Exploring Iranian Women’s Perceptions and Experiences of Their Spouses’ Behavior towards Male Factor Infertility: A Qualitative Study

Author(s): Ali Taghipour, Fatemeh Zahra Karimi*, Robab Latifnejad Roudsari

Journal Name: Current Women`s Health Reviews

Volume 16 , Issue 1 , 2020

Become EABM
Become Reviewer

Graphical Abstract:


Background: Infertility, as a life crisis, affects women more than men, even when women are not infertile.

Objective: This study was conducted aimed at exploring Iranian women’s perceptions and experiences of their husbands’ behavior towards male factor infertility.

Methods: This qualitative study was performed using content analysis. A purposeful sampling method was employed and continued until data saturation for women who had referred to Milad Fertility Clinic and Health Care Centers within the time period of 2014-2015 in Mashhad, Iran, with their husbands being infertile. Thirty semi-structured in-depth interviews were conducted with 18 women. Conventional content analysis was employed to analyze the data. Besides, Lincoln and Guba's evaluative criteria were utilized to check the trustworthiness of the study.

Results: Perceived spousal emotional distress was the main topic of the study, which consisted of two subgroups, i.e., 1- husbands’ chaotic emotions with the sub-categories, including the “feelings of inferiority and incompetence”, “isolationism in life”, “irritability and arrogance”, “pessimism and cynicism”, as well as “anxiety and aggression”, and 2- husbands’ reluctance to seek treatment, including “inattention to medical prescriptions”, “resistance to the sperm analysis test”, and “opposition to the assisted reproductive technology and adoption”.

Conclusion: Male infertility can lead to marital problems and mistreatment of women. Hence, supportive and preventive measures are required to improve the conditions of such women.

Keywords: Male infertility, women, spouse behavior, perceptions, experiences, qualitative study, content analysis.

Shreffler KM, Greil AL, McQuillan J. Responding to infertility: Lessons from a growing body of research and suggested guidelines for practice. Fam Relat 2017; 66(4): 644-58.
[http://dx.doi.org/10.1111/fare.12281] [PMID: 29422703]
Hanson B, Johnstone E, Dorais J, Silver B, Peterson CM, Hotaling J. Female infertility, infertility-associated diagnoses, and comorbidities: a review. J Assist Reprod Genet 2017; 34(2): 167-77.
[http://dx.doi.org/10.1007/s10815-016-0836-8] [PMID: 27817040]
Berek JS. Berek & Novak’s Gynecology. 15th ed. Philadelphia: Lippincott Williams & Wilkins 2012.
Fritz MA, Speroff L. Clinical Gynecologic Endocrinology and Infertility. 8th ed. Philadelphia: Lippincott Williams & Wilkins 2010.
Kumar N, Singh AK. Trends of male factor infertility, an important cause of infertility: A review of literature. J Hum Reprod Sci 2015; 8(4): 191-6.
[http://dx.doi.org/10.4103/0974-1208.170370] [PMID: 26752853]
Hadizadeh-Talasaz F, Simbar M, Esmaily H, Latifnejad Roudsari R. Development and validation of a decision-making donor conception questionnaire in iranian infertile couples. Int J Fertil Steril 2019; 13(3): 215-24.
[PMID: 31310076]
Karimi FZ, Taghipour A, Roudsari RL, Kimiaei SA, Mazlom SR, Amirian M. Psycho - social effects of male infertility in Iranian women: A qualitative study. Majallah-i Zanan, Mamai va Nazai-i Iran 2016; 19(10): 20-32.
Tuzer V, Tuncel A, Goka S, et al. Marital adjustment and emotional symptoms in infertile couples: Gender differences. Turk J Med Sci 2010; 40(2): 229-37.
Bakhshayesh AR, Kazeraninejad M, Dehghan Mongabadi M, Raghebian M. A comparison of general health and coping strategies in fertile and infertile women in Yazd. Iran. J Reprod Med 2012; 10(6): 601-6.
[PMID: 25246933]
Cousineau TM, Domar AD. Psychological impact of infertility. Best Pract Res Clin Obstet Gynaecol 2007; 21(2): 293-308.
[http://dx.doi.org/10.1016/j.bpobgyn.2006.12.003] [PMID: 17241818]
Mohammadi MR, Farahani FKA. Emotional and psychological problems of infertility and strategies to overcome them. J Reprod Infertil 2001; 2(4): 33-9.
Sciarra J. Infertility: an international health problem. Int J Gynaecol Obstet 1994; 46(2): 155-63.
[http://dx.doi.org/10.1016/0020-7292(94)90230-5] [PMID: 7995454]
Johansson M, Berg M. Women’s experiences of childlessness 2 years after the end of in vitro fertilization treatment. Scand J Caring Sci 2005; 19(1): 58-63.
[http://dx.doi.org/10.1111/j.1471-6712.2005.00319.x] [PMID: 15737167]
Tamannai Far M. A comprative study of mental health, marital adjustment and coping responses among fertile-infertile women. CPAP 2011; 2(4): 51-60.
Khodakarami N, Hashemi S, Seddigh S, Hamdiyeh M, Taheripanah R. Life experience with infertility; a phenomenological study. J Reprod Infertil 2010; 10(4): 287-97.
Fooladi E, Danesh M, Kashfi F, Khani S, Mohammadpor R. Study of infertile husbands’ and wives’ point of view to infertility and marital adjustment in patients reffering to Royan infertility center of Tehran in 2005. Majallah-i Danishgah-i Ulum-i Pizishki-i Mazandaran 2006; 16(55): 131-7.
Greil AL, Slauson-Blevins K, McQuillan J. The experience of infertility: a review of recent literature. Sociol Health Illn 2010; 32(1): 140-62.
[http://dx.doi.org/10.1111/j.1467-9566.2009.01213.x] [PMID: 20003036]
Bagshawe A, Taylor A. ABC of subfertility. Counselling. BMJ 2003; 327(7422): 1038-40.
[http://dx.doi.org/10.1136/bmj.327.7422.1038] [PMID: 14593042]
Rigcheshme MZ, Mirzaian B, Hasanzade R, Shahidi M. Comparing sexual attitudes of fertile and infertile couples. Majallah-i Danishgah-i Ulum-i Pizishki-i Mazandaran 2012; 21(1): 271-81.
Ardekani ZB, Akhondi MM, Kamali K, Khalaf ZF, Eskandari S, Ghorbani B. Mental health status of patients attending avicenna infertility clinic. J Reprod Infertil 2010; 11(4): 319-24.
Saleh RA, Ranga GM, Raina R, Nelson DR, Agarwal A. Sexual dysfunction in men undergoing infertility evaluation: a cohort observational study. Fertil Steril 2003; 79(4): 909-12.
[http://dx.doi.org/10.1016/S0015-0282(02)04921-X] [PMID: 12749429]
Akhondi MM, Binaafar S, Ardakani ZB, Kamali K, Kosari H, Ghorbani B. Aspects of psychosocial development in infertile versus fertile men. J Reprod Infertil 2013; 14(2): 90-3.
[PMID: 23926571]
Ola TM. The socio-cultural perception and implications of childlessness among men and women in an urban area, Southwest, Nigeria. J Soc Sci 2009; 21(3): 205-9.
Roupa Z, Polikandrioti M, Sotiropoulou P, et al. Causes of infertility in women at reproductive age. HSJ 2009; 3(2): 80-7.
Salmela-Aro K, Suikkari A-M. Letting go of your dreams-adjustment of child-related goal appraisals and depressive symptoms during infertility treatment. J Res Pers 2008; 42(4): 988-1003.
Jafarzadeh-Kenarsari F, Ghahiri A, Habibi M, Zargham-Boroujeni A. Exploration of infertile couples’ support requirements: a qualitative study. Int J Fertil Steril 2015; 9(1): 81-92.
[PMID: 25918596]
Riahi ME, Zarezade Mehrizi E. A study on the gender differences in psycho-social consequences of infertility: Infertile couples using Yazd’. Infertility Center Services Women’s Strategic Studies 2012; 14(56): 155-210.
Aarts JW, van Empel IW, Boivin J, Nelen WL, Kremer JA, Verhaak CM. Relationship between quality of life and distress in infertility: a validation study of the Dutch FertiQoL. Hum Reprod 2011; 26(5): 1112-8.
[http://dx.doi.org/10.1093/humrep/der051] [PMID: 21372046]
Thorn P. Understanding infertility: Psychological and social considerations from a counselling perspective. Int J Fertil Steril 2009; 3(2): 48-51.
Gibson DM, Myers JE. Gender and infertility: A relational approach to counseling women. J Couns Dev 2000; 78(4): 400-10.
Najmi B, Ahmadi SS, Ghassemi GR. Psychological characteristics of infertile couples referring to Isfahan Fertility and Infertility Center (IFIC). J Reprod Infertil 2001; 2(4): 40-5.
Karimi FZ, Taghipour A, Roudsari RL, Kimiaei SA, Mazlom SR, Amirian M. Cognitive emotional consequences of male infertility in their female partners: a qualitative content analysis. Electron Physician 2015; 7(7): 1449-57.
[http://dx.doi.org/10.19082/149] [PMID: 26767097]
Inhorn MC. The worms are weak. Male infertility and patriarchal paradoxes in Egypt. Men Masc 2003; 5(3): 236-56.
Taghipour A, Karimi FZ, Roudsari RL, Kimiaei SA, Mazlom SR, Amirian M. Women’s perceptions and experiences of the challenges in the process of male infertility treatment: A qualitative study. Electron Physician 2017; 9(5): 4349-56.
[http://dx.doi.org/10.19082/4349] [PMID: 28713506]
Dillu R, Sheoran P, Sarin J. An exploratory study to assess the quality of life of infertile couples at selected infertility clinics in Haryana. IOSR-JNHS 2013; 2: 45-51.
Etuk SJ. Reproductive health: global infertility trend. Niger J Physiol Sci 2009; 24(2): 85-90.
[PMID: 20234744]
Kormi Nouri R. Psycho-Social aspects of infertility. J Reprod Infertil 2000; 1(2): 57-68.
Savadzadeh S. madadzadeh N. Explanation of emotional feelings of women with infertility: A qualitative study. SJIMU 2013; 21(1): 16-24.
Pahlavani H, Malakouti K. Stressors, their coping strategies, and relation to mental health in infertile individuals. Iranian JPCP 2002; 7(4): 79-87.
Sudha G, Reddy K, Reddy K, Reddy B. Emotional distress in infertile couples: Across-cultural study. Asia Pac J Soc Scien 2011; 3(1): 90-101.
Mohammadi Hosseini F, Farzadi L, Seyed Fatemi N. Tense factors and coping strategies in infertile women referring to Alzahra Training Clinical Center of Tabriz (1998). J Reprod Infertil 2001; 2(3): 27-34.
Etesami Pour R, Banihashemian K. Comparison of sex disorders and couple abuse among fertile and infertile women. J Birjand Univ Med Sci 2011; 18(1): 10-7.
Besharat MA, Lashkari M, Rezazadeh MR. Explaining adjustment to infertility according to relationship quality, couples’ beliefs and social support. Fam Psychol 2014; 1(2): 41-54.
Onat G, Kizilkaya Beji N. Effects of infertility on gender differences in marital relationship and quality of life: a case-control study of Turkish couples. Eur J Obstet Gynecol Reprod Biol 2012; 165(2): 243-8.
[http://dx.doi.org/10.1016/j.ejogrb.2012.07.033] [PMID: 22939240]
Zare B, Safyari Jafarabad H. The study of marital satisfaction and its determinants on married women and men in Tehran city. Women’s Stud Sociol Psychol 2015; 13(1): 111-40.
Khatibi A. Survey of Females’ Attitude toward Factors Affecting the Family’s Strength (Research done among women staff of Payam Noor University; Hamadan Province). Woman Family Stud 2015; 3(1): 59-92.
Dyer SJ, Abrahams N, Hoffman M, van der Spuy ZM. ‘Men leave me as I cannot have children’: women’s experiences with involuntary childlessness. Hum Reprod 2002; 17(6): 1663-8.
[http://dx.doi.org/10.1093/humrep/17.6.1663] [PMID: 12042295]
Fahami F, Hoseini Quchani S, Ehsanpour S, Zargham A. Women’s lived experiences of female infertility. Majallah-i Zanan, Mamai va Nazai-i Iran 2010; 4(30): 45-53.
Hasanpoor-Azghdy SB, Simbar M, Vedadhir A. The emotional-psychological consequences of infertility among infertile women seeking treatment: Results of a qualitative study. Iran J Reprod Med 2014; 12(2): 131-8.
[PMID: 24799871]
Kohan S, Ghasemi Z, Beigi M. Exploring infertile women’s experiences about sexual life: A qualitative study. Iran J Nurs Midwifery Res 2015; 20(1): 34-9.
[PMID: 25709688]
Goldenberg I, Goldenberg H. Family Therapy: An OverviewTranslate by Hosseinshahi Baravati, Naghshbandi S. Tehran: Ravan Publication 2011.
Peterson BD, Pirritano M, Christensen U, Schmidt L. The impact of partner coping in couples experiencing infertility. Hum Reprod 2008; 23(5): 1128-37.
[http://dx.doi.org/10.1093/humrep/den067] [PMID: 18325885]
Lee TY, Sun GH, Chao SC. The effect of an infertility diagnosis on the distress, marital and sexual satisfaction between husbands and wives in Taiwan. Hum Reprod 2001; 16(8): 1762-7.
[http://dx.doi.org/10.1093/humrep/16.8.1762] [PMID: 11473979]
Ahmadi Forooshany SH, Yazdkhasti F, Safari Hajataghaie S, Nasr Esfahani MH. Infertile individuals’ marital relationship status, happiness, and mental health: a causal model. Int J Fertil Steril 2014; 8(3): 315-24.
[PMID: 25379161]
Samadaee-Gelehkolaee K, McCarthy BW, Khalilian A, et al. Factors associated with marital satisfaction in infertile couple: A comprehensive literature review. Glob J Health Sci 2015; 8(5): 96-109.
[http://dx.doi.org/10.5539/gjhs.v8n5p96] [PMID: 26652079]
Fledderjohann JJ. ‘Zero is not good for me’: implications of infertility in Ghana. Hum Reprod 2012; 27(5): 1383-90.
[http://dx.doi.org/10.1093/humrep/des035] [PMID: 22357772]
Valsangkar S, Bodhare T, Bele S, Sai S. An evaluation of the effect of infertility on marital, sexual satisfaction indices and health-related quality of life in women. J Hum Reprod Sci 2011; 4(2): 80-5.
[http://dx.doi.org/10.4103/0974-1208.86088] [PMID: 22065832]
Ahmadi SM, Shahverdi J, Rezaei M, et al. The effect of behavioral couple therapy on the improvement of mental health and reduction of marital conflict in infertile couples in Kermanshah: A Randomized Controlled Trial (RCT). J Reprod Infertil 2019; 20(1): 16-23.
[PMID: 30859078]
Kushwaha CH, Sinha P, Gupta U, Srivastava K. Impact of infertility on marital relationships among infertile couples attending OPD of a tertiary health care centre. IJRCOG 2018; 7(3): 1164-7.
Fisher JR, Hammarberg K. Psychological and social aspects of infertility in men: an overview of the evidence and implications for psychologically informed clinical care and future research. Asian J Androl 2012; 14(1): 121-9.
[http://dx.doi.org/10.1038/aja.2011.72] [PMID: 22179515]
Tabong PT, Adongo PB. Infertility and childlessness: a qualitative study of the experiences of infertile couples in Northern Ghana. BMC Pregnancy Childbirth 2013; 13: 72.
[http://dx.doi.org/10.1186/1471-2393-13-72] [PMID: 23517021]
Beaurepaire J, Jones M, Thiering P, Saunders D, Tennant C. Psychosocial adjustment to infertility and its treatment: male and female responses at different stages of IVF/ET treatment. J Psychosom Res 1994; 38(3): 229-40.
[http://dx.doi.org/10.1016/0022-3999(94)90118-X] [PMID: 8027962]
Movahed M, Azizi T. A study on the relationship between the sexual satisfaction of women in a married life and conflicts between spouses, among married women in Shiraz. Women development. Politics 2011; 9(2): 181-206.
Mazaheri MA, Kayghobadi F, Faghihi Imani Z, Ghashang N, Pato M. Problem solving strategies and marital adjustment in infertile and fertile couples. J Reprod Infertil 2001; 2(4): 22-32.
Karaca A, Unsal G. Psychosocial problems and coping strategies among Turkish women with infertility. Asian Nurs Res(Korean Soc Nurs Sci) 2015; 9(3): 243-50.[Korean Soc Nurs Sci].
[http://dx.doi.org/10.1016/j.anr.2015.04.007] [PMID: 26412629]
Pasch LA, Dunkel-Schetter C, Christensen A. Differences between husbands’ and wives’ approach to infertility affect marital communication and adjustment. Fertil Steril 2002; 77(6): 1241-7.
[http://dx.doi.org/10.1016/S0015-0282(02)03097-2] [PMID: 12057735]
Kızılay F, Şahin M, Altay B. Do sperm parameters and infertility affect sexuality of couples? Andrologia 2018; 50(2)e12879
[http://dx.doi.org/10.1111/and.12879] [PMID: 28766811]
Bechoua S, Hamamah S, Scalici E. Male infertility: an obstacle to sexuality? Andrology 2016; 4(3): 395-403.
[http://dx.doi.org/10.1111/andr.12160] [PMID: 27061770]
Lotti F, Maggi M. Sexual dysfunction and male infertility. Nat Rev Urol 2018; 15(5): 287-307.
[http://dx.doi.org/10.1038/nrurol.2018.20] [PMID: 29532805]
Smith JF, Walsh TJ, Shindel AW, et al. Infertility Outcomes Program Project Group Sexual, marital, and social impact of a man’s perceived infertility diagnosis. J Sex Med 2009; 6(9): 2505-15.
[http://dx.doi.org/10.1111/j.1743-6109.2009.01383.x] [PMID: 19619144]
Nyarko SH, Amu H. Self-reported effects of infertility on marital relationships among fertility clients at a public health facility in Accra, Ghana. Fertil Res Pract 2015; 1(1): 10.
[http://dx.doi.org/10.1186/s40738-015-0002-5] [PMID: 28620515]
Martins MV, Costa P, Peterson BD, Costa ME, Schmidt L. Marital stability and repartnering: infertility-related stress trajectories of unsuccessful fertility treatment. Fertil Steril 2014; 102(6): 1716-22.
[http://dx.doi.org/10.1016/j.fertnstert.2014.09.007] [PMID: 25439808]
Abbasi-Shavazi MJ, Asgari-Khanghah A, Razeghi H. Women and infertility experience: A case study in Tehran. J Women Stud 2005; 3(3): 91-114.
Bliss C. The Social Construction of Infertility by Minority Women Doctoral Dissertation . 1999.

Rights & PermissionsPrintExport Cite as

Article Details

Year: 2020
Page: [60 - 68]
Pages: 9
DOI: 10.2174/1573404815666191204113516
Price: $65

Article Metrics

PDF: 14
PRC: 1