The Investigation Holistis Stress In Infertile Women and Relation To Demographic Characteristics In Women Who Referred To Yazd Infertility Center

Investigation holistic Stress in infertile women and relation to demographic Characteristics in women who referred to Yazd infertility center by cross sectional descrpitive study. This study was carried on 400 infertile women who referred to Yazd Infertility Center between 2013-2014. These participants were selected by purposive sampling method. Data were collected using demographic characteristics’ questionnaire, Coudron Stress Test and Perceived Stress Test. Relation between demographic variables and stress obtained from Inferential statistics. Mean score of perceived stress and all level of life, personality and health stress is higher than other causes , when the causes is related to common causes, but there are not any significant difference between them. There are significant difference in stress mean score from duration of infertility. (p<0.05).Positive perceived stress in common causes of infertility and negative perceived stress in unknown causes were higher than other one .There was not any significant difference between educational level, age and stress (p>0.05). Results highlights infertility has a significant impact on the infertile women’s mental health. It is important psychological approach consider as an important part of treatment inside other medical treatments.


INTRODUCTION
Infertility is a major life crisis that leads to serious psychological problems and stressful experiences for infertile people (Sadock et al., 2003).According to the World Health Organization(WHO), fertility rates vary in different parts of the world, but its average is 20 percent (Ramezanzadehet al., 2004a).Wichman et al Studies show that infertility is such a complex experience in terms of psychology that can increase depression in some women(Wichmanet al., 2011). Gourounti et al also suggest that infertility and its treatment are severe stress derivers (Gourountiet al., 2012).Some researchers such as Connolly et al speculate that damaging psychological factors play a major and pathogenic role in infertility .Connolly et al in their research also suggest that infertility causes many mental health problems of infertile cases that these problems can consequently contribute to some infertility treatments. For instance, the stress derived by delaying o rpreventing ovulation may affect the outcome of medical treatment (Connollyet al., 1992).Infertility-induced stress is defined as the interaction between the physical conditions that lead to infertility and medical interventions ,reactions of others and mental characteristics of the individual that may accompany the individual for along time and relapse with any diagnostic or therapeutic intervention including treatment for IVF and other infertility treatments. Numerous medical tests and limb inspection, the long-term treatment of infertility, low rate of treatment success as well as the economic problems caused by infertility treatments include severe stressors for infertile individuals (Covington, Hammer, 2007 (Newtonet al., 1999).Other researchers showed that due to the low success rate of IVF treatment, involvement in infertile women with infertility stress is understandable (Seible, 1997).Litzinger & Gordonstated that 80% of infertile patientssuffer fromapsychologicaldisorder,includingmarital dissatisfaction, disturbance in relationships especially between the couples, the rageand negative emotional effects (Litzinger, Gordon, 2005).Several mechanisms have been proposed for the effects of stress on fertility including impairing secretion of gonadotropins, also anxiety leads to infertility intensification by an increase in cortisol, prolactin (Cooperet al.,2007;Karlidere et al., 2008).Women in infertile couples reported greater psychological symptoms (anxiety & depression) and more decreased marital adjustment than men in infertile couples; but the couples did not show any significant difference with those in control groups regarding these common parameters .Due to the relatively high incidence of infertility and relation between psychosocial symptom and cultural basis in infertile people, we were to examine the complete stress of infertile women (in the dimensions of life, personality and health stress) and to determine its relationship with demographic factors such as duration of infertility, duration of marriage ,cause of infertility, age, occupation and education.

Aim
This study was performed with the aim of examining the holistic stress in infertile women and its association with demographic factors(Sn-causes of infertility-duration of marriage, age, education& job) on women referring toYazd Infertility Center. The data gathering tools have included demographic data and as second section of the questionnaire included perceived stress and holistic coudron stress.

Design
This cross sectional study was carried out on 400 infertile women who referred to Yazd infertility center between 2013-2014.

Sample
The research population was considered all infertile women referring to Infertility Center in Yazd and the research samples were about 400 individuals regarding the prevalence of infertility.

Data collection
The data gathering tools were a questionnaire of perceived stress scale and Coudron stress test. Cohen et al. perceived stress questionnaire was made in 1983. Thescalehas14itemsand each item is answered on the basis of a five-point Likert scale(none, low, medium, high and very high); these options are scored in the order of0, 1, 2, 3and 4 and include positive and negative sub scales of perceived stress.
Internal consistency reliability coefficients of the scale have been achieved through Cranach's alpha coefficient in the range of 0.84to 0.86in two groups of students and a group of smokers who were on the giving-up smoking program. This scale is auseful tool for assessing overall stress experienced in different age groups. Cranach's alpha coefficients for this scale are obtained 0.88and 0.81, respectively.
For reviewing holistic stress in various areas, Coudron stress questionnaire was used. This questionnaire is standardized and has good reliability and validity in several studies.
In repeated use of the questionnaire, validity and reliability of instruments were in all cases higher than7.0andwas8/0, respectively. The applied tools consist of several sections that investigate life, personality-health and institutional stresses. Given that a large portion of the samples were house wives and it was not possible to study workplace stress in them, therefore, this part of the questionnaire was removed and only the other three sections were evaluated. The first sectioncontained23questions that measured personality-driven stress and Intellectual habits of the patients. In this section, some cases such as dissatisfaction with life, worry about the future, feelings of internal anxiety and guilt have been assessed. The second part consisted of16 questions that were used to measure the level of stress in personal life, more over, cases such as divorce, relationship and family conflicts, economic and job concerns were explored. The grading of this type of stress is as follows: lower than 15 as normal, between 15 and 40 as not having a satisfactory life and higher than 40 means that you live in stressful condition so there is the possibility of burnout.
The questions were two-choice questions in a "Yes", "No" fashion. For grading the questions, standard grading method of the questionnaire will be used. This means that for each positive response in the level of stressful thought habits, 1 point will be considered and finally, with respect tothe obtained scores, the score higher than5is considered as a stressful personality. And then the last part of this questionnaire examines health stresses. This questionnaire contains17 questions and measures the stress caused by compliance with health issues.
Health stress which is defined as stress toward one's own life is classified as lower than 30 (care in personal health), between 30 and 60 (health in not such that can be controlled), and higher than 60 ( life-health brings disturbance).

Data analysis
For data analysis, descriptive statistics such asmeans and standard deviation and then correlation coefficient were used to examine the distribution of stress and analytical tests were applied to examine mean differences in terms of demographic factors.

RESULTS
The results showed that most people aged less than 20 years and they have married for less than5yearsso they have less than a 5-yearhistory of infertility (Table 1 cite here).
Table2 shows that the mean score of stresses is higher than in other cases when the stress factor is in both cases. Moreover, when the cause of infertility is unknown, the mean score of stresses has been reported to be higher than that of masculine causes. (Table2 cite here) The results of another research indicate that the level of stress varies in accordance with infertility duration, and this fact shows that there is a significant difference in positive perceptions of stress on the basis of infertility duration.(Table3 cite here) Table 4shows that there is no significant This graph represents that,when infertility exists with an unexplained cause, the mean of negative perception of stress has been observed more than others cases. (Figure1 cite here).While a positive perception of stress is observed to be higher than other cases when both couples are causes of infertility. (Figure2 cite here)

DISCUSSION
According to the results of the present study that aims to examine holistic stresses in infertile women and its association with demographic factors ,the mean score of perceived stress (in both positive and negative perceptions subscale) was more likely than other cases when stress factors were in both individuals. The results of the study by Ogawa et al on 83 infertile Japanese women showed the effect of two factors of age and male infertility on their psychological distress and women whose husbands were infertile had significantly lower scores on psychological distress than women whose husbands were not infertile, the results of this study were inconsistent with those of the present study (Ogawaet al.,2011).
Sheiner et al recognize the reason for stress reduction in women with infertile husbands in Japanese society is that women acknowledge themselves to be responsible for infertility (Sheineret al.,2003).Moreover, the mean score of stress has been reported to be higher than feminine or masculine causes when the cause of infertility is unknown. Other results of this study showed that there was no significant difference in the stress of individuals in terms of infertility causes; in addition, a significant difference was observed in the individuals' stress scores in both life stress and health stress groups. In our study, the mean negative perception of stress was reported to be higher than other cases when infertility existed with

CONCLUSION
Results highlights infertility has a significant impact on the infertile women's mental health. Mental health professionals and consolers can educate couples regarding the ineffectiveness coping strategies as well as the stress management technique and psychological approach while experiencing the stress of infertility. Also it is important these approach consider as an important medical treatment inside medical treatments.

Ethical aspects
The study protocol was approved by the Ethics Committee of the Jahrom University of Medical Sciences, Jahrom, Iran