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

Fertility in the Digital Age: A Survey-Based Evaluation of Fertility App Users' Quality of Life

This study sought to characterize fertility app use among women seen for infertility care and to investigate the association between fertility app use and quality of life. This survey-based study was conducted at an academic infertility clinic. Surveys were administered to patients who presented for a new infertility visit. One survey collected information regarding app use and the second survey was FertiQoL, an internationally validated instrument measuring quality of life in those with infertility. Descriptive statistics were used to characterize the patient population regarding app use and FertiQoL scores. Comparisons between those who did and didn't use an app were evaluated using t-tests and Cochran Armitage test for trend. 149 surveys were collected. Most (75.5%) participants reported using a fertility app. Most participants (85.1%) used a free app and nearly all (97.2%) found their app helpful. There was a significant difference (p = 0.0034) in satisfaction with one's quality of life between app users and non-app users with app users demonstrating higher satisfaction. There were no significant differences between app users and non-app users with their overall FertiQoL scores however there was a statistically significant difference (p = 0.031) in Relational sub-scores with app users displaying higher scores. While overall quality of life, measured by standardized measures, did not differ, self-perceived satisfaction with quality of life improved with more satisfaction reported in those using an app. This self-perceived satisfaction and increased quality of life surrounding relationships carries important implications, especially when one may face the stress of infertility and its treatment.

A multi-faceted exploration of unmet needs in the continuing improvement and development of fertility care amidst a pandemic

PURPOSE

The continuous improvement and development of fertility care, internationally, requires ongoing monitoring of current delivery processes and outcomes in clinical practice. This descriptive and exploratory mixed-methods study was conducted in eight countries (Brazil, China, France, Germany, Italy, Mexico, Spain and the United Kingdom) to assess the unmet needs of fertility patients (male and female), and existing challenges, barriers and educational gaps of physicians and laboratory specialists involved in human fertility care during the COVID-19 pandemic.

MATERIALS AND METHODS

The study was deployed sequentially in two phases: 1) in-depth 45-minute semi-structured interviews (n=76), transcribed, coded and thematically analysed using an inductive reasoning approach, 2) an online survey (n=303) informed by the findings of the qualitative interviews, face validated by experts in reproductive medicine, and analysed using descriptive and inferential statistical methods.

RESULTS

The integrated results of both phases indicated numerous areas of challenges, including: 1) investigating male-related infertility; 2) deciding appropriate treatment for men and selective use of assisted reproductive technology; and 3) maintaining access to high-quality fertility care during a pandemic.

CONCLUSIONS

The paper presents a reflective piece on knowledge and skills that warrant ongoing monitoring and improvement amongst reproductive medicine healthcare professionals amidst future pandemics and unanticipated health system disruptions. Moreover, these findings suggest that there is an additional need to better understand the required changes in policies and organizational processes that would facilitate access to andrology services for male infertility and specialized care, as needed.

Infertility-Related Stress, and Dyadic Coping as Predictors of Quality of Life: Gender Differences Among Couples with Infertility Issues

Background

The purpose of this study was to explore the relationship between infertility-related stress and dyadic coping with quality of life (QoL) in couples with infertility issues, and verify gender differences and dyadic interactions in the associations between them.

Methods

This cross-sectional study included 340 couples who were recruited from the First Affiliated Hospital of Lanzhou University between March 2022 and November 2022. The Fertility Problem Inventory, Dyadic Coping Inventory and FertiQoL were used to measure infertility-related stress, dyadic coping and QoL. The Actor-Partner Interdependence Model was used to analyze the effects of infertility-related stress and dyadic coping on the couple's own QoL (actor effect) as well as on their partner's QoL (partner effect).

Results

Female patients perceived significantly lower levels of QoL and dyadic coping than those of husbands. There was no statistically significant difference in the infertility-related stress between wives and husbands. Husbands' infertility-related stress had actor and partner effects on their own and their wives' QoL, while wives' infertility-related stress only had an actor effect on their own QoL. Husbands' dyadic coping had both actor effect and partner effects on their own and their wives' QoL, meanwhile wives' dyadic coping had both actor effect and partner effects on their own and their husbands' QoL.

Conclusion

Husbands' QoL was impacted by their own infertility-related stress, dyadic coping and their wives' dyadic coping. Whereas wives' QoL was influenced by infertility-related stress and dyadic coping from both their own and their spouses. Therefore, elevating the level of dyadic coping may contribute to improving QoL for both husbands and wives. Moreover, enhancing the ability to cope with infertility-related stress might be useful for husbands and indirectly contribute to wives' QoL.

Health-related quality of life and its associated factors among infertile women compared with fertile women in public hospital Addis Ababa, Ethiopia: a comparative cross-sectional study

BACKGROUND

Infertility can have detrimental physical, psychological, and social effects that significantly impact health-related quality of life. Although the impact of infertility on quality of life is well established, there is a lack of research comparing the quality of life between fertile and infertile women in Ethiopia.

METHODS

A hospital-based comparative cross-sectional study was conducted among 287 infertile and 301 fertile women. Participants were selected using systematic random sampling. A structured, validated tool was used to collect data. An independent sample t-test was conducted to determine if there was a difference in the study participants' quality of life domains and the mean total quality of life score. Multiple linear regressions were used to correlate quality of life scores with significant predictor factors for the infertile group.

RESULTS

Infertile women had a mean total Herbal of 66.54 ± 10.18, and fertile women (72.68 ± 7.57) were found to be statistically different between the groups. All domains except the physical domain were significantly different between the groups. Duration of marriage (β = -0.529), number of previous sexual partners (β = -0.410), total number of working hours per day (β = -0.345), types of infertility (β = -0.34), and history of the sexually transmitted disease (β = -0.277), in decreasing order of effect, were found to be associated with the quality of life of infertile women (R2 = 0.725).

CONCLUSIONS

The study found that infertile women had a lower mean HRQoL score compared to fertile women, with all domains except for the physical domain being significantly different between the two groups. This suggests that infertility can have a significant impact on various aspects of a woman's life, including her emotional well-being, social functioning, and psychological health. The factors associated with the quality of life of infertile women were the duration of marriage, the number of previous sexual partners, the total number of working hours per day, the types of infertility, and the history of sexually transmitted diseases, with duration of marriage having the strongest association. These findings highlight the need for healthcare providers to address the psychological and social aspects of infertility.

A Systematic Review and Meta-analysis of the Psychiatric Morbidities and Quality of Life Differences Between Men and Women in Infertile Couples

Infertility is often associated with diverse psychiatric morbidities and quality of life impairments. Hence, this meta-analysis aimed to compare stress, depression, anxiety and quality of life (QoL) among infertile men and women. We retrieved the relevant articles from multiple databases. For the statistical analyses, we used Comprehensive Meta-Analysis software v. 3.7 (Biostat Inc., Englewood, NJ). Standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated and displayed in forest plots. Among the 4123 articles identified, 35 studies met the inclusion criteria. Our results revealed that stress, depression, and anxiety were higher in infertile women compared to men. Similarly, infertile women presented a lower QoL than infertile men. Subgroup analysis revealed that the assessment tool used, study design, and geographical origin were a source of heterogeneity. This meta-analysis showed that psychological disturbances were higher in infertile women compared to men. Physicians need to consider this difference to enable couples to better understand and support each other.

Longitudinal study on sexual function and quality of life in infertile couples undergoing intrauterine insemination

BACKGROUND

Cross-sectional studies have shown that sexual dysfunction and poor quality of life were prevalent among couples undergoing assisted reproduction at specific time points, but nothing is known about how these outcomes change over the course of their intrauterine insemination (IUI) journey.

AIM

We investigated the longitudinal changes in sexual function and quality of life of infertile couples undergoing IUI.

METHODS

Sixty-six infertile couples completed an anonymous questionnaire at 3 time points: after IUI counseling (T1), 1 day before IUI (T2), and 2 weeks after IUI (T3). The questionnaire consisted of demographic data, Female Sexual Function Index (FSFI) or International Index of Erectile Function-5, and Fertility Quality of Life (FertiQoL).

OUTCOMES

Descriptive statistics, significance testing with the Friedman test, and post hoc analysis with the Wilcoxon signed rank test were used to compare changes in sexual function and quality of life at different time points.

RESULTS

Overall, 18 (26.1%), 16 (23.2%), and 12 (17.4%) women and 29 (42.0%), 37 (53.6%), and 31 (44.9%) men were at risk for sexual dysfunction at T1, T2, and T3, respectively. There were significant differences in mean FSFI scores in arousal (3.87, 4.06, 4.10) and orgasm (4.15, 4.24, 4.39) domains at T1, T2, and T3. After post hoc analysis, only the increase in mean orgasm FSFI scores between T1 and T3 was statistically significant. Men's FertiQoL scores remained high during IUI (74.33-75.63 out of 100). Men also scored significantly higher than women on all FertiQoL domains except environment at the 3 time points. Post hoc analysis showed significant improvement in women's FertiQoL domain scores between T1 and T2: mind-body, environment, treatment, and total. Women's FertiQoL score at T2 for the treatment domain was also significantly higher than that at T3.

CLINICAL IMPLICATIONS

Men should not be neglected during IUI as their erectile function got worse in the process, with half of the men being affected. Although women's quality of life showed some improvement during IUI, most of their scores were lower than men's.

STRENGTHS AND LIMITATIONS

The use of psychometrically validated questionnaires and a longitudinal approach are the major strengths; a small sample size and the lack of a dyadic approach are the major limitations.

CONCLUSION

During IUI, women's sexual performance and quality of life improved. The proportion of men having erectile problems was high for this age group, but men's FertiQoL scores remained good and were better than their partners' throughout IUI.

Psychiatric morbidity and quality of life in infertile females: a cross-sectional, case-controlled hospital-based study

Background

Infertility is a huge global problem with a significant mental health burden. Infertility could become a source of continuous stress leading to psychosocial issues including stress, anxiety, depression, and low self-esteem in these women. A cross-sectional, case-controlled study was conducted between January 2021 and November 2021 to study the effect of infertility on mental health and quality of life. A semi-structured questionnaire was used for sociodemographic and clinical variables. The Oslo Social Support Scale-3 and FertiQol were used to study social support and quality of life respectively. Psychiatric morbidity was assessed using ICD-10 symptom checklist. A total of 56 cases and 102 controls were studied.

Results

The mean age of cases and controls was 30.4 ± 3.5 years and 31.9 ± 2.9 years, respectively. Young infertile females, primary infertility, and female factor for infertility were associated with higher psychiatric morbidity. Psychiatric morbidity was seen in 46.4% of infertile women. FertiQoL score for the infertile group was 64.61 ± 5 with the lowest score in the emotional domain (45.10) and mind-body domain (54.86) (p < 0.0001). The scores in the relational domain and social domain were higher (85.2 and 73.3, respectively). The scores in the mind-body domain and emotional domain were poor among the infertile women regardless of the presence of psychiatric morbidity (48.27 vs 59.80 and 43.57 vs 46.57) (p < 0.0001–0.04).

Conclusions

Our study emphasizes the role of more qualitative instruments like FertiQoL in studying the well-being of infertile women. Even in the absence of psychiatric morbidity, the QoL score could still predict mental well-being in fertility-related issues.

Assessment of Quality of Life in Men Treated for Infertility in Poland

The aim of this study was to assess the quality of life (QoL) of men treated for infertility in Poland. This cross-sectional study was conducted using the Abbreviated World Health Organization Quality of Life questionnaire (WHOQoL-BREF), Fertility Quality of Life tool (FertiQoL) and an author-constructed questionnaire. The study included 1200 men treated for infertility without the use of assisted reproductive technology (non-ART), intrauterine insemination (IUI) and in vitro fertilization (IVF). The control group consisted of 100 healthy men with confirmed fertility. The quality of life assessed by the WHOQoL-BREF questionnaire was significantly lower in study groups in the Environmental domain, compared to the control group (p = 0.009). Statistically significant differences were found in the case of FertiQoL subscales: Emotional, Mind-Body, Relational, and Treatment Environment, depending on applied treatment. Men whose partners were treated without the use of ART assessed their QoL significantly more negatively than those treated with IUI. Reproductive problems and type of their treatment influenced the quality of life of the affected men. Non-ART treatment, rural place of residence, and increased BMI were associated with lower QoL.