Introduction
Fertility and childbirth are essential to human life [1]. Infertility is defined as the failure to conceive after regular intercourse without contraceptives for at least 12 months. There are two types of infertility, including primary and secondary infertility. A woman with primary infertility is currently unable to become pregnant, while a woman with secondary infertility had a pregnancy before but is currently unable to have a child [2]. Having a child is important for improving marriage [3]. Women have a higher tendency to have children compared to men who have a greater tendency to play a parental role [4]. According to the World Health Organization (WHO) report, infertility can adversely affect couples’ mental and emotional health and result in physical and psychological problems [5]. Psychological problems caused by infertility include decreased self-esteem and quality of life, and increased depression and anxiety, which reduces people’s psychological well-being [6]. Psychological well-being as a multidimensional construct that includes emotional and cognitive components. People with better psychological well-being show higher positive affect and are usually more optimistic about events and incidents, while people with lower psychological well-being show negative feelings such as anxiety and depression [7]. In the study by Jabraeili et al., there was a significant difference between infertile and fertile women in three variables of resilience, meta-emotional beliefs, and psychological well-being. The psychological well-being of infertile women was lower than that of fertile women [8].
Morality is also an important and influential factor in marriage. Undoubtedly, ethics and morality play a significant role in guiding behaviors in humans [9]. The moral foundations theory has significantly shown the breadth of morality [10]. Morality affects marital adjustment [11]. There is a significant relationship between moral foundations and life satisfaction in women [12]. Sense of humor plays a crucial role in the quality of marital relationships [13]. A sense of humor is vital in enhancing marital satisfaction and adjustment; it can help couples to reduce tension and turn conflicts into fun moments during stressful and anxious conditions to create marital satisfaction [14].
Some studies have indicated that infertile women have lower psychological well-being and higher mental exhaustion compared to infertile men. Previous studies on male infertility have focused more on medical, physiological, and psychological disorders such as anxiety, depression, and quality of life. No study has been conducted on moral foundations and sense of humor in infertile couples. Therefore, the present study aims to compare psychological well-being, moral foundations, and sense of humor between infertile and fertile couples in Rasht, Iran.

Methods
In this causal-comparative study, participants were 212 couples (106 infertile and 106 fertile couples) in 2022. They completed the questionnaire separately. The inclusion includes were the diagnosis of infertility in one of the couples, having a child without a diagnosis of secondary infertility, high school education, resident of Guilan Province, and age 18-45 years for women and 18-50 years for men. The couples who had been married for one year; had education lower than high school; were living in other provinces; and had age <18 or >50 years were excluded. The Ryff’s psychological well-being scale, moral foundations questionnaire, and multidimensional sense of humor scale were used for data collection. For the analysis of the collected data, analysis of covariance was used in SPSS software, version 28.

Results
The mean age of participants was 34.95±6.91 years in infertile couples and 33.02±6.20 years in fertile couples. This difference was statistically significant (P<0.05) (Table 1).


The results of data analysis showed a significant difference between infertile and fertile couples regarding self-acceptance, positive relations with others, autonomy, and personal growth dimensions of psychological well-being and also in the sanctity/purity dimension of moral foundations, the humor creativity and uses of humor for social purposes dimension of sense of humor, and the total score of psychological well-being (Table 2).





Conclusion
The anxiety caused by infertility has adverse effects on couples’ psychological well-being and physical and mental health. Infertility can lead to depression and anxi- ety among them. Ignoring the psychological disorders of infertile couples can limits the possibility of infertil- ity treatment. In other words, in addition to the physical treatment, psychological conditions of infertile couples should be addressed to increase the success of infertility treatment. There was a non-significant relationship between occupation and between fertility such that the percentage of infertility in employed women was lower than in housewives.
This research revealed a significant difference in some dimensions of psychological well-being, moral foundations, and sense of humor between infertile and fertile couples. 

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of Guilan University of Medical Sciences (Code: IR.GUMS.REC.510.1400).

Funding
This article was taken from a research project. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Authors' contributions
Conceptualization, study design, data acquisition and data analysis: Maliheh Tofighi Naeim and Mohammad Mahdi Pasandideh; Drafting of the manuscript: Maliheh Tofighi Naeim; Critical revision of the manuscript for important intellectual content: Maliheh Tofighi Naeim, Mohammad Mahdi Pasandideh, Adele Eisanazar; Study supervision: Mohammad Mahdi Pasandideh, Adele Eisanazar.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgments
The authors would like to thank the Deputy for Research and Technology of Guilan University of Medical Sciences, Al-Zahra Hospital in Rasht, Payam Noor University of Astara, and all couples participated in this study for their cooperation.


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