Indian Journal of Obstetrics and Gynecology Research 2020;7(2):177–181

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Indian Journal of Obstetrics and Gynecology Research

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Original Research Article

Knowledge and attitude of infertile couples attending rural tertiary care centre

Gomathy E1, *, Kondareddy Radhika1 , Suman Shivanagoud Patil1 , Ruth Sneha1

1 Dept. of Obstetrics and Gynaecology, Sri Devaraj Urs Medical College, Kolar, Karnataka, India

ARTICLE INFO ABSTRACT

Article history: Introduction: Infertility defines as the inability to conceive naturally after one year of regular unprotected
Received 27-08-2019 sexual intercourse. The chance to conceive depends on the length of sexual exposure, frequency of coitus
Accepted 04-11-2019 and couples age. Only 5% of the couples will conceive after one and half year or two years. Both males
Available online 15-06-2020 and females are equally responsible for the causes. Factors contributing to infertility have included male
factors (sperm abnormality), female factors (an ovulation), couple factors (luteal phase defect, poor sperm
production) and factors of unknown origin. Infertility has always existed but is now recognized as a global
Keywords:
reproductive health problem and as an important component of reproductive health. It is a world wide health
Infertility
concern and affects 8 -15% of couples. The knowledge regarding fertility and biology of reproduction was
Knowledge poor. Many women have little awareness about the fertility period and the risk factors.
Attitude Aim and Objectives: 1. To assess the knowledge and attitude of infertile couples attending gynecological
Misconceptions
OPD. 2. To assess the possible risk factors and social consequences towards infertility.
Materials and Methods: This is a cross sectional observational study conducted on infertility patients
attending to R l Jalappa hospital and research centre from February 2018 to July 2018.we designed a fertility
questionnaire for both the partners with questions covering knowledge and attitude towards infertility.
Results: Out of 154 couples, prevalence of primary and secondary infertility was 72.1% and 27.9%
respectively. The mean duration of infertility was 2.97 years. On scoring their level of knowledge, (n=
80) had inadequate, (n= 68) had moderate knowledge and (n= 6) had adequate knowledge. There was no
statistically significant difference in the knowledge in relation to their educational qualification and type of
infertility among participants.

© 2020 Published by Innovative Publication. This is an open access article under the CC BY-NC license
(https://creativecommons.org/licenses/by-nc/4.0/)

1. Introduction practices and face many such social difficulties. Further,

male factor of infertility is a taboo subject and is less often
It is a dream of every married couple to have a child, discussed in the society. This constrains the relationship of
which will bring happiness and joy into their life. Infertility the couples resulting in divorces. Even if the couple seek
is a disease of reproductive system, which affects men treatment, women are often blamed for childlessness and
and women with almost equal frequency. 1 The WHO she alone is expected to undergo the diagnostic procedures
defines primary infertility as inefficiency to conceive after to know the cause of infertility.
a year of unprotected sex and secondary if not conceived
following previous pregnancy. Infertility is a worldwide A global survey of almost 17,500 women (mostly
problem affecting 8-12 percent couple (50-80 million) of childbearing age) from 10 countries revealed that
during their reproductive lives (WHO, 1991). 2 Infertility knowledge regarding infertility and biology of reproduction
has stigmatised women from time immemorial. Women who was poor. 3 Many women have little awareness of the period
are deemed to be infertile are often excluded from religious of the month in which they are most fertile and when to seek
treatment. The risk factors for infertility include obesity,
* Corresponding author. advanced maternal age, menstrual irregularities, sexually
E-mail address: [email protected] (Gomathy E). transmitted infections, smoking, alcohol consumption and

https://doi.org/10.18231/j.ijogr.2020.037
2394-2746/© 2020 Innovative Publication, All rights reserved. 177
178 Gomathy E et al. / Indian Journal of Obstetrics and Gynecology Research 2020;7(2):177–181

many others. 4 In our study only 50% were aware that smoking reduces
Increasing the level of knowledge of these factors may the sperm parameters in men and 57% were aware that
help to decrease the incidence of infertility by allowing increased age in men also reduces fertility.
couples to avoid certain risk factors that might lead to it.
This knowledge may also help wider society to understand 4.2. Attitude towards infertility and its social
and empathize with the infertile couple, which may lead to consequences
a decrease in the psychological burden to those affected. 5
More ever, patient education has been found to be a key Table 3 shows the response of infertile patients to some
aspect of patient satisfaction with infertility care. attitudinal statements towards infertility and its social
Researches exploring the knowledge, behaviors, percep- consequences. In our study, 70% of couples labelled
tions and practices regarding infertility or certain treatment infertility as disease. Only 15.5% were that it was a
options have been carried out in developed countries but problem of the couple and needed investigation of the
very limited data is available from the Indian population couple simultaneously. In our study, we found that 91.5% of
despite high prevalence of infertility. females were blamed by the family members and the society
This present study was conducted in our hospital inspite of the fact that the cause may be related to any one
to evaluate the knowledge of infertile couples attending of the partner.
to outpatient department(OPD) about the risk factors
associated with infertility and to assess their attitude towards 5. Discussion
various methods of infertility treatment.
In a survey among reproductive age women our data
identified significant knowledge gaps and misconceptions
2. Aim and Objectives surrounding the reproductive health and conceptions. Many
1. To assess the knowledge and attitude of infertile women have limited understanding regarding risk factors
couples attending gynecological OPD. related to conception and infertility.
2. To assess the possible risk factors and social The rate of infertility in India is 10-14%. The mean age
consequences towards infertility. of our study was 26 years for female and 30 years for male.
Only 10% were higher education status among females and
3. Materials and Methods 20% are graduates among males.
According to Bunting and Boivin et al 6 2007, knowledge
A prospective observational study was conducted on about fertility issues is a core motivator for fertility
infertility patients attending to R l Jalappa hospital and problems. A Global survey revealed inadequate knowledge
research centre from February 2018 to July 2018, on of women regarding infertility 3 our study also demonstrated
all the infertile couples (n=154). Recruitment was based that the participants had inadequate knowledge about the
on the couple’s willingness to answer the questionnaire. risk factors associated with infertility.
The couples were informed about the study and offered In our study, 75% of female partners were aware that
knowledge and attitude based questionnaires during clinical increasing age results in decline in fertility which is similar
history taking. The questionnaire contains 16 knowledge to study by Bunting and Boivin et al, 6 but there was
based and 7 attitude based questions. Their level of lack of awareness of the significance of age for declining
knowledge was assessed by giving score 1 to correct answer, fertility among childless Canadian women 7 and Australian
Zero for wrong and those do not know the answer. Those women, 8 and among the University students in Sweden. 9
who scored <50% were considered to have inadequate, In our study, we found that 77% were aware that
those with scores >50 to 75% as moderately adequate and obesity has negative effects on infertility which is similar to
those with scores >75% adequate knowledge regarding Abolfotouh et al., 10 Brannian et al., 11 Bunting et al. 12 study
infertility. and Daniluk et al. 7 study.
In our study, we found that 81% women were aware that
4. Results irregular cycles may be a cause for delay in pregnancy, but
in Abolfotouh et al 10 study only 64% were aware about it.
4.1. Knowledge and misconceptions regarding related
It is crucial to know about the fertile period for a women,
to infertility
when she should try to conceive. In our study, fertile period
Table 2 shows the response of infertile towards risk factors was known to only 55% participants similar to Ali et al 13
associated with infertility. In our study, most of the patients 48% were aware of it.
(> 70%) of respondents were aware the common risk In our study 82.5% of female partners were not aware
factors such as advanced age, obesity, irregular menstrual about the genital tract infections as risk factor for infertility.
cycle, stress, advantages of regular exercise. But only 55% Since, diagnosis and treatment of genital tract infections
respondents were aware about fertile period. can prevent the major sequel, the tubal block, awareness of
 Gomathy E et al. / Indian Journal of Obstetrics and Gynecology Research 2020;7(2):177–181 179

Table 1: Demographic data (Parameters)

Mean age of female (years) 26.79±4.721 Range 20-45 years
Mean age of male (years) 30.87±4.168 Range 25-48 years
Type of infertility Primary – 111(72.1%) Secondary – 43 (27.9%)
Mean duration of infertility Primary -2.29±1.093 Secondary-4.73±1.78

Table 2: Response of couple about knowledge based questionnarie

Questions Yes No Don’t Know
Do you think increasing age in women may delay to 116(75.3%) 26(16.9%) 12(7.8%)
achieve pregnancy?
Does obesity in a women delay the fertility? 119(77.3%) 16(10.4%) 19(12.3%)
Do you think irregular cycle may be a cause for delay in 124(80.5%) 14(9.1%) 16(10.4%)
achieving pregnancy?
Does pain in lower abdomen during periods and during 30(19.5%) 53(34.4%) 71(46.1%)
sexual intercourse delays in pregnancy?
What do you mean by fertile period in a women having 84(54.54%) 60(38.96%) 10(6.5%)
regular cycle?
Do you think foul smelling discharge per vagina in a 27(17.53%) 40(25.97%) 87(56.5%)
women is a cause for pregnancy delay?
Does OCP use in past delay conception in the women? 74(48.06%) 20(12.98%) 60(38.96%)
Do you think frequency of intercourse increases the chance 94(61%) 38(24.7%) 22(14.3%)
of pregnancy?
Does lying down in bed for long time after sexual 108(70.1%) 21(13.7%) 25(16.2%)
intercourse increase the pregnancy chance?
Do you think stressful life in a women affects her fertility? 139(90.3%) 07(4.5%) 08(5.2%)
Do you think delay in pregnancy runs in families? 51(33.1%) 57(37%) 46(29.9%)
Do you think exposure to environmental pollutant reduce 70(45.4%) 32(20.8%) 52(33.8%)
fertility
Do you think regular exercise by a women increases her 118(76.6%) 14(9.1%) 22(14.3%)
fertility?
Does smoking reduce sperm parameters in men? 78(50.6%) 44(28.6%) 32(20.8%)
Do you think increasing age in men reduces fertility? 87(56.5%) 40(25.97%) 27(17.53%)
Do you think a women conceived previously might have 48(31.2%) 81(52.6%) 25(16.2%)
problems to conceive again?

Table 3: Response of couple about attitude based questionnarie

Questions Yes No
Do you think infertility is a disease? 108( 70.1%) 46(29.9%)
Who do you think it should be investigated first? H–5(3.24%) W-125 (81.16%) B- 24(15.58%)
Who is being blamed for infertility in the society? H-1(0.7%) W-141(91.5%) B-12(7.8%)
Do you think it is socially acceptable to have a test 8 (5.19%) 132(85.71%) 14(9.1%)
tube baby?
If a couple cannot have a child, do you think they 18(11.7%) 128(83.11%) 8(5.19%)
should adopt?
Do you think your husband should donate sperm 12(7.8%) 108(70.12%) 34(22.1%)
to help an infertile couple to have a baby?
Are you interested to donate your egg to help an 10(6.5%) 106(68.8%) 38(24.7%)
infertile couple to have a baby?

Table 4: Levels of knowledge

Knowledge No Percentage(%)
Inadequate knowledge 80 51.9
Moderately adequate knowledge 68 44.2
Adequate knowledge 8 3.9
180 Gomathy E et al. / Indian Journal of Obstetrics and Gynecology Research 2020;7(2):177–181

genital infection as a risk factor is highly required in our Only a small group of population was studied.
society.
In our study, 48% had misconception that use of oral 7. Conclusion
contraceptive affect their fertility status and 38% were
not aware about the OCP role, this misconception may Infertility is common problem affecting 10-15% of the
have led to unwanted pregnancy loss, but in Ali et population. The knowledge about infertility and its risk
al. 13 study, 61% correctly highlighted use of OCP affecting factors is generally limited among the participants, inspite
the fertility. Study conducted by Bunting 5 also highlighted of their educational status. In fact, there are a lot of
that participants had a false belief that use OCP as risk factor misconceptions, such as OCPs can cause infertility. The
for infertility. cultural and religion perspective about ART is unclear,
In our study, 70% of the respondents had the false belief which has resulted in its reduced acceptability. There should
that lying down in bed for long time after sexual intercourse be some recommendations for enhancing the reproductive
increases the chances of pregnancy, which is similar to healthcare and increase the knowledge regarding it.
Bunting and Boivin et al. 5 study in which participants We should create effective strategies for improving the
believed in the myth that lying down for 10 minutes after awareness and education regarding fertility by conducting
sex increases the pregnancy rate. counseling sessions, interactive classes and web based and
In our study, 90% females were aware about the negative media based education.
effect of stress on fertility, which is had similar to other
studies. 8. Source of Funding
In our study, only 33% of couple belief that infertility None.
runs in family but no other study commented on hereditary
nature of fertility. 9. Conflict of Interest
In our study, 56.5% women thought that increasing man’s
age reduces the chance of infertility, which is similar to None.
Daniluk and Koert et al. study. 7
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Cite this article: Gomathy E , Radhika K, Patil SS, Sneha R.
Knowledge and attitude of infertile couples attending rural tertiary care
centre. Indian J Obstet Gynecol Res 2020;7(2):177-181.