Infertility is defined as the inability to conceive after having unprotected intercourse for one year. In many cases, couples realize they are infertile only after attempting to become pregnant for some time. A healthy husband and wife must acknowledge that they may be infertile. The rate of infertility is high, at approximately 10%, and in many cases the cause is unclear. An increasing number of patients ultimately require assisted reproductive technology (ART), which is accompanied by physical and financial hardships .
Mental stress, particularly anxiety and depression, resulting from infertility may be due to various factors, including uncertainty of the cause of infertility, uncertain treatment duration, financial stress, and pressure from others who know the couple. However, studies have identified no psychological pathologies associated with the mental health of infertile patients . Thus, improving mental health outcomes for such patients has no direct bearing on improving their odds of achieving pregnancy . Treatment for mental health problems has not been examined in such patients. However, some studies have reported that when the mental health of infertile patients and pregnant women is compared, the rates of anxiety and depression of the former are significantly higher . While these occurrences are lower in infertile patients than in those with chronic pain syndromes or HIV, stress levels are similar to those of cancer or coronary heart disease patients . Eliminating psychological stress may also be necessary for successful infertility treatment. .
Women appear to have a higher rate of infertility-related stress than men [7, 8]. Studies have also found that greater than half of the women receiving infertility treatment feel that infertility is the "most stressful experience of their lives" [7, 9].
Several reports are available on factors associated with the anxiety and/or depression of infertile woman. Domar et al. found that depression peaked during the third year of infertility . Vogsten et al. determined that a negative pregnancy test after undergoing IVF is an independent risk factor for mood disorder in women . Ramezanzadeh et al. found that anxiety and/or depression were observed more in housewives than outside employees .
In Japan, few studies have been conducted to assess factors affecting the mental health of infertile patients. A literature search found only four articles in English addressing this subject. In one study, Matsubayashi et al. conducted psychological tests of infertile women and healthy pregnant women. They found that infertile women had significantly higher mental stress scores . The study also found that a contributing factor to the anxiety and depression of these women was the "lack of support from their husbands" . Based on the analysis of psychological tests, Chiba et al. found that stress affects a woman's duration of infertility . Akizuki et al. determined that positive and negative social interactions are experienced by infertile Japanese women within their social networks . However, little is known regarding the mental health of infertile Japanese women.
Moreover, very few reports have been conducted on the psychological background of female patients whose husbands have been found to be infertile. Only one study was found. Nachtigall et al. determined that a man's response to infertility closely approximates that of a woman if the infertility has been attributed to a male factor, but differs considerably if a male factor is not found . Therefore, it is beneficial to investigate factors that cause mental stress to female infertility patients.
To investigate factors leading to the anxiety, depression, and stress of patients receiving outpatient treatment, we conducted psychological tests during the initial patient visit to the infertility outpatient clinic and compared the results by stratifying factors such as age and duration of infertility. Additionally, we examined whether or not psychological differences exist for couples in which the husband was previously known to be infertile.