Impact of the COVID-19 Pandemic on the Lifestyles and Quality of Life of Women With Fertility Problems: A Cross-Sectional Study

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

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

Psychometric properties of the Spanish version of the FertiQoL measure in couples undergoing infertility treatment

BACKGROUND

Both the diagnosis and the process of undergoing fertility treatment have a considerable negative effect on a person's quality of life (QoL). The evaluation of this effect is essential to offer comprehensive and high-quality care. The FertiQoL questionnaire is the most widely used instrument to evaluate QoL in people with fertility issues.

OBJECTIVE

This study is aimed at examining the dimensionality, validity and reliability of the Spanish version of the FertiQoL questionnaire in a sample of Spanish heterosexual couples undergoing fertility treatment.

METHODS

FertiQoL was administered to 500 people (50.2% women; 49.8% men; average age 36.1 years) recruited from a public Assisted Reproduction Unit in Spain. In this cross-sectional study, Confirmatory Factor Analysis (CFA) was used to analyse the dimensionality, validity and reliability of FertiQoL. Discriminant and convergent validity were assessed using the Average Variance Extracted (AVE), and model reliability was shown by Composite Reliability (CR) and Cronbach's alpha.

RESULTS

CFA's results support the 6-factor solution of the original FertiQoL (RMSEA and SRMR <0.09; CFI and TLI >0.9). However, several items had to be eliminated due to their low factorial weights - in particular, items Q4, Q5, Q6, Q11, Q14, Q15 and Q21. Moreover, FertiQoL showed good reliability (CR >0.7) and validity (AVE >0.5).

CONCLUSION

The Spanish version of FertiQoL is a reliable and valid instrument in measuring QoL in heterosexual couples undergoing fertility treatment. The CFA confirms the original 6-factors model but indicates that by eliminating some items the psychometric properties could improve. However, further research is recommended to address some of the measurement issues.

The impact of the COVID-19 pandemic on Mediterranean diet adherence: A narrative systematic review

BACKGROUND

The COVID-19 pandemic upended many aspects of daily life. For some individuals, this was an opportunity to re-evaluate their life and make better choices, while others were overwhelmed with stressors, leading to a deterioration in mental and physical health.

AIM

The aim of this narrative systematic review is to explore the effects of the COVID-19 pandemic on Mediterranean diet adherence.

METHODS

A systematic literature search was carried out on PubMed, Scopus and Web of Science electronic databases utilising the search terms 'Mediterranean diet' AND 'COVID-19'. This yielded 73 articles that fulfilled the inclusion criteria.

RESULTS

The data suggests that a substantial proportion of individuals adhered less to the Mediterranean diet during the COVID-19 lockdown period. However, individuals receiving some form of lifestyle intervention had better adherence to the Mediterranean diet than their unassisted counterparts.

CONCLUSION

This emphasises the importance of professional support during times of crisis to avoid deterioration of a population's health.

Treatment suspension due to the coronavirus pandemic and mental health of infertile patients: a systematic review and meta-analysis of observational studies

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.

Medicinal Plants Used in the Management of Sexual Dysfunction, Infertility and Improving Virility in the East African Community: A Systematic Review

Sexual disorders such as erectile dysfunction (ED), sterility, and sexual inappetence represent some of the complex reproductive challenges that require addressing the underlying causes. The aim of this paper was to systematically synthesize literature on the ethnobotany, phytochemistry, bioactivities, and safety of plants used as remedies for managing sexual dysfunction and infertility, and improving fertility and virility in the EAC. Through an extensive review conducted in multidisciplinary electronic databases, 171 plant species were identified to have been reported for the management of sexual inappetence (i.e., used as aphrodisiacs, 39.4%), ED (35.9%), infertility (18.7%), and increasing fertility (6.0%). The most used plants are Mondia whitei, Acalypha villicaulis, Combretum illairii, Erythrina abyssinica, Pappea capensis, Rhus vulgaris, and Warburgia ugandensis while roots (44.9%), leaves (21.8%), stem and root barks (16.7%) of shrubs (35%), trees (31%), herbs (26%), and climbers (8%) are the preferred organs for making decoctions (69%). The research strides to date indicate that Citropsis articulata, Cola acuminata, Ekebergia capensis, Plumbago zeylanica, Tarenna graveolens, Urtica massaica, and Zingiber officinale have been assessed for their bioactivity. The majority (71.4%) of the plants either increased testosterone levels and mounting frequency or elicited prosexual stimulatory effects in male rats. More studies investigating the relevant pharmacological activities (aphrodisiac, fertility, and phosphodiesterase-5 inhibitory activities), safety aspects, responsible compounds, and clinical studies are warranted to establish the pharmacological potential of the unstudied species and elucidate the mechanism of action of the bioactive compounds.

Implementation of a web-based partnership support program for improving the quality of life of male patients undergoing infertility treatment: a pilot feasibility study

OBJECTIVES

In this study, we aimed to implement and evaluate a Web-based partnership support program to enhance the QoL of male patients undergoing infertility treatment. We conducted a pilot study involving 41 infertile couples from September to October of 2021. We used a quasi-experimental design (pre-test and post-test with comparison) involving purposive sampling. A subgroup analysis was conducted to determine which demographics of the participants would benefit from the program.

RESULTS

Thirty-four participants (mean age 37.3 years; duration of infertility treatment 14.5 months) were included in the final analysis (follow-up rate 82.9%). Although there was no significant increase in the participants' QoL under the Web-based partnership support program, the assisted reproductive technology group (P = 0.03), the no medical history group (P = 0.032), and the with experience of changing hospital group (P = 0.027) showed a significant increase in the relational subscale scores of the QoL before and after the program. The majority of the participants (n = 29; 85.3%) expressed satisfaction with the support program. Participation in the Web-based partnership support program may improve the QoL of some men undergoing infertility treatment. Trial registration Retrospectively registered at the University Hospital Medical Information Network on 26 January 2023 (ID: UMIN0000 000050153).

Impact of COVID-19 lockdown on smoking and vaping: systematic review and meta-analysis

OBJECTIVES

COVID-19 and the implementation of lockdowns have impacted daily lives worldwide. This systematic review and meta-analysis aimed to investigate the impact of lockdowns on the smoking and vaping behaviours of adults during the pandemic.

STUDY DESIGN

This was a systematic review and meta-analysis.

METHODS

A systematic literature search was conducted up to 28 April 2022 in the following databases: PubMed, Embase and Web of Science.

RESULTS

In total, 77 studies met the inclusion criteria for this review. In 34 studies, an increase in smoking behaviour was reported for the majority of participants; however, in 21 and 18 studies, 'no change' and 'decrease' in smoking were the predominant responses, respectively. The results from the meta-analysis, which examined the change in the number of cigarettes smoked per day, showed no difference between the pre- and post-lockdown periods: 0.81 weighted mean difference (95% confidence interval, -0.59 to 2.21). Regarding vaping, three of seven studies reported an increase in smoking for the majority of participants, whereas 'no change' and 'decrease' were the predominant answers in the other four studies.

CONCLUSIONS

The results show that lockdowns led most participants to increase smoking/vaping, whereas a decrease or cessation of smoking/vaping was only reported in the minority of participants. Attention should be given to the non-communicable diseases that could arise as a result of the increase in smoking/vaping during lockdowns, and further research in this area is needed.

How the Presence of a Doctor Known to Patients Impacts a Web-Based Intervention to Promote Physical Activity and Healthy Eating Behaviour in Individuals with an Overweight/Obesity–Hypertension Phenotype: A Randomised Clinical Trial

(1) Background: The ‘Living Better’ web-based programme has shown short- and long-term benefits for body composition and psychological variables in obese patients with hypertension by promoting a healthier lifestyle. To further explore the potential of this programme, in this work we aimed to explore the possible effect of the patient’s ‘own doctor’ appearing in the video content of the Living Better intervention. (2) Methods: A total of 132 patients were randomly assigned either to the experimental (EG, n = 70) or control (CG, n = 62) group (with a doctor the patient knew as ‘their own’ or an ‘unknown doctor’, respectively). The body mass index (BMI), motivation towards physical activity (PA), PA levels, motivation to change one’s eating habits, adherence to the Mediterranean diet, and eating behaviour were all assessed and compared at baseline and post-intervention (12 weeks). (3) Results: The results of this study confirmed the positive effects of the Living Better programme on BMI and external eating style, with significant improvements in these variables in both groups. In addition, in the EG there was higher intrinsic motivation to change eating behaviour (mean difference of 0.9, 95% CI [0.1, 1.6], p = 0.032) and lower amotivation (mean difference of −0.6, 95% CI [−1.2, −0.1], p = 0.027) compared to the CG. (4) Conclusions: This study suggests that the presence of the patients’ own doctor in the audiovisual content of the Living Better intervention did not have significant additional benefits in terms of BMI or external eating style. However, their presence did improve intrinsic motivation and amotivation related to eating habits.

Impact of COVID-19 on mental health of infertile couple: A rapid systematic review

Infertile couples experience a lot of psychological stress due to the inability to achieve the desired social role. Couples who decide to continue assisted reproductive therapy (ART) during the epidemic also experience the psychological impact of the COVID-19 epidemic, which affects their daily lives due to social isolation, quarantine, travel restrictions, and cancellation of treatment. Therefore, the purpose of this study was to assess the mental health of infertile couple pausing or delaying their treatment due to the COVID-19 pandemic. PubMed, Scopus, Cochrane, Embase, Web of Science, ScienceDirect, Google Scholar, Research Gate, and the World Health Organization databases and websites were systematically searched for original studies concerning abortion in the era of COVID-19 pandemic published by August 15, 2021. We used the following keywords: "COVID-19 Corona virus, infertility, reproductive technique, fertilization, assisted reproduction, pregnant termination, psychological, in vitro mental status, depressive symptoms, and anxiety." In sum, after automatically and manually search and excluding duplicates, 269 articles were found. In final, after screening, 18 articles were selected. Most patients experienced negative emotions during the COVID-19 epidemic. When reproductive services were re-established, participants showed higher levels of anxiety and lower quality of life than before quarantine. Women who thought pregnancy was more important than getting COVID-19 had higher levels of anxiety than women who thought otherwise (P < 0.05). The COVID-19 pandemic has negative impacts on the mental health and quality of life of patients seeking fertility services and coping with it requires timely and appropriate psychological intervention, accurate information, and social and organizational support.

Emotions, Stress and Coping among Healthcare Workers in a Reproductive Medicine Unit during the First and Second COVID-19 Lockdowns

The impact of the COVID-19 pandemic on global healthcare workers’ (HCWs) mental health has been well documented in the last two years; however, little is known regarding HCWs working in specific healthcare fields. During two subsequent periods of national lockdown in Italy (June–July 2020, T1, and November–December 2020, T2), a total sample of 47 HCWs working in a reproductive medicine hospital unit completed an ad hoc questionnaire for assessing emotional reactions to the pandemic, stress symptoms, and ways of coping. Moderate–high levels of anger and sadness were experienced by 65.9% and 68.1% of the HCWs, respectively, while moderate–high levels of anxiety and fear were experienced by 51.1% and 56.8%, respectively. Higher stress symptoms experienced by HCWs were hypervigilance, avoidance of thoughts and memories, and tiredness/low energy. At T2, levels of hypervigilance, irritability, intrusive thoughts, and detachment were higher than at T1, while avoidance of external triggers decreased. Moderate–high levels of anxiety resulted significantly associated with several symptoms of stress: irritability/fearfulness, depression/hopelessness, tiredness/low energy, problems with concentration, and intrusive thoughts. Regarding coping strategies, HCWs tended to adopt more problem-focused coping (e.g., contributing to improving a situation) and this tendency was higher at T2. Overall findings suggest a risk for the persistence of stress symptoms and, therefore, a risk for a chronic course, which might interfere with the global quality of mental health at work and the care provided to patients. Clinical implications highlight the relevance of implementing support programs for this category of HCWs focused on the elaboration of negative emotions and on fostering adaptive coping strategies.

Development of a Web-App for the Ecological Momentary Assessment of Dietary Habits among College Students: The HEALTHY-UNICT Project

The transition from adolescence to adulthood is a critical period for the development of healthy behaviors. Yet, it is often characterized by unhealthy food choices. Considering the current pandemic scenario, it is also essential to assess the effects of coronavirus disease-19 (COVID-19) on lifestyles and diet, especially among young people. However, the assessment of dietary habits and their determinants is a complex issue that requires innovative approaches and tools, such as those based on the ecological momentary assessment (EMA). Here, we describe the first phases of the “HEALTHY-UNICT” project, which aimed to develop and validate a web-app for the EMA of dietary data among students from the University of Catania, Italy. The pilot study included 138 students (mean age 24 years, SD = 4.2; 75.4% women), who used the web-app for a week before filling out a food frequency questionnaire with validation purposes. Dietary data obtained through the two tools showed moderate correlations, with the lowest value for butter and margarine and the highest for pizza (Spearman’s correlation coefficients of 0.202 and 0.699, respectively). According to the cross-classification analysis, the percentage of students classified into the same quartile ranged from 36.9% for vegetable oil to 58.1% for pizza. In line with these findings, the weighted-kappa values ranged from 0.15 for vegetable oil to 0.67 for pizza, and most food categories showed values above 0.4. This web-app showed good usability among students, assessed through a 19-item usability scale. Moreover, the web-app also had the potential to evaluate the effect of the COVID-19 pandemic on students’ behaviors and emotions, showing a moderate impact on sedentary activities, level of stress, and depression. These findings, although interesting, might be confirmed by the next phases of the HEALTHY-UNICT project, which aims to characterize lifestyles, dietary habits, and their relationship with anthropometric measures and emotions in a larger sample of students.

The Impact of the COVID-19 Pandemic on the Lifestyles and Levels of Anxiety and Depression of Patients with Schizophrenia: A Retrospective Observational Study

The movement restrictions put in place as a result of the COVID-19 pandemic required modification of the population’s usual routines, including those of the most vulnerable groups such as patients with schizophrenia. This was a retrospective observational study. We used an online survey to collect information on patient adherence to the Mediterranean diet (Mediterranean Diet Adherence Screener questionnaire), physical exercise (International Physical Activity Questionnaire Short Form), and tobacco consumption and levels of anxiety and depression (Hospital Anxiety and Depression Scale) before and during the movement restrictions. A total of 102 people with schizophrenia participated in this study. During the COVID-19 pandemic lockdown the participants significantly increased the number of minutes spent sitting per day (z = −6.73; p < 0.001), decreased the time they spent walking (z = −6.32; p < 0.001), and increased their tobacco consumption (X² = 156.90; p < 0.001). These results were also accompanied by a significant increase in their reported levels of anxiety (z = −7.45; p < 0.001) and depression (z = −7.03, p < 0.001). No significant differences in patient diets during the pandemic compared to before the movement restrictions were reported. These results suggest the need to implement specific programs to improve lifestyle and reduce anxiety and depression during possible future pandemic situations.