The fertility quality of life (FertiQoL) tool: development and general psychometric properties(†)

Boivin, Jacky; Takefman, Janet; Braverman, Andrea

It is currently accepted that to effectively measure the impact of disease, one needs a disease-specific instrument (WHOQOL, 1995) . FertiQol is a reliable and sensitive measurement tool for QoL in individuals with fertility problems. More than 2000 people with fertility problems contributed to the creation of FertiQoL, and it was developed using an integrated mixed-method approach that included literature reviews, international expert consultations, patient focus groups, a cross-cultural feasibility and acceptability survey, and a psychometric survey evaluation. FertiQoL comprises of a Core module evaluating the impact of fertility problems on emotional, mind-body, relational and social domains and an optional Treatment module evaluating treatment environment and tolerability. Subscales and total scales show mainly high reliability and sensitivity of contribute to future research and clinical endeavors aimed at investigating and ultimately improving QoL in people with fertility problems. Certain methodological limitations need to be taken into account. First, despite the multi-disciplinary contributions from experts worldwide, focus groups and a feasibility and acceptability study in 10 countries, the final psychometric evaluation only occurred in five English-speaking countries. Second, targeted efforts to recruit a diverse group of people were not entirely successful in recruiting particular subgroups (i.e. secondary infertile, men). Indeed, more psychometric research on men is required to fully establish reliability and validity. Third, the major proportion of the final sample was recruited online, and differences between the Online and Clinic sample were observed. Although, data generated online have been shown to be as valid as data collected through traditional methods (Bunting and Boivin, 2007; Lieberman, 2008) , one would need to determine whether the differences observed warrant a more in-depth analysis-for example, a different set of norms for clinic samples. We eliminated records coming from the same IP address but it may be possible that the same person replied more than once to the survey. Finally, the subscales of the Core FertiQoL were not entirely orthogonal with cross-loadings on the social and mind/body domains. While these associations are expected, we have now modified the final wording of four FertiQoL items to reduce these crossloadings. Further evaluation of these changes and FertiQoL as a whole on a new sample is required for final validation. These main limitations should be addressed in future psychometric research evaluating FertiQoL. However, the strengths of our mixed-method approach, and consultation and evaluation from infertile people ensure that FertiQoL captures the key life domains affected by fertility problems. It is hoped that FertiQoL will become a gold standard for the measurement of QoL for individuals experiencing fertility problems (whether in treatment or not).