Factors Influencing the Depression Level of Couples Participating in the National Supporting Program for Infertile Couples

Nami Hwang; Insun Jang

doi:10.12799/jkachn.2015.26.3.179

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Original Article
Factors Influencing the Depression Level of Couples Participating in the National Supporting Program for Infertile Couples: Nami Hwang, Insun Jang; Journal of Korean Academy of Community Health Nursing 2015;26(3):179-189.
DOI: https://doi.org/10.12799/jkachn.2015.26.3.179
Published online: September 30, 2015

¹Korea Institute for Health and Social Affairs, Sejong, Korea.

²Department of Nursing, Korea Bible University, Seoul, Korea.

• Received: February 3, 2015 • Revised: March 19, 2015 • Accepted: September 9, 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract

Abstract

Purpose
The purpose of this study was to identify factors influencing depression of participants in the National Supporting Program for Infertile Couples (NSPI) who received a treatment of IVF (in vitro fertilization) or IUI (intra-uterine insemination).
Methods
Using the 2013 NSPI Satisfaction On-line Survey data, secondary data analyses were conducted on 830 cases of IVF and 706 cases of IUI. Descriptive statistics, independent t-test, χ² test, and logistic regression were performed using SPSS/WIN 21.0.
Results
Logistic regression analysis showed that non-pregnancy status (OR=3.05), unexplained infertility (OR=4.29), relationship trouble with spouse (OR=3.57), and relationship trouble with the in-law family (OR=2.78) were significant factors predicting the depression level in the IUI treatment group. Non-pregnancy status (OR=5.28), childlessness (OR=1.92), financial support helpful hardly or not at all (OR=2.63), relationship trouble with spouse (OR=3.28), relationship trouble with the in-law family (OR=2.83), and unemployment (OR=1.60) were significant factors in the IVF treatment group.
Conclusion
To reduce infertile women's depression, adequate attention and care need to be paid to these psychological symptoms. It is suggested to develop counseling and couple-therapy along with methods to enhance social support (including that from the in-law's family).
Key Words: Infertility; Depression; Insemination; In vitro fertilization

Table 1

Comparison of Socio-demographic Characteristics of Respondents

Characteristics	Categories	IUI (n=706)	IVF (n=830)	χ² or t	p
Characteristics	Categories	n (%)	n (%)	χ² or t	p
Wife age (year)	25~29	43 (6.9)	32 (4.3)	48.05	<.001
	30~34	324 (52.3)	286 (38.6)
	35~39	209 (33.7)	298 (40.2)
	40~45	44 (7.1)	125 (16.9)
	M±SD	34.2±3.47	35.6±3.91	-7.14	<.001
Husband age (year)	25~29	15 (2.4)	16 (2.2)	40.68	<.001
	30~34	218 (35.1)	156 (21.2)
	35~39	284 (45.7)	364 (49.5)
	40~45	104 (16.7)	199 (27.1)
	M±SD	36.0±3.59	37.2±3.93	-5.99	<.001
Employment status	Unemployed	239 (38.5)	303 (41.0)	1.02	.599
	Employed	329 (53.1)	372 (50.3)
	Part-time	52 (8.4)	64 (8.7)
Education	≤High school	89 (14.2)	140 (18.9)	5.29	.071
	University	432 (69.1)	482 (65.0)
	≥Graduate school	104 (16.6)	119 (16.1)
Pregnancy status (now)	Yes	145 (23.3)	98 (13.4)	22.60	<.001
Pregnancy status (now)	No	477 (76.7)	635 (86.6)	22.60	<.001
Child (number)	0	417 (67.1)	435 (58.7)	11.43	.003
	1	180 (29.0)	279 (37.7)
	≥2	24 (3.9)	27 (3.6)

Note. Missing data excluded; IUI=intrauterine insemination; IVF=in vitro fertilization.

Table 2

Comparison of Infertility related Characteristics and Family Support of Respondents

Characteristics	Categories		IUI (n=706)	IVF (n=830)	χ² or t	p
Characteristics	Categories		n (%)	n (%)	χ² or t	p
Causes of infertility	Unexplained		488 (70.7)	401 (49.3)	86.13	<.001
	Female		100 (14.5)	273 (33.6)
	Male		68 (9.9)	83 (10.2)
	Both		34 (4.9)	56 (6.9)
Infertility duration (month)	<12		13 (2.3)	20 (3.0)	69.79	<.001
	12~23		71 (12.6)	57 (8.5)
	24~35		143 (25.3)	113 (16.9)
	36~47		175 (31.0)	143 (21.4)
	48~59		83 (14.7)	121 (18.1)
	≥60		80 (14.2)	214 (32.0)
	M±SD		38.2±18.10	50.2±43.36	-6.53	<.001
Treatment result	Fail		489 (75.8)	448 (58.6)	47.12	<.001
	Sucess only pregnancy		48 (7.4)	84 (11.0)
	Sucess delivery		108 (16.7)	232 (30.4)
Distance to hospital (hour)	<1		491 (79.1)	498 (67.1)	28.88	<.001
	1~2		106 (17.1)	173 (23.3)
	≥2		24 (3.9)	71 (9.6)
Financial support	Very helpful		378 (60.6)	365 (49.3)	19.05	<.001
	Moderate helpful		240 (38.5)	358 (48.4)
	Not helpful		6 (1.0)	17 (2.3)
Attendance of health program	Wife	No	290 (41.1)	324 (39.0)	0.70	.403
	Wife	Yes	415 (58.9)	506 (61.0)	0.70	.403
	Husband	No	345 (48.9)	405 (48.8)	0.00	.956
	Husband	Yes	360 (51.1)	425 (51.2)	0.00	.956
Depression	Yes (≥4)		125 (20.5)	177 (24.3)	2.83	.093
Depression	No (≤3)		486 (79.5)	551 (75.7)	2.83	.093
Total number of IVF before			1.55±1.12	2.54±1.18	-13.27	<.001
Total number of IUI before			2.42±2.93	2.05±1.22	2.52	.012
Relationship with spouse	Get better		143 (23.2)	165 (22.5)	5.85	.054
	Not change		452 (73.4)	521 (71.2)
	Get worse		21 (3.4)	46 (6.3)
Relationship with in-laws' house	Get better		71 (11.6)	86 (12.0)	7.22	.027
	Not change		505 (82.4)	561 (78.0)
	Get worse		37 (6.0)	72 (10.0)

Note. Missing data excluded; IUI=intrauterine insemination; IVF=in vitro fertilization.

Table 3

Depression according to Socio-demographic Characteristics of Respondents

Characteristics	Categories	IUI (n=706)		χ² (p)	IVF (n=830)		χ² (p)
		Yes	No		Yes	No
		n (%)	n (%)		n (%)	n (%)
Wife age (year)	25~29	16 (13.1)	24 (5.0)	10.66 (.014)	6 (3.4)	24 (4.4)	5.83 (.120)
	30~34	62 (50.8)	256 (53.1)		80 (45.2)	200 (36.6)
	35~39	36 (29.5)	167 (34.6)		69 (39.0)	221 (40.5)
	40~45	8 (6.6)	35 (7.3)		22 (12.4)	101 (18.5)
Husband age (year)	25~29	5 (4.0)	10 (2.1)	2.15 (.542)	5 (2.9)	10 (1.8)	3.09 (.377)
	30~34	45 (36.0)	167 (34.7)		36 (20.6)	118 (21.8)
	35~39	57 (45.6)	219 (45.5)		93 (53.1)	257 (47.4)
	40~45	18 (14.4)	85 (17.7)		41 (23.4)	157 (29.0)
Employment status	Unemployed	55 (44.4)	177 (36.9)	4.08 (.130)	88 (50.3)	209 (38.3)	8.00 (.018)
	Employed	56 (45.2)	265 (55.2)		73 (41.7)	288 (52.7)
	Part-time	13 (10.5)	38 (7.9)		14 (8.0)	49 (9.0)
Education	≤High school	21 (16.9)	66 (13.6)	0.99 (.610)	40 (23.0)	94 (17.1)	3.87 (.144)
	University	84 (67.7)	336 (69.3)		111 (63.8)	360 (65.6)
	≥Graduate school	19 (15.3)	83 (17.1)		23 (13.2)	95 (17.3)
Pregnancy status (now)	Yes	13 (10.5)	126 (26.1)	13.68 (<.001)	9 (5.2)	89 (16.4)	13.70 (<.001)
Pregnancy status (now)	No	111 (89.5)	356 (73.9)	13.68 (<.001)	163 (94.8)	455 (83.6)	13.70 (<.001)
Child (number)	0	95 (76.0)	314 (65.4)	6.64 (.036)	135 (76.3)	293 (53.6)	28.68 (<.001)
	1	24 (19.2)	148 (30.8)		39 (22.0)	230 (42.0)
	≥2	6 (4.8)	18 (3.8)		3 (1.7)	24 (4.4)

Note. Missing data excluded; IUI=intrauterine insemination; IVF=in vitro fertilization.

Table 4

Depression according to Infertility related Characteristics and Family Support of Respondents

Characteristics	Categories		IUI (n=706)		χ² or t (p)	IVF (n=830)		χ² or t (p)
			Yes	No		Yes	No
			n (%)	n (%)		n (%)	n (%)
Causes of infertility	Unexplained		79 (64.8)	353 (72.8)	11.18 (.011)	75 (43.1)	275 (50.3)	13.76 (.003)
	Female		25 (20.5)	65 (13.4)		76 (43.7)	169 (30.9)
	Male		7 (5.7)	48 (9.9)		9 (5.2)	65 (11.9)
	Both		11 (9.0)	19 (3.9)		14 (8.0)	38 (6.9)
Infertility duration (month)	<12		3 (2.6)	9 (2.0)	6.27 (.281)	3 (1.9)	17 (3.4)	15.73 (.008)
	12~23		9 (7.7)	60 (13.6)		9 (5.6)	47 (9.4)
	24~35		26 (22.2)	115 (26.1)		19 (11.8)	91 (18.2)
	36~47		42 (35.9)	132 (29.9)		29 (18.0)	113 (22.6)
	48~59		22 (18.8)	60 (13.6)		31 (19.3)	89 (17.8)
	≥60		15 (12.8)	65 (14.7)		70 (43.5)	143 (28.6)
Treatment result	Fail		100 (82.0)	356 (74.2)	3.25 (.197)	130 (75.1)	291 (53.4)	31.52 (<.001)
	Sucess only pregnancy		7 (5.7)	37 (7.7)		19 (11.0)	58 (10.6)
	Sucess delivery		15 (12.3)	87 (18.1)		24 (13.9)	196 (36.0)
Distance to hospital (hour)	<1		90 (72.6)	389 (80.9)	4.20 (.123)	97 (55.7)	385 (70.0)	12.40 (.002)
	1~2		27 (21.8)	75 (15.6)		53 (30.5)	119 (21.6)
	≥2		7 (5.6)	17 (3.5)		24 (13.8)	46 (8.4)
Financial support	Very helpful		62 (50.4)	307 (63.4)	7.21 (.027)	55 (31.1)	302 (55.4)	33.46 (<.001)
	Moderate helpful		59 (48.0)	173 (35.7)		114 (64.4)	234 (42.9)
	Not helpful		2 (1.6)	4 (0.8)		8 (4.5)	9 (1.7)
Attendance of health program	Wife	No	39 (31.2)	168 (34.6)	0.52 (.469)	43 (24.3)	192 (34.8)	6.82 (.009)
	Wife	Yes	86 (68.8)	317 (65.4)	0.52 (.469)	134 (75.7)	359 (65.2)	6.82 (.009)
	Husband	No	53 (42.4)	206 (42.5)	0.00 (.988)	68 (38.4)	247 (44.8)	2.24 (.134)
	Husband	Yes	72 (57.6)	279 (57.5)	0.00 (.988)	109 (61.6)	304 (55.2)	2.24 (.134)
Total number of IVF before			1.53±1.16	1.63±0.98	-0.71 (.476)	2.46±1.15	2.85±1.23	-3.80 (<.001)
Total number of IUI before			2.33±2.41	2.76±4.49	-1.40 (.164)	2.05±1.21	2.06±1.24	-0.07 (.942)
Relationship with spouse	Get better		21 (16.8)	121 (25.0)	30.31 (<.001)	30 (17.0)	135 (24.7)	50.58 (<.001)
	Not change		90 (72.0)	356 (73.6)		115 (65.3)	396 (72.5)
	Get worse		14 (11.2)	7 (1.4)		31 (17.6)	15 (2.7)
Relationship with in-laws' house	Get better		5 (4.0)	66 (13.7)	42.36 (<.001)	11 (6.4)	75 (14.0)	60.80 (<.001)
	Not change		98 (78.4)	400 (83.2)		119 (68.8)	434 (81.0)
	Get worse		22 (17.6)	15 (3.1)		43 (24.9)	27 (5.0)

Note. Missing data excluded; IUI=intrauterine insemination; IVF=in vitro fertilization.

Table 5

Factors related to Depression

Variables	IUI				IVF
Variables	β	p	OR	95% CI	β	p	OR	95% CI
(Constant)	-0.473	.701	0.623		-4.845	<.001	0.008
Pregnancy status (1=No)	1.117	.001	3.054	1.61~5.81	1.663	<.001	5.277	2.32~12.00
Child (number) (1=0)	0.431	.089	1.539	0.94~2.53	0.652	.039	1.919	1.03~3.57
Causes of infertility
Unexplained^†	-	.065	-		-	.026	-
Female	-0.844	.063	0.430	0.18~1.05	-0.725	.085	0.484	0.21~1.11
Male	-0.470	.352	0.625	0.23~1.68	-0.141	.738	0.868	0.38~1.99
Both	-1.455	.018	0.233	0.07~0.78	-1.081	.059	0.339	0.11~1.04
Financial support (1=Moderate or not helpful)	0.349	.119	1.418	0.91~2.20	0.969	<.001	2.634	1.67~4.16
Relationship with spouse (1=Get worse)	1.272	.023	3.569	1.20~10.66	1.189	.006	3.284	1.40~7.71
Relationship with in-laws' house (1=Get worse)	1.023	.015	2.783	1.22~6.33	1.038	.004	2.825	1.40~5.71
Wife age	-0.048	.140	0.953	0.89~1.02
Employment status (1=Unemployed)					0.469	.036	1.599	1.03~2.48
Infertility duration					0.001	.801	1.001	1.00~1.01
Treatment result (1=Fail)					0.575	.057	1.777	0.98~3.21
Distance to hospital (1=≥1 hours)					0.452	.142	1.571	0.86~2.87
Attendance of health program (Wife) (1=Yes)					0.448	.070	1.565	0.96~2.54
Total number of IVF before					0.184	.700	1.202	0.99~1.47

^†Causes of infertility-Unexplained: Reference group; IUI=intrauterine insemination; IVF=in vitro fertilization.

1. Statistics Korea. 2013 birth statistics [Internet] Seoul: Statistics Korea; 2014;cited 2015 January 20. Available from: http://www.kostat.go.kr/portal/korea/kor_nw/3/index.board?bmode=read&aSeq=329406&pageNo=4&rowNum=10&amSeq=&sTarget=&sTxt=
2. Centers for Disease Control and Prevention. Infertility FAQ's [Internet] Atlanta: Centers for Disease Control and Prevention; 2013;cited 2013 June 20. Available from: http://www.cdc.gov/reproductivehealth/Infertility/index.htm#1
3. Hwang NM. The status of infertility and policy direction in Korea. Health Welf Policy Forum. 2003;82:88–97.
4. Lee SH, Yoon TK, Choi YM, Kim KC, Lee YD, Hwang NM, et al. Report No.: 11-1352000-000833-10. Analysis and evaluation of the results of national supporting program for infertile couples in 2011. NSPI(National Supporting Program for Infertile couples) Evaluation Report. Seoul: Ministry of Health & Welfare, Chung-Ang University Hospital; 2012. 12.
5. Boivin J, Griffiths E, Venetis CA. Emotional distress in infertile women and failure of assisted reproductive technologies: meta-analysis of prospective psychosocial studies. BMJ. 2011;342:d223Article PubMed PMC
6. Ramezanzadeh F, Aghssa MM, Abedinia N, Zayeri F, Khanafshar N, Shariat M, et al. A survey of relationship between anxiety, depression and duration of infertility. BMC Womens Health. 2004;4(1):9Article PubMed PMC PDF
7. Ogawa M, Takamatsu K, Horiguchi F. Evaluation of factors associated with the anxiety and depression of female infertility patients. Biopsychosoc Med. 2011;5(1):15Article PubMed PMC
8. Lee JH. An analytical study on psychosocial predictors of depression and the effective psychosocial intervention program for reducing depression of infertile women being in infertility treatment [dissertation]. [Seoul]: Korea University; 2013. 131 p.
9. Chang EY. Women's experiences of pregnancy after infertility [master's thesis]. [Seoul]: Ewha Womans University; 1998. 86 p.
10. Lee YJ. An Ethnography on infertile women's grief in Korea [dissertation]. [Seoul]: Kyung Hee University; 2008. 123 p.
11. Domar AD, Zuttermeister PC, Friedman R. The psychological impact of infertility: A comparison with patients with other medical conditions. J Psychosom Obstet Gynaecol. 1993;14:45–52. PubMed
12. Hwang NM. Analysis on factors influencing depression of infertile women. Health Soc Welf Rev. 2013;33(3):161–187.
13. Kim M. Stress, depression, and fetal attachment in pregnant women having infertility treatments. Korean J Women Health Nurs. 2014;20(2):163–172. Article PubMed
14. Min SW, Kim YH, Cho YR. Stress, depression and factors influencing on quality of life of infertile women. J Korean Soc Matern Child Health. 2008;12(1):19–32. Article
15. Valsangkar S, Bodhare T, Bele S, Sai S. An evaluation of the effect of infertility on marital, sexual satisfaction indices and health-related quality of life in women. J Hum Reprod Sci. 2011;4(2):80–85. Article PubMed PMC
16. Kim JH, Shin HS. A structural model for quality of life of infertile women. J Korean Acad Nurs. 2013;43(3):312–320. Article PubMed
17. Irwin M, Artin KH, Oxman MN. Screening for depression in the older adult: criterion validity of the 10-item center for epidemiological studies depression scale (CES-D). Arch Intern Med. 1999;159(15):1701–1704. Article PubMed
18. Verberg MF, Eijkemans MJ, Heijnen EM, Broekmans FJ, de Klerk C, Fauser BC, et al. Why do couples drop-out from IVF treatment? A prospective cohort study. Hum Reprod. 2008;23(9):2050–2055. Article PubMed
19. Domar AD, Rooney KL, Wiegand B, Orav EJ, Alper MM, Berger BM, et al. Impact of a group mind/body intervention on pregnancy rates in IVF patients. Fertil Steril. 2011;95(7):2269–2273. Article PubMed
20. Kim MO. The effect of a mind-body therapeutic program for infertile women repeating IVF treatment on uncertainty, anxiety, and implantation rate [dissertation]. [Seoul]: Yonsei University; 2009. 93 p.
21. Bae KJ, Ro SO, Kim JA. The study of loneliness in infertile women. J Korean Acad Nurs. 1999;29(6):1379–1391. Article PDF
22. Gourounti K, Lykeridou K, Vaslamatzis G. Increased anxiety and depression in greek infertile women results from feelings of marital stress and poor marital communication. Health Sci J. 2012;6(1):69–81.
23. Verhaak CM, Smeenk JMJ, van Minnen A, Kremer JAM, Kraaimaat FW. A longitudinal, prospective study on emotional adjustment before, during and after consecutive fertility treatment cycles. Hum Reprod. 2005;20(8):2253–2260. Article PubMed
24. Mindes E, Ingram K, Kliewer W, James C. Longitudinal analyses of the relationship between unsupportive social interactions and psychological adjustment among women with fertility problems. Soc Sci Med. 2003;56(10):2165–2180. Article PubMed

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Factors Influencing the Depression Level of Couples Participating in the National Supporting Program for Infertile Couples

Characteristics	Categories	IUI (n=706)	IVF (n=830)	χ² or t	p
Characteristics	Categories	n (%)	n (%)	χ² or t	p
Wife age (year)	25~29	43 (6.9)	32 (4.3)	48.05	<.001
	30~34	324 (52.3)	286 (38.6)
	35~39	209 (33.7)	298 (40.2)
	40~45	44 (7.1)	125 (16.9)
	M±SD	34.2±3.47	35.6±3.91	-7.14	<.001
Husband age (year)	25~29	15 (2.4)	16 (2.2)	40.68	<.001
	30~34	218 (35.1)	156 (21.2)
	35~39	284 (45.7)	364 (49.5)
	40~45	104 (16.7)	199 (27.1)
	M±SD	36.0±3.59	37.2±3.93	-5.99	<.001
Employment status	Unemployed	239 (38.5)	303 (41.0)	1.02	.599
	Employed	329 (53.1)	372 (50.3)
	Part-time	52 (8.4)	64 (8.7)
Education	≤High school	89 (14.2)	140 (18.9)	5.29	.071
	University	432 (69.1)	482 (65.0)
	≥Graduate school	104 (16.6)	119 (16.1)
Pregnancy status (now)	Yes	145 (23.3)	98 (13.4)	22.60	<.001
Pregnancy status (now)	No	477 (76.7)	635 (86.6)	22.60	<.001
Child (number)	0	417 (67.1)	435 (58.7)	11.43	.003
	1	180 (29.0)	279 (37.7)
	≥2	24 (3.9)	27 (3.6)

Characteristics	Categories		IUI (n=706)	IVF (n=830)	χ² or t	p
Characteristics	Categories		n (%)	n (%)	χ² or t	p
Causes of infertility	Unexplained		488 (70.7)	401 (49.3)	86.13	<.001
	Female		100 (14.5)	273 (33.6)
	Male		68 (9.9)	83 (10.2)
	Both		34 (4.9)	56 (6.9)
Infertility duration (month)	<12		13 (2.3)	20 (3.0)	69.79	<.001
	12~23		71 (12.6)	57 (8.5)
	24~35		143 (25.3)	113 (16.9)
	36~47		175 (31.0)	143 (21.4)
	48~59		83 (14.7)	121 (18.1)
	≥60		80 (14.2)	214 (32.0)
	M±SD		38.2±18.10	50.2±43.36	-6.53	<.001
Treatment result	Fail		489 (75.8)	448 (58.6)	47.12	<.001
	Sucess only pregnancy		48 (7.4)	84 (11.0)
	Sucess delivery		108 (16.7)	232 (30.4)
Distance to hospital (hour)	<1		491 (79.1)	498 (67.1)	28.88	<.001
	1~2		106 (17.1)	173 (23.3)
	≥2		24 (3.9)	71 (9.6)
Financial support	Very helpful		378 (60.6)	365 (49.3)	19.05	<.001
	Moderate helpful		240 (38.5)	358 (48.4)
	Not helpful		6 (1.0)	17 (2.3)
Attendance of health program	Wife	No	290 (41.1)	324 (39.0)	0.70	.403
	Wife	Yes	415 (58.9)	506 (61.0)	0.70	.403
	Husband	No	345 (48.9)	405 (48.8)	0.00	.956
	Husband	Yes	360 (51.1)	425 (51.2)	0.00	.956
Depression	Yes (≥4)		125 (20.5)	177 (24.3)	2.83	.093
Depression	No (≤3)		486 (79.5)	551 (75.7)	2.83	.093
Total number of IVF before			1.55±1.12	2.54±1.18	-13.27	<.001
Total number of IUI before			2.42±2.93	2.05±1.22	2.52	.012
Relationship with spouse	Get better		143 (23.2)	165 (22.5)	5.85	.054
	Not change		452 (73.4)	521 (71.2)
	Get worse		21 (3.4)	46 (6.3)
Relationship with in-laws' house	Get better		71 (11.6)	86 (12.0)	7.22	.027
	Not change		505 (82.4)	561 (78.0)
	Get worse		37 (6.0)	72 (10.0)

Characteristics	Categories	IUI (n=706)		χ² (p)	IVF (n=830)		χ² (p)
		Yes	No		Yes	No
		n (%)	n (%)		n (%)	n (%)
Wife age (year)	25~29	16 (13.1)	24 (5.0)	10.66 (.014)	6 (3.4)	24 (4.4)	5.83 (.120)
	30~34	62 (50.8)	256 (53.1)		80 (45.2)	200 (36.6)
	35~39	36 (29.5)	167 (34.6)		69 (39.0)	221 (40.5)
	40~45	8 (6.6)	35 (7.3)		22 (12.4)	101 (18.5)
Husband age (year)	25~29	5 (4.0)	10 (2.1)	2.15 (.542)	5 (2.9)	10 (1.8)	3.09 (.377)
	30~34	45 (36.0)	167 (34.7)		36 (20.6)	118 (21.8)
	35~39	57 (45.6)	219 (45.5)		93 (53.1)	257 (47.4)
	40~45	18 (14.4)	85 (17.7)		41 (23.4)	157 (29.0)
Employment status	Unemployed	55 (44.4)	177 (36.9)	4.08 (.130)	88 (50.3)	209 (38.3)	8.00 (.018)
	Employed	56 (45.2)	265 (55.2)		73 (41.7)	288 (52.7)
	Part-time	13 (10.5)	38 (7.9)		14 (8.0)	49 (9.0)
Education	≤High school	21 (16.9)	66 (13.6)	0.99 (.610)	40 (23.0)	94 (17.1)	3.87 (.144)
	University	84 (67.7)	336 (69.3)		111 (63.8)	360 (65.6)
	≥Graduate school	19 (15.3)	83 (17.1)		23 (13.2)	95 (17.3)
Pregnancy status (now)	Yes	13 (10.5)	126 (26.1)	13.68 (<.001)	9 (5.2)	89 (16.4)	13.70 (<.001)
Pregnancy status (now)	No	111 (89.5)	356 (73.9)	13.68 (<.001)	163 (94.8)	455 (83.6)	13.70 (<.001)
Child (number)	0	95 (76.0)	314 (65.4)	6.64 (.036)	135 (76.3)	293 (53.6)	28.68 (<.001)
	1	24 (19.2)	148 (30.8)		39 (22.0)	230 (42.0)
	≥2	6 (4.8)	18 (3.8)		3 (1.7)	24 (4.4)

Characteristics	Categories		IUI (n=706)		χ² or t (p)	IVF (n=830)		χ² or t (p)
			Yes	No		Yes	No
			n (%)	n (%)		n (%)	n (%)
Causes of infertility	Unexplained		79 (64.8)	353 (72.8)	11.18 (.011)	75 (43.1)	275 (50.3)	13.76 (.003)
	Female		25 (20.5)	65 (13.4)		76 (43.7)	169 (30.9)
	Male		7 (5.7)	48 (9.9)		9 (5.2)	65 (11.9)
	Both		11 (9.0)	19 (3.9)		14 (8.0)	38 (6.9)
Infertility duration (month)	<12		3 (2.6)	9 (2.0)	6.27 (.281)	3 (1.9)	17 (3.4)	15.73 (.008)
	12~23		9 (7.7)	60 (13.6)		9 (5.6)	47 (9.4)
	24~35		26 (22.2)	115 (26.1)		19 (11.8)	91 (18.2)
	36~47		42 (35.9)	132 (29.9)		29 (18.0)	113 (22.6)
	48~59		22 (18.8)	60 (13.6)		31 (19.3)	89 (17.8)
	≥60		15 (12.8)	65 (14.7)		70 (43.5)	143 (28.6)
Treatment result	Fail		100 (82.0)	356 (74.2)	3.25 (.197)	130 (75.1)	291 (53.4)	31.52 (<.001)
	Sucess only pregnancy		7 (5.7)	37 (7.7)		19 (11.0)	58 (10.6)
	Sucess delivery		15 (12.3)	87 (18.1)		24 (13.9)	196 (36.0)
Distance to hospital (hour)	<1		90 (72.6)	389 (80.9)	4.20 (.123)	97 (55.7)	385 (70.0)	12.40 (.002)
	1~2		27 (21.8)	75 (15.6)		53 (30.5)	119 (21.6)
	≥2		7 (5.6)	17 (3.5)		24 (13.8)	46 (8.4)
Financial support	Very helpful		62 (50.4)	307 (63.4)	7.21 (.027)	55 (31.1)	302 (55.4)	33.46 (<.001)
	Moderate helpful		59 (48.0)	173 (35.7)		114 (64.4)	234 (42.9)
	Not helpful		2 (1.6)	4 (0.8)		8 (4.5)	9 (1.7)
Attendance of health program	Wife	No	39 (31.2)	168 (34.6)	0.52 (.469)	43 (24.3)	192 (34.8)	6.82 (.009)
	Wife	Yes	86 (68.8)	317 (65.4)	0.52 (.469)	134 (75.7)	359 (65.2)	6.82 (.009)
	Husband	No	53 (42.4)	206 (42.5)	0.00 (.988)	68 (38.4)	247 (44.8)	2.24 (.134)
	Husband	Yes	72 (57.6)	279 (57.5)	0.00 (.988)	109 (61.6)	304 (55.2)	2.24 (.134)
Total number of IVF before			1.53±1.16	1.63±0.98	-0.71 (.476)	2.46±1.15	2.85±1.23	-3.80 (<.001)
Total number of IUI before			2.33±2.41	2.76±4.49	-1.40 (.164)	2.05±1.21	2.06±1.24	-0.07 (.942)
Relationship with spouse	Get better		21 (16.8)	121 (25.0)	30.31 (<.001)	30 (17.0)	135 (24.7)	50.58 (<.001)
	Not change		90 (72.0)	356 (73.6)		115 (65.3)	396 (72.5)
	Get worse		14 (11.2)	7 (1.4)		31 (17.6)	15 (2.7)
Relationship with in-laws' house	Get better		5 (4.0)	66 (13.7)	42.36 (<.001)	11 (6.4)	75 (14.0)	60.80 (<.001)
	Not change		98 (78.4)	400 (83.2)		119 (68.8)	434 (81.0)
	Get worse		22 (17.6)	15 (3.1)		43 (24.9)	27 (5.0)

Variables	IUI				IVF
Variables	β	p	OR	95% CI	β	p	OR	95% CI
(Constant)	-0.473	.701	0.623		-4.845	<.001	0.008
Pregnancy status (1=No)	1.117	.001	3.054	1.61~5.81	1.663	<.001	5.277	2.32~12.00
Child (number) (1=0)	0.431	.089	1.539	0.94~2.53	0.652	.039	1.919	1.03~3.57
Causes of infertility
Unexplained^†	-	.065	-		-	.026	-
Female	-0.844	.063	0.430	0.18~1.05	-0.725	.085	0.484	0.21~1.11
Male	-0.470	.352	0.625	0.23~1.68	-0.141	.738	0.868	0.38~1.99
Both	-1.455	.018	0.233	0.07~0.78	-1.081	.059	0.339	0.11~1.04
Financial support (1=Moderate or not helpful)	0.349	.119	1.418	0.91~2.20	0.969	<.001	2.634	1.67~4.16
Relationship with spouse (1=Get worse)	1.272	.023	3.569	1.20~10.66	1.189	.006	3.284	1.40~7.71
Relationship with in-laws' house (1=Get worse)	1.023	.015	2.783	1.22~6.33	1.038	.004	2.825	1.40~5.71
Wife age	-0.048	.140	0.953	0.89~1.02
Employment status (1=Unemployed)					0.469	.036	1.599	1.03~2.48
Infertility duration					0.001	.801	1.001	1.00~1.01
Treatment result (1=Fail)					0.575	.057	1.777	0.98~3.21
Distance to hospital (1=≥1 hours)					0.452	.142	1.571	0.86~2.87
Attendance of health program (Wife) (1=Yes)					0.448	.070	1.565	0.96~2.54
Total number of IVF before					0.184	.700	1.202	0.99~1.47

Table 1 Comparison of Socio-demographic Characteristics of Respondents

Note. Missing data excluded; IUI=intrauterine insemination; IVF=in vitro fertilization.

Table 2 Comparison of Infertility related Characteristics and Family Support of Respondents

Note. Missing data excluded; IUI=intrauterine insemination; IVF=in vitro fertilization.

Table 3 Depression according to Socio-demographic Characteristics of Respondents

Note. Missing data excluded; IUI=intrauterine insemination; IVF=in vitro fertilization.

Table 4 Depression according to Infertility related Characteristics and Family Support of Respondents

Note. Missing data excluded; IUI=intrauterine insemination; IVF=in vitro fertilization.

Table 5 Factors related to Depression

^†Causes of infertility-Unexplained: Reference group; IUI=intrauterine insemination; IVF=in vitro fertilization.