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Cover page

Title page

Certification        –       –       –       –       –       –       –       –       i

Dedication –       –       –       –       –       –       –       –       –       ii

Acknowledgement      –       –       –       –       –       –       –       iii

Abstract     –       –       –       –       –       –       –       –       –       v

Table of contents        –       –       –       –       –       –       –       –       vi


1.1    Background of the Study     –       –       –       –       –       1

1.2    Statement of Problem  –       –       –       –       –       –       7

1.3    Purpose of the study           –       –       –       –       –       8

1.4    Objective of the Study –       –       –       –       –       –       9

1.4    Research Questions    –       –       –       –       –       –       10

1.5    Research Hypothesis   –       –       –       –       –       –       10

1.6    Significance of the Study     –       –       –       –       –       11

1.7    Scope of the study      –       –       –       –       –       –       11

1.8    Limitation of the study         –       –       –       –       –

1.9    Definition of Terms             –       –       –       –       –       12


2.1    Introduction       –       –       –       –       –       –       –       14

2.2 The Theoretical frame Work –       –       –       –       –       21

2.3 conceptual frame work

2.4 empirical review


3.1    Introduction       –       –       –       –       –       –       –       82

3.2    Area of the study                –       –       –       –       –       –       82

3.3    Research Design        –       –       –       –       –       –       82

3.4    Sample and sampling techniques –       –       –       –       83

3.5    Population of the study               –       –       –       –       –       84

3.6    Procedure for Data Collection      –       –       –       –       85

3.7    Method of Data Analysis      –       –       –       –       –       85


4.1    Introduction       –       –       –       –       –       –       –       87

4.2    Presentation of Data           –       –       –       –       –       87

4.3    Data Analysis     –       –       –       –       –       –       –       88

4.4    Testing of Hypothesis          –       –       –       –       –       91

4.5    Discussion and summary of findings             –       –       94



5.0    Introduction       –       –       –       –       –       –       –       98

5.1    Summary           –       –       –       –       –       –       –       99

5.2    Conclusion –       –       –       –       –       –       –       –       100

5.3    Recommendations      –       –       –       –       –       –       101



Infertility represents a serious stressor for some patients as well as a risk factor for a decrease in sperm quality. The purpose of the present study was to identify coping strategies that went along with both better emotional and physical adjustment to infertility. The sample consisted of 63 patients who contacted an andrological clinic more than one time. Prior to clinical examination, patients filled out a questionnaire referring to the way in which they coped with their wives’ previous menstruation. Participants also completed a scale assessing perceived distress due to infertility. Change in sperm concentration since baseline semen analysis and the level of distress were used to evaluate patient’s adjustment. The better-adjusted patients showed less prominent overall coping efforts, and a higher proportion of distancing coping strategies. An improvement in sperm quality also was associated with a low cognitive involvement in infertility. Situational uncontrollability of infertility could be a moderator of the effectiveness of coping employed by the better-adjusted patients. In addition, the coping behaviour related to better adjustment could be due to a dispositional stress resistance factor. For clinical implementation of the findings, the attitudes of a patient and the expectations of his wife have to be taken into consideration.


`Is infertility-problem stress different?’ (Andrews et al., 1992)–this was the topic of a debate several years ago focusing on the relationship of distress to marital factors as well as to variables of life quality (Andrews et al., 1992, 1993Boivin, 1993). While it remained unclear whether infertility had a special impact on these aspects, the interaction between infertility and distress (Wright et al., 1989) is different from many other stressors. For example, former research suggests that there is a relationship between stress and sperm quality (Gilbin et al., 1988Fukuda et al., 1996). Some well-controlled studies revealed that during in-vitro fertilization (IVF) treatment, the sperm quality of participants decreased, presumably caused by distress (Harrison et al., 1987Ragni and Caccamo, 1992). Moreover, distress due to infertility has predictive value for changes in sperm concentration and motility (Pook et al., 1999). Although sperm quality is not seriously impaired in most of the cases, parameters essential to fertility (e.g. Irvine et al., 1994) may be affected by distress due to infertility.

Besides the empirical research on the consequences of infertility, theoretical considerations were proposed in regard to coping with infertility distress. (Callan and Hennessey, 1989) outlined a framework for coping with infertility, which was based on the stress concept of (Lazarus and Folkman, 1984). They suggested that infertile couples employ appraisal-focused, problem-focused, and emotion-focused coping. The use of appraisal-focused coping is essential for the patient to get information for judging his infertility as well as his behavioural possibilities. Elementary to the use of problem-focused coping is the patient’s belief that something helpful can be done. The strategies of problem-focused coping aim at establishing a solution or a viable alternative. In contrast, emotion-focused coping does not aim at providing a solution but at maintaining the patient’s psychological well being. This can be reached if the patient remains hopeful, if he accepts his infertility or if he distracts himself from it. For appraisal-focused, problem-focused and emotion-focused coping, Callan and Hennessey gave detailed examples of strategies employed by infertile couples (Callan and Hennessey 1989). Their considerations, however, are only descriptive, and provide little information about the benefit of the specific coping forms.

Since the work of Callan and Hennessey, several empirical studies have been carried out on the effectiveness of strategies for coping with infertility. More or less explicitly these studies were based on the assumption that the patient’s level of distress is mediated through his coping behaviour (e.g. Folkman and Lazarus, 1988). Studies on infertile males employing a specific measure of avoidance-coping consistently revealed a positive correlation between this coping behaviour and distress (Cook et al., 1989Stanton, 1991Stanton et al., 1992Slade et al., 1992Abbey et al., 1994Morrow et al., 1995). The findings for other coping strategies of infertile males are less clear. One study (Stanton, 1992) revealed that confrontive-coping and self-controlling are also related to distress. In the same study positive reappraisal was positively correlated with well being. Another study (Sabatelli et al., 1988) revealed that reframing is correlated positively with adjustment to infertility and negatively with depression. The reverse pattern was found with passive appraisal. In addition, seeking help was correlated positively with both adjustments to infertility and depression. Other studies suggested that the use of active problem solving strategies (Abbey et al., 1994) or cognitive involvement in infertility (Pook et al., 1999b) could be related to higher distress for infertile males.

Thus, apart from avoidance-coping there is a variety of findings on the association between coping with infertility and adjustment. This variation could result for different reasons. For example, although the individual coping behaviour is fairly stable some situational factors will influence the type of coping behaviour used (Terry, 1994). Because the correlations of the coping strategies with adjustment were generally found to be small, even a little situational variability of coping could override such a correlation. Another reason for the variety of results could be the usage of different questionnaires. Moreover, even though findings from five out of eight studies cited were based on the itempool of the Ways-of-Coping questionnaire (Lazarus and Folkman, 1984), different factorial solutions were employed. As a consequence, scales that were named similarly consisted of different items and therefore represent slightly different aspects of coping.

The factor solution that was selected for the present study was that which was most frequently chosen in studies relating the coping behaviour of infertile males to adjustment. In addition, situational variability of coping was minimized. Participants of the present study were not asked to describe their coping behaviour in an optional situation related to infertility, but in a situation every male infertility patient knows: the last time he realized that his wife began her menstruation. This highly specific coping behaviour is set in relation to a specific measure of infertility distress as well as to the change in sperm quality since a previous semen analysis.


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