Vol 92, No 2 (2021)
Research paper
Published online: 2020-12-09

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Emotional disorders, marital adaptation and the moderating role of social support for couples under treatment for infertility

Diana Antonia Iordachescu1, Corina Gica23, Elena Otilia Vladislav1, Anca Maria Panaitescu23, Gheorghe Peltecu23, Mirona Elena Furtuna3, Nicolae Gica23
Pubmed: 33448003
Ginekol Pol 2021;92(2):98-104.


Objectives: Over the last few years, the impact of infertility on the psychological well-being of couples has been well recognised. Men and women with infertility experience stress, anxiety and depression and their relationship might be under pressure. Material and methods: We conducted a non-experimental correlational descriptive study where transversal analysis using questionnaires and quantitative data was performed for 76 couples with diagnosed infertility under the care of various reproductive medicine clinics in Romania between 2018 to 2019. Participants were asked to fill, via internet or in person, a set of tests including data on socio-demographic and infertility characteristics along with five psychological tests: The Fertility Problem Inventory (FPI), State-Trait Anxiety Inventory, Beck’s Depression Inventory (BDI), Dyadic Adjustment Scale and Interpersonal Support Evaluation List-12. The aim of the study was to explore how couples with infertility respond and adapt to this diagnosis and to assess the relationship between emotional disorders, marital adjustment and social support. Results: Mean age of females was 34.2 and of males 36.7 and 38.2% of the couples were experiencing infertility for > 6 years. Women had worse scores on infertility-related distress (FPI) (t = –4.35, p = 0.01), on the BDI depression scale (t = –5.43, p = 0.01) and on anxiety scales (t = –5.48, p = 0.01). Participants with a longer duration of infertility scored significantly higher on infertility-related distress than those with more recent difficulties. Marital adjustment scores correlated negatively with emotional disorders. Both appraisal social support and belonging support moderated the relationship between state-anxiety and marital adjustment. Conclusions: Infertility carries a significant psychological burden for the couple and the longer its duration, the higher the distress level. Women seem to be more vulnerable to its psychological consequences. Marital adjustment correlates negatively with the degree of emotional disorders. In couples with high levels of social support, the relationship between state-anxiety and marital adjustment was negatively correlated.

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  1. Ramezanzadeh F, Aghssa MM, Abedinia N, et al. A survey of relationship between anxiety, depression and duration of infertility. BMC Womens Health. 2004; 4(1): 9.
  2. Schmidt L, Holstein BE, Boivin J, et al. Patients' attitudes to medical and psychosocial aspects of care in fertility clinics: findings from the Copenhagen Multi-centre Psychosocial Infertility (COMPI) Research Programme. Hum Reprod. 2003; 18(3): 628–637.
  3. Gica N, Mustata L, Botezatu R, et al. Management of Borderline Ovarian Tumors: Series of Case Report and Review of the Literature. Indian Journal of Surgery. 2020.
  4. Gica N, Panaitescu AM, Iancu G, et al. The role of biological markers in predicting infertility associated with non-obstructive endometriosis. Ginekol Pol. 2020; 91(4): 189–192.
  5. Fassino S, Pierò A, Boggio S, et al. Anxiety, depression and anger suppression in infertile couples: a controlled study. Hum Reprod. 2002; 17(11): 2986–2994.
  6. Zhou FJ, Cai YN, Dong YZ. Stress increases the risk of pregnancy failure in couples undergoing IVF. Stress. 2019; 22(4): 414–420.
  7. Al-Homaidan HT. Depression among Women with Primary Infertility attending an Infertility Clinic in Riyadh, Kingdom of Saudi Arabia: Rate, Severity, and Contributing Factors. Int J Health Sci. 2011; 5: 108–115.
  8. Wiweko B, Anggraheni U, Elvira S, et al. Distribution of stress level among infertility patients. Middle East Fertility Society Journal. 2017; 22(2): 145–148.
  9. Rich CW, Domar AD. Addressing the emotional barriers to access to reproductive care. Fertil Steril. 2016; 105(5): 1124–1127.
  10. Moura-Ramos M, Gameiro S, Canavarro MC, et al. Assessing infertility stress: re-examining the factor structure of the Fertility Problem Inventory. Hum Reprod. 2012; 27(2): 496–505.
  11. Bradbury T, Fincham F, Beach S. Research on the Nature and Determinants of Marital Satisfaction: A Decade in Review. Journal of Marriage and Family. 2000; 62(4): 964–980.
  12. Tao P, Coates R, Maycock B. Investigating marital relationship in infertility: a systematic review of quantitative studies. J Reprod Infertil. 2012; 13(2): 71–80.
  13. Moura-Ramos, M. Psychosocial adjustment in infertility: a comparison study of infertile couples, couples undergoing assisted reproductive technologies and presumed fertile couples. Psic, Saúde & Doenças. 2010; 11(2): 299–319.
  14. Cwikel J, Gidron Y, Sheiner E. Psychological interactions with infertility among women. Eur J Obstet Gynecol Reprod Biol. 2004; 117(2): 126–131.
  15. Yi Z, Deqing Wu. Regional Analysis of Divorce in China since 1980. Demography. 2000; 37(2): 215.
  16. Deka PK, Sarma S. Psychological aspects of infertility. Br J Medical Pract. 2010; 3: 32.
  17. Martins MV, Peterson BD, Almeida V, et al. Dyadic dynamics of perceived social support in couples facing infertility. Hum Reprod. 2014; 29(1): 83–89.
  18. Walen H, Lachman M. Social Support and Strain from Partner, Family, and Friends: Costs and Benefits for Men and Women in Adulthood. Journal of Social and Personal Relationships. 2016; 17(1): 5–30.
  19. Rashidi B, Hosseini S, Beigi P, et al. Infertility Stress: The Role of Coping Strategies, Personality Trait, and Social Support. JFRH. 2011; 5: 101–108.
  20. Newton CR, Sherrard W, Glavac I. The Fertility Problem Inventory: measuring perceived infertility-related stress. Fertil Steril. 1999; 72(1): 54–62.
  21. Spielberger CD, Pitariu HD, Peleasa C. STAI-Y: State-Trait Anxiety Inventory. Cluj-Napoca Sinapsis 2007.
  22. Beck AT, Steer RA, Brown GK. Beck Depression Inventory– second edition (BDI - II). Cluj-Napoca Romanian Psychological Testing Services 2012.
  23. Spanier GB, Iliescu D, Petre L. DAS-Dyadic Adjustment Scale. Cluj-Napoca Sinapsis 2009.
  24. Cohen S, Mermelstein R, Kamarck T, et al. Measuring the Functional Components of Social Support. Social Support: Theory, Research and Applications. 1985: 73–94.
  25. IBM Corp. Released. IBM SPSS Statistics for Windows, Version 25.0. Armonk (NY) IBM Corp 2017.
  27. Bellieni C. The Best Age for Pregnancy and Undue Pressures. J Family Reprod Health. 2016; 10(3): 104–107.
  28. Patel A, Sharma PS, Kumar P, et al. Illness Cognitions, Anxiety, and Depression in Men and Women Undergoing Fertility Treatments: A Dyadic Approach. J Hum Reprod Sci. 2018; 11(2): 180–189.
  29. Holter H, Anderheim L, Bergh C, et al. First IVF treatment--short-term impact on psychological well-being and the marital relationship. Hum Reprod. 2006; 21(12): 3295–3302.
  30. Schmidt L, Holstein B, Christensen U, et al. Does infertility cause marital benefit? An epidemiological study of 2250 women and men in fertility treatment. Patient Educ Couns. 2005; 59(3): 244–251.
  31. de Faria DEP, Grieco SC, de Barros SMO. The effects of infertility on the spouses' relationship. REV ESC ENFERM USP. 2012; 46: 794.
  32. Drosdzol A, Skrzypulec V. Depression and anxiety among Polish infertile couples--an evaluative prevalence study. J Psychosom Obstet Gynaecol. 2009; 30(1): 11–20.
  33. Cousineau TM, Domar AD. Psychological impact of infertility. Best Pract Res Clin Obstet Gynaecol. 2007; 21(2): 293–308.
  34. Saleem S, Qureshi N, Mahmood Z. Attachment, perceived social support and mental health problems in women with primary infertility. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2019; 8(6): 2533.
  35. Gameiro S, Boivin J, Dancet E, et al. ESHRE guideline: routine psychosocial care in infertility and medically assisted reproduction-a guide for fertility staff. Hum Reprod. 2015; 30(11): 2476–2485.
  36. Stanton AL, Dunkel-Schetter C. SpringerLink (Online service). Infertility: Perspectives from Stress and Coping Research. Plenum Press, New York 1991.
  37. Iordăchescu DA. The role of psychological interventions in the infertility treatment. Rev Psih. 2020; 66(2): 167–177.