Social Consequences of Infertility on Families in Iran

Determining the Cultural Care Needs of Infertile Couples in Turkey: A Qualitative Study Guided by the Cultural Competence Model

The cultural competence model is an ethnographic model created to improve the cultural understanding of people's status in the context of health, health promotion and illness. This study aimed to use the Purnell Model for Cultural Competence for determining the cultural care needs of couples undergoing infertility treatment. This study with a qualitative design was conducted at a private in vitro fertilization center in eastern Turkey. The sample of the study consisted of 10 infertile couples with unexplained infertility problems (n = 20). The 12 cultural domains were used as a basis in determining the cultural care needs of the infertile couples, and these domains formed the themes. Data were collected using the method of interpretative phenomenological analysis. The emotions defined in the "spirituality" theme were "seeing it as destiny or seeing it as a test to be passed in terms of religion" and "visiting holy tombs, applying to faith healers and making vows." The first three emotions that came to the fore in the "pregnancy and childbearing" theme were "feelings of deficiency/illness/stigmatization," "deterioration in body image" and "unsatisfactory inability to feel love for own child." In the "healthcare practitioners" theme, it was determined that compliance with treatment was partially sufficient, but the religious-cultural influence was high.

The efficacy of cognitive behavioural therapy on stress, anxiety and depression of infertile couples: a systematic review and meta-analysis

Infertility is considered globally to be a stressful and hard experience that affects the couples psychologically, socially and individually. The aim of this study was to systematically review the effectiveness of cognitive behavioural therapy (CBT) on depression, stress and anxiety in infertile couples. In this systematic review and meta-analysis, databases were searched up to August 2019. Twelve articles were included in the meta-analysis and analysed with Comprehensive Meta-Analysis (CMA) v2. The results of pooled studies showed that the mean scores for depression and anxiety decreased in patients receiving CBT as compared to the control group. The results of three pooled studies showed no significant difference on stress in patients receiving CBT as compared to the control group. The findings of this study provides valuable suggestions for improving mental health status through applying CBT to manage anxiety and depression in infertile couples.

Relationship between coping/attachment styles and infertility-specific distress in Iranian infertile individuals: A cross-sectional study

BACKGROUND

Infertility has been recognized as a stressful clinical condition, significantly affecting couples' emotional functioning.

OBJECTIVE

To investigate the relationship between coping/attachment styles and infertility-specific distress (ISD) in infertile participants.

MATERIALS AND METHODS

Atotal number of 240 infertile participants (120 women and 120 men) who attend the Outpatient Infertility Clinic in Sari, Iran between February and October 2017 were selected using the convenience sampling method. Data were collected using a questionnaire addressing sociodemographic variables. In addition, coping and attachment styles were evaluated via the Coping Strategies Questionnaire and the Revised Adult Attachment Scale by Collins and Read (1990); respectively. Ultimately, the Infertility Distress Scale was used to assess ISD.

RESULTS

The mean ISD score was 42.53 ± 9.63. Secure and insecure attachment styles were observed in 37.9% and 62.1% of the cases, respectively. There was a significant difference among ISD and different groups of attachment styles (p = 0.001) and emotion-focused coping style (p = 0.021). However, no significant relationship was found between problem-focused coping style and ISD (p = 0.985).

CONCLUSION

Considering the relationship between coping/attachment styles and ISD, it was recommended to implement stress prevention and coping education within the framework of coping/attachment theories for infertile individuals.

Infertility within the Lebanese population: beliefs and realities

Background

Infertility affects almost one in five couples but is still poorly understood by the general public. Although the socio-cultural aspect of infertility has already been covered in some countries, there is currently no study concerning the Lebanese population’s view on this topic. This study aims to examine the knowledge and perception of the Lebanese population regarding infertility. The findings of this study could inform the creation of appropriate awareness campaigns aiming to rectify existing ideas based on myths and Lebanese folklore and establish a scientific understanding of infertility.

Results

Six hundred and nine participants were interviewed, and the responses recorded were statistically significant and correlated with p values < 0.05 with the participants’ personal data, in particular their gender and academic level. Men were twice as likely as women to believe that couple infertility is a valid reason for a divorce or a second marriage. In addition, most men said that they would first consult a gynecologist in the event of couple infertility, which highlights the fact that the general population assumes the cause of infertility is of female origin, even though both sexes are frequently affected. In addition, men are twice as likely as women to refuse to live with an infertile spouse and the most educated respondents tend to be more aware and open to the idea of adopting a child or to use in vitro fertilization.

Conclusion

This study is the first to examine the socio-cultural beliefs and habits regarding infertility in Lebanon, with a focus on society’s attribution of infertility to women. More studies are needed to understand how a personal experience of infertility can affect one’s understanding and perceptions regarding infertility. Furthermore, Lebanese physicians should adopt a more multidisciplinary approach when managing couple infertility.

Mini-Review on the Possible Interconnections between the Gut-Brain Axis and the Infertility-Related Neuropsychiatric Comorbidities

Both the gut-brain axis (GBA) and the hypothalamic–pituitary–adrenal (HPA) axis remain an intriguing yet obscure network with a strong influence over other systems of organs. Recent reports have sought to describe the multitude of harmful stressors that may impact the HPA axis along with the interconnections between these. This has improved our knowledge of how the underlying mechanisms working to establish homeostasis are affected. A disruption to the HPA axis can amplify the chances of gastrointestinal deficiencies, whilst also increasing the risk of a wide spectrum of neuropsychiatric disorders. Thus, the influence of microorganisms found throughout the digestive tract possess the ability to affect both physiology and behaviour by triggering responses, which may be unfavourable. This is sometimes the case in of infertility. Numerous supplements have been formulated with the intention of rebalancing the gut microflora. Accordingly, the gut flora may alter the pharmacokinetics of drugs used as part of fertility treatments, potentially exacerbating the predisposition for various neurological disorders, regardless of the age and gender.

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.

Discrepancy in perception of infertility and attitude towards treatment options: Indonesian urban and rural area

Background

In Indonesia infertility affects 10–15% of reproductive-age couples. In addition to medical problem, infertility in Indonesia poses significant social problem. Childlessness is often stigmatized as a failure which victimizes couples, moreover the females. Despite the high prevalence, there is no fertility awareness education which further passes down the common myth, misperception, and negative attitude towards infertility treatment in Indonesian society.

Objective

This study aims to reveal the knowledge, myth, and attitude towards infertility, likewise acceptance towards infertility treatment options.

Method

Cross-sectional study using standardized questionnaire was done to 272 individuals consisted of two parallel groups: Jakarta and Sumba representing urban and rural population respectively. Participants were all outpatients above 18 years old who visited the healthcare centers from February 2017 to June 2017.

Results

Knowledge on biological and lifestyle risk factors of infertility among Jakarta and Sumba groups were comparable. However, belief in supernatural causes of infertility is remarkable in Sumba population. There is a common misconception on the use of contraception as risk factors of infertility in both groups.

Half respondents from both groups think infertility is a disease. In Jakarta 93.4% respondents consider both female and male should be investigated for infertility; in Sumba only 55.4% agree while 33.1% consider only female should be investigated. Infertility is an acceptable reason for polygamy for 41.3% respondents in Sumba, with 34.7% blaming maternal side for childlessness.

Most respondents from both groups accept the use of Assisted Reproductive Technology and fertility enhancing drugs as treatment options.

Conclusion

Lack of understanding, misleading myths, and negative attitude towards infertility have been illustrated in the sample population.

The Effect of Cognitive Behavioral Therapy on Sexual Function in Infertile Women: A Randomized Controlled Clinical Trial

Infertility and its consequences can have effects on various aspects of a couple's life and also in their marital relationships. This study aimed to investigate the effect of cognitive behavioral therapy (CBT) on sexual function in infertile women. The participants included 52 infertile women randomly assigned to intervention and control groups. A group-based, six-session sexual counseling using a CBT approach was also performed for the intervention group. Sexual functions of the participants in both groups were then assessed via the Female Sexual Function Index (FSFI) at three points in time. The findings revealed no statistically significant difference in the baseline FSFI mean scores of both groups. A significant difference was also reported for FSFI mean scores in the intervention group (29.35 ± 2.71) in comparison with those in the control group (25.84 ± 2.52) (p < 0.001) one month after intervention, with an effect size of 0.32. The mean scores of all the sexual-function domains, including sexual desire (p < 0.001), arousal (p < 0.001), lubrication (p < 0.001), orgasm (p < 0.001), satisfaction (p < 0.001), and pain (p < 0.001), among the participants in the intervention group had also significantly increased following CBT implementation. The results of this study could be used to promote sexual health in infertile women.

Uterine size and volume are associated with a higher clinical pregnancy rate in patients undergoing assisted reproduction technology: A longitudinal study (A STROBE-compliant article)

The aim of this study was to investigate the relationships between uterine size and volume and clinical pregnancy rate.This longitudinal study was conducted among patients undergoing assisted reproduction technology (ART) treatment at the Reproductive Medicine Center from January 2010 to May 2017, all of whom provided informed consent to participate in the study. The uterine size, for all patients, was measured by transvaginal ultrasonography before ovarian stimulation. Clinical pregnancy was diagnosed by ultrasound confirmation of at least an intrauterine gestational sac and fetal cardiac activity 4 weeks after embryo transfer.A total of 11,924 patients were enrolled in this study. Compared to patients with uterine lengths of 50 to 59 mm (referent), patients with uterine lengths ≥60 mm had a lower clinical pregnancy rate. Compared to patients with uterine widths of 30 to 39 mm (referent), patients with uterine widths of 40 to 49 mm and those with uterine widths of ≥50 mm had a lower clinical pregnancy rate. Compared with those with a uterine anteroposterior diameter of <30 mm (referent), patients with uterine anteroposterior diameters of ≥50 mm had a lower clinical pregnancy rate. Compared with those with a uterine volume of 30 to 49 mL (referent), patients with a uterine volume ≥70 mL had a lower clinical pregnancy rate.The patients with an optimal uterine length, width, anteroposterior diameter, and volume had a higher clinical pregnancy rate than those with suboptimal uterine measurements. Uterine sizes and volumes that were too large reduced the clinical pregnancy rate.

Fertility testing for men before marriage: Is it acceptable?

Addressing male infertility issue before marriage, at least to the mate and her family, seems reasonable to avoid several psychosocial, economic and biological consequences. Here, we intended to comprehend whether fertility testing (i.e. semen analysis) for men before marriage is acceptable and can be applied in Jordanian society. To achieve this contribution, we designed a questionnaire that shows the opinion of a sample of the Jordanian population in applying fertility testing for men before marriage. A total of 740 adult individuals (>18 years old, 364 males, 382 females) were selected randomly from different martial, economic, social, ethnic, religious and education statuses to fill the questionnaire. A total of 523 (70.11%) participants had a positive attitude towards applying fertility testing for men before marriage. This opinion was found not to be affected by gender (p = 0.305), age (p = 0.329), body mass index (p = 0.061), smoking (p = 0.059), monthly income (p = 0.094), education level (p = 0.131) and family members with infertility (p = 0.074); while, it is found to be affected by the social status of the participant (p = 0.004). In conclusion, applying fertility testing for men before marriage appears to be acceptable in Jordanian society.

Uterine dimensions in gravida 0 phase according to age, body mass index, and height in Chinese infertile women

The aim of this study was to describe the size and the shape of gravida-0 uteri in infertile Chinese Han women according to age, height, and body mass index (BMI).Registered data obtained from the Department of Reproductive Medicine, Xiangya Hospital of Central South University, were collected and analyzed. The length, width, and anteroposterior diameter of the uteri of nonpregnant women aged 20 to 45 years were measured by transvaginal ultrasonography. Statistical analyses among different populations were conducted using a 1-way analysis of variance analysis or a Kruskal-Wallis H test.A total of 5726 primary infertile women were enrolled. The mean age of the sample group was 29.18 ± 4.22 years, and the mean BMI and the mean height of them were 21.51 ± 2.91 kg/m and 158.13 ± 4.71 cm, respectively. The mean uterine length, width, anteroposterior diameter, and L/W ratio were 49.33 ± 7.00 mm, 39.94 ± 7.23 mm, 44.95 ± 8.11 mm, and 1.2662 ± 0.2465, respectively. There were a statistically significant positive correlations between uterine length, width, anteroposterior diameter, and age in infertile women (all P < .001). Uterine L/W ratio gradually decreased with age, which was statistically significant (P < .001). The correlations between uterine length, width, anteroposterior diameter, and height were also considered statistically significant (all P < .001), while there was no correlation between L/W ratio and height. The results showed that uterine size and BMI had no statistical significance.The uterine length, width, and anteroposterior diameter gradually increased with increased age and height, but the increasing extents was different, and the uterine shape became rounder with age and had not changed with height in primary infertile women.