الفهرس 
Male InfertilityOnly 14 pages are availabe for public view
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Abstract
Reproductive phenomena is a natural process in living organisms, which in human being, in addition to physiologic aspects, has social and psychological dimensions; so that one of the goals of marriage and making family is reproduction and fertility. Birth of an infant can strengthen the family basis, meet the emotional needs of the people and finally, lead to renewal and continuity of the generation. But, infertility is a fact which is incompatible with all the mentioned cases (Berek, 2006). Having a baby is still one of the most effective ways of feeling completely fulfilled from a human point of view. Children provide emotional satisfaction, make life interesting and provide a reason for living. People also want children because it is almost like a biological need, as they want to see a part of themselves in their child. Some want to be able to spend the wealth they have acquired or achieved on someone, and a biological offspring is the best person to spend it on (Collier, 2010).
Both men and women agreed that children are the most important thing in life and that, without them, it is very difficult to lead a fulfilling and happy life (Dhont et al., 2011).
In this context, fertility oriented behavior represents a social norm which is violated by infertility (Dyer et al., 2009). Once the decision to have a baby has been taken, the desire to conceive can become extremely strong, and the consequences if it does not happen can lead to a serious emotional crisis (Collier, 2010).Infertility is a prevalent condition and represents a significant social and public health problem (Zegers-Hochschild et al., 2009). There is no doubt that infertility like other physiological phenomenon has social and psychological aspects and it is classified in the realm of behavioral sciences. Studies show that psychological factors can have an important role in infertility and infertility has also many psychological consequences (Fariba, 2010). In our society which fertility is given very attention and reproduction is considered as one of the fundamental goals of marriage, infertility causes many mental problems for the infertile men (Fariba et al., 2010). Research shows that men diagnosed with male factor infertility experience more suffering than men with infertility due to other causes, and that it is socially unfavorable to be diagnosed with male factor infertility (Peronace et al, 2007). Depression and anxiety are normal responses to infertility realization. (Eugster and Vingerhoets, 1999). It was concluded that ”men in infertile relationships have a significant incidence of mental health derangement with almost one third having documented depression.” (Ohebshalom et al, 2006). This thesis was designed aiming at covering the following items in the theoretical part :(1) An overview on the medical aspect of male infertility, (2) Review the related psychiatric aspects of male infertility, and (3) Review how male infertility problem is viewed in different cultures and religions.The practical part aimed at:
1- Estimate psychiatric morbidity among infertile males with comparison between infertile men and fertile ones regarding details of diagnosable psychiatric disorders.
2- Investigate how infertility problem can affect the quality of life of infertile males.
3- Highlight the relation between the diagnosis of male infertility and self esteem.
4- Identify variables influencing psychiatric morbidity, quality of life and self esteem of infertile men.
The present study evaluated collectively one hundred males. They were organized into two major groups, patient group which consisted of 50 infertile men attending the outpatient clinic of Dermatology and Andrology department, Faculty of Medicine, Ain Shams University internal medicine hospital, and the Assisted Reproductive Technique Unit in the Department of Obstetrics and Gynecology, Ain Shams University Hospitals, and control group which consisted of 50 cross matched fertile controls.
We obtained an informed consent and inclusion criteria were insured before the study which included being infertile male patient fulfilling the diagnosis of primary male factor infertility, with age ranging from 25 to 40 years old, with neither history of female factor infertility, major general medical diseases or previous psychiatric illness.
The tools were carefully selected to serve for the purpose of the study, this included (1) Clinical psychiatric assessment, (2) General Health questionnaire, (3) Standardized psychiatric assessment using The Structured Clinical Interview for DSM-IV (SCID- I and II), (4) Clinical psychological assessment tools including Beck Depression Inventory (BDI), The Taylor Manifest Anxiety Scale, PCASEE Quality of Life questionnaire, Self Esteem scale.
All data gathered were recorded, tabulated and transferred on Statistical Package for Social Sciences (SPSS) Version 15, using personal computer and the suitable statistical parameters were used. Results were displayed to answer questions raised in the hypothesis of this study.
The first important group of results aimed at estimation of psychiatric morbidity among infertile males with comparison between infertile men and fertile ones regarding details of diagnosable psychiatric disorders. This was done through evaluation of psychiatric morbidity among infertile males (Axis I and Axis II diagnoses) together with investigating severity of depression and anxiety, quality of life and self esteem.
Only 44% among infertile males had regular sexual relation with their partners in comparison to 66% of control fertile males which was statistically significant.
64% of examined infertile males were labeling psychiatric diagnosis at time of interview in comparison to 36% only in control group which was highly statistically significant.
Generalized anxiety disorder was the most prevalent diagnosis being 36%, followed by major depression which reached 26% and 22% labeled social phobia, then 15.9% fulfilled diagnostic criteria of substance abuse disorder. All mentioned psychiatric diagnoses had statistical significant difference when compared to the control group.
48% of the infertile patients had comorbidity between different psychiatric diagnoses compared with 14% of the control group, which was statistically significant.Infertile males showed no significant prevalence of personality disorders (52%) compared with the control groups (62%).
The most frequently encountered categorical Axis II diagnoses among the infertile males were avoidant and depressive being 18% each, followed by paranoid personality disorders (10%).
On Beck depression inventory, no statistical significant difference was found between mean scores of cases versus control group.
On Taylor’s Manifest anxiety scale, it was obvious that infertile patients’ group were more anxious than control group, whether in the mean value or the categorical values.
Infertility patients group were significantly less than the control group in QoL regarding the total score and most subscales (physical, affective, social and ego functioning).
Infertility patients were significantly less than the control group regarding their self esteem total score.
The second group of results aimed at identifying variables influencing psychiatric morbidity of infertile males, we were concerned by socio-demographic variables, infertility history and personality profile.
As we compared infertile males with psychiatric morbidity by those who had no psychiatric morbidity, data revealed the following:None of socio-demographic variables was significantly associated with psychiatric morbidity (axis-I) or (axis-II) diagnosis.from all socio-demographic variables, longer marriage duration was statistically significantly correlated to severity of depression, while older age and longer marriage duration were the only sociodemographic variables that were directly related to severity of anxiety.
Occupation was significantly correlated to the economic domain of quality of life, while Marriage duration was significantly inversely correlated to cognitive, economic and ego function domains of quality of life. Moreover, marriage duration was the only sociodemographic variable that was significantly inversely correlated with self esteem.
Positive family history of psychiatric illness had statistical significant correlation with psychiatric morbidity, specifically major depression and PTSD. It was found also that there is no correlation between family history of psychiatric illness and axis-II diagnosis, severity of depression and anxiety as well as self esteem, yet there was significant relation between it and physical and ego function domains of quality of life.
No statisticaly significant correlation was found between all items of infertility history with having an axis-I diagnosis. Yet, GAD was significantly correlated to family history of infertility and treatment trials number. Panic disorder was significantly correlated to treatment trials number. Social phobia was significantly correlated to treatment trials type and regularity of sexual relation. Lastly, depression was significantly correlated to regularity of sexual relation.
Infertility duration was significantly correlated with severity of both depression and anxiety. Treatment trials number was significantly correlated to the severity of anxiety.
from all infertility history items, it was found that family history of infertility, duration of infertility and sexual regularity had significant correlation with mean score of quality of life in infertile patients, as well as other quality of life domains. Furthermore, it was found that there is a significant inverse correlation between self esteem and treatment trials number and infertility duration and direct correlation with sexual regularity.
Having an axis-II diagnosis is highly significantly correlated to severity of depression but not severity of anxiety. Yet, depressive personality disorder obtained significant high scores on BDI and Tailor Manifest Anxiety Scale. Moreover, infertile patients with avoidant and obsessive personality disorders obtained significantly high scores on Tailor Manifest Anxiety Scale.
Infertile patients with depressive personality disorder obtained less mean scores of Quality of Life as well as Physical, affective and economic domains of quality of life compared with infertile patients without depressive personality disorder. Moreover, Infertile patients with depressive personality disorder obtained a highly significant inverse correlation with mean scores of self esteem compared with infertile patients without.
Infertile patients with narcissistic personality disorder obtained higher mean scores of Quality of Life as well as Physical, cognitive, affective, social and ego functioning domains of quality of life compared with infertile patients without narcissistic personality disorder.The last group of results was displayed to highlight the possible relationship between Quality of Life and Self Esteem and the nature of psychiatric morbidity among infertile males.
Infertile patients with axis-I diagnosis had poor Quality of life compared to infertile patients without. Additionally, patients with major depression, GAD, social phobia and panic disorder had low scores on several QOL subcategories compared to infertile men free from those disorders.
There is an inverse significant relation between severity of depression and quality of life as well as most of its subcategories. The same relation comes between severity of anxiety and social and economic domains of quality of life.
Patients with low scores of total quality of life, as well as physical, cognitive, affective and economic domains of quality of life tend to have significant low scores of self esteem.
Infertile patients with psychiatric morbidity had poor self esteem when compared to infertile patients without psychiatric morbidity, especially patients with major depression, panic disorder, social phobia, GAD and somatization.
Infertile patients with low self esteem scores had significantly high scores on BDI and Taylor anxiety scale.