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A Study to Assess the Knowledge of Infertile Couples Regarding Infertility in Selected Areas at Raichur, by B. Padma, Navodaya College of Nursing, Raichur

A Study to Assess the Knowledge of Infertile Couples Regarding Infertility in Selected Areas at Raichur, by B. Padma, Navodaya College of Nursing, Raichur

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    Infertile couples knowledge nurs Infertile couples knowledge nurs Document Transcript

    • A Study to Assess the Knowledge of Infertile Couples Regarding Infertility in Selected Areas at Raichur by B. Padma Dissertation Submitted to the Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore In partial fulfillment of the requirements for the degree of Master of Science in Nursing In Obstetrics and Gynaecology Under the guidance of Dr. R. Vasundhara Department of Obstetrics and Gynaecology Navodaya College of Nursing Raichur.December, 2005.Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore I
    • DECLARATION BY THE CANDIDATE I hereby declare that this dissertation/thesis entitled “A Study toAssess the Knowledge of Infertile Couples Regarding Infertility inSelected Areas at Raichur” is a bonafide and genuine research workcarried out by me under the guidance of Dr. R. Vasundhara, R.N;R.M;R.P.H.N; M.N; M.Sc(Psy); P.G.D.H.E; Ph.D. Principal & Professor,Navodaya College of Nursing, Raichur.Date: Signature of the CandidatePlace: Raichur B. Padma II
    • CERTIFICATE BY THE GUIDE This is to certify that the dissertation entitled “A Study to Assess theKnowledge of Infertile Couples Regarding Infertility in Selected Areasat Raichur” is a bonafide research work done by B. Padma in partialfulfillment of the requirement for the degree of Master of Science inNursing.Date: Dr. R. Vasundhara,Place: Raichur R.N;R.M;R.P.H.N;M.N;MSc(Psy); P.G.D.H.E;Ph.D Principal & Professor, Obstetrics & Gynaecology Department Navodaya College of Nursing, Raichur. III
    • ENDORSEMENT BY THE HOD, PRINCIPAL/HEAD OF THE INSTITUTION This is to certify that the dissertation entitled “A Study to Assess theKnowledge of Infertile Couples Regarding Infertility in Selected Areasat Raichur” is a bonafide research work done by B. Padma under theguidance of Dr. R. Vasundhara, R.N;R.M; R.P.H.N; M.N; MSc(Psy);P.G.D.H.E; Ph.D. Principal & Professor, Navodaya College of Nursing,Raichur.Seal & Signature of the HOD Seal & Signature of the PrincipalDr.R.Vasundhara Dr.R.VasundharaProfessor R.N;R.M;R.P.H.N;M.N;M.Sc(Psy),P.G.D.H.E;Ph.DNavodaya College of Nursing, PrincipalRaichur Navodaya College of Nursing, Raichur IV
    • COPY RIGHT Declaration by the Candidate I hereby declare that the Rajiv Gandhi University of Health Sciences,Karnataka shall have rights to preserve, use and disseminate thisdissertation/thesis in print or electronic format for academic/researchpurpose.Date: Signature of the CandidatePlace: Raichur B.Padma © RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA V
    • ACKNOWLEDGEMENT Thanks and honour over flow from my heart and mind to AlmightyGod for his support, guidance, protection, and strength from the beginning tothe end of this dissertation which enabled me to complete it to my optimalsatisfaction. It is my proud privilege to express my deep sense of gratitude to Mrs.Dr. Vasundhara. R.N; R.M; R.P.H.N., M.N., M.Sc. (Psy.), P.G.D.H.E.,Ph.D., Principal and Professor, Navodaya College of Nursing, Raichur,Karnataka for her expert guidance, valuable suggestions, continuousencouragement and ongoing support throughout the course. I express mypersonal gratitude to her for her enthusiasm in making the student perfectand bound to profession. I extend my profound thanks to Dr. K.P. Neeraja. R.N; R.M;R.P.H.N., B.Sc., M.Sc.(N)., M.A(Socio)., Ph.D Professor, NavodayaCollege of Nursing Raichur, Karnataka who helped me at various stagesof the study. I feel happy to express my pleasant and sincere thanks to Mrs.Sreelekha Saji C, M.Sc (N), Lecturer, Navodaya College of Nursing,Raichur for her valuable guidance, enlightening ideas, sustained support tocomplete the study successfully. VI
    • I extend my deep sense of gratitude to the Management of NavodayaEducational Trust, Raichur, for giving me an opportunity to undergo thepost-graduate programme in their esteemed institution. I desire to express my immense thanks to Mrs. Shameen GulnazUnnisa, Lecturer, Mrs. Prema Balu, Lecturer, Mrs. Annapurna,Lecturer for their suggestions and guidance at various stages of the study. I offer my gratefulness to the panel of experts in giving theirexpertise to this study. I derive a great delight to owe my thanks to library staff ofInformation Center, National Institute of Nutrition, National Instituteof Family Welfare, Hyderabad and Navodaya College of Nursing fortheir assistance in collection of studies for research review. I reserve my grateful thanks to Mr.Pranay, HOD, Department ofStatistics, Chaitanya Degree College, Warangal for his guidance anduseful suggestions in statistical analysis. I express my humble gratitude to Ms. Neethi Sundari, M.PhilLecturer, Government Degree College, Warangal for editing this script. I am indeed thankful to Mr. Subhash.M and Mr. Suresh.D, PruthviComputers, and Mr.Mohiddin R. Proprietor of Comtech Computers fortyping this manuscript meticulously and computerizing this project in aperfect form. VII
    • I express my special thanks to my classmates and friends for their co-operation and active participation during data collection. Appreciation is extended to my parents Sri. B.K Sammaiah, Smt.B. Sulochana, Sisters Ms. B. Bhavani and Ms. B. Deepthi, Brothers Mr.B. Ashok and Mr. Venkat for their perpetual love, Prayers and supportthroughout my study period. Without their co-operation and never endinghelp my education would be a dream. I submit my gratefulness to my mother-in-law Mrs. K. Lakshmi forher encouragement and blessings throughout this study period. Specialacknowledgement and sincere thanks to my Brother-in-laws Mr. B. ShyamSunder and Mr. B. Mallesh, Son-in-law Mr. P. Praveen for their kindsupport and help throughout the study period. I am deeply indebted to my husband Mr.G.B. Rajeshwar Rao forrooting in- depth strength and faith in me, both at times of happiness andsorrow, at all stages of the work. Last but not least, my love to mysweetheart, darling daughter G. Hamsika. Thank you for your co-operationin balancing me with peace & joy and giving me strength to complete mywork by God’s grace. B.Padma VIII
    • TABLE OF CONTENTSS. NO CHAPTERS PAGE. NOI INTRODUCTION Background of the Study 1-8 Need for the Study 8-14 Statement of the Problem 14 Objectives of the Study 14 Selected Variables 15-18 Operational Definitions 19 Assumptions 20 Delimitations 20 Hypotheses 21-22 Conceptual Framework 22-26 Organization of the Report 27II REVIEW OF LITERATURE Studies related to knowledge of infertile couples on infertility. 28-33 Studies related to comparison of knowledge of infertile males and females on infertility. 33-38 Studies related to causes of infertility. 38-41 Studies related to investigations of infertility. 41-44 Studies related to treatment of infertility. 44-47 Studies related to prevention of infertility 47-48 IX
    • III METHODOLOGY Research Approach 49-50 Research Design 50-51 Setting of the Study 53 Description of the Area 53 Population 55 Sample & Sampling Technique 55 Inclusion Criteria 56 Exclusion Criteria 56 Method of Data Collection 57 Development and Description of the Tool 57-58 Content Validity of the Tool 58 Reliability of the Tool 58 Pilot Study 59 Collection of Data 59 Plan for Data Analysis 60IV RESULTS Section I : Sample Characteristics 62-69 Section II: Item Wise Analysis of Knowledge Questions 81-106 on Infertility Section III : Relationship of Knowledge of Infertile 107-111 Couples on Infertility with Selected Variables and Comparison of Knowledge on Infertility Between Infertile Males and Females X
    • V DISCUSSION 112-126VI SUMMARY 127-134VII CONCLUSION 135VIII IMPLICATIONS AND RECOMMENDATIONS 136-138 BIBLIOGRAPHY 139-151 ANNEXURES 152-186 ABSTRACT OF THE REPORT 187-190 XI
    • LIST OF TABLESS. CHAPTER PAGE.NO NO1. Frequency and Percentage Distribution of Infertile Couples by Age, Sex, Education, Source of Information, Income, Religion, Duration of Infertility and Screening. 62-662. Frequency and Percentage Distribution of Infertile Couples by Reasons for Infertility According to Wife and Reasons for Infertility According to Husband 67-683. Frequency and Percentage Distribution of Infertile Couples by Treatment Option 68-694. Frequency and Percentage Distribution of Infertile Couples Knowledge on Concept of Infertility. 81-835. Frequency and Percentage Distribution of Infertile Couples Having Correct Knowledge About Anatomy and Physiology of Male and Female Reproduction 83-866. Frequency and Percentage Distribution of Infertile Couples Having Correct Knowledge About Pregnancy. 86-887. Frequency and Percentage Distribution of Infertile Couples Having Correct Knowledge About Causes of Infertility. 88-908. Frequency and Percentage Distribution of Infertile Couples Having Correct Knowledge About Diagnosis of Infertility. 91-92 XII
    • 9. Frequency and Percentage Distribution of Infertile Couples Having Correct Knowledge About 92-93 Psychological Response to Infertility.10. Frequency and Percentage Distribution of Infertile Couples Having Correct Knowledge on Treatment of Infertility. 93-9711. Frequency and Percentage Distribution of Infertile Couples Having Correct Knowledge About Prevention of Infertility. 98-9912. Variables Wise Mean and Standard Deviation of Infertile Couples Knowledge on Infertility. 100-10613. Chi-Square Values Showing Relationship of Knowledge Scores of Infertility Couples on Infertility with Age, Sex, Education, Source of Information, Income, Religion, Duration of Infertility, Screening, Reasons for Infertility According to Wife, Reasons for Infertility According to Husband and Treatment Option. 107-11014. Comparison of Knowledge on Infertility Between Infertile Males and Females. 111 XIII
    • LIST OF FIGURESS.No FIGURES PAGE NO 1. Primary and Secondary Infertility Rates in Asia 10 2. Conceptual Frame Work Based On Pender’s Modified Health Promotion Model. 26 3. The Schematic Design of the Study 52 4. Map Showing the Area of the Study 54 5. Percentage Distribution of Infertile Couples According to Age. 70 6. Percentage Distribution of Infertile Couples According to Sex. 71 7. Percentage Distribution of Infertile Couples According to Education. 72 8. Percentage Distribution of Infertile Couples According to Source of Information. 73 9. Percentage Distribution of Infertile Couples According to Income. 74 10. Percentage Distribution of Infertile Couples According to Religion. 75 11. Percentage Distribution of Infertile Couples According to Duration of Infertility. 76 12. Percentage Distribution of Infertile Couples According to Screening 77 13. Percentage Distribution of Infertile Couples According to Reasons for Infertility Expressed by Wives. 78 14. Percentage Distribution of Infertile Couples According 79 to Reasons for Infertility Expressed by Husbands. 15. Percentage Distribution of Infertile Couples According to Treatment Option. 80 XIV
    • LIST OF ANNEXURESS. NO CONTENT PAGE. NO 1. Letter Seeking Acceptance From the Content Validators. 152 2. List of Experts Consulted for Content Validity of the Tool. 153 3. Letter Seeking Permission From the Municipal Officer to Conduct Study. 154 4. Questionnaire to Assess the Knowledge of Infertile Couples on Infertility. 155-168 5. Kannada Version of Questionnaire to Assess the Knowledge of Infertile Couples on Infertility. 169-184 6. Scoring Key. 185-186 XV
    • I INTRODUCTION Background of the Study “Flesh of my flesh, bone of my bone and miraculously my very own, never forget a single moment, you didn’t grow under my heart, but in it” - Dear Born Parenthood is a fundamental human need. The urge to reproduce isvirtually universal. Every human being has a desire to become a parent andlook after his or her children. The very desire for parenthood is a step in thedirection of creating a family1. Fertility or the ability to produce children has a positive social valuewhereas, infertility has a negative social value in Indian culture. Family andsociety look down couple who is not able to bear children within areasonable period of time following marriage. Another reason for so muchimportance being attached to the social aspect of fertility behaviour is thatfamily name will not be carried forward without a child2. Today fertility and infertility have both emerged equally problematicin the world population context. Most fertile couples around 90% should getpregnancy within a year of regular intercourse. This rises to 95% over atwo-year period3. 1
    • Infertility is usually defined as involuntary failure to conceiveafter one year of unprotected sexual intercourse4. A report available at theWHO 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 toconceive, despite sexual relation for a period of one year, it is secondaryinfertility5.” Infertility affects 15% of couples and it is estimated that half of thosecouples who attend infertility clinics will be successful but equally abouthalf do not get the baby they seek. Between 80-90% of couples who will geta pregnancy without assistance succeed within the first year of unprotectedintercourse and about 95% within 2 years4. The problem of infertility has troubled mankind since ages. It is noteasy to be certain when the first references to infertility appeared in theliterature or in art. The story is told in the first chapter of the first book ofSamuel of Hew Hannah who was childless, prayed silently and tearfully inthe house of the Lord for the gift of a child. She explained to him her greatneed and she vowed that, if she would have a child, she would give the childto the hard to serve him all his life6. From mythology to factual history–The great Hippocrates (460-377B.C) wrote that if a woman does not conceive and wish to ascertain whethershe can conceive, wrap her up in blankets, fumigate below and if it appearsthat the scent passes through the body to the nostrils and mouth think that 2
    • she is not unfruitful. Aristotle (384 – 332 B.C) said that male is generativeup to the age of 65 years and female is capable to conceive up to the age of45 years6. About 8% to 10% of couples of reproductive age experience infertilityand in approximately 40% of these male infertility is the major factor.Another 40% is due to abnormalities of woman’s reproductive system andthe remaining 20% involve couples that both suffer reproductivedifficulties7. Men are most likely to be infertile, if they had sperm counts below13.5 million, less than 32% sperm motility, fewer than 9% of sperm had anormal appearance. The causes of infertility in female were ovulationproblems (20-25%), tubal problems (15-25%), endometriosis (4-8%),cervical mucus hostility (1-2%), uterine problems(2.5%).Unexplainedinfertility was seen in 10-15% of couples. Other causes might be maritalproblems, psychological factors, sexual factors, lack of education andknowledge4. About 15% of couples had more than one cause for their infertility. Itis therefore, important to make complete investigations from the outsetrather than focusing treatment on the first cause identified8. Data from Western communities, where no artificial methods are usedto control fertility show a gradual decline in fertility with age that becomesmore after 40 years and approaches 0 by 49 years. Increasing age of male 3
    • and female partners and reduced vital frequency may also influence thisdecline9. Infertile couples describe their lives without children as beingmeaningless, fruitless, miserable, shameful and unhappy. There isunderstandable grief in response to their loss of the ability to have children.There is little known of the long term outcomes of such couples but it seemslikely that for some it will be devastating experience that will affect their lifetime mental health10. In addition to the above-mentioned problems, familyand social problems such as in marital relations and conflicts such as secondmarriage, separation and divorce were of important problems, which makethe psychological counseling services very important11. Six ways of coping with infertility were identified by Dear born Increasing the space or distancing oneself from reminders of infertility. Instituting measures for regaining control. Acting to increase self-esteem by being the best. Looking for hidden meaning in infertility. Giving into feelings. Sharing the burden with others. Women go through various treatment-seeking modes to avoid theadverse consequences of childlessness. Adoption is not an acceptable optionfor many as women face psychological, familial and community pressure toproduce a biological child12. Couples seek varied traditional methods and 4
    • religious practices, including visits to temples, abstaining from visiting aplace where a woman has delivered a child, observing tantric rites, wearingcharms, participating in rituals and visiting astrologers13. More recent studieshave identified allopathy as the first treatment sought. Couples also followreligious practices with such treatment, either simultaneously orsubsequently14. As a last resort, when allopathic treatment does not work, women seekother methods, such as ayurveda, homeopathy, unani and other traditionalmethods, or visit holy places and spiritual healers. Most couples seektreatment after trying to conceive for one to four years14. Couples may delay seeking medical advice because of the fear of afinal definite diagnosis, emotional stress, the physical discomfort of the teststhey would have to undergo and admitting failure in their efforts to conceive.Irrespective of who the infertile person is, it is the woman who usuallyinitiates the first contact with a physician. Couples with primary infertilityare usually more interested in treatment than those with secondaryinfertility15. Treatment sometimes continues over a long period; for example, inone study, women sought allopathic treatment for 25 years and somecontinued to rely on rituals or religious practices for over 30 years. Althoughmost studies reveal that male participation in infertility diagnosis andtreatment tends to be limited as infertility is perceived to be a woman’sproblem, in some contexts, husbands also participate and accept treatment ifrequired. Stigmatizing beliefs, limited male participation, cost, indifferent 5
    • quality of care and lack of services in the public sector are major barriers toprompt and appropriate treatment seeking. Patterns of treatment seekingdepend on the woman/couple’s socio-economic status, decision-makingwithin the family, the level of information and accessibility of treatment12. Childlessness is Universal. Medical management is more or lesssimilar all over the world. Treatment depends on the cause of infertility .Itmay range from simple education and counseling to the use of medicinesthat treat infection or promote ovulation to highly sophisticated medicalprocedures like invitro-fertilization. In the fast moving world of today,Assisted Reproductive Technologies have become a procedure of choice inthe management of infertility. It includes intrauterineinsemination to somesophisticated techniques like Gamate intrafallopian transfer (GIFT), Zygoteintrafallopian transfer (ZIFT), Intracytoplasmic Sperm Injection (ICSI).Thousands of babies are born using these techniques16. Often preventing infertility is much easier than better treating it . Thebiggest preventable danger to infertility is due to uncontrolled sexuallytransmitted diseases such as syphilis, gonorrhoea & chlamydia.Contraception can also pose a hazard to future fertility, if not selectedcarefully. Dr. Aniruddha Malpani suggested following guidelines for prevention ofinfertility. Vaccinate children with mumps, measles and rubella vaccine. Avoid excessive alcohol, smoking, cocaine and marijuana. 6
    • Undescended testes should be surgically treated at an early age preferably before 2 years. Avoid intense exposure to heat in the work place and radiation. Avoid over exercise, obesity, excessive dieting, stress and tension. Avoid having multiple sexual partners. Avoid poorly treated sexually transmitted infections. Avoid unnecessary abortions. Avoid intrauterine device use in adolescents and youth. Be aware of fertility decline after 35 years of age. Prepare pregnancy by improving pregnancy knowledge of regular prenatal checkups. Everyone should have a healthy diet, rich in fresh fruits andvegetables, whole grains and replacing animal fats with monounsaturatedoils and fish oils. A study in 2002 found that infertile men who took zinc(60mg) and folic acid (5mg) supplements daily for 6 months increased theirsperm counts by 74 per cent. Researchers in India discovered an antioxidant,lycopene, which is found in watermelon, grapes, tomatoes and some sorts ofshellfish can boost sperm concentrations in infertile men17. Infertility can dominate the lives of the infertile. What had not beachieved until the 20th century was a proper scientific approach to theinvestigation and treatment of infertility. The new reproductive technologieswhich have resulted from the work which led to the birth of the first test tubebaby on July 25th, 1978 has raised new hopes for millions of infertile couplesaround the world. In the past, the cause of infertility was always assumed tothe fault of woman. That too has changed6. 7
    • Supportive and therapeutic counselling is a vital part of the servicesprovided by a fertility unit. The distress of the infertile, the fear anddiscomfort associated with treatment programmes, the uncertainty of successand the possibility of having to accept failure are also situations for whichfew can ever be equipped by their past experience. They can be madebearable by expert counselling. In this aspect world infertility month wascelebrated in the month of June, 200218. Need for the Study Fertility is nature’s design to propagate the race. Having a child is thesingle most wonderful thing two people, who love one another, can do.Nature may occasionally default and may be responsible for infertility. Inmost of the societies children are considered as a natural result of union ofman and a woman in the institution of marriage. In all cultures, beingpregnant or to produce a child is considered as a major event in the family.Everyone expects woman to sail through 9 months of pregnancy joyfully andgive birth to a child6. A paradox in Indian society is that, on one hand, is greatly valuesfertility and motherhood within marriage, but on the other, it totally rejectsthe unwed mother and the child born out of wed-lock18. If a woman does not conceive within one year after marriage, it isconsidered as a stigma for the woman in Indian society. Unfortunately, thefinger is pointed to the woman and not to the husband, for infertility. 8
    • Infertile woman reported rude behaviour by neighbours and relatives morefrequently than did their husbands. This indicates that a grave social stigmacontinues to be attached to infertility and has to be largely borne by woman.Inability to reproduce is often experienced as a threat to future expectationsand dreams witch can cause great social and psychological embarrassment19. Infertility is a worldwide problem. About 8-12% of all marriedcouples are infertile. Woman starting to try to conceive at the age of 30, tostart a successful pregnancy within one year is 7.75%. This falls to 66% forthose who start at 35 and drops to 44% for woman starting at age 40 20. Infertility is a global phenomenon. An estimated one in ten couplesaround the world has difficulty conceiving at some point in theirreproductive lives. Nearly 5.3 million American woman are infertile,representing 9.1% of all woman aged 15to 44. Infertility affects 15% to 20%of all couples who are trying to conceive. The problem may be associatedwith male factors (40%) or both, 10-15% are unexplained21. According to 1995 National Survey of Family Growth, 1.2 million(2% of 60 million) woman of reproductive age had an infertility relatedmedical appointment and an additional 23% received infertility servicessometimes in their lives. Approximately, 1/6th of marriages are involuntarily childless althoughthe exact number inevitably depends on how the complaint is defined .Of100 couples trying to conceive, 40 will not be pregnant after 9months and 15will not have conceived after a year of trying22. 9
    • Indian society attaches a grave stigma to infertile woman. A newconcept of reproductive health envisages the provision of a package ofhealth care to woman that includes family planning and safe motherhood,treatment of reproductive tract infections as well as for helping infertilecouples to have children, thereby giving infertility a due place in the healthcare delivery system23. Primary and Secondary infertility rates in Asia according to WHO areas follows: 25 20 15 Secondary 10 5 Primary 0 Pakistan Nepal India Indonesia Srilanka Bangladesh Thailand Fig:1 Primary & Secondary Infertility Rates in Asia as per WHO Globally, between 50-80 million couples have a variety of biologicaland behavioral determinants. It is estimated that about 8-12% of all couplesexperience some form of infertility during their reproductive lives. In a coreof about 5% of couples, the causes of infertility are attributed to anatomical,genetic, endocrinological or immunological factors. The remaining 5-7% isthe consequence of STD’s or of complications suffered post partum or postabortion2. 10
    • In the Indian context there is great pressure on the woman to proveher fertility within a few years of her marriage. The 1981 census data wereanalyzed to show the pattern of childlessness among married woman. InIndia 18.5% of married woman are childless. As a whole there are 5.6% ofwoman in the 30-49 age group who are childless and the percentage in ruraland urban areas are almost the same. The Hindus who comprise nearly 84%of all married Woman have the highest percentage of childless Woman,followed with approximately 11% of Muslims24. A Community based survey was done in an urban slum covering 7620populations. The prevalence of primary infertility was 3.27%. Majority ofWoman with problems of infertility had problems of ill treatment by thehusband & in laws. After counseling, 6.66% agreed to avail services fromgovernment hospital but only 42.87% compiled with the treatment, majorobstacle being non-co-operation from husband25. Overall 7% of currently married women in India were childless,Southern (10.9%) and Western (10.7%) region shows highest percentage ofchildless women followed by Eastern region (6.5%). However, Centralregion exhibits lowest (4.7%) of childlessness. Andhra Pradesh showshighest percentage of childless women (13.3%) in India followed by Goa(11.8%). Urban areas have more percentage of childless women than theirrural counterparts. Results reveal that age is negatively associated withchildlessness26. 11
    • A study conducted on infertility in Primary Health Centers ofNorth India shown that, on an average there were 3 infertile couples pervillage (1-2 of primary and 1-2 of secondary infertility). Each PHC in Indiais thus expected to have a load of around 50-70 infertile couples. In thepresent population based study, both primary (48.5%) and secondaryinfertility (53.5%) cases were almost equally represented. In clinical basedstudies, primary infertility cases out numbered the secondary infertilitycases. Reproductive and child health programme in India envisages serviceprovision through a life style approach. Infertility is a crucial component ofreproductive rights and health affecting 7 to 10% of population. A facilitysurvey was done in 25 district hospitals, 13 rural hospitals and 10 privatespecialists at taluka places. The diagnostic facilities in public sector wereinadequate. The private practitioners managed majority of infertility cases.Political parties, if they provide reproductive services for infertility at theperiphery will help disadvantaged couples in fulfilling their hopes of childbearing27. High costs sometimes results in discontinuation of treatment or resortto unqualified practitioners. Traditional beliefs about women beingpossessed by evil spirits also inhibit women from seeking appropriatetreatment. The public health system does not offer access to adequatepreventive, curative and counselling services. Though infertility treatment istheoretically available at government facilities, effective treatment is oftendifficult to access as there is little coordination between gynaecologists, 12
    • infertility specialists, surgeons and laboratory technicians. Services areavailable in the private sector but are of varying quality and costs28. Time management for infertile couples is important, not only tomaximize chances of conceiving, but also to maximize the pleasure they getfrom parenting. Couples with unexplained infertility often find it verydifficult to accept this diagnosis and their commonest complaint is … “Iwish I knew why I wasn’t getting pregnancy.” They are also not sure how toproceed - “After all, if the doctor cannot find out what the problem is, howwill he be able to treat it” 29? Considering the magnitude of the problems of infertility and itsconsequences on couples like, the feeling of disbelief and denial, feeling offrustration, anger and anxiety, there seems to be a huge unmet demand forappropriate management of theses problems. Childlessness causes couples toperceive a sense of loss in relationship, in health status, prestige, self-esteem,self-confidence, security and perceived loss of something of symbolic value. Infertility has been recognized as an intrinsic part of family planningcare. The recent concept of reproductive health seeks to provide familyplanning, maternal and child health & care of infertile couples together as apackage. State health services are also expected to help childless couples toenjoy parenthood. This will enhance the faith of the people at large, in thegovernment health services which are often identified with birth controlactivities30. 13
    • Many of the causes for infertility are rectifiable leading to a fruitfulfamily. But, majority of the infertile couples are unaware of the reasons forinfertility and the remedies available to overcome the problem. Hence, as afirst step towards this, the researcher has planned to conduct a study toassess the knowledge of infertile couples regarding infertility in selectedareas of Raichur. Statement of the Problem “A study to assess the knowledge of infertile couples regardinginfertility in selected areas at Raichur” Objectives of the Study 1. To assess the knowledge of infertile couples regarding infertility. 2. To compare the knowledge of infertile males and females on infertility. 3. To analyze the relationship between the knowledge of infertile couples on infertility and selected factors. 14
    • Selected VariablesAge: It refers to chronological age of infertile couples. For the presentstudy, age is categorized as under: • 20-25 years • 26-30 years • 31-35 years • 36-40 yearsSex: It refers to the gender of the respondent. For the present study malesand females are selected.Education: It refers to training that helps to cultivate the mental abilities of theinfertile couple. For the present study, education is divided into followingcategories: • Knows to read and write • 1st to 10th standard • PUC • Graduation • Post graduation and above 15
    • Source of information: It refers to the large-scale information materials, which can shed lighton the knowledge of infertile couples. For the present study, source ofinformation is divided into following categories: • Newspapers • Health personnel • Elders in the family • Friends • Television • Posters • PamphletsIncome of the family: It refers to the earnings of infertile couples. The following range ofincome is taken for the study: • Less than Rs.2000 per month • Rs.2001-4000 per month • Rs.4001-6000 per month • Rs.6001-8000 per month • More than Rs.10000 per monthReligion: It refers to the system of faith of worship that the infertile couplesfollow. Religion is classified as: 16
    • • Hindus • Muslims • Christians • Any otherDuration of infertility: It refers to the period of failure to conceive despite of unprotectedintercourse. This is classified as: • 1-3 years • 4-6 years • 7-9 years • 10-12 years • Above 12 yearsScreening: It is the fertility seeking behaviour of childless couples. It is dividedinto: • Seeking medical advise • Not seeking medical adviseReasons for infertility according to wife: It refers to the identifiable factors according to wife, affecting thecouple who were unable to conceive despite of unprotected intercourse. 17
    • • Female factors • Male factors • UnexplainedReasons for infertility according to husband: It refers to the identifiable factors according to husband, affecting thecouple who were unable to conceive despite of unprotected intercourse. • Female factors • Male factors • UnexplainedTreatment option: It refers to the type of medical aid chosen by the infertile couples toovercome infertility. • Drug therapy • Hormonal therapy • Invitro-fertilization • Surrogacy • Adoption • No Treatment 18
    • Operational DefinitionsKnowledge: Refers to the level of understanding of infertile couples with regard toinfertility as measured by their correct responses to knowledge items of thequestionnaire.Infertility: It is the inability to conceive even after having unprotected intercoursefor one year.Infertile couple: Couple who have failed to conceive even after one year ofunprotected intercourse. • Primary infertile couple: Couple that has never been able to conceive after a minimum of one year of attempting to do so, through unprotected intercourse. • Secondary infertile couple: Couple who has previously been conceived atleast once, but has not been able to achieve another pregnancy through unprotected intercourse. 19
    • Assumptions The study assumed that –• Infertile couple in the age group of 20-40 years would be willing to participate in the study.• The tool prepared for the study would be sufficient for collecting information about their knowledge on infertility.• Infertile couple in the age group of 20-40 years will have some knowledge regarding infertility. Delimitations The study is delimited to the infertile couple who –• are in the age group of 20-40 years• live in Zaheerabad, Mangalwarpet, IDSMT Ward-3 areas of Raichur.• can read and write Kannada or English 20
    • HypothesesH1 There will be significant association between the knowledge of infertile couples with regard to infertility and their age.H2 Association will be significant between the knowledge of infertile couples on infertility and their sex.H3 Relationship between the knowledge of infertile couples on infertility and their education will be significant.H4 Significant relationship will be there between the knowledge of infertile couples on infertility and their source of health related information.H5 Relationship will be significant between knowledge of infertile couples on infertility and their income.H6 Significant association will be there between knowledge of infertile couples on infertility and their religion.H7 Relationship between knowledge of infertile couples on infertility and duration of infertility will be significant.H8 There will be significant association between the knowledge of infertile couples on infertility and screening done. 21
    • H9 Association will be significant between the knowledge of infertile couples on infertility and reasons for infertility according to wives.H10 Relationship between knowledge of infertile couples on infertility and reasons for infertility according to husbands will be significant.H11 Significant association will be there between knowledge of infertile couples on infertility and their treatment option.H12 Significant difference will be there between the knowledge scores of infertile males and females on infertility. Conceptual Framework Conceptual framework deals with the inter-related concepts orabstractions that are assembled together in some rational scheme by virtue oftheir relevance to common theme31. Conceptual models are models made up of concepts, which describethe mental images of a phenomenon and integrate them into a meaningfulconfiguration. The conceptual framework gives the idea to the researchersmain view and core theme of the research i.e., it is a visual diagram bywhich the researcher explains the specific area of interest 31. 22
    • The conceptual framework of the study is based on Pender’s HealthPromotion Model. In 1975, Dr. Pender published “A conceptual model forPreventive Health Behaviour, which was a basis for studying howindividuals made decisions about their own health care. In 1984, it was changed to Health Promotion Model with the conceptof promoting optimal health along with disease prevention. According to Dr. Pender, Health Promotion Model seeks to increasean individual’s level of well being. It explains the relationship among thefactors believed to influence health behaviour changes. It identifies theperceptual factors, in the individuals that are modified by situational,personal and interpersonal characteristics to result in the health promotingbehaviour in the presence of a cue to action. Assessing the knowledge of infertile couples on infertility willinfluence how a couple thinks about their health problem, which has agreater impact on adoption of treatment modalities. Pender’s model includes the following components.1. Modifying factors These are the factors, which influence the health behaviour of anindividual. They include demographic characteristics, biologicalcharacteristics, interpersonal influences, situational factors and behaviouralfactors. 23
    • 2. Perceptual factors This is the individual current state of feeling of wellness or feeling ofillness, which determines the likelihood that health-promoting behaviourwill be initiated.3. Likelihood of action It is the individual’s evaluation of the advocated health behaviour interms of feasibility and efficaciousness i.e., an estimate of the actionspotential benefits in reducing susceptibility or severity.4. Cues to action The cue to action makes the individual become conscious of feelingsand begin thinking about how to deal with the problem. It includespreventive, promotive and curative services. Conceptual framework of the present study is based on theassumptions that the infertile couples will have some knowledge regardinginfertility, which is influenced by their demographic variables like age, sex,education, source of information, income, religion, duration of infertility,screening, reasons for infertility according to wife, reasons for infertilityaccording to husband and treatment option. The modifying factors andperceptual factors directly influence the infertile couples to participate inhealth promotion activity. The outcome of this can be favourable,moderately favourable or unfavourable. The infertile couples withfavourable outcome will have above average knowledge, which enhance thelikelihood for having active role to overcome the problem. Thus, itpromotes the health and helps for better adoption of treatment modalities. 24
    • On the other hand, the infertile couples with moderately favourableand unfavourable outcome will have average and below average knowledge,which in turn results in likelihood for having moderate role and not havingany active role respectively, to overcome the problem. This will lead to poorhealth and poor adoption of treatment modalities. At this juncture the nurseprovides health information on preventive and curative aspects of infertilityand promotive aspect of existing health, which acts as cues to action toobtain an adequate level of knowledge on infertility. The nursing action will be reinforcement for those who have aboveaverage knowledge. It will improve the knowledge and change intofavourable outcome for those who have average and below averageknowledge.The conceptual frame work of the study is presented in figure 2 25
    • Modifying factors Likelihood of action Above Average Individual Active Perception role to Promotion Favourable over come of health Demographic Outcome the and better problem adoption of Variables treatment • Age modalities I Average • Sex N F • Education Knowledge L Moderately • Source of information U active role of Infertile E Moderately • Income N Favourable to Couples on overcome Moderately C outcome or poor • Religion Infertility E the S problem health and • Duration of infertility moderate • Screening or poor Below average adoption of • Reasons for infertility treatment according to No active modalities role toImprovement -Wife Unfavourable overcome Reinforcement -Husband outcome the Treatment option problem Cues to Preventive Health Promotive Action Education Curative Fig : 2 Conceptual frame work based on Modified Pender’s Health Promotion Model Not Understudy 26 26 Understudy
    • Organization of the Report This chapter dealt with the introduction, the need for the study,statement of the problem, objectives, operational definitions, hypotheses,assumptions, limitations and the conceptual framework of the study. Areview of literature was presented in second chapter and methodology of thestudy was the subject of the third chapter. Results were reported in fourthchapter while discussion on analysis and interpretation of results werepresented in fifth chapter. Summary was presented in sixth chapter, whileconclusion occupied seventh chapter. Recommendation and implicationswere reported in eighth chapter. The report ended with bibliography,annexure and abstract. 27
    • II REVIEW OF LITERATURE The review of literature is an extensive, systematic selection ofpotential sources of previous work, acquainted fact-findings afterscrutinization and location of reference to the problem under study. It ishelpful in understanding and developing in sight into the selected problemunder study and also to develop a conceptual framework for the study 31. The chapter on review of literature for this study is presented underthe following headings: 1. Studies related to knowledge of infertile couples regarding infertility 2. Studies related to comparison of knowledge of infertile males and females on infertility. 3. Studies related to causes of infertility 4. Studies related to investigations of infertility 5. Studies related to treatment of infertility 6. Studies related to prevention of infertility 1. Studies related to knowledge of infertile couples regarding infertility A descriptive study was conducted to measure the prevalence of self-reported infertility as well as the level of knowledge of causes of infertilityin selected hospitals of Ghana. Data were collected from a random sampleof 2179 men and women between 15 to 49 years by using a structuredquestionnaire. The study results showed that the prevalence of infertilitywas 11.8% among women and 15.8% among men. The knowledge 28
    • regarding the causes of infertility was limited. Only 46.5% of therespondents reported any cause. Most of the respondents failed to identifyreproductive tract infections as causes of infertility 32. A descriptive study was conducted to assess the knowledge of infertilewomen about fertility and the causes of infertility, their treatment seekingbehaviour in selected urban community areas of South Africa. They hadselected 150 infertile women between 15 to 44 years of age by simplerandom method and data were collected by questionnaire method. The studyresults showed that 28.7% women had little knowledge about humanreproduction and treatment options for infertility. Eleven percentage ofwomen correctly answered for modern treatment options 33. A descriptive study was conducted to assess the knowledge, attitudeand practice of child adoption among infertile Nigerian women in selectedareas of South Eastern Nigeria. They had collected data from 279 infertilewomen by using questionnaire method. The study results showed that 228(86.4%) were aware of child adoption; only 72 (27.3) answered its correctmeaning. Fifty- seven (21.6%) knew how to adopt a baby, while the rest didnot; One hundred and eighty three (69.3%) expressed their unwillingness toadopt a baby, while remaining 81 (30.7%) were willing 34. A descriptive study was conducted to assess the knowledge of infertilewomen with regard to infertility and their treatment seeking behaviour inselected areas of Denmark. Data were collected from randomly selectedsample of 3743 women between 15 to 44 years by interview method. Thestudy results showed that, of the women who attempted to have a child, 29
    • 26.2% had experienced infertility; 4.1% of women aged 25-44 years wereprimarily infertile and 47.4% had the knowledge of type of infertilitytreatment35. A descriptive study was conducted to assess the knowledge, attitudesand experiences of infertile males regarding cancer related infertility andsperm banking in selected hospitals of Texas. A random sample of 904 menwas selected and data were collected by postal survey. The study resultsshowed that 51% of men wanted children in future, including 77% of menwho were childless at cancer diagnosis. Among them 51% had knowledgeabout sperm banking. Those who discussed infertility with their physicianshad higher knowledge about cancer related infertility and were significantlymore likely to donate sperms to bank. 36. A descriptive study was conducted to determine whether theknowledge of treatments in women undergoing fertility treatment isadequate in selected areas of Canada. A self-report survey of 404 womenundergoing infertility treatments was taken for the study. The study resultsshowed that 67.8% reported taking fertility drugs. Most women (61.7%)wanted to share knowledge with their doctors and 56% wanted to decidealone. Over half of women (57.2%) who had taken fertility drugs wereunaware of a possible link between fertility drugs and pregnancy andmajority of women (61.8%) who knew this association reported that theylearned about it from the print media. 37. 30
    • An exploratory study was conducted to assess the knowledge, unmetneeds and attitudes of women aged between 15-44 years with infertilityproblems in selected areas of Ghana. Data were collected from 120 womenwith primary and secondary infertility by using interview method. Thestudy results showed that 68% of women described that seeking treatmentfor infertility included the use of infertility drugs, surgery, donorinsemination and invitro-fertilization and being of low income they cannotafford to pay directly for this. They revealed that 32% of womenexperienced difficulties in clinical settings due to language barriers38. A descriptive survey was conducted to assess the knowledge and useof infertility services by infertile women in selected areas of Washington.Data were collected from a Nationally representative survey of 1,210 womenaged 15-44 years. The study results showed that 42% of women hadreceived some form of infertility services. The most common servicesreceived by these women were about advices (60%), diagnostic tests (50%),and drugs to induce ovulation (35%)39. A descriptive study was conducted to assess the knowledge of fertilityamong infertile women in selected hospitals of Auckland. Data werecollected from 80 women between 15-44 years by questionnaire method.The study results showed that less than 50% of subjects had an adequateunderstanding of when the fertile time occurred in their menstrual cycle.Only 26% of women had adequate fertility awareness. The highestpercentage of women (46%) with previous natural family planning hadadequate fertility awareness scores40. 31
    • A comparative study was conducted to assess the knowledge ofpreconception folic acid intake (PFAI) and its use by infertile women andreproductive age women from results of a national survey in selected areasof Rhode Island, USA. Data were collected from 86 women by surveymethod. The study results showed that infertile women were more aware ofthe benefits of preconception folic acid intake than general population(65% vs. 13%) and used it more frequently (52% vs. 29%) 41. A descriptive study was conducted to assess the knowledge, healthseeking behaviour and experiences related to infertility among men inselected urban areas of South Africa. Data were collected from 127 men byinterview method. The study results showed that men had little knowledgeabout the physiology of human fertility, causes of infertility and moderntreatment options. Twenty six percent of men had male factor awareness.Sixteen percent of men appeared involved in the health seeking process.Men who described their emotional reactions to infertility and its impact onmarital stability were 38%42. A descriptive study was conducted to analyze the emotional needs ofwomen who undergo treatment for invitro-fertilization (IVF) in selectedareas of Greece. Data were collected from 235 infertile women by using aquestionnaire. The study results showed 59.3% of the women sought moremedical information and another 32.5% sought emotional support43. A descriptive study was conducted to explore adolescents definitionof fertility and range of beliefs on causes of infertility in selected hospitals ofUSA. A random sample of 500 was taken for the study and data were 32
    • collected by interview method. The study results showed that majority ofadolescents generally understood fertility as the ability to become pregnant.Ten themes emerged as causes of infertility. Most of the respondentsgenerated anatomic causes. Others mentioned the common causes as malefactors, sexually transmitted diseases, substance use, genetics, stress,contraception, environmental toxins, violence and injury to genital organs 44. A descriptive study was conducted to assess the knowledge, attitudeand practices of infertile couples pertaining to unhealthy life styles as well ashealth promoting activities in selected areas of Canada. Data were collectedfrom 106 infertile couples by using questionnaire method. The study resultsshowed that 53% couples reported cigarette smoking, 69% admitted toalcohol consumption and 77% were using drugs. Only 28% of the smokerswere knowledgeable about the value of smoking cessation intervention.Only 59 per cent of alcohol users considered its consumption to beundesirable when trying to conceive 45. 2. Studies related to comparison of knowledge of infertile males and females on infertility A comparative study was conducted to explore how individuals withinan infertile couple differ from one another in their knowledge towards theconception of twin gestations in selected areas of Chicago. Data werecollected from 90 couples by interview method. The study results showedthat the knowledge on the incidence of prematurity was high among malesi.e. 27% when compared to 17% in females. The knowledge of males 33
    • regarding low birth weight and pre-eclampsia was 26% when compared to16% in females 46. A comparative study was conducted to analyze the relationship amonginfertile couples regarding infertility and psychosexual disorders in selectedhospitals of Shahdara, Delhi. They collected data from 175 subjects byusing questionnaire. The study results showed that amongst the males,premature ejaculations (66%) was most common problem followed byerectile dysfunction (15%), decreased libido (11%) and orgasmic failure 8%.Amongst females dyspareunia (58%), decreased libido (28%) andorganismic failure (14%) were most common problems 47. A study was conducted to describe infertile couples experience andassessment of knowledge on infertility treatment in selected fertility clinicsof Denmark. Data were collected from 26 couples by interview method. Thesubjects were selected by using purposive sampling technique. The studyresults showed that infertile couples preferred treatment that was organizedin a separate clinic where there were only a few staff members. Both theparticipants experienced infertility treatment as a psychological strain. Theywanted detailed information about technical aspects of infertility andtreatment as well as psychosocial and sexual advice and support 48. A comparative study was conducted to assess the attitudes aboutinfertility interventions among fertile and infertile couples in selected areasof Michigan. Data were collected from 185 infertile and 90 presumed fertilecouples by interview method. The study results showed that 7% of fertile 34
    • couples viewed interventions to be favourable and 4% had negative attitude.Infertile couples accepted all interventions, except for adoption 49. A descriptive study was conducted to investigate the benefits ofinfertility support- group participation as perceived by infertile couples inselected areas of Brazil. Data were collected from 16 men and 22 women byusing questionnaire using. The study results showed that fewer men thanwomen initially wanted to join the group (P < .01), but both men and womenperceived similar amounts of benefit. Length of membership and frequencyattendance were both positively correlated with amount of benefitsperceived50. A prospective study was conducted to determine the impact ofrepeated treatment failure of clomiphene and intrauterine insemination onquality of life of couples with infertility in selected areas of Montreal,Australia. Data were collected from 3 groups of 50 couples each by usingquestionnaire method. The first group consisted of infertile couples withrepeated treatment failure (FT), second group without any treatment (NT)and third was a control group with one child. The study results showed thatquality of life score of control group was higher than the scores reported bygroup without any treatment and couples with repeated treatment failure(P < .001). Among women, a high quality of life was reported by 22% ingroup with treatment failure, 14% in group without treatment and 54% incontrol group 51. 35
    • A study was conducted to develop and test a coping scale for infertilecouples that would be sensitive to the differences in gender in selected areasof Taiwan. Data were collected from 138 couples by using questionnaire.The study results showed that sharing the burden of infertility was to agreater degree among wives than their husbands. A significant correlationwith distress, stress and coping measures was found by this study 52. A study was conducted to assess the gender differences andsimilarities in psychological reactions related to infertility in selected areasof Sweden. Data were collected from 91 couples by using questionnaire.The study results showed that the women reacted more strongly to theirinfertility than the men as measured by the infertility reaction scale(P< 0.05). Effect of sexual life was similar for men and women.Significantly, more men than women had not confined in anyone about theirinfertility problem (P< 0.001) 53. A descriptive study was conducted to examine congruence betweenpartners perceived infertility related stress and its relationship to maritaladjustment and depression among infertile couples in selected areas of USA.Data were taken from 60 couples by using interview technique. The studyresults showed that a higher level of marital adjustment was found amongmen than women. Couple incongruence was unrelated to depression inmales; incongruence over relationship concerns and the need for parenthoodwas related to female depression 54. 36
    • A comparative study was conducted to determine the differencesbetween infertile wives and husbands, levels of loneliness and perception ofsocial support and to determine if there is a relationship between them inselected areas of USA. Data were taken from 62 couples with either primaryor secondary infertility by using interview technique. The study resultsshowed that wives were lonelier than husbands (t = 2.053, p = 0.04).Loneliness was inversely related to social support and reciprocities both forwives (r = -0.62, p = 0.001 and r = -0.50, p = 0.002, respectively) andhusbands (r = -0.74, p= 0.001 and r = -0.56, p = 0.001) 55. A comparative study was conducted to evaluate gender differences inthe psychosocial responses of infertile couples attending an assistedreproduction programme in selected areas of China. Data were collectedfrom 75 infertile couples by using questionnaire method. The study resultsshowed that women showed higher psychosocial distress than their partners.The differences between couples in psychiatric symptoms reached statisticalsignificance of P<0.0556. A comparative study was conducted to examine differences in dailyemotional, physical and social reactions among husbands and wives duringinvitro-fertilization (IVF) in selected areas of United Kingdom. Data werecollected from 40 couples by using questionnaire method. The study resultsshowed that men and women had a similar response pattern to oocyteretrieval, fertilization, embyo transfer and the pregnancy test. These stageswere associated with the most significant changes in reactions for bothspouses57. 37
    • A study was conducted to evaluate the emotional reactions and copingbehaviours as well as correlated factors for infertile couples receivingassisted reproductive technologies in selected areas of Michigam. Data weretaken from 120 infertile couples by using questionnaire. The study resultsshowed that infertile wives experienced more emotional disturbance thanhusbands did. It was also shown that wives adopted more coping behavioursto deal with infertility and treatment than husbands did58. A study was conducted to investigate the perceived life, marital andsexual satisfaction of married couples undergoing treatment for infertility inselected areas of Netherlands. Data were collected from 43 husband-wifepairs by using questionnaire method. The study results showed that wiveshad a significantly lower level of satisfaction with life than their husbandsand that there were significant relationships between husband-wife pairs forboth marital and sexual satisfaction. It was evident that individuals,especially females, undergoing treatment for infertility experienced stress invarious areas of their lives59.3. Studies related to causes of infertility A descriptive study was conducted to reveal that genital tuberculosisis a major etiologic factor of infertility in Indian women in selected areas ofBombay. Data were collected by clinical analysis from 300 infertile womenwith tubal damage. The study results showed that the underlying causes oftubal infertility were pelvic inflammatory diseases other than tuberculosis in106 women or 35%, pelvic tuberculosis in 117 women (39%), endometriosisin 63 women (21%), previous tubal ectopic pregnancy in 8 women (3%). 38
    • Nineteen women had evidence of extragenital tuberculosis and from the 104women counseled about invitro-fertilization, 34 underwent procedure andthe pregnancy rate was 16.6% per transfer60. A descriptive study was conducted to assess the etiological factors ofmale infertility in selected areas of Chandigarh. They had collected datafrom 72 infertile men based on clinical assessment. The study resultsshowed that smallpox and mumps were the causes for 3-4 patients. Sevenpatients had varicocele (9.2%) and small atrophic testes were found in nine(12.5%). Azoospermia was reported in 41 patients (58.3%) and oligospermiain 17 patients (23.6%) and 14 patients (19.4) had normal sperm counts. Noetiology could be determined in 11(16%) patients61. A descriptive study was conducted to assess the menstrual pattern andovulation among women with primary infertility at Srinagar. The data werecollected based on clinical assessment of 250 females. The study resultsshowed that anovulation was found in 54 (21.60%), hyperprolactinemia in26 (10.40%) and premature ovarian failure in 22 (8.80%). Out of 105women with regular predictable cycles, 146 had ovulatory cycles eventhough 12 women with anovulation and 7 women with hyperprolactinemiaalso had menstrual cycles62. A descriptive study was conducted to assess the role ofsmallpox infection as an etiologic factor of infertility among men inselected areas of Bombay. Data were collected from 358 cases withprevious smallpox infection by clinical assessment. The study resultsshowed that the incidence of azoospermia was 42.57% in small pox affected 39
    • men. The incidence of obstructive azoospermia was high in 79.36% ofsmallpox affected men. They revealed that the site of obstruction is usuallyat the lower end of the epididymis63. A study was conducted to assess the estimation of the prevalence andcauses of infertility in selected areas of Western Siberia. Data were takenfrom 168 randomly selected couples by using interview method and clinicalinvestigation. The study results showed that the causes of infertility in bothpartners was found in 38.7%, female partner infertility in 52.7% and malepartner infertility in 6.4%. The most frequent causes of female infertilitywere disturbances in tubal patency (36.5%) and pelvic adhesions (23.6%).Endocrine pathology was found in 32.8% of cases. In men, the mostfrequent causes were idiopathic infertility or pathospermia (20.9%) andvaricocele (11.3%)64. A study was conducted to assess the role of antisperm antibodies tolabel immunological role in cases of infertility in selected areas of Aligarh.Data were collected from 47 infertile couples with either primary orsecondary infertility by clinicas assessment. The study results showed that78 percent cases of primary infertility and 66.7 percent cases of secondaryinfertility were positive for antisperm antibodies65. A study was conducted to assess the clinical and hormonal profile ofpolycystic ovary disease (PCOD) in infertility cases in selected areas ofVaranasi. Data were taken from 21 women with PCOD by using clinicalanalysis. The study results showed that most frequent findings in these caseswere menstrual disturbances, hirsutism and infertility. Elevated leutinising 40
    • hormone (LH) was found in 38% only. Normal leutinising hormone withlow follicle stimulating hormone (FSH) in 28.6% and normal leutinisinghormone and follicle stimulating hormone in 33 percent was found66.4. Studies related to investigations of infertility A descriptive study was conducted for infertility investigation inpublic sector in selected hospitals of Johannesburg. Data were collectedfrom 206 women through hospital records. The study results showed that 79(38.4%) had primary infertility and 127 (61.6%) had secondary infertility.The hysterosalpingogram (HSG) analysis showed only 38 women (18.5%)had fallopian tubes with no blockage. Sixteen percent had one side tubalobstruction, 65.5 percent had bilateral obstruction. Hysterosalpingogramtesting has the benefits of being a simple, low cost and reliable method fordetermining fallopian tube obstruction67. A study was conducted for detection of ovulation by rapid OPD basedtechniques in selected hospitals of Nagpur. Data were taken from 206infertile females of reproductive age group without any systemic illness bycervical mucus, vaginal cytology and endometrial cytology and comparedwith endometrial biopsy. The study results showed that majority of cases inthe age group of 20 to 25 years were with 83% primary and 17% secondaryinfertility. The endometrial biopsy was ovulatory in 68% and proliferativein 32% cases. Cervical mucus studies, vaginal cytology and cervical mucusstudies had 100% sensitivity each and their specificity was 95.6%, 97.05%and 72.36% respectively68. 41
    • A study was carried out to assess the cost effective approach in theevaluation of female infertility in selected hospitals of Assam. Data werecollected from 200 infertile females by using transvaginal pelvic scan alongwith sonosalpingography. The study results showed that transvaginal scanrevealed normal pelvic organs in 59% of cases and the remaining 41 percentshowed different abnormalities of the pelvic organs. Sixty two percent casesshowed abnormal ovarian morphology 69. A study was conducted for evaluation of causes of secondaryinfertility by hysterosalpingography (HSG) and hysteroscopy in selectedmilitary hospitals of India. Data were taken by these two investigativemodalities among 50 infertile women. The study results showed thatcomplete agreement between hysterosalpingography and hysteroscopy wasestablish in 43 (86%) cases. Hysterosalpingography showed a false positiverate of 23% and false negative rate of 6 percent. Hysterosalpingographyshowed a good correlation with hysteroscopy and was a simple and safeprocedure70. A study was conducted to compare Transabdominal sonography(TAS) and Transvaginal sonography (TVS) in selected hospital ofBarrackpore, India. Data were collected from 73 infertile women by clinicalassessment. The study results showed that patient compliance andacceptance was excellent for transvaginal sonography technique ascompared to transabdominal sonography technique. The overall resolutionof ovarian and follicular anatomy was much better in transvaginalsonography. With transabdominal sonography only 35.6% had good 42
    • visualization of follicles as compared to 80.8 percent (P<0.05) intransvaginal scan71. A study was conducted for laparoscopic evaluation of infertility inselected hospitals of Orissa. Data were taken from 48 infertile women bylaparoscopic technique. The study results showed that no abnormality wasfound in 10 cases, while in 26 cases various etiological factors werediagnosed, commonest being tubal pathology. In 11 cases tubal factor wasconsidered to be primary cause of infertility, whereas, endometriosis andtuberculosis were responsible in four cases and two cases respectively72. A study was conducted for immunological assessment of infertility byestimation of antisperm antibodies among infertile couples in selectedhospitals of New Delhi. Data were taken from 40 infertile couples withunexplained infertility by clinical assessment. The sample collectedincluded serum and seminal plasma of male partners and serum and cervicalmucus samples of female partners. The study results showed that antispermantibodies were detected in 30% of couples, which included 25% female and10% male partners. Among the cases positive for antisperm antibodies,antibodies were detected most frequently in female sera 58.4% followed bymale sera 33% and 25% in cervical mucus73. A descriptive study was conducted to examine for spermatozoalcounts, morphological changes in the spermatozoa and its relation toureaplasmas urealyticum in selected areas of India. Data were taken from197 males by using clinical assessment. The study results showed that 43
    • ureaplasmas urealyticum and mycoplasmas were grown in 43.15% and16.75% in comparison to control figures of 15.9% and 11.4%, respectively74. A study was conducted for sonographic assessment of fallopian tubepatency in the investigation of female infertility in selected hospitals ofNigeria. Data were taken from 50 infertile females by clinical examination.The study results showed that analysis of the data gave a positive predictivevalue of 98.3% and a negative predictive value of 75%. It was accepted thatthere is no statistical significant difference (P=0.237) between the results ofthe two methods (hysterosalpingography and sonohysterosalpingography) 75.5. Studies related to treatment of infertility A study was conducted to assess the surgical treatment of tubalinfertility in selected hospitals of Norway. Data were taken from 308infertile women by clinical analysis. The study results showed that 119women (39 %) became pregnant after tubal surgery, resulting in 79 births(26%). Gynaecological laparotomy had been previously performed on 79women; 20% of these achieved term pregnancies, 27 were re-operated afterprevious tubal surgery and 11% gave birth to a live born infant. The bestprognosis was after salpingostomy among unilateral operations andsalpingolysis among bilateral salpingostomies76. A study was conducted to assess the benefits of laparotomy for femaleinfertility in selected hospitals of Jamshedpur. Data were taken from 45cases of laparotomy for infertility. The proportion of primary and secondaryinfertility was 62.22% and 37.77%. The single major indication for 44
    • laparotomy was bilaterally blocked tubes on hysterosalpingogram which waspresent in 20 cases. Among other indications, infrequent ovulation waspresent in 10 (22.2%) cases. In 3 cases the abnormality was peritubaladhesions. Of the 13 cases where no lesion was found, the indication oflaparotomy was bilateral corneal block77. A prospective study was conducted to assess the role and costeffectiveness of intrauterine insemination (IUI) of invitro-fertilization (IVF)in idiopathic sub-fertility and male sub-fertility in selected hospitals ofLancet. Data were taken from 258 couples with idiopathic or male sub-fertility. The results showed that the pregnancy rate per cycle was higher forinvitro-fertilization (12.2%) than for intrauterine insemination with orwithout stimulation (8.7% and 7.4%). Couples in the invitro-fertilizationgroup were more likely than others to give up treatment before theirmaximum of six attempts78. A study was conducted to assess the pregnancy rates afterlaparoscopic treatment and differences related to tubal status and presence ofendometriosis in selected areas of Egypt. Data were taken from 186 infertilewomen after laparoscopic adhesiolysis of tubes and removal ofendometriotic lesions. The study results showed that after 18 months, thepregnancy rate was lower among women who had bilateral tubal adhesions(13.2%) than among women with no tubal adhesions (41.8%) or unilateraltubal adhesions (45.7%)79. 45
    • A study was conducted to assess the Assisted Reproduction in LatinAmerica. Data were taken from 2039 infertile couples by examininghospital records. The study results were compared to centers in developedcountries with a pregnancy rate per cycle of 19.7 percent for invitro-fertilization (IVF), 30.3 percent for gammate intrafallopian transfer (GIFT)and 24.5 percent for other techniques. Rates were higher for youngerwomen and for couples whose infertility was unexplained80. A study was conducted to assess the value of varicocele ligations inimproving semen parameters in cases of male infertility in selected hospitalsof Bombay. Data were taken from 17 cases of varicocele ligations. Thestudy results showed that in 47% of cases, there was a significantimprovement in the sperm count. In 82% of the cases, sperm motilityreturned to normal after the operation81. A study was conducted to assess the easy cost effects of first linetreatment for infertility in selected hospitals of Srinagar. Data werecollected from 88 infertile cases by taking a detailed history and routineexamination. Selected cases were put on 5 mg of folic acid and 100 mg ofvitamin B6 daily. The study results showed that 62 cases (70.45%)conceived within 4 months of treatment. Conception rate was more inprimary infertility cases (76.39%) than in secondary infertility cases(43.75%)82. A study was conducted to assess the management of idiopathicoligospermia with lycopene in selected hospitals of New Delhi. Data weretaken from 50 infertile male cases with no cause for their infertility but 46
    • showing oligospermia and they were given Tab.Lycopene, 8 mg daily. Thestudy results showed that a 36% pregnancy rate with improvement of spermcount and sperm concentration in 70%, motility and motility indeximprovement in 54% and sperm morphology improvement in 38% cases wasfound 17. A study was conducted to assess the treatment of unrelatedpregnancies among infertile couples in selected hospitals of Mumbai. Datawere taken from 227 infertile couples without any specific treatment. Thestudy results showed that pregnancy occurred in 44 (42%) couples who wereactually treated and 43 (35%) couples who formed treatment independentpregnancy group83.6. Studies related to prevention of infertility A study was conducted to find out whether boys with undescendedtestes got treatment at ideal age to prevent infertility in selected hospitals ofKerala. Data were collected from 139 boys between 11 months to 12 yearsby studying the discharge summaries of operated boys. The study resultsshowed that 19.4% patients were less than 2 years of age, 11.1% of totaltestes were atrophic and ochiopexy was done in almost all remaining cases.Majority of boys with undescended testes attended for treatment at a higherage than that recommended. They said that the ideal age of treatment isbelow 2 years of age84. A report was submitted by WHO in 1992 on prevention of infertilityof infectious origin in adolescents. They have mentioned that some causesof infertility can be prevented. Genital infections represent a major source of 47
    • infertility. The prevention of sexually transmitted diseases (STDs), whichcauses male and female infertility is accomplished by the prevention ofsexual transmission of HIV. Teenagers represent a target of choice for theeducational campaigns promoting condom use. They said that the role ofphysicians, especially when teenagers are asking for contraception must becomplementary to the public health campaign to decrease the spread ofhuman immuno deficiency virus and other sexually transmitted diseases,thereby preventing infertility85. A report was submitted by World Health Organization regarding themeeting held on the prevention of infertility at the primary health care levelin Geneva. The objectives of the meeting were 1) to initiate thedevelopment of guidelines for primary health care workers on the diagnosis,treatment and referral of lower genital tract infections in women, urethraldischarge in men. 2) to assess the organization and resources needed toprovide services and 3) to prepare plans for support to research projectsaimed at the prevention of infertility at the primary health care level 86. For answer to an article, on optimal technique for tubal reanastomosis,Dr. Meldrum suggested that choice of suture material is important both insurgical treatment of infertility and in prevention of infertility resulting frompelvic surgery. Most important criterion was tissue reactivity, with nylonand prolene which are ideal non reactive, non-absorbable sutures. Dexonand vicryl are less reactive. Chromic catgut and silk are among the mostreactive. Microsurgical technique has resulted in intrauterine pregnancyrates more than 3 times as high with fewer ectopic pregnancies thanresulting from conventional surgical techniques87. 48
    • III METHODOLOGY Research methodology is a way to systematically solve the researchproblem. It is a set of methods and principles used to perform a particularactivity. It is the most important part of any research study, which enablesthe researcher to form blue print for the study undertaken31. Researchmethodology involves the systematic procedure by which the researcherstarts from the time of initial identification of the problem to its finalconclusion 88. In this chapter the researcher discusses the methodology adopted forthe study. It presents the research approach, research design, the setting ofthe study, population, sample and sampling technique, inclusion criteria,exclusion criteria, method of data collection, development and description oftool, pilot study, collection of data and plan for data analysis. Research Approach Research approach is the most significant part of any research. Theappropriate choice of the research approach depends upon the purpose of theresearch study, which was undertaken. The approach to research is theumbrella, which covers the basic procedure for conducting research 89. The present study was intended to assess the knowledge of infertilecouples on infertility. 49
    • A descriptive method that is exploratory in nature was found to be themost suitable approach for attainment of the objectives of the study.Descriptive studies describe in-depth the characteristics of one or a limitednumber of cases. It involves systematic collection and presentation of data togive a clear picture of a particular situation 89. Research Design Research design helps the researcher to obtain accurate andmeaningful description of the phenomenon under study. It also helps theresearcher in selection of subjects, manipulation of experimental variables,control of extraneous variables, procedure of data collection and the type ofstatistical analysis to be used to interpret the data. The term research design refers to the plan or organization of ascientific investigation. It is the conceptual structure within which researchis conducted. A researcher’s overall plan for obtaining answer to theresearch question or for testing the hypothesis is referred to as researchdesign 31. The research design spells out the basic strategies that the researcheradopts to develop information that is accurate and interpretable 90 50
    • Selection of design is based on the purpose of the study. Researchdesign selected for the present study was descriptive co- relational design.The purpose of this design is to assess, document and analyze the knowledgeof infertile couples regarding infertility. The researcher tried to find therelationship between knowledge of infertile couples on infertility andselected variables.The Schematic design of the study was presented in Fig :3 51
    • Independent Variables Target Population•Age Infertile couples in the age group of 20-40•Sex years in Raichur, Karnataka•Education•Source of Information Accessible Population•Income Infertile couples in the age group of 20-40 years•Religion in Zaheerabad,Mangalwarpet and IDSMT Wd :3•Duration of Infertility areas of Raichur, Karnataka Purposive•Screening sampling•Reasons for infertility techniqueaccording to Study Sample -Wife 100 subjects -Husband •50 Male•Treatment option •50 Female Data Structured Questionnaire Collection Demographic Knowledge Data on Infertility Dependent variables Knowledge scores on infertility Below Average Average Above average 1-50 % 51-75 % Above 75% 52 Fig 3. The Schematic Design of the Study 52
    • Setting of the Study The present study was conducted in Raichur district. Raichur districtis in the North Eastern region of Karnataka. It has an area of 60 sqm. andconsists of 5 towns and 300 villages, with a population of 3,42,686. Amongthis urban population comprises of 2,24,617. In that male population was1,15,556 and female population was 1,09,061. Zaheerabad, Mangalwarpetand IDSMT layout areas were chosen for conducting the study. Description of the Area The Raichur town consists of 33 wards and a total population of3,42,686. The investigator had chosen Ward No.13 i.e. Zaheerabad area,Ward No.3 of IDSMT layout and Mangalwarpet areas for the present study. Zaheerabad area has the following boundaries – KSRTC DivisionalControl Office to the East, Ashok Depot Road and Kurumgadda to the West,Church to the North and Ganganiwas to the South. It has a population of14,233 out of which eligible couples were 1642. IDSMT ward.3 area has got the boundaries of Dr.Ambedkar hostel tothe East, Goodshed road to the West, Aamtalab and hillocks to the North,Grave yard to the South with a population of 11,532.Among this males were6,813 and females were 4,719.The eligible couples were 2,719. The total population of Mangalwarpet was 10,203, of which 6,302were males and 3,901 were females. The eligible couples in this area were960. The boundaries in this area were KSRTC office to the North,Graveyard to South, Kurum gadda to West and Hillocks to East. 53
    • 54
    • Population “A population is a complete set of persons or subjects that possesssome common characteristics that is of interest to the researcher”31. Thepopulation for the present study was infertile couples residing inZaheerabad, IDSMT ward 3 and Mangalwarpet areas of Raichur town. Sample and Sampling Technique The sample is a sub group that is chosen to represent the population. 31.Purposive sampling technique was used in the present study to select thesubjects, according to the purpose. Purposive sampling is a type of non-probability sampling method in which the researcher selects the subjects forthe study based on personal judgment, about which ones will be mostrepresentative31. Sample size for the present study was 100 including 50 males and 50females from Zaheerabad, Mangalwarpet and IDSMT Ward-3 areas ofRaichur. Door-to-door survey was done in these areas and 50 infertilecouples were selected by purposive sampling technique. Twenty couplesfrom Mangalwarpet, 15 couples from Zaheerabad and 15 couples fromIDSMT Ward-3 were purposively selected for the study according to theavailability of the subjects. 55
    • Inclusion CriteriaThe study includes infertile couples who are- • having either primary or secondary infertility • residing at Zaheerabad, IDSMT Ward-3 and Mangalwarpet areas of Raichur • willing to participate in the study • available at the time of data collection • able to read and write Kannada or English • falling in the age group of 20-40 years • living with the spouse. Exclusion CriteriaThe study excludes infertile couples who are • having marital life of less than one year • residing at Raichur other than Zaheerabad, IDSMT Ward-3 and Mangalwarpet areas of Raichur • not willing to participate in the study • not available at the time of data collection • not able to read and write Kannada or English • not falling in the age group of 20-40 years • not living with the spouse. 56
    • Method of Data Collection Data collection is a precise, systematic gathering of information, 31relevant to research purpose . Since the study was primarily concernedwith assessment of knowledge of infertile couples on infertility, theresearcher planned to collect the relevant data from the research subjects byquestionnaire. The instrument selected in a research must be the vehicle thatobtains the best data for drawing conclusion to the study 89. “Questionnairerefers to a paper and pencil, self report instrument used to gather data fromsubjects” 92. A structured questionnaire was prepared by the researcher tocollect the information about knowledge on infertility. The questionnairewas framed very carefully by considering the language, clarity, organizationand sequence of items. The questions were formulated and options weregiven below the questions. Development and Description of the Tool The questionnaire was developed with the help of many resources likeliterature, consultation with experts, validity of tool etc. The questionnaireused in the study consisted of two sections namely; Section ‘A’ and Section‘B’. Section ‘A’ consisted of eleven questions seeking the demographic dataof the subjects. Section ‘B’ consisted of 38 multiple choice questions relatedto knowledge on infertility with 5 options. Out of five options only one wasthe right option, 3 were wrong and the remaining one was ‘do not know’. Ascoring system was developed for the items. Each correct answer wasassigned a score of one and wrong answer a score of ‘zero’. ‘Do not know’option carried no score. The total score of section ‘B’ was 38. The subjects 57
    • who got the score of above 75% were considered as having the aboveaverage knowledge on infertility. The scores between 51-75% wereconsidered as possessing average knowledge on infertility and the score withbelow 50% were considered as having below average knowledge oninfertility. Content Validity Content validity is concerned with the sampling adequacy of thecontent area being measured. It refers to the fact that the items included inthe tool represent a reasonable sampling of all possible items/ behaviours 93that make the domain being measured . Content validity of the tool wasobtained by giving the tool to a total of 5 experts, out of which 3 werenursing personnel and 2 of them were gynaecologists. The validators hadsuggested some modifications in the knowledge questions of infertility.Their suggestions were incorporated in the tool and the approved tool wasused for the data collection. Reliability Reliability refers to the accuracy and consistency of a measuring tool.A measure is reliable when an individual remains nearly same in repeatedmeasurements 31. The reliability of the tool was elicited by using test-retest method,where ten respondents were chosen and asked to fill the questionnaire twicewith a gap of one week between the first and second administration of the 58
    • tool. Karl Pearson’s coefficient ‘r’ was computed for finding out thereliability. The ‘r’ for the items of questionnaire was 0.79. This had a highpositive correlation, which indicated that the tool was highly reliable. Pilot Study Pilot study is the study carried out at the end of planning phase ofresearch, in order to explore and test the research elements91. After obtainingpermission from the authorities and subjects, a pilot study was conducted on5 infertile couples, out of which 5 were wives and 5 were husbands. Thesubjects were chosen purposively from Zaheerabad area of Raichur. Thenthe investigator administered questionnaire to the subjects for 30-45 minutesto elicit the information. Subjects followed the questionnaire easily.Confidentiality about data and findings were assured to the participants. Collection of Data Data collection is the gathering of information needed to address aresearch problem. The formal permission was obtained from the authoritiesand subjects of Zaheerabad, IDSMT Ward-3 and Mangalwarpet areas ofRaichur. The data was collected from 30.07.2005 to 30.08.2005. Onehundred subjects, including 50 wives (females) and 50 husbands (males)were selected by using purposive sampling technique. The couples wereadministered questionnaire personally by the investigator at their residenceafter a door-to-door survey. All the couples were receptive and co-operativeduring data collection. 59
    • Plan for Data Analysis The word ‘analysis’ means the categorizing, ordering andsummarizing the data statistically to obtain answers to research questions.Analysis of data consists of putting all the factual information collected intoan order and summarize according to the variables studied, objectives drawnand the hypotheses stated 93 It was planned to analyze and interpret data by using descriptive andinferential statistics. The following methods were planned to analyze thedata. Descriptive Statistics 1. Frequency and percentages to summarize the sample characteristics. 2. Mean and standard deviation to determine the knowledge of infertile couples. Inferential Statistics 1. Mean, standard deviation and paired ‘t’ test to compare the knowledge of infertility between infertile males and females. The level of significance was set at 1%. 2. Chi-square values to find out the relationship between knowledge of infertile couples on infertility and selected variables i.e., age, sex, educational status, source of information, income, religion, duration of infertility, screening, reasons for infertility according to wife, reasons for infertility according to husband and treatment option. The level of significance was set at 5%. 60
    • IV. RESULTS ‘Analysis’ means the categorizing, ordering and summarizing the datastatistically to obtain answers to research questions. Interpretation is theprocess of studying the results of analysis, making inferences about itsoccurrences or relations and drawing conclusions about these relations 93 This chapter deals with the analysis and interpretation of datacollected from 100 males and females with infertility through structuredquestionnaire. The data collected were tabulated, analyzed and interpretedusing descriptive and inferential statistics. The analysis and interpretation of data were presented under 4sections.Section-I : Sample characteristicsSection-II : Total score and item-wise analysis of knowledge questions on infertility.Section-III : Relationship of knowledge of infertile couples with selected variables and comparison of knowledge between infertile males and females. 61
    • Section-I Sample Characteristics Sample characteristics included in the study were age, sex, education,source of information, income, religion, duration of infertility, screening,reasons for infertility according to wife, reasons for infertility according tohusband and treatment option. Table 1 Frequency and Percentage Distribution of Infertile Couples by Age, Sex, Education, Source of Information, Income, Religion, Duration of Infertility and Screening._____________________________________________________ N=100 Sample characteristics Total f %_____________________________________________________________Age in Years:20 –25 Years 10 1026-30 years 31 3131-35 years 51 5136-40 years 8 8 62
    • Sex:Male 50 50Female 50 50Education:Knows to read and write 11 111st to 10th Standard 28 28PUC 21 21Graduation 28 28Post Graduation and above 12 12Source of information:Newspapers 10 10Health Personnel 29 29Elders in the family 45 45Friends 13 13Television 3 3Posters - -Pamphlets - -Income:Less than Rs.2000/- per month 7 7Rs.2001 – 4000/- per month 23 23Rs.4001 – 6000/- per month 31 31Rs.6001 - 8000/- per month 26 26Rs.8001 – 10000/- per month 7 7More than Rs.10000/- per month 6 6 63
    • Religion:Hindus 46 46Muslims 32 32Christians 20 20Any other 2 2Duration of infertility:1 – 3 years 14 144 – 6 years 62 627 – 9 years 20 2010 - 12 years 2 2Above 12 Years 2 2Screening:Seeking medical advise 52 52Not seeking medical advise 48 48_____________________________________________________________Age: The table-1 shows the data on age, which reveals that the majority ofrespondents (51 i.e. 51%) were in the age group of 31-35 years, followed by26-30 years age group (31 i.e.31%); 20-25 years (10 i.e.10%) and 36-40years (8 i.e.8%). 64
    • Sex: Table-1 shows the data on sex distribution, which reveals thatequal number of infertile males and females were included in thestudy (50 i.e. 50 % each).Education: The data on educational status reveals that, equal number ofrespondents were graduates and with first to tenth standard education(28 i.e.28% in each). This was followed by the respondents with PUC(21 i.e. 21%), Post graduation (12 i.e. 12%) and 11(11%) respondents knewonly to read and write.Source of information: As far as the source of information is concerned, majority ofrespondents (45 i.e. 45%) received information regarding infertility fromelders in the family , followed by health personnel (29 i.e.29%), friends(13 i.e.13%), newspapers (10 i.e. 10%) and television (3 i.e. 3%). None ofthe respondents received information through posters and pamphlets.Income: Regarding the monthly family income, nearly 31 (31%) respondentshad the income of Rs.4001 to 6000, followed by 26 (26%) respondents inRs.6001 to 8000 income group, 23 (23%) in Rs.2001-Rs.4000. Equalnumber of respondents were getting less than Rs.2000 and Rs.8001 to10,000 (7 i.e. 7% in each) and 6 (6%) respondents had monthly income ofmore than Rs.10000. 65
    • Religion: As far as the religion is concerned, majority of respondentswere Hindus (45 i.e. 45%), followed by Muslims (33 i.e. 33%), Christians(21 i.e. 21%) and 2 (2%) respondents were Sikhs.Duration of infertility: Considering the duration of infertility, majority of respondents(62 i.e. 62%) were in the category of 4-6 years, followed by 20 (20%) in 7-9years category, 14 (14%) were in 1-3 years category. Equal number ofrespondents were in 10-12 years and more than 12 years category.Screening: The data on screening reveals that, majority of respondents (52 i.e.52%) were seeking medical advice and 48 (48%) were not seeking anymedical advise. 66
    • Table 2 Frequency and Percentage Distribution of Infertile Couples by Reasons for Infertility According to Wife and Reasons for Infertility According to Husband______________________________________________________N=50 Sample characteristics Total f %_____________________________________________________________Reasons for infertility according to wife:Female factors 19 38Male factors 20 40Unexplained 11 22Reasons for infertility according to husband:Female factors 20 40Male factors 20 40Unexplained 10 20_____________________________________________________________Reasons for infertility according to wife: Regarding reasons for infertility according to wife, (20 i.e. 40%)of respondents answered that male factors were responsible for infertility,19 (38%) as female factors and 11 (22%) were unexplained. 67
    • Reasons for infertility according to husband: With regard to reasons for infertility according to husband, equalnumber of respondents answered that female and male factor wereresponsible (20 i.e. 40% in each) for infertility. Ten respondents (20%)answered the cause to be unexplained. Table 3 Frequency and Percentage Distribution of Infertile Couples by Treatment Option_____________________________________________________ N=100Sample Characteristics Total f %_____________________________________________________________Treatment OptionDrug Therapy 13 13Hormonal Therapy 29 29Invitro-fertilization (Test tube baby) 10 10Surrogacy - -Adoption 16 16No treatment 32 32_____________________________________________________________ 68
    • Treatment option: The data on treatment option reveals that, majority of respondentswere not seeking any treatment (32 i.e. 32%), 29 (29%) were usinghormonal therapy, 16 (16%) were interested in adoption, 13 (13%) weretaking drug therapy and 10 (10%) opted for invitro-fertilization. None of therespondents preferred surrogacy. 69
    • Section II Total Score and Item-Wise Analysis of Knowledge of Infertile Couples on Infertility. This section deals with item-wise analysis as well as mean andstandard deviation of knowledge scores of infertile couples on infertility. Table 4 Frequency and Percentage Distribution of Infertile Couples Knowledge on Concept of Infertility. N=100 Total Contents f %1) What is the meaning of infertility? a) Inability of couple to become pregnant after 100 100 one year of sexual life b) Inability of the couple to become pregnant -- -- within one year of sexual life c) Inability of male to have sex till one year after -- -- marriage d) Inability of female to have sex till one year after -- -- marriage e) Do not know -- -- 81
    • 2) What is the meaning of primary infertility? a. Couple without sexual relations 2 2 b. Couple who do not have any children 52 52 c. Couple living together without marriage 5 5 d. Couple who do not want children 9 9 e. Do not know 32 323) What is the meaning of secondary infertility? a. Inability of the couple to have a second child 35 35 b. Couple not planning for second child 4 4 c. Couple who do not have any children 16 16 d. Couple who got separated 11 11 e. Do not know 34 344) What is unexplained infertility? a. Only female causes of infertility are known 5 5 b. Only male causes of infertility are known 5 5 c. Cause for infertility is not found even after all 34 34 tests d. Couple not able to explain the meaning of infertility 10 10 e. Do not know 46 46_____________________________________________________________ 82
    • The data presented in the table 4 reveals that all 100 respondents(100%) knew correctly that, inability of couple to become pregnant after oneyear of sexual life is infertility. Only 52 respondents (52%) answeredcorrectly that primary infertility means couple who do not have any children.Thirty five respondents (35%) answered correctly that secondary infertilitymeans inability of the couple to have a second child and 34 respondents(34%) knew that unexplained infertility means failure to find the cause forinfertility even after doing the diagnostic tests. Table 5 Frequency and Percentage Distribution of Infertile Couples Having Correct Knowledge About Anatomy and Physiology of Male and Female Reproduction. N=100 Total Contents f %1) What are the female reproductive organs? a. Uterus, ovaries, fallopian tubes, vagina 79 79 b. Penis, vas deferens, testes, scrotum 1 1 c. Scrotum, uterus, ovaries, testes 2 2 d. Cervix, vagina, penis, testes 3 3 e. Do not know 15 15 83
    • 2) What are the male reproductive organs? a. Testes, vas deferens, vagina, scrotum 5 5 b. Uterus, ovaries, fallopian tubes, vagina 2 2 c. Ovaries, vas deferens, uterus, scrotum 3 3 d. Testes, vas deferens, penis, scrotum 74 74 e. Do not know 16 163) What do you mean by ovulation? a. Production of more ova in the ovary 1 1 b. Release of ovum from ovary 47 47 c. Union of sperm and ovum 6 6 d. Growth of baby in the uterus 18 18 e. Do not know 28 284) When does ovulation occur? a. Everyday 3 3 b. 5 days before menses 4 4 c. 14 days before menses 47 47 d. During menses 5 5 e. Do not know 41 415) How many times does ovulation occur in a month? a. 2 times 3 3 b. 4 times 3 3 c. 3 times 4 4 d. 1 time 50 50 e. Do not know 40 40 84
    • 6) How many ova are released in a month? a. Only one 63 63 b. Hundreds 2 2 c. Millions 5 5 d. Lakhs 4 4 e. Do not know 26 267) When the sperms are released from testes? a. Everyday 1 1 b. During urination 5 5 c. During sexual act 47 47 d. Once in a month 8 8 e. Do not know 39 398) How many sperms are released during each sexual contact? a. Only one 6 6 b. Millions 36 36 c. Lakhs 9 9 d. Hundreds 6 6 e. Do not know 43 439) What do you mean by ejaculation? a. Having sex 3 3 b. Development of genital organs 3 3 c. Enjoying sex 10 10 d. Release of semen from penis 42 42 e. Do not know 42 42 85
    • The data presented in table 5 reveals that, 79 respondents (79%) knewcorrectly that the female reproductive organs are uterus, ovaries, fallopiantubes and vagina; 74 respondents (74%) answered correctly that malereproductive organs are testes, vas deferens, penis, scrotum; equal number ofrespondents knew correctly the meaning of ovulation and that it occurs 14days before menses (47 i.e. 47% each); 50 (50%) knew that ovulation occursone time in a month; 63 (63%) answered correctly that sperms are releasedfrom testes during sexual act; 36 (36%) responded correctly that millions ofsperms are released during each sexual act and 42 respondents (42%) knewthat ejaculation is the release of semen from penis. Table 6 Frequency and Percentage Distribution of Infertile Couples Having Correct Knowledge About Pregnancy N=100 Total Contents ___________ f %1) What is fertilization? a. Union of sperm and ovum 48 48 b. Union of male and female 6 6 c. Development of sperm and ovum 12 12 d. Growth of baby in the uterus 4 4 e. Do not know 30 30 86
    • 2) Where does fertilization take place? a. Ovaries 1 1 b. Uterus 7 7 c. Vagina 6 6 d. Fallopian tube 59 59 e. Do not know 27 273) What is an embryo? a. Unborn baby up to 2 weeks of age 12 12 b. Unborn baby up to 8 weeks of age 44 44 c. Unborn baby up to 16 weeks of age 7 7 d. Unborn baby up to 32 weeks of age 7 7 e. Do not know 30 304) When should the couple participate in sex to become pregnant? a. During menses 0 0 b. Any day before menses 9 9 c. During ovulation 47 47 d. Any day after marriage 19 19 e. Do not know 25 255) What conditions favour pregnancy? a. Healthy sperm, healthy ovum, suitable uterus 59 59 b. More ova, more sperms, more sex 3 3 c. Daily sex, good nutrition, exercise 2 2 d. Enjoying the sex, adequate rest and sleep 4 4 e. Do not know 32 32 87
    • The data shown in the table 6 reveals that, 48 respondents (48%)knew the correct answer that union of sperm and ovum is fertilization; 59(59%) answered correctly that fertilization takes place in fallopian tubes; 44(44%) knew that unborn baby up to 8 weeks of age is embryo; 47(47%)responded correctly that the couple should participate in sex duringovulation to become pregnant; majority of respondents (59 i.e. 59%) gave acorrect opinion that healthy sperm, healthy ovum and suitable uterus are theconditions favourable for pregnancy. Table 7 Frequency and Percentage Distribution of Infertile Couples Having Correct Knowledge About Causes of Infertility N=100 Total Contents f %1) Who is responsible for infertility? a. Only female 0 0 b. Only male 1 1 c. Both male and female 75 75 d. God 3 3 e. Do not know 21 21 88
    • 2) What are the causes for female infertility? a. Lack of ovulation, tubal block, hormonal 51 51 imbalance b. Heredity, early menses, self-medication 5 5 c. Gods curse, impact of previous birth, doing sin 5 5 d. Seeking sexual pleasure, quarrelling, more sleep 6 6 e. Do not know 33 333) What are the causes for male infertility? a. Taking more oily food, more rest 3 3 b. Increased sperm motility, less sex 11 11 c. Not interested in sex, beating wife 7 7 d. Low sperm count, failure of ejaculation 52 52 e. Do not know 27 274) What are the common causes for secondary infertility in female? a. Above 35 years of age, irregular ovulation, 53 53 tubal block b. Heredity, gods curse, doing sin 4 4 c. Heavy work, more sex, quarreling 5 5 d. Lack of interest in sex, less sex, stressful life 12 12 e. Do not know 26 26 89
    • 5) What are the common causes for secondary infertility in male? a. Gods curse, ill-treating first child 2 2 b. Enjoying sexual life, more sleep 6 6 c. Age more than 35 years, decreased sperm 43 43 motility d. Impact of previous birth, increased sperm 10 10 e. Do not know 39 39_____________________________________________________________ The data presented in table 7 reveals that, majority of respondents (75i.e. 75%) answered correctly that both male and female are responsible forinfertility; 51 (51%) knew that lack of ovulation, tubal block, hormonalimbalance are the causes for female infertility; 52 (52%) knew that thecauses for male infertility are low sperm count and failure of ejaculation.Fifty-three (53%) knew that the common causes for secondary infertility infemale are age above 35 years, irregular ovulation and tubal block; 43 (43%)respondents answered correctly that the common causes for secondaryinfertility in male are age more than 35 years and decreased sperm motility. 90
    • Table 8 Frequency and Percentage Distribution of Infertile Couples Having Correct Knowledge About Diagnosis of Infertility N=100 Total Contents f %1) When should a couple seek doctor’s advice for infertility? a. If pregnancy does not occur after 6 months 1 1 of sexual life b. If pregnancy does not occur even after one 51 51 year of sexual life c. If pregnancy does not occur after 2 years of 7 7 sexual life d. If pregnancy does not occur after 5 years of 15 15 married life e. Do not know 26 262) What are the common tests done for male infertility? a. Blood test, semen test 40 40 b. Stool test, semen test 6 6 c. Scanning, semen test 7 7 d. E.C.G, semen test 6 6 e. Do not know 41 41 91
    • 3) What are the common tests done for female infertility? a. Urine test, checking blood pressure 1 1 b. Blood test, ultrasonography (scanning) 34 34 c. Scanning, stool test 16 16 d. Saliva test, checking breathing pattern 10 10 e. Do not know 39 39_____________________________________________________________ The data presented in table 8 reveals that, 51(51%) respondentsanswered correctly that a couple should seek doctors advice, if pregnancydoes not occur even after one year of sexual life; 40 (40%) respondentsknew that the common tests done for male infertility are blood tests andsemen tests. Only 34 (34%) knew about the common tests done for femaleinfertility are blood tests and ultrasonography (scanning). Table 9 Frequency and Percentage Distribution of Infertile Couples Having Correct Knowledge About Psychological Response With Infertility____________________________________________________N=100 Contents Total f %1) What are the common feelings of infertile couples? a) Jealous, angry, nervous, tense 4 4 b) Calm, secure, comfortable, confident 10 10 c) Tense, nervous, superiority, increased sexual 15 15 desire 92
    • d) Anxiety, inferiority, depression, reduced sexual 37 37 desire e) Do not know 34 34_____________________________________________________________ The data presented in table 9 reveals that 37 respondents (37%)answered correctly that the common feelings of infertile couples are anxiety,inferiority, depression and reduced sexual desire. Table 10 Frequency and Percentage Distribution of Infertile Couples Having Correct Knowledge on Treatment of Infertility________________________________________________________N=100 Contents Total f %_____________________________________________________________1) How the male infertility can be treated? a. Antibiotics, having more sex 3 3 b. Light work, more rest 7 7 c. Hormonal drugs, surgery 42 42 d. Using home made drugs, yoga 4 4 e. Do not know 44 44 93
    • 2) How female infertility can be treated? a. Dieting, weight reduction, more exercise, 2 2 light work b. Timing the intercourse, hormonal drugs, 35 35 invitro-fertilization, artificial insemination c. Self medication, enjoying sex, surrogacy, 4 4 adopting any child, mantras d. Meditation, acupuncture, using herbal 15 15 preparation e. Do not know 44 443) What do you mean by artificial insemination? a. Collection of semen for laboratory test 24 24 b. Collection of vaginal fluid for laboratory test 12 12 c. Introducing semen into uterus through a rubber 5 5 Tube d. Introducing others ovum in to uterus through a 12 12 rubber tube e. Do not know 47 47 94
    • 4) What do you mean by Invitro fertilization (Test tube baby)? a. Fusion of sperm and ovum in uterus and 11 11 transferring to a test tube b. Fusion of sperm and ovum in a test tube and 36 36 transferring it into uterus c. Creating artificial environment for growth of 10 10 baby in a test tube d. Placing sperms into uterus through a test tube 6 6 e. Do not know 37 375) How long does laboratory process take for a successful invitro- fertilization? a. 2 Weeks 13 13 b. 2 years 17 17 c. 2 days 11 11 d. 2 hours 11 11 e. Do not know 48 486) What is the meaning of surrogacy? a. A woman who donates her ovum for others 22 22 b. A woman who lends her uterus for carrying unborn baby of others 14 14 c. A woman who goes for second marriage to 11 11 have children d. A mother who takes care of children of others 11 11 e. Do not know 42 42 95
    • 7) Who can donate sperms and ova? a. People between 18 to 45 years with any disorder 3 3 b. People above 45 without any disorder 8 8 c. People between 18 to 45 years without genetic 32 32 disorders and infection d. People below 18 years without any disorder and 32 32 infection e. Do not know 49 498) What is the other option for infertility besides treatment? a. Marriage with other person 4 4 b. Keeping quite 6 6 c. Taking self-medication 4 4 d. Adopting any child 43 43 e. Do not know 43 43 The data presented in the table 10 reveals that, more than one third ofthe respondents (42 i.e. 42%) had the correct knowledge that hormonal drugsand surgery are used for treating male infertility. Less than half of the respondents (35 i.e. 35%) were aware about thetreatment for female infertility includes timing the intercourse, hormonaldrugs, invitro-fertilization and artificial insemination. 96
    • Very few respondents (5 i.e. 5%) answered correctly the meaning ofartificial insemination that, it is introducing semen into the uterus through arubber tube. Thirty-six respondents (36%) gave correct answer that fusion ofsperm and ovum in a test tube and transferring it into uterus is the meaningfor invitro-fertilization (test tube baby). Only 13 respondents (13%) knew that it takes 2 weeks time for thelaboratory process to complete, for a successful invitro-fertilization. Very few respondents (14 i.e. 14%) answered that the meaning ofsurrogacy is a woman who lends her uterus for carrying unborn baby ofothers. Thirty-two respondents (32%) answered correctly that peoplebetween 18 to 45 years without genetic disorders and infection can donatesperms and ovum. Nearly half (43 i.e. 43%) preferred for adopting any child which is theother option for infertility besides treatment. 97
    • Table 11 Frequency and Percentage Distribution of Infertile Couples Having Correct Knowledge About Prevention of Infertility________________________________________________________N=100 Contents Total f %_____________________________________________________________1) What can a man do to increase his sperm count? a. Avoid heat around genital organs, reduce stress 32 32 b. Self-medication, exercises 7 7 c. Cold application around genital organs, good nutrition 4 4 d. Having less sex, adequate sleep 11 11 e. Do not know 46 462) What are the preventive measures for male infertility? a. Avoid more sex, enjoying sex 3 3 b. Daily exercises, good nutrition 13 13 c. Mumps vaccine in childhood, avoid frequent x-rays 38 38 d. Gymnastics, heavy work 8 8 e. Do not know 38 383) What are the preventive measures for female infertility? a. Treating husband as God, performing pujas, having, less sex, helping others 2 2 b. Avoid unsafe abortions, sexually transmitted diseases, excessive alcohol and smoking 52 52 98
    • c. Decreasing weight, fasting, taking more water, doing heavy work 4 4 d. Taking well balanced diet, adequate rest and sleep,doing less work 7 7 e. Do not know 35 35_____________________________________________________________ The data presented in table 11 shows that 32 respondents (32%) hadthe correct knowledge, that a man should avoid heat around genital organsand reduce stress in order to increase his sperm count. Thirty- eightrespondents (38%) were aware of the preventive measures for maleinfertility includes, giving mumps vaccine in childhood and avoidingfrequent exposure to x-rays. More than half of the respondents (52 i.e. 52%) answered correctlythat the preventive measures for female infertility includes avoiding unsafeabortions, sexually transmitted diseases, excessive alcohol and smoking. 99
    • Table 12 Variable Wise Mean and Standard Deviation of Infertile Couples Knowledge on Infertility Variables Mean S.D Knowledge Score (Total Score=38)1.Age in years • 20-25 Years 16.00 3.22 • 26-30 Years 18.83 5.30 • 31-35 Years 19.45 5.80 • 36-40 Years 14.62 2.392.Sex • Male 18.42 4.96 • Female 18.66 5.413.Education • Knows to read and write 15.45 3.20 • 1st to 10th standard 15.85 3.85 • PUC 17.28 3.61 • Graduation 20.50 3.75 • Post Graduation 25.16 6.38 100
    • 4.Source of Information • News Papers 21.6 5.62 • Health Personnel 21.24 5.60 • Elders in the family 16.31 3.65 • Friends 18.84 6.38 • Television 19.33 5.31 • Poster - - • Pamphlets - -5.Income of the family • Less than 2000/- Per month 15.42 3.33 • Rs.2001- Rs. 4000 16.30 2.88 • Rs.4001- Rs. 6000 17.35 4.84 • Rs.6001- Rs. 8000 20.5 6.07 • Rs.8001- Rs. 10000 18.57 4.65 • More than Rs.10000 26.6 3.946.Religion • Hindu 19.97 5.86 • Muslim 18.18 5.48 • Christian 16.25 3.63 • Any other 13.50 1.50 101
    • 7.Duration of Infertility • 1-3 years 16.00 6.60 • 4-6 years 19.70 5.96 • 7-9 years 16.7 2.56 • 10-12 years 18.50 0.50 • Above 12 years 12.50 5.508.Screening • Seeking medical advise 20.32 6.17 • Not seeking medical advise16.58 16.58 3.479.Reasons for infertility according to wife • Female factors 8.21 2.88 • Male factors 9.72 3.72 • Unexplained 8.27 2.9410.Reasons for infertility according to husband • Female factors 7.82 2.94 • Male factors 9.94 3.08 • Unexplained 7.63 2.16 102
    • 11.Treatment option • Drug therapy 16.89 71.4 • Hormonal therapy 17.82 4.31 • Invitro-fertilization 27.80 6.89 • Surrogacy - - • Adoption 18.75 6.45 • No treatment 16.61 3.17Age: The respondents in the age group of 31-35 years had highest meanscore of 19.45 with a standard deviation of 5.80, followed by 26-30 yearsage group (⎯x=18.83, S.D=5.30); 20-25 year age group (⎯x = 16.00,S.D= 3.22); 36- 40 years age group (⎯x=14.62, S.D=2.39). This impliesthat 31-35 years age group had more knowledge on infertility than the otherage groups.Sex: The table 12 shows that the respondents in the female group gothighest mean score for knowledge on infertility i.e. 18.66 with a standarddeviation of 4.96, followed by male group with a mean score of 18.42 and astandard deviation of 5.41. This implies that female group had moreknowledge on infertility than the male group. 103
    • Education: The highest mean knowledge score was seen in post graduates(⎯x = 25.2, S. D=6.38), followed by graduates (⎯x = 20.5, S. D = 3.75); PUC(⎯x =17.28, S.D =3.6); 1 to 10th standard (⎯x=15.85, S.D=3.85); who knewto read and write (⎯x =15.45, S.D. = 3.20). This indicates that infertilecouples with education up to post graduation had highest knowledgeregarding infertility, followed by graduates.Source of information: The highest mean knowledge score was almost equal in couples whosought information regarding infertility through newspapers and healthpersonnel (⎯x = 21.6, S.D = 5.60 and ⎯x =21.24, S.D=5.60 respectively).The mean knowledge score of respondents who got information throughtelevision was 19.33 and standard deviation was 5.31, followed by friends(⎯x =18.84, S.D=6.38), elders in the family (⎯x = 16.31, S.D = 3.65). Itindicates that couples who received information from health personnel andnewspapers had more knowledge on infertility, followed by those whoreceived from television, friends and elders in the family.Income of family: The highest mean score for knowledge on infertility was found in thecouples whose income was more than Rs.10000 (⎯x = 26.6, S.D =3.94),followed by Rs.6001 to 8000 (⎯x= 20.5, S.D= 6.07); Rs.8001 to 10000 104
    • (⎯x=18.57,S.D=4.65); Rs.4001 to 6000 (⎯x=17.35, S.D=4.84); Rs.2001 to4000 (⎯x=16.30, S.D=2.88) and less than 2000 (⎯x=15.42, S.D=3.33). Thisimplies that couples who had income from more than Rs.6000 had moreknowledge on infertility.Religion: The highest mean score was found in Hindus (⎯x = 19.97,S.D = 5.86), followed by Muslims (⎯x=18.18, S.D=5.48); Christians(⎯x =16.25, S.D=3.63) and Sikhs (⎯x = 13.50, S.D 1.50).Duration of infertility: The highest mean knowledge score was found in couples withduration of infertility from 4-6 years (⎯x =19.70, S.D = 5.96), followed by10-12 years (⎯x =18.50, S.D=0.50); 7-9 years (⎯x=16.7,S.D=2.56); 1-3 years(⎯x=16.00, S.D=6.60) and above 12 years (⎯x = 12.50; S.D = 5.50). Thisimplies that infertile couples with 4-6 years duration of infertility had moreknowledge on infertility.Screening: The highest mean knowledge score was seen in infertile couples whosought medical advice (⎯x = 20.32, S.D = 6.17), followed by couples whodid not seek any medical advice (⎯x = 16.58, S.D = 3.45). This implies thatcouples who had gone for medical advice had more knowledge on infertility. 105
    • Reasons for infertility according to wife: The mean knowledge score of male factors, expressed by wives as thereason for infertility was high (⎯x=9.72, S.D=3.72), followed by femalefactors (⎯x=8.21, S.D=2.88) and unexplained infertility (⎯x= 8.27,S.D=2.94).Reasons for infertility according to husband: The mean knowledge score of male factors, expressed by husbands asthe reason for infertility was high (⎯x=9.94, S.D= 3.08, followed by femalefactors (⎯x=7.82, S.D =2.94 and unexplained infertility had (⎯x= 7.63,S.D=2.16.)Treatment Option: The highest mean knowledge score was found in infertile couple whoopted for invitro-fertilization as treatment for infertility(⎯x=27.80,S.D=6.89), followed by respondents who received hormonaltherapy (⎯x=17.82, S.D=4.31); adoption (⎯x=18.75, S.D=6.45) and drugtherapy (⎯x=16.89, S.D=4.71). The respondents who received no treatmentfor infertility had mean score of 16.61 with a standard deviation of 3.17.Thisimplies that couple opting for invitro-fertilization as treatment for infertilityhad highest knowledge on infertility. 106
    • Section III Relationship of Knowledge of Infertile Couples on Infertility with Selected Variables. This section presents the findings on the relationship betweenknowledge scores of infertile couples on infertility with selected variablessuch as age, sex, education, source of information, income, religion, durationof infertility, screening, reasons for infertility according to wife, reasons forinfertility according to husband and treatment option. The following nullhypotheses were stated to find the statistical significanceH01 There will not be any significant relationship between the knowledge of infertile couples with regard to infertility and their age.H02 Association will not be significant between the knowledge of infertile couples on infertility and their sex.H03 Relationship between the knowledge of infertile couples on infertility and their education will not be significant.H04 Significant relationship will not be there between the knowledge of infertile couples on infertility and the source of information.H05 Relationship will not be significant between knowledge of infertile couples on infertility and their income. 107
    • H06 No significant association will be there between the knowledge of infertile couples on infertility and their religion.H07 Relationship between knowledge of infertile couples on infertility and duration of infertility will not be significant.H08 There will be no significant association between the knowledge of infertile couples on infertility and screening done.H09 Association will not be significant between the knowledge of infertile couples on infertility and reasons for infertility expressed by wives.H010 Relationship between knowledge of infertile couples on infertility and reasons for infertility according to husbands will not be significant.H011 No significant association will be there between knowledge of infertile couples on infertility and their treatment option.H012 Significant difference will not be there between the knowledge scores of infertile males and females on infertility. 108
    • Table 13Chi-square Values Showing Relationship of Knowledge Scores of InfertileCouples on Infertility with Age, Sex, Education, Source of Information, Income, Religion, Duration of Infertility, Screening, Reasons for Infertility According to Wife, Reasons for Infertility According to Husband and Treatment Option.S.No Variables χ2 value of Table value d.f. knowledge at 5 % level1. Age 16.3* 12.59 62. Sex 6.99* 5.79 23. Education 53.63* 15.51 84. Source of information 16.82 N.S 21.03 125. Income of the family 46.69* 18.31 106. Religion 9.55 N.S 12.59 67. Duration of infertility 6.70 N.S 15.51 88. Screening 37.75* 5.99 29. Reasons according to wife 5.77 N.S 9.49 410. Reasons according to husband 6.7 N.S 9.49 411. Treatment option 19.75* 18.31 10 N.S=Not Significant at 5% level *=Significant at 5% level 109
    • Knowledge and the Selected Variables The chi -square values obtained for knowledge scores and age(χ2 = 16.3), sex (χ 2 =6.99), education (χ 2 =53.63), income (χ2 = 46.69),screening (χ2=37.75), treatment (χ2=19.75) were higher than the table values.This indicated that there was a significant relationship between knowledgeof infertile couples on infertility and their age, sex, education, income,screening and treatment. Hence, the research hypotheses H1, H2, H3, H5, H8,H11 were retained and null hypotheses H01, H02, H03, H05, H08, and H011, wererejected. The chi-square values for knowledge scores and source of information(χ2 = 16.82), religion (χ2 = 9.55), duration of infertility (χ2=6.70), reasons forinfertility according to wife (χ2 =5.77), reasons for infertility according tohusband (χ2=6.7) were found to be less than the table values which indicatedthat they were not significant at 5% level. Hence, there was no significantrelationship existing between knowledge scores of infertile couples oninfertility and source of information, religion, duration of infertility, reasonsaccording to wife, and reasons according to husband. Therefore, theresearcher failed to reject null hypotheses H04, H06, H07, H09, and H010. 110
    • Table 14 Comparison of Knowledge on Infertility Between Infertile Males and Females N=100Knowledge on Mean S.D ‘t’ Value Infertility (Paired) Male 18.42 4.96 6.75** Female 18.66 5.41 **Significant at 1% level Table 14 shows that the mean value for knowledge on infertility washigher in infertile females (⎯x =18.66, S.D=5.41) when compared to infertilemales (⎯x=18.42, S.D=4.96). The obtained ‘t’ value was 6.75, which wassignificant at 1% level. This clearly indicated that there was a significantdifference in the knowledge with regard to infertility between infertile malesand females. Hence, H012 was rejected and H12 was accepted. 111
    • V. DISCUSSION The term ‘infertility’ is defined as the inability to conceive despiteregular and unprotected intercourse for one year. The incidence of infertilitywas reported to be 8-12% worldwide. About 15% of couple will be havingmore than one cause for their infertility. In about 25% of couples no definitecause will be found even after complete investigation. In patriarchal settings, such as India where a woman’s identity isdetermined by her ability to bear children, particularly sons, infertility couldhave far reaching consequences. Attempts to overcome infertility has beengoing on since years, but it is only recently that one has seen greatimprovement in treatment due to advances in assisted reproductivetechnologies. Counselling the infertile couple is an increasing part of practice today.It is important to investigate a couple as a unit and to establish a diagnosis.Sometimes nature needs to start pregnancy. Prevention and treatment ofinfertility is possible in low resource settings and Reproductive HealthProgramme could be an entry point for couple with infertility problem. However, there is a need to enhance existing services and improve thequality of care to infertile couples. 112
    • The collected data for the present study was analyzed statistically andthe results based on demographic characteristics and objectives of the studywere discussed below:Sample Characteristics:1. One hundred subjects including 50 females and 50 males were selected for the study. The data on age reveals that half of the respondents were in the age group of 31-35 years (51 i.e. 51%), followed by 26-30 years (31 i.e. 31%), 20-25 years (10 i.e. 10%). The reason for high percentage of the couples in the age group of 31-35 years might be due to the reasons such as late marriages, decision to postpone child bearing. This also shows that a couple’s fertility behaviour declines after 30 years of age.2. Educational status reveals that equal number of respondents were graduates and with 1 to 10th standard education (28 i.e. 28% in each), P.U.C (21 i.e. 21%), Post graduation (12 i.e. 12%), very few (11 i.e. 11%) knew to read write. This might be due to the fact that the sample from selected areas for the study i.e. IDSMT ward-3 were more educated and from Zaheerabad and Mangalwarpet areas were with minimum education as these areas are underdeveloped in Raichur city. This reveals that education level of the respondents is one of the important variable in 113
    • influencing the behaviour of the individual. The knowledge acquired will have tremendous effect on their health behaviour.3. Considering the source of information, about 45(45%) respondents received information regarding infertility from elders in the family, followed by health personnel (29 i.e. 29%), friends (13 i.e. 13%), newspapers (10 i.e. 10%) and television (3 i.e. 3%). Usually, elders in the family educate their youngsters regarding customs, traditions, ideals, values etc. They have the most profound influence over the youngsters. It is clearly evident from the findings that the respondents had intimate relationship with the elders in the family and acquired the knowledge on infertility.4. Regarding monthly income, nearly 31(31%) respondents had the income of Rs.4001 to Rs.6000, followed by 26 (26%) in Rs. 6001 to Rs. 8000 income group, 23 (23%) in Rs.2001 to 4000. Equal number were getting less than 2000 and Rs.8001 to Rs.10000 (7 i.e. 7% in each). The standard of living and quality of life depends on the economic power. Income of the family is an important factor in seeking the health care. The findings of the study suggest that majority of respondents had income of less than Rs. 6000, which is not sufficient for their infertility treatment. The reason for this might be due to least employment opportunities in backward areas like Raichur town. 114
    • 5. As far as the religion is concerned, majority of respondents were Hindus (46 i.e. 46%), followed by Muslims (32 i.e. 32%), Christians (20 i.e. 20%) and 2(2%) respondents were Sikhs. This might be due to the fact that Raichur town predominantly consists of Hindus. Religion plays a vital role in dictating the way of living.6. Considering duration of infertility, majority of respondents (62 i.e. 62%) were in the category of 4-6 years, followed by 20(20%) in 7-9 years, 14(14%) in 1-3 years category. In today’s generation both husband and wife want to first establish their career, build assets for themselves and then start a family. It is evident from above findings that the respondents might have taken the decision to post- pone child bearing for more than 3 years.7. The data on screening reveals that, majority of respondents (52 i.e. 52%) were seeking medical advice and 48(48%) were not seeking any medical advice. One of the major factors influencing health status is education. It is evident from the above findings that, the respondents who were with minimum education and less income did not prefer to seek any medical advice. 115
    • 8. Regarding reasons for infertility according to wife, 20(40%) answered that male factors were responsible followed by female factors (19 i.e. 38%) and unexplained infertility (11 i.e. 22%). By this, it is inferred that infertility was no longer seen as a women’s burden alone.9. With regard to reasons for infertility according to husband, equal number of respondents answered that female and male factor were responsible for infertility (20 i.e. 40% in each). Ten respondents (20%) answered the cause to be unexplained. This is suggesting that infertility treatment should focus on the couple as a team.10. The data on treatment option reveals that, majority of respondents were not seeking any treatment (32 i.e. 32%), 29(29%) were taking hormonal therapy, 16(16%) were interested in adoption, 15(15%) were taking drug therapy. The reason could be attributed to the fact that, less income and lower education leads to poor awareness of treatment facilities available for infertility. As the education level and economic power increases, the understanding capacity of the subjects also increases. They learn new things and acquire new knowledge in variety of areas, which will have tremendous effect on their health behaviour. 116
    • Objectives of the StudyTo assess the knowledge of infertile couples regarding infertility. The above-mentioned objective was met by mean, standard deviation, frequency and percentage distribution of infertile couple based on their knowledge scores.Results revealed that: 1. All the infertile couples responded correctly the meaning of infertility (100 i.e. 100 %), majority knew the meaning of primary infertility ( 52 i.e. 52%), only 35 respondents (35%) had the correct knowledge about the meaning of secondary infertility and 46 (46%) answered that they did not know the meaning for unexplained infertility. It is evident from the above findings that all the respondents had adequate knowledge on infertility. But, they had below average knowledge on primary, secondary and unexplained infertility This is supported by the study conducted by Wimberley in 2003. The study results showed that majority of couples understood that infertility is the inability to become pregnant. This is also consistent with the study conducted by Kannagi in 2000, which showed that maximum number of respondents i.e. 75% had inadequate knowledge on the types of infertility. 117
    • 2. Majority of respondents had correct knowledge on female reproductive organs (79 i.e. 79%), male reproductive organs (74 i.e. 74%), meaning and occurrence of ovulation (47 i.e. 47%), number of ova released in a month (63 i.e. 63%), release of sperms from testes during sexual act (47 i.e. 47%), number of sperms released during each sexual act (43 i.e. 43%). It is evident from the above findings that majority of the respondents had above average knowledge on the Anatomy and physiology of human reproduction except in some aspects like ovulation and ejaculation, they had average knowledge. These results are supported by the study conducted by Blake. D in 1997, which showed that more than 50% of the subjects had an adequate understanding of human reproduction. Only 46% of women had adequate fertility awareness and when the fertile time occurred in their menstrual cycle. A study conducted by Dyer in 2004, showed that 28.7% of women had little knowledge about human reproduction. Hence, health education and counselling need to be integrated3. Majority of infertile couples knew the person responsible for infertility (75 i.e. 75%), 51(51%) were aware of the causes for female infertility, 52(52%) about male infertility causes, 53(53%) about common causes for female secondary infertility and 43(43%) answered correctly about common causes for secondary infertility in male. 118
    • It is evident from the above findings that majority of the respondents knew that both male and female are responsible for infertility. With respect to causes, they had average knowledge on causes for male and female infertility. The following studies support the results: A study conducted by Greelhoed in 2002, revealed that only 46.5% of the respondents reported the causes for infertility. A study conducted by Dyer in 2004, revealed that men had little knowledge about causes of infertility. Twenty–six percent of men had male factor awareness. Hence, there is a need for developing health education package on causes of infertility.4. Fifty-one (51%) respondents answered correctly to when a couple should seek doctors advice to become pregnant, 40(40%) respondents knew the common tests done for male infertility and only 34 (34%) knew about the common tests done for female infertility. It is evident from the above findings that the respondents had below average knowledge on the common tests done for both male and female infertility. These findings are supported by a study conducted by Andrews in 1994, which revealed that only 40% of respondents had the knowledge about the diagnostic tests done for infertility. 119
    • A study conducted by Elizabeth in 2003, revealed that only 39.3% of women sought more medical information on diagnostic tests done for female infertility.5. Only 37 respondents (37%) answered correctly the common feelings of infertile couples. From this, it is consistent that the respondents were not aware of the common feelings of infertile couples. They might not be willing to express the feelings. A study conducted by Lee S.H in 1995, showed that women showed higher psychosocial distress than their partners. A study conducted by Hyness in 1992, showed that wives had a lower level of satisfaction with life than their husbands. They experienced symptoms like anxiety, reduced sexual desire. Hence, there is a need to enhance the quality of life of infertile couples.6. More than one third of the respondents (42 i.e. 42%) had the correct knowledge about treatment of male infertility; 35 (35%) respondents were aware of treatment of female infertility; 5 (5%) about artificial insemination; 36(36%) about invitro-fertilization and only 13 (13%) knew the time taken for successful invitro-fertilization. Very few respondents (14 i.e. 14%) answered about meaning for surrogacy and 32 (32%) knew the procedure for donation of sperm and ovum. Nearly half (43 i.e. 43%) preferred for adoption. 120
    • The findings stated above revealed that, the respondents had inadequate knowledge on various treatment modalities for infertility. The following studies support the above findings: A study conducted by Schmidt in 1995, showed that only 47.4% of the infertile women had the knowledge of infertility treatment. A study conducted by Mokoena in 2004, revealed that men had little knowledge about modern treatment options. A study conducted by Abraham in 2002, revealed that women had little knowledge about modern treatment options for infertility. A study conducted by Yebei in 2000, revealed that only 25% of women described the treatment for infertility, which included drugs, surgery, donor insemination and invitrofertilization. Hence, there is a need for developing health education packages on treatment options for infertility.7. Thirty-eight respondents (38%) had the correct knowledge on preventive measures for male infertility, 52 (52%) on preventive measures for female infertility and only 32(32%) had the knowledge on measures to be followed to improve sperm count. The above-mentioned findings revealed that the respondents had average knowledge on preventive measures for female infertility. Regarding preventive measures for male infertility they had below average knowledge. 121
    • The above findings are supported by a study conducted by Rajendran in 2002, which revealed that majority of boys with undescended testes attended for treatment at a higher age than that recommended. A report was submitted by WHO in 1992 and they had mentioned that some causes of infertility could be prevented. Hence, a public health campaign should be organized to decrease the spread of sexually transmitted diseases and knowledge on preventive measures for infertility should be incorporated.1. The mean score for knowledge on infertility was highest for the respondents who belonged to the age group of 31-35 years (⎯x=19.45, S.D = 5.80). This might be due to the fact that a couples fertility behaviour starts to decline after 30 years of age.2. The mean score for knowledge on infertility was highest in female respondents (⎯x=18.66, S.D=4.96). As women react more strongly to their infertility than men and as women are made responsible for infertility in the society, they concentrate more on improving their knowledge in order to overcome the problem.3. The mean score for knowledge on infertility was highest in respondents with post graduation (⎯x=25.2, S.D= 6.38). This reveals that higher the education, higher knowledge the people acquire. Education teaches individuals the use of various abilities. As the 122
    • education level increases, the understanding capacity of the subjects also increases.4. The mean score for knowledge on infertility was highest in respondents who sought information regarding infertility through newspapers and health personnel (⎯x=21.6, S.D=5.6 and ⎯x=21.24, S.D =5.60 respectively). This shows that health personnel and print media play an important role to improve the infertile couples understanding about various aspects of fertility behaviour.5. The mean score was highest in respondents with income of more than Rs.10000 (⎯x=26.6, S.D=3.94). By this it could be said that the couples were aware of the cost of infertility treatment.6. The mean score was highest in Hindus (⎯x=19.97, S.D=5.86). Majority of respondents who belonged to Hindu religion were having higher education, which influenced their knowledge on infertility.7. The highest mean score was seen in respondents with 4-6 years duration of infertility (⎯x=19.70, S.D.=5.96). This shows that as the period of infertility experience increased, the couple gained more knowledge, to overcome the problem.8. The knowledge mean score was highest in respondents who sought medical advice (⎯x=20.32, S.D=16.17). This shows the importance of health personnel in making the couple understand about infertility. 123
    • 9. The highest mean knowledge score was seen for male factors, expressed by both husbands (⎯x=9.72, S.D=2.72) and wives (⎯x=9.94, S.D =3.08) as the reason for infertility. This shows the increased awareness of male factor infertility.10. The mean knowledge score was highest in respondents who opted for invitro-fertilization (⎯x=27.80, S.D=6.89). This shows the advancement in assisted reproductive technologies, which showers on to the infertile couples the blessing of a child.Comparison of knowledge between infertile males and females. The mean value for knowledge on infertility in infertile males waslower (⎯x =18.42, S.D=4.96) when compared to mean value for infertilefemales (⎯x= 18.66, S.D.=2.41). The obtained ‘t’ value was 6.75. Thisindicated that females were having more knowledge on infertility whencompared to men. This is supported by a study conducted by Margaret in 1925, whichrevealed that females were having more knowledge on infertility than males. As women react more strongly to their infertility than men, they try toget detailed information about various aspects of infertility such astreatment, sexual advice and support. This might be the reason for womenpossessing more knowledge on infertility when compared to men. 124
    • Analyzing the relationship between the knowledge of infertile coupleson infertility with selected factors. The chi-square values computed for knowledge score and age 2 2 2(χ =16.3), sex (χ2=6.99), education (χ =53.63), income (χ =49.69), 2 2screening (χ =37.75), treatment (χ = 19.75) were found to be statisticallyhighly significant at 5% level, which indicated that there was a significantrelationship between knowledge of infertile couples on infertility and theirage, sex, education, income, screening and treatment. This is supported by a study conducted by Stewart D.E in 2001, whichrevealed that most of the women (61.7%), who were taking fertility drugs,and with education till graduation had more knowledge on infertility andwanted to share knowledge with their doctors. The chi-square values for knowledge scores and sources of 2 2information (χ = 16.82), religion (χ =9.55), duration of infertility 2 2(χ = 6.70), reasons for infertility according to wife (χ =5.77), reasons for 2infertility according to husband (χ = 6.7) were found to be less than tablevalues. Hence, there is no significant relationship between knowledge scoresof infertile couples and sources of information, religion, duration ofinfertility, reasons for infertility according to wife and reasons for infertilityaccording to husband. A study conducted by Stewart D.E in 2001, revealed that over 57.2%of women who sought information from health personnel and media wereunaware of a possible link between fertility drugs and pregnancy. 125
    • Hence, public health policy makers must find ways to improve thegeneral public and infertile couples understanding about fertility treatmentoutcomes. The health care systems should see that the infertile couples fromlower social classes are offered proper information on possibility ofinfertility treatments. So, information module on infertility could be prepared by nurses anddistributed to the infertile couples, which will be helpful for them to improvetheir knowledge. 126
    • VI SUMMARY This chapter deals with the summary of the study and its majorfindings. The present study was intended to assess the knowledge of infertilecouples on infertility in selected areas at Raichur.The objectives of the study were:1. To assess the knowledge of infertile couples regarding infertility.2. To compare the knowledge of infertile males and females on infertility.3. To analyze the relationship between the knowledge of infertile couples on infertility and selected factors.The research hypotheses formulated were:H1 There will be significant association between the knowledge of infertile couples with regard to infertility and their age.H2 Association will be there between the knowledge of infertile couples on infertility and their sex. 127
    • H3 Relationship between the knowledge of infertile couples on infertility and their education will be significant.H4 Significant relationship will be there between the knowledge of infertile couples on infertility and their source of health related information.H5 Relationship will be significant between knowledge of infertile couples on infertility and their income.H6 Significant association will be there between knowledge of infertile couples on infertility and their religion.H7 Relationship between knowledge of infertile couples on infertility and duration of infertility will be significant.H8 There will be significant association between the knowledge of infertile couples on infertility and screening done.H9 Association will be significant between the knowledge of infertile couples on infertility and reasons for infertility according to wives.H10 Relationship between knowledge of infertile couples on infertility and reasons for infertility according to husbands will be significant.H11 Significant association will be there between knowledge of infertile couples on infertility and their treatment option. 128
    • H12 Significant difference will be there between the knowledge scores of infertile males and females on infertility. A review of related literature helped the researcher to develop theconceptual framework and methodology for the study. The research approach used in the study was a descriptive method.The study was conducted in Zaheerabad, IDSMT ward-3, Mangalwarpetareas of Raichur town, Karnataka. A structured questionnaire was developedon the basis of related literature after consulting with the experts. Contentvalidity of the tool was established by obtaining the suggestions of experts.Reliability of the tool was done by test, re-test method. The ‘r’ value ofknowledge was 0.79 indicating that, the tool was highly reliable. The pilot study was conducted on 10 subjects i.e., 5 infertile malesand 5 infertile females. The results revealed that the tool was reliable. Datarelated to knowledge on infertility were collected from 50 infertile males and50 infertile females by using purposive sampling technique. The datacollected were analyzed and interpreted with descriptive and inferentialstatistics. Frequency and percentages were computed to summarize thesample characteristics and item wise descriptions of the knowledge ofinfertile couples. Chi–square was computed to find out the relationshipbetween knowledge and the selected variables and ‘t’ test was done tocompare the knowledge of infertile males and females. 129
    • The major findings of the study were organized under the followingheadings:Characteristics of the Sample:1. Out of 100 respondents, majority belonged to 31–35 years age group (51 i.e. 51%) and least were between 36-40 years (8 i.e. 8%).2. Among 100 respondents, equal number were having education from 1st to 10th standard and graduation (28 i.e. 28% in each). Very few knew to read and write (11 i.e.11%).3. Regarding source of information, majority of respondents received information regarding infertility from elders in the family (45 i.e. 45%) and very few got it through television (3 i.e. 3%).4. While considering the income of the family, nearly 31 respondents (31%) were having the income between Rs.4001 to Rs.6000 per month and very few had the income of more than Rs.10000 (6 i.e. 6%). Equal number of respondents were having income between Rs.8000 to Rs.10000 and less than Rs.2000 per month (7 i.e. 7% in each).5. With regard to religion, 46 respondents (46%) belonged to Hindu religion and least were Sikhs (2 i.e. 2%). Others were Muslims (32 i.e. 32%) and Christians (20 i.e. 20%).6. Regarding duration of infertility 62 (62%) respondents were in the category of 4-6 years and 2 i.e. 2% were in 10-12 years category.7. As far as screening was concerned, majority (52 i.e. 52%) were seeking medical advice, whereas 48 (48%) were not seeking any medical advice. 130
    • 8. Among 50 respondents, male factors expressed by wives as reasons for infertility were 20 i.e. 40%, followed by female factors (19 i.e. 38%) and remaining were unexplained (11 i.e. 22%).9. Among 50 respondents, male and female factors were expressed by husbands as equally responsible for infertility (20 i.e. 40% in each) and unexplained were 10 i.e. 20%.10. When treatment option was considered, majority ( 32 i.e.32% ) were not taking any treatment and least (10 i.e. 10%) opted for invitro- fertilization.Analysis of knowledge scores:1. All the infertile couples responded correctly to the meaning of infertility (100 i.e. 100%); half of the respondents (52 i.e. 52%) had correct opinion about primary infertility and secondary infertility (35 i.e. 35%) and 34 respondents (34%) knew about the meaning of unexplained infertility.2. Majority of the respondents (79 i.e. 79%) knew correctly about female reproductive organs; male reproductive organs (74 i.e. 74%); meaning and occurrence of ovulation (47% i.e. 47%); number of times ovulation occurs in a month (50 i.e. 50%); time of release of sperms (63 i.e. 63%); number of sperms released during each sexual act (36 i.e. 36%) and 42 respondents (42%) knew that ejaculation is the release of semen from penis. 131
    • 3. Nearly half of the respondents (48 i.e. 48%) knew the correct answer for fertilization; fertilization takes place in fallopian tubes (59 i.e. 59%); meaning of embryo (44 i.e. 44%); when the couple should participate in sex to become pregnant (47 i.e. 47%); conditions favourable for pregnancy (59 i.e. 59%).4. Majority of respondents (75 i.e. 75%) answered correctly that both male and female are responsible for infertility; causes for female inferlity (51 i.e. 51%); causes for male infertility (52 i.e. 52%); causes for female secondary infertility (53 i.e. 53%); causes for male secondary infertility (45 i.e. 45%).5. Half of the respondents (51 i.e. 51%) answered correctly that a couple should seek doctors advice, if pregnancy does not occur even after one year of sexual life; common tests done for male infertility (40 i.e. 40%); common tests done for female infertility (34 i.e. 34%).6. Thirty–seven respondents (37%) answered correctly the common feelings of infertile couples; treatment for male infertility (42 i.e. 42%); treatment for female infertility (35 i.e. 35%); meaning of artificial insemination (5 i.e. 5%); meaning for invitro–fertilization (36 i.e. 36%); time for successful invitro–fertilization (13 i.e. 13%); meaning of surrogacy (14 i.e. 14%); procedure for donating sperms and ovum (32 i.e. 32%). Nearly half of the respondents preferred for adopting any child (43 i.e. 43%). 132
    • 7. Only 32 respondents (32%) had the correct knowledge on measures to be followed to increase a man’s sperm count; preventive measures for male infertility (38 i.e. 39%); preventive measures for female infertility (52 i.e. 52%). The mean score of knowledge on infertility was highest for therespondents, who belonged to the age group of 31-35 years (⎯x=19.45,S.D.=5.80); females (⎯x=18.66 S.D=4.96); post graduates (⎯x=25.2,S.D=6.38); who sought information through newspapers and healthpersonnel (⎯x=21.6, S.D=5.60 and ⎯x=21.24, S.D=5.60 respectively); withincome more than Rs. 10000 (⎯x=19.97, S.D=5.86); Hindus (⎯x=19.97,S.D=5.86); duration of infertility from 4-6 years (⎯x=19.70, S.D=6.17); malefactors as reason for infertility according to wives (⎯x=9.72, S.D=2.72);male factors as the reasons for infertility according to husbands (⎯x=9.94,S.D=3.08); who opted for invitro-fertilization (⎯x=27.80, S.D=6.89). 133
    • Comparison of knowledge between infertile males and females The mean value for knowledge on infertility in infertile males waslower (⎯x =18.42, S.D=4.96) when compared to mean value for infertilefemales (⎯x =18.66, S.D=2.41). The obtained ‘t’ value was 6.75, which wasconsidered to be significant at 1% level. This indicated that there was asignificant difference in the knowledge regarding infertility between infertilemales and females.Relationship of the knowledge of infertile couples on infertility withselected variables There was a significant relationship between knowledge scores and 2 2 2the infertile couples age (χ = 16.3), sex (χ = 6.99), education (χ =53.63), 2 2 2income (χ = 46.49), screening (χ =37.75), treatment (χ = 19.75). Hence,the research hypotheses H1, H2, H3, H5, H8 and H11 were retained and nullhypotheses H01, H02, H03, H05, H08 and H011 were rejected. Insignificant relationship was found between the knowledge scores ofthe infertile couples and the source of information (χ2 = 16.82), religion(χ2 = 9.55), duration of infertility (χ2 =6.70), reason for infertility accordingto wife (χ2 = 5.77), reason for infertility according to husband (χ2 = 6.7).Hence, the researcher failed to reject null hypotheses H04, H06, H07, H09, andH010 . 134
    • VII CONCLUSIONSThe following conclusions were formed on the basis of the study results:1. The findings revealed that the respondents had adequate knowledge regarding the meaning of infertility. But, they lacked knowledge in few aspects like causes, diagnosis, treatment and preventive measures for infertility.2. The knowledge of infertile couples was influenced by age, sex, education, income, screening and treatment.3. There was no relationship between knowledge of infertile couples on infertility and source of information, religion, duration of infertility, reasons for infertility according to wife and reasons for infertility according to husband.4. Among the couples, females were having more knowledge on infertility when compared to males. LIMITATIONS1. The size of the sample was small to draw generalizations.2. Only those who could read and write Kannada or English were included in the study.3. The study was limited to those infertile couples residing only at Zaheerabad, IDSMT ward 3 and Mangalwarpet areas of Raichur. 135
    • VIII IMPLICATIONS AND RECOMMENDATIONS. The findings of study have following implications in the areas ofnursing service, nursing administration, nursing education, and nursingresearch.a. Implications of the present study in the nursing services Nurses are in the best position to give information regarding variousaspects of infertility, as the infertile couple will be free to reveal theirproblems to nurses. Since, the present study showed that almost all thecouples had inadequate knowledge on infertility, nurses in changing era haveto prepare themselves to provide care and give appropriate information tothe couples. There is a greater demand for getting the resources extractedfrom infertile couples, by the nurses in the form of knowledge. Realizing thehealth care needs of people, nurses must incorporate scientific basedknowledge.b. Implications of present study in nursing administration Nurses have to play a multidimentional role and their skills have to becombined with a specialized knowledge base to ensure improved healthstatus of the infertile couples. The nurses could participate in publicawareness programmes through mass media and administration should takeinitiative to organize educational programmes for health personnel regardingvarious aspects of infertility. Nurses, in turn could improve the knowledge ofinfertile couples for a good prognosis in future. 136
    • c. Implications of the present study in nursing education The findings of the study indicated that more emphasis should beplaced in the nursing curriculum on infertility. Periodic infertility awarenessprogrammes should be arranged for nursing students which would be a greathelp for promoting themselves as well as other who are in need.d. Implications of the present study in the nursing research The study will be a motivation to beginning researchers to conductsimilar studies on a large scale. The findings of the study serve as a basis forthe professional and the student nurses to conduct further studies oninfertility. In depth study on counselling for infertile couples, prevention andtreatment of infertility in low resource settings could be conducted. RECOMMENDATIONS The following recommendations were made for further research,based on the study findings.1. A similar study could be taken up with a large sample for assessing the knowledge of infertile couples on infertility for making a more valid generalization.2. A similar study could be conducted to assess the knowledge of infertile couples on infertility who are attending infertility clinics. 137
    • 3. A comparative study could be conducted to assess the psychosocial problems between infertile males and females.4. A comparative study could be conducted to assess the incidence of treatment seeking behaviour of infertile couples in government and private infertile clinics.5. A study could be done to develop the health education packages on infertility and evaluate its effectiveness.6. A comparative study could be conducted to assess the knowledge, attitude and practices of men and women towards infertility with different demographic characteristics.7. A study could be conducted to assess the operationally feasible and cost-effective treatment of infertility in low resource settings. 138
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    • Annexure ILetter Seeking Acceptance From The Content ValidatorsFrom,Mrs. B. PadmaII Year M.Sc Nursing StudentNavodaya College of NursingRaichurTo, Through the proper channelRespected Sir/Madam, Sub: Letter for opinion and suggestions of experts for establishing contentvalidity of the research tool requesting regarding. I am, Mrs. B. Padma doing my final year M.Sc Nursing at Navodaya College ofNursing in Raichur, have selected the following topic for dissertation, to be submitted toRGUHS, as partial fulfillment of University requirement for awarding Master of Nursingdegree. Topic: “A Study to Assess the Knowledge of Infertile Couples RegardingInfertility in Selected Areas of Raichur". In this behalf, I have developed a tool, which is organized in the followingheadings. Section A : Demographic Data Section B : Questionnaire to assess the knowledge of Infertile Couples regarding Infertility I will be very thankful to you if you could kindly go through the tool and giveyour valuable suggestions on content validity. I am herewith enclosing the studyobjectives, variables and certification of validation. Thanking you, Yours faithfully,Signature of Guide & Principal (B.Padma) Dr.R.Vasundhara 152
    • ANNEXURE II List of Experts Consulted for Content Validity of the Tool Experts of OBG1. Mrs. Rafath Razia Professor Govt. College of Nursing Hyderbad2. Mrs. Swarnalatha Lecturer SVIMS Tirupathi3. Mrs. S. Jyothi Lecturer Govt. College of Nursing Kurnool4. Dr. Subhash Reddy H.O.D of OBG Navodaya Medical College Raichur5. Dr. Shailaja Verma Associate Professor Navodaya Medical College Raichur 153
    • ANNEXURE III Letter Seeking Permission From the District Municipal OfficerTo,The District Municipal OfficerRaichur, Karnataka.Sir/Madam, This is to introduce Mrs. Padma a final year student of M.Sc (N)course in our college, who has to conduct a research project, which issubmitted to the Rajiv Gandhi University of Health Sciences, Karnataka inpartial fulfillment of university requirement for the award of M.Sc (N).Topic: “ A Study to Assess the Knowledge of Infertile Couples RegardingInfertility in Selected Areas at Raichur.” The student is in need of your esteemed help and co-operation has sheis interested to conduct her study in Zaheerabad, IDSMT Ward No.3,Mangalwarpet areas of Raichur. I am to request you to kindly extendnecessary assistance and help to her. Thanking you,Date: Yours Sincerely,Place: Principal 154
    • ANNEXURE IV Questionnaire to Assess the Knowledge of Infertile Couples Regarding InfertilityNote I, Mrs. B.Padma, am doing M.Sc. Nursing Final Year at NavodayaCollege Of Nursing Raichur. As a part of my course requirement, I havetaken up a research project, the completion of which depends upon yourcooperation in the form of answering to this questionnaire. I promise you that all the information collected from you will be keptvery confidential and will be used only for my study purpose.Instructions 1. Please be free and frank in answering the questions. 2. Please answer all questions. 3. Your responses will be held strictly confidential and will be used for research study only. 4. You need not write your name.Note: Please tick mark against the best choice in the blank given 155
    • Section –A Demographic DataSubject Code:1. Age in Years a. 20 –25 Years b. 26-30 years c. 31-35 years d. 36-40 years2. Sex a. Male _____ b. Female _____3. Education a. Knows to read and write b. 1st to 10th Standard c. P.U.C d. Graduation e. Post Graduation and above4. Source of information a. Newspapers b. Health Personnel c. Elders in the family d. Friends e. Television f. Posters g. Pamphlets 156
    • 5. Income a. Less than Rs.2000/- per month b. Rs.2001 – 4000/- per month c. Rs.4001 – 6000/- per month d. Rs.6001 - 8000/- per month e. Rs.8001 – 10000/- per month f. More than Rs.10000/- per month6. Religion a. Hindus b. Muslims c. Christians d. Any other7. Duration of infertility a. 1 - 3 years b. 4 - 6 years c. 7 - 9 years d. 10 - 12 years e. Above 12 Years8. Screening a. Seeking medical advise b. Not seeking medical advise9. Reasons for infertility according to wife a. Female factors b. Male factors c. Unexplained 157
    • 10. Reasons for infertility according to husband a. Female factors b. Male factors c. Unexplained11. Treatment Option a. Drug Therapy b. Hormonal Therapy c. Invitrofertilization (Test tube baby) d. Surrogacy e. Adoption f. No treatment SECTION –BQuestions on knowledge items with regard to infertility1) What is the meaning of infertility? a. Inability of couple to become pregnant after one year of sexual life b. Inability of the couple to become pregnant within one year of sexual life c. Inability of male to have sex till one year after marriage d. Inability of female to have sex till one year after marriage e. Do not know 158
    • 2) What is the meaning of primary infertility? a. Couple without sexual relations b. Couple who do not have any children c. Couple living together without marriage d. Couple who do not want children e. Do not know3) What is the meaning of secondary infertility? a. Inability of the couple to have a second child _____ b. Couple not planning for second child c. Couple who do not have any children d. Couple who got separated e. Do not know4) What is unexplained infertility? a. Only female causes of infertility are known b. Only male causes of infertility are known c. Cause for infertility is not found even after all tests d. Couple not able to explain the meaning of infertility e. Do not know5) What are the female reproductive organs? a. Uterus, ovaries, fallopian tubes, vagina b. Penis, vas deferens, testes, scrotum c. Scrotum, uterus, ovaries, testes d. Cervix, vagina, penis, testes e. Do not know 159
    • 6) What are the male reproductive organs? a. Testes, vas deferens, vagina, scrotum b. Uterus, ovaries, fallopian tubes, vagina c. Ovaries, vas deferens, uterus, scrotum d. Testes, vas deferens, penis, scrotum e. Do not know7) What do you mean by ovulation? a. Production of more ova in the ovary b. Release of ovum from ovary c. Union of sperm and ovum d. Growth of baby in the uterus e. Do not know8) When does ovulation occur? a. Everyday b. 5 days before menses c. 14 days before menses d. During menses e. Do not know9) How many times does ovulation occur in a month? a. 2 times b. 4 times c. 3 times d. 1 time e. Do not know 160
    • 10) How many Ova are released in a month? a. Only one b. Hundreds c. Millions d. Lakhs e. Do not know11) When the sperms are released from testes? a. Everyday b. During urination c. During sexual act d. Once in a month e. Do not know12) How many sperms are released during each sexual contact? a. Only one b. Millions c. Lakhs d. Hundreds e. Do not know13) What do you mean by ejaculation? a. Having sex b. Development of genital organs c. Enjoying sex d. Release of semen from penis e. Do not know 161
    • 14) What is fertilization? a. Union of sperm and ovum b. Union of male and female c. Development of sperm and ovum d. Growth of baby in the uterus e. Do not know15) Where does fertilization take place? a. Ovaries b. Uterus c. Vagina d. Fallopian tube e. Do not know16) What is an embryo? a. Unborn baby upto 2 weeks of age b. Unborn baby upto 8 weeks of age c. Unborn baby upto 16 weeks of age d. Unborn baby upto 32 weeks of age e. Do not know17) When should the couple participate in sex to become pregnant? a. During menses b. Any day before menses c. During ovulation d. Any day after marriage e. Do not know 162
    • 18) What conditions favour pregnancy? a. Healthy sperm, healthy ovum, suitable uterus b. More ova, more sperms, more sex c. Daily sex, good nutrition, exercise d. Enjoying the sex, adequate rest and sleep e. Do not know19) Who is responsible for infertility? a. Only female b. Only male c. Both male and female d. God e. Do not know20) What are the causes for female infertility? a. Lack of ovulation, tubal block, hormonal imbalance b. Heredity, early menses, self-medication ____ c. Gods curse, impact of previous birth, doing sin d. Seeking sexual pleasure, quarrelling, more sleep e. Do not know21) What are the causes for male infertility? a. Taking more oily food, more rest b. Increased sperm motility, less sex c. Not interested in sex, beating wife d. Low sperm count, failure of ejaculation e. Do not know 163
    • 22) What are the common causes for secondary infertility in female? a. Above 35 years of age, irregular ovulation, tubal block b. Heredity, gods curse, doing sin c. Heavy work, more sex, quarreling d. Lack of interest in sex, less sex, stressful life e. Do not know23) What are the common causes for secondary infertility in male? a. Gods curse, illtreating first child b. Enjoying sexual life, more sleep c. Age more than 35 years, decreased sperm motility d. Impact of previous birth, increased sperm motility e. Do not know24) When should a couple seek doctors advice for infertility? a. If pregnancy does not occur after 6 months of sexual life b. If pregnancy does not occur even after one year of sexual life c. If pregnancy does not occur after 2 years of sexual life d. If pregnancy does not occur after 5 years of married life e. Do not know25) What are the common tests done for male infertility? a. Blood test, semen test b. Stool test, semen test c. Scanning, semen test 164
    • d. E.C.G, semen test e. Do not know26) What are the common tests done for female infertility? a. Urine test, checking blood pressure b. Blood test, ultrasonography (scanning) c. Scanning, stool test d. Saliva test, checking breathing pattern e. Do not know27) What are the common feelings of infertile couples? a. Jealous, angry, nervous, tense b. Calm, secure, comfortable, confident c. Tense, nervous, superiority, increased sexual desire d. Anxiety, inferiority, depression, reduced sexual desire e. Do not know28) How the male infertility can be treated ? a. Antibiotics, having more sex _____ b. Light work, more rest c. Hormonal drugs, surgery d. Using home made drugs, yoga e. Do not know 165
    • 29) How female infertility can be treated? a. Dieting, weight reduction, more exercise, light work b. Timing the intercourse, hormonal drugs, invitrofertilization, artificial insemination c. Self medication, enjoying sex, surrogacy, adopting any child, mantras d. Meditation, acupuncture, using herbal preparation e. Do not know30) What do you mean by artificial insemination? a. Collection of semen for laboratory test b. Collection of vaginal fluid for laboratory test c. Introducing semen into uterus through a rubber tube d. Introducing others ovum into uterus through a rubber tube e. Do not know31) What do you mean by Invitrofertilization (Test tube baby)? a. Fusion of sperm and ovum in uterus and transferring to a test tube b. Fusion of sperm and ovum in a test tube and transferring it into uterus _____ c. Creating artificial environment for growth of baby in a test tube d. Placing sperm into uterus through a test tube e. Do not know 166
    • 32) How long does laboratory process take for a successful invitro-fertilization? a. 2 Weeks _____ b. 2 years c. 2 days d. 2 hours e. Do not know33) What is the meaning of surrogacy? a. A woman who donates her ovum for others b. A woman who lends her uterus for carrying unborn baby of others c. A woman who goes for second marriage to have children d. A mother who takes care of children of others e. Do not know34) Who can donate sperms and ova? a. People between 18 to 45 years with any disorder b. People above 45 without any disorder c. People between 18 to 45 years without genetic disorders and infection _____ d. People below 18 years without any disorder and infection e. Do not know35) What is the other option for infertility besides treatment? a. Marriage with other person b. Keeping quite c. Taking self-medication d. Adopting any child e. Do not know 167
    • 36) What can a man do to increase his sperm count? a. Avoid heat around genital organs, reduce stress b. Self-medication, exercises c. Cold application around genital organs, good nutrition d. Having less sex, adequate sleep e. Do not know37) What are the preventive measures for male infertility? a. Avoid more sex, enjoying sex b. Daily exercises, good nutrition c. Mumps vaccine in childhood, avoid frequent x-rays d. Gymnastics, heavy work e. Do not know38) What are the preventive measures for female infertility? a. Treating husband as God, performing pujas, having less sex, helping others b. Avoid unsafe abortions, sexually transmitted diseases, excessive alcohol and smoking c. Decreasing weight, fasting, taking more water, doing heavy work _____ d. Taking well balanced diet, adequate rest and sleep, doing less work e. Do not know 168
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    • 38. ¹ÛçÃAiÀÄgÀ°è §AeÉvÀ£À ¤AiÀÄAwæ¸À®Ä PÀæªÀÄUÀ¼ÉãÀÄ? 1. UÀAqÀ£Éà zÉêÀgÉAzÀÄ w½AiÀÄĪÀÅzÀÄ, ¥ÀÆeÉ ªÀiÁqÀĪÀÅzÀÄ, ---- «ÄvÀ¯ÉåAVÃPÀvÉ, E£ÀÄߧâjUÉ ¸ÀºÁAiÀÄ ªÀiÁqÀĪÀÅzÀÄ. ---- 2. C¸ÀÄgÀPÀëvÀ UÀ¨sÀð¥ÁvÀ, ¯ÉåAVÃPÀ gÉÆÃUÀUÀ¼ÀÄ, CwAiÀiÁzÀ ªÀÄzÀå¥Á£À, ªÀÄvÀÄÛ zÀĪÀÄ¥Á£À vÀ¥Àà¹. ---- 3. zÉúÀzÀ vÀÆPÀ E½¸ÀĪÀÅzÀÄ, G¥ÀªÁ¸ÀªÀiÁqÀĪÀÅzÀÄ, ºÉZÀÄÑ, ¤ÃgÀÄ PÀÄrAiÀÄĪÀÅzÀÄ. ---- 4. ¸ÀªÀÄvÀÆPÀzÀ DºÁgÀ ¸ÉêɣÉ, ¸ÁPÀμÀÄÖ «±ÁæAw ºÁUÀƤzÉæ PÀrªÉÄ PÉ®¸À ªÀiÁqÀĪÀÅzÀÄ. ---- 4. UÉÆwÛ®è. ---- 184
    • Annexure VI Scoring KeyQuestionnaire to Assess the Knowledge of Infertile Couples RegardingInfertility Q. No Correct Answer Score 1. a 1 2. b 1 3. a 1 4. c 1 5. a 1 6. d 1 7. b 1 8. c 1 9. d 1 10. a 1 11. c 1 12. b 1 13. d 1 14. a 1 15. d 1 16. b 1 17. c 1 18. a 1 19. c 1 20. a 1 21. d 1 22. a 1 23. c 1 24. b 1 25. a 1 26. b 1 27. d 1 28. c 1 29. b 1 185
    • 30. c 131. b 132. a 133. b 134. c 135. d 136. a 137. c 138. b 1 total 38 Maximum Score – 38 186
    • ABSTRACTA study was conducted “to assess the knowledge of infertile couplesregarding infertility in selected areas at Raichur”.The objectives of the study were 1. To assess the knowledge of infertile couples regarding infertility 2. To compare the knowledge of infertile males and females on infertility 3. To analyze the relationship between the knowledge of infertile couples on infertility and selected factors. The research approach used in the study was a descriptiveco-rrelational method. The subjects were selected by using purposivesampling technique. The sample size was 100, out of which 50 werefemales and 50 were males. Data were collected by using structuredquestionnaire. Analysis of the data was done by using descriptive andinferential statistics.The findings were1. On the whole, majority of the infertile couples had inadequate knowledge about infertility.2. Significant relationship was found between knowledge scores of infertile couples and their age, sex, education, income, screening and treatment. 187
    • 3. Insignificant relationship was found between knowledge and their source of health related information, religion, duration of infertility, reasons according to wife and reasons according to husband. 4. Among the couples, knowledge of infertility was found more in infertile females when compared to infertile males. The mean score for knowledge on infertility was highest for the respondents, who belonged to the age group of 31-35 years (⎯x=19.45, S.D.=5.80); females (⎯x=18.66 S.D=4.96); post graduates (⎯x=25.2, S.D=6.38); who sought information through newspapers and health personnel (⎯x=21.6, S.D=5.60 and ⎯x=21.24, S.D=5.60 respectively); with income more than Rs. 10000 ( ⎯x=19.97, S.D=5.86); Hindus (⎯x=19.97, S.D=5.86); duration of infertility from 4-6 years (⎯x=19.70, S.D=6.17); male factors as reason for infertility according to wives (⎯x=9.72, S.D=2.72); male factors as the reasons for infertility according to husbands (⎯x=9.94, S.D=3.08); who opted for invitro-fertilization (⎯x=27.80, S.D=6.89). The findings led to the following conclusions1. The respondents had adequate knowledge regarding the meaning of infertility. But, they lacked knowledge in few aspects like causes, diagnosis, treatment and preventive measures for infertility.2. The knowledge of infertile couples was influenced by age, sex, education, income, screening and treatment. 188
    • 3. There was no relationship between knowledge of infertile couples on infertility and source of information, religion, duration of infertility, reasons for infertility according to wife and reasons according to husband.4. Among the couples, females were having more knowledge on infertility when compared to males. Based on the results following implications were made 1. Nurses must incorporate scientific based knowledge on various aspects of infertility, realizing the health care needs of infertile couples. 2. Nurses should participate in public awareness programmes through mass India. 3. Nursing administration should take initiative to organize educational programmes for nurses on various aspects of infertility. 4. More emphasis should be placed in curriculum about infertility. 5. The beginning researchers should conduct similar studies on a large scale. The study has drawn following recommendations 1. A similar study could be taken up with a large sample for assessing the knowledge of infertile couples on infertility for making a more valid generalization. 2. A similar study could be conducted to assess the knowledge of infertile couples on infertility who are attending infertility clinics. 189
    • 3. A comparative study could be conducted to assess the psychosocial problems between infertile males and females.4. A comparative study could be conducted to assess the incidence of treatment seeking behaviour of infertile couples in government and private infertile clinics.5. A study could be done to develop the health education packages on infertility and evaluate its effectiveness.6. A comparative study could be conducted to assess the knowledge, attitude and practices of men and women towards infertility with different demographic characteristics.7. A study could be conducted to assess the operationally feasible and cost-effective treatment of infertility in low resource. 190
    • 52 60 50 40 30 20-25 years 26-30 years 30 31-35 years 36-40 years 20 10 8 10 0 20-25 years 26-30 years 31-35 years 36-40 yearsFig No:5 Percentage Distribution of Infertile Couples According to Age
    • 50 5050.045.040.035.030.0 Male25.0 Female20.015.010.0 5.0 0.0 Male FemaleFig No:6 Percentage Distribution of Infertile Couples According to Sex
    • 28 28 30 25 21 20 Knows to re ad and wri te 1st to 10th 15 12 Standard 11 PUC 10 5 0 Knows to re ad 1st to 10th PUC Graduati on Post Graduation and write Standard and aboveFig No: 7 Percentage Distribution of Infertile Couples According to Education
    • 45 45 40 35 News Papers 29 Health Personnel 30 Elders in the Family 25 Friends 20 Television Posters 15 13 Pamphlets 10 10 5 3 0 0 0 Ne ws Elde rs in Te le vision Pamphle ts Pape rs the FamilyFig No :8 Percentage Distribution of Infertile Couples According to Source of Information
    • 35 3130 2625 2320 Less than Rs.2000 Rs.2001-4000 Rs.4001-600015 Rs.6001-8000 Rs.8001-1000010 More than Rs.10000 7 7 6 5 0 Less than Rs.2001- Rs.4001- Rs.6001- Rs.8001- More than Rs.2000 4000 6000 8000 10000 Rs.10000 Fig No:9 Percentage Distribution of Infertile Couples According to Income
    • 50 46 45 40 32 Hindus 35 30 Muslims 25 Christians 20 20 Any Other 15 10 2 5 0 Hindus Muslims Christians Any OtherFig No: 10 Percentage Distribution of Infertile Couples According to Religion
    • 70 6260 1-3 Years50 4-6 Years40 7-9 Years30 10-12 Years 2020 14 Above 12 Years10 2 20 1-3 Ye ars 4-6 Ye ars 7-9 Ye ars 10-12 Years Above 12 Ye ars Fig No: 11 Percentage Distribution of Infertile Couples According to Duration of Infertility
    • 48 Seeking medical advice 52 Not seeking medical advise Fig No : 12 Percentage Distribution of Infertile Couples According to Screening Done
    • 22 38 Femae factors Male factors Unexplained 40Fig No:13 Percentage Distribution of Infertile Couples According to Reasons for Infertility Expressed by Wives
    • 20 40 Female fators Male factors Unexplained 40Fig No: 14. Percentage Distribution of Infertile Couples According to Reasons for Infertility Expressed by Husbands
    • 35302520 Treatment Option 32 291510 16 13 10 5 0 0 Dru g Th e rapy Hormon al Th e rapy In vi ti ro- S u rrogacy Adopti on No Tre atm e n t fe rti l i z ati on (Te st tu be baby) Fig No :15. Percentage Distribution of Infertile Couples According to Treatment Option