Article

Psychosocial characteristics of women and men attending infertility counselling

Centre for Psychosocial Medicine, Institute of Medical Psychology, University of Heidelberg, Bergheimer Strasse 20, D-69115 Heidelberg, Germany.
Human Reproduction (Impact Factor: 4.57). 02/2009; 24(2):378-85. DOI: 10.1093/humrep/den401
Source: PubMed

ABSTRACT

Little is known about the psychosocial characteristics of infertile couples seeking psychological help. This study describes couples attending infertility counselling.
Questionnaires pertaining to socio-demographic factors, motives for wanting a child, lay aetiology of their infertility, dimensions of life and partnership satisfaction, and a complaints list were completed by 974 women and 906 men. Of those who indicated an openness to counselling, almost half actually attended infertility counselling, and two groups, 'no counselling' (358 women and 292 male partners) and 'taking up counselling' (275 women and 243 male partners), were therefore compared.
More couples with stressful life events were found in the counselling group. For women taking up counselling, psychological distress, in the form of suffering from childlessness and depression as well as subjective excessive demand (as a potential cause for infertility), was higher in comparison to women not counselled. The higher distress for men in the counselling group was indicated by relative dissatisfaction with partnership and sexuality and by accentuating the women's depression.
Infertile couples seeking psychological help are characterized by high levels of psychological distress, primarily in women. The women's distress seems to be more important for attending infertility counselling than that of the men.

Download full-text

Full-text

Available from: Tewes Wischmann
  • Source
    • "Infertility is a shared condition, including a woman and her partner, therefore both members of the infertile couple should be studied individually before an accurate design for psychological interventions can be developed. Many studies that included both members of the infertile couple found differences in psychological responses to infertility, in which women appeared to experience more distress than partners (Ragni et al., 2005; Verhaak et al., 2005; Schmidt, 2006; Rashidi et al., 2008; Lund et al., 2009; Wischmann et al., 2009; Chachamovich et al., 2010). However, several other studies reported similar levels of QoL and distress in both infertile partners (Fekkes et al., 2003; Peterson et al., 2003, 2008; Chachamovich et al., 2009). "
    [Show abstract] [Hide abstract]
    ABSTRACT: STUDY QUESTIONDo the quality of life (QoL) and the risk factors for emotional problems during and after treatment of infertile women differ from their partners?SUMMARY ANSWERWomen have lower levels of fertility-related QoL, and more and differing risk factors for emotional problems during and after treatment than their partners.WHAT IS KNOWN ALREADY?The psychological impact of infertility in patients negatively affects their QoL and is also related to increased discontinuation of treatment. Moreover, psychological factors might positively affect pregnancy rates. However, it is still unclear if differences in QoL and emotional status exist between infertile women and their partners. So far, research mainly focused on generic instruments to measure patients' QoL in the area of fertility care.STUDY DESIGN, SIZE, DURATIONA cross-sectional study of infertile couples within 32 Dutch fertility clinics.PARTICIPANTS/MATERIALS, SETTING, METHODS We included infertile women and their partners (both heterosexual and lesbian couples) under any treatment and at any stage of treatment in one of the 32 participating clinics. Per clinic, 25-75 patients were randomly selected depending on clinic size. In total, 1620 women and their partners were invited separately to complete the FertiQoL and SCREENIVF questionnaires to measure their level of QoL and risk factors for emotional problems during and after treatment, respectively.MAIN RESULTS AND THE ROLE OF CHANCEA total of 946 women (response rate 58%) and 670 partners (response rate 41%) completed the questionnaire set. As 250 women and 150 partners were already pregnant, questionnaires from 696 women and 520 partners could be analysed. Women scored significantly lower on the FertiQoL total scores [B = -6.31; 95% confidence interval (CI) = -7.63 to 4.98] and three of the FertiQoL subscales (Emotional, Mind-Body and Social) than their partners, indicating lower QoL. Scores on the SCREENIVF questionnaire were significantly higher for women (B = 0.22; 95% CI = 0.06-0.38), indicating that women are more at risk for developing emotional problems (and these factors differed from those of their partners) during and after fertility treatment than their partners.LIMITATIONS, REASONS FOR CAUTIONAlthough the number of participants is high (n = 1216), the relatively low response rate, especially for partners (41%), may have influenced the results through selection bias. An analysis of non-responders could not be performed. The FertiQoL and SCREENIVF questionnaires, which have been validated only in women starting a first IVF cycle, should also be validated for studying partners. In addition, the SCREENIVF questionnaire has been validated in Dutch women only and further research in an international setting is also required.WIDER IMPLICATIONS OF THE FINDINGSOur study results represent the Dutch infertile population as more than one-third of all Dutch clinics participated in the study. As the FertiQoL questionnaire is an internationally validated questionnaire already, these results can be put in a more broader and international perspective.STUDY FUNDING/COMPETING INTEREST(S)This work was supported by Merck Sharp & Dohme (MSD), The Netherlands. There are no competing interests.
    Full-text · Article · Jun 2013 · Human Reproduction
  • Source
    • "Infertility is a shared condition, including a woman and her partner, therefore both members of the infertile couple should be studied individually before an accurate design for psychological interventions can be developed. Many studies that included both members of the infertile couple found differences in psychological responses to infertility, in which women appeared to experience more distress than partners (Ragni et al., 2005; Verhaak et al., 2005; Schmidt, 2006; Rashidi et al., 2008; Lund et al., 2009; Wischmann et al., 2009; Chachamovich et al., 2010). However, several other studies reported similar levels of QoL and distress in both infertile partners (Fekkes et al., 2003; Peterson et al., 2003, 2008; Chachamovich et al., 2009). "
    [Show abstract] [Hide abstract]
    ABSTRACT: STUDY QUESTIONAre clinic factors, including patients' experiences with patient-centred care, associated with dropout in fertility care?SUMMARY ANSWERClinic factors, including patients' experiences with patient-centred care, are not related to dropout.WHAT IS KNOWN ALREADYIn fertility care, a significant proportion of patients do not achieve pregnancy because they discontinue treatment prematurely. Many studies have tried to identify factors predicting dropout, showing incompatible results. However, these studies mainly focus on factors at the treatment and patient level, while clinic factors have received little attention.STUDY DESIGN, SIZE, DURATIONThis prospective, longitudinal study was nested within a large RCT, which aims to improve the level of patient-centredness of Dutch fertility care. Of the 1620 infertile women who were invited to participate, the baseline measurement of the study (T0) included 693 women who completed a questionnaire about their experiences with patient-centred fertility care. The follow-up of the patients was 1 year (T1).PARTICIPANTS/MATERIALS, SETTING, METHODS All included women suffered from infertility and were undergoing treatment in one of the 32 Dutch clinics involved in the trial. Levels of patient-centredness were determined using the Patient-Centredness Questionnaire-Infertility (PCQ-Infertility) at T0. Meanwhile, a professionals' questionnaire was used to gather additional information on characteristics of the clinic (e.g. the number of patients per year or the presence of a fertility nurse). After 1 year, at T1 measurement, patients completed a questionnaire on their current status in fertility care, including their main reason for discontinuation if applicable.MAIN RESULTS AND THE ROLE OF CHANCEA total of 693 non-pregnant women completed the questionnaire set at T0 and 534 women (77.1%) provided consent for follow-up. At T1 measurement, 434 women (81.3%) completed the questionnaire and 153 of these women (35.2%) continued treatment while 76 women (17.5%) dropped out. Another 175 women (40.3%) had achieved pregnancy and 30 patients (7.9%) were advised to discontinue treatment for medical reasons. Neither levels of patient-centredness nor the additional clinic characteristics differed significantly between dropouts and compliers. However, patients who did not receive assisted reproduction treatment (ART; e.g. underwent intrauterine insemination, IUI) before they dropped out had significantly lower scores on the PCQ-Infertility subscale 'Respect for patients' values' than patients who continued their treatment [odds ratio (OR) 0.57; 95% confidence interval (CI) 0.34-0.95]. Patients who received ART and, subsequently, dropped out had higher scores on the PCQ-Infertility subscale 'Patient involvement' than those receiving non-ART (OR 2.39; 95% CI 1.02-5.59).LIMITATIONS, REASONS FOR CAUTIONWe were not able to follow-up a significant proportion (ca. 19%) of the 1620 women who were invited for T0 measurement, which might have biased our results. We also excluded patients who were still in the diagnostic work-up stage and this might have influenced our results as it is known that patients dropout at this stage. As the PCQ-Infertility was validated in patients who were already undergoing treatment, we decided to focus on this patient group only.WIDER IMPLICATIONS OF THE FINDINGSThe results of this study provide a better insight into those factors influencing dropout from the perspective of factors in the clinic itself. Although most clinic factors were not related to dropout, clinic factors might be of use when predicting dropout for specific patient groups, such as patients receiving ART and non-ART. Future research should involve an exploration of more specific predictors of dropout at the patient, treatment and clinic levels.STUDY FUNDING/COMPETING INTERESTSThis work was supported by Merck Serono, the Netherlands. No competing interests declared.
    Full-text · Article · May 2013 · Human Reproduction
  • Source
    • "[32] "
    [Show abstract] [Hide abstract]
    ABSTRACT: Early diagnosis of ovarian torsion can help prevent irreversible damage to the adnexal structures in women desiring to maintain fertility. The patient was transferred by ambulance for a six-hour history of severe lower abdominal pain. Magnetic resonance imaging (MRI) revealed bilateral enlarged ovaries measuring 5 x 6 cm (right) and 4 x 5 cm (left) with a right twisted and thickened peduncle. Ultrasonography failed to detect the peduncle changes. At surgery, the right adnexa was twisted 180 degrees in a clockwise direction with no findings suggestive of gangrenous change, hemorrhagic infarction or ischemic change. Detorsion of the twisted ovary was performed. Detection of tube torsion at MRI may be useful in the preoperative evaluation for surgical detorsion of twisted adnexa encountered in enlarged ovaries.
    Preview · Article · Jan 2010 · Clinical and experimental obstetrics & gynecology
Show more