Reconstructing Their Lives: A Longitudinal, Qualitative Analysis of the Transition to Biological Childlessness for Infertile Couples

Fertility clinics have a duty of care towards patients who do not have children with treatment

In medically assisted reproduction (MAR) success has mostly been measured in terms of achieving (healthy) livebirths. We argue this focus is too narrow and that success should be measured in terms of alleviating patient suffering caused by an unfulfilled child wish. The major implication is that clinics must better tailored care to effectively support patients who do not have child(ren) with treatment. First, we argue that clinics have a duty of care towards patients for whom MAR does not result in children because this is a common treatment outcome, because treatment is burdensome and creates new losses for patients, and because the field has the necessary expertise to provide support and it is part of patient-centred care. Then, we examine concerns about the adequacy of addressing the possibility that treatment may end without children, namely, that this may hinder patients' hope and put them off doing treatment, and that it may be perceived as a sign of clinical incompetence, as well as concerns about the required skill set. We end with a set of research-informed recommendations to promote healthy adjustment to ending fertility treatment without children. These focus on the need to reconceptualize 'success' and 'failure' in MAR, to promote open discussion about the possibility of treatment not resulting in children and encourage patients to develop 'plan(s) B', to support patients who end treatment without children, and to create the organizational structures needed to support clinics and healthcare professionals in this endeavour.

Psychosocial experiences of involuntary definitive childless women: a comparative study based on reproductive status

STUDY QUESTION

Do involuntary definitive childless women have lower psychosocial adjustment levels than women with infertility diagnoses actively trying to conceive and presumably fertile women?

SUMMARY ANSWER

Involuntary definitive childless women have lower levels of sexual functioning than infertile women actively trying to conceive and presumably fertile women, and higher levels of depression than presumably fertile women.

WHAT IS KNOWN ALREADY

Involuntary definitive childless defines those who wanted to become parents but were unable to do so. Studies have provided evidence about infertility and its psychosocial consequences, but there is a lack of knowledge about the impact of involuntary definitive childlessness, namely on sexual function, social support, marital satisfaction, and psychological adjustment.

STUDY DESIGN, SIZE, DURATION

This associative study was conducted between July 2021 and January 2022 for involuntary definitive childless women and between July 2016 and February 2018 for women with an infertility diagnosis actively trying to conceive as well as presumably fertile women. An online questionnaire announced in social media and gynaecology and fertility clinics was used. The inclusion criteria for all participants were being childless, in a heterosexual relationship and cohabiting for at least 2 years. Specific inclusion criteria for involuntary definitive childless women were: trying to conceive for at least 2 years; not achieving pregnancy because of biological and medical constraints; and not undergoing fertility treatment or being a candidate for adopting a child at time of the study. For women with an infertility diagnosis the inclusion criteria were: actively trying to conceive (naturally or through fertility treatments); having a primary fertility diagnosis; and aged between 22 and 42 years old. For presumably fertile women, the inclusion criteria were: having a parenthood wish in the future; and not knowing of any condition that could prevent them from conceiving.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Out of 360 women completing the survey, only 203 were eligible for this study (60 involuntary definitive childless women, 78 women with an infertility diagnosis actively trying to conceive, and 65 presumably fertile women). All participants completed a questionnaire including sociodemographic and clinical data, the Female Sexual Function Index, the 2-Way Social Support Scale, the Relationship Assessment Scale, and Hospital Anxiety and Depression Scale. Binary logistic regression was performed to assess the relation between sexual function, social support, marital satisfaction, anxiety, depression, and reproductive status, adjusting for age, and cohabitation length. Presumably fertile women were used as a reference group.

MAIN RESULTS AND THE ROLE OF CHANCE

Women were 34.31 years old (SD = 5.89) and cohabited with their partners for 6.55 years (SD = 4.57). The odds ratio (OR) showed that involuntary definitive childless women had significantly lower sexual function than infertile women actively trying to conceive (OR = 0.88, 95% CI = 0.79-0.99) and presumably fertile women (OR = 34.89, 95% CI = 1.98-614.03), and higher depression levels than presumably fertile women (OR = 99.89, 95% CI = 3.29-3037.87). Women with an infertility diagnosis actively trying to conceive did not differ from presumably fertile women in sexual function, social support, marital satisfaction, anxiety, and depression.

LIMITATIONS, REASONS FOR CAUTION

The majority of childless women underwent fertility treatments, and childlessness for circumstantial reasons owing to lack of a partner was not included, therefore these results may not reflect the experiences of all women with an involuntary childless lifestyle. There was a time gap in the recruitment process, and only the definitive childlessness group filled out the questionnaire after the coronavirus disease 2019 pandemic. We did not ask participants if they self-identified themselves with the groups' terminology they were assigned to.

WIDER IMPLICATIONS OF THE FINDINGS

Our results emphasize the importance of future research to provide a more comprehensive understanding of the adjustment experiences of childless women and an awareness of the poor adjustment they might experience, highlighting the need to keep following women after unsuccessful treatments. Clinical practitioners must attend to these dimensions when consulting involuntary definitive childless women who might not have gone through treatments but also experience these adverse outcomes.

STUDY FUNDING/COMPETING INTEREST(S)

This study was partially supported by the Portuguese Foundation for Science and Technology. The authors declare that they have no conflict of interest.

TRIAL REGISTRATION NUMBER

N/A.

How Individuals Use Metaphors to Negotiate Fertility Treatment Decision-Making with Their Romantic Partners

Fertility problems, or the inability to conceive or carry a pregnancy to term for a period of over 12 months while engaging in unprotected sex, affects 12% of women and 9% of men of childbearing age. To answer calls for more research about individuals' fertility decision-making (DM) with their partners, we conducted in-depth, semi-structured interviews with 53 individuals who have experienced fertility decision-making with a romantic partner at some point in their lives. Our findings indicate at least three primary ways individuals and their partners navigated their decision-making communication in their infertility "journeys:" (1) the Driver-Navigator, (2) Driver-Passenger, and (3) Driver-Backseat Driver approaches. All decision-making communication approaches were viewed by individuals as collaborative (i.e. shared), but varied in degrees of "togetherness" (high, moderate, low) in how they communicated with each other about treatment decisions. Implications include helping couples and their clinicians to be aware of their DM approach(es) and offering alternative DM approaches based on understanding how and why certain approaches may (not) be effective in addressing goals, needs, and identities.

Examining willingness to donate frozen oocytes among women of reproductive age

RESEARCH QUESTION

What are the predictors of willingness to donate frozen oocytes among women of reproductive age in Australia?

DESIGN

An online survey involving 303 women of reproductive age (18-49 years) in Australia who had not frozen their oocytes or planned to freeze their oocytes in the next 12 months. The survey assessed demographic variables, prototype willingness model variables (attitude, subjective norm, prototype similarity and prototype favourability) and additional variables (altruism, empathy and infertility awareness) as predictors of hypothetical scenarios of willingness to donate frozen oocytes. A multivariate repeated measures analysis of variance explored differences in willingness to donate frozen oocytes. Hierarchical multiple regression analysis examined predictors of donor willingness.

RESULTS

Women's willingness to donate their frozen oocytes was higher for donating to a friend or family member and to research compared with an egg bank or fertility clinic, or a couple advertising online for an egg donor (all P < 0.001). The prototype willingness model variables were significant predictors of willingness to donate showing slightly varied patterns across four scenarios. After accounting for demographics, regression models including prototype willingness model variables and additional variables accounted for 45-64% of variance in donor willingness.

CONCLUSIONS

Frozen oocyte donation may be facilitated by improving attitudes towards donation and establishing positive images of donors. Professionals requiring frozen oocytes for research could focus on creating a sense of social approval for donating in this context. Encouraging frozen oocyte donation could increase access to oocytes for IVF treatment and aid in reducing the psychological burdens associated with involuntary childlessness.

Exploring the Landscape of Social Egg Freezing: Navigating Medical Advancements, Ethical Dilemmas, and Societal Impacts

This narrative review article comprehensively explores the multifaceted landscape of social egg freezing, delving into its medical, ethical, societal, psychological, legal, and cultural dimensions. Oocyte cryopreservation, a developing procedure, gives women the chance to match their life goals with fertility goals. Informed decision-making, morally sound guidance, and open communication are all stressed by ethical considerations. Family planning practices, workplace cultures, and gender equality all have an impact on societal dynamics. The process's emotional toll and associated coping mechanisms are highlighted by psychological elements. Legal and policy frameworks need constant ethical reflection and understanding of the regulatory environment. Religious and cultural views highlight the variety of perspectives that influence attitudes toward this practice. For responsible practice to ensure individual liberty while navigating the evolving landscape of reproductive options, it is essential to comprehend how these aspects interact.

The psychosocial outcomes of older parenthood in early to mid-childhood: a mini-review

Recent decades have seen a global trend towards delaying parenthood, referred to as the 'postponement transition'. Whilst there is plentiful research regarding obstetric and paediatric outcomes related to delayed parenthood, relatively little is known about the psychosocial outcomes associated with advanced parental age during early and middle childhood. This mini-review examines the current literature regarding the psychosocial functioning of families headed by older parents. First, we give an overview of the literature that examines the psychological wellbeing of older first-time parents. We then review the literature regarding the quality of the parent-child relationship in older parent families. Finally, we discuss the psychosocial adjustment and cognitive development of children of older parents. We conclude with suggestions for future research avenues.

Discussing the possibility of fertility treatment being unsuccessful as part of routine care offered at clinics: patients' experiences, willingness, and preferences

STUDY QUESTION

Are patients willing to discuss the possibility of treatment being unsuccessful as part of routine care offered at clinics, and what are the factors associated with this willingness?

SUMMARY ANSWER

Nine in every 10 patients are willing to discuss this possibility as part of routine care, with willingness being associated with higher perceived benefits, lower barriers, and stronger positive attitudes towards it.

WHAT IS KNOWN ALREADY

Fifty-eight percent of patients who complete up to three cycles of IVF/ICSI in the UK do not achieve a live birth. Offering psychosocial care for unsuccessful fertility treatment (PCUFT), defined as assistance and guidance on the implications of treatment being unsuccessful, could reduce the psychosocial distress patients experience when it happens, and promote positive adjustment to this loss. Research shows 56% of patients are willing to plan for an unsuccessful cycle, but little is known about their willingness and preferences towards discussing the possibility of definitive unsuccessful treatment.

STUDY DESIGN, SIZE, DURATION

The study was of cross-sectional design, comprising a theoretically driven and patient-centred bilingual (English, Portuguese) mixed-methods online survey. The survey was disseminated via social media (April 2021-January 2022). Eligibility criteria included being aged 18 or older, waiting to or undergoing an IVF/ICSI cycle, or having completed a cycle within the previous 6 months without achieving a pregnancy. Out of 651 people accessing the survey, 451 (69.3%) consented to participate. From these, 100 did not complete 50% of the survey questions, nine did not report on the primary outcome variable (willingness), and 342 completed the survey (completion rate 75.8%, 338 women).

PARTICIPANTS/MATERIALS, SETTING, METHODS

The survey was informed by the Health Belief Model (HBM) and Theory of Planned Behaviour (TPB). Quantitative questions covered sociodemographic characteristics and treatment history. Quantitative and qualitative questions gathered data on past experiences, willingness, and preferences (with whom, what, how and when) to receive PCUFT, as well as theory-informed factors hypothesized to be associated with patients' willingness to receive it. Descriptive and inferential statistics were used on quantitative data about PCUFT experiences, willingness, and preferences, and thematic analysis was applied to textual data. Two logistic regressions were used to investigate the factors associated with patients' willingness.

MAIN RESULTS AND THE ROLE OF CHANCE

Participants were, on average, 36 years old and most resided in Portugal (59.9%) and the UK (38.0%). The majority (97.1%) were in a relationship for around 10 years, and 86.3% were childless. Participants were undergoing treatment for, on average, 2 years [SD = 2.11, range: 0-12 years], with most (71.8%) having completed at least one IVF/ICSI cycle in the past, almost all (93.5%) without success. Around one-third (34.9%) reported having received PCUFT. Thematic analysis showed participants received it mainly from their consultant. The main topic discussed was patients' low prognosis, with the emphasis being put on achieving a positive outcome. Almost all participants (93.3%) would like to receive PCUFT. Reported preferences indicated that 78.6% wanted to receive it from a psychologist/psychiatrist/counsellor, mostly in case of a bad prognosis (79.4%), emotional distress (73.5%), or difficulties in accepting the possibility of treatment being unsuccessful (71.2%). The preferred time to receive PCUFT was before initiating the first cycle (73.3%), while the preferred format was in an individual (mean = 6.37, SD = 1.17; in 1-7 scale) or couple (mean = 6.34, SD = 1.24; in 1-7 scale) session. Thematic analysis showed participants would like PCUFT to provide an overview of treatment and all possible outcomes tailored to each patient's circumstances and to encompass psychosocial support, mainly focused on coping strategies to process loss and sustain hope towards the future. Willingness to receive PCUFT was associated with higher perceived benefit of building psychosocial resources and coping strategies (odds ratios (ORs) 3.40, 95% CI 1.23-9.38), lower perceived barrier of triggering negative emotions (OR 0.49, 95% CI 0.24-0.98), and stronger positive attitudes about PCUFT being beneficial and useful (OR 3.32, 95% CI 2.12-5.20).

LIMITATIONS, REASONS FOR CAUTION

Self-selected sample, mainly composed of female patients who had not yet achieved their parenthood goals. The small number of participants unwilling to receive PCUFT reduced statistical power. The primary outcome variable was intentions, and research shows a moderate association between intentions and actual behaviour.

WIDER IMPLICATIONS OF THE FINDINGS

Fertility clinics should provide patients with early opportunities to discuss the possibility of their treatment being unsuccessful as part of routine care. PCUFT should focus on minimizing suffering associated with grief and loss by reassuring patients they can cope with any treatment outcome, promoting coping resources, and signposting to additional support.

STUDY FUNDING/COMPETING INTEREST(S)

M.S.-L. holds a doctoral fellowship from the Portuguese Foundation for Science and Technology, I.P. [Fundação para a Ciência e a Tecnologia] (FCT; SFRH/BD/144429/2019). R.C. holds a post-doctoral fellowship supported by the European Social Fund (ESF) and FCT (SFRH/BPD/117597/2016). The EPIUnit, ITR and CIPsi (PSI/01662) are also financed by FCT through the Portuguese State Budget, in the scope of the projects UIDB/04750/2020, LA/P/0064/2020 and UIDB/PSI/01662/2020, respectively. Dr Gameiro reports consultancy fees from TMRW Life Sciences and Ferring Pharmaceuticals A/S, speaker fees from Access Fertility, SONA-Pharm LLC, Meridiano Congress International and Gedeon Richter, grants from Merck Serono Ltd, an affiliate of Merck KgaA, Darmstadt, Germany.

TRIAL REGISTRATION NUMBER

N/A.

Feasibility and acceptability of psychosocial care for unsuccessful fertility treatment

INTRODUCTION

Many people undergo fertility treatment to have biological children, but around four in ten patients complete all treatment cycles without having the children they desire. This triggers intense grief from which patients report taking on average 2 years to recover. Fertility guidelines and regulators stress the need to support patients through this process, but there is a scarcity of evaluated interventions to this end and evidence about when and how to offer care is lacking. This study explored patients' and healthcare professionals' (HCPs) experiences of and views about provision of psychosocial care (to patients facing unsuccessful fertility treatment, i.e., care provided by a mental health professional to address the emotional, cognitive, behavioural, relational and social needs that patients have at this stage of treatment).

METHODS

Five qualitative online focus groups were conducted with Portuguese participants: three with patients waiting to initiate or undergoing their last cycle of in vitro fertilization/intracytoplasmic sperm injection or having completed it within the last 2 months without achieving a pregnancy and two with HCPs working at fertility clinics. Focus groups were recorded and transcribed verbatim, and data were analysed with Framework Analysis.

RESULTS

Thirteen patients and nine HCPs participated. Analysis resulted in 1293 codes, systematically organized into 13 categories, 4 themes and 1 metatheme. The latter showed high consensus about the need for psychosocial care for unsuccessful treatment, but perceived challenges in its implementation. Themes reflected (1) consensual demand for psychosocial care at all stages of treatment but particularly at the end, (2) high perceived acceptability of integrating preventive care initiated during treatment with early psychosocial care only for those patients who experience unsuccessful treatment, (3) perceived challenges of implementing psychosocial care for unsuccessful treatment at clinics and (4) suggestions to promote its acceptability and feasibility.

CONCLUSION

Patients and HCPs perceive that clinics should improve care provision across the whole treatment pathway and in particular for unsuccessful fertility treatment. Suggestions were made to inform future research focusing on the development and evaluation of psychosocial interventions to this end.

PATIENT OR PUBLIC CONTRIBUTION

Patients and HCPs participated in the focus groups. Two HCPs also revised the manuscript.

Feasibility randomized controlled trial of a self-guided online intervention to promote psychosocial adjustment to unmet parenthood goals

STUDY QUESTION

Is it feasible to implement and evaluate an online self-guided psychosocial intervention for people with an unmet parenthood goal (UPG), aimed to improve well-being, in an online randomized controlled trial (RCT)?

SUMMARY ANSWER

The evaluation of an online bilingual self-guided psychosocial intervention for people with a UPG is feasible, reflected by high demand, good acceptability, good adaptation and promise of efficacy, but minor adjustments to the intervention and study design of the RCT should be made to enhance practicality.

WHAT IS KNOWN ALREADY

Self-identifying as having a UPG, defined as being unable to have children or as many as desired, is associated with impaired well-being and mental health. Practice guidelines and regulatory bodies have highlighted the need to address the lack of evidence-based support for this population. It is unknown if MyJourney (www.myjourney.pt), the first online self-guided intervention for people with UPGs, can be implemented and evaluated in an RCT.

STUDY DESIGN, SIZE, DURATION

To evaluate the feasibility of MyJourney, we conducted a registered, two-arm, parallel group, non-blinded feasibility RCT, with a 1:1 computer-generated randomized allocation and embedded qualitative process evaluation. Participants were included between November 2020 and March 2021. Assessments were made before randomization (T1), 10 weeks (T2) and 6 months after (T3, intervention group only). Participants allocated to the intervention group received an email to access MyJourney immediately after randomization. Participants in the waitlist control group were given access to MyJourney after completing the 10-week assessment (T2).

PARTICIPANTS/MATERIALS, SETTING, METHODS

Participants were recruited via social media advertising of MyJourney and its feasibility study. People who self-identified as having a UPG could click on a link to participate, and of these 235 were randomized. Outcome measures related to demand, acceptability, implementation, practicality, adaptation and limited efficacy were assessed via online surveys. The primary outcome in limited efficacy testing was hedonic well-being, measured with the World Health Organisation Wellbeing Index (WHO-5).

MAIN RESULTS AND THE ROLE OF CHANCE

Participation and retention rates were 58.3%, 31.7% (T2) and 45.2% (T3, intervention group only), respectively. Of participants invited to register with MyJourney, 91 (76.5%) set up an account, 51 (47.2%) completed the first Step of MyJourney, 12 (11.1%) completed six Steps (sufficient dose) and 6 (5.6%) completed all Steps within the 10-week recommended period. Acceptability ranged from 2.79 (successful at supporting) to 4.42 (easy to understand) on a 1 (not at all) to 5 (extremely acceptable) scale. Average time to complete sufficient dose was 15.6 h (SD = 18.15) and to complete all Steps was 12.4 h (SD = 18.15), with no differences found for participants using MyJourney in Portuguese and English. Modified intention-to-treat analysis showed a moderate increase in well-being from T1 to T2 in the intervention group (η_p² = 0.156, mean difference (MD) = 9.300 (2.285, 16.315)) and no changes in the control group (η_p² = 0.000, MD = 0.047 (−3.265, 3.358)). Participants in the process evaluation reported MyJourney was needed and answered their needs for support (reflecting high demand and acceptability), the recommended period to engage with MyJourney was short, and their engagement was influenced by multiple factors, including personal (e.g. lack of time) and MyJourney related (e.g. reminders).

LIMITATIONS, REASONS FOR CAUTION

Participants were mostly white, well-educated, employed, childless women. Non-blinded allocation, use of self-reported questionnaire assessments and high attrition in the intervention group could have triggered bias favourable to positive evaluations of MyJourney and resulted in low power to detect T2 to T3 changes in limited efficacy outcomes.

WIDER IMPLICATIONS OF THE FINDINGS

MyJourney can proceed to efficacy testing, but future work should eliminate barriers for engagement and explore strategies to maximize adherence. Entities wanting to support people with UPGs now have a freely accessible and promising resource that can be further tested and evaluated in different settings.

STUDY FUNDING/COMPETING INTEREST(S)

MyJourney’s development was funded by the charity Portuguese Fertility Association, Cardiff University and University of Coimbra (CINEICC). Dr S.G. reports consultancy fees from Ferring Pharmaceuticals A/S, speaker fees from Access Fertility, SONA-Pharm LLC, Meridiano Congress International and Gedeon Richter and grants from Merck Serono Ltd. Bethan Rowbottom holds a PhD scholarship funded by the School of Psychology, Cardiff University. The other authors have no conflicts of interest.

TRIAL REGISTRATION NUMBER

Clinical Trials.gov NCT04850482.

Investigating the association between infertility and psychological distress using Australian Longitudinal Study on Women's Health (ALSWH)

Infertility affects millions of people globally. Although an estimated 1 in 6 couples in Australia are unable to conceive without medical intervention, little is known about the mental health impacts of infertility. This study investigated how infertility impacts the mental health of women. The study used nationally representative Australian Longitudinal Study on Women's Health (ALSWH) data. We analysed data from survey periods 2-8 conducted every three years between 2000 and 2018 for 6582 women born in 1973-78. We used a Generalised Equation Modelling (GEE) method to investigate the association of primary, secondary and resolved fertility status and psychological distress over time. Multiple measures were used to measure psychological distress: the (1) the mental health index subscale of the 36-item short form survey (SF-36), (2) the Center for Epidemiological Studies Depression Scale (CESD-10), (3) the Goldberg Anxiety and Depression Scale (GADanx) anxiety subscale; and a (4) composite psychological distress variable. About a third (30%) of women reported infertility at any of the survey rounds; a steady increase over 18 years from 1.7% at round 2 to 19.3% at round 8. Half of the women reporting primary or secondary infertility reported psychological distress, with the odds of having psychological distress was higher in women reporting primary (odds ratio (OR) 1.24, 95% confidence interval (CI) 1.06-1.45), secondary (OR 1.27, 95% CI 1.10-1.46) or resolved infertility (OR 1.15, 95% CI 1.05-1.26) compared to women reporting normal fertility status. Women with partners, underweight or higher BMI, smoking, and high-risk alcohol use had higher odds of psychological distress, whereas women in paid work had significantly lower odds of psychological distress (p < 0.001). Diabetes, high blood pressure, asthma, and other chronic physical illness were independently associated with higher odds of psychological distress. Infertility has a significant impact on mental health even after it is resolved. Frequent mental health assessment and a holistic approach to address the lifestyle factors should be undertaken during the treatment of infertility.

Quality of life of Sudanese patients attending a fertility clinic: a mixed methods study

BACKGROUND

Infertility affects over 50 million people globally, the burden is disproportionately borne by women, especially in low and middle-income countries (LMIC). The impact of infertility on quality of life (QoL) has not been well documented or assessed qualitatively in LMIC like Sudan, where infertility is a pervasive problem. Therefore, the purpose of this mixed-methods study was to assess the fertility-related QoL of infertile individuals in Sudan using the fertility quality of life (FertiQoL) tool.

METHODS

We used explanatory sequential design (surveys and interviews) in a fertility clinic in Sudan (January 2017-May 2018). We collected socio-demographic information, medical/reproductive history and used Arabic FertiQoL. We generated descriptive statistics of FertiQoL (core, domain) scores and independent variables; multiple linear regression models to assess the relationship between FertiQoL and dependent variables; and t-tests to compare mean core/domain scores. We conducted thematic analysis on qualitative data about the subjective experience of being infertile.

RESULTS

The study included 102 participants (72 women), 70 educated beyond secondary school, mean age 33.89 years (SD = 7.82) and mean duration of infertility was 4.03 years (SD 3.29). Mean FertiQoL core score 76.02 (SD = 16.26), domain scores: emotional 71.61 (SD = 22.04), relational 78.06 (SD = 16.62), mind/body 74.06 (SD 22.53) and social 78.88 (SD = 18.24). Men had better fertility-related QoL.

FOUR THEMES EMERGED

A sense of something missing because of childlessness; social pressure from peoples' questions; impact on the spousal relationship (which differed amongst participants) and coping (faith-based and non-faith-based) which was necessary when the lived experience led to internal distress.

CONCLUSIONS

Infertility negatively impacted the QoL of participants in this study, and women were worse off. Cognitive appraisal, social support and pressure may be key factors influencing the QoL of infertile individuals, therefore they should be encouraged to seek social and professional support. FertiQoL is a useful tool to assess fertility QoL in LMIC like Sudan.

Assessment of Impact of Infertility & its Treatment on Quality of Life of Infertile Couples using Fertility Quality of Life Questionnaire

Background:

With rising trends of infertility in India, it is no longer just a medical concern, but is rapidly becoming a public health issue due to its social and interpersonal ramifications. Limited data is available regarding quality of life of the infertile couples.

Aim:

The aim of this study was to understand the quality of life (QOL) of Indian infertile couples using the fertility QOL (FertiQoL) tool and to find the correlation between the values of the core and treatment FertiQoL and various sociodemographic and clinical factors.

Study Setting and Design:

This cross-sectional study was conducted at fertility clinic at an urban tertiary care center.

Materials and Methods:

Over a period of 12 months, 274 completed questionnaires obtained from 137 couples were selected for the analysis. Demographic and clinical characteristics of all the patients were recorded. Data analysis was performed using the Statistical Package for the Social Sciences software version 25:0. IBM Chicago, USA.

Results:

Women had worse QOL than their male partners. They scored lower than men on emotional and mind body subscales. Women showed positive and uniform trend in mean scores of all core FertiQoL subscales with age and education. Rural population had poorer QOL. Patients with primary infertility had poorer QOL except in the relational domain. Couples, in whom both partners had some pathology, had the worse QOL compared to female factor, male factor or unexplained infertility.

Conclusion:

Our study is a step in the direction to establish the baseline QOL objectively in Indian couples with infertility.

What About Fertility Staff Emotions? An Explorative Analysis of Healthcare Professionals' Subjective Perspective

Infertility-related psychological research is traditionally oriented to analyze the wellbeing of couples undergoing Assisted Reproductive Technologies (ART), than to study the job-related effects on the healthcare fertility staff. This piece of research aims at understanding the subjective perspective of the fertility professionals and contribute to identify their emotional dynamics in their work environment. An in-depth explorative research study was conducted on 12 healthcare professionals of an Italian ART hospital clinic. Structured interviews with open-ended questions were administered to explore their deep feelings about their professional experience. Emotional text analysis was then conducted to analyze the textual corpus of their narratives to grasp their affective symbolizations. Statistical multidimensional techniques were used to detect some thematic domains (cluster analysis) and latent factors organizing the contraposition between them (multiple correspondence analysis). Five thematic domains were detected which refer to different emotional dimensions, as follows: performance anxiety (Cluster 1), ambivalence between omnipotence and powerlessness (Cluster 2), care burden (Cluster 3), feeling of duty (Cluster 4), and sense of interdependence (Cluster 5). Then, four latent factors were identified dealing with the laborious attempt to remedy, the realistic sense of limitation, the incumbent feeling of pressure and the restorative sense of justice, respectively. The results are discussed based on the existing literature and some useful recommendations for staff education, training and clinical supervision are provided accordingly.

Success of in vitro fertilization and its association with the levels of psychophysiological stress before and during the treatment

Despite the advance of assisted reproduction, high rates of failure in treatment are still observed. Herein, we investigated how the psychophysiological stress profiles of patients can modulate the in vitro fertilization treatment (IVF) outcome. The women who had failure in IVF (n = 13; 65%) had higher baseline salivary cortisol awakening response and anxiety-state during treatment than patients who became pregnant (n = 7; 35%). Patients with major stress levels and religious coping style showed lower social support, which was correlated with higher anxiety. Therefore, we appointed stress modulators that negatively affect IVF and should be improved aiming to increase its success.

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

STUDY QUESTION

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

SUMMARY ANSWER

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

WHAT IS KNOWN ALREADY

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

STUDY DESIGN, SIZE, DURATION

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

PARTICIPANTS/MATERIALS, SETTING, METHODS

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

MAIN RESULTS AND THE ROLE OF CHANCE

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

LIMITATIONS, REASONS FOR CAUTION

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

WIDER IMPLICATIONS OF THE FINDINGS

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

STUDY FUNDING/COMPETING INTEREST(S)

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

Extreme Desire for Motherhood: Analysis of Narratives From Women Undergoing Assisted Reproductive Technology (ART)

The problem of infertility and its consequent treatment (denoted as Assisted Reproductive Technology or ART) represent an increasing phenomenon, especially in industrialized countries. Confronting with one’s own procreative limitations can generate strong negative emotional reactions. This study aims at understanding how the desire for motherhood manifests itself in infertile women undergoing ART, studying their emotional and subjective perspective. An in-depth explorative research study was conducted on 17 infertile women attending an Italian hospital clinic for fertility treatment. Emotional text analysis was conducted to analyze the corpus of their interviews, allowing the identification of four thematic domains (clusters) which refer, respectively, to the following emotional dimensions: an inclination to self-sacrifice, seen as the price to be paid for the desired success of the treatment (Cluster 1), pursuit of inclusion in the world of procreative mothers (Cluster 2), precarious equilibrium between the deep desire for a baby and the withdrawal from the treatment (Cluster 3), surrender to any possible consequence in order to obtain the desired mother-child relationship (Cluster 4). The witness of the couples’ suffering for their condition of infertility and their strong desire for parenting can represent a source of high pressure for the fertility care staff, as they are the only ones responsible for the fulfillment of the great dream of biological parenthood. For these reasons, a multidisciplinary approach, which involves psychological as well as medical experts all working together, could benefit both the patients and the healthcare professionals and improve the quality of the reproductive healthcare services.

Infertility Centrality in the Woman's Identity and Goal Adjustment Predict Psychological Adjustment Among Women in Ongoing Fertility Treatments

PURPOSE

Some of the women that go through repeated fertility treatments will not adjust well to the treatments and will experience increased distress. The present study examined how centrality of the fertility problem in the woman's identity and dispositional goal adjustment (disengagement and reengagement) are associated with the woman's psychological adjustment. These issues are examined in a context of a pro-natal society (Israel) where parenthood is a major life goal.

METHODS

One hundred ninety-three women in ongoing fertility treatments filled out questionnaires, and follow-up on their psychological well-being was carried out after 3 months (N = 130).

RESULTS

Women who perceived their fertility problem as more central to their identity experienced greater distress (β = 0.34, p < 0.01) and less well-being (β = - 0.31, p < 0.01). Concurrently, high ability for goal disengagement was a resource that protected women from these feelings. Women high on goal disengagement who were low on goal reengagement experienced greater distress (β of interaction = - 0.24, p < 0.01), probably because they remained with feelings of emptiness and lack of purpose. These findings were found in both cross-sectional and longitudinal analyses. Finally, the models predicting well-being and distress at T2 using centrality, goal adjustment, and T1 well-being/distress explained 42 and 47.5% of the variance, respectively.

CONCLUSIONS

Much research and therapeutic attention has been invested in coping with fertility treatments, while the options of reducing investment in treatments and finding alternative goals did not receive adequate attention. This study discusses these issues and their possible clinical implications especially in a pro-natal context.

When time runs out: reconciling permanent childlessness after delayed childbearing

OBJECTIVE

This study aimed to examine the experience of permanent childlessness after delayed childbearing.

BACKGROUND

More women are delaying childbearing while they pursue a career, gain financial stability and seek an appropriate partner. However, given that fertility declines with age, there is concern that more women will end up permanently, unintentionally childless after postponing childbearing. There is little known about this growing and invisible group.

METHODS

An interpretive phenomenological analysis was used to conduct the study. A purposive sample of 15 women who identified as being permanently childless after delaying childbearing participated in the study. Data were collected using in-depth semi-structured interviews.

RESULTS

Themes included feelings of grief, loss and isolation; a need to make sense of their childlessness; and a need to rebuild and refocus their lives and identities regardless of whether they had actually tried to conceive during their childbearing years. Women struggled with feelings of regret and the need to reconcile the reality of their choice to delay childbearing based on their values and beliefs about the ideal conditions within which to raise a child with feelings of powerlessness to pursue motherhood when they were likely still fertile.

CONCLUSION

Women who are permanently childless after delaying childbearing experience similar feelings to those who are childless after infertility and failed fertility treatments regardless of whether they tried to conceive during their reproductive years. However, this group has unique needs based on their feelings of regret, powerlessness and responsibility for their childlessness.

The Trauma of Birth or Parenting a Child: Effect on Parents' Negative Emotion in China

The present study assessed negative emotions associated with the traumas of infertility and child rearing (child's disability or death) and the correlates of duration of trauma. The widely used Chinese Mental Health Scale was used to assess negative emotions in 294 individuals who experienced the aforementioned traumas and 124 who did not (control group). Results showed that individuals with infertility exhibited greater anxiety, depression, and solitude than the control group; bereaved parents and had greater solitude and fear than control group; and parents of children with disabilities had greater solitude than the control group. Parents who experienced the death of a child had more fear and physiological maladjustment than parents of a child with disabilities. In addition, individuals without parenting experience had higher scores on solitude, fear, and physiological disease than those with parenting experience. After controlling for demographic variables, the duration of trauma significantly negatively predicted depression in the infertile group and for bereaved parents. The results suggest that in order to prevent psychological and physiological health problems among infertile couples, parents of a disabled child, and parents who experience the death of child, family and community-based strategies should be developed and implemented.

Self-Regulation and Wellbeing When Facing a Blocked Parenthood Goal: A Systematic Review and Meta-Analysis

Developmental regulation theories claim that continuing to pursue a goal when it becomes blocked contributes to poorer wellbeing. This consequence is expected to lead to the use of self-regulation strategies in the form of higher disengagement from the goal and higher reengagement in other meaningful goals. The use of these strategies is expected to lead to better wellbeing. A systematic-review and meta-analyses were conducted to test the major predictions of developmental regulation theories for blocked parenthood goal and to investigate possible moderator variables, particularly type and degree of blockage. A total of eight meta-analyses were performed using random-effects models. Moderation was tested with subgroup analysis. After searching eight databases, 4977 potential relevant manuscripts were identified but only six met inclusion criteria. From the eight meta-analyses conducted, only two were significant. In line with prediction, higher goal blockage was related to higher negative mood and reengagement in other life goals was associated to higher positive mood (p < .001). From a total of eight subgroup analyses performed, results showed that disengaging had a positive impact on wellbeing for people experiencing an unanticipated type of blockage (i.e., infertility) but not for those with an anticipated one (i.e., postponing parenthood; X2 = 4.867, p = .03). From the total of twelve sensitivity analyses performed only one suggested that results might differ. The association between disengagement and mood varied according to study quality. When only average studies were included this association was negative, although non-significant. The evidence obtained did not fully support developmental regulation theories for the pursuit of parenthood goal, but primary research had too many methodological limitations to reach firm conclusions. Future studies aimed at investigating blocked parenthood goal are required to evaluate the value of developmental regulation theories.

Women's narratives of crisis and change: Transitioning from infertility to pregnancy

This study explores ways women, who endured prolonged fertility difficulties, after which they eventually conceived, integrate the two phases within their life stories. A total of 12 women were interviewed during their first pregnancy after having experienced 2-6 years of infertility. Three types of narratives were identified: (1) the infertility overshadows the pregnancy and approaching motherhood, (2) the pregnancy leads to a dissociation concerning the infertile period, and (3) the two states coexist together along an integrated continuum. We suggested that the different narrative types may occur in diverse circumstances that entail integrating a crisis or prolonged illness into a constructive and meaningful life story.

Experiential avoidance, self-compassion, self-judgment and coping styles in infertility

OBJECTIVES

This study sought out to explore the existence of differences regarding emotion regulation processes (psychological inflexibility/experiential avoidance, self-judgment and self-compassion) and coping styles (emotional/detached, avoidant and rational) in three different groups of couples: 120 fertile couples (FG), 147 couples with an infertility diagnosis who were pursuing medical treatment for their fertility problem(s) (IG), and 59 couples with infertility applying for adoption (AG).

STUDY DESIGN

Cross-sectional survey, using the couple as unit of analysis.

MAIN OUTCOME MEASURES

Participants filled in paper-pencil questionnaires assessing coping styles, psychological inflexibility/experiential avoidance, self-judgment and self-compassion.

RESULTS

IG couples, and particularly women, tend to use more experiential avoidance and self-judgment mechanisms and less emotional/detached coping style. When compared to FG couples, IG and AG couples tend to apply more avoidant coping strategies. AG couples showed higher self-compassion.

CONCLUSIONS

Findings suggest that emotion regulation processes may be an important target in psychological interventions for patients dealing with infertility and with the demands of medical treatment.

A New Way to Estimate the Potential Unmet Need for Infertility Services Among Women in the United States

BACKGROUND

Fewer than 50% of women who meet the medical/behavioral criteria for infertility receive medical services. Estimating the number of women who both meet the medical/behavioral criteria for infertility and who have pro-conception attitudes will allow for better estimates of the potential need and unmet need for infertility services in the United States.

METHODS

The National Survey of Fertility Barriers was administered by telephone to a probability sample of 4,712 women in the United States. The sample for this analysis was 292 women who reported an experience of infertility within 3 years of the time of the interview. Infertile women were asked if they were trying to conceive at the time of their infertility experience and if they wanted to have a child to determine who could be considered in need of services.

RESULTS

Among U.S. women who have met medical criteria for infertility within the past three years, 15.9% report that they were neither trying to have a child nor wanted to have a child and can be classified as not in need of treatment. Of the 84.9% of infertile women in need of treatment, 58.1% did not even talk to a doctor about ways to become pregnant.

DISCUSSION

Even after taking into account that not all infertile women are in need of treatment, there is still a large unmet need for infertility treatment in the United States.

CONCLUSION

Studies of the incidence of infertility should include measures of both trying to have a child and wanting to have a child.

The Experience of Chinese Couples Undergoing In Vitro Fertilization Treatment: Perception of the Treatment Process and Partner Support

Background

Couples undergoing In Vitro Fertilization (IVF) Treatment suffer as dyads from the stressful experience of the painful treatment and the fear that the IVF cycle will fail. They are likely to report that their marital relationship has become unstable due to the prolonged period of treatment.

Methods

This is a qualitative study that was conducted to explore the experiences that Chinese couples have had with IVF treatment, especially their perceptions of the process and the support between couples.

Results

The interviews revealed that couples suffered from the process, experiencing physical and emotional pain, struggling with the urgency and inflexibility of bearing a child, and experiencing disturbances in their daily routines and work. The participants described how they endured the hardships as a couple and how it affected their relationship. The couples felt that sharing feelings and supporting each other contribute to psychological well-being and improves the marital relationship. They also identified some unfavorable aspects in their partner relationship. They were ambivalent about receiving social support from friends and family members.

Conclusions

With the couples indicating that the support that they received from each other affected their experience during the treatment process, it is suggested that a supportive intervention that focuses on enhancing the partnership of the couples and dealing with their inflexibility on the issue of bearing a child might result in improvements in the psychological status and marital relationship of infertile couples undergoing IVF treatment.

Role of the mental health professional in education and support of the medical staff

This review argues that mental health professionals are underutilized in the reproductive health care system. Counselors in the field of reproductive medicine could broaden their care from a strictly one-on-one patient care perspective to a more integrated and collaborative approach that also involves education, training, and support of the fertility clinic staff. The literature has shed light on reasons for patient discontinuation, but little is known about staff burnout in reproductive health care, and even less has been done to address work-related stress, job dissatisfaction, and poor emotional and physical health among fertility clinic staff. Specific educational strategies and training techniques are addressed to help reduce staff stress, prevent burnout, and improve overall patient care.

Evolution of psychology and counseling in infertility

Five key paradigm shifts are described to illustrate the evolution of psychology and counseling in infertility. The first paradigm shift was in the 1930s when psychosomatic concepts were introduced in obstetrics and gynecology as causal factors to explain why some couples could not conceive despite the absence of organic pathology. In the second shift, the nurse advocacy movement of the 1970s stimulated the investigation of the psychosocial consequences of infertility and promoted counseling to help couples grieve childlessness when medical treatments often could not help them conceive. The third shift occurred with the advent of IVF, which created a demand for mental health professionals in fertility clinics. Mental health professionals assessed the ability of couples to withstand the demands of this new high technology treatment as well as their suitability as potential parents. The fourth shift, in the 1990s, saw reproductive medicine embrace the principles of evidence-based medicine, which introduced a much more rigorous approach to medical practice (effectiveness and safety) that extended to psychosocial interventions. The most recent paradigm shift, in the new millennium, occurred with the realization that compliance with protracted fertility treatment depended on the adoption of an integrated approach to fertility care. An integrated approach could reduce treatment burden arising from multiple sources (i.e., patient, clinic, and treatment). This review describes these paradigm shifts and reflects on future clinical and research directions for mental health professionals.

An Analysis of the Concept of Partnership in the Couples Undergoing Infertility Treatment

The elements of a partnership in the couples undergoing infertility treatment are not well understood. This article aims to fill the gap by using Rodger's evolutionary method of concept analysis. The attributes of the concept partnership that were identified are a process of joint hardship, sharing, intracouple communication, and mutual support. The antecedents are love and attraction for each other, agreement, and interpersonal skills. The consequences are marital benefit, improvement in psychological status, and quality of life. A middle-range model for partnership in relationship to infertile couples is proposed. The understanding of the phenomenon of partnership will enable the researchers to develop interventions, identify the appropriate assessment instruments, and to determine directions for future research on effort to support infertile couples through their hardship.

Is being childless detrimental to a woman's health and well-being across her life course?

BACKGROUND

Childlessness is a growing phenomenon. Previous research examining health and well-being differentials between women with and without children has produced conflicting results. Most of this research has been conducted in the United States or parts of Europe. There has been limited research in Australia that has examined the health and well-being of women with and without children across the life course. The aim of the current study was to examine the association between motherhood status and general physical and mental health and well-being over a 10-year time period.

METHODS

Using 10 waves of data from the Household, Income and Labour Dynamics in Australia study, longitudinal linear mixed models with time varying variables (both dependent and independent) were constructed to assess the effect of childlessness on health and well-being based on the Short Form-36 Health Survey Version 1 (n=52,381 observations).

FINDINGS

Findings suggest that childless women experience poorer physical and mental health and well-being during the peak reproductive years; however, this trend is reversed for women aged 65 years or more. Although never-married, childless women experienced better health and well-being compared with mothers, this was not the case for childless women who were divorced, separated, or widowed or in a relationship.

CONCLUSION

The findings support the notion that whether or not a woman has children does have consequences for her health and well-being; however, this differs across the life course.

Psychosocial services for couples in infertility treatment: what do couples really want?

OBJECTIVES

To describe the psychosocial supports that infertile couples desire to help cope with infertility-related distress, which psychosocial services they sought, and the benefits and drawbacks of these services.

METHODS

Qualitative interview study with 32 heterosexual infertile couples seeking infertility treatment. Maximum variation sampling was used; data were analyzed using thematic analysis.

RESULTS

Most couples desired psychosocial support, but only half of the sample sought support. Some couples met with psychologists for help with relationship conflict and coping strategies. Participants suggested peer mentoring to fulfill needs for coping, shared experience, and guidance through the treatment process. Couples also desired written information about practical and emotional aspects of treatment. Negative attitudes toward psychological counseling and a lack of information about support services prevented some couples from seeking support.

CONCLUSIONS

Infertile couples expressed numerous needs for psychosocial supports, but often felt that supports were not available. A variety of services should be offered in order to fulfill patients' varied needs.

PRACTICE IMPLICATIONS

Awareness of the reasons why patients desire psychosocial services will help clinicians to refer patients to currently available psychosocial supports, and will aid in the development of appropriate supports, including couples counseling, peer mentoring, and written information in lay language.

A randomized controlled trial of the effects of nursing care based on Watson's Theory of Human Caring on distress, self-efficacy and adjustment in infertile women

AIMS

To investigate the effects of nursing care based on the Theory of Human Caring on distress caused by infertility, perceived self-efficacy and adjustment levels.

BACKGROUND

Infertility leads to individual, familial and social problems. Nursing care standards for women affected by infertility have yet to emerge.

DESIGN

A randomized controlled trial.

METHODS

This study was conducted from May 2010-February 2011, with 105 Turkish women with infertility (intervention group: 52, control group: 53). We collected data using the Infertility Distress Scale, the Turkish-Infertility Self Efficacy Scale Short Form and the Turkish-Fertility Adjustment Scale. The intervention group received nursing care based on the Theory of Human Caring. Data were analysed using t-tests, chi-square tests and intention-to-treat analyses.

RESULTS

The intervention and control groups significantly differed with regard to infertility distress, self-efficacy and adjustment levels. The intervention group's mean self-efficacy score increased by seven points and adjustment score decreased by seven points (in a positive direction). In addition, there was a significant reduction in infertility distress scores in the intervention group, but there was no change in the control group.

CONCLUSION

Nursing care based on the Theory of Human Caring decreased the negative impact of infertility in women receiving infertility treatment and increased self-efficacy and adjustment.

Cassandra's prophecy: a psychological perspective. Why we need to do more than just tell women

The most salient psychological issue in the article 'Cassandra's prophecy' is the lack of fertility knowledge. This lack of knowledge exhibited by both Jane and the medical professionals resulted in a delay in trying to get pregnant and in seeking and receiving appropriate care, ultimately resulting in inadvertent childlessness. We identify five educational initiatives to increase fertility knowledge and personal awareness in order to promote informed decision-making about fertility health issues. These initiatives cover: (i) better sexual education for children; (ii) family planning for young adults that involves value and preference clarification about future parenthood goals; (iii) public health campaigns to increase awareness of the risk factors associated with reduced fertility; (iv) investigation of adherence to fertility guidelines within the medical profession; and (v) clearer information about the benefits and limitations of available fertility treatment. The future of fertility health care must be centred on providing people with information leading to informed choice about all aspects of their own fertility health. Empowerment may mean that people can better optimize their fertility health and be more likely to reach their parenthood goals.

Tackling burden in ART: an integrated approach for medical staff

Discontinuation is a problem in fertility clinics. Many couples discontinue assisted reproductive technologies (ART) without achieving a live birth for reasons other than poor prognosis or the cost of treatment. Discontinuation has been attributed to the burden of treatment. The causes of burden can be broadly classified according to whether they originate in the patient, clinic or treatment. Interventions to alleviate these burdens include provision of comprehensive educational material, screening to identify highly distressed patients, provision of tailored coping tools and improvements in the clinic environment and medical interventions. Practical interventions to reduce the different causes of burden in ART exist, but further development and evaluation of the efficacy of these interventions requires more precise definition of terms and theory. In this paper, we propose a general integrated approach to cover different perspectives in dealing with burden in ART clinics. We firstly describe the integrated approach and present common sources of burden. We then describe interventions that could help reduce the burden in ART. Our paper is aimed at fertility clinic staff because of their day-to-day involvement with patients. However, this discussion should also be relevant to companies that develop treatments and to psychosocial experts. Reducing the burden of treatment should lead to improved outcomes, namely better quality of life during treatment and lower discontinuation rates.

Information provision and decision-making in assisted reproduction treatment: results from a survey in Germany

BACKGROUND

The objective of this study was to investigate the views of patients and experts in Germany on information provision and decision-making in assisted reproduction treatment (ART).

METHODS

Standard questionnaire techniques were used for interviewing Reproductive Physicians (n= 230), Psychosocial Counsellors (n = 66) and Patients (n = 1590). Descriptive data analyses and non-parametric tests for significance were performed.

RESULTS

Higher scores were assigned for information on the chances for treatment success and on direct, physical risks of fertility treatment than for information on the risks and burden of multiple pregnancies and on the emotional risks and burden associated with infertility treatment. Three-quarters (74%) of the Patients (P) reported that they had experienced an overwhelming desire for a child at some point during their treatment, and half (47%) stated that they had experienced the feeling of losing control over the situation. According to 25% of the Reproductive Physicians (RP) and 47% of the Psychosocial Counsellors (PC), patients are often or very often limited in their capacity to decide when to stop the treatment.

CONCLUSIONS

A significant number of patients in reproductive care in Germany are not well informed on all the aspects that are relevant for treatment decision-making, are overwhelmed by their desire for a child, lose control over the situation, and are limited in their capacity to end unsuccessful treatment. Information provision should be ensured and monitored during treatment by standardized safeguards. A strategy for stopping ART and embarking on alternative ways of coping with infertility should be installed from the outset of every treatment.

The fertility quality of life (FertiQoL) tool: development and general psychometric properties

BACKGROUND

To develop the first international instrument to measure fertility quality of life (FertiQoL) in men and women experiencing fertility problems, to evaluate the preliminary psychometric properties of this new tool and to translate FertiQoL into multiple languages.

METHOD

We conducted a survey, both online and in fertility clinics in USA, Australia/New Zealand, Canada and UK. A total of 1414 people with fertility problems participated. The main outcome measure was the FertiQoL tool.

RESULTS

FertiQoL consists of 36 items that assess core (24 items) and treatment-related quality of life (QoL) (10 items) and overall life and physical health (2 items). Cronbach reliability statistics for the Core and Treatment FertiQoL (and subscales) were satisfactory and in the range of 0.72 and 0.92. Sensitivity analyses showed that FertiQoL detected expected relations between QoL and gender, parity and support-seeking. FertiQoL was translated into 20 languages by the same translation team with each translation verified by local bilingual fertility experts.

CONCLUSIONS

FertiQoL is a reliable measure of the impact of fertility problems and its treatment on QoL. Future research should establish its use in cross-cultural research and clinical work.

Infertility treatment and fertility-specific distress: A longitudinal analysis of a population-based sample of U.S. women

Because research on infertile women usually uses clinic-based samples of treatment seekers, it is difficult to sort out to what extent distress is the result of the condition of infertility itself and to what extent it is a consequence of the experience of infertility treatment. We use the National Survey of Fertility Barriers, a two-wave national probability sample of U.S. women, to disentangle the effects of infertility and infertility treatment on fertility-specific distress. Using a series of ANOVAs, we examine 266 infertile women who experienced infertility both at Wave 1 and at Wave 2, three years later. We compare eight groups of infertile women based on whether or not they have received treatment and on whether or not they have had a live birth. At Wave 1, infertile women who did not receive treatment and who had no live birth reported lower distress levels than women who received treatment at Wave 1 only, regardless of whether their infertility episode was followed by a live birth. At Wave 2, women who received no treatment have significantly lower fertility-specific distress than women who were treated at Wave 1 or at Waves 1 and 2, regardless of whether there was a subsequent live birth. Furthermore, fertility-specific distress did not increase over time among infertile women who did not receive treatment. The increase infertility-specific distress was significantly higher for women who received treatment at Wave 2 that was not followed by a live birth than for women who received no treatment or for women who received treatment at Wave 1 only. These patterns suggest that infertility treatment is associated with levels of distress over and above those associated with the state of being infertile in and of itself.

The Fertility Quality of Life (FertiQoL) tool: development and general psychometric properties

Objective

To develop the first international instrument to measure fertility quality of life, FertiQoL, in men and women experiencing fertility problems, to evaluate the preliminary psychometric properties of this new tool and to translate FertiQoL into multiple languages.

Design

Survey.

Setting

Online and fertility clinics in USA, Australia/New Zealand, Canada, and United Kingdom.

Participants

A total of 1,414 people with fertility problems.

Intervention(s)

None.

Main Outcome Measure(s)

FertiQoL.

Result(s)

FertiQoL consists of 36 items that assess core (24 items) and treatment-related (10 items) quality of life as well as overall life and physical health (2 items). Cronbach reliability statistics for the Core and Treatment FertiQoL (and subscales) were satisfactory, in the range of 0.72 and 0.92. Sensitivity analyses showed that FertiQoL detected expected relations between quality of life and gender, parity, and support seeking. FertiQoL was translated into 20 languages by the same translation team, with each translation verified by local bilingual fertility experts.

Conclusion(s)

FertiQoL is a reliable measure of the impact of fertility problems and its treatment on quality of life. Future research should establish its use in cross-cultural research and clinical work.