Effects of infertility on gender differences in marital relationship and quality of life: a case-control study of Turkish couples

Objectives

Although there are many studies trying to evaluate the effect of infertility on marital relations (MR) and quality of life (QoL) in developed counties, there have been no studies in Turkey. As in many societies around the world, lack of pregnancy and the resulting childlessness are often highly stigmatized, leading to profound social suffering for infertile couples in Turkey.

Study Design

This study was planned as a case–control study in order to investigate the effects of infertility on MR and QoL. It was conducted among 58 primary infertile and 51 fertile couples. The Dyadic Adjustment Scale (DAS) and the World Health Organization QoL Scale (WHOQOL-BREF) were applied at the infertility department of the Istanbul University's faculty of medicine. The t-test, Mann–Whitney U, ANOVA and Pearson's correlation coefficient were used.

Results

The socio-demographic properties were similar for both groups. The QoL average score was higher for the infertile group. There were no gender differences in QoL for infertile couples. The total DAS score was higher than the cut-off score for both groups (114.44 ± 18.53 for infertile, 110.29 ± 18.28 for fertile couples; p > 0.05). Infertile women's DAS and QoL scores were higher than the fertile women's (p < 0.05). Other than in the social domain, all QoL scores were higher for infertile men than fertile men (p < 0.05). There was a positive correlation between the DAS and QoL scores.

Conclusions

It was determined that infertility did not have a negative impact on MR and QoL measurements. There were no gender differences.     

Psychological evaluation test after the use of assisted reproduction techniques

Purpose : The emotional changes provoked by the use of assisted reproduction techniques (ART) may trigger important psychological reactions. The objective of the present study was to develop a psychological evaluation test (PET–ART) in order to identify the occurrence of psychological problems and to facilitate their treatment. Methods : A total of 128 women were submitted to PET–ART of the Center for Human Reproduction, Sinhá Junqueira Maternity Foundation, after application of IVF/ICSI program at least once. The causes of infertility were male-related in 45% of cases, female-related in 48%, and both male- and female-related in 7%. Infertility was primary in 79% of cases and secondary in 21%. The mean age of the women was 34.5 ± 5.2 years and the mean age of the men was 37.9 ± 6.8 years. The PET–ART was evaluated using a questionnaire with 15 questions selected in order to detect emotional reactions caused by infertility. The responses were assigned four grades with respect to intensity (1 = mild intensity; 2 = medium intensity; 3 = high intensity; and 4 = maximum or unbearable intensity). The sum of the responses corresponded to PET–ART score ranging from 15 to 60 points. The reliability of the questionnaire was evaluated by the alpha coefficient of Cronbach. Results : The PET–ART identified five questions receiving 50% or more responses of the high/maximum intensity type (sum of the percentages of responses with a score of 3 and 4). The questions were the following: 1—The waiting time before being submitted to a pregnancy test (82.8% of the patients); 2—A negative result of the pregnancy test (77.3% of the patients); 3—The degree of anxiety in a new attempt to obtain pregnancy (76.5% of the patients); 4—Finding the money necessary for the repetition of the IVF/ICSI techniques (66.4% of the patients); 5—The possibility of collecting few eggs, or of forming or not an embryo in the laboratory is an expectation that makes me anxious (57.8% of the patients). The mean PET–ART was 33 ± 6. The alpha coefficient of Cronbach was 0.757. Conclusions : The PET–ART was an efficient tool for the identification of women with emotional changes provoked by the application of ART and for the planning of their treatment. However, a general psychological approach was developed for each emotional factor regardless of PET–ART.     

Erectile Dysfunction and Associated Risk Factors in Chinese Males of Infertile Couples

Background

Knowledge on the occurrence of erectile dysfunction (ED) and timely ovulatory intercourse failure (TOIF) in Chinese men of infertile couples is limited.

Quality of life and sexual functioning of Polish infertile couples

Objectives To evaluate the influence of infertility on the quality of life (QoL) and sexual functioning of infertile couples.

Methods The research group consisted of 206 infertile couples and the control group of 190 fertile couples. A specific questionnaire was used as a research tool. It gathered information about socio-demographic features and infertility status, and included validated scales: Short Form-36 Health Survey, Female Sexual Function Index and International Index of Erectile Function.

Results The QoL parameters in all categories were generally lower for infertile women than for those of the control group. Clinical sexual dysfunctions were not significantly more common among infertile than fertile women (17.5% versus 12.1%, p = 0.13). Clinically relevant erectile dysfunctions were diagnosed in 23.9% of infertile men and in 13.7% of the controls. Male infertility had the most significant negative effect on men's sexual functioning.

Conclusions The risk groups for decreased QoL are infertile women and older subjects with lower education and occupationally inactive. Clinically relevant sexual disorders in the infertile population most frequently affect older men, with a lower educational level and with previously diagnosed male infertility.     

A psychological study of male,female related and unexplained infertility in Indian urban couples

Objective: The study intended to see the impact of infertility on experience of emotional trauma, belief pattern and formation of psychopathology and also to explore the psychopathology with respect to degree of infertility related stress impact among male, female and unexplained factor infertility in couples suffering from primary infertility.

Design: This was a clinic-based, cross-sectional comparative study based on a consecutive sampling method.

Subjects: Sixty couples were studied of whom 10 couples had male-related infertility (MF), 10 had female-related infertility (FF) and 10 unexplained infertility (UF). Another 30 fertile couples were also included as comparative group (CG) after matching on certain sociodemographic variables with the clinical groups.

Measures: Impact of Event Scale, Symptom Checklist-90 Revised and Irrational Belief Scale were used.

Results: The impact of emotional trauma and irrational belief was greatest in the male-related infertility couples, and somatisation in the unexplained group, whereas depression and interpersonal sensitivity were higher in the female-related infertility couples. An impact of moderate to severe infertility-related stress on depression and irrational beliefs was also observed. Gender difference was evident with respect to psychopathology and types of infertility.

Conclusion: The impact of infertility is evident with respect to psychopathology with differential impact of various types of infertility groups among Indian couples.     

Quality of life of infertile Tunisian couples and differences according to gender

Objective

To compare quality-of-life gender differences within infertile couples from Tunisia and between infertile couples and controls.

Methods

The present case–control study included 100 couples with primary infertility who, during 2009, underwent assisted reproductive technology at Farhat Hached Hospital in Sousse, Tunisia, and 100 control couples. The 36-item Short-Form Health Survey (SF-36) was administered to assess quality of life.

Results

Compared with male controls, men in the infertility group had lower scores in the mental dimension (P = 0.020), social functioning (P = 0.007), and role–emotional (P < 0.001) categories of the SF-36. Women in the infertility group had lower mental and physical dimension scores (P < 0.001) and lower vitality (P = 0.022), social functioning (P < 0.001), role–emotional (P < 0.001), and mental health (P < 0.001) scores than female controls. Within infertile couples, female partners had lower total (P = 0.01) and mental dimension (P < 0.001) scores than their spouses. Delay of the first consultation was correlated with bodily pain, vitality, and mental health among women in the infertility group.

Conclusion

Women in infertile couples had a lower quality of life than their spouses, and infertile couples had a lower quality of life than controls. These findings confirm the need for psychological support for infertile couples.     

General psychopathology,anxiety, depression and self-esteem in couples undergoing infertility treatment: a comparative study between men and women

Objective

To compare measures of psychological distress between men and women undergoing ART in the Unit of Reproductive Medicine “UMR” in the Department of Obstetrics and Gynecology at “Farhat Hached” Hospital in Sousse, Tunisia.

Study design

We conducted a gender comparative study of psychological profile in infertile couples. Recruitment was done during period from January to May 2009. 100 infertile couples with primary infertility were recruited. Scores of general psychopathology, depression, anxiety and self-esteem were evaluated. We administrated questionnaires on psychological factors among infertile couples before starting a new infertility treatment cycle. Psychological factors included the symptom check-list (SCL-90-R), the hospital anxiety and depression scale (HAD-S) and the Rosenberg self-esteem scale (RSE).

Result(s)

Infertile women had higher scores than their spouses in the three global scores of the SCL-90-R and in several items such as somatisation, obsessive symptoms, interpersonal sensitivity and phobias. Scores of HADS were higher among women for both depression and anxiety. Scores of self-esteem were lower among women.

Conclusion(s)

Women endorsed higher psychological distress than men across multiple symptoms domains: general psychopathology, anxiety, depression and self esteem.     

Delayed Motherhood Increases the Probability of Sons to be Infertile

Purpose: To ascertain whether advanced maternal age at birth is associated with offspring infertility. Methods: A written questionnaire was completed by infertile couples attending our clinic in the presence of a researcher. Results: Maternal age at birth (odds ratio 1.236, 95% CI 1.100–1.388) and birth order of all respondents and their respective siblings (odds ratio 0.551, 95% CI 0.351–0.865) were significant predictors of male infertility. The probability of a man being infertile increased as mother's age at birth increased (regression coefficient ± standard error 0.212 ± 0.059; P < 0.001), but decreased as birth order increased (regression coefficient ± standard error –0.596 ± 0.230; P = 0.010). Conclusions: Delayed motherhood may enhance the probability of sons to be infertile. The probability of a man being infertile would be greater if he comes from a small family than if he comes from a large family.     

Effects of a psychological intervention on depression in infertile couples

OBJECTIVE: To determine factors affecting depression in infertile couples and the impact of a psychological intervention before or during infertility treatment. METHODS: In a cross-sectional study with 638 infertile couples assessed for depression, 140 couples with a member who had a Beck Depression Inventory (BDI) score of 17 or higher were randomized to receive psychological treatment either before or during infertility treatment. Logistic regression was performed to eliminate confounding factors. RESULTS: Depression was initially found in 48% of women and 23.8% of men. The mean+/-SD Beck scores fell from 18.7+/-9.7 to 10.7+/-5.8 (P<0.001) in the group psychologically treated before they received infertility treatment. CONCLUSION: The psychological intervention was found useful in alleviating depression in infertile couples before they received infertility treatment.     

Endurance with partnership: a preliminary conceptual framework for couples undergoing in vitro fertilisation treatment

Background/objectives: Infertility affects both women and men in the physical, emotional, existential, and interpersonal realms. When couples seek in vitro fertilisation (IVF) treatment, they further suffer from the difficulties of the treatment and the uncertainty of its outcome. The aim of this study was to develop a preliminary conceptual framework for couples undergoing IVF treatment to give health professionals a better understanding of the experiences of such couples, and to guide the development of an intervention.

Methods: The process of identifying frameworks adopted in intervention studies confirmed that there is no established framework for infertile couples undergoing IVF treatment. A skeletal framework identified from previous studies provides an internal structure for the proposed framework for couples undergoing IVF treatment, filled out with concepts drawn from a concept analysis and a qualitative study, knitting the structure together.

Results: This preliminary framework is the Endurance with Partnership Conceptual Framework (P-EPCF). It consists of four domains: the impacts of infertility and stressors, dyadic mediators, dyadic moderators and dyadic outcomes. According to the P-EPCF, the impacts of infertility and IVF treatment can be mediated by the couples’ partnership and dyadic coping. Improvements in the psychological well-being and marital functioning of IVF couples can then be expected.

Conclusions: The P-EPCF would be potentially valuable in guiding the development of a complex, couple-based intervention, which could focus on enhancing the partnership of couples and their coping strategies.     

Modern and traditional practices of Turkish infertile couples

Objective?This investigation was carried out to determine modern and traditional practices of infertile couples in Kayseri, Turkey.

Methods?Two hundred and fifty-two infertile couples were selected from the study area. Modern and traditional practices of the infertile women and their husbands were investigated through a questionnaire. The effects of some factors on the utilization of traditional methods were analysed through the logistic regression method.

Results?It was found out that 92.5% of the infertile women and 71.8% of their husbands had consulted a physician for infertility and 92.1% of the women and 32.6% of their husbands had applied for medical or surgical intervention. However, only 11.1% of the couples had attempted in vitro fertilization. In contrast, 61.5% of the infertile couples admitted to carrying out traditional practices. All traditional practices were more prevalent among the women than the men.

Conclusion?It was concluded that traditional practices were more prevalent in the rural areas and among the older couples.     

Sexual,Marital, and Social Impact of a Man's Perceived Infertility Diagnosis

IntroductionMale factor infertility is a relatively common problem. This diagnosis may increase sexual, marital, and relationship strain in male partners of infertile couples.AimTo measure the personal, social, sexual, and marital impacts of a male factor infertility diagnosis among men in couples evaluated for infertility.MethodsCross-sectional analysis of 357 men in infertile couples from eight academic and community-based fertility clinics. Participants completed written surveys and face-to-face and telephone interviews at study enrollment. This interview queried each participant's perception of their infertility etiology to determine the primary study exposure (i.e., male factor only, male and female factors, female factor only, unknown).Main Outcome MeasuresPersonal Impact, Social Impact, Marital Impact, and Sexual Impact scales.ResultsAmong the 357 men, no male factor was reported in 47%, isolated male factor was present in 12%, combined male and female factors were present in 16%, and unexplained infertility was present in 25% of couples. Male factor infertility was independently associated with worse Sexual (mean 39 vs. 30, standard deviation [SD] 2.7, P = 0.004) and Personal (mean 37 vs. 29, SD 3.8, P = 0.04) Impact scores relative to men in couples without male factor infertility. These differences remained statistically significant after controlling for male age, partner age, race, religion, educational level, employment status, prior pregnancy, duration of infertility, and prior paternity.ConclusionsMale partners in couples who perceive isolated male factor infertility have a lower sexual and personal quality of life compared with male partners of couples without perceived male factor infertility. Social strain is highest among couples without a clear etiology for infertility. These findings highlight the clinically significant negative sexual, personal, and social strains of a perceived infertility diagnosis for men. Smith JF, Walsh TJ, Shindel AW, Turek PJ, Wing H, Pasch L, Katz PP, and The Infertility Outcomes Program Project Group. Sexual, marital, and social impact of a man's perceived infertility diagnosis. J Sex Med 2009;6:2505–2515.     

What every gynecologist should know about male infertility: an update

Purpose

Our article reviews the evolving concepts in the field of male infertility for gynecologists and other health professionals involved in the care of men and women experiencing difficulty in having a child. The increased knowledge will help in the better management and treatment of infertile couples.

Methods

Review of literature through Pubmed, Science Direct, Online Library.

Results

Gynecologists are often the first healthcare providers to assess an infertile couple. Because half of all infertility problems stem from male factors, it is crucial for the gynecologist to remain updated on the main conditions that cause male infertility as well as current diagnostic tools and treatment options, including conventional strategies and assisted reproductive techniques.

Conclusions

Extraordinary advances have been achieved in the field of male infertility over the past several years and many old concepts are now challenged. Therefore, it is imperative that male infertility physicians should update the gynecologists about the recent advances in the work-up of infertile men in terms of diagnosis and management. Such convention will help improve the standards of care for the infertile couple and enhance the cooperation between male and female reproductive endocrinologists.     

Evaluation of Pregnancy Rates After Intrauterine Insemination According to Indication, Age, and Sperm Parameters

Purpose: Our purpose was to evaluate intrauterine insemination results obtained in our clinic and identify prognostic factors for the chance of pregnancy. Methods: A retrospective study of data from 1989 to 1996 was undertaken. Only first attempts were included in this study, except for the part on the cumulative pregnancy rates. Couples with either one-sided tubapathology, hormonal dysfunction, idiopathic infertility, or andrological indication were selected. All women were stimulated with clomiphene citrate. Five hundred sixty-six couples who underwent 1763 cycles were included in the study. Results: The overall pregnancy rate for first pregnancies was 6.9% per cycle and 21.4% per patient. For first intrauterine insemination attempts this was 8.8% per cycle/patient, varying between 5.0% for andrological indication and 10.6% for tubapathology, 10.0% for idiopatic indication, and 10.3% for hormonal indication. These differences were not significant. Age did not have a significant effect either, although there were no pregnancies observed in women 40 years or older. The number of inseminated spermatozoa significantly affected the pregnancy rate: <2 million, 4.6%; 2 to <10 million, 3.9%; and 10 million, 11.3%. Conclusions: Unless semen characteristics are insufficient, intrauterine insemination is a useful treatment for infertile couples.     

The Effects of Age and Abnormal Sperm Count on the Nondisjunction of Spermatozoa

Purpose: The effect of paternal age on the nondisjunctionof sex chromosomes is controversial. Also, the prevalenceof chromosomal anomalies in infertile patients iscontroversial, it has been reported that the sex chromosomalaneuploidy rate following treatment with intracytoplasmic sperminjection (ICSI) is higher than in naturally conceivedpregnancies. We investigated the influence of paternal age andoligozoospermia on the nondisjunction of spermatozoa. Methods: We determined the rate of aneuploidy forgonosomes and autosomes, using two-color fluorescence in situhybridization (FISH) of the X and Y chromosomes andchromosomes 12 and 18 in 10 donors under 25 years of agewho had a normal sperm count (20 × 10⁶/ml), 10 donorsover the age of 39 years with idiopathic infertility andnormozoospermia (20 × 10⁶/ml), and 5 oligozoospermicdonors (<20 × 10⁶/ml). Results: There was no obvious relationship betweenincreasing age and autosomal disomy (disomy 12 and disomy 18).Neither autosomal disomy nor diploidy was increased inany group. The frequency of X-, Y-, XX-, and YY-bearingsperm did not differ significantly among groups, but thefrequency of XY-bearing sperm was significantly higher inthe older infertile group than in the control donors. Conclusions: The incidence of nondisjunction of paternalsex chromosome in meiosis I was higher in older men withidiopathic infertility. The present results suggest that therisk of producing XXY fetuses is higher among men >39years of age with idiopathic infertility.     

Karyotype analysis in large-sample infertile couples living in Central China: a study of 14965 couples

Objective

To explore that it is necessary to routinely detect chromosomes in fertile couples, we detected peripheral blood lymphocyte karyotype in 14965 infertile couples living in Central China and analyzed the incidence and type of chromosomal anomaly.

Methods

G-banding karyotype analysis of peripheral blood lymphocytes was performed in 14965 couples who went to the outpatient department of our reproductive medical center for counseling on infertility between January 2004 and December 2011. Semen analysis was performed three times in all the men from the 14965 couples.

Results

The rate of chromosomal anomaly in the 14965 infertile couples was 3.84 % (1150/29930). The rate of chromosomal anomaly in the men from 14965 couples was 6.84 % (1024/14965) and in the women 0.84 % (126/14965). The rates of chromosomal anomaly were 1.69 % in normal semen group, 11.82 % in light oligo-astheno-spermis group, 6.58 % in moderate to severe olig-astheno-spermia group and 17.26 % in azoospermia group.

Conclusion

Since the rates of chromosomal anomaly are 1.69 % and 11.82 % even in normal semen group and light oligo-astheno-spermia group, respectively, it is necessary to detect peripheral blood lymphocyte karyotype in all infertile couples.     

ORIGINAL RESEARCH—COUPLES' SEXUAL DYSFUNCTIONS: Sexual Disorders in Infertile Couples

IntroductionSexuality and the desire for a child are strongly interconnected. The same applies to sexual disorders and the unfulfilled desire for a child.AimThis article indicates the relations between sexual disorders and the unfulfilled desire for a child and outlines the potential effects of diagnostics and treatment in the context of reproductive medicine on the couples' sexuality.MethodsA research drive was undertaken in well-established medical and psychological literature database with the keywords “infertile” or “infertility” and “sexual dysfunction” or “sexual satisfaction.”ResultsSexual dysfunctions (of organic or of psychic origin) as a cause of involuntary childlessness are relatively unusual. By contrast (temporary) sexual disorders resulting from diagnosis and medical therapy are common in couples with fertility problems, with women more frequently affected than men.ConclusionsCounseling for couples with the unfulfilled desire for a child should invariably include explicit and appropriately tactful reference to sexuality and (functional) sexual disorders by the therapist. Wischmann TH. Sexual disorders in infertile couples.     

Depression and anxiety among Polish infertile couples – an evaluative prevalence study

Aim. The aim of this study was to evaluate the influence of infertility on the severity of anxiety and depression in infertile couples.

Material and methods. This was a cross-sectional study of differences between infertile couples (206 women and 188 men) and fertile couples (n = 190) with symptoms of depression and anxiety, as measured by the Beck Depression Inventory and Beck Anxiety Inventory.

Results. Infertile women (35.44%) scored above the cut-off for severe symptoms of depression, compared with 19.47% of fertile women. In the case of anxiety evaluation there was significant total prevalence among infertile women (15.53%). In the male groups there was a comparable frequency of negative results for depression and anxiety and their intensity. Among Female Infertile, depression occurred most frequently in combined infertility, whilst among Male Infertile in male infertility, with a time-frame of 3–6 years causing the creation and severity of depressive symptoms.

Conclusion. The risk factors of depression and anxiety in infertility include: female sex, age over 30, lower level of education, lack of occupational activity, diagnosed male infertility and infertility duration of 3–6 years.