Quality of Life Research

, Volume 27, Issue 4, pp 945–954 | Cite as

Predictors of quality of life and psychological health in infertile couples: the moderating role of duration of infertility

  • Maria Clelia Zurlo
  • Maria Francesca Cattaneo Della Volta
  • Federica Vallone



To investigate the influence of individual characteristics (age, gender, educational level, coping strategies), perceived couple’s Dyadic Adjustment, type of diagnosis and duration of infertility on self-reported quality of life (QoL) and psychological health in infertile couples, examining the potential moderating role of duration of infertility.


A questionnaire composed by socio-demographics, Coping Orientations to Problem Experienced, Dyadic Adjustment Scale, FertiQoL, State-Trait Anxiety Inventory and Edinburgh Depression Scale was submitted to 206 couples undergoing infertility treatments.


Female patients perceived significantly lower levels of QoL and higher levels of Anxiety and Depression. High Educational level and Social Support Coping strategy were associated with higher QoL and psychological health only in female patients. Problem Solving Coping strategy was associated with higher QoL and psychological health only in male patients. Positive Attitude and Avoidance/Distancing Coping strategies and perceived couple’s Dyadic Adjustment were associated with higher QoL and psychological health in both male and female patients. Duration of infertility > 3 years was associated with a reduction of protective effects of all coping strategies but did not affect protective effects of Educational level and couple’s Dyadic Adjustment.


Both positive/active and avoiding/distancing coping strategies are effective to promote QoL and psychological health in infertile couples, but they are all compromised by a long duration of infertility. Conversely, positive effects of educational level and couple’s Dyadic Adjustment persist and should be emphasised in the definition of interventions to promote well-being in couples undergoing long-term treatments.


Infertility Quality of life Coping strategies Couple’s dyadic adjustment Anxiety Depression 



The authors would like to thank all the study participants.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the study were in accordance with ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Zegers-Hochschild, F., Adamson, G. D., de Mouzon, J., Ishihara, O., Mansour, R., Nygren, K., Sullivan, E., & van der Poel, S. (2009). The International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) revised glossary on ART terminology. Fertility and Sterility, 92(5), 1520–1524. Scholar
  2. 2.
    Boivin, J., Bunting, L., Collins, J. A., & Nygren, K. G. (2007). International estimates of infertility prevalence and treatment-seeking: Potential need and demand for infertility medical care. Human Reproduction, 22(6), 1506–1512. Scholar
  3. 3.
    Boivin, J., Andersson, L., Shoog-Svanberg, A., Hjelmstedt, A., Collins, A., & Bergh, T. (1998). Psychological reactions during in vitro fertilization (IVF): Similar response patterns in husbands and wives. Human Reproduction, 13(11), 3262–3267.CrossRefPubMedGoogle Scholar
  4. 4.
    Newton, C. R., Sherrard, W., & Glavac, I. (1999). The Fertility Problem Inventory: Measuring perceived infertility-related stress. Fertility and Sterility, 72(1), 54–62.CrossRefPubMedGoogle Scholar
  5. 5.
    Cousineau, T. M., & Domar, A. D. (2007). Psychological impact of infertility. Best Practice & Research, Clinical Obstetrics & Gynaecology, 21(2), 293–308. Scholar
  6. 6.
    Peterson, B. D., Pirritano, M., Christensen, U., & Schmidt, L. (2008). The impact of partner coping in couples experiencing infertility. Human Reproduction, 23(5), 1128–1137. Scholar
  7. 7.
    Zurlo, M. C., Della Volta, C., M. F., & Vallone, F. (2017). Factor structure and psychometric properties of the Fertility Problem Inventory—Short Form (FPI-SF). Health Psychology Open, 4(2), 1–11. Scholar
  8. 8.
    Peterson, B. D., Sejbaek, C. S., Pirritano, M., & Schmidt, L. (2013). Are severe depressive symptoms associated with infertility-related distress in individuals and their partners? Human Reproduction, 29(1), 76–82. Scholar
  9. 9.
    Volgsten, H., Skoog Svanberg, A., Ekselius, L., Lundkvist, O., & Sundstroom, P. (2008). Prevalence of psychiatric disorders in infertile women and men undergoing in vitro fertilization treatment. Human Reproduction, 23(9), 2056–2063. Scholar
  10. 10.
    Boivin, J., & Lancastle, D. (2010). Medical waiting periods: Imminence, emotions and coping. Women’s Health, 6(1), 59–69. Scholar
  11. 11.
    Boivin, J., Takefman, J., & Braverman, A. (2011). Development and preliminary validation of the fertility quality of life (FertiQoL) tool. Human Reproduction, 26(8), 2084–2091. Scholar
  12. 12.
    Boivin, J., Takefman, J., & Braverman, A. (2011). The Fertility Quality of Life (FertiQoL) tool: Development and general psychometric properties. Fertility and Sterility, 96(2), 409–415. Scholar
  13. 13.
    Chachamovich, J., Chachamovich, E., Ezer, H., Fleck, M., Knauth, D., & Passos, E. (2010). Investigating quality of life and health-related quality of life in infertility: A systematic review. Journal of Psychosomatic Obstetrics & Gynecology, 31(2), 101–110. Scholar
  14. 14.
    Huppelschoten, A. G., van Dongen, A. J. C. M., Verhaak, C. M., Smeenk, J. M. J., Kremer, J. A. M., & Nelen, W. L. D. M. (2013). Differences in quality of life and emotional status between infertile women and their partners. Human Reproduction, 28(8), 2168–2176. Scholar
  15. 15.
    Monga, M., Alexandrescu, B., Katz, S. E., Stein, M., & Ganiats, T. (2004). Impact of infertility on quality of life, marital adjustment, and sexual function. Urology, 63(1), 126–130.CrossRefPubMedGoogle Scholar
  16. 16.
    The WHOQOL Group (1994). The development of the World Health Organization Quality of Life Assessment Instrument (the WHOQOL). In: J. Orley & W. Kuyken (Eds.), Quality of life assessment: International perspectives. Heidelberg: Springer.Google Scholar
  17. 17.
    Ragni, G., Mosconi, P., Baldini, M. P., Somigliana, E., Vegetti, W., Caliari, I., & Nicolosi, A. E. (2005). Health-related quality of life and need for IVF in 1000 Italian infertile couples. Human Reproduction, 20(5), 1286–1291. Scholar
  18. 18.
    Ware, J. E., Snow, K. K., Kosinski, M., & Gandek, B. (1993). SF-36 Health Survey manual and interpretation guide. Boston, MA: New England Medical Center, The Health Institute.Google Scholar
  19. 19.
    Aarts, J. W. M., van Empel, I. W. H., Boivin, J., Nelen, W. L., Kremer, J. A. M., & Verhaak, C. M. (2011). Relationship between quality of life and distress in infertility: A validation study of the Dutch FertiQoL. Human Reproduction, 26(5), 1112–1118. Scholar
  20. 20.
    Ozkan, S., Karabulut, A., Oğuz, N., & Sorkun, H. C. (2015). Coping with the stress of infertility. Males versus females. The Journal of Reproductive Medicine, 60(7–8), 339–344.PubMedGoogle Scholar
  21. 21.
    El Kissi, Y., Romdhane, A. B., Hidar, S., Bannour, S., Ayoubi Idrissi, K., Khairi, H., & Ben Hadj Ali B. (2013). General psychopathology, anxiety, depression and self-esteem in couples undergoing infertility treatment: A comparative study between men and women. European Journal of Obstetrics & Gynecology and Reproductive Biology, 167(2), 185–189. Scholar
  22. 22.
    Wischmann, T., Scherg, H., Strowitski, T., & Verres, R. (2009). Psychosocial characteristics of women and men attending infertility counselling. Human Reproduction, 24(2), 378–385. Scholar
  23. 23.
    Swift, B. E., & Liu, K. E. (2014). The effect of age, ethnicity, and level of education on fertility awareness and duration of infertility. Journal of Obstetrics and Gynaecology Canada, 36(11), 990–999. Scholar
  24. 24.
    Verhaak, C. M., Smeenk, J. M. J., Evers, A. W. M., van Minnen, A., Kremer, J. A. M., & Kraaimaat, F. W. (2005). Predicting emotional response to unsuccessful fertility treatment: A prospective study. Journal of Behavioral Medicine, 28(2), 181–190. Scholar
  25. 25.
    Ried, K., & Alfred, A. (2013). Quality of life, coping strategies and support needs of women seeking Traditional Chinese Medicine for infertility and viable pregnancy in Australia: A mixed methods approach. BMC Women’s Health, 13, 17. Scholar
  26. 26.
    Schmidt, L., Christensen, U., & Holstein, B. E. (2005). The social epidemiology of coping with infertility. Human Reproduction, 20(4), 1044–1052. Scholar
  27. 27.
    Jordan, C. B., & Revenson, T. A. (1999). Gender differences in coping with infertility: A meta-analysis. Journal of Behavioral Medicine, 22(4), 341–358. Scholar
  28. 28.
    Slade, P., O’Neill, C., Simpson, A. J., & Lashen, H. (2007). The relationship between perceived stigma, disclosure patterns, support and distress in new attendees at an infertility clinic. Human Reproduction, 22(8), 2309–2317. Scholar
  29. 29.
    Terry, D. J., & Hynes, G. J. (1998). Adjustment to a low-control situation: Reexamining the role of coping responses. Journal of Personality and Social Psychology, 74(4), 1078–1092. Scholar
  30. 30.
    Berghuis, J. P., & Stanton, A. L. (2002). Adjustment to a dyadic stressor: A longitudinal study of coping and depressive symptoms in infertile couples over an insemination attempt. Journal of Consulting and Clinical Psychology, 70(2), 433–438. Scholar
  31. 31.
    Kraaij, V., Garnefski, N., & Schroevers, M. J. (2009). Coping, goal adjustment, and positive and negative affect in definitive infertility. Journal of Health Psychology, 14(1), 18–26. Scholar
  32. 32.
    Daniluk, J. C. (1988). Infertility: Intrapersonal and interpersonal impact. Fertility and Sterility, 49(6), 982–990.CrossRefPubMedGoogle Scholar
  33. 33.
    Herrmann, D., Scherg, H., Verres, R., von Hagens, C., Strowitzki, T., & Wischmann, T. (2011). Resilience in infertile couples acts as a protective factor against infertility specific distress and impaired quality of life. Journal of Assisted Reproduction and Genetics, 28(11), 1111–1117.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Greil, A. L., Slauson-Blevins, K., & McQuillan, J. (2010). The experience of infertility: A review of recent literature. Sociology of Health and Illness, 32(1), 140–162. Scholar
  35. 35.
    Boivin, J., Griffiths, E., & Venetis, C. A. (2011). Emotional Distress in infertile women and failure of assisted reproductive technologies: Meta-analysis of prospective psychosocial studies. British Medical Journal, 342, d223. Scholar
  36. 36.
    Ebbesen, S. M., Zachariae, R., Mehlsen, M. Y., Thomsen, D., Hojgaard, A., Ottosen, L., Petersen, T., & Ingerslev, H. J. (2009). Stressful life events are associated with a poor in-vitro fertilization (IVF) outcome: A prospective study. Human Reproduction, 24(9), 2173–2182. Scholar
  37. 37.
    Matthiesen, S. M., Frederiksen, Y., Ingerslev, H. J., & Zachariae, R. (2011). Stress, distress and outcome of assisted reproductive technology (ART): A meta-analysis. Human Reproduction, 26(10), 2763–2776. Scholar
  38. 38.
    Baron, R. M., & Kenny, D. A. (1986). The mediator-moderator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173–1182.CrossRefPubMedGoogle Scholar
  39. 39.
    Carver, C. S., Scheier, M. F., & Weintraub, J. K. (1989). Assessing coping strategies: A theoretically based approach. Journal of Personality and Social Psychology, 56(2), 267–283.CrossRefPubMedGoogle Scholar
  40. 40.
    Sica, C., Magni, C., Ghisi, M., Altoè, G., Sighinolfi, C., Chiri, L. R., & Franceschini, S. (2008). Coping orientation problems experienced—Nuova versione italiana (COPE-NVI): Uno strumento per la misura degli stili di coping [Coping Orientation to the Problems Experienced-New Italian Version (COPE-NVI)]. Psicoterapia Cognitiva e Comportamentale, 14(1), 27–53.Google Scholar
  41. 41.
    Spanier, G. B. (1976). Measuring dyadic adjustment: New scales for assessing the quality of marriage and similar dyads. Journal of Marriage and the Family, 38(1), 15–28.CrossRefGoogle Scholar
  42. 42.
    Gentili, P., Contrearas, L., Cassaniti, M., & D’Arista, F. (2002). La Dyadic Adjustment Scale. Una misura dell’adattamento di coppia [The Dyadic Adjustment Scale. A measurement of dyadic adjustment]. Minerva Psichiatrica, 43(2), 107–116.Google Scholar
  43. 43.
    Spielberger, C. (1972). Anxiety: Current trends in research. London: Academic Press.Google Scholar
  44. 44.
    Pedrabissi, L., & Santinello, M. (1989). Nuova versione italiana dello S.T.A.I.-Forma Y [New Italian version of the S.T.A.I.-Form Y]. Firenze: Organizzazioni Speciali.Google Scholar
  45. 45.
    Murray, D., & Cox, J. L. (1990). Screening for depression during pregnancy with the Edinburgh Depression Scale (EDDS). Journal of Reproductive and Infant Psychology, 8(2), 99–107. Scholar
  46. 46.
    Benvenuti, P., Ferrara, M., Niccolai, C., Valoriani, V., & Cox, J. L. (1999). The Edinburgh Postnatal Depression Scale: Validation for an Italian sample. Journal of Affective Disorders, 53(2), 137–141. Scholar
  47. 47.
    Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal and coping. New York: Springer.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Political SciencesUniversity of Naples Federico IINaplesItaly
  2. 2.Department of Humanistic StudiesUniversity of Naples Federico IINaplesItaly

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