Impact of Infertility on Women Health Attending Gynecology Outpatient Department: Our Hospital Experience
Sabahat Fatima1, Hajira2, Rahila Imtiaz3, Asma Jabeen4, Rubina Amjad5, Humaira Qureshi6 1. Sabahat Fatima, Assistant Professor Gynaecology and Obstetrics, Ghulam Muhammad Mahar Medical College Sukkur Pakistan. email: [email protected] 2. Hajira, Resident Medical officer Gynaecology and Obstetrics, Sindh Government
Qatar Hospital Karachi Pakistan. email: [email protected]
3. Rahila Imtiaz, Assistant Professor Gynaecology and Obstetrics, Karachi Medical and Dental College Pakistan. email: [email protected]
4. Asma Jabeen, Associate professor Gynaecology and Obstetrics, Muhammad Medical Collage Mirpurkhas Pakistan. email: [email protected]
5. Rubina Amjad, Assistant Professor Gynaecology and Obstetrics, Mekran Medical College Teaching Hospital Turbat Kech Pakistan. Email: [email protected] 6. Humaira Qureshi, Senior Medical officer Gynaecology and Obstetrics, Maternal and
Child Care Center Hyderabad Pakistan. email: [email protected]
Corresponding Author: Sabahat Fatima, Assistant Professor Gynaecology and Obstetrics, Ghulam Muhammad Mahar Medical College Sukkur Pakistan. email:
Abstract
Aim: To assess the impact of infertility on women health attending gynecology outpatient department.
Study design: Cross-sectional study
Place and duration: This study was conducted at Ghulam Muhammad Mahar Medical College Sukkur Pakistan from March 2020 to March 2021.
Methodology The study of infertility experiences was conducted using a descriptive phenomenological research approach. Purposive sampling was used to select 16 women experiencing infertility. Interviews were conducted using an unstructured questionnaire and theme analysis was used to gather information.
Results: Among the 16 women, 46.66% had gynecological issues and 53.33% had medical issues such as hypothyroidism and hyperthyroidism. Thirdly, 33% of those polled said that their partner was having issues with oligospermia or azoospermia. The vast majority of participants and their spouses were receiving medical attention. A total of 60% of those polled reported mental health issues related to their infertility, while 26.66% reported physical and sexual health disorder.
Conclusions: In addition to physical and sexual issues, individuals experienced a wide range of mental issues. The majority of individuals claimed they would continue trying for a baby
until their fertility ceased. Male factor infertility involved in one-third of the participants..
Providing infertility therapy to couples is encouraged by the hospital's governing body.
Keywords: Infertility, Women, Physical problems, psychosocial problems Introduction
Infertility is defined as a woman is unable to get pregnant after having unprotected sex for more than a year [1].WHO says that 48.5 million couples around the world were unable to have a child [2].The number of women who wanted a child but couldn't have their first live birth was about 1.9% [3]. This resulting in discrimination from family members and neighbours, social isolation, depression, murder, or suicide are all linked to infertility [4, 5].
When a couple can't have child,it's a problem for the whole family . Even though infertile couple encounter emotional and social distress, they need support and help to survive with healthy mental and social well-being.
Many women blame themselves, no matter who is to blame. The threat of another marriage or divorce can happen to women in some cases, and many fear that they will lose their social and economic safety. They could be a victim of violence, abuse, or social isolation, and these things could happen to them [6, 7]. Some husbands are supportive and help their wives to fight back against family pressure or criticism, even if they don't want to do that [8]. Physical abuse and mental torture are commonly found among infertile couple [9]. A study of Nepal found that people who told their story had been abused in any way [10].The Current study is planned to assess the impact of infertility on women’s health.
Methodology
The phenomenological research design was used to look into the lives of women who have infertility. People who took part in the study were 16 women who were infertile and went to the gynecology outpatient department at our hospital. Samples were chosen by a non- probability sampling method. Data was gathered through an in-depth interview method with the help of a questionnaire.
Each person who took part in the study had to sign a written consent form that explained the purpose of the study. Members of the study were told that the information they gave would be kept private and only used for the study. Verbal and nonverbal expressions of the people who were interviewed were looked at in a certain amount of time. It was after the interview that all of the field notes were marked with codes. Data was gathered and then analysis was done by using SPSS version 22.
Results
According to socio-demographic factors, 60% of the women were between the ages of 26 and 40 years. A total of 30.93% of women were literate. Sixty percent of the people lived in a joint family. Fifty-three percent of the people said that their spouse was between the ages of 31 and 40. All of them were literate. Table1 provides information about gynecological and medical conditions and the various treatments available.
The sperm count was abnormal in 33% of the subjects, with 60% having low sperm count and 20% having a normal sperm count, although only 15% of the people had abnormal sperm, azoospermia, or low testosterone. Eighty percent of the participants' partners with a sperm issue were receiving therapy. Table 2 shows that out of the 16 responders, all of them had experienced difficulties due to infertility.
Among the participants, 47 percent stated that their mother-in-law or sister-in-law are the perpetrator of the violence, with 71.42 percent and 14.28 percent respectively. More than half of the participants reported using coping techniques, including sobbing, fasting and worshipping, not eating, praying, and sharing more burden of household work and looking after other’s children and maintaining prolong fasting during the crisis. Of the 87 percent who spoke about their support system, 53.84 percent agreed that their husband is cooperative, and 7.69 percent said that their sister-in-law is supportive. Most respondents (67%) plan to pursue infertility therapy and conception attempts until they have the child, while 13.33 percent stated they are considering adopting the baby from a family member.
Table 1: Patient’s Gynecological and clinical problems and treatment types Case
No
Gynecological problem Medical problem Treatment of problems
1 Tubal obstruction Hyperthyroidism, Diabetes Mellitus
Undertreatment of Hyperthyroidism, diabetes mellitus, and treatment of infertility
2 Vaginal discharge and irregular menstruation
No Treatment of Leucorrhea and 2 times IUI tried but did not occur ovulation
3 No Hyperthyroidism Under medication of
Hyperthyroidism
4 Polycystic ovary
syndrome
Hyperthyroidism Under medication of Hyperthyroidism
5 No Vertigo and
fainting
Under medication of irregular menstruation
6 Menorrhagia and
intramural fibroid
No Under medication
7 No Pain abdomen Treatment of Pain abdomen
8 No No No
9 No Hyperthyroidism Under medication
10 No No No
11 Heavy menstrual
bleeding
Hyperthyroidism Under medication 12 Oligo amenorrhea and
dysmenorrhea
Hyperthyroidism Under medication
13 Ovarian cyst No
14 No No
15 No No
16 No No Under medication
Table 2: Experiences of women with infertility Case
No
Physical Problem
Psycho-social problems
Financial problem
Problems in sexual and marital relationship
1 No Back Biting Borrowing
money for treatment
Normal
2 Workload Back Biting, Threaten for 2nd marriage of husband
No Husband insists to have sex even she is not ready
3 Workload Back Biting Parents
give money
Husbands insist to have sex everyday with the hope of conception
4 The query The query for not having a baby
No Good but sometimes she avoids sexual contact for anxiety
5 No No No Excess sexual intercourse but
sometimes she does not want
6 No No No Good
7 No No No Good
8 No No No Good
9 Workload Back Biting No Normal
10 Workload Back Biting, give pressure to have baby
No Normal
11 No give pressure to have baby
No Normal
12 No give pressure to have baby
No Normal
13 No No No Normal
14 No Blaming for not having a baby
No Good
15 No No No Normal
16 No No No Normal
Discussion
In this study participants' families exhibited a significant level of male dominance,.the family
more likely to be affected by gender discrimination than males. Some female participants were blamed for being infertile even though their fertility workup was normal but their husbands were the cause of infertility with abnormal sperm count and morphology. Iranian research demonstrates that many societies define womanhood in terms of motherhood, and infertile women are often blamed for the inability of couples to procreate [11].
Infertility treatment success largely depends on the cause of infertility and age of the involved women [12]. As a result of their shorter reproductive periods, elderly women faces more distress an pressure to become pregnant [13]. Researchers discovered that seven of the nine women in the study, all of whom were between the ages of 36 and 40years had a severe emotional difficulties due to infertility.
There was a heavy strain of domestic work responsibility for the the individuals who shared a common home. Five people in the joint family had had emotional stress because other family members taken them for granted and believed childless women had more time because they didn't have to be involved in their own childcare.The length of an infertile couple's marriage has been shown the predictor of impair mental and psychological health[14]. Emotional issues were reported by eight individuals who had been married for six to nine years.
Participants who were older and had been married for a longer period appeared more anxious and desperate for child than those who were younger and had just wed [15].
It is essential in most of the south east asian society to have more children as compare to western world. There was a lot of strain on those individuals whose husbands were the sole sons of their families. The mother-in-law of one of the participants said she had threatened her for marrying a second time. Research demonstrates that children are strongly wanted, parenting is culturally required, and childlessness is socially distressful [16].
Infertility can be caused by a variety of factors, including those specific to men, [17]. Five of the participants' husbands experienced an issue with their sperm count in this research. Those in the family who are aware of the cause of infertility, don't put pressure on their son to have a kid or point the finger at their daughter-in-law.Moreover, half of the people who participated in the research had been trying to get pregnant for many year. Among the subjects, 40% reported having had therapy. One person had been receiving ayurvedic therapy for two years, while the other had previously sought help from a religious healer. In this investigation, it was discovered that the husbands of four particepant with oligospermia, were receiving their Infertility treatment, it may be traditional or mystical in according to certain cultures [18]; in other societies, a child might be adopted, remarried, or even divorced to alleviate the infertility problem. When a couple approaches the hospital to find out the cause of infertility, they aareinvestigated and accordingly given treatment depending on their economic standing [19]
An in-depth interview with 80% of participants revealed that they appeared melancholy, worried, and disturbed. Study participants said that the experience of infertility affects the lives of infertile women, causing them to feel alone, anxious, and depressed. In research conducted in Iran, it was shown that infertile couples' relatives had fewer interactions with
them than fertile ones [20]. As a result of social isolation from family members’ and friends the infertile couples have psychological difficulties and mental health problem [21].
For many couples, infertility is the main source of stress and cause of sexual disfunction in either partner[22]. The study found that four participants' husbands pushed on continuing an excessive sexual intercourse in the hopes of conceiving .Despite their husband's increased demand , two women among them were unable to engage in sexual activity and avoids their husband and wants to escape from sexual relationship particularly they felt it useless and fruitless[23], according to recent research. Fulfillment of marital pleasure and satisfaction can be achieved by having a kid but when it is not achieved then stressful and frustrated woman turns to a variety of coping techniques. Researchers discovered that infertility-related stress was handled in a variety of ways by individuals [24]. The coping techniques of thirteen individuals included fasting,engaging more themselves in house hold wok,taking care of others children etc, social support can help them to get through it and even thrive [25]. There were seven supportive husbands among the participants, five supportive wives of infertile males and and four supportive moms and inlaws among participants.
Participants' plans were sought out by researchers if they were unable to conceive. Two of the participants plan to adopt a kid from inside their own family (brother and brother-in-law).
Infertility therapy and attempts to conceive will continue for ten of the individuals. Childless women in Pakistan want a kid, regardless of gender [26], according to a recent survey. It doesn't matter if the kid is male or female; he or she will be a source of dignity, respect, and recognition as an adult.
Conclusion
Infertility is viewed and felt like a bad circumstance that is linked to family conflict, continual health-seeking, and treatment failures and their effects. Infertility is a negative experience. Unfortunately, even though infertility has a medical reason, infertile women in our culture continue to be persecuted in every aspect of their personal and social lives.
Funding source None
Conflict of interest None
Permission
Permission was taken from the ethical review committee of the institute References
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