IOSR Journal of Nursing and Health Science (IOSR-JNHS)

e-ISSN: 2320–1959.p- ISSN: 2320–1940 Volume 2, Issue 3 (Sep. – Oct. 2013), PP 45-51
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An Exploratory Study to Assess the Quality of Life of Infertile

Couples at Selected Infertility Clinics in Haryana
Rebecca Dillu1, Poonam Sheoran2 and Jyoti Sarin3
1
M Sc Nursing(Obstetrics and Gynaecology)Maharishi Markandeshwar College of Nursing, Mullana, Ambala,
Haryana
2
Principal,Maharishi Markandeshwar Institute of Nursing, Mullana, Ambala, Haryana
3
Director Principal, Maharishi MarkandeshwarCollege of Nursing, Mullana, Ambala, Haryana

Abstract
Introduction: Infertility is defined as the inability to achieve pregnancy after one year of
unprotected intercourse. An estimated 15% of couples around the world meet this criterion and are considered
infertile.
Objective: An exploratory study to assess the quality of life of infertile couples at selected infertility clinics in
Haryana.
Design: Exploratory correlational survey design
Setting:The study was conducted at selected infertility clinics i.e. MMIMSR& Hospital, Mullana, infertility
clinics at district Ambala and Karnal
Participants: 100 infertile couples were selected at MMIMSR& Hospital, Mullana, infertility clinics at district
Ambala and district Karnal by purposive sampling technique.
Measurements and tool: A standardised tool i.e. FertiQol tool was administered to collect data and an
informational booklet on “Coping with Infertility” were also given to the infertile couples.
Findings: Findings revealed that male partners had better quality of life than the infertile female partners in all
the domains of quality of life i.e. emotional, mind/body, relational, social, environmental and tolerability
domain and there was a significant difference in the quality of life of infertile male and female partners. The
correlation between the various domains of infertile male and female partners showed that the emotional
domain was positively correlated to other domains (except the environmental domain in female partners).
Infertility had influenced all the domains of infertile couples but it had major impact on the emotional domain.
There was a significant association between levels of Fertility Quality of life scores and occupation of male
partners and age, religion, type of family, age at marriage, duration of marriage, trying for conception self and
with doctor’s help and number of miscarriages of female partners.
Conclusion:The study concluded that the infertility affects all the domains of quality of life but it has major
impact on the emotional aspect of the infertile couples hence health professionals need to include assessment of
psychological symptomatology to plan more efficient interventions to infertile patients.
Keywords: quality of life, infertile couple, infertility clinics, selected variables, informational booklet.

I. Introduction
Infertility remains an important problem worldwide which affects men and women equally. It does
affect a large percentage of the population and are on the rise in many countries. There are millions of couples
right now struggling with infertility. It can be a hard struggle as couples see other people with their babies and
wonder why it is not so easy for them.1,2
The World Health Organization (WHO,2004) estimates that 60 to 80 million couples worldwide
currently suffer from infertility3. Infertility varies across regions of the world and is estimated to affect 8 to 12
per cent of couples worldwide4,5. According to WHO, primary infertility is the Inability to conceive within two
years of exposure to pregnancy (i.e. - sexually active, non-contracepting, and non-lactating) among women 15 to
49 yr old6. Secondary infertility refers to the inability to conceive following a previous pregnancy. Globally,
most infertile couples suffer from primary infertility7.
Health related quality of life now is considered as an important outcome measure in many clinical
settings. Since infertility and its treatment has several psychosocial effects on infertile couples, studying health
related quality of life in these group of people is very crucial8,9.
A study was conducted in which it was found that infertile women attained higher neurotic scores in
the Madzeli questionnaire as compared to fertile women 10. Findings from earlier studies on marital relationship
in infertile individuals, showed a significant correlation between stressful life events and marital quality 11.
A study was carried out that showed that the individual‟s marital relation was related to characteristics such as
socio-economic status, personality, mental health, communication and duration of marriage. For both the

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An Exploratory Study to Assess the Quality of Life of Infertile Couples at Selected Infertility Clinics in

infertile males and females, their marital relationship could be influenced by the above factors directly or
indirectly12.
Men also suffer because of gender norms and there is increasing recognition of this fact. A WHO study
of 5,800 infertile couples in 22 developed and developing countries found that men were either the sole cause or
a contributing factor to infertility in more than half of the couples. Further it was found that in only 12.8 percent
of cases infertility was solely due to the female with no demonstrable cause in the male13.
There is some evidence that with technical advancements and increasing awareness that there are
treatments for a failure to conceive, women in India have started approaching qualified medical providers for
help though they still also turn to religious practices for “treatment”. In a study, of 225 cases, 109 childless
women sought treatment within one year and all sought allopathic or religious treatments at some point 14.
Women experience stigma and isolation. Infertility can threaten a woman‟s identity, status and economic
security and consequently, be a major source of anxiety leading to lowered self-esteem and a sense of
powerlessness. According to a study in Mumbai, “She is called waanj (barren). There is a superstition that if
she touches a baby, the baby will die13.” A study in Andhra Pradesh showed that, anticipating taunts and hostile
behaviour from others, many women shun social functions15.
Factors that predicting quality of life may vary in different infertile populations, different gender and
different ethnic backgrounds. Thus, the identification of factors associated with better or worse quality of life in
different domains is vital in order to propose and test scientifically based interventions for infertile populations.

Objectives
1. To assess the quality of life among infertile couples and compare the quality of life of male and female
partners.
2. To determine the relationship between various domains of quality of life of infertile couples; emotional,
mind/body, relational, social, environmental and tolerability.
3. To determine the association of levels of quality of life of infertile couples with the selected variables.
4. To develop and validate the information booklet on “coping with infertility”.

HYPOTHESIS
H1: There will be a significant difference in Quality of life (QOL) of infertile male and female partners as
measured by fertility quality of life (FertiQoL) tool at 0.05 level of significance.
H2:There will be a significant relationship between various domains of quality of life of infertile couples;
emotional, mind/body, relational, social, environmental and tolerability at 0.05 level of significance.
H3: There will be a significant association of levels of quality of life of infertile couples with the selected
variables at 0.05 level of significance.

II. Materials And Methods

It was a non-experimental study in which exploratory correlational survey design was usedto assess the
Quality of life of infertile (QOL) of infertile couples.Sample for the present study included 100 infertile couples
attending selected infertility clinics in Haryana. Data was collected after obtaining the ethical approval from the
Institutional Ethical Committee for conducting the study.

Data Collection Procedure

 100 infertile couples those meeting the inclusion criteria and were attending selected infertility clinics were
selected using purposive sampling.
 Purpose of the study was explained to the samples, the confidentiality of their responses was assured and
their written consent was taken prior to the study.
 Data was collected by the researcher using self-administered questionnaire i.e. Fertility quality of life
(FertiQoL) questionnaire.
 Both male and female partners filled the questionnaire separately.
 A validated informational booklet titled “COPING WITH INFERTILITY” was distributed to the infertile
couples after administration of the questionnaire.

Plan For Data Analysis

 Selected variables of sample were described using descriptive statistics i.e. frequency and percentage
distribution.
 Assessment of quality of life was analysed by using descriptive statistics i.e. frequency and percentage
distribution (%) and findings regarding significant difference in the Quality of Life of infertile male and
female partners was analysed by using unpaired „t‟ test.

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An Exploratory Study to Assess the Quality of Life of Infertile Couples at Selected Infertility Clinics in

 Karl Pearson correlation of coefficient method was used to find the correlation between various dimensions.
 Association of quality of life with selected variables was analysed by using inferential statistics i.e. chi-
square test.

Findings
Findings regarding selected variables revealed more than half (53%) of male partners and 44% female
partners were in the age group of 25-31 years. Most (82%) of the infertile female partners were in the age group
of 18-24 years at the time of their marriage. Half (50%) of female partners had 1-5 years of the duration of their
marriage. Majority (64%) of female partners had primary infertility. It was noticed that half (50%) of female
partners were trying self for conception and with doctor‟s help since 1-5 years.
Majority (67%) of the infertile couples together had good quality of life, 31% had fair quality of life while very
few (2%) of them had very good QOL (Figure 1).
Gender-wise frequency and percentage distribution of infertile male and female partners according to
level of quality of life indicates that majority (82%) of the male partners had good quality of life whereas less
than half (43%) of the female partners had good quality of life, only 12% of the male partners had fair quality of
life whereas more than half (55%) of the female partners had fair quality of life and 6% of the male partners had
very good quality of life whereas very few (2%) of the female partners had very good quality of life (Figure 2).
The table 1 thus shows that the mean of fertility quality of life scores of male partners were higher than the
female partners indicating male partners had better quality of life than female partners of infertile couples.

TABLE 1
Mean, Median & Standard Deviation of Fertility Quality of Life Scores of Infertile Couples
N=200
Range Mean Median Standard Deviation

Male 61-129 94.39 94 10.99

(n= 100)

Female 59-129 83.97 83 11.82

(n= 100)

Table 2 shows that the mean fertility quality of life scores of the male partners were greater than the female
partners of the infertile couples in all the domains of quality of life i.e. emotional, mind/body, relational, social,
environmental and tolerability domain which indicates that the male partners had better quality of life than the
female partners in all the domains. Infertility had influenced all the domains but emotional domain was the most
affected domain in both male and female partners of the infertile couples. Domain wise ranking of Quality of
Life (QOL) scores showed that the emotional domain had the lowest rank (VI) in both male and female partners
indicating that the emotional domain was the most affected domain having the greatest impact on their quality of
life of both male and female partners followed by mind/body, environmental and tolerability domain. Relational
domain got the second (II) rank for male partners whereas for female partners it was I and social domain of the
male partners had got the highest rank (I) whereas for female partners, social domain had the second (II) rank.

TABLE 2
Domain Wise Mean, Standard Deviation, Mean Percentage and Rank of Fertility Quality of Life Scores of
Male and Female Partners of Infertile Couples
N=200 (male=100
female=100)
Domains Range Mean+SD Mean % Rank

Emotional
Male 05-24 11.99+ 3.32 49.6 VI
Female 04-24 8.7+3.46 36.25 VI
Mind/body
Male 05-24 15.73+3.20 65.54 V
Female 04-22 11.86+3.38 49.4 V
Relational
Male 12-23 18.64+2.19 77.67 II
Female 11-23 18.58+2.57 77.4 I
Social
Male 07-24 19.64+ 3.01 81.83 I
Female 10-24 17.19+3.23 71.6 II
Environmental
Male 09-23 16.59+ 2.31 69.13 IV

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An Exploratory Study to Assess the Quality of Life of Infertile Couples at Selected Infertility Clinics in
Female 07-23 16.44+2.17 68.5 IV
Tolerability
Male 07-16 11.80+ 2.13 73.75 III
Female 4-15 11.20+2.17 70.00 III
Maximum Score= 24; Minimum Score= 0
Item wise percentage fertility quality of life scores of infertile male and female partners on domains of quality of
life depicts that the emotional domain of both male and female partners was affected to a great extent due to
infertility and among them female partners were emotionally more weak than the male partners as they
experienced grief, feeling of loss, sad, depressed and anger due to fertility problems. Mind/body domain had
major impact on the quality of life of female partners as compared to the male partners as evidenced by female
partners‟ impaired thought and concentration due to fertility problems. Female partners felt more drained out,
pain and physical discomfort because of fertility problems.
Relational domain of quality of life of both male and female partners was not much affected due to
infertility as the male and female partners were satisfied and content with their relationship. They never felt
difficult in talking about their fertility problems with their partners. Social domain was less affected domain of
both the male and female partners as the couples were satisfied with the support they received from their friends
and family and never felt inferior to the couples with children. They hardly felt any social pressure to have
children.
Environmental domain of both male and female partners was less affected by the infertility as the
couples were satisfied with the surgical or medical treatment they received, they were satisfied with their
interactions with the fertility medical staff and with the quality of services available to them to address their
emotional needs. Infertility had affected the tolerability domain of both the male and female partners to some
extent as the couples were bothered a little with the side effects of the medications and treatment and they found
it complicated in dealing with the procedure carried out for infertility treatment(s).
The computed „t‟ value (table 3) indicated that there was a significant difference in the Quality of life
of male and female partners of infertile couples as evidenced by the significant difference in the domain total of
male and female partners at the 0.05 level of significance. It indicated that male partners of infertile couples had
better quality of life than the female partners of infertile couples.

TABLE 3
Mean, Mean difference, Standard Error of Mean Difference and ‘t’ Value of Fertility Quality of Life (QOL)
Scores of Male and Female Partners of Infertile Couples
N=200
Domains Mean Mean Difference S.E.MD S.D.D ‘t’ Value

Emotional
Male (n=100) 94.39
83.97 10.42 2.49 11.62 6.45*
Female (n=100)

df (98)=1.97 at 0.05 level significance

Table 4 depicts that emotional domain was found to be positively correlated with all the domains mind/body,
relational, social, environmental and tolerability domain as well as the domain total of male and female partners
except for environmental domain in female partners which indicates that the emotional domain is the main link
that has the impact on the other domains. The study showed that total quality of life of both male and female
partners got affected by all the domains of quality of life and all the domains had influence of infertility on their
quality of life. The study also depicted that total quality of life of both male and female partners was
significantly related to all the domains and got affected by all the domains of quality of life i.e. infertility had an
impact on total quality of life of both male and female partners of infertile couples.

TABLE 4
Correlation between various domains of the male and female partners of infertile couples
N=100
DOMAIN MIND/BOD RELATIO SOCIA ENVIRONME TOLERABI DOMAIN
Y NAL L NTAL LITY TOTAL
EMOTIONAL Male 0.72* 0.41* 0.39* 0.21* 0.21* 0.79*
Female 0.75* 0.46* 0.61* 0.08NS 0.37* 0.86*

MIND/BODY Male 0.37* 0.56* 0.31* 0.17NS 0.84*

Female 0.42* 0.7* -0.00NS 0.30* 0.84*

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RELATIONAL Male 0.27* 0.03NS 0.27* 0.57*

Female 0.54* 0.01NS 0.18NS 0.66*

SOCIAL Male 0.25* 0.28* 0.72*

Female -0.06NS 0.30* 0.81*

ENVIRONMENT Male 0.29* 0.5*

AL Female 0.17NS 0.22*

TOLERABILITY Male 0.50*

Female 0.53*

df (98) =0.197 at 0.05 level of significance

There was a significant association at 0.05 level of significance of levels of fertility quality of life and
occupation of the male partners and there was a significant association between the levels of fertility quality of
life and age at marriage, duration of marriage, trying for conception and trying for conception with doctor‟s help
and number of miscarriages of female partners (data not shown).

III. Discussion
The collected data for the present study was analysed statistically and the results based on the
objectives of the study are discussed below:
The present study shows that the majority (44%) of the infertile female partners are in the age group of
25-31 years which was similar to the findings of a study conducted by Paul C. Adamson et al. which showed
that most of the infertile women were in the age group of 16-30 years100.
The present study shows that the majority of the female partners (64%) are having primary infertility while 36%
are suffering from secondary infertility which is consistent with the findings of the report of Haryana 23 which
showed that more than three-fourths (76.7 percent) of married women reported to have experienced problems
in conceiving for the first time.
Present study indicates that the majority (82%) of the male partners had good quality of life whereas only 43%
of female partners had good quality of life. Similar finding was described by BatoolRashidi et al. (2008)80 who
reported that there were significant differences between women and men indicating that male patients had a
better health-related quality of life.
The findings of the present study which showed that women scored lowest in the emotional domain were in
accordance of the study as by Ofovwe&Aziken(2005) who reported mood disturbance was the most frequent
symptom expressed by the infertile women 94.
The present study findings suggests that levels of fertility quality of life of female partners is dependent upon
the duration of infertility which is inconsistent with the findings of a study conducted by Mohammad Hossein
et al(2011) which showed that was no relation between the duration of infertility and general health scores70.
A finding inconsistent to the present study reported by BatoolRashidi et al. (2008) states that younger age was
found to be a significant predictor of poorer condition whereas present study indicated that there the majority
(63.63%) of female partners who belonged to 25-31 years of age had fair quality of life80.
The present study showed that there was significant difference in the mind/ body and social domains of fertility
quality of life of male and female partners which is consistent with the findings of a study conducted by Bolsoy
N, Taspinar A, Kavlak O and Sirin A (2010) which indicated that physical health and social relations domain
score did not show significant differences between infertile women and infertile men 78.
The present study indicated that the female partners of the infertile couples had low scores on mind/body, social
and emotional domain than the male partners which is similar to the study conducted by Chachamovich JR et
al (2010) which showed that infertile women had significant lower scores on mental health, social functioning
and emotional behaviour 79.
According to present study there was a significant association of level of fertility quality of life with the age,
duration of marriage and length of trying for conception by female partners which is dissimilar to the findings of
the study conducted by Aliyeh G. and Laya F. (2007) which showed that there was no significant correlation
was found between quality of life and age, length of married life, or length of time seeking treatment.
Present study suggested that majority (81%) of the female partners of the infertile couples were satisfied with
the sexual relationship with their male counterparts which is consistent with the findings of the study conducted
by Manoj Monga et al (2004) which showed that no statistically significant impact on sexual functioning in
women was noted86.
The present study suggested that none of the male partners had problem with erection and/or ejaculation which
is inconsistent with the findings of the study of Florence E Omu and Alexander E Omu (2010) which
indicated that 14.9% experienced premature ejaculation, 5.2% weak ejaculation and 7.9% had impotence.

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IV. Conclusion
The study illuminates that male partners had better quality of life than the infertile female partners and
there was a significant difference in the quality of life of infertile male and female partners. Infertility affects all
the domains but it has the major impact on the emotional aspect of the infertile couples hence it is needed that
health professionals should include assessment of psychological symptomatology to plan more efficient
interventions to infertile patients. Nurses are in key positions where they can identify the factors that affect
quality of life and should plan to meet their needs accordingly.

V. Conflict Of Interest
There was no conflict of interest existed between the author (or the author's institution) and reviewer
and there was no conflict in the financial or personal relationships that could inappropriately influenced (biased)
her actions.

Recommendations
 A study can be done to assess the effectiveness of traditional methods of treatment on the quality of life of
infertile couples.
 Qualitative study can be done to explore the perception of infertile couples regarding their quality of life.

ACKNOWLEDGEMENT
I take this opportunity to put my deepest sense of gratitude to the numerous people who have stood by
my side; helping, guiding and encouraging me in this accomplishment. My gratitude cannot be spelt out in few
words. I will nonetheless try.
First and foremost, I thank to Almighty God, who always blessed me and stood by my side in every situation.
It is my privilege to express my special gratitude to my esteemed advisor Mrs.PoonamSheoran, Principal,
Maharishi Markandeshwar Institute of Nursing Mullana, Ambala), for her expert guidance, valuable suggestions
and who helped me to coordinate my research project and supported me in the successful completion of this
study and encouragement for the conduct of the study. Without her encouragement and guidance this research
project would not have materialized and completed.
I express my sincere thanks and deepest appreciation to my respected advisor Dr. (Mrs.) JyotiSarin, Director-
Principal, Maharishi Markandeshwar College of Nursing (Mullana, Ambala) for her constant encouragement
and support. It is indeed a great honour and privilege to have worked under her expert and constant guidance till
the completion of this study.
My sincere gratitude to the research committee members for their contributions and valuable constructive
criticism throughout the project.
I am greatly indebted to the entire faculty of post graduate nursing of M.M. College of Nursing, Mullana,
Ambala for their guidance, support, suggestions which have helped in giving a better shape to this project. My
sincere gratitude is expressed to all experts who willingly gave their valuable time and suggestions for content
validation and refining the tool.
I wish to express my heartfelt thanks with much appreciation the staff of infertility clinics of district Ambala and
district Karnal for extending their cooperation and granting me permission to conduct the study in their
esteemed Institution.
There are no enough words to describe my gratitude to my greatest asset, My Parents for their strength, support,
encouragement and blessings without which it would not have been impossible to compete this study. I pay my
grateful salutations to my parents and all my family members for their never ending support, valuable prayers
and who have supported me throughout the entire period of my study, both by keeping me harmonious and
helping me putting pieces together.
Last but not the least; I would like to thank and express my deepest appreciation to each and every one who
provided me the possibility directly or indirectly to complete this research project.
Rebecca Dillu
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