Infertility and Emotional Supports: Pathways to Family Adjustment Among Couples Undergoing IVF in China

Background and Purpose: Prior studies showed that family supports are associated with better mental health and social wellness in both infertile women and men. Studies investigating supportive roles of original and in-law families are still lacking, especially among Chinese who ascribe to a patriarchal tradition. This study attempts to investigate whether original/in-law emotional supports affect perceived family relationships of infertile couples.

Method and Design: A cross-sectioned study was implemented during October to December 2016. The final sample consisted of 421 pairs of infertile couples who were officially diagnosed with infertility and had intentions to undergo in vitro fertilization (IVF) treatment in a public fertility center at a hospital in Beijing, China. Measurements adopted in this study were validated in Chinese context. Hypotheses were examined by actor-partner interdependence model (APIM) using structural equation modeling with Mplus software 1.4. 

Main results and the role of chance:  In the current study, mean age of wives and husbands were 32.50± 5.13 and 34.19± 6.22, respectively. Couples had been married for an average (±SD) of 5.99±4.44 years, and have been attempting a natural conception for an average of 3.65±2.68 years. Perceptions of ES by wife and husband on their own maternal families were negatively associated with the partner’s reports of family harmony (b=-0.20, p≤0.05 for wife report on family harmony; b=-0.17, p≤0.05 for husband report on family harmony). In terms of in-law ES, both actor and partner effects were verified for wives (b=0.42, p≤0.001 for wife report of family harmony; b=0.30, p≤0.01 for husband report of family harmony). In the baseline APIM model with a good overall fit (χ² /df = 3.02, CFI = 0.92, RMSEA = 0.07), the combined actor and partner effects accounted for 12.5% and 7.6% of the variance in perceived family harmony by wife and husband respectively. To further testify causal relations between two endogenous variables, we tentatively established paths between wife and husband perceived family harmony in two APIM models. Results showed a bigger power of wife’s in-law ES in predicting harmonious family environment by confirming a full mediation effect of wife’s family harmony (b=0.452, p<0.001) in model 2 and a partial mediation effect of husband’s family harmony (b=0.48, p<0.001) in model 3.

Limitations, reasons for caution: This study was a cross-sectional research design and the generalizability of results was limited by self-selection. Additionally, tools measuring emotional supports from previous generation adopted in this study were more universal rather than infertility-specific. 

Conclusion and Implications: For the dyads, one’s enmeshment with original family would decrease spousal appraisal of family harmony. Wife’s in-law ES was positively associated with her family harmony and ultimately influenced on husband’s family harmony. Overall, paternal ES showed a bigger power in predicting harmonious family environment than maternal ES for infertile couples. It was necessary to incorporate systematic family perspective in working with infertile couples. Moreover, family therapy and psychosocial education concerning intergenerational ties should be designed and delivered in relation to the different functions of original/in-law families.