Psychological Distress Among Infertility Patients: A Network Analysis

Infertility-related stress and marital intimacy among infertile couples undergoing in vitro fertilization treatment in Western Iran: A cross-sectional study

Background

Given the fundamental role of fertility and childbearing in Iranian families, along with its cultural and social dimensions, and considering the importance of paying attention to marital issues among infertile couples, despite the limited and contradictory studies in this area, the present research aimed to Study marital intimacy and infertility stress in infertile couples undergoing in Vitro Fertilization (IVF) treatment in the west of Iran.

Methods

In 2023, a cross-sectional study from 1 September until December was undertaken on 117 couples at an Infertility Center in Hamadan City, Iran. Measurement tools were demographic characteristics, Newton's infertility stress questionnaire and the marital intimacy questionnaire. A convenience sampling method was utilized to recruit a total of 117 eligible women, each part of a couple, for the study. All participants completed the questionnaires of demographic characteristics, newton's infertility stress and the marital intimacy as required. Data analysis was carried out using Stata-17 software, with significance set at a level below 0.05.

Results

In the present study the number of 234 cases was investigated. There wasn't a significant difference observed in infertility-related stress domains by gender (P > 0.05).Significant direct correlations were observed between infertility-related stress and age (r = 0.55, P < 0.001), duration of marriage(r = 0.72, P < 0.001), duration of infertility (r = 0.64, P < 0.001), and duration of treatment (r = 0.67, P < 0.001). Conversely, marital intimacy exhibited significant inverse correlations with these variables (P < 0.001). Additionally, a significant negative correlation was found between marital intimacy and infertility-related stress (r = -0.67, P < 0.001).

Conclusion

The present study has shown that the mean score of marital intimacy among women is significantly higher than men. Additionally, there is a significant negative correlation between marital intimacy and infertility-related stress. Considering the importance of mental health in infertile couples and its potential impact on the outcome of IVF treatment, it appears that supportive interventions and counseling sessions to increase marital intimacy in infertile couples undergoing IVF treatment.

A Qualitative Study of Fertility Preservation Experience in Women with Breast Cancer

Objective

To explore the experiences of women with breast cancer who have undergone fertility preservation and to explore the psychological needs of patients.

Methods

Using descriptive phenomenological research methods, 11 patients who underwent oocyte or embryo cryopreservation after diagnosis of breast cancer were selected for semi-structured interviews in a tertiary care hospital. Themes were distilled using Colaizzi's 7-step analysis and reported according to COREQ guidelines.

Results

The experiences of women with breast cancer who underwent fertility preservation can be categorized into 4 themes and 11 sub-themes: a. Physical pain and discomfort (physiological pain, tolerance of physical discomfort); b. heavy psychological burdens (fertility worries, self-blame and guilt, loneliness and helplessness, bias from others and self); c. Actively seeking and benefiting from ways of coping with illness (life over procreation; hope, confidence and courage; positive coping with illness; adequate social support; growth follow in adversity); d. Lack of fertility-related information support.

Conclusion

Oncology and reproductive health professionals should pay attention to the experiences of breast cancer patients undergoing fertility preservation and target timely, scientific, and effective interventions to promote disease recovery and improve quality of life.

Using network analysis to identify central symptoms of depression and anxiety in different profiles of infertility patients

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.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Enhanced sperm isolation via bulk acoustic waves for high-throughput motility screening

The increasing infertility rate has become a worrying global challenge in recent years. According to the report of the World Health Organization, the male factor is responsible for over half of infertility cases, which includes the lack of desirable characteristics in sperm motility, morphology, and DNA integrity. In recent years, it has been shown that clinical methods including density gradient centrifugation cause damage to sperm DNA and besides being invasive, they are costly and time-consuming. In contrast, microfluidics has been used as a promising and non-invasive approach to manipulate biological cells. Here, by using the microvortices created by the oscillation of the bubbles caused by the bulk acoustic waves, we were able to trap sperms with less motility. In contrast, the highly motile sperms overcame the force of the microvortices and were guided to the outlet pool by following the channel boundaries. As a result, over 50% and 44% improvement in sperm progressive motility and viability, respectively, as well as 40% improvement in DNA integrity, were observed in the analysis of sperms retrieved from the output pool. In addition to being fast and non-invasive, the proposed device benefits from an easy method for sperms retrieval and does not require any preprocessing of the raw sperm sample.

Identification of Psychological Symptom Clusters and Their Influencing Factors in Women Undergoing Assisted Reproductive Technology in China: a Cross-Sectional Study

Background

There are multiple psychological symptoms in women undergoing assisted reproductive technology, which seriously affect health-related quality of life and even cause patients to stop treatment.

Aim

This study aimed to identify psychological symptom clusters and their influencing factors in women undergoing assisted reproductive technology.

Methods

A cross-sectional survey was conducted from June to November 2023 at the reproductive centers of Nanjing Women and Children's Healthcare Hospital. Data on demographic and clinical characteristics and Symptom Checklist-90 were collected. Exploratory factor analysis was performed to identify psychological symptom clusters. Univariate logistic regression analysis and multivariate logistic regression analysis were performed to explore influencing factors.

Results

A total of 213 patients were recruited. The study found that the included participants scored higher on all SCL scales than the general Chinese females. The three most common were trouble remembering things (81.7%), feeling easily annoyed or irritated (81.2%), and feeling low in energy or slowed down (70.9%). Six symptom clusters were identified: paranoid ideation, depression, obsessive-compulsive disorder, interpersonal sensitivity, somatization, and sleep disorders. Multivariate logistic regression analysis showed that duration of infertility treatment (>12 months) was identified as a risk factor for sleep disorder cluster (OR=2.833, 95% CI:1.355~5.922), adverse pregnancy history was identified as a risk factor for paranoid ideation cluster (OR=2.961,95% CI:1.406~6.253), depression cluster (OR=2.404,95% CI:1.240~4.660), and obsessive-compulsive cluster (OR=1.810, 95% CI:1.016~3.233), financial burden during treatment was identified as risk factors for all symptom clusters[(OR=5.869, 95% CI:1.717~20.057),(OR=6.490,95% CI:2.210~19.063),(OR=3.034,95% CI:1.560~5.898),(OR=7.078,95% CI:2.420~20.698),(OR=4.532,95% CI:1.845~10.397),(OR=2.151,95% CI:1.129~4.098)].

Conclusion

Women undergoing ART experience various psychological symptoms that are interrelated and exist in the form of symptom clusters. More attention should be paid to the psychological status of patients with longer duration of infertility treatment, adverse pregnancy history, and financial burden during treatment. This study guides the development of targeted and effective psychological interventions to facilitate symptom management in women undergoing ART.

Positive sexuality, relationship satisfaction, and health: a network analysis

Introduction

Positive sexuality, defined as the happiness and fulfillment individuals derive from their sexual experiences, expressions, and behaviors, has been linked to relationship satisfaction and health. However, the intricate associations between positive sexuality and relationship functioning and health indicators have rarely been explored from a network perspective. This approach, by analyzing the interconnections among these factors within a broader system, can offer insights into complex dynamics and identify key variables for targeted interventions.

Methods

The present study applied network analysis to uncover interconnections between positive sexuality, relationship satisfaction, and health indicators, highlight the most relevant variables and explore potential gender-based differences in a sample of 992 partnered individuals (51% women, aged 18-71 years). Networks were estimated via Gaussian Graphical Models, and network comparison test was used to compare men and women.

Results

Results indicated that variables related to positive sexuality were more highly interconnected than the rest of the network. There were small-to-negligible connections between positive sexuality and relationship satisfaction variables, both of which had negligible or no connections with health. The network was globally invariant across gender, though a few connections were gender-specific. The most important variables, regardless of gender, related to pleasurable feelings during sexual intercourse.

Discussion

The findings underscore the importance of enhancing positive sexual experiences within intimate relationships and have implications for research and clinical practice in positive sexuality.

Stress Biomarkers Transferred Into the Female Reproductive Tract by Seminal Plasma Are Associated with ICSI Outcomes

This study aimed to determine whether male stress is related to seminal stress biomarkers and pregnancy achievement in women exposed to their partner's seminal plasma (SP) in the intracytoplasmic sperm injection (ICSI) cycle. In this pilot prospective study, 20 couples undergoing ICSI, as well as 5 fertile sperm donors and 10 saliva donors, were investigated. Women were exposed to their partner's SP via unprotected sexual intercourse during the ICSI cycle and intravaginal application on the day of ovum pick-up (Day-OPU). Semen samples were collected from male partners by masturbation on the Day-OPU. Saliva and serum samples were collected prior to masturbation. Body fluids were frozen at - 80 °C until assayed. Biomarkers of activity of the sympathetic adrenomedullary axis (salivary alpha-amylase and adrenaline), sympathetic neural axis (noradrenaline and dopamine), hypothalamic-pituitary-adrenal (HPA) system (cortisol), and immune system (C-reactive protein and interleukin (IL)-18) were estimated to examine their association with SP composition and clinical pregnancy achievement. The clinical pregnancy rate was 45.0%. In the unsuccessful ICSI group, blunted levels of salivary and serum cortisol were found compared to the successful ICSI group and the fertile sperm donors. With regard to seminal markers, decreased cortisol level and elevated noradrenaline, noradrenaline/cortisol ratio, and lL-18 levels were strongly associated with ICSI failure (areas under the ROC curves were, 0.813, 0.848, 0.899, and 0.828, respectively). These findings confirm that stress response systems activity affects SP composition, which in turn is associated with ICSI outcomes in women exposed to their partner's SP during an ICSI cycle.

The causal relationship of female infertility and psychiatric disorders in the European population: a bidirectional two-sample Mendelian randomization study

BACKGROUND

Infertility affects many couples globally, causing physical, emotional, and financial burdens. While observational studies suggest a link between psychiatric disorders and female infertility, causal relationships remain uncertain. Mendelian randomization analysis, using genome-wide association studies data, minimizes confounding factors and reverse causation, providing valuable insights into causal associations.

METHODS

We conducted Mendelian randomization analysis to explore the potential causal relationship between female infertility and psychiatric disorders. Genome-wide association studies summary data for female infertility (112,105 individuals of European ancestry, comprising 11,442 cases and 100,663 controls), depression (807,553 individuals of European ancestry, comprising 246,363 cases and 561,190 controls), anxiety (21,763 individuals of European ancestry, comprising 7,016 cases and 14,745 controls), bipolar disorder (51,710 individuals of European ancestry, comprising 20,352 cases and 31,358 controls), and eating disorders (72,517 individuals of European ancestry, comprising 16,992 cases and 55,525 controls) were utilized. Instrumental variables were selected based on significant single nucleotide polymorphisms associated with each phenotype. We assessed instrumental variable strength, examined confounding factors, and employed inverse variance weighting, weighted median, and MR-Egger approaches for analysis.

RESULTS

Our analysis included 85 single nucleotide polymorphisms for female infertility and 62 single nucleotide polymorphisms for psychiatric disorders. Results suggest a potential causal relationship between depression and female infertility, with both inverse variance weighting and weighted median methods showing increased infertility risk in depressed patients. Evidence is weak regarding bipolar disorder not increasing female infertility risk. We found no evidence supporting causal links between anxiety, eating disorders, and female infertility. Similarly, no causal relationship was found between female infertility and psychiatric disorders in the opposite direction. Sensitivity analyses and tests for heterogeneity and polymorphism supported result robustness.

CONCLUSIONS

This analysis provides evidence for a potential causal relationship between depression and female infertility. Addressing depression in infertile women may improve fertility outcomes. Further research is needed to explore underlying mechanisms and potential interventions for improving fertility outcomes in women with psychiatric disorders.

Psychological distress among women undergoing in vitro fertilization-embryo transfer: A cross-sectional and longitudinal network analysis

BACKGROUND

Women undergoing in vitro fertilization-embryo transfer (IVF-ET) treatment were generally found to experience varying degrees of psychological distress across the treatment. Existing studies focused on total scores and diagnostic thresholds to characterize the symptoms' severity, which might hinder scientific progress in understanding and treating psychological distress.

AIMS

We aimed to investigate (a) how depression and anxiety symptoms are interconnected within a network, and (b) the changes of the network (symptom connections and network centralities) over time, in women undergoing in vitro fertilization-embryo transfer.

METHODS

A 4-wave longitudinal study was designed with 343 eligible women recruited from the Reproductive Medicine Center of a tertiary hospital in China. The network models were created to explore the relationship and changes between psychopathology symptoms both within and across anxiety and depression, with anxiety measured by the Generalized Anxiety Disorder-7 and depression measured by the Patient Health Questionnaire-9. Symptom network analysis was conducted to evaluate network and network properties, network centrality, and bridge centrality, as well as change trajectory network.

RESULTS

For the strength centrality, "inability to control worry" and "worrying too much" were the most central symptoms at T1; however, these symptoms decreased. The centrality of "sadness" and "guilt" tended to increase steadily and became dominant symptoms. For bridge centrality indices, several bridge symptoms were identified separately from T1 to T4: "irritability," "concentration difficulties," "nervousness," and "restlessness;" "guilt" exhibited increased bridge symptoms. Furthermore, the change trajectory network indicated that "suicide ideation" became more closely related to guilt but not to worrying too much over time.

CONCLUSION

This study provides novel insights into the changes in central features, connections, and bridge symptoms during IVF-ET treatment and identified several bridge symptoms separately at different stages, which could activate the connection between psychopathology symptoms. The results revealed that sense of guilt was associated with worsening psychopathology symptoms, indicating that future psychological interventions should target guilt-related symptoms as a priority.