Introduction
Infertility is not only a medical condition but also a significant psychological and social challenge that can affect many aspects of individuals’ lives. For this reason, researchers and clinicians increasingly emphasize the importance of assessing infertility-related stress when evaluating patient well-being and treatment outcomes. The Fertility Problem Inventory (FPI), developed by Christopher R. Newton, Wendy Sherrard, and Irene Glavac in 1999 and published in the Fertility and Sterility Journal, was designed specifically to measure the psychological impact of infertility. Since its introduction, the instrument has received over 900 citations, demonstrating its widespread use in reproductive health research and psychosocial assessment.
This article provides an overview of the Fertility Problem Inventory (FPI), including its structure, scoring method, key applications, and psychometric properties. It also highlights how researchers and clinicians can use the tool to better understand infertility-related stress and support patient-centered care.
Key Features of the Fertility Problem Inventory (FPI)
Purpose and Use
The Fertility Problem Inventory (FPI) primarily evaluates the perceived psychological stress associated with infertility. Specifically, the instrument captures the emotional, social, and relational consequences that individuals or couples experience while attempting to conceive.
Researchers and clinicians frequently use the FPI to:
Identify infertility-related stress levelsScreen for psychosocial distressduring fertility treatmentMonitor emotional responsesthroughout reproductive therapyInform psychological counseling or support interventionsSupport research on infertility, mental health, and reproductive outcomesBecause infertility often affects multiple areas of life simultaneously, the FPI provides valuable insights into patients’ experiences beyond medical indicators alone.
Target Population
The Fertility Problem Inventory (FPI) was validated primarily in adults of reproductive age (20–45 years) experiencing infertility challenges.
Typical populations include:
Young adults (18–24 years)Middle-aged adults (25–44 years)Individuals or couples trying to become parentsPatients undergoing fertility evaluation or treatmentImportantly, the questionnaire focuses specifically on individuals or couples experiencing infertility rather than general populations.
Structure
The FPI contains 46 items, making it one of the most comprehensive infertility-specific psychosocial assessment tools.
These items evaluate stress across five major subdomains:
Social Concerne.g., feelings of social isolation, perceived stigma
Sexual Concerne.g., pressure to perform, loss of sexual spontaneity
Relationship Concerne.g., marital strain, communication problems
Rejection of Childfree Lifestylee.g., difficulty accepting a life without children
Need for Parenthoode.g., the personal importance of having a child
These domains provide a multidimensional picture of infertility-related stress.
Scoring Method
The Fertility Problem Inventory (FPI) uses a 6-point Likert scale, where participants rate their agreement with each statement:
1.Strongly agree
2. Moderately agree
3. Slightly agree
4. Slightly disagree
5. Moderately disagree
6. Strongly disagree
Subscale scores are calculated by summing the responses within each domain. Subsequently, researchers compute a global score by summing all 46 items.
Higher scores indicate greater infertility-related psychological distress.
Several items require reverse scoring before calculating total or subscale values. Therefore, researchers must consult the original scoring guidelines to ensure accurate interpretation.
Notably, no universal clinical cut-off score exists, so interpretation relies on normative data and percentile comparisons.
Administration Format
The Fertility Problem Inventory (FPI) is designed as a self-administered questionnaire, which simplifies implementation in both clinical and research settings.
Researchers and clinicians may administer it using:
Paper-based formatsDigital online surveysIn-person interviewsPhone or video callsMost participants complete the questionnaire in 10–15 minutes, which balances comprehensiveness with practical usability.
Applications of the Fertility Problem Inventory (FPI)
The FPI serves several critical roles in reproductive health research and clinical practice.
Common applications include:
ScreeningIdentifying patients experiencing high levels of infertility-related psychological stress.
MonitoringTracking emotional responses during fertility treatments such as IVF or hormonal therapy.
Treatment PlanningHelping clinicians determine whether psychological counseling or stress-management interventions may be beneficial.
ResearchInvestigating psychosocial predictors of fertility treatment outcomes.
Because infertility frequently affects couples rather than individuals alone, the FPI also supports research examining relational dynamics within reproductive health contexts.
Languages and availability
The Fertility Problem Inventory (FPI) is available in several validated language versions, including:
• English
• Mandarin Chinese
• Hindi
• Korean
• Persian
• Italian and other languages
Use of the questionnaire typically requires permission from the copyright holders. Academic research use may be permitted with authorization from the American Society for Reproductive Medicine (ASRM) or Elsevier, while commercial use or reproduction may involve licensing fees.
Reliability and Validity
The Fertility Problem Inventory (FPI) is widely regarded as highly reliable and valid, demonstrating excellent psychometric properties.
The original validation study reported a Cronbach’s alpha of 0.93, indicating outstanding internal consistency.
Subscale reliability values include:
Social Concern α = 0.87Sexual Concern α = 0.77Relationship Concern α = 0.82Rejection of Childfree Lifestyle α = 0.80Need for Parenthood α = 0.84Validation studies across multiple populations have further confirmed the instrument’s structural stability and reliability.
The original validation study linkValidation of the Mandarin version (M-FPI) linkValidation of the Korean version linkValidation of the Persian version linkValidation in Italian couples undergoing infertility treatment linkValidation of the indian version linkLimitations and Considerations
Despite its strengths, the Fertility Problem Inventory (FPI) has several limitations.
Length — The 46-item questionnaire may feel lengthy for some participants.Self-report nature — Responses may be influenced by personal perceptionCultural considerations — Cultural differences in attitudes toward fertility may affect interpretation.Age limitations — Validation primarily involves adults of reproductive age.Language Barriers — Limited availability of validated translations may affect its use in some populations.Social Desirability Bias — Participants may respond in a way they perceive as socially acceptableOther Versions And Related Questionnaires
Researchers often use the FPI alongside complementary psychosocial instruments.
Related questionnaires include:
Fertility Quality of Life (FertiQoL)SCREENIVF (psychological screening in fertility treatment)Infertility Self-Efficacy Scale (ISES)Additionally, short forms of the FPI have been proposed in some validation studies to reduce respondent burden.
Additional Resources
The original validation study linkFor permissions and licensing regarding the Fertility Problem Inventory (FPI), researchers should contact the American Society for Reproductive Medicine through the following e-mail:asrm@asrm.org
Elsevier permissions portalFrequently Asked Questions (FAQ)
Who can use the Fertility Problem Inventory (FPI)?Researchers, clinicians, and reproductive health specialists use the FPI to assess infertility-related stress in adults undergoing fertility treatment.
How long does it take to complete the FPI?Most participants complete the questionnaire in 10–15 minutes.
How is the FPI administered?The questionnaire can be administered via paper forms, digital surveys, interviews, or remote communication platforms.
Is there any cost associated with using the FPI?Academic researchers may use it with authorization, although permission from the publisher may be required, particularly for commercial use.
A Word from ResRef about the Fertility Problem Inventory
The Fertility Problem Inventory (FPI) remains a foundational and highly robust instrument for capturing the multidimensional nature of infertility-related stress. Its excellent psychometric properties and comprehensive subscales make it invaluable for both clinical assessment and research aimed at understanding and improving the psychological well-being of individuals and couples on their fertility journey. Users are advised to employ culturally validated versions where available.
References
1.Newton, C. R., Sherrard, W., & Glavac, I. (1999). The fertility problem inventory: Measuring perceived infertility-related stress. Fertility and Sterility, 72(1). link
2.Peng, T., Coates, R., Merriman, G., Zhao, Y., & Maycock, B. (2011). Testing the psychometric properties of Mandarin version of the fertility problem inventory (M-FPI) in an infertile Chinese sample. Journal of Psychosomatic Obstetrics & Gynecology, 32(4), 173–181. link
3.Ju Hee Kim, Hye Sook Shin,Validation of a Korean Version of Fertility Problem Inventory,Asian Nursing Research,Volume 8, Issue 3,2014,Pages 207-212,ISSN 1976-1317.link
4.Reza Omani Samani, Amir Almasi-Hashiani, Fatemeh Shokri, Saman Maroufizadeh, Samira Vesali, Mahdi Sepidarkish,Validation study of the Fertility Problem Inventory in Iranian infertile patients,Middle East Fertility Society Journal,Volume 22, Issue 1,2017,Pages 48-53,ISSN 1110-5690.link
5.Donarelli, Z., Gullo, S., Lo Coco, G., Marino, A., Scaglione, P., Volpes, A., & Allegra, A. (2015). Assessing infertility-related stress: the factor structure of the Fertility Problem Inventory in Italian couples undergoing infertility treatment. Journal of Psychosomatic Obstetrics & Gynecology, 36(2), 58–65. link
6.Patel A, Nair BVS, Das SK, Kumar P, Sharma PSVN. Re-examining Psychometric Properties of Fertility Problem Inventory: A Clinic-Based Study from India. J Hum Reprod Sci. 2022 Apr-Jun;15(2):177-186.link