Psychological and social aspects of infertility and infertility treatment : the Persian experience
This pioneering investigation is based on a longitudinal research, expanding over a 3 year period, exploring the Psychological and Social aspects of infertility and infertility treatment on Persian (henceforth referred to as Iranian) infertile couples attending infertility clinics in Tehran. In phase 1 of the investigation an 85-item questionnaire in Farsi (Persian) was developed and validated, based on a four point Likert-type scale measuring the following factors: Psychological Distress, Social Extroversion, Marital Satisfaction, Attitudes Towards Modem Medicine and Religious Beliefs. In phase 2 of the investigation, lasting over a period of two years, the above 85-item questionnaire was administered at three time phases, namely: initial assessment (when patients first attended the clinic for the purpose of diagnosis of their problem), during In Vitro Fertilisation (IVF) treatment (24 hours before egg collection), and a week after an unsuccessful treatment cycle. The same questionnaire was also administered to fertile couples (the control group) attending the clinics for routine and non-fertility related treatment at three time phases (about three weeks between each administration). The data from the patient group (n = 37 couples) and control group (n = 10 couples), together with data obtained from the general population (n = 197) i.e. those who responded to the items for the purpose of validating the questionnaire (norms), was subjected to statistical analysis. In comparison to norms and control group, infertile patients were more psychologically distressed. This finding is true for both men and women investigated. The degree of this psychological distress, however, is significantly greater for women than for men. Standard Multiple Regression Analyses of the infertile patients' data showed that the main predictors of psychological distress were gender, marital satisfaction, attitudes towards modem medicine, and religious beliefs. F or female patients, marital satisfaction was a significant predictor of their psychological distress. Marital satisfaction was the main contributing factor to the socially withdrawn behaviour of the patients. In phase 3 of the investigation, a year after data collection, examination of patients' notes showed that 7 out of the 37 infertile couples eventually had successful IVF with a term pregnancy. Results of a Stepwise Regression Analysis showed that the degree of psychological distress was the main predictor of pregnancy. In particular, couples who eventually conceived scored lower on psychological distress measures than those who did not. These findings are discussed in line with comparable reported literature on a mainly Western population, and implications of the findings for future research and counselling of infertile patients are outlined.