RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,BANGALORE, KARNATAKA

SYNOPSIS PROFORMA FOR REGISTRATION OFSUBJECT FOR DISSERTATION

MISS. V. KANCHANA

IST YEAR M.SC., NURSING

PSYCHIATRIC NURSING

YEAR 2009-2010

SUSHRUTHA COLLEGE OF NURSING#23, PAPAIAH GARDEN, DIAGONAL

ROAD, BSK 3RD STAGE,

BANGALORE – 560 085.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. NAME OF THE CANDIDATE AND ADDRESS

Miss. V. KANCHANA,1st Year M.Sc., NursingSUSHRUTHA COLLEGE OF NURSING,#23, PAPAIAH GARDEN, DIAGONALROAD BSK 3RD STAGE,BANGALORE – 560 085.

2 NAME OF THE INSTITUTION

SUSHRUTHA COLLEGE OF NURSING,#23, PAPAIAH GARDEN, DIAGONALROAD BSK 3RD STAGE,CHANAMMANKERE ACHUKATTU,BANGALORE – 560 085.

3. COURSE OF STUDY AND SUBJECT

M.Sc., NURSINGPSYCHIATRIC NURSING

4. DATE OF ADMISSION TO THE COURSE 03-06-2009

5. TITLE OF THE TOPIC A STUDY TO ASSESS THE LEVEL OF STRESS AMONG INFERTILITY WOMEN WHO ARE ALL ATTENDING THE INFERTILITY CLINICS IN SELECTED HOSPITAL AT BANGALORE.

6. BRIEF REUSME OF THE INTENDED WORK:

6.1 INTRODUCTION :

“Stress causes illness causes more stress causes more illness”.

The World Health organization (WHO) ( 1988) had defined infertility as a

failure to conceive after unprotected intercourse for a period of one year.

American Society for reproductive medicine, (2008) had defined stress is

a stimulus which produces mental tension or physiological reaction, so the

experience of infertility is the stimulus. The experience of infertility leads to the

suffering.

According to Dr. Aniruddha Malponi (2009) said that, when diagnosed

with infertility, many couples feel helpless and no longer in control of their bodies

or their life plan. Infertility can be a major crisis because the important life goal of

parenthood is threatened. Most couples are accustomed to planning their lives and

experience his shown then that if they work hard at something they can active it

with infertility, this many not be the case.

Stress among the infertile women is one of the problem in our country. In

the US, an estimated 10.2% of women between the ages of 15 to 44 or about 6.2

million women, have impaired fertility, and the incidence is increasing about 5%

of women experience some period of infertility during their reproductive years.

Between 1982 and 1988 there was a 37% increase of infertile women is expected

ages of 35 to 44. The number of infertile women is expected to reach 6.3 million

on the year 2000, and may be as high as 7.7 million in 2025. So in 2025 similarly

the stress level also increase in infertile women.

According to Sahana Charan in any population the incidence of infertility

is around 15 percent. According to studies conduced, in India the incidence is

between 10 to 20 percent.

According to Padmini Prasad, Gynaecologist and Director of Institute of

Sexual Medicine, told The Hindu, Lifestyle problem. “The reason for infertility

may be various. In Bangalore, a large number of couples who seek advice for

problems in conceiving are professionals with high-stress jobs. Working long

hours, night shifts, frequent travel, stress at the workplace and advancing age

affect a couple’s sexual life. This is addition to certain medical problems may

result in decreased fertility.

According to “young Joo Park” November (1994). The mean of stress of

the infertile women is 2.78 the mean of stress in 4 dimensions 3.81 in cognitive

dimensions, 3.05 in the affective dimension, 2.06 in the marital adjustment

dimension and 2.41 in the social adjustment dimension. The predictors of the

stress of the infertile women are their educational levels and subjective economic

status. They explain 14.08% of total variance.

According to Blenner (1990) describes the predictable progression of

infertility is emotional toll. There are 8 stages, that is Dawning of awareness,

facing a new reality, spiraling down, letting go, quilting and moving out, shifting

focus.

According to Stanton, Duntel, Schetler, (1991) the influence on infertility

related stress is relatively unknown.

According to Comar (1992), He verified that infertility does cause stress

and reported that infertile women experience twice the level of depression when

compared to their fertile counterparts.

According to Daniels (1993) suggested that stress has generally been

considered psychological rather than psychosocial phenomenon, and attention to

social factors that might affect a couple has been neglected help has therefore been

focused on the couple experiencing the fertility problem.

“Seibel, (1997) said one in six couples will experience fertility problems at

some time in their lived and only one half will succeed in becoming pregnant”

According to remerinicle, (2000) infertility is described by the diagnosed

couples as the toughest crisis in their lives. The process of fertility treatments

causes acute stress, which may lead to distress and harm the partness relationship.

A loss of self-esteem may accrue, and fertility failure may negatively affect the

couple’s pride both as a pair and as individual studies show that women more than

men – may experience loss of self esteem, especially after treatment failure.

According to peter S. Finamore, (2007) Asian/Indian women were almost

five times as likely to disclose ( 95% CI 1.35, 16.35).

Disclosure verses non-disclosure in each group and the correlation.

DISCLOSE NON-DISCLOSE P VALUE

Stress about

Infertility(non

responders n = 18)

Not at all 4/13 ( 31%) 9/13 ( 69%)

Mildly 17/44 39%) 27/44 ( 61%)

Moderately 37/86 ( 43%) 49/86 ( 57%)

Very stressed 21/38 ( 55%) 17/38 ( 45%) .3

Comparison of age, satisfaction at work, freedom at work, and global stress

scale for those who disclosure versus those who do not disclosure.

Disclose Nondisclose P=Value

Patient’s age –

mean (SD)

3.5 (4.3) 34.4 (5.6) P=.9

Satisfaction at

work – median

( range )

5 (1-7) 5 (1-7) P=.2

Freedom at work –

median ( range )

5 ( 1-7) 5 ( 1-7) P=.4

Perceived stress

scale score – mean

6.1 6.7 P=.2

According to the Danilute indicates that 97% of couples supported a need

for psychological services in their initial contacts with an infertility clinic. If the

mental health professional ( eg. Psychologist, psychiatrist, social workers ) is

included as paid to delivery of comprehensive fertility services, his or her role can

determined in a variety of ways )

6.2 NEED FOR THE STUDY :

Fertility and parenting are highly important in our society, considered to be a

main value and a developmental task of the adult person.

So when infertility rate is increase in women if may be as high as 7.7 million

in 2025. So the stress level may be increase. Some studies are mention that the

infertile women are having psychiatric disorder and anxiety disorder and other

physical illness it is due to in day to day life the infertile women’s are facing the

stress in their life events.

I seen some of the case of infertile women and they had high level of stress

during the infertility period. During my UG studies this point is motivated me to

do assess the stress level in infertility women. To treat the infertility problem in

infertile women the gynaecologist need is important as well as the psychiatrist

need is important that is to share the feelings of infertile women and to have good

interpersonal relationship with them.

So this concept initiated me to do studies regarding this topics in psychiatrist

Nursing. Very few studies have been conducted till date regarding the stress in

infertile women in the filed of psychiatric nursing. The current study is an initial

effort aiming to improve the mental health of infertile women by assessing the

stress level among those who were attending an infertility clinics. So we planned

to make a study on A STUDY TO ASSESS THE LEVEL OF STRESS

AMONG INFERTILITY WOMEN WHO ARE ALL ATTENDING THE

INFERTILITY CLINICS IN SELECTED HOSPITAL AT BANGALORE.

The institute of Sexual Medicine, Bangalore (2006) , conducted a study

few years ago to identify the incidence and types of sexual and reproductive

problems among IT professional couples in the city who form a major chunk of

those seeking help from the institute for infertility problems. The study came out

with some startling revelations; of the 900 patients examine between April 2005

and May 2006, 180 had not consummated their marriage; 300 had infertility

problems such as low sperm count, problems in the vagina and the hymen, and

defects in the fallopian tube or the uterus;100 suffered from erectile dysfunction or

ejaculatory problems; 100 had by dyspareunia ( pain during intercourse ) while 99

had decreased libido ( sexual anorexia ).

According to Balterman ( 1985 ) Gibson & Myers. ( 2002 ) conducted

study to investigated psychosocial factors thought to be associated with perceived

stress over the course of infertility treatment. The study were to identify the extent

to which psychosocial factors were associated with variation in perceived stress at

regular time intervals during infertility treatment and to identify the extent to

which psychosocial factors were associated with change in perceived stress over

the course of treatment. Identifying factors that may explain stress to provide

potential targets for intervention to reduce stress has significance for those who

provide care for infertile couples.

According to Blickstein, Ba or, ( 2004 ). The rate of couples who suffer

from infertility problems in Israel is rising like in other countries. According to

estimation 10% - 12% of the couples in fertility age are suffering infertility

problems.

According to Harefuah (2008) said that in the industrialized world

approximately 12% of couples suffer from infertility.

6.3 REVIEW OF LITERATURE

The review of literature in a research report is a summary of current

knowledge about a particular problem and includes what is known and not known

about the problem. The literature is reviewed to summarize knowledge for use in

practice or to provide a basis of conducting a study. Review of literature section

includes a description of the current knowledge of a particular problem, the gaps in

this knowledge base and the contribution of the study to the development of

knowledge in this area. Review of literature is a key steps in research process.

The typical purpose for analyzing a review existing literature is generate

research question to identify what is known and what is not known about the topic.

The major goals of review of literature are to develop a strong knowledge base to

carry out research and non research scholarly activity.

Review of literature is the study of the prevalent materials to the research.

This help the researcher to get a clear idea about the particular filed. It is important

for the researcher to carryout the research successfully. A critical summary of

research on a topic of interest. Often prepared to put a research problem in

context.

Review of literature for the study has been organized under the following

headings.

Studies related to stress of infertile women

Studies related to information about stress in infertility treatment

Studies related to information about stress coping scale.

1. STUDIES RELATED TO STRESS OF INFERTILE WOMEN

According to young Joo Park (1994) conducted a study on 131 infertile

women were in primary or secondary infertility the were sampled out from the

infertility clinics or K University Medical Center and C Hospital in Second. The

data were collected by using the infertility stress scale which consisted of 35 items

with four dimensions ( Cognitive, affective, marital and social stress ) from adjust

to November 1994. Duncan’s multiple comparison test and multiple regression.

The results are as follows; 1. The mean of the stress of infertile women is 2.78.

The means of the stress in 4 dimentions are 3.81 in the cognitive dimension,

3.05 in the affective dimension, 2.06 in the marital adjustment dimension and 2.41

in the social adjustment dimension. 2. The predictors of the stress of the infertile

women are their educational levels and subjective economic status. They explain

14.08% of total variance.

According to A.R. Bharathi (2002) the study conducted on 60 infertile

women. The findings of the study related that level of depression among 60

infertility women 36 ( 50%) showed mild level of depression 11 ( 18.33%) showed

severe depression 9 ( 15%) showed moderate depression and 4 ( 6.67%) were not

depressed .

According to Tara M. Counsineau (2008) conducted study on 190 female

patients were recruited from three US fertility centers and were randomized into

two experimental and two no treatment control groups. The psychological

outcomes assessed included infertility distress, infertility self-efficacy decisional

conflict, marital cohesion and coping style. Women exposed to the online program

significantly improved in the area of social concerns ( P = 0.038) related to

infertility distress, and felt more informed about a medical decision with which

they were contending ( P = 0.059) distress related to child-free living ( P = 0.063),

increased infertility self-efficacy ( P = 0.067) and decision making clarity ( P =

0.079) A dosage response was observed in the experimental groups for women

who spent > 60 non online for decreased global stress ( P = 0.028) and increased

self efficacy ( P 0.024). This evidence – based Health program for women

experiencing infertility suggests that a web-based patient education intervention

can have beneficial effects in several psychological domain and may be a lost

effective resource for fertility practices.

2. STUDIES RELATED TO INFORMATION ABOUT STRESS IN

INFERTILITY TREATMENT :

According to Venkatesan latha ( 2005) By this study the data was

collected from 100 infertile women who were undergoing treatment for primary

infertility and attended the OPD of Rao Hopsitals, Coimbatore. Path analysis was

used to predict the bio-psycho-socio-behavioral determinants of self-concept. The

results and discussion of this study is a majority of the infertile women ( 65%) had

moderate level of self-concept. It was significantly associated with age ( P. The

self-concept was low in women with age > 30 years, educational status above

higher secondary level and with duration of infertility more then 6 years. The

Following significant predictions were also identified through regression. One unit

increase in family support predicted 44.4% increase in self-concept. One unit

increase in marital adjustment predicted 46.67% increase in self-concept. One unit

increase in depression caused 53.5% decrease in self-concept. One unit increase in

stress reaction to infertility decreased 38.5% of self-concept.

According to Alice D. Domar (2009) study said women who experience

infertility report increased levels of distress, as this condition has an impact on

virtually every aspect of lives – i.e., partner relationship, sex life, employment

relationship with fertile family members and friends, financial stability (Most

insurance policies do not cover treatment ) and even religious beliefs. In addition

many infertile women are blamed by other for their education. In this study 112

infertile women were interviewed by a psychiatrist prior to treatment, 40.2% met

criteria for a psychiatric disorder. The most common diagnosis was on anxiety

disorder ( 23.2%) followed by major depressive disorder (17%) this compares with

an average prevalence of 3%.

The level of distress in infertility patients tends to increase as treatment

intensifies, so it is possible that the 40% noted in this study would be even higher

in a population of patient undergoing in vitro fertilization (IDF).

According to Alice M. Domer ( 2009 ) conducted Study in the Netherlands,

where assisted reproduction cycles are covered by insurance, showed a cumulative

dropout rate after three cycles of 62%, with only 14% due to active censoring.

Research also suggests that cost is not the determinant for many IVF patients. In a

study of 974 Swedish couples, 65% did not complete the three covered IVF cycles

due to the psychological burden of therapy. Australian couples who were offered

up to six cycles free of charge started a mean number of 3.1 cycles, regardless of

whether a live birth was achieved. The most common reasons for terminating

treatment were emotional ( 66%).

A retrospective study analyzed data on 2,130 German patients who were

covered by insurance for four cycles. The dropout rate for nonpregnant patients

was 40% after the first cycle and 62% after the fourth cycle, and was attributed to

increasing stress and frustration. This study included an analysis of the cumulative

pregnancy rates for patients who did not discontinue treatment. The patients

underwent a mean of only 1.92 IVF cycles, even though the mean number of

cycles to conception was 2.12, and 49% underwent only one cycle. The real

cumulative pregnancy rate was 31.4% after four cycles. However, it was estimated

that if all nonpregnant patients had returned for only one more cycle, the

cumulative pregnancy rate would have increased to 41% - translating to an

ongoing pregnancy rate of 53%, increase to 60% after six cycles.

In a study of 211 couples who had insurance coverage for IVF but

discontinued for reasons other than active censoring, the most commonly cited

factor was psychological burden, followed by the perception of poor prognosis.

Patients who discontinued treatment were as satisfied with therapy as those who

continued. This is consistent with prior research showing that IVF poses more of a

psychological than physical burden.

According to Katerina Lykeridou, (2009), In this studies conducted on

infertility treatment, little is known about the psychological impact of infertility

when it is due to male or female factors and its role in the cause of higher levels of

anxiety and stress. The study involved 404 women undergoing fertility treatment

in a public clinic in Athens. The research instruments were three self-

administrated questionnaires. State and trait anxiety, infertility-related stress

( personal, social and marital domain ) and depression were measured. Women

with male factor infertility had higher levels of state anxiety ( p = 0.007) and social

stress ( p = 0.007) than women with female, mixed and unknown infertility.

Women with idiopathic infertility also had higher levels of trait anxiety (p =

0.001). Thus, the psychological status of women is strongly related to the

aetiology of the infertility problem, and as a result it is necessary for women

undergoing treatment for infertility to have an individualized psychological

support, based on their infertility problem.

According to Latha Venkatesan ( 2009 ) The study conducted on the

impact of positive therapy upon the stress levels in infertile women was studied

through a randomized clinical that the infertile women were randomly assigned in

to the control ( n = 60 ) and experimental group ( n = 60 ) of women pre test stress

was assessed on day 2 of the menstrual cycle of control and experimental group of

infertile women and the positive therapy was implemented from day 2 to 7 of the

menstrual cycle only for the experimental group of women post test stress was

assessed on day 14 of the cycle in both the groups. The results have shown that in

experimental group the post test stress level ( M = 247.51, Standard Deviation –

23.14) was less that the pretest stress level ( M = 164.30 SD = 19.03 ) and the

difference was statistically significant at P < .001 level in control group there was

no statistical difference between the pre test ( = 246 65 5 D = 22.18 ) and post test

( M .247.06 SD = 21.89) stress levels. The result can be attributed to the

effectiveness of positive therapy and has direct implications for nursing practice.

3. STUDIES RELATED TO INFORMATION ABOUT STRESS

COPING SCALE.:

According to T.Y. Lee (2008) A study conducted on total of 138 infertile

couples participated in this study. The Coping Scale for Infertile Couples was

administered with the Infertility Questionnaire, the Perceived Stress Scale, and the

Jalowiec Coping Scale as measures of concurrent validity. Results suggested that

this measure has good reliability and validity, which can contribute toward the

elucidation of coping strategies used by infertile couples and assist in planning

effective interventions.

STATEMENT OF THE PROBLEM:

“A STUDY TO ASSESS THE LEVEL OF STRESS AMONG INFERTILITY

WOMEN WHO ARE ALL ATTENDING THE INFERTILITY CLINICS IN

SELECTED HOSPITAL AT BANGALORE”.

6.4 OBJECTIVE OF THE STUDY:

1) To asses the level of stress among infertile women who are all

attending the infertility clinics.

2) To correlate demographic data with the level of stress among infertile

women who are all attending the infertility clinics.

6.5 OPERATIONAL DEFINITION :

1. STRESS :

Stress is the body’s reaction to a change that requires a physical mental or

emotional adjustment or response.

2. WOMEN :

Women who had failed to conceive after unprotected inter course for a

period of one year.

3. INFERTILITY :

Refers to a condition in which the married women is unable to conceive after

at least one year of unprotected regular intercourse and diagnosed as infertile by an

obstetrician.

6.7 ASSUMPTION :

1. All infertile woman experience stress

2. The level of stress experienced for infertility differs from women to women.

3. Education will enhance the knowledge about stress and stress management of

infertility.

6.8 DELIMINATION :

The study is limited to the infertile women in selected infertility clinics.

The study is limited to who can read and write kannada or English.

The study was limited to women who were willing to participate in the

study.

The sample size is limited to 60.

7. MATERIAL AND METHODS :

DEFINITION :

Methodology refers to the means of gathering data that are common to all

sciences including nursing. It is different from the word technique which refer to

specific tools that are used in a given method. We may classify all methods of data

collection methods as follows.

7.1 SOURCE OF DATA :

The data will be collected from infertile women in infertility clinics at

selected hospital at Bangalore.

7.2 METHODS OF COLLECTION OF DATA :

Data will be collected through questionnaire by interview method.

VARIABLES :

INDEPENDENT VARIBALE

selected demographic variable Name, age, sex, education occupation,

Income, religion.

DEPENDEDT VARIABLE :

Knowledge regarding the level of stress of infertility.

7.2.1 RESEARCH APPROACH :

Research approach will be conducted by survey method.

7.2.2 RESEARCH DESIGN :

A Descriptive study was chosen to assess the level of stress among infertile

women who are all attending the infertility clinics in a selected hospital at

Bangalore.

7.2.3 RESEARCH SETTNG :

The present study will be conducted at who are all attending the infertility

clinics in selected hospital at Bangalore.

7.2.4 POPULATION :

The population for the present study is done on infertile women who are all

attending infertility clinics in selected hospital at Bangalore.

7.2.5 SAMPLE SIZE :

The sample consists of 60 No’s infertile women who are all attending the

infertile clinic in selected hospitals at Bangalore.

Women who are willing to participate in the study.

Infertile women who are all attending the infertility clinics.

7.2.6 SAMPLING TECHNIQUE :

Samples were selected by the investigator using convenient sampling

technique.

7.2.7 SAMPLING CRITERIA :

INCLUSION CRITERIA :

1. Infertile women were at the age group of above 20-45 yrs.

2. Infertile women who are all willing to participate in the study

3. Infertile women who are all available during the period of data collection in

OPD.

4. Infertile women’s who can understand Kannada and English.

EXCLUSION CRITRIA :

Infertile women were at the age group of <20 and >45 yrs.

Infertile women who are all not willing to participate in the study.

Infertile women who are not available during the period of data collection.

Infertile women who cannot understand Kannada and English.

Infertile women who had severe physical & mental illness.

7.2.8. TOOLS FOR DATA COLLECTION :

Instruments used for this study consist of 2 parts they are described below

Part – I – Demographic data

Part – II – Standardised stress scale-cohen’s scale

Part – I

The demographic data is relation to age,sex, educational status, occupation

monthly income, religion, type of family and duration of married life.

Part – II

It consist of 14 items.

7.2.9 METHODS OF DATA ANALYSIS AND PRESENTATION :

Data analysis will be through descriptive and inferential statistics.

Descriptive Statistics

Frequency, percentage, mean, median and standard deviation will be used.

Inferential Statistics :

Chi-square test will be used.

PROJECTED OUTCOMES

Much scope is there for mental health nurse to play a pivotal role in

imparting knowledge to the infertility women and their family members to reduce

the level of stress.

The psychiatric nurse can play important role in the management of Stress

by planning and co-ordinating the multi-modality treatment programme.

This study will help nursing students to conduct health education

programme regarding special emotional needs of infertility.

In research, this study is helpful for nurses, to find out various effective

interventions for stress among women who were attending infertility clinic.

India is a developing country. Productive citizens determine the future of

the nation also. By assessing the level of stress among women who were attending

the infertility clinic, nurses can play major role in maintaining mental health of

infertility women by early investigation which is turn, contribute to the national

development.

7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR

INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER

HUMANS OR ANIMALS ? IF SO, PLEASE DESCRIBE BRIEFLY.

No.

7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR

INSTITUTION ?

Permission will be obtained from the research committee of the Sushrutha

College of Nursing.

Informed consent will be taken from the hospital where the data will be

collected.

8. LIST OF REFERENCES :

BOOKS REFERENCES:

1. Evelyn Corsini, Trau C. Green, Tara M. Causinean et al. ‘Human

Reproduction’ 2008 volume 23, published by oxford university press

page No. 55-566.

2. Emuni research souk 2009 ( Emuni Res 2009 ) the Euro –

Mediterranean student research Multi-conference a Juma 2009

“Fertility problems and Psycho – Social Aspects.

3. Peter S. Finamore, “ Fertility – Sterility” 2007-Vol. 88, Published by

Elsevier inc. Page No. 817-821.

4. KEYE – CHANG “infertility evaluation – treatment” 1995 – chapter – 4

published by W. B.Saunders company , Page No– 259-39.

5. Dr. Aniruddha Malpani et al “How to have a Baby”-2009, overcoming

infertility chapter – 32.

INTERNET REFERENCE

Pubmed index for midline.

www.google.com

JOURNALS

Latha Venkatesan “The impact of positive therapy upon the stress level in

infertile women”The journal of Nightingale Nursing times 2009.

Journal of Reproductive and Infant Psychology, Volume 27, Issue 3 August

2009.

THESIS REFERENCES :

(i) Young Joo-Park (1995). “The stress of the Infertile women.”

(ii) Evelyn corsirin : Trak C.Green, Tara M. Cousinean et al.2008).

“Online psychoeducational support for infertile women”:

(iii) Blickstein, And Baor, L. ( 2004 ) “Trends in Multiple Births in

Israel”. Hare Fuah, 143(11) 79-832.

(iv) Remernick, L.( 2000) “Childless in land of imperative motherhood;

stigma and coping among Infertile Israeli women” Sex Roles.

(v) Myra G. Schneides et al (2000) “Association of Psychosocial Factors

with the stress of infertility Treatment”.

(vi) Alice M. Doman (2009) “Infertility and the mind/body connection”.

(vii) Katerina Lykeridou (2009). “The impact of infertility diagnosis on

psychological status of women undergoing fertility treatment”.

(viii) Harefuah, (2008) “Stress and distress in infertility among women.”

(ix) Boivin J, Schmidt L 2005.. “Infertility – related stress in men and

women predicts treatment outcomes 1 year later”

(x) Gallinelli A. Roncaglia R. Matteo ML, Ciaccio I. Volpe A.

Facchinetti F.(2001) “Immunological changes and stress associated

with different implantation rates in patients undergoing in vitro

fertilization-embryo transfer”.

(xi) A.R.Bharathi,(2002) “Level of depression among infertile women”

9. SIGNATURE OF THE

CANDIDATE

10. REMARKS OF THE GUIDE The topic is relevant and it will reduce the strees

level among infertile women through

information booklet.

11. NAME AND DESIGNATION

11.1 GUIDE Ms. A. R. BHARATHI,

PROFESSOR CUM PRINCIPAL

DEPT. OF PSYCHIATRIC NURSING

SUSHRUTHA COLLEGE OF NURSING

BANGALORE.

11.2 SIGNATURE

11.3 CO-GUIDE

11.4 SIGNATURE

11.5 HEAD OF THE

DEPARTMENT

Ms. A. R. BHARATHI,

PROFESSOR CUM PRINCIPAL

DEPT. OF PSYCHIATRIC NURSING

SUSHRUTHA COLLEGE OF NURSING

BANGALORE.

11.6 SIGNATURE

12.

12.1

REMARKS OF THE

CHAIRMAN AND

PRINCIPAL

12.2 SIGNATURE