DISSERTATION ON
A STUDY TO ASSESS THE EFFECTIVENESS OF FOCUSED MIDWIFE PROGRAMME ON SELECTED
PROBLEMS OF WOMEN ON ARTIFICIAL REPRODUCTIVE TREATMENT ATTENDING INFERTILITY CLINIC AT MATERNITY TERTIARY
CARE HOSPITAL, CHENNAI.
M.Sc (NURSING) DEGREE EXAMINATION
III–OBSTETRICS AND GYNAECOLOGICAL NURSING COLLEGE OF NURSING
MADRAS MEDICAL COLLEGE, CHENNAI – 600 003.
A dissertation submitted to
THE TAMIL NADU DR.M.G.R.MEDICAL UNIVERSITY, CHENNAI – 600 032.
In partial fulfilment of the requirement for the award of degree of
MASTER OF SCIENCE IN NURSING
OCTOBER 2020
DISSERTATION ON
A STUDY TO ASSESS THE EFFECTIVENESS OF FOCUSED MIDWIFE PROGRAMME ON SELECTED
PROBLEMS OF WOMEN ON ARTIFICIAL REPRODUCTIVE TREATMENT ATTENDING INFERTILITY CLINIC AT MATERNITY TERTIARY
CARE HOSPITAL, CHENNAI.
Examination : M.Sc (Nursing) Degree Examination Examination month and year : OCTOBER 2020
Branch & Course : III–OBSTETRICS AND
GYNAECOLOGICAL NURSING
Register No : 301821258
Institution : COLLEGE OF NURSING,
MADRAS MEDICAL COLLEGE, CHENNAI – 600 003
Sd: ________________________ Sd:___________________
Internal Examiner External Examiner
Date: Date:
THE TAMIL NADU DR.M.G.R.MEDICAL UNIVERSITY,
CHENNAI – 600 032.
CERTIFICATE
This is to certify that this dissertation titled, “A STUDY TO ASSESS THE EFFECTIVENESS OF FOCUSED MIDWIFE PROGRAMME ON SELECTED PROBLEMS OF WOMEN ON ARTIFICIAL REPRODUCTIVE TREATMENT ATTENDING INFERTILITY CLINIC AT MATERNITY TERTIARY CARE HOSPITAL, CHENNAI”, is a bonafide work done by L.SUSHMITHA, M.Sc.,(Nursing) II Year student, College of Nursing, Madras Medical College, Chennai-03, submitted to the Tamil Nadu Dr. M.G.R. Medical University, Chennai in partial fulfillment of requirement for the award of the degree of Master of Science in Nursing BRANCH-III, OBSTETRICS AND GYNECOLOGICAL NURSING under our guidance and supervision during academic period from 2018- 2020.
Mrs.A.Thahira Begum, M.Sc.(N), MBA., M.Phil.
Principal,
College of Nursing, Madras Medical College , Chennai- 03.
Dr.E.Theranirajan, MD., DCH., MRCP(UK)., FRCPCH(UK)., Dean,
Madras Medical College , Chennai- 03.
A STUDY TO ASSESS THE EFFECTIVENESS OF FOCUSED MIDWIFE PROGRAMME ON SELECTED
PROBLEMS OF WOMEN ON ARTIFICIAL REPRODUCTIVE TREATMENT ATTENDING INFERTILITY CLINIC AT MATERNITY TERTIARY
CARE HOSPITAL, CHENNAI.
Approved by the dissertation committee on 12.11.2019
CLINICAL SPECIALITY GUIDE
Mrs. S.Theanmozhi,M.Sc(N), _________________
Obstetrics and Gynaecological Nursing, College of Nursing,
Madras Medical College, Chennai-03.
PRINCIPAL
Mrs.A.Thahira Begum, M.Sc(N)., M.B.A., M.Phil., _________________
Principal,
College of Nursing, Madras Medical College, Chennai -03.
DEAN
Dr.E.Theranirajan, MD., DCH.,
MRCP(UK)., FRCPCH(UK)., _________________
Dean,
Madras Medical College , Chennai- 03.
A dissertation submitted to
THE TAMIL NADU DR.M.G.R.MEDICAL UNIVERSITY, CHENNAI – 600 032.
In partial fulfilment of the requirement for the award of degree of
MASTER OF SCIENCE IN NURSING
ACKNOWLEDGEMENT
I praise and thank the God Almighty for showering his everlasting love and blessings to make my dream of studying in an esteemed college possible in real. He has been bestowed his blessings over me throughout my study period with a joy of spirit and enthusiasm in the completion of this dissertation successfully.
I extend my sincere thanks to Dr.F.Theranirajan, MD., MRCP(UK)., FRCPCH(UK)., The Dean, Madras Medical College, Chennai-03. Dr.R.Jayanthi, MD., F.R.C.P.(Glasg)., Former Dean, Madras Medical College, Chennnai – 03. for permitting me to conduct the study in this prestigious institution.
I am more privileged to thank Institutional Ethics Committee, of Madras Medical College, Chennai-03 for giving me an approval to conduct this study.
I am extreme grateful to Dr.Vijaya, MBBS., MD., Medical Director, Institute of Obstetrics & Gynecology and Government Hospital for Women and Children, Chennai -08 for tha valuable suggestion and guidance throughout the study.
I express my heartfelt thanks to Mrs.A.Thahira Begum, M.Sc(N)., M.B.A., M.Phil., Principal, College of Nursing, Madras Medical College, Chennai -03 for her constant visionary support, excellent guidance, esteemed research mentorship, moral support and untired efforts which motivated me in completion of the study successfully. Her kind guidance is truly immeasurable.
I owe my sincere thanks to Mr.Nithiyanantham, M.Sc(N)., Vice Principal, College of Nursing, Madras Medical College, Chennai -03 for his constant support throughout the study.
I extend my sincere thanks to Dr.R.Shankar Shanmugam, M.Sc(N)., M.B.A., Ph.D., for guiding to select the research topic for my study and his motivating efforts in driving us to complete my study in a right way.
His motivating words and supportive inputs helped us to take the study in an appropriate direction .
My great pleasure and privileges to express my gratitude to Mrs.S.Thenmozhi, M.Sc(N)., Lecturer, Obstetric and Gynaecological Nursing Department, College of Nursing, Madras Medical College, Chennai – 03 for her constant support, calm approach, supportive guidance which helped me to complete the study peacefully and successfully.
I extend my thanks to Mrs.S.Lilly Puspam, M.Sc(N)., Reader, former Head of the Department, Obstetrical and Gynaecological Nursing Department for her valuable guidance and suggestions.
My sincere thanks to Mrs.D.Rajeswari, M.Sc(N), Nursing Tutor, College of Nursing, Madras Medical College, Chennai -03 for her sincere, support and facilitation which guided us in making the study successfully.
I express my sincere gratitude to Dr.G.Mala, M.Sc(N)., Ph.D., Former Nursing Tutor, Mr.K.Kannan, M.Sc(N)., Nursing Tutor, and Mrs.P.TamilSelvi, M.Sc(N)., Nursing Tutor, College of Nursing, Madras Medical College, Chennai -03 for her valuable suggestions and in carrying out the study.
I wish to express my heartfelt gratitude to all the Faculty Members of College of Nursing, Madras Medical College, Chennai – 03 for their valuable guidance and suggestions in conducting this study.
I express my heartfelt gratitude to the Nursing Superintendent
Hospital for women and children, Chennai -08 for their assistance and help during data collection
It’s my privilege to express my gratitude to Dr.C.Susila., RNRM M.Sc(N) Ph.D., Principal, Obsterrics and Gynecological Nursing, Billroth College Of Nursing, Chennai and Prof.A.I.Chitra, M.Sc(N)., Vice Principal, GRT College Of Nursing,Tiruttani, for their content validation, valuable suggestions contributed to the refinement of the data collection tool.
My sincere thanks to.Dr.A.Vengatesan, M.Sc., M.Phil., Ph.D., P.G.D.C.A. Former Deputy Director (Statistics), Directorate of Medical Education, Chennai for his valuable suggestion and guidance in the successful completion of statistical analysis and compiling of this study.
My special word of thanks to Mr.Ravi, M.A., MLIS., Librarian for extending his support in providing all the necessary materials needed to complete the study in an organized manner.
I owe my great sense of gratitude to Mr.Jas Ahamed Aslam, Shajee Computers and Mr.Ramesh B.A., MSM Xerox for their enthusiastic help and sincere effort in typing manuscript using valuable computer skills and also bringing this study into a printed form.
My special and deep thanks to my parents Mr.Lawrence.P, Mrs.Rajeswari.N and my brother Mr.Aravinth.L and my other family members for their loving support and timely help to complete the study
successfully and my heartfelt thanks to Mr.Sethupathy.R, Ms. Poornima.P and Ms Nandhini.N for always being there for me and
thank you for encouraging and motivating me in all of my pursuits and inspiring me to follow my dreams. I always knew that you believed in me and wanted the best for me..
I would like to convey my thanks to Mr.A.Saravanan, M.A., B.Ed., for his immense help in English and grammatical corrections for my study.
My deep sense of gratitude to Mrs.C.Rajakumari, M.Sc., M.ED., For her great help in Tamil correction for my study.
I take this opportunity to thank all the Teaching and Non Teaching Staff Members, College Of Nursing, Madras Medical College, Chennai-03, for their support and help rendered.
I extend my heartfelt gratitude to my OBG family, Mrs.Dhamayanthi.R, Mrs.Indhumathi.S, Mrs.Mahalakshmi.P, Mrs.Nirmala.A, Mrs.Sagayaponkala.I, Mrs.Sangeetha.T and Mrs.Vijayalakshmi.N and my beloved other department friends who helped me during the course of my study.
I am greatly indebted to all my Colleagues, Classmates and Friends who helped me during the course of my study.
My earnest gratitude to all the Women, who had enthusiastically participated in this study without them it was not possible for me to complete this study.
I perceive this opportunity as the milestone in my career development. I will strive to apply this knowledge in the best possible way.
Finally, I extend my special thanks and gratitude to one, and all those who have been directly and indirectly listening, offering me Advice, and supporting me through this entire process and helped me to complete the thesis wonderfully.
Thank you all.
ABSTRACT
“A study to assess the effectiveness of Focused Midwife Programme on selected problems of women on Artificial Reproductive Treatment attending Infertility clinic at Maternity Tertiary Care Hospital, Chennai.”
INTRODUCTION
Childbirth is the most joyous event in every woman’s life.
Fertility plays a vital role in a woman’s life. Artificial reproductive technology is a methods used to achieve pregnancy by artificial means.
It also interferes with the marital dynamics, sometimes leading to depression marital instability, and occasionally divorce, polygamy or remarriage.Hence to address this issue, proper education and guidance should be provided which will reduce the social and psychological consequences of women with infertility problems
OBJECTIVES
1. To assess the pretest level of selected problems on knowledge and depression among women on artificial reproductive treatment both in experimental and control group.
2. To evaluate the effectiveness of focused midwife programme on selected problems on knowledge and depression among women on artificial reproductive treatment in experimental group.
3. To compare the pretest and post test level of selected problems on knowledge and depression among women on artificial reproductive treatment both in experimental group and control group.
4. To find out the association of post test level of selected problems on knowledge and depression among women on artificial reproductive treatment with their selected demographic variables.
METHODOLOGY
The study was adopted with Quantative approach as Quasi experimental study and Non-randomized control group design was selected. It was conducted in Institute of Obstetrics and Gynaecology and Govt. Hospital for Women and Children, Chennai, A total of 60 women(30 control group 30 and experimental group) attending infertility clinic who fulfil the inclusion criteria were selected as samples for the study by using non- probability purposive sampling technique.The data was collected by using Semi-Structured multiple choice knowledge questionnaire and Beck's Depression Inventory tool.
RESULTS
The findings of the study revealed that regarding post test knowledge among the experimental group, markedly there was no inadequate knowledge, which was highly significant, only 26.67% of women were having moderate knowledge and also 73.33% of them gained adequate knowledge, from the pretest score which shows the efficacy of focused midwife programme. Whereas in the control group, 56.67% of them were having inadequate knowledge, 43.33% of moderate knowledge and no one had adequate knowledge, which was highly significant with the mean difference of 4.87(p<0.001).
Regarding post test depression level among experimental group, 30.00% of them are having mild depression, 33.33% of them are having borderline depression and 36.67% of them are having moderate score and remarkably none of the women are having extreme and severe level of depression which indicates the efficacy of focused midwife
having severe depression and moderate depression score and also 13.34% of them are having Extreme depression and none of them are having, mild, borderline level of depression with mean difference of 13.87 (p<0.001). This shows the effectiveness of focused midwife programme on reduction of depression among women on artificial reproductive technology. The findings concluded that there was association between the post test level of selected problem on knowledge and depression among women on artificial reproductive treatment with selected demographic variables such as educational status, nature of marriage, and type of family.
DISCUSSION
Focused midwife programme is easy to implement, informative for women. The study also reveals that, Focused midwife programme is very effective in improving knowledge and reducing depression among women on artificial reproductive treatment.
TABLE OF CONTENTS
CHAPTER CONTENT PAGE
NO
I INTRODUCTION 1
1.1 Backround Of The Study 4
1.2 Need for the study 8
1.3 Statement of the problem 12
1.4 Objectives of the study 12
1.5 Operational definitions 12
1.6 Research Hypothesis 13
1.7 Assumptions 14
1.8 Delimitations 14
1.9 Conceptual framework 14
II REVIEW OF LITERATURE 20
III RESEARCH METHODOLOGY 37
3.1 Research approach 37
3.2 Research design 37
3.3 Research variables of the study 38
3.4 Study Setting 39
3.5 Study population 39
3.6 Study sample 39
3.7 Criteria for sample selection 3.7.1 Inclusion criteria
40
3.7.2 Exclusion criteria 40
3.8 Sample size 40
3.9 Sampling technique 40
CHAPTER CONTENT PAGE NO 3.10 Development and description of the tool 3.10.1 Development of the tool
40
3.10.2 Description of the tool 41 3.10.3 description of Intrevention tool 42
3.11 Content validity 42
3.12 Reliability of the tool 43
3.13 Ethical consideration 43
3.14 Pilot study 44
3.15 Data collection procedure 45
3.16 Plan for Data analysis 46
IV DATA ANALYSIS AND INTERPRETATION 49
V DISCUSSIONS 117
VI SUMMARY, CONCLUSION,IMPLICATION, RECOMMENDATION AND LIMITATIONS
6.1 Summary of the study 135
6.2 Major Findings of the Study 136
6.3 Conclusion 143
6.4 Nursing implications 143
6.5 Recommendation 147
6.6 Limitations 148
REFERENCES APPENDICES
LIST OF TABLES
TABLE
NO TITLE PAGE
NO
3.1 Scoring interpretation of knowledge 41
3.2 Scoring interpretation of depression level 42 4.1 Demographic variables and infertility related
variables of women 51
4.2 Each question wise pretest percentage of knowledge
score 66
4.3 Comparison of pretest level of knowledge score 68 4.4 Comparison of mean pretest knowledge score 69 4.5 Each questionwise pretest percentage of depression
score 70
4.6 Comparison of pretest level of depression score 72 4.7 Comparison of mean pretest depression score 73 4.8 Each questionwise post test percentage of knowledge
score 74
4.9 Comparison of post test level of knowledge score 76 4.10 Comparison of mean post test level of knowledge
score 77
4.11 Each questionwise post test level of depression score 78 4.12 Comparison of post test level of depression score 80 4.13 Comparison of mean post test depession score 81 4.14 Effectiveness of focused midwife programme and
generalization of knowledge gain score
84
4.15 Effectiveness of focused midwife programme and generalization of depression reduction score
85
4.16 Comparison of pretest and post test level of knowledge score
87
TABLE
NO TITLE PAGE
NO 4.17 Comparison of pretest and post test mean knowledge
score
89
4.18 Comparison of pretest and post test level of depression score
91
4.19 Comparison of pretest and post test mean depression score
92
4.20 Association between post test level of knowledge score and women’ demographic variables in experimental group
96
4.21 Association between post test level of knowledge score and women’ demographic variables in control group
103
4.22
Association between post test level of depression score and women’ demographic variables in experimental group
106
4.23 Association between post test level of depression score and women’ demographic variables in control group
113
LIST OF FIGURES
FIGURE
NO TITLE
1.1 Global prevalence of primary infertility, 2017 1.2 Global prevalence of secondary infertility, 2017 1.3 Fertility trends; total fertility rate in Tamil Nadu
1.4 Conceptual framework based on modified Imogene Kings Goal Attainment model
3.1 Schematic representation of research methodology 4.1 Age distribution of women
4.2 Education qualification of women 4.3 Family monthly income of women 4.4 Religion of women
4.5 Place of residence of women 4.6 Type of family of women 4.7 Nature of marriage of women 4.8 Occupation of women
4.9 Exercising habit of women 4.10 Duration of infertilityof women 4.11 Nature of marriage of women
4.12 Person motivated the women to attend the clinic 4.13 History of systemic illness for women
4.14 Treatment for women
4.15 Family history of infertility for women
4.16 Pretest and post test level of knowledge score
FIGURE
NO TITLE
4.18 Bar diagram - compares the pretest and post test knowledge score among experiment group and control group
4.19 Bar diagram compares the pretest and post test depression score among experiment group and control group
4.20 Association between post test level of knowledge score and women education status
4.21 Association between post test level of knowledge score and women type of family
4.24 Association between post test level of knowledge score and women nature of marriage
4.25 Association between post test level of depression score and women education status
4.26 Association between post test level of depression score and women nature of marriage
4.27 Association between post test level of depression score and women duration of infertility
4.28 Association between post test level of depression score and women history of systemic disorder
LIST OF APPENDICES
S.NO CONTENT
1 Certificate of approval from Institutional ethics committee 2 Permission letter
3 Certificate of content validity
4 Informed consent –English and Tamil 5 Certificate of English editing
6 Certificate of Tamil editing
7 Tool for data collection -English and Tamil 8 Lesson plan English and Tamil
10 Module -Focused Midwife Programme 11 Photos
LIST OF ABBREVIATIONS
ABBREVIATION EXPANSION
ART Artificial reproductive treatment ANOVA Analysis of variance
ASA Anti sperm antobody
CBT Cognitive behavioural therapy CI Class interval
DF Degree of freedom
DI Donor insemination
ES Effect size
ET Embryo transfer
EM Endometriosis
FertiIQoL Fertility quality of life
FSH Follicle stimulating hormone GIFT Gamete intrafallopian transfer
ICU Intensive care unit
ICSI Intracytoplasmic sperm injection
IMSI Intracytoplasmic morphologically slected sperm injection
IUI Intra uterine insemination IVF In-Vitro fertilization
LH Lutenizing hormone
NFHS National family health survey NS Nonsignificant
OPD Outpatient dep[artment
OBG Obstetrics and gynaecologyical
ABBREVIATION EXPANSION OT Operation theater
OHSS Ovarial hyper stimulation syndrome PID Pelvic inflammatory disease
RCT Randomized control trial
RR Risk ratio
SD Standard deviation
STP Structured teaching programme SDS Self rating depression scale TFR Total fertility rate
TB Tuberculosis
WHQ World health questionnaire WHO World health organization
ZIFT Zygote intrafallopian transfer
CHAPTER-I INTRODUCTION
“It is marvellous that we are the only species That creates gracious forms.
To create is Divine, to reproduce is Human”
-Man Ray Parenthood is a dream of many couples. However they may not plan a pregnancy keeping advancing age and issues pertaining to infertility in mind. Both unplanned pregnancy and infertility occur commonly. Traditionally fertility awareness was considered to be knowledge on female anatomy and physiology and its application to family planning. However, age at first conception is increasing globally, the epidemic of infertility looms large. The global trend in delaying parenthood is being attributed to a number of factors, primarily, pursuit of higher education and career goals, desire for a stable job and delay in finding a suitable partner.
Reproduction is the gift of God to each and every living creations. God created this world for all his living creations to reproduce and fill and flourish it. Each human, on his birth is gifted a life. And each new day is added to his life not only to live but to bring out offspring‟s of him and double the happiness of him. Reproduction is that process where a living organism with the union of another of its own kind produces a new young one. Fertility, according to the Longman Dictionary of Contemporary English, refers to the condition or state of being fertile, that is being able to produce many young, fruits or seeds.
In the past, fertility was very important to the people. For instance, the people of the Indus Valley in India were believed to have worshipped the Mother Goddess, who was a symbol of fertility.
In the United States, around 10 percent of women aged 15 to 44 years are estimated to have difficulty in conceiving or staying pregnant.
Worldwide, 8 to 12% of couples experience fertility related problems.
Between 45 and 50% of cases are thought to stem from factors that affect the man.
Fertility plays a vital role in a woman‟s life. In our tradition, fertility is the most important part of marital life. The feeling of being conceived is wonderful, and the mother is filled with joy on the first kick of her child in-utero. Loss of this precious aspect, indeed results in stress and depression. With so much of technological advancements and other newer inventions in the field of science and reproduction. It is still a dream for many women to get conveived. “Infertility” is the name of this dream. When fertility is disturbed the women ultimately ends up in stress. As per Perry.E.Shannon, infertility is the inability to become pregnant even after one year of unprotected sex. Both men and women contribute to this threat. It is broadly classified into two types, Primary infertility and secondary infertility. Primary infertility is that where a woman has not conceived even once in her life time. Secondary infertility is one where woman has conceived at least once irrespective of the pregnancy outcome. Infertility is a global health issue and i t is not a newly emerging issue and it has its crux from the olden days. Even today it is a pre – existing problem and a threat to the social integration of families.
Infertility is not merely a health problem but, it is also a matter of social injustice and inequality. Infertility also complicates with marital dynamics, leading to marital instability, occasionally divorce, polygamy and remarriage. As motherhood is considered a mandatory status, infertile women may be harassed and tormented. Infertility, being a medical condition also has a social dimension. It is a poorly controlled
psychological consequences. It is true that some people never want to have children. However, for most people who want children, infertility is devastating. Part of this is a sociological problem. Society encourages couples to have children and looks down upon those that don't, calling them selfish and childless. The suffering of infertility is a product of a pronatal society, which values women largely for their ability to bear children.
Assisted reproductive treatment (ART) is a general term referring to methods used to achieve pregnancy by artificial or partially artificial means. It is reproductive technology which is primarily used in infertility treatments. Techniques like In-vitro fertilization and embryo transfer (IVF-ET), zygote intrafallopian transfer (ZIFT), gamete intrafallopian transfer (GIFT), and intracytoplasmic sperm injection (ICSI) etc., therapies are available
Some of the pain of infertility and childlessness is due to the fact that family life is still very much the norm, even if single/career options are there. In most industrialized as well as developing countries the prevalence of infertility is between 2% and 10% of all women. There is no substantial evidence the women emphasize that they have experienced the problem, but there are no viable solutions at the time when they were young. So they remained childless, but have quite vague memories about trauma emotionally faced by them.
It has been observed that couples have a basic knowledge of factors affecting fertility, but remain unaware of the impact that advancing age has on a women‟s fertility. It is well known that female fertility declines after age of 30 and more rapidly once women turn 35 years. The advent of artificial reproductive treatment (ART) and its widespread availability has helped many couples realize their dream of parenthood.
A major factor responsible for delayed child bearing and increasing incidence of sub-fertility is lack of awareness about fertility potential. Decisions about whether, how and when to conceive, should be a matter of individual or couples‟ choice. However, an accurate understanding of reproductive fact is essential for informed fertility decision making. Moreover awareness about fertility is still low worldwide.
1.1 BACKGROUND OF THE STUDY
Global PrevalenceInfertility is becoming more and more a social issue in today‟s world. Being a problem which exist from the past, its magnitude is increasing day by day. The impact of this problem contributes a lot to the disharmony among young couples. The first census of U.S. was in 1790, that time the crude birth rate was 55 / 1000 total population; in 2017 it was 14.3 / 1000 total population. It has decreased about 75%
over the past 200 plus years. It affects approximately 8 – 10 % of the couples worldwide (Raikin Noel 2017)(Fig1.1 and 1.2)
GLOBAL PREVALENCE OF PRIMARY INFERTILITY, 2017
Fig 1.1: Global Prevalence Of Primary Infertility, 2017
GLOBAL PREVALENCE OF SECONDARY INFERTILITY, 2017
Fig1.2: Global Prevalence Of Secondary Infertility, 2017
Available data indicate that, at least 50 million couples worldwide experience infertility. Importantly, studies estimating the global prevalence of infertility employ different methodologies, including different operational definitions for infertility, producing inconsistent results. Nevertheless, research has shown consistently that secondary infertility, which refers to women who have had at least one pregnancy and live birth previously, is more common than primary fertility, which refers to women without a biological child.
A Global Survey of 17,500 people of childbearing age from 10 countries in Europe, Africa, Middle East and South America revealed that on the whole level of knowledge regarding fertility and biology of reproduction was very poor. (World Fertility Awareness Month, 2016)
According to the American Society for Reproductive Medicine the prevalence of infertility is about 5.3 million among the Americans, or 9% of the reproductive age population. Obesity and lifestyle modifications have contributed a lot to this. Almost 7% of the couple
every year, at the reproductive age, reported that they had not used any contraceptives for more than twelve months and yet not become pregnant. Overall long term decline in fertility rates is due to, late marriage frequent divorce, more use of contraception, delayed beginning of childbirth process and decreased family size.
Approximately 1/3rd of infertility problems are attributable to female factors and < 1/3rd are tied to male factors. 20% of problems result from combined male and female factors. In approximately 15% of cases, infertility cannot be classified as attributable to any one party or cause. (American Society for Reproductive Medicine, 2016)
In Canada, the Royal Commission on New Reproductive Technologies and provincial ministries of health have explicitly affirmed infertility as a legitimate medical concern and infertility as legitimate medical care for public funding. In Africa, rates are high as 20 – 30% in some areas. In some Sub-Saharan Africa almost 1/3rd of the couples are unable to conceive. This is called the infertility belt.
International Scenario
World Fertility Survey and others estimated rates of infertility in South Asia, such as 4% in Bangladesh, 6% in Nepal, 5% in Pakistan and 4% in Sri Lanka. One estimate of overall primary and secondary infertility in South Asia, on the basis of women at the end of their reproductive lives in the age group 45-49 years, suggests an infertility rate of approximately 8% in India, 10% in Pakistan, 11% in Sri Lanka, 12% in Nepal and 15% in Bangladesh. India is a country with a billion plus population, and every minute a child is born. It stands second next to China in population. But, statistics shows that childlessness is around 2.5% in India. Even with population explosion now, on the long run there may be families who don‟t have offspring‟s to carry their genes
small family norms have stated “we two ours one “stressing at least one for a family (K.Park 2018).
In Tamil Nadu:
According to Tamil Nadu state statistics of 2018 approximately 3.58% of the estimated population has reported impaired fertility.
According to Primary Report on the Risk Factors Affecting Female Infertility in South Indian Districts of Tamil Nadu and Kerala it has been stated that, the prevalence of female infertility was 45.67% in Kanyakumari 44.24% in Thirunelveli and 41.91% in Thiruvananthapuram. Primary infertility is as common distressing problem in India as in other parts of the world. Zargar et al., reported that the magnitude of primary infertility in India was 50%.The present study clearly indicates that primary infertility was more dominating than secondary infertility in South India. We observed maximum number of infertile females in the age group of 25 - 30 years indicating a shift in the fertility potential age.
The Total Fertility Rate (TFR) in Tamil Nadu is 1.7 children per woman, implying that the state remains below replacement level fertility. Fertility decreased by 0.7 children in the 13 years between NFHS-1 and NFHS-3, and has declined further by 0.1 children in the 10 years between NFHS-3 and NFHS-4. Among births in the three years preceding the survey, 2 percent were of birth order four or higher, compared with 7 percent in NFHS-3.
FERTILITY TRENDS:
TOTAL FERTILITY RATE IN TAMILNADU
Fig 1.3: Fertility Trends; Total Fertility Rate In Tamilnadu Knowledge imparted to the couples create positive attitude towards infertility and increases the treatment seeking behaviour of couples in its early stage. The main focus of this study was to teach the couples regarding infertility in order to increase their knowledge and to help them to reach their goal of becoming parents.
1.2 NEED FOR THE STUDY
Growth of science and technology has given rise to rapid advancement in the field of medical and nursing science as well as in the nursing care. The year 1978 was the hallmark for the field of assisted reproductive technology as the first In-Vitro fertilisation baby was born in England, has been the milestone for thousand couple, which until then were not able to realize the dream of completing their family. Since then, science has continued to challenge and exponentially reveal the mysteries of the human genome and reproduction.
Some estimates suggested that worldwide, between 3-7% of all
incidence of infertility is 1/6th couples in United States. For IVF in UK roughly ½ fertility problems with the diagnosed cause are due to problem with the man and about ½ with woman and 99% of assisted reproductive treatment used In-Vitro fertilisation.
Childbirth is the most joyous event in every woman‟s life.
Parenthood is viewed in most cultures as an entry into adulthood, and also an important part of status. Some couple delay pregnancy due to the changing lifestyle and career involvement. At the same time, many couples experience difficulty in conceiving and carrying a child.
Infertility may be perceived as a tragedy in the lives of many women in developing countries. It is considered as the responsibility of the females to give birth to their own children. Women without children may be stigmatized and isolated from the society. Childlessness leads to an increased incidence of domestic violence in female partner and remarriage in male partner.
The desire for children is strong among many couples. If a couple did not achieve pregnancy or produce a living child as expected, the man and woman often experience psychological distress. They may feel unlovable and unappealing to their mates.
On the basis of Current world population (2016-2017), 72.4 million people were infertile and of these 40.5 million were seeking infertility medical care. According to Delhi IVF Fertility Research centre (2016) infertility affects as many as 1 in 6 couples and 8-10 million infertile couples were estimated in India.
Prevalence of primary infertility in India (2019) was given in the study by Ashwini Katole et al., in a community-based cross-sectional study stated that all married women between 15 to 49 years of age in urban field practice area were included. The data were collected by face - to-face interview method with the help of predesigned and pretested
questionnaire. The majority of the women (39.3%) belonged to 25–29 years of age group. The overall prevalence of primary infertility among reproductive age group women was 8.9% (51/570). The prevalence rate of primary infertility in urban population of Central India was lower than reported trends of infertility from developing countries. Sound knowledge about various factors related to infertility can help health - care providers and policymakers to design and implement various policies.
In India, the incidence of male infertility is up to 30% and female infertility is up to 40%. Approximately 1/3rd of the infertility problems include both partners. In Karnataka the infertility rate is 35-40%.
Sarah Hodin, MPH, According to a systematic analysis of national health surveys, in 2010, approximately 10.5% of women around the world experienced secondary infertility, and roughly 2% experienced primary infertility. The prevalence of secondary infertility, in particular, varies widely by region and country, ranging from less than 6% to greater than 16% of women. The majority of researchers agree that infectious disease, which can lead to fallopian tube blockage , contributes largely to variation among populations and changes over time. Since infertility risk tends to increase with age, age at childbearing likely play a role. Relatively little is known about the specific risk factors for and prevalence of male infertility around the world.
Anhvi Manohar and Dr. Brundha, M. P.,conducted a study on prevalence and causes of female infertility at Chennai in fertility clinics. Patient records from these fertility clinics were analysed and 2112 women out of 3051 women were identified as being infertile with the major cause of being Polycystic ovary syndrome. The treatment modalities offered to these women were IUI and ICSI. This study aims
to create awareness about infertility and its early detection as the treatment modalities are expensive.
Most of the studies had focused on knowledge, prevalence and risk factors on infertility mothers. Only a few studies has been conducted on knowledge and depression among infertility mothers in this state, which justifies the need for this study. Infertility mothers need some knowledge on various infertility treatments.
Nurses are the vital members of the fertility healthcare team and often assume responsibility for health assessment, client education and counselling. Nurses must understand the current methods of diagnosis and treatment, and appreciate the important human issues related to infertility. The new advancement and technology increases the nurses‟
responsibility to update their knowledge on infertility and its management with newer trends (ART).
Moreover nurses play an active role in educating the mothers regarding knowledge on artificial reproductive treatments and the importance of it by focused midwife programme on artificial reproductive treatments and behavioural practices to reduce the depression caused by infertility.
Hence the researcher has selected this study because nowadays even educated mothers are having less awareness about infertility, its treatments and most of them suffer with depression consequently it leads to physical and mental stress and disturbance. Hence the researcher felt the need to identify the mothers who are infertile and educate those regarding artificial reproductive treatments and reduce depression by breathing exercises through focused midwife programme at Tertiary Maternity Care Hospital, Chennai.
1.3 STATEMENT OF THE PROBLEM
“A study to assess the effectiveness of Focused Midwife Programme on selected problems of women on Artificial Reproductive Treatment attending Infertility clinic at Maternity Tertiary Care Hospital, Chennai.”
1.4 OBJECTIVES
1. To assess the pretest level of selected problems on knowledge and depression among women on artificial reproductive treatment both in experimental and control group.
2. To evaluate the effectiveness of focused midwife programme on selected problems on knowledge and depression among women on artificial reproductive treatment in experimental group.
3. To compare the pretest and post test level of selected problems on knowledge and depression among women on artificial reproductive treatment both in experimental group and control group.
4. To find out the association of post test level of selected problems on knowledge and depression among women on artificial reproductive treatment with their selected demographic variables.
1.5 OPERATIONAL DEFINITION
AssessIt refers to the determination of knowledge and depressi on among mothers attending artificial reproductive treatment.
Effectiveness
It is the organized systemic and continuous process of evaluating the effectiveness of the intervention.
Focused Midwife Programme
It is referred to as specific education given to the study samples to improve the knowledge regarding infertility, its management and reduce depression by breathing exercises.
Selected Problems
Knowledge and depression are the selected problems in the study.
Artificial Reproductive Treatment
Artificial reproductive treatments (ART) are various medical procedures used primarily to address and manage infertility
Women
It refers to the women who are diagnosed to have impaired fertility with the age between 20-40 years and attending infertility clinic for treatment.
Infertility
It refers to the childlessness of a couple even with unprotected sex and not using other contraceptives for a period of more than two years.
Maternity Tertiary Care Hospital
It is the designated maternity tertiary care hospitals, which provides the highest levels of obstetric and neonatal care, with specialities which provides primary and secondary care to the mother and newborn.
1.6 RESEARCH HYPOTHESIS
H1: There is effectiveness in focused midwife programme on selected problems on knowledge and depression among women on artificial reproductive treatment in experimental group.
H2: There is a significant difference pretest and post test level of selected problems on knowledge and depression among women on artificial reproductive treatment both in experimental group and control group.
H3: There is a significant association between the post test level of selected problems on knowledge and depression among women on artificial reproductive treatment with their selected demographic variables.
1.7 ASSUMPTIONS
1. Mothers who are infertile need some sort of education to improve their knowledge regarding artificial reproductive treatment.
2. Focused midwife programme will improve the knowledge among infertile mothers.
3. Behavioural practices will reduce the depression caused by infertility.
1.8 DELIMITATION
1. The data collection period is only four weeks
2. The study is limited only to women attending infertility clinic at tertiary maternity care hospital, Chennai.
3. The study is limited to the mothers who are available during the study period.
4. The sample size was limited to sixty.
1.9 CONCEPTUAL FRAMEWORK
A conceptual framework or model is made up of concepts, which are the mental images of the phenomena. A conceptual framework
provides the guidelines to attain the objectives of the study based on the theory. It is the schematic representation of activities, steps and action of the study. A conceptual framework is used in research to outline the possible course of action to present a preferred approach to an ide a or thought.
Conceptualization is a process of forming ideas, designs and plans. A conceptual framework deal with the concepts assembled together by virtue of relevance to research problems, which provides a certain framework of reference for clinical practice, research and education.
The conceptual frame work used for the study is “Imogene Kings Goal Attainment Theory (2011)”.
According to King, a human being refers to a social being who is rational and sentient. He or she has the ability to perceive, thi nk, feel, choose, set goals, select means to achieve goals and make decisions.
The Theory of Goal Attainment defines nursing as “A process of action, reaction and interaction by which nurse and client share
information about their perception in a nursing situation” and
“A process of human interactions between nurse and client whereby each perceives the other and the situation, and through communication , they set goals, explore means and agree on means to achieve goals.” In this definition, action is a sequence of behaviours involving mental and physical action and reaction is included in the sequence of behaviours described in action. King states that the goal of a nurse is to help individuals to maintain their health so they can function in their roles.
The domain of the nurse “includes promoting, maintaining, restoring health, caring for the sick, injured and dying.” The function of a professional nurse is “to interpret information in the nur sing process to plan, implement and evaluate nursing care.”
The present study is aimed at developing and evaluating the focused midwife programme on artificial reproductive treatment with a view to improve the knowledge and to reduce the depression among infertile mothers.
CONCEPTS
Perception
Action
Interaction
Transaction
Feedback
These types are typically viewed as separate forms of evaluation, by they can also be viewed as steps or stages in a comprehensive evaluation.
PERCEPTION
It highlights the environment in which the proposed programme exists describes the plan for decisions and collection of data apart from providing rationale for the determination of objectives. It helps in programme planning decisions.
The present study is carried out to assess the effectiveness of focused midwife programme on selected problems of women on Artificial Reproductive Treatment. Based on the findings of other studies it is assumed that:-
Infertility mothers are having many problems like lack of knowledge and depression.
Infertile mothers need some knowledge to be imparted regarding the artificial reproductive treatments
Here are the various extraneous variables such as demographic aspects come into role and it greatly influences the context.
ACTION
It serves as basis for structuring decisions; it specifies resources strategies and designs to meet programme goals and objectives. Here in the present study input refers to the
Development of focused midwife intervention on selected problems of women on Artificial Reproductive Treatment.
Development of tools.
Validation of tool and teaching strategy by getting the experts opinion.
Establishments of reliability of tool by split half method.
Selection of 60 samples
Framing the research
Preparing audio visual aids
INTERCATION
It focuses on implementing decisions and involves identifying decisions, limitation and records its activities and events.
It refers to,
Pilot study.
Assessing the level of selected problems of samples regarding artificial reproductive treatments.
Administration of focused midwife programme.
TRANSACTION
It includes determining and examining the general and specific outcomes of the programme and enables recycling of decisions as it is related to the goals and objectives of the input information and process information.
It refers to,
Comparing pretest and post test scores.
This step of model, further leads to recycling decisions and need for modification, which is not included in this study.
FEEDBACK
In this study, it includes various aspects of outcome eg., good knowledge, adequate knowledge and poor knowledge.
It has two strategies
Positive feedback: repetition of intervention is done for sustainability of the knowledge
Negative feedback: it is restarted from assessment again
PERCEPTION ACTION INTERACTION TRANSACTION
POSTTEST Assessment of post test knowledge and depression among women on artificial
reproductive treatment using:
1. Semi- Structured knowledge
questionnaire
2. Beck’s depression inventory tool
PRETEST
1. Demographic variables such as
Age in years
Educational qualification
Family Income
Religion
Place of residence
Type of family
Nature of marriage
Occupation
Exercising habits
Duration of infertility
Reason for infertility
Person motivated to attend infertility clinic
History of systemic disorders
Treatment
Family history of infertility 2. Semi- Structured knowledge
questionnaire
3. Beck’s depression inventory tool
INTERVENTION Focused midwife
intervention on selected problems
of women on artificial reproductive
treatment
Reassessment
CONTROL GROUP
Routine Activities EXPERIMENTAL
GROUP
Powerpoint Presentaion
Booklet
Behavioural Practices
FEEDBACK
CONCEPTUAL FRAMEWORK BASED ON IMOGENE KINGS GOAL ATTAINMENT MODEL (2011)
KNOWLEDGE
LEVEL OF DEPRESSION
NORMAL
BORDERLINE CLINICAL DEPRESSION MILD MOOD DISTURBANCE
MODERATE DEPRESSION SEVERE DEPRESSION
GOOD ADEQUATE
Knowledge INADEQUATE
Knowledge
EXTREME DEPRESSION
Fig 1.4: CONCEPTUAL FRAMEWORK BASED ON IMOGENE KINGS GOAL ATTAINMENT MODEL (2011)
Inadequate Knowledge and Severe/Extreme Level
of Depression Enhancement and reinforcement of
the intervention Good/Adequate Knowledge and normal/mild/borderline moderate
Level of Depression
CHAPTER-II
REVIEW OF LITERATURE
Literature review is an organized written presentation of what has been published on a topic by scholars. Review of literature is an ongoing process and it covers the entire planning stage. A good research is always supported by its evidences and review of literature serves as a mean of support.
-Polit and Hungler Review of literature is important to an investigator in order to know what has been established and documented as there are critical summaries of what is known about a particular topic. Therefore a review of literature helps to relate the present study to the previous ones in the same field.
The literature relevant to the topic of the study was reviewed after referring the primary and secondary sources from books, journals net references and expert opinion. The most relevant and recent ones in this topic are stated in order to support this study further.
The review of literature for this study has been given as
Section–A: Reviews related to the prevalence and causes of infertility.
Section–B: Reviews related to the impact of lifestyle factors on infertility.
Section–C: Reviews related to knowledge on infertility Section–D: Reviews related to management for infertility
Section–E: Reviews related to psychological problems associated
Section–F: Reviews related to the effectiveness of educational and behavioural intervention on various aspects of problems related to infertility
SECTION-A: REVIEWS RELATED TO THE PREVALENCE AND CAUSES OF INFERTILITY.
Zhonghua, (2019) conducted a cross sectional study to investigate the prevalence of infertility and its risk factors in the fertile- age couples of Beijing, China using purposive sampling method. They showed that a total of 97 couples were classified as infertile. And the total prevalence of infertility in 7 Beijing districts was 1.72%. The standardized prevalence of infertility was 2.1%. 57 (58.76%) couples were classified as of primary infertility and 40 (41.24%) of secondary infertility. They proved that the risk factors of infertility were tuberculosis (TB), endometriosis (EM) and pelvic infection disease (PID).They concluded that the prevalence rate of infertility declines with age in women. Both EM and PID are the risk factors for infertility
Paul C. Adamson, et al., (2019) conducted a descriptive study to assess the prevalence and correlates of primary infertility among 897 sexually active young women aged 15-30 years using random sampling method in Mysore, India. The results revealed that the mean age of women was 25.9 years and the prevalence of primary infertility was 12.6%. the main factor associated with primary infertility was Herpes Simplex Virus-2 sero positivity.
Roupa.Z, et al., (2018) conducted a descriptive study to investigate the causes of infertility in women of reproductive age among 110 infertile women in a private Assisted Reproductive Center using random probablity sampling method. The results of the study showed that 27.4% of infertility cases were due to fallopian tubes dysfunction, 24.5% of cases were due to unknown causes, 20% cases were due to
disorders of menstruation, 9.1% were due to problems of uterus, 2.7% of cases were due to sexual disorders, 2.7% cases were due to increased age and 45.5% of them were smokers.
Nagaria Tripti, et al., (2018) conducted a study to evaluate the role of serum anti sperm antibody (ASA) in infertility in Pt.J.N.M.Medical College, Rajpur among couples with primary and secondary infertility. Among 105 couples were selected by using convenient sampling technique. The results stated that, serum ASA- positive males were 38(39.19%), of which definite serum ASA positive 9 were (8.57%), borderline (equivocal) were 29(27.61%), and negative were 67(63.08%). Among females, serum ASA positive were 42(40%), in which definite ASA positive were 19(18.09%), borderline 23(21.9%), and negative 63(60%) and pregnancy was achieved in 45.23% ASA- positive females and 31.57% ASA- positive males. The study concluded that Serum ASA prevent the motility of sperm and thus it can be a cause for unexplained infertility.
Kumar D, (2017) conducted a study using purposive sampling design in the Sidhi district of Madhya Pradesh in Central India from a total of 1305 people in 284 households to investigate the prevalence of infertility among Khairwar and non-Khairwar tribes.133eligible couples belonged to the Khairwar tribes and 99 eligible couples belonged to non- Khairwar tribes The study showed that the prevalence of infertility was 33(14.2%) out of 232 women. The number of women with infertility is higher in the Khairwars (17.2%) compared with non- Khairwars(10%).
SECTION–B: REVIEWS RELATED TO THE IMPACT OF LIFESTYLE FACTORS ON INFERTILITY
Dushyant Singh Gaur, et al., (2019) conducted a prospective study to determine the specific impact of alcohol and smoking on semen quality of male partners of couples seeking treatment for primary
infertility at the Himalayan Institute of Medical Sciences, Uttarakhand, India.404 samples were selected using purposive sampling. Among 100 alcoholics and100 cigarette smokers with 100 strict non-alcoholic and non-smoker males,12% alcoholics and 6% smokers showed normo- zoospermia compared to 37% non-alcoholic non-smoker males. Heavy alcoholics and smokers showed asthenozoospermia, teratozoospermia and oligozoospermia.The study results concluded that alcohol abuse targets sperm morphology and sperm production where smoking affects sperm motility and seminal fluid quality.
Adiga SK, et al., (2016) conducted a retrospective study to investigate the semen quality among 7770 infertile individuals at Kasturba Hospital, Manipal over a period of 13 years from 1993. The results showed that average sperm density, sperm motility and normal sperm morphology among infertile men during 2004-2005 were 26.61 ± 0.71 millions/mL, 47.14% and 19.75% respectively but the values during 1993-1994 were 38.18 ± 1.46 millions/mL, 61.16% and 40.51%
respectively. The study revealed that the quality of human semen is deteriorating in the southern part of the India over the years, probably due to environmental, nutritional, life style or socioeconomic factors.
SECTION–C: REVIEWS RELATED TO KNOWLEDGE ON INFERTILITY
Ashley Wiltshir, et al., (2019) conducted a cross sectional study to assess infertility knowledge and treatment beliefs. A convenience sample of a total of 158 women receiving outpatient care was recruited.
Infertility knowledge and treatment beliefs were assessed using a previously applied and field-tested survey from the International Fertility Decision Making Study and the study concluded as women in our urban clinic setting seem to have a limited level of knowledge pertaining to infertility. Further research is needed to understand how
differences in knowledge and beliefs translate into infertility care decision-making and future childbearing.
Eunice Amaechi Osian, et al., (2018) conducted a cross-sectional study to examined the knowledge and perception of ART among women that attended a tertiary health facility. 348 women through stratified probability sampling method, and a self-structured questionnaire with open-ended and Likert scale questions used as instrument was administered. The results showed that the perception of ART had a huge mean of 3.99 (0.50). The result also revealed 73.0% awareness level of ART. Hypotheses testing brought out the mean comparison of perception of ART based on educational level using one-way ANOVA, which showed F = 0.071 and P = 0.552 and the findings concluded as there is a high awareness level but low knowledge about ART; therefore, appropriate policies and programs must be put in place to educate the populace on the importance and success rate of ART.
Gagandeep Kaur, et al., (2017) conducted a descriptive study to assess the knowledge on infertility among women.100 infertile women were selected by using convenience sampling technique. Self Structured knowledge questionnaire was used to assess the knowledge on infertility among women and the Present study revealed that the majority of women 79(79%) had average knowledge on infertility, they scored 9.00 - 17.00. 15(15%) of them had poor knowledge, they scored < 8.00 and only 6(6%) of them had good knowledge, they scored 18.00-26.00.The level of knowledge showed significant association (p<0.01) with Educational status, occupational status, monthly income, age at marriage while rest of the variables showed non-significant association.
Nina Olsén Sørensen, et al., (2016) conducted a cross-sectional study based on Fertility awareness and attitudes towards parenthood using a validated 49-item questionnaire , based on this study the results
were Though the majority of all participants wished to have children in the future (>86%), there was significant difference between the genders (p=0.002). Women rated having children to be more important than men did (p<0.001), while men rated higher the likelihood of abstaining from having children if faced with infertility (p=0.003). Knowledge about fertility issues was similar between genders including poor knowledge about the age-related decline in female fertility. While women found it more important to have children before being „too old‟ (p=0.04) , still more than 40% of all respondents intended to have their last child after the age of 35 years. For both genders the most important prerequisite for parenthood was having a partner to share responsibility with. Perceived or experienced life changes related to parenthood were generally positive such as personal development and they concluded saying the majority of respondents wished to have children, but many desired to have these after the biological decline in female fertility. The moderate knowledge level among both genders uncovered in this study is of concern. Future research should address the potential link between fertility knowledge and planning of parenthood. We may benefit from intervention studies examining the effect of routine preconceptio n care.
Sumera Ali, et al., (2016) conducted a study to assess the Knowledge, perceptions and myths regarding infertility. A cross- sectional survey was carried out by interviewing a sample of 447 adults were interviewed one-on-one with the help of a pretested questionnaire and the results were stated as correct knowledge of infertility was found to be limited amongst the participants. Only 25% correctly identified when infertility is pathological and only 46% knew about the fertile period in women‟s cycle. Seeking alternative treatment for infertility remains a popular option for 28% of the participant as a primary preference and 75% as a secondary preference. IVF remains an unfamiliar (78%) and an unacceptable option (55%) and is concluded as
Knowledge about infertility is limited in the population and a lot of misconceptions and myths are prevalent in the society. Alternative medicine is a popular option for seeking infertility treatment. The cultural and religious perspective about assisted reproductive technologies is unclear, which has resulted in it‟s reduce acceptability.
Gundla Sowjanya, (2016) conducted a descriptive study to assess the knowledge and attitude of infertile women regarding Assisted Reproductive Techniques in Gunasheela IVF center, Bangalore. Among 50 infertile couples selected through purposive sampling, 64% had moderately adequate knowledge and 80% had neutral attitude towards Assisted Reproductive Techniques and there was a positive correlation between the knowledge and attitude of couples. The study concluded that there was a need for health education to couples who were attending the infertility clinic.
Farnaz Sohrabvand, et al., (2015) conducted a descriptive cross- sectional study to evaluate knowledge and attitude of infertile coupl es about assisted reproductive technology. 400 infertile patients were investigated by a self- administered structured questionnaire about demographic data, infertility history, and several relevant variables in an outpatient infertility clinic of a university hospital. The main outcome measurements included scoring the answers in the questionnaire regarding knowledge, and grouping the answers regarding attitude.
Resulted data were analyzed in relation to patient‟s gender and treatment history, and educational, ethnic and religious groups and is concluded as less than half of patients presented to be knowledgeable about ART. Not a great portion of the patients agreed with sperm donation. ART expense is mentioned to be burdensome by nearly all of the patients.
