604 research paper
TRANSCRIPT
Running head: INFERTILITY & CULTURE 1
The Effects of Infertility on Relationship Quality in Different Cultures
Anastasia Theisen
Northern Illinois University
INFERTILITY & CULTURE 2
The Effects of Infertility on Relationship Quality in Different Cultures
Introduction and Justification
Infertility is defined as the reduced ability to conceive a child and the inability to carry a
child to term, or complete a full pregnancy (Oregon Reproductive Medicine, n.d.). Infertility
affects as many as 6-27% of women and 9.4-12% of men in the United States, with older women
and African American women more likely to experience infertility than younger women and
Caucasian women (Chandra, Copen, & Stephen, 2013); These men and women are often
involved in romantic relationships. Expectations of romantic relationships in this society usually
include marriage and at least one child; family members often expect that their recently married
relatives will soon conceive. Therefore, the pressure to produce a child can be overwhelming for
a couple, even more so if they find that they are unable to do so.
The inability to conceive a child can be quite stressful for a couple and can lead to an
abundance of relational issues as well as mental health issues, especially if the couple greatly
desired children (McDaniel, Doherty, & Hepworth, 2014; Tao, Coates, & Maycock, 2012; Amor
et al, 2008; Kilmartin, 2009). The experience of the couple and the infertile individual may differ
depending on who the infertile partner is, why he or she is infertile, how badly the couple wanted
a child, and if the couple can afford to seek alternatives (McDaniel, Doherty, & Hepworth,
2014). Differences in responses regarding the infertility diagnosis can also be seen according to
gender. Women are typically found to be more distraught when given the news of their or their
partner’s infertility, while men tend to take the news in silence (McDaniel, Doherty, &
Hepworth, 2014). The alternatives to an infertility diagnosis are quite expensive and can lead to
their own mental health or relational conflicts, and some individuals may have a religious
aversion to some of the infertility procedures (McDaniel, Doherty, & Hepworth, 2014;
INFERTILITY & CULTURE 3
Marquardt, Glenn, & Clark, 2010; Akker, 2007). Given the amount of stress that can result from
a diagnosis of infertility, it is important to examine how this affects the quality of the couple
relationship.
While there have been many studies conducted that examine the effects of infertility on
both relationship quality and the individual, there are very few studies that have been conducted
that take into a account those from different cultural backgrounds. Certain countries, such as
India, place a heavy emphasis on reproduction, and many cultures greatly emphasize the
importance of carrying on the family lineage (Mahalingam, Haritatos, & Jackson, 2007).
Hispanics and Latinos are typically very family-oriented and place a great deal of importance on
family (Miranda, Bilot, Peluso, Berman, & Meek, 2006). Therefore, looking at how infertility
would affect a couple of these backgrounds is very important.
Given that, in many cultures, it is the woman’s job to provide a family for her husband
and to produce children, particularly males, a diagnosis of infertility for these women can be
extremely devastating and can have lasting consequences (United Nations Publication, 2010).
There are many social implications that infertility can lead to for both men and women
depending on the culture from which they come; they could be subject to being an outcast, may
be alienated from other family members, and may be shunned from their community (Kilmartin,
2009; United Nations Publication, 2010). Looking at how a diagnosis of infertility can differ in
psychological reactions across the different cultures and seeing how the couple relationship is
then affected is a necessary avenue of study in order to implement ways to assist these couples in
a clinical setting.
INFERTILITY & CULTURE 4
Statement of the Research Problem & Hypothesis
The purpose of this study is to examine how an infertility diagnosis affects the
relationship quality in the romantic relationship, as well as to examine how these responses differ
according to the cultural and ethnic backgrounds of the individuals in the couple relationships. It
is hypothesized that there will be significant differences in relationship quality in regards to the
infertility diagnosis according to culture. Relationship quality is the dependent variable in the
study, with culture and infertility/no infertility being independent variables.
INFERTILITY & CULTURE 5
Review of the Literature
Men and Women’s Reactions to Infertility Diagnosis
In regards to an infertility diagnosis, men and women may react differently to a diagnosis
of infertility. The rate of infertility in regards to males and females is about the same, with
approximately 1/3 of the causes being male-related, 1/3 being female-related, and the remaining
percentage of causes being unidentifiable or are a combination of male and female causes
(McDaniel, Doherty, & Hepworth, 2014). Much of the differences in reactions to a diagnosis of
infertility relates to gender norms and how males and females are socialized to behave and react
in certain situations. Depending on the gender of the person in the couple relationship that is
receiving the infertility diagnosis, the reactions can differ and the couple relationship and
satisfaction of the relationship can differ based on the response.
Men’s reactions to infertility diagnosis
According to McDaniel, Doherty, & Hepworth (2014), men may appear to be
emotionally unaffected when first receiving news of infertility; the reaction displayed has been
categorized as “silent” or “accepting.” Unfortunately, much of this may be related to how men
are socialized. The socialization of men is vastly different than the socialization of women in
many cultures, and although socialization does of course vary according to culture and each
culture emphasizes different aspects of self, men in the cultures of study in this article, which are
Western, African American, Latino/Hispanic, and Asian, are taught to be strong and masculinity
is often emphasized.
In the Western culture, men are typically socialized to value qualities such as emotional
strength and are frequently criticized in their early childhoods for expressing emotions, often
being met with the phrase “boys don’t cry” (Kilmartin, 2009). Men in the western part of the
INFERTILITY & CULTURE 6
world are encouraged to solve their problems with actions and are taught that emotional
expressiveness is unmasculine (Kimartin, 2009). In African American and Latino/Hispanic
cultures, men are expected to be strong and to be a provider of strength for their families (Corr &
Corr, 2012). Men in Asian cultures are often socialized to keep emotions private and to resist
displays of emotion in public; this socialization may prevent these men from properly grieving
(Corr & Corr, 2012). These socialization techniques of the men in the major cultures being
studied in this article (Western, African American, Latino/Hispanic, and Asian) as to why some
men often react to the news of infertility with a quiet acceptance.
In addition to the emphasized quality of strength, reproduction is often an expectation of
males in many cultures. In fact, there are biologically based theoretical perspectives on male
promiscuity that have to do with the desire to reproduce (Kilmartin, 2009). It is evident
throughout the histories of many countries that much of the pressure on males was to produce a
male heir, often to take over the throne in societies in which there was a monarchy or to carry on
the family name. The desire for a male heir was also because women’s families often had to bear
the expenses of the weddings, a tradition which is upheld in many cultures today. Asian cultures
tend to especially desire a male child; some families would go so far as to commit female
infanticide (Ding & Hesketh, 2005).
The mental health implications of males who receive news of infertility may feel guilty,
angry, depressed, or be consumed with self-hatred due to their inability to provide their wives or
partners with a child; they may feel as though they are not living up to their obligations and
duties as sexual partners and may feel less masculine than men who do not have problems related
to infertility (Kilmartin, 2009). These mental health implications can significantly impact the
relationship quality of the couple and the satisfaction that the partners feel in their relationship.
INFERTILITY & CULTURE 7
Women’s reactions to infertility diagnosis
Upon hearing news of infertility, it is common for women to be, or at least appear to be,
emotionally devastated at the news of infertility (McDaniel, Doherty, & Hepworth, 2014). The
reason for this could lie heavily in the ways in which women are socialized according to culture.
In most of the major cultures being examined in this article, women are typically encouraged to
express their emotions and be more open about their feelings (Parkins, 2012). The exception to
this may be Asian cultures, in which women are socialized to keep emotions private and to resist
displaying emotion in public (Corr & Corr, 2012). In most cultures, women are typically taught
to deal with their issues by examining their feelings as opposed to men who are often taught to
take action (Kilmartin, 2009). Because women are generally taught that it is acceptable for them
to display their emotions, they may feel more comfortable expressing their feelings on an
infertility diagnosis.
The socialization of females in many cultures puts a heavy emphasis on having children
and becoming a mother, and the gender-based activities girls are introduced to at a young age
usually include babysitting, homemaking, and caregiving. Most cultures place high expectations
on women to be competent mothers, and in some cultures women are taught that it is extremely
important for women to bear children in order for them to provide for their families (United
Nations Publications, 2010). Women are also told that there is an expiration date on their ability
to produce healthy children; this coupled with the social expectations of having a family can
make infertility an especially difficult diagnosis to receive (McDaniel, Doherty, & Hepworth,
2014). Common reactions of women in regards to news of infertility include depression, anxiety,
and grief; Unfortunately, many healthcare professions are oftentimes unaware of the mental
INFERTILITY & CULTURE 8
health implications if this diagnosis, which can be especially severe in the case of a miscarriage
(Kong, Lok, Lam, Yip, & Chung, 2010).
Reason for Infertility
Depending on why the partner is infertile, the reaction of both partners and the
satisfaction of the couple relationship could potentially change. The causes of infertility may be
biological and unpreventable, voluntary, the result of the use certain medications, or could even
be the result of certain lifestyle choices. All of these different causes can lead to different
reactions and feelings about the infertility diagnosis.
Biological
The biological causes of infertility vary depending on the gender. For men, these causes
can include sperm production or function issues, sexual problems such as premature ejaculation,
the blockage of the epididymis, exposure to chemicals or toxins which can cause hypoglandism
or the malfunction of the pituitary gland, or damage to the reproductive organ (Mayo Clinic
Staff, 2014). Potential biological causes of infertility for women include injury to the female
reproductive system, polycystic ovary syndrome in which the ovaries produce an abundance of
androgen and not enough estrogen or progesterone, Hyperprolactinemia in which there is an
excess of the hormone prolactin, an abnormal shape of the uterus, blockage of the fallopian tube,
endometriosis, early menopause, and certain disorders such as diabetes (Mayo Clinic Staff,
2014). Biological causes of infertility can lead to feelings of hopelessness due to the
unpreventable and unchangeable nature of most of them (McDaniel, Doherty, & Hepworth,
2014). In addition, if the infertility is caused by a partner’s genetic anomaly, feelings of anger at
his or her family as well as feelings of guilt may arise (McDaniel et al., 2014).
INFERTILITY & CULTURE 9
Voluntary
Voluntary causes of infertility include vasectomies for men or a tubal ligation for women,
in which the fallopian tubes are intentionally blocked (Mayo Clinic Staff, 2014). While it may
seem as though less severe psychological implications would accompany a voluntary cause of
infertility, these procedures can indeed have important psychological after effects. In a study
conducted by Amor, Rogstad, Tindall, Moore, Giles, and Harvey in 2008, it was found that many
factors played into a man’s decision to get a vasectomy, including lifestyle choices, personal
issues, pressure from peers or family members, and the media. Even for those men who engaged
in a voluntary vasectomy procedure, the majority felt less masculine and suffered from
psychological implications such as depression or anxiety as a result (Amor et al., 2008). As for
women, even if they undergo a voluntary tubal ligation procedure, they may come to regret the
choice years later and therefore suffer major psychological after effects (McDaniel, Doherty, &
Hepworth, 2014).
Medications
The use of anti-depressants, especially SSRIs, can fragment sperm DNA and cause
problems related to erectile dysfunction and ejaculation (Brezina, Yunus, & Zhao, 2011). Men
who receive an infertility diagnosis due to their use of antidepressants may feel unmasculine,
weak, guilty, or shamed (Brezina et al., 2011). Because those who have mental disorders such as
depression or anxiety are often looked down on and considered weak, men may feel especially
shamed because of their “inability” to align with the social perception of needing to display
strength coupled with the negative perception of mental disorders (Angermeyer & Dietrich,
2005). For women, medications typically cause only temporary infertility (McDaniel, Doherty,
& Hepworth, 2014).
INFERTILITY & CULTURE 10
Lifestyle choices
There are certain lifestyle choices that could potentially lead to an infertility diagnosis,
including excess smoking or drinking, STDs or STIs, and eating disorders (McDaniel, Doherty,
& Hepworth, 2014). While some may disagree with the placement of eating disorders in this
section, it is placed here because it is preventable and best fits this particular category. If lifestyle
choices are the reason behind infertility, the implications on both the individual and the
relationship can be especially severe. Feelings of guilt or shame may emerge, and the diagnosis
may feel more like a punishment (McDaniel et al., 2014). The partner may feel angry toward the
infertile partner and the relationship could henceforth become strained.
Culture Influences/Differences & Views on Infertility
The researchers understand that there is a distinct difference between race and culture; we
define culture as the values and ideals that the individual prescribes to. Therefore, culture in this
study is subjective, meaning the researchers will ask the participants which culture they most
closely align with; there will be examples of the ideals and values of each culture given to the
participant.
Western culture is most prominent in European countries as well as the United States,
though there is a little bit of Western culture present in almost all societies today (van der Wal,
2008). Western cultures predominantly value individualism, or the needs and wants of the
individual over the collective group (van der Wal, 2008). Self-sufficiency and success are major
attributes in this culture as well; wealth and status are considered of importance (van der Wal,
2008). While marriages are still celebrated and viewed positively in Western cultures, marriages
are occurring at later ages and couples are less concerned with having children right away or at
all (Orchard, 2001). With the values of individualism, career, and wealth emphasized and the
INFERTILITY & CULTURE 11
idea of children and family being of lesser importance or concern, those in Western cultures may
not react as strongly as individuals from other cultures when hearing news of infertility.
Additionally, considering the fact that most in the Western culture value progressivism and
modernism, individuals in this culture are able to pursue options like adoption or infertility
treatments without fear of backlash from friends or family members or concerns of the morality
of the procedures (McDaniel, Doherty, & Hepworth, 2014).
Individuals who identify in the African American culture often put a high emphasis on
caring for family members (Corr & Corr, 2012). The African American culture also emphasizes
relationships within the community, and these relationships are often treated as though they are
familial (Corr & Corr, 2012). Marriages within this culture are typically thought of as marriages
between entire families as opposed to simply between a man and a woman (Barbarin, 2002).
Women in the African American culture are typically expected to care for other members of the
family and receive a lot of responsibility and pressure to be caregivers (Burton, 2007). In a way,
these families operate from a collectivist perspective and often view the needs of the group over
the needs of the individual. Women in this culture are taught to express their feelings, while the
males are typically socialized to be strong and to be providers (Corr & Corr, 2012). Given this
information, couples who identify with the African American culture may react more strongly to
news of infertility than other cultural couples, and the relationship could suffer.
Those who identify with the Hispanic culture often have a collectivist point of view, in
which the needs of the family or group are placed above the needs of the individual (Ruiz, 2005).
Many Hispanic individuals also value pleasant relationships, self-worth, respect, and family
(Ruiz, 2005). Harmonious relationships are desired as opposed to difficult, negative
relationships; negative behaviors such as criticizing, confronting, or talking down that is
INFERTILITY & CULTURE 12
exhibited by an individual in a relationship is strongly discouraged in this culture (Ruiz, 2005).
Families are a major aspect and of extreme importance in this culture; these individuals believe
in emotional or material support, the reliance on other family members, and the modeling of
behaviors after others in the family (Ruiz, 2005). Women in this culture are typically socialized
to display emotions and to be caregivers for others in the family; men in this culture are
socialized to be strong or “macho” and to be providers (Corr & Corr, 2012). Based on this
information, the reaction of a couple at the news of infertility would most likely be quite
negative due to the importance of family, but given the emphasis on mutual support between
family members, the relationship may not suffer from news of infertility but may actually
improve due to the mutual support each partner is receiving.
Those who identify with the Asian culture usually adhere to distinct values. While the
Asian culture tends to place emphasis on collectivism, or the needs of the group over the needs
of the individual, they also place a high emphasis on success and self-reliance and tend to avoid
seeking help in situations (Corr & Corr, 2012). Familial relationships, while important in a sense,
tend to be disconnected due to the emphasis that is placed on self-reliance and emotional control
(Corr & Corr, 2012). However, there is a high emphasis placed on having children, especially
males, so that the family name can be carried on (Corr & Corr, 2012). Due to these quite
conflicting values, the reaction to the news of infertility could be one of muted sadness; however,
the relationship satisfaction between the couple could potentially decline due to feelings of
shame and pressure from family members to have children.
Infertility Diagnosis & Couple’s Relationship Quality
Relationship quality can be defined in this review as the subjective evaluation each
partner has regarding how well the relationship seems to be working and how happy he or she is
INFERTILITY & CULTURE 13
with the current state of the relationship (Fincham & Rogge, 2010). Relationship quality can
decline due to decreased sexual satisfaction, as sex can begin to feel like a chore that must be
done in order to produce a child, financial difficulties if the couple attempts to undergo fertility
treatments or decides to adopt, a fear of abandonment, which can be especially prominent if the
fertility is caused by rising age, anger at the infertile partner (Tao, Coates, & Maycock, 2012).
The strain on the relationship can also be due to outside pressure from family members or friends
on the couple to have a child. The financial, social, and personal strain that is placed on these
relationships can severely impact and decrease the quality if the couple is unable to work through
the difficulties or provide each other with mutual support (Tao et al., 2012).
The researchers expect there to be a decline in relationship quality after a diagnosis of
infertility and that the decline will differ based on culture. The researchers also expect that the
gender of the individual with the diagnosis and the reason for the infertility diagnosis will play a
significant role in the relationship quality as well, with biological causes, lifestyle choices, and
medications more prominently affecting relationship quality than voluntary causes. The
researchers expect that the gender of the person receiving the infertile diagnosis will more
directly impact personal reactions as opposed to relationship quality.
Summary of Review of the Literature
While cultures socialize their men and women to value different things, the four cultures
being tested in this study place high emphasis on family and tend to socialize their men to value
strength and their women to value childrearing. However, with the emphasis on western culture
shifting toward a more individualistic perspective, there may be less significant impacts on
western couples than on couples that come from the other cultures. Many additional factors can
influence how one reacts to the news of infertility, those being the cause of the infertility and the
INFERTILITY & CULTURE 14
gender of the individual receiving the diagnosis. The researchers suspect that the cause of
infertility will impact the couple relationship, while the gender of the individual will more
prominently affect the individual’s reaction and psychological health.
INFERTILITY & CULTURE 15
Methods
Participants
The participants will be couples in which one of the partners has received a diagnosis of
infertility from a gynecologist or a physician while in the relationship with his or her current
partner. Because the idea behind this study is to gather information regarding how relationship
satisfaction is impacted by the news of an infertility diagnosis and how that impact varies across
cultures, it is imperative that the participants have already been in the relationship prior to
receiving news of an infertility diagnosis and still be in that relationship at the time the study is
conducted. A stipulation for inclusion in this study is that participants had to be in a
monogamous, romantic relationship with their partners for at least 6 months or longer; another
stipulation is that participants could be no younger than 18 years of age and no older than 40
years of age, which would ensure that the couples are within typical child-bearing age. A
preference for the study is that couples be married, though that is not a stipulation. It is also
preferred that the pairs of couples be from the same cultural background, though that is not a
stipulation. The reason behind this is to maintain continuity between couples, as individuals from
different cultural backgrounds may have different values regarding children and relationships.
Intra-culture couples are therefore preferred.
There will also be a comparison group of individuals years 18 – 40 who have been with
their partners for 6 months or longer and do not have a diagnosis of infertility. These participants
will also have to be in a monogamous, romantic relationship, and the same preferences will
apply to this control group, again in order to maintain continuity between couples in regards to
their cultural backgrounds. The control group will be able to provide a comparison group to the
participants who have received an infertility diagnosis in order to compare relationship
INFERTILITY & CULTURE 16
satisfaction scores between couples who have received a diagnosis of infertility and couples who
have not.
Prior to the collection of the data and the beginnings of the research process, a form will
be submitted to the Institutional Review Board (IRB) at Northern Illinois University; this will
allow the researchers to gain permission to use human subjects in this study. Because the consent
forms will be signed online, there will be no need to send these to participants beforehand.
Procedure
This study will use a variation of both convenience and snowball sampling techniques.
Therapists and clinical psychologists from a wide range of states and locations in the United
States will be given information about the study and will be asked to recommend clients who are
seeking marital, couples, or individual therapy and who have had a diagnosis of infertility and
then inform the clients of the study. The researchers will also contact gynecologists and
physicians who work with infertility patients and will be asked to inform these clients of the
study and recommend them to participate. This is in the hopes that a wide-range of participants
from a variety of cultural backgrounds will be interested in participating.
As for the control group, these couples will also be selected using snowball sampling in
order to maintain continuity for the study. Individuals will be asked to refer intra-culture couples
to participate in this study; these individuals will also be from a wide range of states and
locations in the United States, again in the hopes of obtaining a wide-range of couples from a
variety of cultural backgrounds so that the control group will be similar to the clinical group.
The participants of the study will be able to access the questionnaires through an
approved online psychological website and a social media website, where they will be required
to review the conditions for participations and digitally sign an informed consent form before
INFERTILITY & CULTURE 17
proceeding. Participants will then encounter a basic demographic questionnaire. Following this
questionnaire, there will be three additional questionnaires designed to measure relationship
satisfaction and cultural affinity; these three questionnaires will be in randomized order. Once
the participants have completed the forms, they will be debriefed and given information on the
purpose of this particular study.
Measures/Instruments
A total of three questionnaires will be used in this study; one will gather demographic
information and will include questions regarding the participant’s culture and adherence to
cultural norms. The other questions on the questionnaire are designed to gather information
regarding the participant’s age, biological sex, the length of his or her current relationship, the
marital status of the participant, the approximate date that he or she received news of the
infertility diagnosis, why the individual is infertile (i.e., what caused the individual to become
infertile), and the sexual orientation of the participant. I will be using this demographic
information to make inferences regarding the effect of the culture on an infertility diagnosis.
Refer to C1 for the demographics questionnaire.
One of the scales designed to measure relationship satisfaction is entitled the Realistic
Experiences Questionnaire and was developed by Miller & Teddar (2011). This questionnaire
asks the participant questions related to how well he or she believes his or her partner
communicates, how much he or she trusts his or her partner, and other related questions. This
questionnaire breaks down the responses in nine different categories: maintenance behaviors,
commitment to the relationship, the quality of the communication between partners, the conflict
resolution skills of the partners, the amount of self-disclosure in the relationship, the subjective
amount of affection, the certainty and security the participants feel in their respective
INFERTILITY & CULTURE 18
relationships, the roles the participants play in their respective relationships, and the subjective
amount of equity within the relationship. The scale of this questionnaire will be slightly altered
in order to include more choices and will range from Strongly Disagree to Strongly Agree with
three in-between options to choose from. The Reality Questionnaire, developed by Miller &
Teddar (2011), has a total of 45 questions with 5 in each of the 9 categories. Some of the items
will be reverse scored, and all of the questions will be score coded, with Strongly Disagree = 1,
Disagree = 2, Neutral = 3, Agree = 4, and Strongly Agree = 5. In order to get a participant’s
score, the items must be added together and then divided by the total number of questions, which
for this scale would be 45. As with the RAS scale, a higher score indicates a higher satisfaction
with the relationship, and a lower score indicates a lower satisfaction with the relationship.
Examples of the questions from this scale include, “I do not feel comfortable disclosing what I
need or want from our relationship” and “My partner tries to understand why I am upset.” Refer
to appendix C2 for more information on this questionnaire and C4 for more information as to
which categories the questions were in.
The other questionnaire designed to measure relationship satisfaction in this study is
called the Relationship Assessment Scale (RAS) and was developed by Hendrick in 1988.
Hendrick’s Relationship Assessment Scale (RAS) is comprised of seven questions and uses a
Likert-typed to assess the answers of the participants. Items 4 and 7 on the scale are reverse
scored, and the questions are score-coded, with A=1, B=2, C=3, D=4, and E=5. Adding the
scores together and diving by seven, which is the total number of items, determines the mean
score. A higher score indicates a higher satisfaction with or a better subjective view of the
participant’s relationship. Refer to C3 for more information on this scale. Two questionnaires for
relationship satisfaction will be utilized because the RAS is a widely used instrument to measure
INFERTILITY & CULTURE 19
relationship satisfaction, but the Realistic Experiences Questionnaire is more detailed and
provides more thorough information. These questionnaires are randomized for the participants so
that the researchers could rule out previous exposure to like questions as a limitation of the
study. The length of time to complete these surveys is approximately 45 – 60 minutes.
Data Analysis
Design and methodology
This research design is anticipated to be a survey research design, due to the fact that the
researchers are unable to control for the variables of infertility or culture and the participants will
therefore be pre-assigned to groups. The alpha score or p value for this study will be set at <
0.05.
Treatment of data
The analysis of this data must be a univariate model due to the fact that there are two
independent variables, culture and infertility diagnosis. The researchers will therefore be using a
factorial ANOVA test to see whether a combination of the two independent variables (infertility
and culture) can predict the outcome of the dependent variable (relationship satisfaction). This
model is able to analyze the effects of the categorical independent variables on the continuous
dependent variable.
Hypothesis testing
The hypothesis of this study is that there will be significant differences in relationship
satisfaction in regards to a diagnosis of infertility according to culture. This could lead to the
conclusion that, because of the differences in cultural values in the areas of family, the
importance of children, and the different cultural views of the roles of men and women should
play in relationships, some couples from certain cultures may be significantly more impacted by
INFERTILITY & CULTURE 20
the news of infertility and thus experience a more significant drop in relationship satisfaction
than couples from other cultures. The researchers also expect there the be a significant difference
in relationship quality according to infertility diagnosis, regardless of culture. The cultural values
will be derived from the demographic questionnaire as will the information on fertility. The
dependent variable to be examined in this study is relationship satisfaction, which will be
gathered from the RAS and the Reality Questionnaires. These scores will be analyzed and then
compared to the cultural values to which the participant prescribes as well as whether or not that
individual has an infertility diagnosis.
INFERTILITY & CULTURE 21
Limitations
The way that the sample will be collected poses potential limitations for this study.
Snowball and convenience sampling methods are not random sampling, and therefore the sample
could be skewed or biased because not everyone in the population had an equal chance of being
selected. It would also be difficult to have all of the different cultures, Western, African
American, Hispanic/Latino, and Asian, be equally represented, which is another limitation that
this study potentially poses. A third possible limitation of this study is that many who have had
problems with infertility may be unwilling to disclose that information and thus by unwilling to
participate in the study; the clinical sample may therefore be difficult to come by.
Future research for this study should focus on expanding the definitions of couples and
possibly look into how same sex couples are affected by news of infertility. Future research
could also potentially add the variable of how badly the couple wanted a child; this could
increase the negative feelings associated with the news of infertility and therefore decrease the
satisfaction within the couple relationship. Future research should also examine the reasoning
behind the infertility diagnosis and how that impacts the couple relationships. The differences
could potentially impact the couple relationship in different ways, as voluntary reasons could
have a more negative impact than biological reasons that are unpreventable. Finally, an
important area of future research involves how infertility treatments affect the couple
relationship. Different methods of infertility treatments could potentially negatively impact the
psychological functioning of the individual.
In sum, future studies should look at addressing these limitations and examining the
different methods of infertility treatments and how they could potentially impact the couple
relationship. This area of research could provide clinicians with different methods when working
INFERTILITY & CULTURE 22
with couples in a clinical setting. Working with couples who have experienced infertility have
their own sets of challenges that clinicians should be aware of. Providing a clinical model to
work with when treating couples who have experienced infertility would be the next step and
what future research should focus and build on.
INFERTILITY & CULTURE 23
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APPENDIX B
INFORMED CONSENT DOCUMENT
Title of Study: The effects of infertility on relationship quality in different cultures
Investigators: Anastasia Theisen, Graduate StudentNorthern Illinois University
This is a research study. Please take your time in deciding if you would like to participate. Please feel free to ask questions at any time.
INTRODUCTION
The purpose of this study is to learn more about how cultural beliefs affect the relationship quality of a couple following a diagnosis of infertility.
DESCRIPTION OF PROCEDURES
If you agree to participate in this study, your participation will last for approximately (and no longer than) 1 hour. During the study you may expect the following study procedures to be followed:
You will be asked to answer questions on the computer or on paper. These questions will ask you various questions about your current romantic relationship, particularly the quality. In addition, you will be asked about your cultural beliefs.
At the end of the study, the experimenter will provide a debriefing explaining in more detail the purpose and goals of the current research. You should feel free to ask any questions or express any concerns you may have regarding the research.
PARTICIPANTSParticipants are those who have experienced a diagnosis of infertility with their current partner, whom they have been in a romantic relationship with for at least 6 months. Participation in this study is completely voluntary. You can end your participation at any time. If you decide to not participate in the study or leave the study early, it will not result in any penalty or loss of benefits to which you are otherwise entitled.
RISKS
There are minimal foreseeable risks from participating in this study. Some of the questions ask about personal information, including sexual orientation, race and religion, and maybe somewhat uncomfortable to answer. However, you are free to skip any question you wish if it makes you uncomfortable to answer it.
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BENEFITS
If you decide to participate in this study there may be no direct benefit to you apart from what you learn about psychological research. It is hoped that the information gained in this study will benefit society by helping psychologists better understand how a diagnosis of infertility affects those from different cultures in different ways.
COSTS AND COMPENSATION
You will not have any costs from participating in this study. There is no compensation for completing this study.
CONFIDENTIALITY
Records identifying participants will be kept confidential to the extent permitted by applicable laws and regulations and will not be made publicly available. To ensure confidentiality to the extent permitted by law, the following measures will be taken:
Participants will be randomly assigned a unique ID number, which will be noted on all of their materials. Once the data are collected, any information that links the name of the participant to their ID number will be destroyed. Data will be stored in a cabinet in the supervising faculty member’s laboratory space, which is kept locked. Data will be retained until all are collected, entered, and analyzed. If the results are published, your identity will remain confidential. We will take all reasonable steps to protect your identity. Consistent with the American Psychological Association rules, the data will be retained for 5 years after publication, but your identity will never be associated with your responses.
QUESTIONS OR PROBLEMSYou are encouraged to ask questions at any time during this study. For further information about the study contact Anastasia Theisen, Master’s Candidate at 618-946-6085, [email protected].
******************************************************************************PARTICIPANT SIGNATURE
I have read the material above, and any questions I asked have been answered to my satisfaction. I understand a copy of this form will be made available to me for the relevant information and phone numbers. I realize I may withdraw without prejudice at any time. Participant’s Name (printed)
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APPENDIX C1
DEMOGRAPHICS
The information you provide in this questionnaire is completely confidential, so please answer honestly. YOU CAN SKIP ANY QUESTION YOU DO NOT WISH TO ANSWER. If you have questions, feel free to ask the experimenter for clarification.
BASIC INFORMATIONAge: ________ Gender/sex: _______
Marital Status: ________ Sexual orientation: __________
1) What is your romantic partner’s race/ethnicity? _________________2) What is your romantic partner’s gender/sex _____________________3) How long have you been dating your current partner? (please fill in the number of
months and years – for example, 2 months, 1 year) Months Years
4) How long ago did you or your partner receive a diagnosis of infertility? ______
5) What was the reasoning behind the infertility diagnosis? ________
6) What culture would you say best describes your beliefs?Asian: Collectivist; good of the group over good of the individual; emotions are a private
experience; self-reliance; importance of childrenWestern: Individualist; good of the individual over good of the group; self-sufficiency and
success are important; careers over having children; progressivismHispanic/Latino: Collectivist; good of the group over good of the individual; harmonious
relationships are important; family is very important; emotional support; women are caregivers.
African American: Collectivist; good of the group over good of the individual; high emphasis on caring for family members; community members are considered family; women are caregivers
Asian: _________ Hispanic/Latino: _________
Western: _______ African American: ________
7) How strongly would you say you adhere to your cultural beliefs?1 2 3 4 5 6 7 8 9 10
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APPENDIX C2
REALITY QUESTIONNAIRE
In my current relationship:
I do not feel comfortable disclosing what I need or want from our relationship.Strongly Disagree Disagree Neutral Agree Strongly Agree
I am under-benefited.Strongly Disagree Disagree Neutral Agree Strongly Agree
I feel like my partner is romantically interested in me.Strongly Disagree Disagree Neutral Agree Strongly Agree
I see a future with my partner.Strongly Disagree Disagree Neutral Agree Strongly Agree
I am fully committed to my partner.Strongly Disagree Disagree Neutral Agree Strongly Agree
My partner attempts to make our interactions enjoyable.Strongly Disagree Disagree Neutral Agree Strongly Agree
My partner is willing to do things with my friends or family.Strongly Disagree Disagree Neutral Agree Strongly Agree
My partner is not willing to compromise.Strongly Disagree Disagree Neutral Agree Strongly Agree
I am confident about myself as an intimate partner.Strongly Disagree Disagree Neutral Agree Strongly Agree
I feel that I should be able to disclose intimate, personal things about myself withouthesitation.Strongly Disagree Disagree Neutral Agree Strongly Agree
My partner and I feel the same way about each other.Strongly Disagree Disagree Neutral Agree Strongly Agree
My partner displays an appropriate amount of affection towards me.Strongly Disagree Disagree Neutral Agree Strongly Agree
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My partner’s feelings are as strong for me as mine are for them.Strongly Disagree Disagree Neutral Agree Strongly Agree
I do not feel my partner is committed to me.Strongly Disagree Disagree Neutral Agree Strongly Agree
My partner and I use open communication.Strongly Disagree Disagree Neutral Agree Strongly Agree
I am patient and forgiving of my partner.Strongly Disagree Disagree Neutral Agree Strongly Agree
My partner and I work together to solve conflicts.Strongly Disagree Disagree Neutral Agree Strongly Agree
I am happy with my role in the relationship.Strongly Disagree Disagree Neutral Agree Strongly Agree
My partner sincerely reveals to me their feelings and experiences.Strongly Disagree Disagree Neutral Agree Strongly Agree
I expect the same standard of behavior from my partner as they expect of me.Strongly Disagree Disagree Neutral Agree Strongly Agree
I am happy with the amount of physical affection.Strongly Disagree Disagree Neutral Agree Strongly Agree
I do not want my relationship to last.Strongly Disagree Disagree Neutral Agree Strongly Agree
My partner is strongly motivated to devote their time and effort to our relationship.Strongly Disagree Disagree Neutral Agree Strongly Agree
My partner listens to me.Strongly Disagree Disagree Neutral Agree Strongly Agree
I feel like my partner does things to maintain our relationship.Strongly Disagree Disagree Neutral Agree Strongly Agree
My partner tries to understand why I am upset.
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Strongly Disagree Disagree Neutral Agree Strongly AgreeI am happy with my partner’s role in the relationship.Strongly Disagree Disagree Neutral Agree Strongly Agree
I intimately disclose who I really am, openly and fully.Strongly Disagree Disagree Neutral Agree Strongly Agree
My partner does not contribute as much to our relationship (financially) as I do.Strongly Disagree Disagree Neutral Agree Strongly Agree
My partner compliments me often.Strongly Disagree Disagree Neutral Agree Strongly Agree
I am strongly motivated to devote time and effort.Strongly Disagree Disagree Neutral Agree Strongly Agree
My partner often discusses our future together.Strongly Disagree Disagree Neutral Agree Strongly Agree
I feel comfortable voicing my preferences in the relationship.Strongly Disagree Disagree Neutral Agree Strongly Agree
I am not very motivated to be involved.Strongly Disagree Disagree Neutral Agree Strongly Agree
I feel comfortable letting my partner know when I am upset.Strongly Disagree Disagree Neutral Agree Strongly Agree
My partner is not dependable.Strongly Disagree Disagree Neutral Agree Strongly Agree
As a whole, my partner’s disclosures about our relationship are more positive thannegative.Strongly Disagree Disagree Neutral Agree Strongly Agree
My partner supports me in my endeavors as much as I support them.Strongly Disagree Disagree Neutral Agree Strongly Agree
I do not feel cared for.Strongly Disagree Disagree Neutral Agree Strongly Agree
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I am certain my feelings for my partner will not change.Strongly Disagree Disagree Neutral Agree Strongly Agree
My partner keeps their promisesStrongly Disagree Disagree Neutral Agree Strongly Agree
My partner does not try to understand my needs.Strongly Disagree Disagree Neutral Agree Strongly Agree
I experience honesty from my partner.Strongly Disagree Disagree Neutral Agree Strongly Agree
My partner and I are able to successfully reach conflict resolution.Strongly Disagree Disagree Neutral Agree Strongly Agree
My partner feels responsible for their part.Strongly Disagree Disagree Neutral Agree Strongly Agree
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APPENDIX C3
RELATIONSHIP ASSESSMENT SCALE
Please mark on the answer sheet the letter for each item which best answers that item for you.
How well does your partner meet your needs?A B C D EPoorly Average Extremely well
In general, how satisfied are you with your relationship?A B C D EUnsatisfied Average Extremely satisfied
How good is your relationship compared to most?A B C D EPoor Average Excellent
How often do you wish you hadn’t gotten in this relationship?A B C D ENever Average Very often
To what extent has your relationship met your original expectations:A B C D EHardly at all Average Completely
How much do you love your partner?A B C D ENot much Average Very much
How many problems are there in your relationship?A B C D EVery few Average Very many
NOTE: Items 4 and 7 are reverse scored. A=1, B=2, C=3, D=4, E=5. You add up the items and divide by 7 to get a mean score.
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APPENDIX C4REALITY QUESTIONNAIRE (CATEGORIES)
In my current relationship:
[Self-disclosure]1. I do not feel comfortable disclosing what I need or want from our relationship.2. I feel that I should be able to disclose intimate, personal things about myself withouthesitation.3. My partner sincerely reveals to me their feelings and experiences.4. I intimately disclose who I really am, openly and fully.5. As a whole, my partner’s disclosures about our relationship are more positive thannegative.
[Equity]1. I am under-benefited.2. My partner and I feel the same way about each other.3. I expect the same standard of behavior from my partner as they expect of me.4. My partner does not contribute as much to our relationship (financially) as I do.5. My partner supports me in my endeavors as much as I support them.
[Affection]1. I feel like my partner is romantically interested in me.2. My partner displays an appropriate amount of affection towards me.3. I am happy with the amount of physical affection.4. My partner compliments me often.5. I do not feel cared for.
[Relational certainty/security]1. I see a future with my partner.2. My partner’s feelings are as strong for me as mine are for them.3. I do not want my relationship to last.4. I am strongly motivated to devote time and effort.5. I am certain my feelings for my partner will not change.
[Commitment]1. I am fully committed to my partner.2. I do not feel my partner is committed to me.3. My partner is strongly motivated to devote their time and effort to our relationship.4. My partner often discusses our future together.5. My partner keeps their promises.
[Quality of communication]1. My partner attempts to make our interactions enjoyable.2. My partner and I use open communication.3. My partner listens to me.
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4. I feel comfortable voicing my preferences in the relationship.5. My partner does not understand my needs.
[Maintenance behaviors]1. My partner is willing to do things with my friends or family.2. I am patient and forgiving of my partner.3. I feel like my partner does things to maintain our relationship.4. I am not very motivated to be involved.5. I experience honesty from my partner.
[Conflict resolution]1. My partner is not willing to compromise.2. My partner and I work together to solve conflicts.3. My partner tries to understand why I am upset.4. I feel comfortable letting my partner know when I am upset.5. My partner and I are able to successfully reach conflict resolution.
[Role in relationship]1. I am confident about myself as an intimate partner.2. I am happy with my role in the relationship.3. I am happy with my partner’s role in the relationship.4. My partner is not dependable.5. My partner feels responsible for their part.* One item out of each of the nine factors was phrased in such a way that they can be reversed
scored.