The complex relationship between infertility and psychological distress (Review)

Infertile women of Ethiopia: Psychological challenges and coping strategies

Worldwide, an estimated 48 million couples and 186 million individuals are infertile, according to estimates from the World Health Organization. Ethiopia has a higher rate of infertility than the World Health Organization estimated for the entire world. Though research on the issue of infertility is growing both globally and in Ethiopia, not much has been studied. Therefore, the main objective of this study was to explore the psychological and coping strategies of infertile women in Bichena town, Ethiopia. The study followed a qualitative research approach and a descriptive phenomenological design. Data were collected through in-depth interviews with 15 infertile women using a purpose-sampling technique. Thematic analysis was the method of data analysis. The findings of this study indicated that stress, anxiety, depression, low self-esteem, and sexual dissatisfaction were the main psychological challenges that infertile women experience. Infertile women also used a variety of coping strategies, such as religious strategies, traditional strategies, medical strategies, and other strategies (marital separation and acceptance). The study concluded that infertile women in the study area were challenged by psychological factors and used different coping strategies to manage their ongoing problems. This study also has theoretical implications for the current literature and practical implications for infertile women, non-governmental organizations, community and health professionals.

Knowledge, attitude and practice on ovarian reserve function among women of childbearing age: a prospective cross-sectional study in Chongqing and surrounding regions

OBJECTIVES

To evaluate the knowledge, attitudes and practice (KAP) on ovarian reserve function among women of childbearing age in Chongqing and surrounding regions, China.

DESIGN

Cross-sectional study.

SETTING

Chongqing and surrounding regions, China.

PARTICIPANTS

Women of childbearing age (18-48 years) by convenience sampling.

PRIMARY AND SECONDARY OUTCOME MEASURES

The demographic characteristics of the respondents and their KAP on ovarian reserve function were collected by administering 38-item questionnaires.

RESULTS

A total of 510 valid questionnaires were collected. The mean knowledge score of all respondents was 7.56±2.03 (possible range: 0-10), the mean attitude score was 29.12±3.98 (possible range: 8-40) and the mean practice score was 23.45±3.58 (possible range: 6-30). The multivariable analysis showed knowledge level (OR 1.175, 95% CI 1.049 to 1.317, p=0.002), attitude level (OR 1.249, 95% CI 1.167 to 1.337, p<0.001) and eating habits (self-cooked vs eating out, OR 1.958, 95% CI 1.201 to 3.190, p=0.007) were independently associated with better practice level. The structural equation modelling analysis showed that knowledge had a direct influence on attitude (β=0.487, p=0.030) and practice (β=0.312, p=0.012) and an indirect influence on practice (β=0.213, p=0.016). Attitude had a direct influence on practice (β=0.438, p=0.007). The total influence of knowledge on practice was significant (β=0.525, p=0.012).

CONCLUSIONS

The women living in Chongqing and surrounding regions had good knowledge, moderate attitude and good practice towards ovarian reserve function. The knowledge aspect can be further improved by education, which in turn might also improve practice among women of childbearing age.

Depression, anxiety, and stress in infertile couples during the COVID-19 pandemic: the consequences we face

OBJECTIVE

Postponing assisted reproductive technology treatment can cause pronounced mental health problems. The aim of this study was to examine the level of depression, anxiety, stress, and overall infertility-related distress experienced by infertile couples during the pandemic, as well as the differences between men and women in the examined variables and the correlations between them.

METHODS

A total of 131 participants were included in the study, 65 men and 66 women. They were selected based on their responses in the Fertility Problems Inventory (FPI); the Depression, Anxiety, and Stress Scale-21 (DASS-21); and a general data questionnaire provided to them at the time of IVF.

RESULTS

The levels of depression, anxiety, and stress in women and men resided within the normal range. Depression (p<0.05), anxiety (p<0.01), stress (p<0.01), and social concern (p<0.05) were more pronounced among women. Significant correlations were found between depression, anxiety, stress, and global stress and its three dimensions: social concern, sexual concern, and relationship concern.

CONCLUSIONS

During the pandemic, women undergoing assisted reproductive technology treatment experienced significantly higher levels of depression, anxiety, stress, and overall infertility-related stress than men. Furthermore, depression, anxiety, and stress were apparently correlated with overall infertility-related stress.

Psychosocial Impact of Infertility Diagnosis and Conformity to Gender Norms on the Quality of Life of Infertile Spanish Couples

Epidemiological data show that human reproductive disorders are a common problem worldwide, affecting almost one in six people of reproductive age. As a result, infertility has been identified by the World Health Organization as a public health disease. Reproductive problems can take a heavy toll on the psychosocial well-being of couples suffering from infertility. This is especially true for women, who tend to be the ones who undergo the most treatment. The main objective of the present study is to find out whether a sex-based infertility diagnosis influences the quality of life of couples with infertility. Also, we aim to find out whether the degree of adherence to gender norms influences their quality of life. A cross-sectional study was conducted using the Fertility Quality of Life Questionnaire (FertiQoL) and the Conformity to Feminine and Masculine Norms Inventories in a sample of 219 infertile Spanish couples (438 participants). The results show that, in all cases, regardless of the degree of conformity to gender norms and whether the infertility diagnosis was of female or male origin, women have lower scores on the self-perceived quality of life. This suggests that being female is already a psychosocial risk factor when assessing the psychosocial consequences of infertility.

Exploring the psycho-social burden of infertility: Perspectives of infertile couples in Cape Coast, Ghana

Infertility is a complex and often sensitive issue with far-reaching psycho-social ramifications for couples and their families. This study therefore seeks to delve into the psycho-social burden of infertility in Cape Coast, a major city in Ghana. Specifically, we explored the impact of infertility on the psychological and social health of infertile couples receiving fertility treatment. It also delves into the strategies they adopt to cope with their conditions. The study employs a qualitative approach to inquiry using phenomenology as a study design to explore the experiences of the study participants. In-depth interviews were conducted using interview guides, voice recorded and transcribed verbatim. Both inductive and deductive/framework coding techniques were used to code the data leading to the generation of themes and sub-themes. The results show that most of the study participants dealing with infertility faced psychological burdens from different sources including their families, society and themselves. These burdens take a toll on their mental health, pushing them into a state of desperation and depression. It was, however, revealed that infertile couples are able to cope with the help of their family, spouses and the church. Curiously, some of them opt for withdrawal from social events as a coping mechanism. Infertility exerts an enormous negative psycho-social impact on affected couples, especially women. The family and society serve as the main sources of stressors for infertile couples. Therefore, programmes that are aimed at fertility treatment should deliberately consider addressing the psychosocial burden of infertility through education targeting actors, especially interpersonal-level actors.

Predictors of nonresponse to treatment and low adherence to internet-based cognitive behavioral therapy in depressed/anxious women facing the couple's fertility problems: a secondary analysis of a randomized control trial

BACKGROUND

The study aimed to examine the predictors of treatment nonresponse and low adherence to Internet-based cognitive behavioral therapy and face-to-face therapy for treating depression and anxiety in women facing the couple's fertility problems.

METHODS

This is a secondary analysis based on a previous randomized controlled trial including 152 depressed/anxious women facing the couple's fertility problems. The study defines low adherence as receiving less than 4 sessions (out of 8 sessions). Nonresponse to treatment refers to a < 50% reduction in the anxiety and depression total scores.

RESULTS

A high level of anxiety/depression score before psychotherapy increases the risk of nonresponse to both Internet-based and face-to-face psychotherapies by 1.4 to 2 times in women facing the couple's fertility problems after the treatment and in the 6-month follow-up. However, 4 factors, including diagnosis of mixed anxiety and depression, low education level, long marriage duration, and infertility caused by mixed female/male factors, reduced the risk of nonresponse to psychotherapies.

CONCLUSION

Women facing the couple's fertility problems with high depression and anxiety scores are at risk of poor prognosis in response to psychotherapy. Psychologists and healthcare providers of infertility centers should pay more attention to the timely identification and referral of depressed/anxious patients to psychologists.

Efficacy of Dry Cupping versus Counselling with Mindfulness-based Cognitive Therapy Approach on Fertility Quality of Life and Conception Success in Infertile Women due to Polycystic Ovary Syndrome: A Pilot Randomized Clinical Trial

Background

Physical and psychological interventions could affect the quality of life (QoL) of women with infertility. The purpose of this study was to compare the effectiveness of dry cupping and counselling with the mindfulness-based cognitive therapy (MBCT) approach on fertility QoL and conception success in infertile women due to polycystic ovary syndrome (PCOS).

Methods

This was a two-arm pilot randomized clinical trial from first January 2021 to the end of November 2022. In this regard, 19 women with infertility who were referred to the health centers affiliated with Shiraz University of Medical Sciences and met the inclusion criteria were enrolled in the study. Participants were randomly divided into two groups (10 in the virtual MBCT group and 9 in the cupping group). All participants completed the fertility quality of life (FertiQol) tool before the intervention and three months after the end of the intervention. In addition, after the end of the intervention, a human chorionic gonadotropin test was performed monthly for three months, too. We used ANOVA/ANCOVA and its related effect sizes, including mean difference (MD) and standard mean difference (SMD: Hedges's g), and chi-square tests to compare the study group outcomes in Stata 14.2. P-values equal to or less than 0.10 were considered significant.

Results

The intervention resulted in significant differences in the mean overall scores of FertiQol between the counseling and cupping groups (61.76±14.28 and 50.65±12.53, respectively) [P=0.091, MD=11.11 (90% CI: 0.33 to 21.89), SMD=1.07 (90% CI: 0.279 to 1.84)]. No significant difference was found in conception rates between the groups after the intervention.

Conclusion

This pilot study found that MBCT improved the fertility QoL in PCOS-related infertility patients better than cupping therapy.

Trial registration

IRCT201706110334452N1.

The social determinants of mental health disorders among women with infertility: a systematic review

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.

Psychological distress in infertile women: the role of quality of marital relationships and self-compassion

Infertility is a common disease. At least 10-15% of women deal with infertility in some way. Infertile women suffer from a higher degree of psychological distress compared to fertile women. This study aims to identify the role of the quality of marital relationships and self-compassion in psychological distress in infertile women. The participants were 400 women who were referred to fertility clinics in Iran over a two-year period. Questionnaires containing Demographic Questionnaire, Psychological Distress Scale (DASS), Marital Quality Scale (MQS) and Self-Compassion Scale (MCS). The results showed that predictor variables explain a total of 29.9% of the variance of psychological distress in infertile women. The quality of marital relationships (p  =  0.001 and β  =  -0.49) and self-compassion (p < 0.05 and β  =  -0.08) can negatively predict the psychological distress of infertile women. Considering that the significant role of the quality of marital relationships and self-compassion in the psychological distress of infertile women has been confirmed; therefore, interventions that focus on the quality of marital relationships and self-compassion may be effective and should be used as a resource to combat psychological distress in infertile women.

Effectiveness of Group Cognitive-Behavioral Therapy for Managing Anxiety and Depression in Women Following Hysterectomy for Uterine Cancer

OBJECTIVE

Hysterectomy as well as uterine cancer could be associated with a long-term risk of mental disorders. The purpose of this study is to investigate the effectiveness of group cognitive-behavioral therapy (GCBT) in reducing anxiety and depression in women who have undergone hysterectomy for uterine cancer.

METHOD

This experimental, pretest-post-test study was conducted in an academic hospital. 26 women with uterine cancer who underwent hysterectomy were recruited and randomly divided into two equal groups as the experimental and control groups. The experimental group was treated by GCBT for eight 1-hour sessions (by a senior psychology expert) every week until 8 weeks. Otherwise, no intervention was performed for the control group. The anxiety and depression scores of all participants were assessed and compared before and after the therapy sessions by Beck Anxiety (BAI) and Beck Depression-second version (BDI-II) questionnaires.

RESULTS

The mean±SD age of the participants was 33.6±4.1. Our result found significant different after GCBT in both anxiety (p=0.000) and depression (p=0.000) scores in the experimental group. However, no differences between pre and post-test scores in the control group were observed. Compared to the control group the rate of depression (p=0.000) and anxiety (p=0.000) in the case group was significantly decreased after therapy.

CONCLUSION

GCBT is effective in reducing anxiety and depression in women after hysterectomy. The use of GCBT in oncology centers along with medical treatments to reduce mental distress, improve mental health, and accelerate the recovery process of patients with uterine cancer and other cancers seems necessary.

Women's Narratives on Infertility as a Traumatic Event: An Exploration of Emotional Processing through the Referential Activity Linguistic Program

BACKGROUND

the diagnosis of infertility and its related treatment can be traumatic, leading to profound psychological distress and a variety of psychopathological symptoms. The primary objective of this study is to contrast the linguistic features of narratives from women undergoing Assisted Reproductive Treatment with those of women not undergoing any fertility treatment. This study examines the speech of both groups of individuals as an indicator of their capacity to cope with current and past distressing experiences.

METHOD

44 women (mean age 36.05; SD = 4.66) enrolled in a fertility medical center in Rome, and 43 control women (mean age 36.07; SD = 3.47) completed a socio-demographic questionnaire and a semi-structured interview designed to collect their memories of a neutral, a positive, and a negative event. This interview also aimed to investigate: (a) (for women with fertility difficulties) how they realized they and their partner had fertility problems and a description of an event when they talked about these difficulties with their partner; and (b) (for control group participants) the most difficult moment of their pregnancy and an event when they talked about it with their partner. The interviews were audio recorded and transcribed, and the text was analyzed using the referential process (RP) linguistic measures software.

RESULTS

Mann-Whitney non-parametric U tests for the independent samples showed several significant differences regarding the linguistic measures applied to the narratives of neutral, positive, negative, and difficult experiences in the form of a linguistic style, with more intellectualization and defenses in all the narratives associated with the women with fertility problems compared to the women in the control group.

CONCLUSIONS

the traumatic and painful experience of infertility and ART seems to characterize the whole mode of narrating life experiences. Present findings sustain the importance of helping women to elaborate on their experience and to understand and recognize the difficult feelings that are activated in relation to the difficulties of having a child.

Therapeutic Effect of Tinospora cordifolia (Willd) Extracts on Letrozole-Induced Polycystic Ovarian Syndrome and its Complications in Murine Model

Background

Tinosopora cordifolia (Willd) (TC) is commonly used in Ayurvedic medicine since long time for number of ailments and its preparations are also considered by food safety and standards authority of India as nutritional supplement. However the scientific evidence on its possible safety and efficacy in polycystic ovarian syndrome and associated complications was not studied in detail.

Objectives

The purpose of this investigation is to examine whether or not TC can have therapeutic effects on letrozole induced PCOS and related complications such as body weight, dyslipidaemia, glucose tolerance, hormonal regulation, insulin resistance and sensitivity, severity of PCOS and histopathological changes in ovary using mice animal model.

Design

Present study is a preclinical study involving laboratory animals.

Methods and analysis

After verifying the absence of PCOS, the animals began receiving Letrozole, which lasted for 21 days. Fasting blood glucose (FBG), the oral glucose tolerance test (OGTT), triglycerides, cholesterol, and weight were recorded. The levels of hormones like oestrogen, progesterone, insulin, testosterone, luteinising hormone (LH) and follicle stimulating hormone (FSH), histopathology was carried out.

Ethics

The Institutional Animal Ethics Committee at DITU gave its clearance to the animal experimentation on July 10, 2021 (DITU/IAEC/21-22/07-06).

Discussion

The majority of cornified epithelial cells were seen in groups treated with TC extract during the estrous phase of the cycle. Mice exposed to TC retained normal body weight. FBG, 1- and 2-hour OGTT, triglyceride and cholesterol levels were all significantly improved by extracts. Estradiol, progesterone, testosterone, insulin, LH and FSH concentration were all corrected in TC-treated animals. The HOMA-IR, HOMA-Beta and QUICKI values were also corrected with TC extracts. The morphological and microscopic features of the ovary were also greatly enhanced. Based on these findings, we conclude that treating PCOS mice with TC extracts significantly ameliorates the disease and severity down to nil-to-moderate levels by reducing hyperinsulinemia, hyperandrogenism, dyslipidaemia, enhancing insulin sensitivity, correcting oestrogen, progesterone, LH and FSH levels via enhanced ovarian function. Further molecular and cellular level of study is recommended for further elaboration of mechanism of action.

Plain language summaries

• Tinospora cordifolia satva, oil and hydroalcoholic extract were studied in letrozole-induced PCOS in mice model• Anti PCOS efficacy of 3 preparations studied with respect to their mechanism of action in detail• For the first time proposing method of calculating severity of PCOS in animal model• Tinospora cordifolia oil preparation completely reversed PCOS effect of letrozole and made them normal• Histopathological and morphological studies support the biochemical claims.

Treatment-seeking behaviour among infertile tribal women of Palghar district in India

Background

The tribal culture views health care practices differently from the mainstream. Infertile tribal women practice treatment-seeking behaviour that reflects the community's cultural access to and availability of treatment as well as customs to meet their health care needs. In the environment of rising awareness of infertility and numerous treatment options, this study aims to highlight the infertility treatment-seeking behaviour of tribal communities.

Data and methods

The study employed a mix methods approach to collect data from 153 tribal couples suffering with infertility (interview schedule) and the community (in-depth interviews-14 and focus group discussions-12). The data was analyzed using Stata 13.0, and NVivo 10. Results of the quantitative data were triangulated with qualitative data for writing.

Results

Many treatment options were available for infertility in the community. Generally, traditional healers (98.7%) were preferred over modern healthcare practitioners (35%). Community members usually guided infertile couples for choosing providers. Treatment practices were very different among primary infertile women than sub-fertile. Women frequently discontinued treatment and switched between providers because of unaffordability, poor connectivity, distance, travel time, time constraints, and non-supportive circumstances. The couples were advised to consume herbs, and eat or avoid certain food items, were given massage, burns on the abdomen (dagani), removed black blood (phasani) and other various rituals to appease spirits, get rid of ghosts while offering animal sacrifice, and conducting shidwa ritual. The mean expenditure on treatment was INR 18,374. If treatment did not yield any result, couple resorted to add another wife, divorce, accept childlessness and foster a child.

Conclusion

Local authorities should strive to work towards the socio-economic development of the tribal communities and provide good healthcare services at their doorstep. The infertility problem needs to be understood in the context of poverty, tribal beliefs, and unequal access to healthcare resources.

Psychometric Measurement of Fertility-related Quality of Life across Gender in Primary Infertile Couples

Background

Infertility is a crucial global public health issue that affects millions of people of reproductive age. Fertility-related stress can negatively impact infertile couples' quality of life (QoL).

Aims

This study aimed to assess and compare the psychometric properties of fertility QoL between primary infertile couples' male and female partners.

Settings and Design

This cross-sectional study included 114 primary infertile couples visiting the Andrology Laboratory referred from the Gynaecology and Obstetrics Department, AIIMS, Patna.

Materials and Methods

Data were collected using the Fertility QoL (FertiQoL) tool, an internationally validated questionnaire to measure the reproductive QoL, demographic information and medical history. The FertiQoL questionnaire responses were recorded and analysed.

Statistical Analyses Used

Statistical analyses used were performed using the SPSS 20.0 version. Descriptive statistics, Kolmogorov-Smirnov test, Cronbach's alpha and Student's independent t-tests were used. Statistical significance was set at P < 0.05.

Results

In our study, the overall estimated Cronbach's α was 0.83, and males had a significantly better fertility-related QoL in all domains of the FertiQoL, such as emotional (P < 0.000), mind-body (P < 0.000), social (P < 0.004) and tolerability (P < 0.000), except relational and environmental domains, which were lower in them. However, between the groups, the relational domain was significant (0.000) and the environmental domain was non-significant (0.592). Overall, males had a significantly better total core score, total treatment score and overall total FertiQoL score, while females had lower scores.

Conclusion

Amongst infertile couples, the reproductive QoL was poorer in females than in males. Our study suggests psychological counselling and mental support for females during infertility management.

Health Literacy, General Health, and Lifestyle among Infertile Men and Women in the Southeastern Iran

Background

Infertility is a growing social problem, and health literacy is one of the factors that affects infertility, thereby affecting life quality. On the other hand, lifestyle factors exert a considerable impact on reproductive capacity and general health. Against this backdrop, this study aims to determine health literacy, general health, and lifestyle in infertile people in Zahedan, Iran.

Methods

In this descriptive cross-sectional study, 86 male and 181 female participants who referred to Molod Infertility center (AliIbnAbiTalib Hospital) in Zahedan were randomly selected. Health Literacy Standard Questionnaires (HELIA), the General Health Questionnaire (GHQ), and the Miller-Smith Lifestyle Assessment Inventory (LSI) were used to collect data. In addition, data were analyzed by SPSS V.22.

Results

The participants' mean age was 30.87±7.5. Besides, 39% and 70% of the participations did not have enough health literacy and had a moderate lifestyle, respectively. In addition, the general health of 68.9% was exposed to damage. Moreover, there was a significant relationship between the three aforementioned factors, with the participants of higher levels of health literacy having had higher levels of general health and lifestyle.

Conclusion

According to the findings of this study, the infertile people's health literacy was not enough, and most of them had a moderate lifestyle. In addition, their general health was exposed to damage in most cases. Thus, it is necessary to pay attention to providing proper education and health services to infertile men and women to improve their level of health literacy and healthy fertility in order to support childbearing in the society.

Dynamics of Microbiome Changes in the Endometrium and Uterine Cervix during Embryo Implantation: A Comparative Analysis

BACKGROUND The microbiome is the collection of all micro-organisms and their genes, which naturally live in and on the body. The cervical and endometrial bacterial microbiome has previously been reported to affect fertility and influence the outcomes of assisted reproductive therapy (ART), including embryo transfer. This study aimed to evaluate the cervical and endometrial bacterial microbiome in 177 women treated for infertility before, during, and after embryo implantation, and the outcomes. MATERIAL AND METHODS Cervical and endometrial swabs were collected from 177 women diagnosed with infertility at 3 time points: (1) during the initial examination, (2) during implantation, (3) 10-14 days after implantation. Next-generation sequencing (NGS) was used to analyze the bacterial microbiome. Taxonomic identification was performed with the Usearch algorithm. RESULTS There was a significant change in the number of patients with Escherichia coli depending on the collection time. For the first swab collection, there were significant negative relationships between the percentage of Gardnerella vaginalis and Lactobacillus spp. For the second collection, there was a negative relationship between Lactobacillus helveticus and Lactobacillus jensenii. For the third collection, negative relationships were found between Escherichia coli and Lactobacillus spp. A similar distribution of the bacterial microbiome was observed in all 3 swab collections. CONCLUSIONS Lactobacillus spp. were the main bacteria identified in the cervix and endometrium, present before, during, and after successful embryo transfer. E. coli and G. vaginalis reduced the protective effect of Lactobacilli before, during, and after embryo transfer.

Amino Acid Profiling of Follicular Fluid in Assisted Reproduction Reveals Important Roles of Several Amino Acids in Patients with Insulin Resistance

The global prevalence of insulin resistance (IR) is increasing continuously, influencing metabolic parameters and fertility. The metabolic changes due to IR can alter the molecular composition of plasma and other body fluids. Follicular fluid (FF) is derived mainly from plasma, and it is a critical microenvironment for the developing oocytes. It contains various metabolites and amino acids, and the quality of the oocytes is linked at least partially to amino acid metabolism. Our goal was to quantitatively determine the amino acid (AA) profile of FF in IVF patients and to compare IR and non-insulin resistance (NIR) groups to investigate the AA changes in their FF. Using UHPLC-based methods, we quantified the main 20 amino acids from human FF samples in the IR and NIR groups. Several amino acids (aspartate, glycine, glutamate, and cysteine) differed significantly (p < 0.05 or less) between the two groups. The most significant alterations between the IR and NIR groups were related to the glutathione metabolic pathway involving glycine, serine, and threonine. Since insulin resistance alters the amino acid composition of the FF, the oocytes may undergo metabolism-induced changes resulting in poor oocyte quality and less fertility in the insulin resistance groups.

Pre-pregnancy complications - associated factors and wellbeing in early pregnancy: a Swedish cohort study

BACKGROUND

Many couples experience difficulties to become pregnant or carry a pregnancy to term due to unknown causes. Here we define pre-pregnancy complications as having prior recurrent pregnancy loss, prior late miscarriages, time to pregnancy more than one year, or the use of artificial reproductive technologies. We aim to identify factors associated with pre-pregnancy complications and poor well-being in early pregnancy.

METHODS

Online questionnaire data from 5330 unique pregnancies in Sweden were collected from November 2017 - February 2021. Multivariable logistic regression modelling was used to investigate potential risk factors for pre-pregnancy complications and differences in early pregnancy symptoms.

RESULTS

Pre-pregnancy complications were identified in 1142 participants (21%). Risk factors included diagnosed endometriosis, thyroid medication, opioids and other strong pain medication, body mass index > 25 kg/m² and age over 35 years. Different subgroups of pre-pregnancy complications had unique risk factors. The groups also experienced different pregnancy symptoms in early pregnancy, where women that had experienced recurrent pregnancy loss were at higher risk of depression in their current pregnancy.

CONCLUSION

We report one of the largest pregnancy cohorts with high frequency of pre-pregnancy complications compared to the Swedish population. Prescribed drug use and body weight were the top potentially modifiable risk factors in all groups. Participants that experienced pre-pregnancy complications also had higher risk of depression and pregnancy problems in early pregnancy.

The specific psychosocial modulator factors of emotional adjustment in infertile individuals compared to fertile people

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.

Creating affiliations, learning, and mindfulness for in vitro fertilization patients (CALM IVF): a clinical trial

Objective

Determine if group psychoeducational support can improve in vitro fertilization (IVF) patients' quality of life (QoL).

Design

Randomized controlled trial (NCT04048772).

Setting

University-affiliated IVF clinic.

Patients

Women (n = 76) and male partners undergoing initial autologous IVF cycle from August 2019, to December 2020.

Interventions

Couples were assigned to groups based on projected oocyte retrieval date. Groups were randomly assigned to the control or intervention arm. Clinic closures because of the COVID-19 pandemic delayed treatment for a portion of participants. Groups were conducted in person before and virtually during the pandemic.

Main Outcome Measures

The primary outcome was a change in fertility quality of life (FertiQoL) from baseline to 3 days after retrieval. Secondary outcomes were changes in depression (Patient Health Questionnaire 9), anxiety (Generalized Anxiety Disorder 7), resilience (Connor-Davidson Resilience scale), IVF knowledge scores, and the likelihood of return to treatment.

Results

Knowledge scores among women in Creating Affiliations, Learning, and Mindfulness (CALM) for IVF groups significantly increased compared with control (mean difference 13.19 [3.53 - 22.84]) before the pandemic. During the pandemic, women in CALM IVF had significant improvement in the social FertiQoL score compared with controls (10.42 [1.79 - 19.04]). Compared with controls, male CALM IVF participants had significantly greater improvement in total FertiQoL (mean difference 6.68 [0.39 - 12.98]), treatment FertiQoL (8.26 [0.69 - 15.82]), and resilience (Connor-Davidson 1.13 [0.54 - 1.72]). Immediate return to care did not significantly differ between arms.

Conclusions

For women undergoing IVF, group psychoeducational programs can improve IVF knowledge and social QoL during a pandemic. Participation in a group psychoeducational program can improve QoL and resilience in IVF dyad male partners.

Clinical Trial Registration Number

Trial registration NCT04048772.

The Influence of Metabolic Factors and Diet on Fertility

Infertility is a disease globally affecting 20-30% of the reproductive age female population. However, in up to 50% on recorded cases, problems with infertility are ascribed to men; therefore, it is important to popularize healthy eating also in this group. During the last decade, it has been observed that society's lifestyle changed drastically: reduced energy expenditure in physical activity per day, increased consumption of hypercaloric and high-glycemic-index foods with high content of trans fats, and reduced consumption of dietary fiber, which negatively affects fertility. Increasing evidence points to a link between diet and fertility. It is becoming clear that well-planned nutrition can also contribute to the effectiveness of ART. The low-GI plant-based diet appears to have a positive effect, especially when it is based on Mediterranean dietary patterns: rich in antioxidants, vegetable protein, fiber, MUFA fatty acids, omega-3, vitamins, and minerals. Importantly, this diet has been shown to protect against chronic diseases associated with oxidative stress, which also translates into pregnancy success. As lifestyle and nutrition seem to be important factors affecting fertility, it is worth expanding knowledge in this regard among couples trying to conceive a child.

Successful Implementation of Menstrual Cycle Biomarkers in the Treatment of Infertility in Polycystic Ovary Syndrome-Case Report

Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility. Absent, impaired, or rare ovulation induces progesterone deficiency in the luteal phase, which is a critical problem in PCOS. A usual pattern of progesterone administration from a fixed and arbitrary pre-determined day of a menstrual cycle may preserve infertility but can easily be avoided. We present the case of a 29-year-old infertile woman who had been ineffectively treated for over two years. We introduced a line of therapy that was suited to her individual menstrual cycle by implementing biomarker recording. Supplementation based on a standardized observation of the basal body temperature (BBT) and cervical mucus stopped the vicious circle of absent ovulation and hyperandrogenism, restoring regular bleeding, ovulation cycles, and fertility. The implementation of a reliable fertility awareness method (FAM), accompanied by a standardized teaching methodology and periodic review of the observations recorded by the patient, validated through an ultrasound examination and plasma gonadotropins, estrogens, and progesterone concentrations, is key to achieving therapeutic success. The presented case is an example of a clinical vignette for many patients who have successfully managed to improve their fertility and pregnancy outcomes by applying the principles of a personalized treatment approach together with gestagens by recording their fertility biomarkers.

The value of motherhood and psychological distress among infertile women: The mediating role of coping strategies

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.

Emotional reactions to infertility diagnosis: thematic and natural language processing analyses of the 1000 Dreams survey

RESEARCH QUESTION

What are the emotional effects of infertility on patients, partners, or both, and how can qualitative thematic analyses and natural language processing (NLP) help evaluate textual data?

DESIGN

A cross-sectional, multi-country survey conducted between March 2019 and May 2019. A total of 1944 patients, partners, or both, from nine countries responded to the open-ended question asking about their initial feelings related to an infertility diagnosis. A mixed-method approach that integrated NLP topic modelling and thematic analyses was used to analyse responses. Sentiment polarity was quantified for each response. Linear regression evaluated the association between patient characteristics and sentiment negativity.

RESULTS

Common emotional reactions to infertility diagnoses were sadness, depression, stress, disappointment, anxiety, frustration, confusion and loss of self-confidence. NLP topic modelling found additional reactions, i.e. shared feelings with partners, recollections about causes of infertility and treatment experience. Responses to the open-ended question were brief (median: three words) with 71.8% conveying negative sentiments. Some respondent characteristics showed small but significant associations with sentiment negativity, i.e. country (Spain, China and France were more negative than the USA, P < 0.001, P < 0.003 and P < 0.009 respectively), treatment engagement (no treatment was more negative than one or more treatment, P = 0.027) and marital status (missing/other was more negative than divorced, P = 0.003).

CONCLUSION

Infertility diagnoses create an emotional burden for patients and partners. The mixed-method approach provides a compelling synergy in support of the validity of these findings and shows potential for these techniques in future research.

Therapist-guided internet-based cognitive behavioral therapy versus face-to-face CBT for depression/anxiety symptoms in infertile women with adjustment disorders: A randomized controlled trial

Objective: The present study compared the effectiveness of ICBT to face-to-face CBT on the improvement of adjustment disorder symptoms in infertile women.Method: In a pragmatic, multi-center (public or private), single-blinded, non-inferior randomized controlled trial (RCT), 152 patients with AD (100 women in public center and 52 women in private canter) were assigned to ICBT and CBT. Primary outcomes were Adjustment Disorder New Module-20 (ADNM-20) and Hospital Anxiety and Depression (HADS). Secondary outcomes were the Fertility Problem Inventory (FPI) and Fertility Adjustment Scale (FAS).Results: "Peaceful mind" ICBT was feasible and accessible for delivering the treatment to infertile women with AD. At end-of-treatment, improvements in ICBT were non-inferior to CBT for symptoms of AD, anxiety, and depression. Additionally, the non-inferiority of ICBT to CBT was maintained at a three-month follow-up.Conclusions: ICBT was non-inferior to CBT in improving mental symptoms in infertile women with AD.

Predictors and incidence of depression and anxiety in women undergoing infertility treatment: A cross-sectional study

The global incidence of infertility is increasing year by year, and the association between infertility and mental illness has been widely concerned. The aim of this study was to investigate the incidence of anxiety and depression in infertile women in China and explore the risk factors which might lead to anxiety and depression. From January 2020 to December 2020, female infertile patients who received assisted reproduction technology (ART) treatment at West China Second Hospital were recruited and a total of 1712 eligible female patients were finally enrolled in this study. Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionaire-9 (PHQ-9) were used to evaluate the patients' psychological status. The reliability of all scales was evaluated by Cronbach's α and Spearman-Brown half coefficient, and Kaiser-Meyer-Olkin (KMO) value was calculated by factor analysis to evaluate validity. Univariate and multivariate logistic regression analysis were applied for assessing independent risk factors of anxiety and depression, respectively. The incidence of anxiety and depression in infertile women were 25.2% and 31.3%, respectively. Cronbach's α coefficients and Spearman-Brown half-fold coefficients of GAD-7 and PHQ-9 were 0.870, 0.825, 0.852 and 0.793, respectively. Univariate and multivariate logistic regression analysis showed that education level (junior college degree or above, OR:1. 6, 95% CI: 1.2-2.1, P = 0.003), somatic symptoms (severe somatic symptoms, OR:15.2, 95%CI: 5.6-41.3, P<0.001), sleep quality (poor sleep quality, OR:9.3, 95% CI:4.7-18.4, P<0.001) were independent risk factors for anxiety. And age>35 years old, moderate and severe somatic symptoms and poor sleep quality were independent risk factors for depression. Somatic symptoms and poor sleep quality are both the risk factors of anxiety and depression symptoms of infertile woman. And high educated (junior college degree or above) patients are more likely to be complicated with anxiety symptoms, while elderly patients (age>35) are prone to be complicated with depression symptoms.

The effect of e-health interventions on meeting the needs of individuals with infertility: a narrative review

Background

The mental health and well-being of millions of people worldwide are negatively impacted by infertility. A promising solution to meet the needs of people suffering from infertility is e-health interventions, such as online counseling and support groups. This study aims to review the current literature on e-health interventions and how they impact people with infertility.

Main body of the abstract

Relevant studies were searched in PubMed, Web of Science, and Scopus databases. Articles were entered into the EndNote software and screened for duplicates and relevance. Two authors then reviewed full-text articles independently, with a third person resolving any disagreements. Thirteen studies conducted between 2007 and 2022 were identified. The interventions aimed to meet various needs, including training on drug use (n = 23), lifestyle modifications (n = 1), periconceptional behavior modifications (n = 1), drug management (n = 1), IVF training (n = 4), psychological support to reduce distress (n = 4), and promoting a positive sexual self-concept (n = 1).

Short conclusion

The limited number of e-health interventions for infertile patients, the heterogeneity of interventions, and the lack of long-term effectiveness data make it challenging to compare e-health interventions to nonelectronic alternatives. However, the increasing use of technology in healthcare, especially during and after the Covid-19 pandemic, suggests that e-health educational interventions such as those using the Internet, psychological support, and patient interaction will continue to play a crucial role in healthcare.

Supplementary Information

The online version contains supplementary material available at 10.1186/s43043-023-00137-7.

Cognitive behavioural therapy for women with infertility: A systematic review and meta-analysis

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.

Risk Factors of Pregnancy Failure in Infertile Patients Undergoing Assisted Reproductive Technology

Background

Infertile couples need to use assisted reproductive technology (ART) to give birth. However, pregnancy failure after ART is not uncommon. At present, the results of studies on the causes of pregnancy failure after ART are inconsistent.

Methods

A retrospective cohort study involving 715 embryo transfer cycles was conducted at the Reproductive Medicine Center of Meizhou People's Hospital, from December 2015 to June 2022. According to the pregnancy, they were divided into clinical pregnancy group and pregnancy failure group. The relationship between demographic characteristics and pregnancy status between the two groups was analyzed.

Results

The pregnancy failure rate after ART was 49.7% (355/715). There were statistically significant distribution differences of maternal age, paternal age, COH protocols, and number of embryos transferred between clinical pregnancy and pregnancy failure groups (all P<0.01). Multiple logistic regression analysis shows that high maternal age (>35 years old vs ≤35 years old: OR 2.173, 95% CI: 1.386-3.407, P=0.001), and GnRH-a short protocol (GnRH-a short protocol vs GnRH-a long protocol: OR 2.139, 95% CI: 1.127-4.058, P=0.020) may increase risk of pregnancy failure in ART pregnancies, while two embryos transferred (two embryos transferred vs one embryo transferred: OR 0.563, 95% CI: 0.377-0.839, P=0.005) may reduce risk of pregnancy failure. In addition, high maternal age, GnRH antagonist protocol, and GnRH-a short protocol may increase risk of implantation failure, while two embryos transferred may reduce risk of implantation failure. And high maternal age may increase risk of biochemical pregnancy.

Conclusion

The risk of pregnancy failure increased in ART cycles with maternal age >35 years old and GnRH-a short protocol, while reduced with two embryos transferred.

The effectiveness of cognitive-behavioural group therapy on infertile men, a randomised clinical trial

BACKGROUND

Infertility can result in the emergence of depression and anger, the loss of one's identity, and the feeling of guilt in the infertile person. Present study aimed to investigate the effects of cognitive behavioural group therapy (CBGT) on infertile men's anger and positive and negative affect.

MATERIALS AND METHODS

Forty-three men with infertility for at least five years were selected for the present randomised clinical study. Spielberger's State-Trait Anger Expression Inventory-II (STAXI-II) and the PANAS scale (positive and negative affect) were filled out by the participants, and they were randomly divided into the experimental (22) and control (21) groups. The experimental group received 18 ninety-minute sessions of hybrid group therapy held twice a week, while the control group received no intervention. When the intervention program was over, all participants performed the post-test. Moreover, the post-hoc stage was held two months later.

RESULTS

The effects of the intervention were significant in terms of state anger, trait anger, anger expression in, anger expression out, positive effects, and negative effects (p < 0.004), but they were not significant concerning the anger control out index (p = 0.241). The significant differences between the two groups were also observed in the post-hoc stage.

CONCLUSIONS

The CBGT therapy seems to be helpful for infertile men to reduce their anger and negative affect and increase their positive affect by implementing a set of techniques like cognitive regeneration, assertiveness, daily joyful activities, exercises to relax one's muscles, diaphragm respiration, the identification of various fillings, and emotional expression.

Risk Factors of Preterm Birth and Low Birth Weight in Singletons Conceived Through Frozen Embryo Transfer: A Retrospective Study

Background

The risks of adverse perinatal outcomes in offspring conceived following frozen-thawed embryo transfer (FET) assisted reproductive technology (ART) are inconsistent. The aim of this study was to analyze the risk factors for preterm birth and low birth weight in singletons after FET.

Methods

386 FET cycles was conducted at the Reproductive Medicine Center of Meizhou People's Hospital. The relationship between clinical characteristics and outcomes (term birth and preterm birth, normal birth weight and low birth weight) was analyzed.

Results

The rate of primary infertility, basal FSH and T levels, gestational age, birth weight, and proportion of male fetuses were significantly different in the preterm and full-term groups. Logistic regression analysis showed that high maternal age (≥35 years) (OR 3.652, 95% CI: 1.683-7.925, P=0.001), primary infertility (OR 2.869, 95% CI: 1.461-5.632, P=0.002), low FSH level (<6.215 mIU/mL) (OR 3.272, 95% CI: 1.743-6.144, P<0.001), and hormone replacement therapy (HRT) method (OR 2.780, 95% CI: 1.088-7.100, P=0.033) may increase risk of preterm birth after FET. Gestational age and birth weight were significantly different in fetuses with low birth weight (<2500g, n=38) and normal birth weight (≥2500g and <4000g, n=333). Logistic regression analysis showed that low basal FSH level (<6.215 mIU/mL) (OR 0.425, 95% CI: 0.209-0.865, P=0.018), and HRT method of endometrial preparation for FET (OR 0.272, 95% CI: 0.079-0.934, P=0.039) may reduce the risk of low birth weight after FET.

Conclusion

High maternal age, primary infertility, low FSH level, HRT method of endometrial preparation for FET, and male fetus may increase risk of preterm birth after FET. In addition, primary infertility, low basal FSH level, and HRT method of endometrial preparation may reduce the risk of low birth weight after FET.

Psychological Problems Related to Infertility

Infertility is a problem of great significance among millions of couples. In our society, to have a child means living a fulfilled life. Thus, couples who cannot do so feel barren and incomplete. Therefore, infertility is more than just a medical problem. It affects all aspects of life, the most important being mental health. For many years, a person's mental health has been overlooked, but in the past few years, it has gained importance that mental health is as significant as physical health, which has also been stated in the WHO definition of health. This article discusses the mental toll that infertility takes on a person's life. A person may experience a myriad of psychological problems, of which stress for extended periods is one. Furthermore, it may cause feelings of guilt, emptiness, anxiety, and depression. The article mainly focuses on the need for counseling for couples dealing with infertility and under treatment because of the long waiting periods accompanying it. Although both men and women can contribute to infertility in India, women are exclusively held responsible, leading to more significant stress while undergoing treatment. The paper also provides an overview of infertility, the factors responsible, and the treatments currently available. Various studies have shown that delivering psychological support through psychiatric clinical specialists may accentuate the results of IVF (In-vitro fertilization) and ART (Assisted Reproductive Technology). This review sheds light on the effects of infertility on quality of life and how it can be prevented or reduced through psychotherapy.   

The effect of male and female factor infertility on women's anxiety, depression, self-esteem, quality of life and sexual function parameters: a prospective, cross-sectional study from Turkey

OBJECTIVES

Despite the development of diagnosis and treatment methods, the psychological effects of infertility on women were not adequately addressed. This study investigated the effect of male and female factor infertility on women's anxiety, depression, self-esteem, quality of life, and sexual function parameters.

METHODS

In this prospective, cross-sectional study, 480 women [n = 234, with male factor infertility (MFI) (MFI group) and n = 246, with female factor infertility (FFI) (FFI group)], who could not conceive despite unprotected intercourse for 1 year, and 242 fertile healthy women (control group) who had children within the last 1 year were included. Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II), Rosenberg Self Esteem Scale (RSES), Fertility Quality of Life (FertiQol) and Female Sexual Function Index (FSFI) questionnaires were used for patients' evaluation.

RESULTS

RSES, BAI and BDI-II scores were significantly higher and FSFI score was significantly lower in the FFI group compared to other groups. RSES, BAI and BDI-II scores were also significantly higher and FSFI score was significantly lower in the MFI group compared to the control group. FertiQol total score was significantly lower in the FFI group compared to the MFI group. RSES score was positively correlated with BDI-II and BAI scores; however, it was negatively correlated with FertiQol and FSFI scores.

CONCLUSIONS

The negative psychological effects of infertility are ignored by many centres, especially in the treatment process of infertility. Regardless of the infertility factor (male or female), we believe that psychological support should be given to all women to improve their life quality.

Cohort profile: Anhui Maternal-Child Health Study in China

PURPOSE

The Anhui Maternal-Child Health Study (AMCHS) aims to examine determinants of reproduction, pregnancy and postpartum maternal and child health outcomes in Chinese women who received assisted reproductive technology (ART).

STUDY DESIGN AND PARTICIPANTS

AMCHS is an ongoing cohort study starting from May 2017. AMCHS recruits participants from all couples who sought ART treatment in the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China. The participants are interviewed to document baseline sociodemography, lifestyles, dietary intake and environmental exposure. Their clinical characteristics are obtained from hospital records. Samples of blood, follicular fluid and semen are collected at the clinic. Participants receive a standard long pituitary downregulation or a short protocol with an antagonist for the treatment. They are followed up from preconception to delivery, or discontinuation of ART treatment. Details of their children's health are documented through a questionnaire focusing on developmental status and anthropometry measurement.

FINDINGS TO DATE

Until April 2021, AMCHS had recruited 2042 couples in the study. 111 women withdrew from the study and 19 failed to retrieve oocytes. Among the 1475 confirmed pregnancies, 146 had miscarriages or terminated their pregnancies, 9 had stillbirths and 263 were ongoing pregnancies. The implantation failure increased with maternal age; adjusted OR was 1.43 (95% CI 1.16 to 1.77) in the age of 31-35 years, 1.97 (95% CI 1.46 to 2.66) in 35-39 years and 6.52 (95% CI 3.35 to 12.68) in ≥40 years compared with those aged 20-30 years. Among the 1057 couples with successful ART who were followed up for delivering babies, 576 had their children examined at age 30-42 days, 459 at 6 months and 375 at 12 months.

FUTURE PLANS

The AMCHS will identify comprehensive risk factors for poor ART outcomes and explore potential interaction effects of multiple factors including sociopsychological aspects of environmental exposure, dietary intake and genetics on maternal and child health.

Reprotoxic Impact of Environment, Diet, and Behavior

Reproductive health is progressively declining due to multiples endogenous and exogenous factors, such as environmental contaminants, diet and behavior. Accumulated evidences confirm that fertility and reproductive function have been adversely affected by exposure to chemical contaminants released in the environment. Today, the impact of diet and behavior on reproductive processes is also receiving special attention from the scientific community. Indeed, a close relationship between diet and fertility has been proven. Furthermore, a combination of unhealthy behavior, such as exposure to hazardous compounds and stress factors, poses living organisms at higher risk of reprotoxic effects. In particular, it has been described that poor life behaviors are associated with reduced male and female fertility due to decreased gamete quality and function. Most of the erroneous behaviors are, furthermore, a source of oxidative stress that, leading to epigenetic alterations, results in an impaired reproductive fitness. This review reports the detrimental impact of the most common environmental chemical stressors, diet, and behavior on reproductive functionality and success. Although clear evidences are still scarce, reassuring data are provided that a healthy diet and reverting unhealthy lifestyles may be of help to recover physiological reproductive conditions.

HYSTERICAL APNEA IN THE WORK OF GALEN (CA 129 - 199 AD): GENDER EQUITY IN THE HISTORY OF PSYCHOSOMATIC MEDICINE

OBJECTIVE

The aim: To presents clinical, epidemiological and pathophysiological aspects of the disease described by Galenos of Pergamon during the 2nd century AD and discusses its implications on contemporary discourse on gender equity and gender - based discrimination.

PATIENTS AND METHODS

Materials and methods: The authors searched original medical texts written in Greek language and attributed to Galenos for records related to hysterical apnea.

CONCLUSION

Conclusions: Galen attempted to interpret hysterical apnea by combining clinical and epidemiological observations with anatomical and functional lesions. His approach denounced the anatomically unsound notion of the wandering womb and availed the knowledge of his period in a rational manner. Investigating gender - related aspects of contemporary psychosomatic conditions related to fertility and pregnancy can help address gender - based discrimination in modern societies.

Couples undergoing Assisted Reproductive Techniques: An Actor-Partner Interdependence Model of dyadic adjustment, attachment, and body-image avoidance

The aim is to assess the commonalities and interdependence referred to body-image avoidance among 118 couples newly introduced to first-level assisted reproductive techniques. Results showed non-clinical functioning levels, and partners showed a correlated, yet low, dyadic adjustment. The couple-effect was modeled through an Actor Partner Interdependence Model. For both partners, dyadic adjustment’s actor-effect associates with body-image avoidance. Moreover, psychological symptoms’ actor-effect associate to body-image avoidance, resulting significantly more influential than the partner-effect. Only for males, alexithymia’s actor-effect was significant. To conclude, partners’ functioning is quite specular yet not interdependent, as they do not show a couple-as-a-unit modality of functioning. Clinical implications are discussed.