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Bayar E, Williams NJ, Alghrani A, Murugesu S, Saso S, Bracewell-Milnes T, Thum MY, Nicopoullos J, Sangster P, Yasmin E, Smith JR, Wilkinson S, Pacey A, Jones BP. Fertility preservation and realignment in transgender women. HUM FERTIL 2023; 26:463-482. [PMID: 36799335 DOI: 10.1080/14647273.2022.2163195] [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: 03/17/2022] [Accepted: 09/01/2022] [Indexed: 02/18/2023]
Abstract
Medical care for transgender people is multi-faceted and attention to individual reproductive aspirations and planning are an essential, yet often overlooked aspect of care. Given the impact of hormonal therapy and other gender affirmation procedures on reproductive function, extensive counselling and consideration of fertility preservation is recommended prior to their commencement. This review article explores the reproductive aspirations of transgender women and considers the current disparity between stated desires regarding utilisation of fertility preservation services. Current fertility preservation options and prospective treatments currently showing promise in the research arena are explored.
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Affiliation(s)
- Erna Bayar
- Department of Gynaecology, Hammersmith Hospital, Imperial College NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Nicola J Williams
- Department of Politics, Philosophy and Religion, Lancaster University, Lancaster, UK
| | - Amel Alghrani
- School of Law and Social Justice, University of Liverpool, Liverpool, UK
| | - Sughashini Murugesu
- Department of Gynaecology, Hammersmith Hospital, Imperial College NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Srdjan Saso
- Department of Gynaecology, Hammersmith Hospital, Imperial College NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Meen-Yau Thum
- Lister Fertility Clinic, The Lister Hospital, Chelsea Bridge Road, London, UK
| | - James Nicopoullos
- Lister Fertility Clinic, The Lister Hospital, Chelsea Bridge Road, London, UK
| | - Philippa Sangster
- Reproductive Medicine Unit, University College London Hospital, London, UK
| | - Ephia Yasmin
- Reproductive Medicine Unit, University College London Hospital, London, UK
| | - J Richard Smith
- Department of Gynaecology, Hammersmith Hospital, Imperial College NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Stephen Wilkinson
- Department of Politics, Philosophy and Religion, Lancaster University, Lancaster, UK
| | - Allan Pacey
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - Benjamin P Jones
- Department of Gynaecology, Hammersmith Hospital, Imperial College NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
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Mason A, Crowe E, Haragan B, Smith S, Kyriakou A. Gender Dysphoria in Young People: A Model of Chronic Stress. Horm Res Paediatr 2023; 96:54-65. [PMID: 34673639 DOI: 10.1159/000520361] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/08/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Gender dysphoria (GD) refers to the distress that may accompany gender incongruence, often heightened at the onset of puberty, with the development of secondary sex characteristics. Children and adolescents may be especially vulnerable to severe stressors, including GD, with potentially irreversible effects if these exposures occur during critical periods of development and brain maturation. SUMMARY We describe the evidence for GD as a chronic stressor, drawing parallels to other established models of stress, activating both innate psychological and biological stress responses. As well as being an inherently distressing experience, a person who experiences GD may also experience minority stress. Minority stress has been demonstrated in young people who experience GD with higher rates of social rejection and internalized stigma and shame. The biological stress response in young people with GD is illustrated through the activation of the hypothalamic-pituitary-adrenal axis, autonomic nervous system, and pro-inflammatory response. The number of young people who report experiencing GD has increased exponentially worldwide in the past decade, demanding a change in the clinic infrastructure. Paediatric endocrinologists and specialists in mental health work together to both support psychosocial well-being and offer individualized treatment to align the phenotype with gender identity with the aim of alleviating the distress of GD. Medical interventions may include puberty suppression and gender-affirming hormones. Ongoing monitoring is required prior to initiation and during treatment to ensure that the goals of treatment are being achieved.
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Affiliation(s)
- Avril Mason
- Department of Paediatric Endocrinology, Royal Hospital for Children, Glasgow, UK
| | - Eimear Crowe
- Young People's Gender Service, Sandyford Services, Glasgow, UK
| | - Beccy Haragan
- Young People's Gender Service, Sandyford Services, Glasgow, UK
| | - Simon Smith
- Young People's Gender Service, Sandyford Services, Glasgow, UK
| | - Andreas Kyriakou
- Department of Paediatric Endocrinology, Royal Hospital for Children, Glasgow, UK.,Department of Paediatric Endocrinology, Makarios Children's Hospital, Nicosia, Cyprus
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Santona A, Vismara L, Gorla L, Tognasso G, Ambrosini C, Luli A, Rollè L. The Relationship between Attachment, Dyadic Adjustment, and Sexuality: A Comparison between Infertile Men and Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3020. [PMID: 36833722 PMCID: PMC9962621 DOI: 10.3390/ijerph20043020] [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: 12/30/2022] [Revised: 01/23/2023] [Accepted: 02/08/2023] [Indexed: 06/18/2023]
Abstract
Infertility impacts several life dimensions. Among them, sexuality is particularly affected; yet studies have mainly focused on infertile women. We aimed to explore infertile men's and women's experiences in sexual satisfaction, internal control, and anxiety, and the relationship between attachment, dyadic adjustment, and sexuality. The sample consisted of 129 infertile people (47.3% females, 52.7% males, Mage = 39 years) who fulfilled an ad hoc questionnaire, the Multidimensional Sexuality Questionnaire (MSQ), the Experiences in Close Relationship-Revised (ECR-R), and the Dyadic Adjustment Scale (DAS). We found a significant effect of type of infertility and infertility factors on sexual anxiety only in infertile men. As regards infertile women, dyadic adjustment predicted sexual satisfaction, anxious attachment decreased sexual internal control, and avoidant attachment reduced sexual anxiety. As regards infertile men, high dyadic adjustment increased sexual satisfaction and a high avoidant attachment predicted high levels of sexual internal control. There was no relationship between attachment, dyadic adjustment, and sexual anxiety for infertile men. From the results, it emerges how important is to consider both dyadic adjustment and attachment in studying how infertility impacts women's and men's lives.
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Affiliation(s)
- Alessandra Santona
- Department of Psychology, University of Milano-Bicocca, 20126 Milan, Italy
| | - Laura Vismara
- Department of Pedagogy, Psychology, Philosophy, University of Cagliari, 09123 Cagliari, Italy
| | - Laura Gorla
- Department of Psychology, University of Milano-Bicocca, 20126 Milan, Italy
| | - Giacomo Tognasso
- Department of Psychology, University of Milano-Bicocca, 20126 Milan, Italy
| | - Carolina Ambrosini
- Department of Developmental Psychology and Socialisation, University of Padua, 35131 Padova, Italy
| | - Anisa Luli
- Department of Psychology, University of Milano-Bicocca, 20126 Milan, Italy
| | - Luca Rollè
- Department of Psychology, University of Torino, 10124 Torino, Italy
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Margraf J, Lavallee KL, Zhang XC, Woike JK, Schneider S. Mental health and the wish to have a child: a longitudinal, cross-cultural comparison between Germany and China. J Psychosom Obstet Gynaecol 2022; 43:177-189. [PMID: 32914664 DOI: 10.1080/0167482x.2020.1816959] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The desire to have children has been declining globally, especially in industrialized nations. This study examines the physical health correlates, and positive and negative mental health correlates of the wish to have a child across time and in two countries. METHOD Questionnaire data were obtained from large-scale university samples of 12,574 participants in Germany and China. RESULTS The wish to have a child (child wish) is related to positive and negative mental health in China and, to a lesser degree, in Germany. Child wish is positively related to some aspects of mental and somatic health for Chinese women and men, negatively to depression for Chinese and German men and Chinese women, and positively to stress for German men, with generally small effects. Effects hold when controlling for age, partnership status, and family affluence. Most relationships were almost equal between women and men (in both China and Germany), and between countries with the exception of two different paths in each gender group. That is, having a partner is associated with a higher child wish in both Chinese and German female students. In China, older female students are more likely to want to have a child, while older female students in Germany are less likely to want to have a child. Neither partnership nor age predict child wish for the next year. CONCLUSION In sum, Chinese students reported feeling more positively about having children when they were happy and healthy, with the exception that highly satisfied Chinese males report lower child wish in the next year. More depressed Chinese and German men and Chinese women reported lowered child wish, and stressed German men reported more child wish. Older students reported more (Chinese) or less (German) child wish depending on country.
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Affiliation(s)
- Jürgen Margraf
- The Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Germany
| | - Kristen L Lavallee
- The Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Germany
| | - Xiao Chi Zhang
- The Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Germany
| | - Jan K Woike
- Center for Adaptive Rationality (ARC), Max Planck Institute for Human Development, Berlin, Germany
| | - Silvia Schneider
- The Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Germany
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Borrás A, Manau D, Fabregues F, Peralta S, Calafell JM, Casals G, Saco A, Agustí I, Carmona F. Comparison between slow freezing and vitrification of ovarian tissue cryopreservation in assigned female at birth transgender people receiving testosterone therapy: data on histological and viability parameters. J Assist Reprod Genet 2022; 39:527-541. [PMID: 35098405 PMCID: PMC8956766 DOI: 10.1007/s10815-021-02386-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 12/20/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The use of fertility preservation (FP) techniques has significantly increased in recent years in the assigned female at birth (AFAB) transgender population. Oocyte cryopreservation is the established method for FP, but ovarian tissue cryopreservation may be considered an alternative option, especially during gender-affirming surgery (GAS). The slow freezing (SF) cryopreservation technique is the standard method for human ovarian tissue, but recently, several studies have shown good results with the vitrification (VT) technique. The objective of this study was to compare the effectiveness of VT and SF techniques in ovarian tissue from AFAB transgender people. METHODS This was a prospective study including 18 AFAB transgender people after GAS. Ovarian tissue pieces from each ovary were cryopreserved by SF and VT and compared with fresh tissue. Study by light microscopy (LM) assessed follicular morphology and density. The percentage of surviving and degenerated follicles was studied with the tissue viability test. Oocytes, granulosa cells and stroma were analysed separately by transmission electron microscopy. RESULTS The VT technique preserves follicle and stromal tissue as well as the SF method, but with some differences. Evaluation by LM showed better follicle preservation with VT, but the ultrastructural study showed the presence of minor damage with both techniques compared to fresh tissue. CONCLUSION Both cryopreservation techniques are accurate for maintaining the follicular population and stromal tissue. Further studies are needed to determine the impact of VT on ovarian tissue and the subsequent follicular activation mechanisms in AFAB ovarian tissue.
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Affiliation(s)
- Aina Borrás
- Assisted Reproduction Unit, Clinical Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clínic de Barcelona, Carrer de Villarroel N° 170, 08036 Barcelona, Spain
| | - Dolors Manau
- Assisted Reproduction Unit, Clinical Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clínic de Barcelona, Carrer de Villarroel N° 170, 08036 Barcelona, Spain ,Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Francesc Fabregues
- Assisted Reproduction Unit, Clinical Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clínic de Barcelona, Carrer de Villarroel N° 170, 08036 Barcelona, Spain ,Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Sara Peralta
- Assisted Reproduction Unit, Clinical Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clínic de Barcelona, Carrer de Villarroel N° 170, 08036 Barcelona, Spain
| | - Josep Maria Calafell
- Assisted Reproduction Unit, Clinical Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clínic de Barcelona, Carrer de Villarroel N° 170, 08036 Barcelona, Spain
| | - Gemma Casals
- Assisted Reproduction Unit, Clinical Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clínic de Barcelona, Carrer de Villarroel N° 170, 08036 Barcelona, Spain ,Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Adela Saco
- Department of Pathology, Hospital Clinic, University of Barcelona, Barcelona, Spain ,Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Inés Agustí
- Assisted Reproduction Unit, Clinical Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clínic de Barcelona, Carrer de Villarroel N° 170, 08036 Barcelona, Spain
| | - Francisco Carmona
- Assisted Reproduction Unit, Clinical Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clínic de Barcelona, Carrer de Villarroel N° 170, 08036 Barcelona, Spain ,Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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McCallion S, Smith S, Kyle H, Shaikh MG, Wilkinson G, Kyriakou A. An appraisal of current service delivery and future models of care for young people with gender dysphoria. Eur J Pediatr 2021; 180:2969-2976. [PMID: 33855617 DOI: 10.1007/s00431-021-04075-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/01/2021] [Accepted: 04/08/2021] [Indexed: 10/21/2022]
Abstract
The clinical needs of young people with gender dysphoria (GD) have outpaced the capacity of health services to provide appropriate care. The study aimed to explore the interface of Paediatric Endocrinology and young people with GD, detailing the clinical characteristics and the clinical care provided, in order to inform future service development. Medical records of all young people with GD (n=91, 59 (65%) birth-assigned females and 32 (35%) birth-assigned males) referred to Paediatric Endocrinology during 2011-2019 for puberty suppression were reviewed. Median age at initial assessment was 14.6 years (range 8.8-17.6 years). There was a threefold increase from 2016 (n=22) to 2019 (n=73). Mental health disorders were present in 34 (37%) and autistic spectrum disorder in 21 (23%), while 54 (59%) had at least one comorbidity. Sixty-four (70%) young people fulfilled the criteria for consideration of fertility preservation, with 6 (9%) of them preserving their gametes. Seventy-nine (87%) young people commenced treatment with gonadotrophin-releasing hormone analogue, at a median age of 14.8 years (range 9.7-18.0 years). Six (8%) of those discontinued treatment, following a median duration of 6 months (range 6-18 months). Forty-one young people commenced gender-affirming hormones. One (2%) of those who started gender-affirming hormones discontinued treatment.Conclusions: We have witnessed increasing numbers of young people with GD attending Paediatric Endocrinology, with an over-representation of comorbidities, necessitating provision of an individualised approach to treatment. Addressing young people's acceptability of fertility services and ongoing close collaboration between endocrinology and mental health professionals require innovative models of multidisciplinary care. What is Known: • A worldwide increase in presentation of gender dysphoria has been mirrored in our service, with majority assigned female at birth and post-pubertal. • An over-representation of comorbidities exists, notably mental health disorders and autistic spectrum disorder. What is New: • Coordination of interprofessional care to meet complex needs, at an individual level, while improving efficiency of working, at a systemic level, can be met by the development of specialist centres. • The reasons for low uptake of fertility services demand further exploration.
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Affiliation(s)
- Stephanie McCallion
- Department of Paediatric Endocrinology, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - Simon Smith
- Young People's Gender Service, Sandyford Services, 2-6 Sandyford Place, Glasgow, G3 7NB, UK
| | - Heather Kyle
- Department of Paediatric Endocrinology, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - M Guftar Shaikh
- Department of Paediatric Endocrinology, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - Gordon Wilkinson
- Young People's Gender Service, Sandyford Services, 2-6 Sandyford Place, Glasgow, G3 7NB, UK
| | - Andreas Kyriakou
- Department of Paediatric Endocrinology, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, UK.
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Chakraverty D, Baumeister A, Aldin A, Jakob T, Seven ÜS, Woopen C, Skoetz N, Kalbe E. Gender-Specific Aspects of Health Literacy: Perceptions of Interactions with Migrants among Health Care Providers in Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2189. [PMID: 32218279 PMCID: PMC7177965 DOI: 10.3390/ijerph17072189] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/12/2020] [Accepted: 03/20/2020] [Indexed: 02/03/2023]
Abstract
Health literacy can be described as a complex process shaped by individual resources and preferences and by the nature and quality of health-related information people encounter. The main objective of this study was to explore the views of health care professionals on how gender as a personal determinant of health literacy affected their interactions with migrant patients. The interrelated challenges, needs and applied solutions were analyzed from a health literacy perspective. Five focus group discussions with health care professionals working with migrants (n = 31) were conducted in Cologne, Germany, audio recorded, transcribed and analyzed by qualitative content analysis. Gender-specific aspects, such as the gender of health care providers as a factor, were portrayed above all in relation to patients from Turkey and Arab countries regarding access to and understanding of health-related information. These statements exclusively represent the possibly biased or assumptions-based perspectives of health care professionals on their migrant patients and were made against the background of a systemic lack of time and the challenge of overcoming language barriers. Especially in this context, reducing time pressure and improving communication in the treatment setting may be to the benefit of all actors within healthcare.
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Affiliation(s)
- Digo Chakraverty
- Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (Ü.S.S.); (E.K.)
| | - Annika Baumeister
- Research Unit Ethics, Faculty of Medicine and University Hospital of Cologne, and Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (CERES), University of Cologne, 50931 Cologne, Germany; (A.B.); (C.W.)
| | - Angela Aldin
- Evidence-Based Internal Medicine, Department I of Internal Medicine and Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50935 Cologne, Germany; (A.A.); (T.J.); (N.S.)
| | - Tina Jakob
- Evidence-Based Internal Medicine, Department I of Internal Medicine and Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50935 Cologne, Germany; (A.A.); (T.J.); (N.S.)
| | - Ümran Sema Seven
- Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (Ü.S.S.); (E.K.)
| | - Christiane Woopen
- Research Unit Ethics, Faculty of Medicine and University Hospital of Cologne, and Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (CERES), University of Cologne, 50931 Cologne, Germany; (A.B.); (C.W.)
| | - Nicole Skoetz
- Evidence-Based Internal Medicine, Department I of Internal Medicine and Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50935 Cologne, Germany; (A.A.); (T.J.); (N.S.)
| | - Elke Kalbe
- Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (Ü.S.S.); (E.K.)
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Hegyi BE, Kozinszky Z, Badó A, Dombi E, Németh G, Pásztor N. Anxiety and depression symptoms in infertile men during their first infertility evaluation visit. J Psychosom Obstet Gynaecol 2019; 40:311-317. [PMID: 30624134 DOI: 10.1080/0167482x.2018.1515906] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objective: To assess the psychological condition of men at the start of the infertility work-up. Methods: Men seeking an infertility evaluation for the first time were recruited. Depression and anxiety symptoms and subjective psychological burden were assessed with the Beck Depression Inventory (BDI), the Spielberger State-Trait Anxiety Inventory (STAI), and a visual analog scale (VAS). Results: Data from 113 patients were analyzed. The mean age of the patients was 33.3 (range: 23-54) years, whereas the mean duration of infertility was 16.3 (range: 0-96) months. Results from the BDI and STAI were 2.24 (SD: ±3.18) and 33.74 (SD: ±8.04). Mild depressive symptoms were found in 4.5% of patients, whereas anxiety reached an abnormal level in 4.9%. There were significant correlations between the results from the BDI score and the duration of infertility (p = .024), whereas the STAI and VAS scores showed no similar connection (p = .142 and p = .261, respectively). Among patients with infertility longer than 2 years, mild depressive symptoms occurred in 23.1%. Conclusion: Among men, the levels of depressive and anxiety symptoms were low at the start of the infertility work-up. Depressive symptom levels increased significantly with the duration of infertility, whereas anxiety levels and VAS scores did not demonstrate a similar correlation.
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Affiliation(s)
- Borbála Eszter Hegyi
- Department of Obstetrics and Gynecology, University of Szeged , Szeged , Hungary
| | - Zoltan Kozinszky
- Department of Obstetrics and Gynaecology, Blekinge Hospital, Landstinget Blekinge , Karlskrona , Sweden
| | - Attila Badó
- Department of Obstetrics and Gynecology, University of Szeged , Szeged , Hungary
| | - Edina Dombi
- Department of Obstetrics and Gynecology, University of Szeged , Szeged , Hungary
| | - Gábor Németh
- Department of Obstetrics and Gynecology, University of Szeged , Szeged , Hungary
| | - Norbert Pásztor
- Department of Obstetrics and Gynecology, University of Szeged , Szeged , Hungary
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Sousa-Leite M, Figueiredo B, Ter Keurst A, Boivin J, Gameiro S. Women's attitudes and beliefs about using fertility preservation to prevent age-related fertility decline-A two-year follow-up. PATIENT EDUCATION AND COUNSELING 2019; 102:1695-1702. [PMID: 31003877 DOI: 10.1016/j.pec.2019.03.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 03/25/2019] [Accepted: 03/26/2019] [Indexed: 05/23/2023]
Abstract
OBJECTIVE The health belief and transtheoretical model were used to describe how women make decisions about fertility preservation (FP) and identify factors that predict their decisions. METHODS This is a two-year prospective study with 107 childless women aged 30-37. Women filled anonline survey assessing individual factors, intentions to do FP, variables of the health belief model, FP decisional stage and FP behaviour. RESULTS Women´s intentions, desire and number of children wanted decreased, fertility knowledge and perceived susceptibility to infertility increased and perceived severity of infertility decreased. A low number of women progressed through the stages of the decision-making process. Only 14% reached a decision and all decided not to do FP. Women's baseline intentions to do FP predicted their decision. CONCLUSION Women at the optimal age range to do FP (28-35 years) do not engage in decision-making about it, which reflects their initial low intentions to do FP. Women's decision about FP is influenced by their perceptions about the technique. PRATICAL IMPLICATIONS Women with a high desire for parenthood and within the optimal age range to do FP should receive accurate information about it and could benefit from prompts to engage in active decision-making about doing it.
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Affiliation(s)
- Mariana Sousa-Leite
- School of Psychology, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal.
| | - Bárbara Figueiredo
- School of Psychology, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal.
| | - Anne Ter Keurst
- Rijnstate Hospital, Wagnerlaan 55, 6815 AD Arnhem, the Netherlands.
| | - Jacky Boivin
- Cardiff Fertility Studies Group, School of Psychology, Cardiff University, 70 Park Place, CF10 3AT, Cardiff, UK.
| | - Sofia Gameiro
- Cardiff Fertility Studies Group, School of Psychology, Cardiff University, 70 Park Place, CF10 3AT, Cardiff, UK.
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10
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Desire to Have Children Among Transgender People in Germany: A Cross-Sectional Multi-Center Study. J Sex Med 2018; 15:757-767. [DOI: 10.1016/j.jsxm.2018.03.083] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 03/22/2018] [Accepted: 03/27/2018] [Indexed: 11/23/2022]
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Kato T. Associations of gender role attitudes with fertility intentions: A Japanese population-based study on single men and women of reproductive ages. SEXUAL & REPRODUCTIVE HEALTHCARE 2018; 16:15-22. [PMID: 29804759 DOI: 10.1016/j.srhc.2018.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 01/11/2018] [Accepted: 01/13/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Japan has been experiencing low fertility for many years. In this study, I investigated the relationship between gender role attitudes and fertility intentions among Japanese single men and women of reproductive ages. STUDY DESIGN Utilizing the Longitudinal Survey of Adults in the 21st Century data, 8944 men and 7924 women aged 20-34 years with single, childless status were analyzed. Gender role attitudes were assessed by participants' preferences for the division of labor between a man and a woman: income earning, housework, and childcare. Those who preferred men to earn income and women to perform housework and childcare were considered to have traditional attitudes, whereas those who preferred women and men to share these responsibilities were considered to have egalitarian attitudes. MAIN OUTCOME MEASURES Outcomes were fertility intentions measured by a desire to have children and ideal number of children. Logistic regression analyses were conducted. RESULTS Egalitarian attitudes about income earning and housework were associated with low fertility intentions (a lesser desire for children) compared to traditional attitudes: adjusted odds ratios were 1.56 [1.36, 1.80] for men and 1.47 [1.26, 1.72] for women with income earning. Men's preference for sharing childcare responsibility was associated with high fertility intentions. CONCLUSIONS Japanese society has not shifted away from the traditional division of labor despite the increase in female labor force participation. Low fertility intentions among Japanese men and women with egalitarian attitudes suggest that institutional support for balancing work and family may be necessary to improve the low fertility trend.
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Affiliation(s)
- Tsuguhiko Kato
- Division Chief, the Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan.
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Wolf LJ, Maio GR, Karremans JC, Leygue C. On implicit racial prejudice against infants. GROUP PROCESSES & INTERGROUP RELATIONS 2016. [DOI: 10.1177/1368430216629812] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Because of the innocence and dependence of children, it would be reassuring to believe that implicit racial prejudice against out-group children is lower than implicit prejudice against out-group adults. Yet, prior research has not directly tested whether or not adults exhibit less spontaneous prejudice toward child targets than adult targets. Three studies addressed this issue, contrasting adults with very young child targets. Studies 1A and B revealed that participants belonging to an ethnic majority group (White Europeans) showed greater spontaneous favorability toward their ethnic in-group than toward an ethnic out-group (South Asians), and this prejudice emerged equally for infant and adult targets. Study 2 found that this pattern occurred even when race was not a salient dimension of categorization in the implicit measure. Thus, there was a robust preference for in-group children over out-group children, and there was no evidence that this prejudice is weaker than that exhibited toward adults.
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La Sala GB, Morini D, Gizzo S, Nicoli A, Palomba S. Two consecutive singleton pregnancies versus one twins pregnancy as preferred outcome of in vitro fertilization for mothers and infants: a retrospective case-control study. Curr Med Res Opin 2016; 32:687-92. [PMID: 26709632 DOI: 10.1185/03007995.2015.1136602] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Many infertile couples request a multiple embryo transfer because they desire more than one child. Based on this consideration, the current study aimed to compare the reproductive and perinatal outcomes of two consecutive singleton pregnancies versus one twin pregnancy in a large cohort of in vitro fertilization (IVF) patients. RESEARCH DESIGN AND METHODS Retrospective analysis of data from patients with clinical twin pregnancy after IVF fresh cycles and from patients with two consecutive IVF fresh cycles and clinical singleton pregnancy. MAIN OUTCOME MEASURES Miscarriage rate, delivery rate, gestational age at birth, neonatal birth weight, and perinatal complications. A sub-analysis of data according to vanishing twin syndrome (VTS) was also performed. RESULTS A total of 18,703 autologous fresh cycles were analyzed. One hundred seven patients had two consecutive singleton clinical pregnancies, whereas one clinical twin pregnancy occurred in 641 women. In patients who had two consecutive singleton clinical pregnancies the rates of overall pregnancies lost (odds ratio [OR] 4.9, 95% confidence interval [CI] 3.4, 6.9) and live births (OR 0.2, 95% CI 0.1, 0.3) were, respectively, higher and lower when compared to patients who had one clinical twin pregnancy. That data did not change after sub-analysis for VTS. The overall risk of perinatal complications was significantly higher in patients who had one twin delivery rather than patients who had two consecutive singleton deliveries (OR 31.8, 95% CI 14.1, 71.5). No difference between groups was detected in terms of intrauterine/neonatal deaths, perinatal mortality and neonatal intensive care unit admission. Data did not change after adjusting for confounders. CONCLUSIONS When compared with two consecutive singleton pregnancies, twin pregnancies are characterized by higher success rates but worse perinatal outcomes irrespectively of VTS. Well designed prospective controlled studies are needed to confirm or rebut current retrospective findings.
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Affiliation(s)
- Giovanni Battista La Sala
- a Center of Reproductive Medicine and Surgery, Arcispedale Santa Maria Nuova (ASMN) - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) , Reggio Emilia , Italy
- b University of Modena and Reggio Emilia , Italy
| | - Daria Morini
- a Center of Reproductive Medicine and Surgery, Arcispedale Santa Maria Nuova (ASMN) - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) , Reggio Emilia , Italy
| | - Salvatore Gizzo
- c Department of Woman and Child Health , University of Padua , Padua , Italy
| | - Alessia Nicoli
- a Center of Reproductive Medicine and Surgery, Arcispedale Santa Maria Nuova (ASMN) - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) , Reggio Emilia , Italy
| | - Stefano Palomba
- a Center of Reproductive Medicine and Surgery, Arcispedale Santa Maria Nuova (ASMN) - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) , Reggio Emilia , Italy
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Kleinert E, Martin O, Brähler E, Stöbel-Richter Y. Motives and decisions for and against having children among nonheterosexuals and the impact of experiences of discrimination, internalized stigma, and social acceptance. JOURNAL OF SEX RESEARCH 2013; 52:174-185. [PMID: 24354688 DOI: 10.1080/00224499.2013.838745] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Same-sex parents are increasingly a topic of public discourse. A growing number of homosexuals openly speak about their desire to have children or are already living together in different family constellations. The current study examined the decisions for or against having children and the motivations behind those decisions among nonheterosexuals living in Germany. A sample of 1,283 nonheterosexuals participated by means of an online survey. As some nonheterosexual individuals do not identify themselves with a male or female gender identity, a third category, "gender different," was generated. Motives for (not) having children, perceptions of social acceptance, experiences of discrimination in relation to one's sexual orientation, and levels of internalized stigma were taken into account regarding their influence on the decision about parenthood. Most respondents (80%) reported that they did not have children. However, among this group, 43% stated that they had decided to have children later in their lives, 24% were undecided, and 11% had already decided against having children. The most important influences on the decision of whether to have children were respondents' age and their desire for emotional stabilization. Negative experiences as a result of sexual orientation and internalized stigma had no impact on the decisions regarding parenthood.
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Affiliation(s)
- Evelyn Kleinert
- a Department of Medical Psychology and Medical Sociology , University of Leipzig
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Fügener J, Matthes A, Strauß B. Knowledge and Behaviour of Young People Concerning Fertility Risks - Results of a Questionnaire. Geburtshilfe Frauenheilkd 2013; 73:800-807. [PMID: 24771934 DOI: 10.1055/s-0033-1350761] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Revised: 06/18/2013] [Accepted: 07/26/2013] [Indexed: 10/26/2022] Open
Abstract
Purpose: The aim of this study was, in the light of the increasing number of involuntarily childless couples, to investigate the state of knowledge of young people of fertile age about the risks for fertility disorders and their own risk behaviour. In addition, we wanted to check for a relationship between these aspects and the motives for wanting children, individual personality traits and psychological status. Materials and Methods: 498 women and men between the ages of 18 and 30 years participated in an anonymous survey. The sample consisted of 153 medical students, 190 students from other faculties and 155 vocational trainees. Their knowledge was tested by way of open questions on reproduction. The sum total from relevant life-style factors was used to estimate their risk-taking behaviour. Their psychic states were examined using the Health Questionnaire for Patients "Gesundheitsfragebogen für Patienten" PHQ-D, in addition the Leipzig Questionnaire on Motives for Wanting Children "Der Leipziger Fragebogen zu Kinderwunschmotiven" and the short version of the "Big Five Inventory" BFI-K were used. Results: The participants were aware of the risks for fertility disorders but did not always correctly assess their influence on fertility. Their knowledge about reproduction was rather low (on average 6.3 from 16 points). Medical students had a significantly higher state of knowledge and exhibited less risky behaviour as compared to the other two groups. Depressiveness and risky behaviour correlated positively and emotional aspects played the major role in attitudes towards having children. Risk behaviour was best predicted by the variables depressiveness, low level of knowledge and the feeling of being restricted in personal life by children. Discussion: Lack of knowledge on the topics fertility and reproduction could be a reason for risky behaviour and thus have a negative impact on lifestyle factors relating to fertility. Young people are aware of the risk factors that may affect fertility but do not always act accordingly. Primary prevention or, respectively, health promotion is thus necessary to prevent further increases in the number of infertile couples.
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Affiliation(s)
- J Fügener
- Institut für Psychosoziale Medizin und Psychotherapie, Universitätsklinikum Jena, Jena
| | - A Matthes
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Jena, Jena
| | - B Strauß
- Institut für Psychosoziale Medizin und Psychotherapie, Universitätsklinikum Jena, Jena
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Papaligoura ZG, Papadatou D, Bellali T. The wish for a child among individuals who conceive with assisted reproduction technologies. J Reprod Infant Psychol 2012. [DOI: 10.1080/02646838.2012.744960] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Zaira G. Papaligoura
- a Department of Psychology , Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Danai Papadatou
- b Department of Nursing , University of Athens , Athens , Greece
| | - Thalia Bellali
- c Faculty of Nursing, Alexandreio Technological Educational Institute , Thessaloniki, Greece
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Hammarberg K, Setter T, Norman RJ, Holden CA, Michelmore J, Johnson L. Knowledge about factors that influence fertility among Australians of reproductive age: a population-based survey. Fertil Steril 2012; 99:502-7. [PMID: 23158832 DOI: 10.1016/j.fertnstert.2012.10.031] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 10/02/2012] [Accepted: 10/16/2012] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To explore knowledge about the effects on fertility of age, obesity, smoking, and timing of intercourse among Australians of reproductive age. DESIGN Telephone survey of a representative sample of Australians. SETTING Not applicable. PATIENT(S) Australians aged 18 to 45 years who wish to have a child or another child now or in the future. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Knowledge about the effect on fertility of age, obesity, smoking, and timing of intercourse. RESULT(S) A total of 462 interviews were conducted. The majority of respondents underestimated, by about 10 years, the age at which male and female fertility starts to decline. Only one in four correctly identified that female fertility starts to decline before age 35, and one in three identified that male fertility starts to decline before age 45. Most (59%) were aware that female obesity and smoking affect fertility, but fewer recognized that male obesity (30%) and smoking (36%) also influence fertility. Almost 40% of respondents had inadequate knowledge of when in the menstrual cycle a woman is most likely to conceive. CONCLUSION(S) Considerable knowledge gaps about modifiable factors that affect fertility were identified. These are targeted in a national education campaign to promote awareness of factors that influence fertility.
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Affiliation(s)
- Karin Hammarberg
- Victorian Assisted Reproductive Treatment Authority, Melbourne, Victoria, Australia.
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Moura-Ramos M, Gameiro S, Canavarro M, Soares I, Santos T. The indirect effect of contextual factors on the emotional distress of infertile couples. Psychol Health 2012; 27:533-49. [DOI: 10.1080/08870446.2011.598231] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Mascarenhas MN, Flaxman SR, Boerma T, Vanderpoel S, Stevens GA. National, regional, and global trends in infertility prevalence since 1990: a systematic analysis of 277 health surveys. PLoS Med 2012; 9:e1001356. [PMID: 23271957 PMCID: PMC3525527 DOI: 10.1371/journal.pmed.1001356] [Citation(s) in RCA: 1119] [Impact Index Per Article: 93.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 11/07/2012] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Global, regional, and national estimates of prevalence of and tends in infertility are needed to target prevention and treatment efforts. By applying a consistent algorithm to demographic and reproductive surveys available from developed and developing countries, we estimate infertility prevalence and trends, 1990 to 2010, by country and region. METHODS AND FINDINGS We accessed and analyzed household survey data from 277 demographic and reproductive health surveys using a consistent algorithm to calculate infertility. We used a demographic infertility measure with live birth as the outcome and a 5-y exposure period based on union status, contraceptive use, and desire for a child. We corrected for biases arising from the use of incomplete information on past union status and contraceptive use. We used a Bayesian hierarchical model to estimate prevalence of and trends in infertility in 190 countries and territories. In 2010, among women 20-44 y of age who were exposed to the risk of pregnancy, 1.9% (95% uncertainty interval 1.7%, 2.2%) were unable to attain a live birth (primary infertility). Out of women who had had at least one live birth and were exposed to the risk of pregnancy, 10.5% (9.5%, 11.7%) were unable to have another child (secondary infertility). Infertility prevalence was highest in South Asia, Sub-Saharan Africa, North Africa/Middle East, and Central/Eastern Europe and Central Asia. Levels of infertility in 2010 were similar to those in 1990 in most world regions, apart from declines in primary and secondary infertility in Sub-Saharan Africa and primary infertility in South Asia (posterior probability [pp] ≥0.99). Although there were no statistically significant changes in the prevalence of infertility in most regions amongst women who were exposed to the risk of pregnancy, reduced child-seeking behavior resulted in a reduction of primary infertility among all women from 1.6% to 1.5% (pp=0.90) and a reduction of secondary infertility among all women from 3.9% to 3.0% (pp>0.99) from 1990 to 2010. Due to population growth, however, the absolute number of couples affected by infertility increased from 42.0 million (39.6 million, 44.8 million) in 1990 to 48.5 million (45.0 million, 52.6 million) in 2010. Limitations of the study include gaps in survey data for some countries and the use of proxies to determine exposure to pregnancy. CONCLUSIONS We analyzed demographic and reproductive household survey data to reveal global patterns and trends in infertility. Independent from population growth and worldwide declines in the preferred number of children, we found little evidence of changes in infertility over two decades, apart from in the regions of Sub-Saharan Africa and South Asia. Further research is needed to identify the etiological causes of these patterns and trends.
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Affiliation(s)
- Maya N. Mascarenhas
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
| | - Seth R. Flaxman
- Machine Learning Department, School of Computer Science, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States of America
- School of Public Policy and Management, H. John Heinz III College, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States of America
| | - Ties Boerma
- Department of Health Statistics and Information Systems, World Health Organization, Geneva, Switzerland
| | - Sheryl Vanderpoel
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Gretchen A. Stevens
- Department of Health Statistics and Information Systems, World Health Organization, Geneva, Switzerland
- * E-mail:
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Fisher JRW, Hammarberg K. Psychological and social aspects of infertility in men: an overview of the evidence and implications for psychologically informed clinical care and future research. Asian J Androl 2011; 14:121-9. [PMID: 22179515 DOI: 10.1038/aja.2011.72] [Citation(s) in RCA: 121] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Research concerning the psychosocial aspects of infertility and infertility treatment focuses more often on women than men. The aim of this review was to synthesize the English-language evidence related to the psychological and social aspects of infertility in men and discuss the implications of these reports for clinical care and future research. A structured search identified 73 studies that reported data concerning the desire for fatherhood and the psychological and social aspects of diagnosis, assisted reproductive technology (ART) treatment and unsuccessful treatment among men with fertility difficulties. The studies are diverse in conceptualisation, design, setting and data collection, but the findings were reasonably consistent. These studies indicated that fertile and infertile childless men of reproductive age have desires to experience parenthood that are similar to those of their female counterparts; in addition, diagnosis and initiation of treatment are associated with elevated infertility-specific anxiety, and unsuccessful treatment can lead to a state of lasting sadness. However, rates of clinically significant mental health problems among this patient population are no higher than in the general population. Infertile men who are socially isolated, have an avoidant coping style and appraise stressful events as overwhelming, are more vulnerable to severe anxiety than men without these characteristics. Men prefer oral to written treatment information and prefer to receive emotional support from infertility clinicians rather than from mental health professionals, self-help support groups or friends. Nevertheless, structured, facilitated psycho-educational groups that are didactic but permit informal sharing of experiences might be beneficial. There are gaps in knowledge about factors governing seeking, persisting with and deciding to cease treatment; experiences of invasive procedures; parenting after assisted conception; adoption and infertility-related grief and shame among men. Few resource-constrained countries have any data concerning male experiences of infertility.
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Affiliation(s)
- Jane R W Fisher
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Clayton, Vic., Australia.
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Loke AY, Yu PL, Hayter M. Experiences of sub-fertility among Chinese couples in Hong Kong: a qualitative study. J Clin Nurs 2011; 21:504-12. [DOI: 10.1111/j.1365-2702.2010.03632.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Mancini J, Rey D, Préau M, Le Corroller-Soriano AG, Moatti JP. Barriers to procreational intentions among cancer survivors 2 years after diagnosis: a French national cross-sectional survey. Psychooncology 2011; 20:12-8. [PMID: 20151410 DOI: 10.1002/pon.1714] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To determine the procreational intention rates among cancer survivors whose fertility was unimpaired and to identify the factors associated with their procreational intentions. METHODS Six thousand nine hundred and fifty-seven adult cancer patients treated between September and October 2002 were randomly selected from the French National Health Insurance Fund's Chronic Disease File. Of the 6957, 4270 responded to a cross-sectional questionnaire 2 years after diagnosis, of whom 959 reported being fertile and responded to a question about their procreational intentions. RESULTS Among the 257 male and female survivors aged 20-44, 86 (33.5%) had procreational intentions. After adjusting for age, gender, and already having children, only a high educational level (adjusted odds ratio: 3.1, 95% confidence interval 1.3-7.8) and stable or increasing financial resources (2.4, 1.0-5.7) were independently associated with the respondents' procreational intentions. Neither cancer stage at diagnosis nor the present stage significantly affected their plans in this respect. CONCLUSIONS Two years after cancer diagnosis, the reasons why some survivors who are still fertile have no parenthood projects were similar to those earlier given by members of the general population.
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Affiliation(s)
- Julien Mancini
- INSERM, U912 Economic & Social Sciences, Health Systems & Societies, Paoli-Calmettes Institute, Marseille, France.
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Leeners B, Neumaier-Wagner P, Kuse S, Merki S, Stiller R, Neises M, Imthurn B, Rath W. Motivation for motherhood in women with hypertensive diseases in pregnancy. J Psychosom Obstet Gynaecol 2009; 30:133-40. [PMID: 19533494 DOI: 10.1080/01674820802545438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To investigate the motivation for motherhood in women with hypertensive diseases in pregnancy. METHODS A questionnaire was sent to 2600 women with hypertensive diseases in pregnancy and 1233 controls. Diagnoses from medical records were differentiated according to the International Society for the Study of Hypertension in Pregnancy criteria. After matching, data from 739 patients and 623 controls were evaluated with Student's-t, Chi square tests and multiple logistic regression models. RESULTS Women with hypertensive diseases in pregnancy longed more often for children (85.3%/70.3%, p < 0.0001), considered children more often as the sense of their life (33.6%/29.7%, p < 0.005) and used pregnancy more often to stop a disliked professional activity (9.7%/2.3%, p < 0.0001). Controls reported more often to give birth to avoid termination of pregnancy (5.3%/10.4%, p = 0.0005). CONCLUSIONS Women with hypertensive diseases in pregnancy concentrate more extensively on motherhood in their life. If this attitude is already present before pregnancy it may augment the risk for disease and might be used for prophylaxis.
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Affiliation(s)
- Brigitte Leeners
- Department of Gynecology and Obstetrics, University Hospital Zürich, Zürich, Swizterland.
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Rios MG, Gomes IC. Casamento contemporâneo: revisão de literatura acerca da opção por não ter filhos. ESTUDOS DE PSICOLOGIA (CAMPINAS) 2009. [DOI: 10.1590/s0103-166x2009000200009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Em meio às diversas transformações sofridas pelo casamento e pela família ao longo da história, várias configurações familiares convivem na contemporaneidade: nuclear, monoparental, homoparental, recomposta, entre outras possibilidades. Nesse contexto, aumenta, em vários países, e mais recentemente no Brasil, o número de casais que escolhem não ter filhos. O objetivo deste trabalho foi realizar uma revisão bibliográfica sobre o tema, incluindo publicações nacionais e internacionais. A busca foi feita em bases de dados (Web of Science, PsycINFO, Medline, SciELO, Lilacs, Psicodoc, BVS-Psi, Dedalus), e foram levantados artigos completos em periódicos indexados e resumos de teses e dissertações produzidas nos últimos dez anos. Os resultados coletados abordam diversas facetas do fenômeno da escolha contemporânea por não ter filhos: motivações declaradas, associação entre esse tipo de escolha e a situação profissional, relação com fatores de história de vida e família de origem, satisfação de vida e conjugal, preconceito e estereótipos negativos.
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Baruffi RLR, Mauri AL, Petersen CG, Nicoletti A, Pontes A, Oliveira JBA, Franco JG. Single-embryo transfer reduces clinical pregnancy rates and live births in fresh IVF and Intracytoplasmic Sperm Injection (ICSI) cycles: a meta-analysis. Reprod Biol Endocrinol 2009; 7:36. [PMID: 19389258 PMCID: PMC2680863 DOI: 10.1186/1477-7827-7-36] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Accepted: 04/23/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It has become an accepted procedure to transfer more than one embryo to the patient to achieve acceptable ongoing pregnancy rates. However, transfers of more than a single embryo increase the probability of establishing a multiple gestation. Single-embryo transfer can minimize twin pregnancies but may also lower live birth rates. This meta-analysis aimed to compare current data on single-embryo versus double-embryo transfer in fresh IVF/ICSI cycles with respect to implantation, ongoing pregnancy and live birth rates. METHODS Search strategies included on-line surveys of databases from 1995 to 2008. Data management and analysis were conducted using the Stats Direct statistical software. The fixed-effect model was used for odds ratio (OR). Fixed-effect effectiveness was evaluated by the Mantel Haenszel method. Seven trials fulfilled the inclusion criteria. RESULTS When pooling results under the fixed-effect model, the implantation rate was not significantly different between double-embryo transfer (34.5%) and single-embryo transfer group (34.7%) (P = 0.96; OR = 0.99, 95% CI 0.78, 1.25). On the other hand, double-embryo transfer produced a statistically significantly higher ongoing clinical pregnancy rate (44.5%) than single-embryo transfer (28.3%) (P < 0.0001; OR:2.06, 95% CI = 1.64,2.60). At the same time, pooling results presented a significantly higher live birth rate when double-embryo transfer (42.5%) (P < 0.001; OR: 1.87, 95% CI = 1.44,2.42) was compared with single-embryo transfer (28.4%). CONCLUSION Meta-analysis with 95% confidence showed that, despite similar implantation rates, fresh double-embryo transfer had a 1.64 to 2.60 times greater ongoing pregnancy rate and 1.44 to 2.42 times greater live birth rate than single-embryo transfer in a population suitable for ART treatment.
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Affiliation(s)
- Ricardo LR Baruffi
- Center for Human Reproduction – Prof Franco Junior, Ribeirão Preto, Sao Paolo, Brazil
| | - Ana L Mauri
- Center for Human Reproduction – Prof Franco Junior, Ribeirão Preto, Sao Paolo, Brazil
| | - Claudia G Petersen
- Center for Human Reproduction – Prof Franco Junior, Ribeirão Preto, Sao Paolo, Brazil
| | - Andréia Nicoletti
- Center for Human Reproduction – Prof Franco Junior, Ribeirão Preto, Sao Paolo, Brazil
| | - Anagloria Pontes
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University – UNESP, Botucatu, Sao Paolo, Brazil
| | - João Batista A Oliveira
- Center for Human Reproduction – Prof Franco Junior, Ribeirão Preto, Sao Paolo, Brazil
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University – UNESP, Botucatu, Sao Paolo, Brazil
| | - José G Franco
- Center for Human Reproduction – Prof Franco Junior, Ribeirão Preto, Sao Paolo, Brazil
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University – UNESP, Botucatu, Sao Paolo, Brazil
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Fisher JRW, Baker GHW, Hammarberg K. Long-term health, well-being, life satisfaction, and attitudes toward parenthood in men diagnosed as infertile: challenges to gender stereotypes and implications for practice. Fertil Steril 2009; 94:574-80. [PMID: 19342027 DOI: 10.1016/j.fertnstert.2009.01.165] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Revised: 01/22/2009] [Accepted: 01/30/2009] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To investigate attitudes toward parenthood, long-term life satisfaction, and health and well-being in men diagnosed as infertile. DESIGN A cross-sectional survey of a cohort of men 5 years after diagnosis of infertility. SETTING The andrology clinic at the Royal Women's Hospital Reproductive Services, Melbourne Australia. PATIENT(S) All men diagnosed at this center as infertile in 2001 and 2002. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Attitudes to parenthood (Meaning of Parenthood), quality of intimate relationship (Intimate Bonds Measure), personality characteristics (Vulnerable Personality Style Questionnaire), life satisfaction (Satisfaction with Life Scale), and self-rated physical health (Physical Component Summary of SF-12 [PCS-12]) and relationship with mental health (Mental Component Summary of SF12 [MCS-12]). RESULT(S) A total of 112 (41%) of 276 men completed the survey. Of these, 96% had pursued infertility treatment and 87% had become fathers. Only 10% thought that fertility confirmed by fatherhood reflected masculinity, and 84% desired parenthood as much as their partners did. When all other factors were controlled for, men who had not become fathers had poorer mental health (MCS-12 score = 43.9 +/- 9.9) than those who were fathers (MCS-12 score = 49.25 +/- 8.7). CONCLUSION(S) Clinical practice should not presume that infertile men conflate fertility and masculinity, are less distressed than women about the potential loss of parenthood, or adjust more readily to childlessness, which appear to be inaccurate but widespread stereotypes.
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Affiliation(s)
- Jane R W Fisher
- Key Centre for Women's Health in Society, Melbourne School of Population Health, University of Melbourne, Melbourne, Victoria, Australia.
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Scarpa B, Dunson DB, Giacchi E. Bayesian selection of optimal rules for timing intercourse to conceive by using calendar and mucus. Fertil Steril 2007; 88:915-24. [PMID: 17601602 DOI: 10.1016/j.fertnstert.2006.12.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2006] [Revised: 12/13/2006] [Accepted: 12/13/2006] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To find optimal clinical rules that maximize the probability of conception while limiting the number of intercourse days required. DESIGN Multicenter prospective study. Women were followed prospectively while they kept daily records of menstrual bleeding, intercourse, and mucus symptom characteristics. In some cycles, women sought to conceive, whereas in other cycles, they sought to avoid pregnancy. SETTING Four centers providing services on fertility awareness. PATIENT(S) One hundred ninety-one healthy women using the Billings Ovulation Method. Women were invited to enroll by their instructors if they satisfied the entry criteria. We excluded cycles in which mucus was not recorded on a day with intercourse. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Clinically identified pregnancies. There were 161 clinically identified pregnancies in 2,536 menstrual cycles from 191 women. RESULT(S) Our approach relies on a statistical model that relates daily predictors, such as type of mucus symptom, to the day-specific probabilities of conception. By using Bayesian methods to search over a large set of possible clinical rules, focusing on rules based on calendar and mucus, we found that simple rules that are based on days within the midcycle calendar interval that also have the most fertile-type mucus symptom present have high utility. CONCLUSION(S) Couples can shorten their time to pregnancy efficiently by timing intercourse on days that the most fertile-type mucus symptom is observed at the vulva.
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Affiliation(s)
- Bruno Scarpa
- Department of Statistical Sciences, University of Padua, Padua, Italy
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29
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Abstract
Parenting a child is one of the most universal, common and fundamental assumptions the majority of men and women make from an early age about their future. This common and historic assumption was challenged in modernized Western societies in the 1960s with the opportunities for 'mass control' of reproduction and then again supported in the 1980s with the advance of 'mass enhancement' of reproduction. This study qualitatively assessed the meaning of parenthood of post modern British individuals of different ages, gender, cultural backgrounds and parity. The results of the Interpretative Phenomenological Analyses revealed a number of common ideologies about parenthood, and a number of specific age, gender, parity and cultural differences in how individuals interpret and experience parenthood. These individual differences play a significant part in the quality of life of people gaining or losing the opportunity to parent, as has been discussed 'around the globe' by Frank van Balen and his team, and must be considered in counselling people faced with decisions which challenge their personal and universal assumptions to parent a genetically related child.
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Affiliation(s)
- Satvinder Purewal
- Department of Psychology, School of Life & Health Sciences, Aston University, Birmingham, UK.
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30
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Krones T, Neuwohner E, Bock K, Manolopoulos K, Tinneberg HR, Richter G. Attitudes of patients, healthcare professionals and ethicists towards embryonic stem cell research and donation of gametes and embryos in Germany. Reprod Biomed Online 2007; 13:607-17. [PMID: 17169169 DOI: 10.1016/s1472-6483(10)60650-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Due to the Embryo Protection Act, creation of supernumerary embryos, as well as egg and embryo donation, is prohibited in Germany. Human stem cell research is regulated through the Act on stem cells that came into force in 2002. A cross-sectional survey of 101 IVF couples (n=202) in two fertility centres, and representative samples of healthcare professionals and ethicists (n=879), was carried out, and their attitudes towards embryonic stem cell research and donation of gametes and embryos compared. A clear majority of IVF couples favoured legalization of egg and embryo donation and embryonic stem cell research for various purposes. The willingness of couples to donate was related to purpose and to other independent influences. The majority of physicians voted for legalization of embryonic stem cell production from surplus embryos. Most human geneticists and obstetricians approved egg, but not embryo, donation to other couples. Ethicists and midwives were opposed to every kind of donation and research on surplus embryos. The IVF couples surveyed have positive attitudes towards donation and research using surplus embryos, whereas the healthcare professionals and ethicists are predominantly sceptical about most research activities destroying human embryos. This difference should be considered carefully in legal and ethical discussions on reprogenetics.
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Affiliation(s)
- T Krones
- Bioethics-Clinical Ethics, University of Marburg, Pilgrimsstein 3, 35033 Marburg, and Department of Obstetrics, University Hospital, Giessen, Germany.
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van Wely M, Twisk M, Mol BW, van der Veen F. Is twin pregnancy necessarily an adverse outcome of assisted reproductive technologies? Hum Reprod 2006; 21:2736-8. [PMID: 16793994 DOI: 10.1093/humrep/del249] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
It has recently been suggested that the measure of success of assisted reproductive technologies (ART) should be the birth of a singleton baby, whereas a twin pregnancy should be considered as a complication. Although the maternal and neonatal complications in twin pregnancies are significantly higher than those in singleton pregnancies, the classification of a twin pregnancy as a complication of ART is in our opinion debatable. Most twin pregnancies result in the birth of two healthy babies, with little or no complication for the mother, and only few twin pregnancies results in serious morbidity of the mother and of one or both of the children. The crux of our arguments is that one should consider those cases as poor outcomes and not a twin pregnancy per se.
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Affiliation(s)
- M van Wely
- Center for Reproductive Medicine, Academic Medical Center, Amsterdam, The Netherlands.
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