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| ORIGINAL ARTICLE |
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| Year : 2021 | Volume
: 4
| Issue : 3 | Page : 105-109 |
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Marital adjustment as a predictor of quality of life in infertile couples
Samereh Eghtedar1, Elnaz Asghari2, Fatemeh-Sara Aparnak3, Zoleikha Asgarloo4, Parinaz Rasti5
1 Department of Medical-Surgical Nursing, Nursing and Midwifery School, Urmia University of Medical Sciences, Urmia Branch, Iran
2 Department of Medical- Surgical Nursing, Nursing and Midwifery School, Tabrtiz University of Medical Sciences, Tabriz, Iran
3 Department of Midwifery, Islamic Azad University, Urmia Branch, Iran
4 Department of Midwifery, Khoy University of Medical Sciences, Urmia, Iran
5 Department of Medical-Surgical Nursing, Khatamolanbia Hospital, Salmas, Urmia, Iran
| Date of Submission | 06-Feb-2021 |
| Date of Decision | 27-May-2021 |
| Date of Acceptance | 31-May-2021 |
| Date of Web Publication | 26-Jul-2021 |
Correspondence Address:
Elnaz Asghari
Nursing and Midwifery School, Shariatee Street, Tabriz
Iran
 Source of Support: None, Conflict of Interest: None  | 2 |
DOI: 10.4103/shb.shb_10_21
Introduction: Quality of life of couples may be affected by infertility. Information about their quality of life can be used for developing health promotion programs by the nurses. The purpose of this study was to predict the factors that affect the quality of life of infertile couples based on marital adjustment, factors related to infertility, and background characteristics. Methods: In this descriptive correlational study, 131 women and 79 men referred to an infertility center were recruited using a convenience method. Data were collected using the quality of life and Spiner's marital adjustment questionnaires. Regression analysis was used for the data analysis through the SPSS software version 16. Results: The means of the females and males' age were 35.74 ± 6.11 years and 32.45 ± 5.72 years, respectively. Of variables with a P < 0.1 that entered the regression analysis, marital adjustment (β = −0.444, P < 0.001), gender (β = 0.138, P < 0.023), and insurance (β = 0.199, P < 0.001) accounted for 78% of the observed variance in the quality of life of the infertile couples. Conclusion: The results revealed that fundamental interventions are needed to improve the quality of life of infertile couples. Providing the necessary training when couples go to the infertility clinic and improving insurance coverage for infertility treatment is recommended based on the results.
Keywords: Infertile couples, marital adjustment, predictor, quality of life
How to cite this article:
Eghtedar S, Asghari E, Aparnak FS, Asgarloo Z, Rasti P. Marital adjustment as a predictor of quality of life in infertile couples. Asian J Soc Health Behav 2021;4:105-9 |
| Introduction | |  |
Infertility is still a major problem globally.[1] While the use of infertility, health-care services have been increased in recent decades, the prevalence of infertility has remained constant. The prevalence of infertility is reported to be 3.5%–16.7% in developed countries and 9.9%–9.3% in developing countries.[2]
The problem of infertility has become a social concern that can lead to severe psychological problems and psychological imbalance between couples and even divorce.[3] Infertility can be considered a crisis in life, identity problem, and a chronic illness.[4] Infertile couples have less satisfaction with life than their counterparts.[5] Particularly, in those societies that bringing children immediately after marriage is encouraged, infertility has a greater impact on couples' quality of life.
The quality of life is a multi-dimensional concept that is influenced by physical, psychological, emotional, and social factors.[6] Therefore, the need to assess the underlying social and psychological factors affecting the quality of life of infertile couples is appropriate. Furthermore, more attention should be given to the factors affecting couples' relationships and marital adjustment. Marital adjustment is defined as the process of modifying, accepting, or changing the behavior of the individual to engage in the achievement of the highest level of marital satisfaction.[7],[8] The marital adjustment of infertile couples is reportedly less than that of fertile couples.[9]
In Iran, there are more than one million infertile couples. The religious and cultural history of the Iranian society emphasizes childbearing. Therefore, infertility is considered a major social issue and a cause of divorce.[1] Individual's feelings of the quality of life varies according to the time, situation, and living conditions. Furthermore, there are various factors related to the quality of life in different societies and cultures.[10],[11] Identifying factors that influence couples' marital problems and declines their quality of life is very important for identifying couples who need supportive care. Knowledge of background characteristics and marital adjustment and their impacts on the quality of life can be used for health planning and family counseling to improve couples' quality of life and relationships. The present study was conducted to predict the factors affecting the quality of life of infertile couples using marital adjustment, factors related to infertility, and background characteristics.
| Methods | | |
Design
This study is a descriptive-correlational research. Both to provide a snapshot of the current state of affairs and to discover the relationships among quality of life with marital adjustment, factors related to infertility and background characteristics, and to allow the prediction of future events from present knowledge.
Setting
This study was conducted in an infertility clinic in an urban area of Tabriz, Iran. This clinic is the largest and most well-equipped university-centered infertility clinic in the Northwest of Iran.
Participants
The inclusion criteria were in the age range of 15–45 years; the documented diagnosis of infertility (the inability for a couple to conceive after a year of regular, unprotected sexual intercourse); no history of severe mental problems; and no other acute physical problems. Using a census sampling method from July 23, 2019, to January 21, 2020, 131 women and 79 men were found eligible to take part in this study.
Measurement
The background characteristics and infertility-related questionnaire, the infertile women's quality of life, and Spiner's marital adjustment questionnaires were used for the data collection. The infertile couples' quality of life questionnaire had 72 items in seven dimensions as physical, psychological, spiritual, religious, economic, emotional, sexual, and social. Scores varied from 72 to 288, and higher grades indicate better quality of life. Its validity and reliability have already been confirmed in similar studies.[12] The Cronbach's alpha coefficients of each domain were higher than 0.81 and for the whole instrument were 0.89.
The Spiner's marital adjustment questionnaire was a 15-item instrument developed by lock Wallace. This questionnaire examined the extent of couples' agreement in various areas. Scores varied from 2 to 155, and grades <100 indicated tensions in marital adjustment. The internal consistency coefficient of this questionnaire was reported satisfactory in the similar context.[13]
Statistical analysis
Descriptive and inferential statistics were used for the data analysis through the SPSS software version 16 (Chicago, Illinois, USA). The normality of data was confirmed using the Kolmogorov–Smirnov test. The t-test (two groups) and analysis of variance (more than two groups) were used to compare the difference in the mean of quality of life according to marital adjustment, factors related to infertility, and background characteristics. The Pearson correlation coefficient was used for the study of the correlation of the quality of life and continuous variable such as age. All independent variables with a P < 0.10 from the univariate analysis were entered into a multiple linear regression model. In multiple regression analyses, the stepwise method was used to arrive at the final model and deduce a multivariate summary model of determinants of the outcome variables. The independent variables in this study were a mixture of continuous and categorical variables. In multiple regression analyses, the categorical variables with more than two groups were coded as “dummy variables.”[14]
Ethical consideration
This research was approved by the Student Research Committee affiliated with Tabriz University of Medical Sciences, Iran (code number: 5/46/4880). This study was conducted after obtaining permissions from the Ethics Committee, as well as explaining the study's aim to the couples and achieving their informed consent. The participants were explained about the voluntary nature of participation in this study, the possibility of withdrawal from the study at any time without being penalized.
| Results | | |
In this study, 131 women and 79 men filled out the questionnaires. The means of the women and men's age were 35.74 ± 6.11 years and 32.45 ± 5.72 years, respectively. The average duration of marriage and duration of infertility diagnosis were 2.25 ± 4.30 and 1.74 ± 2.73 years, respectively. The mean score of marital adjustment was 97.40 ± 23.70, which was in the range 45–152. Other demographic and background characteristics of the couples are reported in [Table 1]. | Table 1: The univariate associations between the quality of life with infertility-related and demographic characteristics
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The relationships between quality of life with age (P < 0.05, r = −0.139) and marital adjustment (P < 0.01, r = −0.544) were statistically significant, but no significant relationship was found between marriage and duration of infertility (P < 0.22, r = −0.821).
The univariate associations between the quality of life and other factors associated with infertility and demographic characteristics are presented in [Table 1]. Accordingly, variables that had a P < 0.1 entered the regression analysis test [Table 2]. | Table 2: The prediction of variance in the quality of life based on input variables
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| Discussion | | |
The purpose of this study was to predict the factors affecting the quality of life of infertile couples using marital adjustment, factors related to infertility, and background characteristics. In the regression analysis, gender, insurance, and marital adjustment accounted for more than 78% of the observed variance in the quality of life of the infertile couples.
Gender was one of the predictors of the quality of life, as men had a better quality of life in this study. A poorer quality of life of women than men in other studies was also shown.[11],[15] This indicated a more negative effect of infertility on the women's quality of life. Childbearing for women is more important than men as they feel more responsibility toward it.[16] Evidences have shown that women experience more stress even when their husbands have the physical problem.[17] The disagreement between couples' attitudes toward infertility can be attributed to the more importance of childbearing for women than men.[16] Furthermore, women are more likely than men to pursue the treatment of infertility. On the other hand, more women than men talk with their spouses about childbearing, while men do not express clearly their concerns.[17]
Insurance was another factor that affected the quality of life of infertile couples. Economic factors are among important factors that affect the quality of life of couples.[18] This is particularly important for infertile couples, because the costs of infertility treatment are high. In the past, infertility treatment was not subject to medical insurance. Recently, the reduction of the reproductive rate in Iran has made that several measures are taken to incorporate the diagnostic and therapeutic interventions of infertility into medical insurance. Perhaps, this was the reason that the insurance coverage was more a predictor of the quality of life than living expenses for the infertile couples. This finding reveals the importance and necessity of a wider coverage of infertility treatment by medical insurance.[19]
Another predictor of the quality of life was marital adjustment. Marital adjustment is one of the important concepts of couples' quality life.[20] According to the findings of this study, marital adjustment was one of the most important criteria for the prediction of variation in the infertile couples' quality of life. Couples' adjustment and improving couples' understanding of the marital life have many positive emotional effects on them, especially those who experience stress.[1] It can influence the quality of life in physical, psychological, spiritual and religious, economic, emotional, sexual, and social dimensions.[10]
Limitation
The limitations of this research may influence generalization of the findings. In this study, infertility was studied when the couples were following therapeutic measures. Therefore, other periods of the couples' life such as the time of infertility diagnosis and disappointment with fertility were not considered in this study. It was also impossible to achieve the perspectives of couples simultaneously. Comparing the perspectives of couples would have provided a more accurate understanding of this phenomenon.
| Conclusion | | |
In general, gender, insurance, and marital adjustment influence the couples' quality of life. The findings of this study revealed the clinical value of appropriate interventions to promote marital adjustment and rectify the underlying causes that increase the infertile couples' quality of life. In this context, more attention should be paid to women, the use of insurance and widening the scope of insurance for the treatment of infertility. Furthermore, it is suggested that suitable educational courses are held to increase marital adjustment among couples.
Acknowledgment
This article was based on a research project approved by the Student Research Committee affiliated with Tabriz University of Medical Sciences, Iran. Therefore, we are grateful to the Vice-Chancellor for Research of Tabriz University of Medical Sciences who supported this study financially. We also appreciate the close cooperation of the staff and officials of the infertility center and all couples in this study.
Financial support and sponsorship
This study was financially supported by grant from the Student Research Committee affiliated with Tabriz University of Medical Sciences, Iran (Code Number: 5/46/4880).
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Faghih S, Kazemi H. Effectiveness of emotionally focused couples therapy on the control of infertile couples' emotions. J Holistic Nurs Midwifery 2019;29:31-6.  |
| 2. | Farrag RE, El-Tohamy N. Oocyte cryopreservation: Awareness and perception of infertile couple undergoing in-vitro fertilization. Egypt J Health Care 2020;11:300-21. |
| 3. | Sahakian JP, El Helou E, Azoury J, Salameh L, Abou Jaoude I, Sleilaty G. Infertility within the Lebanese population: Beliefs and realities. Middle East Fertil Soc J 2020;25:1-8. |
| 4. | Taebi M, Kariman N, Montazeri A, Majd HA. Development and psychometric evaluation of the female infertility stigma instrument (ISI-F): Protocol for a mixed method study. Reprod Health 2020;17:1-6. |
| 5. | Li X, Ye L, Tian L, Huo Y, Zhou M. Infertility-related stress and life satisfaction among Chinese infertile women: A moderated mediation model of marital satisfaction and resilience. Sex Roles 2020;82:44-52. |
| 6. | Yilmaz FA, Avci D, Tahta T. Relationship between marriage satisfaction and sexual functions in couples undergoing infertility treatment. Int J Sex Health 2020;32:1-2. |
| 7. | Molgora S, Fenaroli V, Acquati C, De Donno A, Baldini MP, Saita E. Examining the role of dyadic coping on the marital adjustment of couples undergoing assisted reproductive technology (ART). Front Psychol 2019;10:415. |
| 8. | Chaves C, Canavarro MC, Moura-Ramos M. The role of dyadic coping on the marital and emotional adjustment of couples with infertility. Fam Process 2019;58:509-23. |
| 9. | Mirghafourvand M, Farshbaf-Khalili A, Ghanbari-Homayi S. Marital adjustment and its relationship with religious orientations among Iranian infertile and fertile women: A cross-sectional study. J Relig Health 2019;58:965-76. |
| 10. | 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. [Full text] |
| 11. | Zeren F, Gürsoy E, Çolak E. The quality of life and dyadic adjustment of couples receiving infertility treatment. Afr J Reprod Health 2019;23:117-27. |
| 12. | Navabi Rigi S, Kianian T, Kermansaravi F, Yaghmaei F. Quality of life of infertile women referring to an infertility treatment center in Shiraz, Iran. Payesh 2016;15:549-58. |
| 13. | Dowlatabadi FH. The role of the attachment styles and coping strategies in predicting the marital adjustment in female teachers. Int J Human Cultural Stud 2016;2:1029-40. |
| 14. | Kleinbaum D, Kupper L, Nizam A, Rosenberg E. Applied Regression Analysis and Other Multivariable Methods. San Francisco, CA: Nelson Education; 2013. |
| 15. | Mohamed Ali Mohamed Ali S, Yousif Ahmed A, Abdelati I. Quality of life of infertile couples at Mansaura University Hospital. Port Said Sci J Nurs 2019;6:229-43. |
| 16. | Bakhtiyar K, Beiranvand R, Ardalan A, Changaee F, Almasian M, Badrizadeh A, et al. An investigation of the effects of infertility on Women's quality of life: A case-control study. BMC Womens Health 2019;19:114. |
| 17. | Fang M, Li G, Kang X, Hou F, Lv G, Xu X, et al. The role of gender and self-esteem as moderators of the relationship between stigma and psychological distress among infertile couples. Psychol Health Med 2020;1-4. |
| 18. | Kiani Z, Simbar M, Hajian S, Zayeri F. Development and psychometric evaluation of a quality of life questionnaire for infertile women: A mixed method study. Reprod Health 2020;17:1-9. |
| 19. | Namdar A, Naghizadeh MM, Zamani M, Yaghmaei F, Sameni MH. Quality of life and general health of infertile women. Health Qual Life Outcomes 2017;15:139. |
| 20. | Shahbazi S, Kafi Masuleh SM, Fallahi M, Shafti V. Self-efficacy, marital adjustment, and quality of life in women with polycystic ovary syndrome. J Holistic Nurs Midwifery 2017;27:87-93. |
[Table 1], [Table 2]
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