Document Type : Original Article
1 Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Centre, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
2 Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Centre, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
Infertility is defined by the failure to achieve a clinical
pregnancy after 12 months or more of regular unprotected
sexual intercourse (
Health-seeking behaviour among couples with infertility
is directly related to their understanding of reproductive
biology and their beliefs about infertility. Those
with better knowledge of fertility health issues may
show improved use of health care resources with a consequent
reduction in infertility (
Infertility awareness is considered a critical first step towards
fertility preservation or infertility care by lifestyle
modifications or changes (
Providing relevant information to patients, respecting their wishes, and considering their capacity to make treatment decisions is crucial for high-quality and patient-centred fertility care (
This descriptive cross-sectional study was the first phase of a large survey on women and men who undergo infertility treatment in the largest referral fertility clinic in Iran, Royan Institute, where people are examined from all socio-economic and ethnic backgrounds. Participants recruited were a convenience sample of all infertile patients who received first-time assisted reproductive treatments, and who did not have any previous infertility treatment failures. Patients were seen at Royan Institute between January and March, 2015.
In this questionnaire-based study, the researchers developed a tool that was validated on the basis of a literature review. The questionnaire included questions about satisfaction with information about cause of infertility (3 questions); type of recommended treatment (3 questions); diagnostic procedures (3 questions); approximate treatment duration (3 questions); success rate of the treatment (3 questions); approximate financial cost of treatment (3 questions); and non-therapeutic factors in treatment success such as diet, exercise, taking supplements, and cigarette smoking (2 questions) to measure satisfaction with infertile patients’ self-perception of the informing process.
Demographic and clinical information of the participants were gathered from their records in the fertility centre. Question types included yes/no, a 5-point Likert scale that ranged from 1 to 5 (dissatisfied, low satisfaction, neither satisfied nor dissatisfied, satisfied, very satisfied), and choice of one option. The questionnaire was also designed for the Iranian context and validated by a group of 18 gynaecologists, embryologists, methodologists, and nurses for content, ease of understanding, and acceptability. Face validity was performed by a Persian literature expert and the wording of the questions was adapted to the context and perspectives of the participants. One interviewer who was aware of the main objective of the present study was responsible for distribution and collection of the questionnaires among participants.
The Ethics Committee of Royan Institute approved this study (EC/92/106). Aims of the study were clearly explained for all participants prior to the investigation. Voluntarily completion of the questionnaire was considered as consent. Eligible individuals were assured that their confidentiality and anonymity, and that their decision to participate in or withdraw from the study would not impact their current or future relationship with the clinic. Participants were also assured that their level of satisfaction did not affect provision of care services.
Statistical analyses were carried out using the Statistical Package for Social Science (SPSS, version 20.0 for Windows; SPSS Inc., Chicago, IL, USA). Continuous variables were expressed as mean ± SD (standard deviation) and categorical variables as numbers (percentages). Responses with the 5-point Likert scale (range: 1 to 5) were compared by the independent samples t test because it is robust when one might encounter ordinal scaled data. The statistical issue was demonstrated by Heeren and D'Agostino (
In this study, 235 infertile patients were invited to participate. In total, 200 participants (100 men and 100 women) responded to the questionnaire completely and returned completed questionnaires, which yielded a response rate of about 85%. The mean age of participants was 30.93 ± 5.56 years. Of participants, 67 (33.5%) patients were diagnosed with male infertility and 31 (15.5%) had female infertility. Recommended therapies to the patients included the following: 36 (18%)
A total mean score of satisfaction with the informing process for each area in
Demographic and clinical characteristics of the study participants (n=200)
|Demographic and clinical variables||n (%)|
|Cause of infertility|
|No answer||12 (6)|
|In vitro fertilization (IVF)||36 (18)|
|Micro injection||52 (26)|
|Intra uterine injection (IUI)||71 (35.5)|
|No answer||22 (11)|
|Blood and urine||114 (57)|
|Pap smear||41 (20.5)|
|Genetic counseling||10 (5)|
|Sperm motility||73 (36.5)|
|No answer||30 (15)|
In terms of satisfaction with information provided about cause of infertility, male responders reported the lowest mean score (3.59 ± 1.05) compared to female responders (3.82 ± 0.85); there was no statistically significant difference between men and women (P=0.078,
Patients’ satisfaction with the informing process areas (n=200 participants).
Description of infertile patients’ satisfaction with the informing process
|Cause of infertility||3.71||0.96||1||5|
|Estimated treatment duration||3.42||0.99||1||5|
|Success rate of the treatment||3.39||1.11||1||5|
|Approximate cost of treatment||3.31||1.1||1||5|
|Non-therapeuticfactors in treatment success||3.52||1.5||1||5|
Frequency of information on infertility treatment obtained from medical staff
|Physiciann (%)||Nurse n (%)||Midwifen (%)||Receptionn (%)||Other n (%)|
|Cause of infertility||127 (67.2)||9 (4.2)||17 (9.0)||13 (5.8)||23 (12.2)|
|Recommended therapies||117 (65.0)||9 (5.0)||16 (8.9)||11 (5.6)||27 (15.0)|
|Diagnostic procedures||126 (71.6)||10 (5.7)||6 (3.4)||15 (8.5)||16 (9.1)|
|Estimated treatment duration||103 (60.6)||17 (10.0)||11 (6.5)||12 (7.1)||24 (14.1)|
|Treatment Success rate||92 (58.2)||20 (12.7)||18 (11.4)||6 (3.8)||19 (12.0)|
|Approximate cost of treatment||72 (47.7)||12 (7.9)||6 (4.0)||25 (16.6)||33 (21.9)|
|Non-therapeutic factors in treatment success||94 (58.8)||12 (7.5)||7 (4.4)||18 (11.3)||27 (16.9)|
To the best of our knowledge, this was the first national survey of infertile clients that pertained to satisfaction with information provision in infertility care. Determining the extent of the patients’ satisfaction with information about infertility and its treatment would be beneficial for planning education programs related to the prevention of failures in infertility treatment or withdrawal. The findings of this study have provided useful insights into potentially modifiable factors that influence infertile patient’s co-operation with medical staff in the infertility clinics and compliance with assisted reproductive treatments.
From this study, it was apparent that most infertile patients who participated were more satisfied with the informing process related to the cause of infertility and recommended therapies. In contrast, the vast majority of participants were less satisfied with the information provided for approximate financial cost of their treatment. Overall satisfaction with this infertility care centre was usually high in the survey, but provided no reliable measure for the quality of care (
Of note, those who had a history of infertility treatment were more aware of infertility-related information such as causes, therapeutic procedures, and financial cost. Hence, over-reporting of satisfaction with information provided to the patients was unavoidable. In this study, we attempted to recruit all infertile patients who received assisted reproductive treatments for first time and did not have any previous infertility treatment failures.
Problems exist with the absence of data registration from all Iranian infertility care clinics. However, objective data collection on satisfaction with information provision in infertility care is difficult. This study was in line with most studies that relied on interviews. Possibly, the answers of the respondents were to some extent biased by incorrect recall and self-interest (
To the best of our knowledge, we did not find any research that measured satisfaction with infertility treatment information available to infertile people in the literature. Rauprich et al. (
In the present study, both men and women participants were more satisfied with information provided about type of recommended treatment. The objective of another study was to assess patients’ satisfaction with the investigation and initial management of infertility in 1366 women who attended outpatient clinics at 12 hospitals throughout Scotland. Overall, 87% of respondents were satisfied or very satisfied with their care, but there were a number of deficiencies identified.
A total of 86% felt they had not been given enough assistance with the emotional aspects of infertility, whereas 47% felt they were not given a clear plan for the future and 23% of those who had been given drug treatments reported receiving little or no information about the treatment or possible side-effects (
Despite the remaining limitations and risks of bias, the present methodical strategies have provided sufficient validity for the principal results of the study. The findings are limited to the particular context of fertility care in Iran, and are not transferable or generalizable elsewhere.
Information about infertility should be provided more systematically to all treated patients by medical staff, especially for success rate of treatment and financial cost of therapy. However, most infertile patient participants were more satisfied with the informing process related to the cause of infertility and recommended therapies. Therefore, the information should be clarified for all infertile patients prior to the onset of any therapeutic procedures.