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Chen X, Hao X, Xie L, Liu X. A bidirectional causal relationship study between mental disorders and male and female infertility. Front Psychiatry 2024; 15:1378224. [PMID: 38699446 PMCID: PMC11064171 DOI: 10.3389/fpsyt.2024.1378224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/28/2024] [Indexed: 05/05/2024] Open
Abstract
Background The relation between mental disorders (MDs) and infertility can be reciprocal. But exactly which MD affects infertility remains controversial. Our aim was to use Mendelian randomization (MR) to explore bidirectional causality between 15 MDs and male infertility and female infertility. Methods The data of MDs, male infertility, and female infertility were derived from published genome-wide association studies (GWAS). The inverse variance weighted method was considered to be the main analytical approach. Sensitivity analysis was performed using MR-Egger, Cochran's Q, radial MR, and MR-PRESSO tests. Results Our results found that mood disorders (OR, 1.4497; 95% CI, 1.0093 - 2.0823; P = 0.0444) and attention deficit hyperactivity disorder (OR, 1.3921; 95% CI, 1.0943 - 1.7709; P = 0.0071) were positively correlated with male infertility, but obsessive-compulsive disorder (OR, 0.8208; 95% CI, 0.7146 - 0.9429; P = 0.0052) was negatively associated with male infertility. For females, anorexia nervosa (OR, 1.0898; 95% CI, 1.0070 - 1.1794; P = 0.0329), attention deficit hyperactivity disorder (OR, 1.1013; 95% CI, 1.0041 - 1.2079; P = 0.0406), and major depressive disorder (OR, 1.1423; 95% CI, 1.0213 - 1.2778; P = 0.0199) increased risk of infertility. In reverse relationship, female infertility increased the incidence of bipolar disorder (OR, 1.0009; 95% CI, 1.0001 - 1.0017; P = 0.0281). Conclusion We demonstrated the association between five MDs and male or female infertility. Female infertility was also found to be associated with an increased risk of one MD. We look forward to better designed epidemiological studies to support our results.
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Affiliation(s)
| | | | | | - Xiaoqiang Liu
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
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Huang C, Shi Q, Xing J, Yan Y, Shen X, Shan H, Sun H, Mei J. The relationship between duration of infertility and clinical outcomes of intrauterine insemination for younger women: a retrospective clinical study. BMC Pregnancy Childbirth 2024; 24:199. [PMID: 38486148 PMCID: PMC10938817 DOI: 10.1186/s12884-024-06398-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 03/07/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND The objective of this research was to elucidate the association between the length of infertility and the outcomes of intrauterine insemination (IUI) in women of varying ages - a topic that has been the subject of investigation for numerous years, yet lacks a definitive consensus. METHODS A retrospective cohort investigation involving 5268 IUI cycles was undertaken at the Reproductive Medicine Center of Nanjing Drum Tower Hospital from 2016 to 2022. Utilizing the smooth fitting curve along with threshold and saturation effect analysis, the correlation between infertility duration and IUI clinical pregnancy rates was discerned. Moreover, patients were bifurcated into two cohorts based on their respective infertility durations. A secondary examination was also performed employing propensity-score matching to mitigate the impact of confounding variables. Subsequent threshold and saturation effect analysis was carried out across various subgroups, segmented on the basis of age differentiation. RESULTS When the duration of infertility was more than 5 years, the clinical pregnancy rate decreased with the increase of infertility duration (aOR: 0.894, 95%CI: 0.817-0.991, p = 0.043). The multivariate regression analysis suggested that longer duration of infertility (≥ 5 years) was significantly correlated with the lower clinical pregnancy rate (aOR: 0.782, 95% CI: 0.643-0.950, p = 0.01). After the propensity-score matching, the clinical pregnancy rate of women with longer infertility duration were also higher. When the duration of infertility was more than 5 years, the clinical pregnancy rate of women younger than 35 years old decreased with the increase of infertility duration (aOR: 0.906, 95%CI: 0.800-0.998, p = 0.043). CONCLUSIONS The clinical pregnancy rate and live birth rate of IUI in young women (< 35 years old) who have been infertile for more than 5 years significantly decrease with the prolongation of infertility time. Therefore, for young women who have been infertile for more than 5 years, IUI may not be the best choice.
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Affiliation(s)
- Chenyang Huang
- Center for Reproductive Medicine and Obstetrics and Gynecology, Drum Tower Clinic Medical College of Nanjing Medical University, Nanjing, 210008, China
| | - Qingqing Shi
- Center for Reproductive Medicine and Obstetrics and Gynecology, Drum Tower Clinic Medical College of Nanjing Medical University, Nanjing, 210008, China
| | - Jun Xing
- Center for Reproductive Medicine and Obstetrics and Gynecology, Drum Tower Clinic Medical College of Nanjing Medical University, Nanjing, 210008, China
| | - Yuan Yan
- Center for Reproductive Medicine and Obstetrics and Gynecology, Drum Tower Clinic Medical College of Nanjing Medical University, Nanjing, 210008, China
| | - Xiaoyue Shen
- Center for Reproductive Medicine and Obstetrics and Gynecology, Drum Tower Clinic Medical College of Nanjing Medical University, Nanjing, 210008, China
| | - Huizhi Shan
- Center for Reproductive Medicine and Obstetrics and Gynecology, Drum Tower Clinic Medical College of Nanjing Medical University, Nanjing, 210008, China
| | - Haixiang Sun
- Center for Reproductive Medicine and Obstetrics and Gynecology, Drum Tower Clinic Medical College of Nanjing Medical University, Nanjing, 210008, China.
| | - Jie Mei
- Center for Reproductive Medicine and Obstetrics and Gynecology, Drum Tower Clinic Medical College of Nanjing Medical University, Nanjing, 210008, China.
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Yadav A, Tiwari P, Dada R. Yoga and Lifestyle Changes: A Path to Improved Fertility - A Narrative Review. Int J Yoga 2024; 17:10-19. [PMID: 38899142 PMCID: PMC11185437 DOI: 10.4103/ijoy.ijoy_211_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/22/2023] [Accepted: 01/10/2024] [Indexed: 06/21/2024] Open
Abstract
Infertility, a widespread medical condition affecting numerous couples globally, persists as a challenge despite advances in assisted reproductive technologies (ARTs), often burdened by financial, physical, and emotional strains. Complementary and alternative approaches, notably yoga, have garnered attention for potentially enhancing fertility outcomes. Studies reveal yoga's influence on factors contributing to infertility, including reduced oxidative stress (OS) and oxidative DNA damage (ODD). OS, linked to mutagenic base formation, higher malondialdehyde levels, abnormal methylation, and altered gene expression, can impair sperm genome integrity. Yoga's efficacy is evident in lowering OS, positively affecting signal transmission, gene expression, and physiological systems. Furthermore, yoga has a positive impact on addressing the dysregulation of apoptosis, resulting in improved processes such as spermatogenesis, sperm maturation, and motility, while also reducing DNA fragmentation. OS correlates with genome-wide hypomethylation, telomere shortening, and mitochondrial dysfunction, contributing to genome instability. Yoga and meditation significantly reduce OS and ODD, ensuring proper reactive oxygen levels and preserving physiological systems. The review explores potential mechanisms underlying yoga's positive impact on infertility, including enhanced blood flow, reduced inflammation, relaxation response, and modulation of the hypothalamic-pituitary-adrenal axis. Furthermore, a comprehensive review of the literature reveals substantial evidence supporting the positive effects of yoga on infertility factors. These include oxidative stress (OS), oxidative DNA damage (ODD), epigenetic changes, hormonal balance, ovarian function, menstrual irregularities, and stress reduction. In summary, yoga emerges as a promising adjunctive therapy for infertility, demonstrating the potential to mitigate key factors influencing reproductive success. Although preliminary evidence indicates the positive effects of yoga on infertility, further clinical research is imperative to define specific benefits, molecular mechanisms associated, optimal protocols, and long-term effects in infertility treatment plans.
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Affiliation(s)
- Anjali Yadav
- Department of Anatomy, Lab for Molecular Reproduction and Genetics, All India Institute of Medical Sciences, New Delhi, India
| | - Prabhakar Tiwari
- Department of Anatomy, Lab for Molecular Reproduction and Genetics, All India Institute of Medical Sciences, New Delhi, India
| | - Rima Dada
- Department of Anatomy, Lab for Molecular Reproduction and Genetics, All India Institute of Medical Sciences, New Delhi, India
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Chen D, Wang A, Zhang W, Guo Y, Yao S, Chen X, Zhang J. Effectiveness of double ABCX-based psychotherapy for psychological distress among women undergoing in vitro fertilization-embryo transfer: a three-arm randomized controlled trial. J Psychosom Obstet Gynaecol 2023; 44:2278015. [PMID: 38056467 DOI: 10.1080/0167482x.2023.2278015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 10/27/2023] [Indexed: 12/08/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate the effectiveness of double ABCX-based psychotherapy for psychological distress during in vitro fertilization-embryo transfer (IVF-ET) among a female group (FG), couple group (CoG) and control group (CG). METHODS A total of 201 women undergoing their first IVF-ET cycle were randomized into three groups. The 6-session intervention was delivered at each visit to the IVF clinic. The primary outcomes were depression and anxiety, and the secondary outcomes included sleep quality, serum cortisol (nmol/L) levels and the clinical pregnancy rate, which were assessed before and after the intervention. RESULTS The group-by-time effects were significant for depression, anxiety, sleep quality and serum cortisol levels, with larger effect sizes in the FG than in the CoG. There was no significant difference in the pregnancy rate among the three groups. CONCLUSION Psychotherapy effectively mitigated psychological distress, suggesting greater effectiveness for couples undergoing IVF couples than for women only. It is structured and easy to use during the IVF treatment cycle. TRIAL REGISTRATION NUMBER https://register.clinicaltrials.gov (NCT03931187, retrospectively registered on April 23, 2019).
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Affiliation(s)
- Dan Chen
- Nursing Department, Medical College, Hunan Normal University, Changsha, China
| | - Anni Wang
- School of Nursing, Fudan University, Shanghai, China
| | - Wen Zhang
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China
| | - Yufang Guo
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Shuyu Yao
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaoxuan Chen
- School of Mathematics, Hunan Normal University, Changsha, China
| | - Jingping Zhang
- Xiangya School of Nursing, Central South University, Changsha, China
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Bakkensen JB, Smith KS, Cheung EO, Moreno PI, Goldman KN, Lawson AK, Feinberg EC. Childbearing, Infertility, and Career Trajectories Among Women in Medicine. JAMA Netw Open 2023; 6:e2326192. [PMID: 37498595 PMCID: PMC10375303 DOI: 10.1001/jamanetworkopen.2023.26192] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/14/2023] [Indexed: 07/28/2023] Open
Abstract
Importance Although women are increasingly represented within medicine, gender disparities persist in time to promotion, achievement of academic rank, and appointment to leadership positions, with no narrowing of this gap over time. Career-specific fertility and family building challenges among women physicians may contribute to ongoing disparities and academic attrition. Objective To evaluate delayed childbearing and infertility among women in medicine and investigate the extent to which women physicians may alter career trajectories to accommodate family building and parenthood. Design, Setting, and Participants This survey study was conducted among women physicians, with surveys distributed through medical society electronic mailing lists (listserves) and social media from March to August 2022. Main Outcomes and Measures Baseline demographic information and fertility knowledge were assessed. Descriptive data on delayed childbearing, infertility, use of assisted reproductive technology, and career alterations to accommodate parenthood were collected. Factors associated with timing of pregnancy and family building regret were assessed using Likert-type scales. Group differences in fertility knowledge, delayed childbearing, infertility, and family building regret were evaluated using χ2 analyses. Results A total of 1056 cisgender women (mean [SD] age, 38.3 [7.7] years) were surveyed across level of training (714 attending physicians [67.6%] and 283 residents or fellows [26.8%]), specialty (408 surgical [38.6%] and 638 nonsurgical [60.4%] specialties), and practice setting (323 academic [45.2%], 263 private [24.9%], and 222 community [21.0%] settings). Among respondents, 1036 individuals [98.1%] resided in the US. Overall, 910 respondents (86.2%) were married or partnered and 690 respondents (65.3%) had children. While 824 physicians (78.0%) correctly identified the age of precipitous fertility decline, 798 individuals (75.6%) reported delaying family building and 389 individuals (36.8%) had experienced infertility. Concerning measures taken to accommodate childbearing or parenthood, 199 women (28.8%) said they had taken extended leave, 171 women (24.8%) said they had chosen a different specialty, 325 women (47.1%) said they had reduced their work hours, 171women (24.8%) said they had changed their practice setting, and 326 women (47.2%) said they had passed up opportunities for career advancement among those with children. Additionally, 30 women with children (4.3%) had left medicine entirely. Conclusions and Relevance In this survey study, women physicians reported that career-related pressures influenced the timing of childbearing and led to marked alterations to career trajectories to accommodate family building and parenthood. These findings suggest that fertility and family building concerns among women in medicine may contribute to ongoing gender disparities and attrition and represent a potentially critical area for policy reform and future change.
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Affiliation(s)
- Jennifer B. Bakkensen
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kathryn S. Smith
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Elaine O. Cheung
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Hinge, New York, New York
| | - Patricia I. Moreno
- Department of Public Health Sciences at the University of Miami Miller School of Medicine, Miami, Florida
| | - Kara N. Goldman
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Angela K. Lawson
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Eve C. Feinberg
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Domar AD, Jasulaitis L, Matevossian K, Jasulaitis S, Grill EA, Uhler ML. The Impact of the FertiStrong Mobile Application on Anxiety and Depression in Men: A Randomised Control Pilot Study. J Hum Reprod Sci 2023; 16:195-203. [PMID: 38045496 PMCID: PMC10688279 DOI: 10.4103/jhrs.jhrs_75_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/14/2023] [Accepted: 09/16/2023] [Indexed: 12/05/2023] Open
Abstract
Background Male factor accounts for up to half of all cases of infertility. Previously, research has focused on the psychological effects of infertility on female partners, but recent studies show negative consequences on male patients as well. Despite evidence that men are affected by infertility, there is limited studies focusing on coping methods for them. Aims Determine if a cognitive-behavioral and relaxation mobile application, targeted at men experiencing infertility, could lead to decreases in psychological distress. Settings and Design Randomized controlled. Materials and Methods Thirty-nine men participated in a randomized pilot study of the FertiStrong application. Participants completed a demographic form, the Hospital Anxiety and Depression Scale (HADS) and Fertility Problem Inventory (FPI) at baseline and one month follow-up. The intervention group downloaded the FertiStrong application and used it when needed. Control participants received routine infertility care. Statistical Analysis Used Normally distributed data is presented as mean+/- SD; Differences in proportions were tested using Chi-square test and within group comparison were performed using paired t-test. Results One participant was excluded, resulting in 38 participants, 19 in each group. There were no baseline differences in demographic characteristics (P>0.31). For the HADS anxiety domain, the control group had a small increase between baseline and follow up, while the intervention group had a small decrease. For the HADS depression domain, there was a slight increase in the controls. For the FPI, the control group had a two-point increase, from moderately stressed to extremely high while the intervention group had a five-point decrease, from extremely high to moderately high, but was not significant. Each FPI domain-specific score in the intervention group decreased and one, Rejection of Childfree lifestyle, was significant (P=0.03). The increase in stress level was significantly greater in the control group (P<0.02). Conclusion Recruitment was challenging due to the short recruitment phase and the sample size was smaller than planned. However, there were several significant improvements noted in the intervention group and on all testing, the intervention group trended to less distress. More research is needed on convenient interventions for men experiencing infertility.
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Affiliation(s)
- Alice D. Domar
- Inception Fertility, Houston TX, Harvard Medical School, Boston MA
| | | | - Karine Matevossian
- Women and Infants Hospital, Warren Alpert Medical School of Brown University, Wakefield, Rhode Island
| | | | - Elizabeth A. Grill
- Center for Reproductive Medicine, Weill Cornell Medicine, New York, NY, USA
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Kremer F, Ditzen B, Wischmann T. Effectiveness of psychosocial interventions for infertile women: A systematic review and meta-analysis with a focus on a method-critical evaluation. PLoS One 2023; 18:e0282065. [PMID: 36854039 PMCID: PMC9974119 DOI: 10.1371/journal.pone.0282065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/07/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Approximately seven to nine percent of couples of reproductive age do not get pregnant despite regular and unprotected sexual intercourse. Various psychosocial interventions for women and men with fertility disorders are repeatedly found in the literature. The effects of these interventions on outcomes such as anxiety and depression, as well as on the probability of pregnancy, do not currently allow for reliable generalisable statements. This review includes studies published since 2015 performing a method-critical evaluation of the studies. Furthermore, we suggest how interventions could be implemented in the future to improve anxiety, depression, and pregnancy rates. METHOD The project was registered with Prospero (CRD42021242683 13 April 2021). The literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Six databases were searched and 479 potential studies were discovered. After reviewing the full texts, ten studies were included for the synthesis. Not all studies reported the three outcomes: four studies each for depression, three for anxiety and nine studies for pregnancy rates were included in the meta-analysis, which was conducted using the Comprehensive meta-analysis (CMA) software. RESULTS Psychosocial interventions do not significantly change women's anxiety (Hedges' g -0,006; CI: -0,667 to 0,655; p = 0,985), but they have a significant impact on depression in infertile women (Hedges' g -0,893; CI: -1,644 to -0,145; p = 0,026). Implementations of psychosocial interventions during assisted reproductive technology (ART) treatment do not increase pregnancy rates (odds ratio 1,337; 95% CI 0,983 to 1,820; p = 0,064). The methodological critical evaluation indicates heterogeneous study design and samples. The results of the studies were determined with different methods and make comparability difficult. All these factors do not allow for a uniform conclusion. METHODOLOGICAL CRITICAL EVALUATION Study design (duration and timing of intervention, type of intervention, type of data collection) and samples (age of women, reason for infertility, duration of infertility) are very heterogeneous. The results of the studies were determined with different methods and make comparability difficult. All these factors do not allow for a uniform conclusion. CONCLUSION In order to be able to better compare psychosocial interventions and their influence on ART treatment and thus also to achieve valid results, a standardised procedure to the mentioned factors is necessary.
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Affiliation(s)
- Franziska Kremer
- Institute of Medical Psychology, Centre for Psychosocial Medicine, University Hospital, Heidelberg, Germany
- * E-mail:
| | - Beate Ditzen
- Institute of Medical Psychology, Centre for Psychosocial Medicine, University Hospital, Heidelberg, Germany
| | - Tewes Wischmann
- Institute of Medical Psychology, Centre for Psychosocial Medicine, University Hospital, Heidelberg, Germany
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Impact of Stress and Financials on Romanian Infertile Women Accessing Assisted Reproductive Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063256. [PMID: 35328944 PMCID: PMC8948966 DOI: 10.3390/ijerph19063256] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/25/2022] [Accepted: 03/08/2022] [Indexed: 11/17/2022]
Abstract
Around 20% of couples worldwide are affected by infertility issues, with numbers in the European Union reaching as high as 25%, while access to reproductive care varies significantly by geopolitical and country-specific variables. The purpose of this research is to shed light on the unique social, psychological, and financial difficulties faced by Romanian couples seeking access to assisted reproductive therapy (ART). A cross-sectional study was conducted between 2017 and 2019 to involve women who accessed ART at fertility clinics in Romania by completing two infertility surveys. We analyzed the data in terms of all facets of infertility and ART, including the effect of personal background and stress levels on succeeding to conceive, the impact of treatment costs, and household income. A total of 829 participants completed the survey. We observed that high stress exposure leads to a substantially higher duration to conceive using ART, although the proportions of successful pregnancies did not differ between low-stress and high-stress groups. A significantly higher number of couples achieved pregnancy when their monthly household income was higher than EUR 1000 and if the ART method was more expensive. Additionally, we observed that advanced age, high stress levels, and the high cost of ART had a negative association with achieving pregnancy using ART. The findings indicated that Romanian couples experiencing infertility must contend with significant expenses for specialist infertility treatments, as well as treatment-related stress, both of which have a detrimental effect on their odds of attaining conception.
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Emotional Support for Infertility Patients: Integrating Mental Health Professionals in the Fertility Care Team. WOMEN 2022. [DOI: 10.3390/women2010008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Patients seeking fertility treatment are at risk of experiencing psychological distress, with both women and men reporting higher levels of depression and anxiety during infertility treatment than patients in the general population. Multiple professional societies, fertility care providers, and patients have advocated for integrating mental health providers in the treatment of infertile patients in order to provide comprehensive patient-centered care. Research with other patient populations shows that embedding mental health professionals into clinics provides the greatest benefit to patients. Despite acknowledging the importance of mental health in infertility care, professional societies, such as ASRM and ESHRE, have not universally standardized recommendations or methods for imbedding mental health providers in the fertility team. This review article aims to serve as a resource for providers and patients to appraise the available literature on the importance of embedding mental health providers into the fertility treatment team and discusses feasible methods to develop this comprehensive care team.
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Mahoney DE, Russell CL. Women's Reports of Barriers to and Facilitators of Oral Medication Adherence During Ovarian Stimulation: A Mixed Methods Pilot Study. J Reprod Infertil 2021; 22:184-200. [PMID: 34900639 PMCID: PMC8607872 DOI: 10.18502/jri.v22i3.6719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 08/03/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Adherence to lifestyle modification recommendations remains problematic for women undergoing fertility treatment, raising concerns about the extent to which women adhere to prescribed medication regimens. Limited data have shown suboptimal oral medication adherence rates of 19% to 74%. The objective of this study was to explore what women perceive as barriers to and facilitators of oral medication adherence during fertility treatment cycles. Methods: An exploratory mixed methods pilot study was conducted among a sample of 30 women who were actively taking one to two cycles of letrozole or clomiphene citrate for ovarian stimulation in conjunction with intrauterine insemination cycles. Medication adherence barriers were measured using a 20-item survey. Medication adherence facilitators and personal experiences with fertility treatment were assessed with structured interviews. Medication adherence was assessed with electronic event monitoring. Results: The overall medication adherence median was 0.97 with a range of 0.75 to 1.00, and nine women (50%) demonstrated perfect adherence. The most commonly reported barriers were recently feeling sad, down, or blue (53%), and taking medication more than once per day (40%). Women with higher barrier scores had significantly lower medication adherence scores (p=0.02) compared to women with lower total barrier scores. Facilitators included using physical aides as reminders (60%) and establishing a daily routine (50%). No significant correlation was found between medication adherence scores and facilitators. Conclusion: The dynamic interplay between perceived barriers and facilitators and women’s medication-taking patterns could influence whether or not medication regimens are followed correctly.
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Affiliation(s)
- Diane E Mahoney
- School of Nursing, University of Kansas Medical Center, Kansas, US
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11
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Raad G, Tanios J, Kerbaj S, Mourad Y, Fakih F, Shamas F, Azouri J, Fakih C. Stress Management during the Intracytoplasmic Sperm Injection Cycle May Slow Down First Embryo Cleavage and Accelerate Embryo Compaction: A Pilot Randomized Controlled Trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 90:119-126. [PMID: 33333526 DOI: 10.1159/000512530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 10/21/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION A firm consensus on the effectiveness of psychological interventions during infertility treatment has not been reached yet in terms of mental health and pregnancy rates. Moreover, the influence of these interventions on embryo cleavage kinetics has not been investigated. OBJECTIVE The aim of this work was to study whether stress management in couples undergoing an intracytoplasmic sperm injection (ICSI) cycle influences stress levels, mitochondrial DNA (mtDNA) levels in granulosa cells, and cleavage-stage embryos. METHODS Infertile couples were randomized into a treatment as usual (TAU) group (n = 30) and stress management program (SMP) group (n = 29) at the beginning of an ICSI cycle. Couples in the SMP group attended education and relaxation sessions at each visit to the clinic for folliculometry. The perceived stress scale (PSS) was used to assess stress levels at the beginning and end of the cycle. Moreover, mtDNA levels of granulosa cells and embryo morphokinetics were evaluated. RESULTS Post-intervention, women in the SMP group had significantly lower PSS scores than their initial PSS (p < 0.001; effect size, ES = 0.5) and than the final PSS of the TAU group (p = 0.02; ES = 0.09). Additionally, mtDNA levels were significantly lower in luteal granulosa cells of the SMP group than the TAU group (p = 0.02). An earlier time of pronuclei appearance (p = 0.03) and time to 2 cells (p = 0.015) and a faster time to full compaction (p = 0.045) were detected in the embryos of the SMP group compared with the TAU group. CONCLUSION(S) The implemented program may reduce stress levels, retard first embryo cleavage, and accelerate embryo compaction. Further studies with an active control group are needed to confirm these results.
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Affiliation(s)
- Georges Raad
- Al-Hadi Laboratory and Medical Center, Beirut, Lebanon,
| | | | - Simone Kerbaj
- Azoury IVF Clinic, Mount-Lebanon Hospital, Hazmieh, Lebanon
| | - Youmna Mourad
- Al-Hadi Laboratory and Medical Center, Beirut, Lebanon
| | - Fadi Fakih
- Al-Hadi Laboratory and Medical Center, Beirut, Lebanon
| | - Fatmeh Shamas
- Al-Hadi Laboratory and Medical Center, Beirut, Lebanon
| | - Joseph Azouri
- Azoury IVF Clinic, Mount-Lebanon Hospital, Hazmieh, Lebanon
| | - Chadi Fakih
- Al-Hadi Laboratory and Medical Center, Beirut, Lebanon.,Obstetrics and Gynecology Department, Faculty of Medicine, Lebanese University, Beirut, Lebanon
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Mori A, Nishii O, Takai Y, Momoeda M, Kamisawa E, Shimizu K, Nozawa M, Takemura Y, Fujimoto A. Influence of a patient education and care program on women undergoing non-assisted reproductive technology fertility treatment. Reprod Med Biol 2021; 20:513-523. [PMID: 34646080 PMCID: PMC8499593 DOI: 10.1002/rmb2.12406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/20/2021] [Accepted: 07/29/2021] [Indexed: 12/02/2022] Open
Abstract
PURPOSE To determine the influence of a patient education and care program on the quality of life (QOL) of female patients undergoing non-assisted reproductive technology (ART) fertility treatment. METHODS Participants completed the MOS 36-Item Short-Form Health Survey and fertility QOL (FertiQoL) questionnaires at baseline and at 3, 6, and 12 months of treatment. The responses of patients who underwent three sessions of the program (at baseline, 3 months, and 6 months of treatment) were compared with those of patients who did not receive the program. RESULTS This study compared 69 patients who received an additional care program with 104 patients in the control group, all from 13 facilities. Treatment FertiQoL responses (p = 0.004) and treatment tolerability (p = 0.043) differed between the program and control groups at 3 months using the repeated measures mixed model. The cost of treatment per pregnancy was lower in the program group than in the control group. CONCLUSION The patient education and care program provided by reproductive fertility specialists or fertility nurses during non-ART fertility programs improves patient satisfaction.
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Affiliation(s)
- Akiko Mori
- Department of NursingSchool of NursingShonan Kamakura University of Medical SciencesKanagawaJapan
| | - Osamu Nishii
- Department of Obstetrics and GynecologyTeikyo University School of Medicine Hospital MizonokuchiKanagawaJapan
| | - Yasushi Takai
- Department of Obstetrics and GynecologySaitama Ika Daigaku Sogo Iryo CenterSaitamaJapan
| | - Mikio Momoeda
- Center for Advanced ReproductionSt. Luke's International UniversityHospital, TokyoJapan
| | - Etsuko Kamisawa
- Graduate School of NursingKyoto Tachibana UniversityKyotoJapan
| | - Kiyomi Shimizu
- Department of NursingSchool of NursingJosai International UniversityChibaJapan
| | - Mieko Nozawa
- Department of NursingTokyo University of Technology School of Health SciencesTokyoJapan
| | | | - Akihisa Fujimoto
- Department of Obstetrics and GynecologyTeikyo University School of Medicine Hospital MizonokuchiKanagawaJapan
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Negris O, Lawson A, Brown D, Warren C, Galic I, Bozen A, Swanson A, Jain T. Emotional stress and reproduction: what do fertility patients believe? J Assist Reprod Genet 2021; 38:877-887. [PMID: 33548005 PMCID: PMC8079591 DOI: 10.1007/s10815-021-02079-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 01/18/2021] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To better understand the beliefs about a causal role of emotional stress maintained by women seeking fertility care. METHODS A cross-sectional, self-administered survey was distributed to fertility care patients at an academic fertility center in Illinois. Of 5000 consecutive patients, 1460 completed the survey and were included in the study sample. RESULTS Members of our sample (N = 1460) were between 20 and 58 years (mean = 36.2, SD = 4.4). Most respondents were White (72.2%), were in a heterosexual relationship (86.8%), and felt that their physician understood their cultural background (79.4%). Of the sample, 28.9% believed emotional stress could cause infertility, 69.0% believed emotional stress could reduce success with fertility treatment, and 31.3% believed that emotional stress could cause a miscarriage, with evidence of significant racial differences. Less than a quarter (23.8%) of the sample believed emotional stress had no impact on fertility. Lower household income and educational attainment were associated with a greater belief in emotional stress as a causative factor in reproduction with regard to infertility, fertility treatment, and miscarriage. CONCLUSION The majority of women seeking fertility care believe emotional stress could reduce the success of fertility treatment. Furthermore, beliefs about emotional stress and reproduction significantly differ based on race/ethnicity, income, and education. Particular attention should be paid to specific groups of women who may more likely not be aware of the lack of a proven biological relationship between emotional stress and reproduction.
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Affiliation(s)
- Olivia Negris
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Angela Lawson
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Dannielle Brown
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Christopher Warren
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Stanford University School of Medicine, Stanford, CA, USA
| | - Isabel Galic
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alexandria Bozen
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Amelia Swanson
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Tarun Jain
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- Northwestern Center for Fertility and Reproductive Medicine, 676 North St Clair St, Suite 2310, Chicago, IL, 60611, USA.
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Paraskevi L, Antigoni S, Kleanthi G. Stress and Anxiety Levels in Couples who Undergo Fertility Treatment: a Review of Systematic Reviews. Mater Sociomed 2021; 33:60-64. [PMID: 34012353 PMCID: PMC8116083 DOI: 10.5455/msm.2021.33.60-64] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background: Infertility is an issue that affects many parameters peoples’ lives, as individuals and as couples. Besides the physical and economic impact of infertility on the couples, there is a significant reflection of infertility on their mental health and well-being, which follows them from the moment of the diagnosis up until the end of their treatment. Objective: The aim of this review was to investigate whether psychological factors such as stress, anxiety or depression have an impact on the assisted reproduction treatment outcome and whether the use of supporting methods may help couples to minimize their fertility related stress, anxiety and depression and improve the treatment outcome. Methods: After a systematic search of the electronic databases, fourteen studies were included in this umbrella review. The included studies were systematic reviews and meta-analyses published between January 2015 and February 2020. The population of interest was women, men or couples facing infertility and undergoing fertility treatment. The included studies assessed the relationship between stress and anxiety in couples undergoing fertility treatment and the outcome of the treatment, the psychological state and psychological adjustment of the couples after a negative result and the impact of interventional methods for reducing stress, anxiety or depression on the psychological state of the couples undergoing treatment and their pregnancy outcomes. Results: This review fails to provide a certain answer to our research hypothesis due to conflicting results in the included studies. However, it has been observed that couples who reported better psychological state or have been treated with an interventional method for psychological support, were more likely to adjust better to the treatment procedure and the outcome as well. Conclusion: Psychological support and consultation during assisted reproduction treatment is highly recommended by researchers and clinicians.
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Ventimiglia E, Pozzi E, Capogrosso P, Boeri L, Alfano M, Cazzaniga W, Matloob R, Abbate C, Viganò P, Montorsi F, Salonia A. Extensive Assessment of Underlying Etiological Factors in Primary Infertile Men Reduces the Proportion of Men With Idiopathic Infertility. Front Endocrinol (Lausanne) 2021; 12:801125. [PMID: 35002977 PMCID: PMC8739963 DOI: 10.3389/fendo.2021.801125] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 12/03/2021] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE Up to 40% of infertile men remain without a recognized cause (i.e., idiopathic infertility). We aimed to identify, categorize, and report the supposed causes of male infertility in a cohort of white-European men presenting for primary couple's infertility, by using a thorough and extensive baseline diagnostic work-up. MATERIAL AND METHODS Cross-sectional study of 1,174 primary infertile men who underwent a thorough diagnostic work-up including: detailed medical history, physical examination, hormonal assessment, genetic testing, semen analyses; semen and urine cultures; testis color Duplex US. Men without any identified causal factor were considered as idiopathic. Six different etiological categories were established, and their prevalence was estimated. Logistic regression models estimated the risk of missing causal identification. RESULTS A possible causal factor was identified in 928 (81%) men. Hypogonadism was the most frequent identified cause (37%), followed by varicocele (27%). Genetic abnormalities were found in 5% of patients. A causal factor was more easily identifiable for the more severe infertility cases, and azoospermic men were those less likely to be defined as idiopathic (OR and 95% CIs: 0.09; 0.04-0.20). Relative proportion of identified causes remained constant during the 10-year study period (p>0.43). CONCLUSIONS Due to a more comprehensive and extensive diagnostic work-up, at least one underlying cause of male infertility factor in 4 out of 5 infertile men can be identified. Men with a less severe phenotype remain a clinical challenge in terms of establishing a possible etiologic factor. Further studies are needed to assess which subset of infertile men deserves a more extensive work-up.
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Affiliation(s)
- Eugenio Ventimiglia
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Ospedale San Raffaele, Milan, Italy
- Department of Urology, University Vita-Salute San Raffaele, Milan, Italy
| | - Edoardo Pozzi
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Ospedale San Raffaele, Milan, Italy
- Department of Urology, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Fondazione Ca’ Granda – Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Paolo Capogrosso
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Ospedale San Raffaele, Milan, Italy
- Department of Urology, University Vita-Salute San Raffaele, Milan, Italy
| | - Luca Boeri
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Ospedale San Raffaele, Milan, Italy
- Department of Urology, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Fondazione Ca’ Granda – Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Massimo Alfano
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Ospedale San Raffaele, Milan, Italy
| | - Walter Cazzaniga
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Ospedale San Raffaele, Milan, Italy
- Department of Urology, University Vita-Salute San Raffaele, Milan, Italy
| | - Rayan Matloob
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Ospedale San Raffaele, Milan, Italy
| | - Costantino Abbate
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Ospedale San Raffaele, Milan, Italy
| | - Paola Viganò
- Infertility Unit, Unit of Obstetrics/Gynecology, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Ospedale San Raffaele, Milan, Italy
- Department of Urology, University Vita-Salute San Raffaele, Milan, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Ospedale San Raffaele, Milan, Italy
- Department of Urology, University Vita-Salute San Raffaele, Milan, Italy
- *Correspondence: Andrea Salonia,
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Ventimiglia E, Capogrosso P, Boeri L, Cazzaniga W, Matloob R, Pozzi E, Chierigo F, Abbate C, Viganò P, Montorsi F, Salonia A. Leukocytospermia is not an informative predictor of positive semen culture in infertile men: results from a validation study of available guidelines. Hum Reprod Open 2020; 2020:hoaa039. [PMID: 32995564 PMCID: PMC7508024 DOI: 10.1093/hropen/hoaa039] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 07/01/2020] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Are the European Association of Urology (EAU) guidelines for performing semen culture accurate enough for detecting a positive semen culture in Caucasian-European infertile men? SUMMARY ANSWER The majority (80%) of asymptomatic infertile men with a positive sperm culture may miss a proper diagnostic assessment when relying on EAU guidelines; no single parameter can assist in medical decision-making. WHAT IS KNOWN ALREADY The EAU guidelines suggest performing semen culture in case of increased leukocytes in semen (>106 peroxidase positive white blood cells/ml, i.e. leukocytospermia). STUDY DESIGN SIZE DURATION A cross-sectional validation study including 523 infertile men was carried out during 2010-2018. PARTICIPANTS/MATERIALS SETTING METHODS Infertile men who were asymptomatic for genital infections were enrolled at a single academic center, and a semen culture was obtained in every case. A concentration of >103 cfu/ml urinary tract pathogens in the ejaculate was considered indicative of significant bacteriospermia. Semen analysis values were assessed on the basis of 2010 World Health Organization reference criteria. EAU guidelines for semen culture were used to predict positive semen culture in our cohort and thus validated. Moreover, we tested the predictive performance and accuracy of several clinical parameters and compared them to EAU guidelines. MAIN RESULTS AND THE ROLE OF CHANCE A positive semen culture was found in 54 men (10%). The application of EAU guidelines would have missed 43 out of 54 (80%) positive semen cultures with 120/131 (92%) useless examinations. EAU guidelines specificity, sensitivity and discrimination were 74%, 20% and 47%, respectively. When trying to improve positive semen culture prediction, we were unable to find any informative baseline parameter except for serum neutrophil-to-lymphocyte ratio (odds ratio 1.70 (95% CI 1.04-2.77)), although without any improvement in terms of discrimination (P = 0.10). LIMITATIONS REASONS FOR CAUTION The study was limited by the lack of a control group of fertile men its retrospective nature. Moreover, monoclonal antibodies were not used for leukocyte assessment. WIDER IMPLICATIONS OF THE FINDINGS Since it is not possible to identify infertile men at risk of semen infection, further studies are needed to tailor the execution of semen culture. STUDY FUNDING/COMPETING INTERESTS No funding was received for this study. There are no competing interests.
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Affiliation(s)
- Eugenio Ventimiglia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Paolo Capogrosso
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Luca Boeri
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Department of Urology, IRCCS Fondazione Ca’ Granda—Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Walter Cazzaniga
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Rayan Matloob
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Edoardo Pozzi
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Francesco Chierigo
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Costantino Abbate
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Paola Viganò
- Infertility Unit, Unit of Obstetrics/Gynecology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
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Caution is warranted when discussing correlations between stress and reproductive outcomes. Fertil Steril 2020; 114:972-973. [PMID: 32907746 DOI: 10.1016/j.fertnstert.2020.07.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 11/22/2022]
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Gaitzsch H, Benard J, Hugon-Rodin J, Benzakour L, Streuli I. The effect of mind-body interventions on psychological and pregnancy outcomes in infertile women: a systematic review. Arch Womens Ment Health 2020; 23:479-491. [PMID: 31897607 DOI: 10.1007/s00737-019-01009-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 11/07/2019] [Indexed: 11/25/2022]
Abstract
Preliminary evidence suggests that mind-body interventions, including mindfulness-based interventions and yoga, may be effective in reducing mental health difficulties and psychological distress in infertile patients undergoing fertility treatments. We systematically reviewed and synthesized current medical literature of the effectiveness of mind-body interventions in reducing the severity of psychological distress and improving marital function and pregnancy outcomes in infertile women/couple. Databases including PsychINFO, PubMed, EMBASE, and the Cochrane Library were searched for relevant studies. Manual searches were conducted in relevant articles. We included 12 studies that met the inclusion criteria. Four studies were randomized controlled trials (RCT), 4 non-randomized controlled trial (NRCT), and 4 uncontrolled studies (UCT). Participation in a mind-body intervention was associated with reduced anxiety trait and depression scores. The reduction was of low or moderate amplitude in most studies. Our review offers evidence for the effectiveness of mind-body interventions in reducing anxiety state and depression in infertile women and a possible improvement in pregnancy rate. Further RCTs with a precise timing of intervention are needed.
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Affiliation(s)
- Hélène Gaitzsch
- Unit for Reproductive Medicine and Gynecological Endocrinology, Department for Gynecology and Obstetrics, University Hospitals of Geneva and the Faculty of Medicine of the University of Geneva, 30 boulevard de la Cluse, 1205, Geneva, Switzerland
| | - Julie Benard
- Unit for Reproductive Medicine and Gynecological Endocrinology, Department for Gynecology and Obstetrics, University Hospitals of Geneva and the Faculty of Medicine of the University of Geneva, 30 boulevard de la Cluse, 1205, Geneva, Switzerland
| | | | - Lamyae Benzakour
- Division for Liaison Psychiatry and Crisis Intervention, Department of Mental Health, University Hospitals of Geneva, 30 boulevard de la Cluse, 1205, Geneva, Switzerland
| | - Isabelle Streuli
- Unit for Reproductive Medicine and Gynecological Endocrinology, Department for Gynecology and Obstetrics, University Hospitals of Geneva and the Faculty of Medicine of the University of Geneva, 30 boulevard de la Cluse, 1205, Geneva, Switzerland.
- Hélène Gaitzsch Medical Resident Unit for Reproductive Medicine and Gynecological Endocrinology, Department for Gynecology and Obstetrics, University Hospitals of Geneva, 30 boulevard de la Cluse, 1205, Geneva, Switzerland.
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The impact of disturbances in natural conception cycles. Arch Gynecol Obstet 2020; 301:1069-1080. [PMID: 32140804 DOI: 10.1007/s00404-020-05464-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/13/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Many physicians and other healthcare professionals are often asked questions on interfering factors for conception by couples with a desire for children. Such possible disturbances include, for example, the very common minor diseases, stress and also sexual intercourse during the suspected implantation period. Non-scientifically based statements about disturbances in conception cycles, as found in many layman publications and on the internet, can strongly unsettle couples with a desire for children and force them into corset of rules of conduct. Therefore, a systematic scientific evaluation of the impact of disturbances on conception is urgently needed. METHODS A search for possible disturbances in natural conception cycles together with up to three of the respective pre-cycles in a large cycle database from users of the symptothermal method of natural family planning in Germany was performed. Disturbances were qualified by scientific panel decision and analysed statistically with their effects on the chances of spontaneous conception. Mixed logistical regression models and survival time analyses were used. RESULTS A total of 237 women with a total of 747 cycles could be included in the analysis. In 61% of all 237 conception cycles, disturbances occurred. The statistical analysis shows that disturbances in natural conception cycles unexpectedly increase the likelihood of pregnancy by an overall factor of 1.32 (95% CI 1.04-1.70). Sexual intercourse in the window of implantation does not decrease the chances of conception. Relaxation states at the time of ovulation and/or during the implantation period have no representable effect and do not increase the chance of pregnancy. CONCLUSIONS Couples trying to conceive should at least be informed that disturbances in conception cycles, such as minor diseases, stress or sexual intercourse during the implantation period do not interfere with conception. Relaxation has no effect in favour of success. This takes away the guilty feeling of couples, fearing that they possibly did something wrong in cycles without the desired pregnancy.
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Mohamed A, Staite E, Ismail K, Winkley K. A systematic review of diabetes self-management education interventions for people with type 2 diabetes mellitus in the Asian Western Pacific (AWP) region. Nurs Open 2019; 6:1424-1437. [PMID: 31660170 PMCID: PMC6805261 DOI: 10.1002/nop2.340] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 05/31/2019] [Accepted: 07/01/2019] [Indexed: 12/24/2022] Open
Abstract
AIMS AND OBJECTIVES To assess the effectiveness of educational and/or psychological diabetes self-management education (DSME) intervention for people with type 2 diabetes (T2DM) in the Asian Western Pacific (AWP) region. BACKGROUND Translational research indicates that DSME is effective; therefore, it is important to look at the AWP region to see what has been implemented and what the potential barriers are for the low integration of DSME. The need for DSME is present, and programmes are being developed. Therefore, focusing a systematic review of DSME research in the AWP region would give a better understanding of which intervention approaches are associated with better clinical outcomes and are culturally acceptable. DESIGN A systematic review. METHODS A review of randomized controlled trials (RCTs) and comparative studies to evaluate the effectiveness of face-to-face delivery reporting educational and/or psychological interventions for people with T2DM was implemented. We conducted searches using MEDLINE, EMBASE, CINAHL, PubMed and ASSIA databases between January 1990-June 2018. Studies published in English and non-English were included. Two reviewers independently extracted data on participant and intervention characteristics. The quality of evidence was rated on predetermined criteria. Main outcomes included glycaemic control (reduction in HbA1c level). RESULTS We included 21 DSME programmes (17 RCTs), while 15 were group-based approaches. Twelve studies (60%) were categorized as high quality. Three studies (25%) had a moderate (good) effect. Eight trials were effective in improving glycaemic control and reported statistically significant improvements in HbA1c levels. 50% of these were high-intensity group-based programmes.
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Affiliation(s)
- Arbaktun Mohamed
- Department of Psychological MedicineInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK
| | - Emily Staite
- Department of Psychological MedicineInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK
| | - Khalida Ismail
- Department of Psychological MedicineInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK
| | - Kirsty Winkley
- Florence Nightingale Faculty of NursingMidwifery & Palliative CareKing’s College LondonLondonUK
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Boedt T, Dancet E, Lie Fong S, Peeraer K, De Neubourg D, Pelckmans S, van de Vijver A, Seghers J, Van der Gucht K, Van Calster B, Spiessens C, Matthys C. Effectiveness of a mobile preconception lifestyle programme in couples undergoing in vitro fertilisation (IVF): the protocol for the PreLiFe randomised controlled trial (PreLiFe-RCT). BMJ Open 2019; 9:e029665. [PMID: 31366659 PMCID: PMC6678004 DOI: 10.1136/bmjopen-2019-029665] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Infertility and in vitro fertilisation (IVF; with or without intracytoplasmic sperm injection) result in considerable emotional and financial burden. Increasing evidence suggests that lifestyle factors, including diet, physical activity and personal well-being, are associated with IVF-success rates. Currently, IVF is not routinely combined with a lifestyle programme. The preconception lifestyle (PreLiFe) randomised controlled trial (RCT) assesses the effects of a new mobile PreLiFe programme in couples undergoing IVF. METHODS AND ANALYSIS A multicentre RCT including 460 heterosexual couples starting IVF in Belgian fertility clinics. IVF couples are randomised between an attention control group or the PreLiFe programme for a period of 12 months or until an ongoing pregnancy is confirmed by ultrasound. The attention control programme includes a mobile application with treatment information (ie, appointments and medication instructions) in addition to standard care. The PreLiFe programme includes a mobile application with the same treatment information in combination with a lifestyle programme. This new lifestyle programme includes tailored advice and skills training on diet, physical activity and mindfulness in combination with text messages and telephone interaction with a healthcare professional trained in motivational interviewing. The primary outcome of this RCT is the cumulative ongoing pregnancy rate within 12 months after randomisation. Secondary outcomes include changes in diet, physical activity, emotional distress, body mass index, waist circumference, quality of life and other reproductive outcomes including IVF discontinuation, clinical pregnancy rate and time to pregnancy. Additionally, partner support and the feasibility (use and acceptability) of the PreLiFe programme will be evaluated in the intervention group. Analysis will be according to intention to treat. ETHICS AND DISSEMINATION This study has been approved by the Medical Ethical Committee of the Leuven University Hospital (Belgium) and the other recruiting clinics. The findings of this RCT will be disseminated through presentations at international scientific meetings and peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT03790449; Pre-results.
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Affiliation(s)
- Tessy Boedt
- Department of Chronic Diseases Metabolism and Ageing, KU Leuven, Leuven, Belgium
- Leuven University Fertility Centre, University Hospitals Leuven, Leuven, Belgium
| | - Eline Dancet
- Leuven University Fertility Centre, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Sharon Lie Fong
- Leuven University Fertility Centre, University Hospitals Leuven, Leuven, Belgium
| | - Karen Peeraer
- Leuven University Fertility Centre, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Diane De Neubourg
- Antwerp University Hospital, Centre for Reproductive Medicine, Edegem, Belgium
| | - Sofie Pelckmans
- Department of Obstetrics and Gynaecology, Imelda Hospital Bonheiden, Bonheiden, Belgium
| | - Arne van de Vijver
- Department of Obstetrics and Gynaecology, General Hospital Sint Jan Bruges-Ostend, Brugge, Belgium
| | - Jan Seghers
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Katleen Van der Gucht
- Leuven Mindfulness Centre, KU Leuven, Leuven, Belgium
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Ben Van Calster
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, Netherlands
| | - Carl Spiessens
- Leuven University Fertility Centre, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Christophe Matthys
- Department of Chronic Diseases Metabolism and Ageing, KU Leuven, Leuven, Belgium
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
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22
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Dancet EAF, D'Hooghe TM, Dreischor F, van Wely M, Laan ETM, Lambalk CB, Repping S, Custers IM. The 'Pleasure&Pregnancy' web-based interactive educational programme versus expectant management in the treatment of unexplained subfertility: protocol for a randomised controlled trial. BMJ Open 2019; 9:e025845. [PMID: 31289062 PMCID: PMC6615847 DOI: 10.1136/bmjopen-2018-025845] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Many subfertile couples are diagnosed with (relatively) unexplained subfertility and a good prognosis. National professional guidelines (eg, the Netherlands and UK) advise 'expectant management (EM)' for 6-12 months, in which no interaction with healthcare staff is offered. Underpowered studies indicate that face-to-face sex-counselling increases the ongoing pregnancy rates of these couples. In patients with other conditions, web-based interactive educational programmes have the same effect on sexual functioning as face-to-face sex counselling. The 'Pleasure&Pregnancy randomised controlled trial (RCT)' will examine in couples with unexplained subfertility and a good prognosis whether a new web-based interactive educational programme results in a higher chance of naturally conceiving an ongoing pregnancy within 6 months as compared with EM. METHODS AND ANALYSIS A multicentre RCT with cost-effectiveness analysis will include heterosexual couples diagnosed with (relatively) unexplained subfertility and a good prognosis in Dutch and Belgian secondary or tertiary fertility clinics. Couples will be randomised between 6 months of EM and 6 months of the Pleasure&Pregnancy-programme. This new web-based interactive educational programme includes eight progressive modules of information (on the biology of conception and pleasurable sex) and sensate focus, couple communication and mindfulness exercises. Couples are offered interaction with their coaches via email and can take part in three moderated chat sessions with peers. The primary outcome of this RCT is the probability of naturally conceiving an ongoing pregnancy within 6 months after randomisation. Secondary outcomes include time-to-pregnancy, live birth rate, costs, sexual functioning and personal and relational well-being. Analysis will be according to intention to treat. ETHICS AND DISSEMINATION This study has been approved by the Medical Ethical Committees of the Academic Medical Centre (the Netherlands) and the Leuven University Hospital (Belgium). The findings of this RCT will be disseminated through presentations at international scientific meetings and peer-reviewed publications. TRAIL REGISTRATION NUMBER NTR5709; Pre-results.
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Affiliation(s)
- Eline A F Dancet
- Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium
- Postdoctoral fellow, Research Foundation - Flanders, Belgium
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Thomas M D'Hooghe
- Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium
| | - Felicia Dreischor
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Madelon van Wely
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Ellen T M Laan
- Department of Sexology and Psychosomatic Obstetrics/Gynecology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Cornelius B Lambalk
- Department of Obstetrics and Gynaecology, Reproduction and Development, Amsterdam University Medical Centre, Free University of Amsterdam, Amsterdam, The Netherlands
| | - Sjoerd Repping
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Inge M Custers
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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23
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Asazawa K, Jitsuzaki M, Mori A, Ichikawa T, Shinozaki K, Porter SE. Quality-of-life predictors for men undergoing infertility treatment in Japan. Jpn J Nurs Sci 2018; 16:329-341. [PMID: 30525294 DOI: 10.1111/jjns.12248] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 07/27/2018] [Accepted: 09/25/2018] [Indexed: 11/30/2022]
Abstract
AIM To dentify the predictors of the quality of life (QOL) of infertile men who are undergoing infertility treatments in Japan and to create a QOL prediction model, with the main variables aimed at providing more adequate support to male patients. METHODS This cross-sectional study used the quantitative data that were collected from 321 returned self-report questionnaires that had been distributed to the men of 411 couples who were undergoing fertility treatment. The following four scales were used to measure the main outcomes: FertiQoL, psychological distress, spousal support, and workplace support. The data were analyzed by descriptive statistics, multiple regression analyses, and structural equation modeling. RESULTS The number of returned questionnaires was 321 (78.1%). The QOL that was measured by FertiQoL was significantly lower in those men who were diagnosed with male factor infertility than in the other male patients. The two significant predictors of QOL were: spousal support and the infertility period. The structural equation modeling revealed that the same factors were related to QOL. CONCLUSIONS Male factor infertility, less spousal support, and a longer period of infertility were associated with a poorer QOL of those men who were undergoing infertility treatment. These results suggest that focusing on infertility causes, the length of the infertility period, and the couples' partnership during treatment is needed to provide full support to men who have been diagnosed with infertility.
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Affiliation(s)
- Kyoko Asazawa
- Department of Nursing, Tokyo Healthcare University, Tokyo, Japan
| | - Mina Jitsuzaki
- Department of Nursing, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Akiko Mori
- Women's Health and Midwifery Graduate School, St. Luke's International University, Tokyo, Japan
| | | | - Katsuko Shinozaki
- Graduate School of Health and Welfare Science, International University of Health and Welfare, Fukuoka, Japan
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24
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Donarelli Z, Salerno L, Lo Coco G, Allegra A, Marino A, Kivlighan DM. From telescope to binoculars. Dyadic outcome resulting from psychological counselling for infertile couples undergoing ART. J Reprod Infant Psychol 2018; 37:13-25. [DOI: 10.1080/02646838.2018.1548757] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Laura Salerno
- Psychology Unit, ANDROS Day Surgery Clinic, Palermo, Italy
| | - Gianluca Lo Coco
- Department of Psychology and Educational Sciences, University of Palermo, Palermo, Italy
| | - Adolfo Allegra
- Reproductive Medicine Unit, ANDROS Day Surgery Clinic, Palermo, Italy
| | - Angelo Marino
- Reproductive Medicine Unit, ANDROS Day Surgery Clinic, Palermo, Italy
| | - Dennis M. Kivlighan
- Department of Counseling, Higher Education, and Special Education, University of Maryland, College Park, USA
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25
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Abstract
The relationship between stress and infertility has been debated for years. Women with infertility report elevated levels of anxiety and depression, so it is clear that infertility causes stress. What is less clear, however, is whether or not stress causes infertility. The impact of distress on treatment outcome is difficult to investigate for a number of factors, including inaccurate self-report measures and feelings of increased optimism at treatment onset. However, the most recent research has documented the efficacy of psychological interventions in lowering psychological distress as well as being associated with significant increases in pregnancy rates. A cognitive-behavioral group approach may be the most efficient way to achieve both goals. Given the distress levels reported by many infertile women, it is vital to expand the availability of these programs.
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Affiliation(s)
| | - Alice D Domar
- Boston IVF, Waltham, Massachusetts USA; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts, USA; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston Massachusetts, USA
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26
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Ussher JM, Perz J. Threat of biographical disruption: the gendered construction and experience of infertility following cancer for women and men. BMC Cancer 2018; 18:250. [PMID: 29506492 PMCID: PMC5836444 DOI: 10.1186/s12885-018-4172-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 02/26/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Infertility is a major concern for people with cancer and their partners. There have been calls for further research on the gendered nature of psychosocial, emotional and identity concomitants of fertility post-cancer across women and men. METHOD The gendered construction and experience of infertility following cancer was examined through a survey of 693 women and 185 men, and in-depth one-to-one interviews with a subsample of survey respondents, 61 women and 17 men, purposively selected across cancer types and age groups. Thematic decomposition was used to examine the open ended survey responses and interviews. The chi square test for independence was used to test for group differences between women and men on closed survey items. RESULTS In the thematic decomposition, infertility was identified as providing a 'Threat of Biographical Disruption' which impacted on life course and identity, for both women and men. Subthemes identified were: 'Parenthood as central to adulthood'; 'Infertility as a threat to gender identity'; ' Unknown fertility status and delayed parenthood'; 'Feelings of loss and grief'; 'Absence of understanding and support'; 'Benefit finding and renegotiation of identity'. In the closed survey items, the majority of women and men agreed that they had always 'wanted to be a parent' and that 'parenthood was a more important life goal than a satisfying career'. 'It is hard to feel like a true adult until you have a child' and impact upon 'my feelings about myself as a man or a woman' was reported by both women and men, with significantly more women reporting 'I feel empty because of fertility issues'. Many participants agreed they 'could visualise a happy life without a child' and there is 'freedom without children'. Significantly more men than women reported that they had not discussed fertility with a health care professional. CONCLUSION The fear of infertility following cancer, or knowledge of compromised fertility, can have negative effects on identity and psychological wellbeing for both women and men, serving to create biographical disruption. Support from family, partners and health care professionals can facilitate renegotiation of identity and coping.
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Affiliation(s)
- Jane M. Ussher
- Translational Health Research Institute, School of Medicine, Western Sydney University, Locked Bag 1797, Penrith South, 2751 Australia
| | - Janette Perz
- Translational Health Research Institute, School of Medicine, Western Sydney University, Locked Bag 1797, Penrith South, 2751 Australia
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27
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Rooney KL, Domar AD. The relationship between stress and infertility. DIALOGUES IN CLINICAL NEUROSCIENCE 2018; 20:41-47. [PMID: 29946210 PMCID: PMC6016043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
The relationship between stress and infertility has been debated for years. Women with infertility report elevated levels of anxiety and depression, so it is clear that infertility causes stress. What is less clear, however, is whether or not stress causes infertility. The impact of distress on treatment outcome is difficult to investigate for a number of factors, including inaccurate self-report measures and feelings of increased optimism at treatment onset. However, the most recent research has documented the efficacy of psychological interventions in lowering psychological distress as well as being associated with significant increases in pregnancy rates. A cognitive-behavioral group approach may be the most efficient way to achieve both goals. Given the distress levels reported by many infertile women, it is vital to expand the availability of these programs.
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Affiliation(s)
| | - Alice D Domar
- Boston IVF, Waltham, Massachusetts USA; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts, USA; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston Massachusetts, USA
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