Original Article

The Effect of Behavioral Couple Therapy on the Improvement of Mental Health

and Reduction of Marital Conflict in Infertile Couples in Kermanshah:
A Randomized Controlled Trial (RCT)
Seyed Mojtaba Ahmadi 1, Jamile Shahverdi 2, Mansour Rezaei 3, Mitra Bakhtiari 4, Kheirollah Sadeghi 2, Fateme
Veisy 5, Maryam Shahverdi 6

1- Department of clinical psychology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2- Department of Psychology, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
3- Department of Biostatistics and Epidemiology, Social Development and Health Promotion Research Center, Kermanshah Univer-
sity of Medical Sciences, Kermanshah, Iran
4- Department of Anatomy and Biology, Faculty of Medicine, Kermanshah University of Medical Science, Kermanshah, Iran
5- Department of Clinical Psychology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
6- Department of Information Technology, Payame Noor University Tehran West, Tehran, Iran

Abstract
Background: Infertility is a common disorder, exposing couples to complication such as the
loss of mental health and the increase of marital conflicts. The aim of this study was to evalu-
ate the effect of behavioral couple therapy on the enhancement of mental health and reduc-

Downloaded from http://www.jri.ir

tion of marital conflicts.
Methods: In this clinical trial, 24 couples were selected using convenience sampling and
were divided randomly into control (12 couples) and experimental (12 couples) groups. Men-
tal Health Questionnaire (GHQ-28) and Kansas Marital Conflict Scale (KMCS) were used to
collect data. These questionnaires were filled and pretest, posttest and followup were done in
two months. Data were analyzed by Repeated Measures Analysis of Variance, chi-square, in-
dependent sample T test, and Bonferroni tests using SPSS-16 software. The significant level
* Corresponding Author: of the test was 0.05.
Jamile Shahverdi, Results: The results of the data analysis between experimental and control groups of females
Department of Psychology, in the marital conflict variable showed that the effect of time (p=0.002) and time and group
Faculty of Medicine, interactional effect (p=0.001) were significant. Moreover, in both experimental and control
Kermanshah University of groups of males, time effect was significant (p=0.01), but time and group interactional effect
Medical Sciences, was not significant (p=0.14). Also, the results of the data analysis between experimental and
Kermanshah, Iran control groups of females in the mental health and time effect was significant (p=0.001) and
E-mail: time and group interactional effect was significant as well (p=0.001). But in both experi-
Shahverdi.jamile@yahoo.
mental and control groups of males, time effect (p=0.71) and time and group interactional ef-
com
fect were not significant (p=0.60).
Received: May 22, 2018 Conclusion: Behavioral couple therapy can be used in the treatment of infertile couples, es-
Accepted: Nov. 6, 2018 pecially in women.

Keywords: Behavioral couple therapy, Infertility, Marital conflict, Mental health.

To cite this article: Ahmadi SM, Shahverdi J, Rezaei M, Bakhtiari M, Sadeghi Kh,
Veisy F, et al. The Effect of Behavioral Couple Therapy on the Improvement of Mental
Health and Reduction of Marital Conflict in Infertile Couples in Kermanshah: A Randomized
Controlled Trial (RCT). J Reprod Infertil. 2019;20(1):16-23.

Introduction
nfertility is defined as the absence of preg- have (1). According to World Health Organization
nancy following intercourse for one year (WHO), 50 to 80 million people around the world
without using contraceptives. According to are involved with primary or secondary infertility
researches conducted, 0.15 of couples have no (2). Infertility prevalence in Iran has been reported
children despite their tendency and 0.10 of them to be 13.2%. The rate of primary infertility in Iran
have less than the number of children they want to was 2.2 and secondary infertility was 3.2 (3).

J Reprod Infertil. 2019;20(1):16-23

 Ahmadi SM, et al. JRI
The process of infertility can cause certain emo- coherent relation between them (11).
tional aspects. There are cases which create pres- Based on these issues, ignoring the psychologi-
sure and emotional conflict which can be en- cal problems of infertility and just checking the
hanced in time. Anxiety, depression and marital medical aspect can be a major obstacle in the way
disruption are the results of pressure from infer- in which the total understanding of infertility is
tility, lack of emotional and psychological sup- shaped. Therefore, infertility must be seen through
port, and the stress of high costs of infertility treat- the realm of Behavioral Sciences at the same time.
ment, the absence from work for treatment, the Obviously, referral of infertile couples to modern
disappointing treatment outcome and the feeling infertility treatment centers can induce the feeling
of permanent infertility (4). The prevalence of psy- that the health system only targets their physical
chiatric problems in infertile couples are estimat- problem and ignores their general conditions (12).
ed to be between 0.25 and 0.60 and the rate of Despite the importance of conflicts in marital
depression and anxiety was significantly higher life, there have been very few researches on it yet.
than the fertile group and the general population This research aimed to investigate the theory of
(5). One study in Bandar Abbas on 200 infertile couple behavioral treatment in social-cultural con-
women showed that 0.45% of them get higher ditions in Iran with the goal of reducing the cou-
scores than the cut-off point in the mental health ple conflict and helping to increase their general
questionnaire (6). In the meta-analysis conducted health.
in Iran, prevalence of depression in infertile cou-
ples was 0.47%; the rate was 0.46 among women Methods

Downloaded from http://www.jri.ir

and 0.47% among men (7). This research is a randomized controlled clinical
According to the findings of researches, high trial. Study population of this research consisted
levels of anxiety and depression, decrease fertility of all the infertile couples in Kermanshah who
even when IVF strategies are in process. Accord- went to Motazedi infertility treatment center for
ing to Reed findings, anxiety and depression can the treatment of their infertility. The research sam-
cause failure and the repetition of treatment is re- ple consisted of 24 couples. Inclusion criteria in-
quired. 0.33% of infertile women suffer from de- cluded having a score higher than 22 in GHQ (Gen-
pression while only 0.18% of fertile women face eral health questionnaire), the confirmation of the
depression. Therefore, psychological problems as- presence of general health problems based on the
sociated with infertility are the most important clinical interview structured for disorders DSM-
challenge faced by infertile people which affect IV-TR. Every person needed to consent to partici-
the their treatment (8). Infertility is one of the pate in the research by signing a consent form,
main causes of family relationships problem, dis- non-interfering in the process of infertility treat-
ruption, divorce, lack of self-confidence and so- ment, confirming the absence of any other psychi-
cial isolation (6, 9). Studies have shown that infer- atric disorder at the time of study and being mar-
tile women compared with fertile women have ried at least for two years. Exclusion criteria of
less mental health and marital adjustment (10). the study included any significant disruption in
According to Saeedi et al., marital complain comes the axis I, except those which are being studied,
from the lack of coordination of needs and irre- any physical disorder which can affect the process
sponsible behaviors among couples. Marital con- of psychotherapy, signs and symptoms of psycho-
flict when the response to individual differences is sis including hallucinations and delusions, exac-
arising into a level of feeling of anger, hostility, in erbation of depressive symptoms during treatment,
the couple’s relationship and become destructive and personality disorder on axis II. The evaluation
(10). of I, II axes was done by using structured inter-
Rice discussed two types of conflict in marriage views (SCID).
in 1996, namely constructive conflict and destruc- SCID is a semi-structured clinical interview that
tive conflict. In constructive conflict, the focus is provides diagnosis based on DSM-IV. It includes
on problem solving, trust, and respect where there two versions of SCID-I for Axis I disorder and
is little verbal contact and negative emotion be- SCID-II that examines personality disorders. In
tween them. In destructive conflict, the couple at- this study, SCID-I was used for the diagnosis of
tack each other instead of working on the problem major depression. This tool was studied on 299
and try to dominate the other, use negative expres- people who referred to psychiatric centers in Teh-
sion to call each other and this causes a non– ran, Iran. The results showed that the Persian ver-

J Reprod Infertil, Vol 20, No 1, Jan-Mar 2019 17

JRI Behavioral Couple Therapy in Infertility

sion of SCID is a reliable tool for diagnosis for important principles in communication. The fourth
clinical research and educational purposes (13). session: understanding the concept of documents,
Tools: Two questionnaires were used in this re- types of marital attribution. The fifth session: teach-
search, namely general health questionnaire (GHQ- ing appropriate nonverbal and verbal behaviors
28) and Kansas Marital Conflict Scale (KMCS). and male–female communication differences. The
General health questionnaire (GHQ-28) was de- sixth session: training the basic principles of rein-
signed by Goldberg and Hiller. It contains 28 items forcement-punishment and mutual relations. The
and 4 subscales: 1) physical symptoms, 2) anxiety seventh session: learning of cognitive factors, and
and insomnia, 3) social dysfunctions, and 4) de- cognitive errors by couples. The eighth session:
pression. The scores lower than 22 on this ques- learning behavioral–communication modeling (six
tionnaire is a sign of good general health. By Cron- aspects). The ninth session: learning problem-
bach's alpha coefficients, reliability coefficient for solving skills. And the tenth session: conclusion,
the total scale has been reported 0.88 and for sub- getting feedback and running posttest (15, 16).
scales from 0.66 to 0.85. Behjati ardekani report- This study has the certificate no.4451 by Ker-
ed the reliability of the questionnaire 0.85 based manshah University of Medical Sciences Ethics
on test- retest method and 0.76 on by Cronbach's Committee and has been registered in center of
coefficient (14). clinical trial of Iran under the no. IRCT 2014
Kansas Marital Conflict Scale (KMCS) is a test 010716121N1.
including 27 items that aims to measure the cou-
Results

Downloaded from http://www.jri.ir

ple conflict. It has a good internal consistency.
Half of the participants were females and the
The alpha range for men comes to 0.91 to 0.95.
other half were males. 43.8% of them were edu-
Consistency of test- retest reliability in all 3 steps
cated (Graduated from university) and 45.8% of
ranged between 0.64 to 0.96 (15). By Cronbach's
them were housewives, 35.4% were self-employ-
alpha coefficients, reliability coefficient for the
ed and 18.8% were clerks. Based on their eco-
total scale has been reported 0.75.
nomic situations (Reported by couples), they were
Statistical analysis: Data were analyzed using mostly middle class families. They were married
SPSS-16 and descriptive statistics (The mean and for 2 to 8 years. Primary infertility was observed
standard deviation) and inferential statistics (In- in four couples. The results showed that there was
dependent sample T test, mixed analysis of vari- no significant difference in demographic charac-
ance -between and within groups, repeated mea- teristics between the two groups.
sures variance analysis and Bonferroni tests). The The mean and the standard deviation of marital
significant level of the test was 0.05. conflict and mental health in women and men in
The research process: First, a pretest was given to both control and experimental groups were as-
the infertile couples who had come to The Mota- sessed at three different time periods (Table 1).
zedi infertility treatment center which led to se- In the marital conflict scale, among both males
lecting 24 couples gaining at least 22 in general and females in experimental groups, a rise in
health. Then, they were divided randomly into scores in posttest and follow up compared to pre-
two groups of test and control. While the control test was seen. In Kansas Marital Conflict Scale
group received only the routine infertility treat- (KMCS), marital conflict decreases with the in-
ment, the test group was subjected to intervention crease in scores. However, there was no signifi-
trial in 10 sessions of 90 min duration (Running cant variety in scores in control groups. In the
one session every week). A posttest was done in scale of mental health, both females and males in
both groups after the 10 session intervention trial. experimental group had a remarkable loss of
Follow up was done after 2 months. The summary scores in posttest and follow up (the lower the
of treatment meetings is reported here; the first mental health questionnaire score, the better the
session: stating the objectives and rules in the mental health). However, there is a rise in scores
group, outlining the general principles of behav- among members of control group (Table 1).
ioral relation based treatment, and the concept of Repeated Measures Analysis of Variance in mar-
marital conflict. The second session: learning the ital conflict and mental health variables showed
basic principles of behavior therapy, and listening that (p<0.05) the changes in periods of time, me-
skills. The third session: learning to understand thod of therapy, interactive effects of time and
the generality of communication and expressing group can be significant among females. Howev-

18 J Reprod Infertil, Vol 20, No 1, Jan-Mar 2019

 Ahmadi SM, et al. JRI
Table 1. The mean and the standard deviation of marital conflict and mental health in women and men in both control and experi-
mental groups, assessed at three different time periods according to sex
Pretest Posttest Follow up
Variables Sex Groups p-value p- value p-value
Mean SD Mean SD Mean SD
Marital conflict
Experiment 75.50 7.47 88.75 7.93 90.33 6.05
Female 0.17 0.006 0.001
Control 79.91 8.08 77.33 10.48 79.25 8.30
Experiment 80.91 11.68 91.54 9.78 95.22 8.87
Male 0.47 0.116 0.07
Control 84.25 11.20 85.41 9.61 88.08 10.27
Mental health
Experiment 61.75 7.91 41.58 10.21 43.08 10.80
Female 0.49 p<0.001 0.001
Control 58.91 11.88 63.16 12.95 61.25 12.01
Experiment 46.72 7.21 42.18 7.89 38.90 4.06
Male 0.67 0.15 0.02
Control 45.08 9.04 46.50 8.69 45.25 7.87

er, interactive effect of time and group is not sig- 13.25 scores (p=0.003) and in follow up test com-
nificant among males (p=0.60) (Table 2). pared with the pretest increased about 14.83
Marital conflict among females: The results of an- scores (p=0.001). These changes were significant;
alyzing data among females showed that the effect however, there was a reduction in follow up phase

Downloaded from http://www.jri.ir

of time (p=0.002) and time and group interaction- compared with the pretest of 1.58 scores that is
al effect were significant (p=0.001). Considering not significant.
the significant effect of time and group, analysis The comparison between the groups regarding
of variance of Repeated Measures Analysis of marital conflict variable in the female groups in
Variance was performed in experimental and con- the pretest, posttest and follow up stages is report-
trol groups separately, and the comparison be- ed in table 1. As shown in table 1, the marital con-
tween pretest, posttest and follow up results was flict in the pretest stage does not show a signifi-
done between intervention and control groups. cant difference (p=0.17), but in the posttest phase,
For Repeated Measures Analysis of Variance, an increase in the experimental group compared
first, Mauchly’s test was analyzed. The homoge- with the control group (p=0.006) was observed. In
neity of the variance covariance matrix exists in the follow up phase, this increase in marital con-
experimental group (p=0.73) and in control group flict continued to be higher than the control group
(p=0.81). The results showed that marital conflict (p=0.001) (Table1, Figure 1).
did not show a significant change during the time Marital conflict among males: The results of ana-
in the control group (p=0.47), but in the experi- lyzing data among males showed that the effect of
ment group, there was a significant increase dur- time was significant (p=0.01), but time and group
ing the time (p<0.001). interactional effect was not significant (p=2.23).
Bonferroni's results showed that the average To analyze the trend of changes in posttest and
change of scores of marital conflict in the post- follow up, Repeated Measures Analysis of Vari-
test compared with the pretest increased about ance was performed separately.

Table 2. Within- subject effects of marital conflicts and mental health according to sex
Variables Sex Variables SS DF MS F p
Marital conflict
time 602.083 1 601.083 12.710 0.002
Female
time*group 720.750 1 720.750 15.21 0.001
time 981.021 1 981.021 6.745 0.016
Male
time*group 325.521 1 325.521 2.238 0.149
Mental health
time 800.333 1 800.333 15.092 0.001
Female
time*group 1323.000 1 1323.000 24.948 0.001
time 157.688 1 157.688 3.609 0.71
Male
time*group 172.521 1 172.521 3.948 0.60

J Reprod Infertil, Vol 20, No 1, Jan-Mar 2019 19

JRI Behavioral Couple Therapy in Infertility

Measures Analysis of Variance was performed in

experimental and control groups, and the compar-
ison between pretest, posttest and follow up re-
sults was done between the intervention and con-
trol groups.
For Repeated Measures Analysis of Variance,
first, Mauchly’s test was analyzed. The homoge-
neity of the variance covariance matrix exists in
Figure 1. Graph of changes in marital conflict scores be- experimental group (p=0.554) and in control
tween female experimental and control groups
group (p=0.002). The results showed that mental
health did not show a significant change during
For Repeated Measures Analysis of Variance, the time in the control group (p=2.48), but in the
first, Mauchly’s test was analyzed. The homoge- experiment group, there was a significant increase
neity of the variance covariance matrix exists in during the time (p<0.001).
experimental group (p=0.20) and in control group Bonferroni's results showed that the average
(p=0.09). The results showed that marital conflict change of scores of mental health in the posttest
did not show a significant change during the time compared with the pretest increased about 20.17
in the control group (p=0.62), but in the experi- scores (p=0.003) and in follow up test compared
ment group, there was a significant change during with the pretest decreased about 1.5 scores (P=1).
the time (p=0.001). The score was not significant (p=1).

Downloaded from http://www.jri.ir

Bonferroni's results showed that the average The comparison between the groups regarding
change of scores of marital conflict in the post- the mental health variable in the female group in
test compared with the pretest increased about the pretest, posttest and follow up stages is report-
10.63 scores (p=0.07) which is not significant, but ed in table 1. As shown in table 1, the pretest
in follow up test compared with the pretest, it in- stage score does not show a significant difference
creased about 14.31 scores (p=0.04); this change (p=0.49), but in the posttest phase, a decrease in
was significant. the mean of the experimental group compared
The comparison between the groups regarding with the control group (p<0.001) was observed. In
the marital conflict variable in the male group in the follow up phase, this decrease in mental health
the pretest, posttest and follow up stages is report- continued to be higher than control group (p=
ed in table 1. As shown in table 1, the marital con- 0.001) (Table1, Figure 3).
flict in the pretest stage does not show a signifi- Mental health among males: The results of analyz-
cant difference (p=0.47), and in the posttest and ing data among males showed that the effect of
follow up stage, no significant difference between time (p=0.71) and time and group interactional ef-
the control group and the experimental group fect were not significant (p=0.60, f=3.94). Con-
(p>0.05) is observed (Table1, Figure 2). sidering the significant effect of time and group,
Mental health among females: The results of ana- Repeated Measures Analysis of Variance was per-
lyzing data among females showed that the effect formed in experimental and control groups, and
of time (p=0.001) and time and group interaction- the comparison between pretest, posttest and fol-
al effect were significant (p=0.001). Considering low up results was done between the intervention
the significant effect of time and group, Repeated and control groups.
The comparison between the groups regarding
the mental health variable in the male group in the
pretest, posttest and follow up stages is reported in
table 1. As shown in table 1, pretest stage score
does not show a significant difference (p=0.49),
but in the posttest phase, a decrease in the mean of
experimental group compared with the control
group (p<0.001) was observed which is not signif-
icant. In the follow up phase, this decrease in
Figure 2. Graph of changes in marital conflict scores be- mental health continued to be higher than control
tween male experimental and control groups group (p=0.001) (Table1, Figure 4).

20 J Reprod Infertil, Vol 20, No 1, Jan-Mar 2019

 Ahmadi SM, et al. JRI
Mir Ahmadi et al. (21), Abdulqader (22), Khalat-
bari et al. (23), Soltani et al. (24), Soleimani et al.
(17), and Hasani (25).
Frederiksen et al. showed in their research that
psychosocial interventions for couples in treat-
ment for infertility, in particular CBT, could be
efficacious, both in reducing psychological dis-
Figure 3. Graph of changes in mental health score between tress and in improving clinical pregnancy rates
female experimental and control groups (20). In a study by Mir Ahmadi et al., the results
showed that short term couple therapy is effective
for increasing mental health and decreasing de-
pression (21).
Khalatbari et al. in their study showed that the
behavioral cognitive therapy has a significant pos-
itive influence over depression of the experi-
mental group compared with the control group
which had received no therapeutic interference
(23). Soltani et al. showed that emotionally fo-
Figure 4. Graph of changes in mental health score between
male experimental and control groups cused therapy could reduce the rate of depression,
anxiety and stress in infertile couples, regardless

Downloaded from http://www.jri.ir

Discussion of the gender, namely male or female, as the cause
Infertility has devastating psycho-social conse- of infertility (24).
quences on infertile couples. It causes a world- Soleimani et al. showed in their research that
wide challenge (17). Infertility usually causes nu- EFT-C significantly affected marital adjustment
merous emotional reactions like depression, anxi- and sexual satisfaction (17). Hasani in his study
ety, and stress (18). Mental health means the ab- on "Comparing the effectiveness of behavioral-
sence of disease in individuals. It is one of the cognitive and emotional output in an emotion-
most important factors in improving human life. focused depression in infertile husbands" showed
The World Health Organization (WHO) defines that this treatment had some effects on the infer-
mental health as the total ability to play social, tile males treatment (25).
emotional and physical roles. Family has a very The results of these researches showed that the
important role in mental health, because, our first rate of marital problems was high among infertile
experience of living begins in the family (19). couples before the interventions but it was mean-
Goldstein defines mental health as the balance ingfully reduced after their treatment. The scores
between the members and the environment to were higher in females in experimental group in
achieve self-actualization. In fact, mental health is comparison with the control group. But it didn’t
something more than being healthy. People with have any significant difference in males in both
proper mental health encounter less confusion and experimental and control groups.
conflict in marital life. Regardless of the source of Abdulqader in his research showed that marital
a breach in the relationship, learning communica- satisfaction after psychological intervention in-
tive skills can help couples in development of ap- creased among infertile couples (22). Concerning
propriate communicative behaviors and decreas- the marital conflicts, the results of this research
ing marital conflict (20). This research aimed to were in alignment with researches mentioned be-
show the effect of behavioral couple therapy on fore. Soudani et al. researched the effectiveness of
increasing mental health and decreasing marital Bernstein behavioral-association therapy on mari-
conflict among infertile couples. The results of the tal therapy. The results showed that it can de-
covariance analysis showed that there is a signifi- crease marital conflicts (16).
cant difference between the experimental group Nazari et al. studied the effectiveness of fortified
who received the behavioral couple therapy and cognitive-behavioral and blended couple therapy
the control group who had no treatment or thera- on increasing the couple satisfaction. The results
py. In this regard, the findings of this research are showed that both therapies had good effects on
in line with the results of Frederiksen et al. (20), couples’ satisfaction. However, fortified cognitive-

J Reprod Infertil, Vol 20, No 1, Jan-Mar 2019 21

JRI Behavioral Couple Therapy in Infertility

behavioral therapy showed to be more effective References

than the blended couples therapy (26). 1. Pazandeh F,Sharghi Someeh N, Karami Nory R,
Behavioral couple therapy was helpful to reduce Alavimajd H. [The relationship between infertility
marital conflict and improved mental health of with well-being and marital satisfaction]. Pejouhan-
infertile couples after following the therapy ses- deh. 2005:9(42):355-60. Persian.
sions in two months. Perhaps as the main cause of 2. Faal Kalkhoran L, Bahrami H, Farrokhi NA, Zeraati
infertility, the couple's conflicts and psychological H, Tarahomi M. [Comparing Anxiety, Depression
issues can affect even the physical infertility treat- and Sexual Life Satisfaction in Two Groups of
ment. Moreover, there were two pregnancies in Fertile and Infertile Women in Tehran]. J Reprod
Infertil. 2011;12(2):157-62. Persian.
experimental group after the intervention. These
results show that for those infertile couples who 3. Direkvand Moghaddam A, Delpisheh A, K Sayemi-
go to the gynecologist for treatment without any ri. The prevalence of infertility in Iran, a systematic
significant physical cause for infertility, counsel- review. Iran J Obstet Gynecol Infertil. 2013;16(81):
1-7.
ing and psychotherapy centers are the best options
and behavioral couple therapy which can be very 4. Behdani F, Erfanian M, Hebrani P, Hojat SK. [Pre-
effective as part of the treatment process should valence of depression and related factors in infertile
be used for them. The historical value of the re- women]. The Quarterly Journal of Fundamental of
Mental Health. 2004-2005;6(23-24):141-6. Persian.
search showed that educational interventions in
the field of couple therapy can increase the mental 5. De Berardis D, Mazza M, Marini S, Del Nibletto L,
health and reduce the marital conflicts among Serroni N, Pino MC, et al. Psychopathology, emo-

Downloaded from http://www.jri.ir

couples. Using this treatment plan can help to in- tional aspects and psychological counselling in in-
fertility: a review. Clin Ter. 2014;165(3):163-9.
crease couples’ mental health, leading to the over-
all improvement in relations of couples. 6. Hesam AA, Taghipour L, Rasekhi S, Fallahi S, He-
sam Z. Investigating the multiple aspects of mental
Conclusion health in infertile women. Int J Ment Health Addict.
2017;15(4):928-32.
According to the results of the present study, it
can be concluded that the behavioral couple ther- 7. Masoumi SZ, Poorolajal J, Keramati A, Moosavi S
apy plays an important role in mental health and A. Prevalence of depression among infertile couples
marital conflict between males and females. And in Iran: a meta-analysis study. Iran J Public Health.
2013;42(5):458-66.
according to the results, the benefit of this method
is more for females than males. It is recommended 8. Van Horn AS, Reed SA. Medical of psychological
that infertile couples who go to the gynecologist aspects of infertility and assisted reproductive tech-
without any physical cause for infertility, be sent nology for the primary care provider. Mil Med.
2001;166(11):1018-22.
to counseling centers as part of the treatment pro-
cess. Educational interventions in the field of 9. Tamanay far M.R. Comparison of mental health,
couple’s therapy could increase the general health adjustment and coping responses in fertile and in-
and reduce the marital conflicts. Generalization of fertile women. Scientific-Research. J Shahed Univ.
2011;4:51-60.
the results requires further investigation, but be-
havioral couple therapy has an important effect on 10. Saeedi L, Bahrami F, atemady O. The effective-
the infertile couples and helps them in the proce- ness of a short-term solution focused couples thera-
dure of infertility treatment. py to reduce conflicts between spouses city of Is-
fahan, Khomeini. News Res Serv. 2008;5(20):39-
52.
Acknowledgement
This project was fully and financially supported 11. Hasani F, Navabinezhad SH, Noranipoor R. A
by Kermanshah University of Medical Sciences. comparison of effectiveness of two couple thera-
pies, CBCT and EFT, on depression in infertile
The authors of this research thank all the hard-
male-factor pairs. Women Dev Polit. 2008;6(3):61-
working personnel of Motazedi infertility treat- 83.
ment center and patients who helped them in data
collection. 12. Sharifi V, Asaadi SM, Mohammadi MM, Amini H,
Kaviyani H, Semnani Y, et al. The reliability and
execution of the persian version of the diagnostic
Conflict of Interest DSM-IV structured interpretation (SCID). J New
There is no conflict of interest in this study. Cogn Sci. 2004;1(2):10-22.

22 J Reprod Infertil, Vol 20, No 1, Jan-Mar 2019

 Ahmadi SM, et al. JRI
13. Eggeman K, Moxley V, Schumm WR. (1985). As- NG, Ingerslev HJ, Zachariae R. Efficacy of psy-
sessing spouses' perceptions of Gottman's temporal chosocial interventions for psychological and preg-
form in marital conflict. Psychol Rep. 1985;57(1): nancy outcomes in infertile women and men: a sys-
171-81. tematic review and meta-analysis. BMJ Open.
14. Behjati Ardakani Z, Akhondi MM, Kamali K, 2015;5(1):e006592.
Fazli Khalaf Z, Eskandari Sh, Ghorbani B, et al. 21. Mirahmadi I, Seyed ahmadi A, Bahrami F. Short-
[Mental Health Status of Patients Attending Avi- term efficacy of couple therapy on mental health
cenna Infertility Clinic]. J Reprod Infertil. 2010;11 self-regulatory approach depression and marriage.
(4):319-24. Persian. J Appl Psychol. 2011;5(3):99-111.
15. Sodani M, Nazarifar M, Mehrabizadeh Honarmand 22. Abdulqader HG. Effect of psychological interven-
M. The effectiveness of bornstein behavioral-com- tion on marital satisfaction rate of infertile couples.
munication couple therapy on marital conflicts. J Int J Educ Pol Res Rev. 2014;1(3):28-36.
Clin Psychol. 2011;8(4):1-8. 23. Khalatbari J, Ghorbanshirodi Sh, Akhshabi M,
16. Vizheh M, Pakgohar M, Babaei G, Ramezanzadeh Hamzehpour T, Eslamipour M. The effectiveness
F. Effect of counseling on quality of marital re- of the behavioral- cognitive therapy on the reduc-
lationship of infertile couples: a randomizd, con- tion of the rate of the depression and anxiety of the
trolled (RCT) study. Arch Gynecol Obstet. 2013; infertile women of the Rasht city Indian J Sci
287(3):583-9. Technol. 2011;4(11):1578-82.
17. Soleimani AA, Najafi M, Ahmadi K, Javidi N, Ho- 24. Soltani M, Shairi MR, Roshan R, Rahimi CR. The
seini Kamkar E, Mahboubi M. The effectiveness of impact of emotionally focused therapy on emotion-

Downloaded from http://www.jri.ir

emotionally focused couples therapy on sexual al distress in infertile couples. Int J Fertil Steril.
satisfaction and marital adjustment of infertile 2014;7(4):337-44.
couples with marital conflicts international. J Fertil 25. Hasani F. The comparison of effectiveness be-
Steril. 2015;9(3):393-402. tween two couple therapies, CBCT and EFT on
18. Mirahmadi L, Ahmadi A, Bahrami F. Short-term marital satisfaction in infertile male factor pairs.
effectiveness of marital therapy to self-regulation Andisheh va Raftar. 2008;4(14):77-88.
practices of happiness and mental health. New 26. Nazari V, Mohammadkhani P, Dolat shahi B.
Find Psychol. 2012;22:33-43. Comparative efficacy of cognitive-behavioral mari-
19. Alipour A, Rahimi A, Zare H. [The relationship tal therapy and enhanced behavioral marital thera-
between mental health and marital satisfaction of py combined increase in marital satisfaction. Mod
married students, payame noor university of The- J Psychol. 2011;6(22):149-75.
ran]. J Urmia Univ Med Sci. 2013;24(7):557-65.
Persian.
20. Frederiksen Y, Farver-Vestergaard I, Skovgård

J Reprod Infertil, Vol 20, No 1, Jan-Mar 2019 23