Based on the nature and method, the present study is a descriptive-survey research of correlation type and applied in terms of purpose. The statistical population of the study will be all women with primary and secondary infertility diagnoses who referred to infertility centers and obstetrics and gynecology medical centers in Tehran in 1400. According to researchers, the minimum sample size for structural equation modeling studies is 200 people; in the present study, due to the lack of full access to infertile women in Tehran, 300 of them will be selected by available sampling method and will participate in the research through an online questionnaire. Data were collected using the marital Taxon self-report measure (Taxon Wiseman et al. (18), the infertility stigma of Fu et al. (19) and the Nelson and Carroll (20) Hidden relational Aggression Questionnaire.
Marital Taxon Self-Report measure (MTSRM)
This measure was developed by Wiseman et al. (18) and consists of 10 items adapted from the Marital Distress Questionnaire (MSI_R) to which respondents answered yes or no. This tool measures marital discord and turmoil. This test has time stability and standard validity in distinguishing disturbed couples from non-disturbed couples. The scores of this test range from 0 to 10, that a score of 4 as the cut-off score for marital turmoil. The validity of this questionnaire has been confirmed by its creators and has a reliability above 0.70 (18). In Iran, for the first time, its revised version was implemented by Behradfar et al. (21) in married men and women, and its validity was reported to be 0.94. In the present study, the reliability of Cronbach's alpha method was 0.79.
Infertile Stigma Scale (ISS):
This scale is used as an indicator of perceived stigma and stigma itself for women dealing with the diagnosis and treatment of infertility. This scale was compiled by Fu et al. (19) and consists of 27 items with options in a 5 Likert scale are arranged from strongly disagree = 1, somewhat disagree = 2, not sure = 3, somewhat agree = 4, and strongly agree = 5. The minimum and maximum scores in this tool are 27 and 135, respectively. Translation back was used to obtain the Persian version. In the exploratory factor analysis, 4 factors were extracted by rotating the varimax of the Persian version of the infertility stigma scale: personal worthlessness, social withdrawal, general stigma and family stigma. Also, Cronbach's alpha reliability coefficients of the whole scale and 4 extracted factors were satisfactory. There is a significant correlation between retest coefficient (two weeks apart) of 0.58 and this scale with Rosenberg self-esteem scales and general self-efficacy beliefs as divergent validity coefficient and self-critical scale as convergent validity coefficient (22). In the present study, the reliability of Cronbach's alpha method was 0.95.
The covert relational Aggression Scale (CRAS)
Designed by Nelson and Carroll in 2006 to measure Adult romantic relationships scale is Linder, Crick, and Collins (23). Covert relational Aggression Scale has 12 items (6 items per subscale). This scale is scored by Likert method according to the answers of 1 to 7 degrees. Carroll et al. (24) reported Cronbach's alpha coefficient of emotional withdrawal scores of 0.90 for husbands and 0.86 for spouses, as well as Cronbach's alpha of deteriorating social prestige 0.88 for husbands and 0.90 for wives. In the study of Meng et al. (25), the results of confirmatory factor analysis show the validity of the original version of the scale. Cronbach's alpha coefficient for social deterioration and emotional withdrawal has also been reported 0/9 and 0/86 in men and 0/88 and 0/9 in women, respectively.. In the present study, the reliability of Cronbach's alpha method was 0.94.
Methods of implementation and analysis: After obtaining the necessary permits and receiving ethic’s code from Mohaghegh Ardabili University, he referred to infertility centers and obstetrics and gynecology medical centers in Tehran and with the coordination of the questionnaires were distributed among infertile women. In This research available sampling method was used. Since the online questionnaire link was broadcast, the link remained active for three weeks, during this time, 300 questionnaires were provided to researchers by eliminating incomplete items. Necessary explanations such as the purpose of the research and how to answer the questions were provided in the questionnaire and individuals participated in this research completely voluntarily.
Inclusion criteria include willingness to participate in the study, failure to achieve a successful pregnancy after 12 months or more of the appropriate time with unprotected intercourse, age range 25 to 45 years, minimum literacy level, no underlying diseases and exclusion criteria this research also includes the unwillingness to cooperate and the distortion of the questionnaire. In this research Common codes of ethics in medical research include 13, 14 and 2 (benefits from the findings for the advancement of human knowledge), code 20 (coordination of research with religious and cultural standards) and codes 1, 3 and 24 (satisfaction of subjects and representatives) have been observed.