title: Cross-cultural comparison of fertility specific quality of life in German, Hungarian and Jordanian couples attending a fertility center.
abstract: BACKGROUND
  Only a few studies have reported cross-cultural comparisons regarding psychosocial consequences of infertility. Differences between societies with different cultural backgrounds were revealed and seemed to be based on the importance of pronatalism. Our aim was to measure cross-cultural differences in fertility specific quality of life of infertile couples in Germany, Hungary and Jordan who attend a fertility center in a cross-sectional study.
  
  
  METHODS
  A cross-sectional study was conducted in one fertility clinic in Germany, in five fertility clinics in Hungary and in one fertility clinic in Jordan. Overall 750 couples (252 couples in Jordan, 246 couples in Germany and 252 couples in Hungary) attending the first medical infertility consultation were asked to fill out our questionnaire set. Fertility specific quality of life (FertiQoL) and sociodemographic differences were measured between couples from three countries.
  
  
  RESULTS
  Jordanian couples had the shortest relationship (5.8 ± 4.3 yrs.), though they reported the longest duration of child wish (4.2 ± 3.6 yrs.) and fertility treatments (3.0 ± 3.3 yrs.). The proportion of high education was considerably higher in Jordanian women and men (60 % and 66 %, respectively) compared to the other two samples. First, marked cross-country differences were obtained on Emotional, Mind/Body and Relational subscales of the FertiQoL, indicating that Jordanian couples reported poorer fertility-related quality of life than Germans and Hungarians (p < 0.001). After controlling for the sociodemographic and medical variables, a significant difference only in the Emotional domain was observed (p < 0.001).
  
  
  CONCLUSIONS
  The study revealed only a few cultural based differences in fertility specific quality of life between the couples of the three countries. Thus, infertility counselors should pay attention to psychosocial problems rooted in individual sociocultural aspects of the infertile couple regardless of cultural stereotypes. Further studies should identify sociocultural factors within different subgroups of infertile patients instead of focusing different societies as a whole because intra-cultural psychosocial differences in experiencing infertility seem to be more important for the individual patient than intercultural differences.
authors.affiliation: Institute of Medical Psychology, Center for Psychosocial Medicine, Ruprecht-Karls University Heidelberg, Bergheimer Strasse 20, 69115, Heidelberg, Germany. reka.sexty@med.uni-heidelberg.de.
authors.forename: Réka E
authors.initials: RE
authors.lastname: Sexty
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, King Abdullah University Hospital, Irbid, Jordan. jehan_hamadneh@yahoo.com.
authors.forename: Jehan
authors.initials: J
authors.lastname: Hamadneh
authors.affiliation: Department of Gynecological Endocrinology and Reproductive Medicine, Women's Hospital, Ruprecht-Karls University Heidelberg, Heidelberg, Germany. sabine.roesner@med.uni-heidelberg.de.
authors.forename: Sabine
authors.initials: S
authors.lastname: Rösner
authors.affiliation: Department of Gynecological Endocrinology and Reproductive Medicine, Women's Hospital, Ruprecht-Karls University Heidelberg, Heidelberg, Germany. thomas.strowitzki@med.uni-heidelberg.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Strowitzki
authors.affiliation: Institute of Medical Psychology, Center for Psychosocial Medicine, Ruprecht-Karls University Heidelberg, Bergheimer Strasse 20, 69115, Heidelberg, Germany. beate.ditzen@med.uni-heidelberg.de.
authors.forename: Beate
authors.initials: B
authors.lastname: Ditzen
authors.affiliation: Department of Gynecological Endocrinology and Reproductive Medicine, Women's Hospital, Ruprecht-Karls University Heidelberg, Heidelberg, Germany. bettina.toth@med.uni-heidelberg.de.
authors.forename: Bettina
authors.initials: B
authors.lastname: Toth
authors.affiliation: Institute of Medical Psychology, Center for Psychosocial Medicine, Ruprecht-Karls University Heidelberg, Bergheimer Strasse 20, 69115, Heidelberg, Germany. tewes.wischmann@med.uni-heidelberg.de.
authors.forename: Tewes
authors.initials: T
authors.lastname: Wischmann
mesh_terms: D000328:Adult; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D004644:Emotions; D005260:Female; D005298:Fertility; D005858:Germany; D006801:Humans; D006814:Hungary; D007246:Infertility / Q000453:epidemiology*; D007597:Jordan; D008297:Male; D008393:Marriage / Q000706:statistics & numerical data; D011788:Quality of Life / Q000523:psychology*; D011795:Surveys and Questionnaires