Psychological characteristics of infertile patients: discriminating etiological factors from reactive changes

Our objective was to discriminate psychological factors playing an etiological role in infertility and psychological problems as consequences of infertility. The design was a prospective study of couples with initially Undetermined Fertility (UF couples) and couples with initially Known Infertility (KI couples). After a 13-month follow-up, three groups could be defined: fertile UF couples; infertile UF couples; and KI couples. Hypotheses were the following. If a psychological factor played an etiological role, measures in fertile UF couples should be different from measures in infertile UF couples and in KI couples. If a psychological measure reflected a reactive change, KI couples should differ from both groups of UF couples. Finally, if a psychological variable played both roles, the three pairwise comparisons between groups should reveal differences, with the largest difference between fertile UF couples and KI couples. The questionnaires used were the Child Project Questionnaire (CPQ), with three factor scores (different for men and women) and a Sexual Problems Score (SPS); the Dyadic Adjustment Scale; the State-Trait Anxiety Inventory; the Neonatal Perception Inventory. In women, on CPQ factor II, i.e. Frequency of Thoughts and Concerns related to the Project to Conceive a Child and on the SPS, KI women had scores significantly higher than both groups of UF women. In men, on CPQ factor II, i.e. Quality of Integration between Wish for a Child and Sexuality, men from fertile UF couples had significantly higher scores than men from both infertile groups; the two latter groups did not differ significantly. On the SPS, scores of men from infertile UF couples and scores of men from KI couples were significantly higher than scores of men from fertile UF couples; scores were similar in both groups of men from infertile couples. We conclude that in women, CPQ factor II and sexual problems reflected reactive changes to infertility and that in men CPQ factor II and sexual problems represented etiological factors.