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Ozer G. Initial β-hCG levels and 2-day-later increase rates effectively predict pregnancy outcomes in single blastocyst transfer in frozen-thawed or fresh cycles: A retrospective cohort study. Medicine (Baltimore) 2023; 102:e35605. [PMID: 37861533 PMCID: PMC10589581 DOI: 10.1097/md.0000000000035605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 09/21/2023] [Indexed: 10/21/2023] Open
Abstract
To investigate whether the initial beta-human chorionic gonadotropin (β-hCG) levels and their rate of increase differ after single fresh and frozen blastocyst transfers, and whether these values effectively predict pregnancy outcomes. This retrospective cohort study was conducted at the Sisli Memorial Hospital, assisted reproductive technology, and Reproductive Genetics Center in Istanbul, Turkey, between January 2016 and January 2022. Three thousand two hundred thirty-eight single blastocyst transfers with positive pregnancy test results were evaluated. Of these, 738 were fresh transfer cycles and 2500 were frozen-thawed embryo transfer (FET) cycles. β-hCG test results from 9 days after fresh and FET cycles were compared between the groups with biochemical pregnancy, early pregnancy loss, and live birth outcomes. The threshold values were determined for each pregnancy outcome. The rate of increase between the first and second β-hCG tests performed 2 days apart was determined for each pregnancy outcome. Finally, the listed values were compared between the FET and fresh cycle. Mean baseline β-hCG levels were significantly higher in FET cycles than in fresh cycles, regardless of pregnancy outcomes (P < .005). Baseline β-hCG levels were higher in fresh cycles with live births (171.76 ± 109.64 IU/L) compared to biochemical and clinical pregnancy losses (50.37 ± 24.31 and 114.86 ± 72.42, respectively) (P < .001). Live births in FET cycles resulted in higher baseline β-hCG levels (193.57 ± 100.38 IU/L) compared to biochemical and clinical pregnancy loss groups (68.41 ± 51.85 and 149.29 ± 96.99 IU/L, respectively) (P < .001). The β-hCG threshold for live birth for fresh cycles was 116.5 IU/L (sensitivity 80%, specificity 70%, positive predictive value 90%, negative predictive value 54%) and 131.5 IU/L for FET cycles (sensitivity 71%, specificity 68%, positive predictive value 87%, negative predictive value 50%). The percentage of the area under the curve for single fresh blastocyst transfers was 0.81 and 0.76 for frozen transfers. The rate of increase in β-hCG was similar in fresh and FET cycles. Initial β-hCG levels and 2-day increases are effective parameters for diagnosing pregnancy in fresh and FET cycles. The initial β-hCG level was significantly higher in the FET cycles than in the fresh cycles. Predicting outcomes earlier helps clinicians to manage and follow high-risk pregnancies.
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Affiliation(s)
- Gonul Ozer
- Memorial Sisli Hospital, IVF and Reproductive Genetics Centre, Istanbul, Turkey
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2
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Wu L, Sun L, Wang J, Sun Y, Zhang X, Huang Y, Lu Y, Cao F. Psychological distress among women undergoing in vitro fertilization-embryo transfer: A cross-sectional and longitudinal network analysis. Front Psychol 2023; 13:1095365. [PMID: 36687877 PMCID: PMC9849569 DOI: 10.3389/fpsyg.2022.1095365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 12/12/2022] [Indexed: 01/07/2023] Open
Abstract
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.
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Affiliation(s)
- Liuliu Wu
- Department of Health Psychology, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Lijing Sun
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Juan Wang
- Department of Health Psychology, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Yaoyao Sun
- Institute of Mental Health, Peking University Sixth Hospital, Beijing, China
| | - Xuan Zhang
- Department of Health Psychology, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Yongqi Huang
- Department of Health Psychology, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Yan’e Lu
- Department of Health Psychology, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Fenglin Cao
- Department of Health Psychology, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China,*Correspondence: Fenglin Cao, ✉
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Bosch E, Hund M, van der Does R, Caracena L, Ahlers S, Labarta E. Early detection of pregnancy after IVF and embryo transfer with hyperglycosylated HCG versus Elecsys HCG+β assay. Reprod Biomed Online 2021:S1472-6483(21)00519-8. [PMID: 34924288 DOI: 10.1016/j.rbmo.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/29/2021] [Accepted: 10/11/2021] [Indexed: 11/22/2022]
Abstract
RESEARCH QUESTION Is measurement of hyperglycosylated HCG (hHCG) superior to beta-HCG (HCG+β) for early pregnancy detection after IVF and embryo transfer? DESIGN Blood samples were collected on day 4 (+1), 7 (+1) and 11 (+2) after embryo transfer from women aged 18-45 years undergoing first or second fresh or frozen IVF embryo transfer cycles. Biochemical pregnancy was assessed on-site by HCG determination on day 11; clinical pregnancy was assessed by ultrasound on day 21 (+4/-3). Serum hHCG (immunochemiluminometric assay) and HCG+β (Elecsys® HCG+β assay) concentrations were measured. Performance of hHCG and HCG+β for predicting pregnancy was evaluated and cut-offs selected. RESULTS In total, 155 women were enrolled and underwent IVF and embryo transfer. Area under the curve (AUC) (95% CI) on day 4 was not significantly different for hHCG (AUC 0.88; 95% CI 0.83 to 0.94) and HCG+β (AUC 0.90; 95% CI 0.84 to 0.95), as was predictive performance on day 7 and 11, with higher AUC estimates compared with day 4. Applying cut-offs derived according to Youden's index on day 4 (hHCG, 100 pg/ml; HCG+β, 1.30 mIU/ml), both biomarkers demonstrated high negative predictive values for ruling out pregnancy (hHCG, 83.8%; HCG+β, 82.8%) and high positive predictive values for ruling in pregnancy (hHCG, 89.0%; HCG+β, 84.9%) on day 21. Diagnostic performance improved from day 4 to day 11. CONCLUSIONS Predictive performance for early pregnancy post-IVF embryo transfer of day-5 blastocysts was not significantly different for hHCG and HCG+β; hHCG superiority over HCG+β was not shown.
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Kirca N, Ongen M. Perceived stress and sleep quality before oocyte pick-up, embryo transfer, and pregnancy test in women receiving in vitro fertilization treatment. Sleep Breath 2021; 25:1977-1985. [PMID: 33624218 DOI: 10.1007/s11325-021-02328-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/05/2021] [Accepted: 02/12/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Infertility is a major health problem that affects both the family and the community. Women receiving infertility treatment may suffer from stress and even experience sleep disturbance. Sleep quality is an important factor of human health and well-being. Sleep disturbances tend to occur among infertile women during in vitro fertilization treatment. Many studies have focused on the stress and sleep quality associated with their treatment in infertile women. However, few studies have investigated factors linked to their sleep disturbances. OBJECTIVE This study investigated the relationship between perceived stress and sleep quality before oocyte pick-up, in vitro fertilization-embryo transfer, and pregnancy test in women receiving in vitro fertilization treatment. MATERIAL AND METHODS This prospective, longitudinal study was conducted between January and May 2020. One hundred fifty-seven women receiving infertility treatment were included in the study. A personal information form, the Perceived Stress Scale (PSS), and the Pittsburgh Sleep Quality Index (PSQI) were used to collect data. RESULTS The relationship between the Perceived Stress Scale scores and the Pittsburgh Sleep Quality Index scores in all stages of infertility treatment was found to be positively significant at the p < .001 significance level. CONCLUSION Perceived stress level was high in women throughout the infertility treatment. Our study suggested that sleep quality was impaired as stress increased. TRIAL REGISTRATION 70904504/38.
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Affiliation(s)
- Nurcan Kirca
- Department of Obstetrics & Gynecological Nursing, Faculty of Nursing, Akdeniz University, Dumlupinar Boulevard, Antalya, Turkey.
| | - Meryem Ongen
- Department of Obstetrics & Gynecological Nursing, Faculty of Nursing, Akdeniz University, Dumlupinar Boulevard, Antalya, Turkey
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Cao LB, Hao Q, Liu Y, Sun Q, Wu B, Chen L, Yan L. Anxiety Level During the Second Localized COVID-19 Pandemic Among Quarantined Infertile Women: A Cross-Sectional Survey in China. Front Psychiatry 2021; 12:647483. [PMID: 34366908 PMCID: PMC8339465 DOI: 10.3389/fpsyt.2021.647483] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 06/28/2021] [Indexed: 11/29/2022] Open
Abstract
Infertility usually causes mental health problems for patients and unfavorable emotions such as anxiety and depression can have an adverse effect on women's normal pregnancy. We aimed to compare the anxiety level between infertile female patients in quarantined and non-quarantined areas during the second wave of COVID-19 epidemic. A total of 759 infertile women were included in this cross-sectional study conducted through an online survey. Anxiety was measured by the State-Trait Anxiety Inventory (STAI) tool. Participants were divided into the quarantined group (QG) and non-quarantined group (Non-QG). Independent sample T-test and chi-square test were performed to examine the difference between the two groups. There was no significant difference in the average STAI score of the two groups of infertile women, but responses to the emotional state showed that women in the QG had a higher tendency to be anxious. Participants in QG spent more time paying attention to the dynamics of the epidemic every day, and their sleep (p < 0.01) and mood conditions were worse (p < 0.01) than in the Non-QG. The family relationship of QG is more tense than non-QG. Through the research on the infertility treatment information of the overall research population, it is found the average STAI-State (STAI-S) (p = 0.031) score and STAI-Trait (STAI-T) (p = 0.005) score of women who were infertile for more than 3 years were significantly higher than those of women with <2 years. The STAI-T score of infertile women who underwent in vitro fertilization (IVF) was higher than that of non-IVF women (p = 0.007), but no significant difference was observed with the STAI-S score. To conclude, although the second wave of quarantine during COVID-19 epidemic did not significantly increase anxiety in infertile women, it did lead to an increase in other negative emotions and worse family relationships. Patients with long-term infertility treatment and those who have had IVF are more anxious subgroups.
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Affiliation(s)
- Lian-Bao Cao
- School of Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qianjie Hao
- Department of Obstetrics and Gynecology, The Eighth People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Yan Liu
- Department of Obstetrics and Gynecology, The Eighth People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Qiang Sun
- Department of Obstetrics and Gynecology, Zaozhuang Municipal Hospital, Zhaozhuang, China
| | - Bing Wu
- Department of Obstetrics and Gynecology, The Eighth People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Lili Chen
- Department of Obstetrics and Gynecology, The Eighth People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Lei Yan
- School of Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Obstetrics and Gynecology, The Eighth People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
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Gabnai-Nagy E, Bugán A, Bodnár B, Papp G, Nagy BE. Association between Emotional State Changes in Infertile Couples and Outcome of Fertility Treatment. Geburtshilfe Frauenheilkd 2020; 80:200-210. [PMID: 32109972 PMCID: PMC7035132 DOI: 10.1055/a-0854-5987] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 12/14/2018] [Accepted: 02/10/2019] [Indexed: 11/26/2022] Open
Abstract
Aims Infertility and its treatment are associated with considerable psychological distress for infertile couples. The aim of our study was to explore to what extent positive and negative affectivity and a predisposition to depression and anxiety appear in infertile couples during in vitro fertilization (IVF) treatment. We also aimed to explore how the emotional state of couples changed during IVF in relation to treatment outcomes. Method In our longitudinal study, 174 people (87 couples) were followed up during treatment by means of questionnaires. Their emotional state was assessed with PANAS, BDI-R, and STAI at the beginning of treatment, before embryo transfer, and before taking a pregnancy test. Couples who achieved pregnancy after treatment were included in the successful group (n = 82), while those who did not were included in the unsuccessful group (n = 92). Results We found more favorable emotional states in IVF couples compared to patient populations and the average population. In successful IVF couples, positive affectivity decreased, and negative affectivity increased in women until the time of embryo transfer. This was accompanied by an increase in positive affectivity in men, which remained until the time of the pregnancy test and provided emotional support to their partner. These results were confirmed by changes in the levels of depression. Conclusion Our study suggests the importance of couples' emotional dynamics for having a child and an association between couples' emotional reactions during IVF cycles and treatment success.
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Affiliation(s)
- Erika Gabnai-Nagy
- Institute of Behavioural Sciences, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Antal Bugán
- Institute of Behavioural Sciences, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Béla Bodnár
- Assisted Reproduction Center, Clinical Centre, University of Debrecen, Debrecen, Hungary
| | - Gábor Papp
- Institute of Psychology, Faculty of Humanities, University of Debrecen, Debrecen, Hungary
| | - Beáta Erika Nagy
- Department of Pediatrics, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Aisenberg Romano G, Fried Zaig I, Halevy A, Azem F, Amit A, Bloch M. Prophylactic SSRI treatment for women suffering from mood and anxiety symptoms undergoing in vitro fertilization-a prospective placebo-controlled study. Arch Womens Ment Health 2019; 22:503-510. [PMID: 30225529 DOI: 10.1007/s00737-018-0911-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 09/07/2018] [Indexed: 11/29/2022]
Abstract
To explore the mood protective effect of prophylactic SSRI treatment on women undergoing IVF suffering from moderate affective and anxiety symptoms. In a randomized double blind, placebo-controlled, parallel design study, 41 women diagnosed with an Adjustment Disorder, who were undergoing IVF treatments, were randomized into two groups; a study group (n = 22) administered escitalopram 10 mg/day, and a control group (n = 19) administered placebo for a total of 8 weeks before and during the IVF treatment cycle. Patients were assessed at the onset of drug treatment and at embryo transfer. The main outcome measure was the difference in mean score severity rating of depression and anxiety symptoms on the CES-D and Zung questionnaires between groups at the time of embryo transfer. Secondary outcome measures included the MHI rating subscales addressing aspects of psychological distress and coping. At the day of embryo transfer (6 weeks of drug treatment), the CES-D average score for the treatment group was 6.40 (6.71) and 27.47 (4.29) on the Zung Self-Rating Anxiety Scale, while the placebo group scored an average of 15.83 (8.69) and 33.17 (6.95) receptively. These findings were significant (p = .004, p = .015 receptively) and were endorsed by the scoring on the MHI questionnaire subscales. Short-term treatment with SSRI may serve as a prophylactic treatment against the perpetuation and possible worsening of depressive and anxiety symptoms in women undergoing IVF treatments. Further studies concerning pharmacological interventions in larger samples and studies addressing screening for psychological stress indicators in this population are warranted.
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Affiliation(s)
- Gabi Aisenberg Romano
- Department of Psychiatry, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel.
| | - Inbar Fried Zaig
- Department of Psychiatry, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel
| | - Anat Halevy
- Department of Psychiatry, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel
| | - Foad Azem
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel.,IVF Unit, Lis Women's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel
| | - Ami Amit
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel.,IVF Unit, Lis Women's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel
| | - Miki Bloch
- Department of Psychiatry, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
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Ginsburg ES, Jellerette-Nolan T, Daftary G, Du Y, Silverberg KM. Patient experience in a randomized trial of a weekly progesterone vaginal ring versus a daily progesterone gel for luteal support after in vitro fertilization. Fertil Steril 2019; 110:1101-1108.e3. [PMID: 30396554 DOI: 10.1016/j.fertnstert.2018.07.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 06/30/2018] [Accepted: 07/12/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To assess patient experience and convenience of using progesterone vaginal ring (VR) versus vaginal gel for women requiring luteal phase support during in vitro fertilization (IVF). DESIGN Post hoc analysis of a prospective, randomized, single-blind, multicenter, phase 3 clinical trial. SETTING Twenty-two U.S. IVF centers. PATIENT(S) Women undergoing IVF (N = 1,297). INTERVENTION(S) Randomization to weekly VR or daily gel the day after egg retrieval for up to 10 weeks, with fresh embryo transfer IVF per site-specific procedures. MAIN OUTCOME MEASURE(S) Patient satisfaction questionnaire completed at final study visit. RESULT(S) In the women who were taking ≥1 dose of either VR (n = 647) or gel (n = 650), >97% reported that learning to use the formulation, remembering to take it at the correct time, and using it as prescribed was "easy" or "somewhat easy." More VR than gel users reported noninterference with daily activity (93.3% vs. 74.7%, P<.001), sexual comfort (80.3% vs. 67.8%, P<.001), and sexual desire (73.8% vs. 61.8%, P<.001), as well as not being bothered during sexual intercourse (66.9% vs. 39.2%, P<.001). More gel than VR users reported no difficulty with application (97.4% vs. 80.9%, P<.001). Among women who had previously used progesterone during IVF, more VR users than gel users preferred their currently assigned treatment to their previous treatment (91.4% vs. 83.0%, P=.03). CONCLUSION(S) Weekly progesterone VR and daily progesterone gel were easy to use, with limited impact on quality of life. Overall, the VR appeared to interfere less with daily life, social activities, and sexual activity although the gel was less difficult or stressful to apply. CLINICAL TRIAL REGISTRATION NUMBER NCT00615251.
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Affiliation(s)
- Elizabeth S Ginsburg
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts.
| | | | | | - Yunling Du
- Ferring International Pharmascience Center US, Parsippany, New Jersey
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Awtani M, Kapoor GK, Kaur P, Saha J, Crasta D, Banker M. Anxiety and Stress at Different Stages of Treatment in Women Undergoing In vitro Fertilization-Intracytoplasmic Sperm Injection. J Hum Reprod Sci 2019; 12:47-52. [PMID: 31007467 PMCID: PMC6472199 DOI: 10.4103/jhrs.jhrs_23_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Aim: The aim of the present study is to evaluate the state anxiety (the present state of mind), trait anxiety (general anxiety), as well as perceived stress in women undergoing in vitro fertilization (IVF) treatment at three stages: T1 (on the day of start of stimulation), T2 (on the day of embryo transfer), and T3 (10 days after embryo transfer). The data at T3 level were collected telephonically. Methodology: The present study was carried out on 137 women undergoing IVF intracytoplasmic sperm injection cycle at four different clinics of four cities from October to April 2016. State-trait anxiety inventory (Spielberger) and perceived stress scale (Okun, et al.) were used as the tools. Statistical Analysis: The analysis was done at two levels; descriptive and inferential (analysis of variance [ANOVA], Student's t-test, Levene's test) using SPSS v16. Results: The state anxiety was higher at all the three levels than trait anxiety. The overt anxiety was highest at T3 level (mean = 45.77) followed by T1 level (mean = 44.23) and T2 level (mean = 43.04). Perceived stress was elevated at T1 level (mean = 17.93) followed by T3 level (mean = 17.28) and T2 level (mean = 16.72). The results of ANOVA showed a significant difference in anxiety among all the three levels (P = 0.036), but no significant difference was found for perceived stress (P = 0.169). t-test revealed that there was a significant difference between state and trait anxiety at T1, T2, and T3 levels (P = 0.01, P = 0.21, P = 0.00, respectively). A significant difference was only seen between the T1 and T2 levels in perceived stress (P = 0.052). In state anxiety, a significant difference was observed only between T2 and T3 levels (P = 0.23). Conclusion: It was observed that anxiety and stress are present in women throughout the treatment. The waiting period (T3) is the most anxious for them and their level of state anxiety is higher compared to their trait anxiety. Perceived stress is observed to be more on the day of start of stimulation followed by the waiting period.
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Affiliation(s)
- Manisha Awtani
- Counselor, Nova IVI Fertility, Ahmedabad, Gujarat, India
| | | | - Parveen Kaur
- Counselor, Nova IVI Fertility, Jalandhar, Punjab, India
| | - Jayeeta Saha
- Counselor, Nova IVI Fertility, Kolkata, West Bengal, India
| | - Diana Crasta
- Chief Counselor, Nova IVI Fertility, Bengaluru, Karnataka, India
| | - Manish Banker
- Senior Consultant, Nova IVI Fertility, Ahmedabad, Gujarat, India
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Cheung CWC, Saravelos SH, Chan TYA, Sahota DS, Wang CC, Chung PW, Li TC. A prospective observational study on the stress levels at the time of embryo transfer and pregnancy testing following in vitro fertilisation treatment: a comparison between women with different treatment outcomes. BJOG 2018; 126:271-279. [DOI: 10.1111/1471-0528.15434] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2018] [Indexed: 11/28/2022]
Affiliation(s)
- CWC Cheung
- Assisted Reproductive Technology Unit Department of Obstetrics and Gynaecology Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
| | - SH Saravelos
- Assisted Reproductive Technology Unit Department of Obstetrics and Gynaecology Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
| | - TYA Chan
- Department of Psychology The Chinese University of Hong Kong Hong Kong China
| | - DS Sahota
- Assisted Reproductive Technology Unit Department of Obstetrics and Gynaecology Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
| | - CC Wang
- Assisted Reproductive Technology Unit Department of Obstetrics and Gynaecology Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
| | - PW Chung
- Assisted Reproductive Technology Unit Department of Obstetrics and Gynaecology Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
| | - TC Li
- Assisted Reproductive Technology Unit Department of Obstetrics and Gynaecology Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
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Blanchet C, Lavallée É, Babineau V, Ruchat SM. Do Physical Activity Behaviours Influence the Success of Assisted Reproductive Technology? A Systematic Review of the Literature. Journal of Obstetrics and Gynaecology Canada 2018; 40:342-350. [DOI: 10.1016/j.jogc.2017.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 07/01/2017] [Accepted: 07/04/2017] [Indexed: 11/25/2022]
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Ying L, Wu X, Wu LH, Shu J, Loke AY. A Partnership and Coping Enhancement Program for Couples Undergoing In Vitro Fertilization Treatment: An Intervention Study. J Sex Marital Ther 2018; 44:533-551. [PMID: 29297779 DOI: 10.1080/0092623x.2017.1420716] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This is a feasibility study to examine the effects of a partnership and coping enhancement program (PCEP) on improving the psychological well-being and marital functions of couples undergoing in vitro fertilization treatment. A total of 100 couples were recruited consecutively and assigned to a PCEP intervention group or a routine care control group. The couples in the PCEP group received an additional face-to-face, couple-based, 90-minute session on enhancing partnership and coping on the day of the embryo transfer (ET). The outcome measures were assessed at baseline (T0), 10 days after the ET (T1), and one month after the ET (T2). The level of anxiety of the women was lower in the intervention than in the control group at T1. Significant improvements in partnership and dyadic coping were seen in women at T2. The men of infertile couples reported a significant improvement in the scores for partnership at T2. The PCEP had no significant effects on marital satisfaction and marital adjustment for both the females and males of the infertile couples. The findings indicated that the PCEP is feasible and acceptable. Before a larger simple-size randomized controlled trial with participants drawn from multiple reproductive medical centers is conducted to further confirm its effectiveness.
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Affiliation(s)
- Liying Ying
- a School of Nursing , Zhejiang Chinese Medical University , Hangzhou , Zhejiang , China
- b School of Nursing , The Hong Kong Polytechnic University , Hong Kong , China
| | - Xiangli Wu
- c Department of Reproductive Endocrinology , Zhejiang Provincial People's Hospital , Hangzhou , Zhejiang , China
| | - Lai Har Wu
- b School of Nursing , The Hong Kong Polytechnic University , Hong Kong , China
| | - Jing Shu
- c Department of Reproductive Endocrinology , Zhejiang Provincial People's Hospital , Hangzhou , Zhejiang , China
| | - Alice Yuen Loke
- b School of Nursing , The Hong Kong Polytechnic University , Hong Kong , China
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Maleki-Saghooni N, Amirian M, Sadeghi R, Latifnejad Roudsari R. Effectiveness of infertility counseling on pregnancy rate in infertile patients undergoing assisted reproductive technologies: A systematic review and meta-analysis. Int J Reprod Biomed 2017. [DOI: 10.29252/ijrm.15.7.391] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Maleki-Saghooni N, Amirian M, Sadeghi R, Latifnejad Roudsari R. Effectiveness of infertility counseling on pregnancy rate in infertile patients undergoing assisted reproductive technologies: A systematic review and meta-analysis. Int J Reprod Biomed 2017; 15:391-402. [PMID: 29177241 PMCID: PMC5601930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Psychological interventions such as counseling for infertile patients seem to increase pregnancy rate. OBJECTIVE The aim of this systematic review and meta-analysis was to examine if counseling improves pregnancy rate among infertile patients. Thus, randomized controlled trials investigating the effect of counseling on pregnancy rate in infertile patients undergoing ART were pooled in a meta-analysis. MATERIALS AND METHODS The databases of PubMed, Scopus, Cochrane, Google Scholar, and Persian databases including SID, Iran Medex, and Magiran were searched from 1997 to July 2016 to identify relevant articles. Included studies were trials on infertile patients (women or couples) receiving counseling independent of actual medical treatment. The outcome measure was pregnancy rate. Out of 620 relevant published trials, a total of nine RCTs were ultimately reviewed systematically and included in a meta-analysis to measure the efficacy of counseling on pregnancy rate. Odds ratio and Risk difference were calculated for pregnancy rate. All statistical analyses were done by Comprehensive Meta-analysis Version 2. RESULTS Nine RCTs involving 1079 infertile women/couples were included in the study. The findings from RCTs indicated significant effect of counseling on pregnancy rate so that there was a positive impact of counseling on pregnancy rate (OR= 3.852; 95% CI: 2.492-5.956; p=0.00) and (RD= 0.282; 95%; CI: 0.208-0.355; p=0.00). CONCLUSION Counseling was found to improve patients' chances of becoming pregnant. So counseling represents an attractive treatment option, in particular, for infertile patients who are not receiving medical treatments.
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Affiliation(s)
- Nahid Maleki-Saghooni
- Student Research Committee, Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Malihe Amirian
- Department of Obstetrics and Gynecology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Ramin Sadeghi
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Robab Latifnejad Roudsari
- Evidence-Based Care Research Center, Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.
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Durgun Ozan Y, Okumuş H. Effects of Nursing Care Based on Watson's Theory of Human Caring on Anxiety, Distress, And Coping, When Infertility Treatment Fails: A Randomized Controlled Trial. J Caring Sci 2017; 6:95-109. [PMID: 28680864 PMCID: PMC5488674 DOI: 10.15171/jcs.2017.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 05/05/2017] [Indexed: 11/29/2022] Open
Abstract
Introduction: The failure of infertility treatment leads to
individual, familial, and social problems. The objective of this study was to evaluate the
effectiveness of the nursing care program based on Watson’s "Theory of Human Caring" on
anxiety and distress caused by coping when the treatment fails. Methods: This study randomized controlled trial study was
conducted from April to November 2012, with 86 Turkish women with infertility
(intervention group: 45, control group: 41). Follow-up of 32 infertile women, who failed
infertility treatment from intervention group, and 35 infertile women, who failed
infertility treatment from control group, continued for another four weeks. Data were
collected through Spiel Berger’s State/Trait Anxiety Inventory, Distress Scale, and Ways
of Coping Questionnaire. The analyses of data were conducted using SPSS ver 13. Results: The intervention and control groups significantly
differed in terms of anxiety, distress, and coping levels. The intervention group’s mean
anxiety score decreased by thirteen points and distress by fourteen points (in a positive
direction). The intervention group’s mean positive coping style score increased. Whereas a
negative increase was observed in the control group’s values depending on the failure of
the treatment. Conclusion: Watson’s theory of human caring is recommended
as a guide to nursing patients with infertility treatment to decrease levels of anxiety
and distress, and to increase the positive coping style among infertile women.
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Affiliation(s)
- Yeter Durgun Ozan
- Department of Nursing, Faculty of Health Nursing, Dicle University, Diyarbakır, Turkey
| | - Hülya Okumuş
- Department of Nursing, Faculty of Nursing, Dokuz Eylül University, Diyarbakır, Turkey
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Kahyaoğlu İ, Demir B, Ertürk Aksakal S, Kaplanoğlu İ, Mollamahmutoğlu L. Value of Post-transfer Day-12 Beta Human Chorionic Gonadotropin Levels for Pregnancy Outcome Prediction of Intracytoplasmic Sperm Injection Cycles. Balkan Med J 2017; 34:450-457. [PMID: 28443593 PMCID: PMC5635633 DOI: 10.4274/balkanmedj.2016.1769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Several markers were studied previously in order to predict the pregnancy outcome of assisted reproductive techniques; however, serum beta human chorionic gonadotropin was found to be the most predictive marker. AIMS To evaluate the value of serum beta human chorionic gonadotropin levels in discriminating biochemical and clinical pregnancies 12 days after embryo transfer, while determining the factors predicting ongoing pregnancy was established as the secondary aim. STUDY DESIGN Retrospective cross-sectional study. METHODS A total of 445 pregnant cycles were retrospectively analysed in 2359 embryo transfer cycles. Patients were divided into two groups according to the outcome of pregnancy: biochemical and clinical. RESULTS The cut-off value of beta human chorionic gonadotropin levels on day 12 in predicting clinical pregnancies was 86.8 IU/mL with 65.1% sensitivity and 74.7% specificity [CI: 0.76 (0.71-0.81). Receiver operating characteristic curve analysis revealed different cut-off values for embryo transfer days (57 mIU/mL for day 3 embryo transfer CI: 0.59-0.79 and 87 mIU/mL for day 5 embryo transfer, CI: 0.74-0.86). Subgroup analysis of clinical pregnancies revealed a significant difference between ongoing pregnancies and early fetal losses regarding duration of infertility (81.3±54.4 vs. 100.2±62.2 months), serum oestradiol on hCG day (2667.4±1276.4 vs. 2094.6±1260.5 pg/mL), number of transferred embryos (1.9±0.8 vs. 1.5±0.7) and the prevalence of diminished ovarian reserve as an indication (2.3% vs 12.2%). CONCLUSION Beta human chorionic gonadotropin levels on day 12 following embryo transfer provide an important parameter for the prediction of clinical pregnancy; however, other stimulation parameters are indicated in the prediction of ongoing pregnancies.
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Affiliation(s)
- İnci Kahyaoğlu
- Department of Obstetrics and Gynecology, University of Health Sciences, Ankara Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey
| | - Berfu Demir
- Department of Obstetrics and Gynecology, University of Health Sciences, Ankara Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey
| | - Sezin Ertürk Aksakal
- Department of Obstetrics and Gynecology, University of Health Sciences, Ankara Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey
| | - İskender Kaplanoğlu
- Center of Assisted Reproduction, University of Health Sciences, Ankara Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey
| | - Leyla Mollamahmutoğlu
- Department of Obstetrics and Gynecology, University of Health Sciences, Ankara Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey
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Chen X, Huang Y, Guo PP, Ye DS, Xu LJ, Chen SL. The association between serum β-hCG on day 24 of pregnancy and ongoing pregnancy in frozen embryo transfer cycles. Int J Gynaecol Obstet 2016; 134:278-81. [DOI: 10.1016/j.ijgo.2016.02.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 02/12/2016] [Accepted: 05/23/2016] [Indexed: 11/26/2022]
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Forte M, Faustini F, Maggiulli R, Scarica C, Romano S, Ottolini C, Farcomeni A, Palagiano A, Capalbo A, Ubaldi FM, Rienzi L. Electronic witness system in IVF-patients perspective. J Assist Reprod Genet 2016; 33:1215-22. [PMID: 27387889 DOI: 10.1007/s10815-016-0759-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 06/15/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The objective of this study is to evaluate patient concerns about in vitro fertilization (IVF) errors and electronic witness systems (EWS) satisfaction. DESIGN The design of this study is a prospective single-center cohort study. SETTING The setting of this study was located in the private IVF center. PATIENT(S) Four hundred eight infertile patients attending an IVF cycle at a GENERA center in Italy were equipped with an EWS. INTERVENTION(S) Although generally recognized as a very rare event in IVF, biological sample mix-up has been reported in the literature. For this reason, some IVF laboratories have introduced EWS with the aim to further reduce the risk of error during biological samples handling. Participating patients received a questionnaire developed through a Likert scale ranging from 1 to 6. MAIN OUTCOMES MEASURE(S) Patient concerns about sample mix-up without and with an EWS were assessed. RESULT(S) 90.4 % of patients expressed significant concerns relating to sample mix-up. The EWS reduced these concerns in 92.1 % of patients, 97.1 % of which were particularly satisfied with the electronic traceability of their gametes and embryos in the IVF laboratory. 97.1 % of patients felt highly comfortable with an IVF center equipped with an EWS. Female patients had a significantly higher appreciation of the EWS when compared to their male partners (p = 0.029). A significant mix-up event occurred in an Italian hospital during the study and patient's satisfaction increased significantly towards the use of the EWS after the event (p = 0.032). CONCLUSION(S) EWS, by sensibly reducing the risk for sample mix-up in IVF cycles, has been proved to be a trusted strategy from patient's perspective.
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Affiliation(s)
- Marina Forte
- G.ENE.R.A. Centre for Reproductive Medicine, Clinica Valle Giulia, Via G. De Notaris 2b, 00197, Rome, Italy
| | - Federica Faustini
- G.ENE.R.A. Centre for Reproductive Medicine, Clinica Valle Giulia, Via G. De Notaris 2b, 00197, Rome, Italy
| | - Roberta Maggiulli
- G.ENE.R.A. Centre for Reproductive Medicine, Clinica Valle Giulia, Via G. De Notaris 2b, 00197, Rome, Italy
| | - Catello Scarica
- G.ENE.R.A. Centre for Reproductive Medicine, Clinica Valle Giulia, Via G. De Notaris 2b, 00197, Rome, Italy.,The Bridge Centre, London, UK
| | - Stefania Romano
- G.ENE.R.A. Centre for Reproductive Medicine, Clinica Valle Giulia, Via G. De Notaris 2b, 00197, Rome, Italy
| | | | - Alessio Farcomeni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | | | - Antonio Capalbo
- G.ENE.R.A. Centre for Reproductive Medicine, Clinica Valle Giulia, Via G. De Notaris 2b, 00197, Rome, Italy.,GENETYX, Molecular Genetics Laboratory, E.Fermi, 1 36063 Marostica, Vicenza, Italy
| | - Filippo Maria Ubaldi
- G.ENE.R.A. Centre for Reproductive Medicine, Clinica Valle Giulia, Via G. De Notaris 2b, 00197, Rome, Italy
| | - Laura Rienzi
- G.ENE.R.A. Centre for Reproductive Medicine, Clinica Valle Giulia, Via G. De Notaris 2b, 00197, Rome, Italy.
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Cunha M, Galhardo A, Pinto-Gouveia J. Experiential avoidance, self-compassion, self-judgment and coping styles in infertility. Sex Reprod Healthc 2016; 10:41-47. [PMID: 27938872 DOI: 10.1016/j.srhc.2016.04.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 03/23/2016] [Accepted: 04/05/2016] [Indexed: 01/07/2023]
Abstract
OBJECTIVES This study sought out to explore the existence of differences regarding emotion regulation processes (psychological inflexibility/experiential avoidance, self-judgment and self-compassion) and coping styles (emotional/detached, avoidant and rational) in three different groups of couples: 120 fertile couples (FG), 147 couples with an infertility diagnosis who were pursuing medical treatment for their fertility problem(s) (IG), and 59 couples with infertility applying for adoption (AG). STUDY DESIGN Cross-sectional survey, using the couple as unit of analysis. MAIN OUTCOME MEASURES Participants filled in paper-pencil questionnaires assessing coping styles, psychological inflexibility/experiential avoidance, self-judgment and self-compassion. RESULTS IG couples, and particularly women, tend to use more experiential avoidance and self-judgment mechanisms and less emotional/detached coping style. When compared to FG couples, IG and AG couples tend to apply more avoidant coping strategies. AG couples showed higher self-compassion. CONCLUSIONS Findings suggest that emotion regulation processes may be an important target in psychological interventions for patients dealing with infertility and with the demands of medical treatment.
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Affiliation(s)
- Marina Cunha
- Instituto Superior Miguel Torga, Largo da Cruz de Celas, n°1, 3000-132 Coimbra, Portugal; CINEICC, Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, 3001-802 Coimbra, Portugal
| | - Ana Galhardo
- Instituto Superior Miguel Torga, Largo da Cruz de Celas, n°1, 3000-132 Coimbra, Portugal; CINEICC, Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, 3001-802 Coimbra, Portugal.
| | - José Pinto-Gouveia
- CINEICC, Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, 3001-802 Coimbra, Portugal
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Craciunas L, Tsampras N. Bed rest following embryo transfer might negatively affect the outcome of IVF/ICSI: a systematic review and meta-analysis. HUM FERTIL 2016; 19:16-22. [DOI: 10.3109/14647273.2016.1148272] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ying L, Wu LH, Loke AY. The effects of psychosocial interventions on the mental health, pregnancy rates, and marital function of infertile couples undergoing in vitro fertilization: a systematic review. J Assist Reprod Genet 2016; 33:689-701. [PMID: 26979745 DOI: 10.1007/s10815-016-0690-8] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 03/01/2016] [Indexed: 10/22/2022] Open
Abstract
PURPOSE The purpose of this study was to examine the effects of psychosocial interventions on the mental health, pregnancy rates, and marital function of infertile couples undergoing in vitro fertilization (IVF), as determined through RCT studies. METHODS Using the electronic databases PubMed, EMBase, Cochrane Library, CINAHL, PsycInfo, and CAJ, a systematic literature search was conducted in July 2015. MeSH terms, key words, and free words such as "infertility," "fertilization in vitro," "psychotherapy," "intervention," "anxiety," "depression," and "marital satisfaction" were used to identify all potential studies. The quality of the studies that were included was assessed using the risk of bias assessment tool developed by the Cochrane Back Review Group. Descriptive analysis was adopted to synthesize the results. RESULTS A total of 20 randomized controlled trials were included in this review. There were reports of positive effects on the anxiety levels, pregnancy rates, or marital function of infertile couples in six studies that adopted different psychosocial approaches, including mind body intervention (Eastern body-mind-spirit, Integrative body-mind-spirit, and Mind/body intervention), cognitive behavioral therapy, group psychotherapy, and harp therapy. However, there were methodological or practical issues related to measurement points and attrition rates in these studies. None of these interventions were found to be efficacious in relieving the depression or stress of individuals or couples undergoing IVF treatment. None of the included studies tackled or measured the mental health status of the couples during the most stressful time of waiting for the pregnancy results of their treatment. CONCLUSIONS A complex intervention, based on sound evidence, should be developed targeting both females and males of infertile couples undergoing IVF treatment, particularly during the stressful period of waiting for the results of the pregnancy test result and after failed cycles.
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Ying L, Wu LH, Loke AY. Gender differences in emotional reactions to in vitro fertilization treatment: a systematic review. J Assist Reprod Genet 2016; 33:167-79. [PMID: 26712577 PMCID: PMC4759000 DOI: 10.1007/s10815-015-0638-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 12/10/2015] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The purposes of this paper are to provide a comprehensive picture of men and women's emotional reactions to infertility treatment, specifically In Vitro Fertilization (IVF) pursued by heterosexual couples, and to identify any differences between the genders. METHODS Nonexperimental studies exploring the psychological effects of IVF treatment on infertile couples were included. Six electronic databases were used to conduct a systematic search from the years 2000 to 2014. The references of the articles selected for review and other related systematic reviews were also screened to retrieve additional relevant articles. The quality of the included studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. Descriptive analysis was adopted to synthesize the results. RESULTS A total of 22 quantitative and 4 qualitative studies were identified and included in this review. Although both men and women experienced psychological distress during the treatment, gender differences existed. Women had elevated anxiety and depression levels prior to the treatment, which became even higher on the day of the oocyte retrieval, pre- and post embryo transfer, and during the waiting period before the pregnancy test. Men of the infertile couples reported elevated depression scores before treatment, which usually increased during the time spent waiting for the outcome of the IVF treatment. Both men and women had lower scores on positive affect before the pregnancy test. A failed IVF cycle had long-term negative psychological consequences for both spouses. CONCLUSIONS The results of this review pointed to the need for a couple-based support program, aimed at improving the psychological well-being of couples.
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Affiliation(s)
- Liying Ying
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China.
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
| | - Lai Har Wu
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China.
| | - Alice Yuen Loke
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China.
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Galhardo A, Moura-Ramos M, Cunha M, Pinto-Gouveia J. The infertility trap: how defeat and entrapment affect depressive symptoms. Hum Reprod 2015; 31:419-26. [DOI: 10.1093/humrep/dev311] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 11/20/2015] [Indexed: 11/14/2022] Open
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Oron G, Allnutt E, Lackman T, Sokal-Arnon T, Holzer H, Takefman J. A prospective study using Hatha Yoga for stress reduction among women waiting for IVF treatment. Reprod Biomed Online 2015; 30:542-8. [PMID: 25779021 DOI: 10.1016/j.rbmo.2015.01.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 01/17/2015] [Accepted: 01/20/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Galia Oron
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec H3A 1A1, Canada.
| | - Erica Allnutt
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec H3A 1A1, Canada
| | - Tasha Lackman
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec H3A 1A1, Canada
| | - Tamar Sokal-Arnon
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec H3A 1A1, Canada
| | - Hananel Holzer
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec H3A 1A1, Canada
| | - Janet Takefman
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec H3A 1A1, Canada.
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Ockhuijsen H, van den Hoogen A, Eijkemans M, Macklon N, Boivin J. Clarifying the benefits of the positive reappraisal coping intervention for women waiting for the outcome of IVF. Hum Reprod 2014; 29:2712-8. [DOI: 10.1093/humrep/deu253] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ockhuijsen H, van den Hoogen A, Eijkemans M, Macklon N, Boivin J. The impact of a self-administered coping intervention on emotional well-being in women awaiting the outcome of IVF treatment: a randomized controlled trial. Hum Reprod 2014; 29:1459-70. [PMID: 24812317 DOI: 10.1093/humrep/deu093] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION What is the effect of the positive reappraisal coping intervention (PRCI) on anxiety in women awaiting the outcome of an IVF/ICSI cycle? SUMMARY ANSWER Women reported significantly more anxiety during the waiting period than before treatment, but the use of the PRCI did not significantly reduce anxiety during the waiting period. WHAT IS KNOWN ALREADY Waiting for the outcome of IVF/ICSI treatment after embryo transfer is one of the most stressful periods of fertility treatments. At present, no evidence-based coping interventions are available to assist women though this waiting period. The PRCI has been designed to address this unmet need by promoting positive reappraisal coping. STUDY DESIGN, SIZE, DURATION A three-armed randomized controlled trail (RCT) was designed to evaluate the PRCI in women undergoing IVF/ICSI. Data were collected between October 2010 and June 2012. A total of 377 participants were randomized to receive either the PRCI and emotional monitoring, emotional monitoring only, or routine care. Only the PRCI-monitoring group received the coping intervention, comprising an explanatory leaflet and ten statements to be read at least once in the morning and once in the evening. PARTICIPANT, MATERIALS, SETTING, METHODS To capture the general impact of the PRCI, all three groups completed questionnaires at three time points: just before the waiting period (time 1: stimulation phase), on Day 10 of the 14-day waiting period (time 2: waiting period) and 6 weeks after the start of the waiting period (time 3: 6-week follow-up). In addition, to capture the specific impacts of the PRCI on the days of the waiting period, the PRCI-monitoring group and the monitoring-control group also rated their emotions and reactions daily, for the 14-day waiting period. MAIN RESULTS AND THE ROLE OF CHANCE Of the women who agreed to participate and who met eligibility criteria, 377 were randomized. All study participants reported significantly more anxiety and depression during the waiting period than before treatment (P < 0.001). The mean difference in anxiety between time 1 versus time 2 was 1.465 (95% CI 1.098–1.832). The mean difference in depression between time 1 versus time 2 was 0.514 (95% CI 0.215–0.813). Use of the PRCI did not significantly reduce anxiety or depression, or daily negative emotions during the waiting period. However, patients randomized to the PRCI reported significantly more positive emotions during the waiting period (P < 0.001) than the monitoring-control group, and reported the intervention to be easy to use, and as having a positive psychological effect. No significant differences were found between the groups in treatment outcome. LIMITATIONS, REASONS FOR CAUTION The lack of difference observed in the present study for anxiety levels between the PRCI and the monitoring-control group could have been due to the effects of monitoring itself or its ability to attenuate or obscure the effects of the PRCI intervention in unknown ways. A randomized group of women who used only the PRCI without daily monitoring would provide more insight. WIDER IMPLICATIONS OF THE FINDINGS The PRCI was shown to help women reinterpret the demands of the waiting period in a more positive way. These results are consistent with previous studies showing that positive reappraisal coping is a useful strategy for unpredictable and uncontrollable situations represented by a medical waiting period. This simple low cost self-help coping intervention increases positive affect during the waiting period in an IVF/ICSI treatment. STUDY FUNDING/COMPETENT INTEREST(S): The Women and Baby Division of the University Medical Centre Utrecht funded the study. The authors have no conflicting interest(s). TRIAL REGISTRATION NUMBER The study is registered at the Clinical Tials.gov (NCT01701011).
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Coughlan C, Walters S, Ledger W, Li TC. A comparison of psychological stress among women with and without reproductive failure. Int J Gynaecol Obstet 2013; 124:143-7. [PMID: 24290538 DOI: 10.1016/j.ijgo.2013.08.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Revised: 08/06/2013] [Accepted: 10/24/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine whether women with recurrent implantation failure (RIF) after in vitro fertilization (IVF), similar to women with recurrent pregnancy loss, have significantly higher stress levels than women without reproductive failure, and to compare stress levels between women with RIF and women with recurrent pregnancy loss. METHODS In a questionnaire-based study between September 2009 and January 2011, psychological stress was measured among patients attending recurrent pregnancy loss and RIF clinics at the Royal Hallamshire Hospital, Sheffield, UK. Participants completed the Fertility Problem Inventory (FPI), the Perceived Stress Scale (PSS), and the Positive and Negative Affect Schedule (PANAS) on their first visit to their respective clinic. Thirty fertile control women also completed the 3 validated questionnaires. RESULTS Compared with the control group, women with RIF and recurrent pregnancy loss had significantly higher scores in the FPI (RIF, P<0.001; recurrent pregnancy loss, P=0.003) and the PANAS negative affect domain (RIF, P=0.004; recurrent pregnancy loss, P=0.001), and lower scores in the PANAS positive affect domain (RIF, P<0.001; recurrent pregnancy loss, P<0.001). Whereas the perceived stress score (PSS) of the recurrent pregnancy loss group was significantly higher than that of the control group (P=0.006), the score of the RIF group was not, although the difference tended toward statistical significance (P=0.058). CONCLUSION The study findings confirm the stressful nature of RIF and recurrent pregnancy loss.
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Affiliation(s)
- Carol Coughlan
- Department of Reproductive Medicine, Jessop Wing, Sheffield, UK
| | - Stephen Walters
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - William Ledger
- Department of Obstetrics and Gynaecology, University of New South Wales, Sydney, Australia
| | - T C Li
- Department of Reproductive Medicine, Jessop Wing, Sheffield, UK.
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Ockhuijsen HDL, van den Hoogen A, Macklon NS, Boivin J. The PRCI study: design of a randomized clinical trial to evaluate a coping intervention for medical waiting periods used by women undergoing a fertility treatment. BMC Womens Health 2013; 13:35. [PMID: 24004640 PMCID: PMC3766696 DOI: 10.1186/1472-6874-13-35] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 08/30/2013] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Many medical situations necessitate a stressful period of waiting for potentially threatening test results. The medical waiting period is often associated with negative anticipatory anxiety and rumination about the outcome of treatment. Few evidence-based self-help coping interventions are available to assist individuals manage these periods. Theory and research suggest that positive reappraisal coping strategies may be particularly useful for this type of unpredictable and uncontrollable stressful context. The objective of this study is to investigate the effects of a Positive Reappraisal Coping Intervention (PRCI) on psychological well-being of women waiting for the outcome of their fertility treatment cycle. METHODS/DESIGN In a three-armed randomized controlled trial, the effectiveness of the PRCI will be tested. Consecutive patients undergoing in vitro fertilisation in a Dutch university hospital and meeting selection criteria will be invited to participate. Those who agree will be randomized to one of three experimental groups (N=372). The PRCI Intervention group will receive the intervention that comprises an explanatory leaflet and the 10 statements designed to promote positive reappraisal coping, to be read at least once in the morning, once in the evening. To capture the general impact of PRCI on psychological wellbeing patients will complete questionnaires before the waiting period (pre-intervention), on day ten of the 14-day waiting period (intervention) and six weeks after the start of the waiting period (post-intervention). To capture the specific effects of the PRCI during the waiting period, patients will also be asked to monitor daily their emotions and reactions during the 14-day waiting period. The primary outcome is general anxiety, measured by the Hospital Anxiety and Depression Scale. Secondary outcomes are positive and negative emotions during the waiting period, depression, quality of life, coping and treatment outcome. During recruitment for the RCT it was decided to add a fourth non-randomized group, a PRCI Control group that received the PRCI and completed the questionnaires but did not complete daily monitoring. DISCUSSION Positive reappraisal is one of the few ways of coping that has been shown to be associated with increased wellbeing during unpredictable and uncontrollable situations like medical waiting periods. A simple evidence based self-help intervention could facilitate coping during this common medical situation. This RCT study will evaluate the value of a self-help coping intervention designed for medical waiting periods in women undergoing fertility treatment. TRIAL REGISTRATION The study is registered at the Clinical Tials.gov (NCT01701011).
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Affiliation(s)
- Henrietta DL Ockhuijsen
- Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Agnes van den Hoogen
- Department of Neonatology, Wilhelmina Children’s Hospital and University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Nickolas S Macklon
- Department of Obstetrics and Gynaecology, Academic Unit of Human Development and Health, University of Southampton, Southampton, UK
| | - Jacky Boivin
- School of Psychology, Cardiff University, Cardiff, UK
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Brod M, Fennema H. Validation of the controlled ovarian stimulation impact measure (COSI): assessing the patient perspective. Health Qual Life Outcomes 2013; 11:130. [PMID: 23902854 PMCID: PMC3734046 DOI: 10.1186/1477-7525-11-130] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 06/27/2013] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Controlled Ovarian Stimulation (COS) is the first step for in vitro fertilization (IVF) treatment, a treatment often described and experienced as stressful to patients and their partners. COS also requires concerted efforts by the patients in administering medication and general compliance to treatment protocols. Little is known about the impacts on patients that may be specific to this important first step in treatment. The absence of a conceptually sound and well-validated measure assessing patient experience and functioning during ovarian stimulation has been an obstacle to understanding the impacts of ovarian stimulation on women pursuing IVF. To address this gap, the Controlled Ovarian Stimulation Impact Measure (COSI) was developed based upon accepted methods for designing patient reported outcome (PRO) measures. The purpose of this study was to psychometrically validate the COSI. METHODS 267 patients from three countries (Ireland, United Kingdom, United States) were administered the COSI. Psychometric validation was conducted according to an a priori statistical analysis plan. RESULTS The final 28-item COSI was found to have robust scale structure with four domains: Interference in Daily Life (Work and Home), Injection Burden, Psychological Health and Compliance Worry. Internal consistency of all domains was adequate (between 0.80 to 0.87) as was test-retest reliability (between 0.72-0.87). All a-priori hypotheses for convergent and known-groups validity tests were met. CONCLUSIONS There is a measurable impact of COS on patient functioning and well-being. The COSI is a well-developed and validated PRO measure of this impact. Future work should include examination of responsiveness and confirmation of concepts in non-western countries.
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Affiliation(s)
- Meryl Brod
- The Brod Group, 219 Julia Avenue, Mill Valley, CA 94941, USA
| | - Hein Fennema
- Merck Sharp & Dohme BV, Molenstraat 11, 5342 CC Oss, The Netherlands
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Turner K, Reynolds-May MF, Zitek EM, Tisdale RL, Carlisle AB, Westphal LM. Stress and anxiety scores in first and repeat IVF cycles: a pilot study. PLoS One 2013; 8:e63743. [PMID: 23717472 PMCID: PMC3662783 DOI: 10.1371/journal.pone.0063743] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 04/05/2013] [Indexed: 12/02/2022] Open
Abstract
Background The role of stress in reproduction, particularly during treatment for infertility, has been of considerable interest; however, few studies have objectively measured stress and anxiety over the course of the IVF cycle or compared the experience of first-time and repeat patients. Methods This prospective cohort pilot study enrolled 44 women undergoing IVF at a university-based clinic to complete the State-Trait Anxiety Inventory (STAI), Perceived Stress Scale (PSS) and Infertility Self-Efficacy Scale (ISES) at three time points prior to ovarian stimulation (T1), one day prior to oocyte retrieval (T2), and 5–7 days post embryo transfer (T3). Results Mean STAI State scores were significantly elevated at all three time points (p<0.01). STAI State and PSS mean values did not change over time and did not differ in first-time vs. repeat patients. Self-efficacy (ISES) scores declined over time, with a greater decline for repeat patients. Of the 36 women who completed a cycle, 15 achieved clinical pregnancy. Using logistic regression modeling, all scores at T2 were correlated with pregnancy outcome with lower scores on the STAI State and PSS and higher scores on the ISES associated with higher pregnancy rates. Conclusions Stress and anxiety levels remained elevated across all cycles. Women with lower stress and anxiety levels on the day prior to oocyte retrieval had a higher pregnancy rate. These results emphasize the need to investigate stress reduction modalities throughout the IVF cycle.
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Affiliation(s)
- Kathy Turner
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, United States of America
| | - Margaret F. Reynolds-May
- Department of Psychiatry, Stanford University School of Medicine, Stanford, California, United States of America
| | - Emily M. Zitek
- Department of Psychology, Stanford University, Stanford, California, United States of America
| | - Rebecca L. Tisdale
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, United States of America
| | - Allison B. Carlisle
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, United States of America
| | - Lynn M. Westphal
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, United States of America
- * E-mail:
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Küçük M. Bed rest after embryo transfer: is it harmful? Eur J Obstet Gynecol Reprod Biol 2013; 167:123-6. [DOI: 10.1016/j.ejogrb.2012.11.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 08/07/2012] [Accepted: 11/29/2012] [Indexed: 11/28/2022]
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An Y, Sun Z, Li L, Zhang Y, Ji H. Relationship between psychological stress and reproductive outcome in women undergoing in vitro fertilization treatment: psychological and neurohormonal assessment. J Assist Reprod Genet 2012; 30:35-41. [PMID: 23212833 DOI: 10.1007/s10815-012-9904-x] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 11/21/2012] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To evaluate whether psychological stress, as well as changes in hypothalamus-pituitary-adrenal (HPA) axis and sympathetic nervous system (SNS) at different time points during a first in vitro fertilization (IVF) cycle, correlates with the reproductive outcome. METHODS A prospective study was conducted in 264 women undergoing IVF or intracytoplasmic sperm injection (ICSI) treatment between January 2009 and March 2010. Standardized psychological questionnaires were used to assess anxiety and depression. Norepinephrine and cortisol in serum were measured with specific assays. RESULTS The non-pregnant women reported higher anxiety and depression scores at the pregnancy detection day compared with the pregnant group. Lower levels of norepinephrine and cortisol at the time of oocyte retrieval and lower levels of cortisol at the time of pregnancy test were found in women with successful treatment. Significant increases in serum norepinephrine and cortisol values were observed during ovarian stimulation. State Anxiety scores were negatively correlated with live birth rate, and positively associated with serum norepinephrine and cortisol values. CONCLUSIONS State anxiety is associated with both pregnancy rate and live birth rate in IVF patients, an effect that is partly mediated by activities in the HPA and SNS.
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Affiliation(s)
- Yuan An
- Department of Reproductive Medicine, The First Affiliated Hospital of Harbin Medical University, 23 Youzheng Street, Nangang District, Harbin, Heilongjiang, 150001, China
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Galhardo A, Cunha M, Pinto-Gouveia J. Measuring self-efficacy to deal with infertility: Psychometric properties and confirmatory factor analysis of the portuguese version of the infertility self-efficacy scale. Res Nurs Health 2012; 36:65-74. [DOI: 10.1002/nur.21516] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2012] [Indexed: 11/10/2022]
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Harata T, Goto M, Iwase A, Kurotsuchi S, Ando H, Osawa M, Sugita A, Kondo M, Nakamura T, Nakahara T, Takikawa S, Manabe S, Kikkawa F. Psychological stress during in vitro fertilization and embryo transfer is influenced by the patients' background and gender. Reprod Med Biol 2012; 11:143-8. [PMID: 29662362 DOI: 10.1007/s12522-012-0124-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 02/29/2012] [Indexed: 10/28/2022] Open
Abstract
Purpose This study evaluated the changes in psychological stress during in vitro fertilization and embryo transfer (IVF-ET) and the relationship of such stress to the patients' background and gender. Methods Sixty couples undergoing IVF-ET were administered the State-Trait Anxiety Inventory-JYZ (STAI) test at six different points during IVF-ET procedures. Anxiety scores at each time point were recorded and analyzed according to gender, fertility status, and duration of treatment. Results The median state anxiety score for women increased following induction until oocyte collection, after which it temporarily declined and then increased again until the pregnancy test. No such changes were noted in men. Scores for women who had undergone a shorter period of IVF treatments were higher while state and trait anxiety in men increased with a prolonged treatment period. Unsuccessful treatment increased the state and trait anxiety of women. Conclusions Psychological stress changed periodically depending on the duration of the patients' treatment and fertility status also influenced anxiety levels. These findings will prove helpful in guiding psychological therapy and counseling for couples attempting to conceive by in vitro fertilization.
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Skiadas CC, Terry K, De Pari M, Geoghegan A, Lubetsky L, Levy S, Haimovici F, Ashby R. Does emotional support during the luteal phase decrease the stress of in vitro fertilization? Fertil Steril 2011; 96:1467-72. [PMID: 22000914 DOI: 10.1016/j.fertnstert.2011.09.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 09/15/2011] [Accepted: 09/16/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine if phone calls between ET and pregnancy test, decrease stress levels as determined by the Perceived Stress Scale (PSS). DESIGN Randomized controlled trial. SETTING Academic medical center. PATIENT(S) Women undergoing a first fresh cycle of assisted reproductive technology using autologous oocytes with a day 2 or 3 ET. INTERVENTION(S) Phone calls from specialized social workers or standard of care. MAIN OUTCOME MEASURE(S) Primary outcome was the change in PSS score from day of ET compared with 10 days after ET; secondary outcome was perceived patient benefit. RESULT(S) A total of 131 patients were randomized to the intervention (n = 66) or control (n = 65) group. No differences were seen in the final PSS score or the change in PSS score between groups. At the completion of the study, the intervention group was more likely to report that participating in this study was helpful (65.9% vs. 21.4%), as well as to recommend emotional support during an IVF cycle (95.4% vs. 78.6%). CONCLUSION(S) Although we observed no significant change in PSS score, first-cycle IVF patients felt that increased emotional support was needed during the waiting period between ET and pregnancy test. Additional research should be conducted to determine the best interventions for this time period.
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Chiaffarino F, Baldini MP, Scarduelli C, Bommarito F, Ambrosio S, D’Orsi C, Torretta R, Bonizzoni M, Ragni G. Prevalence and incidence of depressive and anxious symptoms in couples undergoing assisted reproductive treatment in an Italian infertility department. Eur J Obstet Gynecol Reprod Biol 2011; 158:235-41. [DOI: 10.1016/j.ejogrb.2011.04.032] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2010] [Revised: 03/22/2011] [Accepted: 04/30/2011] [Indexed: 10/18/2022]
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Galhardo A, Pinto-Gouveia J, Cunha M, Matos M. The impact of shame and self-judgment on psychopathology in infertile patients. Hum Reprod 2011; 26:2408-14. [DOI: 10.1093/humrep/der209] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lawler CC, Budrys NM, Rodgers AK, Holden A, Brzyski RG, Schenken RS. Serum beta human chorionic gonadotropin levels can inform outcome counseling after in vitro fertilization. Fertil Steril 2011; 96:505-7. [PMID: 21719003 DOI: 10.1016/j.fertnstert.2011.05.071] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 05/22/2011] [Indexed: 11/15/2022]
Abstract
The predictive value of serum beta hCG level for fetal cardiac motion and pregnancy outcome after IVF was evaluated. The serum hCG level 12 days after ET is a useful predictor of subsequent presence of fetal cardiac activity and live birth and may assist clinicians in counseling patients regarding their IVF outcome.
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Affiliation(s)
- Caroline C Lawler
- Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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Abstract
PURPOSE The purpose of this study was to identify effects of guided imagery on stress including cognitive, affective, marital and social, and anxiety among women receiving in vitro fertilization (IVF). METHODS Data were collected between April, 21 and June, 17, 2008. The participants in this study were 57 women (26 for the experimental group, 31 for the control group) receiving IVF for primary or secondary infertility in one of the outpatient infertility centers in Seoul. The guided imagery (Suk, 2001) was provided through audio CD to the experimental group by themselves 8 minutes per day for 2 weeks. Data were analyzed by SPSS 12.0 windows program. RESULTS After guided imagery, the experimental group showed significantly lower affective stress and total stress scores. Anxiety scores increased significantly in the control group, but not in the experimental group after treatment. CONCLUSION The findings suggest that guided imagery is an effective nursing intervention for reducing stress especially affective stress and anxiety among infertile women receiving IVF in outpatient infertility center.
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Affiliation(s)
| | | | - Sue Kim
- College of Nursing, Yonsei University, Korea
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Li B, Zhou H, Li W. Bed rest after embryo transfer. Eur J Obstet Gynecol Reprod Biol 2011; 155:125-8. [DOI: 10.1016/j.ejogrb.2010.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2010] [Revised: 11/15/2010] [Accepted: 12/01/2010] [Indexed: 11/27/2022]
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Ramezanzadeh F, Noorbala AA, Abedinia N, Rahimi Forooshani A, Naghizadeh MM. Psychiatric intervention improved pregnancy rates in infertile couples. Malays J Med Sci 2011; 18:16-24. [PMID: 22135569 PMCID: PMC3216204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Accepted: 08/28/2010] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND Infertility has mental, social, and reproductive consequences. The aim of this study is to evaluate the effect of psychiatric intervention on the pregnancy rate of infertile couples. METHODS In an experimental and intervention-control study, 638 infertile patients who were referred to a university infertility clinic were evaluated; 140 couples (280 patients) with depression (from mild to severe) in at least one of the spouses were followed. All couples provided informed consent and were randomly numbered from 1 to 140. Those with even numbers were assigned to the psychological intervention before infertility treatment, and those with odd numbers were assigned to the psychological intervention during infertility treatment. Patients in the experimental group received 6-8 sessions of psychotherapy (individually) before beginning infertility treatment and were given Fluoxetine (antidepressant) at 20-60 mg per day during the psychotherapy period. The control group did not receive any intervention. Three questionnaires, the Beck Depression Inventory (BDI), the Stress Scale (Holmes-Rahe), and a sociodemographic questionnaire, were administered to all patients before and after treatment. The clinical pregnancy rate was compared between the two groups based on sonographic detection of gestational sac 6 weeks after the last menstrual period. The data were analysed by t test, X(2) and logistic regression methods. RESULTS Pregnancy occurred in 33 (47.1%) couples in the treatment group and in only 5 (7.1%) couples in the control group. There was a significant difference in pregnancy rate between the treatment and control groups (X(2)= 28.318, P < 0.001). To determine the effectiveness of psychiatric interventions on pregnancy, a logistic regression analysis was used. In this analysis, all demographic and infertility variables were entered in a stepwise manner. The results showed that in the treatment group, Pregnancy in the treatment group was 14 times higher than the control group (95% CI 4.8 to 41.7). Furthermore, cause of infertility was an effective factor of pregnancy. The adjusted odds ratio in male factor infertility was 0.115 (95% CI 0.02 to 0.55) and in both factors (male and female) infertility was 0.142 (95% CI 0.03 to 0.76) compared with the unexplained group. In this study, no other variables had any significant effect on pregnancy. CONCLUSION Based on the effectiveness of psychiatric interventions in increasing pregnancy rate, it is crucial to mandate psychiatric counselling in all fertility centres in order to diagnose and treat infertile patients with psychiatric disorders.
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Affiliation(s)
- Fatemeh Ramezanzadeh
- Infertility Clinic, Vali-Asr Hospital, Tehran University of Medical Sciences, Keshavarz Boulevard, Tehran, Iran
| | - Ahmad-Ali Noorbala
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nasrin Abedinia
- Vali-Asr Reproductive Health Research Center and Maternal-Fetal, Neonatal Research Center, Vali-Asr Hospital, Tehran University of Medical Sciences, Keshavarz Boulevard, Tehran, Iran
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Karatas JC, Barlow-Stewart K, Meiser B, McMahon C, Strong KA, Hill W, Roberts C, Kelly PJ. A prospective study assessing anxiety, depression and maternal-fetal attachment in women using PGD. Hum Reprod 2010; 26:148-56. [PMID: 20959384 DOI: 10.1093/humrep/deq281] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND PGD has been described in previous cross-sectional and retrospective studies as a stressful experience. No prospective studies of the psychological impact of PGD are currently available. METHODS Using a prospective study design, validated measures exploring anxiety and depression were used to assess women using PGD prior to treatment, following embryo transfer, following the pregnancy test result and at 24 weeks of pregnancy. Maternal-fetal attachment was also assessed during pregnancy. RESULTS The prospective design revealed the cyclical pathway through PGD for many women, often comprising repeated cycles of ovarian stimulations and IVF and frozen embryo transfers. As predicted, there were significant fluctuations in women's anxiety scores, with increases observed following embryo transfer and pregnancy testing. Women's anxiety scores returned to baseline levels during pregnancy as assessed at 24 weeks gestation. Depression scores did not significantly fluctuate during PGD. Maternal-fetal attachment scores in this sample did not differ from the normative Australian data. CONCLUSIONS For some women, the PGD pathway is convoluted and requires multiple IVF cycles and embryo transfers to achieve pregnancy. A subset of women experience significant emotional burden during PGD treatment, and it is these women who require closer attention and support. In this sample, emotional adjustment in pregnancy following PGD appears to be sound.
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Affiliation(s)
- J C Karatas
- Sydney Medical School, University of Sydney, Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia.
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Gürhan N, Atici D, Akyüz A, Kisa S. Association of Depression and Anxiety with Oocyte and Sperm Numbers and Pregnancy Outcomes during in vitro Fertilization Treatment. Psychol Rep 2009; 104:796-806. [DOI: 10.2466/pr0.104.3.796-806] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To estimate association of depression and anxiety scores with oocyte and sperm numbers and pregnancy rates during in vitro fertilization (IVF) treatment, 80 Turkish couples were administered the Spielberger State and Trait Anxiety and Beck Depression Inventories. A significant correlation ( r= -.25) obtained between Depression and women's oocyte pickup data and number of oocytes, showed that low oocyte numbers were associated with higher Depression. No significant relation was found for sperm counts with Anxiety and Depression scores on the day of oocyte pickup and sperm collection, but sperm motility was weakly and inversely correlated with Depression scores. Women with high State Anxiety score on the oocyte pickup day had significant lower pregnancy rates, as did those with higher Depression. Counseling of couples by health professionals on fertility-related issues to be implemented in IVF units is advisable.
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Affiliation(s)
| | | | - Aygül Akyüz
- Gulhane Military Medical Academy, School of Nursing
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Mahajan NN, Turnbull DA, Davies MJ, Jindal UN, Briggs NE, Taplin JE. Changes in affect and state anxiety across an in vitro fertilization/intracytoplasmic sperm injection cycle. Fertil Steril 2009; 93:517-26. [PMID: 19243748 DOI: 10.1016/j.fertnstert.2008.12.054] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Revised: 10/26/2008] [Accepted: 12/15/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To identify pattern of change in average positive affect (PA), negative affect (NA), and state anxiety (St ANX) across three biological end points of an IVF/intracytoplasmic sperm injection (ICSI) procedure and to examine whether the pattern varied across sociodemographic and biomedical subgroups. DESIGN Longitudinal follow-up study of PA, NA, and St ANX at three different time points: before start of study, before ovum pick-up (OPU), and before embryo transfer. SETTING Three infertility centers in northern India. PATIENT(S) Baseline data were obtained from a consecutive sample of 85 women. However, final analysis was done on data obtained from 74 women who reached the embryo transfer stage and completed the questionnaires at both OPU and embryo transfer. INTERVENTION(S) The PA, NA, and St ANX scores. MAIN OUTCOME MEASURE(S) Change in PA, NA, and St ANX scores at three stages of the treatment: baseline (T(0)), before OPU (T(1)), before embryo transfer (T(2)). RESULT(S) The PA scores before OPU and embryo transfer were significantly lower than those at baseline. The mean NA and St ANX scores before OPU and embryo transfer were significantly higher than baseline scores. Furthermore, mean NA before embryo transfer was significantly higher than mean NA before OPU. The PA and St ANX scores showed statistically insignificance within cycle variations. Furthermore, the mean PA and St ANX for a subgroup of women who reported more than moderate level of burden were less variable. CONCLUSION(S) The OPU and embryo transfer stages are more stressful than the baseline stage for most women across various sociodemographic and biomedical subgroups. Women with more than a moderate level of financial burden were relatively more stable.
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Affiliation(s)
- Neha N Mahajan
- School of Psychology, University of Adelaide, Adelaide, Australia.
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Brod M, Verhaak CM, Wiebinga CJ, Gerris J, Hoomans EHM. Improving clinical understanding of the effect of ovarian stimulation on women's lives. Reprod Biomed Online 2009; 18:391-400. [DOI: 10.1016/s1472-6483(10)60098-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Martins WDP, Ferriani RA, Nastri CO, Dos Reis RM, Mauad Filho F. Measurement of endometrial volume increase during the first week after embryo transfer by three-dimensional ultrasound to detect pregnancy: a preliminary study. Fertil Steril 2008; 90:883-5. [PMID: 17880947 DOI: 10.1016/j.fertnstert.2007.06.084] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2007] [Revised: 06/26/2007] [Accepted: 06/26/2007] [Indexed: 11/28/2022]
Abstract
Endometrial volume and thickness were measured in 20 women undergoing in vitro fertilization on the day before the embryo transfer and one week later by three-dimensional ultrasound. The endometrial volume increase was higher in the 8 pregnant women (0.70 cm(3) at least) than in the 12 nonpregnant women (0.21 cm(3) at most).
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Affiliation(s)
- Wellington de Paula Martins
- Departamento de Ginecologia e Obstetrícia da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil.
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Williams KE, Marsh WK, Rasgon NL. Mood disorders and fertility in women: a critical review of the literature and implications for future research. Hum Reprod Update 2007; 13:607-16. [PMID: 17895237 DOI: 10.1093/humupd/dmm019] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A medline literature review of fertility and mood disorder articles published since 1980 was performed in order to critically review the literature regarding a relationship between mood disorders, fertility and infertility treatment. Previous studies suggests that mood disorders, both in the bipolar and unipolar spectrum, may be associated with decreased fertility rates. Most studies report that women seeking treatment for infertility have an increased rate of depressive symptoms and possibly major depression (none showed evaluated mood elevations). Many, but not all, studies found that depressive symptoms may decrease the success rate of fertility treatment. Treatments for infertility may independently influence mood through their effects on estrogen and progesterone, which have been shown to influence mood through their actions on serotonin. Studies are limited in scope and confounding variables are many, limiting the strength of the results. In conclusion, a range of existing studies suggests that fertility and mood disorders are related in a complex way. Future studies should use clinical interviews and standardized and validated measures to confirm the diagnosis of mood disorders and control for the variables of medication treatment, desire for children, frequency of sexual intercourse, age, FSH levels, menstrual cycle regularity in assessing an interrelationship between mood disorders and fertility.
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Affiliation(s)
- Katherine E Williams
- Stanford Center for Neuroscience in Women's Health, Department of Psychiatry and Behavioural Sciences, Stanford University and Hospitals, Stanford, CA 94305, USA.
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Martins WP, Ferriani RA, dos Reis RM, Nastri CO, Filho FM. Endometrial thickness and volume by three-dimensional ultrasound one week after embryo transfer to detect pregnancy. J Assist Reprod Genet 2007; 24:155-8. [PMID: 17342425 PMCID: PMC3455060 DOI: 10.1007/s10815-007-9113-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2006] [Accepted: 01/25/2007] [Indexed: 10/23/2022] Open
Abstract
PURPOSE Determine if the evaluation of endometrium one week after embryo transfer can predict pregnancy. METHODS Endometrial volume and thickness were evaluated by three-dimensional ultrasound in 40 patients one week after embryo transfer. These results were compared to serum pregnancy test performed one week later. RESULTS Eighteen patients have achieved pregnancy. A significant difference was found for endometrial volume: 6.49+/-1.97 mL versus 3.40+/-1.11 mL (pregnant versus not pregnant); and thickness: 11.15+/-2.75 mm versus 9.77+/-1.85 mm. The ROC curve was used to detect the best cutoff values: endometrial volume of 3.48 mL (sensitivity-100%, specificity-68.2%) and endometrial thickness of 10.3 mm (sensitivity-72.2%, specificity-77.3%). The area under curve was significant higher for endometrial volume (0.909 versus 0.745, p=0.027). No pregnancy was achieved in women who had an endometrial volume <3.8 mL (15 patients) or thickness <7.9 mm (3 patients). CONCLUSIONS The endometrial volume and thickness were significant higher in pregnant women and this difference was more prominent for endometrial volume.
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Affiliation(s)
- Wellington Paula Martins
- Departamento de Ginecologia e Obstetrícia da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo-Brasil, São Paulo, Brasil.
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de Paula Martins W, Ferriani RA, dos Reis RM, Nastri CO, Filho FM. Endometrial thickness and volume by three-dimensional ultrasound one week after embryo transfer to detect pregnancy. J Assist Reprod Genet 2006; 23:347-50. [PMID: 16953464 DOI: 10.1007/s10815-006-9059-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2006] [Accepted: 08/07/2006] [Indexed: 10/24/2022] Open
Abstract
PURPOSE Determine if the evaluation of endometrium one week after embryo transfer can predict pregnancy. METHODS Endometrial volume and thickness were evaluated by three-dimensional ultrasound in 40 patients one week after embryo transfer. These results were compared to serum pregnancy test performed one week later. RESULTS Twenty two patients have achieved pregnancy. A significant difference was found for endometrial volume: 6.49+/-1.97 mL vs. 3.40+/-1.11 mL (pregnant vs. not pregnant); and thickness: 11.15+/-2.75 mm vs. 9.77+/-1.85 mm. The ROC curve was used to detect the best cutoff values: endometrial volume of 3.48 mL (sensitivity-100%, specificity-68.2%) and endometrial thickness of 10.3 mm (sensitivity-72.2%, specificity-77.3%). The area under curve was significant higher for endometrial volume (0.909 vs. 0.745, P=0.027). No pregnancy was achieved in women who had an endometrial volume <3.8 mL (15 patients) or thickness < 7.9 mm (3 patients). CONCLUSIONS The endometrial volume and thickness were significant higher in pregnant women and this difference was more prominent for endometrial volume.
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Affiliation(s)
- Wellington de Paula Martins
- Departamento de Ginecologia e Obstetrícia da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brasil.
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