Fertility Problem Inventory [FPI-46]

Infertility-Related Stress Assessment Scale

Scale Description

The Fertility Problem Inventory (FPI-46) is a widely recognized psychological assessment instrument designed to evaluate the psychological stress associated with infertility. The scale was developed by Newton and colleagues (1999) and aims to measure the emotional, social, interpersonal, and cognitive consequences experienced by women and men facing difficulties with conception.

Infertility represents a complex life experience that may affect multiple areas of functioning, including emotional well-being, couple relationships, social interactions, sexual functioning, and perceptions regarding parenthood. The FPI-46 provides a comprehensive assessment of these psychological dimensions, allowing researchers and healthcare professionals to better understand the burden associated with infertility.

The instrument is used extensively in reproductive health research, clinical psychology, counseling, and assisted reproduction settings, providing valuable information regarding the psychological impact of infertility and supporting the development of appropriate interventions.

The FPI-46 consists of 46 items completed by individuals experiencing fertility difficulties. Responses are provided on a six-point Likert scale, ranging from:

1 = Strongly Agree
to
6 = Strongly Disagree

The scale evaluates five major dimensions of infertility-related stress:

1. Relationship Concern

(10 items)
This dimension assesses the impact of infertility on the couple’s relationship, including emotional distance, communication difficulties, relationship tension, and concerns regarding the effect of infertility on partnership quality.

2. Social Concern

(10 items)
This dimension evaluates difficulties experienced in social interactions, including feelings of isolation, discomfort in social situations involving children or pregnancy, and concerns about social expectations.

3. Sexual Concern

(8 items)
This dimension examines the influence of infertility on sexual functioning, intimacy, and the emotional aspects of the couple’s sexual relationship.

4. Need for Parenthood

(10 items)
This dimension assesses the strength of the desire to become a parent and the emotional importance attributed to achieving parenthood.

5. Rejection of Childfree Lifestyle

(8 items)
This dimension evaluates negative perceptions regarding life without children and the difficulty accepting a future without biological parenthood.

The multidimensional structure of the FPI-46 allows a detailed evaluation of the different psychological consequences associated with infertility.

Data Analysis and Applications

The analysis of data obtained from the Fertility Problem Inventory (FPI-46) is based on calculating scores for each individual dimension through the aggregation of responses from the corresponding items. Each subscale can be examined independently or combined to estimate the overall level of infertility-related psychological distress.

Descriptive Statistical Analysis

Initial statistical analysis includes:

  • Mean scores for each subscale.
  • Standard deviations.
  • Distribution of responses.
  • Item-level analysis.

These analyses provide information regarding the intensity and prevalence of infertility-related stress within a specific population.

Scoring and Interpretation

The FPI-46 is scored by summing responses within each of the five dimensions. Higher scores indicate greater infertility-related stress and increased psychological burden in the corresponding domain.

The scale allows researchers and clinicians to evaluate:

  • Overall infertility-related distress.
  • Specific sources of psychological difficulty.
  • Individual patterns of emotional and interpersonal impact.

The instrument can also be used to compare different groups of individuals or to monitor changes following psychological or medical interventions.

Reliability Analysis

The psychometric reliability of the FPI-46 is commonly evaluated using Cronbach’s alpha (α).

According to the provided material, the five subscales demonstrate satisfactory internal consistency, with Cronbach’s alpha values ranging from 0.72 to 0.82.

The reliability coefficients are:

  • Relationship Concern: α = 0.73
  • Social Concern: α = 0.79
  • Sexual Concern: α = 0.82
  • Need for Parenthood: α = 0.77
  • Rejection of Childfree Lifestyle: α = 0.72

These values indicate acceptable internal consistency across the different dimensions of infertility-related stress.

Correlation and Predictive Analysis

The FPI-46 can be used to investigate relationships between infertility-related stress and other psychological variables, including:

  • Anxiety symptoms.
  • Depression.
  • Quality of life.
  • Couple adjustment.
  • Relationship satisfaction.
  • Emotional coping strategies.
  • Psychological outcomes of assisted reproduction.

The scale is frequently incorporated into research protocols examining the psychological consequences of infertility and the effectiveness of psychological or medical interventions.

Group Comparisons

The FPI-46 can be used to examine differences between groups according to variables such as:

  • Gender.
  • Duration of infertility.
  • Type of infertility diagnosis.
  • Treatment stage.
  • Use of assisted reproductive technologies.
  • Previous treatment experiences.

Statistical methods may include:

  • Independent samples t-tests.
  • Analysis of Variance (ANOVA).
  • Multivariate analysis techniques.

Purpose of the Scale

The primary purpose of the Fertility Problem Inventory (FPI-46) is to systematically assess the psychological stress generated by infertility among women and men.

The scale aims to help healthcare professionals and researchers:

  • Identify the major sources of emotional burden.
  • Evaluate the impact of infertility on personal and social relationships.
  • Understand difficulties related to sexuality and parenthood.
  • Design appropriate psychological counseling and support interventions.

Additionally, the FPI-46 supports research examining the relationship between infertility stress, mental health, quality of life, and outcomes of assisted reproductive treatments.

Psychometric Evaluation and Calibration

Content Validity

Content validity evaluates whether the items adequately represent the major psychological consequences associated with infertility, including emotional distress, relationship difficulties, social concerns, sexuality, and parenthood-related beliefs.

Reliability Assessment

Reliability is evaluated primarily through internal consistency analysis using Cronbach’s alpha coefficients. The available psychometric data indicate satisfactory reliability across all five dimensions of the FPI-46.

Construct Validity

Construct validity can be examined through:

  • Exploratory Factor Analysis (EFA).
  • Confirmatory Factor Analysis (CFA).

These procedures evaluate whether the five-dimensional structure of infertility-related stress is adequately represented by the items.

Criterion-Related Validity

Criterion validity can be assessed by examining associations between FPI-46 scores and related constructs, including:

  • Psychological distress.
  • Depression.
  • Anxiety.
  • Relationship functioning.
  • Quality of life.

Cut-off Scores

The available material does not report specific cut-off scores for categorizing the severity of infertility-related stress. Therefore, interpretation should generally rely on comparative analyses, normative data, or clinical evaluation rather than fixed diagnostic thresholds.

Applications

The Fertility Problem Inventory (FPI-46) can be applied in multiple research and clinical contexts, including:

  • Reproductive psychology, for assessing emotional responses to infertility.
  • Assisted reproduction services, for evaluating psychological needs during fertility treatment.
  • Clinical counseling, for identifying areas requiring psychological support.
  • Couple therapy, for understanding the impact of infertility on relationship functioning.
  • Health psychology research, for studying the relationship between infertility stress and mental health outcomes.

The FPI-46 provides a comprehensive framework for understanding infertility not only as a medical condition but also as a significant psychological and interpersonal experience.

Bibliography

Newton, C. R., Sherrard, W., & Glavac, I. (1999). The Fertility Problem Inventory: Measuring Perceived Infertility-Related Stress. Fertility and Sterility, 72(1), 54–62.

Said, N. (2019). Fertility Concerns While Trying to Conceive.

Zurlo, M. C., Cattaneo Della Volta, M. F., & Vallone, F. (2017). Factor Structure and Psychometric Properties of the Fertility Problem Inventory–Short Form. Health Psychology Open, 4(2), 2055102917738657.