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Kupec T, Wagels L, Caspers R, Meyer-Wilmes P, Najjari L, Stickeler E, Wittenborn J. Predictors of anxiety in endometriosis patients. Arch Gynecol Obstet 2025; 311:1371-1377. [PMID: 39725706 PMCID: PMC12033099 DOI: 10.1007/s00404-024-07878-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2024] [Accepted: 12/06/2024] [Indexed: 12/28/2024]
Abstract
PURPOSE To evaluate the main factors influencing anxiety in endometriosis patients presenting to an endometriosis centre in Germany. METHODS One hundred and eighty-two patients were asked to complete the German version of the STAI (state anxiety and trait anxiety) questionnaire prior to examination for diagnosis and treatment of pelvic pain or suspected endometriosis. Typical endometriosis symptoms, main complaints, operations, type of endometriosis and planned treatment were analyzed as influencing factors of anxiety in endometriosis patients. We performed linear multiple regression analyses using the forward stepwise method to test which characteristics associated with endometriosis symptoms were associated with trait anxiety and state anxiety. RESULTS Analysis of the STAI results showed that higher levels of trait anxiety were found in patients with ovarian endometriosis: t (177) = 3.06, p = 0.003 and in patients with symptoms of dyspareunia: t (177) = 2.36, p < 0.020). On the other hand, patients with recurrent endometriosis showed lower levels of trait anxiety: t (177) = - 2.39, p = 0.018. Significantly higher levels of state anxiety were found in patients with persistent endometriosis: t (177) = - 2.45, p = 0.015 and in women with endometriosis who were indicated for surgical therapy: t (177) = 3.89, p < 0.001. CONCLUSIONS We were able to show that higher levels of ongoing anxiety in endometriosis patients are associated with dyspareunia and ovarian endometriosis, which may have a negative impact on partnership and desire to have children. On the other hand, patients with persistent endometriosis or a type of disease that requires surgery have higher levels of immediate situational anxiety.
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Affiliation(s)
- Tomas Kupec
- Department of Gynecology and Obstetrics, University Hospital of the RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany.
| | - Lisa Wagels
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of the RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
- Research Center Jülich, JARA Institute Brain Structure Function Relationship Institute for Neuroscience and Medicine (INM-10), 52425, Jülich, Germany
| | - Rebecca Caspers
- Department of Gynecology and Obstetrics, University Hospital of the RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Philipp Meyer-Wilmes
- Department of Gynecology and Obstetrics, University Hospital of the RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Laila Najjari
- Department of Gynecology and Obstetrics, University Hospital of the RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Elmar Stickeler
- Department of Gynecology and Obstetrics, University Hospital of the RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Julia Wittenborn
- Department of Gynecology and Obstetrics, University Hospital of the RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
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Liu F, Qiao W, Han W, Fan X, Chen Y, Lu R, Zhai Y, Pan T, Yuan X, Song X, Zhang D. Using network analysis to identify central symptoms of depression and anxiety in different profiles of infertility patients. BMC Psychiatry 2025; 25:229. [PMID: 40069660 PMCID: PMC11899931 DOI: 10.1186/s12888-025-06637-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 02/20/2025] [Indexed: 03/14/2025] Open
Abstract
BACKGROUND Depression and anxiety were not only common but also with serious consequence in infertility patients. The current study endeavors to define distinct depression and anxiety profiles of infertility patients and identify central symptoms within different profiles to facilitate targeted interventions. METHOD The research employed K-means Clustering to delineate the depression and anxiety profiles, followed by a repetition of the analysis using Latent Class Analysis (LCA). Furthermore, network analysis was utilized to identify central symptoms within the various profiles. RESULT K‑means Clustering identified Cluster 1 (16.15%), Cluster 2 (37.08%) and Cluster 3 (46.77%), while LCA yielded the low-risk group (47.23%), the mild-risk group (34.46%) and the high-risk group (18.31%). A majority of patients in the three clusters were predominantly in a single LCA-derived patient class (88.38-100%). Network analysis revealed that connections within each symptom in PHQ-9 and GAD-7 were stronger than those between symptoms. Furthermore, PHQ 2 ("sad mood"), GAD 1 ("nervousness") and GAD 2 ("uncontrollable worry") were identified as the central symptoms in Cluster 1 GAD 3 ("excessive worry"), GAD 2 ("uncontrollable worry") and GAD 5 ("restlessness") emerged as the central symptoms in Cluster 2) Additionally, PHQ 4 ("fatigue"), GAD 6 ("irritability") and GAD 3 ("excessive worry") were identified as the central symptoms in Cluster 3. CONCLUSIONS We defined three distinct depression and anxiety profiles among infertility patients and pinpointed central symptoms within each profile. These findings underscore the importance of directing research towards those central symptoms within each profile in order to develop targeted intervention strategies.
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Affiliation(s)
- Fang Liu
- Department of Operation Management, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wei Qiao
- Department of Operation Management, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wenju Han
- Department of Reproductive Center, Dalian Women and Children's Medical Group, Dalian, China
| | - Xueming Fan
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yingbo Chen
- Department of Operation Management, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ruonan Lu
- Department of Operation Management, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yujie Zhai
- Department of Operation Management, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Tianci Pan
- Department of Reproductive Center, Dalian Women and Children's Medical Group, Dalian, China
| | - Xiuxia Yuan
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan International Joint Laboratory of Biological Psychiatry, Zhengzhou, China
- Henan Psychiatric Transformation Research Key Laboratory, Zhengzhou, China
| | - Xueqin Song
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
- Henan International Joint Laboratory of Biological Psychiatry, Zhengzhou, China.
- Henan Psychiatric Transformation Research Key Laboratory, Zhengzhou, China.
| | - Dongqing Zhang
- Department of Operation Management, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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Pathak BG, Mburu G, Habib N, Kabra R, Malik A, Kiarie J, Chowdhury R, Dhabhai N, Mazumder S. Prevalence and correlates of symptoms of depression, anxiety, and psychological distress among women of reproductive age with delayed conception in urban and peri-urban low to mid-socioeconomic neighborhoods of Delhi, India: A cross-sectional study. PLoS One 2025; 20:e0315347. [PMID: 39908296 PMCID: PMC11798463 DOI: 10.1371/journal.pone.0315347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 11/24/2024] [Indexed: 02/07/2025] Open
Abstract
INTRODUCTION One in six people of reproductive age experience infertility in their lifetime. Infertility can have significant impacts on mental health. Psychological distress is a broad term encompassing emotional suffering and mental health discomfort that can include symptoms of anxiety and depression but is not limited to these conditions. We investigated the prevalence of symptoms of depression, anxiety, and psychological distress and their associated risk factors among women of reproductive age with delayed conception. METHODS A total of 1530 women were recruited from community settings in Northern India. Quantitative data were collected using a 4-item Patient Health Questionnaire-4 (PHQ-4) which is an ultra-brief self-report questionnaire consisting of a 2-item depression scale (PHQ-2) and a 2-item anxiety scale (generalized anxiety depression-2). Data were collected between July 2020 and August 2021. Descriptive analysis was conducted to summarise the characteristics and prevalence of symptoms of depression, anxiety, and psychological distress. Logistic regression was used to identify risk factors for psychological distress. RESULTS We obtained responses from all 1,530 women using these scales. Over half (54.31%) of participants had psychological distress, of whom 38.10% were experiencing mild distress, 10.59% moderate distress, and 5.62% severe distress. Additionally,16.07% of participants reported symptoms of anxiety and 20% reported symptoms of depression. Factors associated with psychological distress were: (i) a higher total number of children that women intended to have in their lifetime, (ii) longer duration of trying to get pregnant (> 18 months), (iii) continuous effort trying to achieve pregnancy, (iv) women's perception that conception is taking long, (v) social isolation, (vi) being emotionally or verbally abused by husband and family members, and (vii) having other co-morbidities such as hypertension, irregular menstrual cycles, irregular bleeding between regular cycles, abnormal vaginal discharge or pain during sex. CONCLUSION This study demonstrates the high mental health burden faced by women with delayed conception in low- to mid-socioeconomic neighbourhoods of North India including high levels of anxiety and depression. To better support individuals and couples achieve their reproductive goals, we advocate for the integration of psychosocial interventions to improve mental health outcomes and promote the well-being of those facing delays in achieving pregnancy. Specifically, addressing social isolation, fostering supportive networks, combating violence towards women, and incorporating fertility counselling and group-based psychosocial interventions within community and healthcare settings are needed to alleviate mental health symptoms among women who have difficulties in conceiving. However, the successful implementation of these recommendations may be challenged by the availability of the state's healthcare resources, necessitating tailored strategies with contextual adaptations.
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Affiliation(s)
- Barsha Gadapani Pathak
- Society for Applied Studies, New Delhi, India
- Centre for International Health, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Gitau Mburu
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Program of Research, Development and Research Training in Human Reproduction (HRP) Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Ndema Habib
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Program of Research, Development and Research Training in Human Reproduction (HRP) Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Rita Kabra
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Program of Research, Development and Research Training in Human Reproduction (HRP) Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Aiysha Malik
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - James Kiarie
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Program of Research, Development and Research Training in Human Reproduction (HRP) Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Ahmad F, Ahmed SH, Choucair F, Chouliaras S, Awwad J, Terranegra A. A disturbed communication between hypothalamic-pituitary-ovary axis and gut microbiota in female infertility: is diet to blame? J Transl Med 2025; 23:92. [PMID: 39838491 PMCID: PMC11749209 DOI: 10.1186/s12967-025-06117-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2024] [Accepted: 01/08/2025] [Indexed: 01/23/2025] Open
Abstract
Female infertility is a multifactorial condition influenced by various genetic, environmental, and lifestyle factors. Recent research has investigated the significant impact of gut microbiome dysbiosis on systemic inflammation, metabolic dysfunction, and hormonal imbalances, which can potentially impair fertility. The gut-brain axis, a bidirectional communication system between the gut and the brain, also plays a significant role in regulating reproductive functions. Emerging evidence suggests that the gut microbiome can influence brain functions and behavior, further emphasizing the importance of the microbiota-gut-brain axis in reproduction. Given their role as a major modulator of the gut microbiome, diet and dietary factors, including dietary patterns and nutrient intake, have been implicated in the development and management of female infertility. Hence, this review aims to highlight the impact of dietary patterns, such as the Western diet (WD) and Mediterranean diet (MD), and to decipher their modulatory action on the microbiota-gut-brain axis in infertile women. By contrasting the detrimental effects of WD with the therapeutic potential of MD, we emphasize the pivotal role of a balanced diet rich in nutrients in promoting a healthy gut microbiome. These insights underscore the potential of targeted dietary interventions and lifestyle modifications as promising strategies to enhance reproductive outcomes in subfertile women.
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Affiliation(s)
- Fatima Ahmad
- Translational Medicine Department, Sidra Medicine, Doha, Qatar
- College of Health and Life Sciences, Hamad bin Khalifa University, Doha, Qatar
| | - Salma H Ahmed
- Translational Medicine Department, Sidra Medicine, Doha, Qatar
| | - Fadi Choucair
- Reproductive Medicine Unit, Sidra Medicine, Doha, Qatar
| | - Spyridon Chouliaras
- Reproductive Medicine Unit, Sidra Medicine, Doha, Qatar
- Weill Cornell Medicine, Ar-Rayyan, Qatar
| | - Johnny Awwad
- Reproductive Medicine Unit, Sidra Medicine, Doha, Qatar
- Vincent Memorial Obstetrics and Gynecology Service, Massachusetts General Hospital, Boston, MA, USA
| | - Annalisa Terranegra
- Translational Medicine Department, Sidra Medicine, Doha, Qatar.
- College of Health and Life Sciences, Hamad bin Khalifa University, Doha, Qatar.
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Kupec T, Kennes LN, Senger R, Meyer-Wilmes P, Najjari L, Stickeler E, Wittenborn J. The Multifactorial Burden of Endometriosis: Predictors of Quality of Life. J Clin Med 2025; 14:323. [PMID: 39860327 PMCID: PMC11765614 DOI: 10.3390/jcm14020323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2024] [Revised: 12/31/2024] [Accepted: 01/03/2025] [Indexed: 01/27/2025] Open
Abstract
Background/Objectives: Endometriosis is a chronic gynecological disorder characterized by ectopic endometrial-like tissue. The symptoms of this disease negatively affect the patient's quality of life, both physically and mentally. This study aims to identify key factors impacting health-related quality of life in endometriosis patients. Methods: A total of 175 patients from the Endometriosis Centre of the RWTH Aachen University Hospital were assessed using the German version of the EHP-30. The EHP is a patient self-report tool used to measure the wide range of impacts that endometriosis can have on women's lives (affecting pain levels, leading to feelings of powerlessness and a loss of control, and affecting their emotional well-being, social support, and self-image). Multivariate linear regression and random forest analyses were performed to evaluate predictors of health-related quality of life, focusing on demographic characteristics, pain severity, endometriosis symptoms and planned procedures. Results: Key factors that have a significant negative impact on QoL include higher pain scores, dysuria, and persistent endometriosis. Higher pain scores negatively affect the EHP-30 pain (p < 0.0001), control and powerlessness (p < 0.0001) and emotional well-being (p < 0.01) scores. Dysuria has a negative effect on pain (p < 0.001), control and powerlessness (p < 0.001), emotional well-being (p < 0.05), and social support (p < 0.05). Persistent endometriosis was negatively associated with pain (p < 0.01), control and powerlessness (p < 0.01), and social support. Previous endometriosis surgery has a positive effect on the EHP-30 scores for pain, control and powerlessness, emotional well-being, and self-image (p < 0.05). Conclusions: Our study highlights the multifactorial impact of endometriosis on health-related QoL. Personalized treatments focusing on pain management, emotional support and social interventions are crucial to improve patient outcomes.
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Affiliation(s)
- Tomas Kupec
- Department of Gynecology and Obstetrics, University Hospital RWTH Aachen, 52074 Aachen, Germany; (R.S.); (P.M.-W.); (L.N.); (E.S.); (J.W.)
| | - Lieven Nils Kennes
- Department of Economics and Business Administration, University of Applied Sciences Stralsund, Zur Schwedenschanze 15, 18435 Stralsund, Germany;
| | - Rebecca Senger
- Department of Gynecology and Obstetrics, University Hospital RWTH Aachen, 52074 Aachen, Germany; (R.S.); (P.M.-W.); (L.N.); (E.S.); (J.W.)
| | - Philipp Meyer-Wilmes
- Department of Gynecology and Obstetrics, University Hospital RWTH Aachen, 52074 Aachen, Germany; (R.S.); (P.M.-W.); (L.N.); (E.S.); (J.W.)
| | - Laila Najjari
- Department of Gynecology and Obstetrics, University Hospital RWTH Aachen, 52074 Aachen, Germany; (R.S.); (P.M.-W.); (L.N.); (E.S.); (J.W.)
| | - Elmar Stickeler
- Department of Gynecology and Obstetrics, University Hospital RWTH Aachen, 52074 Aachen, Germany; (R.S.); (P.M.-W.); (L.N.); (E.S.); (J.W.)
| | - Julia Wittenborn
- Department of Gynecology and Obstetrics, University Hospital RWTH Aachen, 52074 Aachen, Germany; (R.S.); (P.M.-W.); (L.N.); (E.S.); (J.W.)
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Carolino N, Cunha M, Pinto-Gouveia J, Gameiro S, Galhardo A. KindMap: an e-mental health tool to promote the well-being and mental health of people facing infertility-study protocol for a feasibility randomised control trial. BMJ Open 2024; 14:e087447. [PMID: 39653558 PMCID: PMC11628952 DOI: 10.1136/bmjopen-2024-087447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 11/20/2024] [Indexed: 12/12/2024] Open
Abstract
INTRODUCTION Fertility patients increasingly use web-based and mobile-based apps to access psychosocial care. These digital tools may be a helpful alternative to traditional psychological interventions. Developing and evaluating patient-centred e-mental health tools rooted in evidence-based interventions is a priority. The KindMap is a stand-alone, cost-free e-mental health intervention derived from adapting the Mindfulness Based Programme for Infertility (MBPI) contents to a digital format. The KindMap integrates mindfulness and self-compassion skills training and Acceptance and Commitment Therapy components. This protocol is intended to evaluate the KindMap's feasibility and explore the extent to which the web-app mode of delivery limited efficacy results are similar to the MBPI in-person format results. Furthermore, it will test the causal theory underlying KindMap. METHODS AND ANALYSIS A two-arm 2:1 non-blinded feasibility randomised controlled trial (RCT) will be conducted. Participants are people dealing with infertility, who are able to access the Internet and understand Portuguese or English. Consent participants will complete an online survey at 3-time assessment moments. After baseline assessment, participants will be randomised into the KindMap experimental group (KindMap-EG; with immediate access to the web app) or the waiting-list control group. The primary outcome is well-being (WHO Index-5); secondary outcomes are infertility-related stress (Fertility Problem Inventory-Short Form), anxiety and depression (Patient Health Questionnaire for Depression and Anxiety-4); mindfulness (Five Facet Mindfulness Questionnaire-Short Form), self-compassion (Self-Compassion Scale-Short Form), psychological flexibility (Psy-Flex) and infertility-related self-efficacy are the potential mechanisms of change. KindMap-EG will also complete a feasibility survey. ETHICS AND DISSEMINATION The study was approved by the Ethics Committee of the Faculty of Psychology and Educational Sciences of the University of Coimbra (Identifier: CEDI/FPCEUC:78/R_10). The KindMap study may contribute to the existing research on e-health technologies applied to mental health. The study outcomes will be disseminated through publications in peer-reviewed journals and national and international conference presentations. TRIAL REGISTRATION NUMBER NCT05899374.
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Affiliation(s)
- Naír Carolino
- Instituto Superior Miguel Torga, Coimbra, Portugal
- CINEICC—Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Marina Cunha
- Instituto Superior Miguel Torga, Coimbra, Portugal
- CINEICC—Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - José Pinto-Gouveia
- CINEICC—Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Sofia Gameiro
- School of Psychology, Cardiff University, Cardiff, UK
| | - Ana Galhardo
- Instituto Superior Miguel Torga, Coimbra, Portugal
- CINEICC—Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
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Szigeti F J, Kazinczi C, Szabó G, Sipos M, Ujma PP, Purebl G. The clinical effectiveness of the Mind/Body Program for Infertility on wellbeing and assisted reproduction outcomes: a randomized controlled trial in search for active ingredients. Hum Reprod 2024; 39:1735-1751. [PMID: 38852061 PMCID: PMC11291950 DOI: 10.1093/humrep/deae119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 04/20/2024] [Indexed: 06/10/2024] Open
Abstract
STUDY QUESTION Does the Mind/Body Program for Infertility (MBPI) perform better, due to certain distinctive elements, than a partly matched support group in improving the wellbeing and medically assisted reproduction (MAR) outcomes of women with elevated distress levels in a clinical setting? SUMMARY ANSWER While robust enhancements occurred in the wellbeing overall, the cognitive behavioural and formalized stress management elements of the MBPI allowed a significantly stronger improvement in trait anxiety, but not in other mental health and MAR outcomes, compared with a support group. WHAT IS KNOWN ALREADY Mind-body psychological programmes adjacent to MAR have been found to improve women's mental states and possibly increase chances of pregnancy. However, not enough is known about the programme's effectiveness among patients with elevated distress levels in routine clinical settings, nor is it clear which of its particular ingredients are specifically effective. STUDY DESIGN, SIZE, DURATION A pre-post design, single-centre, randomized controlled trial was performed between December 2019 and October 2022 (start and end of recruitment, respectively). The sample size (n = 168) was calculated to detect superiority of the MBPI in improving fertility-related quality of life. Randomization was computer-based, with random numbers concealing identities of patients until after allocation. PARTICIPANTS/MATERIALS, SETTING, METHODS The trial was conducted at a large university teaching hospital. A total of 168 patients were randomly assigned to the mind-body (MBPI) group (n = 84) and the fertility support (FS) control group (n = 84). Patients received a 10-week, 135-min/week group intervention, with the FS group following the same format as the MBPI group, but with a less restricted and systematic content, and without the presumed effective factors. The number of patients analysed was n = 74 (MBPI) and n = 68 (FS) for post-intervention psychological outcomes, and n = 54 (MBPI) and n = 56 (FS) for pregnancy outcomes at a 30-month follow-up. MAIN RESULTS AND THE ROLE OF CHANCE Significant improvements occurred in both groups in all psychological domains (adjusted P < 0.001), except for treatment-related quality of life. Linear mixed-model regression analysis did not reveal significantly greater pre-post improvements in the MBPI group than in the FS group in fertility-related quality of life (difference in differences (DD) = 4.11 [0.42, 7.80], d = 0.32, adjusted P = 0.124), treatment-related quality of life (DD = -3.08 [-7.72, 1.55], d = -0.20, adjusted P = 0.582), infertility-specific stress (DD = -2.54 [-4.68, 0.41], d = -0.36, adjusted P = 0.105), depression (DD = -1.16 [3.61, 1.29], d = -0.13, adjusted P = 0.708), and general stress (DD = -0.62 [-1.91, 0.68], d = -0.13, adjusted P = 0.708), but it did show a significantly larger improvement in trait anxiety (DD = -3.60 [-6.16, -1.04], d = -0.32, adjusted P = 0.042). Logistic regression showed no group effect on MAR pregnancies, spontaneous pregnancies, or live births. LIMITATIONS, REASONS FOR CAUTION The follow-up only covered MAR-related medical outcomes and no psychological variables, and their rates were not equal in the two groups. Biological factors other than age, aetiology, and duration of infertility may have confounded the study results. Loss to follow-up was between 5% and 10%, which may have led to some bias. WIDER IMPLICATIONS OF THE FINDINGS The psychologically and medically heterogeneous sample, the normal clinical setting and the low attrition rate all raise the external validity and generalizability of our study. The MBPI works not only in controlled conditions, but also in routine MAR practice, where it can be introduced as a cost-effective, low-intensity psychological intervention, within the framework of stepped care. More studies are needed to further identify its active ingredients. STUDY FUNDING/COMPETING INTEREST(S) The authors received no financial support for the research, authorship, and/or publication of this article. The authors have no conflict of interest to disclose. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT04151485. TRIAL REGISTRATION DATE 5 November 2019. DATE OF FIRST PATIENT’S ENROLMENT 15 December 2019.
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Affiliation(s)
- Judit Szigeti F
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
- Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis University, Budapest, Hungary
| | - Csaba Kazinczi
- Department of Clinical Psychology, Semmelweis University, Budapest, Hungary
- Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
| | - Georgina Szabó
- Doctoral School of Mental Health Sciences, Semmelweis University, Budapest, Hungary
- Department of Psychiatry, North Buda Saint John’s Hospital Centre and Outpatient Clinic, Budapest, Hungary
| | - Miklós Sipos
- Department of Obstetrics and Gynecology, Assisted Reproduction Centre, Semmelweis University, Budapest, Hungary
| | | | - György Purebl
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
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Simbar M, Ghasemi V, Taherian R, Kalhor M, Mohammadian F, Kiani Z. Prevalence of anxiety symptoms in infertile men: a systematic review and meta-analysis. BMC Public Health 2024; 24:1805. [PMID: 38971742 PMCID: PMC11227185 DOI: 10.1186/s12889-024-19299-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 06/28/2024] [Indexed: 07/08/2024] Open
Abstract
BACKGROUND Infertility in men causes problems in various aspects of their lives, including personal, family and social life. One of the most important of these problems is anxiety. Anxiety in infertile men can affect their health, quality of life, and response to treatment, highlighting the significance of anxiety in these men. Thus, this systematic review and meta-analysis was conducted to investigate the prevalence of anxiety symptoms in infertile men. METHODS To conduct this review study, two researchers independently searched international databases such as PubMed, Cochrane Library, Web of sciences, Scopus, PsyINFO, and the Google scholar search engine in English without considering any time limit until January 2, 2024. Keywords such as "anxiety," "infertility," "prevalence," and "epidemiology" were used, taking into account the specific search method of each database. Using the Newcastle-Ottawa Scale (NOS), the quality of the articles was evaluated by two researchers independently. RESULTS In the systematic part of the study, 27 studies were included, and given the variety of measurement tools (8 different tools) used to investigate anxiety symptoms in infertile men, 24 studies were analyzed in five subgroups of tools. The pooled prevalence of anxiety symptoms in infertile men was 21.37% (95% CI: 15.73-27.02). The lowest and highest prevalence of anxiety in infertile men were related to the Beck anxiety inventory (BAI) and Depression Anxiety Stress Scales (DASS), accounting for 7.08% (95% CI: 3.27-10.90) and 34.90% (95%CI: 28.90-40.90) values respectively. This prevalence was 19.80% (95%CI: 9.01-30.59) for the Hospital Anxiety and Depression Scale (HADS), 30.06% (95%CI: 18.59-41.52) for the Spielberger Trait Anxiety Inventory (STAI-T), and 18.52% (95%CI: 7.76-29.29) for the Self-Rating Anxiety Scale (SAS). CONCLUSION The results of this systematic review and meta-analysis indicated that the prevalence of anxiety symptoms in infertile men requires special attention to healthcare planning. The healthcare system of different countries should evaluate the symptoms of anxiety in infertile men and take appropriate measures to reduce them according to the culture of the countries. It is recommended that all infertile couples be assessed for anxiety symptoms using a standardized tool during their initial evaluation.
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Affiliation(s)
- Masoumeh Simbar
- Midwifery and Reproductive Health Research Center, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Vida Ghasemi
- Department of Public Health, Asadabad School of Medical Sciences, Asadabad, Iran
| | - Reza Taherian
- Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehri Kalhor
- Department of Midwifery and Reproductive Health, Midwifery and Reproductive Health Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fateme Mohammadian
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Kiani
- Midwifery and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Szigeti F J, Sexty RE, Szabó G, Kazinczi C, Kéki Z, Sipos M, Ujma PP, Purebl G. The SCREENIVF Hungarian version is a valid and reliable measure accurately predicting possible depression in female infertility patients. Sci Rep 2024; 14:12880. [PMID: 38839780 PMCID: PMC11153651 DOI: 10.1038/s41598-024-63673-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 05/31/2024] [Indexed: 06/07/2024] Open
Abstract
Infertility patients, often in high distress, are entitled to being informed about their mental status compared to normative data. The objective of this study was to revalidate and test the accuracy of the SCREENIVF, a self-reported tool for screening psychological maladjustment in the assisted reproduction context. A cross-sectional, questionnaire-based online survey was carried out between December 2019 and February 2023 in a consecutive sample of female patients (N = 645, response rate 22.9%) in a university-based assisted reproduction center in Hungary. Confirmatory factor analysis and cluster and ROC analyses were applied to test validity, sensitivity and specificity in relation to Beck Depression Inventory (BDI) scores. Model fit was optimal (chi-square = 630.866, p < 0.001; comparative fit index = 0.99; root-mean-square error of approximation = 0.018 (90% CI 0.013-0.023); standardized-root-mean-square-residual = 0.044), and all dimensions were reliable (α > 0.80). A specific combination of cutoffs correctly predicted 87.4% of BDI-scores possibly indicative of moderate-to-severe depression (χ2(1) = 220.608, p < 0.001, Nagelkerke R2 = 0.462, J = 66.4). The Hungarian version of the SCREENIVF is a valid and reliable tool, with high accuracy in predicting BDI-scores. Low response rate may affect generalizability. The same instrument with different cutoffs can serve various clinical goals.
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Affiliation(s)
- Judit Szigeti F
- Institute of Behavioral Sciences, Semmelweis University, Üllői út 26, 1085, Budapest, Hungary.
- Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis University, Üllői út 26, 1085, Budapest, Hungary.
| | - Réka E Sexty
- Department of Psychology, University of Graz, Dachgeschoß - 2, Stock, 2, 8010, Graz, Austria
| | - Georgina Szabó
- Doctoral School of Mental Health Sciences, Semmelweis University, Üllői út 26, 1085, Budapest, Hungary
- Department of Psychiatry, North Buda Saint John's Hospital Center and Outpatient Clinic, Diós Árok 1-3, 1125, Budapest, Hungary
| | - Csaba Kazinczi
- Department of Clinical Psychology, Semmelweis University, Budapest, Hungary
- Doctoral School of Clinical Medicine, University of Szeged, 6722, Szeged, Hungary
| | - Zsuzsanna Kéki
- Directorate for Human Reproduction, National Directorate General for Hospitals, Buda-part tér 2, BudaPart Gate Irodaház A. ép. 406, 1117, Budapest, Hungary
| | - Miklós Sipos
- Department of Obstetrics and Gynecology, Assisted Reproduction Center, Semmelweis University, Üllői út 26, 1085, Budapest, Hungary
| | - Péter Przemyslaw Ujma
- Institute of Behavioral Sciences, Semmelweis University, Üllői út 26, 1085, Budapest, Hungary
| | - György Purebl
- Institute of Behavioral Sciences, Semmelweis University, Üllői út 26, 1085, Budapest, Hungary
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Olive E, Bull C, Gordon A, Davies-Tuck M, Wang R, Callander E. Economic evaluations of assisted reproductive technologies in high-income countries: a systematic review. Hum Reprod 2024; 39:981-991. [PMID: 38438132 PMCID: PMC11063548 DOI: 10.1093/humrep/deae039] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 01/10/2024] [Indexed: 03/06/2024] Open
Abstract
STUDY QUESTION Which assited reproductive technology (ART) interventions in high-income countries are cost-effective and which are not? SUMMARY ANSWER Among all ART interventions assessed in economic evaluations, most high-cost interventions, including preimplantation genetic testing for aneuploidy (PGT-A) for a general population and ICSI for unexplained infertility, are unlikely to be cost-effective owing to minimal or no increase in effectiveness. WHAT IS KNOWN ALREADY Approaches to reduce costs in order to increase access have been identified as a research priority for future infertility research. There has been an increasing number of ART interventions implemented in routine clinical practice globally, before robust assessments of evidence on economic evaluations. The extent of clinical effectiveness of some studied comparisons has been evaluated in high-quality research, allowing more informative decision making around cost-effectiveness. STUDY DESIGN, SIZE, DURATION We performed a systematic review and searched seven databases (MEDLINE, PUBMED, EMBASE, COCHRANE, ECONLIT, SCOPUS, and CINAHL) for studies examining ART interventions for infertility together with an economic evaluation component (cost-effectiveness, cost-benefit, cost-utility, or cost-minimization assessment), in high-income countries, published since January 2011. The last search was 22 June 2022. PARTICIPANTS/MATERIALS, SETTING, METHODS Two independent reviewers assessed publications and included those fulfilling the eligibility criteria. Studies were examined to assess the cost-effectiveness of the studied intervention, as well as the reporting quality of the study. The chosen outcome measure and payer perspective were also noted. Completeness of reporting was assessed against the Consolidated Health Economic Evaluation Reporting Standard. Results are presented and summarized based on the intervention studied. MAIN RESULTS AND THE ROLE OF CHANCE The review included 40 studies which were conducted in 11 high-income countries. Most studies (n = 34) included a cost-effectiveness analysis. ART interventions included medication or strategies for controlled ovarian stimulation (n = 15), IVF (n = 9), PGT-A (n = 7), single embryo transfer (n = 5), ICSI (n = 3), and freeze-all embryo transfer (n = 1). Live birth was the mostly commonly reported primary outcome (n = 27), and quality-adjusted life years was reported in three studies. The health funder perspective was used in 85% (n = 34) of studies. None of the included studies measured patient preference for treatment. It remains uncertain whether PGT-A improves pregnancy rates compared to IVF cycles managed without PGT-A, and therefore cost-effectiveness could not be demonstrated for this intervention. Similarly, ICSI in non-male factor infertility appears not to be clinically effective compared to standard fertilization in an IVF cycle and is therefore not cost-effective. Interventions such as use of biosimilars or HMG for ovarian stimulation are cheaper but compromise clinical effectiveness. LIMITATIONS, REASONS FOR CAUTION Lack of both preference-based and standardized outcomes limits the comparability of results across studies. The selection of efficacy evidence offered for some interventions for economic evaluations is not always based on high-quality randomized trials and systematic reviews. In addition, there is insufficient knowledge of the willingness to pay thresholds of individuals and state funders for treatment of infertility. There is variable quality of reporting scores, which might increase uncertainty around the cost-effectiveness results. WIDER IMPLICATIONS OF THE FINDINGS Investment in strategies to help infertile people who utilize ART is justifiable at both personal and population levels. This systematic review may assist ART funders decide how to best invest to maximize the likelihood of delivery of a healthy child. STUDY FUNDING/COMPETING INTEREST(S) There was no funding for this study. E.C. and R.W. receive salary support from the National Health and Medical Research Council (NHMRC) through their fellowship scheme (EC GNT1159536, RW 2021/GNT2009767). M.D.-T. reports consulting fees from King Fahad Medical School. All other authors have no competing interests to declare. REGISTRATION NUMBER Prospero CRD42021261537.
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Affiliation(s)
- Emily Olive
- Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Claudia Bull
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Adrienne Gordon
- Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Miranda Davies-Tuck
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia
| | - Rui Wang
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - Emily Callander
- School of Public Health, University of Technology Sydney, Sydney, NSW, Australia
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Ribeiro S, Pedro J, Martins MV. Psychosocial experiences of involuntary definitive childless women: a comparative study based on reproductive status. Hum Reprod 2024; 39:559-568. [PMID: 38290160 DOI: 10.1093/humrep/deae001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/27/2023] [Indexed: 02/01/2024] Open
Abstract
STUDY QUESTION Do involuntary definitive childless women have lower psychosocial adjustment levels than women with infertility diagnoses actively trying to conceive and presumably fertile women? SUMMARY ANSWER Involuntary definitive childless women have lower levels of sexual functioning than infertile women actively trying to conceive and presumably fertile women, and higher levels of depression than presumably fertile women. WHAT IS KNOWN ALREADY Involuntary definitive childless defines those who wanted to become parents but were unable to do so. Studies have provided evidence about infertility and its psychosocial consequences, but there is a lack of knowledge about the impact of involuntary definitive childlessness, namely on sexual function, social support, marital satisfaction, and psychological adjustment. STUDY DESIGN, SIZE, DURATION This associative study was conducted between July 2021 and January 2022 for involuntary definitive childless women and between July 2016 and February 2018 for women with an infertility diagnosis actively trying to conceive as well as presumably fertile women. An online questionnaire announced in social media and gynaecology and fertility clinics was used. The inclusion criteria for all participants were being childless, in a heterosexual relationship and cohabiting for at least 2 years. Specific inclusion criteria for involuntary definitive childless women were: trying to conceive for at least 2 years; not achieving pregnancy because of biological and medical constraints; and not undergoing fertility treatment or being a candidate for adopting a child at time of the study. For women with an infertility diagnosis the inclusion criteria were: actively trying to conceive (naturally or through fertility treatments); having a primary fertility diagnosis; and aged between 22 and 42 years old. For presumably fertile women, the inclusion criteria were: having a parenthood wish in the future; and not knowing of any condition that could prevent them from conceiving. PARTICIPANTS/MATERIALS, SETTING, METHODS Out of 360 women completing the survey, only 203 were eligible for this study (60 involuntary definitive childless women, 78 women with an infertility diagnosis actively trying to conceive, and 65 presumably fertile women). All participants completed a questionnaire including sociodemographic and clinical data, the Female Sexual Function Index, the 2-Way Social Support Scale, the Relationship Assessment Scale, and Hospital Anxiety and Depression Scale. Binary logistic regression was performed to assess the relation between sexual function, social support, marital satisfaction, anxiety, depression, and reproductive status, adjusting for age, and cohabitation length. Presumably fertile women were used as a reference group. MAIN RESULTS AND THE ROLE OF CHANCE Women were 34.31 years old (SD = 5.89) and cohabited with their partners for 6.55 years (SD = 4.57). The odds ratio (OR) showed that involuntary definitive childless women had significantly lower sexual function than infertile women actively trying to conceive (OR = 0.88, 95% CI = 0.79-0.99) and presumably fertile women (OR = 34.89, 95% CI = 1.98-614.03), and higher depression levels than presumably fertile women (OR = 99.89, 95% CI = 3.29-3037.87). Women with an infertility diagnosis actively trying to conceive did not differ from presumably fertile women in sexual function, social support, marital satisfaction, anxiety, and depression. LIMITATIONS, REASONS FOR CAUTION The majority of childless women underwent fertility treatments, and childlessness for circumstantial reasons owing to lack of a partner was not included, therefore these results may not reflect the experiences of all women with an involuntary childless lifestyle. There was a time gap in the recruitment process, and only the definitive childlessness group filled out the questionnaire after the coronavirus disease 2019 pandemic. We did not ask participants if they self-identified themselves with the groups' terminology they were assigned to. WIDER IMPLICATIONS OF THE FINDINGS Our results emphasize the importance of future research to provide a more comprehensive understanding of the adjustment experiences of childless women and an awareness of the poor adjustment they might experience, highlighting the need to keep following women after unsuccessful treatments. Clinical practitioners must attend to these dimensions when consulting involuntary definitive childless women who might not have gone through treatments but also experience these adverse outcomes. STUDY FUNDING/COMPETING INTEREST(S) This study was partially supported by the Portuguese Foundation for Science and Technology. The authors declare that they have no conflict of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Sara Ribeiro
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Juliana Pedro
- Centre for Reproductive Genetics A.Barros, Porto, Portugal
- Center for Psychology at University of Porto, Porto, Portugal
| | - Mariana Veloso Martins
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
- Center for Psychology at University of Porto, Porto, Portugal
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12
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Iranifard E, Yas A, Mansouri Ghezelhesari E, Taghipour A, Mahmoudinia M, Latifnejad Roudsari R. Treatment suspension due to the coronavirus pandemic and mental health of infertile patients: a systematic review and meta-analysis of observational studies. BMC Public Health 2024; 24:174. [PMID: 38218778 PMCID: PMC10787415 DOI: 10.1186/s12889-023-17628-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 12/31/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Access to fertility treatments is considered a reproductive right, but because of the quarantine due to the coronavirus pandemic most infertility treatments were suspended, which might affect the psychological and emotional health of infertile patients. Therefore, this study was conducted to review the mental health of infertile patients facing treatment suspension due to the coronavirus pandemic. METHODS This study was conducted based on the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guideline. The Web of Science, PubMed, Embase, Scopus, and Cochrane library databases were searched by two independent researchers, without time limitation until 31 December 2022. All observational studies regarding the mental health of infertile patients facing treatment suspension including anxiety, depression, and stress were included in the study. Qualitative studies, editorials, brief communications, commentaries, conference papers, guidelines, and studies with no full text were excluded. Quality assessment was carried out using Newcastle-Ottawa Scale by two researchers, independently. The random effects model was used to estimate the pooled prevalence of mental health problems. Meta-regression and subgroup analysis were used to confirm the sources of heterogeneity. RESULTS Out of 681 studies, 21 studies with 5901 infertile patients were systematically reviewed, from which 16 studies were included in the meta-analysis. The results of all pooled studies showed that the prevalence of anxiety, depression, and stress in female patients was 48.4% (95% CI 34.8-62.3), 42% (95% CI 26.7-59.4), and 55% (95% CI 45.4-65), respectively. Additionally, 64.4% (95% CI 50.7-76.1) of patients wished to resume their treatments despite the coronavirus pandemic. CONCLUSION Treatment suspension due to the coronavirus pandemic negatively affected the mental health of infertile patients. It is important to maintain the continuity of fertility care, with special attention paid to mental health of infertile patients, through all the possible measures even during a public health crisis.
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Affiliation(s)
- Elnaz Iranifard
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Atefeh Yas
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Ali Taghipour
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Epidemiology, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Malihe Mahmoudinia
- Maternal and Neonatal Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Obstetrics and Gynecology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Robab Latifnejad Roudsari
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
- Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.
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Mohammadi F, Javanmardifard S, Bijani M. Women living with infertility in Iran: A qualitative content analysis of perception of dignity. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241260027. [PMID: 38836384 PMCID: PMC11155321 DOI: 10.1177/17455057241260027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 05/07/2024] [Accepted: 05/21/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Globally, infertility is known as a major problem which can ruin a couple's relationship. In recent years, many studies have addressed the causes of infertility, the outcomes of treatments for infertility, and the effects of infertility on couples' mental health; however, the concept of dignity of women living with infertility has never been examined in depth. OBJECTIVE This study aimed to explore the dignity of women living with infertility in Iran. DESIGN This qualitative research was conducted via conventional content analysis approach. METHODS This qualitative study was conducted in Iran from February to December 2022. In this research, the data were collected through face-to-face semi-structured in-depth interviews with 23 women living with infertility selected via purposive sampling. The interviews were continued until reaching the data saturation point. Data analysis was performed simultaneously with data collection. The interviews were recorded, transcribed, and analyzed through Graneheim and Lundman style content analysis, with data management done using the MAXQDA software. To achieve the accuracy and validity of the study, the four-dimension criteria by Lincoln and Guba, namely credibility, dependability, conformability, and transformability, were considered and used. RESULTS Analysis of the qualitative data yielded three themes and eight subthemes. The three main themes were (1) overcoming identity crises (overcoming dysthymia, coping with unaccomplished motherhood), (2) respect for personal identity (respect for confidentiality; respect for beliefs, values, and attitudes; avoidance of stigma and pity), and (3) compassion-focused therapy (sympathizing, mental and spiritual support, and enhancement of life skills). CONCLUSION Dignity of women living with infertility encompasses overcoming identity crises, respect for personal identity, and compassion therapy. The policymakers and administrators in the healthcare system can use the findings of this study to create a proper clinical environment toward preserving the dignity of women living with infertility.
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Affiliation(s)
- Fateme Mohammadi
- Chronic Diseases (Home Care) Research Center and Autism Spectrum Disorders Research Center, Department of Nursing, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Sorur Javanmardifard
- Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mostafa Bijani
- Department of Medical Surgical Nursing, School of Nursing, Fasa University of Medical Sciences, Fasa, Iran
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Bagade T, Mersha AG, Majeed T. The social determinants of mental health disorders among women with infertility: a systematic review. BMC Womens Health 2023; 23:668. [PMID: 38093258 PMCID: PMC10720205 DOI: 10.1186/s12905-023-02828-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Infertility is associated with mental health disorders in women, even if a successful pregnancy resolves infertility. However, the link between social determinants of health (SDoH) and mental health in women with infertility is not well understood. We aimed to investigate the determinants thoroughly so that mental health screening and services can be tailored to suit women with infertility who are vulnerable to mental health disorders. METHODOLOGY All observational studies that included women participants of reproductive age with infertility and assessed social determinants associated with mental health disorders were searched using a combination of keywords from MEDLINE, EMBASE, CINAHL, PsycINFO, Scopus, and Web of Science databases and published in English. Two reviewers conducted screening, data extraction, quality assessment and risk of bias. The protocol was registered on PROSPERO (number CRD42022343962). RESULTS The systematic review included 32 studies out of 3405 screened articles from January 1st 2010 to 16th October 2023. Compared to women without infertility, the prevalence of mental health disorders, including anxiety, depression, psychological distress, and stress, is high among women with infertility, with the severity being influenced by social determinants-those with higher education, employment, higher personal or family income, private health insurance, higher social support, stronger religious beliefs, and higher spiritual well-being reported better mental health outcomes. CONCLUSION The study highlights the need for early detection, tailored interventions, and integrated and comprehensive support systems to address the mental health needs of women with infertility and improve their well-being.
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Affiliation(s)
- Tanmay Bagade
- School of Medicine and Public Health, College of Health, Medicine, and Wellbeing, The University of Newcastle, Callaghan, NSW, 2285, Australia.
| | - Amanual Getnet Mersha
- School of Medicine and Public Health, College of Health, Medicine, and Wellbeing, The University of Newcastle, Callaghan, NSW, 2285, Australia
| | - Tazeen Majeed
- School of Medicine and Public Health, College of Health, Medicine, and Wellbeing, The University of Newcastle, Callaghan, NSW, 2285, Australia
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Riddle JN, Hopkins T, Yeaton-Massey A, Hellberg S. No Baby to Bring Home: Perinatal Loss, Infertility, and Mental Illness-Overview and Recommendations for Care. Curr Psychiatry Rep 2023; 25:747-757. [PMID: 37878138 DOI: 10.1007/s11920-023-01469-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/02/2023] [Indexed: 10/26/2023]
Abstract
PURPOSE OF REVIEW Update readers on the state of the research on mental health, perinatal loss, and infertility with a focus on providing a comprehensive overview to empower clinicians in treating this population. RECENT FINDINGS Rates of psychiatric illness are increased in people that experience perinatal loss and infertility. The research remains largely below the clear need for focused screening, prevention, and treatment. Clinicians and researchers need to remain attuned to the impact of perinatal loss and infertility on the mental health of patients and families. Screening, referral, and expanded therapeutic and psychiatric resources are imperative to improving the well-being of these patients and families.
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Affiliation(s)
- Julia N Riddle
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, USA.
| | - Tiffany Hopkins
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, USA
| | - Amanda Yeaton-Massey
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, USA
| | - Samantha Hellberg
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, NC, USA
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Stigliani S, Massarotti C, Maccarini E, Sozzi F, Rebora S, Scaruffi P, Anserini P. Telehealth for infertile patients during SARS-CoV-2 pandemic: far, and yet close. Minerva Obstet Gynecol 2023; 75:405-411. [PMID: 35333035 DOI: 10.23736/s2724-606x.22.05074-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND In Italy during the first pandemic wave of SARS-CoV-2 the activity of fertility centers was stopped, with the exception of fertility preservation in oncological patients. We adopted telehealth and we evaluated whether it could help in the management of infertile couples at a fertility center. METHODS A longitudinal study performed at a public fertility center. Telehealth was offered to 72 couples referred to our center for a first consultation from March 17th to May 31st, 2020. Percentage of patients who performed the first assisted reproduction technology (ART) cycle or intrauterine insemination (IUI) within 6 months from the first visit and drop-out rate were analyzed during COVID-19 pandemic and compared to historical controls (couples admitted to our center in 2017-2019). RESULTS Eighty-five (61/72) percent of the couples accepted telehealth. Time to first treatment after online consultation in telehealth group (4.5±1.8 months) was significantly shorter (P=0.033) respect to time to first treatment after face-to-face visit of historical controls (7.5±6.9 months). After telehealth consultation, we observed a significant reduction (P=0.002) of drop-out rate from 39% in historical controls to 17% of telehealth group. Telehealth significantly diminished the drop-out rate also during the COVID-19 pandemic respect to 73% after traditional face-to-face visits (P=0.0005), with a time to first treatment of 3.7±2.1 months in couples who refused telehealth. CONCLUSIONS Telehealth could be a useful tool to facilitate the path of patients in a fertility center.
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Affiliation(s)
- Sara Stigliani
- Unit of Physiopathology of Human Reproduction, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Claudia Massarotti
- Unit of Physiopathology of Human Reproduction, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Elena Maccarini
- Unit of Physiopathology of Human Reproduction, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Fausta Sozzi
- Unit of Physiopathology of Human Reproduction, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Simona Rebora
- Unit of Clinical Psychology and Psychotherapy, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Paola Scaruffi
- Unit of Physiopathology of Human Reproduction, IRCCS Ospedale Policlinico San Martino, Genoa, Italy -
| | - Paola Anserini
- Unit of Physiopathology of Human Reproduction, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Zargar M, Sayyah M, Nikbakht R, Abdipour Z. Comparison of psychological disorders during and after pregnancies caused by assisted reproductive treatments and spontaneous pregnancies. Cent Nerv Syst Agents Med Chem 2023; 23:CNSAMC-EPUB-133742. [PMID: 37592788 DOI: 10.2174/1871524923666230817102216] [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: 05/10/2023] [Revised: 06/24/2023] [Accepted: 07/17/2023] [Indexed: 08/19/2023]
Abstract
INTRODUCTION Mental disorders during pregnancy are one of the major public health problems because of its effect on both mother and child, but the prevalence of psychiatric disorders in infertile women is largely unknown to compare psychiatric disorders during and after pregnancies with assisted reproductive therapies (ART) and spontaneous pregnancies. METHODS This cross-sectional study was conducted on pregnant women referring to midwifery centers in Ahvaz City in 2022. Pregnant women were included in two groups of either pregnancy caused by ART (n= 84) or spontaneous pregnancy (n= 256). The Symptom Checklist-90-R (SCL90-R) was used to assess psychiatric disorders during and after pregnancies. RESULTS A high percentage of women with spontaneous pregnancy (74.6%) and ART (91.7%) had some degree of psychological disorders. The severity of psychological disorders in both groups was higher during pregnancy than after pregnancy (P<0.001). The intensity of various psychological disorders during and after pregnancy in the ART pregnancy group was significantly higher than the control group (P<0.001). An increased risk of psychiatric disorders during pregnancy was associated with the history of psychiatric disorders [odd ratio (OR): 12.393; P= 0.022], family history of psychiatric disorders (OR:26.168; P<0.001), history of infertility (OR: 19.00; P<0.001), primary infertility (OR: 12.714; P=0.004), infertility duration more than three years (OR: 43.424; P<0.001), and frequency of embryo transfer (OR: 18.939; P=0.045). CONCLUSION Psychiatric disorders were prevalent among pregnant women in the study area especially in pregnant women with ART. Regular screening programs for mental health problem should be included in an antenatal care service especially in this high-risk group.
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Affiliation(s)
- Mahvash Zargar
- Department of Obstetrics and Gynecology, School of Medicine, Fertility Infertility and Perinatology Research Center,
Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mehdi Sayyah
- Educational Development Center, Menopause Andropause Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Roshan Nikbakht
- Department of Obstetrics and Gynecology, School of Medicine, Fertility Infertility and Perinatology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Zahra Abdipour
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Chai Y, Li Q, Wang Y, Niu B, Chen H, Fan T, Ke X, Zou H. Cortisol dysregulation in anxiety infertile women and the influence on IVF treatment outcome. Front Endocrinol (Lausanne) 2023; 14:1107765. [PMID: 37383394 PMCID: PMC10299854 DOI: 10.3389/fendo.2023.1107765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 05/23/2023] [Indexed: 06/30/2023] Open
Abstract
Introduction Dysregulation of the stress-regulatory hormone cortisol is associated with anxiety, but its potential impact on infertile women and in vitro fertilization (IVF) treatment remains unclear. This prospective cross-sectional study aimed at evaluating the dysregulation of cortisol and its correlation to anxiety in infertile women. The influence of stress on IVF outcomes was also investigated. Methods A point-of-care test was used for the measurement of morning serum cortisol in 110 infertile women and 112 age-matching healthy individuals. A Self-Rating Anxiety Scale (SAS) was used for the anxiety assessment of infertile women, and 109 of them underwent IVF treatment starting with the GnRH-antagonist protocol. If clinical pregnancy was not achieved, more IVF cycles were conducted with adjusted protocols until the patients got pregnant or gave up. Results Higher morning serum cortisol level was identified for infertile patients, especially for the elder. Women with no anxiety showed significant differences in cortisol levels, monthly income, and BMI compared with those with severe anxiety. A strong correlation was found between the morning cortisol level and the SAS score. When the cutoff value is 22.25 μg/dL, cortisol concentration could predict the onset of anxiety with high accuracy (95.45%) among infertile women. After IVF treatments, women with high SAS scores (>50) or cortisol levels (>22.25 μg/dL) demonstrated a lower rate of pregnancy (8.0%-10.3%) and more IVF cycles, although the impact of anxiety was not affirmative. Conclusion Hypersecretion of cortisol related to anxiety was prevalent among infertile women, but the influence of anxiety on multi-cycle IVF treatment was not affirmative due to the complicated treatment procedures. This study suggested that the assessment of psychological disorders and stress hormone dysregulation should not be overlooked. An anxiety questionnaire and rapid cortisol test might be included in the treatment protocol to provide better medical care.
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Affiliation(s)
- Yujuan Chai
- Department of Biomedical Engineering, School of Medicine, Shenzhen University, Shenzhen, Guangdong, China
| | - Qihang Li
- Department of Biomedical Engineering, School of Medicine, Shenzhen University, Shenzhen, Guangdong, China
| | - Yang Wang
- Department of Management, Shenzhen University, Shenzhen, Guangdong, China
| | - Ben Niu
- Department of Management, Shenzhen University, Shenzhen, Guangdong, China
| | - Huijia Chen
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tingxuan Fan
- Greater Bay Area International Institute for Innovation, Shenzhen University, Shenzhen, Guangdong, China
| | - Xiatong Ke
- Research Department III, Shenzhen Health Development Research and Data Management Center, Shenzhen, Guangdong, China
| | - Heng Zou
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Kheirkhah F, Faramarzi M, Shafierizi S, Chehrazi M, Basirat Z. Preliminary examination of acceptability, feasibility, and effectiveness of internet-based cognitive behavioral therapy for treatment of depression and anxiety in infertile women. Heliyon 2023; 9:e15760. [PMID: 37180939 PMCID: PMC10173620 DOI: 10.1016/j.heliyon.2023.e15760] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 04/13/2023] [Accepted: 04/20/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Despite a large body of evidence supporting the effectiveness of internet-based cognitive behavior therapy (ICBT) for the treatment of depression and anxiety, there is no report of the efficacy of ICBT program in the Iranian population. The present study aimed to test the acceptability, feasibility, and effectiveness of ICBT program for the treatment of depression or anxiety in infertile women. METHOD This study consisted of two phases. In the first phase, we designed "Peaceful Mind", an eight-session therapist-guided ICBT program. In the second phase, we tested the efficacy of the program by conducting 2-arm parallel group, non-inferiority randomized control trial, between October 2020 and July 2021.60 infertile women diagnosed with depression or anxiety disorders were divided randomly to ICBT treatment (n = 30) and face-to face CBT (n = 30). The participants received individual CBT sessions (60 min, over 8 weeks) and completed the questionnaires at the beginning, in mid-trial, and 8 weeks after the trial. The outcomes comprised Beck Depression Inventory (BDI-II), Beck Anxiety Inventory (BAI, Fertility problem inventory (FPI), Client Satisfaction Questionnaire (CSQ-8), and System usability scale (SUS). RESULTS The usability scores of the "Peaceful Mind" ICBT (M = 67.07, SD = 17.23, range = 1-100) and satisfaction with the treatment (M = 25.06, SD = 4.18, range = 1-32) were high. Patient adherence to the treatment in the ICBT group (86.6%) was the same as that in the CBT (73.3%). The between-group mean differences at the post-trial were -4.79 (CI 95% = -10.81 to 1.23) for depression scores and -4.15 (CI 95% = -9.52 to 1.22) for anxiety scores; both differences were within the non-inferiority margin points for the lower 95%CI. CONCLUSION "Peaceful mind" ICBT was found to be feasible and accessible for delivering the treatment to the patients. The study confirmed that both ICBT face-to face CBT were equally effective in reducing depression and anxiety of the patients.
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Affiliation(s)
- Farzan Kheirkhah
- Psychiatry, Infertility and Health Reproductive Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mahbobeh Faramarzi
- Psychology, Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Shiva Shafierizi
- Midwifery, Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Mohammad Chehrazi
- Biostatistics, Department of Biostatistics and Epidemiology, School of Public Health, Babol University of Medical Sciences, Babol, Iran
| | - Zahra Basirat
- Obstetrics and Gynecology, Infertility and Health Reproductive Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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20
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Antequera-Jurado R, Moreno-Rosset C, Ramírez-Uclés I. The specific psychosocial modulator factors of emotional adjustment in infertile individuals compared to fertile people. CURRENT PSYCHOLOGY 2023. [DOI: 10.1007/s12144-023-04436-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Certain psychological and social factors modulate emotional adjustment in infertility. The aims of this study were: analyse whether there are sex and group differences (infertile vs. fertile) in emotional adjustment, and personality, dispositional optimism, coping strategies, personal and interpersonal resources; observe the modulating role of these psychosocial variables in the emotional adjustment of infertile individuals compared to fertile ones; and determine if the modulator variables associated with emotional adjustment are specific to infertile people. Method: A cross-sectional study design was used with a sample of 139 heterosexual Spanish participants (84 infertile, 55 fertile). For the data analysis we performed correlations, multiple regression analysis, MANOVAS and ANOVAS. Results: The multivariate and univariate analyses showed that the infertile group exhibited greater emotional maladjustment, more personal resources, lesser degree of confrontive coping, social support seeking, positive reappraisal, and lower marital satisfaction than the fertile group. In addition, women (infertile and fertile) sought more social support seeking and the infertile ones made more use of self-controlling strategies. Multiple regression analyses showed that for all subjects the emotional adjustment was modulated by dispositional optimism and escape/avoidance. For infertile participants, the remaining significant modulating factors were personal resources and marital satisfaction, whereas, for the fertile group, they were openness and interpersonal resources. Conclusion: Infertile women and men showed no differences in emotional maladjustment, but levels were higher than in the fertile group. We found differences between infertile and fertile subjects in terms of modulating variables of emotional adjustment. For infertile participants, the development of personal resources and increased marital satisfaction are particularly important.
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21
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Foti FL, Karner-Huţuleac A, Maftei A. The value of motherhood and psychological distress among infertile women: The mediating role of coping strategies. Front Public Health 2023; 11:1024438. [PMID: 36817897 PMCID: PMC9931740 DOI: 10.3389/fpubh.2023.1024438] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 01/06/2023] [Indexed: 02/05/2023] Open
Abstract
Introduction The present study investigated psychological distress and coping strategies among infertile women during the COVID-19 pandemic using a multi-dimensional model of infertility-related stress. We explored the associations between individual (i.e., age) and situational characteristics related to infertility (i.e., duration of infertility, cause of infertility, number of lost pregnancies, and assisted reproductive techniques [ART] status), and perceived-infertility-related factors (i.e., the perceived importance of motherhood). Methods Our total sample consisted of 193 women aged 20 to 46 (M= 33.23, SD = 4.58), out of which 102 were undergoing ART procedures (M = 33.60, SD = 4.23), and 91 were not (M= 32.81, SD = 4.94). Participants filled in questionnaires measuring psychological distress, coping strategies, and the importance of motherhood. Results Correlation analyses suggested that the importance of motherhood was positively associated with psychological distress and negative coping strategies. Mediation analysis results indicated that both in the overall sample and in the sample of women undergoing ART procedures, the negative self-perception fully mediated the link between the importance of motherhood on psychological distress. In the non-ART sample, we found a significant mediation effect of denial on the link between the importance of motherhood and psychological distress. Discussion We discuss the theoretical and practical implications of the present findings, focusing on the mental health-related consequences of the social stigma of infertility heightened by the pressure of parenthood.
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Affiliation(s)
- Florentina Larisa Foti
- Faculty of Psychology and Education Sciences, Alexandru Ioan Cuza University, Iaşi, Romania
| | - Adina Karner-Huţuleac
- Faculty of Psychology and Education Sciences, Alexandru Ioan Cuza University, Iaşi, Romania
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22
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Wang G, Liu X, Lei J. Cognitive behavioural therapy for women with infertility: A systematic review and meta-analysis. Clin Psychol Psychother 2023; 30:38-53. [PMID: 36239578 DOI: 10.1002/cpp.2792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/06/2022] [Accepted: 10/06/2022] [Indexed: 02/03/2023]
Abstract
Cognitive behavioural therapy (CBT) has been used for women with infertility. However, the efficacy of CBT among the infertile female population remains inconclusive. We performed a systematic literature search using the Cochrane Library, MEDLINE (OVID), EMBASE (OVID), CINAHL, PsycINFO (OVID), Web of Science, and ProQuest databases from the inception to May 2022. The Cochrane risk of bias tool for randomized trials was used to assess the methodological quality of the included studies. Revman 5.4 was conducted for statistical analysis, and meta-analyses were performed to calculate the pooled effects of CBT. Sixteen articles were finally included in the meta-analysis. The results of the meta-analysis revealed large, significant effects of cognitive-behavioural interventions that can effectively reduce depression, anxiety symptoms, psychological distress, perceived stress, infertility-specific stress, and improve the quality of life in women with infertility. However, the pooled MD using a fixed-effects model was 0.25, 95% CI [-0.33, 0.84], P = 0.40, and no significant differences in BMI were observed among those who received CBT therapy compared with those who did not. CBT effectively alleviates depression, anxiety, psychological distress, and infertility-specific stress levels and improves the quality of life among women with infertility. Future studies should explore the sustainability and long-term effect of cognitive-behavioural interventions in women with infertility.
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Affiliation(s)
- Guangpeng Wang
- Xiangya School of Nursing, Central South University, Changsha, Hunan Province, China
| | - Xueyan Liu
- School of Nursing, Shandong University, Jinan, Shandong Province, China
| | - Jun Lei
- The Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
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23
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Kiani Z, Simbar M, Hajian S, Zayeri F, RashidiFakari F, Chimeh FJ. Investigating different dimensions of infertile women's quality of life: a descriptive cross-sectional study. BMC Public Health 2022; 22:2436. [PMID: 36575427 PMCID: PMC9793385 DOI: 10.1186/s12889-022-14924-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Infertility is a major challenge in the life of women which affects their quality of life. Infertile women's quality of life is a relatively new field of research that has recently been considered by health researchers. However, there has been no standard tool for measuring different aspects of infertile women's quality of life with female factors, and general and specific tools of infertile couples have been used to assess their quality of life. This study, thus, aimed to analyze different aspects of the quality of life of infertile women. METHODS This descriptive cross-sectional study was conducted on 320 infertile women referred to a teaching hospital affiliated with Mazandaran University of Medical Sciences and private infertility treatment centers in Sari, Iran. Demographic and fertility characteristics and the quality of life questionnaire for infertile women questionnaire (a 25-item tool was designed which measured 7 factors of psychological effects, sexual life with infertility family and social effects, infertility-related concerns, physical effects, adaptive approaches and factors preventing infertility adaptation), were recruited for data gathering. Data were analyzed using SPSS version 22. Descriptive statistics (percentage, mean, standard deviation), correlation coefficient, independent sample t-test, and multiple linear regression were used. P-values less than 0.05 were considered statistically significant. RESULTS The total mean score of infertile women's quality of life was 65.68 ± 8.91%. Findings were indicative of infertile women's quality of life in the dimensions of adaptive approach (70.48 ± 15.02%), psychological (67.88 ± 12.06%), family and social (64.63 ± 10.76%), physical, 63.42 ± 11.36%), inhibitory factors/ factors preventing adaptation (60.98 ± 8.24%), related concerns (51.52 ± 10.21%) and sexual life (40.12 ± 14.28%). According to the final multiple linear regression model, women's education (B = 2.57, p < 0.001), spouse's education (B = 1.56, p = 0.046), economic status (B = 1.64, p < 0.001), age of women (B = -0.62, p < 0.001), age of spouse (B = -0.65, p < 0.001), duration of infertility (B = -0.36, p = 0.024) and duration of marriage (B = -0.39, p = 0.022) were the final predictors of the quality of life score in infertile women of the study. CONCLUSION Given that infertility causes extensive changes in individuals, families, and social dimensions of infertile women, it can affect their quality of life. We can take steps to improve the health of infertile women by promoting various dimensions of their quality of life.
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Affiliation(s)
- Zahra Kiani
- grid.411600.2Midwifery and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoumeh Simbar
- grid.411600.2Midwifery and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran ,grid.411600.2Midwifery and Reproductive Health Research Center, Department of Midwifery, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sepideh Hajian
- grid.411600.2Department of Midwifery, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farid Zayeri
- grid.411600.2Proteomics Research Center and Department of Biostatistics, Faculty of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzaneh RashidiFakari
- grid.464653.60000 0004 0459 3173Department of Midwifery, School of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Fatemeh Jalali Chimeh
- grid.411600.2Midwifery and Reproductive Health Research Center, Department of Midwifery, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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24
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Abdulslam Abdullah A, Ahmed M, Oladokun A, Ibrahim NA, Adam SN. Serum leptin level in Sudanese women with unexplained infertility and its relationship with some reproductive hormones. World J Biol Chem 2022; 13:83-94. [PMID: 36482982 PMCID: PMC9724080 DOI: 10.4331/wjbc.v13.i5.83] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/30/2022] [Accepted: 11/23/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The excessive concentration of leptin has negative effects on all aspects of female reproduction. Despite this established relationship, the exact role of leptin in women's fertility is not clear enough and needs more clarification. AIM To evaluate the serum leptin levels in Sudanese women and to ascertain the relationship between serum leptin levels and unexplained infertility (UI). METHODS A matched (age and body mass index) case-control study was conducted from March 2021 to February 2022. The study samples were 210 women with UI and 190 fertile women of reproductive age who were attending the maternity hospitals and fertility clinics in Khartoum state Sudan. The serum concentration of leptin and other serum biomarkers were determined using enzyme-linked immunosorbent assays. RESULTS The results showed that there was a highly statistically significant difference between the two groups (P < 0.001) for all examined eight biomarkers. Whereby, leptin, luteinizing hormone (LH)/follicular stimulating hormone (FSH) ratio, prolactin hormone (PRL) and testosterone (T) were significantly higher in the UI group compared with the control group. In contrast, FSH and estradiol (E2)/T ratio were significantly lower in the UI group than in the control group and the effect size test for the difference between the two groups was very large (effect size > 0.80), for leptin level, LH/FSH ratio, PRL level, and E2/T ratio, and large (effect size 0.50- ≤ 0.80) for FSH and T. CONCLUSION This study reveals that leptin could be a potential biomarker for UI in Sudanese women and it may be useful for identifying women with a high risk of infertility.
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Affiliation(s)
- Abdullah Abdulslam Abdullah
- Department of Reproductive Health Sciences, Pan African University Life and Earth Sciences Institute, University of Ibadan, Ibadan 119, Oyo, Nigeria
- Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan 119, Oyo, Nigeria
- Department of Biomedical Sciences, Faculty of Veterinary Sciences, University of Gadarif, Gadarif 208, Sudan
| | - Musa Ahmed
- Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan 119, Oyo, Nigeria
- Department of Reproductive Health Sciences, Pan African University Life and Earth Sciences Institute, University of Ibadan, Ibadan 119, Oyo, Nigeria
- Department of Veterinary Surgery, Faculty of Veterinary Medicine, AL-Salam University, Al-fula 120, West Kordofan, Sudan
| | - Adesina Oladokun
- Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan 119, Oyo, Nigeria
| | - Nasir Adam Ibrahim
- Department of Biology, Faculty of Science, Imam Mohammed Ibn Saud Islamic University, Riyadh 13318, Saudi Arabia
- Department of Biochemistry and Physiology, Faculty of Veterinary Medicine, University of Al-butana, Ruffaa 210, Sudan
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Tokgoz VY, Kaya Y, Tekin AB. The level of anxiety in infertile women whose ART cycles are postponed due to the COVID-19 outbreak. J Psychosom Obstet Gynaecol 2022; 43:114-121. [PMID: 32812477 DOI: 10.1080/0167482x.2020.1806819] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
AIM This study evaluated the level of fear and anxiety related to the COVID-19 outbreak, in infertile women whose ART cycles were delayed due to the pandemic. MATERIALS AND METHODS An online survey was sent to women whose ART cycles were postponed due to the COVID-19 outbreak between April and May 2020. The study population were 101 participants. The main outcome measure is to determine the levels of fear and anxiety in infertile women by using the Spielberger State-Trait Anxiety Inventory (STAI-T and STAI-S) and Fear of COVID-19 scale (FCV-19S). The relationship of the COVID-19 outbreak with the willingness to go ahead with the desire for pregnancy was also assessed. RESULTS The state-anxiety levels were significantly higher in women above 35 years (45.0 ± 5.2 vs. 42.2 ± 4.5, p = 0.006). Women with diminished ovarian reserve had a higher state-anxiety compared to other causes, but were not found to be significant (44.7 ± 5.2 vs. 42.5 ± 5.0, p = 0.173). Women who thought that the possibility of not being able to get pregnant was more important than being infected with the COVID-19 had higher anxiety levels than women who thought just the opposite. The diminished ovarian reserve and high duration of infertility were found to be significantly associated with higher anxiety levels (OR = 2.5, p < 0.05). The diminished ovarian reserve and previous ART failure significantly predicted the presence of clinical state-anxiety. CONCLUSION The state-anxiety was found to be higher in women whose cycles were postponed due to the outbreak and the presence of diminished ovarian reserve also significantly affected anxiety levels. Further research is needed to assess whether COVID-19 will have any impact on ART treatments in the next few years.
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Affiliation(s)
- Vehbi Yavuz Tokgoz
- Department of Obstetrics and Gynecology, Eskisehir Osmangazi University, Faculty of Medicine, Eskisehir, Turkey
| | - Yeliz Kaya
- Department Obstetric And Women's Disease Nursing, Eskisehir Osmangazi University, Faculty of Health Sciences, Eskisehir, Turkey
| | - Ahmet Basar Tekin
- Department of Obstetrics and Gynecology, Eskisehir Osmangazi University, Faculty of Medicine, Eskisehir, Turkey
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Nayak H, Gerstl B, Sharma N, Appaneravanda LC, Gunasheela D. The Use of Integrative Medical Services to Address Psychological Concerns around Infertility in an Indian Academic Medical Centre. J Hum Reprod Sci 2022; 15:171-176. [PMID: 35928464 PMCID: PMC9345279 DOI: 10.4103/jhrs.jhrs_188_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 06/12/2022] [Accepted: 06/14/2022] [Indexed: 11/12/2022] Open
Abstract
Background Alternative and complementary therapies have been gaining popularity as ways to reduce anxiety in patients. Aim: This study aimed to assess whether yoga and meditation could decrease the severity of anxiety in Indian women diagnosed with infertility Study. Study Setting and Design: This was a retrospective data analysis of anxiety score of 354 women undergoing treatment at a tertiary infertility hospital between January 2016 and December 2018. Materials and Method: Women participated in group yoga, meditation and counselling therapy intervention during their treatment period. A self-reported questionnaire that used the Generalised Anxiety Disorder-7 criteria measured the participants’ severity of anxiety at the start of and again at the end of the intervention. Statistical Analysis: Demographic analysis and a two-tailed paired t-test were applied between groups. Results: The results indicated that there was a statistically significant mean reduction (7.3 ± 2.7) in the anxiety scores of the participants between entry (12.94 ± 2.65) and following exposure (5.39 ± 1.99) to the intervention (P < 0.0001). The mean reduction in scores remained similar between participants who received ≤6 sessions (7.50 ± 2.68) and participants who received >6 sessions (7.10 ± 2.64) (P > 0.05). Among the participants that experienced mild anxiety at baseline (n = 43), 72.1% (n = 31) reported experiencing minimal anxiety following the intervention (P < 0.0001). Among those that experienced moderate anxiety at baseline (n = 213), 32.4% (n = 69) reported experiencing minimal anxiety post-intervention (P < 0.0001). Participants who expressed severe anxiety at baseline (n = 94, 26.6%), reported experiencing minimal anxiety (13.8% [n = 13)], mild anxiety (81.9% [n = 77]) and moderate anxiety (4.3% [n = 4]) after exposure to the intervention (P < 0.0001). None of the participants reported experiencing severe anxiety post-intervention. Conclusion: The benefits of alternative anxiety-reduction therapies for women diagnosed with infertility have been demonstrated in this study. These therapies can be used to complement the routine treatment of such patients.
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Affiliation(s)
- Hita Nayak
- Department of Reproductive Medicine, Gunasheela Surgical and Maternity Hospital, Bengaluru, Karnataka, India
| | - Brigitte Gerstl
- Department of Reproductive Medicine, Gunasheela Surgical and Maternity Hospital, Bengaluru, Karnataka, India.,Department of Biostatistics, The Kirby Institute, University of New South Wales, Sydney, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
| | - Neha Sharma
- Department of Reproductive Medicine, Gunasheela Surgical and Maternity Hospital, Bengaluru, Karnataka, India
| | | | - Devika Gunasheela
- Department of Reproductive Medicine, Gunasheela Surgical and Maternity Hospital, Bengaluru, Karnataka, India
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27
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Obstructive Sleep Apnea: Another Condition to Screen for in Women with Infertility. WOMEN 2022. [DOI: 10.3390/women2010006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Women with obstructive sleep apnea (OSA) are at increased risk of poor pregnancy outcomes such as fetal growth restriction, hypertensive disorders of pregnancy, and gestational diabetes mellitus. Given this increased risk, we aimed to study the screening prevalence of OSA in women seeking fertility treatment. We performed a cross sectional study of patients presenting to a university-affiliated fertility clinic between March-April 2021. Patients were asked to complete OSA screening (STOP-BANG), anxiety screening (GAD-7), and depression screening (PHQ-2) questionnaires. 107 women completed the surveys. Mean age was 35.1 years and mean body mass index (BMI) was 25.7 kg/m2. Nine (8.4%) women screened positive for OSA using the STOP-BANG screening tool. Women who screened positive for OSA were more likely to be older (37.8 years vs. 34.7 years, p = 0.02) and have a higher BMI (42.6 kg/m2 vs. 27.4 kg/m2, p < 0.001). Women who screened positive for OSA were also more likely to screen positive for mild-severe depressive symptoms (22.2% vs. 3.1%, p = 0.006) and mild-severe anxiety (66.7% vs. 21.4%, p = 0.003) symptoms. 24.3% of the population had polycystic ovary syndrome (PCOS). Women with PCOS were more likely to screen positive for OSA (19.2% vs. 4.9%; p = 0.04). Despite this being a low-risk population of young women seeking fertility evaluation or treatment, 8% screened positive for OSA. Given the association between OSA and adverse pregnancy outcomes, our results underline the need to screen women seeking fertility treatment.
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28
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Psychological impact of suspension/postponement of fertility treatments on infertile women waiting during COVID pandemic. Obstet Gynecol Sci 2022; 65:197-206. [PMID: 35045244 PMCID: PMC8942756 DOI: 10.5468/ogs.21254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/15/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To assess the psychological impact of suspension/postponement of various fertility treatments on infertile women during the coronavirus disease 2019 (COVID-19) pandemic. Methods This was a cross-sectional study conducted as an online survey among infertile women consulting either through teleconsultation or physical consultation at a fertility clinic of a tertiary care referral unit. A validated questionnaire was given as a WhatsApp link to the women who were consulting for the resumption of services. Questions asked were based on their socio-demographic parameters, fertility treatment at the time of suspension, anxiety (self-reported) and stress (perceived stress scale-4, PSS-4) due to delay in treatment, psychosocial effect of pandemic, and wishes regarding the resumption of fertility services. Results Of 430 patients who received the questionnaire, 250 completed the survey (response rate: 58%). The mean age of participants was 29.26±4.18 years and the majority (70.4%) had lower socioeconomic status. The average PSS-4 score was 7.8±0.71, and the prevalence of self-reported anxiety was 72%. Those who suffered migration during the pandemic had significantly higher PSS-4 scores, and increasing age was associated with increased self-reported anxiety due to the suspension of fertility services. The top three priorities reported were infertility and treatment delay (48.4%), job loss (19.2%), and the risk of contracting COVID-19 infection (16%). The degree of spousal support was significantly correlated with lower PSS-4 scores (r=−0.30, P<0.01). On multivariate logistic analysis, duration of infertility, delay in treatment due to suspension of services, and fear of COVID-19 infection were significant predictors of stress and anxiety. Conclusion This study emphasizes the need to investigate psychosocial health and to provide psychological support to this vulnerable population in addition to triaging fertility treatments in a phased manner.
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Gao L, Gao H, Wang W. Androgens improve ovarian follicle function impaired by glucocorticoids through an androgen-IGF1-FSH synergistic effect. Front Endocrinol (Lausanne) 2022; 13:951928. [PMID: 36339442 PMCID: PMC9627217 DOI: 10.3389/fendo.2022.951928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 09/29/2022] [Indexed: 12/02/2022] Open
Abstract
High concentrations of glucocorticoids caused by chronic stress are known to affect ovarian function and cause diminished ovarian reserve. Androgens are essential for early-stage ovarian follicle development, but the effects and mechanisms of androgens on follicle development under chronic stress remain unclear. In this study, we aim to investigate the effects of high concentrations of glucocorticoids on the function of in vitro cultured ovarian cells and mouse early-stage ovarian follicles and to validate the hypothesis that androgen-insulin-like growth factor 1 (IGF1)-follicle-stimulating hormone (FSH) synergistic signaling helps to ameliorate the damage caused by high concentrations of glucocorticoids. KGN cells (human granulosa cell line) and mouse primary cells were treated with different concentrations of glucocorticoids, and the cell proliferation, apoptosis, and sex hormone secretion were detected. The effects of glucocorticoid and androgens on IGF1 receptor (IGF1R) and FSH receptor (FSHR) expression in KGN cells were detected by Western blot. Steroidogenic synthase expressions under androgens and androgen-IGF1-FSH combination treatment were examined by qPCR after manipulation using low and high concentrations of glucocorticoids. The mechanism of androgen regulation of IGF1R and FSHR was explored by small interfering RNA (siRNA) and chromatin immunoprecipitation (ChIP)-qPCR. Damage of glucocorticoids and the treatment effects of androgens were further validated in mouse ovarian follicles cultured in vitro. The results demonstrated that prolonged treatment with high-dose glucocorticoids reduced cell viability of granulosa cells, inhibited their sex hormone secretion, and impaired their sensitivity to IGF1 and FSH signaling by affecting IGF1R and FSHR functions. Androgens at an appropriate dose range improved early-stage follicle development and their hormone secretion under high-dose glucocorticoid treatment, which was related to increased transcription of Igf1r and Fshr. This work showed that excessive glucocorticoids impaired ovarian function and validated that balanced concentrations of androgens synergized with IGF1 and FSH to improve the function of early-stage ovarian follicles under conditions of chronic stress.
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Affiliation(s)
- Lingyun Gao
- Department of Integrated Traditional & Western Medicine, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- Department of Integrated Traditional & Western Medicine, Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China
| | - Hongna Gao
- Department of Integrated Traditional & Western Medicine, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- Department of Integrated Traditional & Western Medicine, Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China
| | - Wenjun Wang
- Department of Integrated Traditional & Western Medicine, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- Department of Integrated Traditional & Western Medicine, Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China
- *Correspondence: Wenjun Wang,
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Yüksekol ÖD, Baltaci N, Yilmaz AN, Ulucan M. Perception of genital self-image, sexual quality of life and marital adjustment in infertile women. SEXUAL AND RELATIONSHIP THERAPY 2021. [DOI: 10.1080/14681994.2021.1998422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Özlem Doğan Yüksekol
- Department of Midwifery, Faculty of Health Sciences, Firat University, Elazig, Turkey
| | - Nazli Baltaci
- Department of Nursing, Faculty of Health Sciences, Ondokuz Mayis University, Samsun, Turkey
| | - Ayşe Nur Yilmaz
- Department of Midwifery, Faculty of Health Sciences, Firat University, Elazig, Turkey
| | - Mihriban Ulucan
- Department of Midwifery, Faculty of Health Sciences, Firat University, Elazig, Turkey
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Lablanche O, Salle B, Perie MA, Labrune E, Langlois-Jacques C, Fraison E. Psychological effect of COVID-19 pandemic among women undergoing infertility care, a French cohort - PsyCovART Psychological effect of COVID-19: PsyCovART. J Gynecol Obstet Hum Reprod 2021; 51:102251. [PMID: 34638007 PMCID: PMC8501520 DOI: 10.1016/j.jogoh.2021.102251] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 10/05/2021] [Accepted: 10/05/2021] [Indexed: 11/30/2022]
Abstract
Purpose: To assess psychological state of women who experienced postponement of ART care during the first COVID-19 wave in a French public ward of reproductive medicine. Methods: An online anonymous survey was emailed between July and August 2020 to all women whose infertility care, including the first consultation for infertility, have been delayed at the beginning of the COVID-19 pandemic. Anxiety, depression, and stress were assessed using Hospital Anxiety and Depression Scale (HADS) and Perceived Stress Scale (PSS-10). Feelings about COVID-19 outbreak, lockdown and suspension of fertility care were assessed by Multiple-Choice Questions and Visual Analog Scales. Results: 435 women answered to the survey (response rate 34.6%). Mean levels of the HADS-A (anxiety), HADS-D (depression) and PSS10 were respectively 7.58(±3.85), 4.51(±3.48), and 27(±6.75). Prevalence of stress was 50.8% and almost half of women presented clear or suggestive anxiety symptoms (respectively 21.6% and 25.7%). Stress and anxiety rates were much higher than those expected in infertile population. Increased stress was observed in women above 35 years and those stopped ‘in cycle’ or during pre-treatment for in-vitro fertilization or frozen embryo transfer. Patient with history of depression or anxiety had a higher prevalence of perceived stress (p = 0.0006). Postponement was perceived as ‘unbearable’ for women experiencing stress (p = 0.0032). After the first wave of pandemic, pregnancy desire remained the same and 84.3% of women wanted to resume fertility care as soon as possible. Conclusion: Stopping fertility care during the COVID-19 pandemic had a significant psychological impact on women with an increase of stress, and anxiety. Psychological counseling should always be offered especially during this difficult period.
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Affiliation(s)
- Océane Lablanche
- Department of Obstetrics and Gynecology, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, 59 Bd Pinel, 69500 Bron, France
| | - Bruno Salle
- Department of Reproductive Medecine, CHU Lyon, Hôpital Femme Mère Enfant, 59 Bd Pinel, 69500 Bron, France; Faculté de Médecine Lyon Sud, 165 chemin du Petit Revoyet, Université Claude Bernard, Oullins, France; INSERM Unité 1208, 18 avenue Doyen Lépine, Bron, France
| | - Marie-Ange Perie
- Department of Reproductive Medecine, CHU Lyon, Hôpital Femme Mère Enfant, 59 Bd Pinel, 69500 Bron, France
| | - Elsa Labrune
- Department of Reproductive Medecine, CHU Lyon, Hôpital Femme Mère Enfant, 59 Bd Pinel, 69500 Bron, France; INSERM Unité 1208, 18 avenue Doyen Lépine, Bron, France; Faculté de Médecine Laennec, Université Claude Bernard, 7 rue Guillaume Paradin, Lyon, France
| | - Carole Langlois-Jacques
- Hospices Civils de Lyon, Service de Biostatistique et Bioinformatique, F-69003 Lyon, France; CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, F-69100 Villeurbanne, France
| | - Eloise Fraison
- Department of Reproductive Medecine, CHU Lyon, Hôpital Femme Mère Enfant, 59 Bd Pinel, 69500 Bron, France; INSERM Unité 1208, 18 avenue Doyen Lépine, Bron, France; Faculté de Médecine Laennec, Université Claude Bernard, 7 rue Guillaume Paradin, Lyon, France.
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A. A. A, Ahmed M, Oladokun A. Prevalence of infertility in Sudan: A systematic review and meta-analysis. Qatar Med J 2021; 2021:47. [PMID: 34650907 PMCID: PMC8491543 DOI: 10.5339/qmj.2021.47] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 08/18/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND/AIM Infertility is defined as the inability of heterosexual couples to achieve a successful clinically recognizable pregnancy after 12 months or more of regular, unprotected sexual intercourse. Infertility estimations are very important to inform the healthcare policymakers and governments to implement appropriate social and economic policies. Thus, this study aimed to estimate the pooled prevalence of infertility (primary and secondary) and its etiologic factors in Sudan. METHODS This study included all published and unpublished studies written in Arabic or English. Electronic sources (namely, PubMed, MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov) and nonelectronic sources (direct Google search, Google Scholar, OpenGrey, OATD, WorldCat log, and university websites) were used from their inception to May 16, 2021. A total of 1955 studies were reviewed, of which only 20 studies were eligible for the meta-analysis. Studies were eligible if they provided the prevalence of infertility in Sudan. The Joanna Briggs Institute Quality Assessment Tool was used to evaluate each study. Data synthesis and statistical analysis were conducted using Jeffrey's Amazing Statistics Program version 0.14.1.0. RESULTS The pooled prevalence of overall infertility, primary infertility, and secondary infertility in Sudan were 13% (I2 = 96.45, p < 0.001), 65% (I2 = 98.5, p < 0.001), and 35% (I2 = 98.5, p < 0.001), respectively, and the prevalence of infertility factors were 41%, 27%, 16%, and 17% for female, male, combined factors, and unexplained factors, respectively. Women with infertility were mainly present because of ovulatory disorders (ovulatory factors, 36%; polycystic ovary syndrome, 38%). By contrast, spermatic disorders such as azoospermia (37%), oligozoospermia (30%), and asthenozoospermia (30%) were the main causes of male infertility. CONCLUSION In Sudan, the prevalence of primary infertility is higher than that of secondary infertility. Female factors were the most common causes of infertility in Sudan, and this study found a high prevalence of unexplained factors. Polycystic ovary syndrome and azoospermia were the most common causes of female and male infertility in Sudan, respectively. The interpretation of these findings should take into consideration the presence of substantial heterogeneity between the included studies.
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Affiliation(s)
| | | | - Adesina Oladokun
- Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Zurlo MC, Cattaneo Della Volta MF, Vallone F. Re-examining the Role of Coping Strategies in the Associations Between Infertility-Related Stress Dimensions and State-Anxiety: Implications for Clinical Interventions With Infertile Couples. Front Psychol 2020; 11:614887. [PMID: 33414752 PMCID: PMC7782436 DOI: 10.3389/fpsyg.2020.614887] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 11/18/2020] [Indexed: 12/22/2022] Open
Abstract
Research has shown a direct relationship between infertility-related stress and anxiety in infertile patients. The present study goes into this relationship in depth, testing the moderating role of coping strategies (Seeking Social Support, Avoidant, Positive Attitude, Problem-Solving, Turning to Religion) in the associations between specific infertility-related stress dimensions (Social Concern, Need for Parenthood, Rejection of Childfree Lifestyle, Couple’s Relationship Concern) and State-Anxiety among male and female partners of infertile couples. Gender differences were also explored. Both members of 254 infertile couples completed a questionnaire consisting of Socio-demographics, Fertility Problem Inventory–Short Form (FPI-SF), Coping Orientation to Problem Experienced–New Italian Version (COPE-NIV), and State-Trait Anxiety Inventory-Y (STAI-Y). The results revealed that Social Concern and Couple’s Relationship Concern, in both partners, and Need for Parenthood, in female partners, had positive correlations with State-Anxiety. Seeking Social Support and Avoidant coping were related to increasing levels of State-Anxiety in both partners, whereas Positive Attitude coping strategies were related to lower levels of State-Anxiety in female partners. Problem-Solving and Avoidant coping played moderating roles between specific infertility-related stress dimensions and State-Anxiety in unexpected directions. Problem-Solving exacerbated the negative effects of Social Concern, whereas Avoidant coping buffered the negative effects of several infertility-related stress dimensions in both partners. Interventions to improve stress management and psychological health in infertile couples should consider that the adequacy of coping strategies is inherently situation specific. It therefore follows that patient-centered clinical interventions should consider the potential inadequacy of promoting Problem-Solving strategies, and that even Avoidance can be an efficient strategy for dealing with specific infertility-related stress dimensions.
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Affiliation(s)
- Maria Clelia Zurlo
- Dynamic Psychology Laboratory, Department of Political Science, University of Naples Federico II, Naples, Italy
| | - Maria Francesca Cattaneo Della Volta
- Dynamic Psychology Laboratory, Department of Political Science, University of Naples Federico II, Naples, Italy.,Department of Humanities, University of Naples Federico II, Naples, Italy
| | - Federica Vallone
- Dynamic Psychology Laboratory, Department of Political Science, University of Naples Federico II, Naples, Italy.,Department of Humanities, University of Naples Federico II, Naples, Italy
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Madjunkov M, Dviri M, Librach C. A comprehensive review of the impact of COVID-19 on human reproductive biology, assisted reproduction care and pregnancy: a Canadian perspective. J Ovarian Res 2020; 13:140. [PMID: 33246480 PMCID: PMC7694590 DOI: 10.1186/s13048-020-00737-1] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/06/2020] [Indexed: 12/13/2022] Open
Abstract
Currently, the world is in the seventh month of the COVID-19 pandemic. Globally, infections with novel SARS-CoV-2 virus are continuously rising with mounting numbers of deaths. International and local public health responses, almost in synchrony, imposed restrictions to minimize spread of the virus, overload of health system capacity, and deficit of personal protective equipment (PPE). Although in most cases the symptoms are mild or absent, SARS-CoV-2 infection can lead to serious acute respiratory disease and multisystem failure. The research community responded to this new disease with a high level of transparency and data sharing; with the aim to better understand the origin, pathophysiology, epidemiology and clinical manifestations. The ultimate goal of this research is to develop vaccines for prevention, mitigation strategies, as well as potential therapeutics.The aim of this review is to summarize current knowledge regarding the novel SARS CoV-2, including its pathophysiology and epidemiology, as well as, what is known about the potential impact of COVID-19 on reproduction, fertility care, pregnancy and neonatal outcome. This summary also evaluates the effects of this pandemic on reproductive care and research, from Canadian perspective, and discusses future implications.In summary, reported data on pregnant women is limited, suggesting that COVID-19 symptoms and severity of the disease during pregnancy are similar to those in non-pregnant women, with pregnancy outcomes closely related to severity of maternal disease. Evidence of SARS-CoV-2 effects on gametes is limited. Human reproduction societies have issued guidelines for practice during COVID-19 pandemic that include implementation of mitigation practices and infection control protocols in fertility care units. In Canada, imposed restrictions at the beginning of the pandemic were successful in containing spread of the infection, allowing for eventual resumption of assisted reproductive treatments under new guidelines for practice. Canada dedicated funds to support COVID-19 research including a surveillance study to monitor outcomes of COVID-19 during pregnancy and assisted reproduction. Continuous evaluation of new evidence must be in place to carefully adjust recommendations on patient management during assisted reproductive technologies (ART) and in pregnancy.
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Affiliation(s)
- Mitko Madjunkov
- CReATe Fertility Centre, 790 Bay Street, Suite 1100, Toronto, M5G1N8, Canada.
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada.
| | - Michal Dviri
- CReATe Fertility Centre, 790 Bay Street, Suite 1100, Toronto, M5G1N8, Canada
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada
| | - Clifford Librach
- CReATe Fertility Centre, 790 Bay Street, Suite 1100, Toronto, M5G1N8, Canada.
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada.
- Institute of Medical Sciences, University of Toronto, Toronto, Canada.
- Department of Physiology, University of Toronto, Toronto, Canada.
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Kiani Z, Simbar M, Hajian S, Zayeri F. Development and psychometric evaluation of a quality of life questionnaire for infertile women: a mixed method study. Reprod Health 2020; 17:140. [PMID: 32912240 PMCID: PMC7488261 DOI: 10.1186/s12978-020-00988-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infertility is one of the most important issues that negatively influences women's quality of life, especially when the cause is associated with females. Given that no instruments have been designed to assess quality of life among infertile women with focus on female factors, this study was conducted to develop and evaluate the psychometric properties of a female-centric quality of life questionnaire for infertile women. METHOD This sequential exploratory study was conducted in two stages. First, the concept of quality of life and its dimensions as they relate to infertile women were elucidated through a qualitative inquiry accompanied with a content analysis. Accordingly, infertile women and key informants from a teaching hospital affiliated with the Mazandaran University of Medical Sciences and a private center for infertility treatment in Sari (north of Iran) were screened through purposive sampling until data saturation. Those who satisfied the inclusion criteria and exhibited maximum variance in terms of age, educational level, employment status, infertility duration, treatment type, and social class were recruited. The conventional content analysis was carried out in accordance with the steps proposed by Graneheim and Lundman, and the accuracy and robustness of the data were verified using Lincoln and Guba's criteria (credibility, transferability, dependability, confirmability and authenticity). Second, the psychometric properties of the instrument developed in the qualitative stage were evaluated using a quantitative method and on the basis of the results of a literature review. The content, face, and construct validity of the instrument was determined, and its test-retest reliability and stability were ascertained using internal correlation and Cronbach's alpha. The collected data were entered into the Statistical Package for the Social Sciences (version 22) for analysis, and descriptive statistics were calculated. DISCUSSION Developing and evaluating the psychometric properties of a valid and reliable female factor-centric instrument that measures quality of life among infertile women will be very useful in the assessment of their future status.
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Affiliation(s)
- Zahra Kiani
- Student Research Committee, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoumeh Simbar
- Midwifery and Reproductive Health Research Center, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sepideh Hajian
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farid Zayeri
- Proteomics Research Center and Department of Biostatistics, Faculty of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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