Document Type : Original Article
Infertility is defined as the failure to achieve a
pregnancy after at least 1 year of regular unprotected
sexual intercourse (
The etiology of infertility is suggested to be related
to a female factor in 25-40% of the cases and to a male
factor in 40-55%. Unexplained infertility accounts up
to 10% of the cases. The most common causes of infertility
include the male factors such as sperm disturbance,
female factors such as ovulation dysfunction
and tubal disorders, both male and female factors, and
unexplained infertility. Prevalence of infertility increases
with the changes in living conditions over the
years. Changing living conditions lead to increased
tobacco use and alcohol consumption, aging of the
population, stressful living conditions, and decreased
physical activity-induced obesity, all of which are
among the reasons that increase the prevalence of infertility
Infertility affects 10-18% of married couples all
over the world, and approximately, 72.4 million
couples are estimated to be infertile (
Infertility is not only a gynecological disease but also an important health problem that has social, economic, cultural, and psychological effects. Infertility manifests itself as a sudden and unexpected life crisis, perhaps could not be explained, the diagnosis is delayed, and causes excessive stress and forcing adaptation that negatively affects the quality of life of couples (
It’s known that levels of anxiety and loneliness are higher among infertile women who are generally more negatively affected than their husbands (
This study aimed to evaluate the prevalence of infertility, to examine some possible factors associated with infertility and to assess the level of loneliness among married women aged 18-49 who were living in the district of Mahmudiye.
This cross-sectional survey of women with infertility and of some characteristics particularly seen in patients with infertility was carried out in Mahmudiye, a rural district of a town in western Turkey. It was conducted on all the married women aged 18-49 years between July 5 and August 29, 2012. According to the Turkish Statistical Institute (TUİK), the total population of the semirural town, in which the study was carried out, was 4731. The total number of the women aged 18-49 years and living in the town was 1057. The number of those who are married was 824 (
The questionnaire consisted of two parts. The first part included the individuals’ socio-demographic characteristics (age, gender, education level, employment status, income level, family type, cigarette and alcohol habits, and obesity) and some of the factors thought to be associated with infertility (menstruation, dysmenorrhea, age at menarche, gynecological disease history, gynecologic surgery history, infertility type, duration of infertility, and individual who are responsible for the infertility) (
Households in the town center were visited one by one during the study period. The study group consisted of a total of 570 women who had marriaged at least once, were at home and accepted to participate in the study.
Permission for the study was obtained prior to collection of data by contacting and receiving approval from the appropriate management authority, the health directorship of the city involved. Informed consent was obtained from the subjects participating in the study according to that established by the Ethical Principles for Medical Research Involving Human Subjects in the Helsinki Declaration (
In our study, women who have inability to become pregnant despite regular sexual intercourse during the last year were considered to be infertile. Couples who have not ever become pregnant were evaluated as primary infertile and those who have been pregnant at least once, but never again were evaluated as secondary infertile.
In this study, UCLA Loneliness Scale was used to assess the level of loneliness. The scale has been developed in 1978 by Russell et al. (
The data were analyzed using Statistical Package for the Social Sciences (SPSS; SPSS Inc., Chicago, USA) version 20. The statistical analysis was carried out using Kruskal-Wallis (KW), Mann Whitney U (U) and Chi-square tests (χ²). A value of p<0.05 was considered as statistically significant.
The mean age of the participants was 35.48 ± 8.39 years (18-49 age range). Of the women, 542 (95.1%) were married and 28 (4.9%) were widowed at that time. In our study, because the number of alcohol consumers was very low (n=2), analysis was not performed for this variable.
The frequency of infertility in our study was found to be 12.8% (n=73). The socio-demographic characteristics of the women with and without infertility are presented in table 1.
The socio-demographic characteristics of the females with infertility and without infertility
|No N (%)a||Yes N (%)a||Total N (%)b||χ²; p|
|61 (91.0)||6 (9.0)||67 (11.8)||3.265; 0.659|
|72 (86.7)||11 (13.3)||83 (14.6)|
|93 (86.9)||14 (13.1)||107 (18.8)|
|102 (90.3)||11 (9.7)||113 (19.8)|
|77 (83.7)||15 (16.3)||92 (16.1)|
|92 (85.2)||16 (14.8)||108 (18.9)|
|84 (84.8)||15 (15.2)||99 (17.4)||0.590; 0.745|
|292 (87.7)||41 (12.3)||333 (58.4)|
|121 (87.7)||17 (12.3)||138 (24.2)|
|439 (86.6)||68 (13.4)||507 (88.9)||1.054; 0.305|
|58 (92.1)||5 (7.9)||63 (11.1)|
|40 (87.0)||6 (13.0)||46 (8.1)||0.151; 0.927|
|366 (86.9)||55 (13.1)||421 (73.9)|
|91 (88.3)||12 (11.7)||103 (18.1)|
|393 (86.4)||62 (13.6)||455 (79.8)||1.017; 0.313|
|104 (90.4)||11 (9.6)||115 (20.2)|
|382 (87.8)||53 (12.2)||435 (76.3)||0.425; 0.515|
|115 (85.2)||20 (14.8)||135 (23.7)|
|392 (88.3)||52 (11.7)||444 (77.9)||1.737; 0.188|
|105 (83.3)||21 (16.7)||126 (22.1)|
|497 (87.2)||73 (12.8)||570 (100.0)|
a; Percent for the row and b; Percent for the column.
Of the women, 116 (20.4%) had a history of gynecological disease and 45 (7.9%) had a history of gynecologic surgery. Most women (80.9%) reported that they had regular menstruation. The frequency of dysmenorrhea was found to be 28.5% among the women menstruating. Some gynecological characteristics of women with/without infertility are given in table 2.
In this study, the numbers of women with primary and secondary infertility were 28 (38.4%) and 45 (61.6%), respectively. On the other hand, it was reported that 46.6% of infertile cases were female-related and 8.6% were male-related. Moreover, 45.2% of the infertile cases were unexplained infertility.
The mean score on UCLA Loneliness Scale was 32.16 ± 9.49 (from 20 to 70). The distribution of mean scores on UCLA Loneliness Scale according to some features of infertility is given in table 3.
In our study, the mean duration of the infertility in women was 6.58 ± 6.41 (from 1-29) years. There was no relationship between the scores of infertile women on UCLA Loneliness Scale and the duration of infertility (rs=0,050; p=0,673). The distribution of the scores on UCLA Loneliness Scale according to the duration of infertility in women is given in figure 1.
Some gynecological characteristics of women with/without infertility
|Gynecological characters||Infertility||Statistical analyses|
|No N (%)a||Yes N (%)a||Total N (%)b||χ²; p|
|132 (90.4)||14 (9.6)||146 (25.6)||6.217; 0.102|
|170 (86.3)||27 (13.7)||197 (3.6)|
|103 (81.7)||23 (1.3)||126 (22.1)|
|92 (91.1)||9 (8.9)||101 (1.7)|
|392 (89.7)||45 (10.3)||437 (80.9)||5.715; 0.017|
|83 (80.6)||20 (19.4)||103 (19.1)|
|340 (88.1)||46 (11.9)||386 (71.5)||0.000; 1.000|
|135 (87.7)||19 (12.3)||154 (28.5)|
|411 (90.5)||43 (9.5)||454 (79.6)||20.785; 0.000|
|86 (74.1)||30 (25.9)||116 (20.4))|
|468 (89.1)||57 (10.9)||525 (92.1)||20.484; 0.000|
|29 (64.4)||16 (35.6)||45 (7.9)|
|497 (87.2)||73 (12.8)||570 (100.0)|
a; Percent for the row, b; Percent for the column, ¥; The number of women who are menstruating
The distribution of UCLA Loneliness Scale mean scores of the study group about some features of infertility
|Some features of infertility||N||UCLA Loneliness Scale score Median (min-max)||Statistical analysesU/KW; P|
|497||30.0 (20.0-67.0)||1.074; 0.283|
|28||32.0 (20.0-70.0)||2.266; 0.023|
|34||31.0 (20.0-60.0)||0.454; 0.797|
The distribution of UCLA Loneliness Scale scores obtained from the duration of infertility in women.
Infertility is a major health problem that is common among married couples and leads to medical, social, cultural, and psychological problems. In this study, the prevalence of infertility was found to be 12.8% (n=73). Studies from some countries have reported the prevalence of infertility to vary between 3.4 and 15.0% (
Decreasing number and quality of oocytes in women with aging may reduce the possibility of fertilization, leading to increased frequency of infertility (
The costs of the diagnosis and treatment of infertility is extremely high. It is easier to cover the expenses of the treatment of infertility for the couples with higher level of income. In the study group, there was no correlation between family income level and the frequency of infertility. Accordingly, Eren and Bayram have also reported no correlation between family income level and the frequency of infertility in their studies (
In the extended family structure, strong family ties increase the responsibility towards the family. This represents an increased pressure on the individual and can lead to high stress which is a major risk factor for infertility. In addition, crowded family pattern may reduce the probability of fertilization by reducing the frequency of sexual intercourse. In this study, there was no difference between the women from a nuclear family structure and from a large family structure in terms of the frequency of infertility. There are also some other researchers finding no relationship between the family type and frequency of infertility (
It has been reported that the frequency of infertility is high among smokers (
One of the major effects of obesity in the body is the increased levels of insulin, leading to insulin resistance. Hyperinsulinemia increases androgen levels by reducing the levels of sex hormone-binding globulin, which can negatively affect the ovulation (
An early age at the first menstruation increases the incidence of diseases such as pelvic inflammatory disease that can cause infertility and spontaneous abortion at later ages (
The major female-related causes of infertility are ovulatory disorders. If hypothalamus, pituitary and ovarian axis do not work appropriately, this can lead to ovulatory disorders such as anovulation, amenorrhea and menstrual disturbances. Many diseases such as polycystic ovary syndrome, hypothyroidism and hypothalamic-pituitary disorders that affect any stage of the axis are most likely to lead to infertility (
Dysmenorrhea is an important finding for many diseases such as polycystic ovary syndrome and endometriosis which are known to cause infertility. Therefore, the prevalence of infertility is likely to be high in women with a history of dysmenorrhea (
Gynecological diseases account for about 30-40% of all cases of female infertility (
Structural changes in the genital organs of patients undergoing pelvic surgery can lead to infertility by preventing ovulation, fecundation, or implantation (
Gradual decrease in the number of oocytes from birth until menopause with no renewal and a reduction in the frequency of sexual intercourse with increasing age are known to decrease the fertility in women in older age (
Primary infertile women feel more defective and incomplete because of having no births. Therefore, women with primary infertility are likely to feel more alone than those with secondary infertility. In our study, the level of loneliness was significantly higher among women with primary infertility than those with secondary infertility. It is well-known that mental disorders such as depression and loneliness are more common in infertile women than their husbands. In the study group, no difference was found between the level of loneliness and the individual who was responsible for infertility.
In the process of infertility, couples feel hopeless, failed and disappointed about having children every month. The repetition of this cycle may lead to feel more lonely and desperate (
The major limitations of this study are that it was a cross-sectional study, that it included only a single town, and that loneliness was not evaluated by precise diagnostic methods.
In this study, infertility was found to be a common health problem among the married women. The prevalence of infertility was higher among women with menstrual disorders and in those with a history of gynecological disease or gynecological surgery. There was no difference between infertile and fertile women in terms of the level of loneliness. Whereas, the higher levels of the loneliness has been found among the women who have a primary infertility problem. It would be useful for the women to be informed about the causes and solutions of infertility, and those with infertility should be referred to a tertiary center. It was concluded that prospective studies are needed in order to expose the relationship between the infertility and the level of loneliness in women.