Objective: The aim of this study is to determine the healthy lifestyle behaviors of infertile women and the factors affecting them.

Methodology: The study was planned in cross-sectional type. For this reason, 190 infertile women followed in a public hospital in Istanbul between September and December 31, 2020 formed the sample of the study. The data of the research; Data were collected using an introductory information form prepared in line with the literature (resources) and the Healthy Lifestyle Behaviors Scale. Mann Whitney U tests were used in the analysis of two-category data, and Kruskal Wallis tests were used in the analysis of data in more than two categories.

Results: The mean age of the women participating in the study was 31.84 ± 5.80 years, more than half (55.8%) were housewives, and 41.6% were childless for more than 5 years. The mean score of healthy lifestyle behaviors (HLBS) of infertile women is 121.66 ± 23.44. The sociodemographic status of women, such as working status and occupation, is not affected by the mean HLBS score (p>0.05). Education level, duration of infertility diagnosis, and the attitude of the spouse and family to the diagnosis of infertility affect the mean HLBS score (p<0.05).

Conclusion: It was determined that the mean HLBS mean scores of women who had a negative spouse attitude after infertility, had a “critical-condescending” family attitude and were ashamed of their spouse and family were found to be lower (p<0.05).

• Infertility • Healthy lifestyle behaviors • Women • Nursing

Infertility is a non-life-threatening health problem in which pregnancy cannot be achieved despite regular and unprotected sexual intercourse for 12 months [1]. 15% of couples of reproductive age are affected by infertility [2]. It is stated that approximately 37% of the factors causing infertility are due to women, 29% to men, 18% to both female and male factors, and 16% to unexplained infertility [3]. In addition to the negative effects of developing technology and industrialization on human health, it is noted that environmental harmful factors (lead, pesticides, etc.) have negative effects on the reproductive system, which is highly sensitive, and increase infertility [4-6]. It is emphasized that the first step to be taken in the solution of infertility, which is a global problem, is to identify risky health behaviors and develop healthy lifestyle behaviors due to its positive effects on infertility prevention and treatment [7,8].

Developing a healthy lifestyle in women can contribute to the optimum level of fertility and prevention of infertility by improving general health and well-being [9,10]. Risky lifestyle behaviors related to infertility are changeable habits, behaviors and situations that have negative effects on fertility. Individual lifestyle behaviors that have been reported to have adverse effects on the female reproductive system and fertility, most commonly smoking [3,11], alcohol consumption [12,13]and drug use [3], body mass index (BMI) below 17 kg/m² and over 27 kg/m² [12], 250 mg daily excessive caffeine consumption [10,12], insufficient or heavy exercise [9,10], stress [13], highcalorie, It has been reported as a diet rich in trans fats and refined carbohydrates [14,15]. In addition, in two systematic reviews examining the effects of environmental and occupational exposures on female infertility, the negative effects of air pollution [16], mostly phthalates, bisphenol A, pesticides [17], on reproductive functions were reported. It has been determined that infertile women use wi-fi-connected technological devices (phones, laptops, etc.) for more than 6-8 hours [13]. All listed lifestyle behaviors and habits are changeable factors that are under the control of the individual [18].

Determining the lifestyle behaviors of infertile couples and improving healthy behaviors by changing the risky ones have an important place in solving the infertility problem, which is expected to increase today, and in increasing the chance of success in assisted reproductive techniques (ART). Physicians, nurses and midwives have important roles and responsibilities in developing healthy lifestyle behaviors and reducing risky situations. It is necessary and important to know the risky lifestyle behaviors of women in order to increase the general health level of women, protect their fertility potential, and plan the necessary education, care and treatment comprehensively for health professionals during the infertility treatment process [9,10]. 

in the literature, there are various studies examining healthy lifestyle behaviors in terms of infertility with different dimensions, their effects on female infertility, and it is stated that more evidence is needed [3,11,14,15,17,19]. A limited number of studies have been found examining healthy lifestyle behaviors in infertile women in Turkey [13,20,21]. For this reason, increasing the number of studies examining the healthy lifestyle of infertile women, taking the necessary precautions for infertility, which is a global problem, will contribute to the development of education and treatment strategies. In this study, it was aimed to determine the healthy lifestyle behaviors of infertile women and the affecting factors.

Research questions 

• What are the healthy lifestyle behaviors of infertile women? 

• What are the factors affecting the healthy lifestyle behaviors of infertile women?

Research design

In order to determine the healthy lifestyle behaviors of infertile women and the factors affecting them, a descriptive study in quantitative design was planned with the participation of infertile women followed in a public hospital in Istanbul between September 1 and December 31, 2020.

The population and sample of the research

The study was planned in cross-sectional type. For this reason, 190 infertile women followed in a public hospital in Istanbul between September and December 31, 2020 formed the sample of the study.

Data collection tools

The data of the research; Data were collected using an introductory information form prepared in line with the literature (resources) and the Healthy Lifestyle Behaviors Scale.

Introductory Information Form: Socio-demographic (age, education, occupation, employment, income, place of residence, duration of marriage) and infertility-related characteristics of primary infertile women (infertility duration, cause, treatment period) and the attitude of the spouse and family to the diagnosis of infertility It consists of questions about the desire to adopt, the effects of the diagnosis of infertility on the relationship between spouses.

Healthy lifestyle behaviors scale (HLBS)

Turkish validity and reliability study of the scale developed by Walker, Bahar et al., by The scale, which consists of a total of 52 questions, is in a 4-point Likert type. The scale consists of 6 sub-dimensions as health responsibility, exercise, nutrition, stress management, interpersonal relationships and spirituality. Each item of the scale is evaluated as 1 point for “never”, 2 points for “sometimes”, 3 points for “often” and 4 points for “regularly”. The score that can be obtained from the scale varies between 52 and 208, and an increase in the total score from the scale indicates that healthy lifestyle behaviors are positive. In the validity and reliability study of Bahar et al., it was determined that the Cronbach Alpha reliability coefficient ranged between 0.94 for the total scale and 0.79-0.87 for the 6 sub-dimensions [22,23]. In our study, while the Cronbach Alpha reliability coefficient was calculated as 0.94 for the whole scale, it was calculated as 0.75 for the health responsibility sub-dimension, 0.73 for the exercise sub-dimension, 0.69 for the nutrition sub-dimension, and 0.76 for the spirituality and interpersonal relations sub-dimension.

Analysis of data

SPSS 22.0 package program was used for statistical analysis in the study. Descriptive statistics were calculated as number (n) and percent (%), mean (X), and Standard deviation (SD). Kolmogorov-Smirnov distribution test was applied to examine the normal distribution and it was determined that the data were non-parametric. For this reason, Mann Whitney U tests were used in the analysis of two-category data, and Kruskal Wallis tests were used in the analysis of data in more than two categories.

Ethical statement

Ethical approval was obtained from a university clinical Ethics Committee (Decision No: 103-14/17). Before the research questions were asked, an informed consent form was included in the online system explaining the purpose of the research and the use of personal data for scientific research. Participants were first asked to read the informed consent document, and then their consent was obtained.

The distribution of sociodemographic characteristics of infertile women is given in Table 1. The mean age of the participants was 31.84 ± 5.80 years, and more than half (50.5%) were between the ages of 30-39. 57.4% of them are secondary school graduates, 64.2% of them are not working. More than half of the participants (55.8%) are housewives. 6 out of 10 participants perceive their income as medium level and 6 out of 10 participants do not live in the city center.

Table 2 gives the distribution of some characteristics of infertile women regarding the infertility problem. Approximately 1 out of every 5 women participating in the study has been married for 11 years or more. 41.6% of them have been childless for more than 5 years- they could not have an involuntary child. While the source of infertility is female in 46.3%, the cause of infertility is unclear in 31.6%. 67.9% of the participants have been receiving infertility treatment for less than 5 years (mean 4.54 ± 3.43 years for all participants). 16.3% of the participants stated that their spouse’s attitude changed after the diagnosis of infertility, and 21.1% stated that their families faced a critical and prejudiced attitude. While 58.9% of infertile women did not consider adopting when they could not have children, 25.3% stated that they were undecided. More than half of the women

(55.8%) stated that they were very unhappy in their marriage because they were diagnosed with infertility.

The mean score of infertile women from the HLBS was 121.66 ± 23.44 (median:123). While the average score they got from the spiritual development sub-dimension was 22.84 ± 4.79, the average score they got from the exercise sub-dimension was the lowest (16.48 ± 4.2).

Perception of education level and income level of infertile women statistically affect the total mean score of HLBS. It was determined that women with a university or higher education level had higher HLBS total and all sub-dimension mean scores. It was found that women who perceived their income level as good had higher HLBS total score and exercise sub-dimension mean score (p0.05) (Table 4).

It was determined that the duration of marriage, the period of being childless, the infertile person, the duration of infertility treatment and the desire to adopt did not affect the mean HLBS scores of infertile women statistically (p>0.05). The attitude of the spouse’s family to the diagnosis is not statistically affected by the factors of the effect of not having children on family life (p>0.05).

The attitude of the spouse towards the diagnosis of infertility, the status of the marital relationship after infertility and the attitudes of the families towards the diagnosis of infertility, the mean score of the infertile women from the HLBS show statistically significant differences (p<0.05).

It was determined that women with a negative spouse attitude and a “critical-condescending” family attitude after infertility had lower HLBS total and all sub-dimension mean scores (p<0.05). It was determined that women who were ashamed of their spouses and family had significantly lower mean scores on HLBS total and health responsibility, nutrition and spirituality sub-dimensions (p<0.05).

Table 3: Distribution of the total and sub-dimension mean scores of the healthy lifestyle behaviors scale of infertile women.

Table 4: Distribution of some sociodemographic characteristics and healthy lifestyle behaviors scale total and sub-dimension mean scores of infertile women