INTRODUCTION:

Background of the study:

Motherhood is a great honor and it is a great gift of god. Fertility is high respected in most cultures and the wish for a child is one of the most basic of all human motivations. Pregnancy and motherhood are developmental milestones for women that are highly emphasized by our culture. When attempts to have a child fall short, it can be an emotionally distressing experience. Unfortunately, all women were not gifted with this.

Pregnancy is the most beautiful word to a women signaling the triumph of life. Having a baby is one of the most beautiful events in a women’s life. Nothing could be compared to the feeling of nurturing a baby, watching it grow, creating a life. In every culture, being pregnant or to produce a child is considered as a major event in the family. However for millions of women, this dream is an exclusive one. For those who cannot achieve pregnancy feel encompassing heart break which leaves them feel isolated, stressed, angry, guilty, and hostile. (WHO, 2010).

Pregnancy is defined as the period from conception to birth. After the egg is fertilized by a sperm and then implanted in the lining of the uterus, it develops into the placenta and embryo, and later into a fetus.

Infertility is defined as a failure to conceive within one or more years of regular unprotected intercourse.

First choice of management for ovulatory dysfunction, induction of ovulation, correction of biochemical abnormality, substitution therapy. The second choice of management is surgery.

One method of reducing muscle tension that people have found helpful is through a technique called Progressive Muscle Relaxation (PMR). Progressive Muscle Relaxation exercise will tense up particular muscles and then relax them, then on practise this technique consistently.

Progressive Muscle Relaxation is a systemic way of tensing and relaxing the different group of muscles throughout the body. It responds to perceived stressors by activating the sympathetic branch of the autonomic nervous system activity and by relaxing works by reducing sympathetic nervous system activity and by activating the parasympathetic nervous system, which helps to reduce the stress.

NEED FOR THE STUDY:

Benagiano (2006) described Global perspective of infertility in the general population. He further states that infertility affects 7% – 8% of all couples. In Europe the prevalence of infertility has been estimated at around 14% women of 30 years of age or younger, the probability of pregnancy has been decreased to about 40%.

Mahboubeh et al., conducted a study to assess the effect of relaxation techniques to ease the stress in infertile women (2004–2005) in Iran. It was indicated that approx 1|4th of Iranian couples experience the infertility. This was a semi- experimental and clinical trial study conducted on 76 infertile women aged between 18–35 years. The women were randomly divided in to two intervention and control group using simple random sampling. There is a significant difference before and after the study in the intervention group and it reduced after the study. The total stress score before the study was 183 in the intervention group and 186.26 in the control group. The total stress score after the study was 148 in the intervention group and 209 in the control group.

The purpose that the investigator selected this topic for research is, that the investigators have seen the following reasons attracted to make the study. Stress among women with infertility cause many issues. Women with infertility are neglected by their family and they were isolated. The irrational myths of the society consider them as unlucky and they hesitate to even attend the functions like marriage, baby shower (seemantham). These painful experiences are very much hurting and cause more stress. And the stress itself lead to hormonal changes, which prevents the conception. This becomes the cycle, and continue to cause extreme heart ache, to many young women who will have to empower the development of our country. So, the researcher wants to help the young infertile women by conducting this study.

PROBLEM STATEMENT:

A study to assess the effectiveness of progressive muscle relaxation on stress among women with infertility in selected hospitals in Kanyakumari district.

OBJECTIVES:

· To determine the level of stress among women with infertility in both experimental and control group.

· To evaluate the effectiveness of Progressive Muscle Relaxation on post test level of stress among women with infertility in experimental group.

· To find out the association between the pre-test level of stress among women with infertility and their selected demographic variables such as family history of infertility, regularity of menstruation, age at puberty.

HYPOTHESIS:

H1- There will be significant difference between pre-test and post-test score of stress among women with infertility in experimental group.

H2- There will be significant difference between score of stress among women with infertility experimental and control group.

H3- There will be a significant association between the score of stress among women with infertility with selected demographic variables such as age, sex, occupation, religion, education, family income, type of family, age at puberty, regularity of menstruation, age at marriage, duration of marital life, use of contraceptives, family history of infertility.

Conceptual Framework:

Conceptual Framework based on modified Roy’s Adaptation Model was used.

METHODS AND MATERIALS:

The study was conducted at selected hospitals, Kanyakumari district. The population of this study is women with infertility and who met the inclusive criteria. Simple random sampling technique was used to select the samples for the study. The total number of samples were 60 (i.e.) 30 in each group. The data collection tool used in this study consisted of two sections. Section one was demographic and clinical variables, section two was perceived stress scale to assess the level of stress among women with infertility. Validity of the tool was obtained from 5 experts. Reliability was tested using test re-test method.

Pilot study was conducted on 6 samples to find out the feasibility of conducting the study. The main study was conducted in Dr. Jeyasekharan hospital, Nagercoil. The level of stress was assessed by perceived stress scale for both groups. After the pretest, progressive muscle relaxation taught and practiced in experimental group. Post-test assessment of level of stress for both groups. The data were analyzed by using descriptive and inferential statistics and tested the hypothesis at p<0.05 level of significant.

RESULTS AND DISCUSSION:

Section I:

· Distribution of women with infertility according to the demographic variables in experimental group and control group.

· Distribution of women with infertility according to the clinical variables in experimental group and control group.

Section II:

Distribution of level of stress among women with infertility in experimental group and control group

Section III:

· Comparison of mean pre test post test stress score among women with infertility in experimental group.

· Comparison of mean pre test post test stress score among women with infertility in control group.

Section IV:

Comparison of post test stress score among women with infertility in experimental and control group.

Section V:

· Association of pre test stress score among women with infertility in experimental group

· Association of pre test stress score among women with infertility in control group

Section I:

Distribution of women with infertility according to the demographic variables in experimental group and control group:

With regard to age in experimental group half of women with infertility 15(50.00%) belonged to the age group of 31–35 years of age, 8(26.67%) belonged to the age group of 26–30 years, and in control group also nearly half of them 14(46.67%) belonged to the age group of 31 – 35 years of age.

Considering the religion more than half in both experimental group and control group 16(53.33%) belonged to Christianity. 13 in experimental group and 12 in control group belonged to the Hindu community. There was equal distribution of women with infertility with regard to occupation ie, 14 of them were home makers in both experimental group and control group. 12 in experimental group and 13 in control group were professionals.

Educational level depicted that almost 2/3rd of them were graduates in experimental group and control group. 43.33% in experimental group and 46.67% in the control group have the family income of Rs. 10,000 – Rs. 20,000. None of them have above 50,000 family income in both groups. Majority of them lived as a nuclear family ie, 56.67% in experimental group and 53.33% in control group, whereas rest of women with infertility belonged to joint family in experimental group and control group.

70% of women with infertility in experimental group and 73.33% in control group attained menarche between the age group of 12–14 years, 10% attained menarche between the age of 15–17 in both groups. Considering the age at marriage majority of them married at the age of 26 – 28 years in both experimental group and control group, and nearly 1/3 rd were married at the age of 23– 25 years in both experimental group and control group

Frequency and percentage distribution of women with infertility according to the clinical variables in experimental group and control group:

With regards to the regularity of menstruation majority of them had regular menstruation in both groups whereas 8 in experimental group and 9 in control group had irregular menstruation. Considering about duration after marriage in both groups, about more than half of them got married for 5 years and 9(30.00%) were married for 2 years. None of them use contraceptives in both the groups.

Majority of women with infertility in experimental group and control group 23(76.67%) had no family history of infertility. Only 8 in experimental group and 7 in control group revealed that they have family history of infertility.

Section II.

Distribution of level of Stress among women with Infertility in Experimental Group and Control Group N = 60

Level of stress	Experimental group		Control group
Level of stress	Frequency	Percentage	Frequency	Percentage
Low	0	0.00	0	0.00
Moderate	30	100.00	30	100.00
Severe	0	0.00	0	0.00

Section III. Comparison of Mean Pre test Post test Stress Score among Women with Infertility in Experimental Group and Control Group.

Figure 1: Comparison of mean pre test post test stress score among women with infertility experimental group

Figure 2:Comparison of Mean Pre test Post test Stress Score Among Women With Infertility In Control Group.

Section IV:

Figure 3: Comparison of Post test Stress Score among Women with Infertility in Experimental Group and Control Group.

Section V:

Association of pre test stress score of women with infertility in the experimental group:

To find out if there is any association between pre test stress score of women with infertility and their selected demographic variables like age, religion, occupation, education, family income, type of family, age at menarche, age of marriage, regularity of menstruation, duration after marriage, family history of infertility.

Here the demographic variable of age of women with infertility is significant at 5% (p > 0.005) in experimental group and the other demographic variables of women with infertility is not significant at 5% level.

Association of Pre test Stress Score of Women with Infertility in The Control Group:

In control group, the demographic variables of age, regularity of menstruation, duration of marriage, family history of infertility of women with infertility there is significant at 5%(p > 0.005*), other demographic variables in control group there is no significant at 5% (p < 0.005#)

LIMITATIONS:

· Women who are between 20 – 40 years of age.

· 60 Women with infertility.

· Women those who are willing Only for 4 weeks of data collection

RECOMMENDATION:

1. A similar study can be conducted with large sample with large setting.

2. A study can be conducted to see the effectiveness of stress relief by progressive muscle relaxation among women with infertility.

3. A study can be conducted to compare the effect of progressive muscle relaxation on women with infertility among primary and secondary women with infertility.

REFERENCE:

1. Adele Pillitteri. (1999). Maternal and Child Health Nursing Philadelphia, JB, Lippincott

2. Basavanthappa, B. T. (2008). Textbook of Nursing Research. New Delhi: Jaypee Brothers Publication.

3. Dutta, D.C. (2007). Textbook of Gynaecology (7^th edition). Calcutta: New Central Book Agency

4. Kamini Rao, (2011). Textbook of midwifery and obstetrics for nurses. New Delhi: Elsevier.

5. Kyle, T. (2008). Maternity and Paediatric Nursing. New York: Wolter Kluwar Publications

6. Lowdermilk, Perry, Bobak, (1997). Maternity and Women’s Health Care, (8^th edition). Philadelphi: Mosby

7. Nima Bhaskar, (2012). Midwifery and Obstetrical Nursing, Bangalore: Emmess Medical Publications.

8. Polit and Hungler. (2007). Nursing Research. (7^th edition). New Delhi: Lippincott Williams and Wilkin.

Received on 04.05.2018 Modified on 19.06.2018

Int. J. Nur. Edu. and Research. 2018; 6(4):363-366.

DOI: 10.5958/2454-2660.2018.00088.1