Advances in Nursing & Midwifery

Vol. 34 No. 1 (2025)

The Relationship between Infertility Stigma, Perceived Infertility Stress, and Fertility-Related Quality of Life in Women: The Mediating Role of Sexual Function

Advances in Nursing & Midwifery, Vol. 34 No. 1 (2025), 15 January 2025 , Page 98-105
https://doi.org/10.22037/anm.v34i1.50432

Abstract

Introduction: Infertility, a prevalent global health concern, imposes significant psychological and social burdens—including stigma and distress—particularly on women, adversely affecting their well-being. This study examines the associations among infertility stigma, perceived infertility stress, and fertility-related quality of life (FertiQoL) in women, emphasizing the mediating role of sexual function.
Methods: A descriptive-correlational design utilizing structural equation modeling (SEM) was employed. The study population comprised married women aged 20–45 years with a confirmed diagnosis of primary infertility in Ahvaz, Iran, in 2024. A convenience sample of 295 women was recruited. Data were collected using validated Persian versions of the Infertility Stigma Scale (ISS), Fertility Problem Inventory (FPI), Female Sexual Function Index (FSFI), and Fertility-Related Quality of Life (FertiQoL) scale (Cronbach's alphas: 0.89–0.93). SEM was conducted using SPSS v.26 and AMOS v.24 to analyze relationships among variables.
Results: The SEM model exhibited a good fit. Perceived infertility stress showed a significant negative direct effect on FertiQoL (P<0.01), whereas the direct effect of infertility stigma on FertiQoL was non-significant. Sexual function significantly mediated the relationships between both infertility stigma and perceived stress (P<0.01) with FertiQoL, indicating an indirect effect.
Conclusions: These findings underscore the importance of addressing psychological stress and sexual dysfunction to enhance FertiQoL in infertile women. While infertility stigma lacks a direct effect, its influence is fully mediated through sexual function. Clinical interventions should prioritize stress reduction and sexual health, which may also positively influence infertility treatment outcomes, to improve well-being.

Keywords:
  • Infertility
  • Quality of life
  • Psychological stress
  • Sexual dysfunction
  • Stigma
  • Women

How to Cite

Behbahani Mondanizadeh, A., Homaei, R., Hafezi, F., & Talebzadeh Shoushtari, M. (2025). The Relationship between Infertility Stigma, Perceived Infertility Stress, and Fertility-Related Quality of Life in Women: The Mediating Role of Sexual Function. Advances in Nursing & Midwifery, 34(1), 98–105. https://doi.org/10.22037/anm.v34i1.50432

References

1. Feng J, Wu Q, Liang Y, Liang Y, Bin Q. Epidemiological characteristics of infertility, 1990-2021, and 15-year forecasts: an analysis based on the global burden of disease study 2021. Reprod Health. 2025;22(1):26. doi: 10.1186/s12978-025-01966-7 pmid: 39972325

2. Imannezhad S, Mirzaei M, Khodadadi B, Heydari O, Dehghani N. Prevalence of Infertility among Iranian Women: An Overview of Systematic Reviews and Meta- Analyses. Health Providers. 2024;4(1):1-8. doi: 10.22034/hp.2024.451486.1043

3. Hasanpoor Azghdy SB, Simbar M, Vedadhir A, Hossein Rashid B. Psychological impact of infertility among infertile women. Advances in Nursing & Midwifery. 2014;23(83):1-10. doi: 10.22037/anm.v23i83.5295

4. Langher V, Fedele F, Caputo A, Marchini F, Aragona C. Extreme Desire for Motherhood: Analysis of Narratives From Women Undergoing Assisted Reproductive Technology (ART). Eur J Psychol. 2019;15(2):292-311. doi: 10.5964/ejop.v15i2.1736 pmid: 33574956

5. Taebi M, Kariman N, Montazeri A, Alavi Majd H. Infertility Stigma: A Qualitative Study on Feelings and Experiences of Infertile Women. Int J Fertil Steril. 2021;15(3):189-96. doi: 10.22074/IJFS.2021.139093.1039 pmid: 34155865

6. Xie Y, Ren Y, Niu C, Zheng Y, Yu P, Li L. The impact of stigma on mental health and quality of life of infertile women: A systematic review. Front Psychol. 2022;13:1093459. doi: 10.3389/fpsyg.2022.1093459 pmid: 36698573

7. Peterson B, Taubman-Ben-Ari O, Chiu B, Brown D, Frederick DA. Infertility stigma and openness with others are related to depressive symptoms and meaning in life in men and women diagnosed with infertility. Reprod Health. 2025;22(1):7. doi: 10.1186/s12978-025-01951-0 pmid: 39856685

8. Jo M, Shin H, Kabbe A, Kim SJ. Depressive symptoms and quality of life among women experiencing infertility: The moderating effect of perceived social support. Heliyon. 2025;11(1):e41544. doi: 10.1016/j.heliyon.2024.e41544 pmid: 39850413

9. Fu B, Qin N, Cheng L, Tang G, Cao Y, Yan C, et al. Development and validation of an Infertility Stigma Scale for Chinese women. J Psychosom Res. 2015;79(1):69-75. doi: 10.1016/j.jpsychores.2014.11.014 pmid: 25499618

10. Bahadur A, Kumari S, Mundhra R, Khoiwal K, Das A, Heda A, et al. Anxiety, Depression, and Quality of Life Among Infertile Women: A Case-Control Study. Cureus. 2024;16(3):e55837. doi: 10.7759/cureus.55837 pmid: 38590470

11. Tang Q, Zhou X, Wang N, Qian X. Irrational parenthood cognition and infertility stigma among infertile women: A cross-sectional study in Changsha, China. Heliyon. 2024;10(15):e34428. doi: 10.1016/j.heliyon.2024.e34428 pmid: 39144931

12. Ni Y, Shen H, Yao H, Zhang E, Tong C, Qian W, et al. Differences in Fertility-Related Quality of Life and Emotional Status Among Women Undergoing Different IVF Treatment Cycles. Psychol Res Behav Manag. 2023;16:1873-82. doi: 10.2147/PRBM.S411740 pmid: 37250753

13. Aflakseir A, Zareh M. Relationship of Infertility Stress with Perception of Control Among a Group of Women with fertility Problem in Shiraz. Zahedan Journal of Research in Medical Sciences. 2019;21(1):e69079. doi: 10.5812/zjrms.69079

14. Abdoli S, Khazaei S, Fazli F, Pilehvari S, Jenabi E. Infertility-related stress and marital intimacy among infertile couples undergoing in vitro fertilization treatment in Western Iran: A cross-sectional study. Eur J Obstet Gynecol Reprod Biol X. 2025;26:100384. doi: 10.1016/j.eurox.2025.100384 pmid: 40230509

15. Taheri T, Jahani Shoorab N, Afiat M, Feyzi J, Jamali J. The Impact of Acceptance and Commitment Therapy on Perceived Stress in Women with Primary Infertility Undergoing in Vitro Fertilization: A Randomized Clinical Trial. Journal of Midwifery and Reproductive Health. 2025;13(1):4557-67. doi: 10.22038/jmrh.2023.69759.2053

16. Batinic B, Milovanovic J, Dragojevic-Dikic S. Correlation between perceived infertility-related stress and fertility quality of life in women diagnosed with primary infertility. European Psychiatry. 2021;64(S1):S600-S1. doi: 10.1192/j.eurpsy.2021.1602

17. Soleimani R, Ansari F, Hamzehgardeshi Z, Elyasi F, Moosazadeh M, Yazdani F, et al. Perceived stress reduction through an infertility coaching program: a randomized controlled clinical trial. Sci Rep. 2023;13(1):14511. doi: 10.1038/s41598-023-41845-4 pmid: 37666933

18. Park JC. Assessment of anxiety, depression, and sexual dysfunction in women undergoing fertility treatment. Clin Exp Reprod Med. 2025;52(1):38-43. doi: 10.5653/cerm.2024.07465 pmid: 40018791

19. Okobi OE. A Systemic Review on the Association Between Infertility and Sexual Dysfunction Among Women Utilizing Female Sexual Function Index as a Measuring Tool. Cureus. 2021;13(6):e16006. doi: 10.7759/cureus.16006 pmid: 34336497

20. Salomao PB, Navarro PA, Romao A, Lerri MR, Lara L. Sexual Function of Women with Infertility. Rev Bras Ginecol Obstet. 2018;40(12):771-8. doi: 10.1055/s-0038-1673699 pmid: 30381810

21. Kohansal F, Nourizadeh R, Attarzadeh Jahdi NS, Mehrabi E, Arab Bafrani M. The Effect of Educational Interventions on Sexual Behavior and Reproductive Health of Women: A Systematic Review. Advances in Nursing & Midwifery. 2022;31(1):14-21. doi: 10.22037/anm.v31i1.39287

22. Amraei S, Abedi P, Nikbakht R, Tadayon M, Maraghi E. Does Infertility Stress Impair Sexual Function in Infertile Women and Men? A Cross-Sectional Study in Iran. Front Med (Lausanne). 2022;9:896538. doi: 10.3389/fmed.2022.896538 pmid: 35814743

23. Boivin J, Takefman J, Braverman A. The fertility quality of life (FertiQoL) tool: development and general psychometric properties. Hum Reprod. 2011;26(8):2084-91. doi: 10.1093/humrep/der171 pmid: 21665875

24. Hekmatzadeh SF, Bazarganipour F, Hosseini N, Allan H, Jalali S, Abbasian Z, et al. Psychometrics properties of the Iranian version of fertility quality of life tool: A cross- sectional study. Int J Reprod Biomed. 2018;16(3):191-8. pmid: 29766150

25. Newton CR, Sherrard W, Glavac I. The Fertility Problem Inventory: measuring perceived infertility-related stress. Fertil Steril. 1999;72(1):54-62. doi: 10.1016/s0015-0282(99)00164-8 pmid: 10428148

26. Samani RO, Almasi-Hashiani A, Shokri F, Maroufizadeh S, Vesali S, Sepidarkish M. Validation study of the Fertility Problem Inventory in Iranian infertile patients. Middle East Fertility Society Journal. 2017;22(1):48-53. doi: 10.1016/j.mefs.2016.07.002

27. Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, et al. The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000;26(2):191-208. doi: 10.1080/009262300278597 pmid: 10782451

28. Ghassamia M, Asghari A, Shaeiri MR, Safarinejad MR. Validation of psychometric properties of the Persian version of the Female Sexual Function Index. Urol J. 2013;10(2):878-85. pmid: 23801471

29. Rajabi G, Amiri Asl J, Jelodari A. Assessing Reliability and Validity of the Persian version of Infertility Stigma Scale (ISS) in Infertile Women. Scientific Journal of Hamadan Nursing & Midwifery Faculty. 2017;25(4):104-13. doi: 10.30699/sjhnmf.25.4.104

30. Jaber DJ, Basheer HA, Albsoul-Younes AM, Elsalem LM, Hamadneh JM, Dweib MK, et al. Prevalence and predictive factors for infertility-related stress among infertile couples: A cross-sectional study from Jordan and the occupied Palestinian territories. Saudi Med J. 2022;43(10):1149-56. doi: 10.15537/smj.2022.43.10.20220411 pmid: 36261208

31. Ashraf DM, Ali D, Azadeh DM. Effect of Infertility on Sexual Function: A Cross-Sectional Study. J Clin Diagn Res. 2015;9(5):QC01-3. doi: 10.7860/JCDR/2015/11148.5934 pmid: 26155520

32. Karunyam BV, Abdul Karim AK, Naina Mohamed I, Ugusman A, Mohamed WMY, Faizal AM, et al. Infertility and cortisol: a systematic review. Front Endocrinol (Lausanne). 2023;14:1147306. doi: 10.3389/fendo.2023.1147306 pmid: 37455908

33. Luo D, Zhouchen YB, Li L, Jiang YL, Liu Y, Redding SR, et al. The Stigma and Infertility-Related Stress of Chinese Infertile Women: A Cross-Sectional Study. Healthcare (Basel). 2024;12(11). doi: 10.3390/healthcare12111053 pmid: 38891128

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