Perception of Assisted Reproductive Technology Among Infertile Married Couples and Stress Faced due to Infertility in Pakistan: A Cross-Sectional Study

Perception of Assisted Reproductive Technology Among Infertile Married Couples and Stress Faced due to Infertility in Pakistan: A Cross-Sectional Study | 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 Perception of Assisted Reproductive Technology Among Infertile Married Couples and Stress Faced due to Infertility in Pakistan: A Cross-Sectional Study Wajeeha Ali, Faiqa Imran, Muhammad Amir Hamza, Faizur Rehman, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7284839/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 18 Nov, 2025 Read the published version in Discover Public Health → Version 1 posted 14 You are reading this latest preprint version Abstract Introduction: Infertility, characterized by being unable to become pregnant after one year of sexual activity without protection (or six months for women over 35 due to age-related fertility decline), is a worldwide problem with serious psychological, social, marital, and individual consequences. By allowing couples to conceive biologically related children, assisted reproductive technologies, or ARTs, give them new hope. However, cultural differences exist in how ART and infertility are seen and dealt with. The purpose of this study is to investigate the psychological strain that infertile couples endure as well as the societal obstacles that prevent them from seeking ART. Methodology: A cross-sectional observational research was carried out between January 1 and March 31, 2025. Data were gathered from patients at Islamabad and Rawalpindi's infertility clinics and PIMS Hospital using a pre-validated self-administered questionnaire. 380 people were recruited through convenience sample technique. SPSS version 27.0 New York, United States, were used to analyze the data and find correlations. Chi-square tests and descriptive statistics were employed for deeper analysis Results: Among the 380 participants, women made up 69.5%. 35 to 45 years old made up the largest age group (49.5%), followed by 25 to 35 years old (39.5%). Level of education varied, with 46.8% finishing matriculation and 40.5% having graduate degrees. Infertility-related emotional suffering was extensively observed: 49.7% reported sleep difficulties, 44.7% expressed regular melancholy, and 43.7% experienced frequent exclusion from family gatherings. Furthermore, 41.1% reported having been the victim of physical or psychological abuse, and 47.4% felt inferior to others. In the 35–45 age range, stress was most common, with 50% reporting frequent exclusion and 47.9% reporting sleep disturbances. Stress was found to be significantly correlated with age (p = 0.0355). A substantial association was found between work status and stress markers, which were particularly common among housewives and those without employment. Conclusion: Stress related to infertility peaks in midlife, particularly for housewives and jobless people. These results emphasize the necessity of focused interventions and psychological support for impacted couples, particularly those pursuing ART and any infertility management treatment. Trial Registration Not Applicable ART Perception Stress Management Couples Mental Health Perceived Stress among Couples Coping with Stress through ART intervention Marital Relationship Stress therapy by ART Introduction Infertility is a critical medical, social, and public health issue that affects a couple's psychological well-being, social functioning, and physical health, particularly for women (Tabassum, Sadia, Huda, & Khan, 2023 ). Infertility is a reproductive health condition that is defined by the World Health Organization as the inability to conceive or carry a pregnancy to term with regular sexual activity("WHO. (2022)," 2022).There are two different kinds of infertility: primary infertility, which refers to couples who never achieved pregnancy, and secondary infertility, which occurs when the couple does not obtain conception after losing one pregnancy (Organization, 2023 ). In the year 2002, the WHO estimated that infertility affected within 80 million people globally. It affects 10–15% of couples during their lives. The overall incidence of infertility is major (up to 21.9), with primary infertility at 3.5% and secondary infertility at 18.4%. It is widely recognized that infertility rates are incorrectly estimated (Hazlina, Norhayati, Bahari, & Arif, 2022 ; Saif, Rohail, & Aqeel, 2021 ). Based on estimates, 48 million married people and 186 million people globally suffer with infertility(Hazlina et al., 2022 ). The factors might impede the measuring of the prevalence, inadequate measurement techniques, and unknown types of infertility stemming from cultural biased (Javaid et al., 2022 ). Primary infertility refers to women who have never conceived. Secondary infertility occurs when at least one conception fails to reoccur. According to estimates, 60 to 80 million couples worldwide are affected by this issue, with 1–8% suffering from original infertility and 35% from secondary infertility. Obviously, one out of every six couples will have infertility at their reproductive age (Warner, Jamieson, & Barfield, 2015 ). Female infertility as frequently referred to as "female factor" infertility, is the cause underlying infertility identified in a female spouse. It is a frequent condition, with 10 out of every 100 ladies worldwide experiencing it. A large number of couples have a known explanation for their infertility, while the remainder have unexplained fertility (Patel, Sharma, Kumar, & Binu, 2018 ). Female spouses account for 40–55% of infertility cases, whereas male partners accounted for 20–40% in Pakistan infertility is a severe and growing issue (Mohamed et al., 2024 ). Despite becoming one of the most populated countries, with a population growth rate of over 2%, Pakistan has a staggering 21.9% infertility prevalence.18.4% is attributable to secondary infertility and 3.5% to primary infertility, implying that about one out of every five married couples is afflicted. This high percentage of subfertility underlines the crucial need for access to reproductive healthcare services (Ateeb et al., 2023 ). Infertility is not limited to a medical problem; it is also a complicated sociocultural dilemma, particularly in low-income areas. In nations like as Pakistan, women suffering from infertility face cultural humiliation, in-law pressure, marital strife, and even divorce. As a result, infertility must be handled as a complex health problem, with implications for human rights, societal well-being, and public health (Appiah & Ganle, 2024 ; Ateeb et al., 2023 ). Understanding the causes and effects of infertility is critical for encouraging healthier lives and decreasing its social and psychological burden, particularly in resource-constrained contexts where knowledge and medical care are few. Infertility has a substantial psychological impact on couples, with women frequently enduring more severe emotional pain than males (Anaman-Torgbor et al., 2021 ). According to studies, women suffering infertility are more likely to suffer from psychological conditions such as despair and anxiety, which can have an impact on all areas of their well-being—emotional, spiritual, sex-related and physical. Common emotional reactions include inadequate self-worth, guilt, loneliness, and social isolation. According to research, up to half of all women have mild to severe depression, with 17% experiencing significant depression (Cui, Wang, & Wang, 2021 ). Anxiety affects approximately 14.7 percent of infertile women and 4.5% of males as well (Dourou et al., 2023 ). Infertility is no longer seen as an incurable illness, despite its emotional and societal effects. Today, depending on the underlying reason, a variety of therapeutic options are accessible, such as hormone therapy, medication, and surgery, thanks to breakthroughs in medical research. When traditional approaches don't work, assisted reproductive technology has become a practical and efficient answer. ART comprises a number of methods that have shown great promise in enhancing fertility outcomes, including embryo transfer, intracytoplasmic sperm injection (ICSI), and in vitro fertilization (IVF) (Ullah et al., 2021 ). Assisted reproductive techniques (ARTs) have transformed the landscape of infertility treatment, offering hope to childless couples. However, the perception of ART among couples is frequently nuanced and highly impacted by cultural, emotional, and societal variables (Whittaker, Gerrits, Hammarberg, & Manderson, 2024 ). Although many see ART as a miraculous treatment that restores their desire for biological motherhood, others are hesitant because of moral, religious, or cultural issues. For many couples, especially in conservative nations, the thought of conception occurring outside the body violates conventional reproductive beliefs (Fiebai & Ikimalo, 2019 ; Hammond & Hamidi, 2025 ). Another highly polarizing topic is the validity of children created by ART using donor gametes, which sometimes results in social shame or family disagreements. These beliefs can influence whether couples seek or avoid therapy, regardless of medical availability. Additionally, the emotional journey of going through ART is filled with uncertainties and psychological stress (Gerrits, 2016 ). Among numerous couples, the ART process can strain their relationship by revealing gender differences in emotional reaction and societal criticism. While ART provides a solution to infertility, the psychological and social ramifications must be understood in order to give total support to couples navigating this challenging rout (Johnson-Ekeleba, Sefogah, Swarray-Deen, & Mumuni, 2024 ). The emotional and psychological strains connected to infertility and its treatment are frequently ignored, even though ART is becoming more widely available worldwide. During therapy, couples receiving ART may struggle with anxiety, melancholy, loneliness, and fear of failing(Truong et al., 2022 ). Infertility is a profoundly embedded sociocultural problem in addition to a medical one, particularly in traditional countries where having children is strongly associated with marital satisfaction, social standing, and family heritage. Infertile couples, especially women, face shame, social marginalization, and emotional suffering in nations like Pakistan where fertility is frequently seen as a fundamental aspect of femininity (Paraskevi, Antigoni, & Kleanthi, 2021 ). Depression, despair, conflict between spouses, and even assault in the home are examples of the emotional toll. The cultural need to carry on the family line and societal expectations of virility also cause psychological distress in men, despite the fact that they are less commonly studied. Research has demonstrated that stress due to infertility is a common occurrence that impacts both spouses' mental health and marital dynamics(Dourou et al., 2023 ). Coping ability is significantly influenced by social support or lack thereof; couples who experience insufficient family and community support report higher stress levels and treatment fatigue. In such situations, infertility's psychosocial components continue to receive insufficient attention in both policy and practice (Khalesi & Kenarsari, 2024 ). Treatments for infertility often emphasizes physical outcomes above the psychological and emotional requirements of the patient. When infertility treatments don't work, it's normal to feel depressed, guilty, frustrated, and hopeless. Cultures where parenting is closely associated with social identity and marital success tend to amplify these sentiments. There is ample evidence that men and women cope differently with infertility (Sana, Abdullah, & Sana, 2024 ). Women are more likely to be psychologically distressed and to be impacted by criticism and demands from community (JONATHAN et al., 2021 ). However, because infertility is associated with a diminished sense of masculinity, men may internalize stress and refrain from expressing their feelings. When treating infertility, the literature emphasizes the need of psychological testing and therapy for both couples (Razzaque et al., 2021 ). Support from a psychologist can lower stress, increase adherence to therapy, and improve a patient's general health. Yet, particularly in underdeveloped nations, mental health assistance is frequently overlooked in infertility plans(Ghafoor & Mushtaq, 2024 ). The current study investigated the view of assisted reproductive technology in married infertile couples who were seeking treatment for their infertility issues at a fertility clinic and mentioned public sector hospital in the hopes of becoming parents through procedures and infertility treatment other than ART, but there were numerous issues that couples faced due to social, religious, cultural, and financial constraints that hampered their ability to obtain a procedure and available treatment. Aims and Objective The study is designed to evaluate respondents' understanding of assisted reproductive technology for infertility and gain a thorough understanding of how they see these procedures (ARTs). It put stain on individuals who are facing infertility and experiencing stress as they are unable to become parents. To ascertain if infertile couples are aware of assisted reproduction techniques. To investigate the level of perception in research participants (married infertile couples) about assisted reproduction technologies. To assess the stress experienced by couples owing to infertility. Materials and Methods Study design The study adhered with the reporting requirements of STROBE (Strengthening the Reporting of Observational Studies in Epidemiology). The Pakistan institute of Medical Sciences (PIMS) gave approval (No.F.1-1/2015/ERB/SZABMU/1357) . Appropriate informed consent was obtained from every participant. Participants The present study, that is the cross-sectional in form, was conducted out between 1 January 2025 and March 31, 2025, on infertile couples who were having trouble acquiring pregnant and who were classified as having primary or secondary infertility. These couples also visited the American and Australian infertility centers in Islamabad and Rawalpindi City for treatment. The Helsinki Declaration's commitment served as the foundation for this investigation(Ashcroft, 2008; Sawicka-Gutaj, Gruszczyński, Guzik, Mostowska, & Walkowiak, 2022). Written informed permission was obtained from each participant. In order to recruit participants, clinicians identified couples who could benefit from ART and other fertility treatments and offered them to make an appointment in advance to visit the fertility center whenever it was most convenient for them. Inclusion and exclusion criteria Ages 18 to 45 years old, primary infertility diagnosed by a doctor, couples who have been married for a year or more but have not gotten pregnant once (one year or more according to the WHO definition of infertility), no medical conditions such as diabetes, hypertension, thyroid, liver, or heart diseases based on files and self-reports, no adverse events in the past each month, no history of psychiatric hospital stay, no addiction, no neurological or other progressive diseases, and no use of neurological or psychiatric medications were among the study's inclusion criteria. If the study participants are unable to read English, then interviewer will clarify the questions to the couples. Unfortunate circumstances such as the loss of a loved one during the trial, getting pregnant spontaneously without the use of ART or any other fertility management throughout the treatment phases, and getting sick either mentally or physically during the study were all grounds for exclusion. Sample size The sample size for this study was estimated to be 377 participants using the Roa soft calculation method with a 5% margin of error, a 95% confidence interval, and a 50% response rate. However, for accuracy and a high response rate, a total of 380 participants were selected from the infertility clinics and the hospital in question. Questionnaire modification After an extensive study of the literature, the validated questionnaire used for the study was modified based on demographics, the characteristics of our study participants, and clinical findings. This resulted in significant modifications to the questionnaire that was completed in order to assess the study participants' perceptions of assisted reproductive technology(Afshani, Abdoli, Hashempour, Baghbeheshti, & Zolfaghari, 2016; Anaman-Torgbor et al., 2021; Kim & Ban, 2024; Newton, Sherrard, & Glavac, 1999). The final subsection addressed the stress that couples experience as a result of their infertility; this section was updated as well and modified using a validated questionnaire with a few minor adjustments, which patients utilized for assessing their overall level of stress(Awtani, Mathur, Shah, & Banker, 2017; Mushtaq & Ghafoor, 2024; Newton et al., 1999). Measurement tools A researcher-designed questionnaire was used to gather participant demographics and characteristics in the first portion. Information like age, gender, educational attainment, household income, work status, and information source were all included in this questionnaire. Diagnosis of infertility information and knowledge of Assisted Reproductive Technology This section encompassed a total of nine questions that asked couples whether they had children, how they conceived if they did, whether they had any complications during the process, whether they began therapy for it, whether they received a proper diagnosis, and whether they had ever heard of ART and, if so, the type of ART. In order to learn more about the recruited participants' knowledge of assisted reproductive technologies and infertility, these kinds of questions were posed. There were nine items in all in this area. Perception of Assisted Reproductive Technology in Infertile Couples The study participants' perceptions of assisted reproductive technology were examined through a total of six items in the third section. The first question asked if they believed that adoption could be an alternative to infertility treatment, including any ART that offered the option. Indeed, no. Do you believe that ART is halal or not? Another question asked whether you were concerned that children born after an ART operation could be more likely to have a genetic condition or defect (yes, no). Which of the following factors prevents you from using ART for your infertility: family and friends, the cost of the treatment, your religious beliefs, and the fact that you don't want to have this procedure because you believe your children will be genetically weak? These options highlight the participants' perceptions of modern infertility procedure awareness and use. Scoring The Infertility Perception Scale for Women (IPS-W) and the Fertility Problem Inventory (FPI), two instruments used to measure attitudes and perceptions in health-related research, are the models from which this score system is derived. These tools measure impressions using Likert-scale replies, which enable classification into positive, neutral, and negative views. Stress faced by couples due to infertility The final component included eight items designed to assess the stress that infertile couples experience. The questions were primarily taken from a scientific literature fertility issue inventory scale(Kim & Ban, 2024; Newton et al., 1999). One of the first questions addressed to participants Does your inability to conceive with the option (rarely, sometimes, many times, and always) score 0-3) (low stress, moderate stress, and high stress with the option always used to access for more stress faced by not having children) prevent you from being invited or welcomed to any family events? In addition, do you find it upsetting when a friend or family member becomes pregnant? Every time you menstruate, do you feel depressed? (asked to women exclusively) Has your everyday connection with your husband been impacted by your inability to produce children? Do other couples' lack of children make you feel inferior? When you consider your incapacity to conceive, do you find it difficult to fall asleep? Does the idea of being childless make you want to flee your house? Is your failure to conceive causing you to experience physical or psychological abuse? The purpose of these questions was to address the stress that the research participants were experiencing. Statistical Analysis Excel and SPSS (Social Package for Social Sciences) 27.0 New York, United States, were used to compile and assess the gathered data. The relationship between sociodemographic traits, additional infertility-related stress, and infertile couples' perceptions of assisted reproductive technology was examined in this study using the chi-square test. To assess the psychological profiles of infertile couples, the Fertility Problem Inventory, Infertility Perception Scale for Women, and sociodemographic were used. The results are shown as a percentage and frequency. Results Demographics of Study Participants The study involved 380 married couples of reproductive ages who were infertile. The participants' demographic details are shown in Table 1. The majority of participants were female (69.5%), 49.5% were between the ages of 35 and 45, and 39.5% were between the ages of 25 and 35. In terms of educational attainment, 40.5% had a graduation degree, and 46.8% had finished matriculation. Of the participants, 34.5% made 20,000 PKR or less per month, while 41.8% made between 20,000 and 40,000 PKR per month. While a lesser percentage were housewives (2.9%), the majority were either working (49.7%) or active in their own business (42.6%). Information on infertility and treatment was most frequently obtained from friends and family (96.1%), the internet (81.6%), and physicians (85.8%). Association between Gender and Stress Gender differences in stress patterns are indicated in Table 2. For instance, women reported being excluded from family gatherings more often than men did (15.5% vs. 12.9%). Women were somewhat more likely to report emotional reactions such feeling inadequate or having strained relationships with their partners. In addition, women reported higher rates of physical and mental violence (23.9%) than did men (21.6%). Although chi-square values indicate the difference was statistically significant (p = 0.033), such distinctions show a gender-based sensitivity, with females more prone to feel stress. Association between Age and Stress In given Table 3 shows that the most stressed-out group of participants was those between the ages of 35 and 45, with 50% experiencing regular feelings of exclusion and 47.9% having trouble sleeping. Age and stress were significantly correlated, according to the chi-square statistics (p = 0.0355). It is noteworthy that those under 25 and over 45 exhibited much lower stress levels, indicating a midlife peak in anguish associated to infertility. Association between Education and Stress A slightly non-significant correlation between stress and education level was shown in Table 4 (p = 0.107). Descriptively, individuals with intermediate levels of education were more likely than those in other groups to express emotional discomfort and frequent exclusion from events (68.8%). People who were illiterate also expressed higher levels of stress. Chi-Square Correlation Summary A chi-square correlation summary is shown in given Table 5. Stress was substantially correlated with income (p = 0.0301–0.0402), age (p = 0.0355), and gender (p = 0.033). While getting close to significance, educational level did not surpass the p < 0.05 cutoff. Gender and Correlation of Perception of Couples Towards ART Procedures Table 5, highlights adoption is similarly accepted by both sexes as an alternative to ART. Male and female perceptions of ART's religious permissibility (Halal) are almost equal. Men were somewhat more reluctant to use ART than women, with the majority of both sexes refusing to use it. Moral hesitancy was seen in the significant percentage of both sexes who would explore ART with ethical concerns. Both men and women generally agree that lab modification of eggs and sperm poses genetic dangers to offspring of ART. Though there are discernible concerns regarding the safety and ethics of ART, overall perceptions are very comparable between the sexes. Association between Demographics and Perception toward ART According to table 6 older responders and female participants were more inclined to embrace ART and view adoption as a legitimate substitute. Greater knowledge and acceptability of ART. Educational level correlation with Diagnosis of Infertility According to the table 7, access to an accurate infertility diagnosis is clearly inversely linked with academic achievement. 75% (71 people) of the illiterate participants said they had not been properly diagnosed, which was the largest percentage of any category. However, only 2.6% of grads said the same. The rates for the intermediate and matriculation classes were 12.5% and 11.8%, respectively. There were very few skip/other replies; among graduates, the highest percentage was 1.9%. These results imply that a lack of knowledge or access to infertility diagnostic treatments is linked to lower educational attainment. This disparity may be closed with the aid of focused educational initiatives and increased health literacy, particularly among people with lower levels of education. Barriers Hindering ART Use by Gender In the table 8, the most frequently mentioned obstacle, particularly for women, is social pressure from friends and family. Barriers related to cost and combination concerns (e.g., religious + genetic + societal) are more commonly reported by women. Religious convictions and other vague explanations are more frequently cited by men as stand-alone obstacles. Multifaceted barriers affect both sexes, but the emphasis is different: males are more influenced by religious and wider societal concerns, while females are more impacted by social and familial pressure. These factors were associated with higher education (p < 0.05). Most respondents lacked literacy, especially regarding the halal or genetically safe status of ART. Discussion The present study interrogated in detail three primary aspects of infertility in Pakistan: how infertile married couples perceive assisted reproductive technologies and other fertility treatments, and how infertility affects their psychological health. This research examined couples to get insight into how infertility is seen, managed, and supported in Pakistan's current healthcare system. Perception of ART in Couples Just 53.2% of respondents correctly identified ART's principal purpose as helping infertile couples conceive, despite the fact that 97.4% of respondents had heard of it. 57.6% of women and 59.5% of men said ART was halal, showing a somewhat positive opinion affected by cultural and religious reasons. This represented a considerable number of participants who expressed ethical and religious concerns. These findings are consistent with past research emphasizing religious allowability as a crucial factor in determining ART acceptance in Islamic(Abazie & Abimbola, 2021). In addition, 97.8% of couples concurred that Pharmacists, Psychologists and therapists need to be included in the multidisciplinary ART team, demonstrating their faith in the capacity of pharmacy specialists to assist and direct therapy. Age and education level had a favorable impact on perceptions, with older and better educated people showing more acceptance and knowledge of ART. This is linked to research that indicates reproductive technologies are more widely accepted when paired with sufficient health literacy(Adesiyun, Ameh, & Avidime, 2011). Stress Due to Infertility Among Couples Fertility is still a major psychosocial stressor, particularly in societies where it is associated with womanhood and marital success. Because of their infertility, more than 60% of the individuals in our study experienced social rejection, melancholy, feelings of inadequacy, and even thoughts of loneliness. Although it was not statistically significant, women reported somewhat greater levels of stress than men. Stress and age (p = 0.035), education (p = 0.073), and income level (p = 0.040) were shown to be significantly correlated by chi-square analyses, indicating that socioeconomic determinants of health have a substantial impact on infertility-related misery. These results are in consistent with studies done in other South Asian contexts, where infertility is frequently linked to marital discord, mental health issues, and societal shame. (Jafar zadeh-Kenarsari, Ahmad-Amraji, & Abouzari-Gazafroodi, 2021). These stressors, which can show up as anxiety, sadness, or interpersonal conflict, are made worse by cultural demands, especially for women.(Lei, You, Luo, & Ren, 2021). The current study set out to compare the stress associated with infertility in men and women and evaluate its correlation with different infertility causes. These results showed that the mean score for stress linked to infertility was greater for women than for males, which is consistent with findings by(El Kissi et al., 2013). Unexpectedly, 9.2% of women reported having experienced or witnessed violence as a result of their infertility, and 30.8% of women said they had trouble falling asleep.(Lei et al., 2021). In order reduce the stigma and redefine fertility problems as a medical condition rather than a moral or societal one, these numbers underscore the critical need for psychosocial therapies and awareness efforts aimed at both men and women. Conclusion This study emphasized the present and future roles of Psychologists and Pharmacists in fertility treatments while thoroughly examining the attitudes and stress levels of infertile married couples in Pakistan. The results show a complicated but changing healthcare environment where structural deficits, professional opportunities, and cultural sensitivities, psychological suffering, and lack of knowledge interact. In the first goal, which was to evaluate married couples' perceptions of ART, positive views and encouraging levels of general awareness were found, especially among healthcare professionals. Most participants understood the terms used in ART and how it is used to treat infertility. However, there was a lack of consistency in deeper understanding, especially with relation to ethical constraints and regulatory monitoring. This disparity highlights the necessity for thorough professional and public education initiatives to raise awareness and ensure accurate comprehension of ART treatments. The evaluation of stress levels among infertile married couples, which is the second goal, confirms that infertility continues to be a major emotional and psychological burden in Pakistani culture. Feelings of guilt, fear, and loneliness are made worse, especially for women, by cultural expectations surrounding reproduction as well as a lack of candid conversation and social support. These results are in line with international research that acknowledges infertility as a significant life stressor with broad consequences for mental health. The study implicitly supports the idea that multidisciplinary support along with organized counseling services, including the assistance of pharmacists with reproductive health training, might help infertile couples in Pakistan. Suggestions Multidisciplinary reproductive Teams Pharmacists and Psychologists should be actively included in patient care teams in medical facilities and reproductive clinics. This would enhance adherence, guarantee safe drug practices, and provide patients with both psychological and medical assistance along their reproductive journey. Enhance Public Knowledge and Health Literacy To dispel stigma around ART, dispel ethical and religious misunderstandings, and increase public awareness of the procedure, nationwide efforts are required. These initiatives should specifically target rural and undereducated people, where stress levels and misunderstandings are more prevalent. Incorporate Counseling and Mental Health Services Treatment for infertility should include psychological support services as a normal component. Counseling programs, particularly those specifically designed for women, may be able to lessen the emotional strain, shame, and conflict that come with infertility. Boost ART Guidelines and Policies The creation of national ART rules should be a top priority for policymakers in order to guarantee access that is morally, legally, and culturally acceptable. Pharmacists' roles ought to be officially acknowledged and encouraged by these policies. Limitations Cross-Sectional Design The use of a cross-sectional survey reduces the capacity to draw conclusions about the causal relationship between knowledge and stress levels or between factors and patient outcomes. Self-Reported Data The research depends on participants' self-reported stress levels, attitudes, and experiences; these data may be skewed by social desirability bias or response bias, especially when discussing culturally sensitive subjects like ART and infertility. Urban-Centric Sample Because the majority of participants were drawn from urban healthcare environments, the results may not be as applicable to underprivileged or rural communities where access to ART and heath literacy may be very different. Restricted Clinical Diversity Despite the fact that the research included couples, it excluded doctors, therapists, and legislators whose viewpoints may have added to our knowledge of the difficulties in implementing ART in Pakistan. Absence of Longitudinal Data Views on ART and emotional stress might change over time. Although this study offers a snapshot, it does not account for changes over time or the impact of treatments on psychological health or knowledge. Unexplored Religious and Ethical Dimensions Although religious convictions were recognized, the study did not go into great detail about the variety of religious interpretations or the moral conundrums that couples encounter, as these factors may have an impact on the acceptance of ART. Abbreviations ART----------Assisted Reproductive Technology SPSS---------Statistical Package of Social Sciences IUI------------Intrauterine Insemination ICSI-----------Intracytoplasmic Sperm Injection STROBE------Strengthening the Reporting of Observational Studies in Epidemiology WHO-----------World Health Organization CDC------------Centre for Disease Control IVF--------------Invitro Fertilization Declarations Ethical Approval and Consent to Participate This study was reviewed and approved by the Riphah Ethical Committee of (Riphah institute of Pharmaceutical Sciences), under Ethical Approval Number: (Ref.No.REC/RIU/2024/18) . All participants were informed about the purpose, procedures, and voluntary nature of the study before data collection. Written informed consent was obtained from each participant. They were assured of confidentiality and anonymity, and their right to withdraw at any stage without any consequences. Consent for Publication All participants gave written informed consent not just to participate in the study but also to have their anonymized data published in scholarly publications or reports. The participants were guaranteed complete secrecy and privacy protection throughout the publication process, as well as the nondisclosure of any personally identifying information. Competing Interests The author declares that this study is free from any conflicting interests or potential conflicts of interest. Author Contributions Wajeeha Ali (W.A) conceptualized and designed the study, collected and analyzed the data, and drafted the manuscript. Muhammad Amir Hamza (M.A.H) and Faizur Rehman (F.R) contributed to statistical analysis and interpretation of data. Faiqa Imran (F.I) assisted with data collection and field coordination. Dr. Sidra Kaleem (S.K) supervised the overall research process, provided methodological guidance, and reviewed the manuscript critically. Dr. Zakir Khan (Z.K) served as co-supervisor and contributed to manuscript review and academic support. All authors reviewed and approved the final manuscript. Funding This study was not funded by any governmental, private, or commercial source. Without any funding, the study was carried out as an element of an academic project. Availability of Data and Materials Under reasonable request, the corresponding author will make the datasets created and/or examined during the current work available. In accordance with ethical guidelines, all data have been anonymized to protect participant confidentiality. Clinical Trial Number Not Applicable References Abazie, O. H., & Abimbola, A. M. (2021). Knowledge, Perception, and Factors influencing the use of Assisted Reproductive Technology among Women in Lagos, Nigeria. Bayero Journal of Nursing and Health Care, 3 (1), 725-736. Adesiyun, A. G., Ameh, N., & Avidime, S. (2011). 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Clinics and Practice, 13 (1), 251-263. El Kissi, Y., Romdhane, A. B., Hidar, S., Bannour, S., Ayoubi Idrissi, K., Khairi, H., & Ben Hadj Ali, B. (2013). General psychopathology, anxiety, depression and self-esteem in couples undergoing infertility treatment: a comparative study between men and women. Eur J Obstet Gynecol Reprod Biol, 167 (2), 185-189. doi:10.1016/j.ejogrb.2012.12.014 Fiebai, P. O., & Ikimalo, J. I. (2019). Challenges with Assisted Reproductive Technology (ART) in Sub-Saharan Africa. African Journal of Reproduction and Gynaecological Endoscopy, 4 (1), 3-8. doi:10.4103/ajiac.ajiac_8_22 Gerrits, T. (2016). Assisted reproductive technologies in Ghana: transnational undertakings, local practices and 'more affordable' IVF. Reprod Biomed Soc Online, 2 , 32-38. doi:10.1016/j.rbms.2016.05.002 Ghafoor, A. A., & Mushtaq, R. (2024). Predictive Association between Perceived Social Support and Infertility-Related Stress in Married Couples in Pakistan: Infertility-Related Stress in Married Couples. Pakistan BioMedical Journal , 14-18. Hammond, K., & Hamidi, N. (2025). Exploring Muslim Communities’ Experiences and Barriers While Accessing Assisted Reproductive Technologies: A Scoping Review of International Literature. Journal of Religion and Health, 64 (1), 330-368. doi:10.1007/s10943-024-02056-x Hazlina, N. H. N., Norhayati, M. N., Bahari, I. S., & Arif, N. A. N. M. (2022). Worldwide prevalence, risk factors and psychological impact of infertility among women: a systematic review and meta-analysis. BMJ open, 12 (3), e057132. Jafar zadeh-Kenarsari, F., Ahmad-Amraji, L., & Abouzari-Gazafroodi, K. (2021). Evaluation of infertility-related stress and its associated factors in infertile clients: a cross-sectional study. Preventive Care in Nursing & Midwifery Journal, 11 (1), 1-10. Javaid, S., Mastoi, S. W., Jahan, E., Khalid, S., Jabeen, A., & Mahajan, N. (2022). Prevalence of infertility and its causes in the population of Pakistan: A cross-sectional study. Annals of the Romanian Society for Cell Biology, 26 (1), 129-133. Johnson-Ekeleba, A. C., Sefogah, P. E., Swarray-Deen, A., & Mumuni, K. (2024). Awareness and acceptability of assisted reproductive technology among non-medical tertiary students in a low-resource setting. Reproductive Biology and Endocrinology, 22 (1), 131. JONATHAN, J., Anaman-Tagbor, J., Asare, L., Osarfo, B., Attivor, R., Bonsu, A., . . . Tarkang, E. (2021). Experiences of Women Undergoing Assisted Reproductive Technology in GhanA: A Qualitative Study. Khalesi, Z. B., & Kenarsari, F. J. (2024). Anxiety, depression, and stress: a comparative study between couples with male and female infertility. BMC women's health, 24 (1), 228. Kim, M., & Ban, M. (2024). Development of an infertility perception scale for women (IPS-W). BMC women's health, 24 (1), 513. Lei, A., You, H., Luo, B., & Ren, J. (2021). The associations between infertility-related stress, family adaptability and family cohesion in infertile couples. Scientific reports, 11 (1), 24220. Mohamed, H. M., Badia, T. S., Khalaf, S. A., Abdullah, S. O., Farghaly, T. A., Fetih, A. N., & Aly, S. E. (2024). Effect of health education program on knowledge, stress, and satisfaction among infertile women undergoing in vitro fertilization injection. Middle East Fertility Society Journal, 29 (1), 1. Mushtaq, R., & Ghafoor, A. A. (2024). Infertility Stress as a Predictor of Marital Satisfaction in Married Couples with Infertility in Pakistan. Pakistan Languages and Humanities Review, 8 (4), 435-444. Newton, C. R., Sherrard, W., & Glavac, I. (1999). The Fertility Problem Inventory: measuring perceived infertility-related stress. Fertility and Sterility, 72 (1), 54-62. Organization, W. H. (2023). Infertility prevalence estimates, 1990–2021 : World Health Organization. Paraskevi, L., Antigoni, S., & Kleanthi, G. (2021). Stress and Anxiety Levels in Couples who Undergo Fertility Treatment: a Review of Systematic Reviews. Mater Sociomed, 33 (1), 60-64. doi:10.5455/msm.2021.33.60-64 Patel, A., Sharma, P. S. V. N., Kumar, P., & Binu, V. S. (2018). Sociocultural Determinants of Infertility Stress in Patients Undergoing Fertility Treatments. Journal of Human Reproductive Sciences, 11 (2), 172-179. doi:10.4103/jhrs.JHRS_134_17 Razzaque, M. A., Ali, A., Ahmed, W., Hussain, S., Wahid, A., & Razzaque, A. (2021). Assessment of the Level of Depression, Anxiety, Stress among Infertile Women (20-45 Years Age) in Tertiary Care Hospital. Journal of Liaquat University of Medical & Health Sciences, 20 (5), 358-362. Saif, J., Rohail, I., & Aqeel, M. (2021). Quality of life, coping strategies, and psychological distress in women with primary and secondary infertility; a mediating model. Nature-Nurture Journal of Psychology, 1 (1), 8-17. Sana, M., Abdullah, M., & Sana, F. (2024). Link Between Psychological Stress and Female Infertility? Call for Increased Research in India and Pakistan. Journal of Psychosexual Health, 6 (3), 297-298. Sawicka-Gutaj, N., Gruszczyński, D., Guzik, P., Mostowska, A., & Walkowiak, J. (2022). Publication ethics of human studies in the light of the Declaration of Helsinki–a mini-review. Journal of Medical Science, 91 (2), e700-e700. Tabassum, A., Sadia, R., Huda, S., & Khan, S. (2023). Infertility-related stress and marital satisfaction among Pakistani infertile individuals. IUB Journal of Social Sciences, 5 (1), 71-81. Truong, L. Q., Luong, T. B., Tran, T., Dang, N. H., Nguyen, L. H., Nguyen, T. T., & Nguyen, P. T. (2022). Infertility-related stress, social support, and coping of women experiencing infertility in Vietnam. Health psychology report, 10 (1). Ullah, A., Ashraf, H., Tariq, M., Aziz, S. Z., Zubair, S., Sikandar, K. U. R., . . . Nisar, M. (2021). Battling the Invisible Infertility Agony. Journal of Ethnic and Cultural Studies, 8 (2), 89-105. Warner, L., Jamieson, D. J., & Barfield, W. D. (2015). CDC releases a National Public Health Action Plan for the Detection, Prevention, and Management of Infertility. Journal of Women's Health (15409996), 24 (7). Whittaker, A., Gerrits, T., Hammarberg, K., & Manderson, L. (2024). Access to assisted reproductive technologies in sub-Saharan Africa: fertility professionals’ views. Sexual and Reproductive Health Matters, 32 (1), 2355790. WHO. (2022). (2022). Retrieved from https://www.who.int/news-room/fact Tables Table 1.1: Demographics Characteristics of Study Participants (N = 380) Characteristics Category f % Gender Male 116 30.50% Female 264 69.50% Age Below 25 14 3.70% 25-35 150 39.50% 35-45 188 49.50% 45 onward 28 7.40% Level of education Illiterate 32 8.40% Matriculation 178 46.80% Intermediate 16 4.20% Graduation 154 40.50% Income 20k 131 34.50% 20k-40k 159 41.80% 40-60k 84 22.10% 60k or above 6 1.60% Employment status Employed 189 49.70% Own business 162 42.60% Unemployed 2 0.50% Retired 16 4.20% Source of information Housewife 11 2.90% (Multiple options) Internet 310 81.60% Family and friends 365 96.10% Doctors 326 85.80% Pharmacists 85 22.40% Table 1.2: Association between Gender and Stress-Related Questions (N = 380) Item Response Category Male (%) (N) Female (%) (N) Are you not invited or welcomed to any family events for not being able to have children? Rarely 8.6% (16) 3.8% (7) Sometimes 33.6% (64) 37.5% (71) Many times 44.8% (85) 43.2% (82) Always 12.9% (25) 15.5% (29) Are you upset when your friend or relative becomes pregnant? Rarely 3.4% (6) 2.3% (4) Sometimes 38.8% (74) 33.0% (63) Many times 42.2% (80) 45.8% (87) Always 15.5% (29) 18.9% (36) Has being unable to have children affected your relationship with your spouse? Rarely 3.4% (6) 3.4% (6) Sometimes 36.2% (69) 31.1% (59) Many times 41.4% (79) 50.0% (95) Always 19.0% (36) 15.5% (29) Do you feel inferior to other couples for not having children? Rarely 6.0% (11) 3.8% (7) Sometimes 36.2% (69) 31.1% (59) Many times 44.8% (85) 51.9% (99) Always 12.9% (25) 13.3% (25) Do you have trouble falling asleep thinking about your infertility? Rarely 9.5% (18) 14.0% (27) Sometimes 41.4% (79) 35.2% (67) Many times 40.5% (77) 41.3% (79) Always 8.6% (16) 9.5% (18) Does the thought of not having a child make you want to run away from home? Rarely 28.4% (54) 26.5% (50) Sometimes 43.1% (82) 37.9% (72) Many times 25.9% (49) 32.6% (62) Always 2.6% (5) 3.0% (6) Are you subjected to mental or physical violence due to infertility? Never 41.4% (79) 46.2% (88) Sometimes 34.5% (66) 29.2% (55) Many times 21.6% (41) 23.9% (45) Always 2.6% (5) 0.8% (2) Table 1.3: Association between age and stress Study Participants (N = 380) Item Response Below 25 (n/%) 25–35 (n/%) 35–45 (n/%) 45 Onward (n/%) Not invited to family events due to infertility Rarely 27 (7.1%) 25 (6.7%) 14 (3.7%) 27 (7.1%) Sometimes 54 (14.3%) 162 (42.7%) 127 (33.5%) 122 (32.1%) Many times 190 (50.0%) 134 (35.3%) 190 (50.0%) 163 (42.9%) Always 109 (28.6%) 58 (15.3%) 49 (12.8%) 68 (17.9%) Upset when friend/relative becomes pregnant Rarely 0 (0.0%) 8 (2.0%) 8 (2.1%) 41 (10.7%) Sometimes 54 (14.3%) 160 (42.0%) 121 (31.9%) 95 (25.0%) Many times 244 (64.3%) 147 (38.7%) 182 (47.9%) 176 (46.4%) Always 81 (21.4%) 66 (17.3%) 69 (18.1%) 68 (17.9%) Infertility affecting spousal relationship Rarely 27 (7.1%) 10 (2.7%) 12 (3.2%) 27 (7.1%) Sometimes 81 (21.4%) 152 (40.0%) 105 (27.7%) 122 (32.1%) Many times 136 (35.7%) 160 (42.0%) 206 (54.3%) 136 (35.7%) Always 136 (35.7%) 58 (15.3%) 57 (14.9%) 95 (25.0%) Feeling inferior to other couples Rarely 54 (14.3%) 15 (4.0%) 14 (3.7%) 27 (7.1%) Sometimes 81 (21.4%) 142 (37.3%) 113 (29.8%) 122 (32.1%) Many times 136 (35.7%) 172 (45.3%) 212 (55.9%) 149 (39.3%) Always 109 (28.6%) 51 (13.3%) 40 (10.6%) 81 (21.4%) Trouble sleeping due to infertility Rarely 27 (7.1%) 48 (12.7%) 43 (11.2%) 95 (25.0%) Sometimes 136 (35.7%) 157 (41.3%) 133 (35.1%) 109 (28.6%) Many times 81 (21.4%) 132 (34.7%) 182 (47.9%) 149 (39.3%) Always 136 (35.7%) 43 (11.3%) 22 (5.9%) 27 (7.1%) Desire to run away due to infertility Rarely 163 (42.9%) 106 (28.0%) 91 (23.9%) 136 (35.7%) Sometimes 109 (28.6%) 175 (46.0%) 133 (35.1%) 149 (39.3%) Many times 109 (28.6%) 89 (23.3%) 144 (37.8%) 81 (21.4%) Always 0 (0.0%) 10 (2.7%) 12 (3.2%) 14 (3.6%) Mental or physical violence due to infertility Never 163 (42.9%) 177 (46.7%) 162 (42.6%) 190 (50.0%) Sometimes 81 (21.4%) 122 (32.0%) 111 (29.3%) 149 (39.3%) Many times 136 (35.7%) 79 (20.7%) 101 (26.6%) 27 (7.1%) Always 0 (0.0%) 3 (0.7%) 6 (1.6%) 14 (3.6%) Table 1.4: Association between level of education and stress Study Participants (N = 380) Question Education Level Rarely (% / n) Sometimes (% / n) Many Times (% / n) Always (% / n) Not invited to family events Illiterate 6.2% / 6 25% / 24 43.8% / 42 25% / 24 Matriculation 5.6% / 5 38.8% / 37 41.6% / 40 14% / 13 Intermediate 12.5% / 12 18.8% / 18 68.8% / 65 0% / 0 Graduation 3.9% / 4 37.7% / 36 43.5% / 41 14.9% / 14 Upset when others become pregnant Illiterate 0% / 0 15.6% / 15 59.4% / 56 25% / 24 Matriculation 1.7% / 2 41.6% / 40 38.2% / 36 18.5% / 18 Intermediate 12.5% / 12 12.5% / 12 56.2% / 53 18.8% / 18 Graduation 3.2% / 3 33.1% / 31 48.1% / 46 15.6% / 15 Relationship with spouse affected Illiterate 6.2% / 6 21.9% / 21 37.5% / 36 34.4% / 33 Matriculation 1.7% / 2 38.2% / 36 46.6% / 44 13.5% / 13 Intermediate 12.5% / 12 37.5% / 36 18.8% / 18 31.2% / 30 Graduation 3.9% / 4 27.9% / 27 53.2% / 51 14.9% / 14 Feel inferior to other couples Illiterate 9.4% / 9 15.6% / 15 37.5% / 36 37.5% / 36 Matriculation 1.7% / 2 37.1% / 35 48.9% / 46 12.4% / 12 Intermediate 12.5% / 12 18.8% / 18 56.2% / 53 12.5% / 12 Graduation 5.8% / 6 32.5% / 31 52.6% / 50 9.1% / 9 Trouble falling asleep Illiterate 9.4% / 9 25% / 24 37.5% / 36 28.1% / 27 Matriculation 11.8% / 11 41% / 39 37.6% / 36 9.6% / 9 Intermediate 18.8% / 18 31.2% / 30 37.5% / 36 12.5% / 12 Graduation 13.6% / 13 35.7% / 34 46.1% / 44 4.5% / 4 Want to run away from home Illiterate 25% / 24 34.4% / 33 34.4% / 33 6.2% / 6 Matriculation 24.7% / 23 43.3% / 41 30.3% / 29 1.7% / 2 Intermediate 43.8% / 42 25% / 24 18.8% / 18 12.5% / 12 Graduation 28.6% / 27 37.7% / 36 31.2% / 30 2.6% / 2 Subjected to mental/physical violence Illiterate 28.1% / 27 34.4% / 33 31.2% / 30 6.2% / 6 Matriculation 43.8% / 42 33.1% / 31 21.9% / 21 1.1% / 1 Intermediate 56.2% / 53 18.8% / 18 18.8% / 18 6.2% / 6 Graduation 48.1% / 46 28.6% / 27 23.4% / 22 0% / 0 Table 1.5: Chi-square Correlation between demographics and Stress related questions Study Participants (N = 380) Variable Category Low Stress(% / N) Moderate Stress(% / N) High Stress(% / N) χ² (df) p-value Gender Male (n = 190) 6.0% / 11 65.5% / 124 28.4% / 54 0.14 (2) 0.033 Female (n = 190) 5.7% / 11 64.0% / 122 30.3% / 58 Age Below 25 (n = 95) 7.1% / 7 64.3% / 61 28.6% / 27 6.60 (6) 0.0355 25–35 (n = 95) 6.7% / 6 70.0% / 67 23.3% / 22 35–45 (n = 95) 4.8% / 5 59.6% / 57 35.6% / 34 45 onward (n = 95) 7.1% / 7 67.9% / 64 25.0% / 24 Medication Use Yes (n = 190) 5.6% / 11 64.8% / 123 29.6% / 56 1.07 (2) 0.0387 No (n = 190) 12.5% / 24 50.0% / 95 37.5% / 71 Table 1.6: Association between demographics and perception assisted reproductive technology Study Participants (N = 380) Gender and age correlation with (do you conceive by natural process?) Age Group (Female) Yes (%) Yes (N) No (%) No (N) Below 25 (n = 48) 71.4% 34 0.0% 0 25–35 (n = 48) 64.0% 31 16.2% 8 35–45 (n = 47) 73.0% 34 5.1% 2 45 onward (n = 47) 66.7% 31 0.0% 0 Table 1.7: Educational level correlation with (do you get proper diagnosis of infertility? Education Level No (%) No (N) Skip/Others (%) Illiterate 75.0% 71 0.0% Matriculation 11.8% 11 0.6% Intermediate 12.5% 12 0.0% Graduation 2.6% 2 1.9% Table 1.8: Barriers Hindering ART Use by Gender (N = 380) Barrier Combination Female (%) Female (N) Cost + Family and Friends 5.3% 14 Cost only 2.6% 7 Cost + Family + Genetic Weakness + Religious Beliefs 3.8% 10 Cost + Religious Beliefs 0.4% 1 Family and Friends only 35.2% 93 Family + Cost + Religious + Genetic Weakness 18.9% 50 Genetic Weakness + Religious + Cost + Family 6.8% 18 Religious Beliefs + Others 0.4% 1 Religious Beliefs only 1.1% 3 Others 0.0% 0 Additional Declarations No competing interests reported. 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09:19:19","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":21074,"visible":true,"origin":"","legend":"","description":"","filename":"supplementrytables.docx","url":"https://assets-eu.researchsquare.com/files/rs-7284839/v1/80724d78374e5a6435fbc8fa.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Perception of Assisted Reproductive Technology Among Infertile Married Couples and Stress Faced due to Infertility in Pakistan: A Cross-Sectional Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eInfertility is a critical medical, social, and public health issue that affects a couple's psychological well-being, social functioning, and physical health, particularly for women (Tabassum, Sadia, Huda, \u0026amp; Khan, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Infertility is a reproductive health condition that is defined by the World Health Organization as the inability to conceive or carry a pregnancy to term with regular sexual activity(\"WHO. (2022),\" 2022).There are two different kinds of infertility: primary infertility, which refers to couples who never achieved pregnancy, and secondary infertility, which occurs when the couple does not obtain conception after losing one pregnancy (Organization, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). In the year 2002, the WHO estimated that infertility affected within 80\u0026nbsp;million people globally. It affects 10\u0026ndash;15% of couples during their lives. The overall incidence of infertility is major (up to 21.9), with primary infertility at 3.5% and secondary infertility at 18.4%. It is widely recognized that infertility rates are incorrectly estimated (Hazlina, Norhayati, Bahari, \u0026amp; Arif, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Saif, Rohail, \u0026amp; Aqeel, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Based on estimates, 48\u0026nbsp;million married people and 186\u0026nbsp;million people globally suffer with infertility(Hazlina et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). The factors might impede the measuring of the prevalence, inadequate measurement techniques, and unknown types of infertility stemming from cultural biased (Javaid et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Primary infertility refers to women who have never conceived. Secondary infertility occurs when at least one conception fails to reoccur. According to estimates, 60 to 80\u0026nbsp;million couples worldwide are affected by this issue, with 1\u0026ndash;8% suffering from original infertility and 35% from secondary infertility. Obviously, one out of every six couples will have infertility at their reproductive age (Warner, Jamieson, \u0026amp; Barfield, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Female infertility as frequently referred to as \"female factor\" infertility, is the cause underlying infertility identified in a female spouse. It is a frequent condition, with 10 out of every 100 ladies worldwide experiencing it. A large number of couples have a known explanation for their infertility, while the remainder have unexplained fertility (Patel, Sharma, Kumar, \u0026amp; Binu, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Female spouses account for 40\u0026ndash;55% of infertility cases, whereas male partners accounted for 20\u0026ndash;40% in Pakistan infertility is a severe and growing issue (Mohamed et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Despite becoming one of the most populated countries, with a population growth rate of over 2%, Pakistan has a staggering 21.9% infertility prevalence.18.4% is attributable to secondary infertility and 3.5% to primary infertility, implying that about one out of every five married couples is afflicted. This high percentage of subfertility underlines the crucial need for access to reproductive healthcare services (Ateeb et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Infertility is not limited to a medical problem; it is also a complicated sociocultural dilemma, particularly in low-income areas. In nations like as Pakistan, women suffering from infertility face cultural humiliation, in-law pressure, marital strife, and even divorce. As a result, infertility must be handled as a complex health problem, with implications for human rights, societal well-being, and public health (Appiah \u0026amp; Ganle, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Ateeb et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Understanding the causes and effects of infertility is critical for encouraging healthier lives and decreasing its social and psychological burden, particularly in resource-constrained contexts where knowledge and medical care are few. Infertility has a substantial psychological impact on couples, with women frequently enduring more severe emotional pain than males (Anaman-Torgbor et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). According to studies, women suffering infertility are more likely to suffer from psychological conditions such as despair and anxiety, which can have an impact on all areas of their well-being\u0026mdash;emotional, spiritual, sex-related and physical. Common emotional reactions include inadequate self-worth, guilt, loneliness, and social isolation. According to research, up to half of all women have mild to severe depression, with 17% experiencing significant depression (Cui, Wang, \u0026amp; Wang, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Anxiety affects approximately 14.7 percent of infertile women and 4.5% of males as well (Dourou et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Infertility is no longer seen as an incurable illness, despite its emotional and societal effects. Today, depending on the underlying reason, a variety of therapeutic options are accessible, such as hormone therapy, medication, and surgery, thanks to breakthroughs in medical research. When traditional approaches don't work, assisted reproductive technology has become a practical and efficient answer. ART comprises a number of methods that have shown great promise in enhancing fertility outcomes, including embryo transfer, intracytoplasmic sperm injection (ICSI), and in vitro fertilization (IVF) (Ullah et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Assisted reproductive techniques (ARTs) have transformed the landscape of infertility treatment, offering hope to childless couples. However, the perception of ART among couples is frequently nuanced and highly impacted by cultural, emotional, and societal variables (Whittaker, Gerrits, Hammarberg, \u0026amp; Manderson, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Although many see ART as a miraculous treatment that restores their desire for biological motherhood, others are hesitant because of moral, religious, or cultural issues. For many couples, especially in conservative nations, the thought of conception occurring outside the body violates conventional reproductive beliefs (Fiebai \u0026amp; Ikimalo, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Hammond \u0026amp; Hamidi, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Another highly polarizing topic is the validity of children created by ART using donor gametes, which sometimes results in social shame or family disagreements. These beliefs can influence whether couples seek or avoid therapy, regardless of medical availability. Additionally, the emotional journey of going through ART is filled with uncertainties and psychological stress (Gerrits, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Among numerous couples, the ART process can strain their relationship by revealing gender differences in emotional reaction and societal criticism. While ART provides a solution to infertility, the psychological and social ramifications must be understood in order to give total support to couples navigating this challenging rout (Johnson-Ekeleba, Sefogah, Swarray-Deen, \u0026amp; Mumuni, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). The emotional and psychological strains connected to infertility and its treatment are frequently ignored, even though ART is becoming more widely available worldwide. During therapy, couples receiving ART may struggle with anxiety, melancholy, loneliness, and fear of failing(Truong et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Infertility is a profoundly embedded sociocultural problem in addition to a medical one, particularly in traditional countries where having children is strongly associated with marital satisfaction, social standing, and family heritage. Infertile couples, especially women, face shame, social marginalization, and emotional suffering in nations like Pakistan where fertility is frequently seen as a fundamental aspect of femininity (Paraskevi, Antigoni, \u0026amp; Kleanthi, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Depression, despair, conflict between spouses, and even assault in the home are examples of the emotional toll. The cultural need to carry on the family line and societal expectations of virility also cause psychological distress in men, despite the fact that they are less commonly studied. Research has demonstrated that stress due to infertility is a common occurrence that impacts both spouses' mental health and marital dynamics(Dourou et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Coping ability is significantly influenced by social support or lack thereof; couples who experience insufficient family and community support report higher stress levels and treatment fatigue. In such situations, infertility's psychosocial components continue to receive insufficient attention in both policy and practice (Khalesi \u0026amp; Kenarsari, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Treatments for infertility often emphasizes physical outcomes above the psychological and emotional requirements of the patient. When infertility treatments don't work, it's normal to feel depressed, guilty, frustrated, and hopeless. Cultures where parenting is closely associated with social identity and marital success tend to amplify these sentiments. There is ample evidence that men and women cope differently with infertility (Sana, Abdullah, \u0026amp; Sana, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Women are more likely to be psychologically distressed and to be impacted by criticism and demands from community (JONATHAN et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). However, because infertility is associated with a diminished sense of masculinity, men may internalize stress and refrain from expressing their feelings. When treating infertility, the literature emphasizes the need of psychological testing and therapy for both couples (Razzaque et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Support from a psychologist can lower stress, increase adherence to therapy, and improve a patient's general health. Yet, particularly in underdeveloped nations, mental health assistance is frequently overlooked in infertility plans(Ghafoor \u0026amp; Mushtaq, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). The current study investigated the view of assisted reproductive technology in married infertile couples who were seeking treatment for their infertility issues at a fertility clinic and mentioned public sector hospital in the hopes of becoming parents through procedures and infertility treatment other than ART, but there were numerous issues that couples faced due to social, religious, cultural, and financial constraints that hampered their ability to obtain a procedure and available treatment.\u003c/p\u003e\n\u003ch3\u003eAims and Objective\u003c/h3\u003e\n\u003cp\u003eThe study is designed to evaluate respondents' understanding of assisted reproductive technology for infertility and gain a thorough understanding of how they see these procedures (ARTs). It put stain on individuals who are facing infertility and experiencing stress as they are unable to become parents. To ascertain if infertile couples are aware of assisted reproduction techniques.\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eTo investigate the level of perception in research participants (married infertile couples) about assisted reproduction technologies.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eTo assess the stress experienced by couples owing to infertility.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study adhered with the reporting requirements of STROBE (Strengthening the Reporting of Observational Studies in Epidemiology). The Pakistan institute of Medical Sciences (PIMS) gave approval \u003cstrong\u003e(No.F.1-1/2015/ERB/SZABMU/1357)\u003c/strong\u003e. Appropriate informed consent was obtained from every participant. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe present study, that is the cross-sectional in form, was conducted out between 1 January 2025 and March 31, 2025, on infertile couples who were having trouble acquiring pregnant and who were classified as having primary or secondary infertility. These couples also visited the American and Australian infertility centers in Islamabad and Rawalpindi City for treatment. The Helsinki Declaration\u0026apos;s commitment served as the foundation for this investigation(Ashcroft, 2008; Sawicka-Gutaj, Gruszczyński, Guzik, Mostowska, \u0026amp; Walkowiak, 2022). Written informed permission was obtained from each participant. In order to recruit participants, clinicians identified couples who could benefit from ART and other fertility treatments and offered them to make an appointment in advance to visit the fertility center whenever it was most convenient for them. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion and exclusion criteria \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAges 18 to 45 years old, primary infertility diagnosed by a doctor, couples who have been married for a year or more but have not gotten pregnant once (one year or more according to the WHO definition of infertility), no medical conditions such as diabetes, hypertension, thyroid, liver, or heart diseases based on files and self-reports, no adverse events in the past each month, no history of psychiatric hospital stay, no addiction, no neurological or other progressive diseases, and no use of neurological or psychiatric medications were among the study\u0026apos;s inclusion criteria. If the study participants are unable to read English, then interviewer will clarify the questions to the couples. Unfortunate circumstances such as the loss of a loved one during the trial, getting pregnant spontaneously without the use of ART or any other fertility management throughout the treatment phases, and getting sick either mentally or physically during the study were all grounds for exclusion. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample size \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe sample size for this study was estimated to be 377 participants using the Roa soft calculation method with a 5% margin of error, a 95% confidence interval, and a 50% response rate. However, for accuracy and a high response rate, a total of 380 participants were selected from the infertility clinics and the hospital in question.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQuestionnaire modification\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter an extensive study of the literature, the validated questionnaire used for the study was modified based on demographics, the characteristics of our study participants, and clinical findings. This resulted in significant modifications to the questionnaire that was completed in order to assess the study participants\u0026apos; perceptions of assisted reproductive technology(Afshani, Abdoli, Hashempour, Baghbeheshti, \u0026amp; Zolfaghari, 2016; Anaman-Torgbor et al., 2021; Kim \u0026amp; Ban, 2024; Newton, Sherrard, \u0026amp; Glavac, 1999). The final subsection addressed the stress that couples experience as a result of their infertility; this section was updated as well and modified using a validated questionnaire with a few minor adjustments, which patients utilized for assessing their overall level of stress(Awtani, Mathur, Shah, \u0026amp; Banker, 2017; Mushtaq \u0026amp; Ghafoor, 2024; Newton et al., 1999). \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMeasurement tools \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA researcher-designed questionnaire was used to gather participant demographics and characteristics in the first portion. Information like age, gender, educational attainment, household income, work status, and information source were all included in this questionnaire.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiagnosis of infertility information and knowledge of Assisted Reproductive Technology\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis section encompassed a total of nine questions that asked couples whether they had children, how they conceived if they did, whether they had any complications during the process, whether they began therapy for it, whether they received a proper diagnosis, and whether they had ever heard of ART and, if so, the type of ART. In order to learn more about the recruited participants\u0026apos; knowledge of assisted reproductive technologies and infertility, these kinds of questions were posed. There were nine items in all in this area. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePerception of Assisted Reproductive Technology in Infertile Couples\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study participants\u0026apos; perceptions of assisted reproductive technology were examined through a total of six items in the third section. The first question asked if they believed that adoption could be an alternative to infertility treatment, including any ART that offered the option. Indeed, no. Do you believe that ART is halal or not? Another question asked whether you were concerned that children born after an ART operation could be more likely to have a genetic condition or defect (yes, no). Which of the following factors prevents you from using ART for your infertility: family and friends, the cost of the treatment, your religious beliefs, and the fact that you don\u0026apos;t want to have this procedure because you believe your children will be genetically weak? These options highlight the participants\u0026apos; perceptions of modern infertility procedure awareness and use. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eScoring\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Infertility Perception Scale for Women (IPS-W) and the Fertility Problem Inventory (FPI), two instruments used to measure attitudes and perceptions in health-related research, are the models from which this score system is derived. These tools measure impressions using Likert-scale replies, which enable classification into positive, neutral, and negative views.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStress faced by couples due to infertility\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe final component included eight items designed to assess the stress that infertile couples experience. The questions were primarily taken from a scientific literature fertility issue inventory scale(Kim \u0026amp; Ban, 2024; Newton et al., 1999). One of the first questions addressed to participants Does your inability to conceive with the option (rarely, sometimes, many times, and always) score 0-3) (low stress, moderate stress, and high stress with the option always used to access for more stress faced by not having children) prevent you from being invited or welcomed to any family events? In addition, do you find it upsetting when a friend or family member becomes pregnant? Every time you menstruate, do you feel depressed? (asked to women exclusively) Has your everyday connection with your husband been impacted by your inability to produce children? Do other couples\u0026apos; lack of children make you feel inferior? When you consider your incapacity to conceive, do you find it difficult to fall asleep? Does the idea of being childless make you want to flee your house? Is your failure to conceive causing you to experience physical or psychological abuse? The purpose of these questions was to address the stress that the research participants were experiencing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eExcel and SPSS (Social Package for Social Sciences) 27.0 New York, United States, were used to compile and assess the gathered data. The relationship between sociodemographic traits, additional infertility-related stress, and infertile couples\u0026apos; perceptions of assisted reproductive technology was examined in this study using the chi-square test. To assess the psychological profiles of infertile couples, the Fertility Problem Inventory, Infertility Perception Scale for Women, and sociodemographic were used. The results are shown as a percentage and frequency.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eDemographics of Study Participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study involved 380 married couples of reproductive ages who were infertile. The participants\u0026apos; demographic details are shown in Table 1. The majority of participants were female (69.5%), 49.5% were between the ages of 35 and 45, and 39.5% were between the ages of 25 and 35. In terms of educational attainment, 40.5% had a graduation degree, and 46.8% had finished matriculation. Of the participants, 34.5% made 20,000 PKR or less per month, while 41.8% made between 20,000 and 40,000 PKR per month. While a lesser percentage were housewives (2.9%), the majority were either working (49.7%) or active in their own business (42.6%). Information on infertility and treatment was most frequently obtained from friends and family (96.1%), the internet (81.6%), and physicians (85.8%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAssociation between Gender and Stress\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGender differences in stress patterns are indicated in Table 2. For instance, women reported being excluded from family gatherings more often than men did (15.5% vs. 12.9%). Women were somewhat more likely to report emotional reactions such feeling inadequate or having strained relationships with their partners. In addition, women reported higher rates of physical and mental violence (23.9%) than did men (21.6%). Although chi-square values indicate the difference was statistically significant (p = 0.033), such distinctions show a gender-based sensitivity, with females more prone to feel stress.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAssociation between Age and Stress\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn given Table 3 shows that the most stressed-out group of participants was those between the ages of 35 and 45, with 50% experiencing regular feelings of exclusion and 47.9% having trouble sleeping. Age and stress were significantly correlated, according to the chi-square statistics (p = 0.0355). It is noteworthy that those under 25 and over 45 exhibited much lower stress levels, indicating a midlife peak in anguish associated to infertility.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAssociation between Education and Stress\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA slightly non-significant correlation between stress and education level was shown in Table 4 (p = 0.107). Descriptively, individuals with intermediate levels of education were more likely than those in other groups to express emotional discomfort and frequent exclusion from events (68.8%). People who were illiterate also expressed higher levels of stress.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eChi-Square Correlation Summary\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA chi-square correlation summary is shown in given Table 5. Stress was substantially correlated with income (p = 0.0301\u0026ndash;0.0402), age (p = 0.0355), and gender (p = 0.033). While getting close to significance, educational level did not surpass the p \u0026lt; 0.05 cutoff.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGender and Correlation of Perception of Couples Towards ART Procedures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 5, highlights adoption is similarly accepted by both sexes as an alternative to ART. Male and female perceptions of ART\u0026apos;s religious permissibility (Halal) are almost equal. Men were somewhat more reluctant to use ART than women, with the majority of both sexes refusing to use it. Moral hesitancy was seen in the significant percentage of both sexes who would explore ART with ethical concerns. Both men and women generally agree that lab modification of eggs and sperm poses genetic dangers to offspring of ART. Though there are discernible concerns regarding the safety and ethics of ART, overall perceptions are very comparable between the sexes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAssociation between Demographics and Perception toward ART\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAccording to table 6 older responders and female participants were more inclined to embrace ART and view adoption as a legitimate substitute. Greater knowledge and acceptability of ART.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEducational level correlation with Diagnosis of Infertility\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAccording to the table 7, access to an accurate infertility diagnosis is clearly inversely linked with academic achievement. 75% (71 people) of the illiterate participants said they had not been properly diagnosed, which was the largest percentage of any category. However, only 2.6% of grads said the same. The rates for the intermediate and matriculation classes were 12.5% and 11.8%, respectively. There were very few skip/other replies; among graduates, the highest percentage was 1.9%. These results imply that a lack of knowledge or access to infertility diagnostic treatments is linked to lower educational attainment. This disparity may be closed with the aid of focused educational initiatives and increased health literacy, particularly among people with lower levels of education.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBarriers Hindering ART Use by Gender\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn the table 8, the most frequently mentioned obstacle, particularly for women, is social pressure from friends and family. Barriers related to cost and combination concerns (e.g., religious + genetic + societal) are more commonly reported by women. Religious convictions and other vague explanations are more frequently cited by men as stand-alone obstacles. Multifaceted barriers affect both sexes, but the emphasis is different: males are more influenced by religious and wider societal concerns, while females are more impacted by social and familial pressure. These factors were associated with higher education (p \u0026lt; 0.05). Most respondents lacked literacy, especially regarding the halal or genetically safe status of ART.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study interrogated in detail three primary aspects of infertility in Pakistan: how infertile married couples perceive assisted reproductive technologies and other fertility treatments, and how infertility affects their psychological health. This research examined couples to get insight into how infertility is seen, managed, and supported in Pakistan\u0026apos;s current healthcare system.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePerception of ART in Couples\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJust 53.2% of respondents correctly identified ART\u0026apos;s principal purpose as helping infertile couples conceive, despite the fact that 97.4% of respondents had heard of it. 57.6% of women and 59.5% of men said ART was halal, showing a somewhat positive opinion affected by cultural and religious reasons. This represented a considerable number of participants who expressed ethical and religious concerns. These findings are consistent with past research emphasizing religious allowability as a crucial factor in determining ART acceptance in Islamic(Abazie \u0026amp; Abimbola, 2021).\u003c/p\u003e\n\u003cp\u003eIn addition, 97.8% of couples concurred that Pharmacists, Psychologists and therapists need to be included in the multidisciplinary ART team, demonstrating their faith in the capacity of pharmacy specialists to assist and direct therapy. Age and education level had a favorable impact on perceptions, with older and better educated people showing more acceptance and knowledge of ART. This is linked to research that indicates reproductive technologies are more widely accepted when paired with sufficient health literacy(Adesiyun, Ameh, \u0026amp; Avidime, 2011).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStress Due to Infertility Among Couples\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFertility is still a major psychosocial stressor, particularly in societies where it is associated with womanhood and marital success. Because of their infertility, more than 60% of the individuals in our study experienced social rejection, melancholy, feelings of inadequacy, and even thoughts of loneliness. Although it was not statistically significant, women reported somewhat greater levels of stress than men. Stress and age (p = 0.035), education (p = 0.073), and income level (p = 0.040) were shown to be significantly correlated by chi-square analyses, indicating that socioeconomic determinants of health have a substantial impact on infertility-related misery. These results are in consistent with studies done in other South Asian contexts, where infertility is frequently linked to marital discord, mental health issues, and societal shame. (Jafar zadeh-Kenarsari, Ahmad-Amraji, \u0026amp; Abouzari-Gazafroodi, 2021). These stressors, which can show up as anxiety, sadness, or interpersonal conflict, are made worse by cultural demands, especially for women.(Lei, You, Luo, \u0026amp; Ren, 2021). The current study set out to compare the stress associated with infertility in men and women and evaluate its correlation with different infertility causes. These results showed that the mean score for stress linked to infertility was greater for women than for males, which is consistent with findings by(El Kissi et al., 2013). Unexpectedly, 9.2% of women reported having experienced or witnessed violence as a result of their infertility, and 30.8% of women said they had trouble falling asleep.(Lei et al., 2021). In order reduce the stigma and redefine fertility problems as a medical condition rather than a moral or societal one, these numbers underscore the critical need for psychosocial therapies and awareness efforts aimed at both men and women.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study emphasized the present and future roles of Psychologists and Pharmacists in fertility treatments while thoroughly examining the attitudes and stress levels of infertile married couples in Pakistan. The results show a complicated but changing healthcare environment where structural deficits, professional opportunities, and cultural sensitivities, psychological suffering, and lack of knowledge interact. In the first goal, which was to evaluate married couples' perceptions of ART, positive views and encouraging levels of general awareness were found, especially among healthcare professionals. Most participants understood the terms used in ART and how it is used to treat infertility. However, there was a lack of consistency in deeper understanding, especially with relation to ethical constraints and regulatory monitoring. This disparity highlights the necessity for thorough professional and public education initiatives to raise awareness and ensure accurate comprehension of ART treatments.\u003c/p\u003e\u003cp\u003eThe evaluation of stress levels among infertile married couples, which is the second goal, confirms that infertility continues to be a major emotional and psychological burden in Pakistani culture. Feelings of guilt, fear, and loneliness are made worse, especially for women, by cultural expectations surrounding reproduction as well as a lack of candid conversation and social support. These results are in line with international research that acknowledges infertility as a significant life stressor with broad consequences for mental health. The study implicitly supports the idea that multidisciplinary support along with organized counseling services, including the assistance of pharmacists with reproductive health training, might help infertile couples in Pakistan.\u003c/p\u003e\u003cdiv id=\"Sec29\" class=\"Section2\"\u003e\u003ch2\u003eSuggestions\u003c/h2\u003e\u003cp\u003e\u003cstrong\u003eMultidisciplinary reproductive Teams\u003c/strong\u003e\u003cp\u003ePharmacists and Psychologists should be actively included in patient care teams in medical facilities and reproductive clinics. This would enhance adherence, guarantee safe drug practices, and provide patients with both psychological and medical assistance along their reproductive journey.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEnhance Public Knowledge and Health Literacy\u003c/strong\u003e\u003cp\u003eTo dispel stigma around ART, dispel ethical and religious misunderstandings, and increase public awareness of the procedure, nationwide efforts are required. These initiatives should specifically target rural and undereducated people, where stress levels and misunderstandings are more prevalent.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eIncorporate Counseling and Mental Health Services\u003c/strong\u003e\u003cp\u003eTreatment for infertility should include psychological support services as a normal component. Counseling programs, particularly those specifically designed for women, may be able to lessen the emotional strain, shame, and conflict that come with infertility.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eBoost ART Guidelines and Policies\u003c/strong\u003e\u003cp\u003eThe creation of national ART rules should be a top priority for policymakers in order to guarantee access that is morally, legally, and culturally acceptable. Pharmacists' roles ought to be officially acknowledged and encouraged by these policies.\u003c/p\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Limitations","content":"\u003cp\u003e\u003cstrong\u003eCross-Sectional Design\u003c/strong\u003e\u003cp\u003eThe use of a cross-sectional survey reduces the capacity to draw conclusions about the causal relationship between knowledge and stress levels or between factors and patient outcomes.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eSelf-Reported Data\u003c/strong\u003e\u003cp\u003eThe research depends on participants' self-reported stress levels, attitudes, and experiences; these data may be skewed by social desirability bias or response bias, especially when discussing culturally sensitive subjects like ART and infertility.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eUrban-Centric Sample\u003c/strong\u003e\u003cp\u003eBecause the majority of participants were drawn from urban healthcare environments, the results may not be as applicable to underprivileged or rural communities where access to ART and heath literacy may be very different.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eRestricted Clinical Diversity\u003c/strong\u003e\u003cp\u003eDespite the fact that the research included couples, it excluded doctors, therapists, and legislators whose viewpoints may have added to our knowledge of the difficulties in implementing ART in Pakistan.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eAbsence of Longitudinal Data\u003c/strong\u003e\u003cp\u003eViews on ART and emotional stress might change over time. Although this study offers a snapshot, it does not account for changes over time or the impact of treatments on psychological health or knowledge.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eUnexplored Religious and Ethical Dimensions\u003c/strong\u003e\u003cp\u003eAlthough religious convictions were recognized, the study did not go into great detail about the variety of religious interpretations or the moral conundrums that couples encounter, as these factors may have an impact on the acceptance of ART.\u003c/p\u003e\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eART----------Assisted Reproductive Technology\u003c/p\u003e\n\u003cp\u003eSPSS---------Statistical Package of Social Sciences\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIUI------------Intrauterine Insemination\u003c/p\u003e\n\u003cp\u003eICSI-----------Intracytoplasmic Sperm Injection\u003c/p\u003e\n\u003cp\u003eSTROBE------Strengthening the Reporting of Observational Studies in Epidemiology\u003c/p\u003e\n\u003cp\u003eWHO-----------World Health Organization\u003c/p\u003e\n\u003cp\u003eCDC------------Centre for Disease Control\u003c/p\u003e\n\u003cp\u003eIVF--------------Invitro Fertilization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was reviewed and approved by the Riphah Ethical Committee of (Riphah institute of Pharmaceutical Sciences), under Ethical Approval Number: \u003cstrong\u003e(Ref.No.REC/RIU/2024/18)\u003c/strong\u003e. All participants were informed about the purpose, procedures, and voluntary nature of the study before data collection. Written informed consent was obtained from each participant. They were assured of confidentiality and anonymity, and their right to withdraw at any stage without any consequences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants gave written informed consent not just to participate in the study but also to have their anonymized data published in scholarly publications or reports. The participants were guaranteed complete secrecy and privacy protection throughout the publication process, as well as the nondisclosure of any personally identifying information.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Competing Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author declares that this study is free from any conflicting interests or potential conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWajeeha Ali \u003cstrong\u003e(W.A)\u003c/strong\u003e conceptualized and designed the study, collected and analyzed the data, and drafted the manuscript. Muhammad Amir Hamza \u003cstrong\u003e(M.A.H)\u003c/strong\u003e and Faizur Rehman \u003cstrong\u003e(F.R)\u003c/strong\u003e contributed to statistical analysis and interpretation of data. Faiqa Imran \u003cstrong\u003e(F.I)\u003c/strong\u003e assisted with data collection and field coordination. Dr. Sidra Kaleem \u003cstrong\u003e(S.K)\u003c/strong\u003e supervised the overall research process, provided methodological guidance, and reviewed the manuscript critically. Dr. Zakir Khan \u003cstrong\u003e(Z.K)\u003c/strong\u003e served as co-supervisor and contributed to manuscript review and academic support. All authors reviewed and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Funding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was not funded by any governmental, private, or commercial source. Without any funding, the study was carried out as an element of an academic project.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUnder reasonable request, the corresponding author will make the datasets created and/or examined during the current work available. In accordance with ethical guidelines, all data have been anonymized to protect participant confidentiality.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAbazie, O. H., \u0026amp; Abimbola, A. M. (2021). Knowledge, Perception, and Factors influencing the use of Assisted Reproductive Technology among Women in Lagos, Nigeria. \u003cem\u003eBayero Journal of Nursing and Health Care, 3\u003c/em\u003e(1), 725-736.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAdesiyun, A. G., Ameh, N., \u0026amp; Avidime, S. (2011). Awareness and perception of assisted reproductive technology practice amongst women with infertility in Northern. \u003cem\u003eOpen Journal of Obstetrics and Gynecology, 1\u003c/em\u003e, 144-148.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAfshani, S. A., Abdoli, A. M., Hashempour, M., Baghbeheshti, M., \u0026amp; Zolfaghari, M. (2016). The attitudes of infertile couples towards assisted reproductive techniques in Yazd, Iran: A cross sectional study in 2014. \u003cem\u003eInternational journal of reproductive biomedicine, 14\u003c/em\u003e(12), 761.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAnaman-Torgbor, J. A., Jonathan, J. W. A., Asare, L., Osarfo, B., Attivor, R., Bonsu, A., . . . Tarkang, E. E. (2021). Experiences of women undergoing assisted reproductive technology in Ghana: a qualitative analysis of their experiences. \u003cem\u003ePlos one, 16\u003c/em\u003e(8), e0255957.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAppiah, D., \u0026amp; Ganle, J. K. (2024). Ethical constraints and dilemmas in the provision of in-vitro fertilization treatment in Ghana: from the perspectives of experts. \u003cem\u003eBMC Medical Ethics, 25\u003c/em\u003e(1), 114. doi:10.1186/s12910-024-01113-0\u003c/li\u003e\n \u003cli\u003eAshcroft, R. E. (2008). 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O., \u0026amp; Ikimalo, J. I. (2019). Challenges with Assisted Reproductive Technology (ART) in Sub-Saharan Africa. \u003cem\u003eAfrican Journal of Reproduction and Gynaecological Endoscopy, 4\u003c/em\u003e(1), 3-8. doi:10.4103/ajiac.ajiac_8_22\u003c/li\u003e\n \u003cli\u003eGerrits, T. (2016). Assisted reproductive technologies in Ghana: transnational undertakings, local practices and \u0026apos;more affordable\u0026apos; IVF. \u003cem\u003eReprod Biomed Soc Online, 2\u003c/em\u003e, 32-38. doi:10.1016/j.rbms.2016.05.002\u003c/li\u003e\n \u003cli\u003eGhafoor, A. A., \u0026amp; Mushtaq, R. (2024). Predictive Association between Perceived Social Support and Infertility-Related Stress in Married Couples in Pakistan: Infertility-Related Stress in Married Couples. \u003cem\u003ePakistan BioMedical Journal\u003c/em\u003e, 14-18.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eHammond, K., \u0026amp; Hamidi, N. (2025). Exploring Muslim Communities\u0026rsquo; Experiences and Barriers While Accessing Assisted Reproductive Technologies: A Scoping Review of International Literature. \u003cem\u003eJournal of Religion and Health, 64\u003c/em\u003e(1), 330-368. doi:10.1007/s10943-024-02056-x\u003c/li\u003e\n \u003cli\u003eHazlina, N. H. N., Norhayati, M. N., Bahari, I. S., \u0026amp; Arif, N. A. N. M. (2022). Worldwide prevalence, risk factors and psychological impact of infertility among women: a systematic review and meta-analysis. \u003cem\u003eBMJ open, 12\u003c/em\u003e(3), e057132.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eJafar zadeh-Kenarsari, F., Ahmad-Amraji, L., \u0026amp; Abouzari-Gazafroodi, K. (2021). Evaluation of infertility-related stress and its associated factors in infertile clients: a cross-sectional study. \u003cem\u003ePreventive Care in Nursing \u0026amp; Midwifery Journal, 11\u003c/em\u003e(1), 1-10.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eJavaid, S., Mastoi, S. W., Jahan, E., Khalid, S., Jabeen, A., \u0026amp; Mahajan, N. (2022). Prevalence of infertility and its causes in the population of Pakistan: A cross-sectional study. \u003cem\u003eAnnals of the Romanian Society for Cell Biology, 26\u003c/em\u003e(1), 129-133.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eJohnson-Ekeleba, A. C., Sefogah, P. E., Swarray-Deen, A., \u0026amp; Mumuni, K. (2024). Awareness and acceptability of assisted reproductive technology among non-medical tertiary students in a low-resource setting. \u003cem\u003eReproductive Biology and Endocrinology, 22\u003c/em\u003e(1), 131.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eJONATHAN, J., Anaman-Tagbor, J., Asare, L., Osarfo, B., Attivor, R., Bonsu, A., . . . Tarkang, E. (2021). Experiences of Women Undergoing Assisted Reproductive Technology in GhanA: A Qualitative Study.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eKhalesi, Z. B., \u0026amp; Kenarsari, F. J. (2024). Anxiety, depression, and stress: a comparative study between couples with male and female infertility. \u003cem\u003eBMC women\u0026apos;s health, 24\u003c/em\u003e(1), 228.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eKim, M., \u0026amp; Ban, M. (2024). Development of an infertility perception scale for women (IPS-W). \u003cem\u003eBMC women\u0026apos;s health, 24\u003c/em\u003e(1), 513.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eLei, A., You, H., Luo, B., \u0026amp; Ren, J. (2021). The associations between infertility-related stress, family adaptability and family cohesion in infertile couples. \u003cem\u003eScientific reports, 11\u003c/em\u003e(1), 24220.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eMohamed, H. M., Badia, T. S., Khalaf, S. A., Abdullah, S. O., Farghaly, T. A., Fetih, A. N., \u0026amp; Aly, S. E. (2024). 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(2023). \u003cem\u003eInfertility prevalence estimates, 1990\u0026ndash;2021\u003c/em\u003e: World Health Organization.\u003c/li\u003e\n \u003cli\u003eParaskevi, L., Antigoni, S., \u0026amp; Kleanthi, G. (2021). Stress and Anxiety Levels in Couples who Undergo Fertility Treatment: a Review of Systematic Reviews. \u003cem\u003eMater Sociomed, 33\u003c/em\u003e(1), 60-64. doi:10.5455/msm.2021.33.60-64\u003c/li\u003e\n \u003cli\u003ePatel, A., Sharma, P. S. V. N., Kumar, P., \u0026amp; Binu, V. S. (2018). Sociocultural Determinants of Infertility Stress in Patients Undergoing Fertility Treatments. \u003cem\u003eJournal of Human Reproductive Sciences, 11\u003c/em\u003e(2), 172-179. doi:10.4103/jhrs.JHRS_134_17\u003c/li\u003e\n \u003cli\u003eRazzaque, M. A., Ali, A., Ahmed, W., Hussain, S., Wahid, A., \u0026amp; Razzaque, A. (2021). Assessment of the Level of Depression, Anxiety, Stress among Infertile Women (20-45 Years Age) in Tertiary Care Hospital. \u003cem\u003eJournal of Liaquat University of Medical \u0026amp; Health Sciences, 20\u003c/em\u003e(5), 358-362.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSaif, J., Rohail, I., \u0026amp; Aqeel, M. (2021). Quality of life, coping strategies, and psychological distress in women with primary and secondary infertility; a mediating model. \u003cem\u003eNature-Nurture Journal of Psychology, 1\u003c/em\u003e(1), 8-17.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSana, M., Abdullah, M., \u0026amp; Sana, F. (2024). Link Between Psychological Stress and Female Infertility? Call for Increased Research in India and Pakistan. \u003cem\u003eJournal of Psychosexual Health, 6\u003c/em\u003e(3), 297-298.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSawicka-Gutaj, N., Gruszczyński, D., Guzik, P., Mostowska, A., \u0026amp; Walkowiak, J. (2022). Publication ethics of human studies in the light of the Declaration of Helsinki\u0026ndash;a mini-review. \u003cem\u003eJournal of Medical Science, 91\u003c/em\u003e(2), e700-e700.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eTabassum, A., Sadia, R., Huda, S., \u0026amp; Khan, S. (2023). Infertility-related stress and marital satisfaction among Pakistani infertile individuals. \u003cem\u003eIUB Journal of Social Sciences, 5\u003c/em\u003e(1), 71-81.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eTruong, L. Q., Luong, T. B., Tran, T., Dang, N. H., Nguyen, L. H., Nguyen, T. T., \u0026amp; Nguyen, P. T. (2022). Infertility-related stress, social support, and coping of women experiencing infertility in Vietnam. \u003cem\u003eHealth psychology report, 10\u003c/em\u003e(1).\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eUllah, A., Ashraf, H., Tariq, M., Aziz, S. Z., Zubair, S., Sikandar, K. U. R., . . . Nisar, M. (2021). Battling the Invisible Infertility Agony. \u003cem\u003eJournal of Ethnic and Cultural Studies, 8\u003c/em\u003e(2), 89-105.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eWarner, L., Jamieson, D. J., \u0026amp; Barfield, W. D. (2015). CDC releases a National Public Health Action Plan for the Detection, Prevention, and Management of Infertility. \u003cem\u003eJournal of Women\u0026apos;s Health (15409996), 24\u003c/em\u003e(7).\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eWhittaker, A., Gerrits, T., Hammarberg, K., \u0026amp; Manderson, L. (2024). Access to assisted reproductive technologies in sub-Saharan Africa: fertility professionals\u0026rsquo; views. \u003cem\u003eSexual and Reproductive Health Matters, 32\u003c/em\u003e(1), 2355790.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eWHO. (2022). (2022). Retrieved from https://www.who.int/news-room/fact\u0026nbsp;\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1.1:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eDemographics Characteristics of Study Participants (N = 380)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"479\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 148px;\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 101px;\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; f\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; %\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"37\" style=\"width: 0px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"37\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e30.50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"21\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e264\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e69.50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"21\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eBelow 25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.70%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"21\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e25-35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e39.50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"21\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e35-45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e188\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e49.50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"21\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e45 onward\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"21\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eLevel of education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eIlliterate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8.40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"21\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMatriculation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e178\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e46.80%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"21\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eIntermediate\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"21\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eGraduation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e40.50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"21\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eIncome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20k\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e34.50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"21\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20k-40k\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e159\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e41.80%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"21\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e40-60k\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e22.10%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"21\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e60k or above\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.60%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"21\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eEmployment status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eEmployed\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e189\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e49.70%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"21\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eOwn business\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e42.60%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"21\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eUnemployed\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"21\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eRetired\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"21\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSource of information\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eHousewife\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.90%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"42\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e(Multiple options)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eInternet\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e310\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e81.60%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"21\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eFamily and friends\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e365\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e96.10%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"42\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDoctors\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e326\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e85.80%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"21\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePharmacists\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e22.40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"21\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.2:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eAssociation between Gender and Stress-Related Questions (N = 380)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eItem\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResponse Category\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale (%) (N)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale (%) (N)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAre you not invited or welcomed to any family events for not being able to have children?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eRarely\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e8.6% (16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e3.8% (7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eSometimes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e33.6% (64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e37.5% (71)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eMany times\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e44.8% (85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e43.2% (82)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eAlways\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e12.9% (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e15.5% (29)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAre you upset when your friend or relative becomes pregnant?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eRarely\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e3.4% (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e2.3% (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eSometimes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e38.8% (74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e33.0% (63)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eMany times\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e42.2% (80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e45.8% (87)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eAlways\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e15.5% (29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e18.9% (36)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHas being unable to have children affected your relationship with your spouse?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eRarely\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e3.4% (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e3.4% (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eSometimes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e36.2% (69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e31.1% (59)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eMany times\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e41.4% (79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e50.0% (95)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eAlways\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e19.0% (36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e15.5% (29)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDo you feel inferior to other couples for not having children?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eRarely\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e6.0% (11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e3.8% (7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eSometimes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e36.2% (69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e31.1% (59)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eMany times\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e44.8% (85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e51.9% (99)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eAlways\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e12.9% (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e13.3% (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDo you have trouble falling asleep thinking about your infertility?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eRarely\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e9.5% (18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e14.0% (27)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eSometimes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e41.4% (79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e35.2% (67)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eMany times\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e40.5% (77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e41.3% (79)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eAlways\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e8.6% (16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e9.5% (18)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDoes the thought of not having a child make you want to run away from home?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eRarely\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e28.4% (54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e26.5% (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eSometimes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e43.1% (82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e37.9% (72)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eMany times\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e25.9% (49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e32.6% (62)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eAlways\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e2.6% (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e3.0% (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAre you subjected to mental or physical violence due to infertility?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e41.4% (79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e46.2% (88)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eSometimes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e34.5% (66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e29.2% (55)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eMany times\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e21.6% (41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e23.9% (45)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eAlways\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e2.6% (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e0.8% (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.3:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eAssociation between age and stress Study Participants (N = 380)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eItem\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResponse\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBelow 25 (n/%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e25\u0026ndash;35 (n/%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e35\u0026ndash;45 (n/%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e45 Onward (n/%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNot invited to family events due to infertility\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003eRarely\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e27 (7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e25 (6.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e14 (3.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e27 (7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003eSometimes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e54 (14.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e162 (42.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e127 (33.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e122 (32.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003eMany times\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e190 (50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e134 (35.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e190 (50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e163 (42.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003eAlways\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e109 (28.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e58 (15.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e49 (12.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e68 (17.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUpset when friend/relative becomes pregnant\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003eRarely\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e8 (2.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e8 (2.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e41 (10.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003eSometimes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e54 (14.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e160 (42.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e121 (31.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e95 (25.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003eMany times\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e244 (64.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e147 (38.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e182 (47.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e176 (46.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003eAlways\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e81 (21.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e66 (17.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e69 (18.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e68 (17.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfertility affecting spousal relationship\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003eRarely\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e27 (7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e10 (2.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e12 (3.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e27 (7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003eSometimes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e81 (21.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e152 (40.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e105 (27.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e122 (32.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003eMany times\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e136 (35.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e160 (42.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e206 (54.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e136 (35.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003eAlways\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e136 (35.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e58 (15.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e57 (14.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e95 (25.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFeeling inferior to other couples\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003eRarely\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e54 (14.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e15 (4.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e14 (3.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e27 (7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003eSometimes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e81 (21.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e142 (37.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e113 (29.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e122 (32.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003eMany times\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e136 (35.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e172 (45.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e212 (55.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e149 (39.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003eAlways\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e109 (28.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e51 (13.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e40 (10.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e81 (21.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTrouble sleeping due to infertility\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003eRarely\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e27 (7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e48 (12.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e43 (11.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e95 (25.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003eSometimes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e136 (35.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e157 (41.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e133 (35.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e109 (28.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003eMany times\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e81 (21.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e132 (34.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e182 (47.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e149 (39.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003eAlways\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e136 (35.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e43 (11.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e22 (5.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e27 (7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDesire to run away due to infertility\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003eRarely\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e163 (42.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e106 (28.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e91 (23.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e136 (35.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003eSometimes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e109 (28.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e175 (46.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e133 (35.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e149 (39.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003eMany times\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e109 (28.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e89 (23.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e144 (37.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e81 (21.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003eAlways\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e10 (2.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e12 (3.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e14 (3.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMental or physical violence due to infertility\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e163 (42.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e177 (46.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e162 (42.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e190 (50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003eSometimes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e81 (21.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e122 (32.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e111 (29.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e149 (39.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003eMany times\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e136 (35.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e79 (20.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e101 (26.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e27 (7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003eAlways\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e3 (0.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e6 (1.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e14 (3.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.4:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Association between level of education and stress Study Participants (N = 380) \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQuestion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation Level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRarely (% / n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSometimes (% / n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMany Times (% / n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlways (% / n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eNot invited to family events\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eIlliterate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e6.2% / 6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e25% / 24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e43.8% / 42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e25% / 24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eMatriculation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e5.6% / 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e38.8% / 37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e41.6% / 40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e14% / 13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eIntermediate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e12.5% / 12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e18.8% / 18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e68.8% / 65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e0% / 0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eGraduation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e3.9% / 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e37.7% / 36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e43.5% / 41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e14.9% / 14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eUpset when others become pregnant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eIlliterate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0% / 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e15.6% / 15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e59.4% / 56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e25% / 24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eMatriculation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e1.7% / 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e41.6% / 40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e38.2% / 36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e18.5% / 18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eIntermediate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e12.5% / 12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e12.5% / 12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e56.2% / 53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e18.8% / 18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eGraduation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e3.2% / 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e33.1% / 31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e48.1% / 46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e15.6% / 15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eRelationship with spouse affected\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eIlliterate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e6.2% / 6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e21.9% / 21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e37.5% / 36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e34.4% / 33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eMatriculation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e1.7% / 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e38.2% / 36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e46.6% / 44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e13.5% / 13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eIntermediate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e12.5% / 12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e37.5% / 36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e18.8% / 18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e31.2% / 30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eGraduation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e3.9% / 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e27.9% / 27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e53.2% / 51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e14.9% / 14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eFeel inferior to other couples\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eIlliterate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e9.4% / 9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e15.6% / 15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e37.5% / 36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e37.5% / 36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eMatriculation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e1.7% / 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e37.1% / 35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e48.9% / 46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e12.4% / 12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eIntermediate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e12.5% / 12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e18.8% / 18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e56.2% / 53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e12.5% / 12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eGraduation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e5.8% / 6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e32.5% / 31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e52.6% / 50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e9.1% / 9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eTrouble falling asleep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eIlliterate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e9.4% / 9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e25% / 24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e37.5% / 36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e28.1% / 27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eMatriculation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e11.8% / 11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e41% / 39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e37.6% / 36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e9.6% / 9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eIntermediate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e18.8% / 18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e31.2% / 30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e37.5% / 36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e12.5% / 12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eGraduation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e13.6% / 13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e35.7% / 34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e46.1% / 44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e4.5% / 4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eWant to run away from home\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eIlliterate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e25% / 24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e34.4% / 33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e34.4% / 33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e6.2% / 6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eMatriculation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e24.7% / 23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e43.3% / 41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e30.3% / 29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e1.7% / 2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eIntermediate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e43.8% / 42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e25% / 24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e18.8% / 18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e12.5% / 12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eGraduation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e28.6% / 27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e37.7% / 36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e31.2% / 30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e2.6% / 2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eSubjected to mental/physical violence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eIlliterate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e28.1% / 27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e34.4% / 33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e31.2% / 30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e6.2% / 6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eMatriculation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e43.8% / 42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e33.1% / 31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e21.9% / 21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e1.1% / 1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eIntermediate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e56.2% / 53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e18.8% / 18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e18.8% / 18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e6.2% / 6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eGraduation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e48.1% / 46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e28.6% / 27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e23.4% / 22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e0% / 0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.5: Chi-square Correlation between demographics and Stress related questions Study Participants (N = 380)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLow Stress(% / N)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModerate Stress(% / N)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHigh Stress(% / N)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026chi;\u0026sup2; (df)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003eMale (n = 190)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e6.0% / 11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e65.5% / 124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e28.4% / 54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.14 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003eFemale (n = 190)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e5.7% / 11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e64.0% / 122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e30.3% / 58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003eBelow 25 (n = 95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e7.1% / 7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e64.3% / 61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e28.6% / 27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e6.60 (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0.0355\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e25\u0026ndash;35 (n = 95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e6.7% / 6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e70.0% / 67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e23.3% / 22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e35\u0026ndash;45 (n = 95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e4.8% / 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e59.6% / 57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e35.6% / 34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e45 onward (n = 95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e7.1% / 7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e67.9% / 64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e25.0% / 24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedication Use\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003eYes (n = 190)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e5.6% / 11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e64.8% / 123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e29.6% / 56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e1.07 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0.0387\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003eNo (n = 190)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e12.5% / 24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e50.0% / 95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e37.5% / 71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.6:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eAssociation between demographics and perception assisted reproductive technology Study Participants (N = 380)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGender and age correlation with (do you conceive by natural process?)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" width=\"653\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 230px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge Group (Female)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes (N)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo (N)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 230px;\"\u003e\n \u003cp\u003eBelow 25 (n = 48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e71.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e0.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 230px;\"\u003e\n \u003cp\u003e25\u0026ndash;35 (n = 48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e64.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e16.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 230px;\"\u003e\n \u003cp\u003e35\u0026ndash;45 (n = 47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e73.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e5.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 230px;\"\u003e\n \u003cp\u003e45 onward (n = 47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e66.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e0.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.7: Educational level correlation with (do you get proper diagnosis of infertility?\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" width=\"657\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation Level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo (N)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSkip/Others (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 162px;\"\u003e\n \u003cp\u003eIlliterate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e75.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e0.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 162px;\"\u003e\n \u003cp\u003eMatriculation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e11.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e0.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 162px;\"\u003e\n \u003cp\u003eIntermediate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e12.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e0.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 162px;\"\u003e\n \u003cp\u003eGraduation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e2.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 227px;\"\u003e\n \u003cp\u003e1.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.8: Barriers Hindering ART Use by Gender (N = 380)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" width=\"694\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 486px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBarrier Combination\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale (N)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 486px;\"\u003e\n \u003cp\u003eCost + Family and Friends\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e5.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 486px;\"\u003e\n \u003cp\u003eCost only\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e2.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 486px;\"\u003e\n \u003cp\u003eCost + Family + Genetic Weakness + Religious Beliefs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e3.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 486px;\"\u003e\n \u003cp\u003eCost + Religious Beliefs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e0.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 486px;\"\u003e\n \u003cp\u003eFamily and Friends only\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e35.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 486px;\"\u003e\n \u003cp\u003eFamily + Cost + Religious + Genetic Weakness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e18.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 486px;\"\u003e\n \u003cp\u003eGenetic Weakness + Religious + Cost + Family\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e6.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 486px;\"\u003e\n \u003cp\u003eReligious Beliefs + Others\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e0.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 486px;\"\u003e\n \u003cp\u003eReligious Beliefs only\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e1.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 486px;\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e0.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"ART Perception, Stress Management, Couples Mental Health, Perceived Stress among Couples, Coping with Stress through ART intervention, Marital Relationship, Stress therapy by ART","lastPublishedDoi":"10.21203/rs.3.rs-7284839/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7284839/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction:\u003cbr\u003e\n \u003c/strong\u003eInfertility, characterized by being unable to become pregnant after one year of sexual activity without protection (or six months for women over 35 due to age-related fertility decline), is a worldwide problem with serious psychological, social, marital, and individual consequences. By allowing couples to conceive biologically related children, assisted reproductive technologies, or ARTs, give them new hope. However, cultural differences exist in how ART and infertility are seen and dealt with. The purpose of this study is to investigate the psychological strain that infertile couples endure as well as the societal obstacles that prevent them from seeking ART.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology:\u003cbr\u003e\n \u003c/strong\u003eA cross-sectional observational research was carried out between January 1 and March 31, 2025. Data were gathered from patients at Islamabad and Rawalpindi's infertility clinics and PIMS Hospital using a pre-validated self-administered questionnaire. 380 people were recruited through convenience sample technique. SPSS version 27.0 New York, United States, were used to analyze the data and find correlations. Chi-square tests and descriptive statistics were employed for deeper analysis\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003cbr\u003e\n \u003c/strong\u003eAmong the 380 participants, women made up 69.5%. 35 to 45 years old made up the largest age group (49.5%), followed by 25 to 35 years old (39.5%). Level of education varied, with 46.8% finishing matriculation and 40.5% having graduate degrees. Infertility-related emotional suffering was extensively observed: 49.7% reported sleep difficulties, 44.7% expressed regular melancholy, and 43.7% experienced frequent exclusion from family gatherings. Furthermore, 41.1% reported having been the victim of physical or psychological abuse, and 47.4% felt inferior to others. In the 35–45 age range, stress was most common, with 50% reporting frequent exclusion and 47.9% reporting sleep disturbances. Stress was found to be significantly correlated with age (p = 0.0355). A substantial association was found between work status and stress markers, which were particularly common among housewives and those without employment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003cbr\u003e\n \u003c/strong\u003eStress related to infertility peaks in midlife, particularly for housewives and jobless people. These results emphasize the necessity of focused interventions and psychological support for impacted couples, particularly those pursuing ART and any infertility management treatment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial Registration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e","manuscriptTitle":"Perception of Assisted Reproductive Technology Among Infertile Married Couples and Stress Faced due to Infertility in Pakistan: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-21 09:19:14","doi":"10.21203/rs.3.rs-7284839/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-26T14:44:03+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-23T15:50:57+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-18T18:19:49+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-18T14:27:24+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-18T00:49:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"93400724824145992357970202461943087400","date":"2025-08-16T12:45:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"107789323606783498906600229219113245530","date":"2025-08-16T12:25:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"93101256015241996133520101035627072568","date":"2025-08-15T07:24:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"52827308029466426556956535451004194137","date":"2025-08-09T23:37:58+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-09T15:53:51+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-09T12:39:59+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-09T06:22:15+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-09T06:19:58+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Public Health","date":"2025-08-03T17:34:11+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"57880179-8d8b-4004-b70a-b50ce1801c0c","owner":[],"postedDate":"August 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-11-24T16:04:48+00:00","versionOfRecord":{"articleIdentity":"rs-7284839","link":"https://doi.org/10.1186/s12982-025-01106-3","journal":{"identity":"discover-public-health","isVorOnly":false,"title":"Discover Public Health"},"publishedOn":"2025-11-18 15:59:01","publishedOnDateReadable":"November 18th, 2025"},"versionCreatedAt":"2025-08-21 09:19:14","video":"","vorDoi":"10.1186/s12982-025-01106-3","vorDoiUrl":"https://doi.org/10.1186/s12982-025-01106-3","workflowStages":[]},"version":"v1","identity":"rs-7284839","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7284839","identity":"rs-7284839","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}