Table I is divided into 3 sections: Demographic factors, Socio-economic factors, and Social religious network of the infertile patients presenting at the infertility centre.
Table I: Socio-demographic factors of the study participants presenting to the infertility Centre
|
|
|
Male (n=334)
|
Female (n=334)
|
P value
|
Age (in years)
Mean ± SD
|
35.53 ±6.72
|
30.87 ± 6.12
|
0.001*
|
Formal Education
Yes
No
|
311 (93.1%)
23 (6.9%)
|
281 (84.1%)
53 (15.9%)
|
<0.001*
|
Years of education (in years)
Median(IQR)
|
14 (10-16)
|
12 (7-16)
|
0.001*
|
Informal Education
Yes
No
|
167 (50.0%)
167 (50.0%)
|
209 (62.6%)
125 (37.4%)
|
0.001*
|
Role in the family
Head
Not Head but take part in decision
Does not take decision, only follower
|
156 (46.7%)
171 (51.2%)
7 (2.10%)
|
8 (2.40%)
251 (75.1%)
75 (22.5%)
|
<0.001*
|
First Marriage
Yes
No
|
305 (91.3%)
29 (8.70%)
|
321 (96.1%)
13 (3.90%)
|
0.011*
|
B. Socioeconomic
|
Working
Yes
No
|
326 (97.6%)
8 (2.40%)
|
52 (15.6%)
282 (84.4%)
|
<0.001*
|
Spouse employed
Yes
No
|
50 (15.0%)
284 (85.0%)
|
330 (98.8%)
4 (1.20%)
|
<0.001*
|
Total household income (in PKR)
Median (IQR)
Total Monthly income (in PKR)
1000-25000
25000-40000
40000-80000
80000-10000000
|
50000 (30000-90000)
61 (18.4%)
58 (17.5%)
106 (32.0%)
106 (32.0%)
|
35000 (20000-50000)
84 (25.3%)
86 (25.9%)
103 (31.0%)
59 (17.8%)
|
<0.001*
<0.001*
|
Total
|
331
|
332
|
|
C. Social/Religious Network
|
No of meet up with friends/week
<1 times /week
1-5 times/ week
≥ 5 times/week
|
195 (58.4%)
133 (39.8%)
6 (12.3%)
|
265 (79.3%)
49 (14.7%)
6 (3.40%)
|
<0.001*
|
Religious activities
Yes
No
|
310 (92.8%)
24 (7.20%)
|
331 (99.1%)
3 (0.90%)
|
<0.001*
|
*significant at p value< 0.05 by t test/chisquare/fisher exact test.
|
Section A of Table 1 describes the demographic factors of the study participants. The mean age was significantly higher among males, 35.53 ±6.72, as compared to females, 30.87 ± 6.12 ( p value 0.001). A higher proportion of males (93.1%) had formal education as compared to their counterparts (84.19%) (p -value <0.001), with higher median years of education among males as compared to females. However, a higher proportion of females (62.6%) had informal education as compared to their counterparts (50%) (p value=0.001). We also observed that a significantly higher proportion of males (46.7%) were heads of the family as compared to females (2.4%) (p value < 0.001). Moreover, a significantly higher proportion of males (8.7%) had more than one marriage as compared to (3.9%) females who were previously married.
Section B of Table 1 describes the socio-economic status of the study participants. We observed that a significantly higher proportion of females (84.4 %) were not working as compared to males (2.4%) (p value < 0.001). The median monthly household income reported by males was significantly higher, i.e. PKR 50,000 (30,000-90,000), as compared to females, PKR 35,000 (20000-50000) (p value < 0.001).
Section C of Table 1 presents the social/ religious network of the study participants. We observed that the males had a greater number of meet ups with their friends as compared to females (p value < 0.001). Moreover, we observed that a significantly higher proportion of females (99.1%) were involved in religious activities as compared to males (92.8%) (p value <0.001).
Resilience, depression, and QoL in infertile males and females
Table II shows resilience, depression, and QoL in infertile males and females. We observed that the mean resilience scores were significantly higher among males, 77.64 ± 8.56, as compared to females, 76.19 ±8.69 with a 95% CI; -2.757, -0.1347 (p value = 0.031). The proportion of less resilient females (29.6%) was significantly higher than that of less resilient males (21.3%). However, a significantly higher proportion of females were depressed (13.8%) as compared to males (6%). We observed that the mean QoL scores for the general health domain, emotional domain, mind and body domain, and relational domain, and the total QoL were significantly higher in males as compared to females (p value< 0.001); however, QoL for the social domain was not significantly different in both the groups.
Table II: Resilience, Depression and QoL among infertile males and females
|
Resilience/Depression
|
Male (n=334)
|
Female (n=334)
|
p-value
|
Resilience
|
Resilience (Mean± SD)
|
77.64 ± 8.56
|
76.19 ± 8.69
|
0.031*
|
Resilience
<73 (less resilient)
≥73 (more resilient)
|
71 (21.3%)
263 (78.7%)
|
99 (29.6%)
235 (70.4%)
|
0.013*
|
Depression
|
Depression (Median(IQR))
|
3.00 (1.00-7.00)
|
7.00 (2.00-12.00)
|
<0.001*
|
Depression
<17 (not depressed)
≥17 (depressed)
|
314 (94.0%)
20 (6.0%)
|
288 (86.2%)
46 (13.8%)
|
<0.001*
|
Quality of life
|
General Health
Mean ± SD
|
56.45 ± 19.36
|
48.34 ± 11.52
|
<0.001*
|
Emotional Domain
Mean ± SD
|
82.63 ± 13.43
|
60.02 ± 23.38
|
<0.001*
|
Mind and Body Domain
Mean ± SD
|
85.65 ± 15.46
|
55.40 ± 23.60
|
<0.001*
|
Relational Domain
Mean ± SD
|
79.98 ± 19.56
|
88.76 ± 10.60
|
<0.001*
|
Social Domain
Mean ± SD
|
78.23 ± 13.35
|
77.75 ± 18.05
|
0.696
|
Total Qol scores
Mean ± SD
|
81.58 ± 12.15
|
70.48 ±15.69
|
<0.001*
|
*significant at p value < 0.05 by chi-square of independence/ t test
Univariate analysis to assess the relationship of depression, resilience, and demographic factors with the total quality of life, in males and females presenting for infertility treatment
Table III a presents the univariate analysis to assess the relationship of demographic factors, with the total quality of life, in males and females presenting for infertility treatment.
Table III a: Univariate analysis to assess relationship of demographic factors with total quality of life among males and females presenting for infertility treatment
Variables
|
Univariate analysis
|
|
Males
Unadjusted beta coefficient (SE)
|
95% CI
|
Females Unadjusted beta coefficient (SE)
|
95% CI
|
Age (in years)
|
-0.043 (0.099)
|
-0.239, 0.151
|
-0.054 (0.140)
|
-0.331, 0.221
|
Formal Education
Yes (ref)
No
|
-9.051(2.569)
|
-14.106,-3.996*
|
-6.101 (2.329)
|
-10.683,- 1.518*
|
Years of formal education (in years)
|
0.269(0.070)
|
0.131, 0.407 *
|
0.135 (0.071)
|
-0.004, 0.275*
|
Informal Education
Yes (ref)
No
|
2.345 (1.319)
|
-0.249,4.940*
|
3.113 (1.768)
|
-0.365, 6.592*
|
Type of Marriage
Self-Choice (ref)
Arranged
|
0.119 (1.611)
|
-3.051,3.289
|
-6.122 (2.277)
|
-10.602, -1.642*
|
Duration of marriage (in years)
|
-0.302(0.124)
|
-0.546,-0.057 *
|
0.051(0.139)
|
-0.221,0.324
|
Type of family
Extended
Nuclear (ref)
|
2.176 (1.378)
|
-0.535, 4.888*
|
2.759 (1.799)
|
-0.781, 6.300*
|
Role in the family
Head (ref)
Not Head but take part in decision
Does not take decision, only follower
|
-0.449 (1.340)
-5.367 (4.677)
|
-3.086, 2.186*
-14.568, 3.833
|
-11.740 (5.565)
-16.373 (5.763)
|
-22.629, -0.730
-27.711, -5.036
|
Type of infertility
Primary
Secondary (ref)
|
-1.585(1.976)
|
-0.547,2.303
|
-9.248(2.571)
|
-14.305,-4.191*
|
*significant at p value < 0.25 by univariate analysis
We observed that age had a significant association with Qol of male and female infertile patients. However, male and females with no formal education had significantly lower Qol scores i.e 9 and 6 units, respectively, as compared to those with formal education. Similarly, years of formal education significantly increased the QoL of males and females. The QoL scores of female patients who had arrange marriage was 6 units significantly lower as compared to those who had love marriage. On the other hand, there was no significant association in the type of marriage and QoL scores among males. However, there was significant negative association of duration of marriage with QoL among males, but not among females. Moreover, males and females who lived in extended families had significantly higher QoL scores as compared to those who lived in nuclear families. Furthermore, the QoL scores were significantly higher of females who were not the head of the family but took part in decision making as compared to those who did not take part in decision making. The QoL of females with primary infertility was 9 units significantly lower as compared to those with secondary infertility, however there was no significant association of QoL and type of infertility among males.
We also evaluated the relationship of socio-economic factors with mean QoL in males and females (Table III b). We did not observe any significant association of QoL with working status in males and females. However, QoL of females, working outside their house was 9 units significantly higher compared to those working from home. Moreover, the QoL was significantly lower among males and females with low total household monthly income. Furthermore, QoL of males and females who did not have a television and/or a refrigerator in their house, their own cultivated land, and a vehicle was significantly low as compared to those who had any or all of these. Additionally, the quality of life of males decreased significantly by 0.6 units with increase in number of friends; however, this did not have any significant relationship with the QoL of females.
Table III b: Univariate analysis to assess relationship of Socioeconomic with total quality of life among males and females presenting for infertility treatment
|
Variables
|
Males
Unadjusted beta coefficient (SE)
|
95% CI
|
Females Unadjusted beta coefficient (SE)
|
95% CI
|
Working status
Yes (ref)
No
|
-4.957 (4.325)
|
-13.467,3.5523
|
-0.319(2.371)
|
-4.984, 4.346
|
Work Place
Inside the house (ref)
Outside the house
Both
|
-
-4.418 (1.829)
9.312 (12.015)
|
-
-8.016,-0.820*
-14.325,32.950
|
-
9.143 (3.908)
-13.706(9.972)
|
-
1.288, 16.997*
-33.746, 6.334
|
Total Monthly income (in PKR)
1000-25000
25000-40000
40000-80000
80000-10000000(ref)
|
-6.385 (1.921)
-2.255 (1.952)
-4.056 (1.646)
-
|
-10.165, -2.604*
-6.097, 1.586
-7.295 , -0.817*
-
|
-8.401 (2.582)
0.009 (2.569)
2.499 (2.477)
-
|
-13.479, -3.322*
-5.045, 5.063
-2.373, 7.373
-
|
TV in the house
Yes (ref)
No
|
-
-4.945 (1.941)
|
-
-8.763, -1.128*
|
-
-6.244 (2.471)
|
-
-11.161, -1.382*
|
Refrigerator in the house Yes (ref)
No
|
-
-6.655 (2.106)
|
-
-10.797, -2.513*
|
-
-10.016 (2.912)
|
-15.744, -4.287*
|
Own cultivated land
Yes (ref)
No
|
-
-4.184 (1.658)
|
-
-7.446, -0.923*
|
-
-5.092 (1.954)
|
-
-8.937, -1.248*
|
Own Vehicle
Yes(ref)
No
|
-
-6.914(1.575)
|
-
-10.011,-3.815*
|
-
-6.760 (1.989)
|
-
-10.673,-2.847*
|
Number of friends
|
-0.603(0.202)
|
-0.1000, -0.206*
|
-0.126 (0.320)
|
-0.757, 0.504
|
*significant at p value < 0.25 by univariate analysis
|
We also evaluated the relationship of resilience and depression with QoL in males and females ( Table III c) and we observed that QoL of males and females who had low resilience was 12 and 13 units significantly lower, respectively, as compared to those who had higher resilience. Moreover, QoL in males and females was 21 and 22 units significantly lower, respectively, among those were depressed as compared to those who were not depressed.
Table III c: Univariate analysis to assess relationship of Resilience and Depression with quality of life among males and females presenting for infertility treatment
|
Variables
|
Males
Unadjusted beta coefficient (SE)
|
95% CI
|
Females Unadjusted beta coefficient (SE)
|
95% CI
|
Resilience
|
0.677 (0.067)
|
0.543,0.811*
|
0.828 (0.088)
|
0.655,1.001*
|
Resilience
<73 (less resilient)
≥73 (more resilient) (ref)
|
-12.018 (1.479)
-
|
-14.92, -9.108*
-
|
-13.278(1.736)
-
|
-16.694,-9.863*
-
|
Depression
|
-1.057 (0.092)
|
-1.238, -0.888*
|
-1.597 (0.082)
|
-1.758, -1.435*
|
Depression
<17 (not depressed) (ref)
≥17 (depressed
|
-
-21.490(2.532)
|
-
-26.471,16.509*
|
-
-22.369 (2.172)
|
-
-26.642, 18.095*
|
*significant at p value < 0.25 by univariate analysis
Multivariable analysis to assess the relationship of depression, resilience, and demographic factors with the total quality of life, in males and females presenting for infertility treatment
Table IV shows the multivariable analysis to assess the relationship of demographic factors, socio-economic factors, resilience, and depression with the total quality of life, in males and females presenting for infertility treatment.
Table IV: Multivariable analysis to assess relationship of depression, resilience and demographic factors with total quality of life among males and females presenting for infertility treatment
|
Variables
|
Multivariable analysis
|
|
Males
Adjusted Beta Coefficient (SE)
|
95% CI
|
Females
Adjusted Beta Coefficient (SE)
|
95% CI
|
Resilience
<73 (less resilient)
≥73 (more resilient) (ref)
|
-8.470 (1.422)
-
|
-11.268,-5.672*
-
|
-8.606 (1.599)
-
|
-11.753, -5.458*
-
|
Depression
<17 (not depressed) (ref)
≥17 (depressed)
|
-
-17.849 (2.365)
|
-
-22.503, -13.196*
|
-
-19.387(2.078)
|
-
-23.476, -15.298*
|
Formal Education
Yes (ref)
No
|
-
-5.374 (2.245)
|
-
-9.794, -0.954*
|
NS
|
NS
|
Number of friends
|
-0.554 (0.172)
|
-0.893, -0.216*
|
NS
|
NS
|
Total Monthly income (in PKR)
10,000-25,000
25000-40000
40000-80000
80000-10000000(ref)
|
-3.551(1.687)
-1.793 (1.670)
-2.747 (1.386)
-
|
-6.870,-0.231*
-5.079,-1.493
-5.474,-0.020*
-
|
-7.249 (2.161)
-2.615 (2.155)
-0.644 (2.078)
-
|
-11.501, -2.996*
-6.854, 1.624
-3.443, 4.732
-
|
*Significant at p value < 0.05 by multivariable analysis
NS non significant
|
We observed that among males resilience and depression had a significant association with QoL, after adjusting for the covariates educational status, monthly income, and number of friends. Males who were less resilient their QoL was 8 units significantly lower as compared to those who were more resilient. Similarly, those males who were depressed their QoL was 17 units significantly lower as compared to those who were not. Moreover, males who had no formal education their QoL was 5 units lower as compared to those who had received formal education. Males whose household monthly income was between 10,000-80,000 PKR their QoL was lower as compared to those who had an income between 80,000-10,000,000 PKR. Furthermore, males who had more friends had lower QoL scores.
We observed that among females resilience and depression had a significant association with QoL, after adjusting for the covariate monthly income. Females who were less resilient their QoL was 8 units lower as compared those who were more resilient. Similarly, those females who were depressed their QoL was 19 units significantly lower as compared to those who were not. Moreover, females whose household monthly income was between 10,000-25,000 PKR their QoL was 7 units significantly lower as compared to those who had an income between 80,000-10,000,000 PKR.