‘My' Problem or ‘Our' Problem? Understanding the Infertility Diagnoses and Pre-Treatment Distress Among Chinese Women Undergoing in Vitro Fertilization
Infertility is a common medical condition whose cause is not always clearly known. The World Health Organization puts its prevalence at 8-13%. To many people who are struggling with childbearing issues, the journey of infertility treatment usually begins with a series of diagnostic investigations. People generally expect to receive a diagnosis before treatment. This is, however, not always the case: about 15-28% of infertility cases are medically unexplained. The aim of this study is to investigate how women who have received medical diagnosis on their cause of infertility – female, male, mixed, or unexplained factor – display different patterns of distress prior to in-vitro fertilization (IVF) treatment.
Women who were infertile and beginning their first IVF cycle at a university-affiliated hospital in Hong Kong were recruited into the study (valid N = 330). After obtaining their written consent, the participants completed a set of questionnaires about one to three months before their first treatment. Measures included the Chinese versions of State-Trait Anxiety Inventory, Body-Mind-Spirit Well Being Inventory and Kansas Marital Satisfaction Scale.
Somatic distress was found to be highest among women with unexplained infertility, whose differences with male and with female factor infertility were significant in post-hoc analysis (both ps < .05). Women with mixed factor diagnosis reported significantly lower trait anxiety with post-hoc analysis results showing significant differences with male and with female factor infertility (both ps < .05). Spiritual distress, as measured by BMSWBI, was found to be highest in female infertility factor group, although the only marginally significant difference revealed by post-hoc analysis was the one with mixed factor (p = .052). There was no significant difference in marital satisfaction among four groups. In all of the significant results, the effect sizes measured by partial eta squares (η2 = .028 – .033) were between small and medium.
Women with unexplained infertility reported more somatic complaints. The findings suggest that even with the same illness, people who do not have an identifiable cause experience more distress than others. Women with female factor infertility did not report a distress profile significantly different from that of women with male factor infertiliity. A more surprising observation is that women with mixed factor infertility reported less emotional and spiritual distress. A possible explanation is that the feeling of mutual responsibility led to a shared experience of infertility with the spouse, which in turn strengthened the women's coping ability before treatment. While it has been suggested that better marital relationship can be a mediating factor, the current findings do not support such hypothesis. Results can inform counseling professionals about the provision of holistic care in meeting the psychological needs of women with different infertility diagnoses prior to their treatment.