A recent survey has validated the usefulness of the fertility quality of life (FertiQoL) tool in identifying the impact of infertility on the wellbeing of couples, which would in turn enable healthcare providers to better address patient concerns and improve treatment outcomes.
Jacky Boivin, Professor, School of Psychology, Cardiff University, Wales, UK, and coworkers, assessed the psychometric features of the FertiQoL tool, developed by the collaborative effort of the European Society of Human Reproduction and Embryology (ESHRE), American Society for Reproductive Medicine (ASRM), and Merck Serono S.A. in 2002. Published in Human Reproduction, the survey was conducted on 34 men and 1,014 women through patient advocacy websites, and 75 men and 291 women in fertility clinics; all subjects from across Australia/New Zealand, Canada, USA, and UK.
The sociodemographic status, fertility-related characteristics, and medical history were part of the Background Information Form. In addition, a FertiQoL prototype was created, whereby abstract concepts, such as sense of belonging and commitment, were quantified by designing items that jointly helped in analyzing the influence of fertility problems on QoL. Among the 36 items randomly put forward in the prototype, 24 evaluated emotional, relational, mind-body [cognitive and physical], and social domains (core QoL), 10 assessed environment and tolerability (treatment-related QoL), and two analyzed physical health and overall life. A scale of 0-4 was used, whereby elevated scores indicated a more favorable QoL.
The FertiQoL scores were referenced to the probable moderators of QoL such as gender, status of parenthood, and recruitment source. The survey showed that the Core FertiQoL scores were significantly higher in men than in women (M=72.1 vs. 53.3; SD=14.7 vs. 16.2; P<0.001) and also in participants with children compared to those without (M=59.5 vs. 53.3; SD=17.7 vs. 16.3; P<0.001). Scores were also seen to be higher in patients recruited from clinics than those from online sites (M=67.8 vs. 50.7; SD=15.6 vs. 15.1; P<0.001).
On evaluating treatment persistence items and treatment subscales, a greater intention to continue with the treatment was related to improved treatment FertiQoL (r=0.172; P<0.001), particularly in participants from the clinic (r=0.289; P<0.001). According to the sensitivity analyses, FertiQoL was shown to identify the anticipated correlation of QoL with gender, support seeking, and parity.
Based on these study findings, the researchers concluded that the subscales and total scales of the FertiQoL indicate its superior sensitivity and reliability to the well-established regulators of QoL in individuals with fertility issues. Additionally, the tool was made available in 20 different languages.
Similar results of the reliability of FertiQoL to assess QoL of infertile women were reported in another recent study by Aarts et al (Human Reproduction, 2011). The scientists validated the negative correlation of anxiety and depression with QoL as analyzed by the hospital anxiety and depression scale (HADS) and the FertiQoL questionnaire. The reliability of the FertiQoL was psychometrically analyzed and found to be high, with a reliability coefficient in the range of 0.72 to 0.91. They concluded that FertiQoL aids clinicians to individualize the treatment modalities in a more comprehensive and precise manner.
The current study findings reiterate the reliability of the FertiQoL tool in recognizing individuals at risk of impaired QoL. The elective 10-item treatment module, which is an exclusive feature of FertiQoL as opposed to other QoL determinants, evaluates QoL with reference to tolerability of treatment (ramifications on mood and disturbance in daily life) and quality of treatment (communication with staff and quality of information).
The efficacy of new treatment modalities/medicines and quality of services rendered can be scrutinized, and the precise domains that require intervention can be identified using these subscales, ensuring the best possible treatment experience for patients. Nevertheless, the existence of cross-cultural differences, requirement of separate cultural standards, and presence of different mean values for varied populations need to be dealt within the forthcoming FertiQoL studies. Cross-cultural research, especially in developing countries will be facilitated by the availability of the FertiQoL tool in 20 languages. The above-mentioned advantages of the FertiQoL indicate that it may emerge as the gold standard to evaluate the QoL of people with fertility problems, irrespective of the treatment status.
1. Boivin J, Takefman J, Braverman A. The fertility quality of life (FertiQoL) tool: development and general psychometric properties. Hum Reprod. 2011 Aug;26(8):2084-91.
2. Aarts JW, van Empel IW, Boivin J, Nelen WL, Kremer JA, Verhaak CM. Relationship between quality of life and distress in infertility: a validation study of the Dutch FertiQoL. Hum Reprod. 2011 May;26(5):1112-8.