Description of the participants
There were 150 patients in First group out of totally 298 participants, while 148 in Repeat group with 53 of two IVF-ET cycles, 51 of three cycles, and 44 of four or more cycles. The age and marriage age of the patients in the Repeat group were 33.0 ± 3.9 years old and 6.7 ± 3.9 years, which were significantly higher than that of the First group with 31.9 ± 4.3 years old and 5.8 ± 3.9 years (P<0.001). The results showed that the age of patients with repeated IVF-ET was higher and the marriage age was longer. On the other side, compared with the two groups, there was no significant difference in the education level, permanent residence, occupation and family monthly income between the two groups (P > 0.05), see Table 1.
Table 1
Demographic characteristics of infertile women undergoing IVF-ET with different cycles
Variables
|
Total (n=298)
|
First Group (n=150)
|
Repeat Group (n=148)
|
t/χ2
|
P
|
Age (years)
|
31.9±4.3
|
31.0±4.4
|
33.0±3.9
|
-4.175
|
<0.001
|
Marriage Age (years)
|
5.8±3.9
|
4.8±3.7
|
6.7±3.9
|
-4.165
|
<0.001
|
Educational Level, n (%)
|
Junior high school or below
|
56(18.8)
|
28(18.7)
|
28(18.9)
|
0.003
|
0.956
|
Senior high school or above
|
242(81.2)
|
122(81.3)
|
120(81.1)
|
Residence, n (%)
|
Rural
|
67(24.2)
|
36(24.2)
|
31(24.2)
|
0.118
|
0.731
|
City/town
|
210(75.8)
|
113(75.8)
|
97(75.8)
|
Occupation, n (%)
|
Physical
|
60(20.1)
|
28(18.7)
|
32(21.6)
|
0.405
|
0.525
|
Mental
|
238(79.9)
|
122(81.3)
|
116(78.4)
|
Family monthly income (yuan), n (%)
|
<5000
|
112(37.6)
|
55(36.7)
|
57(38.5)
|
4.879
|
0.087
|
5000-10000
|
75(25.2)
|
31(20.7)
|
44(29.7)
|
≥10000
|
111(37.2)
|
64(42.6)
|
47(31.8)
|
Reliability and validity of HHI Scale
The reliability and validity of HHI Scale were analyzed before it was used in the participants of this study. Fifty patients were retested after 2 weeks, and the consistency test results indicated a good test-retest reliability with k=0.805 (P<0.05). The data of patients were analyzed by principal component analysis. The results of suitability test showed that the KMO statistical value was 0.765 (P=0.01), which indicated that factor analysis was suitable. The correlation coefficient matrix was rotated with maximum variance to extract the factors with eigenvalue > 1. The eigenvalues of the three principal components were 2.365, 1.427 and 1.119, respectively. The cumulative variance contribution rate was 69.4%. The factor components produced by statistical analysis are consistent with the theoretical structure.
Hope level, marriage adjustment and social support
The scores of HHI, MAT and SSRS in the Repeat group were 34.4 ± 3.5, 99.0 ± 24.9 and 35.4 ± 7.2, which were significantly lower than 37. 5 ± 3.7, 116.3 ± 22.4 and 39.5 ± 5.2 in the First group (P < 0.001), see Figure 1. It is indicated that the hope level, marital adjustment and social support of patients with repeated IVF-ET are significantly decreased.
Comparing the scores of the three dimensions of HHI, it also showed that the scores of the Repeat group were significantly lower than those of the First group (see Table 2). According to the score, they were divided into low level, medium level and high level subgroups. Further analysis showed that 67.3% (n = 101) of the patients in the First group had high level. However, the high level was only 29.7% (n = 44) in the Repeat group (P < 0.001). It is indicated that more than half of the patients with first-time IVF-ET are at high hope level, while the proportion of patients with high hope level in the Repeat group is significantly decreased, as shown in Table 2.
Table 2
HHI score in dimension and subgroups of infertile women with IVF-ET
|
Total(n=298)
|
First Group(n=150)
|
Repeat Group(n=148)
|
t/χ2
|
P
|
Herth hope index total score
|
35.9±3.9
|
37.5±3.7
|
34.4±3.5
|
7.391
|
<0.001
|
Positive attitude towards reality and future
|
11.9±1.4
|
12.3±1.4
|
11.5±1.4
|
4.930
|
<0.001
|
Positive actions taken
|
11.7±1.6
|
12.1±1.6
|
11.3±1.4
|
4.373
|
<0.001
|
Keep a close relationship with others
|
12.3±1.9
|
13.1±1.7
|
11.5±1.7
|
7.761
|
<0.001
|
Low level
n(%)
|
1
(0.3%)
|
1
(0.7%)
|
0
(0.0%)
|
45.521
|
<0.001*
|
Medium level
n(%)
|
152
(51.0%)
|
48
(32.0%)
|
104
(70.3%)
|
High level
n(%)
|
145
(48.7%)
|
101
(67.3%)
|
44
(29.7%)
|
Note: * P value is the result of likelihood ratio.Note: * P value is the result of likelihood ratio. |
Correlation analysis of influencing factors of hope level
The correlation between HHI and demographic characteristics, MAT and SSRS was analyzed. The results showed that HHI was positively correlated with MAT (r = 0.565, P < 0.01) (see Fig. 2a), SSRs (r = 0.498, P < 0.01) (see Fig. 2b), monthly income (r = 0.269, P < 0.01), education level (r = 0.292, P < 0.01), permanent residence (r = 0.189, P < 0.01) and mental work (r = 0.179, P < 0.01). On the other side, HHI was negatively correlated with age (r = - 0.204, P < 0.01), marriage age (r = - 0.126, P = 0.029) and repeated IVF-ET (r = - 0.480, P < 0.01). It was indicated that the hope level of elderly pregnant women, patients with long marriage age and repeated IVF-ET treatment is low.
Multiple linear regression analysis on the influencing factors of hope level
HHI was used as the dependent variable, and the variables with statistical significance in univariate analysis were included in the multiple linear regression model (Stepwise regression). As shown in Table 3, the results showed that repeated IVF-ET (β = -0.859, P < 0.001) and age (β = -0.223, P < 0.001) were negatively correlated with hope level. However, education level, monthly income, marriage age, MAT and SSRS scores were positively correlated with HHI. It is indicated that repeated IVF-ET and age are independent factors of HHI down-regulation.
Table 3
Multivariate Linear Regression Analysis of Influencing Factors of HHI of infertile women with IVF-ET
Variables
|
Non standardized coefficient B
|
Standard error
|
Standardized coefficient β
|
t
|
P
|
95% confidence interval
|
constant
|
30.288
|
2.066
|
-
|
14.664
|
<0.001
|
26.223~34.353
|
Repeated IVF-ET
|
-0.859
|
0.141
|
- 0.291
|
-6.095
|
<0.001
|
-1.136~ -0.581
|
MAT
|
0.045
|
0.009
|
0.288
|
5.266
|
<0.001
|
0.028~ 0.062
|
SSRS
|
0.117
|
0.031
|
0.198
|
3.802
|
<0.001
|
0.057~ 0.178
|
age
|
-0.223
|
0.059
|
-0.242
|
-3.779
|
<0.001
|
-0.339~ -0.107
|
Marriage age
|
0.275
|
0.064
|
0.274
|
4.306
|
<0.001
|
0.150~0.401
|
Monthly income
|
0.516
|
0.220
|
0.114
|
2.349
|
0.020
|
0.084~0.949
|
education level
|
1.474
|
0.478
|
0.147
|
3.081
|
0.002
|
0.532~2.416
|
Note: R2=0.487,adjusted R2=0.475,P<0.05Note: R2=0.487,adjusted R2=0.475,P<0.05 |