Typology of family involvement and fertility-specific Quality of Life among Chinese couples with infertility: A cluster analysis

Abstract

Study question: To identify subgroups of Chinese infertile couples based on their experiences with family emotional supports, economic supports and interference. Summary answer: Four relatively distinct subgroups regarding family involvement were identified, namely, intrusive, detached, emotionally responsive, and economically supportive categories. What is known already: Family involvements, largely divided into supports and interference were found to have mixed effects on wellbeing of married couples. As the primary social support reservoir, family supports served as protective factors for couples to overcome psychosocial distress caused by infertility. However, overwhelming interferences and unwanted inquiries from social networks could turn into detrimental stressors for married couples, especially during experiences of infertility. There are limited evidences regarding the typology of family involvements experienced by infertile couples, which constraint the development of family-oriented psychosocial services. Study design, size, duration: A cross-sectioned study was implemented during October to December 2016. Current study recruited 429 infertile couples in a reproductive center affiliated to a public hospital in Beijing, China. Eligibility criteria for inclusion were couples who were (1) legally married; (2) medically diagnosed with infertility and (3) undergoing assisted reproductive treatments. After obtaining written consents, infertile couples were invited to take questionnaires separately and independently to avoid dyadic interference. Participants/materials, setting, methods: Despite demographic information, family involvement scale and Fertility-specific Quality of Life were used to measure key variables. Mean age of wives and husbands were 34.21±6.22 and 32.50±5.12, respectively and couples had been married for six years approximately. More than half of participants received tertiary education (62.9%) and 69.4% had a full-time job. In terms of the infertility etiology, there are 252 female factor, 250 male factor, 170 both factor and 148 unexplained factor infertility. Main results and the role of chance: Cluster analysis identified four subgroups regarding emotional responsiveness, economic supports and interference, namely, intrusive (44 pairs), detached (92 pairs), emotionally responsive (107 pairs), and economically supportive (178 supports) groups. There were significant between-group differences regarding FertiQoL scores (F=3.09, P<0.05 for husbands; F=4.58, P<0.01 for wives). Multiple comparison results indicated wives in intrusive subgroups show significant lowest emotional QoL, social QoL and total FertiQoL scores comparing to their counterparts in other three subgroups. For social QoL, husbands in detached subgroups show significantly lower scores than husbands in emotionally and economically supportive subgroups. Moreover, husbands in emotionally supportive subgroups show higher emotional QoL and total FertiQoL scores than husbands in intrusive and detached subgroups. In terms of relational QoL, both wives and husbands in emotionally and economically supportive subgroups reported significantly higher scores than their counterparts in detached and intrusive subgroups. No significant between-group differences on mind-body QoL for couples. Limitations, reasons for caution: Current study carried several limitations. First of all, measures used to evaluate family supports and interference was universal, rather than being specific to infertility. Secondly, cross-sectional research design adopted by current study was constrained to draw causal inferences. Finally, self-selection bias might limit generalizability of results found in this study. Wider implications of the findings: Despite person-centered and dyadic approach in infertility counseling, family-oriented interventions should be designed to improve quality of life for couples during experiences of infertility. Given the significance of emotional supports, it is extremely important to extend the therapeutic alliance through educating extended families regarding emotional competence and skills.