The effects of psychosocial interventions on the mental health, pregnancy rates, and marital function of infertile couples undergoing in vitro fertilization: a systematic review

Stress and Anxiety Levels in Couples who Undergo Fertility Treatment: a Review of Systematic Reviews

Background:

Infertility is an issue that affects many parameters peoples’ lives, as individuals and as couples. Besides the physical and economic impact of infertility on the couples, there is a significant reflection of infertility on their mental health and well-being, which follows them from the moment of the diagnosis up until the end of their treatment.

Objective:

The aim of this review was to investigate whether psychological factors such as stress, anxiety or depression have an impact on the assisted reproduction treatment outcome and whether the use of supporting methods may help couples to minimize their fertility related stress, anxiety and depression and improve the treatment outcome.

Methods:

After a systematic search of the electronic databases, fourteen studies were included in this umbrella review. The included studies were systematic reviews and meta-analyses published between January 2015 and February 2020. The population of interest was women, men or couples facing infertility and undergoing fertility treatment. The included studies assessed the relationship between stress and anxiety in couples undergoing fertility treatment and the outcome of the treatment, the psychological state and psychological adjustment of the couples after a negative result and the impact of interventional methods for reducing stress, anxiety or depression on the psychological state of the couples undergoing treatment and their pregnancy outcomes.

Results:

This review fails to provide a certain answer to our research hypothesis due to conflicting results in the included studies. However, it has been observed that couples who reported better psychological state or have been treated with an interventional method for psychological support, were more likely to adjust better to the treatment procedure and the outcome as well.

Conclusion:

Psychological support and consultation during assisted reproduction treatment is highly recommended by researchers and clinicians.

Anxiety Level During the Second Localized COVID-19 Pandemic Among Quarantined Infertile Women: A Cross-Sectional Survey in China

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.

The Analysis of Anxiety and Depression in Different Stages of in vitro Fertilization-Embryo Transfer in Couples in China

BACKGROUND

This study aimed to examine the differences in anxiety and depression between infertile Chinese couples in diverse stages of in vitro fertilization-embryo transfer (IVF-ET) and their relationship with the IVF-ET outcomes.

METHODS

From February 2016 to December 2018, a total of 247 couples that were undergoing IVF-ET were randomly selected for this study. On the day they started their treatment (T1), the day human chorionic gonadotropin was administered (T2), and 4 days after the embryo transfer (T3), self-designed questionnaires, the Self-Rating Anxiety Scale, and the Self-Rating Depression Scale were completed to investigate anxiety and depression in different stages.

RESULTS

Age had an effect on the anxiety and depression in women. Male infertility type and the cause of infertility had an effect on the anxiety and depression in men. The incidence of anxiety in women in the T1, T2, and T3 stages was 29.96%, 44.94%, and 17.81%, respectively. The anxiety scores of women were 46.14 ± 8.37, 50.83 ± 8.50, and 44.09 ± 8.17, respectively, which were significantly higher than those of men (p < 0.05). The anxiety score in stage T2 was the highest in women, and the depression score of women in stage T1 was the highest. The incidence of anxiety in men in the T1, T2, and T3 stages was 20.65%, 8.50%, and 6.07%, respectively. The incidence of anxiety was not significantly different in diverse stages (p > 0.05), and the same result was obtained for the incidence of depression. The anxiety and depression scores of the infertile couples in different stages were not related to the outcome of IVF-ET.

CONCLUSION

The incidence of anxiety and depression in infertile couples in diverse stages of IVF-ET is different, especially in women, and the anxiety and depression of infertile couples in the process of IVF-ET may not be related to the outcome of assisted pregnancy.

Experiences of Infertile Couples of West Bengal With Male Factor, Female Factor, and Unexplained Infertility Factor: A Qualitative Study

Background: Infertility is a very stressful life state of a couple. The consequences of infertility have a considerable differential effect not only on couples but also on culture and social strata. Inability to conceive can be a very troublesome matter for a couple and potentially it can turn into a traumatic experience with far-reaching consequences. Qualitative understanding of strain can be helpful for in-depth understanding of factors that might need psychosocial intervention.

Objective: The purpose of this study is to zero in on the multiple psychosocial aspects of infertile couples, ranging from male etiology, female determinants, and unexplained domains of infertility.

Materials and Methods: This was a qualitative cross-sectional content analysis study. 15 couples were interviewed with the mean age of (27± 2.95) years for females and (30±2.43) years for males. Data collection strategies employed in this research included semi-structured open face-to-face interviews and field notes.

Results: Qualitative data analysis identified 5 themes—negative emotional reactions, social pressure, marital and sexual dissatisfaction, decreased quality of life, and treatment problems.

Conclusion: The various psychosocial crises (unfulfilled maternal instinct, emotional support, unmet social role, diminished social security) related to various types of infertility are evident. Addressing those issues might be helpful to improve the quality of life of couples.

Self-reported quality of life scales in women undergoing oocyte freezing versus in vitro fertilization

PURPOSE

The objective of this study was to investigate stress levels among women undergoing elective oocyte cryopreservation by comparing their self-reported quality of life measures with women undergoing in vitro fertilization during the fertility treatment cycle.

METHODS

Patients undergoing oocyte retrieval at a single institution were offered a voluntary, anonymous, and written questionnaire. The survey was adapted and validated from the Fertility Quality of Life tool to assess self-reported fertility treatment-related problems and was tested for construct validity and reliability. Based on exploratory factor analyses, three subscales were created as follows: fertility treatment-related stress, tolerability, and environment. Relationships between patient characteristics and fertility treatment-related measures were examined with Fisher's exact test, ANOVA, and multivariate regression with significance p < 0.05.

RESULTS

A total of 461 patients (331 IVF, 130 egg freeze) were included in the analysis. Medically indicated egg freezing patients were excluded. Overall, both IVF and egg freeze patients reported stress during the current fertility cycle and there were no significant differences between IVF and egg freeze patients for any subscale scores. Three sets of generalized linear models were run and found age to be associated with fertility treatment-related stress and tolerability scores, with younger patients experiencing greater difficulties. Additionally, patients who underwent repeat cycles reported more fertility treatment-related stress.

CONCLUSIONS

Patients undergoing egg freezing have similar responses to quality of life questions as patients undergoing IVF. Repeat cycles and younger age contribute to perceptions of stress. This information supports developing stress reduction strategies for all women undergoing egg freezing.

The effect of mind-body interventions on psychological and pregnancy outcomes in infertile women: a systematic review

Preliminary evidence suggests that mind-body interventions, including mindfulness-based interventions and yoga, may be effective in reducing mental health difficulties and psychological distress in infertile patients undergoing fertility treatments. We systematically reviewed and synthesized current medical literature of the effectiveness of mind-body interventions in reducing the severity of psychological distress and improving marital function and pregnancy outcomes in infertile women/couple. Databases including PsychINFO, PubMed, EMBASE, and the Cochrane Library were searched for relevant studies. Manual searches were conducted in relevant articles. We included 12 studies that met the inclusion criteria. Four studies were randomized controlled trials (RCT), 4 non-randomized controlled trial (NRCT), and 4 uncontrolled studies (UCT). Participation in a mind-body intervention was associated with reduced anxiety trait and depression scores. The reduction was of low or moderate amplitude in most studies. Our review offers evidence for the effectiveness of mind-body interventions in reducing anxiety state and depression in infertile women and a possible improvement in pregnancy rate. Further RCTs with a precise timing of intervention are needed.

Impact of anxiety levels on difficulty of intrauterine insemination and treatment outcomes

AIM

The objective of this study was to determine the effect of anxiety on intrauterine insemination (IUI) results in couples with unexplained infertility. Second, the relationship between difficulty level of IUI procedure and anxiety were investigated.

METHODS

A total of 100 women undergoing first IUI treatment were enrolled into this prospective cross-sectional study. Participants were asked to complete the Beck Anxiety Inventory (BAI) before the IUI procedure and classified into two groups according to the anxiety score (minimal anxiety; BAI score <8, n = 73 and mild-to-moderate anxiety; BAI score ≥8, n = 27). Cervical condition was evaluated with speculum and presence of congenital anomalies, extensive leucorrhea or polypoid lesions were classified as unfavorable cervix. All of the patients were evaluated for difficulty of IUI and asked to state the severity of their pain with a visual analog scale after the procedure. Clinical pregnancy rates were also analyzed.

RESULTS

There was no statistically significant difference between the groups in terms of pregnancy rates (12.3% vs 14.8%, P = 0.743). visual analog scale score was significantly higher in mild-to-moderate anxiety group (P = 0.002). Anxiety levels were higher in patients with difficult IUI (10.5 vs 4.3, P < 0.001). In multivariate analysis, higher BAI scores (odds ratio: 1.1, 95% confidence interval: 1.0-1.2, P = 0.01) and unfavorable cervical condition (odds ratio: 3.6, 95% confidence interval: 1.2-10.7, P = 0.01) emerged as independent predictors for difficulty of IUI.

CONCLUSION

Evaluation of anxiety before IUI might help to predict difficulty of IUI and related pain. Although anxiety increases the difficulty of IUI, it does not affect pregnancy outcomes of the treatment.

Effectiveness of psychological interventions on mental health, quality of life and relationship satisfaction for individuals and/or couples undergoing fertility treatment: a systematic review and meta-analysis protocol

INTRODUCTION

Infertility is a global public health problem affecting men, women and couples worldwide. The medical implications of infertility are often of primary focus in healthcare settings, but the experience of infertility also has a considerable social, emotional and psychological impact. Interventions aimed at alleviating psychological symptoms in individual and/or couples undergoing fertility treatment requires a systematic and comprehensive review of the literature to determine the efficacy of psychological interventions. The objective of this review is to evaluate the effectiveness, feasibility and acceptability of psychological interventions for individuals and/or couples seeking fertility to treat anxiety, depression, distress, quality of life and relationship satisfaction, as well as improve pregnancy rates.

METHODS AND ANALYSIS

The search strategy will involve 11 databases, including MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily (Ovid), EMBASE (Ovid), PsycINFO (Ovid), Cochrane Central Register of Controlled Trials (OVID), The Cumulative Index to Nursing and Allied Health Literature (CINAHL) with Full Text (EBSCO), Social Work Abstracts (EBSCO), SocINDEX with Full Text (EBSCO), Academic Search Complete (EBSCO), Family & Society Studies Worldwide (EBSCO), Family Studies Abstracts (EBSCO) and Scopus. These databases will be searched from their inception to September 2019. Independent reviewers will search peer-reviewed published studies through electronic databases and additional sources, will extract the data and assess the methodological quality. Random-effects meta-analysis will be carried out by calculating effect sizes as Cohen's d indices. Heterogeneity will be examined by the I2 and the Q statistics.

ETHICS AND DISSEMINATION

The current review does not require ethics approval. The results will be disseminated through publications in peer-reviewed journals.

PROSPERO REGISTRATION NUMBER

CRD42019133757.

Patient perspectives and experiences with in vitro fertilization and genetic testing options

Objective:

Decision-making and patient experiences with embryo selection during in vitro fertilization often include genetic testing options. The purpose of this study was to gain insight about the experiences and perspectives of women using in vitro fertilization and genetic technologies.

Methods:

Interviews (n = 37) were conducted among female patients who had undergone in vitro fertilization, underwent expanded carrier screening, and were offered pre-implantation genetic testing for aneuploidy between July 2016 and July 2017. The interviews were transcribed and a content analysis was conducted on the transcripts.

Results:

Categories that emerged from the data analysis included unexpected outcomes, uncertainty, unanticipated emotional consequences, too much emphasis on the woman’s contributions and questions about embryo viability. Patient experiences with genetic technologies during in vitro fertilization played a significant role within these results.

Conclusion:

The emotional and psychological impacts of infertility during in vitro fertilization were the primary concerns discussed by participants. Future research is needed to identify ways to help manage unexpected outcomes and continuous uncertainty, including the increasing use of genetic technologies, to not add to the psychological burden of infertility. There is a need to explore more support options or counseling services for patients struggling with infertility during in vitro fertilization treatment.

Prospective study of pregnancy outcome between perceived stress and stress-related hormones

AIM

To evaluate the relationship between physiological and psychological stress on pregnancy outcome in women undergoing in vitro fertilization-embryo transfer (IVF-ET) treatment.

METHODS

Women undergoing the first IVF cycle were enrolled to complete the Self-Rating Anxiety Scale (SAS) and the Self-Rating Depression Scale (SDS). Their blood samples were collected on the 3rd day of the menstrual cycle to measure 5-hydroxytryptamine, renin, norepinephrine, angiotensin II and cortisol. Salivary amylase was obtained on the embryo transfer day.

RESULTS

Compared with normal women who came to the hospital for regular physical examination, the incidence of anxiety and depression was higher in women seeking for IVF treatment. After psychological intervention, the condition got improved and the incidence of anxiety and depression was 6.25% and 7.81% separately in these women. There were no significant differences between the anxiety scores in women with and without pregnancy. The depression scores did show some statistically differences, with higher scores in the nonpregnancy group. The level of 5-hydroxytryptamine, renin, norepinephrine and cortisol were not significantly different between the two groups, while angiotensin II and salivary amylase seemed to be negatively correlated with pregnancy outcome. Simultaneously, a positive correlation was found between angiotensin II and anxiety and depression scores.

CONCLUSION

Depression during IVF has a negative impact on pregnancy outcome. The measurement of angiotensin II and salivary amylase might be reference index for the psychological status of patients during IVF-ET.

A mental health program for infertile couples undergoing oocyte donation: protocol for a mixed methods study

Background

The psychological consequences of infertility in couples undergoing oocyte donation differ culturally, racially, religiously, and legally from other infertile couples undergoing assisted reproductive treatments. Therefore, the inclusion of a mental health program in assisted reproductive services is essential for these couples. As such, the aim of this study is to develop a program for improving the mental health of these couples.

Methods

This study is designed using an exploratory mixed method and the program based on Talbot and Verrinder model. Different steps of this research include determination of a specific topic for planning (needs assessment), initial design of the program, finalization of the program (using the views of experts in this area), implementation of the program, monitoring of the implementation of the program and evaluation of the program. To perform the first step of Talbot’s program, the first phase of the study will be conducted. At first, through a qualitative study, the items of the questionnaire are designed and then its psychometric steps will be performed by a cross-sectional study. In the second and third steps, the classic Delphi technique will be used in four-round for initiation and finalization of the program, and the second phase will be completed. The fourth, fifth and sixth steps of the program including implementation, monitoring of the implementation and evaluation of the program in the future will be performed.

Discussion

Designing an appropriate program based on the documentations of the qualitative study and evidence can improve the mental health and quality of life of the couples undergoing oocyte donation. The program, based on the measurement of needs, will be implemented using a tool designed specifically for the target population and can be useful in the processes of treatment, education, policymaking and legislation as well as research.

Effect of counseling based on the choice theory on irrational parenthood cognition and marital quality in infertile women: A randomized controlled trial

PURPOSE

This study evaluated the effect of counseling based on the choice theory on irrational parenthood cognition (IPC)- and marital quality in infertile women.

DESIGN AND METHODS

This randomized controlled trial was conducted on 50 primary infertile women in Zanjan, Iran. Stratified block randomization was used to allocate participants to groups. The intervention group received counseling, but the control group received routine care. Data were collected using the IPC and marital relationships quality based on the Glasser's choice theory.

FINDINGS

A statistically significant difference was found between the groups in IPC (P = 0.005), but the difference in marital quality was not statically significant ( P = 0.085).

PRACTICE IMPLICATIONS

Counseling can be used for decreasing IPC, but more interventions are needed to increase marital quality.

Effectiveness of two guided self-administered interventions for psychological distress among women with infertility: a three-armed, randomized controlled trial

STUDY QUESTION

What is the effect of two guided self-administered interventions on psychological distress in women undergoing IVF or ICSI?

SUMMARY ANSWER

A brief mindfulness intervention significantly reduced depression and improved sleep quality, while the gratitude journal intervention showed no significant effect on any outcome variables.

WHAT IS KNOWN ALREADY

Mindfulness and gratitude journal interventions have been found to be beneficial in reducing negative affect and improving well-being. However, there are very few mental health professionals who implement such interventions in low- and middle-income countries. Therefore, two guided self-administered interventions for women with infertility were designed to help them cope with their psychological distress.

STUDY DESIGN, SIZE, DURATION

A three-armed, randomized controlled trial was designed to evaluate the mindfulness and gratitude journal interventions for women undergoing IVF/ICSI. Between May 2016 and November 2017, at the reproductive center in a public hospital, 234 women were randomly assigned to the brief mindfulness group (BMG, n = 78), gratitude journal group (GJG, n = 78) or control group (CG, n = 78). The inclusion criteria were being a woman undergoing her first cycle of IVF, having at least junior middle school education and having no biological or adopted children.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Female infertility patients (n = 346) were approached, and 112 did not meet the inclusion criteria. All three randomized groups completed questionnaires on the day of down-regulation (T1), the day before embryo(s) transfer (T2), and 3 days before the pregnancy test (T3). The BMG completed four sessions and listened to a 20-minute audio daily, including guided mindfulness breathing and body scan. The GJG completed four sessions and wrote three gratitude journals daily. The CG received routine care. A generalized estimating equation was used in an intention-to-treat analysis. The primary outcome was depression. Secondary outcomes were anxiety, sleep quality, infertility-related stress, mindfulness and gratitude.

MAIN RESULTS AND THE ROLE OF CHANCE

Participants of the BMG showed decreased depression (mean difference (MD) = −1.69, [−3.01, −0.37], d = 0.44) and improved sleep quality (MD = −1.24, [−1.95, −0.39], d = 0.43) compared to the CG, but the effect was not significant for anxiety, Fertility Problem Inventory totals, mindfulness, gratitude scores or pregnancy rates. The BMG showed a significant reduction in depression and improvement in sleep quality between T1 and T2, a continuous significant reduction between T1 and T3 and no reduction between T2 and T3. There were no significant effects on any of the variables for the GJG.

LIMITATIONS, REASONS FOR CAUTION

The inclusion criteria may result in bias because some participants with low education were excluded and only women with infertility were included. A low compliance rate occurred in the gratitude journals group. Moreover, men were not included in this study. Further research should consider including spouses of the target population.

WIDER IMPLICATIONS OF THE FINDINGS

The brief mindfulness intervention was beneficial in decreasing depression and improving sleep quality. Implementation of guided self-administered mindfulness could make the psychological counseling service more accessible for patients with infertility in resource-poor settings. The efficiency and feasibility of the gratitude journal intervention needs to be investigated further.

STUDY FUNDING/COMPETING INTEREST(S)

This study was funded by the National Social Science Foundation (17BSH054). The authors have no conflicts of interest.

TRIAL REGISTRATION NUMBER

ChiCTR-IOR-16008452.

TRIAL REGISTRATION DATE

9 May 2016

DATE OF FIRST PATIENT’S ENROLMENT

15 May 2016.

Reproductive Health Promotion Behavior of Infertility Women and Normal Women

PURPOSE

To compare reproductive health promoting behaviors (RHPBs) of infertile women with those of normal women and identify effects of RHPB on infertility.

METHODS

A total of 148 females (73 infertile women and 75 normal women) were enrolled in this study. Measurements included their general characteristics and RHPB using self-report questionnaires. Data were analyzed with descriptive statistics, χ2 test, ANCOVA, and hierarchical logistic regression using SPSS.

RESULTS

There were significant difference in incomes, number of family, number of term deliveries, and number of abortions according to infertility diagnosis. Mean duration of infertility was 32.16 months. Only 12.32% women had known cause of infertility. The most common cause of infertility was unknown. Mean RHPB score was 3.98 for infertile women and 4.41 for normal women. In logistic regression, total RHPB (odds ratio [OR], 0.21) and safe sex of RHPB (OR, 0.66) were significant factors influencing infertility. Infertile women's total RHPB and subcategories of RHPB (safe sex behavior and sexual transmitted disease [STD] prevention) were lower than those of normal women.

CONCLUSION

For infertility women, RHPB-related intervention programs are needed, especially information about safe sex behavior and STD prevention.

Testing a New Group Intervention for Couples Seeking Fertility Treatment: Acceptability and Proof of Concept

This study tested the acceptability and preliminary efficacy of a novel group intervention for couples seeking fertility treatment. Twenty-nine couples completed psychological, relational, and sexual outcome measures pre- and post-intervention. Repeated-measures ANOVAs revealed significant reductions in terms of depressive symptoms, rejection of childfree lifestyle, and stress related to the need for parenthood. The results also revealed improvements in marital benefits and fertility-related emotional and relational quality of life. Couples' high participation rates and reported treatment satisfaction indicate adequate acceptability. These results support the preliminary success of the intervention in reducing the psychological and relational burden for couples undergoing fertility treatment.

Quality-of-life predictors for men undergoing infertility treatment in Japan

AIM

To dentify the predictors of the quality of life (QOL) of infertile men who are undergoing infertility treatments in Japan and to create a QOL prediction model, with the main variables aimed at providing more adequate support to male patients.

METHODS

This cross-sectional study used the quantitative data that were collected from 321 returned self-report questionnaires that had been distributed to the men of 411 couples who were undergoing fertility treatment. The following four scales were used to measure the main outcomes: FertiQoL, psychological distress, spousal support, and workplace support. The data were analyzed by descriptive statistics, multiple regression analyses, and structural equation modeling.

RESULTS

The number of returned questionnaires was 321 (78.1%). The QOL that was measured by FertiQoL was significantly lower in those men who were diagnosed with male factor infertility than in the other male patients. The two significant predictors of QOL were: spousal support and the infertility period. The structural equation modeling revealed that the same factors were related to QOL.

CONCLUSIONS

Male factor infertility, less spousal support, and a longer period of infertility were associated with a poorer QOL of those men who were undergoing infertility treatment. These results suggest that focusing on infertility causes, the length of the infertility period, and the couples' partnership during treatment is needed to provide full support to men who have been diagnosed with infertility.

The relationship between stress and infertility

The relationship between stress and infertility has been debated for years. Women with infertility report elevated levels of anxiety and depression, so it is clear that infertility causes stress. What is less clear, however, is whether or not stress causes infertility. The impact of distress on treatment outcome is difficult to investigate for a number of factors, including inaccurate self-report measures and feelings of increased optimism at treatment onset. However, the most recent research has documented the efficacy of psychological interventions in lowering psychological distress as well as being associated with significant increases in pregnancy rates. A cognitive-behavioral group approach may be the most efficient way to achieve both goals. Given the distress levels reported by many infertile women, it is vital to expand the availability of these programs.

Pre-implantation genetic testing: decisional factors to accept or decline among in vitro fertilization patients

PURPOSE

Embryo testing to improve pregnancy outcomes among individuals who are seeking assisted reproduction technologies is increasing. The purpose of this study was to assess decisional factors through in-depth interviews for why women would accept or decline preimplantation genetic testing for aneuploidy (PGT-A) with in vitro fertilization (IVF).

METHODS

Semi-structured telephone interviews were conducted with 37 women who were offered PGT-A with IVF during the summer 2017. Interviews lasted on average 40 min and were audio-recorded, transcribed, and analyzed using a content analysis.

RESULTS

Results identified a number of decisional factors related to values about conception, disability, and pregnancy termination, past pregnancy experiences, optimism toward technology, and cost. Other key issues that were identified include the use of expanded carrier screening prior to IVF, maternal age, and limited education about PGT-A due to the complexity about education for IVF alone.

CONCLUSION

There is a need to develop decision support tools for the increasing choices of genetic testing options for patients seeking IVF. Including patients' values, past pregnancy experiences and attitudes toward science into the decision-making process may help promote a more informed decision.

Endurance with partnership: a preliminary conceptual framework for couples undergoing in vitro fertilisation treatment

BACKGROUND/OBJECTIVES

Infertility affects both women and men in the physical, emotional, existential, and interpersonal realms. When couples seek in vitro fertilisation (IVF) treatment, they further suffer from the difficulties of the treatment and the uncertainty of its outcome. The aim of this study was to develop a preliminary conceptual framework for couples undergoing IVF treatment to give health professionals a better understanding of the experiences of such couples, and to guide the development of an intervention.

METHODS

The process of identifying frameworks adopted in intervention studies confirmed that there is no established framework for infertile couples undergoing IVF treatment. A skeletal framework identified from previous studies provides an internal structure for the proposed framework for couples undergoing IVF treatment, filled out with concepts drawn from a concept analysis and a qualitative study, knitting the structure together.

RESULTS

This preliminary framework is the Endurance with Partnership Conceptual Framework (P-EPCF). It consists of four domains: the impacts of infertility and stressors, dyadic mediators, dyadic moderators and dyadic outcomes. According to the P-EPCF, the impacts of infertility and IVF treatment can be mediated by the couples' partnership and dyadic coping. Improvements in the psychological well-being and marital functioning of IVF couples can then be expected.

CONCLUSIONS

The P-EPCF would be potentially valuable in guiding the development of a complex, couple-based intervention, which could focus on enhancing the partnership of couples and their coping strategies.

The relationship between stress and infertility

The relationship between stress and infertility has been debated for years. Women with infertility report elevated levels of anxiety and depression, so it is clear that infertility causes stress. What is less clear, however, is whether or not stress causes infertility. The impact of distress on treatment outcome is difficult to investigate for a number of factors, including inaccurate self-report measures and feelings of increased optimism at treatment onset. However, the most recent research has documented the efficacy of psychological interventions in lowering psychological distress as well as being associated with significant increases in pregnancy rates. A cognitive-behavioral group approach may be the most efficient way to achieve both goals. Given the distress levels reported by many infertile women, it is vital to expand the availability of these programs.

A Partnership and Coping Enhancement Program for Couples Undergoing In Vitro Fertilization Treatment: An Intervention Study

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.

Promoting healthy lifestyle in fertility clinics; an Australian perspective

STUDY QUESTION

Are Australian fertility clinics adequately addressing unhealthy lifestyle in patients seeking fertility treatment?

SUMMARY ANSWER

This study has highlighted deficiencies in practices and education around managing patients with unhealthy lifestyle undergoing fertility treatment.

WHAT IS KNOWN ALREADY

The association between lifestyle and fertility is well documented, with obesity and smoking being of particular concern to fertility and pregnancy outcomes. Guidelines recommend that unhealthy lifestyle is addressed prior to conception, yet anecdotal experience suggests this is not being addressed. Lifestyle modification programmes can be effective in improving pregnancy rates and outcomes, however, recruitment to such programmes can be challenging.

STUDY DESIGN SIZE, DURATION

A cohort study of Australian fertility clinics’ attitudes and practices regarding lifestyle modification to augment reproductive treatment outcomes was conducted between August and October 2015.

PARTICIPANTS/MATERIALS, SETTING, METHOD

An online survey was administered to senior fertility nurses, from all registered fertility clinics in Australia. Data were collated and subjected to a univariate data analysis, where frequency tables were produced for each question. A separate qualitative analysis was undertaken of data from open ended questions.

MAIN RESULTS AND THE ROLE OF CHANCE

Fifty-three out of 85 potential respondents (62.4%), all from different clincis, completed the survey, with almost all acknowledging the importance of addressing unhealthy lifestyle before offering ART treatment. However, most clinics did not offer internal resources to assist with lifestyle modification. Whilst the promotion of healthy lifestyle was recognised as a key component of the role of a fertility nurse, participants did not feel that nurses were best equipped to provide lifestyle modification programmes, owing to a lack of resources and specific skills in this area. Suggested areas for improved practice included prioritising general health prior to offering treatment, and further utilising and upskilling nurses to assist with lifestyle modification programmes.

LIMITATIONS REASONS FOR CAUTION

The survey was completed by only one nurse from each clinic and as such may not be entirely representative of all clinic practices.

WIDER IMPLICATIONS OF THE FINDINGS

Fertility clinics are likely to see an increasing number of patients with unhealthy lifestyle, resulting in health concerns such as obesity. The results of this study provide an insight into how unhealthy lifestyle is currently being addressed in fertility clinics and suggested areas that could be targeted for improving practice and outcomes.

STUDY FUNDING/COMPETING INTERESTS

No conflict of interest to declare. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

TRIAL REGISTRATION NUMBER

NA

Screening for Psychological Conditions in Infertile Women: Provider Perspectives

PURPOSE

To determine if reproductive specialists are screening new patients for depression or anxiety, explore possible reasons why providers are not screening, and assess physician's views about the impact of mental health disorders on fertility.

MATERIALS AND METHODS

Cross-sectional exploratory study in which 86 practicing reproductive physicians filled out a 20-question survey regarding mental health screening and perception of psychological disorders on reproduction.

RESULTS

The majority of infertility providers believe psychological conditions negatively impact pregnancy success (75%); however, most providers are not formally screening patients for depression or anxiety (28%). Providers who did not screen for depression were more likely to be uncomfortable assessing patients for mental health disorders and to work in a private practice setting.

CONCLUSIONS

This study finds that most infertility specialist respondents believe that mental health conditions negatively impact reproductive outcomes; however, few of these providers are screening for psychological disorders in infertile women. Reasons why providers are not screening infertility patients for psychological disorders include lack of time and unfamiliarity with recommendations for treatment of mental health conditions. Implementing a rapid screen for anxiety and depression and providing easily assessable succinct educational updates to fertility providers on current treatment options for mental health disorders may allow affected patients to be treated sooner, and ultimately, may improve fertility outcomes.

The impact of complementary therapies on psychosocial factors in women undergoing in vitro fertilization (IVF): A systematic literature review

AIM

This review evaluates the impact of complementary therapies on psychosocial factors in women undergoing IVF.

BACKGROUND

According to the CDC, nearly 7% of married women in the United States face infertility. Approximately 1.5% of all infants born in the U.S. annually are conceived through assisted reproductive technologies (ART), such as IVF. Women undergoing ART report distress, anxiety, and depression related to their treatment. Stress has been cited as the top reason why women terminate treatment. Complementary therapies, such as mind-body techniques, have been associated with decreasing stress and anxiety.

METHODS

CINAHL and PubMED databases were searched for studies 1) published from January 2010 to 2017, 2) written in English, 3) that examined the effect of an complementary therapy on the psychological well-being of women undergoing, or about to be undergoing a cycle of IVF.

RESULTS

The search revealed 11 studies published between 2010 and 2015 from a variety of countries. The most common research design was a randomized controlled trial (n=7). The psychosocial factor most frequently measured was anxiety (n=8). The forms of complementary therapy varied, with the most common being Hatha yoga, cognitive behavioral interventions, and mind-body therapies (n=2 each).

CONCLUSIONS

Utilizing complementary therapies appears to be a positive way to decrease women's anxiety, depression, distress, and stress, and to increase fertility quality of life. This review informs providers that incorporating complementary therapies into the plan of care can lead to improved psychosocial health outcomes for women undergoing IVF.

Anxiety and depression symptoms among sub-fertile women, women pregnant after infertility treatment, and naturally pregnant women

BACKGROUND

Infertility has been associated with psychological distress, but whether these symptoms persist after achieving pregnancy via assisted reproductive technology (ART) remains unclear. We compared the prevalence of anxiety and depressive symptoms between women seeking for infertility treatment and women who conceived after ART or naturally.

METHODS

Four hundred and sixty-eight sub-fertile non-pregnant women, 2972 naturally pregnant women and 143 women pregnant after ART completed a questionnaire in this cross-sectional study. The Anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A≥8) and Edinburgh Postnatal Depression Scale (EPDS≥12) were used for assessing anxiety and depressive symptoms, respectively. Multivariate Poisson regression models with robust variance were applied to explore associations with anxiety and depressive symptoms.

RESULTS

The prevalence of anxiety and depressive symptoms among sub-fertile, non-pregnant women (57.6% and 15.7%, respectively) were significantly higher compared to women pregnant after ART (21.1% and 8.5%, respectively) and naturally pregnant women (18.8% and 10.3%, respectively). History of psychiatric diagnosis was identified as an independent risk factor for both anxiety and depressive symptoms. The presence of at least one unhealthy lifestyle behavior (daily tobacco smoking, weekly alcohol consumption, BMI≥25, and regular physical exercise<2h/week) was also associated with anxiety (Prevalence Ratio, PR: 1.24; 95%CI: 1.09-1.40) and depressive symptoms (PR: 1.25; 95%CI: 1.04-1.49).

CONCLUSIONS

Women pregnant after ART showed no difference in anxiety and depressive symptoms compared to naturally pregnant women. However, early psychological counseling and management of unhealthy lifestyle behaviors for sub-fertile women may be advisable, particularly for women with a previous history of psychiatric diagnosis.

The Partnership and Coping Enhancement Programme for couples undergoing in vitro fertilization treatment: the development of a complex intervention in China

PURPOSE

Couples as dyads suffer from the diagnosis of infertility and related treatment. These couples commonly experience emotional and physical pain and tension in their marital lives. The purpose of this study is to report on the process of developing a potentially feasible and effective complex intervention for couples undergoing in vitro fertilization treatment in China.

METHODS

The Medical Research Council (MRC) framework for developing and evaluating the complex intervention was adopted to guide the development of the Partnership and Coping Enhancement Programme (PCEP). In developing the PCEP, three steps were taken, namely, (1) identifying evidence by conducting literature reviews, a concept analysis and a qualitative study; (2) identifying/developing a theory-in this case, a preliminary Endurance with Partnership Conceptual Framework (P-EPCF) was proposed; and (3) modelling the process and outcomes of the PCEP.

RESULTS

The PCEP that was developed is targeted mainly at the domains of the partnership mediators of stress in the P-EPCF. It consists of two sections-partnership and coping-and will be delivered to infertile couples on the day of embryo transfer. The main focuses of the programme are to facilitate mutual sharing and support in infertile couples, and to improve their individual and dyadic coping strategies while undergoing IVF treatment, especially in the period when they are waiting for the results of a pregnancy test and after the disclosure of a negative treatment outcome. The programme is couple-based, consisting of experience sharing, psychoeducation, meditation exercise, skill practise and supplemental written materials.

CONCLUSIONS

The Partnership and Coping Enhancement Programme (PCEP) for couples undergoing in vitro fertilization treatment was developed according to the guideline of the MRC framework. It is recommended that a pilot study be conducted to evaluate its feasibility and to model the process and outcomes of the programme.