Article

Women's emotional adjustment to IVF: A systematic review of 25 years of research

Department of Medical Psychology, Radboud University Nijmegen, Medical Centre, Nijmegen, The Netherlands.
Human Reproduction Update (Impact Factor: 10.17). 01/2007; 13(1):27-36. DOI: 10.1093/humupd/dml040
Source: PubMed

ABSTRACT

This review provides an overview of how women adjust emotionally to the various phases of IVF treatment in terms of anxiety, depression or general distress before, during and after different treatment cycles. A systematic scrutiny of the literature yielded 706 articles that paid attention to emotional aspects of IVF treatment of which 27 investigated the women's emotional adjustment with standardized measures in relation to norm or control groups. Most studies involved concurrent comparisons between women in different treatment phases and different types of control groups. The findings indicated that women starting IVF were only slightly different emotionally from the norm groups. Unsuccessful treatment raised the women's levels of negative emotions, which continued after consecutive unsuccessful cycles. In general, most women proved to adjust well to unsuccessful IVF, although a considerable group showed subclinical emotional problems. When IVF resulted in pregnancy, the negative emotions disappeared, indicating that treatment-induced stress is considerably related to threats of failure. The concurrent research reviewed, should now be underpinned by longitudinal studies to provide more information about women's long-term emotional adjustment to unsuccessful IVF and about indicators of risk factors for problematic emotional adjustment after unsuccessful treatment, to foster focused psychological support for women at risk.

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Available from: Floris W Kraaimaat, Jan 12, 2016
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    • "Psychosocial care is important in infertility care because most patients experience emotional distress during treatment (Verhaak et al., 2007a; Knoll et al., 2009; Karatas et al., 2011), 23% discontinue prematurely because of the perceived burden of treatment (Brandes et al., 2009), and one-third of patients end treatment without achieving pregnancy (Pinborg et al., 2009) and experience difficulties in adjusting to unmet parenthood goals (Verhaak et al., 2007b; Johansson et al., 2010; Wischmann et al., 2012; Gameiro et al., 2014). Even when a pregnancy is achieved, it is experienced with increased anxiety about the viability and health of the foetus (Hammarberg et al., 2008). "
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    ABSTRACT: STUDY QUESTION Based on the best available evidence in the literature, what is the optimal management of routine psychosocial care at infertility and medically assisted reproduction (MAR) clinics? SUMMARY ANSWER Using the structured methodology of the Manual for the European Society of Human Reproduction and Embryology (ESHRE) Guideline Development, 120 recommendations were formulated that answered the 12 key questions on optimal management of routine psychosocial care by all fertility staff. WHAT IS ALREADY KNOWN The 2002 ESHRE Guidelines for counselling in infertility has been a reference point for best psychosocial care in infertility for years, but this guideline needed updating and did not focus on routine psychosocial care that can be delivered by all fertility staff. STUDY, DESIGN, SIZE, DURATION This guideline was produced by a group of experts in the field according to the 12-step process described in the ESHRE Manual for Guideline Development. After scoping the guideline and listing a set of 12 key questions in PICO (Patient, Intervention, Comparison and Outcome) format, thorough systematic searches of the literature were conducted; evidence from papers published until April 2014 was collected, evaluated for quality and analysed. A summary of evidence was written in a reply to each of the key questions and used as the basis for recommendations, which were defined by consensus within the guideline development group (GDG). Patient and additional clinical input was collected during the scoping and the review phase of the guideline development. PARTICIPANTS/MATERIALS, SETTING, METHODS The guideline group, comprising psychologists, two medical doctors, a midwife, a patient representative and a methodological expert, met three times to discuss evidence and reach consensus on the recommendations. MAIN RESULTS AND THE ROLE OF CHANCE: THE GUIDELINE PROVIDES 120 recommendations that aim at guiding fertility clinic staff in providing optimal evidence-based routine psychosocial care to patients dealing with infertility and MAR. The guideline is written in two sections. The first section describes patients' preferences regarding the psychosocial care they would like to receive at clinics and how this care is associated with their well-being. The second section of the guideline provides information about the psychosocial needs patients experience across their treatment pathway (before, during and after treatment) and how fertility clinic staff can detect and address these. Needs refer to conditions assumed necessary for patients to have a healthy experience of the fertility treatment. Needs can be behavioural (lifestyle, exercise, nutrition and compliance), relational (relationship with partner if there is one, family friends and larger network, and work), emotional (well-being, e.g. anxiety, depression and quality of life) and cognitive (treatment concerns and knowledge). LIMITATIONS, REASONS FOR CAUTION We identified many areas in care for which robust evidence was lacking. Gaps in evidence were addressed by formulating good practice points, based on the expert opinion of the GDG, but it is critical for such recommendations to be empirically validated. WIDER IMPLICATIONS OF THE FINDINGS The evidence presented in this guideline shows that providing routine psychosocial care is associated with or has potential to reduce stress and concerns about medical procedures and improve lifestyle outcomes, fertility-related knowledge, patient well-being and compliance with treatment. As only 45 (36.0%) of the 125 recommendations were based on high-quality evidence, the guideline group formulated recommendations to guide future research with the aim of increasing the body of evidence. STUDY FUNDING/COMPETING INTEREST(S) The guideline was developed and funded by ESHRE, covering expenses associated with the guideline meetings, with literature searches, and with the implementation of the guideline. The GDG members did not receive payment. S.G., E.D., C.d.K., M.E., U.V.d.B., C.L.-J. and N.V. report no conflicts of interest. J.B. reports grants from Merck & Co, consulting fees from Merck Serono S.A. and Speaker's fees from Merck Serono S.A. P.T. reports consulting fees from the German government and being the Chair of the German Society for Fertility Counselling. C.V. reports consulting fees from Merck Serono S.A. C.M.V. reports being adviser in projects for Merck Serono S.A. and Ferring S.A. on patient educational material. T.W. reports speaker's fees from Repromed, DGPM, Breitbach, DAAG, fiore, LPTW, MSD, salary/position funding at TAB-beim-Bundestag, BZgA, and being the Vice-chair of the German Society for Fertility Counselling. TRIAL REGISTRATION NUMBER NA. © 2015 The Author 2015. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: [email protected] /* */
    Full-text · Article · Sep 2015 · Human Reproduction
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    • "This author in his literature review also highlights the need to apply methodology and assessment tools that are suitable and specific to the field. Classically, the main variables studied have been anxiety and depression without finding conclusive results in many cases (Verhaak et al., 2007). Antequera, Moreno-Rosset, Jenaro, & Ávila-Espada (2008) provide a review of emotional changes before an infertility diagnosis, during treatment, and during pregnancy and parenting, highlighting the need to differentiate between emotional maladjustment and psychopathological alteration in infertile people in order to detect those couples that are vulnerable to developing psychopa- thology. "
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    ABSTRACT: The objective of this study is to find out if the variables state-anxiety, trait-anxiety, positive-affect, negative-affect, alexithymia, and adaptive (personal and interpersonal) resources can predict emotional maladjustment in infertile people, taking into account the potentially moderating role of gender. A sample of 101 participants with an infertility diagnosis (51 males and 50 females) completed a battery of psychological tests (DERA, Emotional Maladjustment and Adaptive Resources in Infertility questionnaire, State-Trait Anxiety Inventory [STAI], PANAS, Positive and Negative Affect Schedule, and TAS-20, [Toronto Alexithymia Scale]). The moderating, partial, and interactive effects of the variables were analyzed using hierarchical regression analysis. The resulting model explained 71.1% of total variance, resulting in gender as an important moderating variable and trait anxiety, state anxiety, negative affect, and low interpersonal resources as strong predictors of emotional maladjustment in infertile people. These results provide guidance in selecting the most appropriate psychological support and treatment for the emotional adjustment of infertile women and men.
    Full-text · Article · Mar 2015 · Clínica y Salud
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    • "This author in his literature review also highlights the need to apply methodology and assessment tools that are suitable and specific to the field. Classically, the main variables studied have been anxiety and depression without finding conclusive results in many cases (Verhaak et al., 2007). Antequera, Moreno-Rosset, Jenaro, & Ávila-Espada (2008) provide a review of emotional changes before an infertility diagnosis, during treatment, and during pregnancy and parenting, highlighting the need to differentiate between emotional maladjustment and psychopathological alteration in infertile people in order to detect those couples that are vulnerable to developing psychopa- thology. "

    Full-text · Article · Jan 2015 · Clínica y Salud
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