The Mediating Role of Infertility Stress in the Relationship Between Sexual Self-Concept, Family Resilience, and Marital Adjustment in Infertile Women

Infertility, as a major crisis, affects individuals’ quality of life in biopsychosocial and moral domains. Infertile couples, especially infertile women, may experience stress related to infertility. Resilience is a factor that can influence infertility stress and marital adjustment. A major aspect of sexual life is sexual self–concept; it predicts interpersonal behaviors and can promote psychosexual health, especially in stressful situations, like infertility. Infertility may be associated with decreased sexual self–esteem, self–esteem, and confidence concerning sexual function. The current research aimed to investigate the mediating role of infertility stress in the relationship between sexual self–concept, family resilience, and marital adjustment in infertile women.

This correlational study was performed based on structural equation modeling. The statistical population of this study consisted of all infertile women referring to infertility treatment centers in Khuzestan and Isfahan Provinces, Iran, in 2018. According to the number of variables, 260 subjects were selected by the convenience sampling method. After the loss of the subjects and the elimination of confounding questionnaires and multivariate data, 244 questionnaires were analyzed. The inclusion criteria of the study were Iranian nationality, reading and writing literacy, the age of 18 years or older, and a confirmed diagnosis of infertility (primary & secondary). The exclusion criteria included acute psychiatric disorders and consuming psychotropic drugs. The measurement tools consisted of the Multidimensional Sexual Self–Concept Questionnaire (Snell, 1998), Family Resilience Assessment Scale (Sixbey, 2005), Fertility Problem Inventory (Newton et al., 1999), and Dyadic Adjustment Scale (Spanier, 1978). To analyze the research data, SPSS and AMOS were used at the significance levels of 0.01 and 0.05.

The present study results revealed that the direct relationship between sexual self–concept (β=0.13, p=0.025), family resilience (β=0.15, p=0.018), and marital adjustment was positive and significant. The direct relationship between sexual self–concept (β=–0.23, p<0.001), family resilience (β=–0.33, p<0.001), and infertility stress were negative and significant. The relationship between infertility stress and marital adjustment was negative and significant (β=–0.26, p<0.001). Furthermore, the indirect effect of sexual self–concept (β=0.06, p=0.002) and family resilience (β=0.09, p=0.002) on marital adjustment, with the mediating role of infertility stress, was significant. Additionally, the modified research model presented a good fit for the collected data (x2/df=1.18, CFI=0.99, IFI=0.99, TLI=0.99, NFI=0.98, RMSEA=0.02).

Sexual self–concept and family resilience, mediated by infertility stress, were effective on marital adjustment. Infertility stress, directly, and as a mediator, affected marital adjustment in infertile women; thus, it can be considered as an essential characteristic in the provision of infertile couples with health and psychological services.