Fertility quality of life (FertiQoL) among Chinese women undergoing frozen embryo transfer

Type D personality, and quality of life in couples undergoing in vitro fertilization treatment:the role of dyadic coping

There is limited research on the relationship between type D personality, dyadic coping, and quality of life (QoL), with most studies focusing on the individual perspective rather than the dyadic perspective. Additionally, evidence for the systemic-transaction model (STM) is limited, and research on infertile couples is scarce. This study investigated the relationship between type D personality and QoL in couples with infertility through the mediation of dyadic coping mechanisms. The present descriptive cross-sectional study recruited 452 infertile couples (N = 904) receiving in vitro fertilization (IVF) treatment from a tertiary hospital in Hefei, China, between January and May of 2022. Information on sociodemographic and clinical characteristics, type D personality, dyadic coping, and the QoL of the dyads was collected. The dyadic data were examined using the Actor-Partner Interdependence Mediation Model approach (APIMeM). The results suggest that type D personality, dyadic coping, and QoL in infertile couples have Actor-Partner Interdependence effects. The negative impact of Type D personality can spill over from individuals to the dyadic domain of couples. In the later stage, the negative impact of type D personality on QoL can be reduced by enhancing the dyadic coping level of both members of the infertile couple.

Hormonal Status and Quality of Life of Women Treated for Infertility Before and During COVID-19 Pandemic in Poland

Background/Objectives: Infertile people experience a lot of psychological stress due to the inability to conceive and achieve pregnancy. Studies on the quality of life (QoL) of people undergoing infertility treatment typically show a lower QoL for couples struggling with reproductive problems. In recent years, a new factor that may have had a stressful impact on people treated for infertility is the COVID-19 pandemic. The aim of this study is to assess the impact of the COVID-19 pandemic on the QoL of Polish women treated for infertility and on the secretion of selected sex hormones. Methods: The study sample consisted of 600 women undergoing treatment due to infertility and 100 healthy women in a control group. The World Health Organization Quality of Life-BREF (WHOQOL-BREF) and the Polish version of the questionnaire Fertility Quality of Life (FertiQoL) were used for data collection. The levels of selected hormones were measured from blood samples. Results: The effects of the pandemic were visible primarily in the reduced QoL of patients. The QoL in terms of physical health, psychological health, social relationships, and environmental sphere was drastically reduced by COVID-19, especially among women treated with IVF (in vitro fertilization) and IUI (intrauterine insemination). The hormonal status of women treated for infertility during the pandemic significantly changed due to a decrease in FSH (follicle-stimulating hormone) and LH (luteinizing hormone) secretion and an increase in PRL (prolactin). Conclusions: The pandemic resulted in a decline in the QoL of women with reproductive problems. The quality of life was influenced by the type of therapy used during infertility treatment. The study also suggests a relationship between a decrease in the quality of life of persons treated for infertility during the pandemic and their hormonal status.

Network analysis of stress and stigma symptoms and their associations with quality of life among Chinese female infertility patients

BACKGROUND

This study has employed network analysis while investigating the interrelationships among stress and stigma symptoms and their associations with quality of life among Chinese female infertility patients.

METHODS

In this cross-sectional study, 428 female patients who visited the Department of Reproductive Center of Dalian Women and Children's Medical Group with chief complaints of infertility symptoms were recruited using convenience sampling from November 2022 to December 2023. Fertility-related stress and stigma status were examined by the Fertility Problem Inventory (FPI) and Infertility Stigma Scale (ISS), respectively. Quality of life was examined by the Fertility Quality of Life (FertiQoL). Network analysis was conducted to estimate the network of stress and stigma symptoms. The flow network approach was used to identify specific stigma and stress symptoms related to quality of life. Expected influence (EI) and bridge expected influence (bEI) were used to quantify central and bridge symptoms in the network, respectively. The bootstrapping method evaluated the accuracy and robustness of the network estimates.

RESULTS

The average predictability of FPI and ISS symptoms was 0.67. The "relationship concern" was the most central symptom across all centrality indices, followed by "public stigma" and "social concern". The main symptoms bridging the FPI and ISS clusters were "self-devaluation", "social concern", and "relationship concern". The network demonstrated robustness in stability and accuracy tests. In the flow network, "social withdrawal" and "self-devaluation" showed strong negative associations with FertiQoL.

CONCLUSIONS

"Relationship concern," "public stigma," "social concern," and "self-devaluation" have been identified as the main central and bridge symptoms in the stress and stigma network in this study. Notably, stigma symptoms, particularly "social withdrawal" and "self-devaluation", showed stronger associations with FertiQoL compared to stress symptoms, highlighting their importance in potential treatment strategies.

The effectiveness of expressive art therapy on infertile women undergoing surgery: study protocol for a randomized controlled trial

BACKGROUND

Infertility produces infertility-related stress in both members of infertile couples, especially for infertile women. Some studies verified the negative relationship between infertility-related stress and outcomes of infertility treatments. Effective mental health care during fertility treatment is urgently needed, but there has been a lack of efficient support services. To reduce the infertility-related stress of infertile women, expressive art therapeutic schemes will be organized and implemented by certified international expressive art therapists.

METHODS

This study is a randomized controlled trial. Participants in the intervention group will receive expressive art therapies after the baseline investigation. Expressive art therapies will be led by the certified international expressive art therapist. The interventions include progressive muscle relaxation training, music meditation and drawing therapy. Participants in the control group will receive routine care. The Hospital Anxiety and Depression Scale (HADS) and Fertility Problem Inventory (FPI) will be used to investigate the anxiety, depression, and infertility-related stress of all participants at admission and at discharge.

DISCUSSION

This study will verify the effectiveness and efficiency of expressive art therapies for infertile women. The results will provide new knowledge on mental health care strategies for infertile women.

TRIAL REGISTRATION

ChiCTR, ChiCTR2300070618. Registered 14 April 2023.

Reliability and validity of the Chinese version of the COMPI Fertility Problem Stress Scale-Short Form for infertile women

OBJECTIVE

To translate and culturally adapt the COMPI Fertility Problem Stress Scale-Short form (COMPI-FPSS-SF) and to test its reliability and validity in China.

METHODS

The cross-sectional study adopted Brislin's translation model to translate, synthesize, back-translate, and cross-culturally adapt the COMPI-FPSS-SF for the Chinese setting. A total of 279 infertile women were invited to participate in the study to test the reliability and validity of the scale between March and June 2021.

RESULTS

It was verified that the Chinese version of the COMPI-FPSS-SF has three domains with nine items. The Cronbach's α coefficient of the total scale was 0.907, and the coefficient for each dimension ranged from 0.760 to 0.855. The test-retest validity was 0.891. The exploratory factor analysis extracted three common factors with eigenvalues of 4.499, 1.124, and 1.011 and a cumulative variance contribution of 73.706. The validity factor analysis showed good results for the three-factor structure fit. The criterion-related validity with the Fertility Inventory Short-Form Scale was 0.649. The above analysis revealed statistically significant differences (P < 0.001).

CONCLUSIONS

The Chinese version of the COMPI-FPSS-SF can be used for the assessment of fertility-related stress in infertility patients in China with good reliability and validity.

Psychosocial wellbeing shortly after allocation to a freeze-all strategy compared with a fresh transfer strategy in women and men: a sub-study of a randomized controlled trial

STUDY QUESTION

Is the psychosocial wellbeing affected in women and men shortly after allocation to a freeze-all strategy with postponement of embryo transfer compared to a fresh transfer strategy?

SUMMARY ANSWER

In general, psychosocial wellbeing (i.e. emotional reactions to the treatment, quality-of-life, infertility-related stress, and marital benefit) was similar in women and men allocated to a freeze-all versus those allocated to a fresh-transfer strategy 6 days after disclosure of treatment strategy (i.e. 4 days after oocyte retrieval), although women in the freeze-all group reported a slightly higher degree of depressive symptoms and mood swings compared to women in the fresh transfer group.

WHAT IS KNOWN ALREADY

The use of a freeze-all strategy, i.e. freezing of the entire embryo cohort followed by elective frozen embryo transfer in subsequent cycles has increased steadily over the past decade in assisted reproductive technology (ART). This strategy essentially eliminates the risk of ovarian hyperstimulation syndrome and has proven beneficial regarding some reproductive outcomes in subgroups of women. However, patients experience a longer time interval between oocyte retrieval and embryo transfer, hence a longer time to pregnancy, possibly adding additional stress to the ART treatment. So far, little focus has been on the possible psychosocial strains caused by postponement of embryo transfer.

STUDY DESIGN, SIZE, DURATION

This is a self-reported questionnaire based sub-study of a multicentre randomized controlled trial (RCT) including 460 women and 396 male partners initiating their first, second, or third treatment cycle of invitro fertilisation or intracytoplasmic sperm injection (ICSI) from May 2016 to September 2018. This sub-study was included in the primary project protocol and project plan for the RCT, as psychosocial wellbeing was considered a secondary outcome.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Women from eight public fertility clinics in Denmark and Sweden and one private clinic in Spain were randomized in a 1:1 ratio on the day of inclusion (menstrual cycle day 2 or 3) to either a freeze-all strategy with postponement of embryo transfer to a subsequent modified natural menstrual cycle or a fresh transfer strategy with embryo transfer in the hormone stimulated cycle. Treatment allocation was blinded until the day of the ovulation trigger. Women and their male partners were asked to complete a validated self-reported questionnaire 6 days after unblinding of treatment group allocation, corresponding to 4 days after oocyte retrieval, investigating their psychosocial wellbeing related to the treatment defined as emotional reactions to the treatment, quality-of-life, infertility-related stress, and marital benefit. The questionnaire included items from the Copenhagen Multi-Centre Psychosocial Infertility (COMPI) Fertility Problem Stress Scales and the COMPI Marital Benefit Measure.

MAIN RESULTS AND THE ROLE OF CHANCE

Baseline characteristics were comparable between the two groups for both women and men. In total, response rates were 90.7% for women and 90.2% for men. In the freeze-all group, 207 women and 179 men completed the questionnaire compared with 204 women and 178 men in the fresh transfer group. Men in the two treatment groups did not differ in any of the explored aspects of psychosocial wellbeing (i.e. emotional reactions to the treatment, quality-of-life, infertility-related stress, and marital benefit) 6 days after disclosure of treatment strategy. Women in the freeze-all group reported a slightly higher degree of depressive symptoms (P = 0.045) and mood swings (P = 0.001) (i.e. variables included in 'emotional reactions to treatment') compared to women in the fresh transfer group. When adjusted for multiple testing, depressive symptoms were no longer significantly different between the two groups. No additional differences in psychosocial wellbeing were found. Self-reported quality-of-life during treatment was also rated as similar between the two groups in both women and men, but was slightly lower than they would rate their quality-of-life when not in fertility treatment.

LIMITATIONS, REASONS FOR CAUTION

Although response rates were high, selection bias cannot be excluded. As this study was an RCT, we assume that psychosocial characteristics of the participants were equally distributed in the two groups, thus it is unlikely that the identified psychosocial differences between the freeze-all and fresh transfer group were present already at baseline. Furthermore, the questionnaire was completed as a one-time assessment 4 days after oocyte retrieval, thus not reflecting the whole treatment process, whereas an assessment after the full completed treatment cycle is needed to draw firm conclusions about the psychosocial consequences of the whole waiting period. However, a question posted that late would be highly biased on whether or not a pregnancy had been achieved.

WIDER IMPLICATIONS OF THE FINDINGS

The results indicate that individuals in the freeze-all group exhibited slightly higher levels of depressive symptoms and mood swings compared to those in the fresh transfer group. Nevertheless, it is important to note that any worries related to potential emotional strains stemming from delaying embryo transfer should not overshadow the adoption of a freeze-all approach in cases where it is clinically recommended. As long as patients are provided with comprehensive information about the treatment strategy before initiating the process, it is worth emphasising that other aspects of psychosocial wellbeing were comparable between the two groups.

STUDY FUNDING/COMPETING INTEREST(S)

The study is part of the Reprounion collaborative study, co-financed by the European Union, Interreg V Öresund-Kattegat-Skagerrak. L.P. reports financial support from Merck A/S. H.S.N. reports grants from Freya Biosciences ApS, Ferring Pharmaceuticals, BioInnovation Institute, Ministry of Education, Novo Nordic Foundation, Augustinus Fonden, Oda og Hans Svenningsens Fond, Demant Fonden, Ole Kirks Fond and Independent Research Fund Denmark and personal fees from Ferring Pharmaceuticals, Merck A/S, Astra Zeneca, Cook Medical, IBSA Nordic and Gedeon Richter. H.S.N is founder and chairman of the Maternity Foundation and co-developed the Safe Delivery App (non-profit). N.C.F. reports grants from Gedeon Richter, Merck A/S, Cryos International and financial support from Ferring Pharmaceuticals, Merck A/S and Gedeon Richter. N.C.F. is chairman in the steering committee for the guideline groups for The Danish Fertility Society (non-profit). P.H. reports honoraria from Merch A/S, IBSA Nordic and Gedeon Richter. A.L.M.E. reports grants and financial support from Merck A/S and Gedeon Richter. A.P. reports grants from Gedeon Richter, Ferring Pharmaceuticals, Merck A/S and personal fees from Preglem S.A., Novo Nordic Foundation, Ferring Pharmaceuticals, Gedeon Richter, Cryos International, Merch A/S, Theramex and Organon and the lend of embryoscope to the institution from Gedeon Richter. All other authors declare no conflict of interest.

TRIAL REGISTRATION NUMBER

Clinicaltrials.gov NCT02746562.

Evaluating health-related quality of life and subjective wellbeing among infertility patients: a cross-sectional study in mainland China

PURPOSE

This study aimed to explore the health-related quality of life (HRQoL) and subjective wellbeing (SWB) of infertility patients in mainland China and to investigate the relationships between HRQoL and SWB instruments in infertility patients.

METHODS

We conducted this cross-sectional study in the Hospital for Reproductive Medicine Affiliated of Shandong University between April 2019 and November 2019. Participants self-completed the five-level EQ-5D (EQ-5D-5L) questionnaire, the Assessment of Quality of Life (AQoL)-8D, and the WHO-5 wellbeing index (WHO-5). The agreements between EQ-5D-5L and AQoL-8D were assessed employing intraclass correlation coefficient (ICC) and Bland-Altman plots. Exploratory factor analysis (EFA) was conducted to examine the difference in descriptive systems among the three instruments.

RESULTS

We analyzed a valid sample of 618 infertility patients (84.4%). The mean scores of the total EQ-5D-5L, AQoL-8D, and WHO-5 were 0.96 (95%CI 0.96, 0.96), 0.80 (95%CI 0.79, 0.81), and 16.92 (95%CI 16.52, 17.31), respectively. Patients diagnosed with primary infertility had significantly lower HRQoL and SWB than those with secondary infertility. The ICC of EQ-5D-5L and AQoL-8D was 0.14. The AQoL-8D (r = 0.625) was more strongly correlated with WHO-5 than with the EQ-5D-5L (r = 0.262). The EFA results indicated that HRQoL instruments and the WHO-5 instruments were complementary rather than substitutable.

CONCLUSIONS

Poorer HRQoL and SWB were found that primary than secondary infertility patients. There exists a poor agreement between EQ-5D-5L and AQoL-8D and the difference in the psychosocial components may explain the difference. Measuring both HRQoL and SWB could provide complementary information for infertility patients.

Infertility-related stress and quality of life among infertile women with polycystic ovary syndrome: Does body mass index matter?

OBJECTIVE

Infertility and obesity are common among women with Polycystic ovary syndrome (PCOS) and related to poor quality of life (QoL). Obesity may confer an elevated adverse effect of infertility-related stress given its relationship with increased susceptibility to stress. This study aimed to investigate the association of infertility-related stress with QoL among infertile women with PCOS, and to evaluate whether body mass index (BMI) modifies this association.

METHODS

A cross-sectional study was conducted with 306 participants recruited from the infertility outpatient clinic. A self-administered, structured questionnaire including COMPI Fertility Problem Stress Scale (COMPI-FPSS) and the modified PCOS health-related QoL questionnaire (MPCOSQ) was conducted in this study. The moderation model was conducted by the PROCESS macro using SPSS.

RESULTS

The mean score of QoL was 142.67 (SD = 20.11), ranged from 93 to 183 (theoretical range = 30-210). QoL was negatively associated with infertility-related stress (r = -0.373, P < 0.001). Moderation analysis indicated that the interaction term between infertility-related stress and BMI significantly predicted QoL (β = -0.154, P = 0.005, f² = 0.03) as well as emotional disturbance (β = -0.170, P = 0.002, f² = 0.04). Specifically, higher BMI significantly exacerbated the effect of infertility-related stress on QoL and emotional disturbance.

CONCLUSION

Infertile women with PCOS experienced poor QoL. The moderation role of BMI provides a better understanding of individual difference in relationship between infertility-related stress and QoL. Interventions aiming to improve QoL among infertile women with PCOS should focus on alleviating infertility-related stress, especially among women with high BMI.