RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DESSERTATION
1 / NAME AND ADDRESS OF THECANDIDATE. / MS. FIROUZEH SHEIKHI
ACHARYA COLLEGE OF NURSING,
CHOLANAGAR, R.T NAGAR POST,
BANGALORE.
2 / NAME OF THE INSTITUTE. / ACHARYA COLLEGE OF NURSING,
CHOLANAGAR, R.T NAGAR POST,
BANGALORE.
3 / COURSE OF THE STUDY AND SUBJECT / M.SC NURSING 1St YEAR IN OBSTETRICS AND GYNAECOLOGY
4 / DATE OF ADMISSION TO COURSE / 14/06/2013
5 / STATEMENT OF THE PROBLEM / A DISCRIPTIVE STUDY TO ASSESS THE KNOWLEDGE REGARDING INNOVATIVE TREATMENT FOR INFERTILITY AMONG INFERTILITY WOMEN IN SELECTED INFERTILITY CLINIC AT BANGALORE, WITH A VIEW TO DEVELOP AN INFORMATION BOOKLET ON INNOVATIVE TREATMENT FOR INFERTTILITY.
6.BRIEF RESUME OF THE INTENDED WORK
“Pain during labour is tolerable but…emotional pain due to infertility is intolerable”
INTRODUCTION:
Infertility is the inability to conceive children after one year of unprotected intercourse. The risk of infertility increases with advanced age of the female partner (>35years). Female infertility may present as un ovulation, obstructed fallopian tubes, endometriosis or uterine abnormalities. Male factor infertility is characterized by diminished production of morphologically normal, motile sperm. Genetic abnormalities, hormonal imbalances and congenital/infectious malformations of the reproductive tract are some of the common causes of male and female infertility.1
Lifestyle factors such as obesity, diet, smoking and alcohol usealong with environmental chemical exposureshave been increasingly examined as additional modifiers of fertility. Infertility has been conceptualized emotionally stressful and psychologically threatening experience and reaction to it have been compared with grief. Risk factor of Infertility awareness, including knowledge of female risk factors, is a critical first step towards fertility preservation through lifestyle modification.2
On the other hand, different aspects of this technology lead to many serious socio- economical and ethical problems. Particularly for those who practice reproduction techniques, it is important to learn about the various public attitudes related to parental rights, legislation and available resources for assisted reproductive technologies (ART).3
The last quarter of the 20th century has witnessed several major advances in reproductive medicine. One of the most widely publicized, celebrated and, at the time, controversial medical landmarks in this area was the birth, in 1978, of the first human baby resulting from in vitro fertilization (IVF). Since then, IVF has become a routine and widely accepted treatment for infertility. But one of many procedures in the increasingly complex and sophisticated field of biomedicine known as assisted reproduction. Since 1978, nearly one million babies have been born worldwide as the result of assisted reproductive technology (ART) of one form or another.4
Infertility is a global phenomenon. It is commonly accepted that infertility affects more than 80 million people worldwide. In general, one in ten couples experiences primary or secondary infertility, but infertility rates vary amongst countries from less than 5% to more than 30%. Most of those who suffer from infertility live in developing countries where infertility services in general, and ART in particular, are not available.5
Infertility in India is found approximately 5, 056, 070, 60 and about 8% of Karnataka people are infertile. Previous studies of Swedish, Finnish, Italian, American, United Kingdom (UK), Israeliand Canadianuniversity students have reported gaps in awareness of female infertility risk factors and an overestimation of the fertility of women in their late thirties. In the Indian context there is great pressure on the woman to prove her fertility within a few years of her marriage. The 1981 census data were analyzed to show the pattern of childlessness among married woman.6
In India 18.5% of married woman are childless. As a whole there are 5.6% of woman in the 30-49 age group who are childless and the percentage in rural and urban areas are almost the same. Infertility is surrounded by many mistaken beliefs about its causes, such as witch craft and possession by evil spirits, and these beliefs negatively affect its management. Social stigma regarding infertility is especially common across South Asia.6
Knowledge about infertility is inadequate in many parts of the world. A global survey of almost 17,500 women (mostly of childbearing age) from 10 countries revealed that knowledge regarding fertility and biology of reproduction was poor.2
Although infertility may not be a public health priority in many countries, it is a central issue in the lives of the individuals who suffer from it. It is a source of social and psychological suffering for both men and women and can place great pressures on the relationship within the couple. While the role and status of women in society should not be defined solely by their reproductive capacity, in some societies womanhood is defined through motherhood. In these situations, the personal suffering of the infertile woman is exacerbated and can lead to unstable marriage, domestic violence, stigmatization and even ostracism. The experience of infertility as a private harm for which individuals, usually women, are to blame.9
According to the WHO definition of health, it could be argued that the emotional and psychological harms associated with infertility are health harms. Denying psychological harm as a serious health problem is a classic maneuver that has been the cause of pervasive health care discrimination in most countries. severe and very physical violence is based on the frequency of beatings by the husband, cuts and bruises, abusive emotional or verbal behavior of the husband toward the wife, intimidation resulting in fear of the husband, familial or community physical or emotional violence, and sexual abuse (including refusal of sexual relations or rape) by the husband toward the wife.10
A study in Australia showed that 64.2% of people regarded egg donation to be a reasonable treatment for infertility. 7
In another study in Canada 47% of answerers confirmed embryo reduction. In a study done in the United States 71% of infertile couples mentioned no interest to a genetic evaluation and only 14% of them accepted the issue of egg donation as a solution to prevent genetic abnormalities.6
The present study is designed to assess the Knowledge of infertile women about the innovative modalities treatment toward some of its related aspects.
6.1 Need for the study
Infertility is a disease of the reproductive system which affects women with more frequency. Infertility is usually defined as involuntary failure to conceive after one year of unprotected sexual intercourse.1
A report available at the WHO library explains primary and secondary infertility affects 8-12% couples (50-80 million) worldwide. When a woman has never conceived, despite sexual relation, for a period of one year, it is primary infertility. When a woman has previously conceived, and is subsequently unable to conceive, despite sexual relation for a period of one year, it is secondaryinfertility.14
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Throw previous study which shown the knowledge about infertility are poor and level of the attitude and knowledge of infertility risk factors is not good enough specially in south Asian countries and we need to assess more about this sensitive matter and hope to achieve a better understanding of the level of knowledge of infertility for preservation.8
A study was conducted on outcome of assisted reproductive technologies in women with oocyte donation in the treatment cycle. The study suggested that in patients who produce more oocyte, egg donation in the treatment cycle does not influence adversely the outcome of artificial reproductive technology cycle and does not increase miscarriage rate.2
A cross-sectional study about knowledge, perceptions and myths regarding infertility among selected adult population in Pakistan discovered that the knowledge about infertility is generally limited in the population and a lot of misconceptions and myths are prevalent in the society. Alternative medicine is a popular option for seeking infertility treatment. The cultural and religious perspective about assisted reproductive technologies is unclear, which has resulted in its reduced acceptability. . Only 25% correctly identified when infertility is pathological and only 46% knew about the fertile period in women's cycle. People are misinformed that use of IUCD (53%) and OCPs (61%) may cause infertility. Beliefs in evil forces and supernatural powers as a cause of infertility are still prevalent especially amongst people with lower level of education. Seeking alternative treatment for infertility remains a popular option for 28% of the participant as a primary preference and 75% as a secondary preference. IVF remains an unfamiliar (78%) and an unacceptable option (55%).13
A study of knowledge, attitude, and practices of infertility among Saudi women discovered a generally poor level of knowledge (59%) and a neutral attitude (76%) toward infertility were reported by participants. Mistaken beliefs commonly held by the study participants regarding the causes of infertility were Djinns and supernatural causes (58.8%), black magic (67.5%), intrauterine devices (71.3%), and contraceptive pills (42.9%). The healer/Sheikh was reported as the primary and secondary preference for infertility treatment by 6.7% and 44.2% of IVF patients, respectively. Compared with fertile women, IVF patients were significantly less likely to favor divorce (38.5% versus 57.6%;P= 0.001) or marriage to a second wife (62.5% versus 86.2%;P< 0.001), if the woman could not have a baby. The patients with infertility had more favorable attitudes toward fertility drugs (87.5% versus 68.4%;P= 0.003) and having a test tube baby (92.4% versus 70.3%;P< 0.001). Child adoption was accepted as an option for treatment by the majority of IVF patients (60.6%) and fertile outpatients (71.5%). Alternative treatments previously practiced by the IVF patients to improve fertility include practicing Ruqia (61%), using alternative medicine (42%), engaging in physical exercise (39%), eating certain foods (22%), and quitting smoking (12%).8
A study to assess the Knowledge and attitudes of infertile women about assisted reproductive technology in 2005 in Iran between the 400 infertile patients which were investigated by a self- administered structured questionnaire about demographic data, infertility history, and several relevant variables in an out patient infertility clinic of a university hospital. They concluded of 400 cases (251 women and 149 men) 167 patients (41.7%) were scaled to have good knowledge and 223 patients (55.7%) had a poor knowledge about ART. 74.6% of patients with advanced education and 30.3% of patients without advanced education were scaled to be good in knowledge. 45.6% of men, 43.4% of women and 64.8% of patients with a history of passing previous ART cycles had a good knowledge. The source of information was mentioned to be the ART centers in 73% of cases. 95% of patients disagreed to have sperm or ovum donation or to undergo surrogacy. 22% of all patients (27.5% of women versus 12.1% of men) agreed with embryo reduction. 94.5% of patients mentioned the ART expenses not to be affordable readily.2
Wimberley YH et al conducted study on adolescent beliefs about infertility in infertile women. The results evidenced that most adolescents generally understood fertility as the ability to become pregnant. Ten themes emerged as causes of infertility. Anatomic/gynecologic causes generated the most responses and most detailed discussion. 6
A Global Perspective on Infertility: An under Recognized Public Health Issue at the University of North Carolina-Chapel Hill found out the medical condition of infertility exists at the crossroads of personal and societal domains. Individuals and couples suffering from unwanted childlessness experience significant, at times life threatening, consequences. Prevalence is significant and the condition is often linked to preventable infections including HIV and other STIs. Comprehensive reproductive health care, as mandated by human rights documents, often neglects recognition and treatment of infertility.16
A case control study was conducted to assess the differences in attitude towards aspects of assisted reproductive technology between infertile and parous women in a university-based tertiary clinic of Kuopio. The study revealed that response rate in the group of infertile women was 48% (189/392. Two-thirds of infertile women and 58% of parous women agreed to the question that it is the duty of the parents to tell a child about the use of assisted reproductive technology. Infertility was regarded an illness by 65% of the infertile women, but only 34% of the parous women. Thus the study conducted that a split attitude was influenced by the wish of infertile women to help childless couples and to the able to recruit suitable sperm/oocyte donors. Parous women were motivated by their concern for children’s right.17
The risk factors for infertility include smoking, obesity, alcohol consumption, advanced maternal age, sexually transmitted infections, and many others. Women facing infertility exhibit significantly more tension, hostility, anxiety, depression, self-blame, and suicidal ideation.Knowledge about infertility is inadequate in many parts of the world. A global survey of almost 17,500 women (mostly of childbearing age) from 10 countries revealed that knowledge regarding fertility and biology of reproduction was poor. Many women are verbally or physically abused in their own homes, deprived of their inheritance, sent back to their parents, ostracized, looked down upon by society, or even have their marriage dissolved or terminated if they are unable to conceive. Increasing the level of knowledge of these factors may help to decrease the incidence of infertility by allowing women to avoid certain risk factors that might lead to it. This knowledge may also help wider society to understand and empathize with the infertile women, which may lead to a decrease in the psychological burden to that affected.18
The above finding probed the investigator to select the topic regarding descriptive study to assess knowledge regarding innovative treatment for infertility among infertile women attending selected infertility clinics at Bangalore.
6.2 Review of literature
A review of literature enables one to get an insight into the various aspects of the problems under study. It covers promising methodological tools, throws light on ways to improve the efficiency of data collection and suggests how to increase effectiveness of data analysis and interpretation. Review of literature is therefore an essential step in the development of the research project.
I read several published literature about the preventive practices, knowledge and risk factors regarding infertility of women, risk factors and innovative treatment among infertility women which are as follows:
6.2. 1 Review of literature related to infertility among women.
6.2.2 Review of literature related to risk factors of infertility among women.