The aim of this study was to determine the relationship between well-being during infertility, couple’s collaboration, and psychological indicators of infertile couples who were candidates for ART and analyze its structural model. The results showed that a couple’s collaboration was correlated with depression, anxiety, and stress levels by having an effect on well-being during infertility.
The first finding of the study showed that well-being during infertility was dependent on the couple’s collaboration. This finding confirms the results of a study indicating that marital compatibility was related to quality of life [26]. The relationship between marital coping and marital adjustment [13, 27] in infertile couples is also documented.
This finding of the present study shows that collaboration helps couples to be able to deal with other aspects of life despite infertility and to experience the feeling of being good despite the absence of the child. This finding is in line with the results of the study which showed that spousal support was related to the reduction of infertility stress through reducing the rejection of the childless lifestyle and meaning-based coping [28].
Another finding of the study showed that the infertile couples’ levels of depression, anxiety and stress were negatively related to well-being during infertility. The relationship between quality of life and psychological distress has been previously reported [29]. Moreover, in line with the results of the present study, previous studies showed the relationship between coping and dual adjustment and the level of depression, anxiety, and stress in infertile couples [30,31,32]. The positive effects of couple interaction on reducing the despair of infertile couples [33] have also been reported.
One study showed that, through its effect on reducing the rejection of a childless lifestyle and meaning-based coping, spousal support was related to the reduction of infertility stress [28]. Li et al. reported that in infertile couples, women’s mental health was related to social anxiety through the mediation of marital adjustment [34]. These reports indicate the importance of dual interactions of infertile couples with each other and its impact on their mental health.
In this regard and to complement the results of other studies [28, 33, 34], the results of the present study showed that the effect of couple’s collaboration in infertile couples under ART on the level of anxiety and stress was applied only indirectly and through the mediation of well-being during infertility. Unlike the level of anxiety and stress, the couple’s collaboration had a negative effect on depression both directly and indirectly affecting well-being during infertility.
This study finding can be explained by considering the distinct conditions of infertile couples who entered the ART process. The difference in the participation of each couple in the ART process and the difference in each individual’s concerns upon starting the treatment [35, 36] are conditions that may overshadow the effect of the couple’s collaboration on mental health. Studies have shown that while men are more concerned about the financial costs of ART, the duration of treatment [29], and the complications of ovulation stimulation in their wives [37], the main reason for treatment stress in women was social concerns and worries about life without children [38]. These differences may reduce mutual understanding [39] in infertile couples. It has been reported that infertile couples who enter the treatment process face Alexithymia or, in other words, the inability to express their feelings, which reduces their quality of life [40].
These findings show that the relationship between infertile couples can reduce the anxiety and stress of couples when the feeling of being good in the current situation is strengthened. Consequently, in order to improve well-being during infertility and mental health, it is necessary to design intervention programs based on couple interaction by identifying mediating factors related to the well-being of infertile couples undergoing ART.
Another finding of the study showed that, unlike anxiety and stress, which were not directly affected by a couple’s collaboration, depression was directly affected by a couple’s collaboration by the mediation of well-being during infertility. The difference in the effect of couple interaction on depression, anxiety, and stress might be due to the factors that cause each of these psychological indicators. Although depression, anxiety, and stress are often related to each other, the factors directly affecting them are not similar. Reports suggest that unlike depression [41], anxiety levels increase when entering assisted reproductive treatment [37].
These results show that couple’s collaboration in infertile couples undergoing ART can directly moderate couples’ levels of depression; however, in order to control these couples’ anxiety and stress, it is necessary to search for solutions in the context of couple’s collaboration that are associated with increasing well-being during infertility. Although the results of this study have been confirmed using the evaluation of structural equations, in interpreting the results, it is necessary to take into account the limitations of the study. The first and most important limitation of the present study was its cross-sectional nature. In this type of study, it is not possible to determine the priority of each variable. Therefore, presenting a causal pathway between a couple’s collaboration, well-being during infertility, and psychological health is limited.
Although the study was conducted in the infertility treatment center, which was a referral center and patients from other provinces of Iran were also referred to it, the results cannot be generalized to different Iranian ethnic groups. In addition, in this study, the changes in the couple’s collaboration and indicators of depression, anxiety, and stress could not be evaluated in order to be able to consider the effect of the specific conditions of starting ART on each factor. Therefore, the study results are not generalizable for infertile couples who have not yet started the ART process.
The results of this study showed that the couple’s collaboration and well-being during infertility was followed by a reduction in the level of depression, anxiety, and stress. However, the effect of the couple’s collaboration on the level of anxiety and stress of ART couples was applied through the mediation of well-being during infertility. These results suggest the necessity of identifying mediating factors affecting well-being during infertility in order to develop mental health promotion programs for ART couples. It is also suggested that, in the counseling programs of couples who are candidates for ART, the necessity of their couple interaction should be emphasized.
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