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Szabo G, Szigeti F J, Sipos M, Varbiro S, Gonda X. Affective temperaments show stronger association with infertility treatment success compared to somatic factors, highlighting the role of personality focused interventions. Sci Rep 2023; 13:21956. [PMID: 38081851 PMCID: PMC10713532 DOI: 10.1038/s41598-023-47969-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
Infertility has a multifactorial background, where, besides somatic factors, psychological contributors also play a role in development and outcome. While affective temperaments have been associated with development, course, and outcome as well as treatment success in various somatic conditions, their association with infertility and its treatment has not been investigated so far. The purpose of our retrospective cohort study was to evaluate the influence of affective temperaments on fertility treatment outcomes. Among 578 women who underwent infertility treatment in an Assisted Reproduction Centre in Budapest, Hungary, treatment success, detailed medical history, and demographic parameters were recorded, and the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Auto-questionnaire (TEMPS-A) was administered. Possible predictors of assisted reproduction outcome were analyzed using multivariate logistic regression models, followed by a receiver operating curve (ROC) analysis in order to define ideal affective temperament cut-off values for clinical applicability. Aside from age, BMI, and previous miscarriage, cyclothymic scores > 4 (OR = 0.51 CI 0.35-0.74, p < 0.001), depressive scores > 9 (OR = 0.59 CI 0.4-0.87, p = 0.009) and anxious scores > 9 (OR = 0.45 CI 0.31-0.66, p < 0.001) significantly decreased the odds of clinical pregnancy by 49%, 41% and 55%, respectively. Irritable and hyperthymic temperaments, as well as other somatic and socio-economic factors had no effect on infertility treatment outcomes. The results suggest that affective temperaments may be related to the outcome of infertility treatments. Thus, screening for affective temperaments may help identify high-risk patient groups and offer patient-tailored treatment, which may increase the chances of a successful pregnancy and live birth for women undergoing IVF treatment.
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Affiliation(s)
- Georgina Szabo
- Doctoral School of Mental Health Sciences, Semmelweis University, Budapest, Hungary
| | - Judit Szigeti F
- Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary
| | - Miklos Sipos
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Szabolcs Varbiro
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Xenia Gonda
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary.
- NAP3.0-SE Neuropsychopharmacology Research Group, Hungarian Brain Research Program, Semmelweis University, Gyulai Pál Street 2, 1085, Budapest, Hungary.
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Chamorro PP, Herruzo J, Pino MJ, Casas-Rosal JC. Coping, social support and medical factors on psychosocial impact in couples experiencing infertility. JOURNAL OF SEX & MARITAL THERAPY 2023; 50:197-215. [PMID: 37867461 DOI: 10.1080/0092623x.2023.2269983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
This study assessed dyadically the relationship between psychosocial impact of infertility experienced by 87 couples and individual coping strategies, perceived social support and some medical factors. Although problem-focused strategies emerged as positive, certain side effects on partner were revealed. Social support was related to psychosocial outcomes in a positive way, cognitive component of coping strategies resulted as a prominent factor on individual's adjustment as well as the partner's role. Findings suggest the convenience of promoting the awareness about the effects of each partner's feelings, behaviors and beliefs on his/her individual's well-being in this field due to the interdependent context in which they are. Infertility counselors may foster this process by evaluating and educating to them about the functionality of these factors.
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Affiliation(s)
| | - J Herruzo
- Psychology Department, University of Cordoba, Córdoba, Spain
| | - María J Pino
- Psychology Department, University of Cordoba, Córdoba, Spain
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Bensink M, Volkerink J, Teklenburg G, van Bavel CCAW, Kuchenbecker WKH, Cohlen BJ, Curfs MHJM. Value-based healthcare in fertility care using relevant outcome measures for the full cycle of care leading towards shared decision-making: a retrospective cohort study. BMJ Open 2023; 13:e074587. [PMID: 37696630 PMCID: PMC10496656 DOI: 10.1136/bmjopen-2023-074587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/25/2023] [Indexed: 09/13/2023] Open
Abstract
OBJECTIVE To determine if the introduction of value-based healthcare (VBHC) in fertility care can help to create realistic expectations in patients resulting in increased patient value, by demonstrating the relevance of defining outcome measures that truly matter to subfertile patients. DESIGN Retrospective cohort study. SETTING Tertiary fertility centre. RESULTS Time to pregnancy (TTP) and ongoing pregnancy rate (OPR), as a proxy for the live birth rate, for the full cycle of fertility care, regardless of which and how many treatment cycles performed, were identified as the most relevant medical outcome measures. Outcome measures were incorporated into a digital dashboard by using anonymised and validated patient data from the electronic patient file. We were able to present the TTP and OPR for the population as a whole as well as stratified for age, diagnosis, gravidity and type of gamete source used thereby resulting in a virtual 'patient like me' resembling the individual patient in the consultation room. CONCLUSION We have shown that, by applying VBHC principles, relevant outcome measures can be generated and stratified for different patient characteristics, in order to develop a virtual 'patient like me'. This virtual 'patient like me' can be used in the consulting room in the form of a digital dashboard, attributing to create realistic patient expectations. This facilitates healthcare providers and patients in shared decision-making.
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Affiliation(s)
- Milou Bensink
- Fertility Center, Isala Klinieken, Zwolle, The Netherlands
| | - Joy Volkerink
- Fertility Center, Isala Klinieken, Zwolle, The Netherlands
| | | | | | | | - Ben J Cohlen
- Fertility Center, Isala Klinieken, Zwolle, The Netherlands
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Kremer F, Ditzen B, Wischmann T. Effectiveness of psychosocial interventions for infertile women: A systematic review and meta-analysis with a focus on a method-critical evaluation. PLoS One 2023; 18:e0282065. [PMID: 36854039 PMCID: PMC9974119 DOI: 10.1371/journal.pone.0282065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/07/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Approximately seven to nine percent of couples of reproductive age do not get pregnant despite regular and unprotected sexual intercourse. Various psychosocial interventions for women and men with fertility disorders are repeatedly found in the literature. The effects of these interventions on outcomes such as anxiety and depression, as well as on the probability of pregnancy, do not currently allow for reliable generalisable statements. This review includes studies published since 2015 performing a method-critical evaluation of the studies. Furthermore, we suggest how interventions could be implemented in the future to improve anxiety, depression, and pregnancy rates. METHOD The project was registered with Prospero (CRD42021242683 13 April 2021). The literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Six databases were searched and 479 potential studies were discovered. After reviewing the full texts, ten studies were included for the synthesis. Not all studies reported the three outcomes: four studies each for depression, three for anxiety and nine studies for pregnancy rates were included in the meta-analysis, which was conducted using the Comprehensive meta-analysis (CMA) software. RESULTS Psychosocial interventions do not significantly change women's anxiety (Hedges' g -0,006; CI: -0,667 to 0,655; p = 0,985), but they have a significant impact on depression in infertile women (Hedges' g -0,893; CI: -1,644 to -0,145; p = 0,026). Implementations of psychosocial interventions during assisted reproductive technology (ART) treatment do not increase pregnancy rates (odds ratio 1,337; 95% CI 0,983 to 1,820; p = 0,064). The methodological critical evaluation indicates heterogeneous study design and samples. The results of the studies were determined with different methods and make comparability difficult. All these factors do not allow for a uniform conclusion. METHODOLOGICAL CRITICAL EVALUATION Study design (duration and timing of intervention, type of intervention, type of data collection) and samples (age of women, reason for infertility, duration of infertility) are very heterogeneous. The results of the studies were determined with different methods and make comparability difficult. All these factors do not allow for a uniform conclusion. CONCLUSION In order to be able to better compare psychosocial interventions and their influence on ART treatment and thus also to achieve valid results, a standardised procedure to the mentioned factors is necessary.
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Affiliation(s)
- Franziska Kremer
- Institute of Medical Psychology, Centre for Psychosocial Medicine, University Hospital, Heidelberg, Germany
- * E-mail:
| | - Beate Ditzen
- Institute of Medical Psychology, Centre for Psychosocial Medicine, University Hospital, Heidelberg, Germany
| | - Tewes Wischmann
- Institute of Medical Psychology, Centre for Psychosocial Medicine, University Hospital, Heidelberg, Germany
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Dourou P, Gourounti K, Lykeridou A, Gaitanou K, Petrogiannis N, Sarantaki A. Quality of Life among Couples with a Fertility Related Diagnosis. Clin Pract 2023; 13:251-263. [PMID: 36826165 PMCID: PMC9955447 DOI: 10.3390/clinpract13010023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/30/2023] [Accepted: 02/05/2023] [Indexed: 02/11/2023] Open
Abstract
Fertility-related stress can negatively impact infertile couples' quality of life (QoL). Most previous studies have concentrated on the effects of stress and infertility on individual persons, especially women, though infertility affects the QoL of both spouses. Our research aimed to investigate the roles of infertility and stress in couples' quality of life as a single unit. The research sample consisted of 202 spouses, i.e., 101 couples, with a mean age of 39.5 years (SD = 4.9 years) undergoing fertility treatment at Athens Naval Hospital-Assisted Reproduction Unit. Data collection was completed via self-administered questionnaires: the FertiQoL International Questionnaire for measuring the quality of life in infertility and The Demographic Information and Medical History Questionnaire. Data collection was conducted between January and November 2022. Quantitative variables are expressed as mean values (standard deviation) and as median interquartile range, and qualitative variables are expressed as absolute and relative frequencies. Pearson's (r) and Spearman's (rho) correlations coefficients were used to explore the association of two continuous variables. Multiple linear regression analysis was used with dependence on the Ferti-QoL's subscales. The regression equation included terms for participants' demographics and information from their medical history. Adjusted regression coefficients (β) with standard errors (SE) were computed from the results of the linear regression analyses. All reported p values are two-tailed. Statistical significance was set to p < 0.05, and analyses were conducted using SPSS statistical software (version 22.0). We found that greater anxiety and depression were significantly associated with worse quality of life. Additionally, quality of life, according to Ferti-QoL, was significantly worse in women, participants with a high level of education, those with greater depressive symptoms, and those with greater state scores. Findings of this study highlight the need for implementing interventions of supportive care methods, counseling, stress reduction methods, and improving the fertility-related quality of life of infertile couples.
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Affiliation(s)
- Panagiota Dourou
- Department of Midwifery, Faculty of Health and Care Sciences, University of West Attica, 12243 Athens, Greece
- Correspondence:
| | - Kleanthi Gourounti
- Department of Midwifery, Faculty of Health and Care Sciences, University of West Attica, 12243 Athens, Greece
| | - Aikaterini Lykeridou
- Department of Midwifery, Faculty of Health and Care Sciences, University of West Attica, 12243 Athens, Greece
| | | | | | - Antigoni Sarantaki
- Department of Midwifery, Faculty of Health and Care Sciences, University of West Attica, 12243 Athens, Greece
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Martins MV, Fernandes J, Pedro J, Barros A, Xavier P, Schmidt L, Costa ME. Effects of trying to conceive using an every-other-day strategy versus fertile window monitoring on stress: a 12-month randomized controlled trial. Hum Reprod 2022; 37:2845-2855. [PMID: 36272105 DOI: 10.1093/humrep/deac228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 09/23/2022] [Indexed: 12/14/2022] Open
Abstract
STUDY QUESTION Can animation videos on how to optimize the chances of pregnancy influence stress, anxiety, depression and sexual functioning of individuals trying to conceive (TTC)? SUMMARY ANSWER There were no differences between those educated to have intercourse every other day, on the fertile window and a control group (CG), and depression and sexual dysfunction significantly increased over time for all arms. WHAT IS KNOWN ALREADY Recent findings indicate that time to pregnancy can be significantly shortened by targeting the fertile period, but some reproductive care guidelines recommend instead the practice of intercourse every other day on the basis that it is less stressful to the couple. Evidence to support guidelines on how to preserve well-being and psychosocial adjustment and optimize pregnancy chances is lacking. STUDY DESIGN, SIZE, DURATION We conducted a prospective, double-blinded, three-arm randomized controlled trial between July 2016 and November 2019. Participants were randomized to either not having any stimulus (CG) or visualizing a short animated video explaining how to improve chances of pregnancy by having intercourse every other day (EOD group), or by monitoring the fertile window (FWM group). Assessments were made before the intervention (T0), and 6 weeks (T1), 6 months (T2) and 12 months after (T3), with follow-ups censored in case of pregnancy. PARTICIPANTS/MATERIALS, SETTING, METHODS Participants were childless individuals of reproductive age actively TTC and not diagnosed or unaware of a condition that could prevent spontaneous pregnancy. Individuals were excluded from recruitment if they had previous children or had a condition preventing spontaneous pregnancy. Our primary outcome was stress and secondary outcomes included anxiety, depression, sexual functioning and pregnancy. Primary analyses were performed according to intention-to-treat principle. MAIN RESULTS AND THE ROLE OF CHANCE Of the 450 randomized participants 127 were educated to use an every-other-day strategy, 135 to monitor the fertile window, and 134 received no intervention. Groups were similar regarding demographics and months TTC. Repeated measures analysis revealed that there were no significant interaction effects of psychological and sexual well-being between groups over time (P > 0.05). Significant time effects were revealed for stress (F(3,855) = 4.94, P < 0.01), depression (F(3,855) = 14.22, P < 0.01) and sexual functioning (time effects P values <0.001 for female sexual functioning dimensions and <0.002 for male dimensions), but not for anxiety (F(2,299) = 0.51, P > 0.05). Stress levels lowered after 6 months (P < 0.001) and returned to baseline levels at the 1-year follow-up. Depressive symptomatology significantly increased at 6 weeks (P = 0.023), and again 1 year after (P = 0.001). There were also significant decreases in all female sexual functioning dimensions (desire, satisfaction, arousal, pain, orgasm and lubrication). In men, there were significant variations in orgasm, intercourse satisfaction and erectile function, but not desire and sexual satisfaction. Revealed pregnancy rates were 16% for participants in the EOD group, 30% for the FWM group and 20% for the CG. Pregnancies were not significantly different between arms: EOD vs FWM (odds ratio (OR) 2.32; 95% CI 0.92-5.83); EOD vs CG (OR 0.74; 95% CI 0.30-1.87); and FWM vs CG (OR 1.71; 95% CI 0.70-4.18). LIMITATIONS, REASONS FOR CAUTION Participants were recruited after transitioning to procreative sex. The study might be prone to bias as almost 30% of our sample fulfilled the chronological criterion for infertility, and other reproductive strategies could have been tried over time before recruitment. WIDER IMPLICATIONS OF THE FINDINGS Our data suggest that stress does not arise from feeling pressured on the fertile period and that advice on timing of intercourse might have to be personalized. The increasing levels of depression and sexual dysfunction over a year emphasize the crucial role of preconception care and fertility counseling in promoting psychological and sexual well-being. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by European Union Funds (FEDER/COMPETE-Operational Competitiveness Programme) and by national funds (FCT-Portuguese Foundation for Science and Technology) under the projects PTDC/MHC-PSC/4195/2012 and SFRH/BPD/85789/2012. TRIAL REGISTRATION NUMBER NCT02814006. TRIAL REGISTRATION DATE 27 June 2016. DATE OF FIRST PATIENT’S ENROLLMENT 19 July 2016.
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Affiliation(s)
- Mariana V Martins
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal.,Centre for Psychology at University of Porto, Porto, Portugal
| | - Joana Fernandes
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal.,Centre for Psychology at University of Porto, Porto, Portugal
| | - Juliana Pedro
- Centre for Psychology at University of Porto, Porto, Portugal.,Centre for Reproductive Genetics A. Barros, Porto, Portugal
| | - Alberto Barros
- Centre for Reproductive Genetics A. Barros, Porto, Portugal.,Department of Genetics, Faculty of Medicine, University of Porto, Institute of Health Research and Innovation I3S, Porto, Portugal
| | - Pedro Xavier
- Centre for Reproductive Genetics A. Barros, Porto, Portugal.,Department of Gynaecology and Obstetrics, São João Hospital, University of Porto, Porto, Portugal
| | - Lone Schmidt
- Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
| | - Maria E Costa
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal.,Centre for Psychology at University of Porto, Porto, Portugal
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Prémusz V, Ács P, Bódis J, Várnagy Á, Lászik Á, Makai A. Introducing the Hungarian Version of the SCREENIVF Tool into the Clinical Routine Screening of Emotional Maladjustment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10147. [PMID: 36011781 PMCID: PMC9407737 DOI: 10.3390/ijerph191610147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/12/2022] [Accepted: 08/13/2022] [Indexed: 06/15/2023]
Abstract
Examining possible psychosocial maladjustments should be an integral part of fertility care. For the early detection of vulnerability, the present study aimed to adapt and test the reliability and validity of the Hungarian version of SCREENIVF against the Fertility Quality of Life Questionnaire (FertiQoL) in a cross-sectional on subfertile women (n = 60, age 34.6 ± 5.2 years, BMI 24.2 ± 4.9 kg/m2) at a university linked fertility clinic in South-Hungary. A confirmatory factor analysis (CFA) was conducted to investigate the construct validity. For the reliability testing, Cronbach alpha values were calculated. Spearman’s rank correlation tested the criterion validity. Discriminant validity was applied using Mann−Whitney U-test and Kruskal−Wallis test. The Edinburgh Framework and COSMIN checklist were applicable for the analysis using SPSS 27.0; significance was set at p < 0.05. The confirmatory factor analysis indicated a good fit; all dimensions were reliable (α ≥ 0.70). Cronbach’s alpha was excellent (0.825−0.904). Strong correlations were found between the total scale (FertiQoL) and anxiety (R = −0.507, p < 0.001), depression (R = 0.554, p < 0.001), and helplessness cognitions (R = −0.747, p < 0.001) and moderate or no correlation with acceptance cognitions (R = 0.317, p = 0.015) and social support (R = 0.230, p = 0.082). The Hungarian version of SCREENIVF proved a valid and reliable tool to measure psychological maladjustment before ART. A longitudinal, randomized, controlled trial involving the partners could further strengthen the results, which is among our long-term plans.
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Affiliation(s)
- Viktória Prémusz
- Faculty of Health Sciences, University of Pécs, H-7624 Pécs, Hungary
- ELKH-PTE Human Reproduction Scientific Research Group, University of Pécs, H-7624 Pécs, Hungary
- National Laboratory on Human Reproduction, University of Pécs, H-7624 Pécs, Hungary
| | - Pongrác Ács
- Faculty of Health Sciences, University of Pécs, H-7624 Pécs, Hungary
| | - József Bódis
- ELKH-PTE Human Reproduction Scientific Research Group, University of Pécs, H-7624 Pécs, Hungary
- National Laboratory on Human Reproduction, University of Pécs, H-7624 Pécs, Hungary
- Department of Obstetrics and Gynaecology, Medical School, University of Pécs, H-7624 Pécs, Hungary
| | - Ákos Várnagy
- ELKH-PTE Human Reproduction Scientific Research Group, University of Pécs, H-7624 Pécs, Hungary
- National Laboratory on Human Reproduction, University of Pécs, H-7624 Pécs, Hungary
- Department of Obstetrics and Gynaecology, Medical School, University of Pécs, H-7624 Pécs, Hungary
| | - Ágnes Lászik
- Faculty of Health Sciences, University of Pécs, H-7624 Pécs, Hungary
| | - Alexandra Makai
- Faculty of Health Sciences, University of Pécs, H-7624 Pécs, Hungary
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Marr NS, Zainal NH, Newman MG. Focus on and venting of negative emotion mediates the 18-year bi-directional relations between major depressive disorder and generalized anxiety disorder diagnoses. J Affect Disord 2022; 303:10-17. [PMID: 35065091 PMCID: PMC8917061 DOI: 10.1016/j.jad.2022.01.079] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 01/18/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Myriad emotion regulation and coping theories have proposed that avoidant/emotion-oriented coping is a cause and consequence of anxiety and depression. However, few studies have investigated potential mechanisms underlying the prospective anxiety-depression disorder relation. The current study examined various coping strategies (i.e., denial, focus on and venting of emotion (FOAVE), and behavioral disengagement) as potential longitudinal mediators between generalized anxiety disorder (GAD) and major depressive disorder (MDD). METHODS In a nationally representative sample of adults (N = 3,294), MDD and GAD were assessed at Time 1 (T1) and Time 3 (T3) (Composite International Diagnostic Interview - Short-Form), and avoidant coping strategies (denial, behavioral disengagement, and FOAVE) were measured at Time 2 (T2) (Coping Questionnaire). Assessments occurred over 18 years, each spaced approximately 9 years apart. Structural equation modeling mediation analyses examined whether T1 MDD predicted T3 GAD (and vice versa), and if T2 avoidant coping mediated these relations, above and beyond baseline comorbidity. RESULTS FOAVE mediated the T1 MDD-T3 GAD association, and vice versa. Presence of T1 MDD and GAD predicted more T2 FOAVE, and greater T2 FOAVE forecasted T3 MDD and GAD, accounting for 16-21% of the longitudinal MDD-GAD relations. However, behavioral disengagement and denial did not mediate the prospective MDD-GAD relations. Also, T1 MDD and GAD forecasted greater T2 behavioral disengagement. CONCLUSIONS The use of FOAVE, may be a mechanism by which MDD earlier in life may lead to GAD 18 years later, and vice versa. Theoretical and potential clinical implications are discussed.
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Emotional Support for Infertility Patients: Integrating Mental Health Professionals in the Fertility Care Team. WOMEN 2022. [DOI: 10.3390/women2010008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Patients seeking fertility treatment are at risk of experiencing psychological distress, with both women and men reporting higher levels of depression and anxiety during infertility treatment than patients in the general population. Multiple professional societies, fertility care providers, and patients have advocated for integrating mental health providers in the treatment of infertile patients in order to provide comprehensive patient-centered care. Research with other patient populations shows that embedding mental health professionals into clinics provides the greatest benefit to patients. Despite acknowledging the importance of mental health in infertility care, professional societies, such as ASRM and ESHRE, have not universally standardized recommendations or methods for imbedding mental health providers in the fertility team. This review article aims to serve as a resource for providers and patients to appraise the available literature on the importance of embedding mental health providers into the fertility treatment team and discusses feasible methods to develop this comprehensive care team.
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10
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Infertility-related stress, social support, and coping of women experiencing infertility in Vietnam. HEALTH PSYCHOLOGY REPORT 2022. [DOI: 10.5114/hpr.2022.113437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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11
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Darolia S, Ghosh D. Importance of Personality Factors in Determining the Psychological Consequences of Infertility: A Systematic Review. HEALTH EDUCATION & BEHAVIOR 2021; 49:708-723. [PMID: 34814759 DOI: 10.1177/10901981211057109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND PURPOSE The diagnosis of infertility not only involves biological but the psychosocial links have also been established. Individual difference variables, such as personality and temperament have been found playing prominent role in modifying the psychological and biological aspects of infertility. This systematic review aimed to examine evidence-based research on the role of personality traits in determining vulnerability to stress in infertility, understand the gender-based differences, and deliver suggestions for future researches. METHOD The search for studies relating to the variables was accomplished using various electronic databases. The search was kept limited to a time span of about 20 years, that is, from January 2000 to April 2020. Additional researches were collected from library source and others were retrieved by contacting experts. Studies were selected on the basis of a predetermined inclusion and exclusion criteria, and quality of the studies was also taken into account. RESULTS The search of studies through above methods was fruitful in identifying 23 studies including six longitudinal and prospective studies, and 17 cross-sectional studies covering both individual- and model-based personality attributes related findings. The overall quality ratings of the studies ranged from fair to good. CONCLUSION The review revealed that personality factors such as neuroticism, harm avoidance, and psychoticism are the potential risk factors, whereas optimism has a protective impact in the context of fertility disorders. The long-term impact of personality on infertility needs further exploration. Trait modification interventions during the treatment of infertility were also suggested in the light of previous findings.
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Affiliation(s)
| | - Debasruti Ghosh
- Babasaheb Bhimrao Ambedkar Bihar University, Muzaffarpur, Bihar, India
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12
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Ha JY, Ban SH, Lee HJ, Lee M. [Effects of First Assisted Reproductive Technologies on Anxiety and Depression among Infertile Women: A Systematic Review and Meta-Analysis]. J Korean Acad Nurs 2021; 50:369-384. [PMID: 32632071 DOI: 10.4040/jkan.19187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 03/23/2020] [Accepted: 03/23/2020] [Indexed: 11/09/2022]
Abstract
PURPOSE The purpose of this study was to analyze anxiety and depression among infertile women at different time points during the first In Vitro Fertilization (IVF) or Intracytoplasmic Sperm Injection (ICSI) treatment through a systematic review and meta-analysis. METHODS Seven out of 3,011 studies were included for meta-analysis. To estimate the effect size, a meta-analysis of the studies was performed using the RevMan 5.3 program. We compared the measurement outcomes at three time points: before the start of treatment (T0), cancellation of treatment after pregnancy detection (T2), one to six months after treatment (T3). The effect size used was the standardized mean difference (SMD). RESULTS In comparing the different time points of the pregnant women from their cycle, significantly lower levels of depression were found at T2 than at T0. In non-pregnant women, anxiety at T2 and depression at T2 and T3 were significantly higher than those at T0. At T2 and T3, the non-pregnant women reported higher levels of anxiety and depression compared with the pregnant women. CONCLUSION Anxiety and depression in infertile women undergoing the first IVF or ICSI are associated with the time points and pregnancy status after treatment. These findings suggest that attention should be paid to helping infertile women prepare for and cope with treatment and treatment failure.
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Affiliation(s)
- Ju Young Ha
- College of Nursing, Pusan National University, Yangsan, Korea
| | - Seon Hwa Ban
- College of Nursing, Pusan National University, Yangsan, Korea.
| | - Hae Jung Lee
- College of Nursing, Pusan National University, Yangsan, Korea
| | - Misoon Lee
- Department of Nursing, Changshin University, Changwon, Korea
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Marom Haham L, Youngster M, Kuperman Shani A, Yee S, Ben-Kimhy R, Medina-Artom TR, Hourvitz A, Kedem A, Librach C. Suspension of fertility treatment during the COVID-19 pandemic: views, emotional reactions and psychological distress among women undergoing fertility treatment. Reprod Biomed Online 2021; 42:849-858. [PMID: 33558171 PMCID: PMC7816616 DOI: 10.1016/j.rbmo.2021.01.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/23/2020] [Accepted: 01/12/2021] [Indexed: 12/19/2022]
Abstract
RESEARCH QUESTION What are the views and emotional reactions of patients towards the suspension of fertility treatment during the COVID-19 pandemic, and what are the factors affecting their psychological distress? DESIGN A cross-sectional study conducted in an academic fertility centre. Online questionnaires were distributed between 18 April 2020 and 23 April 2020 to patients whose treatment cycle had been postponed or discontinued. The outcome measures included agreement with the reproductive society guidelines to postpone treatments; willingness to resume treatments, given the choice; patients' emotional reactions; and psychological distress level, measured by the Mental Health Inventory validated scale. A multivariate linear regression was conducted to identify factors associated with psychological distress. RESULTS Because of the small number of male respondents, only women were included in the analysis (n = 181). Forty-three per cent expressed disagreement with the guidelines and 82% were willing to resume treatments, given the choice. Sadness and anxiety were the most common emotional reactions expressed towards the guidelines. In the multivariate analysis, COVID-19-related anxiety (B = 0.145, P = 0.04) and disagreement with treatment suspension (B = -0.44, P = 0.001) were found to be significantly associated with patients' psychological distress. Background characteristics of patients did not contribute significantly to their distress. CONCLUSIONS Suspension of fertility treatment during the initial phase of the COVID-19 pandemic was associated with patients' negative emotional reactions. Anxiety related to COVID-19 and disagreement with treatment suspension were found to be significantly associated with psychological distress among women undergoing fertility treatment, regardless of their background characteristics. Our findings suggest the need to monitor the mental health of patients and provide psychological support should a shutdown of fertility care re-occur.
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Affiliation(s)
- Lilach Marom Haham
- CReATe Fertility Centre, Toronto, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada
| | - Michal Youngster
- IVF Unit, Department of Obstetrics & Gynecology, Shamir Medical Center, Zerifin, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Adi Kuperman Shani
- CReATe Fertility Centre, Toronto, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada
| | | | - Reut Ben-Kimhy
- IVF Unit, Department of Obstetrics & Gynecology, Meir (Sapir) Medical Center, Kfar-Saba, Israel; The Gender Studies Program, Bar-Ilan University, Ramat Gan, Israel
| | - Tamar R Medina-Artom
- Smokler Center for Health Policy Research, Myers-JDC-Brookdale Institute Jerusalem, Israel; The Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Ariel Hourvitz
- IVF Unit, Department of Obstetrics & Gynecology, Shamir Medical Center, Zerifin, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Alon Kedem
- IVF Unit, Department of Obstetrics & Gynecology, Shamir Medical Center, Zerifin, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Clifford Librach
- CReATe Fertility Centre, Toronto, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada; Institute of Medical Sciences, University of Toronto, Toronto, Canada; Department of Physiology, University of Toronto, Toronto, Canada.
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14
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Ben-Kimhy R, Youngster M, Medina-Artom TR, Avraham S, Gat I, Marom Haham L, Hourvitz A, Kedem A. Fertility patients under COVID-19: attitudes, perceptions and psychological reactions. Hum Reprod 2021; 35:2774-2783. [PMID: 32877507 PMCID: PMC7499650 DOI: 10.1093/humrep/deaa248] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/24/2020] [Indexed: 01/17/2023] Open
Abstract
STUDY QUESTION What are the perceptions of infertility patients and the factors correlating with their psychological distress, following suspension of fertility treatments during the Corona Virus Disease-19 (COVID-19) pandemic? SUMMARY ANSWER Most patients preferred to resume treatment given the chance regardless of background characteristics; higher self-mastery and greater perceived social support were associated with lower distress, while feeling helpless was associated with higher distress. WHAT IS KNOWN ALREADY Infertility diagnosis and treatment frequently result in significant psychological distress. Recently published data have shown that clinic closure during the COVID-19 pandemic was associated with a sharp increase in the prevalence of anxiety and depression among infertile patients undergoing IVF and was perceived as an uncontrollable and stressful event. Personal resources play an important protective role in times of crisis, helping reduce levels of distress. STUDY DESIGN, SIZE, DURATION This cross-sectional questionnaire study included patients whose fertility treatment was suspended following the COVID-19 pandemic, in a tertiary hospital. The survey was delivered to 297 patients within 12 days at the beginning of April 2020. PARTICIPANTS/MATERIALS, SETTING, METHODS The self-administered questionnaire included items addressing: (i) patients' demographic characteristics, (ii) anxiety related to COVID-19 infection risk and level of social support, (iii) patients' perceptions of the new guidelines and description of subsequently related emotions and (iv) two validated scales assessing levels of emotional distress and self-mastery. Multivariate analysis was conducted to assess factors alleviating or increasing emotional distress during the COVID-19 pandemic. MAIN RESULTS AND THE ROLE OF CHANCE There were 168 patients who completed the survey, giving a response rate of 57%. Study variables in the regression model explained 38.9% of the variance in psychological distress experienced by patients during treatment suspension. None of the background characteristics (e.g. age, marital status, parity, economic level or duration of treatments) had a significant contribution. Feeling helpless following the suspension of treatments was associated with higher distress (P < 0.01). Higher self-mastery and greater perceived social support were associated with lower distress (P < 0.01). Despite the ministry of health's decision, 72% of patients wished to resume treatment at the time of survey. LIMITATIONS, REASONS FOR CAUTION This was a cross-sectional study, thus information about patients' characteristics prior to the COVID-19 pandemic was not available. The length and implications of this pandemic are unknown. Therefore, the ability to draw conclusions about the psychological consequences of the crisis is limited at this point of time. WIDER IMPLICATIONS OF THE FINDINGS Personal resources play an important protective role in times of crisis, helping to reduce levels of distress. Study findings suggest that attention should be paid to strengthening and empowering patients' personal resources together with directly confronting and containing feelings of helplessness. In line with the European Society for Human Reproduction and Embryology (ESHRE) guidelines, especially at this time of high levels of distress, it is imperative to offer emotional support to reduce stress and concerns. Furthermore, as the pandemic is stabilizing, resumption of treatment should be considered as soon as appropriate according to local conditions. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by the IVF unit of the Shamir Medical Center. All authors declare no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Reut Ben-Kimhy
- IVF Unit, Department of Obstetrics and Gynecology, Meir (Sapir) Medical Center, Kfar-Saba, Israel.,The Gender Studies Program, Bar-Ilan University, Ramat Gan, Israel
| | - Michal Youngster
- IVF Unit, Department of Obstetrics and Gynecology, Shamir Medical Center, Zerifin, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tamar R Medina-Artom
- Smokler Center for Health Policy Research, Myers-JDC-Brookdale Institute, Jerusalem, Israel.,The Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Sarit Avraham
- IVF Unit, Department of Obstetrics and Gynecology, Shamir Medical Center, Zerifin, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Itai Gat
- IVF Unit, Department of Obstetrics and Gynecology, Shamir Medical Center, Zerifin, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Sperm Bank & Andrology Unit, Shamir Medical Center, Zerifin, Israel
| | | | - Ariel Hourvitz
- IVF Unit, Department of Obstetrics and Gynecology, Shamir Medical Center, Zerifin, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Alon Kedem
- IVF Unit, Department of Obstetrics and Gynecology, Shamir Medical Center, Zerifin, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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15
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Fedele F, Caputo A, Cordella B, Muzii L, Pietrangeli D, Aragona C, Langher V. What About Fertility Staff Emotions? An Explorative Analysis of Healthcare Professionals' Subjective Perspective. EUROPES JOURNAL OF PSYCHOLOGY 2020; 16:619-638. [PMID: 33680202 PMCID: PMC7909494 DOI: 10.5964/ejop.v16i4.2245] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 02/24/2020] [Indexed: 11/29/2022]
Abstract
Infertility-related psychological research is traditionally oriented to analyze the wellbeing of couples undergoing Assisted Reproductive Technologies (ART), than to study the job-related effects on the healthcare fertility staff. This piece of research aims at understanding the subjective perspective of the fertility professionals and contribute to identify their emotional dynamics in their work environment. An in-depth explorative research study was conducted on 12 healthcare professionals of an Italian ART hospital clinic. Structured interviews with open-ended questions were administered to explore their deep feelings about their professional experience. Emotional text analysis was then conducted to analyze the textual corpus of their narratives to grasp their affective symbolizations. Statistical multidimensional techniques were used to detect some thematic domains (cluster analysis) and latent factors organizing the contraposition between them (multiple correspondence analysis). Five thematic domains were detected which refer to different emotional dimensions, as follows: performance anxiety (Cluster 1), ambivalence between omnipotence and powerlessness (Cluster 2), care burden (Cluster 3), feeling of duty (Cluster 4), and sense of interdependence (Cluster 5). Then, four latent factors were identified dealing with the laborious attempt to remedy, the realistic sense of limitation, the incumbent feeling of pressure and the restorative sense of justice, respectively. The results are discussed based on the existing literature and some useful recommendations for staff education, training and clinical supervision are provided accordingly.
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Affiliation(s)
- Fabiola Fedele
- Department of Dynamic and Clinical Psychology, "Sapienza" University of Rome, Rome, Italy
| | - Andrea Caputo
- Department of Dynamic and Clinical Psychology, "Sapienza" University of Rome, Rome, Italy
| | - Barbara Cordella
- Department of Dynamic and Clinical Psychology, "Sapienza" University of Rome, Rome, Italy
| | - Ludovico Muzii
- Department of Gynecologic-Obstetrical and Urologic Sciences, "Sapienza" University of Rome, Umberto I Hospital, Rome, Italy
| | - Daniela Pietrangeli
- Department of Gynecologic-Obstetrical and Urologic Sciences, "Sapienza" University of Rome, Umberto I Hospital, Rome, Italy
| | - Cesare Aragona
- Department of Gynecologic-Obstetrical and Urologic Sciences, "Sapienza" University of Rome, Umberto I Hospital, Rome, Italy
| | - Viviana Langher
- Department of Dynamic and Clinical Psychology, "Sapienza" University of Rome, Rome, Italy
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16
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Marie M, SaadAdeen S, Battat M. Anxiety disorders and PTSD in Palestine: a literature review. BMC Psychiatry 2020; 20:509. [PMID: 33066736 PMCID: PMC7566157 DOI: 10.1186/s12888-020-02911-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 10/09/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The WHO reports that anxiety disorders are the most common mental disorders worldwide. Most people who experience such events recover from it; however, people with post-traumatic stress disorder (PTSD) continue to be severely depressed and anxious for several months or even years following the event. Palestinians are particularly at a higher risk for developing anxiety disorders and PTSD due to the continuous exposure to political violence, prolonged displacement, and other limitation on professional, educational, financial opportunities, and mental health services. This paper aims to provide a systematic review of the literature and established studies concerning Anxiety disorders besides PTSD in Palestine. METHODS PubMed, Science Direct, Google Scholar was used to search for materials for the critical analysis of empirical articles. The following aspects were taken into consideration: study type, sample, and key findings. RESULTS In this review, we included about twenty-four studies from Palestine (West Bank and Gaza). Five studies relate to children, five relate to adolescents, three relate to women, three relate to physical diseases, and four relate to gender and age differences. Results show that anxiety disorders and PTSD are one of the most common mental disorders in Palestine. Anxiety and PTSD develop from a complex set of risk factors, including genetics, personality, and life events. They are mostly associated with low quality of life and disability. The results indicate that a significant proportion of Palestinian experiencing serious issues that deal with several challenges, distinct barriers including; inconsistent availability of medications, absence of multidisciplinary teamwork, insufficient specialists, fragmented mental health system, and occupation. CONCLUSION As primary prevention, the occupation has to have considered as the main source of anxiety and other mental health disorders in Palestine. Besides, there is a need to implement a mental health care system through multidisciplinary work and raising awareness regarding the prevalence of mental disorders.
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Affiliation(s)
- Mohammad Marie
- Mental Health at Faculty of Medicine and Health Sciences at An-Najah National University, Nablus, Palestine.
| | - Sana SaadAdeen
- grid.11942.3f0000 0004 0631 5695Nurse at primary health care centers-Ministry of Health-Palestine, Community Mental Health Nursing program at An-Najah National University, Nablus, Palestine
| | - Maher Battat
- grid.11942.3f0000 0004 0631 5695Nurse at primary health care centers-Ministry of Health-Palestine, Community Mental Health Nursing program at An-Najah National University, Nablus, Palestine ,Adult oncology/Hematology Ward – An-Najah National University Hospital, Nablus, Palestine
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17
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Maia Bezerra NK, de Menezes Galvão AC, Martins Leite NE, Leão Barbalho Sant'anna A, de Medeiros Garcia Torres M, Galvão Pinto Coelho MC, Kenji Medeiros Shiramizu V, de Sousa MBC, Leite Galvão-Coelho N. Success of in vitro fertilization and its association with the levels of psychophysiological stress before and during the treatment. Health Care Women Int 2020; 42:420-445. [PMID: 32866071 DOI: 10.1080/07399332.2020.1787415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Despite the advance of assisted reproduction, high rates of failure in treatment are still observed. Herein, we investigated how the psychophysiological stress profiles of patients can modulate the in vitro fertilization treatment (IVF) outcome. The women who had failure in IVF (n = 13; 65%) had higher baseline salivary cortisol awakening response and anxiety-state during treatment than patients who became pregnant (n = 7; 35%). Patients with major stress levels and religious coping style showed lower social support, which was correlated with higher anxiety. Therefore, we appointed stress modulators that negatively affect IVF and should be improved aiming to increase its success.
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Affiliation(s)
- Nathália Karen Maia Bezerra
- Laboratory of Hormone Measurement, Department of Physiology and Behavior, Federal University of Rio Grande do Norte, Natal, RN, Brazil.,Postgraduate Program in Psychobiology and Department of Physiology and Behavior, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Ana Cecília de Menezes Galvão
- Laboratory of Hormone Measurement, Department of Physiology and Behavior, Federal University of Rio Grande do Norte, Natal, RN, Brazil.,Postgraduate Program in Psychobiology and Department of Physiology and Behavior, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Nathalia Evelyn Martins Leite
- Laboratory of Hormone Measurement, Department of Physiology and Behavior, Federal University of Rio Grande do Norte, Natal, RN, Brazil.,Postgraduate Program in Psychobiology and Department of Physiology and Behavior, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Adriana Leão Barbalho Sant'anna
- Center of Assisted Reproduction, Januário Cicco Maternity School Hospital of Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Mychelle de Medeiros Garcia Torres
- Center of Assisted Reproduction, Januário Cicco Maternity School Hospital of Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Maria Cecília Galvão Pinto Coelho
- Center of Assisted Reproduction, Januário Cicco Maternity School Hospital of Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | | | - Maria Bernardete Cordeiro de Sousa
- Laboratory of Hormone Measurement, Department of Physiology and Behavior, Federal University of Rio Grande do Norte, Natal, RN, Brazil.,Postgraduate Program in Psychobiology and Department of Physiology and Behavior, Federal University of Rio Grande do Norte, Natal, RN, Brazil.,Brain Institute, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Nicole Leite Galvão-Coelho
- Laboratory of Hormone Measurement, Department of Physiology and Behavior, Federal University of Rio Grande do Norte, Natal, RN, Brazil.,Postgraduate Program in Psychobiology and Department of Physiology and Behavior, Federal University of Rio Grande do Norte, Natal, RN, Brazil.,National Institute of Science and Technology in Translational Medicine, Brazil
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18
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Horowitz E, Weissman A. The stair-step approach in treatment of anovulatory PCOS patients. Ther Adv Reprod Health 2020; 14:2633494120908818. [PMID: 32518914 PMCID: PMC7254579 DOI: 10.1177/2633494120908818] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 01/22/2020] [Indexed: 02/02/2023] Open
Abstract
Clomiphene citrate (CC) is a widely accepted first-line treatment for anovulatory patients with polycystic ovarian syndrome (PCOS). The current practice is to prescribe CC with gradual dose increments until ovulation is achieved. Typically, progesterone withdrawal bleeding is induced between each dose increment and before the commencement of gonadotropin therapy in CC-resistant patients. It has been recently suggested that dose increments of CC can be administered once failure to induce ovulation at a certain dose has been documented, without induction of progesterone withdrawal bleeding, and this approach has been nicknamed the clomiphene-citrate stair-step (CC-SS) protocol. The same principle has been found feasible before introducing gonadotropin therapy in CC-resistant PCOS patients. Our objective was to review the world literature on the CC-SS protocol and to summarize our own experience with extending the CC-SS approach to initiation of gonadotropin therapy. Studies on CC-SS protocol (n = 4) have found that this approach leads to a significant reduction of the time to ovulation and to an increased ovulation rate. In our own retrospective case series, 18 CC-resistant PCOS patients initiated gonadotropin stimulation without induction of progesterone withdrawal bleeding, using the chronic low-dose regimen. The time to ovulation in the study group was 54.2 ± 6.2 days, while the estimated time to ovulation calculated according to the traditional approach was approximately 110 days. The clinical pregnancy rate was 44% (8/18), and all pregnancies were singletons. One patient miscarried; hence, the live birth rate was 38.9% (7/18). In summary, the CC-SS approach and its extension to the initiation of gonadotropin therapy results in considerable reduction of the time to ovulation, and favorable ovulation rates and reproductive outcome. Large-scale confirmation of these findings by properly designed randomized controlled trials may lead to a change of practice in the treatment of anovulatory infertility in PCOS patients, allowing simplification of treatment and a shorter time to ovulation and pregnancy.
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Affiliation(s)
- Eran Horowitz
- IVF Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel
| | - Ariel Weissman
- IVF Unit, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon 58100, Israel
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19
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Bernd M, Schick M, Rösner S, Germeyer A, Strowitzki T, Moessner M, Bauer S, Ditzen B, Wischmann T. Predictors for the Early Termination of a Psychological Intervention During Treatment with Assisted Reproductive Technologies. Geburtshilfe Frauenheilkd 2020; 80:190-199. [PMID: 32109971 PMCID: PMC7035134 DOI: 10.1055/a-0918-6118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 04/25/2019] [Accepted: 05/11/2019] [Indexed: 11/14/2022] Open
Abstract
Introduction
Assisted reproductive technologies are typically perceived by couples as being an emotional burden. The objective of the study “Positive Ausrichtung bei unerfülltem Kinderwunsch” [Positive adjustment in infertility] (PACI) is to examine the efficacy and acceptance of a smartphone-supported psychosocial intervention during infertility treatment. In this investigation, the early drop-out of study subjects from the study is of primary interest. The objective of the investigation was to find predictors for ending a psychological intervention prematurely.
Materials and Methods
There are data available from an eight-month randomised, controlled study in which 141 patients and their partners participated. Sociodemographic and fertility-related data were collected at the start of the study. The couples received the ScreenIVF questionnaire at two points in time. As part of a post-evaluation, a survey was conducted on the efficacy of the psychological online intervention. To analyse the data, a dyadic data structure was used in order to determine connections within the study subject couples between the selected stress indicators and the drop-out. In addition, a “risk score” as a possible predictor for the drop-out was tested.
Results
The descriptive observation of the sample indicates in this interim assessment that the study subjects recruited are less stressed patient couples. Actor–partner interdependence models indicate statistically significant connections between the stress indicators of anxiety, little social support and helplessness and an early drop-out.
Conclusions
The statistically significant effects found in this study with regard to the stress indicators in connection with drop-outs from psychosocial intervention studies indicate that it is advisable to continue to seek measures for people undergoing stressful medical treatments in order to motivate and support them and thus optimally utilise the opportunities of a medical treatment. The number of patients who endure their ART treatment may also increase as a result, which could lead in turn to increased patient satisfaction over the long term (and thus possibly to higher pregnancy rates).
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Affiliation(s)
- Marie Bernd
- Institute of Medical Psychology, Centre for Psychosocial Medicine, University Hospital, Heidelberg, Germany
| | - Maren Schick
- Institute of Medical Psychology, Centre for Psychosocial Medicine, University Hospital, Heidelberg, Germany
| | - Sabine Rösner
- Department of Gynecological Endocrinology and Fertility Disorders, University Women's Hospital Heidelberg, Heidelberg, Germany
| | - Ariane Germeyer
- Department of Gynecological Endocrinology and Fertility Disorders, University Women's Hospital Heidelberg, Heidelberg, Germany
| | - Thomas Strowitzki
- Department of Gynecological Endocrinology and Fertility Disorders, University Women's Hospital Heidelberg, Heidelberg, Germany
| | - Markus Moessner
- Center for Psychotherapy Research, Center for Psychosocial Medicine, University Hospital, Heidelberg, Germany
| | - Stephanie Bauer
- Center for Psychotherapy Research, Center for Psychosocial Medicine, University Hospital, Heidelberg, Germany
| | - Beate Ditzen
- Institute of Medical Psychology, Centre for Psychosocial Medicine, University Hospital, Heidelberg, Germany
| | - Tewes Wischmann
- Institute of Medical Psychology, Centre for Psychosocial Medicine, University Hospital, Heidelberg, Germany
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20
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Bright KS, Mughal MK, Wajid A, Lane-Smith M, Murray L, Roy N, Van Zanten SV, Mcneil DA, Stuart S, Kingston D. Internet-based interpersonal psychotherapy for stress, anxiety, and depression in prenatal women: study protocol for a pilot randomized controlled trial. Trials 2019; 20:814. [PMID: 31888712 PMCID: PMC6938015 DOI: 10.1186/s13063-019-3897-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 11/08/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Psychological distress, defined as depression, anxiety and perceived stress, during pregnancy is common, with 15-25% of women experiencing clinically significant levels of such distress. Despite the far-reaching impact of prenatal psychological distress on mothers and their children, and that women are receptive to screening, few providers routinely screen for prenatal psychological distress and less than one in five women will receive the mental health care that they require. There is a lack of certainty regarding the most effective treatments for prenatal psychological distress. No online interpersonal psychotherapy (IPT) trials have been conducted that focus on improving psychological distress in prenatal women. The purpose of this pilot randomized controlled trial is to evaluate the perspectives of pregnant women on the feasibility and acceptability of online IPT (e-IPT) delivered during pregnancy. METHODS A pilot randomized controlled trial design with repeated measures will evaluate the feasibility and acceptability of e-IPT for pregnant women compared to routine prenatal care. Qualitative interviews with 15-30 individuals in the intervention group will provide further data on the feasibility and acceptability of the intervention. Assessment of feasibility will include the ease of accessing and completing the intervention. Women will also be asked about what barriers there were to starting and completing the e-IPT. Assessment of acceptability will inquire about the perception of women regarding the intervention and its various features. A sample size of 160 consenting pregnant women aged 18 years and older will be enrolled and randomized into the experimental (e-IPT) or control (routine care) condition. The secondary outcome measures include: depression, anxiety and stress symptoms; self-efficacy; self-mastery; self-esteem; relationship quality (spouse, immediate family members); coping; and resilience. All participants will complete the aforementioned measures at baseline during pregnancy (T1), 3 months postrandomization (T2), at 8 months of pregnancy (T3), and 3 months postpartum (T4). DISCUSSION The results of this pilot randomized controlled trial will provide data on the feasibility and acceptability of the intervention and identify necessary adaptations. This study will allow for optimization of full trial processes and inform the evaluation strategy, including sample size calculations for the full randomized controlled trial. TRIAL REGISTRATION ClinicalTrials.gov, NCT01901796. Registered on 18 December 2014.
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Affiliation(s)
- Katherine S. Bright
- Faculty of Nursing, University of Calgary, 2500 University Dr. N.W, Calgary, AB T2N 1N4 Canada
| | - Muhammad Kashif Mughal
- Faculty of Nursing, University of Calgary, 2500 University Dr. N.W, Calgary, AB T2N 1N4 Canada
| | - Abdul Wajid
- Faculty of Nursing, University of Calgary, 2500 University Dr. N.W, Calgary, AB T2N 1N4 Canada
| | - Marie Lane-Smith
- Faculty of Nursing, University of Calgary, 2500 University Dr. N.W, Calgary, AB T2N 1N4 Canada
| | - Lindsay Murray
- Faculty of Nursing, University of Calgary, 2500 University Dr. N.W, Calgary, AB T2N 1N4 Canada
| | - Nicola Roy
- Faculty of Nursing, University of Calgary, 2500 University Dr. N.W, Calgary, AB T2N 1N4 Canada
| | | | - Deborah A. Mcneil
- Faculty of Nursing, University of Calgary, 2500 University Dr. N.W, Calgary, AB T2N 1N4 Canada
- Alberta Health Services, Scientific Director, Maternal Newborn Child and Youth Strategic Clinical Network, Southport Atrium #2237, 10101 Southport Road, S.W., Calgary, AB T2W 3N2 Canada
| | - Scott Stuart
- Faculty of Nursing, University of Calgary, 2500 University Dr. N.W, Calgary, AB T2N 1N4 Canada
- Interpersonal Psychotherapy (IPT) Institute, PO Box 5925, Coralville, Iowa 52241 USA
| | - Dawn Kingston
- Faculty of Nursing, University of Calgary, 2500 University Dr. N.W, Calgary, AB T2N 1N4 Canada
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21
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Aytar A, Aykul A, Altintas A, Tigli AA. Reliability and Validity of the Turkish Version of Illness Cognition Questionnaire. Exp Aging Res 2019; 45:424-435. [PMID: 31514584 DOI: 10.1080/0361073x.2019.1664436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: This study aimed to determine the validity and reliability characteristics of the Illness Cognition Questionnaire (ICQ). Methods: A total of 205 patients who had pain related to chronic musculoskeletal diseases were referred to the study. In order to test the validity, Short Disease Perception Scale (SDPS), Hospital Anxiety and Depression Scale (HADS) were administered together with the ICQ. Confirmatory factor analysis was used to measure the construct validity of the ICQ, and convergent and divergent validities were evaluated using Pearson correlation analysis. In order to achieve the test-retest reliability of the questionnaire, 81 patients re-applied the questionnaire after two days. Cronbach's alpha internal consistency and test-retest reliability coefficients were calculated to determine the reliability level of the questionnaire. Results: The factor loadings of the ICQ helplessness subscale ranged from 0.784 to 0.853, the acceptance subscale ranged from 0.583 to 0.855, and the perceived benefits subscale ranged from 0.733 to 0.794. Internal consistency coefficients of the ICQ were found α = 0.929 for the helplessness subscale, α = 0.868 for the acceptance subscale, and α = 0.896 for perceived benefits subscale. The results of the analysis showed that there was a statistically significant positive correlation between the initial measurement of helplessness sub-scale and the retest helplessness subscale at 0.697 level (p < .05). A statistically significant positive correlation was determined between the test and the retest of acceptance sub-scale at 0.465 level (p < .05). A statistically significant positive correlation was found between the first test of the perceived benefits sub-scale and the retest test at the 0.661 level. Conclusion: The Turkish version of the ICQ was found to be valid and reliable. It is a measurement tool that could be used easily in clinics because of its short application time and easy to understand. We think that ICQ which provides a new awareness in the perception of disease in Turkish society should be examined in different diseases and age groups.
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Affiliation(s)
- Aydan Aytar
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Baskent University , Ankara , Turkey
| | - Aysegul Aykul
- Department of Physical Therapy and Rehabilitation, Baskent Ankara Hospital , Ankara , Turkey
| | - Atahan Altintas
- Department of Sports Science, Faculty of Health Sciences, Baskent University , Ankara , Turkey
| | - Ayca Aytar Tigli
- Vocational School of Health Sciences, Baskent University , Ankara , Turkey
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Schick M, Roesner S, Germeyer A, Moessner M, Bauer S, Ditzen B, Wischmann T. Smartphone-supported Positive Adjustment Coping Intervention (PACI) for couples undergoing fertility treatment: a randomised controlled trial protocol. BMJ Open 2019; 9:e025288. [PMID: 31289056 PMCID: PMC6629398 DOI: 10.1136/bmjopen-2018-025288] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Infertility generally counts as a profound crisis in the lives of couples and as an emotionally stressful experience. For couples undergoing fertility treatment, this is especially true of the waiting period following embryo transfer, which couples say is the most stressful period during treatment. However, at this specific phase, psychosocial counselling is not always available on the spot. The aim of this randomised controlled trial (RCT) study was to test the Positive Adjustment Coping Intervention (PACI), a low-dose, smartphone-supported psychological intervention for women and men undergoing fertility treatment. METHODS AND ANALYSIS The effectiveness of PACI is tested by means of a prospective two-arm RCT. During the 14-day waiting period between oocyte puncture/oocyte thawing and pregnancy test, participants are randomly assigned to one of the two groups, and both women and men receive daily text messages on their smartphones. One group receives text messages with statements reflecting positive-adjustment coping attitudes, the other group messages containing cognitive distractions. The primary outcome of this study is the reduction of psychosocial burden during the waiting period of reproductive treatment. Furthermore, we want to assess whether there are differences between the interventions in a pre-post assessment. The secondary outcomes are information on perceived effectiveness and practicability of the intervention one month after the waiting period. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Ethics Committee of Heidelberg University Faculty of Medicine (S-074/2017). Study findings are planned for dissemination via peer-reviewed journal articles and at national and international conferences. TRIAL REGISTRATION NUMBER NCT03118219; Pre-results. PROTOCOL VERSION Version 2.0 dated 18/02/2019.
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Affiliation(s)
- Maren Schick
- Institute of Medical Psychology, University Hospital Heidelberg, Center for Psychosocial Medicine, Heidelberg, Germany
| | - Sabine Roesner
- Department of Gynecologic Endocrinology and Fertility Disorders, University Women's Hospital Heidelberg, Heidelberg, Germany
| | - Ariane Germeyer
- Department of Gynecologic Endocrinology and Fertility Disorders, University Women's Hospital Heidelberg, Heidelberg, Germany
| | - Markus Moessner
- Center for Psychotherapy Research, University Hospital Heidelberg, Center for Psychosocial Medicine, Heidelberg, Germany
| | - Stephanie Bauer
- Center for Psychotherapy Research, University Hospital Heidelberg, Center for Psychosocial Medicine, Heidelberg, Germany
| | - Beate Ditzen
- Institute of Medical Psychology, University Hospital Heidelberg, Center for Psychosocial Medicine, Heidelberg, Germany
| | - Tewes Wischmann
- Institute of Medical Psychology, University Hospital Heidelberg, Center for Psychosocial Medicine, Heidelberg, Germany
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Langher V, Fedele F, Caputo A, Marchini F, Aragona C. Extreme Desire for Motherhood: Analysis of Narratives From Women Undergoing Assisted Reproductive Technology (ART). EUROPES JOURNAL OF PSYCHOLOGY 2019; 15:292-311. [PMID: 33574956 PMCID: PMC7871747 DOI: 10.5964/ejop.v15i2.1736] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 11/07/2018] [Indexed: 01/04/2023]
Abstract
The problem of infertility and its consequent treatment (denoted as Assisted Reproductive Technology or ART) represent an increasing phenomenon, especially in industrialized countries. Confronting with one’s own procreative limitations can generate strong negative emotional reactions. This study aims at understanding how the desire for motherhood manifests itself in infertile women undergoing ART, studying their emotional and subjective perspective. An in-depth explorative research study was conducted on 17 infertile women attending an Italian hospital clinic for fertility treatment. Emotional text analysis was conducted to analyze the corpus of their interviews, allowing the identification of four thematic domains (clusters) which refer, respectively, to the following emotional dimensions: an inclination to self-sacrifice, seen as the price to be paid for the desired success of the treatment (Cluster 1), pursuit of inclusion in the world of procreative mothers (Cluster 2), precarious equilibrium between the deep desire for a baby and the withdrawal from the treatment (Cluster 3), surrender to any possible consequence in order to obtain the desired mother-child relationship (Cluster 4). The witness of the couples’ suffering for their condition of infertility and their strong desire for parenting can represent a source of high pressure for the fertility care staff, as they are the only ones responsible for the fulfillment of the great dream of biological parenthood. For these reasons, a multidisciplinary approach, which involves psychological as well as medical experts all working together, could benefit both the patients and the healthcare professionals and improve the quality of the reproductive healthcare services.
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Affiliation(s)
- Viviana Langher
- Department of Dynamic and Clinical Psychology, "Sapienza" University, Rome, Italy
| | - Fabiola Fedele
- Department of Dynamic and Clinical Psychology, "Sapienza" University, Rome, Italy
| | - Andrea Caputo
- Department of Dynamic and Clinical Psychology, "Sapienza" University, Rome, Italy
| | - Francesco Marchini
- Department of Dynamic and Clinical Psychology, "Sapienza" University, Rome, Italy
| | - Cesare Aragona
- Department of Gynecologic-Obstetrical and Urologic Sciences, "Sapienza" University Hospital Umberto I, Rome, Italy.,Sterility and Assisted Reproduction Unit, "Sapienza" University Hospital Umberto I, Rome, Italy
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Chaves C, Canavarro MC, Moura-Ramos M. The Role of Dyadic Coping on the Marital and Emotional Adjustment of Couples With Infertility. FAMILY PROCESS 2019; 58:509-523. [PMID: 29709057 DOI: 10.1111/famp.12364] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Infertility is a challenging experience, affecting individual and couples' adjustment. However, the way the members of the couple support each other may affect the experience of infertility and their adjustment. This study aimed to investigate the role of dyadic coping by oneself and by the partner in the association between the impact of infertility and dyadic and emotional adjustment (anxiety and depression) to infertility. In this cross-sectional study, a total of 134 participants (67 couples with infertility) completed self-report questionnaires assessing infertility-related stress, dyadic coping, dyadic adjustment, and depression and anxiety symptoms. A path analysis examined the direct and indirect effects between the impact of infertility in one's life and dyadic and emotional adjustment. There is an indirect effect of the impact of infertility in one's life on dyadic adjustment through men's perceived dyadic coping efforts employed by the self (dyadic coping by oneself) and women's perceived dyadic coping efforts of the partner (dyadic coping by the partner). Regarding the emotional adjustment of infertile couples, infertility stress impact had an indirect effect only on depressive symptoms through men's dyadic coping by oneself. The results highlight the importance of men's dyadic coping strategies for the marital adjustment of couples as well as for men's emotional adjustment. Findings emphasize the importance of involving men in the fertility treatment process, reinforcing the dyadic nature of infertility processes.
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Affiliation(s)
- Catarina Chaves
- Department of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | | | - Mariana Moura-Ramos
- Reproductive Medicine Unit of Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Massarotti C, Gentile G, Ferreccio C, Scaruffi P, Remorgida V, Anserini P. Impact of infertility and infertility treatments on quality of life and levels of anxiety and depression in women undergoing in vitro fertilization. Gynecol Endocrinol 2019; 35:485-489. [PMID: 30612477 DOI: 10.1080/09513590.2018.1540575] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
This study aims to evaluate levels of anxiety and depression in women, correlated with infertility per se and with infertility treatments, highlighting predictors of higher levels of distress. Two validated standardized questionnaires, the Hospital Anxiety and Depression Scale (HADS) and the Fertility Quality of Life (FertiQoL), were administered to 89 women both before their first cycle of infertility treatment and again at the end of the ovarian stimulation for in vitro fertilization (IVF). Women's levels of anxiety were significantly higher before the treatment than during the treatment itself. Stratifying the women in three groups based on principal cause of infertility (male infertility, female infertility, or both male and female), we found significantly higher levels of anxiety and general distress in patients under treatment for female infertility. Higher anxiety levels in our sample before the treatment are probably an effect of not knowing what they are expected to do to solve their problem. Moreover, when the cause of infertility is exclusively female, women experience higher levels of anxiety and general distress both before and during the treatment, probably correlated to a sense of guilt. These data help the treating physician to better counsel patients and to provide a more focused psychological support.
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Affiliation(s)
- Claudia Massarotti
- a Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Academic Unit of Obstetrics and Gynecology , University of Genova , Genova , Italy
- b Physiopathology of Human Reproduction Unit , Ospedale Policlinico San Martino , Genova , Italy
| | - Giulia Gentile
- c Midwifery Course , University of Genova , Genova , Italy
| | - Chiara Ferreccio
- a Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Academic Unit of Obstetrics and Gynecology , University of Genova , Genova , Italy
- b Physiopathology of Human Reproduction Unit , Ospedale Policlinico San Martino , Genova , Italy
| | - Paola Scaruffi
- b Physiopathology of Human Reproduction Unit , Ospedale Policlinico San Martino , Genova , Italy
| | - Valentino Remorgida
- a Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Academic Unit of Obstetrics and Gynecology , University of Genova , Genova , Italy
| | - Paola Anserini
- a Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Academic Unit of Obstetrics and Gynecology , University of Genova , Genova , Italy
- b Physiopathology of Human Reproduction Unit , Ospedale Policlinico San Martino , Genova , Italy
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Ferrer-Buitrago M, Bonte D, Dhaenens L, Vermorgen S, Lu Y, De Sutter P, Heindryckx B. Assessment of the calcium releasing machinery in oocytes that failed to fertilize after conventional ICSI and assisted oocyte activation. Reprod Biomed Online 2018; 38:497-507. [PMID: 30745236 DOI: 10.1016/j.rbmo.2018.12.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/20/2018] [Accepted: 12/10/2018] [Indexed: 10/27/2022]
Abstract
RESEARCH QUESTION Can oocyte-related activation deficiencies be evaluated in oocytes that failed to fertilize after intracytoplasmic sperm injection (ICSI) combined with assisted oocyte activation (AOA)? DESIGN Evaluation of the spindle-chromosome complexes and intracellular distribution of inositol trisphosphate type 1 receptors (IP3R1) in in-vitro matured (IVM) and failed-to-fertilize oocytes from patients undergoing AOA. Assessment of the oocyte-related Ca2+ releasing capacity in response to Ca2+ ionophores and sperm microinjection in oocytes that failed to fertilize after ICSI or ICSI-AOA. RESULTS IVM oocytes from patients undergoing conventional ICSI (control) and ICSI-AOA (study group) revealed a similar normalcy of spindle-chromosome complexes and distribution patterns of IP3R1. Failed-to-fertilize oocytes from both groups showed significant differences in proportion of normal or abnormal spindle-chromosome complex conformations. However, migration of IP3R1 was identified in a higher proportion of failed-to-fertilize oocytes after ICSI-AOA than after conventional ICSI. It was further observed that oocytes which failed to fertilize, either after ICSI or ICSI-AOA, mostly retain their capacity to respond to stimuli such as exposure to Ca2+ ionophores or to sperm microinjection. CONCLUSIONS Evaluation of spindle-chromosome normalcy and distribution of IP3R1 does not help identify the presence of Ca2+ releasing deficiencies in these oocytes. However, oocyte Ca2+ analysis adds value in identifying Ca2+ releasing incapacity of oocytes that failed to fertilize after ICSI or ICSI-AOA. Some patients experiencing fertilization failure after ICSI-AOA present with a suspected activation deficiency downstream of the Ca2+ machinery, which cannot be overcome by ICSI-AOA based on the use of Ca2+ ionophores.
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Affiliation(s)
- Minerva Ferrer-Buitrago
- Ghent-Fertility and Stem Cell Team (G-FaST), Department for Reproductive Medicine, Ghent University Hospital, Ghent, Belgium
| | - Davina Bonte
- Ghent-Fertility and Stem Cell Team (G-FaST), Department for Reproductive Medicine, Ghent University Hospital, Ghent, Belgium
| | - Lien Dhaenens
- Ghent-Fertility and Stem Cell Team (G-FaST), Department for Reproductive Medicine, Ghent University Hospital, Ghent, Belgium
| | - Sanne Vermorgen
- Ghent University (UGent Honours Programme in Life Sciences), Ghent, Belgium
| | - Yuechao Lu
- Ghent-Fertility and Stem Cell Team (G-FaST), Department for Reproductive Medicine, Ghent University Hospital, Ghent, Belgium
| | - Petra De Sutter
- Ghent-Fertility and Stem Cell Team (G-FaST), Department for Reproductive Medicine, Ghent University Hospital, Ghent, Belgium
| | - Björn Heindryckx
- Ghent-Fertility and Stem Cell Team (G-FaST), Department for Reproductive Medicine, Ghent University Hospital, Ghent, Belgium.
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Troisi A. Psychotraumatology: What researchers and clinicians can learn from an evolutionary perspective. Semin Cell Dev Biol 2018; 77:153-160. [DOI: 10.1016/j.semcdb.2017.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/22/2017] [Accepted: 09/05/2017] [Indexed: 12/11/2022]
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The Role of Attachment Anxiety and Attachment Avoidance on the Psychosocial Well-being of Infertile Couples. J Clin Psychol Med Settings 2018; 24:132-143. [PMID: 28536903 DOI: 10.1007/s10880-017-9496-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study's objective was to explore the mediating role of attachment orientation in infertile women and their partners as a mediator of the relationship between need for parenthood and psychosocial well-being. Ninety participants (45 couples) undergoing in vitro fertilization completed self-report questionnaires that assessed representations of the importance of parenthood, attachment orientations, and psychosocial well-being. Path analysis was used to examine the direct and indirect effects. The results indicated that women's attachment anxiety mediated the effect of need for parenthood on the psychological well-being of themselves and their partner. Although causality cannot be assumed, this study highlights the importance of considering attachment orientations and related strategies of emotion regulation in clinical settings and the need to address the meaning of parenthood for promoting couples' well-being.
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Agrawal K, Gainder S, Dhaliwal LK, Suri V. Ovulation Induction Using Clomiphene Citrate Using Stair - Step Regimen versus Traditional Regimen in Polycystic Ovary Syndrome Women - A Randomized Control Trial. J Hum Reprod Sci 2018; 10:261-264. [PMID: 29430152 PMCID: PMC5799929 DOI: 10.4103/jhrs.jhrs_15_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective: To determine the efficacy of the stair-step protocol (SSP) using clomiphene citrate (CC) in patients with polycystic ovary syndrome (PCOS) and compare it with traditional regimen. Design: This was randomized control trial. Setting: Infertility Clinic. Patient(s): Sixty infertile PCOS women. Intervention(s): Patients were randomized into the study (SSP – 30 patients) and control group (traditional protocol – 30 patients). In the SSP, patients were treated with CC 50 mg/day for 5 days and in nonresponsive patients, the dosage was increased to 100 mg/day for 5 days in the same cycle. Maximum dose of 150 mg was given until the dominant follicle was generated. In control group, the dose increment in nonovulatory cases was done in subsequent cycle. Ultrasonography follow-up was done to detect ovulation. Main Outcome Measure(s): Ovulation rate and duration of treatment. Results: Ovulation (66.7% vs. 50% respectively) and pregnancy rates (26.7% vs. 15.7%) were similar between the stair step and the control group. The duration of treatment was significantly shorter in stair step compared to traditional protocol (17.23 vs. 53 days). CC 100 mg was the most effective dose for ovulation in either group. There were no significant differences in the systemic side effect. Conclusions: By using SSP, effective treatment is provided in significantly shorter time period without any detrimental effect on the ovulation and pregnancy rates.
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Affiliation(s)
- K Agrawal
- Department of Obstetrics and Gynecology, PGIMER, Chandigarh, India
| | - Shalini Gainder
- Department of Obstetrics and Gynecology, PGIMER, Chandigarh, India
| | | | - Vanita Suri
- Department of Obstetrics and Gynecology, PGIMER, Chandigarh, India
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Abstract
OBJECTIVE To compare time to ovulation, ovulation rates, and side effect profile of traditional and the stair-step protocol for ovulation induction using clomiphene citrate in women with polycystic ovary syndrome (PCOS). METHODS We performed a retrospective study of women seeking care for infertility with a diagnosis of PCOS at a university-based infertility clinic from July 2012 to July 2014. We included patients who were resistant to the initial starting dose of 50 mg clomiphene. The primary outcome was time to ovulation. Secondary outcomes included ovulation rates, clinical pregnancy rates, and mild and moderate-to-severe side effects based on dose. For the traditional protocol, higher doses of clomiphene were used each subsequent month if no ovulation occurred. For the stair-step protocol, higher doses of clomiphene were given 7 days after the last dose if no dominant follicles were seen on ultrasonography. Our study had 80% power to detect a 20% difference in ovulation. RESULTS One hundred nine patients were included in the analysis with 66 (60.6%) in the traditional and 43 (39.4%) in the stair-step protocol. Age and body mass index were similar between groups. The time to ovulation was decreased in the stair-step protocol group compared with the traditional protocol group (23.1±0.9 days vs 47.5±6.3 days). Ovulation rates were increased in the stair-step group compared with the traditional group at 150 mg (16 [37%] vs 8 [12%], P=.004) and at 200 mg (9 [21%] vs 3 [5%], P=.01). Pregnancy rates were similar between groups once ovulation was achieved (12 [18.1%] vs 7 [16.3%], P=.08). The stair-step protocol had an increased incidence of mild side effects (vasomotor flushes, headaches, gastrointestinal disturbance, mastalgia, changes in mood; 18 [41%] vs 8 [12%]), but there was no difference in the incidence of severe side effects (headaches, visual disturbances). CONCLUSION For women with PCOS, the stair-step clomiphene protocol is associated with decreased time to ovulation and increased ovulation rates at higher doses when compared with the traditional protocol.
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Zurlo MC, Cattaneo Della Volta MF, Vallone F. Predictors of quality of life and psychological health in infertile couples: the moderating role of duration of infertility. Qual Life Res 2018; 27:945-954. [PMID: 29307056 DOI: 10.1007/s11136-017-1781-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE To investigate the influence of individual characteristics (age, gender, educational level, coping strategies), perceived couple's Dyadic Adjustment, type of diagnosis and duration of infertility on self-reported quality of life (QoL) and psychological health in infertile couples, examining the potential moderating role of duration of infertility. METHODS A questionnaire composed by socio-demographics, Coping Orientations to Problem Experienced, Dyadic Adjustment Scale, FertiQoL, State-Trait Anxiety Inventory and Edinburgh Depression Scale was submitted to 206 couples undergoing infertility treatments. RESULTS Female patients perceived significantly lower levels of QoL and higher levels of Anxiety and Depression. High Educational level and Social Support Coping strategy were associated with higher QoL and psychological health only in female patients. Problem Solving Coping strategy was associated with higher QoL and psychological health only in male patients. Positive Attitude and Avoidance/Distancing Coping strategies and perceived couple's Dyadic Adjustment were associated with higher QoL and psychological health in both male and female patients. Duration of infertility > 3 years was associated with a reduction of protective effects of all coping strategies but did not affect protective effects of Educational level and couple's Dyadic Adjustment. CONCLUSIONS Both positive/active and avoiding/distancing coping strategies are effective to promote QoL and psychological health in infertile couples, but they are all compromised by a long duration of infertility. Conversely, positive effects of educational level and couple's Dyadic Adjustment persist and should be emphasised in the definition of interventions to promote well-being in couples undergoing long-term treatments.
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Affiliation(s)
- Maria Clelia Zurlo
- Department of Political Sciences, University of Naples Federico II, Via L. Rodinò 22, 80138, Naples, Italy.
| | | | - Federica Vallone
- Department of Political Sciences, University of Naples Federico II, Via L. Rodinò 22, 80138, Naples, Italy
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Patel A, Sharma PSVN, Kumar P, Binu VS. Illness Cognitions, Anxiety, and Depression in Men and Women Undergoing Fertility Treatments: A Dyadic Approach. J Hum Reprod Sci 2018; 11:180-189. [PMID: 30158816 PMCID: PMC6094532 DOI: 10.4103/jhrs.jhrs_119_17] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Emotional response to infertility is mediated by numerous interrelated psychological variables such as personality, health perceptions, cognitive appraisals, coping, and social support. While men and women respond to infertility differently, illness cognitions are a vital component of their emotional adjustment. The aim of this study is to compare the infertile men and women undergoing fertility treatments on perceived distress, helplessness, acceptance, benefits, anxiety, and depression. Materials and Methods Eighty-one infertile couples, undergoing intrauterine insemination participated in the study. They were assessed on the presence of infertility distress using the fertility problem inventory, for psychiatric morbidity using the Mini International Neuropsychiatric Interview, for affective disturbances using the Hamilton Anxiety and Depression scales, and for illness cognitions using the Illness Cognition Questionnaire. Statistical Analysis Data are analyzed using SPSS version 15. The paired sample t-test is performed for assessing differences on normally distributed data. The Wilcoxon Signed-Rank test is performed for assessing differences in medians obtained on data that was skewed. Results and Discussion Infertile women (wives) were more emotionally distressed, anxious, and depressed than men (husbands). Gender-wise differences were found for perceptions of helplessness and acceptance of infertility. Infertility was perceived to be a nonbeneficial event for both partners investigated. Conclusion Negative cognitions and affective disturbances may contribute to higher treatment burden in couples seeking-assisted conception. The present study suggests that psychosocial intervention for couples plays a central role and should be integrated within the conventional treatments for infertility.
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Affiliation(s)
- Ansha Patel
- Department of Psychiatry, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - P S V N Sharma
- Department of Psychiatry, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Pratap Kumar
- Department of Obstetrics and Gynaecology, The Manipal Assisted Reproduction Centre, Kasturba Medical College, Manipal University, Manipal, Karnataka, India.,The Manipal Assisted Reproduction Centre, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - V S Binu
- Department of Biostatistics, Dr. M.V. Govindasamy Centre, National Institute of Mental Health and Neuro Sciences (An Institute of National Importance), Bengaluru, Bengaluru, Karnataka, India
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Horowitz E, Levran D, Weissman A. Extension of the clomiphene citrate stair-step protocol to gonadotropin treatment in women with clomiphene resistant polycystic ovarian syndrome. Gynecol Endocrinol 2017; 33:807-810. [PMID: 28454491 DOI: 10.1080/09513590.2017.1320381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Our objective was to evaluate the safety and efficacy of direct initiation of gonadotropin ovarian stimulation without prior withdrawal bleeding in anovulatory clomiphene citrate (CC) resistant polycystic ovarian syndrome (PCOS) patients. Eighteen PCOS patients underwent ovulation induction with CC using a stair-step regimen. Patients who failed to respond to the maximal dose of CC initiated gonadotropin stimulation without inducing withdrawal bleeding, using the chronic low dose regimen. The primary outcome measure was the time to ovulation from the beginning of CC treatment until the day of ovulatory trigger. This was compared with the time to ovulation calculated according to the traditional approach, which includes inducing progesterone withdrawal bleeding between each CC dose increment and before gonadotropin therapy. The time to ovulation in the study group was 67.0 ± 6.8 days. The estimated time to ovulation according to the traditional approach was approximately 110 days. The clinical pregnancy rate was 44% (8/18), and all pregnancies were singletons. One patient miscarried; hence the live birth rate was 38.9% (7/18). Direct initiation of gonadotropin therapy without prior induction of withdrawal bleeding in clomiphene resistant PCOS patients results in considerable reduction of the time to ovulation and is both safe and efficacious.
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Affiliation(s)
- Eran Horowitz
- a IVF Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center , Holon , Israel
- b Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel , and
- c Maccabi Healthcare Services, Infertility Clinic , Rishon LeZion , Israel
| | - David Levran
- a IVF Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center , Holon , Israel
| | - Ariel Weissman
- a IVF Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center , Holon , Israel
- b Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel , and
- c Maccabi Healthcare Services, Infertility Clinic , Rishon LeZion , Israel
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Aba YA, Avci D, Guzel Y, Ozcelik SK, Gurtekin B. Effect of music therapy on the anxiety levels and pregnancy rate of women undergoing in vitro fertilization-embryo transfer: A randomized controlled trial. Appl Nurs Res 2017; 36:19-24. [DOI: 10.1016/j.apnr.2017.05.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 04/22/2017] [Accepted: 05/20/2017] [Indexed: 10/19/2022]
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Ockhuijsen HD, van Smeden M, van den Hoogen A, Boivin J. Validation study of the SCREENIVF: an instrument to screen women or men on risk for emotional maladjustment before the start of a fertility treatment. Fertil Steril 2017; 107:1370-1379.e5. [DOI: 10.1016/j.fertnstert.2017.04.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/13/2017] [Accepted: 04/13/2017] [Indexed: 11/28/2022]
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Kitchen H, Aldhouse N, Trigg A, Palencia R, Mitchell S. A review of patient-reported outcome measures to assess female infertility-related quality of life. Health Qual Life Outcomes 2017. [PMID: 28449717 DOI: 10.1186/s12955-017-0666-0.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infertility has a negative impact on quality of life (QoL) and well-being of affected individuals and couples. A variety of patient-reported outcome (PRO) measures to assess infertility-related QoL are available; however, there is a concern regarding potential issues with their development methodology, validation and use. This review aimed to i) identify PRO measures used in infertility interventional studies ii) assess validation evidence to identify a reliable, valid PRO measure to assess changes in QoL or treatment satisfaction in clinical studies with female patients following treatment with novel therapies iii) identify potential gaps in evidence for validity. METHODS A structured literature search of Medline, Embase, and the Cochrane Library (accessed in September 2015) was conducted using pre-defined search terms. The identified publications were reviewed applying eligibility criteria to select interventional female infertility studies using PROs. Infertility-specific PRO measures assessing QoL, treatment satisfaction or psychiatric health, and included in studies by ≥2 research groups were selected and critically reviewed in light of scientific and regulatory guidance (e.g. FDA PRO Guidance for Industry) for evidence of content validity, psychometric strength, and patient acceptability. RESULTS The literature search and hand-searching yielded 122 publications; 78 unique PRO measures assessing QoL, treatment satisfaction or psychiatric health were identified. Five PRO measures met the selection criteria for detailed review: Fertility Quality of Life (FertiQoL); Fertility Problem Inventory (FPI); Fertility Problem Stress (FPS); Infertility Questionnaire (IFQ); Illness Cognitions Questionnaire adapted for Infertility (ICQ-I). None of the PRO measures met all validation criteria. The FertiQoL was the most widely used infertility-specific PRO measure to assess QoL in interventional studies, with reasonable evidence for adequate content validity, psychometric strength, and linguistic validation. However, gaps in evidence remain including test-retest reliability and thresholds for interpreting clinically important changes. While the FPI demonstrated reasonable evidence for content and psychometric validity, its utility as an outcome measure is limited by a lack of recall period. CONCLUSION The FertiQoL and the FPI are potentially useful measures of infertility-related QoL in interventional studies. Further research is recommended to address gaps in evidence and confirm both PRO measures as reliable assessments of patient outcomes.
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Kitchen H, Aldhouse N, Trigg A, Palencia R, Mitchell S. A review of patient-reported outcome measures to assess female infertility-related quality of life. Health Qual Life Outcomes 2017; 15:86. [PMID: 28449717 PMCID: PMC5408488 DOI: 10.1186/s12955-017-0666-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 04/21/2017] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Infertility has a negative impact on quality of life (QoL) and well-being of affected individuals and couples. A variety of patient-reported outcome (PRO) measures to assess infertility-related QoL are available; however, there is a concern regarding potential issues with their development methodology, validation and use. This review aimed to i) identify PRO measures used in infertility interventional studies ii) assess validation evidence to identify a reliable, valid PRO measure to assess changes in QoL or treatment satisfaction in clinical studies with female patients following treatment with novel therapies iii) identify potential gaps in evidence for validity. METHODS A structured literature search of Medline, Embase, and the Cochrane Library (accessed in September 2015) was conducted using pre-defined search terms. The identified publications were reviewed applying eligibility criteria to select interventional female infertility studies using PROs. Infertility-specific PRO measures assessing QoL, treatment satisfaction or psychiatric health, and included in studies by ≥2 research groups were selected and critically reviewed in light of scientific and regulatory guidance (e.g. FDA PRO Guidance for Industry) for evidence of content validity, psychometric strength, and patient acceptability. RESULTS The literature search and hand-searching yielded 122 publications; 78 unique PRO measures assessing QoL, treatment satisfaction or psychiatric health were identified. Five PRO measures met the selection criteria for detailed review: Fertility Quality of Life (FertiQoL); Fertility Problem Inventory (FPI); Fertility Problem Stress (FPS); Infertility Questionnaire (IFQ); Illness Cognitions Questionnaire adapted for Infertility (ICQ-I). None of the PRO measures met all validation criteria. The FertiQoL was the most widely used infertility-specific PRO measure to assess QoL in interventional studies, with reasonable evidence for adequate content validity, psychometric strength, and linguistic validation. However, gaps in evidence remain including test-retest reliability and thresholds for interpreting clinically important changes. While the FPI demonstrated reasonable evidence for content and psychometric validity, its utility as an outcome measure is limited by a lack of recall period. CONCLUSION The FertiQoL and the FPI are potentially useful measures of infertility-related QoL in interventional studies. Further research is recommended to address gaps in evidence and confirm both PRO measures as reliable assessments of patient outcomes.
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The Trauma of Birth or Parenting a Child: Effect on Parents' Negative Emotion in China. Arch Psychiatr Nurs 2017; 31:211-216. [PMID: 28359435 DOI: 10.1016/j.apnu.2016.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 10/12/2016] [Accepted: 10/15/2016] [Indexed: 11/23/2022]
Abstract
The present study assessed negative emotions associated with the traumas of infertility and child rearing (child's disability or death) and the correlates of duration of trauma. The widely used Chinese Mental Health Scale was used to assess negative emotions in 294 individuals who experienced the aforementioned traumas and 124 who did not (control group). Results showed that individuals with infertility exhibited greater anxiety, depression, and solitude than the control group; bereaved parents and had greater solitude and fear than control group; and parents of children with disabilities had greater solitude than the control group. Parents who experienced the death of a child had more fear and physiological maladjustment than parents of a child with disabilities. In addition, individuals without parenting experience had higher scores on solitude, fear, and physiological disease than those with parenting experience. After controlling for demographic variables, the duration of trauma significantly negatively predicted depression in the infertile group and for bereaved parents. The results suggest that in order to prevent psychological and physiological health problems among infertile couples, parents of a disabled child, and parents who experience the death of child, family and community-based strategies should be developed and implemented.
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Li H, Lei J, Xu F, Yan C, Guimerans M, Xing H, Sun Y, Zhang D. A study of sociocultural factors on depression in Chinese infertile women from Hunan Province. J Psychosom Obstet Gynaecol 2017; 38:12-20. [PMID: 27934537 DOI: 10.1080/0167482x.2016.1265500] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To explore the sociocultural factors influencing depression in Chinese infertile women in Hunan Province. METHODS A cross-sectional study was carried out. A total of 211 Chinese infertile women completed demographic details, a disease-related information questionnaire, a self-rating depression scale (SDS) and a social support rating scale (SSRS). RESULTS One hundred and seven (50.71%) of the participants were classified as depressed according to the self-rating depression scale. The average SDS index score was 50.06 ± 10.59. Using analysis of variance (ANOVA), Pearson correlation and a multivariable regression analysis, the results showed family type, feelings of discrimination, social support, feelings of shame and reproductive pressures were influential factors in depression among Chinese infertile women. CONCLUSION Sociocultural factors influence depression levels in Chinese female infertile patients. The unique aspects of Chinese culture may have a negative mental impact on the patients, and cultural factors should be taken into consideration in the development of coping strategies for Chinese infertile women.
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Affiliation(s)
- Hui Li
- a Nursing Department , Medical School, Shaoxing University , Shaoxing , P. R. China.,b The Third XiangYa Hospital, Central South University , Changsha , P. R. China
| | - Jun Lei
- b The Third XiangYa Hospital, Central South University , Changsha , P. R. China
| | - Fengjiao Xu
- a Nursing Department , Medical School, Shaoxing University , Shaoxing , P. R. China
| | - Chunli Yan
- b The Third XiangYa Hospital, Central South University , Changsha , P. R. China
| | - Marin Guimerans
- a Nursing Department , Medical School, Shaoxing University , Shaoxing , P. R. China
| | - Haiyan Xing
- a Nursing Department , Medical School, Shaoxing University , Shaoxing , P. R. China
| | - Yiqin Sun
- a Nursing Department , Medical School, Shaoxing University , Shaoxing , P. R. China
| | - Dengke Zhang
- a Nursing Department , Medical School, Shaoxing University , Shaoxing , P. R. China
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Psychosocial Vulnerability, Resilience Resources, and Coping with Infertility: A Longitudinal Model of Adjustment to Primary Ovarian Insufficiency. Ann Behav Med 2016; 50:272-84. [PMID: 26637185 DOI: 10.1007/s12160-015-9750-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND The infertility associated with primary ovarian insufficiency (POI) presents significant emotional challenges requiring psychosocial adjustment. Few investigations have explored the longitudinal process of adaptation to POI. PURPOSE This longitudinal investigation tests a model of adjustment to POI that includes separate psychosocial vulnerability and resilience resource factors. METHODS Among 102 women with POI, personal attributes reflective of vulnerability and resilience were assessed at baseline. Coping strategies were assessed 4 months later and measures of distress and well-being 12 months later. RESULTS As hypothesized, confirmatory factor analysis yielded separate, inversely correlated vulnerability and resilience resource factors at baseline, and distress and well-being factors at 12 months. Contrary to predictions, maladaptive and adaptive coping strategies were not bi-factorial. Moreover, a single stand-alone strategy, avoidance (i.e., refusing to acknowledge stress), mediated the association between baseline vulnerability and 12-month distress. CONCLUSIONS For women with POI, interventional studies targeted to reduce avoidance are indicated.
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Milazzo A, Mnatzaganian G, Elshaug AG, Hemphill SA, Hiller JE. Depression and Anxiety Outcomes Associated with Failed Assisted Reproductive Technologies: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0165805. [PMID: 27835654 PMCID: PMC5106043 DOI: 10.1371/journal.pone.0165805] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 10/18/2016] [Indexed: 11/18/2022] Open
Abstract
Objective Our study examined the psychological outcomes associated with failed ART treatment outcomes in men and women. Search Strategy A systematic search for studies published between January 1980 and August 2015 was performed across seven electronic databases. Inclusion Criteria Studies were included if they contained data on psychosocial outcomes taken pre and post ART treatment. Data Extraction and Synthesis A standardised form was used to extract data and was verified by two independent reviewers. Studies were meta-analysed to determine the association of depression and anxiety with ART treatment outcomes. Narrative synthesis identified factors to explain variations in the size and directions of effects and relationships explored within and between the studies. Main Results Both depression and anxiety increased after a ART treatment failure with an overall pooled standardised mean difference (SMD) of 0.41 (95% CI: 0.27, 0.55) for depression and 0.21 (95% CI: 0.13, 0.29) for anxiety. In contrast, depression decreased after a successful treatment, SMD of -0.24 (95% CI: -0.37,-0.11). Both depression and anxiety decreased as time passed from ART procedure. Nonetheless, these remained higher than baseline measures in the group with the failed outcome even six months after the procedure. Studies included in the narrative synthesis also confirmed an association with negative psychological outcomes in relation to marital satisfaction and general well-being following treatment failure. Conclusion Linking ART failure and psychosocial outcomes may elucidate the experience of treatment subgroups, influence deliberations around recommendations for resource allocation and health policy and guide patient and clinician decision making.
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Affiliation(s)
- Adriana Milazzo
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - George Mnatzaganian
- College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Victoria, Australia
| | - Adam G. Elshaug
- Menzies Centre for Health Policy, The University of Sydney, Sydney, New South Wales, Australia
| | - Sheryl A. Hemphill
- Learning Sciences Institute Australia, Faculty of Education and Arts, Australian Catholic University, Melbourne, Victoria, Australia
- School of Psychology, Faculty of Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia
| | - Janet E. Hiller
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
- School of Health Sciences, Swinburne University of Technology, Melbourne, Victoria Australia
- * E-mail:
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Chen D, Zhang JP, Jiang L, Liu H, Shu L, Zhang Q, Jiang L. Factors that influence in vitro fertilization treatment outcomes of Chinese men: A cross-sectional study. Appl Nurs Res 2016; 32:222-226. [PMID: 27969032 DOI: 10.1016/j.apnr.2016.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 07/04/2016] [Accepted: 07/05/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND The thought of producing offspring has rooted in Chinese culture after thousands of years of feudal society. Infertility in men would bear significant psychological distress in this social environment. PURPOSE In this study, we explored the association between the outcomes of IVF treatment and anxiety, depression, marital satisfaction, communication, sexual relationship and social support. METHODS A cross-sectional study was conducted. A total of 202 Chinese men who received IVF treatment for the first time were investigated using socio-demographic questionnaire, Self-Rating Anxiety Scale, Self-Rating Depression Scale, ENRICH Marital Inventory and Social Support Rating Scale on the first day of IVF treatment. RESULTS The overall prevalence of depression and anxiety was 49.1% and 27.2%, respectively. Subjects with IVF failure had higher levels of depression and anxiety, lower levels of "Marital satisfaction", "communication" and "Sexual relationship" and social support. Logistic regression analysis indicated that depression, anxiety, marital satisfaction and sexual relationship were independent predictors of IVF failure. CONCLUSION The prevalence of depression and anxiety in Chinese men undergoing IVF was higher than that in other countries. These findings suggest that anxiety, depression, marital satisfaction, and sexual relationship are important factors leading to IVF failure. Therefore, it is important to provide psychological aid to male patients undergoing IVF treatment.
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Affiliation(s)
- Dan Chen
- Nursing psychology research center, Xiang Ya School of Nursing, Central South University, Changsha, China; Medical College, Hunan Normal University, Changsha, China
| | - Jing Ping Zhang
- Nursing psychology research center, Xiang Ya School of Nursing, Central South University, Changsha, China.
| | - Ling Jiang
- Medical College, Hunan Normal University, Changsha, China
| | - Huayan Liu
- Medical College, Hunan Normal University, Changsha, China
| | - Ling Shu
- Medical College, Hunan Normal University, Changsha, China
| | - Qiong Zhang
- Medical College, Hunan Normal University, Changsha, China
| | - LiPing Jiang
- Medical College, Hunan Normal University, Changsha, China
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Verkuijlen J, Verhaak C, Nelen WLDM, Wilkinson J, Farquhar C. Psychological and educational interventions for subfertile men and women. Cochrane Database Syst Rev 2016; 3:CD011034. [PMID: 27031818 PMCID: PMC7104661 DOI: 10.1002/14651858.cd011034.pub2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Approximately one-fifth of all subfertile couples seeking fertility treatment show clinically relevant levels of anxiety, depression, or distress. Psychological and educational interventions are frequently offered to subfertile couples, but their effectiveness, both in improving mental health and pregnancy rates, is unclear. OBJECTIVES To assess the effectiveness of psychological and educational interventions for subfertile couples on psychological and fertility treatment outcomes. SEARCH METHODS We searched (from inception to 2 April 2015) the Cochrane Gynaecology and Fertility Group Specialised Register of Controlled Trials, the Cochrane Central Register of Controlled Trials (CENTRAL; Issue 2, 2015), MEDLINE, EMBASE, PsycINFO, EBSCO CINAHL, DARE, Web of Science, OpenGrey, LILACS, PubMed, and ongoing trials registers. We handsearched reference lists and contacted experts in the field. SELECTION CRITERIA We included published and unpublished randomised controlled trials (RCTs), cluster randomised trials, and cross-over trials (first phase) evaluating the effectiveness of psychological and educational interventions on psychological and fertility treatment outcomes in subfertile couples. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial risk of bias and extracted data. We contacted study authors for additional information. Our primary outcomes were psychological measures (anxiety and depression) and fertility rates (live birth or ongoing pregnancy). We assessed the overall quality of the evidence using GRADE criteria.As we did not consider the included studies to be sufficiently similar to permit meaningful pooling, we summarised the results of the individual studies by presenting the median and interquartile range (IQR) of effects as well as the minimum and maximum values. We calculated standardised mean differences (SMDs) for continuous variables and odds ratios (ORs) for dichotomous outcomes. MAIN RESULTS We included 39 studies involving 4925 participants undergoing assisted reproductive technology. Studies were heterogeneous with respect to a number of factors, including nature and duration of interventions, participants, and comparator groups. As a result, we judged that pooling results would not result in a clinically meaningful estimate of a treatment effect. There were substantial methodological weaknesses in the studies, all of which were judged to be at high risk of bias for one or more quality assessment domains. There was concern about attrition bias (24 studies), performance bias for psychological outcomes (27 studies) and fertility outcomes (18 studies), and detection bias for psychological outcomes (26 studies). We therefore considered study-specific estimates of intervention effects to be unreliable. Thirty-three studies reported the outcome mental health. Only two studies reported the outcome live birth, and both of these had substantial attrition. One study reported ongoing pregnancy, again with substantial attrition. We have combined live birth and ongoing pregnancy in one outcome. Psychological outcomesStudies utilised a variety of measures of anxiety and depression. In all cases a low score denoted benefit from the intervention.SMDs for anxiety were as follows: psychological interventions versus attentional control or usual care: median (IQR) = -0.30 (-0.84 to 0.00), minimum value -5.13; maximum value 0.84, 17 RCTs, 2042 participants; educational interventions versus attentional control or usual care: median = 0.03, minimum value -0.38; maximum value 0.23, 4 RCTs, 330 participants.SMDs for depression were as follows: psychological interventions versus attentional control or usual care: median (IQR) = -0.45 (-0.68 to -0.08), minimum value -3.01; maximum value 1.23, 12 RCTs, 1160 participants; educational interventions versus attentional control or usual care: median = -0.33, minimum value -0.46; maximum value 0.17, 3 RCTs, 304 participants. Fertility outcomesWhen psychological interventions were compared with attentional control or usual care, ORs for live birth or ongoing pregnancy ranged from minimum value 1.13 to maximum value 10.05. No studies of educational interventions reported this outcome. AUTHORS' CONCLUSIONS The effects of psychological and educational interventions on mental health including distress, and live birth or ongoing pregnancy rates is uncertain due to the very low quality of the evidence. Existing trials of psychological and educational interventions for subfertility were generally poorly designed and executed, resulting in very serious risk of bias and serious inconsistency in study findings. There is a need for studies employing appropriate methodological techniques to investigate the benefits of these treatments for this population. In particular, attentional control groups should be employed, that is groups receiving a treatment that mimics the amount of time and attention received by the treatment group but is not thought to have a specific effect upon the participants, in order to distinguish between therapeutic and non-specific effects of interventions. Where attrition cannot be minimised, appropriate statistical techniques for handling drop-out must be applied. Failure to address these issues in study design has resulted in studies that do not provide a valid basis for answering questions about the effectiveness of these interventions.
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Affiliation(s)
- Jolijn Verkuijlen
- Radboud University Nijmegen Medical CentreGeert Grooteplein 10NijmegenNetherlands6525 GA
| | - Christianne Verhaak
- Radboud University Medical CenterMedical psychologistPO Box 9101NijmegenNetherlands6500 HB
| | - Willianne LDM Nelen
- Radboud University Nijmegen Medical CentreGeert Grooteplein 10NijmegenNetherlands6525 GA
| | - Jack Wilkinson
- University of Manchester, Manchester Academic Health Science CentreBiostatistics, Institute of Population HealthClinical Sciences Building Salford Royal NHS Foundation Trust HospitalStott Lane, SalfordManchesterUKM6 8HD
| | - Cindy Farquhar
- University of AucklandDepartment of Obstetrics and GynaecologyFMHS Park RoadGraftonAucklandNew Zealand1003
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Martins MV, Basto-Pereira M, Pedro J, Peterson B, Almeida V, Schmidt L, Costa ME. Male psychological adaptation to unsuccessful medically assisted reproduction treatments: a systematic review. Hum Reprod Update 2016; 22:466-78. [PMID: 27008894 DOI: 10.1093/humupd/dmw009] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 02/25/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Similarly to women, men suffer from engaging in fertility treatments, both physically and psychologically. Although there is a vast body of evidence on the emotional adjustment of women to infertility, there are no systematic reviews focusing on men's psychological adaptation to infertility and related treatments. OBJECTIVE AND RATIONALE The main research questions addressed in this review were 'Does male psychological adaptation to unsuccessful medically assisted reproduction (MAR) treatment vary over time?' and 'Which psychosocial variables act as protective or risk factors for psychological maladaptation?' SEARCH METHODS A literature search was conducted from inception to September 2015 on five databases using combinations of MeSH terms and keywords. Eligible studies had to present quantitative prospective designs and samples including men who did not achieve pregnancy or parenthood at follow-up. A narrative synthesis approach was used to conduct the review. OUTCOMES Twelve studies from three continents were eligible from 2534 records identified in the search. The results revealed that psychological symptoms of maladjustment significantly increased in men 1 year after the first fertility evaluation. No significant differences were found two or more years after the initial consultation. Evidence was found for anxiety, depression, active-avoidance coping, catastrophizing, difficulties in partner communication and the use of avoidance or religious coping from the wife as risk factors for psychological maladjustment. Protective factors were related to the use of coping strategies that involve seeking information and attribution of a positive meaning to infertility, having the support of others and of one's spouse, and engaging in open communication about the infertility problem. WIDER IMPLICATIONS Our findings recommend an active involvement of men during the treatment process by health care professionals, and the inclusion of coping skills training and couple communication enhancement interventions in counselling. Further prospective large studies with high-quality design and power are warranted.
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Affiliation(s)
- Mariana Veloso Martins
- Faculty of Psychology and Education Sciences, University of Porto, 4200-135 Porto, Portugal Center for Psychology at University of Porto, 4200-135 Porto, Portugal
| | | | - Juliana Pedro
- Faculty of Psychology and Education Sciences, University of Porto, 4200-135 Porto, Portugal Center for Psychology at University of Porto, 4200-135 Porto, Portugal
| | - Brennan Peterson
- School of Psychology, University of Minho, 4710-057 Braga, Portugal Crean College of Health and Behavioral Sciences, Chapman University, Orange, CA 92866, USA
| | - Vasco Almeida
- Crean College of Health and Behavioral Sciences, Chapman University, Orange, CA 92866, USA Faculty of Sciences, University of Porto, 4169-007 Porto, Portugal
| | - Lone Schmidt
- Section of Social Medicine, University of Copenhagen, 1014 Copenhagen K, Denmark
| | - Maria Emília Costa
- Faculty of Psychology and Education Sciences, University of Porto, 4200-135 Porto, Portugal Center for Psychology at University of Porto, 4200-135 Porto, Portugal
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van Dongen AJ, Nelen WL, IntHout J, Kremer JA, Verhaak CM. e-Therapy to reduce emotional distress in women undergoing assisted reproductive technology (ART): a feasibility randomized controlled trial. Hum Reprod 2016; 31:1046-57. [DOI: 10.1093/humrep/dew040] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 02/15/2016] [Indexed: 01/17/2023] Open
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Wang J, Chen Y, Tan C, Zhao X. Family functioning, social support, and quality of life for patients with anxiety disorder. Int J Soc Psychiatry 2016; 62:5-11. [PMID: 25964447 DOI: 10.1177/0020764015584649] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Few studies have examined the relationship between family functioning, social support and quality of life in patients with anxiety disorder. There is a paucity of research on anxiety disorders and their predictors in China. AIMS This study aimed to explore family functioning, social support and quality of life for patients with anxiety disorder and examine the relationship between these elements. METHODS A total of 107 patients who met Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) criteria for anxiety disorder and 80 healthy controls completed the McMaster Family Assessment Device, the Perceived Social Support Scale and the short form of the Quality of Life Enjoyment and Satisfaction Questionnaire. RESULTS The findings indicate that patients with anxiety disorder in China tend to have poor family functioning and quality of life, as well as a higher subjective perception of social support. There were strong correlations between family functioning, social support and quality of life. Affective involvement and not living with parents were identified as risk factors for anxiety disorders, while a high family income was a protective factor. CONCLUSION Anxiety disorder is associated with reduced family functioning and poorer quality of life for Chinese patients. In addition, the Family Assessment Device is a suitable instrument for evaluating family functioning in Chinese patients with anxiety disorder.
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Affiliation(s)
- Jikun Wang
- Key Laboratory of Brain Functional Genomics, Ministry of Education, Shanghai Key Laboratory of Brain Functional Genomics, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Yuhao Chen
- Key Laboratory of Brain Functional Genomics, Ministry of Education, Shanghai Key Laboratory of Brain Functional Genomics, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Cuicui Tan
- Key Laboratory of Brain Functional Genomics, Ministry of Education, Shanghai Key Laboratory of Brain Functional Genomics, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Xudong Zhao
- Department of Psychosomatic Medicine, East Hospital, Tongji University School of Medicine, Shanghai, China
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Galhardo A, Moura-Ramos M, Cunha M, Pinto-Gouveia J. The infertility trap: how defeat and entrapment affect depressive symptoms. Hum Reprod 2015; 31:419-26. [DOI: 10.1093/humrep/dev311] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 11/20/2015] [Indexed: 11/14/2022] Open
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[Psychosocial factors in reproductive medicine]. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2015; 61:309-26. [PMID: 26646911 DOI: 10.13109/zptm.2015.61.4.309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Since the development of assisted reproduction technology in the 1970s, assisted reproduction has become increasingly used by couples for various reasons. Concurrently, the diagnostic possibilities regarding the health of the unborn child have been elaborated. METHODS/RESULTS The present literature review describes and discusses the possibilities of assisted reproduction (in-vitro fertilization (IVF), intracytoplasmic sperm injection ICSI, cryopreservation, conception of children with the help of a third person) with respect to their psychosocial meaning for those affected and for the children conceived in this manner. The psychological strain pairs experience in the context of prenatal diagnostics and the resulting decisions are illustrated by a case study. CONCLUSIONS The continued progression in the possibilities and resulting conflicts and decision- making processes in reproductive medicine confronts clinicians and psychosomatic/psychotherapeutic practitioners with many new challenges. In conclusion clinical recommendations for the psychosocial counseling of couples are given.
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Moura-Ramos M, Gameiro S, Canavarro MC, Soares I, Almeida-Santos T. Does infertility history affect the emotional adjustment of couples undergoing assisted reproduction? the mediating role of the importance of parenthood. Br J Health Psychol 2015; 21:302-17. [PMID: 27059275 PMCID: PMC5061027 DOI: 10.1111/bjhp.12169] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 09/25/2015] [Indexed: 11/29/2022]
Abstract
Objectives The emotional adjustment of couples undergoing assisted reproductive technology (ART) treatments has been widely studied; however, it remains unclear whether infertility history contributes to couples' adjustment. This study examined the impact of infertility history (duration of infertility and number of previous ART treatment cycles) on the emotional adjustment of couples undergoing an ART cycle and the mediating effect of importance of parenthood on that association. Methods In this cross‐sectional study, 70 infertile couples (70 women and 70 men) completed self‐report questionnaires assessing emotional adjustment and infertility stress during the hormonal stimulation phase of an ART cycle. Path models accounting for the dyadic nature of the data examined the direct and indirect effects (by affecting representations about parenthood and childlessness) of infertility history on emotional adjustment. Results The number of previous cycles affected men's, but not women's, emotional adjustment by affecting the representations on the importance of parenthood and of childlessness. Duration of infertility had the opposite effect, as couples with longer infertility reported heightened importance of parenthood, which negatively affected their emotional adjustment. Conclusions Infertility history was associated with emotional adjustment in men and women, although these associations were complex. The results suggest that progression through treatment is harder for those men and women who attribute higher importance to being parents, which is aggravated by longer infertility. Statement of contribution What is already known about the subject? Infertility is an unexpected and stressful life event Assisted reproductive treatments (ART) are emotionally demanding
What does this study add? The influence of infertility history on adjustment is mediated by the importance of parenthood Men and women are affected by their past history of infertility differently
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Affiliation(s)
- Mariana Moura-Ramos
- Faculty of Psychology and Educational Sciences, University of Coimbra, Portugal
| | - Sofia Gameiro
- Cardiff Fertility Studies Research Group, School of Psychology, Cardiff University, UK
| | | | - Isabel Soares
- School of Psychology, University of Minho, Braga, Portugal
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Gameiro S, Boivin J, Dancet E, de Klerk C, Emery M, Lewis-Jones C, Thorn P, Van den Broeck U, Venetis C, Verhaak CM, Wischmann T, Vermeulen N. ESHRE guideline: routine psychosocial care in infertility and medically assisted reproduction-a guide for fertility staff. Hum Reprod 2015; 30:2476-85. [PMID: 26345684 DOI: 10.1093/humrep/dev177] [Citation(s) in RCA: 159] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 06/11/2015] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Based on the best available evidence in the literature, what is the optimal management of routine psychosocial care at infertility and medically assisted reproduction (MAR) clinics? SUMMARY ANSWER Using the structured methodology of the Manual for the European Society of Human Reproduction and Embryology (ESHRE) Guideline Development, 120 recommendations were formulated that answered the 12 key questions on optimal management of routine psychosocial care by all fertility staff. WHAT IS ALREADY KNOWN The 2002 ESHRE Guidelines for counselling in infertility has been a reference point for best psychosocial care in infertility for years, but this guideline needed updating and did not focus on routine psychosocial care that can be delivered by all fertility staff. STUDY, DESIGN, SIZE, DURATION This guideline was produced by a group of experts in the field according to the 12-step process described in the ESHRE Manual for Guideline Development. After scoping the guideline and listing a set of 12 key questions in PICO (Patient, Intervention, Comparison and Outcome) format, thorough systematic searches of the literature were conducted; evidence from papers published until April 2014 was collected, evaluated for quality and analysed. A summary of evidence was written in a reply to each of the key questions and used as the basis for recommendations, which were defined by consensus within the guideline development group (GDG). Patient and additional clinical input was collected during the scoping and the review phase of the guideline development. PARTICIPANTS/MATERIALS, SETTING, METHODS The guideline group, comprising psychologists, two medical doctors, a midwife, a patient representative and a methodological expert, met three times to discuss evidence and reach consensus on the recommendations. MAIN RESULTS AND THE ROLE OF CHANCE THE GUIDELINE PROVIDES 120 recommendations that aim at guiding fertility clinic staff in providing optimal evidence-based routine psychosocial care to patients dealing with infertility and MAR. The guideline is written in two sections. The first section describes patients' preferences regarding the psychosocial care they would like to receive at clinics and how this care is associated with their well-being. The second section of the guideline provides information about the psychosocial needs patients experience across their treatment pathway (before, during and after treatment) and how fertility clinic staff can detect and address these. Needs refer to conditions assumed necessary for patients to have a healthy experience of the fertility treatment. Needs can be behavioural (lifestyle, exercise, nutrition and compliance), relational (relationship with partner if there is one, family friends and larger network, and work), emotional (well-being, e.g. anxiety, depression and quality of life) and cognitive (treatment concerns and knowledge). LIMITATIONS, REASONS FOR CAUTION We identified many areas in care for which robust evidence was lacking. Gaps in evidence were addressed by formulating good practice points, based on the expert opinion of the GDG, but it is critical for such recommendations to be empirically validated. WIDER IMPLICATIONS OF THE FINDINGS The evidence presented in this guideline shows that providing routine psychosocial care is associated with or has potential to reduce stress and concerns about medical procedures and improve lifestyle outcomes, fertility-related knowledge, patient well-being and compliance with treatment. As only 45 (36.0%) of the 125 recommendations were based on high-quality evidence, the guideline group formulated recommendations to guide future research with the aim of increasing the body of evidence.
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Affiliation(s)
- S Gameiro
- Cardiff Fertility Studies Research Group, School of Psychology, Cardiff University, CF10 3AT Cardiff, UK
| | - J Boivin
- Cardiff Fertility Studies Research Group, School of Psychology, Cardiff University, CF10 3AT Cardiff, UK
| | - E Dancet
- Leuven University Fertility Centre, University Hospitals Leuven, 3000 Leuven, Belgium Center for Reproductive Medicine, Women's and Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam 1105 AZ, The Netherlands
| | - C de Klerk
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus MC University Medical Centre, Rotterdam 3000 CA, The Netherlands
| | - M Emery
- Centre for Medically Assisted Procreation-CPMA, CH-1003 Lausanne, Switzerland
| | | | - P Thorn
- Practice for Couple and Family Therapy, 64546 Moerfelden, Germany
| | - U Van den Broeck
- Leuven University Fertility Centre, University Hospitals Leuven, 3000 Leuven, Belgium
| | - C Venetis
- Women's and Children's Health, St George Hospital, University of New South Wales, NSW 2217 Sydney, Australia
| | - C M Verhaak
- Department of Psychology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - T Wischmann
- Institute of Medical Psychology, Centre for Psychosocial Medicine, Heidelberg University Hospital, 69115 Heidelberg, Germany
| | - N Vermeulen
- European Society for Human Reproduction and Embryology, 1852 Grimbergen, Belgium
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