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

Risk factors for psychiatric disorders in infertile women and men undergoing in vitro fertilization treatment

OBJECTIVE

To identify risk factors associated with depression and anxiety in infertile women and men undergoing in vitro fertilization (IVF).

DESIGN

Prospective study.

SETTING

A university hospital in Sweden during a 2-year period.

PATIENT(S)

825 participants (413 women and 412 men).

INTERVENTION(S)

Primary Care Evaluation of Mental Disorders (PRIME-MD), based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), as the diagnostic tool for evaluating mood and anxiety disorders, and fertility history and outcome of IVF treatment collected from the patients' medical records.

MAIN OUTCOME MEASURE(S)

Risk factors associated with depression and anxiety disorders.

RESULT(S)

A negative pregnancy test and obesity were the independent risk factors for any mood disorders in women. Among men, the only independent risk factor for depression was unexplained infertility. No IVF-related risk factors could be identified for any anxiety disorder.

CONCLUSION(S)

A negative pregnancy test is associated with an increased risk for depression in women undergoing IVF, but no risk of developing anxiety disorders is associated with the pregnancy test result after IVF. Pregnancy test results were not a risk factor for depression or anxiety among men.

Addressing fertility needs of breast cancer patients: oncology perspective

Premenopausal women represent approximately 23% of women diagnosed with breast cancer. As the medial age of first pregnancy increases in developed countries, a greater proportion of women are diagnosed with breast cancer at a time when they have not yet completed their family. For these women, the impact of breast cancer treatment on their reproductive capacity can be of significant concern and may influence their treatment decisions. Despite these concerns only a proportion of premenopausal women with breast cancer are informed about their treatment choices in light of their reproductive needs. The diagnosis of cancer itself as well as systemic cancer treatments, including chemotherapy and hormonal therapy, can delay and/or reduce the reproductive capacity. Treatment decisions need to consider not only adjuvant treatment efficacy but also its risks, including impact on fertility. The risk of chemotherapy-associated amenorrhea varies according to the regime and is age-dependent. Hormonal treatments may delay reproduction further. A variety of fertility preservation strategies have been tried including gonadal protection during chemotherapy, ovarian cryopreservation and in vitro fertilization, but their potential benefits need to be considered in light of risks and, for most of them, the evidence for efficacy is limited. Special fertility considerations are required in women with family history and/or evidence of genetic predisposition to breast cancer as strategies for risk reduction may impact on their fertility choices. Finally, as survival of women with metastatic breast cancer increases, women with advanced cancer who become pregnant pose unique management challenges for oncologists and obstetricians alike.

"Letting go" coping is associated with successful IVF treatment outcome

OBJECTIVE

To examine whether women's baseline coping strategies are associated with IVF outcomes. Psychologic factors have been found to be prospectively associated with the outcome of IVF treatments in several studies. However, the exact role of coping strategies, which are modifiable, remains unclear. Problem-focused coping may be more adaptive for controllable situations, whereas emotion-focused coping (EFC) may be more adaptive for uncontrollable situations, such as most stages of IVF treatment.

DESIGN

Prospective study. Coping strategies were assessed before IVF treatment began.

SETTING

Infertility and IVF unit in a university-affiliated tertiary medical center.

PATIENT(S)

Eighty-eight women undergoing IVF treatment in our unit.

MAIN OUTCOME MEASURE(S)

Pregnancy.

RESULT(S)

Of 88 women participating in the study, 23.9% became pregnant. In the male and female factor infertility groups, the EFC strategy of "letting go" was positively and significantly associated with pregnancy. Adjusting for age, cause of infertility, and number of cycles, the relative risk for pregnancy by "letting go" was 1.88 (95% confidence interval 1.1-3.2).

CONCLUSION(S)

These findings support the notion that in the context of a low-control situation such as IVF treatment, women who try to be actively in control may pay a higher price in terms of pregnancy probabilities. Means of increasing "letting go" are discussed.

Adding phytoestrogens to clomiphene induction in unexplained infertility patients--a randomized trial

This study investigated the role of oral phytoestrogens in improving pregnancy rate and cycle outcomes with clomiphene citrate. Patients with unexplained infertility and recurrent clomiphene citrate induction failure, were randomly divided into two groups: group I (n = 60) and group II (n = 59). Both groups received clomiphene citrate 150 mg per day (days 3 to 7). Group I received additional oral phytoestrogen (Cimicifuga racemosa) 120 mg/day from days 1 to 12. Human chorionic gonadotrophin (HCG) injection (10,000 IU i.m.) was given and timed intercourse was recommended when a leading follicle reached >17 mm and serum oestradiol exceeded 200 (pg/ml). There was a non-significant shortening of induction cycles in group I. Oestradiol and LH concentrations were higher in group I compared with group II. Endometrial thickness, serum progesterone and clinical pregnancy rate were significantly higher in group I (8.9 +/- 1.4 mm versus 7.5 +/- 1.3 mm, P < 0.001; 13.3 +/- 3.1 ng/ml versus 9.3 +/- 2.0 ng/ml, P < 0.01; 36.7% versus 13.6%, P < 0.01, respectively). It is concluded that adding C. racemosa rhizome dry extract to clomiphene citrate induction can improve the pregnancy rate and cycle outcomes in these couples.

Dynamics of Internet usage during the stages of in vitro fertilization

Hospitals and clinics develop Internet strategies to emancipate and empower their patient population. At Radboud University Nijmegen Medical Centre, we developed an Internet-based personal health record that provides patients with general and personal information about their treatment and that provides facilities for communication with fellow patients and with physicians. Because not much is known about information and communication needs of IVF and ICSI patients in relation to their treatment, we observed the intensity of use of this personal health record during the various stages of IVF treatment. We measured the numbers of page views and the number of contributions to the chat room. Data regarding Website use and treatment schedules were available for 51 couples. These couples generated 25,420 page views and posted 11,403 utterances. Two-way analysis of variance showed that significant individual changes occurred in the intensity of use during the different stages of the treatment. During the stages in which there is no contact between the patient and the clinic, patients make use of the Website's communication functions. This reflects the patients' need for continued communication and support during the last stages of treatment, a service that IVF clinics traditionally cannot or do not provide.