Impact of infertility on various psychosocial variables

Bell, 1981 researched on the impact of infertility on various psychosocial variables. In this research he found that infertile couples are more prone to sexual dysfunction, emotional disturbance, impaired social adjustment, and decline in their marital relationship. Sample of the study included women who were admitted in large infertility clinic affiliated with hospitals in the Midwest. The characteristics of the sample was that the participants were selected if the patients had been diagnosed with primary or secondary infertility and they have been unsuccessful in achieving pregnancy, had a dormant patient status, and had not been a patient at the clinic for 6 to 24 months former to the launch of the study. The questionnaires were mailed to 179 women. Frequency distributions of the question concerning whose choice it was to search for cure of infertility, indicated that 61% felt it was a mutual decision. Whereas 36% felt it was by and large the female’s decision. In 3% of the cases it was the man’s choice. Scores were compared on the Index of Marital Satisfaction prior to, through, and after infertility treatment indicated that infertility treatment was linked to decreased marital satisfaction during the time the couple was seeking treatment. But after the execution of treatment, the relationship returned to the level of marital satisfaction which was there before treatment. Marital satisfaction was less in case female initiated for the treatment of infertility. In light of the analysis, the lower the level of contentment within the marital bond the more likely the couple was to seek psychotherapy. This finding showed that those couples who were mostly in distress were seeking help from a counsellor. Limitations of this research were that only women were approached to respond on the questionnaire. The researchers were conscious of the attractiveness of having both partners reply to the questionnaire. However, to lessen the rate of conflict between both partners, only female were approached to participate in the study.

Odile Frank in 1983 conducted a research to identify the prevalence of infertility in Sub Saharan Africa. The results of this study showed two remarkable aspects. Firstly, the occurrence of infertility is surprisingly widespread. 3% prevalence of infertility was taken as a standard. This ratio of infertility was normally expected in a developing country. Infertility is present in almost all areas. Secondly, the intensity of infertility varies fairly clearly, even between small areas that are adjacent to each other. Infertility is insignificant in Burundi and Kenya, with the exclusion of Nairobi and the whole Coastal Province, in an area of Guinea and in the region of Ankole in South Western Uganda. On the other hand very elevated levels of infertility come about in a wide zone of Central Africa, including Southwestern Sudan, Central African Republic, Congo, North Zaire, Gabon and the United Republic of Cameroon. The pattern of disparity in the levels of infertility, accord not only with the mapping of fertility levels, but also with the patterns of ethnical background.

Another research by Anne Martin and Ralph Matthews, 1986 examined the social and psychological implications of infertility and unintentional childlessness. This research attempted to create awareness in the family life professionals towards the lack of attention in existing family studies to the troubles faced by the involuntarily childlessness. Particularly, it has emphasized that these problems precede the concerned biological issues, although these are practically the only aspects measured in any family study or the popular press. The major job of this study is to inform the family practitioners about the social and psychological issues connected with involuntary childlessness and infertility. Family life practitioners must be aware of the psychological and social problems associated with these problems. In this study the practitioners have been given some suggestions by the help of which involuntary childlessness can be better handled.

Greil et al, 1988 used qualitative which was gathered by interviewing infertile couples who were living in New York. 22 couples were interviewed. The authors described how husbands and wives interact with each regarding the process of their infertility. The females experienced infertility as catastrophic role failure, while husbands tend to see infertility as a distressing event but not as a disaster. Most couples appear to consider infertility as a problem of wives only. Lack of communication and irritation were the distinctive results of the conflict of husband’s and wife’s point of view on infertility. Meetings with medical professionals were liable to strengthen these consequences. These interactions among husbands, wives and medical professionals may lead to wrong directions in seeking treatment and to ignore many other treatment options. Socially and psychologically the couples without recognized medical problems can feel infertile even if they have not tried to conceive for 12 months period as identified by the medical definition of infertility. Such couples who are not infertile by the medical definition, can still experience the similar thoughts, emotions, and self definitions like the couples who are infertile or reproductively impaired. Interviews were conducted during 1985 and 1986. Sample was selected by using snowball sampling technique. The couples in the sample were significantly better off than the national average in terms of annual family income and education. Interviews indicated that wives mostly experience infertility as a distressing incident. 19 of the total women interviewed saw infertility as a catastrophic event while only 9 of the total men who were interviewed felt that infertility had individually affected them a lot. The wives frequently reported that they experience infertility as role failure and interpret it as a challenge to their womanhood. The wives thought about infertility most of the time, read about it persistently, and were often willing to do whatever it would take to shed the label of infertility from them. As a result most of the wives tended to be the leaders and initiators in the process of treatment. This study made it clear that the wives were more treatment oriented and the wives experience infertility as a profound failure of their role.

In a study conducted by Mwalali et al., in 1990, infertility was reported to be the second greatest cause of admission in the gynaecology department of Botswana. In the light of the health data reports of Botswana, outpatient turnout of patients having infertility troubles between the age limit of 15 to 45 years was 4400, number of outpatients having infertility problem above the age range of 45 years was 551 and the total number of patients was 4495. So the ratio of outpatients is 0.2%. These statistics do not comprise of the individual persons and couples who were treated by the private physicians, spiritual and conventional healers. Still this issue that how the people of Batswana deal with the problem of infertility is a neglected topic and much importance has not been given in this area.

Infertile women’s scores on measures of depression, anxiety, and hostility were considerably higher than the scores among a large normative sample. It is ordinary for infertile women to feel responsible and view infertility as a punishment for past sexual indiscretions, abortions or contraceptive use (J. Wright, 1991). Infertility has been more aptly described as a model of chronic sorrow (Woods et al., 1991).

Abbey et al, 1992 conducted a research to examine the effects of the stress connected with infertility on wives and husband’s perceived quality of life. Infertility is a widespread life crisis. Three factors were examined in this research; self-esteem, internal control, and interpersonal conflict. Major purpose of this research was to thoroughly examine the relationship between infertility and subjective well being. The stress linked with infertility was anticipated to have a direct depressing effect on husband’s and wife’s life quality. Participants of the research were married, white, middle to upper middle class couples. These couples did not have any children by any member of the couple yet they have strong desire to have children. Brochures describing the research were send to the couples who agreed to participate in the research. After that those couples were contacted by a specialized interviewer from the Survey Research Center at The University of Michigan. Separate face to face interviews were conducted from both husband and wives. Each interview lasted for about an hour. A sequence of nine questions assessed the amount of anxiety and disturbance which the fertility problem had created. Data was collected by using an abbreviated version of Rosen Berg’s self esteem scale. Another scale was developed by the research team which was based upon the previous researches. This scale had 5 items which assessed perceived internal control. Responses were given on a five point Likert type scale. The quantity of interpersonal conflict expected from one’s spouse was also calculated using scales developed in previous research by Abbey et al. in 1985. For both husbands and wives, fertility problem was significantly stressful and was negatively linked with perceived internal control, self-esteem, and quality of life. Also it was considerably and positively associated with interpersonal inconsistency.

In a study, which compared infertile and fertile women who were undergoing usual gynecological care it was found that 11.0% of the total infertile women met the criteria for an existing major depressive episode as compared with 3.9% for the fertile women (J. Downey and M. McKinney, 1992).

According to Writberg, 1992, women appear to be emotionally more susceptible to infertility, and suffer a lot from not being able to become mother, they even suffer from emotional disturbance when the infertility is due to male factor. The female spouse is always the one who takes the lead in going for treatment of infertility.

Gay Becker, 1994 addressed the disturbance in the lives of women and men in the United States subsequent to the discovery of infertility interviewing by 236 women and men who experienced infertility and had undergone medical treatment. The cultural life course and its basis metaphors provided the context in which cultural constructions of infertility were understood. People drew on metaphors such as order and chaos, limbo, life and death, rebirth, and transformation in efforts to make sense of disturbance. Consecutive phases of disturbance, characterized as periods of chaos and limbo, were followed by efforts to make a new sense of order and stability. It is suggested that a cultural model of infertility shapes responses to disturbance and that metaphor mediates the process through which a sense of continuity is sought. As a cultural resource, metaphor is a moderator of disruption that enables people to reconstruct a sense of stability and to rejoin themselves to the social and cultural order after a catastrophe. The efforts to create continuity after a disruption emerge as a complex cultural process. The findings mentioned here are part of a longitudinal, qualitative study of gender and disturbance to individual’s expectations about the composition of their lives, using childlessness as the focal point of the study. Participants of the study were 236 persons out of which 118 were women and 118 were men. Those people were either undergoing medical treatment for infertility at the time of the interview or they had finished treatment during the previous three years. It was observed that responses to infertility were related to sex and to the recognition of an infertility reason (a clinical phrase for a physiological finding that suggests a reason for sterility). In this study, all women and men who had an infertility factor in them were more affected than those men and women who did not have an infertility cause. Men with no infertility factor reported trouble to their lives.

Berg B. et al., 1995 used a sample of 104 infertile couples to study the patterns of distress in the couples. Couples were separated to find out which partner suffers more distress. 22 percent of the females were distressed and 18 percent males were distressed. An astonishing finding of this study was that out of the 18 % distressed males; their wives were not distressed at all. This finding is against the often assumed fact that women suffer more due to infertility. The females having higher levels of psychological distress were receiving treatment for the longest time.

Ulla Larsen, 1995 suggested that specific behavior patterns are linked with superior levels of childlessness, e.g. among women who had constantly lived in urban areas, and those who became sexually active at a young age. During the 1980’s childlessness declined considerably among the women having age less than 40 years in Cameroon and Nigeria. The percentage of women who became infertile before crossing the age of 40 years was mostly found in both Cameroon and Nigeria during the 1980. In Cameroon, the chances of being infertile are clearly higher for Muslims as compared to those for Christians. In all religious groups the downfall in infertility rate during the 1980’s was more noticeable in the North and North West region of Cameroon, than in the Centre South area. Infertile women are more expected to have experienced marital insecurity in both Cameroon and Nigeria.

A survey of population research conducted by Leonard S. Cottrell, Jr. in 1997 showed that many social indices are considerably correlated with the rates of infertility. Some of the relations studied in this research are that there is a negative relation between infertility rates and the extent of urbanization of a known population. There is a negative relationship between infertility rate and socio economic status of the individual. There is a little evidence that the elite class have a low rate of fertility. White collar clerical class had higher infertility rate than the classes lower than and higher than them. The very high socio economic status groups have lower infertility rates as compared to the classes below them. But in some of the European countries there appear to be some inclination for the relation to overturn itself and the lower social economic groups to be more infertile than the upper socio economic status groups. Still, in America, the common relationship of lower infertility in the lower socio economic groups and higher infertility in the upper socio economic groups is true for the current scenario. Another remarkably important finding of the study is that the occupational status is negatively related to the rates of infertility. Another repeatedly observed relationship which appears to be closely linked with the former is the negative co-relation between infertility rates and educational achievement. There seems to be a negative relationship between the infertility rates and the indices of socio economic emancipation of females.

Variety of other invisible conditions such as epilepsy, divorce, mental illness, and infertility in the United States are problematic for the people (Rosenfield, 1997).

The document by Archer, 1998 is a critical review of the literature on the social and psychological effects of infertility, including gender issue. The investigator focused mainly on the research that assumes infertility as a source of psychological distress. Studies which make use of measures of stress and self esteem have established considerable differences between people who are infertile and others. This literature paints an image of infertility as a distressing incident, especially for the women. This review of literature revealed a number of flaws and draw backs, including the failure to study those who have not hunted for treatment of infertility and over sampling of women as women are more probable to be given treatment as compared to men. Seeking treatment of infertility is also influenced by many social variables such as race, social class and region. Also this literature was based on white, middle class and urban samples. Further, research based on clinic samples looks at an artificially short time frame, starts when someone becomes a patient and ends when they leave the clinic.

1998 records of Census Bureau showed that more than I5% of all of the married women has never became mothers in their life. The majority of this childlessness is unintentional, except for a few women who chose to remain childless throughout their live according to their own will. But the wish to have children of one’s own is so much strongly motivated socially and biologically that all the couples decided to have their own family later or sooner in their life. Despite of this strong desire if still a couple remain childless then it is only due to their inability to have children. With the advancement of technology in the medical field, many new techniques have been invented for the infertile people. Almost all of the diagnostic tests and remedial measures which nowadays are considered vital in the care and study of an infertile couple have been developed within the last 20 or 30 years. American scientists have made a great contribution in this field. Two new concepts are of great importance. Out of which one concept is that, infertility is usually not because of a single reason rather multiple number of factors cause it some of them are nutritional, local, and glandular. Also emotional disturbances can also be a cause of infertility. In this case it becomes necessary to take the full history, living style and health condition of the couple to be taken into account. Then the second reason is that in case of infertility usually husbands have the greater responsibility of being childless and this fact has been identified in previous studies. In the near past it was thought that in case of a childless couple only women has the responsibility of infertility. And due to this concept all the treatment and operations were meant only for the females, these procedures were done in order to eliminate the infertility. With the help of newer techniques in the field of seminal fluid study it became clear that in much of the cases of infertility, the husband is responsible for it. Fertility Service of the Margaret Sanger Research Bureau, it was found that in more than 40% of the cases, reproductive deficiency lies with the husband. Nowadays, the medical doctors will not start any long lasting examinations of woman without initially determining the productiveness of her husband.

In a research by Frank Van Balen, 1999, the incidence and consequences of childlessness for women and men were studied. Regarding the issue of childlessness there are large differences between developed and underdeveloped countries. In the Western nations, infertility has a deep influence on the individual well being of women and men, though the communal and financial cost are limited. In many developing nations, the social disgrace of infertility, particularly for women, is often very outspoken, and may escort to isolation and neglect of the infertile women. In some areas, infertile women are even unloved and perceived as wicked human beings.

No one who has endured the trauma of infertility or followed it closely with others can deny its impact on the lives of individuals, couples, and families (Fidler and Bernstein, 1999).

Johanne Sundby, 1999 wrote in this paper about her experiences of infertility as a patient of infertility and as a doctor of infertility. She was an infertility doctor and herself an, infertile women, a counsellor of infertility and a researcher on infertility in Norway and Africa. She was mother of an adopted son. She reported that infertility is a medical and social issue and she did not saw herself as inactive, mistreated and infertile women. She took infertility as a source of her professional development which helped and motivated her to fill this gap in her life, the gap of being childless. According to Johanne, not all of the infertile women can get a PhD degree in infertility, yet there are many attractive ways to fill up those empty rooms, which are in the offing to be invented independently. Her study also looked at what it was akin to being an infertile woman and an infertility sufferer. For this research she reviewed medical records of all the patients of at a major hospital which was providing services to infertile people. She reviewed records of 361 patients during the course of a year. After that she sent them questionnaire almost 5 to 6 years after their infertility investigation. This study confirmed that a lot of people spend many years, frequently 4 to 5 years as patients of infertility and they might spend more time in dealing with the problem at personal level. According to the researcher, the women in Norway have many important roles to play in the society besides being playing the role of a mother. She said that men and women of Norway never suffered from emotional problem regarding their infertility. Infertility issue attracted her interest only because it is a matter of great concern for the people of developing countries. Both men and women have different emotional responses towards infertility and they see these phenomena in totally different context.

Belsey, 2000 reviewed literature on infertility available in Africa. The results revealed that most of the researches have focused on the cause of infertility and the incidence of infertility. A trivial number of researches have found that infertility hurt, that it can be distressing and devastating for women who perceive motherhood to be important and tantamount due to many cultural, personal reasons. When the researcher focused his attention on the incidence of infertility and the causes of infertility, he observed that very less literature was available on the experiences of infertility and about the psychosocial effects of infertility on the lives of the infertile women of Africa. Women oraganizations, researchers, mid wives and nurses also have not given attention to this issue. They haven’t raised voice for the issues and problems of infertile African women. Reasons of this negligence are unknown. One reason can be that in a developing country like Botswana, the rate of infertility is quite high and all the emphasis is given to control infertility rather than focusing on the effects of infertility.

Lee T., Sun G., 2000 carried out a research to find out the psychological responses of infertile Chinese couples. 59 infertile couples took part in this study. The participants of the study filled Infertility Questionnaire, Sexual Satisfaction Questionnaire, and Marital Satisfaction Questionnaire to measure gender differences in coping with infertility problem. Results showed that females experience more stress than males. Females self esteem was lower than that of males also the marital and sexual satisfaction of females was also lower than males. These results made it clear that the responses of Chinese couples towards infertility were similar to the infertile couples of Western Countries.

This paper by Papreen et al. in 2000 explored the perceived causes of infertility, treatment for infertility and the penalty of being childless, mainly for women, amongst Muslim population in urban slums areas of Dhaka, Bangladesh. In detail interviews were conducted from 60 females and 60 males. Sample was randomly selected from the Urban Surveillance System randomly clusters of the International Diarrheal Disease Research Center in Bangladesh. Case studies of 20 infertile women who had formerly participated in a research on the frequency of STD’s (sexually transmitted diseases) and many other reproductive tract diseases were taken. Three traditional healers were also interviewed, taking them as key informants. Both groups of respondents perceive infertility caused due to evil spirits and physiological deficiencies in women, whereas the causes of infertility among male population are physiological and psychosexual problems. Herbal doctors and traditional healers are thought to be the main option of treatment for females while for males, remarriage is considered to be the remedy of infertility. Remarriage is often followed by herbal and traditional treatment. Childlessness has emotional effects, social consequences, role failure for both males and females. Usually this result in stigmatization of the husband and wife, women often suffer more due to stigmatization. Infertility puts women at danger of societal and familial disarticulation, and women clearly suffer the burden of being infertile. Successful programmes for coping with infertility in Bangladesh are required to take in both suitable and valuable sources of healing at societal level and community based interventions are required to throw light on the reasons of infertility, so that people may know why infertility occur in both males and females and from where it is best to seek for the treatment of their infertility.

Catherine R. K., 2002 found out that infertile women deviate from the common and accepted life path and are extremely discredited. Married women who remain infertile in India are invisible in social research, but are very noticeable in their family and community. From the viewpoint of women leading lives in a country where their status depends upon their motherhood, the implication of being childless is intense. Most of the women in India who visit infertility clinic for the treatment of their infertility self blame themselves to be the cause of their childlessness. Bearing and nurturing children are vital to a woman’s authority, security and well being. Giving birth to children bring solid benefits and rewards for the women throughout their life. A baby strengthens a wife’s often delicate relation with her spouse in an arrange marriage and it also improves her position in joint family. She can sooner or later become mother-in-law- if is a mother herself. Being mother in law is a position of significant power and authority in Indian families. Women are stigmatized when they are unable to become mothers. Sometimes women tend to strengthen their relationship with their husband without biological children.

Greil 1991 and Miall, 1986 found that In Western countries, women come across stigma if they do not become mothers.

Childless women are often stigmatized, which result in isolation, abandonment, domestic violence and polygamy (Richards, 2002).

McQuillan et al, 2003 used randomly selected sample of 580 women living in Midwest, and tested their hypothesis that women who are infertile report to have psychological distress. About one third of the total sample have reported having an experience of infertility sometime in their lives, but now majority of the infertile now have their own biological children. By formulating hypotheses from stress and identity theories, the researchers have examined the effects of infertility were restricted only to childless women. Infertility is linked with considerably higher levels of psychological distress. For women in this class, the risk of misery is extensive.

Study by Ciwikal in 2004, demonstrated that infertile women have considerably elevated levels of symptoms of depression, and twice the prevalence of depressive symptoms in relation to fertile women.

Fido et al., 2004 examined the psychological distress amongst the Kuwaiti women having infertility problems and they also explored the causes of infertility. Arabic version of Hospital Anxiety and Depression Scale was used to inspect the psychological condition of 120 infertile Kuwaiti women and 125 healthy pregnant women. Healthy women were used as control group. Results of both groups were compared and it was found that the infertile women had significantly higher psychopathology in all the parameters of HADS. The infertile women had high scores on hostility, anxiety, self blame, tension, and suicidal ideation parameters. Illiterate group of infertile women thought that their infertility is due to evil spirits, witchcraft and God’s retribution. On the other hand infertile educated women blamed marital, dietary, and psycho sexual factors for their infertility. Illiterate women preferred faith healers for treatment and educated women opted for infertility clinics.

Amir et al., 2004 studied the effects of two psychological resources, which are perceived social support and attachment style on adjustment. For this purpose 109 infertile women were studied. In this research the effects of infertility duration and the difference in the effects of primary and secondary infertility were examined. Questionnaires administered to the subjects measured marital adjustment, well being and psychological distress. Results of the study showed that only duration of infertility had a marked influence on the psychological well being of infertile women. Also the psychological assets were greatly linked with the adjustment scores in general. Regression analysis of the data showed that social support and attachment style were linked to quality of married life and to the psychological well being and both of these resources functions as moderators of stress. In the end, it was found that social support and attachment style were vital resources for the individuals at the time of stress especially in the case of infertility scenario.

A report published by World Health Organization (WHO), discussed the gender and mental health in the Eastern Mediterranean Region. Women may experience psychological distress and disorders if they have reproductive health problems. Infertility and hysterectomy have been found to increase women’s risk of affective/ neurotic syndromes. Sample of 37 women at an infertility health clinic in the Islamic Republic of Iran was examined and it was found that 40.8 % women had depression and 86.6 5 had anxiety. Depression was most commonly found after 4-6 years of infertility (Ramezanzadeh F. et al., 2004).

Researches by Zahid, 2004; Zheng & Randy, 2002 revealed that infertile women exhibit a considerable higher level of psychopathology in form of tension, anxiety, depression, self blame and suicidal ideation.

Effects of infertility could be loss of relationship with spouse, loss of relationship with the social network, downfall of health and sexual pleasure, decrease in self esteem, loss of security and loss of hope (Baor and Blickstein, 2005).

Dyer et al., 2005 conducted a research to measure the level of psychological distress among women who were suffering from couple infertility in one of the urban community of South Africa. The Symptom Checklist-90-R (SCL-90-R) was administered to 120 infertile women at the time of their first visit to an infertility clinic. The control group consisted of 120 women who were absolutely healthy. Women who were suffering from infertility had significantly higher scores on distress measuring items of SCL-90-R. The infertile women who were beaten by their husband had higher distress scores than those infertile women who were not beaten by their husband. Infertility is linked with elevated levels of psychological distress. Infertile women in abusive relations were predominantly at risk. The results of this study were similar to the results of previous researches on the same topic.

Mogobe, 2005 conducted a qualitative study to find out, theoretically explain and understand the phenomena of infertility from the view point of 4 members of the traditional medical system and also from the view point of 40 infertile females. In the course of ongoing data gathering and investigation, a hypothetical structure of denying and preserving oneself was constructed. Self preservation means that rising individual actions which are aimed at preventing and decreasing damage inflicted by other people due to one’s infertility. Factors that contribute to denying of oneself are; denying about the experiences of getting pregnant, denying their womanly status, denying immortality, denial of d