Group Cognitive-Behavioural Therapy on Marital Satisfaction in Infertile Women

INTRODUCTION

In the developed world, infertility is on rise and has become a social concern. This is considered as a serious stress in life and exerts a severe psychological impact on the couple.

AIM

This study was conducted to study the efficacy of stress management based on group cognitive-behavioural therapy on marital satisfaction in infertile women.

MATERIALS AND METHODS

This was a quasi-experimental study with a pretest-post-test design and control group. The study sample consisted of 40 infertile women enrolled based on convenience sampling and randomly assigned to two groups: experimental and control, of 20 each. Then, the experimental group underwent 10 two-hour stress management sessions per cognitive-behavioural therapy. The instruments used in this study were marital satisfaction inventory ENRICH and a checklist of demographic characteristics. Immediately and three months after completion of the intervention, the instruments were administered to the participants. The data was analysed by analysis of covariance in SPSS 18.

RESULTS

There was a significant difference in marital satisfaction between the experimental and control groups in both post-test (p=0.001) and follow-up (p=0.001).

CONCLUSION

The stress management based on cognitive-behavioural therapy could contribute to increasing marital satisfaction in infertile women. The effect could remain stable three months after the last interventions (follow-up).