Predictors of fertility quality of life in infertile patients visiting infertility center in Kathmandu, Nepal : a cross-sectional study.

Abstract

In Nepal, infertility is a rising reproductive health issue with an estimated prevalence of 15%. There are few studies on quality of life in infertile women, but none on quality of life in infertile men and women although infertility is a shared condition and has effects on couples. The study objective is to describe the various predictors of infertile patients seeking infertility treatment and find association between these predictors and the quality of life. A cross-sectional study using a self-administered disease specific FertiQoL questionnaire was conducted among 409 infertile men and women seeking infertility treatment in an infertility center in Kathmandu district. Multistage, purposive, convenience sampling technique was used. Frequency and percentages were used to describe the predictor variables socio-demographic, socio-economic, couple-related, fertility related characteristics and medical history. Almost all the respondents felt that having a child was very important to them and their partners were supportive throughout the infertility treatment. Almost 60% of respondents were experiencing primary infertility and 53% had a history of assisted reproductive technologies (ART) failure. Forty seven percent and 19% respondents were undergoing ART using self-gametes and donor respectively. Eighty percent of respondents desired professional psychological support following ART treatment. Forty eight percent of respondents had poor QoL. Their associations with the outcome variable poor Fertility Quality of Life were tested for significance by bivariate and multivariate analysis. The bivariate association between the predictor and outcome variables were analyzed by using a chi-square test. The results show highly significant statistical association at p-value 0.001 for independent variables; travel long distance for service, desire for professional psychological support, duration of infertility, history of ART treatment and current infertility treatment. Similarly, a statistically significant association at p-value 0.05 was found for the following variables: sex, work hours, access to day-off from work, cognition for need of children, duration of infertility and history of reproductive tract surgery. All other variables were not significant. The multivariate logistic regression model entered all the following variables from bivariate analysis; all those given above with significance p-value 0.05, those with p-value 0.2; age, ethnicity, family type, income level, partner's supportiveness, approach to fertility center, cause of infertility, presence for chronic illness, intake of medications and finally the variables education and type of infertility which were significant in the literature. The multivariate analysis results by multiple logistic regression have shown statistically significant association for the following variables; female gender (AOR=1.81, 95% CI=0.32-0.80, p-value 0.004), difficult access to get time off from work (AOR=1.96, 95% CI=1.24-3.09, p-value 0.004), long travel distance for fertility treatment (AOR=0.50, 95% CI=1.15-2.86, p-value 0.011), more than 10 years of marital duration (AOR= 1.68, 95% CI = 1.04-2.71, p-value 0.032), undergoing ART using self-gametes (AOR=1.71, 95% CI=1.05-2.8, p-value 0.030), undergoing donor ART cycles (AOR=1.99, 95% CI=1.07-3.71, p-value 0.030), and desire for professional psychological support (AOR=2.21, 95% CI=1.26-3.89, p-value 0.006). To further enhance the quality of life among infertile patients, it is recommended to provide psychological and emotional support to the patients undergoing infertility treatment. Qualitative studies are also recommended to understand how the quality of life is influenced by the coping capability and behavior of the partner.