Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal.
Centre for Reproductive Genetics A.Barros, Porto, Portugal.
Hum Reprod. 2024 Mar 1;39(3):559-568. doi: 10.1093/humrep/deae001.
Do involuntary definitive childless women have lower psychosocial adjustment levels than women with infertility diagnoses actively trying to conceive and presumably fertile women?
Involuntary definitive childless women have lower levels of sexual functioning than infertile women actively trying to conceive and presumably fertile women, and higher levels of depression than presumably fertile women.
Involuntary definitive childless defines those who wanted to become parents but were unable to do so. Studies have provided evidence about infertility and its psychosocial consequences, but there is a lack of knowledge about the impact of involuntary definitive childlessness, namely on sexual function, social support, marital satisfaction, and psychological adjustment.
STUDY DESIGN, SIZE, DURATION: This associative study was conducted between July 2021 and January 2022 for involuntary definitive childless women and between July 2016 and February 2018 for women with an infertility diagnosis actively trying to conceive as well as presumably fertile women. An online questionnaire announced in social media and gynaecology and fertility clinics was used. The inclusion criteria for all participants were being childless, in a heterosexual relationship and cohabiting for at least 2 years. Specific inclusion criteria for involuntary definitive childless women were: trying to conceive for at least 2 years; not achieving pregnancy because of biological and medical constraints; and not undergoing fertility treatment or being a candidate for adopting a child at time of the study. For women with an infertility diagnosis the inclusion criteria were: actively trying to conceive (naturally or through fertility treatments); having a primary fertility diagnosis; and aged between 22 and 42 years old. For presumably fertile women, the inclusion criteria were: having a parenthood wish in the future; and not knowing of any condition that could prevent them from conceiving.
PARTICIPANTS/MATERIALS, SETTING, METHODS: Out of 360 women completing the survey, only 203 were eligible for this study (60 involuntary definitive childless women, 78 women with an infertility diagnosis actively trying to conceive, and 65 presumably fertile women). All participants completed a questionnaire including sociodemographic and clinical data, the Female Sexual Function Index, the 2-Way Social Support Scale, the Relationship Assessment Scale, and Hospital Anxiety and Depression Scale. Binary logistic regression was performed to assess the relation between sexual function, social support, marital satisfaction, anxiety, depression, and reproductive status, adjusting for age, and cohabitation length. Presumably fertile women were used as a reference group.
Women were 34.31 years old (SD = 5.89) and cohabited with their partners for 6.55 years (SD = 4.57). The odds ratio (OR) showed that involuntary definitive childless women had significantly lower sexual function than infertile women actively trying to conceive (OR = 0.88, 95% CI = 0.79-0.99) and presumably fertile women (OR = 34.89, 95% CI = 1.98-614.03), and higher depression levels than presumably fertile women (OR = 99.89, 95% CI = 3.29-3037.87). Women with an infertility diagnosis actively trying to conceive did not differ from presumably fertile women in sexual function, social support, marital satisfaction, anxiety, and depression.
LIMITATIONS, REASONS FOR CAUTION: The majority of childless women underwent fertility treatments, and childlessness for circumstantial reasons owing to lack of a partner was not included, therefore these results may not reflect the experiences of all women with an involuntary childless lifestyle. There was a time gap in the recruitment process, and only the definitive childlessness group filled out the questionnaire after the coronavirus disease 2019 pandemic. We did not ask participants if they self-identified themselves with the groups' terminology they were assigned to.
Our results emphasize the importance of future research to provide a more comprehensive understanding of the adjustment experiences of childless women and an awareness of the poor adjustment they might experience, highlighting the need to keep following women after unsuccessful treatments. Clinical practitioners must attend to these dimensions when consulting involuntary definitive childless women who might not have gone through treatments but also experience these adverse outcomes.
STUDY FUNDING/COMPETING INTEREST(S): This study was partially supported by the Portuguese Foundation for Science and Technology. The authors declare that they have no conflict of interest.
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与积极尝试怀孕且可能有生育能力的不孕女性相比，非自愿性的明确无子女女性的心理社会适应水平是否更低？
非自愿性明确无子女的女性在性功能方面的水平低于积极尝试怀孕且可能有生育能力的不孕女性，而在抑郁水平方面则高于可能有生育能力的女性。
非自愿性明确无子女定义为那些希望成为父母但却无法实现的人。研究已经提供了关于不孕及其心理社会后果的证据，但对于非自愿性明确无子女的影响，即对性功能、社会支持、婚姻满意度和心理调整的影响，缺乏了解。
研究设计、规模、持续时间：本研究为关联性研究，于 2021 年 7 月至 2022 年 1 月期间纳入非自愿性明确无子女的女性，于 2016 年 7 月至 2018 年 2 月期间纳入积极尝试怀孕且可能有生育能力的不孕女性。使用了在社交媒体和妇科及生育诊所公布的在线问卷。所有参与者的纳入标准均为无子女、处于异性恋关系和同居至少 2 年。非自愿性明确无子女女性的具体纳入标准为：至少尝试怀孕 2 年；由于生物和医学限制而无法怀孕；在研究时未接受生育治疗或不适合领养孩子。对于患有不孕诊断的女性，纳入标准为：积极尝试怀孕（自然或通过生育治疗）；有原发性生育诊断；年龄在 22 至 42 岁之间。对于可能有生育能力的女性，纳入标准为：未来有生育愿望；并且不知道有任何可能妨碍怀孕的情况。
参与者/材料、设置、方法：在完成调查的 360 名女性中，只有 203 名符合本研究的条件（60 名非自愿性明确无子女女性、78 名积极尝试怀孕且可能有生育能力的不孕女性和 65 名可能有生育能力的女性）。所有参与者均完成了一份问卷，包括社会人口学和临床数据、女性性功能指数、双向社会支持量表、关系评估量表和医院焦虑和抑郁量表。采用二元逻辑回归评估性功能、社会支持、婚姻满意度、焦虑、抑郁和生殖状况之间的关系，调整年龄和同居时间。以可能有生育能力的女性为参考组。
女性年龄为 34.31 岁（标准差=5.89），与伴侣同居时间为 6.55 年（标准差=4.57）。比值比（OR）显示，非自愿性明确无子女的女性在性功能方面明显低于积极尝试怀孕且可能有生育能力的不孕女性（OR=0.88，95%置信区间=0.79-0.99）和可能有生育能力的女性（OR=34.89，95%置信区间=1.98-614.03），而抑郁水平则高于可能有生育能力的女性（OR=99.89，95%置信区间=3.29-3037.87）。积极尝试怀孕且可能有生育能力的女性在性功能、社会支持、婚姻满意度、焦虑和抑郁方面与可能有生育能力的女性无差异。
局限性、谨慎原因：大多数无子女的女性都接受了生育治疗，而且由于缺乏伴侣而导致的偶然无子女的情况并不包括在内，因此这些结果可能无法反映所有非自愿无子女生活方式的女性的经历。招募过程中有时间间隔，只有在 2019 年冠状病毒病大流行后，明确无子女组才填写了问卷。我们没有询问参与者是否自我认同为他们被分配到的小组的术语。
我们的研究结果强调了未来研究的重要性，以便更全面地了解无子女女性的适应经历，并认识到她们可能经历的不良适应，这突出了在治疗失败后继续关注无子女女性的必要性。临床医生在咨询可能没有接受过治疗但也经历过这些不良后果的非自愿性明确无子女女性时，必须关注这些方面。
研究资助/利益冲突：本研究部分得到了葡萄牙科学技术基金会的支持。作者声明他们没有利益冲突。
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