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Psychosocial wellbeing and coping strategies of infertile women seeking

infertility treatment

Article · January 2015

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 Journal of Infertility and Reproductive Biology, 2015, Volume 3, Issue 2, Pages: 176-180

Psychosocial wellbeing and coping strategies of infertile women seeking

infertility treatment

D’Souza Vinitha1, Noronha Judith Angelita2*, Kamath Shobha3

1. Manipal College of Nursing, Manipal University, Manipal, India

2. Department of Obstetrics and Gynecological Nursing, Manipal College of Nursing, Manipal University, Manipal,
India
3. Department of Obstetrics and Gynecological Nursing, Manipal College of Nursing, Manipal University, Manipal,
India

Abstract
Infertility refers to the inability of a couple to produce a child even after a year of repeated unprotected
intercourse. It has great impact on people’s lives and their psyche. The objectives of this study were to assess the
psychosocial wellbeing and coping strategies, to examine its relationship and to find the association with selected
demographic variables. A cross sectional survey (n=180) design was used to assess the psychosocial wellbeing and
coping strategies of infertile women (aged 20-40 years) seeking infertility treatment in selected infertility clinics of
Udupi District Karnataka. Study results showed that majority of the study population (146, 81.1%) had moderate
level of psychosocial wellbeing and coped with seeking social support (65.7%). There was a difference in mean
scores and standard deviation in sub areas of psychological wellbeing (42.5±5.95), social wellbeing (45.37±5.7).
Women with good psychosocial wellbeing used less coping strategies(r = -0.2, p<0.01). There was a significant
association between psychosocial wellbeing and educational status of infertile women (p=0.001) and coping
strategies with type of the family (p=0.01). Study findings concluded that infertile women do have disturbed
psychosocial wellbeing. So counseling sessions is needed to improve their psychosocial wellbeing and to get focus
on their treatment.

Keywords: Infertile women, Infertility, Infertility treatment, Psychosocial wellbeing, Coping strategies

1. Introduction
Infertility is the inability of a couple to achieve Parenthood achievement is one of the major life
pregnancy within 12 months of unprotected goals for most men and women. In planning a life
intercourse [1]. Childlessness is worldwide problem together, most of the couples have a vision about how
affecting people of all communities. The WHO their life should be, and most of them wish to have
estimates the overall prevalence of primary infertility children of their own for the future life. When
in India to be between 3.9 and 16.8 percent. fertility fails, the couples become depressed
Estimates of infertility vary widely among Indian psychologically and can experience a wide range of
states from 3.7% in Uttar Pradesh, Himachal Pradesh emotions. Couples may blame themselves even
and Maharashtra, to 5% in Andrapradesh, and 15% in though it is not a personal failure or punishment [3].
Kashmir. Moreover the prevalence of primary Childless women will undergo varied psychological
infertility has also been shown to vary across tribes distress and in order to overcome psychological
and castes within the same region in India [2]. distress and maintain their quality of life they need to
use appropriate coping strategies [4]. In a qualitative
*
Corresponding author: Dr. Judith A Noronha, study conducted in the United States, it was found
Associate Dean and HoD OBG (N), Manipal College that women used coping strategies such as avoidance
of Nursing Manipal Karnataka, India. Contact No. of reminders of infertility, being the best, regaining
9448506594. Email Id: [email protected] control, sharing the burden and giving into feelings in

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 Journal of Infertility and Reproductive Biology, 2015, Volume 3, Issue 2, Pages: 176-180

dealing with the problems of infertility [5]. Another The present study showed that out of 180 study
study also conducted in the United States by Stanton population majority of the infertile women i.e, 146
et al found that women who coped through escape (81.1%) had moderate psychosocial wellbeing, 33
avoidance and through accepting responsibility for (18.3%) had good psychosocial wellbeing and
their infertility showed more distress, whereas 1(0.6%) had poor psychosocial wellbeing (Fig 1).
women who sought more social support were less Table 1 shows that majority of infertile women had
distressed [6]. Seeking social support was an good social wellbeing (45.37±5.7) than that of the
important coping mechanism used by couple during psychological wellbeing (42.5±5.95).
the process of taking treatment for infertility [7].
This study aims to identify the psychosocial
wellbeing and coping strategies of women seeking 0.6% (1)
treatment for infertility. The findings have the
potential of enabling the healthcare personnel in
18.3% (33) Poor
designing and implementing supportive
psychological programs for women faced with Moderate
fertility problems.
Good
2. Materials and methods
Descriptive cross-sectional survey design was
adopted for the study in which 180 infertile women
were selected by using non-probability purposive
sampling. The study included infertile women who 81.1% (146)
were seeking infertility treatment from selected
infertility clinic and hospitals of Udupi district of
Karnataka. Data was collected from January 6 to
February 8, 2014. These centers have adequate
infrastructural facilities for all kinds of clinical
investigations of infertility for both males and Figure 1. Pie diagram showing the percentage of
females. psychosocial wellbeing of infertile women
The women were administered by a validated
questionnaire on psychosocial wellbeing. This
instrument has been developed by the researcher and Table 1. Domain wise Mean and Standard Deviation
validated by experts and modified based on their
(SD) of Psychosocial Wellbeing of Infertile Women
suggestions. To determine the coping strategies a
revised ways of coping developed by Folkman and (n=180)
Lazarus, 1985 (15) was administered. We also used Number
Maximum
demographic questionnaires including biologic Domains possible Mean
of items SD
scores
characteristics to determine the age, education,
occupation, causes, duration of infertility, Psychological
16 64 42.5 5.95
investigation and treatment for infertility. wellbeing
The enrollment of the subjects was done after
Social
giving a clear explanation of the purpose of the study. 16 64 45.37 5.7
wellbeing
Informed written consent was obtained and
anonymity was ensured. They were assured that they
could withdraw from the study at any point of time.
They were also assured that the researcher would 3.2. Coping strategies of infertile women
assume responsibility for the safe-keeping of the The mean percentage scores of ways of coping
data. The exclusion criteria included infertile women (Table 2) was highest in the areas of seeking social
who were not willing to participate in the study and support (65.7%), positive reappraisal (62.8%), self –
suffering from any neurological or psychiatric illness. controlling (59.6%), distancing (59.5%), Planful
problem solving (48.9%), Confrontive (43.3%),
3. Results escape-avoidance (41.1%), accepting responsibility
3.1. Psychosocial wellbeing of infertile women (36.9%).

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 Journal of Infertility and Reproductive Biology, 2015, Volume 3, Issue 2, Pages: 176-180

3.3. Relationship between psychosocial wellbeing and correlated (r = -0.42, p< 0.01).
coping strategies
Lower the psychosocial wellbeing higher the 3.4. Association between psychosocial wellbeing, coping
coping strategies such as Confrontive, distancing, strategies and selected demographic variable
self- controlling, seeking social support, accepting The data revealed that there is a significant
responsibility, escape- avoidance, Planful problem association between psychosocial wellbeing and
solving and positive reappraisal they would use educational status of infertile women (p=0.001) and
(Table 2). Both of the total scales of psychosocial coping strategies with type of the family (p=0.01)
wellbeing and WOC Questionnaire were negatively (Table3).

Table 2. Area wise Mean, Standard Deviation and Mean Percentage Scores of Coping Strategies Used by Infertile
Women. (n=180)
Coping Strategies Minimum Maximum Mean Standard deviation Mean percentage
Confrontive 0 18 7.81 2.40 43.3
Distancing 0 18 10.71 2.69 59.5
Self-controlling 0 21 12.52 3.06 59.6
Seeking social support 0 18 11.83 2.84 65.7
Accepting responsibility 0 12 4.43 1.92 36.9
Escape avoidance 0 24 9.87 3.25 41.1
Planful problem solving 0 18 8.81 2.20 48.9
Positive reappraisal 0 18 11.31 2.47 62.8

Table 3. Correlation between psychosocial wellbeing and coping strategies. (n=180)

Psychosocial wellbeing total scale
Variable Correlation coefficient (r)

Confrontive -0.43 **
Distancing -0.18 *
Self-control -0.25 **
Seeking social support -0.24 **
Accepting responsibility -0.34 **
Escape avoidance -0.52 **
Planful problem solving -0.21 **
Positive reappraisal -0.21 **

Total -0.420**
P* < 0.05, P ** < 0.01.

4. Discussion
In this study majority of infertile women had (74%) of an infertile couple which was associated
moderate level of psychosocial wellbeing. This study with feelings of stress (35%), anger (20%) and guilt
findings was supported by an explorative study as a reason for infertility [8]. Omoaregba JO et.al
conducted by Maria K (2005) on infertile people’s (April-June2008) described in his comparative survey
psychosocial problems in Greece where the results that psychological distress was highly prevalent in
highlighted that severe psychosocial problems infertile women and they require psychologic support
usually had an impact on the everyday life of women [9]. Our study also attributed that majority of the

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 Journal of Infertility and Reproductive Biology, 2015, Volume 3, Issue 2, Pages: 176-180

infertile women coped with seeking social support It also suggested that there is a significant
(65.7%). These results are similar to that observed difference in coping strategies used by the infertile
by (Ried K and Alfred A) suggested that total of the women with type of family [F (2, 177) = 4.331,
infertile women population was actively seeking p=0.01]. No significant difference was found with
social support to improve their quality of life. other variables such as age, education, occupation,
The wellbeing and quality of life were mainly religion, family income and duration of infertility in
influenced by the emotional and instrumental support years. The study findings were supported by a cross-
[10]. However these findings are contradictory to a sectional survey conducted by Lykeridou K(2011)
study byErnestina D and Jane S discovered that reported that women of low/very low social class
majority of the females considered keeping the issue used higher levels of active-confronting coping than
of infertility with themselves (self-controlling) and women of medium or high social class (F = 7.997, p
the basis could be the stigma associated with their < 0.001). It also revealed that women of low/very low
infertility. Moreover, rest of the majority tried to social class used passive avoidance coping than
cope with Christian faith. The others used coping women of medium or high social class. However, this
mechanisms received from their spouses, occupation difference was marginally statistically significant (p
or in the way to grab economic independence and = 0.051). There was no significance association
some avoided remembering their problem of between age, educational level, medical
infertility [11]. characteristics and child existence [14].
The present study also revealed that the total
psychosocial wellbeing scale is negatively correlated Conclusion
with total domains of ways of coping (r= -0.42, Results of the study concluded that infertile
p<0.01). Infertile women who had poor psychosocial women will do experience disturbed psychosocial
wellbeing used many of the coping strategies. To wellbeing and they seek social support in order to
support these study findings a comparative study cope with the infertility stress. They use varities of
conducted by Joshi HI, Singh R, Bindu revealed that coping mechanism to adjust with the infertility.
infertile women do use various coping mechanism to Therefore it is the responsibility of healthcare
improve their quality of life and to eliminate their professionals to identify those infertile women who
psychological distress [12]. In the present study, it need support and counseling so that they can improve
has been observed that there is a significant their psychosocial wellbeing.
association between psychosocial wellbeing and
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