Infertility is one of the most common problems in women that undermines their mental and sexual health. The definition of infertility based on medical records and textbooks, is: Couples who are unproductive after one year of marriage and living together [1]. The average prevalence of infertility in developing countries is estimated at about 6.9% to 9.3% [2]. In recent years, the overall average of infertility in Iran has been reported at 13.2%. Also the overall prevalence of primary infertility in Iran is 5.2% and secondary infertility 3.2% [3].
Infertility is not a disease, but since it affects all aspects of one's life, it can cause significant physical and emotional disorders [4]. From Diner's point of view, a sense of well-being that encompasses a full awareness of wholeness and integration in all aspects of the individual is called psychological well-being. Psychological well-being also consists of three components of satisfaction, negative affect and positive affect [6].
Infertility may also affect couples' marital status, so one of the variables that is important in this group of women is sexual function. This variable is part of the man's behavior and life that he has always considered and has had a significant impact on the quality of life of the individual and his sexual partner. Sexual dysfunction is therefore considered a disorder in psychiatry [9].
Infertility is one of the problems that gradually, if left untreated, can lead to more psychological problems for women and cause more psychological distress in the affected person. Accordingly, the main question of the present study is whether acceptance and commitment therapy have an impact on the psychological well-being and sexual function of women with a history of infertility?

 

The present study is a quasi-experimental study with pretest-posttest design and control group with two months follow-up. The statistical population of the study included all infertile women referring to Mehr infertility clinic in Rasht city during six month in 2017. Inclusion criteria included complete consent to participate in the study, medical diagnosis of infertility, minimum basic education, physical and mental illness, and age range of 20 to 40 years. Exclusion criteria included drug and alcohol use, lack of necessary literacy, absenteeism in more than one-third of treatment sessions, any disability or psychiatric illness, and simultaneous participation in any other educational intervention.
A total of 30 infertile women who were willing to participate in the study were selected by convenience sampling method and after confirming and signing the consent form, they were randomly divided into two groups of intervention and commitment based therapy (n=15) and control (n=15). In the pre-test phase, the two groups completed the Reff Psychological Well-being Questionnaire (1998) and Rosen’s (2000) Women's Sexual Function Questionnaire. Then, the intervention group received an acceptance and commitment based treatment program (including 8 sessions, each weak 1 session 2 of hours) for 2 months. Overall in the therapeutic sessions, items such as familiarity with acceptance and commitment therapy (ACT) concepts and mental flexibility, emotion regulation training, assisting clients in identifying ineffective control strategies and understanding their futility, three-dimensional behavioral model to express behavior / emotion sharing, and empowerment for a better life were presented.
Data were analyzed by SPSS 19 (SPSS Inc., Chicago, IL., USA) using multivariate analysis of covariance and repeated measures analysis of variance.

Demographic data of the participants are shown by experimental group (ACT treatment) and control group. Thirty participants are divided into two groups. Table 1 lists the age, infertility, education, and occupational status of the participants. Also, descriptive results of pre-test, post-test, and follow-up of psychological well-being and sexual function follow-up test in the ACT and control group are presented in Table 2.
According to the results of multivariate analysis of covariance, ACT treatment has a positive effect on self-acceptance, positive relationships with others (P<0.01); autonomy, purposeful life (P<0.05) and overall psychological well-being and sexual function scores (P<0.01). The results also showed that ACT treatment had no significant effect on the components of environmental dominance and individual growth (P<0.05) (Table 3). According to repeated measures analysis of variance, the effect of ACT treatment has been effective on psychological well-being including total psychological well-being and sexual performance (P<0.01), as well as on self-acceptance, positive relationships with others, and purposeful life (P<0.05) (Table 4).

Table 1. Demographic information of participants

 

Most of the subjects (40%) had mild health disorders and only a small percentage (7.3%) had severe health disorders (Table 2).
 

Table 2. Descriptive results of pre-test, post-test and follow up test of psychological well-being and sexual function in treatment group based on acceptance, commitment and control

 

Most of the subjects (63%) were in moderate spiritual health and none of them were in poor spiritual health (Table 3).
 

Table 3. Multivariate analysis of covariance to investigate the effect of Acceptance and Commitment Based Therapy (ACT) on psychological well-being and sexual performance in the post-test phase

 

According to the findings, there was a significant correlation (P<0.05) between spiritual health (religious and existential health) and general health (anxiety and sleep disorders, social functioning symptoms, and depression symptoms and symptoms) (P<0.05) (Table 4).
 

Table 4. Results of repeated measures ANOVA to investigate the effect of Acceptance and Commitment Based Treatment (ACT) on psychological well-being and sexual performance in the follow-up phase

Infertility is one of the major problems of today's societies that has many psychological and emotional consequences for couples. It also affects all aspects of one's life and can lead to significant physical and emotional disorders [4]. Some studies showed that women with infertility experience high levels of anxiety, dissatisfaction with life, and insecurity, and ultimately have lower psychological well-being than ordinary women [7], thus there seems to be a need for psychological intervention for this group of women.

 

According to the results, it can be said that ACT therapy has an effective role in promoting the psychological well-being and sexual function of women with a history of infertility.

 

We would like to thank Dr. Mehrafza, Director of Mehr Disability Treatment Clinic in Rasht, for all the help in this study. This article is taken from a PhD thesis in General Psychology, Islamic Azad University, Rasht Branch, with the Code of Ethics. IAU. RASHT. REC. 1396.90 Organizational Ethics Committee in Biomedical Research.

 

The authors declared no conflict of interest regarding this article.