Document Type : Original Article
Authors
1 Department of Obstetrics and Gynecologic Nursing, Koc University School of Nursing, Istanbul, Turkey
2 Department of Obstetrics and Gynecologic Nursing, Gulhane Military Medical Academy, School of Nursing, Ankara, Turkey
3 Department of Public Health, Gulhane Military Medical Academy, School of Medicine, Ankara, Turkey
Abstract
Keywords
Infertility is defined as failure of pregnancy
in a married couple despite appropriately timed
intercourse (
One methodologically unique study examined
the psychological sequelae of infertility and the
treatment failure among Chinese women. The
prevalence of distress increased from 33 to 43%
after treatment failure, while prevalence of depression remained constant (8%). The severity
of depression following treatment failure was
predicted by duration of infertility (
Couples live in fear and anxiety about infertility as well as the infertility diagnosis, treatment
process, and treatment outcome (
In a study by Yıldızhan et al. (
The last guideline of world health organization (WHO) on international intervention
aimed to alleviate the negative effects of infertility and to improve the quality of infertile
couples’ lives using psychosocial intervention
for both female and male (
Our study aimed to determine the effect of exposure to domestic violence on infertility distress in married women with an infertility diagnosis.
This cross-sectional study was carried out between September and December 2009 at the Infertility Center in Gulhane Military Medical Academy (GMMA) in Ankara, Turkey. Among 210 married women receiving treatment for primary infertility at this center during a-fourmonth data collection period, 152 women who met the criteria were asked to participate in the study using convenience sampling method. Of those selected, 144 (94.7%) consented to participate. After excluding 5 women due to incomplete data, the scope of the study consisted of 139 married women (91.4%).
Data were obtained using the descriptive information questionnaire, infertility distress scale
(IDS) (
The IDS was developed by Akyuz et al. (
The SDVW was developed by Kılıç (
For example;
(never) (sometimes) (always) "my husband insults me"
() () ()
The minimum score is 50, while the maximum is 150. The scale has no cut-off point. The Cronbach’s alpha values obtained during the development of the scale ranged from 0.73 to 0.94. The Cronbach’s alpha coefficient was calculated as 0.83 in this study.
The descriptive information questionnaire
was developed by the present investigators after an evaluation of the relevant literature. The
validity of the content was examined by experts
in the obstetrics field to confirm general appropriateness and applicability. The questionnaire consists of 21 questions and covers sociodemographic data, including the ages of the
women and their spouses, level of education,
occupational status, age at first marriage, and
infertility characteristics. The prepared questionnaire was first administered to 20 infertile
women at the
The Institutional Review Board of Gulhane Military Medical Academy approved this study. After the aim and method of the study were explained, the participating women provided verbal consent. Survey forms were filled out by the principal investigator through face-to-face interviews with each woman. The average time for an interview was approximately 25 minutes.
The SPSS 15.0 software package was used for statistical analysis. The distribution of the data was expressed as counts and percentages. The t test, Pearson correlation, Linear regression, and one-way ANOVA were used for statistical analyses, while a p value less than 0.05 was accepted as statistically significant. The backward method was chosen for the Linear regression analysis
Table 1 presents demographic information, duration of infertility and duration of treatment (
The mean IDS scores of the women participating in the study were 37.76 ± 10.53. There
was no significant relationship between the
age (t: 0.036, p=0.971) and education levels
(F: 0.409, p=0.665) of the women and the total
IDS score. The total IDS score was higher in
women who did not work (t: 3.361, p=0.001)
and those being treated for infertility for more
than three years (t: 3.728, p<0.001). A spouse
younger than 33 years (t: 2.115, p=0.036) with
at least university-level education (t: 2.201,
p=0.030) increased the total IDS score in
women (
The socio-demographic features and infertility stories of the women and their partners
n=139 | Χ ± SD | |||
---|---|---|---|---|
29.8 ± 4.99 | ||||
33.5 ± 5.56 | ||||
6.98 ± 3.48 | ||||
33 | 23.7 | - | - | |
76 | 54.7 | 65 | 46.7 | |
30 | 21.6 | 74 | 53.2 | |
119 | 85.6 | 2 | 1.4 | |
20 | 14.4 | 137 | 98.6 | |
14 | 70.0 | 120 | 87.5 | |
6 | 30.0 | 17 | 12.5 | |
Χ ± SD | ||||
4.59 ± 3.36 | ||||
3.14 ± 2.64 | ||||
There was no significant relationship between age (t: 1.046, p=0.298), education levels (F: 0.555, p=0.575), and employment status
(t: 0.616, p=0.543) of the women and the total SDVW score in the study. The total SDVW
score was higher in women who had been trying
to have a child for more than six years (t: 2.432,
p=0.016) and had received infertility treatment
for longer than three years (t: 2.516, p=0.013).
The SDVW mean scores of infertile women
were 67.0 ± 8.26 (
A weak positive correlation was found between
the total violence, including emotional, verbal,
economic, and sexual violence, scores that the
women received from the SDVW scale and the total IDS score (p<0.05). There was no correlation
between physical violence against women and
their IDS score (
Regression (linear) analysis was conducted
in order to evaluate the relationship between
the independent variables determined to affect
infertility distress and the total IDS score. The
employment status of the women and physical,
emotional, and sexual violence scores were included in the model as it has a statistically significant relationship with the IDS scores. The
value of the correlation between the total IDS
score and the scores obtained from the model
was 0.475. The Durbin-Watson coefficient had
a value close to 2 (1.713), demonstrating that
our model is well formed. The emotional violence score was found to have the highest significance among the variables affecting total
IDS score (B: 0.329; p<0.001) (
Comparison of infertility status and socio-demographic characteristics of the women with the total IDS score.
n=139 | Total IDS score | ||
---|---|---|---|
Χ ± SD | t/F* | P | |
37.8 ± 8.23 | 0.036 | 0.971 | |
37.7 ± 12.7 | |||
38.5 ± 12.9 | 0.409* | 0.665 | |
38.0 ± 11.0 | |||
36.2 ± 4.89 | |||
38.5 ± 11.0 | 3.361 | 0.001 | |
33.3 ± 5.26 | |||
34.7 ± 7.14 | 3.728 | <0.001 | |
41.1 ± 12.6 | |||
39.4 ± 11.7 | 2.115 | 0.036 | |
35.7 ± 8.49 | |||
35.7 ± 7.83 | 2.201 | 0.030 | |
39.5 ± 12.2 | |||
37.76 ± 10.53 | |||
*ANOVA
Comparison of infertility status and socio-demographic characteristics of the women with the total SDVW score
n=139 | Total IDS score | ||
---|---|---|---|
Χ ± SD | t/F* | P | |
66.2 ± 5.74 | 1.046 | 0.298 | |
67.8 ± 10.4 | |||
67.9 ± 8.22 | 0.555* | 0.575 | |
67.1 ± 6.77 | |||
65.7 ± 11.3 | |||
67.1 ± 8.36 | 0.616 | 0.543 | |
66.0 ± 7.75 | |||
66.0 ± 6.90 | 2.432 | 0.016 | |
69.8 ± 10.9 | |||
65.3 ± 6.78 | 2.516 | 0.013 | |
68.8 ± 9.38 | |||
67.0 ± 8.26 | |||
*ANOVA
Comparison of total IDS score and the SDVW score
Total IDS score | |||
---|---|---|---|
P | r | ||
0.289 | 0.001 | ||
0.038 | 0.661 | ||
0.360 | 0.001 | ||
0.267 | 0.001 | ||
0.182 | 0.032 | ||
0.263 | 0.002 | ||
The results of regression analysis between the independent variables affecting infertility distress and the total IDS score
Total IDS score | |||
---|---|---|---|
B | T | P | |
0.344 | -3.180 | 0.002 | |
0.329 | 3.642 | <0.001 | |
0.334 | 2.892 | 0.004 | |
0.183 | -2.410 | 0.017 | |
0.475 | 0.225 | 1.713 | |
Data related to the infertility distress level, the status of being subjected to violence, and the effect of the violence on the infertility distress level of infertile women are discussed in this section. This is the first study showing the effect of violence against infertile women on the infertility distress level. There are very few studies investigating the special status of violence against infertile women, and there is no study showing the effect of violence on the distress caused by infertility in the literature.
The mean IDS score of the women in this study
was 37.76 ± 10.53. The IDS mean score of the
women was determined as 45.94 ± 10.9 in the
validation studies of the scale by Akyuz et al.
(
No significant relationship was found between
the age and education levels of the women and
the infertility distress level in our study. Ünal et
al. (
Infertility is also thought to be a factor causing
domestic violence. Infertile women are twice as
likely to be subjected to domestic violence than
other women (
There was no correlation between the age, education level, and occupational status of the women
and the status of being subjected to violence in this
study. A few studies in the literature on similar subjects also found no significant association between
age and violence among infertile women subjected
to violence (
Violence was found to increase the infertility
distress level in this study. Violence can be experienced in physical, economic, emotional, and verbal
areas (
These results are important as they show that infertile women may be at risk for violence, demonstrate that the women’s psychological infertility distress level, and show that the effect of domestic violence on infertility distress in women. Compliance to treatment and success of therapy are known to be changed due to the psychological influence of infertility on the woman. In this context, healthcare staff serving infertile couples should consider the possibility of domestic violence against women as a factor that affects the psychological infertility distress level. Infertile couples thought to be at risk should, therefore, be followed more closely.
The sample of this study is made up of a specific group of Turkish women. The study was also conducted at a single center. It should, therefore, be noted that these results reflect only a group of Turkish women receiving infertility treatment and that the socio-cultural differences may affect both violence and infertility data. The status of being subjected to domestic violence in women receiving infertility treatment and the effect of violence on infertility distress should, therefore, be assessed in communities with different socio-cultural characteristics.
This study evaluated the status of being subjected to domestic violence in women receiving infertility treatment and the effect of violence on infertility distress with a quantitative method. Therefore, both qualitative and quantitative research is recommended to reveal the exposure to violence in women receiving infertility treatment.