Psychosocial aspects of in vitro fertilization
There is growing recognition of the existence of an interaction between the psychosocial status of women and their (in)fertility. This has prompted study of the psychosocial aspects of in vitro fertilization (IVF). Following a literature survey, a psychosocial questionnaire was constructed using existing tests and a specific IVF attitude questionnaire was developed. This questionnaire was completed by 150 new IVF women who were participating in a multicenter study. The newly-developed specific IVF questionnaire appeared to be reliable and valid, although women had a tendency to give socially desirable answers. The results indicate that IVF women feel more anxious (State-Trait Anxiety Index) than a normal population, but do not express more emotional complaints (Hopkins Symptoms Checklist). Comparison of the answers concerning the situation before and after IVF treatment revealed that treatment outcome has no influence on attitude towards IVF. After treatment, the women's state of anxiety was unchanged, while the quality of couples' relationships was enhanced. A possible influence exerted by psychosocial factors on the chances of achieving pregnancy with IVF could not be confirmed. Several methodological aspects of the study are discussed to explain the results.
Available from: Meryl Brod
- "Researchers have observed increased anxiety levels in patients at several junctures within the IVF cycle . These points of increased impact include prior to the beginning of a cycle [2-6]; before oocyte retrieval and prior to embryo transfer [7-10]; before administering a pregnancy test [9-11]; waiting for the results of IVF [9,11]; and following an unsuccessful IVF [2-4,12-14]. Furthermore, there is some evidence that infertility-related stress, anxiety, and depressive symptoms may negatively affect infertility treatment outcome [15-19], however there are conflicting results in this research area . "
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ABSTRACT: 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.
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.
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.
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.
Available from: Gianluca Lo Coco
- "However, the emotional impact of fertility problems in men is still insufficiently investigated. Many studies have not taken men into account (Hynes et al., 1992; Visser et al., 1994; Lok et al., 2002; Verhaak et al., 2005a,b), although several other studies have shown a lower emotional impact of fertility problems on men compared with women (Newton et al., 1990; Slade et al., 1997; Verhaak et al., 2001; Lund et al., 2009). Earlier studies also reported conflicting results concerning experiences of the marital relationship related to infertility and treatment. "
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ABSTRACT: Study Question Are attachment anxiety and avoidance dimensions in female and male partners in couples seeking infertility treatment associated with her and his infertility-related stress? Summary Answer Attachment dimensions are significantly associated with several aspects of infertility stress in couples undergoing IVF treatment. What is Known and What This Paper AddsAttachment dimensions of anxiety and avoidance (where highly anxious individuals fear rejection and are preoccupied with maintaining proximity to their partner and highly avoidant individuals are uncomfortable with intimacy and prefer to maintain distance from their partner) may influence the well being of individuals undergoing IVF/ICSI treatment. This study showed that one partner's attachment dimensions had a direct effect on the infertility-related stress of the other partner.DESIGNCross-sectional study of consecutive couples before starting their first IVF/ICSI treatment in 2009-2011 at the ANDROS clinic in Palermo, Italy. Participants and Setting Three hundred and fifty-nine couples undergoing fertility treatments were invited to participate in the research. The final sample comprised 316 females and 316 males who filled out the psychological questionnaires (Experiences in Close Relationships; Fertility Problem Inventory; State scale of State-Trait Anxiety Inventory). The participants included patients who had a primary infertility diagnosis and were about to undergo their first IVF or ICSI treatment.DATA ANALYSIS METHOD
Paired t-tests were used to examine gender differences on the study variables (attachment anxiety, attachment avoidance, infertility stress, state anxiety, etc.). Associations between infertility-related stress and the study variables were explored using hierarchical stepwise multivariate linear regression analyses. Main Results and The Role of ChanceAttachment anxiety and attachment avoidance were significantly associated with global infertility stress in both women (β 0.24, P < 0.01 and β 0.27, P < 0.01) and men (β 0.23, P < 0.01 and β 0.37, P < 0.01). Regarding the cross-partner effects, men's infertility stress and relationship concerns were associated with their partners' attachment avoidance (β 0.10 P < 0.05 and β 0.12, P < 0.05); and the infertility stress of women and the scores for need of parenthood were associated with their partners' attachment anxiety (β 0.14 P < 0.05 and β 0.16, P < 0.05).BIAS, Confounding and Other Reasons for Caution The study data are cross sectional, and specifically focus on associations between adult attachment style and infertility stress. Treating the data from couples as independent observations may be a limitation of the analysis. Potential moderators of such relationships (e.g. coping strategies, stress appraisal) are not included in this study. Study Funding/Competing Interest (S)This research was supported by funds provided by Centro Andros S.r.l., Palermo, Italy. The authors declare no financial or commercial conflicts of interest in this study.
Available from: Bettina Meiser
- "Thirteen studies have explored levels of anxiety in women at the pretreatment phase of IVF, and provided equivocal results regarding the presence of increased anxiety. In 7 of 13 studies, an increase in anxiety was identified in the women entering IVF treatment above that of control groups or normative population data (Beaurepaire et al., 1994; Visser et al., 1994; Bringhenti et al., 1997; Mori et al., 1997; Slade et al., 1997; Salvatore et al., 2001; Wang et al., 2007); in 6 of 13 studies, no increase in anxiety was found (Hearn et al., 1987; Edelmann et al., 1994; Csemiczky et al., 2000; Verhaak et al., 2001; Fekkes et al., 2003; Rashidi et al., 2008). The seven studies that have examined depression scores in women entering IVF have provided more conclusive evidence: six studies did not find any significant increases in depression scores relative to control groups or normative population depression rates (Hearn et al., 1987; Beaurepaire et al., 1994; Edelmann et al., 1994; Bringhenti et al., 1997; Salvatore et al., 2001; Verhaak et al., 2001). "
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ABSTRACT: Women often enter preimplantation genetic diagnosis (PGD) treatment following traumatic reproductive and genetic histories, the detrimental psychological effects of which are known to be long lasting in some cases. In addition, attempting IVF with PGD requires an in-depth understanding of the aspects of the technology. The level of information that is required and retained by women entering treatment is important for clinicians to understand. To date, neither of these issues has been explored empirically. To address this, we assessed mood and information-seeking behavior in a sample of women entering PGD.
Fifty women entering PGD treatment completed self-administered questionnaires that assessed anxiety, depression, knowledge of technical aspects of PGD, expectancy of establishing a pregnancy and unmet information needs.
Anxiety and depression rates were similar to normal population data. State anxiety was associated with degree of financial worry [beta = 0.36, t = 2.60, P = 0.01, 95% confidence interval (CI): 0.03-0.23], and living in an inner metropolitan area (beta = 0.30, P = 0.03, 95% CI: 0.32-10.81). Unmet information needs were positively associated with women's education (beta = 0.97, P = 0.01, 95% CI: 0.22-1.73). Lastly, expectancy of establishing a pregnancy was above that of what clinicians provide as realistic PGD pregnancy chances and, unexpectedly, was also associated with degree of financial worry (beta = 0.36, P = 0.01, 95% CI: 0.07-0.56).
Women entering PGD are emotionally well adjusted although the financial costs associated with PGD are associated with increases in anxiety. The study is limited by its small sample size and the fact that partners were not assessed.
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