The experience of infertility: a review of recent literature

Association of depression and resilience with fertility quality of life among patients presenting to the infertility centre for treatment in Karachi, Pakistan

Background

In Pakistan there is a dire need to explore the quality of life in infertile males and females and its undesirable psychological outcomes. This, study aimed to compare the quality of life (QoL) of males and females visiting an infertility centre for treatment and to assess its association with resilience, depression, and other socio-demographic factors.

Methods

An Analytical Cross-Sectional study was conducted amongst infertile males and females at the Australian Concept Infertility Medical Centre (ACIMC), Karachi, Pakistan. The non-probability (purposive) sampling strategy was used to recruit the participants. The sample size was 668. Data was analysed using STATA version 12. FertiQoL tool, Beck II Depression Inventory Tool and Resilience Scale 14 (RS-14) were used for assessing the quality of life, depression and resilience respectively of infertile patients.

Results

Total 668 infertile patients, 334 males and 334 females participated in the study. The mean age was 35.53 ± 6.72, among males, and 30.87 ± 6.12 among females. The mean resilience scores were significantly higher among males, (77.64 ± 8.56), as compared to females (76.19 ± 8.69) (95% CI; − 2.757, − 0.1347). However, a significantly higher proportion of females were depressed (13.8%) as compared to males (6%). The mean QoL scores for the general health domain, emotional domain, mind and body domain, and relational domain, and the total QoL were significantly higher in males as compared to females (p value< 0.001); however, QoL for the social domain was not significantly different in both the groups. On multivariable linear regression resilience and depression among males had a significant association with QoL, after adjusting for the covariates educational status, monthly income, and number of friends. Similar association was observed among females after adjusting for the covariate monthly income only.

Conclusion

Fertility related QoL of men and women has a significant association with no formal education, number of friends, income, depression and resilience. Therefore, health care professionals in the field of infertility must be adequately trained to respond to the needs of individuals going through these psychological problems.

Support or stressor? The community as a predictor of perceptions of infertility

Perceptions of women experiencing infertility may influence their coping and psychological adjustment. This study examined the influence of community pressure and support on the perception of fertility problems among 156 women in religious Jewish societies in Israel, undergoing fertility treatment. Regression analyses indicated that perceptions of pressure from the community were associated with more problematic consequences and problem severity and timeline, while perceptions of community support were simultaneously associated with lower levels of loss of control and higher levels of problematic consequences. Thus, social work interventions should consider ways to increase support, while reducing the stress resulting from it.

Quality of life and related constructs in a group of infertile Hungarian women: a validation study of the FertiQoL

Quality-of-life measurement is a basic prerequisite for psychologically sensitive fertility care and the FertiQoL is a psychometrically sound outcome measure in this field. The aim of the present research was to investigate the reliability and validity of the Hungarian Core FertiQoL. Two independent samples of infertile women were merged (n = 320). While the model fit of the four-factor Confirmatory Factor Analysis was under the level of acceptability (χ²(246) = 626.36, p < 0.001, RMSEA = 0.070 [CI₉₀ = 0.063-0.076], CFI = 0.878, SRMR = 0.071), the four-factor Exploratory Structural Equation Model showed much improved model fit (χ²(186) = 395.63, p < 0.001, RMSEA = 0.059 [CI₉₀ = 0.051-0.067], CFI = 0.933, SRMR = 0.035). Good internal consistency (Cronbach's Alphas 0.77-0.92) and construct reliability (0.75-0.95) were found for both factor structures. Depression correlated negatively with fertility-specific quality of life. Almost a quarter of the sample suffered from moderate-to-severe depression. Multivariate analysis of variance indicated that Beck Depression Inventory categories (mild, moderate etc.) co-occurred with significantly distinct FertiQoL score ranges, leading to a possible, clinically meaningful threshold on the Core FertiQoL. Pearson coefficients showed secondary infertility, rural residency and pre-treatment status to be associated with better fertility quality of life.

Reproductive Health Literacy and Fertility Awareness Among Polish Female Students

The falling fertility indicators and high prevalence of infertility in Poland make it important for people of reproductive age to have good knowledge of their own fertility in order to be able to take care of their reproductive health. This paper examines reproductive health literacy and fertility awareness among Polish female students. It can help identify gaps in reproductive health education in Poland. The study group included 456 women aged 18–29, who were students of 6 public universities located in Poznan, Poland. The method used was a survey using a self-developed questionnaire assessing the students' knowledge of female and male fertility-related physiology and fertility patterns. The respondents' knowledge was assessed on the basis of the percentage of correct answers. Regression analysis and univariate analysis of variance were used to explore relationships between the students' knowledge and their age, year of study, university and source(s) of information. The average score of correct answers was 55.8%. Older students and medical university students were the most knowledgeable. 93.4% of the respondents correctly identified the optimum age for a woman to have the first child from the point of view of achieving pregnancy fast. Over 90% of the respondents knew such fertility-compromising risks as smoking, diseases and psychological distress. There was much poorer awareness of the adverse effect of unbalanced diet, irregular sleep, and long-lasting physical effort. 47.1% of the students reported gaining information from a number of sources, but as many as 28.3% said their only source was primary or middle school classes. Reproductive health knowledge among the young female students is incomplete, especially as regards lifestyle-related risks. They should be encouraged to supplement it by consulting reliable sources such as health professionals. It is advisable to ensure that the curricula of medical university students provide thorough knowledge in this area, and to arrange suitable electives for students from other universities. As primary and secondary school classes remain an important source of information, quality teaching at these levels should be offered with a focus on making the knowledge as practical and operational as possible. Relevant graduate, postgraduate and in-service courses should be available to professionals responsible for spreading reproductive health knowledge.

Women from diverse minority ethnic or religious backgrounds desire more infertility education and more culturally and personally sensitive fertility care

STUDY QUESTION

What are the views, experiences and healthcare needs of infertile women from a minority ethnic or religious background living in Wales?

SUMMARY ANSWER

Women from ethnic and religious minority backgrounds consider that their communities have highly pronatalistic attitudes and stigmatize infertility, and express the need for more infertility education (for themselves and their communities), as well as more socio-culturally and interpersonally sensitive fertility care.

WHAT IS ALREADY KNOWN

Some people from minority ethnic or religious groups perceive pressure to conceive from their communities, experience social costs when they are unable to have children and stressful interactions with the fertility healthcare system while attempting to conceive.

STUDY DESIGN, SIZE, DURATION

This study was based on a one-day drawing workshop to collect visual (artwork produced by participants) and textual (all conversations and discussions during the workshop) data about the participants' views and experiences of infertility and their fertility care needs.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Participants were nine adult women with a minority ethnic or religious status living in Wales, UK, who were experiencing or had experienced infertility in the past. The workshop comprised five activities: (i) small and large group discussion of infertility-related drawings, (ii) lide-based lecture consisting of an introduction to the basics of drawing objects and people and (iii) thoughts and feelings, (iv) free drawing session and (v) group sharing. Audio recordings of the workshop were transcribed verbatim. Textual data was analysed with thematic analysis. Risk for bias was addressed via individual coding by two authors followed by joint presentation and discussion of results with the research team and participants.

MAIN RESULTS AND THE ROLE OF CHANCE

Forty-one themes were identified and grouped into eight distinct higher order themes. These themes described the emotional, relational and social burden of infertility experienced by women, which they perceived to result from their communities' highly pronatalistic attitudes and stigmatization of infertility. Themes also captured women's adaptive coping strategies and critical attitude towards pronatalist ideologies. Lastly, themes captured their overall positive evaluation of their fertility health care, their desire for more infertility education (for themselves and their communities) and for culturally competent and interpersonally sensitive care.

LIMITATIONS, REASONS FOR CAUTION

Our participants were a small, non-random sample recruited in collaboration with a local charity, which may mean that all participants were well integrated in their communities. Analysis focused on capturing commonalities in participants' experiences and this may sometimes result in homogenising diverse experiences.

WIDER IMPLICATIONS OF THE FINDINGS

More education about the infertility experiences of minority ethnic and religious groups at the community and healthcare delivery level may translate into lessened negative attitudes towards infertility and more culturally competent care, which can be beneficial for women.

STUDY FUNDING/COMPETING INTEREST(S)

This research was funded by Welsh Crucible. The authors have no conflict of interests to declare.

Fertility awareness and parenting intentions among Mexican undergraduate and graduate university students

An online, cross-sectional survey was carried out between November 2017 and January 2018 to assess fertility awareness among students attending the National Autonomous University of Mexico (UNAM) in Mexico City. A total of 371 students participated in the survey (n = 228 females, 143 males). 75% of females and 74% of males believed a woman's fertility begins to decline markedly after age 40. Over 75% of all participants overestimated the probability of couples having a live birth after undergoing one cycle of IVF. With regard to parenting intentions, only 48% of females wished to have children compared to 59% of males (p = 0.037) and men were more likely to have their first child at age 30 or later (71% men vs 55% women). In the event of infertility, participants had a higher preference not to have children or to pursue adoption rather than use in vitro fertilisation (IVF). In summary, university students in Mexico City demonstrated low levels of fertility awareness and a smaller proportion indicated a wish to have children than has been reported by young people elsewhere in the world.

Predictors of infertility-related concerns in a Canadian survey of men and women seeking fertility treatment

OBJECTIVE

To examine if and how factors associated with infertility-related concerns and opportunity to discuss concerns differ between male and female fertility patients.

METHODS

A cross-sectional survey of 313 female and 254 male patients recruited from Canadian fertility clinics. An online survey asked about sociodemographic characteristics, psychological distress, the severity of psychosocial concerns on a scale of 0 (not concerned) to 5 (very concerned) related to fertility treatment, and their opportunity and desire to discuss concerns with healthcare providers (HCPs).

RESULTS

For women, higher stress, educational attainment and being childless were associated with higher concern (F(6, 287) = 14.73, p < .001). For men, higher stress, being religious and longer treatment duration were associated with higher concern (F(8, 222) = 9.87, p < .001). No significant difference existed between men's and women's average concern scores (t(558) = -1.62, p = .11) or opportunity to discuss concerns (t(149) = 0.28, p = .78).

CONCLUSION

Our results indicate an unmet need and desire for support among subgroups of patients who were concerned about psychosocial issues related to infertility, but did not have the opportunity to discuss these issues with HCPs.

PRACTICE IMPLICATIONS

There is a need to tailor resources to address the concerns of male and female fertility patients from diverse sociodemographic backgrounds and with different fertility histories.

Is perception of inability to procreate a temporal phenomenon?: A longitudinal exploration of changes and determinants among women and men of reproductive age in Germany

Continued postponement of births and increasing use of reproductive medicine enhance the relevance of infertility and related perceptions for fertility research. Fertility researchers tend to assume that an existing perception of inability to procreate is a stable trait among persons of reproductive age. This assumption is questionable from a life course perspective and has not been thoroughly investigated. Therefore we investigate the prevalence, stability, and correlates of perceived inability to procreate. We apply between-within logit models to annual panel data (2008-2015) to study variation in perceived inability to procreate within individuals over time and between individuals. We find that approximately every 20th person of reproductive age is affected. There is considerable instability among those who ever perceive an inability to procreate: On average, 39 % of women and 48 % of men who perceive an inability in one year change to not perceiving an inability in the next year. Multivariate analysis shows that increases in age and perception of one's partner as unable to procreate are associated with higher odds of perceiving an inability to procreate. Not using contraception is associated with higher odds of perceiving an inability to procreate. Perceived procreative ability further differs by parity, level of education, immigration background, and religious denomination. In summary, perception of inability to procreate is a temporal phenomenon that is shaped by lifecourse contexts and social group differences.

Oxidative Stress is Associated with Reduced Sperm Motility in Normal Semen

Infertility is among the most serious medical problems worldwide. Male factors contribute to 40%-50% of all infertility cases, and approximately 7% of men worldwide are affected by infertility. Spermatozoa are extremely vulnerable to oxidative insult. Oxidative stress results in axonemal damage and increased midpiece sperm morphological defects, which lead to reduced sperm motility. The aim of the study is to evaluate the association between sperm motility and the levels of selected antioxidants, cytokines, and markers of oxidative damage in the seminal plasma.The study group included 107 healthy males, who were split into two subgroups based on the percentage of motile spermatozoa after 1 hr: low motility (LM, n = 51) and high motility (HM, n = 56).The glucose-6-phosphate dehydrogenase (G6PD) activity was 52% lower in the LM group compared to that in the HM group. The level of malondialdehyde (MDA) was 12% higher in the LM group compared to that in the HM group. Similarly, the median values of interleukin (IL)-1β, IL-10, IL-12, and tumor necrosis factor alpha (TNF-α) were higher in the LM group than those in the HM group. Results of the present study revealed that the percentage of motile spermatozoa after 1 hr correlated positively with the levels of IL-1β, IL-10, IL-12, and TNFα.The lower motility of spermatozoa in healthy men is associated with a decreased activity of G6PD and increased levels of cytokines, which may be related to increased oxidative stress in seminal plasma that manifests as an increased level of MDA.

The role of gender and self-esteem as moderators of the relationship between stigma and psychological distress among infertile couples

To determine if perceived stigma is positively associated with psychological distress, and examine if self-esteem has a moderating effect on the relationship between stigma and psychological distress among infertile Chinese couples. 369 infertile couples completed questionnaires including socio-demographic and clinical characteristics, stigma, self-esteem, and psychological distress. Stigma had a significant, positive association with psychological distress (r = 0.461, P < 0.01). Self-esteem moderated the association between stigma and psychological distress differently for men compared to women. Stigma had a positive, moderate association with psychological distress in men with high self-esteem compared to men with low self-esteem (t = 3.232, P < 0.01). However, there was no significant difference in the relationship between stigma and psychological distress between women with high and low self-esteem, tests of the simple slopes showed that non-significant difference of slopes between the two groups (t = -0.017, P = 0.987). The results indicate that self-esteem buffers the net effect of stigma on psychological distress in men but not women. Future research should focus on interventions that use self-esteem as a way to decrease the negative association of stigma with psychological distress, especially among men who are infertile and have low self-esteem.

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.

Does Self-Identifying as Having a Health Problem Precede Medical Contact? The Case of Infertility

Studies of medical help-seeking presume that self-identifying as having a health problem precedes medical contact, but this ordering of the identity-behavior relationship has not been systematically examined. We used longitudinal data from the National Survey of Fertility Barriers (2004 to 2010) on 412 women with infertility to document the temporal relationship between self-identifying as having a fertility problem and making medical contact. The symbolic interactionist perspective suggests that infertility will be perceived as identity disruption and that in response women will align self-identity and medical behavior over time. Cross-tabulation analysis indicated that more women do self-identify as having a fertility problem first (24 percent) as opposed to making medical contact first (5.5 percent). There was also a tendency toward aligning self-identification and behavior over time. Latent class analyses revealed six patterns: 1) consistently involved, 2) early consulters, 3) consistently uninvolved, 4) consistent perceivers, 5) medical dropouts, and 6) early perceivers. Strong fertility intent and primary infertility, two identity-relevant characteristics, had the strongest associations with latent class membership. The relationship between self-identification and medical help-seeking is thus dynamic and complex.

Stressful life events, the incidence of infertility, and the moderating effect of maternal responsiveness: a longitudinal study

Although the association between stress and poor reproductive health is well established, this association has not been examined from a life course perspective. Using data from the National Longitudinal Survey of Youth 1997 cohort (N = 1652), we fit logistic regression models to test the association between stressful life events (SLEs) (e.g., death of a close relative, victim of a violent crime) during childhood, adolescence, and early adulthood and later experiences of infertility (inability to achieve pregnancy after 12 months of intercourse without contraception) reported by female respondents. Because reactions to SLEs may be moderated by different family life experiences, we stratified responses by maternal responsiveness (based on the Conger and Elder Parent-Youth Relationship scale) in adolescence. After adjusting for demographic and environmental factors, in comparison to respondents with one or zero SLEs, those with 3 SLEs and ≥ 4 SLEs had 1.68 (1.16, 2.42) and 1.88 (1.38, 2.57) times higher odds of infertility, respectively. Respondents with low maternal responsiveness had higher odds of infertility that increased in a dose-response manner. Among respondents with high maternal responsiveness, only those experiencing four or more SLEs had an elevated risk of infertility (aOR = 1.53; 1.05, 2.25). In this novel investigation, we demonstrate a temporal association between the experience of SLEs and self-reported infertility. This association varies by maternal responsiveness in adolescence, highlighting the importance of maternal behavior toward children in mitigating harms associated with stress over the life course.

Effects of psychological intervention for Korean infertile women under In Vitro Fertilization on infertility stress, depression, intimacy, sexual satisfaction and fatigue

This quasi-experimental study with a nonequivalent control group pretest-posttest design was conducted to evaluate the effects of a psychological intervention program for 50 women with infertility (experimental group: 26, control group: 24) utilizing assisted reproductive technology. The experimental group received six four-hour sessions of intervention, with outcomes measured at baseline and four weeks post-intervention. The experimental group demonstrated significant improvements in marital intimacy (z = 6.528, p < .001) and sexual satisfaction (z = 3.148, p = .003) and significant reductions in depression (z = -4.850, p < .001) and fatigue (z = -4.597, p < .001). Thus, the program can alleviate depression and fatigue. Further, psychological intervention centered on the marital and personal dimensions may improve marital intimacy and sexual satisfaction.

Success of assisted reproductive technology treatment and couple relationship: A pilot study on the role of romantic attachment

Infertility is a deeply distressing experience, which can threaten important personal and martial goals, frequently affecting the psychophysical health. A supportive relationship and a secure romantic attachment appear to reduce infertility stress, as well as play a relevant role in the success of assisted reproductive technology treatments. The principal aim of the study is to investigate the predictive effect of romantic attachment, couple characteristics, quality of life and age on assisted reproductive technology outcome. A total of 88 infertile women, enrolled in an assisted reproductive technology Centre of Rome, completed the Experience in Close Relationship-Revised, the Couple Relationship Inventory, the Fertility Quality of Life and a socio-demographic questionnaire. The participants completed the questionnaires at the beginning of the medical treatment. Data analyses showed significant associations among Experience in Close Relationship-Revised dimensions, Couple Relationship Inventory and Fertility Quality of Life Scales. Assisted reproductive technology outcome was negatively correlated to Experience in Close Relationship-Revised Avoidance and positively related to Couple Relationship Inventory Dependence. A multi-variable logistic regression revealed that Experience in Close Relationship-Revised Avoidance decreased the probability of pregnancy. The present findings partially confirmed the study hypotheses since several associations among couple characteristics, attachment anxiety and avoidance dimensions, infertility-related quality of life in infertile women were found. Furthermore, according to a definition of Avoidance, assisted reproductive technology positive outcome appears to be associated to lower levels of fear of dependence and interpersonal intimacy, and to a low need both for self-reliance and for reluctance to self-disclose within the romantic relationship. Further investigations are needed both to confirm this preliminary finding and for promoting focused therapeutic interventions for couples facing assisted reproductive technology.

Futures and fears in the freezer: Danish women's experiences with ovarian tissue cryopreservation and transplantation

RESEARCH QUESTION

Ovarian tissue cryopreservation (OTC) and subsequent re-transplantation is gaining ground as a valid technique to preserve fertility in patients facing imminent cancer treatment. This study explores patients' experiences with OTC and transplantation, including their reflections on long-term storage of tissue and the use of surplus tissue.

DESIGN

Semi-structured qualitative interviews with 42 Danish women undergoing OTC between 2003 and 2018, 32 of whom had ovarian tissue transplanted.

RESULTS

Overall, OTC was associated with positive experiences linked to the production of future-oriented hope and reproductive possibilities. It also generated a range of worries, particularly regarding hormone-sensitive cancers and the risk of re-transplanting malignant cells, and the women's arduous journeys to conceive after cancer resonated through the accounts. Moreover, the women's understanding of, and access to, information about the OTC procedure and its prospects affected the ways in which they approached storage and transplantation of their frozen tissue. Finally, the interviews showed how the stored ovarian tissue was also infused with potentiality beyond the scope of reproduction, both as a remedy to restore hormonal cycles and in the imagination of the-yet-to-be-discovered potential informing the women's reflections on donation and destruction.

CONCLUSION

Although OTC is a 'hope technology' compared with freezing of oocytes and embryos, ovarian tissue is interlinked with risk and disease and positioned as an asset beyond the scope of reproduction. Importantly, this study underscores the need for provision of specialized information, follow-up, and fertility counselling after OTC and cancer treatment.

Development and psychometric evaluation of the female infertility stigma instrument (ISI-F): protocol for a mixed method study

Background

Infertility stigma is one of the greatest challenges in most societies for reproduction and sexual health of infertile women. Since no specific tool exists for assessing the infertility stigma in women, this study would be conducted to develop and evaluate the psychometric properties of Female Infertility Stigma Instrument (ISI-F).

Methods

This is a mixed method study with sequential exploratory design (qualitative and quantitative phase). In the first qualitative phase, semi-structured interviews would be performed with infertile female who had experienced infertility whithout any psychological disorder. Women who are eligible for participating in the study will be selected using purposeful sampling method with maximum variation in terms of age, education, occupation and infertility duration. Data would be analyzed using conventional content analysis and in this phase the primary item pool will be developed for the Female Infertility Stigma Instrument (ISI-F). In the quantitative phase, the psychometric properties of the Instrument would be evaluated, including the content, face and construct validity as well as reliability via the internal consistency and stability. The psychometric properties described in the COSMIN checklist will be utilized for designing the instrument.

Discussion

Developing a valid and reliable scale for Female Infertility Stigma Instrument (ISI-F) would be helpful for future studies to assess the status of this situation. It also helps planning interventional studies for improvement of the reproductive health of infertile women.

The role of social media for persons affected by infertility

Background

Infertility remains a common universal disorder and a whole range of assisted reproductive technologies has been established. Society may fail to recognize the grief caused by infertility, which may lead to those struggling with it hiding their feelings. Previous research points out that infertile persons experience shortcomings in fertility care regarding continuity of care and social support. Social media may provide social and psychological support for infertile persons. Finding others who are going through similar experiences can help in the realization that the person is not alone and that her/his feelings are reasonable. The aim was to explore the roles of social media for persons affected by infertility.

Methods

A cross-sectional, computer-assisted, self-administered online questionnaire, containing both open and closed questions, was used to collect data. The questionnaire was linked to the bulletin board of six closed infertility social forums. Both quantitative and qualitative analysis methods were used. A total of 132 participants completed the questionnaire containing questions about their use of social media dealing with infertility.

Results

Most of the questionnaires were answered by females (97.7%) through Facebook (87%). Over 60% of the respondents had taken part in discussions about infertility in social media, between one and three years and 39% participated more than once a day. Half of the participants devoted one to three hours weekly to the forums and wrote 1–5 postings per week. The forums offered participants information, solidarity, and the opportunity to receive and give support. However, an adverse aspect that was described concerned advice that were not evidence-based. Infertility was experienced as being alienated from social life and being fragmented as a person.

Conclusion

Participating in infertility forums offers persons information about fertility treatments and social support in the process of coping with infertility.

Stress, stigma, violence experiences and social support of US infertile women

Objectives: Previous studies investigated the physical, psychological and sociological effects of infertility; however, stigma and violence experiences of infertile women haven't yet been studied in the US. The objective of the study is to examine the perceived stress, stigma, violence experiences, and social support of US infertile women and to compare with fertile women in order to understand the effects of infertility on stress levels, violence exposures, and support. Methods: The descriptive, cross-sectional study was conducted with fertile and infertile women who use social media for an online support group. A convenience sample of 786 women completed an online survey. Results: In the study, 41.6% of participants were fertile and 58.4% were infertile. We found infertile women experienced high levels of stigma and moderate stress. One in five infertile women has been exposed to emotional or physical violence. Compared to fertile women, infertile women had significantly higher perceived stress levels and were less likely to experience emotional or physical violence. Conclusion: These findings highlight that infertile women have experienced stigma and high levels of stress in a developed country. They are also exposed to emotional or physical violence, but surprisingly infertile women are less likely to report violence than fertile women.

'Either stay grieving, or deal with it': the psychological impact of involuntary childlessness for women living in midlife

STUDY QUESTION

What is it like for women to be involuntarily childless in midlife?

SUMMARY ANSWER

Involuntarily childless women may be suffering from prolonged grief due to its ambiguous and intangible nature; however, they are also striving to find ways of dealing with their internal pain in order to live with their loss.

WHAT IS KNOWN ALREADY

Many studies examining issues around human reproduction have tended to place childlessness in the realm of medicalised infertility and report generalised mental issues, such as depression and psychological distress, existing amongst women undergoing fertility treatments. Few studies, however, have focused on the individual with regard to the experiential significance of involuntary childlessness and living beyond the phase of trying for a baby.

STUDY DESIGN, SIZE, DURATION

A phenomenologically oriented person-centred qualitative design was used. In-depth semi-structured interviews were conducted with 12 White British women, who identified themselves as involuntarily childless, recruited via three leading childless support networks in the UK.

PARTICIPANTS/MATERIALS, SETTING, METHODS

In order to retain an idiographic commitment to the detailed account of a person's experience, a homogeneous and purposive sampling was used applying the following criteria: women aged between 45 and 55; in long-term heterosexual relationships with no adopted children, stepchildren or children of a partner from a previous marriage or relationship; and no longer trying to have a child. Considering the homogeneity of ethnic background and wishing to respect cultural differences, this study focused on White British women living in the UK. Of the 12, one woman was found to not meet the criteria, and therefore, the experiential data of 11 interviews were used for the study and analysed using interpretative phenomenological analysis (IPA).

MAIN RESULTS AND THE ROLE OF CHANCE

Two higher-order levels of themes that illustrate intrapersonal features were identified: the intrapersonal consequences of loss and confronting internal pain. The former explicated the depth of internal pain while the latter revealed ways in which the participants deal with it in their everyday lives. The important finding here is that both themes are co-existing internal features and dynamically experienced by the participants as they live with the absence of much-hoped-for children.

LIMITATIONS, REASONS FOR CAUTION

Given the homogeneous sampling and the small number of participants, which is consistent with IPA, we want to be cautious in generalising our study findings.

WIDER IMPLICATIONS OF THE FINDINGS

This study offers the view that there might be potential mental health issues surrounding involuntary childlessness that are currently overlooked. Particularly because the loss of hope cannot be pathologised, and the grief is ambiguous and intangible, it might make people's grieving process more complicated. An ongoing sense of uncertainty also may persist in that involuntarily childless people may develop symptoms similar to those diagnosed with prolonged grief disorder (PGD). The overall findings elucidate the need for clinicians, counsellors and health professionals to be aware of the possible association with PGD and promote long-term support and care in helping to maintain psychological well-being for people dealing with involuntary childlessness. Furthermore, this research points to an educational application for younger people by offering information beyond an explanation of infertility and fertility treatment, helping to understand the lived experience of involuntary childlessness.

STUDY FUNDING/COMPETING INTEREST(S)

No funding was obtained for this study. The authors have no conflicts of interest to declare.

TRIAL REGISTRATION NUMBER

Not applicable.

Measuring the Multidimensional Reproductive Concerns of Young Adult Male Cancer Survivors

Purpose: The aims of this study were to adapt the multidimensional Reproductive Concerns After Cancer (RCAC) scale for use with young adult (YA) male cancer survivors, defined as current age 18-35 years and at least 1 year postdiagnosis, and to examine the factor structure, reliability, and validity of the newly adapted RCAC-Male (RCAC-M) scale. Methods: We conducted cognitive interviews with 10 YA male cancer survivors to inform modifications to RCAC item wording. Online surveys were then completed by 170 YA male cancer survivors. We used confirmatory factor analysis to examine structural models of the RCAC-M scale, and assessed reliability and construct validity. Results: The oblique six-factor model of the RCAC-M scale provided the best model fit. Omega total and Revelle's omega total estimates for all six three-item subscales were in the nearly satisfactory to good range (0.69-0.88). As hypothesized, men who wanted to have a baby and men who believed that having a biological child was very important scored higher on at least one RCAC-M subscale. We observed correlations in the expected directions between the RCAC-M and measures of depression and health-related quality of life. Conclusion: The RCAC-M scale is a multidimensional scale that is best represented as a profile of subscale scores. This scale demonstrated good reliability and construct validity and can be used to inform tailored interventions to more effectively address men's reproductive concerns.

The status of medication literacy and associated factors of hypertensive patients in China: a cross-sectional study

The adverse consequence of low medication literacy is a major problem that threatens patients' health. The number of people with hypertension is increasing in China. We described the current situation of medication literacy of patients with hypertension in China and its related influencing factor. We conducted a cross-sectional study, which contains 590 hypertensive patients. Stratified sampling was adopted according to the hospital level in China. To determine the factors related to medication literacy, multiple linear regression analysis was used to determine associations between medication literacy of hypertensive patients and other factors. Among 590 respondents, results showed that they have poor medication literacy. Multiple linear regression analysis showed that level of education, annual income, occupation status, and type of medical insurance were significantly associated with medication literacy level of hypertensive patients. In addition, our study also demonstrates that we can identify the medication literacy level of hypertensive patients using the Chinese version Medication Literacy Scale for Hypertensive Patients. High medication literacy is an important factor for hypertensive patients to improve medication adherence, so as to better control blood pressure. We should pay attention to the improvement of medication literacy and take corresponding measures.

Is infertility resolution associated with a change in women's well-being?

STUDY QUESTION

Is giving birth associated with improved subjective well-being among involuntarily childless women?

SUMMARY ANSWER

Resolution of infertility is associated with increased life satisfaction and self-esteem, but not with a decrease in depressive symptoms.

WHAT IS KNOWN ALREADY

Cross-sectional data and studies of treatment-seekers show that infertility is associated with lower subjective well-being. Childless women with infertility tend to report lower subjective well-being than women who experience secondary infertility, but a prospective study using a random sample of involuntarily childless women over time has not previously been conducted.

STUDY DESIGN, SIZE, DURATION

The sample for the current study includes all women without children who met medical criteria for infertility or perceived a fertility problem (N = 283) at baseline and who were interviewed in both waves (3 years apart) of the National Survey of Fertility Barriers (NSFB), in a random-digit dialing telephone survey. It is therefore possible to explore here whether there are differences in the association of infertility resolution and subjective well-being among women who do and do not perceive themselves as having a fertility problem.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Depressive symptoms (as measured by the Center for Epidemiologic Studies-Depression Scale), self-esteem (as measured by a modified version of the Rosenberg Self-esteem Scale) and life satisfaction (as measured by a modified version of the Satisfaction with Life Scale) were assessed for all 283 participants at both waves. For all three variables, change scores of 47 involuntarily childless women who resolved their infertility through a live birth were compared to the scores for the 236 women who remained childless. A number of variables shown to be associated with subjective well-being among infertile women were included as controls.

MAIN RESULTS AND THE ROLE OF CHANCE

No relationship between infertility resolution and change in depressive symptoms was observed (b = -0.04; P > 0.05). Involuntarily childless women who resolved their infertility improved in self-esteem (b = 0.74; P < 0.01) and life satisfaction (b = 1.06; P < 0.01).

LIMITATIONS, REASONS FOR CAUTION

Women were measured at only two time points. Only 47 women had a live birth between waves. While it is common practice to make causal interpretations based on panel data, such interpretations should be made with caution. In addition, the NSFB was conducted in the USA where medical expenditures are high and most fertility treatment expenses are not covered by insurance. Thus it may not be possible to generalize the findings to other modern industrialized societies.

WIDER IMPLICATIONS OF THE FINDINGS

Knowing that resolution of infertility is associated with improved subjective well-being is important for infertile couples and infertility professionals alike.

STUDY FUNDING/COMPETING INTEREST(S)

This research was supported in part by NICHD grant R01-HD044144 and NIGMS grant P20-GM109097 from the National Institutes of Health. The authors have no competing interests.

Individual and community-level impact of infertility-related stigma in Malawi

Infertility, a common experience among women and men worldwide, remains on the margins of public health and medicine in low-resource settings. Previous studies identified associations between individual experiences of infertility and negative outcomes, particularly in contexts where childbearing is imperative, but few have examined broader implications of infertility and infertility-related stigma on communities. To understand the production and impact of infertility-related stigma, this study analyzes 12 focus group discussions (FGDs) conducted with 104 women and men in rural Malawi. FGDs, conducted July-September 2018, were used to elicit the range of community norms around family formation, pregnancy, fertility, and infertility. Data were analyzed through memo-ing during and after data collection and collaborative, thematic coding. We found that stigma manifested within existing systems of gender and power. Aligning with Link and Phelan's stigma framework (2001) there were three primary mechanisms by which infertility-related stigma was produced and reinforced: labeling of a person perceived to be infertile (i.e., establishing 'other'), perpetuating negative stereotypes associated with suspected causes of infertility (e.g., abortion, multiple sexual partners, weak sperm), and consequences of infertility that reinforced stigma (e.g., social ridicule and distancing, divorce). Labels, presumed causes, and consequences of infertility were entrenched within gender and sexuality norms. Women perceived as infertile were unable to follow a normative path to achieving adult status, presumed to be sexually transgressive, and considered "useless." Men's masculinity was questioned. Both women's and men's identities, as well as social positions within relationships and communities, were threatened by perceptions of infertility. Ultimately, the manifestation of infertility-related stigma contributed to an environment wherein the risk of being perceived as infertile was highly consequential and unrelenting. Pervasive stigma, at the community-level, impacts decisions around contraceptive use and timing of childbearing, as women and men not only wanted to avoid infertility, but also the appearance of infertility.

Conversation Orientation Moderates the Relationship between Information Sharing of Medically Assisted Reproduction and Child Adjustment

Parents who experienced infertility have increasingly used medically assisted reproduction (MAR) to add children to their families over the past few decades. These parents will need to decide if they will tell their children about being conceived using MAR. Although MAR information sharing operates within family contexts, little is known about the role of conversation orientation-one family contextual factor-in child outcomes associated with MAR information sharing in middle childhood. Derived from the Family Communication Patterns Theory, this study proposes that conversation orientation moderates the associations between MAR information sharing and children's psychosocial adjustment. This proposal was tested using a sample of 81 6- to 12-year-old MAR-conceived children from 55 families and a structured observational measure of conversation orientation. Multiple regression analyses showed that MAR information sharing interacted with conversation orientation to influence children's behavioral and attention problems but not emotional problems. In families with high conversation orientation, MAR information sharing was not significantly associated with children's behavioral and attention problems. In families with low conversation orientation, MAR information sharing was significantly associated with an increase in children's behavioral and attention problems. Results of this exploratory study demonstrate the potential significance of general communication orientation in understanding child outcomes of MAR information sharing and highlight the needed family context nuances in MAR research.

The social construction of male infertility: a qualitative questionnaire study of men with a male factor infertility diagnosis

Although recent research has highlighted the distressing impact of infertility for men, fertility issues are still routinely seen as a 'women's issue' - even when male factor infertility is highlighted. This article reports findings from a qualitative questionnaire study focusing on a sample of men with a male factor infertility diagnosis; an under-researched and marginalised group in the context of reproductive medicine. Our analysis suggests that male factor infertility is viewed by men as a failure of masculinity, as stigmatising and silencing, and as an isolating and traumatic experience. It is also clear that these themes are shaped by wider societal discourses which present men as (unproblematically) fertile, uninvested in parenthood and stoic in their approach to emotional distress. Such norms also ensure that reproduction continues to be presented as a 'women's issue' which burdens women and marginalises men. In understanding male factor infertility experiences, the damaging nature of the social construction of male fertility is then more clearly illuminated.

Adaptive coping strategies in male infertility, paramedical counselling as a way of support

Aims: In the last decades, the number of infertile males increased worldwide which gained more focus. The extent to which a person or a couple is able to cope adaptively with the problem of infertility depends on the combined effect of several variables. Our aim was to apply counselling among males suffering from infertility problems. During the therapy - besides providing information - we aim to elaborate the effects of the treatment and experiences, to process information, to develop adaptive coping strategies against stress and to indirectly or directly change health behaviours influencing reproduction.Methods: Only patients with male factor infertility were involved. They were divided into an observed group (n = 57) and a control (n = 51) group after a thorough physical examination and assessment of their reactions to, and awareness of, the disease.Results: The group that received the interventions had an intense awareness of the diagnosis and aims and nature of the indicated treatment. They employed purposeful problem-solving coping strategies, reported being satisfied with the infertility treatment.Conclusions: The counselling of clients with infertility problems a more favourable mental well-being can be established by the active participation of professional helpers. Patients might receive effective, targeted and problem-specific help.Abbreviations: ART: Assisted Reproductive Technology.

Analysis and exploration of infertility policies in Iran: a study protocol

BACKGROUND

Infertility is a complex and neglected reproductive health issue of global proportions, with varying effects on couples and their relationships. Therefore, international organisations and several countries have been compelled to consider infertility policies. In recent years, a shift in population policy trends toward increasing birth rates in Iran have set infertility policies in the health sector's agenda. Since infertility and its associated problems are multifactorial, all health systems, including that of Iran, need to have a comprehensive policy package that covers all of its dimensions. Policy analysis is necessary to formulate such policies. This project will therefore analyse the infertility policies in Iran's health sector and clarify the multilateral effects of their different components.

METHODS

This multidisciplinary study outlines the conceptual framework of infertility policies and consists of three stages. Stage I will involve the review of infertility policies in selected countries and Iran for the operational model of infertility programmes, rules and policies. Stage II will consist of a documentary infertility policy analysis of Iran. At this stage, Iran's infertility policies will be analysed using the Walt and Gilson framework in four areas, namely content, context, process and actors. Stage III will involve the analysis of infertility policies in Iran. At this stage, a qualitative study will be conducted to understand and provide in-depth explanations of the existing policies. Finally, the concepts and outcomes obtained from the first stage will be combined with the content of the qualitative analysis of the second and third stages for exploration of Iran's infertility policies, and a package including a framework for infertility policies will be proposed.

DISCUSSION

The findings of this study can be used by the Ministry of Health and public health policy-makers to determine which policies, in view of socio-cultural and economic contexts and actors' roles in each country, can be used to reach the goals defined by international organisations, on the prevention of infertility and reproductive health.

Intersex, infertility and the future: early diagnoses and the imagined life course

Infertility is often recognised as a status that is medically identified in adulthood after unsuccessful attempts to conceive. This paper develops existing literature by illustrating how current conceptualisations of infertility do not incorporate a full range of experiences. Drawing on detailed, reflective diaries and in-depth interviews with five participants, I explore how infertility is experienced and understood by women with variations of sex characteristics (VSCs) or intersex traits. I argue that greater consideration needs to be applied to intersex people and the circumstances of an infertility status that may be received in infancy, childhood or adolescence, before or outside of attempts to conceive, and without undergoing fertility treatment. Through discussions of time and futurity, this paper seeks to explore how visions of the future coalesce with an infertile status that is received in combination with an atypical sex status early in life. The paper indicates that early infertility can hinder some intersex children and young people's ambitions. However, infertility is not understood to be pathological or consistently prohibitive throughout the lives of everyone affected. Intersex women's conceptions of a potentially childless future are varied, complex, ambivalent and, in some cases, transitional throughout the life course.

Ejaculatory abstinence in semen analysis: does it make any sense?

BACKGROUND

The precise effect of ejaculatory abstinence on semen parameters is highly debatable, especially among subfertile men. Previous studies on effect of abstinence time on different semen parameters have reported controversial results. The aim of this study was to retrospectively assess the variance of semen parameters with different periods of ejaculatory abstinence among both a population of normozoospermic (n = 1621) and oligozoospermic (n = 416) Tamil men, presenting to a fertility clinic for an infertility evaluation (N = 2037).

MATERIALS AND METHODS

A retrospective analysis of 2037 semen analysis reports involved grouping patients based on their ejaculatory abstinence, that is, <24 h, 1 to 2 days, 3 to 7 days, 8 to 15 days, 16 to 30 days, and >30 days. All semen parameters were assessed as per the World Health Organization (WHO, 2010) recommended guidelines. The unpaired two-tailed t-test and Welch's analysis of variance (ANOVA) combined with Games-Howell post hoc test were used for statistical analysis. A p value <0.05 was considered to be statistically significant.

RESULT

A retrospective analysis of data (N = 2037) identified no statistically significant differences in semen parameters of sperm concentration, percentage of progressively motile sperm, and normal sperm morphology in both normozoospermic and oligozoospermic individuals across different groups of abstinence. Semen volume was the only parameter that showed a statistically significant difference in both groups (p < 0.0001). In both normozoospermic and oligozoospermic men, the group with <24 h abstinence had the highest mean percentage of progressively motile sperm and normal sperm morphology.

CONCLUSION

The findings of this study suggest that ejaculatory abstinence may be highly arbitrary, and the recommendation of a strict 2- to 7-day abstinence per the WHO may be liberalized. In both normozoospermic and oligozoospermic men, semen parameters associated with an abstinence of <24 h were found to be noninferior as compared to longer ejaculatory abstinence intervals. These findings support in eliminating conservative recommendations as far as abstinence is concerned and suggest that patients may be asked to collect a semen sample on the day they present for an infertility evaluation, regardless of abstinence.

Drawing the line on in vitro gametogenesis

In vitro gametogenesis (IVG) might offer numerous research and clinical benefits. Some potential clinical applications of IVG, such as allowing opposite-sex couples experiencing infertility to have genetically related children, have attracted support. Others, such as enabling same-sex reproduction and solo reproduction, have attracted significantly more criticism. In this paper, we examine how different ethical principles might help us to draw lines and distinguish between ethically desirable and undesirable uses of IVG. We discuss the alleged distinction between therapeutic and non-therapeutic uses of assisted reproduction in the context of IVG, and show how it is both problematic to apply in practice and theoretically dubious. We then discuss how the ethical principles of reproductive justice and beneficence apply to IVG for opposite-sex reproduction, same-sex reproduction, and solo reproduction. We suggest that these principles generate strong reasons for the use of IVG for opposite-sex and same-sex reproduction, but not for solo reproduction.

"My mother in-law forced my husband to divorce me": Experiences of women with infertility in Zamfara State of Nigeria

Introduction

Women with infertility have different experiences that determine the quality of their psychosocial health. Cultural constructions of infertility in Africa have made the experience of infertility among African women more burdensome. Yet, little is known about the psychosocial experiences of women with infertility in Zamfara State of Nigeria. The purpose of this study was to explore the psychosocial experiences of women with infertility in Zamfara.

Materials and methods

An exploratory qualitative design was used for this exploration. Individual in-depth interviews were conducted using a semi-structured interview guide. Ethical approval was received from the Institutional Review Board of the Nogouchi Memorial Institute for Medical Research in the University of Ghana. Women who were married and seeking treatment for infertility from a public hospital were recruited and interviewed. A total of 12 women were interviewed with each interview lasting 45 minutes. The interviews were audiotaped with permission from the participants, transcribed verbatim, and content analysed.

Results

The findings revealed that psychologically, majority of the women had experienced anxiety, stress and depression as a result of their inability to get pregnant. Socially, the women suffered self and social isolation, social stigma, social pressure and marital problems.

Conclusion

These women have psychosocial health problems that need the attention of health professionals to enhance their wellbeing.

Searching the Internet for Infertility Information: A Survey of Patient Needs and Preferences

Background

Given the complexity of infertility diagnoses and treatments and the convenience of the internet for finding health-related information, people undergoing infertility treatments often use Web-based resources to obtain infertility information and support. However, little is known about the types of information and support resources infertility patients search for on the internet and whether these resources meet their needs.

Objective

The aims of this study were to (1) examine what individual factors, namely, demographic characteristics and distress, are associated with searching the internet for different types of infertility-related information and support resources and (2) determine whether Web-based resources meet the needs of patients.

Methods

Men and women seeking infertility care responded to a survey assessing use of Web-based resources for accessing infertility-related information and support. The survey further assessed satisfaction with Web-based resources as well as perceived stress and depressive symptomatology.

Results

A total of 567 participants, including 254 men and 313 women, completed the survey. Most participants (490/558, 87.8%) had searched the internet for infertility information and support. Searchers were more likely to be women (P<.001), highly educated (P=.04), long-term patients (P=.03), and more distressed (P=.04). Causes of infertility, treatment options, and scientific literature about infertility were the three most frequently searched topics, whereas ways to discuss treatment with family and friends as well as surrogacy and ways to find peer support were the three least searched topics. Of those who searched the internet, 70.9% (346/488) indicated that their needs were met by Web-based information, whereas 29.1% (142/488) said that their needs were not met. Having unmet needs was related to greater levels of perceived stress (P=.005) and depressive symptomatology (P=.03).

Conclusions

This study provides evidence for the important role of the internet in accessing infertility information and support and for the ability of Web-based resources to meet patients’ needs. However, although distressed patients reported particularly high rates of searching, their needs were not always met, suggesting that they may benefit from alternative sources of information and support or guidance from health care providers when searching the internet.

Recent advances and future opportunities to diagnose male infertility

PURPOSE OF REVIEW

Infertility affects 10-15% of couples, making it one of the most frequent health disorders for individuals of reproductive age. The state of childlessness and efforts to restore fertility cause substantial emotional, social, and financial stress on couples. Male factors contribute to about half of all infertility cases, and yet are understudied relative to female factors. The result is that the majority of men with infertility lack specific causal diagnoses, which serves as a missed opportunity to inform therapies for these couples.

RECENT FINDINGS

In this review, we describe current standards for diagnosing male infertility and the various interventions offered to men in response to differential diagnoses. We then discuss recent advances in the field of genetics to identify novel etiologies for formerly unexplained infertility.

SUMMARY

With a specific genetic diagnosis, male factors can be addressed with appropriate reproductive counseling and with potential access to assisted reproductive technologies to improve chances of a healthy pregnancy.

Anxiety and depression symptoms in infertile men during their first infertility evaluation visit

Objective: To assess the psychological condition of men at the start of the infertility work-up. Methods: Men seeking an infertility evaluation for the first time were recruited. Depression and anxiety symptoms and subjective psychological burden were assessed with the Beck Depression Inventory (BDI), the Spielberger State-Trait Anxiety Inventory (STAI), and a visual analog scale (VAS). Results: Data from 113 patients were analyzed. The mean age of the patients was 33.3 (range: 23-54) years, whereas the mean duration of infertility was 16.3 (range: 0-96) months. Results from the BDI and STAI were 2.24 (SD: ±3.18) and 33.74 (SD: ±8.04). Mild depressive symptoms were found in 4.5% of patients, whereas anxiety reached an abnormal level in 4.9%. There were significant correlations between the results from the BDI score and the duration of infertility (p = .024), whereas the STAI and VAS scores showed no similar connection (p = .142 and p = .261, respectively). Among patients with infertility longer than 2 years, mild depressive symptoms occurred in 23.1%. Conclusion: Among men, the levels of depressive and anxiety symptoms were low at the start of the infertility work-up. Depressive symptom levels increased significantly with the duration of infertility, whereas anxiety levels and VAS scores did not demonstrate a similar correlation.

Retinoic acid and 17β-estradiol improve male germ cell differentiation from mouse-induced pluripotent stem cells

This research aimed to explore the impacts of retinoic acid (RA)/17β-estradiol (E) induction and embryoid body formation to enhance differentiation of mouse-induced pluripotent stem cells (miPSCs) into male germ cells in vitro. Flow cytometry and qPCR were conducted to describe miPSCs differentiation process. Various temporal expression profiles of germ cell-related genes were traced. Stra8 gene expression increased in the RA group on the 4th day compared to other groups. The RA group experienced a more significant increase than E group. The expression of Sycp3 increased in RA + E group on 4th day compared with other groups. Expression of AKAP3 enhanced in the RA + E group than other groups on day 4. Moreover, miPSCs showed that this gene expression in the RA + E group was increased in comparison to RA and E groups on day 7. AKAP3 gene expression on day 7 of miPSCs decreased in RA and E groups. Flow cytometry data indicated that 3%-8% of the cells in sub-G1 stage were haploid after RA and E induction compared to other groups on day 4. This study showed that miPSCs possess the power for differentiating into male germ cells in vitro via formation of embryoid body by RA with/or E induction.

Quality of Life and General Health in Pregnant Women Conceived with Assisted Reproductive Technology: A Case-Control Study

Background

Infertility affects different aspects of life including the quality of life (QOL) in infertile couples. Many infertile couples conceive via using assisted reproductive technology (ART). However, the effect of pregnancy and childbearing on QOL is not known in these couples. This study aimed to evaluate QOL and general health during pregnancy and after successful treatment of infertility, in women conceived with ART.

Materials and Methods

In this case-control study, QOL and general heath were evaluated in 40 women conceived with ART and 40 women who conceived spontaneously and served as the control group. WHO quality of life- BREF (WHOQOL-BREF) inventory was used to evaluate QOL and General Health Questionnaire-28 (GHQ-28) was applied to evaluate general health. These two questionnaires were completed in the first and second trimester of pregnancy and results were compared between the two groups.

Results

Mean age of women was 29.4 ± 4.4 and 29.6 ± 5 years in ART and control group, respectively. QOL in women conceived with ART was similar to QOL in the control group in the first and second trimester of pregnancy while general health score (distress level) in women conceived with ART was significantly higher than that of the control group in both trimesters. Although distress level decreased in the second trimester in ART group, but yet, it was higher than that recorded for the control group.

Conclusion

After pregnancy, QOL in women conceived with ART is similar to women conceived spontaneously. However, these women experience higher distress level in the first and second trimester of pregnancy compared to women conceived spontaneously.

Self-compassion training and psychological well-being of infertile female

Background

The empowerment of psychological well-being is an important and fundamental issue among infertile females.

Objective

The present study investigates the effect of teaching self-compassion on the psychological well-being of initial infertile women.

Materials and Methods

In this cross-sectional, quasi-experimental study with pre-test and post-test, 32 infertile women who were referred to the Yazd Reproductive Sciences Institute during 2016-2017 were enrolled. The participants were randomly divided in two groups as control and experiment (n = 16/each). The participants only in the experimental group received 8 sessions of 90 min training (Self-Compassion Training). Ryff's psychological well-being questionnaire was applied (reliability coefficient = 0.82) and covariance analysis statistical test was used to test the research hypothesis.

Results

There was a significant difference between the estimated mean scores for improving the psychological well-being of the participants in the experiment and control groups (p = 0.007), and the difference indicates that 72.7% of the covariance of the post-test scores is due to self-compassion intervention. Therefore, the intervention of self-compassion training affects the improvement of psychological well-being among infertile women. Also, the pre-test variable is significant with the effect of 94.2% (p = 0.006).

Conclusion

The findings showed that teaching self-compassion to initial infertile women has an effect on their psychological well-being.

'We are not infertile': challenges and limitations faced by women in same-sex relationships when seeking conception services in São Paulo, Brazil

The use of reproductive technologies has expanded beyond cases of infertility, and opportunities for individuals of different sexual orientations to use such technologies for conception have increased. The authors examined the challenges and limitations faced by women in same-sex relationships seeking conception services in São Paulo, Brazil. They interviewed 16 women in same-sex relationships who conceived children using reproductive technologies. Access to public health services for conception remains limited and exclusive to infertile heterosexual couples. Women in same-sex relationships are forced to select between costly medical treatments in the private sector, or self-insemination with sperm from a known donor. In this study, individuals reported that they experienced adverse effects of treatments; were treated with technologies for infertility when they were, in fact, fertile; and were exposed to unnecessary and invasive interventions. Growing political conservatism and the reduction of investment in public health services are factors that can directly affect sexual and reproductive health, including that of lesbians. Public policies that enable same-sex couples to conceive have yet to be developed in many countries, and a clearer articulation of the right to evidence-informed, rights-based care, consistent with national and international guidelines is a much-needed next step.

Psychological well-being of identity-release egg donation parents with infants

STUDY QUESTION

What are the psychological health, relationship quality and perceived social support outcomes of heterosexual couples who have conceived an infant through identity-release egg donation?

SUMMARY ANSWER

Parents' scores on all measures were within the normal range. Egg donation mothers had poorer perceived social support, and egg donation fathers had less optimal psychological health than a comparison group of IVF parents, although these differences were associated with the older age of egg donation parents, rather than being an effect of family type.

WHAT IS KNOWN ALREADY

There is limited understanding of the psychological health and couple relationship quality of egg donation parents, and no empirical data on parents' social support, during the first year of parenthood. No studies have included families who have used an identity-release egg donor. The study offers the first examination of the psychological well-being of identity-release egg donation parents.

STUDY DESIGN, SIZE, DURATION

This study included 57 families created through identity-release egg donation, and a comparison group of 56 families who had used IVF with their own gametes, recruited through UK fertility clinics. Families were visited at home between October 2013 and June 2015. The sample forms part of a larger study examining family functioning in families created following fertility treatment.

PARTICIPANTS/MATERIALS, SETTING, METHOD

All families were heterosexual two-parent families with an infant aged 6-18 months. Mothers and fathers were administered standardised questionnaires assessing psychological health (Edinburgh Postnatal Depression Scale, Trait Anxiety Inventory and Parenting Stress Index-short form), couple relationship quality (Golombok Rust Inventory of Marital State) and perceived social support (Multidimensional Scale of Perceived Social Support).

MAIN RESULTS AND THE ROLE OF CHANCE

Scores from the egg donation and IVF parents were within the normal range on all measures. Significant differences were found between the groups indicating less optimal social support in egg donation mothers compared to IVF mothers, and poorer psychological health in egg donation fathers compared to IVF fathers. These differences appeared to be related to the older age of egg donation parents or to twin parenthood, rather than to egg donation per se. No differences were found between the groups in the parents' relationship quality.

LIMITATIONS, REASONS FOR CAUTION

It is possible that families who were managing the transition to parenthood less well may have been less likely to participate in research. Fewer IVF than egg donation fathers participated in the study, so the statistical power was lower for comparisons between fathers.

WIDER IMPLICATIONS OF THE FINDINGS

The findings are of relevance to UK clinics offering identity-release egg donation. That scores of egg donation parents on measures of psychological well-being were more similar than different to those of IVF parents should prove reassuring to individuals considering this treatment type. As less optimal outcomes were found for egg donation parents on several measures, and these were associated with parental age rather than conception type, it is recommended that clinics discuss with older patients how they may establish a social support network and signpost patients to appropriate post-natal support.

STUDY FUNDING, COMPETING INTERESTS

This research was supported by a Wellcome Trust Senior Investigator Award [097857/Z/11/Z] and a CHESS-ESRC studentship. The authors have no conflicts of interest to declare.

TRIAL REGISTRATION NUMBER

N/A.

Iranian infertile couples' strategies to manage social interactions after unsuccessful treatment with assisted reproductive technologies

Many infertile couples feel vulnerable after failed treatment cycles and find insensitive remarks or inappropriate support distressing. They fear that the stress of failed treatment cycles may affect their marriage and lead to marriage breakdown. This study explored the strategies a sample of infertile couples used to manage social interactions after unsuccessful treatment with assisted reproductive technologies. A descriptive qualitative study was conducted with 34 participants including nine infertile couples, nine infertile women and two infertile men with primary infertility, two relatives, and three fertility clinic staff. The participants were selected through purposive sampling at an infertility centre in Iran, between 2016 and 2017. Data were collected using semi-structured face-to-face interviews and analysed by qualitative content analysis approach. Participants found some social interactions after failed assisted reproductive treatment cycles to be distressing and painful. They described tolerating painful emotions which cause them sadness and sorrow as well as feeling embarrassed. As a result, they found they needed to maintain their adopting concealment strategies with their families through not permitting speculation, selective disclosure, not giving details and hiding the truth. This study showed that social interactions following failed assisted reproductive cycles can be upsetting for infertile couples. Couples use different strategies to manage potentially distressing social interactions. Healthcare providers and psychologists may provide a space for safe social interactions in order to help couples to use appropriate strategies in these circumstances.

Estimates of donated sperm use in the United States: National Survey of Family Growth 1995-2017

OBJECTIVE

To provide national estimates of donor insemination (DI) use in the United States and a description of the population of users.

DESIGN

Population estimates were generated from nationally representative data through weighted proportions and count estimates.

SETTING

Not applicable.

PATIENT(S)

Participants were U.S. women of childbearing age (15-44 years) sampled for interview in the National Survey of Family Growth.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Respondents who reported having received artificial insemination were asked the origin of the sperm. Responses could include husband/partner, donor only, or mixed donor and husband/partner.

RESULT(S)

In 1995, an estimated 170,701 (95% confidence interval 106,577-234,825) women had undergone DI using donor or mixed sperm. In 2015-2017, 440,986 (95% confidence interval 108,458-773,513) women were estimated to have used it. The DI users were mostly white, urban, older, college-educated, and had high family incomes.

CONCLUSION(S)

The DI use changed over time, from a decrease between 1995 and 2013 to a precipitous growth in 2015 to 2017. In recent years, nearly half a million women may be dealing with personal, relationship, and familial issues born of DI use. The United States does not maintain records on the usage of donor sperm, but better tracking of the use and outcomes of treatment would provide better estimates of the size of the affected population.

Depression and Anxiety in Pathways of Medically Assisted Reproduction: The Role of Infertility Stress Dimensions

Background:

Depressive and anxious symptoms are common psychological reactions to infertility and Medically Assisted Reproduction (MAR). No study compared depressive and anxious symptoms and infertility stress dimensions across homologous and heterologous MAR, nor explored the specific role of the infertility stress dimensions in the two pathways. Homologous MAR may be associated with higher distress as the couple feel that the responsibility to reproduce and carry on the family line falls on them, and they feel inadequate if they are unable to bear children.

Objective:

We compared depressive/anxious symptoms and infertility stress dimensions between individuals undergoing homologous and heterologous MAR. We also explored the association between the infertility stress dimensions and depressive/anxious symptoms separately in two MAR pathways.

Methods:

Two-hundred twenty-six individuals participated [mean age = 39.71 years; 54.45% women]: 118 (52.2%) in homologous and 108 (47.8%) in heterologous MAR. The Fertility Problem Inventory, Beck Depression Inventory-II, and State and Trait Anxiety Inventory-Y form were administered.

Results:

Individuals in homologous MAR had higher depressive/state-trait anxious symptoms, general infertility stress, and infertility-related sexual concerns than those in heterologous MAR. In homologous MAR, social and sexual concerns were associated with depressive/trait anxious symptoms while gender had no effect. In heterologous MAR, male gender was associated with lower state anxious symptoms while infertility stress dimensions had no effect.

Conclusion:

Individuals in homologous MAR are a more distressed subgroup which requires a tailored supportive psychological intervention specifically on sexual and social concerns.

Perceptions, expectations and challenges among men during in vitro fertilization treatment in a low resource setting: a qualitative study

Introduction

Partner support is very important in alleviating the burden of infertility related stress and although understudied, partner coping patterns also play a key role in the other partner’s ability to cope with the infertility experience which eventually affects treatment outcomes. Very few studies more so in a low to middle income setting, explore the psychological and social aspects of infertility in men. There is a need for a deeper understanding into men’s perceptions, expectations and challenges of fertility treatment in our low resource setting.

Objective

To explore men’s perceptions, expectations, challenges and experiences during IVF treatment among men in a low resource setting.

Methods

A qualitative research design was utilised. The study was conducted at life sure fertility and gynaecology centre. The study participants were men participating in the IVF cycles. They were selected purposefully by maximum variation sampling. All the interviews took place on the day of enrolment for treatment and inductive content analysis was used to draw meaning from the transcripts. Ethical approval for the study will be sought from Nsambya Hospital IRB/REC.

Results

Seven major themes arose, and these included: (1) Societal influence on IVF treatment experience; (2) Social support during IVF treatment; (3) Feeling insignificant; (4) Financial burden; (5) IVF as an emotional bridge; (6) Inadequate sensitization; (7) Fear of treatment failure.

Conclusion

Men’s experiences during IVF treatment were negatively affected by the society’s perceptions of IVF treatment and infertility, cost of treatment, perceived men’s involvement and insufficient knowledge about the IVF process. However, spouse and friends’ support helped with coping and the IVF treatment experience strengthened emotional bonds.

Electronic supplementary material

The online version of this article (10.1186/s40738-019-0058-8) contains supplementary material, which is available to authorized users.

Development and Validation of A Decision-Making Donor Conception Questionnaire in Iranian Infertile Couples

Background

Despite the fact that many infertile couples have to decide about whether or not to choose donor con- ception, there is no predictive scale for evaluating the process of decision-making on donor conception and its deter- minants in such couples. The present study was conducted to develop a decision-making questionnaire for selecting donor conception and assess its psychometric properties in Iranian infertile couples.

Materials and Methods

This cross-sectional validation study was conducted based on the method developed by DeVellis (2012) in four steps at Milad Infertility Clinic, Mashhad, Iran. The dimensions of the concept of decision- making were determined in the first step based on the qualitative results obtained from 38 semi-structured in-depth interviews. Items that were appropriate for the questionnaire were developed in the second step using the qualitative data and a review of the literature. In the third step, the research team reviewed and eliminated some of the items. The fourth step evaluated the face, content and construct validity of the questionnaire through exploratory factor analysis on a sample of 220 infertile couples using convenience sampling and investigated its initial and final reliability.

Results

Based on the results of the qualitative study, a pool of 170 items was developed, 101 of which were elimi- nated after revision due to ambiguity, repetition or their poor face and content validity and initial reliability. The questionnaire was evaluated for its construct validity with 69 items. After the exploratory factor analysis, the decision- making donor conception questionnaire (DMDCQ) having 51 items and seven factors, was finalized. All the factors had Cronbach’s alpha values of 0.75-0.87 and intra-class correlation coefficients (ICC) greater than 0.7.

Conclusion

This study led to development of a valid and reliable scale for examining infertile couples’ decision- making about whether or not to use donor conception as well as the determinants of this decision.