1

Chapter I THE PROBLEM AND ITS SCOPE INTRODUCTION

Rationale of the Study Infertility is an experience that strikes at the very core of a personthe sense of self, connection to others, values, roles, goals and dreams. The ability to procreate and regenerate is considered one of the most basic of all human drives, as well as the core need to bear and raise children. This drive propels people on a quest for fertility and family, yet is a journey that few people are trained to take or are prepared for what to expect ( Kumar, 2007). Many marriage customs, such as throwing rice, originate from old rituals to promote fertility. The existence of such common rituals provides evidence about the importance of having children for the average couple and society as a whole. Many people spend much of their life trying not to get pregnant so when they are ready to start a family, they usually dont anticipate having a problem. The longer time goes on without a baby, the more difficult the journey becomes. Repeated monthly cycles of hope, anticipation, and then sadness often create a looming sense of despair as couples wonder not when but if they will ever become parents until it they realized

that both has to face a certain truth on what is infertility and the challenges it could bring. Infertility is defined as the inability to conceive a child after one (1) year of regular sexual intercourse unprotected by

contraception, or to carry a pregnancy to terms ( DeMasters, 2004). Many People take the ability to conceive and produce a child for granted, but infertility affects about 1.6 million Americans, or ten (10%) percent of the reproductive-age population according to the American Society for Reproductive Medicine (2002). Every year, around a third of the pregnancy cases are lost. Almost half of these are accounted for by miscarriages and ectopic pregnancies. There are numerous infertility cases among all the couples who try to conceive a child. Around 10 to 15% of the entire population of females in the world has had some trouble in getting pregnant. And of these ten to fifteen percent, about 90% are between the ages of 15 to 45 although among this large group of females, only a small percentage of women seek treatment. These statistics reflect the way a lot of people think - that infertility cannot be possibly happening to them. This also reflects the view that

infertility is a disability that women should undergo through alone(http://ezinearticles.com/?Basic-Information-on-Infertility). Dealing with infertility can bring about distress and even crisis. For many couples, this will be one of the most difficult challenges they will ever face together. The researcher is a registered nurse, a wife and a mother. The researcher has also known relatives and friends who are facing challenges brought by infertility that prompted her to conduct the study. Infertility is a serious medical problem that affects the quality of life and problem not only to reproductive-age couples but also to the community as a whole. The researcher has observed that that individuals confronted with such problem will face series of loses that include loss of self-esteem, relationships, health, and financial security due to the complex impact of the infertility. With the explosion of new technologies to treat and deal with impaired fertility, there has also been an increasing need for an

understanding of the psychosocial implications of impaired fertility, its treatment and its impact to the life status of these individuals.

Theoretical Background This study is anchored on Myra Estrin Levines Conservation Model. The model presents that the way people think about their disease changes over time. Reproduction is considered one of the main basic necessities of humans, and a psychological crisis may occur when something interferes with their ability to reproduce. A crisis of infertility is a difficult emotional experience since it has an impact on various aspects of marital or individual life such as social relationships, life objectives, self-image, and sexual relations, among others. There are three major concepts of Conservation Model namely: Wholeness, Adaptation and Conservation. Wholeness ( Holism). Whole, health, hale are all derivations of the Anglo-Saxon word hal. Levine based her use of wholeness on Eriksons description of wholeness as an open system. Integrity means the oneness of the individual, emphasizing that they respond in an integrated, singular fashion to environmental challenges ( Alligood, 2002).

. Adaptation. Adaptation is a process of change whereby the individual retains his integrity within the realities of his internal and external environment. Conservation is the outcome. Some

adaptations are successful and some are not. Adaptation is a matter of degree, not an all-or-nothing process. There is no such thing as maladaptation. Levine speaks of three (3) characteristics of

adaptation: historicity, specificity and redundancy. Levine states that every species has fixed patterns of responses uniquely designed to ensure success in essential life activities, demonstrating that adaptation is both historical and specific. patterns In addition, adaptive

maybe hidden in individuals genetic code. Redundancy

represents the fail-safe options available to individuals to ensure adaptation. Loss of redundant choices either through trauma, age, disease, or environmental conditions makes it difficult for the individual to maintain life. Levine suggest that possibility exists that aging itself is a consequence of failed redundancy of physiological and psychological processes( Alligood, 2002). Environment. Environment is where the person is constantly actively involved. The person and his or her relationship to the

environment is what counts. Levine views that each individual as having his or her environment, both internally and externally. Nurses can relate the internal environment as the physiological and pathophysiological aspect of the patient. While the external

environment suggests three levels: perceptual, operational, and conceptual. These levels give dimension to the interactions between individuals and their environment ( Alligood, 2002). Organismic response refers to the capacity to adapt to his or her environmental condition. This is divided into three levels: fight or flight, inflammatory response, response to stress and perceptual awareness ( Alligood, 2002). Fight or Flight. The most primitive response wherein the individual perceives he or she is threatened, whether or not a threat really exist. Hospitalization, illness and new experiences elicit a response. The individual responds by being on alert to find more information and to ensure his or her safety and well being( Alligood, 2002). Inflammatory response. This defense mechanism protects the self from insult in a hostile environment. It is a way of healing. The

response uses available energy to remove or keep out unwanted irritants or pathogens. It is limited in time because it drains the individuals energy reserves. Environmental control is very important ( Alligood, 2002). Response to Stress. The wear and tear of life is recorded on the tissues and reflects longterm hormonal responses to life experiences that cause structural changes. It is characterized by irreversibility and influences the way patients respond to nursing care( Alligood, 2002). Perceptual Awareness. The response is based on the

individuals perceptual awareness. It occurs only as the individual experiences the world around him or her. The individual uses this response to seek and maintain safety. It is information

seeking( Alligood, 2002). Conservation is from the Latin Word conservatio which means to keep together. Conservation describes the way complex systems are able to continue to function even when severely challenged. Through conservation, individuals are able to confront obstacles, adapt accordingly, and maintain their uniqueness. The

goal of conservation is health and the strength to confront disability as the rules of conservation and integrity hold in all situations where nursing is required. The primary focus of conservation is keeping together of the wholeness of the individual. Although nursing interventions may deal with one particular conservation principle, nurses must also recognize the influence of the other conservation principles( Alligood, 2002). Levines model stresses nursing interaction and interventions that are intended to keep together the unique and individual resources interactions that each individual brings to his predicament. Those are based on the scientific background of the

conservation principles. Conservation focuses on achieving a balance of energy supply and demand within the biological realities unique to the individual. Nursing care is based on the scientific knowledge and nursing skills( Alligood, 2002). Conservation Priniciples. Conservation of Energy refers to that individual requires a balance of energy and a constant renewal of energy to maintain life activities. Processes such as healing and aging challenge that energy. Conservation of Structural Integrity. Healing is a process of restoring structural and functional integrity in

defense of wholeness. Conservation of Personal integrity. Self-worth and a sense of identity are important. The most vulnerable become patients. This begins to the erosion of privacy and creation of anxiety. The nurses goal is to impart knowledge and strength so that the individual can resume a private life. Conservation of Social integrity. Life gains meaning through social communities and health is socially determined( Alligood, 2002). This study is also supported by Sister Callista Roys Adaptation Model. The model presents the person as a holistic adaptive system in constant interaction with the internal and the external

environment. The main task of the human system is to maintain integrity in the face of environment stimuli ( Philips, 2010). The Goal of nursing is to foster successful adaptation. Adaptation refers to the process and outcome whereby thinking and feeling persons as individuals or in groups, use conscious awareness and choice to create human and environmental integration. Adaptation leads to optimal health and well-being, to quality life, and death with dignity. The adaptation level represents the condition of the life process. Three level are decribed by Roy: Integrated, compensatory, and compromised life processes. An

10

integrated life process may change to compensatory process, which attempts to reestablished adaptation. If the compensatory processes are not adequate, compromised processes result ( Alligood, 2002). Coping Processes in the Roy Adaptation Model include both coping mechanisms and acquired coping mechanisms. Innate coping processes are genetically determined or common to the species; they are generally viewed as automatic processes. In contrast, acquired coping processes are learned and developed through customary responses. The Processes for coping in the Roy are further categorized as the regulator and cognator subsystems as they apply to individuals, and the stabilizer and innovator subsystem as applied to groups. A basic type of adaptive process, the regulator subsystem responds through neural, chemical, and endocrine coping channels. Stimuli from the internal and external environment acts as inputs through the senses to the nervous sytem, thereby affecting the fluid, electrolyte, and acid- base balance as well as the endocrine system( Alligood, 2002). The second adaptive process, the cognator subsystem,

responds through four cognitive- emotional channels, perceptual and

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information processing, learning, judgment and emotion( Alligood, 2002) Nurses should therefore, must recognize infertility and

understand its causes and treatment options so that they can help couples understand the possibilities and the limitations of current therapies for infertility. The caring aspect of the professional nursing is an essential component of meeting the special needs of these couples. Prevention of infertility through education should also be incorporated into any client-nurse interaction. According to the study of ( Klock, 2008) , fertility is highly valued in most cultures and the wish for a child is one of the most basic of all human motivations. For women, pregnancy and motherhood are developmental milestones that are highly

emphasized by our culture. When attempts to have a child fail, it can be an emotionally devastating experience. But in the past two decades, advances in reproductive medicine have made the

treatment of infertility a highly successful prospect that has given hope and success to thousands of couples. The high-tech

reproductive technologies have associated psychological and ethical issues that must be addressed by the infertile couple. Therefore, it is

12

important for the health care professional to understand the psychological issues surrounding infertility. As cited by ( Klock, 2008) Infertility is defined as 12 months of appropriately timed intercourse that does not result in conception. Approximately 16% of couples in the United States will have difficulty having a child. This appears in part because of the trend for some women to delay childbirth until the mid- to late 30s and the associated decrease in fertility after the age of 35. Although there is the perception that infertility is on the rise, it is actually an artifact of the large number of women currently in the childbearing years because of the baby boom of the 1950s and early 1960s. The base rate of infertility among women has remained the same but the absolute number of women in the reproductive years has increased. Approximately 40% of infertile couples have female factor infertility, 40% male factor, and 20% a combination of both or infertility of unknown etiology. The inability to meet one of their most important life goals is devastating to the infertile individual. The emotional impact of infertility has been described via clinical observation and empirical research. Men and women are affected by infertility in different

13

ways. Most couples experience the struggle in much the same way. This is related to the traditional ways men and women have been trained to think, feel and act (http://www.ivf.com/emotion.html) Women are typically seen, by others as well as themselves, as the emotional caretakers or providers of the relationship. Women typically feel responsible not only for everyone's bad feelings, but also for anything bad that happens. When women try to repress feelings, their emotions can become more ominous until they finally feel out of control. Their emotions can become a monster about to swallow them whole (http://www.ivf.com/emotion.html). Men are traditionally seen as the financial providers of the relationship and are responsible for protecting the family from real or imagined dangers. Men usually feel more threatened expressing themselves since they have often been conditioned to repress their emotions. They are trained to be more instructional to take charge, to make decisions and to think without being sidetracked by emotions.Males in infertile couples often feel overwhelmed by the intensity of their partner's emotions as well as an inability to access their own. They tend to focus their energy back into their work, a

14

place

where

they

feel

they

can

have

more

success

(http://www.ivf.com/emotion.html). As a result of taking responsibility for the emotional impact of the infertility, the woman experiences intense feelings, such as pain, anger, fear, etc., which, combined with the messages that her way of dealing with things is in some way dysfunctional or "crazy", causes her to feel an anxious depression. As feelings spill out, she feels out of control and doesn't really know how to ask for what she needs, especially from the husband she is struggling so hard to protect. She may yearn for an emotional connection/interaction at one moment and in the next withdraw emotionally from her husband when she fears she has disappointed him.

(http://www.ivf.com/emotion.html). Because of the emotional consequences of infertility, it is clear that patients require psychological support as part of the medical treatment process, and it is the responsibility of all members of the team of a human reproduction center to provide this support. Interactions with each member of the team, from the administrative clerk to the physician, influence the perception of the patient concerning the care provided, thus modifying her level of stress.

15

Sensitivity, patience, and human warmth create a supportive environment for the patients. In addition, although the primary goal of doctors, nurses, and embryologists is the diagnosis and treatment of infertility, they should also remember that they are treating a patient, not a disease. In fact, the real hallmark of success of a reproduction center is the ability of the team to help the patients feel that they and the team did the best, even when treatment failed (Journal of Assisted Reproduction and Genetics,2002) .

Etiology and Risk Factors of Infertility. Multiple known and unknown factors affect fertility. Female-factor infertility is detected in about 40% of cases, male factor infertility in about 40% of cases. The remaining 20% fall into a category of combined ( both male and female factors) or unexplained infertility ( Gray et al.,2004). Statistics, however, show that more and more people are becoming more aware that infertility is actually a disability that must be dealt with. This is apparent in the sudden increase of reported cases related to infertility globally. The increase has become alarming since it shows that plenty of couples are affected by it. Reasons behind the infertility of couples are varied. However, most

16

of the cases are due to biological anomalies. These account for about 85 to 90% of the cases. These reasons include problems with the female's ovaries and uterus, men's sperm count and quality, etc. Among the remaining cases with a percentage of 10 to 15%, infertility are caused by emotional disturbances and psychological effects such as infertility stress (http://ezinearticles.com/?BasicInformation-on-Infertility). For example, women older than 40 have a 50% decreased fertility rate. Probable causes of infertility include the trend toward delaying pregnancy until later life, when fertility decreases naturally and the prevalence of diseases such as endometriosis and ovulatory dysfunction increases ( Stewart 1998). In Women, ovarian dysfunction (40%) and tubal/ pelvic pathology (40%) are the primary contributing factors to infertility. Risk factors for infertility include: Overweight or underweight ( can disrupt hormone function); Hormonal imbalances leading to irregular ovulation; fibroids; tubal blockages; chronic illnesses such as diabetes, thyroid disease, asthma, STI ( Sexually Transmitted Diseases); Age older than 27; endometriosis, History of Pelvic

17

Infection Diseases, Smoking and Alcohol consumption; multiple miscarriages; psychological stress ( Womens Heath Guide, 2004). For men includes exposure to toxic substances ( lead, mercury, x-rays), cigarette or marijuana smoke, heavy alcohol consumption, use of prescription drugs for ulcers or psoriasis, exposure of the genitals to high temperatures ( hot tubes or saunas), hernia repair, frequent long distance cycling, Sexually transmitted diseases, undecided testicles ( cryptorchidism), mumps after puberty ( Womens Health Guide, 2004). Assessment. Infertile couples are under trememdous pressure and can be by nature secretive, considering their problems to be very personal. The couple if often beset by feeling of inadequacy and guilt, many are subjected to pressures from both family and friends As their problem becomes more chronic , they may begin to blame one another, with consequent marital discord. Seeking help is often a very difficult step for them, and it may take a lot of courage to discuss something about which they feel deeply embarrassed or upset. The nurse working in this specialty setting must be aware of the conflict and problems couples present with and must be very sensitive to their needs( Youngskin & Davis, 2004).

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A full medical history should be taken from both partners. along with a physical examination. There are numerous causes of and contributing factors to infertility, so it is important to use the process of elimination, determining what problems do not exist in order to better comprehend the problems that do exist. Male Factors. The initial screening evaluation for the male partner should include a reproductive history and a semen analysis. From the male perspective, three things must happen for the conception to take place: there must be an adequate number of sperm; those sperm must be healthy and mature; and the sperm must be able to penetrate and fertilize the egg. Semen analysis is the most important indicator of male fertility. The man should abstain from sexual activity for 24- 48 hours before giving the sample. For a semen examination, the man is asked to produce a specimen by ejaculating into a specimen container and delivering it to the laboratory for analysis within 1-2 hours. When the specimen is brought to the laboratory, it is analyzed for volume, viscosity,

number of sperm, sperm viability, motility, and sperm shape. If semen parameters are normal, no further male evaluation is necessary ( Youngskin & Davis, 2004).

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Female Factors. The initial assessment of the woman should include a thorough history of factors associated with ovulation and the pelvic organs. Diagnostic tests to determine female infertility may include: Assessment of ovarian function and pelvic organs( Youngskin & Davis, 2004). Treatment. The test results are presented to the couple and different treatment options are suggested. The majority of infertility cases are treated with drugs or surgery. Various ovulationenhancement drugs and times intercourse might be used for the woman with ovulation problems. The woman should understand the drugs benefits and side effects before consenting to take them. Depending on the type of drug used and dosage, some women may experience multiple births. If the womans reproductive organs are damaged , surgery can be done to repair them. Still other couples might opt for the high-tech approaches of artificial insemination ( Bucker and McKenry, 2004) There is some controversy regarding whether there has been an increase in male infertility, or whether male infertility is being more readily identified because of improvements in diagnosis. Diagnosis and treatment of infertility require considerable physical, assessment of

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emotional and financial investment over an extended period. Men and women often perceive infertility differently, with women having more stress and treatments, placing greater importance on having children, being more accepting indicated treatments, and wanting children more than men (Stephen1998). Further, as cited by ( Klock, 2008), Freeman and colleagues found that approximately half of the women in their sample rated infertility as the most stressful experience of their life. In addition they found that 18% of men and 16% of women had significant psychological distress including high levels of depression and somatization. Leiblum and associates found that women reported more depression before and after infertility treatment than men and that 34% of the women in her study rated IVF as being very stressful. Baram and associates surveyed couples after they had completed one cycle of IVF and as an indirect measure of how stressful the procedure was, asked couples if they would undergo IVF again. They found that 38% of the couples reported that they would not undergo IVF again because it was too expensive, the success rate was too low, and they were unwilling to undergo the emotional pain of the procedure. In addition, 18% reported that

21

infertility had a negative impact on their marriage and 66% of women reported that they had become depressed after the procedure, with 13% of the women reporting that they had suicidal ideation after an unsuccessful IVF. See Greil for a review of the literature on infertility and psychological distress. A cross-sectional study tested nine hypotheses developed from a midrange theory derived from Roy's Adaptation Model and previous research with marital partners with fertility problems. One hundred and twenty one couples with fertility problems and a comparison group of fifty presumed fertile couples constituted the sample. Variables included in the study were: coping strategies, physical demands, self-esteem, home and work functioning, social support and conflict, subjective well-being, and marital satisfaction. Use of some coping strategies and levels of coping effectiveness were found to be related to levels of physical demands, self-esteem, home and work functioning and social support( Ciambelli, 1996). Physical demands were inversely related; self-esteem was positively related; home and work function was positively related; social support was positively related; and conflict was inversely related with levels of subjective well-being and marital satisfaction

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for the couples with fertility problems. Partner's spousal well-being and marital satisfaction were positively correlated. Coping

strategies, adaptive mode variables, and spousal well-being and marital satisfaction contributed a significant amount of variance to subjective well-being and marital satisfaction for infertile partners. ( Ciambelli, 1996). The majority of the hypotheses were supported. Four research questions were also included in this study. Differences were found in the use of confrontive, emotive, palliative, supporting and total use scores between infertile wives and infertile husbands in the sample. Differences in coping effectiveness were found in optimistic, fatalistic, palliative, and supporting scores for infertile wives and husbands. Differences were also found between infertile wives and their husbands in levels of physical demands, self-esteem,

interpersonal support, reciprocity, subjective well-being and dyadic consensus. Gender related differences were also found between the scores of wives and husbands in general in: coping strategies use and effectiveness, self-esteem, interpersonal support, reciprocity, and subjective well-being ( Ciambelli, 1996).

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Another study demonstrated that one of the characteristics of Brazilian infertile couples is that women are habitually more affected by the situation of infertility than men. The PET is a simple and efficient tool for the identification of women and/or men requiring psychological support due to infertility. The team of the Center for Human Reproduction (employees, biologists, nurses, doctors etc.) has started to use the information provided by the PET in the daily routine, and all patients are informed and counseled about the factors generating emotional changes in infertility. Advice is

provided (practicing sports, traveling, activatingpersonal projects etc.) in order to help combat distress.Aspecialized psychological evaluation was indicated in selected cases (PET score >30 points) ( Journal of Assisted Reproduction and Genetics,2002). Another findings show that men and women in couples who perceived equal levels of social infertility stress reported higher levels of marital adjustment when compared to men and women in couples who perceived the stress differently. In addition, women in couples who felt a similar need for parenthood reported significantly higher levels of marital satisfaction when compared to women in couples where the males reported a greater need for parenthood.

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While couple incongruence was unrelated to depression in males, incongruence over relationship concerns and the need for

parenthood was related to female depression. These findings provide initial support for the theory that high levels of agreement between partners related to the stresses they experience help them successfully manage the impact of these stressful life events ( Peterson, 2003). Some people have difficulty believing that infertility is a physical problem. In a sense, they are right. Infertility is not only a physical ailment, but also a psychological and social problem. The above mentioned theories and concepts shall serve as a springboard of the study in determining the profile, psychological crisis and

sexual self-concept of men and women dealing with infertility.

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THE PROBLEM Statement of the Problem This study determined the level of psycho-emotional

responses and level of sexual self-concept among men and women living with a reproductive challenge in Tacloban City. Specifically, it sought to answer the following questions: 1. What is the profile of the respondents in terms of: 1.1 1.2 Age; Gender;

1.3 Relationship Status;

1.4 1.5 1.6 1.7

Length of Relationship; Years of Formal Education; Occupation; Year Diagnosed; and

2. What is the level of psycho-emotional responses as perceived

by the respondents?

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3. What is the level of sexual self-concept of the respondents? 4. Is there a significant relationship between:
4.1 profile and level of psycho-emotional responses; 4.2 profile and level of sexual self-concept; and 4.3 level of psychological-emotional responses and level of

sexual self-concept? 5. How do the respondents describe their sexual relationship? 6.What are the coping mechanism of the respondents?

Statement of the Null Hypotheses HO1. There is no significant relationship between:

1.1 1.2 1.3

profile and level of psycho-emotional responses; profile and level of sexual self-concept; and level of psycho-emotional responses and level of sexual self-concept.

Significance of the Study

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Infertility typically has a profound impact on both men and women and this is a widespread and growing problem not only to couples but to the community as a whole. So the researcher would like to believe that the following entitles are the beneficiaries of the study: Women affected by infertility. Every woman would want to become a mother and a wife. Bearing a child is an incomparable gift a woman could give for her man. But it is the intent of this study to let women realize that they are born to become emotional caretakers, their sensitivity, patience and human warmth can the balance thinking and feeling. That they may see psychological and emotional differences then they may work side by side to make the relationship better. Men affected by Infertility. Men are traditionally seen as the financial providers of the relationship and are responsible for protecting the family from real or imagined dangers. That through this study, they may be able to realize that they are trained to solve problems and their positive energy can help them in the process of treatment or counseling.

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Couples affected by Infertility. Good communication, patience and awareness that there is no right or wrong with how to feel, to deal and how solve issues regarding infertility can help them move forward. It is the intent of the study to help them realize that difficulty of coping does not mean that marriage is a failure. Nurses. Nurses have major responsibility for teaching and providing emotional support throughout infertility testing and treatment. Feelings of anger, frustration, grief, and helplessness may heighten as additional diagnostic tests are performed. Through this study, they will be able to understand the importance of their role. Health Care Providers. Navigating the world of infertility treatments can quickly become overwhelming, especially when deciding whether or not to seek medical advice and treatment. Health care providers shall understand better their roles in empowering patients and guiding them in the long process of counseling and treatment. The Community. That they may be able to realize that infertility is a growing problem which should not be underestimated. Every now and then people die or face situaltional crisis not just

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from accidents and diseases but also because of depression and other psycho-emotional problems. The Researcher. This study will help the researcher explore the possibilities on helping patients holistically especially those problem areas that can be identified through the study. Through this study, the researcher will be able to understand the role of a nurse especially when it comes to dealing with patients affected with infertility. Future Researchers. Infertility is not just a physical problem but a psychological and social problem which is actually growing. Through this study, they may be able to develop new studies using various related variables on which the researcher has failed to cover.

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RESEARCH METHODOLOGY Research Design This study utilized the descriptive-correlational design

employing the quantitative-qualitative approach to determine the level of psycho-emotional responses and level of sexual self-concept among men and women living with a reproductive challenge. Furthermore, it also determined on how do the respondents describe their sexual relationship; and what are the coping mechanism of the respondents. Research Environment The study was conducted in Tacloban City, which is located in the northeastern part of the Island of Leyte, one of the islands in Eastern Visayas or Region 8. It lays 11 degrees 14 38.19 north latitude and 125 degrees 0 18.24 East longitude and is situated about 580 kilometers southwest of Manila.During the 2007

population census, Tacloban City has an actual total population count of 217,199. With an average annual population growth rate of 2.73 percent, it is projected that for the year 2008, Tacloban Citys population would be 223,130 and based on this projected

population, Tacloban City has a population density of 1,106 persons

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per square kilometer or 11 persons per hectare. Tacloban City has a proportionate total household of 43,415 for 2008. Using the same method, Total Number of Families counts at 47,014 with an Average Household Size of 5.1. Tacloban Citys populace is predominantly Waray-Waray as it is the spoken dialect in the city accounting ninety percent (90%) of

the population. Cebuano/Kana/Visayan speaking populace accounts 6.08% of the total population, 0.80% are Tagalog, 0.10% are Ilocano, 0.07% are Kapampangan while 2.95% come from other ethnic origins. Tacloban City is 94.52% Roman Catholic while the Islam
faith is 0.12% of the population. Iglesia ni Kristo has 0.83% faithful followers, 0.94% are Evangelicals, 0.49% Seventh Day Adventist and 3.10% are faithful followers of 22 other religions.

Research Respondents This study utilized thirty (59 ) respondents. The research respondents will be men and women ages 18-50 who are in relationship with a regular partner or a spouse. They should be together for at least a year or more and has failed to conceive after one year of regular intercourse without contraception. This study will utilize purposive sampling wherein the researcher will first identify

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men and women who are in relationship and determine if they are not using any contraception and been together for at least a year. Convenience sampling will respondents only in also be used in City wherein determining the respondents are

Tacloban

accessible or a self selection of individuals who are willing to participate in the study. Research Instrument This study utilized one instrument with three (3) parts. The first part is a researcher-made tool that determined the

demographic profile of the respondents in terms of age, gender, relationship status, length of relationship, years of formal education, occupation, and duration of infertility. The second part is a researcher-modified tool taken from The Multidimensional Sexual Self-Concept Questionnaire (MSSCQ)

authored by Dr. William E. Snell, Jr. (1996). This is a fifteen (15)-item questionnaire to determine the level of sexual selfconcept of the respondents. It is a 4-point scale

questionnaire answerable with: 1-Almost Never, 2- Often, 3Sometimes, and 4-Almost Always.

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The third part is a researcher-modified tool taken from the Journal of Assisted Reproduction and Genetics, Vol. 19, No. 6, June 2002 ( C 2002) entitled Psychological Evaluation Test for Infertile Couples authored by Jose GoncAlves Franco Jr., Ricardo Luiz Razera Baruffi, Ana Lucia Mauri,Claudia G. Petersen, Valeria Felipe, and Erika Garbellini. This is a fifteen (15)-item questionnaire to determine the level of psychological crisis of men and women on infertility. It is a 4-point scale questionnaire answerable with : 1Almost Never, 2-Often, 3-Sometimes and 4-Almost Always. The last part is the semi-structured interview guide with two (2) open-ended questions that explored and determined on how do the respondents describe their sexual relationship; and what are the coping mechanism of the respondents. Research Procedures
Data Gathering. In the gathering of data, the researcher first

sought permission from the Dean of the Graduate School for the approval of the title. After the permission is granted, pre-testing was be conducted to ensure the validity of the questionnaire to 10 men and women in a Provincial Hospital.

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The researcher identified the respondents who fit the inclusion criteria. A transmittal letter and a consent form was provided for the respondents then they were invited to come to a specific venue and time wherein the researcher have explained the questionnaire in Waray as well the statements in the tool for better understanding. Couples were be seated separately to provide privacy of answers to facilitate better results. Then they were given an ample time to answer. After which the researcher without reviewing it in front of collected their the questionnaire to provide

partners

confidentiality and to prevent conflicts in each party. Then, the researcher chose 10 informants, 5 men and women for the interview. The researcher spent 20-30 minutes each of them in a separate room to provide privacy especially with some sensitive questions asked. The researcher documented the interview through noting down every verbatim and recording using a tape recorder. Afterwards, treatment. Treatment of Data. The following statistical treatments were used in the study: the data collected was presented for statistical

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The study employed simple percentage to determine the age, gender, relationship status, length of relationship, occupation and duration of infertility. Weighted mean was used to determine level psychoemotional responses and the level of sexual self-concept. Parameter Limits Level of Psycho-Emotional Responses Scale Response Category Interpretation 3.26-4.00 Almost Always High 2.51-3.25 Sometimes Moderately High 1.76-2.50 Rarely Fair 1.00-1.75 Almost Never Poor

Scale 3.26-4.00 2.51-3.25 1.76-2.50 1.00-1.75

Parameter Limits Level of Sexual Self-Concept. Response Category Interpretation Almost Always High Sometimes Moderately High Rarely Fair Almost Never Poor

Chi-square was be used to determine the relationship between the profile and level of psycho-emotional responses and the profile and the level of sexual self-concept.

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Pearson-r was

used to determine the relationship between

the level of psycho-emotional responses and level of sexual selfconcept and lastly, Thematic Content Analysis was employed to extract common themes from the qualitative data gathered.

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Definition of Terms In order to fully understand the terms used in the study, the following words are defined operationally: Infertility refers to the respondents inability to conceive a child after one (1) year of regular sexual intercourse unprotected by contraception, or to carry a pregnancy to terms. Level of Psychological-emotional responses refers to the level of respondents emotional changes associated with infertility like anger, anxiety, depression and assertiveness. Level of Sexual self-concept refers to the level of self-concept in terms of the respondents sexuality, sexual life and how it is being affected by infertility. Profile refers to the age, gender, and relationship status, length of relationship, occupation and possible causes of infertility. Relationship status refers to the respondents status if they are married, live-in partners or unwed. Length of Relationship refers to the number of years being together as regular partners or couples.

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Respondents refers to the men and women ages 18-50 who are in relationship with a regular partner or a spouse, together for at least a year or more and has failed to conceive after one year of regular intercourse without contraception. Duration of infertility refers to the length of infertility from the time of diagnosis up to the present.