The present study has provided useful data about the personality features and the sexual behavior of infertile couples.
Regarding the psychological dimension we did not find any distinctive feature in infertile patients. This finding is in accordance with the extensive review of Greil et al. that states that most studies have failed to uncover many personality differences between infertile and fertile groups. However, in a recent study exploring individual psychological functioning and marital adjustment, infertile couples showed higher scores in measures of depression, external and internal shame, acceptance and self-compassion compared to fertile controls and adoption candidates. Furthermore, infertile patients pursuing medical treatment presented higher avoidant and emotional coping styles. A possible reason for these contradictory results may be the lack of an adequate follow-up in all groups.
Our study did not point out any gender difference in the emotional profile of infertile patients, whereas previous studies have demonstrated that infertility is a more devastating experience for the female partner[29, 30]. A Canadian survey, although dated, is still significant in this field, since it enrolled 449 couples. Women displayed higher distress than their partners on a global measure of psychiatric symptoms and in the subscales of anxiety, depression, hostility and cognitive disturbances as well as on measures of stress and self-esteem. Besides, a two-year longitudinal study aimed at assessing the psychosocial impact of infertility confirmed that women experience substantially higher levels of stress than men at the time of diagnosis. However this gender difference is reduced in time. Furthermore, a gender comparison between men and women candidate to in-vitro fertilization (IVF) showed a greater distress in the female partner. The negative emotional response was related both to infertility diagnosis and to infertility treatment. In addition to that women were more likely to endorse negative reactions to IVF failure. It has been speculated that three factors operate together in driving the women distress level higher than their spouses. First of all the social responsibility of conceivement and pregnancy is still attributed mainly to the female partner. Furthermore medical treatment is more intrusive on women than men (time-counsuming, painful[31, 32]. Finally coping strategies differ between men and women: men tend to deny and remain active, while women cannot imagine life with no children and develop depressive reactions[31, 33].
As far as sexual functioning is concerned, we found significant differences both between men and women and among the groups. With regard to gender difference, women displayed lower scores in the subscales “orgasm”, “sexual satisfaction” and “desire”. This finding is in accordance with the results of previous studies[6, 10]. Female partners enrolled in a large survey of 121 infertile couples reported low mean scores in FSFI, 26% of which were consistent with high risk of sexual dysfunction. Furthermore Laffont’s study showed a marked drop in sexual desire in the women enrolled. Finally, according to the results of Ohl’s research, women experience less sexual satisfaction compared to their partners and avoid sexual intercourse more frequently.
Focusing on the difference between the groups, we might speculate a different impact of the stage of treatment. As far as IIEF is concerned, Group A scored lower than the controls in the “erectile dysfunction” subscale. This datum highlights the importance of an infertility diagnosis on male sexual function. According to the literature, temporary erectile disorders could often be caused by the diagnostic exams, such as semen analyses and post-coital tests. A meaningful finding in this respect is that in one study 11% of men with a previously abnormal semen analysis are unable to produce the sperm needed for a second spermiogram. Another significant difference between Group A and normal controls were the decline in “orgasm”, “desire”, “sexual satisfaction” and “overall satisfaction” in the former. These can be due to the progressive erotic disinvestment of sexual activity, enhanced by medical prescriptions that encourage patients to have sex preferably on fertile days. As far as FSFI is concerned, most of the parameters analyzed were significantly lower in infertile patients if compared to fertile controls: sexual intercourse is deprived of its erotic value, thus it is characterized by fewer preliminaries, lower sexual desire, poorer perception of psychic excitation and fewer signs of physical excitation.
The current study findings should be interpreted considering some methodological limitations. First of all, the small sample size could have prevented us from finding statistically significant differences in some of the fields explored. Moreover, an adequate follow-up was not carried out, thus possible consequences of infertility treatment might have been underestimated. Further studies on bigger samples and longer follow-up will settle the issue. Furthermore objections could be raised to the instruments used in the present study. Since no study has proved the relationship between FSFI/IIEF and personality measures yet, still the latter are not universally recognized as predictors of sexual functioning. On the other hand, psychopathological symptoms related to infertility, like anxiety, hostility, depression have not been directly evaluated in the present study, although they are known to affect sexual functioning. Thus the differences found between infertile couples and non-infertile couples cannot be completely attributed to infertility or to the psychological maladjustment resulting from infertility. Additionally it can be argued that, since our control group was not looking for pregnancy (right now/ in the short term), the erotic valence of sex would be potentially higher in this group (that has more freedom to decide when and how to have sex), possibly affecting the scores on FSFI/IIEF (particularly sexual desire, lubrication, female orgasm). Besides no distinctions were made on the grounds of the duration of infertility; it would be useful, instead, to examine possible differences depending on the duration of involuntary childlessness. What is more, our results can be regarded as partial because the couples enrolled were candidate to IUI. Thus it can be argued that our sample was made up of patients suffering from milder infertility conditions that do not require complex techniques, so they might have had a more optimistic view of their situation and have experienced lower sexual and emotional distress. On the other hand most of the studies on this topic engage patients undergoing Intracytoplasmic sperm injection (ICSI) or in vitro fertilization and embryo transfer (IVF/ET). Besides, our data proved to be useful in assessing two important dimensions of the infertile couple’s background: sexuality and personality. Furthermore they provide a useful “portrait” of the infertile couple in the very first phase of the treatment. Even if the sexual disturbances detected differed both according to the gender and to the phase of treatment, they overall showed a strong relation to infertility and its treatment. Thus sexual counseling should be introduced in the clinical management of infertile couples in order to preserve the quality of the couple’s sexual relationship and optimize the chances of pregnancy. In fact many studies have claimed the importance of a global approach to the childless couples, in which the systematical discussion of sexual problems should be granted[4, 7, 10]. Furthermore sexual counseling could help prevent psycho-sexual repercussions, favoring the couple’s adjustment to infertility diagnosis and medical treatment, and it could point out possible distress caused by sexual disturbances. Above all, sexual counseling should aim at restoring the playful, spontaneous, and imaginative side of sexuality, regardless of the fertile days.