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

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Abstract

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.

Introduction

Infertility is generally defined as the inability to conceive after 12 months of regular unprotected sexual intercourse. It is a prevalent condition and represents a significant social and public health problem [1], [2], [3]. In industrialized countries, the prevalence of infertility has been estimated to range from 8.5% to 20% [4]. There are 11 million married couples in Turkey and it is estimated that 1.1 million of these couples are infertile [5].

Infertility is not only a gynecologic illness but also a bio-psycho-social health problem including a lower quality of life (QoL), psychiatric problems, marital conflicts and sexual dissatisfaction [4], [6]. In one study, the majority of the couples reported conflict, communication problems, disagreement over medical treatment, lack of empathy, and differential investment in the infertility treatment process [7]. Other studies, on the other hand, suggest that infertility and infertility therapy do not necessarily have a negative impact on marital satisfaction [8], [9] or sexual function [10].

Although infertility affects both males and females, gender differences have also been observed [2], [11]. Studies show that infertile females seem to demonstrate stronger and more extensive QoL impairment, compared to infertile males [12], [13], [14]. Although there is no significant difference between men's QoL and marital adjustment scores compared to those of controls in case–control studies, the women's scores were lower than those of the men and the control groups [2], [15], [16], [17], [18].

To have a child is an effective factor in gaining social status in the Turkish population. In Turkey, like many societies around the world, lack of pregnancy and the resulting childlessness are often highly stigmatized, leading to profound social suffering for infertile couples. Kavlak and Saruhan found that loneliness level of Turkish infertile females is high [19]. In addition, marital relations may be damaged by the diagnosis of infertility since couples are usually confused about the ways of handling this condition. Taşçi et al. determined that there is a meaningful difference between the mean of consistency point in marriage and experiencing social pressure about having a baby [20]. In the literature there are no studies about the effects of infertility on QoL and the marital relationship (MR) aspect of gender differences among a Turkish sample.

The following questions guided this study. What are the effects of infertility on MR and QoL? Are there any differences between infertile and fertile couples in terms of their MR and QoL? Are there any gender differences in terms of the effects of infertility on MR and QoL?

This study aimed to report from a developing country where infertility might cause several social problems for infertile couples, especially for women. Knowing about the effects of infertility on MR and QoL will be helpful in providing care to the couples. If a health care provider knows the disabilities of the couples she/he can plan appropriate intervention to prevent, and improve their condition.

Section snippets

Research process

This study was designed as a case–control study. It was conducted at Istanbul University Istanbul Medical Faculty Reproductive Endocrinology and Infertility Department (Istanbul city, Turkey) between October 2007 and December 2008. The data were collected from 58 primary infertile couples who composed the case group, through interviews which revealed their socio-demographic characteristics. The criteria for selection were: (i) being married, (ii) having been diagnosed with infertility for least

Characteristics of the participants

The comparison of socio-demographic characteristics is presented in Table 1. The essential difference between two groups was the number of children they had. Although infertile group did not have any children, the fertile group had a minimum of one and a maximum of four children (mean 1.7 ± 0.7). In the infertile group, 37.1% of responders had male factor, 20.7% female factor, 29.3% unexplained, and 12.9% mixed type infertility. The mean of infertility duration was 7 ± 3 years.

Findings in relation to DAS and WHOQOL-Bref

Table 2 demonstrates

DAS Scores of the fertile and infertile groups

This study has demonstrated that marriage compatibility of the infertile couples was high in that the mean of DAS total scores (114.44 ± 18.53) were higher than DAS cutting scores. DAS total scores of the infertile men and women in this study correlate with the scores in other studies. [12], [13], [26], [27]. This study detected no significant differences between infertile and control groups in terms of their DAS scores. Various studies mention the negative impacts of infertility on marriage

Acknowledgments

The present work was supported by the Research Fund of Istanbul University. Project No: T- 1826.

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