Effect of Whatsapp Based Good Enough Sex Consultation on Infertility Stress and Sexual Satisfaction in Iranian Women Who Applied for Infertility Treatment: A Randomized Control Trial

Effect of Whatsapp Based Good Enough Sex Consultation on Infertility Stress and Sexual Satisfaction in Iranian Women Who Applied for Infertility Treatment: A Randomized Control Trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effect of Whatsapp Based Good Enough Sex Consultation on Infertility Stress and Sexual Satisfaction in Iranian Women Who Applied for Infertility Treatment: A Randomized Control Trial Fatemeh Moghaddam-tabrizi, shahla Emdadi-Babanazar, Mahmonir Haghighi, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2416471/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Infertility is associated with the reduction of sexual activity and always there is a relationship between infertility and sexual dysfunction. Infertility stress refers to a group of symptoms that appear following infertility diagnosis; these symptoms are similar to those of post-traumatic stress disorder and are specifically evident in the beliefs and feelings associated with infertility. The present study aimed to determine the effect of whatsapp based good enough sex consultation on infertility stress and sexual satisfaction in infertile women who applied for infertility treatment in a randomized control trial. Methods This is a double-blinded, randomized controlled trial in which a total of 100 infertile women were recruited using convenience sampling and then randomly assigned to two groups of whatsapp based GES model consultation and routine care. Data collection tools consisted of a demographic, the Larson's Sexual Satisfaction and Newton Infertility Stress questionnairs. In the pretest stage, participants in both groups completed the above questionnaires before the intervention. Participants in the intervention group were given access to the 6-week GES model consultation program. The program consisted of six consultation and assignments packages, regarding all 12 dimensions of GES model. Then participants re-completed questionnaires immediately and one month after the intervention. Data were analyzed with SPSS software version 20 using chi-squared test, independent-samples t-test, and repeated measures Analysis of Variance. The significance level (p-value) was considered to be less than 0.05. Results The results of rANOVA indicated that there was a significant difference in the mean scores of sexual satisfaction (with its all dimensions: desire to have sex, sexual adjustment, quality of sexual life, sexual attitude) and infertility stress (and it's all dimensions: social concern, sexual concern, relationship concern, need for parenthood, life without children) between the two groups from pre- to post-intervention, and then over the one month follow-up period in the intervention group, while scores of control participants did not show this pattern during the study ( p ˂ 0.001 ). Considering the partial Eta squared, the effect of intervention had the highest interaction effect on both variables of sexual satisfaction ( η2 = 0.52) and infertility stress ( η2 = 0.82 ). Conclusions Since whatsapp based GES sex model intervention had significant effect on infertility stress and sexual satisfaction. Therefore, it is recommended to be considered as one of the practical plans in the process of treatment and counseling of infertility. Trial registration number: IRCT20210926052593N1, The date of registration: 13-10-2021. Good Enough Sex Model Consultation Whatsapp Infertility Stress Sexual Satisfaction Infertility. Figures Figure 1 Figure 2 Figure 3 Background Infertility is defined by the World Health Organization (WHO) as the inability to conceive after 1 year (or longer) of unprotected intercourse [1]. The prevalence of primary infertility worldwide is about 12-14% [2]. According to Sun et al., from 1990-2017, the prevalence of primary infertility has increased to 14.9% in women and 8.2% in men [3]. In 2019, the prevalence of infertility was reported as 2.20%. Such studies have estimated the prevalence of infertility in Iran to be higher than the global average [4]. According to a review study, the rate of infertility in Iran was estimated at 34.1% [5]. Infertility is a worldwide health problem with a high effect on individuals of both sexes and community. Infertility is categorized as the 5th highest important general disability with a negative effect on the psychosocial matters of those who are involved. Women suffer more than men from the consequences of infertility [6, 7]. Infertility stress refers to a group of symptoms that appear following infertility diagnosis; these symptoms are similar to those of post-traumatic stress disorder and are specifically evident in the beliefs and feelings associated with infertility [8, 9]. Infertility is associated with the reduction of sexual activity and always there is a relationship between infertility and sexual dysfunction [10]. Prevalence of sexual dysfunction is high in infertile women, but little attention has been paid to this problem, and women are less likely to be treated [11]. While detection the infertility produces injuries and stresses, psychological interventions help infertile couples work through their problems and adapt to infertility [12]. Several studies emphasized that psychosexual consultations interventions for couples with infertility problems are effective in improving couples’ sexual relations. [13-16]. One of the models applied for decreasing sexual complications is the Good- Enough Sex Model (GESM) developed by Metz and McCarthy. The model is modified for couples with sexual problems and it contain two fundamental subjects: (i) mutual sexual relationships to enjoy the sexual relationship, and (ii) intimacy and adoring in order to obtain highest pleasure in individual with sexual dysfunction based on their capability. It concentrates on substitute the classic intercourse anticipations with pleasure-based and flexible sexual activity [17]. The model is developed on six fundamental concepts that ultimately cover 12 aspects of the model. The detailed characteristics of the model are presented in Table 1. Sexual problems causes feeling of shame and guilty so they are not reported to health care providers or therapists due to considering such issues as taboos in Iran, so discussion about sexual issues is avoided [18, 19]. Couples often have trouble in expressing sexual issues with others, consequently being deprived of face-to-face counseling services. on the other hand ignorance of sexual and reproductive health are in opposition to women's empowerment and in contravention of these human rights [20]. Online help has advantages over face-to-face contact. One of the benefits of whatsapp based educations is increasing access to education, improving self-efficacy, knowledge production, cost effectiveness, learner flexibility and interaction [21, 22]. For some individuals, the anonymity that is sometimes provided during online consultation can make it a preferable option compared with face-to-face types of therapy[21]. In addition during the COVID-19 pandemic and banning the gatherings and laws based on reducing traffic, which led to limited access to medical and counseling services, the importance of paying attention to the issue of reproductive and sexual health of infertile women should not have been ignored. So the present study aimed to investigate the effect of whatsapp based sexual counseling using the GES model on the infertility stress and sexual satisfaction in infertile women who referred to infertility centers in Urmia in Iran. Methods Research design and participants The aim of the study is to determine the effect of whatsapp based consultation based on Good Enough Sex model on infertility stress and sexual satisfaction in women who referred for infertility centers in Urmia. A double-blinded, parallel, randomized controlled trial was conducted on 100 infertile women visiting the infertility clinic in Kowsar women comprehensive educational and medical center as the governmental and Dr. Tizro infertility center as the nongovernmental center in Urmia, from September 2021 to April 2022. The inclusion criteria were the women with primary infertility, married women living with spouse, women in reproductive age (25-35 years), no intention to use a donated embryo or ovum or rent a womb, no adopted child , no major psychiatric disorder at the time of the study (initial diagnosis by a psychiatrist) and no use of psychiatric medications, non-use of cigarette, hookah, alcohol and no systemic diseases such as diabetes based on medical history, receiving total score less than 23 in GHQ-28, not taking any other education or counseling for their sexual dysfunction, absence of sexual dysfunction in the spouse according to the individual declaration, possibility of access to couples in the next 4 months at least and having a smart phone with internet access. Exclusion criteria were any physical or mental illness or any accident and psychological trauma with affecting their sexual performance, pregnancy during the implementation of the study, leave the group, participating in other counseling sessions outside of the study program. Sampling initiated after obtaining the ethical approval code from Ethics Committee of Urmia University of Medical Sciences (#IR.UMSU.REC.1400.247) and registering the study information on the Registry Center of Clinical Trials (#IRCT20210926052593N1). For implementation of the study first of all, researcher attended at the infertility centers and selected 100 eligible participants out of 168 infertile women [Figure 1], using convenience sampling; and then the participants were equally allocated to the intervention (whatsapp based GES model consultation) group and the control group using a concealed randomized allocation. For this purpose, each of the letters A (intervention) and B (control) was written on 100 cards. Then each patient randomly selected one of the cards and was allocated to the intervention or the control group based on the letter written on the card. This section was done by a person who was not involved in the process of the study (to follow the blinding). Then, consenting women in both groups were asked to sign the consent form. After that, the pretest questionnaires, including demographic information, Newton infertility stress questionnaire and Larson's sexual satisfaction questionnaire were completed by women and then the obtained score was considered as the base score for comparison. Finally whatsapp based whatsup groups for both intervention and control groups were created and for the respecting the privacy and security of the participants who were unwilling to reveal their identity, 20 SIMcarts were gifted by researchers. In the control group, only routine infertility counseling, based on instructions of the centers, included training topics related to the time of intercourse, personal and health care, was carried out through the whatsup group. In order to fallow the research ethics, the participants in control group had access to the intervention program after last completion the questionnaires. In the intervention group in addition to the routine infertility advices, participants received the intervention program. Sample size The sample size was based on Mofid et al.'s study (2016) and using the mean difference formula for two independent groups of G power software, with the Larson Sexual Satisfaction Questionnaire (LSSQ) index in the two intervention and control groups (Mean1: 89, Mean2: 93.67 , SD1: 7.89, SD2: 8.07) Each group is 42 people. Considering 20% attrition for each group, 50 participants (100 women in total) were obtained [21]. Intervention Participants in the intervention group were given access to the 6-week GES model consultation program. The program consisted of six consultation and assignments packages, regarding all 12 dimensions of GES model (Table 1). The participants also had opportunities to daily expressions of their experiences and feelings in both privet and group online. Information was provided through written texts and video clips. The participants' diaries were reviewed by the researcher and their experiences were discussed. Daily written feedbacks were provided by trained researcher. If required addition replies and individual consultation could take place through private contacts. The women in the intervention group were asked to share the perceived information to their partners and practice with together. Table 1: The Whatsapp based Intervention Program Based on the Good-Enough Sex Model [17] Sex is an important element in life and constitutes a significant part of peace, intimacy, satisfaction and self-confidence of couples • Biological requirements and sexual satisfaction, • Emphasis and correcting of fears, beliefs, disgust, shame and negative attitudes as the threatening obstacles for sexual health and sexual satisfaction, Identifying couples' sexuality Relationship quality and sexual satisfaction are the ultimate goal of sexual development and are essentially integrated • Couples are an "intimated unite" • Sexual relations are formed in the context of an intimate relationship , • Cooperation in daily life, resolving the interactive differences, • For an intimate relationship, couples should activities, sharing feelings and emotions create an empathetic style, • Different ways of men and women intimacy achievement are not against each other. To set positive, realistic expectations about their sexual bodies as well as psychological and interpersonal dimensions • The over-emphasis on perfectionistic sexuality in the society which is saturated with images and myths about beauty for marketing purposes, • Sexuality as a life-long developmental process that involves changes and differences from young adulthood to older age, disease are in relation to sexual problems, Periodic sexual problems are common, • Sexual enjoyment varies; orgasm is not essential to sexual satisfaction, • The importance of seeking scientifically accurate knowledge from trusted websites and/or books Good physical health and healthy behavioral habits are vital for sexual health • Healthy behaviors (e.g. adequate sleep, exercise, eating, and moderate drinking) are an important dimension of continuing sexual functioning, • Helping to rehabilitate and create sexual motivation in the presence of disease with the combination of a healthy lifestyle in couples Relaxation is the foundation for pleasure and function • Creating cognitive, emotional and behavioral skills such as individual responsibility for honestly acceptance of feelings towards sexual relationships and a positive body image, learning sexual response, sharing enjoyable exercises and development of stimulating scenarios Pleasure is as important as function • The emphasis on touch and pleasure as much as or more than sexual performance. For example (encouraging flirting during the day, recognizing physical and sexual characteristics, creating a safe and calm environment, using body language and making continuous eye contact, etc.). Valuing variable, flexible sexual experiences and abandoning the need for perfect performance, overcoming fears of failure • Reasonable expectations of sex and acceptance of changes in the quality of sex reduce anxiety and make couples cope with sexual problems due to aging or illness, • However, irrational expectations are potential predictors of decreased libido The five purposes for sex are integrated into the couple’s sexual relationship • Integrate the five fundamental purposes for sex: (1) reproduction; (2) tension and anxiety reduction; (3) sensual enjoyment and pleasure; (4) self-esteem and confidence; and (5) relationship closeness and satisfaction Integrate and flexibly use the three sexual arousal styles • Partner Interaction, Self-entrancement, Role enactment Gender differences are respectfully valued and similarities mutually accepted • Men and women are often different in their arousal patterns, • Accepting and appreciating the gender preferences and similarities are important • Women focus on feeling ‘‘desired’’ or ‘‘attractive’’ to their man, • Men focus on feeling ‘‘invited’’ or ‘‘welcomed’’ to engage in sex, • Sexual confidence, then, is more about function for men while women’s confidence may involve trust, security, and caring, • Men are commonly prompted for sex by the biophysiological drive, women are prompted for sex by more of a bio-emotional drive, Sex is integrated into real life and real life is integrated into sex • Sexuality is developing, growing and evolving throughout life, Integration of life events with love is one of the goals of sexual relations, • Sex is connected to the daily life of a couple, are integrated with their sexual life to create a unique sexual experience for couples, • Life provides opportunities for sexual experience in delicate but distinctly and rich ways Sexuality is personalized: Sex can be playful, spiritual, special • To challenge couples to consider not only lovemaking behaviors and psychosexual skills but emotional experiences and intimate relationship, • The emotional intimacy and relationship satisfaction is the ultimate focus. Group Activities: Encouraging participants to: • Express all concerns and their emotional negative feelings about infertility and its treatments issues, • To share their not private positive experiences to overcome the problems, • To discuss the barriers and facilitators to deal with the complicated issues, Designing a sexual relationship scenario by considering and accepting changes in sexual life after the onset of infertility Assignments consisted of the recognition of the causes of fears, beliefs, disgust, shame and negative attitudes as the threatening obstacles for sexual health, identification of destroying factors of couple's daily life cooperation and intimacy, setting goals to obtain intimate relationships by practicing to share feeling and emotions, perusing self formulated goals to follow healthy quality of life through adequate sleep, exercise, eating, and moderate drinking as the predicting factors for higher sexual satisfaction, trying to distinguish the barriers of acceptance of positive body image, following self regulated goals to value flexible sexual experiences and abandoning the need for perfect performance, overcoming performance pressure, fears of failure. The master's degree of consultation in midwifery student besides the related subjects in her academic curriculum, she has been attended in sexology consultations workshops so she has eligible certificate to handle the intervention. All of the intervention program’s content and questions were under the guidance of expert psychiatrist who is a faculty member of the university and she was as the advisor in the present master's degree thesis. Data collection tools Demographic questionnaire Demographic questions were age of the patient and spouse, level of education of the patient and spouse, occupation of the patient and spouse, adequacy of the family income, the length of infertility detection, treatment length, and cause of infertility. General Health Questionnaire (GHQ-28) The GHQ-28 was used to screen the subjects' mental health. The GHQ-28 consists of four subscales including somatic symptoms (items 1–7), anxiety/insomnia (items 8–14), social dysfunction (items 15–21) and severe depression (items 22–28). All items are responded on a 4-point Likert scale of none, mild, moderate, and severe which are scored from zero to three. The score 23 or above was the cut-off point for probability of having a mental health disorder [23] Accordingly, women who obtained scores >23 were excluded from the study. Validity and reliability of the GHQ-28 was approved by several studies [24, 25]. Larson's sexual satisfaction questionnaire The Larson's sexual satisfaction questionnaire was used as a valid tool to determine sexual satisfaction in the participants[26]. Validity and reliability of this questionnaire have been verified and approved in Farsi language[27, 28]. This questionnaire contained 25 questions, which were measured on a 5-point Likert scale according to the choices of never, hardly ever, sometimes, often, and always; scores ranged from 1e125. To determine the levels of sexual satisfaction, the scores were categorized. A high score was associated with high sexual satisfaction. A score <50 indicated low sexual satisfaction, a score of 51e100 indicated moderate sexual satisfaction, and <100 indicated high satisfaction[29]. Newton Infertility Stress Questionnaire Newton Infertility Stress Questionnaire is a reliable self-report questionnaire with appropriate validity and reliability [30] Therefore, this tool can be used to diagnose infertility stress. The Newton Infertility Stress Questionnaire is a 46-item tool designed by Newton in 1995 and consists of five subtests including social concerns (10 questions), sexual concerns (8 questions), communication concerns (10 questions), rejection of life without children (8 questions), and the need to become a parent (10 questions). This questionnaire is rated based on a 6-point Likert scale. The overall score of the questionnaire is between 46 and 276, with higher scores indicating more stress [30]. This questionnaire was administered in Iran in 2005 by Alizadeh et al. to establish its reliability among a sample of 30 infertile people (15 males and 15 females), and the obtained Cronbach's alpha coefficients for the subscales of social concerns, sexual concerns, communication concerns, rejection of childless lifestyle, and need for parenthood were respectively 0.78, 0.77, 0.78, 0.75, and 0.84, and the Cronbach's alpha coefficient for overall stress was 0.91 [31]. Data Analysis Data were first entered into SPSS Statistics for Windows, version 20 (SPSS Inc., Chicago, Ill., USA). The clinical and demographic information of the two groups were compared using the chi-squared test and independent-samples t-test. To recognize the significance of the difference between the mean scores of infertility stress and sexual satisfaction at three time points in each group, repeated-measures Analysis of Variance (rANOVA) was applied. Before conducting the rANOVA, the condition of equality of between-groups variances was met by observing the assumptions and performing the necessary tests. In this regard, it should be considered that the amount of residual variance of the dependent variables was equal in all groups. In addition, the significance level ( p -value) was considered to be less than 0.05. All analyses were performed by a researcher who was blind to the data. Results Among 168 infertile women who were visited, 68 people were excluded because they did not meet the inclusion criteria (21woman did not have access to internet, 13 woman were low literacy, 18 women with secondary infertility, 8 woman who were not willing to attendant in the study, 8 women taking medicine because of medical issues. Finally the remained 100 women were interviewed by the author to fill out the GHQ- 28 , Larson's sexual satisfaction and Newton's stress related to infertility questionnaires, using the convenience sampling method then , they were randomized allocated to the intervention and control groups (50 participants in control and 50 in intervention group). In the next step, whatsApp groups were created for each group, and the intervention group were given access to the 6–week continually GES model sexual consultation program. Control group received only routine self-care advices. Since there was not seen any attrition in this study, it seems the weekly scheduled program and its informative and practical assignments were enough effective to encourage the participants to attend for 6 consecutive weeks. Therefore, 50 women in the intervention and 50 women in the control group were followed up and analyzed in the post-intervention evaluation and one month later (Fig. 1). To investigate the similarity between the groups in terms of socio-demographic profile and infertility related information of the participants, the chi-square, trend chi-square test, Fisher’s exact test, and the independent t-test were used. There was no significant difference between the intervention and control groups in the mentioned items (P > 0.05). The mean (SD: standard deviation) duration of infertility was 3.16 (1.64) and 3.22 (1.78) years in the intervention and control groups respectively. About 14% of participants in the intervention and 12% of them in the control groups were housewife and 34% participants in both groups had academic education. About 36% of participants in the intervention group and 40% of them in the control group reported sufficient income for living expenses (Table 2). The results of rANOVA on the significance of the difference in the mean scores of infertility stress and sexual satisfaction in the two groups are presented in Table 3 and Table 4. In these tables, three types of interaction effects are also reviewed. Based on the results, the time by intervention interaction was found to be significant ( p˂.001 ). This indicated that there was a significant difference in the mean scores of infertility stress and sexual satisfaction between the two groups at different time points. In other words, the trend of the mean scores of response variables was not similar in the two groups over time. In this study, the main effect of time was also found to be significant and this showed a statistically significant difference between the mean scores of infertility stress and sexual satisfaction at different time points in the intervention group ( p˂.001 ). The main effect of the intervention also revealed that there was a statistically significant difference in the mean scores of infertility stress and sexual satisfaction between the two groups regardless of the effect of time. In other words, it was concluded that the lower infertility stress and higher sexual satisfaction mean scores in the intervention group in compare to mean scores of control group were seen ( p˂0.001 ). Considering the partial Eta squared, the effect of intervention had the highest interaction effect on both variables of sexual satisfaction ( η2=.0.52) and infertility stress ( η2=0.82 ). The changes in the mean scores of infertility stress and sexual satisfaction at different time points in the two groups are clarified in Figures 2 and 3. Based on the results, it was illustrated that the mean scores of infertility stress reduced and sexual satisfaction mean scores significantly increased in the intervention group at time points of immediately and one month after consultation compared to before it. Moreover, the lowest mean score of infertility stress and the highest mean score of sexual satisfaction was obtained at the measurement time point of immediately after the intervention. Table 2. Comparison of Socio demographic Characteristics and Some Infertility Related Clinical Issues of Participants in Control (n=50) and intervention (n=50) groups Variables Control Intervention Statistics Qualitative N(%) N(%) Level of education Middle school 7(14) 9(18) X 2 =0.017, df=3 **P=0.80 High school 9(18) 11(22) Diploma 17(34) 13(26) College 17(34) 17(34) Women's job Housekeeper 6(12) 7(14) X 2 =0.017 df=2 ** P=0.9 Self-employment 33(66) 31(62) Governmental Job 11(22) 12(24) Husband's level of education Elementary 2(4) 2(4) ** * P fisher =0.49 Guidance 9(18 10(20) High school 9(18) 10(20) Diploma 14(28) 12(24) College 16(32) 14(28) Husband’s job Unemployed 2(4) 0(0) X 2 =2.86 df=4 **P =0.58 manual worker 14(28) 12(24) Employee 14(28) 15(30) Shopkeeper 11(22) 15(30) Other 9(18) 8(16) Sufficient family income Enough 20(40) 18(36) X 2 =0.029, df=2 Insufficient 9(18) 11(22) **P=0.85 Relatively enough 21(42) 21(42) Cause of infertility Ovarian 28(56) 27(54) ***P fishe =0.98 Fallopian tube 8(16) 9(18) Endometriosis 5(10) 5(10) Uterine disorders 3(6) 2(4) Thyroid disorders 4(8) 5(10) Other cases 2(4) 2(4) Quantitave M(SD) M(SD) Age 28.64(5.20) 29.20(5.20) t= 0.56, df=98 *P =0.57 Frequency of IVF 0.58(0.85) 0.52(0.76) t=0.36, df=98 *P =0.71 Duration of infertility(year) 2.66(1.30) 2.70(1.28) t= 0.15, df=98 *P =0.87 *Independent Samples t Test , **Chi-Square , ***Fisher Exact Test Table 3. The results of the repeated measure ANOVA in comparison of the mean scores of sexual satisfaction and its dimensions at three time points of before, 1 week, and 5 weeks after intervention in the control and treatment groups. Variables Effect Source SST DF* MS F P-value Eta Desire to have sex Between Group 1610.1 1 1610.1 98.16 <0.001 0.50 Within Time 932.5 2 466.3 47.07 <0.001 0.32 Group by Time 969.4 2 48.94 48.94 <0.001 0.33 Sexual attitude Between Group 1830.3 1 1830.3 84.00 <0.001 0.46 Within Time 1368.7 2 684.4 50.55 <0.001 0.34 Group by Time 1148.5 2 574.2 42.42 <0.001 0.30 Quality of sex life Between Group 3468.0 1 3468.0 98.81 <0.001 0.50 Within Time 2659.8 1.88 1418.3 63.89 <0.001 0.40 Group by Time 2254.7 1.88 1202.3 54.16 <0.001 0.36 Sexual adjustment Between Group 2144.0 1 2144.0 105.9 <0.001 0.52 Within Time 1466.6 1.85 7933.4 49.37 <0.001 0.34 Group by Time 1324.9 1.85 716.7 44.60 <0.001 0.31 Sexual satisfaction Between Group 35381 1 35381 107.9 <0.001 0.52 Within Time 24764 1.88 13202 62.60 <0.001 0.39 Group by Time 22138 1.88 11802 55.96 <0.001 0.36 SST: Sum of Squares, DF: Degree of Freedom, MS: Mean of Squares. * Mauchly’s test is used to test whether or not the assumption of sphericity is met in a repeated measures ANOVA. If the spherisity assumption is rejected, we adjust the degrees of freedom using Greenhouse-Geisser correction in within-subjects effects. Table 4. The results of the repeated measure ANOVA in comparison of the mean scores of stress related to infertility and its dimensions at three time points of before, 1 week, and 5 weeks after intervention in the control and treatment groups. Variables Effect Source SST DF* MS F P-value Eta Social concerns Between Group 8597.4 1 8597.4 365.1 <0.001 0.79 Within Time 6774.7 2 3387.2 149.9 <0.001 0.61 Group by Time 5429.9 2 2714.9 120.2 <0.001 0.55 Sexual concerns Between Group 7311.2 1 7311.2 218.9 <0.001 0.69 Within Time 4662.1 2 2331.1 108.5 <0.001 0.53 Group by Time 4153.4 2 2076.7 96.67 <0.001 0.50 Communication concerns Between Group 8748.0 1 8740.0 357.8 <0.001 0.78 Within Time 8205.1 1.59 5159.1 152.6 <0.001 0.61 Group by Time 7277.2 1.59 4575.7 135.4 <0.001 0.58 need to become parents Between Group 10372 1 10372 410.4 <0.001 0.81 Within Time 8793.1 1.78 4929.9 165.5 <0.001 0.63 Group by Time 7795.8 1.78 4370.7 146.8 <0.001 0.60 life without children Between Group 8070.4 1 8070.4 179.4 <0.001 0.65 Within Time 1830.5 2 915.2 75.95 <0.001 0.44 Group by Time 1788.8 2 894.4 74.22 <0.001 0.43 Stress related to infertility Between Group 214775 1 214775 452.3 <0.001 0.82 Within Time 137719 1.76 78075 216.5 <0.001 0.69 Group by Time 121167 1.76 68692 190.5 <0.001 0.66 Note: SST: Sum of Squares, DF: Degree of Freedom, MS: Mean of Squares. * Mauchly’s test is used to test whether or not the assumption of sphericity is met in a repeated measures ANOVA. If the spherisity assumption is rejected, we adjust the degrees of freedom using Greenhouse-Geisser correction in within-subjects effects. Discussion This randomized control trial study aimed to investigate the effect of Whatsapp based sexual counseling using the GES model on the sexual satisfaction and infertility stress in infertile women who referred to infertility centers. The findings suggest that intervention program had a significant effect on management the infertility stress and promoting sexual satisfaction in infertile women. In the present study, the both intervention and control groups were homogeneous regarding socio-demographic characteristics (age, employment status, education, economic status, and other factors that mentioned in Table 2). The mentioned variables are known as the factors affecting on infertility stress and sexual satisfaction [32-35]. In agreement with our findings, Firoozi et al. revealed that the GES model were effective to promote attitude and sexual satisfaction of infertile women [36]. Jamalifar et al. indicated that GES model is an applicable educational intervention for improving the sexual satisfaction and sexual intimacy in women who suffer from multiple sclerosis [37]. In a study conducted by Yazdani et al was illustrated that counseling based on sexual self-concept trough social networks on smartphone in infertile women was effective in improving the sexual self-concept and promotion the couples 'sexual relations [13]. Another study administered in Netherlands indicated that the internet-based sex education program consisted of psychosexual education, couple relationship, mindfulness and sensate focus practices was suitable method for enhancement the sexual functioning and even elevated pregnancy chances [38]. Sexual interventions trough internet had effective impact on sexual functioning during the intervention and several months after completing the intervention program [22]. Hucker et al demonstrated online, mindfulness-based, cognitive-behavioral therapy for female with sexual disorders and relationship functioning had significant impact on promotion sexual and emotional intimacy[39]. Infertility and its related treatments had adversely influenced on self-esteem, self-image, sexual relationship and couple intimacy[40]. Although the challenges caused by infertility have a negative effect on both men and women, women are more affected by this problem than men [41]. Studies conducted in Iran shows that infertile women face social and self-stigma which threatens their psychosocial wellbeing, self-esteem and also it is associated with the feeling of shame and secrecy [42, 43]. A phenomenological study about life experience with infertility by Khodakarami showed that infertility, affects the sexual relationships and emotional status in infertile couples[44]. Couples often have trouble in expressing sexual issues with others, because of feeling of shame and guilty due to considering such issues as taboo in Iran, consequently being deprived of face-to-face counseling services [18, 19]. Therefore it is important to conduct counseling sessions where the clients feel more comfortable [45]. So whatsapp based consultation in the present study created an opportunity for participants, remain anonymous, find a safe atmosphere, feel more freedom to express their biological requirements and sexual satisfaction, emphasis on fears, beliefs, disgust, shame and negative attitudes as the threatening and obstacles for sexual relationship and all face to face unspoken words. This kind of counseling not only is provided greater access to the researcher and the participants anywhere and anytime, but also participants could express their attitudes without feeling shame from sexual issues [46]. Through whatsapp based GES model approach consoler were struggling to encourage the participants to reach a better interaction in sexual relationship and change their sex life, improve personal interactions and focus on quality of the relation and create a new constructive and enjoyable experiences in order to decrease the stress caused by high expectations in sexual functioning. The GES model tried to provide a platform for the women to learn cooperation in daily life, resolve the interactive differences; respect the different ways of men and women intimacy achievement, individual responsibility for honestly acceptance of a body image as the ways for obtaining the intimacy as a main clue to reach sexual satisfaction. This interventional program attempted to conceive them that the all over- emphasizing social media to images and myths about beauty is for marketing purposes. Through this virtual consultation, participants were motivated to notice that good physical health and healthy behavioral habits are vital for sexual health, so they motivated to persuade that healthy behaviors (e.g. adequate sleep, exercise, eating, and moderate drinking) as an important dimension of continuing sexual functioning. So for creating a unique sexual experience for couples they should keep in their mind that sex is integrated into the couple's daily life and daily life is integrated into their sex life. The intervention program emphasized living daily life well with its responsibilities, stresses, and conflicts, provides the opportunity to experience sexual interactions in a subtle yet distinctively personalized and enriched way. Intervention highlighted that adjusting expectation and expressing mutual emotions, concentrating on mind and body to obtain the calmness as the clue factor to reach high intimacy. Also educations to enhance sexual satisfaction through accepting the requests and understanding differences and mutual respect for partners in order to moderate individual’s expectations to a rational and reasonable level were provided. By designing a sexual relationship scenario through GES model researcher tried to consider that sex at times is experienced as pleasure, stress relief, mature playfulness, and on another occasion as a spiritual union; so for being intimate, couples should value multiple purposes for sex. In group discussion and privet consultation through whatsapp, participants with sharing their experiences emphasized that the quality of sex varies from day to day and from very good to mediocre or even dysfunctional . So they recognized that such reasonable expectations are an important feature of sexual satisfaction as well as to be released the couple from disappointment and sexual problems in the future. Suggestions : There is a huge amount of nonscientific information through virtual invalid resources is receiving by patients that reliability of them is doubtful. So it seems health policy makers should be persuade to produce the educational packages based on reliable scientific texts regarding infertility and unsolved sexual complication and related stresses, especially in the cultures that some of the life realties like sexual issues are considered to be taboos. Strengths and Limitations: whatsapp -based intervention provided greater access to the counselor and participants anywhere and anytime. This way of counseling was also more economical, and participants could express openly about the worries and concerns without feeling shame especially regarding the subjects like sexual issues which are consider as a taboo in some cultures. Having similar characteristics in distributed women at base line in both control and intervention groups would minimize intervention bias that could result from differences in baseline provider confidence and preparedness. A limitation of the study is that the participants were educated, impacting generalizability of findings to illiterate women. Conclusions Since whatsapp based GES sex model intervention had significant effect on infertility stress and sexual satisfaction. Therefore, it is recommended to be considered as one of the practical plans in the process of treatment and counseling of infertility. In addition during the COVID-19 pandemic and banning the gatherings and laws based on reducing traffic, which led to limited access to medical and counseling services, the present study provided an opportunity to pay attention the sexual issues. So participants could access to appropriate consultation for empowering themselves to reduce infertility stress and obtain sexual satisfaction as their human rights. Abbreviations GES model GES Good Enough Sex Model Declarations Ethics approval and consent to participate: This study obtained the approval from the Research Ethics Committee of Urmia University of Medical Sciences, Iran (approval No. IR.UMSU.REC.1400.247). All the participants signed written informed consent for their participation in the study. All procedures were performed in accordance with relevant guidelines. Consent for publication: Not applicable Availability of data and materials: The datasets used and/or analyzed during the current study are available from the corresponding author. Competing interests: The authors have no relevant financial or nonfinancial relationships to disclose. Funding: This study was supported a grant from the Urmia University of Medical Sciences. Authors' contributions: F.M.T contributed to the conception and design of this study, conducted the whole study process and participated in the writing of this manuscript. M.H Contributed to designing the study and critically reviewed the manuscript. SH.E.B Performed data collection and data analysis led the drafting of this manuscript. R.G Conducted statistical analysis and participated in a revision of this manuscript. All the authors reviewed and confirmed the final version of the manuscript. Acknowledgements: This article is derived from a master thesis in midwifery counsultation. The authors would like to thank the honorable Research Vice President of Urmia University of Medical Sciences, and all participants for their cooperation in this study. References Organization WH: WHO fact sheet on infertility . In . , vol. 6: LWW; 2021: e52. Deshpande PS, Gupta AS: Causes and prevalence of factors causing infertility in a public health facility . Journal of human reproductive sciences 2019, 12 (4):287. Sun H, Gong T-T, Jiang Y-T, Zhang S, Zhao Y-H, Wu Q-J: Global, regional, and national prevalence and disability-adjusted life-years for infertility in 195 countries and territories, 1990–2017: results from a global burden of disease study, 2017 . Aging (Albany NY) 2019, 11 (23):10952. Akhondi MM, Ranjbar F, Shirzad M, Ardakani ZB, Kamali K, Mohammad K: Practical difficulties in estimating the prevalence of primary infertility in Iran . International journal of fertility & sterility 2019, 13 (2):113. Parsanezhad ME, Jahromi BN, Zare N, Keramati P, Khalili A, Parsa-Nezhad M: Epidemiology and etiology of infertility in Iran, systematic review and meta-analysis . J Womens Health, Issues Care 2013, 2 (6):2. Zayed AA, El-Hadidy MA: Sexual satisfaction and self-esteem in women with primary infertility . Middle East Fertility Society Journal 2020, 25 (1):1-5. Saleem S, Shaheen A, Jabeen A, Mahmood Z: Psychosocial Issues in Women with Primary Infertility: A Psychometric Study . Annals of King Edward Medical University 2021, 27 (1):37-42. Arab-Sheybani K, Janbozorgi M, Akyuz A: Admissibility investigation and validation of infertility distress scale (IDS) in Iranian infertile women . International Journal of Fertility & Sterility 2012, 6 (1):37. Woods BM, Patrician PA, Fazeli PL, Ladores S: Infertility ‐ related stress: A concept analysis . In: Nursing Forum: 2022 : Wiley Online Library; 2022: 437-445. Ashrafi M, Jahangiri N, Jahanian Sadatmahalleh S, Mirzaei N, Gharagozloo Hesari N, Rostami F, Mousavi SS, Zeinaloo M: Does prevalence of sexual dysfunction differ among the most common causes of infertility? A cross-sectional study . BMC Women's Health 2022, 22 (1):1-8. Amiri SE, Brassard A, Rosen NO, Rossi MA, Beaulieu N, Bergeron S, Péloquin K: Sexual function and satisfaction in couples with infertility: A closer look at the role of personal and relational characteristics . The journal of sexual medicine 2021, 18 (12):1984-1997. Ha J-Y, Park H-J, Ban S-H: Efficacy of psychosocial interventions for pregnancy rates of infertile women undergoing in vitro fertilization: a systematic review and meta-analysis . Journal of Psychosomatic Obstetrics & Gynecology 2023, 44 (1):2142777. Yazdani M, Mahmoodi Z, Azin SA, Qorbani M: The effect of counseling based on sexual self-concept via social networks on smartphone in infertile women: a randomized controlled trial . International Journal of Community Based Nursing and Midwifery 2019, 7 (3):231. Karakas S, Aslan E: Sexual counseling in women with primary infertility and sexual dysfunction: Use of the BETTER model . Journal of sex & marital therapy 2019, 45 (1):21-30. Dastaran F, Maasoumi R, Foroozanfard F, Haghani S: The Effect of BETTER-Based Sex Counseling on Sexual Quality of Life in Infertile Women: a Randomized Controlled Clinical Trial . Sexuality and Disability 2022, 40 (4):785-806. Sahraeian M, Lotfi R, Qorbani M, Faramarzi M, Dinpajooh F, Ramezani Tehrani F: The effect of Cognitive Behavioral Therapy on sexual function in infertile women: A randomized controlled clinical trial . Journal of sex & marital therapy 2019, 45 (7):574-584. Metz ME, McCarthy BW: The “Good-Enough Sex” model for couple sexual satisfaction . Sexual and Relationship Therapy 2007, 22 (3):351-362. Motamedi M, Shahbazi M, Merghati-Khoei E, Salehi M, Hajebi A, Rahimi-Naghani S, Shah S, Kamali K, Khalajabadi-Farahani F: Perceived Barriers to Implementing Sexual Health Programs from the Viewpoint of Health Policymakers in Iran: A Qualitative Study . Sexuality Research and Social Policy 2022, 19 (1):273-285. Janghorban R, Latifnejad Roudsari R, Taghipour A, Abbasi M, Lottes I: The shadow of silence on the sexual rights of married Iranian women . BioMed research international 2015, 2015 . Fried ST, Espinoza-Kim A: Sexual health and sexual rights . International human rights of women 2019:285-304. Mofid V, Fatehi Zadeh M, Ahmadi A, Etemadi O: The effect of solution-focused counseling on sexual satisfaction and family function among women in isfahan . Knowledge & Research in Applied Psychology 2017, 17 (3):73-80. van Lankveld J: Internet-based interventions for women’s sexual dysfunction . Current sexual health reports 2016, 8 (3):136-143. Goldberg LR: The development of markers for the Big-Five factor structure . Psychological assessment 1992, 4 (1):26. Moreta-Herrera R, Dominguez-Lara S, Vaca-Quintana D, Zambrano-Estrella J, Gavilanes-Gómez D, Ruperti-Lucero E, Bonilla D: Psychometric properties of the General Health Questionnaire (GHQ-28) in Ecuadorian college students . Psihologijske teme 2021, 30 (3):573-590. Nourbala AA, Bagheri YS, Mohammad K: The validation of general health questionnaire-28 as a psychiatric screening tool . 2009. Larson JH, Anderson SM, Holman TB, Niemann BK: A longitudinal study of the effects of premarital communication, relationship stability, and self-esteem on sexual satisfaction in the first year of marriage . Journal of sex & marital therapy 1998, 24 (3):193-206. Bahrami N, Yaghoobzadeh A, Sharif Nia H, Soliemani M, Haghdoost A: Psychometric properties of the Persian version of Larsons sexual satisfaction questionnaire in a sample of Iranian infertile couples . Iranian Journal of Epidemiology 2016, 12 (2):18-31. Afzali M, Khani S, Hamzehgardeshi Z, Mohammadpour R-A, Elyasi F: Investigation of the social determinants of sexual satisfaction in Iranian women . Sexual medicine 2020, 8 (2):290-296. Bahrami N, Yaghoob Zadeh A, Sharif Nia H, Soliemani MA, Haghdoost AA: Validity and reliability of the persian version of Larson sexual satisfaction questionnaire in couples . Journal of Kerman University of Medical Sciences 2016, 23 (3):344-356. Newton CR, Sherrard W, Glavac I: The Fertility Problem Inventory: measuring perceived infertility-related stress . Fertility and sterility 1999, 72 (1):54-62. Alizadeh T, Farahani MN, Shahraray M, Alizadegan S: The relationship between self esteem and locus of control with infertility related stress of no related infertile men and women . Journal of Reproduction & Infertility 2005, 6 (2). Royani Z, Heidari M, Vatanparast M, Yaghmaei F, Sarcheshme AK, Majomerd JK: Predictors of quality of life in infertile couples . Journal of Menopausal Medicine 2019, 25 (1):35-40. Mahadeen AI, Hamdan-Mansour AM, Habashneh SA, Dardas LA: Sexual satisfaction among infertile couples: demographics and psychosocial health factors . Journal of Psychosocial Nursing and Mental Health Services 2020, 58 (9):40-47. Sohbati F, Hasanpoor-Azghady SB, Jafarabadi M, Amiri-Farahani L, Mohebbi M: Psychological well-being of infertile women and its relationship with demographic factors and fertility history: a cross-sectional study . BMC Women's Health 2021, 21 (1):1-7. Aba A, Kofi A, Kwasi B, Peter T, Perditer O: Knowledge, Attitudes and Socio-Demographic Factors Associated with Males’ Involvement in Fertility Treatment in Ghana . J Women's Health Care 2021, 10 (522):2167-0420.2121. Firoozi A, Lotfikashani F, Vaziri S: Effectiveness of Narrative Therapy and Good Enough Sex Model on sexual attitude and sexual satisfaction in married infertile couples . Payesh (Health Monitor) :0-0. Jamalianfar F, Riazi H, Firoozi A, Nasiri M, Montazeri A: The Effectiveness of ‘Good-Enough Sex Model’on Sexual Satisfaction and Sexual Intimacy in Women with Multiple Sclerosis: A Randomized Trail . Sexuality and Disability 2021, 39 (3):507-519. Dreischor F, Laan E, Apers S, Repping S, van Lunsen R, Lambalk C, D’Hooghe T, Goddijn M, Custers I, Dancet E: The stepwise development of an interactive web-based sex education programme for subfertile couples: the Pleasure & Pregnancy programme . Human Reproduction 2020, 35 (8):1839-1854. Hucker A, McCabe MP: An online, mindfulness-based, cognitive-behavioral therapy for female sexual difficulties: impact on relationship functioning . Journal of sex & marital therapy 2014, 40 (6):561-576. Dadkhah S, Jarareh J, Akbari Asbagh F: The relationships between self-compassion, positive and negative affect, and marital quality in infertile women: a systematic review and meta-analysis . Iranian Rehabilitation Journal 2021, 19 (1):1-12. Hasanpoor-Azghady SB, Simbar M, Vedadhir AA, Azin SA, Amiri-Farahani L: The social construction of infertility among Iranian infertile women: a qualitative study . Journal of reproduction & infertility 2019, 20 (3):178. Taebi M, Kariman N, Montazeri A, Majd HA: Infertility stigma: A qualitative study on feelings and experiences of infertile women . International Journal of Fertility & Sterility 2021, 15 (3):189. Fahami F, Quchani SH, Ehsanpour S, Boroujeni AZ: Lived experience of infertile men with male infertility cause . Iranian journal of nursing and midwifery research 2010, 15 (Suppl1):265. Khodakarami N, Hashemi S, Seddigh S, Hamdiyeh M, Taheripanah R: Life experience with infertility; a phenomenological study . Journal of Reproduction & Infertility 2010, 10 (4). Sadock BJ: Kaplan & Sadock's synopsis of psychiatry: behavioral sciences/clinical psychiatry . 2007. Gibson K, Cartwright C: Young people's experiences of mobile phone text counselling: Balancing connection and control . Children and youth services review 2014, 43 :96-104. Additional Declarations No competing interests reported. Supplementary Files ENDCONSORT2010Checklist2.doc Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2416471","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":166141510,"identity":"c7caed17-297f-45f0-bff4-e94c2d364a73","order_by":0,"name":"Fatemeh 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16:44:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2416471/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2416471/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":31432114,"identity":"ef577112-e10b-4ae3-967c-c887f29f9990","added_by":"auto","created_at":"2023-01-11 15:42:02","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":50755,"visible":true,"origin":"","legend":"\u003cp\u003eFlow chart of patients inclusion, follow-up, and data analysis\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-2416471/v1/5e4db294f495cbb04b2c4939.png"},{"id":31433049,"identity":"34122628-e58b-4279-8968-b171e40a1c6f","added_by":"auto","created_at":"2023-01-11 15:50:02","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":17009,"visible":true,"origin":"","legend":"\u003cp\u003eChanges in the mean score of infertility stress in two groups throughout the measurment time points\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-2416471/v1/9ad0dfb51dc449f999e63a0f.png"},{"id":31432115,"identity":"8f509672-36bb-4617-a48e-c51499e95c93","added_by":"auto","created_at":"2023-01-11 15:42:02","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":16889,"visible":true,"origin":"","legend":"\u003cp\u003eChanges in the mean score of infertility stress in two groups throughout the measurment time points\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-2416471/v1/12c563f6b9afaed23631a85c.png"},{"id":37731404,"identity":"79a4326d-c368-417e-b081-21174aeba354","added_by":"auto","created_at":"2023-05-31 06:45:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1691283,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2416471/v1/77958ad9-7cc4-4779-8baa-ada05420c9a2.pdf"},{"id":31432119,"identity":"5e673a3b-4afb-42b9-ba39-71ddf6b0ebd2","added_by":"auto","created_at":"2023-01-11 15:42:03","extension":"doc","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":231424,"visible":true,"origin":"","legend":"","description":"","filename":"ENDCONSORT2010Checklist2.doc","url":"https://assets-eu.researchsquare.com/files/rs-2416471/v1/bce1fd12395a72b34b5714df.doc"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effect of Whatsapp Based Good Enough Sex Consultation on Infertility Stress and Sexual Satisfaction in Iranian Women Who Applied for Infertility Treatment: A Randomized Control Trial","fulltext":[{"header":"Background","content":"\u003cp\u003eInfertility is defined by the World Health Organization (WHO) as the inability to conceive after 1 year (or longer) of unprotected intercourse [1].\u0026nbsp;The prevalence of primary infertility worldwide is about 12-14% [2]. According to Sun et al., from 1990-2017, the prevalence of primary infertility has increased to 14.9% in women and 8.2% in men [3].\u0026nbsp;In 2019, the prevalence of infertility was reported as 2.20%.\u0026nbsp;Such studies have estimated the prevalence of infertility in Iran to be higher than the global average [4].\u0026nbsp;According to a review study, the\u0026nbsp;rate of infertility in Iran was estimated at 34.1% [5].\u003c/p\u003e\n\u003cp\u003eInfertility is a worldwide health problem with a high effect on individuals of both sexes and community. Infertility is categorized as the 5th highest important general disability with a negative effect on the psychosocial matters of those who are involved.\u0026nbsp;Women suffer more than men\u0026nbsp;from the consequences of infertility [6, 7].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInfertility stress refers to a group of symptoms that appear following infertility diagnosis; these symptoms are similar to those of post-traumatic stress disorder and are specifically evident in the beliefs and feelings associated with infertility [8, 9].\u003c/p\u003e\n\u003cp\u003eInfertility is associated with the reduction of sexual activity and always there is a relationship between infertility and sexual dysfunction [10]. Prevalence of sexual dysfunction is high in infertile women, but little attention has been paid to this problem, and women are less likely to be treated\u0026nbsp;[11].\u003c/p\u003e\n\u003cp\u003eWhile detection the infertility produces injuries and stresses, psychological interventions help infertile couples work through their problems and adapt to infertility [12]. Several studies emphasized that psychosexual consultations interventions for couples with infertility problems are effective in improving couples\u0026rsquo; sexual relations.\u0026nbsp;[13-16].\u003c/p\u003e\n\u003cp\u003eOne of the models applied for decreasing sexual complications is the Good- Enough Sex\u0026nbsp;Model (GESM) developed by Metz and McCarthy. The model is modified for couples with sexual problems and it contain two fundamental subjects: (i) mutual sexual relationships to enjoy the sexual relationship, and (ii) intimacy and adoring in order to obtain highest pleasure in individual with sexual dysfunction based on their capability. It concentrates on substitute the classic intercourse anticipations with pleasure-based and flexible sexual activity\u0026nbsp;[17].\u003c/p\u003e\n\u003cp\u003eThe model is developed on six fundamental concepts that ultimately cover 12 aspects of the model. The detailed characteristics of the model are presented in Table 1.\u003c/p\u003e\n\u003cp\u003eSexual problems causes feeling of shame and guilty so they are not reported to health care providers or therapists due to considering such issues as taboos in Iran, so discussion about sexual issues is avoided\u0026nbsp;[18, 19]. Couples often have trouble in expressing sexual issues with others, consequently\u0026nbsp;being deprived of face-to-face counseling services. on the other hand\u0026nbsp;ignorance of sexual and reproductive health are in opposition to women\u0026apos;s empowerment and in contravention of these human rights\u0026nbsp;[20]. Online help has advantages over face-to-face contact. One of the benefits of whatsapp based educations is increasing access to education, improving self-efficacy, knowledge production, cost effectiveness, learner flexibility and interaction [21, 22]. For some individuals, the anonymity that is sometimes provided during online consultation can make it a preferable option compared with face-to-face types of therapy[21].\u003c/p\u003e\n\u003cp\u003eIn addition during the COVID-19 pandemic and banning the gatherings and laws based on reducing traffic, which led to limited access to medical and counseling services, the importance of paying attention to the issue of reproductive and sexual health of infertile women should not have been ignored. So the present study aimed to investigate the effect of whatsapp based sexual counseling using the GES model on the infertility stress and sexual satisfaction in infertile women who referred to infertility centers in Urmia in Iran.\u0026nbsp;\u003c/p\u003e"},{"header":"Methods","content":"\u003cp skip=\"true\"\u003e\u003cstrong\u003eResearch design and participants\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe aim of the study is to determine the effect of whatsapp based consultation based on Good Enough Sex model on infertility stress and sexual satisfaction in women who referred for infertility centers in Urmia. A double-blinded, parallel, randomized controlled trial was conducted\u0026nbsp;on 100 infertile women visiting the infertility clinic in Kowsar\u0026nbsp;women comprehensive\u0026nbsp;educational and medical center as the governmental and Dr. Tizro infertility center as the nongovernmental center in Urmia,\u0026nbsp;from September 2021 to April \u0026nbsp; 2022.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe inclusion criteria were the women with\u0026nbsp;primary infertility, married women living with spouse, women in reproductive age (25-35 years), no intention to use a donated embryo or ovum or rent a womb, no adopted child , no major psychiatric disorder at the time of the study (initial diagnosis by a psychiatrist) and no use of psychiatric medications, non-use of cigarette, hookah, alcohol and no systemic diseases such as diabetes based on medical history, receiving total score less than 23 in GHQ-28, not taking any other education or counseling for their sexual dysfunction, absence of sexual dysfunction in the spouse according to the individual declaration, possibility of access to couples in the next 4 months at least and having a smart phone with internet access. Exclusion criteria were any physical or mental illness or any accident and psychological trauma with affecting their sexual performance, pregnancy during the implementation of the study, leave the group, participating in other counseling sessions outside of the study program.\u003c/p\u003e\n\u003cp skip=\"true\"\u003eSampling initiated after obtaining the ethical approval code from Ethics Committee of Urmia University of Medical Sciences (#IR.UMSU.REC.1400.247) and registering the study information on the Registry Center of Clinical Trials (#IRCT20210926052593N1).\u0026nbsp;\u0026nbsp;For implementation of the study first of all, researcher attended at the infertility centers and selected 100 eligible participants out of 168 infertile women [Figure 1], using convenience sampling; and then the participants were equally allocated to the intervention (whatsapp based GES model consultation) group and the control group using a concealed randomized allocation. For this purpose, each of the letters A (intervention) and B (control) was written on 100 cards. Then each patient randomly selected one of the cards and was allocated to the intervention or the control group based on the letter written on the card. This section was done by a person who was not involved in the process of the study (to follow the blinding). Then, consenting women in both groups were asked to sign the consent form. After that, the pretest questionnaires, including demographic information, Newton infertility stress questionnaire and Larson's sexual satisfaction questionnaire were completed by women and then the obtained score was considered as the base score for comparison.\u0026nbsp;\u0026nbsp;Finally whatsapp based whatsup groups for both intervention and control groups were created and for the respecting the privacy and security of the participants who were unwilling to reveal their identity, 20 SIMcarts were gifted by researchers.\u003c/p\u003e\n\u003cp\u003eIn the control group, only routine infertility counseling, based on instructions of the centers, included training topics related to the time of intercourse, personal and health care, was carried out through the whatsup group.\u0026nbsp;In order to fallow the research ethics, the participants in control group had access to the intervention program after last completion the questionnaires.\u0026nbsp;In the intervention group in addition to the routine infertility advices, participants received the intervention program.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample size\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe sample size was based on Mofid et al.'s study (2016) and using the mean difference formula for two independent groups of G power software, with the Larson Sexual Satisfaction Questionnaire (LSSQ) index in the two intervention and control groups (Mean1: 89, Mean2: 93.67 , SD1: 7.89, SD2: 8.07) Each group is 42 people.\u0026nbsp;Considering 20% attrition\u0026nbsp;for each group, 50 participants (100 women in total) were obtained [21].\u003c/p\u003e\n\u003cp\u003e\u003cimg 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\"\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIntervention\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants in the intervention group were given access to the 6-week GES model consultation program. The program consisted of six consultation and assignments packages, regarding all 12 dimensions of GES model (Table 1).\u0026nbsp;The participants also had opportunities to daily expressions of their experiences and feelings in both privet and\u0026nbsp;group online. Information was provided through written texts and video clips.\u0026nbsp;The participants' diaries were reviewed by the researcher and their experiences were discussed. Daily written feedbacks were provided by trained researcher. If required addition replies and individual consultation could take place through private contacts. The women in the intervention group were asked to share the perceived information to their partners and practice with together.\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"718\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"100%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;1: The\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eWhatsapp\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;based \u0026nbsp;Intervention Program Based on the Good-Enough Sex Model\u0026nbsp;[17]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"100%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex is an important element in life and constitutes a significant part of peace, intimacy, satisfaction and self-confidence of couples\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026bull; Biological requirements and sexual satisfaction,\u003c/p\u003e\n \u003cp\u003e\u0026bull; Emphasis and correcting of fears, beliefs, disgust, shame and negative attitudes as the threatening obstacles for sexual health and sexual satisfaction, Identifying couples\u0026apos; sexuality\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eRelationship quality and sexual satisfaction are the ultimate goal of sexual development and are essentially integrated\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026bull; Couples are an \u0026quot;intimated unite\u0026quot;\u003c/p\u003e\n \u003cp\u003e\u0026bull; Sexual relations are formed in the context of an intimate relationship\u0026nbsp;,\u003c/p\u003e\n \u003cp\u003e\u0026bull; Cooperation in daily life, resolving the interactive differences,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026bull; For an intimate relationship, couples should activities,\u0026nbsp;\u0026nbsp;sharing feelings and emotions create an empathetic style,\u003c/p\u003e\n \u003cp\u003e\u0026bull; Different ways of men and women intimacy achievement are not against each other.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTo set positive, realistic expectations about their sexual bodies as well as psychological and interpersonal dimensions\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026bull; The over-emphasis on perfectionistic sexuality in the society which is saturated with images and myths about beauty \u0026nbsp;for marketing purposes,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026bull; Sexuality as a life-long developmental process that involves changes and differences from young adulthood to older age,\u0026nbsp;disease are in relation to sexual problems,\u0026nbsp;Periodic sexual problems are common,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026bull; Sexual enjoyment varies; orgasm is not essential to sexual satisfaction,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026bull; The importance of seeking scientifically accurate knowledge from trusted websites and/or books\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eGood physical health and healthy behavioral habits are vital for sexual health\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026bull; Healthy behaviors (e.g. adequate sleep, exercise, eating, and moderate drinking) are an important dimension of continuing sexual functioning,\u003c/p\u003e\n \u003cp\u003e\u0026bull; Helping to rehabilitate and create sexual motivation in the presence of disease with the combination of a healthy lifestyle in couples\u0026nbsp;\u003cstrong\u003eRelaxation is the foundation for pleasure and function\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026bull; Creating cognitive, emotional and behavioral skills such as individual responsibility for honestly acceptance of feelings towards sexual relationships and a positive body image, learning sexual response, sharing enjoyable exercises and development of stimulating scenarios \u003cstrong\u003ePleasure is as important as function\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026bull; The emphasis on touch and pleasure as much as or more than sexual performance. For example (encouraging flirting during the day, recognizing physical and sexual characteristics, creating a safe and calm environment, using body language and making continuous eye contact, etc.).\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eValuing variable, flexible sexual experiences and abandoning the need for perfect performance, overcoming fears of failure\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026bull; Reasonable expectations of sex and acceptance of changes in the quality of sex reduce anxiety and make couples cope with sexual problems due to aging or illness,\u003c/p\u003e\n \u003cp\u003e\u0026bull; \u0026nbsp;However, irrational expectations are potential predictors of decreased libido\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eThe five purposes for sex are integrated into the couple\u0026rsquo;s sexual relationship\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026bull; Integrate the five fundamental purposes for sex: (1) reproduction; (2) tension and anxiety reduction; (3) sensual enjoyment and pleasure; (4) self-esteem and confidence; and (5) relationship closeness and satisfaction\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eIntegrate and flexibly use the three sexual arousal styles\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026bull; Partner Interaction, Self-entrancement, Role enactment\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eGender differences are respectfully valued and similarities mutually accepted\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026bull; Men and women are often different in their arousal patterns,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026bull; Accepting and appreciating the gender preferences and similarities are important\u003c/p\u003e\n \u003cp\u003e\u0026bull; Women focus on feeling \u0026lsquo;\u0026lsquo;desired\u0026rsquo;\u0026rsquo; or \u0026lsquo;\u0026lsquo;attractive\u0026rsquo;\u0026rsquo; to their man,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026bull; Men focus on feeling \u0026lsquo;\u0026lsquo;invited\u0026rsquo;\u0026rsquo; or \u0026lsquo;\u0026lsquo;welcomed\u0026rsquo;\u0026rsquo; to engage in sex,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026bull; Sexual confidence, then, is more about function for men while women\u0026rsquo;s confidence may involve trust, security, and caring,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026bull; Men are commonly prompted for sex by the biophysiological drive, women are prompted for sex by more of a bio-emotional drive,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSex is integrated into real life and real life is integrated into sex\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026bull; Sexuality is developing, growing and evolving throughout life,\u0026nbsp;Integration of life events with love is one of the goals of sexual relations,\u003c/p\u003e\n \u003cp\u003e\u0026bull; Sex is connected to the daily life of a couple, are integrated with their sexual life to create a unique sexual experience for couples,\u003c/p\u003e\n \u003cp\u003e\u0026bull; Life provides opportunities for sexual experience in delicate but distinctly and rich ways\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSexuality is personalized: Sex can be playful, spiritual, special\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026bull; To challenge couples to consider not only lovemaking behaviors and psychosexual skills but emotional experiences and intimate relationship,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026bull; The emotional intimacy and relationship satisfaction is the ultimate focus.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eGroup Activities:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eEncouraging participants to:\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026bull; Express all concerns and their \u0026nbsp;emotional \u0026nbsp; \u0026nbsp; negative feelings about \u0026nbsp; \u0026nbsp; infertility and its treatments issues,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026bull; To share their not private positive experiences to overcome the problems,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026bull; To discuss the barriers and facilitators to deal with the complicated issues,\u003c/p\u003e\n \u003cp\u003eDesigning a sexual relationship scenario by considering and accepting changes in sexual life after the onset of infertility\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAssignments consisted of the recognition of the causes of fears, beliefs, disgust, shame and negative attitudes as the threatening obstacles for sexual health, identification of destroying factors of couple's daily life cooperation and intimacy, setting goals to obtain intimate relationships by practicing to share feeling and emotions, perusing self formulated goals to follow healthy quality of life through adequate sleep, exercise, eating, and moderate drinking as the predicting factors for higher sexual satisfaction, trying to distinguish the barriers of acceptance of positive body image, following self regulated goals to value flexible sexual experiences and abandoning the need for perfect performance, overcoming performance pressure, fears of failure.\u003c/p\u003e\n\u003cp\u003eThe master's degree of consultation in midwifery student besides the related subjects in her academic\u0026nbsp;curriculum, she\u0026nbsp;has been attended in sexology consultations workshops so she has eligible certificate to handle the intervention.\u003c/p\u003e\n\u003cp\u003eAll of the intervention program’s content and questions were under the guidance of expert psychiatrist who is a faculty member of the university and she was as the advisor in the present master's degree thesis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection tools\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDemographic questionnaire\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDemographic questions were age of the patient and spouse, level of education of the patient and spouse, occupation of the patient and spouse, adequacy of the family income, the length of infertility detection, treatment length,\u0026nbsp;and cause of infertility.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGeneral Health Questionnaire (GHQ-28)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe GHQ-28 was used to screen the subjects' mental health. The GHQ-28 consists of four subscales including somatic symptoms (items 1–7), anxiety/insomnia (items 8–14), social dysfunction (items 15–21) and severe depression (items 22–28). All items are responded on a 4-point Likert scale of none, mild, moderate, and severe which are scored from zero to three. The score 23 or above was the cut-off point for probability of having a mental health disorder\u0026nbsp;[23] Accordingly, women who obtained scores \u0026gt;23 were excluded from the study. Validity and reliability of the GHQ-28 was approved by several studies [24, 25].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLarson's sexual satisfaction questionnaire\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Larson's sexual satisfaction questionnaire was used as a valid tool to determine sexual satisfaction in the participants[26]. Validity and reliability of this questionnaire have been verified and approved in Farsi language[27, 28]. This questionnaire contained 25 questions, which were measured on a 5-point Likert scale according to the choices of never, hardly ever, sometimes, often, and always; scores ranged from 1e125. To determine the levels of sexual satisfaction, the scores were categorized. A high score was associated with high sexual satisfaction. A score \u0026lt;50 indicated low sexual satisfaction, a score of 51e100 indicated moderate sexual satisfaction, and \u0026lt;100 indicated high satisfaction[29].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNewton Infertility Stress Questionnaire\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNewton Infertility Stress Questionnaire is a reliable self-report questionnaire with appropriate validity and reliability [30] Therefore, this tool can be used to diagnose infertility stress. The Newton Infertility Stress Questionnaire is a 46-item tool designed by Newton in 1995 and consists of five subtests including social concerns (10 questions), sexual concerns (8 questions), communication concerns (10 questions), rejection of life without children (8 questions), and the need to become a parent (10 questions). This questionnaire is rated based on a 6-point Likert scale. The overall score of the questionnaire is between 46 and 276, with higher scores indicating more stress [30]. This questionnaire was administered in Iran in 2005 by Alizadeh et al. to establish its reliability among a sample of 30 infertile people (15 males and 15 females), and the obtained Cronbach's alpha coefficients for the subscales of social concerns, sexual concerns, communication concerns, rejection of childless lifestyle, and need for parenthood were respectively 0.78, 0.77, 0.78, 0.75, and 0.84, and the Cronbach's alpha coefficient for overall stress was 0.91 [31].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were first entered into SPSS Statistics for Windows, version 20 (SPSS Inc., Chicago, Ill., USA). The clinical and demographic information of the two groups were compared using the chi-squared test and independent-samples t-test. To recognize the significance of the difference between the mean scores of infertility stress and sexual satisfaction at three time points in each group, repeated-measures Analysis of Variance (rANOVA) was applied. Before conducting the rANOVA, the condition of equality of between-groups variances was met by observing the assumptions and performing the necessary tests. In this regard, it should be considered that the amount of residual variance of the dependent variables was equal in all groups. In addition, the significance level (\u003cem\u003ep\u003c/em\u003e-value) was considered to be less than 0.05. All analyses were performed by a researcher who was blind to the data.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAmong 168 infertile women who were visited, 68 people were excluded because they did not meet the inclusion criteria (21woman did not have access to internet,\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e13 woman were low literacy, 18 women with secondary infertility, 8 woman who were not willing to attendant in the study, \u0026nbsp;8 women taking medicine because of medical issues.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFinally the remained 100 women were interviewed by the author to fill out the GHQ- 28 , Larson\u0026apos;s sexual satisfaction and Newton\u0026apos;s stress related to infertility questionnaires, using the convenience sampling method then , they were randomized \u0026nbsp;allocated \u0026nbsp; to the intervention and control groups (50 participants in control and 50 in intervention group).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn the next step, whatsApp groups were created for each group, and the intervention group were given access to the 6\u0026ndash;week continually GES model sexual consultation program. Control group received only routine self-care advices.\u003c/p\u003e\n\u003cp\u003eSince there was not seen any attrition in this study, it seems the weekly scheduled program and its informative and practical assignments were enough effective to encourage the participants to attend for 6 consecutive weeks. Therefore, 50 women in the intervention and 50 women in the control group were followed up and analyzed in the post-intervention evaluation and one month later (Fig. 1).\u003c/p\u003e\n\u003cp\u003eTo investigate the similarity between the groups in terms of socio-demographic profile and infertility related information of the participants, the chi-square, trend chi-square test, Fisher\u0026rsquo;s exact test, and the independent t-test were used. There was no significant difference between the intervention and control groups in the mentioned items (P \u0026gt; 0.05). The mean (SD: standard deviation) duration of infertility was 3.16 (1.64) and 3.22 (1.78) years in the intervention and control groups respectively. About 14% of participants in the intervention and 12% of them in the control groups were housewife and 34% participants in both groups had academic education. About 36% of participants in the intervention group and 40% of them in the control group reported sufficient income for living expenses (Table 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe results of rANOVA on the significance of the difference in the mean scores of infertility stress and sexual satisfaction in the two groups are presented in Table 3 and Table 4. In these tables, three types of interaction effects are also reviewed. Based on the results, the time by intervention interaction was found to be significant (\u003cem\u003ep˂.001\u003c/em\u003e). This indicated that there was a significant difference in the mean scores of infertility stress and sexual satisfaction between the two groups at different time points. In other words, the trend of the mean scores of response variables was not similar in the two groups over time.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn this study, the main effect of time was also found to be significant and this showed a statistically significant difference between the mean scores of infertility stress and sexual satisfaction at different time points in the intervention group (\u003cem\u003ep˂.001\u003c/em\u003e). The main effect of the intervention also revealed that there was a statistically significant difference in the mean scores of infertility stress and sexual satisfaction between the two groups regardless of the effect of time. In other words, it was concluded that the lower infertility stress and higher sexual satisfaction mean scores in the intervention group in compare to mean scores of control group were seen (\u003cem\u003ep˂0.001\u003c/em\u003e). Considering the partial Eta squared, the effect of intervention had the highest interaction effect on both variables of sexual satisfaction (\u003cem\u003e\u0026eta;2=.0.52)\u003c/em\u003e and infertility stress (\u003cem\u003e\u0026eta;2=0.82\u003c/em\u003e).\u003c/p\u003e\n\u003cp\u003eThe changes in the mean scores of infertility stress and sexual satisfaction at different time points in the two groups are clarified in Figures 2 and 3. Based on the results, it was illustrated that the mean scores of infertility stress reduced and sexual satisfaction mean scores significantly increased in the intervention group at time points of immediately and one month after consultation compared to before it. Moreover, the lowest mean score of infertility stress and the highest mean score of sexual satisfaction was obtained at the measurement time point of immediately after the intervention.\u003c/p\u003e\n\u003cp\u003eTable 2. Comparison of Socio demographic Characteristics and Some Infertility Related Clinical Issues\u0026nbsp;of Participants in Control (n=50) and intervention (n=50) groups\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"671\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"53.20417287630402%\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.157973174366617%\"\u003e\n \u003cp\u003eControl\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.008941877794337%\"\u003e\n \u003cp\u003eIntervention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.628912071535023%\"\u003e\n \u003cp\u003eStatistics\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"26.37853949329359%\"\u003e\n \u003cp\u003eQualitative\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.825633383010434%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.157973174366617%\"\u003e\n \u003cp\u003eN(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.008941877794337%\"\u003e\n \u003cp\u003eN(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.628912071535023%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" width=\"26.37853949329359%\"\u003e\n \u003cp\u003eLevel of education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.825633383010434%\"\u003e\n \u003cp\u003eMiddle school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.157973174366617%\"\u003e\n \u003cp\u003e7(14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.008941877794337%\"\u003e\n \u003cp\u003e9(18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" width=\"18.628912071535023%\"\u003e\n \u003cp\u003eX\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e=0.017, df=3\u003c/p\u003e\n \u003cp\u003e**P=0.80\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"48.78048780487805%\"\u003e\n \u003cp\u003eHigh school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.745257452574524%\"\u003e\n \u003cp\u003e9(18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.474254742547426%\"\u003e\n \u003cp\u003e11(22)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"48.78048780487805%\"\u003e\n \u003cp\u003eDiploma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.745257452574524%\"\u003e\n \u003cp\u003e17(34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.474254742547426%\"\u003e\n \u003cp\u003e13(26)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"48.78048780487805%\"\u003e\n \u003cp\u003eCollege\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.745257452574524%\"\u003e\n \u003cp\u003e17(34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.474254742547426%\"\u003e\n \u003cp\u003e17(34)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" width=\"26.37853949329359%\"\u003e\n \u003cp\u003eWomen\u0026apos;s job\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.825633383010434%\"\u003e\n \u003cp\u003eHousekeeper\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.157973174366617%\"\u003e\n \u003cp\u003e6(12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.008941877794337%\"\u003e\n \u003cp\u003e7(14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" width=\"18.628912071535023%\"\u003e\n \u003cp\u003eX\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e=0.017\u003c/p\u003e\n \u003cp\u003edf=2\u003c/p\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e**\u003c/span\u003eP=0.9\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"48.78048780487805%\"\u003e\n \u003cp\u003eSelf-employment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.745257452574524%\"\u003e\n \u003cp\u003e33(66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.474254742547426%\"\u003e\n \u003cp\u003e31(62)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"48.78048780487805%\"\u003e\n \u003cp\u003eGovernmental Job\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.745257452574524%\"\u003e\n \u003cp\u003e11(22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.474254742547426%\"\u003e\n \u003cp\u003e12(24)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" width=\"26.37853949329359%\"\u003e\n \u003cp\u003eHusband\u0026apos;s \u0026nbsp;level of education\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.825633383010434%\"\u003e\n \u003cp\u003eElementary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.157973174366617%\"\u003e\n \u003cp\u003e2(4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.008941877794337%\"\u003e\n \u003cp\u003e2(4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" width=\"18.628912071535023%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003csup\u003e\u003cspan dir=\"RTL\"\u003e**\u003c/span\u003e\u003c/sup\u003e\u003csup\u003e*\u0026nbsp;\u003c/sup\u003eP\u003csub\u003efisher\u003c/sub\u003e =0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"48.78048780487805%\"\u003e\n \u003cp\u003eGuidance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.745257452574524%\"\u003e\n \u003cp\u003e9(18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.474254742547426%\"\u003e\n \u003cp\u003e10(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"48.78048780487805%\"\u003e\n \u003cp\u003eHigh school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.745257452574524%\"\u003e\n \u003cp\u003e9(18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.474254742547426%\"\u003e\n \u003cp\u003e10(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"48.78048780487805%\"\u003e\n \u003cp\u003eDiploma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.745257452574524%\"\u003e\n \u003cp\u003e14(28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.474254742547426%\"\u003e\n \u003cp\u003e12(24)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"48.78048780487805%\"\u003e\n \u003cp\u003eCollege\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.745257452574524%\"\u003e\n \u003cp\u003e16(32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.474254742547426%\"\u003e\n \u003cp\u003e14(28)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" width=\"26.37853949329359%\"\u003e\n \u003cp\u003eHusband\u0026rsquo;s job\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.825633383010434%\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.157973174366617%\"\u003e\n \u003cp\u003e2(4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.008941877794337%\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" width=\"18.628912071535023%\"\u003e\n \u003cp\u003eX\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e=2.86\u003c/p\u003e\n \u003cp\u003edf=4\u003c/p\u003e\n \u003cp\u003e**P =0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"48.78048780487805%\"\u003e\n \u003cp\u003emanual worker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.745257452574524%\"\u003e\n \u003cp\u003e14(28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.474254742547426%\"\u003e\n \u003cp\u003e12(24)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"48.78048780487805%\"\u003e\n \u003cp\u003eEmployee\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.745257452574524%\"\u003e\n \u003cp\u003e14(28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.474254742547426%\"\u003e\n \u003cp\u003e15(30)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"48.78048780487805%\"\u003e\n \u003cp\u003eShopkeeper\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.745257452574524%\"\u003e\n \u003cp\u003e11(22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.474254742547426%\"\u003e\n \u003cp\u003e15(30)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"48.78048780487805%\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.745257452574524%\"\u003e\n \u003cp\u003e9(18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.474254742547426%\"\u003e\n \u003cp\u003e8(16)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"26.37853949329359%\"\u003e\n \u003cp\u003eSufficient family income\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.825633383010434%\"\u003e\n \u003cp\u003eEnough\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.157973174366617%\"\u003e\n \u003cp\u003e20(40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.008941877794337%\"\u003e\n \u003cp\u003e18(36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.628912071535023%\"\u003e\n \u003cp\u003eX\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e=0.029, df=2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"26.37853949329359%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.825633383010434%\"\u003e\n \u003cp\u003eInsufficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.157973174366617%\"\u003e\n \u003cp\u003e9(18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.008941877794337%\"\u003e\n \u003cp\u003e11(22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"18.628912071535023%\"\u003e\n \u003cp\u003e**P=0.85\u003cs\u003e\u0026nbsp;\u003c/s\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"48.78048780487805%\"\u003e\n \u003cp\u003eRelatively enough\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.745257452574524%\"\u003e\n \u003cp\u003e21(42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.474254742547426%\"\u003e\n \u003cp\u003e21(42)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" width=\"26.37853949329359%\"\u003e\n \u003cp\u003eCause of infertility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.825633383010434%\"\u003e\n \u003cp\u003eOvarian\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.157973174366617%\"\u003e\n \u003cp\u003e28(56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.008941877794337%\"\u003e\n \u003cp\u003e27(54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" width=\"18.628912071535023%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;***P\u003csub\u003efishe\u003c/sub\u003e=0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"48.78048780487805%\"\u003e\n \u003cp\u003eFallopian tube\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.745257452574524%\"\u003e\n \u003cp\u003e8(16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.474254742547426%\"\u003e\n \u003cp\u003e9(18)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"48.78048780487805%\"\u003e\n \u003cp\u003eEndometriosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.745257452574524%\"\u003e\n \u003cp\u003e5(10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.474254742547426%\"\u003e\n \u003cp\u003e5(10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"48.78048780487805%\"\u003e\n \u003cp\u003eUterine disorders\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.745257452574524%\"\u003e\n \u003cp\u003e3(6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.474254742547426%\"\u003e\n \u003cp\u003e2(4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"48.78048780487805%\"\u003e\n \u003cp\u003eThyroid disorders\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.745257452574524%\"\u003e\n \u003cp\u003e4(8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.474254742547426%\"\u003e\n \u003cp\u003e5(10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"48.78048780487805%\"\u003e\n \u003cp\u003eOther cases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.745257452574524%\"\u003e\n \u003cp\u003e2(4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.474254742547426%\"\u003e\n \u003cp\u003e2(4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"26.37853949329359%\"\u003e\n \u003cp\u003eQuantitave\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.825633383010434%\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.157973174366617%\"\u003e\n \u003cp\u003eM(SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.008941877794337%\"\u003e\n \u003cp\u003eM(SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.628912071535023%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"26.37853949329359%\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.825633383010434%\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.157973174366617%\"\u003e\n \u003cp\u003e28.64(5.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.008941877794337%\"\u003e\n \u003cp\u003e29.20(5.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.628912071535023%\"\u003e\n \u003cp\u003et= 0.56, df=98\u003c/p\u003e\n \u003cp\u003e*P =0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"26.37853949329359%\"\u003e\n \u003cp\u003eFrequency of IVF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.825633383010434%\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.157973174366617%\"\u003e\n \u003cp\u003e0.58(0.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.008941877794337%\"\u003e\n \u003cp\u003e0.52(0.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.628912071535023%\"\u003e\n \u003cp\u003et=0.36, df=98\u003c/p\u003e\n \u003cp\u003e*P =0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"26.37853949329359%\"\u003e\n \u003cp\u003eDuration of infertility(year)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.825633383010434%\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.157973174366617%\"\u003e\n \u003cp\u003e2.66(1.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.008941877794337%\"\u003e\n \u003cp\u003e2.70(1.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.628912071535023%\"\u003e\n \u003cp\u003et= 0.15, df=98\u003c/p\u003e\n \u003cp\u003e*P =0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Independent Samples t Test , **Chi-Square , ***Fisher Exact Test\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u003c/strong\u003e The results of the repeated measure ANOVA in comparison of the mean scores of sexual satisfaction and its dimensions at three time points of before, 1 week, and 5 weeks after intervention in the control and treatment groups.\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"700\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"18%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.714285714285714%\"\u003e\n \u003cp\u003e\u003cstrong\u003eEffect\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.142857142857142%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSource\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSST\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.285714285714286%\"\u003e\n \u003cp\u003e\u003cstrong\u003eDF*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u003cstrong\u003eF\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e\u003cstrong\u003eEta\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"18%\"\u003e\n \u003cp\u003e\u003cstrong\u003eDesire to have sex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.714285714285714%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBetween\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.142857142857142%\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e1610.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.285714285714286%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e1610.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e98.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"18%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.714285714285714%\"\u003e\n \u003cp\u003e\u003cstrong\u003eWithin\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.142857142857142%\"\u003e\n \u003cp\u003eTime\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e932.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.285714285714286%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e466.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e47.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"18%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.714285714285714%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.142857142857142%\"\u003e\n \u003cp\u003eGroup by Time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e969.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.285714285714286%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e48.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e48.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"18%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSexual attitude\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.714285714285714%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBetween\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.142857142857142%\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e1830.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.285714285714286%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e1830.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e84.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"18%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.714285714285714%\"\u003e\n \u003cp\u003e\u003cstrong\u003eWithin\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.142857142857142%\"\u003e\n \u003cp\u003eTime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e1368.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.285714285714286%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e684.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e50.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"18%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.714285714285714%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.142857142857142%\"\u003e\n \u003cp\u003eGroup by Time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e1148.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.285714285714286%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e574.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e42.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e0.30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"18%\"\u003e\n \u003cp\u003e\u003cstrong\u003eQuality of sex life\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.714285714285714%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBetween\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.142857142857142%\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e3468.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.285714285714286%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e3468.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e98.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"18%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.714285714285714%\"\u003e\n \u003cp\u003e\u003cstrong\u003eWithin\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.142857142857142%\"\u003e\n \u003cp\u003eTime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e2659.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.285714285714286%\"\u003e\n \u003cp\u003e1.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e1418.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e63.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"18%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.714285714285714%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.142857142857142%\"\u003e\n \u003cp\u003eGroup by Time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e2254.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.285714285714286%\"\u003e\n \u003cp\u003e1.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e1202.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e54.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"18%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSexual adjustment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.714285714285714%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBetween\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.142857142857142%\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e2144.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.285714285714286%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e2144.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e105.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"18%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.714285714285714%\"\u003e\n \u003cp\u003e\u003cstrong\u003eWithin\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.142857142857142%\"\u003e\n \u003cp\u003eTime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e1466.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.285714285714286%\"\u003e\n \u003cp\u003e1.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e7933.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e49.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"18%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.714285714285714%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.142857142857142%\"\u003e\n \u003cp\u003eGroup by Time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e1324.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.285714285714286%\"\u003e\n \u003cp\u003e1.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e716.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e44.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"18%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSexual satisfaction\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.714285714285714%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBetween\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.142857142857142%\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e35381\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.285714285714286%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e35381\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e107.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"18%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.714285714285714%\"\u003e\n \u003cp\u003e\u003cstrong\u003eWithin\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.142857142857142%\"\u003e\n \u003cp\u003eTime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e24764\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.285714285714286%\"\u003e\n \u003cp\u003e1.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e13202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e62.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"18%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.714285714285714%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.142857142857142%\"\u003e\n \u003cp\u003eGroup by Time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e22138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.285714285714286%\"\u003e\n \u003cp\u003e1.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e11802\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e55.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eSST: Sum of Squares, DF: Degree of Freedom, MS: Mean of Squares.\u003c/p\u003e\n\u003cp\u003e* Mauchly\u0026rsquo;s test is used to test whether or not the assumption of sphericity is met in a repeated measures ANOVA. If the spherisity assumption is rejected, we adjust the degrees of freedom using Greenhouse-Geisser correction in within-subjects effects.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4.\u003c/strong\u003e The results of the repeated measure ANOVA in comparison of the mean scores of stress related to infertility and its dimensions at three time points of before, 1 week, and 5 weeks after intervention in the control and treatment groups.\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"700\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"18%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.142857142857142%\"\u003e\n \u003cp\u003e\u003cstrong\u003eEffect\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.428571428571429%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSource\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.571428571428571%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSST\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u003cstrong\u003eDF*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u003cstrong\u003eF\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e\u003cstrong\u003eEta\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"18%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocial concerns\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.142857142857142%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBetween\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.428571428571429%\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.571428571428571%\"\u003e\n \u003cp\u003e8597.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e8597.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e365.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"18%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.142857142857142%\"\u003e\n \u003cp\u003e\u003cstrong\u003eWithin\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.428571428571429%\"\u003e\n \u003cp\u003eTime\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.571428571428571%\"\u003e\n \u003cp\u003e6774.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e3387.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e149.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"18%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.142857142857142%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.428571428571429%\"\u003e\n \u003cp\u003eGroup by Time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.571428571428571%\"\u003e\n \u003cp\u003e5429.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e2714.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e120.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"18%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSexual concerns\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.142857142857142%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBetween\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.428571428571429%\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.571428571428571%\"\u003e\n \u003cp\u003e7311.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e7311.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e218.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"18%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.142857142857142%\"\u003e\n \u003cp\u003e\u003cstrong\u003eWithin\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.428571428571429%\"\u003e\n \u003cp\u003eTime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.571428571428571%\"\u003e\n \u003cp\u003e4662.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e2331.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e108.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"18%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.142857142857142%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.428571428571429%\"\u003e\n \u003cp\u003eGroup by Time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.571428571428571%\"\u003e\n \u003cp\u003e4153.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e2076.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e96.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"18%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCommunication concerns\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.142857142857142%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBetween\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.428571428571429%\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.571428571428571%\"\u003e\n \u003cp\u003e8748.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e8740.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e357.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"18%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.142857142857142%\"\u003e\n \u003cp\u003e\u003cstrong\u003eWithin\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.428571428571429%\"\u003e\n \u003cp\u003eTime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.571428571428571%\"\u003e\n \u003cp\u003e8205.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e1.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e5159.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e152.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"18%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.142857142857142%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.428571428571429%\"\u003e\n \u003cp\u003eGroup by Time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.571428571428571%\"\u003e\n \u003cp\u003e7277.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e1.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e4575.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e135.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"18%\"\u003e\n \u003cp\u003e\u003cstrong\u003eneed to become parents\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.142857142857142%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBetween\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.428571428571429%\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.571428571428571%\"\u003e\n \u003cp\u003e10372\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e10372\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e410.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"18%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.142857142857142%\"\u003e\n \u003cp\u003e\u003cstrong\u003eWithin\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.428571428571429%\"\u003e\n \u003cp\u003eTime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.571428571428571%\"\u003e\n \u003cp\u003e8793.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e1.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e4929.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e165.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"18%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.142857142857142%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.428571428571429%\"\u003e\n \u003cp\u003eGroup by Time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.571428571428571%\"\u003e\n \u003cp\u003e7795.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e1.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e4370.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e146.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"18%\"\u003e\n \u003cp\u003e\u003cstrong\u003elife without children\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.142857142857142%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBetween\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.428571428571429%\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.571428571428571%\"\u003e\n \u003cp\u003e8070.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e8070.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e179.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"18%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.142857142857142%\"\u003e\n \u003cp\u003e\u003cstrong\u003eWithin\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.428571428571429%\"\u003e\n \u003cp\u003eTime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.571428571428571%\"\u003e\n \u003cp\u003e1830.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e915.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e75.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"18%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.142857142857142%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.428571428571429%\"\u003e\n \u003cp\u003eGroup by Time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.571428571428571%\"\u003e\n \u003cp\u003e1788.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e894.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e74.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"18%\"\u003e\n \u003cp\u003e\u003cstrong\u003eStress related to infertility\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.142857142857142%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBetween\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.428571428571429%\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.571428571428571%\"\u003e\n \u003cp\u003e214775\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e214775\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e452.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"18%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.142857142857142%\"\u003e\n \u003cp\u003e\u003cstrong\u003eWithin\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.428571428571429%\"\u003e\n \u003cp\u003eTime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.571428571428571%\"\u003e\n \u003cp\u003e137719\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e1.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e78075\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e216.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"18%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.142857142857142%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.428571428571429%\"\u003e\n \u003cp\u003eGroup by Time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.571428571428571%\"\u003e\n \u003cp\u003e121167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e1.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e68692\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e190.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.285714285714286%\"\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: SST: Sum of Squares, DF: Degree of Freedom, MS: Mean of Squares.\u003c/p\u003e\n\u003cp\u003e* Mauchly\u0026rsquo;s test is used to test whether or not the assumption of sphericity is met in a repeated measures ANOVA. If the spherisity assumption is rejected, we adjust the degrees of freedom using Greenhouse-Geisser correction in within-subjects effects.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis randomized control trial study aimed to investigate the effect of Whatsapp based sexual counseling using the GES model on the sexual satisfaction and infertility stress in infertile women who referred to infertility centers. The findings suggest that intervention program had a significant effect on management the infertility stress and promoting sexual satisfaction in infertile women.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn the present study, the both intervention and control groups were homogeneous regarding socio-demographic characteristics (age, employment status, education, economic status, and other factors that mentioned in Table 2). The mentioned variables are known as the factors affecting on infertility stress and sexual satisfaction [32-35].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn agreement with our findings, Firoozi \u0026nbsp;et al. revealed that the GES model were effective to promote attitude and sexual satisfaction of infertile women [36]. Jamalifar et al. indicated that GES model is an applicable educational intervention for improving the sexual satisfaction and sexual intimacy in women who suffer from multiple sclerosis [37]. In a study conducted by Yazdani et al was illustrated that counseling based on sexual self-concept trough social networks on smartphone in infertile women was effective in improving the sexual self-concept and promotion the couples \u0026apos;sexual relations [13]. Another study administered in Netherlands indicated that the internet-based sex education program consisted of psychosexual education, couple relationship, mindfulness and sensate focus practices was suitable method for enhancement the sexual functioning and even elevated pregnancy chances [38]. Sexual interventions trough internet had effective impact on sexual functioning during the intervention and several months after completing the intervention program [22]. Hucker et al demonstrated online, mindfulness-based, cognitive-behavioral therapy for female with sexual disorders and relationship functioning had significant impact on promotion sexual and emotional intimacy[39]. Infertility and its related treatments had adversely influenced on self-esteem, self-image, sexual relationship and couple intimacy[40].\u0026nbsp;Although the challenges caused by infertility have a negative effect on both men and women, women are more affected by this problem than men\u0026nbsp;[41]. Studies conducted in Iran shows that infertile women face social and self-stigma which threatens their psychosocial wellbeing, self-esteem and also it is associated with the feeling of shame and secrecy [42, 43].\u0026nbsp;A phenomenological study about life experience with infertility by Khodakarami showed that infertility, affects the sexual relationships and emotional status in infertile couples[44].\u003c/p\u003e\n\u003cp\u003eCouples often have trouble in expressing sexual issues with others, because of feeling of shame and guilty due to considering such issues as taboo in Iran,\u0026nbsp;consequently\u0026nbsp;being deprived of face-to-face counseling services [18, 19].\u0026nbsp;Therefore it is important to conduct counseling sessions where the clients feel more comfortable [45].\u0026nbsp;So\u0026nbsp;whatsapp\u0026nbsp;based \u0026nbsp;consultation in the present study created an opportunity for participants, remain anonymous, find a safe atmosphere, feel more freedom to express their\u0026nbsp;biological requirements and sexual satisfaction, emphasis on fears, beliefs, disgust, shame and negative attitudes as the threatening and obstacles for sexual relationship and all\u0026nbsp;face to face unspoken words.\u0026nbsp;\u0026nbsp;This kind of counseling not only is provided greater access to the researcher and the participants anywhere and anytime, but also participants could express\u0026nbsp;their attitudes\u0026nbsp;without feeling shame from sexual issues [46].\u003c/p\u003e\n\u003cp\u003eThrough whatsapp\u0026nbsp;based GES model approach consoler were struggling to encourage the participants to reach a better interaction in sexual relationship and change their sex life, improve personal interactions and focus on quality of the relation and create a new constructive and enjoyable experiences in order to decrease the stress caused by high expectations in sexual functioning.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe GES model tried to provide a platform for the women to learn\u0026nbsp;cooperation in daily life, resolve the interactive differences;\u0026nbsp;respect the different ways of men and women intimacy achievement,\u0026nbsp;individual responsibility for honestly acceptance of\u0026nbsp;a body image as the\u0026nbsp;ways for obtaining the intimacy as a main clue to reach sexual satisfaction. This interventional program attempted to conceive them that the all over- emphasizing social media to\u0026nbsp;images and myths about beauty is for marketing purposes.\u003c/p\u003e\n\u003cp\u003eThrough this virtual consultation, participants were motivated to\u0026nbsp;notice that good physical health and healthy behavioral habits are vital for sexual health, so they motivated to persuade that healthy behaviors (e.g. adequate sleep, exercise, eating, and moderate drinking) as an important dimension of continuing sexual functioning. So for creating\u0026nbsp;a unique sexual experience for couples\u0026nbsp;they should keep in their mind that sex is integrated into the couple\u0026apos;s daily life and daily life is integrated into their sex life. The intervention program emphasized living daily life well with its responsibilities, stresses, and conflicts, provides the opportunity to experience sexual interactions in a subtle yet distinctively personalized and enriched way.\u003c/p\u003e\n\u003cp\u003eIntervention highlighted that adjusting expectation and expressing mutual emotions, concentrating on mind and body to obtain the calmness as the clue factor to reach high intimacy.\u0026nbsp; \u0026nbsp;Also educations to enhance sexual satisfaction through accepting the requests and understanding differences and mutual respect for partners in order to moderate individual\u0026rsquo;s expectations to a rational and reasonable level were provided.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBy designing a sexual relationship scenario through GES model researcher tried to consider that sex at times is experienced as pleasure, stress relief, mature playfulness, and on another occasion as a spiritual union; \u0026nbsp;so for being intimate, \u0026nbsp;couples should \u0026nbsp;value multiple purposes for sex.\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eIn group discussion and privet consultation through whatsapp, participants with sharing their experiences emphasized that the quality of sex varies from day to day and from very good to mediocre or even dysfunctional\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e So they recognized that such reasonable expectations are an important feature of sexual satisfaction as well as to be released the couple from disappointment and sexual problems in the future. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSuggestions\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere is a huge amount of nonscientific information through virtual invalid resources is receiving by patients that reliability of them is doubtful. So it seems health policy makers should be persuade to produce the educational packages based on reliable scientific texts regarding infertility and unsolved sexual complication and related stresses, \u0026nbsp; especially in the cultures that some of the life realties like sexual issues are considered to be taboos.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStrengths and Limitations:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ewhatsapp -based intervention\u0026nbsp;provided greater access to the counselor and participants anywhere and anytime. This way of counseling was also more economical, and participants could express openly\u0026nbsp;about the worries and concerns without feeling shame especially\u0026nbsp;regarding the subjects like sexual issues which are consider as a taboo in some cultures.\u003c/p\u003e\n\u003cp\u003eHaving similar characteristics in distributed women at base line in both\u0026nbsp;control and intervention groups would minimize intervention bias that could result from differences in baseline provider confidence and preparedness.\u003c/p\u003e\n\u003cp\u003eA limitation of the study is that the participants were educated, impacting generalizability of findings to illiterate women.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eSince whatsapp based GES sex model intervention had significant effect on infertility stress and sexual satisfaction. Therefore, it is recommended to be considered as one of the practical plans in the process of treatment and counseling of infertility.\u003c/p\u003e \u003cp\u003eIn addition during the COVID-19 pandemic and banning the gatherings and laws based on reducing traffic, which led to limited access to medical and counseling services, the present study provided an opportunity to pay attention the sexual issues. So participants could access to appropriate consultation for empowering themselves to reduce infertility stress and obtain sexual satisfaction as their human rights.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eGES model\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGES Good Enough Sex Model\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study obtained the approval from the Research Ethics Committee of Urmia University of Medical Sciences, Iran (approval No. IR.UMSU.REC.1400.247). All the participants signed written informed consent for their participation in the study. All procedures were performed in accordance with relevant guidelines.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no relevant financial or nonfinancial relationships to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported a grant from the Urmia University of Medical Sciences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eF.M.T contributed to the conception and design of this study, conducted the whole study process and participated in the writing of this manuscript. M.H Contributed to designing the study and critically reviewed the manuscript. \u0026nbsp;SH.E.B Performed data collection and data analysis led the drafting of this manuscript. \u0026nbsp; R.G Conducted statistical analysis and participated in a revision of this manuscript. All the authors reviewed and confirmed the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis article is derived from a master thesis in midwifery counsultation. The authors would like to thank the honorable Research Vice President of Urmia University of Medical Sciences, and all participants for their cooperation in this study.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eOrganization WH: \u003cstrong\u003eWHO fact sheet on infertility\u003c/strong\u003e. In\u003cem\u003e.\u003c/em\u003e, vol. 6: LWW; 2021: e52.\u003c/li\u003e\n\u003cli\u003eDeshpande PS, Gupta AS: \u003cstrong\u003eCauses and prevalence of factors causing infertility in a public health facility\u003c/strong\u003e. \u003cem\u003eJournal of human reproductive sciences \u003c/em\u003e2019, \u003cstrong\u003e12\u003c/strong\u003e(4):287.\u003c/li\u003e\n\u003cli\u003eSun H, Gong T-T, Jiang Y-T, Zhang S, Zhao Y-H, Wu Q-J: \u003cstrong\u003eGlobal, regional, and national prevalence and disability-adjusted life-years for infertility in 195 countries and territories, 1990\u0026ndash;2017: results from a global burden of disease study, 2017\u003c/strong\u003e. \u003cem\u003eAging (Albany NY) \u003c/em\u003e2019, \u003cstrong\u003e11\u003c/strong\u003e(23):10952.\u003c/li\u003e\n\u003cli\u003eAkhondi MM, Ranjbar F, Shirzad M, Ardakani ZB, Kamali K, Mohammad K: \u003cstrong\u003ePractical difficulties in estimating the prevalence of primary infertility in Iran\u003c/strong\u003e. \u003cem\u003eInternational journal of fertility \u0026amp; sterility \u003c/em\u003e2019, \u003cstrong\u003e13\u003c/strong\u003e(2):113.\u003c/li\u003e\n\u003cli\u003eParsanezhad ME, Jahromi BN, Zare N, Keramati P, Khalili A, Parsa-Nezhad M: \u003cstrong\u003eEpidemiology and etiology of infertility in Iran, systematic review and meta-analysis\u003c/strong\u003e. \u003cem\u003eJ Womens Health, Issues Care \u003c/em\u003e2013, \u003cstrong\u003e2\u003c/strong\u003e(6):2.\u003c/li\u003e\n\u003cli\u003eZayed AA, El-Hadidy MA: \u003cstrong\u003eSexual satisfaction and self-esteem in women with primary infertility\u003c/strong\u003e. \u003cem\u003eMiddle East Fertility Society Journal \u003c/em\u003e2020, \u003cstrong\u003e25\u003c/strong\u003e(1):1-5.\u003c/li\u003e\n\u003cli\u003eSaleem S, Shaheen A, Jabeen A, Mahmood Z: \u003cstrong\u003ePsychosocial Issues in Women with Primary Infertility: A Psychometric Study\u003c/strong\u003e. \u003cem\u003eAnnals of King Edward Medical University \u003c/em\u003e2021, \u003cstrong\u003e27\u003c/strong\u003e(1):37-42.\u003c/li\u003e\n\u003cli\u003eArab-Sheybani K, Janbozorgi M, Akyuz A: \u003cstrong\u003eAdmissibility investigation and validation of infertility distress scale (IDS) in Iranian infertile women\u003c/strong\u003e. \u003cem\u003eInternational Journal of Fertility \u0026amp; Sterility \u003c/em\u003e2012, \u003cstrong\u003e6\u003c/strong\u003e(1):37.\u003c/li\u003e\n\u003cli\u003eWoods BM, Patrician PA, Fazeli PL, Ladores S: \u003cstrong\u003eInfertility\u003c/strong\u003e\u003cstrong\u003e‐\u003c/strong\u003e\u003cstrong\u003erelated stress: A concept analysis\u003c/strong\u003e. In: \u003cem\u003eNursing Forum: 2022\u003c/em\u003e: Wiley Online Library; 2022: 437-445.\u003c/li\u003e\n\u003cli\u003eAshrafi M, Jahangiri N, Jahanian Sadatmahalleh S, Mirzaei N, Gharagozloo Hesari N, Rostami F, Mousavi SS, Zeinaloo M: \u003cstrong\u003eDoes prevalence of sexual dysfunction differ among the most common causes of infertility? A cross-sectional study\u003c/strong\u003e. \u003cem\u003eBMC Women\u0026apos;s Health \u003c/em\u003e2022, \u003cstrong\u003e22\u003c/strong\u003e(1):1-8.\u003c/li\u003e\n\u003cli\u003eAmiri SE, Brassard A, Rosen NO, Rossi MA, Beaulieu N, Bergeron S, P\u0026eacute;loquin K: \u003cstrong\u003eSexual function and satisfaction in couples with infertility: A closer look at the role of personal and relational characteristics\u003c/strong\u003e. \u003cem\u003eThe journal of sexual medicine \u003c/em\u003e2021, \u003cstrong\u003e18\u003c/strong\u003e(12):1984-1997.\u003c/li\u003e\n\u003cli\u003eHa J-Y, Park H-J, Ban S-H: \u003cstrong\u003eEfficacy of psychosocial interventions for pregnancy rates of infertile women undergoing in vitro fertilization: a systematic review and meta-analysis\u003c/strong\u003e. \u003cem\u003eJournal of Psychosomatic Obstetrics \u0026amp; Gynecology \u003c/em\u003e2023, \u003cstrong\u003e44\u003c/strong\u003e(1):2142777.\u003c/li\u003e\n\u003cli\u003eYazdani M, Mahmoodi Z, Azin SA, Qorbani M: \u003cstrong\u003eThe effect of counseling based on sexual self-concept via social networks on smartphone in infertile women: a randomized controlled trial\u003c/strong\u003e. \u003cem\u003eInternational Journal of Community Based Nursing and Midwifery \u003c/em\u003e2019, \u003cstrong\u003e7\u003c/strong\u003e(3):231.\u003c/li\u003e\n\u003cli\u003eKarakas S, Aslan E: \u003cstrong\u003eSexual counseling in women with primary infertility and sexual dysfunction: Use of the BETTER model\u003c/strong\u003e. \u003cem\u003eJournal of sex \u0026amp; marital therapy \u003c/em\u003e2019, \u003cstrong\u003e45\u003c/strong\u003e(1):21-30.\u003c/li\u003e\n\u003cli\u003eDastaran F, Maasoumi R, Foroozanfard F, Haghani S: \u003cstrong\u003eThe Effect of BETTER-Based Sex Counseling on Sexual Quality of Life in Infertile Women: a Randomized Controlled Clinical Trial\u003c/strong\u003e. \u003cem\u003eSexuality and Disability \u003c/em\u003e2022, \u003cstrong\u003e40\u003c/strong\u003e(4):785-806.\u003c/li\u003e\n\u003cli\u003eSahraeian M, Lotfi R, Qorbani M, Faramarzi M, Dinpajooh F, Ramezani Tehrani F: \u003cstrong\u003eThe effect of Cognitive Behavioral Therapy on sexual function in infertile women: A randomized controlled clinical trial\u003c/strong\u003e. \u003cem\u003eJournal of sex \u0026amp; marital therapy \u003c/em\u003e2019, \u003cstrong\u003e45\u003c/strong\u003e(7):574-584.\u003c/li\u003e\n\u003cli\u003eMetz ME, McCarthy BW: \u003cstrong\u003eThe \u0026ldquo;Good-Enough Sex\u0026rdquo; model for couple sexual satisfaction\u003c/strong\u003e. \u003cem\u003eSexual and Relationship Therapy \u003c/em\u003e2007, \u003cstrong\u003e22\u003c/strong\u003e(3):351-362.\u003c/li\u003e\n\u003cli\u003eMotamedi M, Shahbazi M, Merghati-Khoei E, Salehi M, Hajebi A, Rahimi-Naghani S, Shah S, Kamali K, Khalajabadi-Farahani F: \u003cstrong\u003ePerceived Barriers to Implementing Sexual Health Programs from the Viewpoint of Health Policymakers in Iran: A Qualitative Study\u003c/strong\u003e. \u003cem\u003eSexuality Research and Social Policy \u003c/em\u003e2022, \u003cstrong\u003e19\u003c/strong\u003e(1):273-285.\u003c/li\u003e\n\u003cli\u003eJanghorban R, Latifnejad Roudsari R, Taghipour A, Abbasi M, Lottes I: \u003cstrong\u003eThe shadow of silence on the sexual rights of married Iranian women\u003c/strong\u003e. \u003cem\u003eBioMed research international \u003c/em\u003e2015, \u003cstrong\u003e2015\u003c/strong\u003e.\u003c/li\u003e\n\u003cli\u003eFried ST, Espinoza-Kim A: \u003cstrong\u003eSexual health and sexual rights\u003c/strong\u003e. \u003cem\u003eInternational human rights of women \u003c/em\u003e2019:285-304.\u003c/li\u003e\n\u003cli\u003eMofid V, Fatehi Zadeh M, Ahmadi A, Etemadi O: \u003cstrong\u003eThe effect of solution-focused counseling on sexual satisfaction and family function among women in isfahan\u003c/strong\u003e. \u003cem\u003eKnowledge \u0026amp; Research in Applied Psychology \u003c/em\u003e2017, \u003cstrong\u003e17\u003c/strong\u003e(3):73-80.\u003c/li\u003e\n\u003cli\u003evan Lankveld J: \u003cstrong\u003eInternet-based interventions for women\u0026rsquo;s sexual dysfunction\u003c/strong\u003e. \u003cem\u003eCurrent sexual health reports \u003c/em\u003e2016, \u003cstrong\u003e8\u003c/strong\u003e(3):136-143.\u003c/li\u003e\n\u003cli\u003eGoldberg LR: \u003cstrong\u003eThe development of markers for the Big-Five factor structure\u003c/strong\u003e. \u003cem\u003ePsychological assessment \u003c/em\u003e1992, \u003cstrong\u003e4\u003c/strong\u003e(1):26.\u003c/li\u003e\n\u003cli\u003eMoreta-Herrera R, Dominguez-Lara S, Vaca-Quintana D, Zambrano-Estrella J, Gavilanes-G\u0026oacute;mez D, Ruperti-Lucero E, Bonilla D: \u003cstrong\u003ePsychometric properties of the General Health Questionnaire (GHQ-28) in Ecuadorian college students\u003c/strong\u003e. \u003cem\u003ePsihologijske teme \u003c/em\u003e2021, \u003cstrong\u003e30\u003c/strong\u003e(3):573-590.\u003c/li\u003e\n\u003cli\u003eNourbala AA, Bagheri YS, Mohammad K: \u003cstrong\u003eThe validation of general health questionnaire-28 as a psychiatric screening tool\u003c/strong\u003e. 2009.\u003c/li\u003e\n\u003cli\u003eLarson JH, Anderson SM, Holman TB, Niemann BK: \u003cstrong\u003eA longitudinal study of the effects of premarital communication, relationship stability, and self-esteem on sexual satisfaction in the first year of marriage\u003c/strong\u003e. \u003cem\u003eJournal of sex \u0026amp; marital therapy \u003c/em\u003e1998, \u003cstrong\u003e24\u003c/strong\u003e(3):193-206.\u003c/li\u003e\n\u003cli\u003eBahrami N, Yaghoobzadeh A, Sharif Nia H, Soliemani M, Haghdoost A: \u003cstrong\u003ePsychometric properties of the Persian version of Larsons sexual satisfaction questionnaire in a sample of Iranian infertile couples\u003c/strong\u003e. \u003cem\u003eIranian Journal of Epidemiology \u003c/em\u003e2016, \u003cstrong\u003e12\u003c/strong\u003e(2):18-31.\u003c/li\u003e\n\u003cli\u003eAfzali M, Khani S, Hamzehgardeshi Z, Mohammadpour R-A, Elyasi F: \u003cstrong\u003eInvestigation of the social determinants of sexual satisfaction in Iranian women\u003c/strong\u003e. \u003cem\u003eSexual medicine \u003c/em\u003e2020, \u003cstrong\u003e8\u003c/strong\u003e(2):290-296.\u003c/li\u003e\n\u003cli\u003eBahrami N, Yaghoob Zadeh A, Sharif Nia H, Soliemani MA, Haghdoost AA: \u003cstrong\u003eValidity and reliability of the persian version of Larson sexual satisfaction questionnaire in couples\u003c/strong\u003e. \u003cem\u003eJournal of Kerman University of Medical Sciences \u003c/em\u003e2016, \u003cstrong\u003e23\u003c/strong\u003e(3):344-356.\u003c/li\u003e\n\u003cli\u003eNewton CR, Sherrard W, Glavac I: \u003cstrong\u003eThe Fertility Problem Inventory: measuring perceived infertility-related stress\u003c/strong\u003e. \u003cem\u003eFertility and sterility \u003c/em\u003e1999, \u003cstrong\u003e72\u003c/strong\u003e(1):54-62.\u003c/li\u003e\n\u003cli\u003eAlizadeh T, Farahani MN, Shahraray M, Alizadegan S: \u003cstrong\u003eThe relationship between self esteem and locus of control with infertility related stress of no related infertile men and women\u003c/strong\u003e. \u003cem\u003eJournal of Reproduction \u0026amp; Infertility \u003c/em\u003e2005, \u003cstrong\u003e6\u003c/strong\u003e(2).\u003c/li\u003e\n\u003cli\u003eRoyani Z, Heidari M, Vatanparast M, Yaghmaei F, Sarcheshme AK, Majomerd JK: \u003cstrong\u003ePredictors of quality of life in infertile couples\u003c/strong\u003e. \u003cem\u003eJournal of Menopausal Medicine \u003c/em\u003e2019, \u003cstrong\u003e25\u003c/strong\u003e(1):35-40.\u003c/li\u003e\n\u003cli\u003eMahadeen AI, Hamdan-Mansour AM, Habashneh SA, Dardas LA: \u003cstrong\u003eSexual satisfaction among infertile couples: demographics and psychosocial health factors\u003c/strong\u003e. \u003cem\u003eJournal of Psychosocial Nursing and Mental Health Services \u003c/em\u003e2020, \u003cstrong\u003e58\u003c/strong\u003e(9):40-47.\u003c/li\u003e\n\u003cli\u003eSohbati F, Hasanpoor-Azghady SB, Jafarabadi M, Amiri-Farahani L, Mohebbi M: \u003cstrong\u003ePsychological well-being of infertile women and its relationship with demographic factors and fertility history: a cross-sectional study\u003c/strong\u003e. \u003cem\u003eBMC Women\u0026apos;s Health \u003c/em\u003e2021, \u003cstrong\u003e21\u003c/strong\u003e(1):1-7.\u003c/li\u003e\n\u003cli\u003eAba A, Kofi A, Kwasi B, Peter T, Perditer O: \u003cstrong\u003eKnowledge, Attitudes and Socio-Demographic Factors Associated with Males\u0026rsquo; Involvement in Fertility Treatment in Ghana\u003c/strong\u003e. \u003cem\u003eJ Women\u0026apos;s Health Care \u003c/em\u003e2021, \u003cstrong\u003e10\u003c/strong\u003e(522):2167-0420.2121.\u003c/li\u003e\n\u003cli\u003eFiroozi A, Lotfikashani F, Vaziri S: \u003cstrong\u003eEffectiveness of Narrative Therapy and Good Enough Sex Model on sexual attitude and sexual satisfaction in married infertile couples\u003c/strong\u003e. \u003cem\u003ePayesh (Health Monitor)\u003c/em\u003e:0-0.\u003c/li\u003e\n\u003cli\u003eJamalianfar F, Riazi H, Firoozi A, Nasiri M, Montazeri A: \u003cstrong\u003eThe Effectiveness of \u0026lsquo;Good-Enough Sex Model\u0026rsquo;on Sexual Satisfaction and Sexual Intimacy in Women with Multiple Sclerosis: A Randomized Trail\u003c/strong\u003e. \u003cem\u003eSexuality and Disability \u003c/em\u003e2021, \u003cstrong\u003e39\u003c/strong\u003e(3):507-519.\u003c/li\u003e\n\u003cli\u003eDreischor F, Laan E, Apers S, Repping S, van Lunsen R, Lambalk C, D\u0026rsquo;Hooghe T, Goddijn M, Custers I, Dancet E: \u003cstrong\u003eThe stepwise development of an interactive web-based sex education programme for subfertile couples: the Pleasure \u0026amp; Pregnancy programme\u003c/strong\u003e. \u003cem\u003eHuman Reproduction \u003c/em\u003e2020, \u003cstrong\u003e35\u003c/strong\u003e(8):1839-1854.\u003c/li\u003e\n\u003cli\u003eHucker A, McCabe MP: \u003cstrong\u003eAn online, mindfulness-based, cognitive-behavioral therapy for female sexual difficulties: impact on relationship functioning\u003c/strong\u003e. \u003cem\u003eJournal of sex \u0026amp; marital therapy \u003c/em\u003e2014, \u003cstrong\u003e40\u003c/strong\u003e(6):561-576.\u003c/li\u003e\n\u003cli\u003eDadkhah S, Jarareh J, Akbari Asbagh F: \u003cstrong\u003eThe relationships between self-compassion, positive and negative affect, and marital quality in infertile women: a systematic review and meta-analysis\u003c/strong\u003e. \u003cem\u003eIranian Rehabilitation Journal \u003c/em\u003e2021, \u003cstrong\u003e19\u003c/strong\u003e(1):1-12.\u003c/li\u003e\n\u003cli\u003eHasanpoor-Azghady SB, Simbar M, Vedadhir AA, Azin SA, Amiri-Farahani L: \u003cstrong\u003eThe social construction of infertility among Iranian infertile women: a qualitative study\u003c/strong\u003e. \u003cem\u003eJournal of reproduction \u0026amp; infertility \u003c/em\u003e2019, \u003cstrong\u003e20\u003c/strong\u003e(3):178.\u003c/li\u003e\n\u003cli\u003eTaebi M, Kariman N, Montazeri A, Majd HA: \u003cstrong\u003eInfertility stigma: A qualitative study on feelings and experiences of infertile women\u003c/strong\u003e. \u003cem\u003eInternational Journal of Fertility \u0026amp; Sterility \u003c/em\u003e2021, \u003cstrong\u003e15\u003c/strong\u003e(3):189.\u003c/li\u003e\n\u003cli\u003eFahami F, Quchani SH, Ehsanpour S, Boroujeni AZ: \u003cstrong\u003eLived experience of infertile men with male infertility cause\u003c/strong\u003e. \u003cem\u003eIranian journal of nursing and midwifery research \u003c/em\u003e2010, \u003cstrong\u003e15\u003c/strong\u003e(Suppl1):265.\u003c/li\u003e\n\u003cli\u003eKhodakarami N, Hashemi S, Seddigh S, Hamdiyeh M, Taheripanah R: \u003cstrong\u003eLife experience with infertility; a phenomenological study\u003c/strong\u003e. \u003cem\u003eJournal of Reproduction \u0026amp; Infertility \u003c/em\u003e2010, \u003cstrong\u003e10\u003c/strong\u003e(4).\u003c/li\u003e\n\u003cli\u003eSadock BJ: \u003cstrong\u003eKaplan \u0026amp; Sadock\u0026apos;s synopsis of psychiatry: behavioral sciences/clinical psychiatry\u003c/strong\u003e. 2007.\u003c/li\u003e\n\u003cli\u003eGibson K, Cartwright C: \u003cstrong\u003eYoung people\u0026apos;s experiences of mobile phone text counselling: Balancing connection and control\u003c/strong\u003e. \u003cem\u003eChildren and youth services review \u003c/em\u003e2014, \u003cstrong\u003e43\u003c/strong\u003e:96-104.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Good Enough Sex Model, Consultation, Whatsapp, Infertility Stress, Sexual Satisfaction, Infertility.","lastPublishedDoi":"10.21203/rs.3.rs-2416471/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2416471/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\n\u003cp\u003eInfertility is associated with the reduction of sexual activity and always there is a relationship between infertility and sexual dysfunction. Infertility stress refers to a group of symptoms that appear following infertility diagnosis; these symptoms are similar to those of post-traumatic stress disorder and are specifically evident in the beliefs and feelings associated with infertility. The present study aimed to determine the effect of whatsapp based good enough sex consultation on infertility stress and sexual satisfaction in infertile women who applied for infertility treatment in a randomized control trial.\u003c/p\u003e\n\u003ch2\u003eMethods\u003c/h2\u003e\n\u003cp\u003eThis is a double-blinded, randomized controlled trial in which a total of 100 infertile women were recruited using convenience sampling and then randomly assigned to two groups of whatsapp based GES model consultation and routine care. Data collection tools consisted of a demographic, the Larson's Sexual Satisfaction and Newton Infertility Stress questionnairs. In the pretest stage, participants in both groups completed the above questionnaires before the intervention. Participants in the intervention group were given access to the 6-week GES model consultation program. The program consisted of six consultation and assignments packages, regarding all 12 dimensions of GES model. Then participants re-completed questionnaires immediately and one month after the intervention. Data were analyzed with SPSS software version 20 using chi-squared test, independent-samples t-test, and repeated measures Analysis of Variance. The significance level (p-value) was considered to be less than 0.05.\u003c/p\u003e\n\u003ch2\u003eResults\u003c/h2\u003e\n\u003cp\u003eThe results of rANOVA indicated that there was a significant difference in the mean scores of sexual satisfaction (with its all dimensions: desire to have sex, sexual adjustment, quality of sexual life, sexual attitude) and infertility stress (and it's all dimensions: social concern, sexual concern, relationship concern, need for parenthood, life without children) between the two groups from pre- to post-intervention, and then over the one month follow-up period in the intervention group, while scores of control participants did not show this pattern during the study (\u003cem\u003ep ˂ 0.001\u003c/em\u003e). Considering the partial Eta squared, the effect of intervention had the highest interaction effect on both variables of sexual satisfaction (\u003cem\u003eη2\u003c/em\u003e = \u003cem\u003e0.52)\u003c/em\u003e and infertility stress (\u003cem\u003eη2\u003c/em\u003e = \u003cem\u003e0.82\u003c/em\u003e).\u003c/p\u003e\n\u003ch2\u003eConclusions\u003c/h2\u003e\n\u003cp\u003eSince whatsapp based GES sex model intervention had significant effect on infertility stress and sexual satisfaction. Therefore, it is recommended to be considered as one of the practical plans in the process of treatment and counseling of infertility.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration number: \u003c/strong\u003eIRCT20210926052593N1,\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe date of registration: \u003c/strong\u003e13-10-2021.\u003c/p\u003e","manuscriptTitle":"Effect of Whatsapp Based Good Enough Sex Consultation on Infertility Stress and Sexual Satisfaction in Iranian Women Who Applied for Infertility Treatment: A Randomized Control Trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-01-11 15:41:57","doi":"10.21203/rs.3.rs-2416471/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b8d618ac-e22e-47df-b866-86a088ca2882","owner":[],"postedDate":"January 11th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-05-31T06:45:09+00:00","versionOfRecord":[],"versionCreatedAt":"2023-01-11 15:41:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2416471","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2416471","identity":"rs-2416471","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}