The experience of infertility: a review of recent literature

Too much time? Time use and fertility-specific quality of life among men and women seeking specialty care for infertility

Background

There are known gender differences in the impacts infertility has on quality of life and well-being. Less is known about how infertile couples spend time on fertility-related tasks and associations with quality of life. The purpose of this study is to evaluate whether time spent on tasks related to family-building decision-making (including research, reflection, discussions with partner, discussions with others, and logistics) were associated with fertility-specific quality of life or anxiety among new patients.

Methods

Couples or individuals (N = 156) with upcoming initial consultations with a reproductive specialist completed the Fertility Quality of Life (FertiQoL) tool, which produces a Core (total) score and four subscales: Emotional, Relational, Social, and Mind-Body. We developed questions to measure time spent in the previous 24 h on tasks related to family-building. We tested for differences by gender in time use (McNemar’s Test) and used ordinary least squares regression to analyze the relationship between time use and FertiQoL scores.

Results

In the week before a new consultation, a higher percentage of women reported time spent in the past 24 h in research, reflecting, discussion with others, and logistics compared to male partners (all p < 0.05). In adjusted models, more time spent reflecting was associated with worse FertiQoL scores for both men and women, as well as with higher anxiety for men. Time spent in discussion with others was associated with higher anxiety for women but better Social FertiQoL scores for men.

Conclusions

Couples seeking infertility consultation with a specialist reported spending time on tasks related to family-building before the initial visit. There were gender differences in the amount of time spent on these tasks, and time was associated with fertility-specific quality of life and anxiety.

Smartphone-supported Positive Adjustment Coping Intervention (PACI) for couples undergoing fertility treatment: a randomised controlled trial protocol

INTRODUCTION

Infertility generally counts as a profound crisis in the lives of couples and as an emotionally stressful experience. For couples undergoing fertility treatment, this is especially true of the waiting period following embryo transfer, which couples say is the most stressful period during treatment. However, at this specific phase, psychosocial counselling is not always available on the spot. The aim of this randomised controlled trial (RCT) study was to test the Positive Adjustment Coping Intervention (PACI), a low-dose, smartphone-supported psychological intervention for women and men undergoing fertility treatment.

METHODS AND ANALYSIS

The effectiveness of PACI is tested by means of a prospective two-arm RCT. During the 14-day waiting period between oocyte puncture/oocyte thawing and pregnancy test, participants are randomly assigned to one of the two groups, and both women and men receive daily text messages on their smartphones. One group receives text messages with statements reflecting positive-adjustment coping attitudes, the other group messages containing cognitive distractions. The primary outcome of this study is the reduction of psychosocial burden during the waiting period of reproductive treatment. Furthermore, we want to assess whether there are differences between the interventions in a pre-post assessment. The secondary outcomes are information on perceived effectiveness and practicability of the intervention one month after the waiting period.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from the Ethics Committee of Heidelberg University Faculty of Medicine (S-074/2017). Study findings are planned for dissemination via peer-reviewed journal articles and at national and international conferences.

TRIAL REGISTRATION NUMBER

NCT03118219; Pre-results.

PROTOCOL VERSION

Version 2.0 dated 18/02/2019.

‘It's most of my life – going to the pub or the group’: the social networks of involuntarily childless older men

The social networks of older people are a significant influence on their health and wellbeing. Adult children are an important element in their parent's network and provide the majority of informal care. The morphology of personal networks alters with age, employment, gender and relationships. Not having children automatically reduces both vertical familial structure and affects the wider formal and informal social links that children can bring. Childless men are missing from gerontological, reproduction, sociological and psychological research. These fields have all mainly focused on family and women. This paper reports on an auto/biographical qualitative study framed by biographical, feminist, gerontological and lifecourse approaches. Data were gathered from semi-structured biographical interviews with 14 self-defined involuntarily childless men aged between 49 and 82 years old. A latent thematic analysis highlighted the complex intersections between childlessness and individual agency, relationships and socio-cultural structures. The impact of major lifecourse events and non-events had significant implications for how childless people perform and view their social and self-identity. I argue that involuntary childlessness affects the social, emotional and relational aspects of men's lived experience across the lifecourse.

Gender Differences in the Experience of Infertility Concerning Polish Couples: Preliminary Research

The World Health Organization (WHO) determines infertility as a disease of the reproductive system defined clinically by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. Estimates indicate that the problem of infertility in the world is continuing to grow. The aim of the study was to compare approaches to disease in partners of both sexes diagnosed with infertility. The study was conducted among 61 couples treated for infertility using an original questionnaire developed by the authors. The Chi square independence test was used for statistical analysis. Both men and women responded to the diagnosis of infertility with negative emotions. Regardless of sex, sadness and anxiety were the dominant feelings associated with the diagnosis of infertility. Women believed in the success of the treatment to a greater extent than men. Mainly women attempted to talk openly about the problem of infertility, while men were more restrained in this respect. Women accepted the assisted reproductive technologies (ART) to a greater extent than men, but men would accept childlessness more often than women.

Narrative Study of the Significance of Infertility and Its Treatment for Maternal Identity

OBJECTIVE

To explore how women who experienced infertility and underwent fertility treatments constructed maternal identities after they successfully gave birth.

DESIGN

Narrative qualitative study.

SETTING

Finland, Scandinavia.

PARTICIPANTS

Twenty-six previously infertile Finnish women who later conceived were recruited via social media, health clinics, and relevant informal support organizations.

METHODS

Narrative analysis was used to process written accounts and individual episodic interviews with each of the 26 women.

RESULTS

Four different identity stories emerged from the data: Fractured Maternity, Pursuing Maternity, Learning Maternity, and Discovering Maternity. Infertility, its treatment, and childbirth were narrated as turning points in the participants' life courses, but the significance of these turning points for maternal identity varied across the four stories.

CONCLUSION

These findings have important implications for nursing practice. Health care professionals should be aware of the effects of previous long-standing infertility on the subsequent experience of motherhood so they can provide women with understanding, sufficient support, and appropriate interventions throughout the transition to motherhood.

Experiences and psychological distress of fertility treatment and employment

Purpose: This study examined experiences and psychological distress about fertility treatment in people combining work and treatment. Methods: Five hundred and sixty-three participants in the UK completed an online survey asking about difficulties in combining work and treatment; workplace disclosure, support, absence and policy; and psychological distress about treatment. Results: Absence from work and perceptions that treatment has an impact on work and career prospects were reported by the majority of participants and this was related to the psychological distress of treatment. Around three quarters of participants disclosed to their employer and colleagues. The key reason for disclosure was needing to ask for absence from work and the main reason for non-disclosure was privacy. Workplace policy relating to managing fertility treatment and support from colleagues and their employer was related to reduced psychological distress but workplace policy was reported by less than one quarter of participants. Conclusion: Difficulties experienced in combining work and treatment suggest that support is needed. Specific workplace policy, guidance for supervisors and flexibility in fertility clinic times should help support employees during treatment and reduce psychological distress, thereby potentially influencing physical health and treatment outcomes.

The Role of Dyadic Coping on the Marital and Emotional Adjustment of Couples With Infertility

Infertility is a challenging experience, affecting individual and couples' adjustment. However, the way the members of the couple support each other may affect the experience of infertility and their adjustment. This study aimed to investigate the role of dyadic coping by oneself and by the partner in the association between the impact of infertility and dyadic and emotional adjustment (anxiety and depression) to infertility. In this cross-sectional study, a total of 134 participants (67 couples with infertility) completed self-report questionnaires assessing infertility-related stress, dyadic coping, dyadic adjustment, and depression and anxiety symptoms. A path analysis examined the direct and indirect effects between the impact of infertility in one's life and dyadic and emotional adjustment. There is an indirect effect of the impact of infertility in one's life on dyadic adjustment through men's perceived dyadic coping efforts employed by the self (dyadic coping by oneself) and women's perceived dyadic coping efforts of the partner (dyadic coping by the partner). Regarding the emotional adjustment of infertile couples, infertility stress impact had an indirect effect only on depressive symptoms through men's dyadic coping by oneself. The results highlight the importance of men's dyadic coping strategies for the marital adjustment of couples as well as for men's emotional adjustment. Findings emphasize the importance of involving men in the fertility treatment process, reinforcing the dyadic nature of infertility processes.

Infertile Couples' Needs after Unsuccessful Fertility Treatment: a Qualitative Study

Introduction: Infertility is a major medical issue. Investigations and treatment of infertility are the beginning of a complex, time-consuming and stressful process for couples that may fail well. The present study explored the needs of infertile couples following treatment failure with Assisted Reproductive Technologies (ARTs).

Methods: A descriptive qualitative study was conducted in an Iranian infertility center, in the Northeast of the country between April 2016 and June 2017. The researchers recruited 29 individuals including 9 couples, 9 women and two men with primary infertility through purposive sampling. The data were collected using semi-structured interviews and analyzed iteratively, using conventional content analysis with MAXQDA software.

Results: The main concepts obtained from the data were classified into one theme titled: ""The need for support"" and four main categories along with their subcategories, and included the need for psychological support, the need for more useful information, the need for social support and the need to access to supplementary services.

Conclusion: The findings show that following treatment failure, the infertile patients’ expressed needs and preferences were not met. Identifying and meeting their needs may help the infertile couples to deal with ARTs failure and to reach a decision about future treatment.

Infertility patient-provider communication and (dis)continuity of care: An exploration of illness identity transitions

OBJECTIVE

To identify how and why infertility patients' communication with health care providers relates to their continuity of care within infertility treatment.

METHOD

A grounded theory analysis was conducted for 25 in-depth interviews across three coding phases, where we remained open to all themes present in the data, narrowed to most prominent themes, and found the connections between the themes.

RESULTS

Based on our identified themes, we created a conceptual model that explains why infertility patients (dis)continued care with one or more clinician. Through this model, we describe two infertility identity transitions for patients: Transition 1: "Infertility as Temporary" to "Infertility as Enduring"; and Transition 2: "Infertility as Enduring" to "Infertility as Integrated."

CONCLUSION

The study explains how and why patients' view of their infertility affects their communication, and thus their continuity of care, with clinicians.

PRACTICE IMPLICATIONS

To provide patient-centered care within infertility treatment, providers can recognize how patients' view of their infertility, and thus their needs, goals, and expectations, shift throughout their infertility experience.

Religious Women's Coping with Infertility: Do Culturally Adapted Religious Coping Strategies Contribute to Well-Being and Health?

BACKGROUND

Infertility is a source of stress, particularly in pronatalist societies in which a lifestyle without children is viewed as an unacceptable option. The present study examined the relationship between the use of culturally adapted religious coping strategies and emotional adjustment among women coping with fertility problems.

METHODS

This is a cross-sectional correlational study. One hundred and eighty-six religious Israeli women undergoing fertility treatment filled out questionnaires assessing their use of culturally adapted religious coping strategies and emotional adjustment (distress/well-being).

RESULTS

A path analysis showed that the culturally adapted religious coping strategies of seeking the support of Rabbis and seeking the support of God had a strong correlation with reduced psychological distress, but not with enhanced psychological well-being. Seeking approval and recognition from the community was correlated with reduced distress and enhanced well-being. However, seeking ties and belonging to the community was correlated with increased psychological distress and reduced psychological well-being. Finally, women without children experienced greater psychological distress than women with children and sought more support of Rabbis and fewer ties with the community.

CONCLUSIONS

In a pronatalist culture that sanctifies childbirth, infertility is a source of significant distress. Professionals' awareness of the culturally adapted religious coping strategies utilized by their clients may help them conduct culturally sensitive intervention, which may greatly help to enhance emotional adjustment. Future research is recommended to develop instruments that measure culturally adapted strategies and their influence on emotional adjustment over time, in different states of health while comparing different cultures.

I wish I had known sooner: stratified reproduction as a consequence of disparities in infertility awareness, diagnosis, and management

Infertility affects one in eight couples in the US, yet many couples report feeling blindsided by the diagnosis. Lack of awareness about infertility can lead to missed opportunities for prevention, delays in diagnosis, and greater emotional distress when a diagnosis is made. This paper reports on the results of interviews with 54 American women experiencing infertility, conducted via phone between 2013 and 2015 with participants from across the country. The interviews explored whether differences in infertility awareness were related to patient trajectories for time to diagnosis and initiation of treatment. Interview data indicated a significant lack of informational resources for these women concerned about fertility. Older participants expressed regret that they were not educated about age-related fertility decline, while patients with infertility secondary to medical conditions often reported delays in diagnosis and lack of counseling about fertility implications. Participants' data also revealed that infertility was consistently absent from sex education curricula and that minorities may be more likely to experience delayed diagnosis of infertility and lack of appropriate fertility counseling. These findings suggest that the inequitable distribution of health information and education about reproduction is one mechanism by which experiences of infertility can become racially stratified.

Resilience acts as a moderator in the relationship between infertility-related stress and fertility quality of life among women with infertility: a cross-sectional study

BACKGROUND

Infertility-related stress can seriously impact the fertility quality of life (QoL) of infertile women. Resilience, as a coping resource, can effectively combat psychological stress. This study aimed to evaluate the fertility QoL of infertile women and to examine whether resilience moderates the association of infertility-related stress with fertility QoL.

METHODS

This cross-sectional study was conducted in northeast of China from December 2017 to February 2018. Out of 559 women outpatients with infertility, 498 (89.1%) completed self-reported questionnaires including the FertiQoL Scale, Fertility Problem Inventory (FPI) and Connor-Davidson Resilience Scale (CD-RISC). Hierarchical multiple regression analysis and simple slope analysis were applied to explore the influencing factors related to fertility QoL as well as to examine the moderating effect of resilience on the association of infertility-related stress with fertility QoL.

RESULTS

The mean FertiQoL score was 64.54 ± 16.90 among the participants. Household monthly income and causes of infertility were significantly related to fertility QoL. In addition, infertility-related stress was negatively related to fertility QoL, and resilience was positively associated with fertility QoL, explaining 36.3% of the variance. Resilience moderated the association of infertility-related stress with fertility QoL. Specifically, the effect of infertility-related stress on fertility QoL varied by low(1 SD below the mean, B = - 0.496, β = - 0.714, P < 0.001), mean (B = - 0.293, β = - 0.422, P < 0.001) and high (1 SD above the mean, B = - 0.090, β = - 0.130, P < 0.001) levels of resilience. The higher resilience was, the weaker the effect of infertility-related stress on fertility QoL was.

CONCLUSIONS

Overall, women with infertility in China had relatively low FertiQoL scores. Resilience influenced the association of infertility-related stress with fertility QoL. Infertile patients' psychological status must be addressed and adequate resilience-based interventions such as mindfulness-based skills should be provided to improve fertility QoL of women with infertility.

The Impact of Infertility on Daily Occupations and Roles

BACKGROUND

Infertility impacts approximately 16% of couples in the United States-roughly five million individuals. Experiencing infertility takes a physical and psychological toll on the infertile individual, as well as his/her partner. The goal of the current study was to explore and provide better insight into how infertility affects the roles and daily occupations (Such as self-care and work related tasks) of females. This information can better assist health care providers in providing quality care to such clients.

METHODS

21 participants, females ranging in age from 20 to 46 years and experiencing infertility, participated in this qualitative, phenomenological research study. They partook in two telephone interviews aimed at exploring how infertility has impacted their roles and daily occupations. Inductive content data analysis was utilized to analyze the data.

RESULTS

Findings resulted in three main themes. Quotes from participants were used to title the themes. They are "when you're dealing with infertility, every aspect of your life is impacted by it", "infertility impacted my areas of interest in life" and "infertility is very lonely".

CONCLUSION

Infertility has the potential to impact every area of a female's life. The emotional impact infertility may have on women, in addition to the physical and time constraints involved with pursuing fertility treatments, frequently resulted in decreased occupational engagement and fulfillment of roles as spouse or friend. Those experiencing infertility need more resources and support to navigate their journey.

The Social Construction of Infertility Among Iranian Infertile Women: A Qualitative Study

BACKGROUND

Infertility is considered an important phenomenon in couples' life. Infertility and its treatment process influence all aspects of the individual's life. This study aimed to explain the psycho-social process of social construction of infertility among Iranian infertile women.

METHODS

This was a qualitative study using a grounded theory approach. The study setting was the Vali-e-Asr Fertility Health Research Center and Avicenna Fertility clinic in Tehran. The sampling started purposefully and it was continued theoretically. The data collection was performed by using 36 semi-structured interviews, observation and field notes with 27 women who suffered from primary and secondary infertility having no living child. The method suggested by Strauss and Corbin was used for data analysis.

RESULTS

Results indicate that "Concerns over life instability" and "being judged by others" were the participants' most important preoccupation. Attempts to stabilize life and get rid of being judged by others were key aspects of the social construction of infertility and the main strategies for resolving their preoccupation. This core concept explained the basic psychological-social process of infertility in relation to axial codes.

CONCLUSION

The results of the study show that various interactive factors affect the social construction of infertility among infertile women who focus on the central concept of attempts to stabilize life and get rid of being judged by others. Therefore, in order to achieve this goal, infertile women should be empowered by effective coping strategies.

Effects of Group Counseling on Stress and Gender-Role Attitudes in Infertile Women: A Clinical Trial

BACKGROUND

Infertility stress can have a devastating impact on the lives of couples and influence their physical and psychological health. The purpose of this study was to investigate the effects of group counseling on female stress and gender-role attitudes in infertile women.

METHODS

The present study is a randomized clinical trial conducted on 90 infertile women referred to Rooyesh Infertility Treatment Center in the city of Karaj, Iran. The convenience sampling method was used. Samples were divided into intervention and control groups through four-block random allocations. Accordingly, the intervention group received five-session group counselling and the control group only received routine care. Newton's fertility problem inventory (FPI) and gender role questionnaire (GRQ) were used for collecting data before, after, and one month after the intervention. The significance level was set at 0.05.

RESULTS

The result showed a significant relationship between gender role attitude and stress in infertile women (p=0.03) and indirect association between of them (r=0.13). And also repeated measures test indicated that length of time had affected the total scores of infertility stress (p<0.001) and gender role attitude scores (p= 0.001) and there was a significant difference between the two groups in infertility stress scores (p<0.001) and gender role attitude scores (p=0.001).

CONCLUSION

Group counseling can be used in stress reduction and also improved gender role attitude of infertile women.

Psychometric characteristics of the FertiQoL questionnaire in a German sample of infertile individuals and couples

BACKGROUND

FertiQoL is a questionnaire internationally developed to measure fertility-specific quality of life. It has been validated with infertile populations in many countries and used in several studies focusing on the psychosocial consequences of infertility in Europe, Asia, and North America.

METHODS

Over a period of two years, 596 infertile women and men took part in the study conducted at three German fertility clinics. Psychometric properties of FertiQoL were tested by performing confirmatory factor analyses, calculating average variance extracted values, reliability and correlation coefficients. Hierarchical regression analyses were conducted to determine the relations between FertiQoL subscales and both sociodemographic and medical variables. Individual and cross-partner effects were tested for.

RESULTS

The confirmatory factor analyses conducted on our FertiQoL data supported the original four-factor solution for both women and men but, resulted in some unsatisfactory indices. Family and friends' support items loaded weakly on the Social subscale of FertiQoL (.27 and .34 in women, .32 and .19 in men). The Emotional and Mind/Body subscales revealed a strong intercorrelation (r = .77, p < .001 in women, r = .74, p < .001 in men). Women scored lower than men on the Emotional and Mind/Body subscales only, and they reported better fertility-specific relational QoL. In women, the perceived cause of infertility and already mothering a child related significantly to individual FertiQoL scores, while in men, age, educational level, and the duration of their wish for a child had an impact on the FertiQoL subscales (all p < .05). The men's educational level, the women's educational level, and the subjective perceived medical cause of fertility problems exerted cross-partner effects on QoL (all p < .05).

CONCLUSIONS

Our study results represent a contribution both to research and clinical practice. The findings suggest the importance of considering the personal experience of infertility in different cultural and gender specific settings and that the strong connections between the emotional, physical, and cognitive aspects of an individual's fertility-specific quality of life should be regarded as a more coherent system.

TRIAL REGISTRATION

DRKS: DRKS00014707 . Registered 1 May 2018 (retrospectively registered).

Lived experience of infertility among Hong Kong Chinese women

PURPOSE

This study aims to explore and describe the phenomenon of women with infertility and to enhance understanding on how infertility affects their lives and the specific social consequence they encountered.

METHOD

A qualitative phenomenological design was adopted in this study. A total of 13 women who are infertile participated in the study. A snowball sampling method was adopted. Data were analysed through thematic analysis.

RESULTS

Four themes emerged in the study, including (i) non-escapable cultural burden in Chinese family; (ii) psychological distress: isolation caused by envy; (iii) disappointment towards reproductive health services; and (iv) self-compassion and religion as coping strategies.

CONCLUSIONS

The causes of infertility are highly complex. Apart from medical conditions, many social conditions would also probably trigger the difficulty of conceiving. Health care professional should also focus on the social and psychological aspects of women of infertility.

Causal explanations for lack of pregnancy applying the common sense model of illness representation to the fertility context

OBJECTIVES

The current study explored causal explanations for lack of pregnancy and association with help-seeking behaviour. Differences based on gender and country Human Development Index were examined.

DESIGN

A mixed method design was used.

MAIN OUTCOME MEASURES

Data were drawn from the International Fertility Decision-Making Study, a cross-sectional study of 10,045 individuals (1690 men; 8355 women) from 79 countries. Respondents rated to what extent they believed their lack of pregnancy was due to something they or their partner had done/not done or other factors and described their reasons for making this rating.

RESULTS

Respondents were aged 18-50 (M = 31.83) years, partnered and had been trying to achieve a pregnancy/father a child for over six months (M = 2.8 years). Men and women primarily believed their lack of pregnancy was due to medical problems or chance/bad luck. Thematic analysis of textual responses from 29.7% of the sample found that respondents focused on their personal experience or a salient life event when describing the cause of their lack of pregnancy. Women expressed more regret and helplessness about causes than men. Significant country differences were observed.

CONCLUSIONS

Individuals may develop inaccurate causal explanations based on their personal experiences. Access to accurate information is necessary to facilitate timely help-seeking.

The Human Responses and Nursing Diagnoses of Those Living With Infertility: A Qualitative Systematic Review

OBJECTIVE

To systematically retrieve, critique, and synthesize patients' human responses about living with infertility and identify possible related nursing diagnoses according to NANDA-I.

METHODS

Systematic review of qualitative nursing studies.

FINDINGS

A total of 39 papers were included, 49 human responses, and 77 potential infertility-related nursing diagnoses were identified across three themes. Main foci matching nursing diagnosis were related to spiritual well-being, spiritual distress, and resilience.

CONCLUSIONS

Patients respond to infertility in a variety of ways and this raises the need for a more effective, holistic, and accurate nursing diagnosis.

IMPLICATIONS FOR PRACTICE

The accuracy of the nursing diagnosis is critical in raising the quality of the nursing process and in meeting infertile patients' circumstances and care expectations.

Can men be trusted in population-based surveys to report couples' medical care for infertility?

BACKGROUND

Men are usually excluded from surveys on reproductive health as some works have cast doubts on their ability to accurately report information on reproduction. Recent papers challenged this viewpoint, arguing that the quality of men's reports depends strongly on use of an appropriate study design. We aimed to explore the relevance of evaluating couples' use of medical care for infertility based on men's interviews in a population-based survey.

METHODS

The study was based on the last French sexual and reproductive health study (Fecond) conducted by phone interviews among a population-based sample of 2863 men and 4629 women aged 20-49 years.

RESULTS

Among respondents who had ever tried to have a child, the use of infertility medical care by couples (i.e. by the respondents and/or their partners) within the previous 15 years was 16% (95%CI 14 to 18%) based on men's reports and 17% (95%CI 15 to 18%) based on women's reports (p = 0.43). Men's and women's reports were remarkably concordant on most items (infertility duration, treatment). The main discrepancy concerned male medical checkup, which was reported much more often by male respondents than female respondents (86% vs. 57%, p < 0.001 for sperm analysis, 56% vs. 27%, p < 0.001 for male genital examination).

CONCLUSIONS

It is time to trust men to report couples' infertility medical care in reproductive surveys, as they provide information remarkably concordant with that provided by women. Conversely, women may poorly report the infertility checkups of their male partner.

Retinoid signaling controlled by SRC-2 in decidualization revealed by transcriptomics

Establishment of a successful pregnancy requires not only implantation of a healthy embryo into a receptive uterus but also progesterone receptor (PGR)-dependent transformation of endometrial stromal cells (ESCs) into specialized decidual cells. Decidual cells support the developing embryo and are critical for placentation. We have previously shown that a known transcriptional coregulator of the PGR, steroid receptor coactivator-2 (SRC-2), is a critical driver of endometrial decidualization in both human and mouse endometrium. However, the full spectrum of genes transcriptionally controlled by SRC-2 in decidualizing ESCs has not been identified. Therefore, using an RNA- and chromatin immunoprecipitation-sequencing approach, we have identified the transcriptome of decidualizing human ESCs (hESCs) that requires SRC-2. We revealed that the majority of hESC genes regulated by SRC-2 are associated with decidualization. Over 50% of SRC-2-regulated genes are also controlled by the PGR. While ontology analysis showed that SRC-2-dependent genes are functionally linked to signaling processes known to underpin hESC decidualization, cell membrane processes were significantly enriched in this analysis. Follow-up studies showed that retinoid signaling is dependent on SRC-2 during hESC decidualization. Specifically, SRC-2 is required for full induction of the retinol transporter, stimulated by retinoic acid 6 (STRA6), which is essential for hESC decidualization. Together our findings show that a critical subset of genes transcriptionally reprogramed by PGR during hESC decidualization requires SRC-2. Among the multiple genes, pathways and networks that are dependent on SRC-2 during hESC decidualization, first-line analysis supports a critical role for this coregulator in maintaining retinoid signaling during progesterone-driven decidualization.

"In Cycles of Dreams, Despair, and Desperation:" Research Perspectives on Infertility Specific Distress in Patients Undergoing Fertility Treatments

"Emotional distress in infertility" is a broad expression that loosely denotes anxiety, depression, grief, crisis, depleting psychological well-being, and all forms of affective and interpersonal disturbances faced by individuals with infertility. The distress is usually associated with involuntary childlessness as it is an unwelcoming event. The developmental crisis associated with childlessness poses a threat to one's sense of self at all levels (individual, family and social). Distress may begin before or during treatments as a person experiences the loss of control over attaining parenthood, anxiety or dejection after the diagnosis, treatments, its complications particularly its limited success rates. This paper reviews the basic concepts, theoretical models related to infertility specific distress (ISD). It elaborates on the effects of individual and treatment-specific variables on ISD with special highlights gathered from the national and international research.

Anxiety, depression and probability of live birth in a cohort of women with self-reported infertility in the HUNT 2 Study and Medical Birth Registry of Norway

OBJECTIVE

The 'psychogenic' hypothesis has a long history in the field of infertility. The present study investigated whether anxiety or depressive symptoms are associated with probability of subsequent live birth in a cohort of infertile women from the general population.

METHODS

Using linked data from 12,987 women in the North-Trøndelag Health Study 1995-97 (HUNT 2) and the Medical Birth Registry of Norway (MBRN) a cohort of 467 women with self-reported infertility was followed prospectively in the MBRN for 11 years with regard to live birth. Anxiety and depressive symptoms were measured at baseline in HUNT 2 by the Hospital Anxiety and Depression Scale (HADS), i.e. the Anxiety (HADS-A) and Depression (HADS-D) sub-scales. The relationship between anxiety or depressive symptoms and live birth in the MBRN was analysed using Cox proportional hazards regression analysis.

RESULTS

Anxiety and depressive symptoms were not associated with live birth rates. For anxiety symptoms, the crude hazard ratios (HR) for live birth was 1.004 (95% confidence interval (CI) = 0.96; 1.05); adjusted HR = 0.99 (95% CI = 0.94; 1.04), for depressive symptoms crude HR was 0.98 (95% CI = 0.92; 1.04); adjusted HR = 1.01 (95% CI = 0.94; 1.08). Among the 104 women with HADS-A ≥ 8 and/or HADS-D ≥ 8, 34 (32.7%) were registered with live birth in MBRN during the period of observation. However, 100 (27.6%) of the 363 women with both HADS-A ≤ 7 and HADS-D ≤ 7 were registered with live birth.

CONCLUSION

Anxiety and depressive symptoms are not associated with probability of live birth in women with self-reported infertility in the general population.

Fertility patients demonstrate an unmet need for the provision of psychological information: A cross sectional study

OBJECTIVES

To examine the provision of information by health care providers (HCPs) to fertility patients about accessing psychological resources.

METHODS

This study utilized data from a cross-sectional survey of 659 male and female patients seeking fertility treatment at clinics in Toronto and Montreal. Regression analyses were used to assess if sociodemographic and treatment variables were associated with the receipt of information, the desire for information, the helpfulness of the information, and the likelihood that participants had sought counselling.

RESULTS

The majority of respondents (79.8%) said that their HCP had not given them information about accessing psychological resources. Of the patients who did not receive this information, most (60%) said that they wanted it. Regression analysis revealed that immigrants, women, and patients with higher perceived stress scores were significantly more likely to desire this information. Furthermore, having received this information was associated with increased odds of counselling seeking (odds ratio = 3.31, p = 0.013).

CONCLUSION

Fertility patients demonstrated an unmet need for information about accessing psychological resources, and HCPs may play an integral role in bridging this information gap.

PRACTICE IMPLICATIONS

To improve the patient-centeredness of fertility care, HCPs should be proactive in informing all patients about how to access psychological resources.

Improving access to ART in low-income settings through knowledge transfer: a case study from Zimbabwe

It may be assumed that infertility is not a problem in resource-poor areas where fertility rates are high. However, evidence overwhelmingly shows that childlessness is highly stigmatized in these settings and that women who are unable to bear children suffer significant social and psychological consequences. The World Health Organization has recommended that infertility be considered a global health problem and stated the need for ART to be adapted to low-resource settings. This paper describes a model for improving access to ART in low-resource settings. Experienced ART health professionals from Australia and Italy representing medical science, embryology, nursing and counselling used knowledge transfer to support a clinician, a laboratory scientist and a nurse to establish an ART service in Harare, Zimbabwe. Support and mentorship provided between October 2016 and December 2017 included: hosting the clinician and the embryologist for the new service in established ART clinics for short periods and providing them with dedicated mentorship and training during their stay; funding an experienced embryologist to travel to Zimbabwe (three times) to oversee the setting up of the lab and provide hands-on embryology training; funding a scientist and a nurse to travel to Zimbabwe to troubleshoot and establish protocols for record keeping and psychosocial care; and contributing approximately AUD $15,000 to the purchase of some equipment. By 31 March 2018, the team at IVF Zimbabwe had performed 166 ART procedures, which at time of writing had resulted in 16 births and 4 ongoing pregnancies. This case study demonstrates that with mentorship and modest financial support from ART experts from high-income settings, health professionals in low-income settings can deliver affordable ART with successful outcomes.

Reproductive Desires and Disappointments

In this introduction we consider how people who have difficulties achieving "natural" parenthood seek to form families, and their experiences of reproductive negotiations and losses in this pursuit. We highlight gaps in the literature on infertility and loss globally, and identify how the special edition addresses the dearth of research in this field with men, with non-elites and on loss. We consider the key insights drawn from studies conducted in divergent geographical, cultural, socioeconomic and political contexts, including perspectives from Ghana, Indonesia, Romania, Spain, the United Kingdom, and the United States. In these contexts we explore both high tech and no tech reproductive strategies, encompassing assisted reproductive technologies, third party donation, surrogacy, as well as intra-family and transnational adoption. We illuminate how people attribute meaning to their lived experiences of reproductive disappointments ranging from failed conception (primary and secondary infertility), miscarriage, stillbirths, neonatal death, and failed adoption. We reflect on both local and transnational practices embedded in family making, highlighting the complexity and dynamism of reproductive opportunities, and how these opportunities are embedded in multifarious power relations. We articulate a range of important themes for the anthropology of reproduction, including: the sociality of reproductive desires and disappointments; gender sexuality and emergent masculinities; migration, practices of belonging, and kinship; reproductive stratification and leveling; and reproduction and relationality.

Determinants of fertility issues experienced by young women diagnosed with breast or gynaecological cancer - a quantitative, cross-cultural study

BACKGROUND

Although there is a recognition of the importance of fertility to young women with cancer, we do not know who is at risk of distress related to fertility issues following diagnosis. We investigated the determinants of fertility-related distress adopting a cross-cultural perspective and using the Common Sense Model (CSM). We chose the CSM as a theoretical framework as it allows to explore how individuals conceptualise illness within the socio-cultural context.

METHODS

British and Polish women with breast or gynaecological cancer were recruited through outpatient clinics or online outlets and completed a questionnaire. Linear regression, mediation and moderated mediation methods were performed.

RESULTS

One hundred sixty-four women participated (mean age 34.55 (SD = 6.66); 78.7% had gynaecological cancer). The determinants of fertility-related distress were: country of origin, recruitment site, negative affect, desire to have children, treatment regret, and total illness perception score. The impact of the desire to have children on fertility-related distress was mediated by psychological value of children, perceived consequences of cancer on one's life, emotional representation, and treatment-related regret. Country of origin moderated the relationship between the desire to have children and fertility-related distress when mediated by treatment-related regret.

CONCLUSIONS

The CSM proved useful in investigating predictors of fertility-related distress, with emotional, rather than cognitive representation of illness determining its levels. Socio-cultural background played a role in determining one's fertility-related distress and contributed to the explanation of the relationship between one's desire to have children, treatment-related regret, and fertility-related distress.

Is pre-implantation genetic diagnosis (PGD) more of a strain regarding satisfaction with marital quality for male or female partners? A three-year follow-up study

INTRODUCTION

Men and women with a hereditary genetic disease are faced with different options when they plan to become parents. One is pre-implantation genetic diagnosis (PGD) which is a combination of in vitro fertilization (IVF) and genetic analysis of the embryo before implantation. The present study focuses on how men and women planning for PGD experience the quality of marital satisfaction when they apply for treatment and again, three years later.

METHODS

The study was a prospective cohort study where all couples (n = 22) applying for PGD during 2010 and 2011 were eligible. Nineteen women and 17 men (i.e. 17 couples and two women) participated. Participants answered several questionnaires (Dyadic Adjustment Scale, Hospital Anxiety and Depression Scale and Parental Stress Questionnaire) before PGD treatment, and again three years later.

RESULTS

Women who underwent PGD rated the quality of their marital relationship similarly to that of first-time parents and IVF couples, whereas men rated the marital quality somewhat lower than the contrasts groups. Satisfaction with marital quality was stable over the three-year period although men were less satisfied than women on both occasions. At year three, there was a significant correlation between martial satisfaction and parental stress in men, and between martial satisfaction and anxiety and depression in women.

DISCUSSION

Men are equally, or more, affected by their situation than their female partners, with consequences for satisfaction with marital quality. For this reason they should be included in any counselling offered.

Experiences of women living with infertility in Africa: a qualitative systematic review protocol

REVIEW QUESTION

What are the experiences of women living with infertility in Africa?

[Solutions against Declining Birthrates Confronting Japan's Aging Society by Supporting Female Workers in Harmonizing Work with Their Health and Social Issues: Fertility, Chronic Illness, and Raising Children]

Japan is currently facing serious social problems related to low birth rates and aging. We propose two possible solutions from the perspective of occupational health. First, companies should establish support systems to help working women with pregnancy and childbirth. Such systems would require the cooperation and understanding of coworkers, including men, and the introduction of flexible work schedules that are also designed to allow workers to care for family members with disabilities. Additionally, with regard to the protection and promotion of the fertility of working women, occupational health staff members should provide education to working women regarding appropriate lifestyle choices in areas such as diet, prevention of work-related health problems, and mental health before and after childbirth. Moreover, workers undergoing assisted reproductive technology procedures should be supported as they experience physical, mental, and economic burdens associated with this process. Second, companies should guarantee the right of workers to take a sick leave and then return to work so they can balance work and the need to treat chronic conditions. Occupational staff members should follow up employees who return to work, by offering, for example, mental health care to cancer survivors. They should also play important roles in preventing the exacerbation of disease and empowering workers to continue their visits to medical institutions. Collaborative study bridges between companies and medical institutions are necessary for the promotion of these harmonization schemes.

Infertility patients' need and preferences for online peer support

This study sought to determine the level of interest in online peer support among infertility patients, factors associated with such interest, and preferences for features of an online peer support network. A sample of 236 men and 283 women (n = 519) seeking fertility treatment were recruited from four clinics in Ontario and Quebec, Canada. Participants completed an anonymous online questionnaire assessing demographics, perceived stress and fertility characteristics, in addition to interest in and preferences for online infertility peer support. Most men (80.1%) and women (89.8%) expressed interest in online peer support, with perceived stress being related to interest among both men and women. Non-White ethnicity and lower income were related to greater interest among men. Patients reported a preference for mobile accessibility, monitored peer-to-peer communication, and links to information. Men and women, particularly those with high levels of perceived stress, expressed interest in online peer support and shared similar preferences for features irrespective of fertility characteristics. Demographic characteristics and perceived stress were related to a desire for more personalized support options.

'Being able to bear a child': Insights from Zimbabwean women in Melbourne

PROBLEM

In non-Western societies, childlessness carries numerous social consequences and has a significant impact on the gender identity and well-being of the women.

BACKGROUND

The desire of women in non-Western societies is governed by numerous socio-cultural expectations including social norms and their own social position. At present, little is known about how Zimbabwean migrant women living in Australia perceive and experience childlessness and motherhood.

AIM

To discuss how children are seen in Zimbabwean culture and examine the personal and social ramification of infertility and cultural expectations of motherhood among Zimbabwean migrant women living in Australia. The perspectives and experiences of this migrant community are crucial so that we can avoid misunderstanding about the essence of motherhood among Zimbabwean women. This will ultimately lead to sensitive and culturally appropriate health and social care for migrants in a multicultural society of Australia.

METHODS

The study is situated within the constructivist paradigm. Qualitative methods (in-depth interviewing, drawings and photo elicitation) were conducted with 15 Zimbabwean women. Data were analysed using thematic analysis method.

FINDINGS

Being able to bear a child in Zimbabwean culture had a significant meaning to the women. Not only children could ensure the continuity of the society, having children was a form of social security as parents would be cared for by their children in old age. Childlessness threatens the social position of a woman and carries social consequences which significantly impact on their gender identity and well-being. Cultural expectations of motherhood placed the sole responsibility of caring for the children emotionally and physically on the mother.

CONCLUSION

The procreative value has not diminished despite having settled in Australia. An increased awareness of procreative needs for Zimbabwean women in a culturally and sensitive manner would enhance the emotional well-being of these women.

The contribution of social-environmental factors to the emotional adjustment of Israeli religious Jewish women coping with infertility

The community is often considered a resource for coping with health-related stress but has potential for negative effects when coping with fertility problems. In this study, we examined the associations between the social-environmental variables (seeking the support of the community, perception of pressure from the community, and perception of spouse support as a possible moderator of this pressure) and emotional adjustment to fertility problems among religious Jewish women in Israel, a highly pronatalist society. Data were collected from January to August 2011. Structural equation modeling using data from 186 women indicated that perception of pressure from the community was associated with poorer emotional adjustment. This association was not moderated by perceived spouse support, but spouse support was associated with better adjustment. Seeking the support of the community was found to be composed of two dimensions: Seeking Ties and Belonging to the Community, which was associated with poorer adjustment, and Seeking Approval and Recognition from the Community, which was associated with better adjustment. These results point to the complexity of dealing with health-related stress when it comes to important community values. Understanding this complexity can help professionals conduct culturally sensitive evaluation and treatment that will contribute to women's emotional adjustment to fertility problems.

Myrianthus arboreus P. Beauv (Cecropiaceae) Extracts Accelerates Sexual Maturation, and Increases Fertility Index and Gestational Rate in Female Wistar Rats

Background: Despite the wide use of leaves of Myrianthus arboreus (Cecropiaceae) in several African countries including Cameroon as food and against amenorrhea and female infertility, it has never been tested for this purpose. Methods: Using immature female Wistar rats, the impact of M. arboreus on the sexual maturation parameters (vaginal opening, ovarian relative weight and follicle maturation, gonadotropins and ovarian hormones serum levels) and fertility index has been evaluated through a 30-day oral administration of aqueous and methanol extracts of leaves at the doses of 20, 110 and 200 g/kg/day. Results: Aqueous extract increased the ovarian relative weight (p < 0.001), progesterone (p < 0.001) and gonadotropins (p < 0.001) serum levels, and induced the maturation of ovarian follicles. The methanol extract additionally induced an early vaginal opening (p < 0.001), uterine growth (p < 0.01) and increased estradiol (p < 0.001) serum levels. The fertility index generally increased following treatments, while the gestation rate remained almost unaffected except at the highest tested dose of M. arboreus extracts where lowest values were observed. Conclusion: Globally, M. arboreus induced an early puberty onset and an increased fertility rate validating at least in part its traditional use for female infertility.

Frequency of cytomegalovirus in fertile and infertile men, referring to Afzalipour Hospital IVF Research Center, Kerman, IRAN: A case-control study

BACKGROUND

Cytomegalovirus (CMV) virus can hide in urinary genital tract cells and affect male infertility disorders.

OBJECTIVE

To evaluate frequency of CMV in the semen samples of men with infertility problems referring to a in vitro fertilization (IVF) center in Kerman, Iran and its association with the parameters of semen.

MATERIALS AND METHODS

In this case-control study, Real time polymerase chain reaction test was performed for detection of human cytomegalovirus in 100 fertile men compared to 100 infertile men referred to the IVF center of Afzalipour Hospital, Kerman, Iran.

RESULTS

Out of 200 samples, 30 samples (15%) were positive for CMV DNA virus (23/100 men (23%) in case group and 7/100 men (7%) in the control group). Sperm counts and motility in the control group were more than the case group (p˂0.0001). There was a significant relationship between the prevalence of CMV infection and male infertility (p˂0.001).

CONCLUSION

Our finding showed that, prevalence of CMV infection was higher in infertile men compared to fertile men and CMV infection can be considered as an important part of male infertility. So; antiviral treatment of positive cases can be effective in improving sperm quality and successful IVF. The relationship between CMV infection in semen and infertility was obtained in previous studies and was confirmed by our study.

Protective effect of curcumin on fertility of rats after exposure to compact fluorescent lamps: An experimental study

BACKGROUND

Testicular function is modified by maturational gonadostatic control highly susceptible to negative physiologic niche-altering factors like UV-rays.

OBJECTIVE

This study was performed in order to uncover new aspects of Compact Florescent Lamps (CFLs) induced damages on the testicular tissue of rats and evaluating the effect of curcumin on testis of rats after exposure to compact florescent Lamps.

MATERIALS AND METHODS

Twenty-four adult male Albino rats were randomly divided into three groups: control group (ethyl oleate 0.2 ml, IP, for 45 days, without CFLs exposure), fluorescent group (ethyl oleate 0.2 ml, IP, daily and treated with 12 hr CFLs exposure for 45 days) and curcumin group (curcumin 20 µ M, IP along with 12 hr CFLs exposure for 45 days). The rats were anesthetized at the end of the experiment. Gonadotropin hormones and prolactin levels were measured; Histopathological and histomorphometrical analysis of the testis was carried out.

RESULTS

Results of this study showed that CFLs significantly decreased serum levels of follicle stimulating hormone, prolactin, testicular weight, sperm motility, TDI, and SPI. Furthermore, CFLs had no effect on serum levels of luteinizing hormone and sperm count and also, increased abnormal sperm shapes. Our results also showed that curcumin supplementation following CFLs reversed these alterations.

CONCLUSION

These results strongly suggest that CFLs severely impairs testis while curcumin as an antioxidant had protective effects on undesirable effects in testis induced by CFLs.

Positive and negative adjustment in couples undergoing infertility treatment: The impact of support exchange

BACKGROUND

Perceived social support relates to infertility-related distress in couples undergoing assisted reproductive technology (ART) treatment. Studies examining the effect of other support types on both positive and negative adjustment among infertile couples are scarce or non-existent. Therefore, this study investigated the effects of support receipt, provision, invisibility (the discrepancy between one partner's received and the other partner's provided support), and equity (the discrepancy between each partner's received and provided support) on the positive (life purpose) and negative (depressive symptoms) indices of well-being in couples undergoing ART treatment.

METHODS

Depressive symptoms (CES-D), life purpose (PIL), and social support (BSSS) were assessed among 31 married couples (mean age 32.67 years) undergoing ART treatment. Data were analyzed by applying the Actor-Partner-Interdependence Model (APIM) using multilevel modeling.

FINDINGS

Both receiving and providing support had beneficial effects in women and men. However, sub-analysis showed differences according to gender and the support exchange effects. Women reported higher depression and lower life purpose but benefited more from support, and their well-being was more dependent on their own perception of support provision and receipt. Men demonstrated higher adjustment to infertility but benefited less from support, and their well-being was mostly correlated with supportive behaviors of their wives.

DISCUSSION

Adjustment mechanisms of women and men undergoing ART treatment vary considerably; thus, gender should be taken into consideration in interventions. Future studies should focus on costs/benefits and gender differences of visible and invisible support in infertility settings.

The relationship of sociocultural beliefs and infertile couples' attitude toward reproductive donation: A descriptive-correlational study

Background

There are controversial views on accepting a reproductive donation in the world.

Objective

This study aimed to determine the relationship between the sociocultural beliefs and infertile couples' attitude toward reproductive donation in Mashhad, Iran.

Materials and Methods

This descriptive correlational study was conducted out on 115 infertile couples visiting Milad Infertility Center in Mashhad, Iran with using convenience sampling. The research instruments were valid and reliable sociocultural beliefs and attitude questionnaires, which were completed by the respondents on a self-report basis.

Results

The mean score of attitude toward reproductive donation in infertile women and men was 58.3 ± 12.6 and 57.8 ± 12.0, and the mean score of sociocultural beliefs in infertile women and men was 67.7 ± 11.5 and 67.6 ± 12.4, respectively. There was a direct correlation between sociocultural beliefs and attitude toward reproductive donation in infertile women (p < 0.001) and men (p < 0.001), that is, women and men with a higher score of sociocultural beliefs had a higher score of attitude as well. A direct correlation was also seen between sociocultural beliefs and infertile women and men's public attitude, their attitude towards genetic bound between parents and children, their attitude regarding the issue of confidentiality of the donation process, as well as attitude in relation to oocyte donation, embryo donation, and surrogacy (p < 0.001).

Conclusion

The findings suggest that sociocultural beliefs that surround reproductive donation could influence infertile couple's attitude toward accepting these therapeutic alternatives in infertile couples. It is therefore recommended to take steps to incorporate sociocultural beliefs into the routine care of infertile couples with the help of social media to give them ability for making more pragmatic decision in relation to their chosen options.

Conceptualising women's motivations for social egg freezing and experience of reproductive delay

As the average age of motherhood in many Western countries continues to rise, the spectacle of the older mother and the trend towards delayed childbearing has been the subject of much public debate and interest. Concurrent to this trend has been the development and use of a new form of fertility preservation - social egg freezing - a technology which by its very nature is meant to enable reproductive delay. Whilst previous studies have been able to provide insights into the complex and often interrelating structural, economic, and relational factors shaping the timing of motherhood, and in some cases women's use of social egg freezing, fewer studies have clearly demonstrated the way these factors themselves, as well as the accounts of individual women, can be seen as being shaped by ideological and discursive forces. Drawing on interviews with 31 users of social egg freezing this article will demonstrate how women's accounts of reproductive delay and use of egg freezing technology can be seen as being shaped by neoliberal rationality, heteronormativity, discourses of 'appropriate parenting' and gendered ideologies of parenthood.

'Half a woman, half a man; that is how they make me feel': a qualitative study of rural Jordanian women's experience of infertility

Infertility is a health problem encompassing physical, psychological and social consequences that may threaten women's quality of life. Few studies have been conducted in Jordan examining rural women's experiences of infertility. This study aimed to explore responses to infertility and its consequences in the Jordanian rural sociocultural context. Using a descriptive qualitative design, data were collected between April and September 2016 from a fertility clinic in a military hospital in Northern Jordan. Semi-structured interviews were conducted with 14 purposively selected Jordanian women. Data were analysed using thematic analysis. Findings revealing women's responses to infertility included: submission and docility, self-isolation, internalisation and persistence in getting pregnant by seeking modern and traditional methods of treatment. The impact of infertility complicated women's everyday living through their experiences of violence, kinship and patriarchal interference, stigma, negative perceptions of the infertile woman, and other's surveillance of their sexuality. Women living in rural areas of Jordan have negative experiences of infertility that are ingrained in sociocultural beliefs about fertility and reproduction. Healthcare professionals are encouraged to raise public awareness about infertility's adverse consequences and to help families by enhancing positive responses to infertility.

The Role of Attachment Anxiety and Attachment Avoidance on the Psychosocial Well-being of Infertile Couples

This study's objective was to explore the mediating role of attachment orientation in infertile women and their partners as a mediator of the relationship between need for parenthood and psychosocial well-being. Ninety participants (45 couples) undergoing in vitro fertilization completed self-report questionnaires that assessed representations of the importance of parenthood, attachment orientations, and psychosocial well-being. Path analysis was used to examine the direct and indirect effects. The results indicated that women's attachment anxiety mediated the effect of need for parenthood on the psychological well-being of themselves and their partner. Although causality cannot be assumed, this study highlights the importance of considering attachment orientations and related strategies of emotion regulation in clinical settings and the need to address the meaning of parenthood for promoting couples' well-being.

Resolved Parental Infertility and Children's Educational Achievement

Although difficulty conceiving a child has long been a major medical and social preoccupation, it has not been considered as a predictor of long-term outcomes in children ultimately conceived. This is consistent with a broader gap in knowledge regarding the consequences of parental health for educational performance in offspring. Here we address that omission, asking how resolved parental infertility relates to children's academic achievement. In a sample of all Swedish births between 1988 and 1995, we find that involuntary childlessness prior to either a first or a second birth is associated with lower academic achievement (both test scores and GPA) in children at age 16, even if the period of infertility was prior to a sibling's birth rather than the child's own. Our results support a conceptualization of infertility as a cumulative physical and social experience with effects extending well beyond the point at which a child is born, and emphasize the need to better understand how specific parental health conditions constrain children's educational outcomes.

Moving forward together, stronger, and closer: An interpretative phenomenological analysis of marital benefits in infertile couples

Some couples find in infertility the bonding opportunities that reinforce their relationship. Using an interpretative phenomenological analysis, this study examined marital benefits in three couples seeking fertility treatment. Interviews revealed five types of benefits: being engaged in a shared hardship, feeling closer to one another, feeling reassured in the relationship, developing a satisfying communication and support behaviors, and having faith in the couple’s capacity to face adversity. A dyadic analysis also illustrated how marital benefits developed in each couple. Marital benefits nourished marital satisfaction, thus underscoring their importance to help couples cope through fertility treatment.