Psychiatric morbidity in couples attending a fertility service

The impact of successful assisted reproduction treatment on female and male mental health during transition to parenthood: a prospective controlled study

BACKGROUND

The dynamics of mental health during the transition to parenthood have not been a focus of research. Our prospective longitudinal study was designed to reveal whether there are differences in mental health during the transition to parenthood between parents undergoing treatment with assisted reproduction techniques (ART) and those who conceive spontaneously.

METHODS

STUDY GROUP

367 couples with a singleton ART pregnancy using their own gametes.

CONTROL GROUP

379 couples with a spontaneous singleton pregnancy. Men and women separately filled in questionnaires including the General Health Questionnaire: at the 18th-20th week of pregnancy, 2 months postpartum and 1 year postpartum (T3). The effect of social and child-related factors on mental health was examined.

RESULTS

ART women had fewer depressive symptoms during pregnancy than controls, but at T3 their depressive symptoms were at the same level as seen in controls. Anxiety symptoms increased among control but not among ART women across the transition. ART men reported generally fewer mental health symptoms than their controls. Social and child-related stressors had negative impacts on mental health changes among control couples, whereas no impact was found among ART couples.

CONCLUSIONS

Successful ART did not predict mental health problems during the transition to parenthood. Moreover, ART couples' mental health was remarkably resistant to social and child-related stress during the transition to parenthood.

Estresse e função reprodutiva feminina

Este artigo discute a relação do estresse sobre a função reprodutiva, considerando que a infertilidade pode ter causas psicológicas (hipótese da psicogênese) ou pode ser a origem do estresse psicológico. A presença do estresse tem o potencial de ativar o eixo hipotálamo-hipófise-adrenal, o qual, inibe o eixo hipotálamo-hipófise-ovariano, levando à paralisação temporária das menstruações. Esse processo pode resultar em infertilidade transitória para as mulheres. Os autores enfatizam a necessidade de uma abordagem psicológica nos serviços de reprodução, objetivando trabalhar as tensões e frustrações advindas da infertilidade e do seu tratamento.

A survey of relationship between anxiety, depression and duration of infertility

Background

A cross sectional study was designed to survey the relationship between anxiety/depression and duration/cause of infertility, in Vali-e-Asr Reproductive Health Research Center, Tehran, Iran.

Methods

After obtaining their consents, 370 female patients with different infertility causes participated in, and data gathered by Beck Depression Inventory(BDI) and Cattle questionnaires for surveying anxiety and depression due to the duration of infertility. This was studied in relation to patients' age, educational level, socio-economic status and job (patients and their husbands).

Results

Age range was 17–45 years and duration and cause of infertility was 1–20 years. This survey showed that 151 women (40.8%) had depression and 321 women (86.8%) had anxiety. Depression had a significant relation with cause of infertility, duration of infertility, educational level, and job of women. Anxiety had a significant relationship with duration of infertility and educational level, but not with cause of infertility, or job. Findings showed that anxiety and depression were most common after 4–6 years of infertility and especially severe depression could be found in those who had infertility for 7–9 years.

Conclusions

Adequate attention to these patients psychologically and treating them properly, is of great importance for their mental health and will improve quality of their lives.

Prevalence of depressive and anxiety disorders in an assisted reproductive technique clinic

BACKGROUND

Little is known about the prevalence of specific depressive and anxiety disorders in women before a new course of assisted reproductive technology treatment. Few studies have adopted the proper psychiatric diagnostic procedures.

METHODS

All consecutive women visiting the assisted reproduction clinic of a university-affiliated medical centre, with the intention of starting a new assisted reproduction treatment course, were recruited. A psychiatrist made a diagnosis of psychiatric disorders using a structured interview, the Mini-International Neuropsychiatric Interview (MINI).

RESULTS

Of a total of 112 participants, 40.2% had a psychiatric disorder. The most common diagnosis was generalized anxiety disorder (23.2%), followed by major depressive disorder (17.0%), and dysthymic disorder (9.8%). Participants with a psychiatric morbidity did not differ from those without in terms of age, education, income, or years of infertility. Women with a history of previous assisted reproduction treatment did not differ from those without in depression or anxiety.

CONCLUSIONS

Depressive and anxiety disorders were highly prevalent among women who visited an assisted reproduction clinic for a new course of the treatment. Demographic features and a history of previous assisted reproduction treatment were not risk factors for these psychiatric morbidities in the assisted reproduction clinic.

Comparison of the psychological evaluation test and classical psychoanalysis in infertile women

This study aims to compare a psychological evaluation test to classical psychoanalysis in infertile women. Two hundred women were submitted to the Psychological Evaluation Test (PET). The sum of the scores for the responses ranged from 15 to 60 points, with scores >/=30 points being defined as 'psycho-emotional maladjustment' (cut-off point: median + 25%). For comparison, the patients were simultaneously submitted to a psychological examination by a psychologist, who was unaware of the PET results. Of the 200 patients, 66 (33%) presented a test with >/=30 points ('psycho-emotional maladjustment') and 134 (67%) a test with <30 points (normal). Upon psychological examination, 105 (52.5%) presented an abnormal evaluation and 95 (47.5%) a normal evaluation. For the PET, statistical analysis showed 82% efficiency, 62% sensitivity, 98% positive predictive value, 99% specificity, 70% negative predictive value, likelihood ratio for a positive test result 62, and likelihood ratio for negative test result 0.38. The PET proved to be a useful clinical instrument, being of help in the selection of patients with psychological needs induced by infertility.

Stress in assisted reproductive technology: implications for nursing practice

In a follow-up study about women's experience of assisted reproductive technology (ART) some events were identified as particularly stressful, including making the decision to try ART, starting treatment, waiting for results after a scan, having oocyte collection, the 2 week wait after embryo transfer and finding out that the treatment was unsuccessful. On the basis of these findings, a review of the literature and extensive clinical practice as a nurse co-ordinator in an ART programme, implications for nursing practice are discussed and strategies to use that may help reduce stress and improve the well-being of ART participants are suggested.

A time for change and a time for equality--infertility services and the NHS

The provision of infertility services has always provoked controversy. On the one hand, patients' groups and clinicians involved with infertile couples have long campaigned against the 'postcode lottery'. On the other hand, commissioners have been reluctant to commit resources to what they see as a low priority in health care. The issue has been brought back into the news with the government's decision to ask the National Institute of Clinical Excellence to review the inequalities in provision of fertility services. This article sets out the evidence for viewing infertility as an illness that deserves public funding, and argues that assisted conception should be viewed in the same light as other chronic non-life-threatening conditions that are currently funded by the NHS.