| Abstract|| |
Background and Purpose: Infertility in most societies across the world is considered as a stain and shame which leads to the infertile couples suffering. It also affects all aspects of their quality of life (QOL). Most previous studies have concentrated on the effect of infertility on one of the spouses especially women while infertility affects QOL of both spouses. Thus, this study tries to analyze QOL and its aspects and the factors that may affect them. Methodology: This analytical-descriptive study examined 324 infertile couples (162 men and 162 women) who were referred to Kerman's Afzalipoor Infertility Treatment Center. The data were collected using demographic profile questionnaire, World Health Organization-QOL-BREF and Beck's Depression Inventory and results were analyzed using SPSS version 21. Descriptive statistical, paired t-test and multiple linear regression were used to analyze the data. Results: The results of this study showed that in general in infertile couples men enjoys a higher QOL which is significant statistically (P < 0.05). Regarding various aspects of the QOL, men gained higher scores in the two physical and mental aspects rather women, which is significant statistically (P < 0.05). However, there was no difference between men and women in terms of social relations and environmental health. In infertile men, there was a significant relationship between age and infertility period, and the general QOL score was P < 0.05. For women, there was a significant relationship between the level of education and treatment period and QOL (P < 0.05). Assessing intensity of depression scale indicated that women in contrast to men suffer from a higher level of depression as the average scores of depression in men and women were 10.24 and 15.1 respectively which was significant statistically (P < 0.001). Conclusions: This study made it clear that although infertility may affect women's general QOL rather men's when we pay attention to details, it will be clear that in some aspects men QOL is influenced by infertility as much as women's QOL. Hence, infertility would affect QOL of men and women equally. Although women are usually subject to the infertility treatments, treatment duration will affect QOL of both spouses.
Keywords: Depression, infertility, quality of life
|How to cite this article:|
Marzieh S, Nikvarz F, Zangiabadizadeh M. The quality of life and some effective factors on infertile couples. Ann Trop Med Public Health 2017;10:928-38
|How to cite this URL:|
Marzieh S, Nikvarz F, Zangiabadizadeh M. The quality of life and some effective factors on infertile couples. Ann Trop Med Public Health [serial online] 2017 [cited 2019 Sep 19];10:928-38. Available from: http://www.atmph.org/text.asp?2017/10/4/928/215867
| Introduction|| |
Infertility in most societies across the world is considered as a stain and shame which leads to the infertile couples to suffering. As the official figures show, about 5%–10% of the world's various populations suffer from infertility, but the fact is that it is due to women's increasing inclination to postpone their pregnancy. Although infertility is not a rare condition in societies, individuals with infertility feel lonely. In fact, infertility brings about a huge problem to people with infertility by creating stressful situations in their life. The World Health Organization (WHO) believes that although infertility is not considered as a disease, it can develop several emotional and social disorders with consequences. It can affect various aspects of life such as social, occupational, and even sexual aspects of life. It can also affect the couples' relations and impose many mental pressures on them. Some studies have shown that infertility results in intensive stress and reduction in love among the infertile couples. Many people in such situation sometimes reconsiders their relations. Chachamovich et al. suggested that infertile couples experience more stress and tension in their relations with their spouses. The results of various studies showed that infertility is accompanied by a lack of sexual desire and marital dissatisfaction, stress, anxiety, and depression in the infertile couples. Infertility challenges people's feelings and their social values and can lead to sense of failure, sin, and shame. Several studies suggested that depression is the most common response of people to infertility. Infertility makes people weak and hence depressed. Sargolzaie showed that infertility reduces intimacy in people and women in contrast to men suffer more from its negative consequences. As some studies showed since women are subject to most infertility tests and treatment while in most culture, childbearing is a womanly duty, so women experience more stress than men., Studies showed that life satisfaction declines when infertility is diagnosed, and treatment started. However, on the other hand, studies have shown that more men experience psychological disorders than women.,, In general, mental pressures caused by infertility both in men and women are always accompanied with reduced quality of life (QOL) in all aspects. QOL is one of the most important components of health which has been considered in recent years considerably. QOL is a mental concept which deals with the positive and negative aspects of someone's life from his/her perspective. In fact, QOL is a perception one may have about his life and other personal life aspects and is a sort of reaction he/she may show in a certain condition. Although there is not any consensus about the definition of QOL, WHO has offered a definition which is recognized by various entities: QOL is an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns. Infertility will result in lower QOL for infertile people through developing mental and social stress, decreasing life satisfaction, and increasing marital problems. Many studies have been conducted about the analysis of QOL in infertile people but most of them have focused on QOL in one of the spouses especially women, and there are few and rare studies which have considered QOL in both spouses as a unit. Analyzing the relationships between infertile people and their QOL will help us to examine couples' differences in terms of how they face the issue of infertility. Studies showed that the less the spouses are matched the less the satisfaction of marriage would be. On the other hand, higher match between QOL scores has been associated with less stress and better ability to manage stressful conditions. Thus, this study tried to analyze QOL and its aspects and the factors that may affect them.
| Methodology|| |
Our study was an analytical-descriptive study. The population of this study included all infertile couples who have referred been to Kerman's Afzalipour Infertility Treatment Center from May 22 to September 22, 2012. According to the previous studies, sample size was 162 couples. After being informed about the objective of the study and signing the content form, the samples were selected using simple (available) sampling method. The inclusion criteria were: (1) monogamy; (2) lack of any fertility background; (3) lack of any drug addiction experience or chronic diseases such as diabetes; and (4) ability of reading and writing.
Couples were asked to fill WHOQOL-BREF questionnaire, demographic profile survey, and Beck's Depression Inventory separately. The demographic profile survey was used to collect gender, age, duration of the marriage, duration of infertility, duration of treatment, and cause of infertility.
WHOQOL-BREF questionnaire includes 26 questions which assesses people's life of quality through four areas: physical health, mental health, social relations and environmental health. These areas include 7, 6, 3, and 8 questions, respectively. Two first questions are not covered by any area and they analyze the general health condition and general QOL of people from their own perspective. This questionnaire is scaled with a five-degree Likert scale: completely agree, agree, no idea, disagree, and completely disagree. After performing necessary calculations and comparing the results with the table, a score between 4 and 20 will be calculated for each area in which 4 shows the worst and 20 indicates the best QOL. Translation and validity assessment of this questionnaire was been conducted by Dr. Nejat in 2006 in Iran. Beck's Depression Inventory was used to assess the intensity of depression. The inventory includes 21 items; 0–10 score show lack of depression; 11–18 scores represent mild depression; 19–29 scores reflect moderate depression; and >30 scores show severe depression.
SPSS version 19 (IBM Corporation) was used to analyze data and data were assessed using descriptive statistics, t-test with independent samples, t-test and multiple regression.
| Results|| |
In this study, 324 infertile men and women (162 couples) were analyzed in terms of QOL and intensity of depression. The average ages of women and men were 28.3-year-old and 32.7-year-old, respectively. As the results showed the average duration of infertility in this population was 4.7 years, and the average duration of marriage was found 5.8 years.
The average duration of infertility was found 2.7 years. The most common cause of infertility in the assessed samples was feminine cause (41.5%) while only 32.6% of causes had a masculine origin. [Table 1] summarizes other demographic features of the groups studied here. [Table 2] summarizes scores of QOL of couples. In general, men's QOL was better than women's, and there was a significant difference between them (P < 0.05). The total QOL in WHQ-QOL was assessed with Likert Scale. Among various areas of QOL, the significant difference was seen only in two physical and mental areas (P < 0.001). [Table 3] using multiple regression test examines the effect of score of depression on the couple's QOL and indicates that in physical and mental areas there is a significant relationship between depression and QOL for both men and women (P < 0.000). However, in social relations and environment areas, the relationship was not significant for men (P = 0.004).
|Table 3: Analysis of the effect of age, duration of marriage, education level, and duration of infertility and treatment duration on total quality of life separated by gender|
Click here to view
Evaluating the intensity of depression showed that women more than men suffer from depression. The average scores of depression for men and women were 10.24 and 15.1 respectively which it a significant difference (P < 0.001). As the results of this study showed, 8.2% of men and 78.4% of women did not show depression. About 12.9% of men and 15.4% of women showed mild depression, and it was become evident that 1.9% of men and 6.2% of women suffered from moderate depression, while severe depression was not reported at all.
| Discussion and Conclusions|| |
The results of our study show that the total of men's QOL was more than that in women with a significant difference (P < 0.05). More detailed studies showed that in mental and physical health areas men have a higher QOL rather women which make it statistically significant. In other words, infertile men in contrast to infertile women enjoy a better life. Chachamovich et al. in Brazil showed in infertile men; they enjoy better mental and physical health than women. Their results are consistent with the result of our study. Rashidi et al. showed that men gain higher scores in physical performance and mental health. Since most treatments of infertility and the advanced measurements which entail surgery and anesthesia (e.g., in vitro fertilization) are for women, it result in women becoming convinced that they are the patients, therefore, their QOL in physical area is influenced more than men. Living long hours in the medical centers, fear of anesthesia and surgery not only affect women's physical health but also they threaten their mental health as well.
However, in social relations and environmental health, there is not a significant difference between women and their husbands. Behjati Ardakani et al. showed that women in contrast to men suffer from worse mental health, but there was no significant difference between them in terms of social function. Our results are compatible with these results. Our results show that infertile women in contrast to infertile men suffer from more severe depression. Several studies have shown that infertility brings about depression and neural stresses in people and women suffer more from depression in response to infertility. Chachamovich et al. reported of similar results. There are several factors that can affect the infertile couples' QOL. Therefore, this study tried to analyze the relationship between the total score of QOL and some of its effective factors such as age, level of education, duration of infertility, and duration of treatment.
As the results showed based on the multiple linear regression analysis, age and duration of treatment in men have a significant relationship with the QOL. These variables have a negative effect on the general QOL, but the duration of marriage and infertility have no significant effect on QOL of men.
For women, the level of education and duration of treatment have a significant effect on the total QOL, so they have a negative effect on the women's QOL. However, age and duration of infertility have no significant effect on the general QOL in women. Rooney and Domar suggested that when the treatment duration is increased more stress and pressure is imposed on couples which in turn will result in a reduction of their QOL level. Yazdani et al. (2016) indicated that the QOL of infertile men is reduced over time when they get older, maybe it is because older men have experienced more treatments and more failures in their life which resulted in their QOL decreasing but in women their infertility will be less important for others over time and also experiencing several treatments will decrease their stress and fear of treatment which does not lead to any effect on their QOL. However, since educated women enjoy better social relations skills and can attract more attentions will result in infertile women with higher education levels having decreased QOL.
As the results show, it seems that infertile women in physical and mental health dimensions have a lower QOL rather men. Thus, to improve their QOL, they are recommended to find medical programs which will take less hours in the medical centers. They also have to follow their medical programs with each other (i.e. partner). Counseling programs are necessary in the treatment package of infertile couples and responses of spouses must be focused equally.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Inhorn MC. Global infertility and the globalization of new reproductive technologies: Illustrations from Egypt. Soc Sci Med 2003;56:1837-51.
Evers JL. Female subfertility. Lancet 2002;360:151-9.
Aarts JW, Huppelschoten AG, van Empel IW, Boivin J, Verhaak CM, Kremer JA, et al.
How patient-centred care relates to patients' quality of life and distress: A study in 427 women experiencing infertility. Hum Reprod 2012;27:488-95.
Monga M, Alexandrescu B, Katz SE, Stein M, Ganiats T. Impact of infertility on quality of life, marital adjustment, and sexual function. Urology 2004;63:126-30.
Mohamadi MR, Khljabadi F. Psychological and emotional problems induced infertility. Fertil Infertil J 2004;3:45-52.
Shiraishi K, Oka S, Matsuyama H. Assessment of quality of life during gonadotrophin treatment for male hypogonadotrophic hypogonadism. Clin Endocrinol (Oxf) 2014;81:259-65.
Herrmann D, Scherg H, Verres R, von Hagens C, Strowitzki T, Wischmann T. Resilience in infertile couples acts as a protective factor against infertility-specific distress and impaired quality of life. J Assist Reprod Genet 2011;28:1111-7.
Chachamovich J, Chachamovich E, Fleck MP, Cordova FP, Knauth D, Passos E. Congruence of quality of life among infertile men and women: Findings from a couple-based study. Hum Reprod 2009;24:2151-7.
Khosravi Z. Mental health predictive factors in infertile couples. J Reprod Infertil 2001;3:56-64.
Haririan H, Mohammadpuor Y, Aghajanloo A. Prevalence of depression in infertile women referred to Kosar infertility clinic of Oromieh city. Iran J Obstet Gynecol Infertil 2009;13:45-9.
Sargolzaie MR, Moharreri F, Ershadi HR, Javidi K, Kamali K, Fazeli MR. Sexual and psychological problems in infertile women referred to infertility clinic of Mashhad. Fertil Infertil J 2002;32:46-51.
Peivandi S, Hosseini H, Mahammadpour RA. The prevalence of depression and marital satisfaction and related factors in infertile women referred to infertility clinic of Sari city. J Mazandaran Univ Med Sci 2011;21:26-32.
Chachamovich JL, Chachamovich E, Ezer H, Cordova FP, Fleck MM, Knauth DR, et al.
Psychological distress as predictor of quality of life in men experiencing infertility: A cross-sectional survey. Reprod Health 2010;7:3.
Ragni G, Mosconi P, Baldini MP, Somigliana E, Vegetti W, Caliari I, et al.
Health-related quality of life and need for IVF in 1000 Italian infertile couples. Hum Reprod 2005;20:1286-91.
Skevington SM, O'Connell KA; WHOQOL Group. Can we identify the poorest quality of life? Assessing the importance of quality of life using the WHOQOL-100. Qual Life Res 2004;13:23-34.
Fekkes M, Buitendijk SE, Verrips GH, Braat DD, Brewaeys AM, Dolfing JG, et al.
Health-related quality of life in relation to gender and age in couples planning IVF treatment. Hum Reprod 2003;18:1536-43.
Hassanin IM, Abd-El-Raheem T, Shahin AY. Primary infertility and health-related quality of life in Upper Egypt. Int J Gynaecol Obstet 2010;110:118-21.
Rashidi B, Montazeri A, Ramezanzadeh F, Shariat M, Abedinia N, Ashrafi M. Health-related quality of life in infertile couples receiving IVF or ICSI treatment. BMC Health Serv Res 2008;8:186.
Behjati Ardakani Z, Akhondi MM, Kamali K, Phazli Khalaf Z, Eskandari SH, Ghorbani B. Evaluation of psychological health in infertile couple in Ebnesina center. Fertil Infertil J 2010;11:4.
Valsangkar S, Bodhare T, Bele S, Sai S. An evaluation of the effect of infertility on marital, sexual satisfaction indices and health-related quality of life in women. J Hum Reprod Sci 2011;4:80-5.
] [Full text]
Rooney KL, Domar AD. The impact of stress on fertility treatment. Curr Opin Obstet Gynecol 2016;28:198-201.
Yazdani F, Kazemi A, Fooladi MM, Samani HR. The relations between marital quality, social support, social acceptation coping strategies among the infertile Iranian couples. Eur J Obstet Gynecol Reprod Biol 2016;200:58-62.
Department of Midwifery, Islamic Azad University Kerman Branch, Kerman
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3]