Psychological distress and quality of life of Malaysian infertile couples

Noorfaizah Ibrahim, Salina Mohamed, Zaliha Ismail, Mohd Razali Salleh


Background: Infertility is an intense situation experienced by couples that causes emotional discomfort and worsening of their quality of life (QoL). The husband and wives of the infertile couples may reacted differently to stress.

Methods: This is a cross-sectional study involving 100 infertile couples attending fertility clinics. Cases were selected by systematic random sampling. The severity of depression, anxiety and stress was measured using the Depression, Anxiety and Stress Scale (DASS-21) and QoL was assessed with the Fertility Quality of Life (FertiQoL) questionnaire.

Results: Multivariate analysis revealed that depression, anxiety and stress-related difficulties were reported at a higher level by wives (p<0.001). Total Ferti QoL scores were significantly higher in husbands (p<0.001). The female gender (wives) was the only significant variable associated with the severity of all three DASS-21 sub-scale scores (p <0.001) and considered as a high-risk factor for psychological distress. Poor Qol were significantly associated with wives (p<0.001), male cause of infertility (p=0.004), primary infertility (p=0.022) and previous history of receiving intrauterine insemination (IUI) (p =0.020).

Conclusions: The wives of the infertile couples were at higher risk of developing psychological distress and had poor QoL than their husbands. The severity of the anxiety, depression and stress were adversely affected the QoL.


Gender differences, Infertility, Quality of life, Psychological distress

Full Text:



Zegers-Hochschild F, Adamson, GD, de Mouzon J, Ishihara O, Mansour R, Nygren K, et al. The International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) Revised Glossary of ART Terminology, 2009. Hum Reprod. 2009;24(11):2683-7.

Skevington SM, Lotfy M, O’Connell KA. World Health Organisation’s WHOQOL-BRIEF quality of life assessment: psychometric properties and results of the international field trial. A report from the WHOQOL. Qual Life Res. 2004;13:299-310.

Maruani P, Schwartz D. Sterility and fecundability estimation. J Theor Biol. 1983;105(9):211-9.

Sexton MB, Byrd MR, Von Kluge S. Measuring resilience in women experiencing infertility using the CD-RISC: Examining infertility-related stress, general distress, and coping styles. J Psychiatr Res. 2010;44(4):236-41.

Alhassan A, Ziblim A, Muntaka S. A survey on depression among infertile women in Ghana. BMC Womens Health. 2014;42:14.

Kucur Suna K, Ilay G, Aysenur A, Kerem Han G, Eda Ulku U, Pasa U, et al. Effects of infertility etiology and depression on female sexual function. J Sex Marital Ther. 2016;42(1):27-35.

Aarts JWM, Van Empel IWH, Boivin J, Nelen WL, Kremer JAM, Verhaak CM. Relationship between quality of life and distress in infertility: A validation study of the Dutch FertiQoL. Hum Reprod. 2011;26(5):1112-8.

Dyer S. The value of children in African countries: insights from studies on infertility. J Psychosom Obstet Gynaecol. 2007;28(2):69-77.

Connolly KJ, Edelmann RJ, Cooke ID, Robson J. The impact of infertility on psychological functioning. J Psychosom Res. 1992;36(5):459-68.

Greil AL. Infertility and psychological stress, A critical review of the literature. Soc Sci Med. 1997;45(11):1679-704.

Newton CR. The fertility problem inventory: Measuring perceived infertilty-related stress problem. Fertil Steril. 1999;77(6):1233-40.

Luk BHK, Loke AC.The impact of infertility on the psychological well-being, marital relationships, sexual relationships, and quality of life of couples: A systematic review. J Sex Marital Ther. 2015;41(6):610-25.

Rashid SA, Ghani AP, Daud N, Azemi SNAN, Hilmi ZAG, Razak MR, et al. Fertility dynamics in Malaysia: comparison of Malays, Chinese and Indian ethnics. In 3rd International Conference on Education and Social Sciences (INTCESS 2016). 8th to 10th February 2016, Istanbul, Turkey. Available at:

Hazliza NNH, Norliza M, Bahari SI, Hasanah CI. Etiological factors and psychosocial impacts of female partner in couples with infertility. Int Med J. 2006;13(1):59-65.

Musa R, Ramli R, Yazmie AWA, Khadijah MBS, Hayati MY, Midin M, et al. A preliminary study of the psychological differences in infertile couples and their relation to the coping styles. Compr Psychiatry. 2014;55(Suppl. 1):S65–9.

Musa R, Ariff MF, Zaini Z. Translation, validation and psychometric properties of Bahasa Malaysia version of the Depression Anxiety and Stress Scales (DASS). Asean J Psychiatr. 2007;8(2):82-9.

Farnanza A, Suzanna D, Zaliha I,Rozman R, Ani ZA. Validation of Malay version Fertility Quality of Life (FertiQoL). J Clin Health Sci. 2017;2(Suppl 2).

Lovibond PF. Long-term stability of depression, anxiety, and stress syndromes. J Abnorm Psychol. 1998;107(3):520-2.

Boivin J, Takefman J, Braverman A. The fertility quality of life (FertiQoL) tool: Development and general psychometric properties. Hum Reprod. 2011;26(8):2084–91.

Lemeshow S, Hosmer DW, Klar J, Lwanga SK, World Health Organization. Adequacy of sample size in health studies. Chichester: Wiley; 1990.

Hsu PY, Lin MW, Hwang JL, Lee MS, Wu MH. The fertility quality of life (FertiQoL) questionnaire in Taiwanese infertile couples. Taiwan J Obstet Gynecol. 2013;52:204-9.

Population Quick Information, Department of Statistic Malaysia, Kuala Lumpur; 2018. Available at: Assessed 2020 April 26.

Guerra D, Llobera A, Veiga A, Barri PN. Psychiatric morbidity in couples attending a fertility service. Human Reproduction. Hum Reprod. 1998;13(6):1733–6.

Tarlatzis I, Tarlatzis BC, Diakogiannis I, Bontis J, Lagos S, Gavriilidou D, Mantalenakis S. Psychosocial impacts of infertility on Greek couples. Hum Reprod. 1993;8(3):396-401.

Ashkani H, Akbari A, Heydari S. Epidemiology of depression among infertile and fertile couples in Shiraz, Southern Iran. Indian J Med Sci. 2006;60(10):399-406.

Matsubayashi H, Hosaka T, Izumi SI, Suzuki T, Kondo A, Makino T. Increased depression and anxiety in infertile Japanese women resulting from lack of husband’s support and feelings of stress. Gen Hosp Psychiatry. 2004;26(5):398-404.

Yusuf L. Depression, anxiety and stress among female patients of infertility; A case control study. Pak J Med Sci. 2016;32(6):1340-3.

Malik S, Coulson N. The male experience of infertility: a thematic analysis of an online infertility support group bulletin board. J Reprod Infant Psychol. 2008;6(1):18-30.

Huppelschoten AG, Van Dongen AJ, Verhaak CM, Smeenk JM, Kremer JA, Nelen WL. Differences in quality of life and emotional status between infertile women and their partners. Human Reprod. 2013;28(8):2168-76.