Research reveals emotional and work-life strain in infertility treatment patients

Infertility is a problem that affects between 8% and 12% of couples of reproductive age worldwide – for some of them, the problem interrupts a life project, which is the desire to have children and build a family. Advances in technology and medicine have made assisted reproductive treatments possible, but they can be physically and psychologically draining for the couples involved, especially because of expectations of results that may not be achieved.

The emotional impact of treatment is well documented in the scientific literature. Frustration with negative results has an impact on the psychological and social well-being of the couple, who may develop symptoms such as depression, anxiety, anger and stress, thus worsening their quality of life. Now, for the first time, a study supported by FAPESP and carried out at the ABC Medical School (FM-ABC) in Santo André, a municipality in the Metropolitan Region of São Paulo (MRSP), in Brazil, has examined work-family conflicts in these patients, which can be associated with frequent absences due to medical appointments or tests, for example.

The results, published in the journal Psychology, Health & Medicine, indicate that levels of work-family conflict are higher among men, while stress affects women more.

A total of 242 couples undergoing assisted reproductive treatment at the Ideia Fértil Institute, linked to the FM-ABC, in the MRSP, were studied. Among the participants, the median age was 37 years; 60% were women; 67% had a university degree; 37% had been married for more than ten years, 26% for between five and ten years, and 37% for five years or less.

In most cases, assisted reproductive treatments require time and large financial investments, which can be stressful for working patients. However, the scientific literature lacks data on the impact of this procedure on work-family conflicts.

Infertile patients undergoing treatment can risk losing their jobs due to frequent absences for medical appointments and tests. For example, it's common for a woman to ask for a medical certificate without the clinic's logo so that her employer doesn't know she's trying to get pregnant."

Victor Zaia, professor in the Postgraduate Program in Health Sciences at the FM-ABC and lead author of the study

In addition, these patients may also experience reduced productivity, difficulty concentrating, challenges in managing medication side effects, and difficulties with time management. "Work-family conflict occurs when these individuals experience tension as they try to fulfill their professional and personal responsibilities. Many experience stress, fatigue, emotional exhaustion, sleep disturbances, dissatisfaction, marital problems, and decreased productivity. The result can be conflicts between these roles, with physical and psychological consequences."

Evaluation scales

To arrive at the results, the researchers used online questionnaires to assess the couples. They answered questions from four internationally validated scales: Infertility-Related Stress Scale-Brazil (IRSS); Connor-Davidson Resilience Scale 10 (CD-RISC 10); Perceived Social Support Scale (PSSS); and Work-Family Conflict Scale.

On the Infertility-Related Stress Scale, the volunteers answered 12 questions about interpersonal stress (how infertility situations would disrupt the person's daily life with friends, family, spouse) and questions about intrapersonal stress (how much the infertility problem affects their physical and emotional well-being).

On the Resilience Scale, the participants answered ten questions about their ability to adapt to life's changes; about overcoming difficulties after illness or other problems; and about being able to think clearly when under pressure, among others.

The difference in this case, Zaia explains, is that the research focused on something that was happening at the time – the assisted reproductive treatment – whereas many studies on resilience ask about something that has already happened in the past, looking for memories. "In our study, people were starting reproductive treatment. So the impact, the risky situation, was being experienced in the now."

The third tool used in the survey was the Perceived Social Support Scale, which, as its name suggests, is a 29-question scale designed to understand whether the participant receives and perceives any type of emotional or practical support from their spouse, family, and friends.

Finally, the researchers applied the Work-Family Conflict Scale – the most important in the study. It aims to assess the interference between the family and work environments within two sub-scales: Work Interference in the Family and Family Interference in Work.

In the analyses, the male participants showed greater resilience and lower levels of stress, both intrapersonal and interpersonal, compared to the women undergoing infertility treatment. However, the male patients reported higher levels of work interference in the family. In addition, there were significant differences in work-family conflict based on the couple's income: those with higher incomes reported more interference.

On the other hand, the study found that women undergoing infertility treatment had lower levels of resilience and higher levels of stress, which the authors suggest may be explained by societal expectations about motherhood, which is considered a central role for women. The researchers also found significant correlations between resilience and emotional support, intrapersonal stress, and interpersonal stress.

"Stress alone doesn't explain work-family conflict. But we concluded that if a person has more stress, little social support and less resilience, they'll most likely have higher levels of conflict. And if they can't manage those conflicts, they'll probably have more stress, leading to a kind of vicious circle," Zaia explains.

From a clinical practice standpoint, Zaia says, these findings can guide health professionals in working with couples to reinforce strategies to improve and strengthen aspects of resilience and emotional support. "All the issues are important. This couple is suffering. We need to improve communication and support, as well as working on stress management strategies so that they can better adapt to treatment," the researcher explained. 

According to Zaia, there are two ways to try to overcome these conflicts: resilience (which is the ability to adapt to significant changes in life) and social support. Resilience is considered a protective factor because it can moderate the relationship between stress and quality of life, reducing the possible negative effects of stress related to infertility. And social support, in turn, helps because being surrounded by people who provide emotional and practical support can reduce the affective burden of infertility and possibly ease the challenges of treatment.

Assisted reproduction

Infertility is defined as the inability to get pregnant after at least one year of regular unprotected intercourse. Assisted reproductive treatments are available, but they are time-consuming and costly. There are few services in the Sistema Único de Saúde (SUS, Brazil's national public health network) that offer this treatment – and they are very restrictive (imposing age limits, for example).

A report by the United Nations Population Fund (UNFPA) in Brazil, published in March 2024, points out that Brazil has 192 assisted reproduction clinics, of which only 11 are public (6%). In 2023, the cost of a complete IVF cycle varied between BRL 15,000 and BRL 100,000, depending on the number of attempts, the procedure used and the location of the clinic. The clinic involved in the study is a social organization and the patients treated there pay only the cost of the treatments, which start at BRL 3,000.