RELATIONSHIPS BETWEEN INFERTILITY-RELATED STRESS, HAIR CORTISOL, COPING, AND QUALITY OF LIFE IN U.S. WOMEN UNDERGOING INFERTILITY TREATMENTS

Abstract

Women with infertility, the inability to achieve or maintain a pregnancy after 12 months of unprotected sexual intercourse, are known to experience psychological distress. Little is known about infertility-related stress (IRS), coping strategies, and quality of life (QOL) in infertile women in the United States (U.S.). Hair cortisol, a measure of chronic stress, has not been compared to IRS, coping, or QOL. This study used a descriptive quantitative cross-sectional survey design to examine the relationships between IRS, hair cortisol, coping, and QOL in U.S. women undergoing infertility treatments, and these relationships to treatment type and pregnancy loss. After conducting an integrative review, Facebook was found to be a viable option for recruiting participants in nursing research. In this study, 230 participants were recruited from infertility-related Facebook groups and pages. Infertility-related stress, coping, and QOL was measured using the Copenhagen Multi-centre Psychosocial Infertility Fertility Problem Scale Score (COMPI-FPSS), COMPI Coping Styles Scale (COMPI-CSS), and the Fertility Quality of Life (FertiQoL) tool, which was congruent with the study's theoretical framework of Lazarus and Folkman's transactional theory of stress and coping. Participants also completed demographic and infertility background information. Hair samples were collected from a subsample of 37 participants and analyzed by an independent laboratory. Pearson correlations and independent t-tests were conducted to compare IRS, coping, QOL, and in comparing these relationships to pregnancy loss and treatment groups (IVF vs. non-IVF). Findings concluded that high levels of IRS were associated with active-avoidance coping and lower QOL scores. There were no statistical differences in IRS among treatment groups, however women in the non-IVF group used more active-avoidance and had lower social QOL than women in the IVF group. Women with pregnancy loss were found to have higher levels of IRS, use more active-avoidance coping, and had lower QOL scores compared to women without pregnancy loss. Hypocortisolism was found in the subsample, with large and significant negative correlations found between hair cortisol levels and marital stress, and moderate and significant positive correlations found between hair cortisol and relational QOL and core QOL. This study was significant in providing new knowledge of IRS, hair cortisol, coping, and QOL in U.S. women undergoing infertility treatments. Healthcare providers should provide psychological support to all women in infertility treatments, especially to support the quality of the partnered relationship and in women experiencing pregnancy loss. Future studies should further examine the impact of pregnancy loss within the infertility experience and investigate psychological interventions that reduce IRS, contribute to positive coping behaviors, and lead to positive pregnancy outcomes. In addition, the significance of hypocortisolism in women with infertility should be further explored.