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Mayette E, Scalise A, Li A, McGeorge N, James K, Mahalingaiah S. Assisted reproductive technology (ART) patient information-seeking behavior: a qualitative study. BMC Womens Health 2024; 24:346. [PMID: 38877503 PMCID: PMC11179360 DOI: 10.1186/s12905-024-03183-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 06/05/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Approximately 13% of women in the United States of reproductive age seek infertility services. Assisted reproductive technology (ART), including in vitro fertilization, is used to help patients achieve pregnancy. Many people are not familiar with these treatments prior to becoming patients and possess knowledge gaps about care. METHODS This study employed qualitative methods to investigate how patients interact with information sources during care. Patients who underwent ART including embryo transfer between January 2017 and April 2022 at a large urban healthcare center were eligible. Semi-structured, in-depth interviews were conducted between August and October 2022. Fifteen females with an average age of 39 years participated. Reflexive thematic analysis was performed. RESULTS Two main themes emerged. Participants (1) utilized clinic-provided information and then turned to outside sources to fill knowledge gaps; (2) struggled to learn about costs, insurance, and mental health resources to support care. Participants preferred clinic-provided resources and then utilized academic sources, the internet, and social media when they had unfulfilled information needs. Knowledge gaps related to cost, insurance, and mental health support were reported. CONCLUSION ART clinics can consider providing more information about cost, insurance, and mental health support to patients. TRIAL REGISTRATION The Massachusetts General Hospital Institutional Review Board approved this study (#2022P000474) and informed consent was obtained from each participant.
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Affiliation(s)
- Emma Mayette
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Massachusetts General Hospital, 55 Fruit Street, Yawkey 10, Boston, MA, 02114, USA.
| | - Ariel Scalise
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Massachusetts General Hospital, 55 Fruit Street, Yawkey 10, Boston, MA, 02114, USA
| | - Angela Li
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA
| | - Nicolette McGeorge
- Charles River Analytics, Inc., 625 Mount Auburn St., Cambridge, MA, 02148, USA
| | - Kaitlyn James
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Massachusetts General Hospital, 55 Fruit Street, Yawkey 10, Boston, MA, 02114, USA
| | - Shruthi Mahalingaiah
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Massachusetts General Hospital, 55 Fruit Street, Yawkey 10, Boston, MA, 02114, USA
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA
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2
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Petra T, Wischmann T, Mayer-Lewis B. Evaluation of infertility counselling in Germany. Arch Gynecol Obstet 2024; 309:1065-1073. [PMID: 38172455 DOI: 10.1007/s00404-023-07316-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/21/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE This paper reports on the first evaluation of infertility counselling in Germany. METHODS Sixty-nine infertility counsellors provided feedback via 524 survey sheets and 182 questionnaires were filled in by clients. RESULTS The results show a high level of satisfaction on behalf of the clients. They valued the emotional support, information, and exploration of family-building options with and without medical assistance and the counsellors' expertise. During counselling, coping with the emotional burden of infertility was an important issue, but in more than half of all counselling sessions, future parental issues were addressed. The group of clients seeking support can be described to be very heterogeneous, and counselling issues comprise a wide range of aspects. CONCLUSIONS This piece of research suggests that the following issues need to be considered to improve infertility counselling. Better integration of counselling in infertility clinics, more awareness for infertility counselling for other medical and non-medical professions Better funding for counselling so that its uptake is not dependent upon the financial resources of clients Awareness for new groups of clients and counselling issues such as single and transgender individuals, co-parenting families There is a need for more research and the development of counselling concepts.
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Affiliation(s)
- Thorn Petra
- Praxis für Paar- und Familientherapie, Langener Strasse 37, 64546, Moerfelden, Germany.
| | - Tewes Wischmann
- Institute of Medical Psychology, University Hospital Heidelberg, Bergheimer Str. 20, 69115, Heidelberg, Germany
| | - Birgit Mayer-Lewis
- Lutheran University of Applied Sciences-Evangelische Hochschule Nürnberg, Bärenschanzstraße 4, 90429, Nuremberg, Germany
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3
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Zimmermann M, Moore Simas TA, Howard M, Byatt N. The Pressing Need to Integrate Mental Health into Obstetric Care. Clin Obstet Gynecol 2024; 67:117-133. [PMID: 38281172 DOI: 10.1097/grf.0000000000000837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Mental health and substance use conditions are prevalent among perinatal individuals. These conditions have a negative impact on the health of perinatal individuals, their infants, and families, yet are underdiagnosed and undertreated. Populations that have been marginalized disproportionately face barriers to accessing care. Integrating mental health into obstetric care could address the perinatal mental health crisis. We review perinatal mental health conditions and substance use, outline the impact associated with these conditions, and describe the promise and potential of integrating mental health into obstetric settings to improve outcomes for patients receiving obstetric and gynecologic care.
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Affiliation(s)
| | - Tiffany A Moore Simas
- Department of Obstetrics & Gynecology, UMass Chan Medical School/UMass Memorial Health Memorial Campus, Worcester, Massachusetts
| | - Margaret Howard
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Nancy Byatt
- Department of Psychiatry, UMass Chan Medical School, Shrewsbury
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4
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Sahraian K, Abdollahpour Ranjbar H, Namavar Jahromi B, Cheung HN, Ciarrochi J, Habibi Asgarabad M. Effectiveness of mindful self-compassion therapy on psychopathology symptoms, psychological distress and life expectancy in infertile women treated with in vitro fertilization: a two-arm double-blind parallel randomized controlled trial. BMC Psychiatry 2024; 24:174. [PMID: 38429659 PMCID: PMC10908010 DOI: 10.1186/s12888-023-05411-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 11/28/2023] [Indexed: 03/03/2024] Open
Abstract
OBJECTIVES Infertility is a prominent problem affecting millions of couples worldwide. Recently, there has been a hightened emphasis on elucidating the subtle linkages between infertility treatment leveraging assisted reproductive technology and the complex realm of psychological challenges, as well as efforts in implementation of psychological interventions.The Mindful Self-Compassion (MSC) program seeks to improve self-compassion, compassion for others, mindfulness, and life satisfaction while reducing depression, anxiety, and stress. In the current study, an MSC intervention was performed on infertile women (IW) undergoing in vitro fertilization (IVF) to assess the effectiveness of this intervention in reducing psychological distress and psychopathological symptoms and enhancing life expectancy. METHODS Fifty-seven IW undergoing IVF were randomly allocated to two groups: MSC (n = 29) or treatment as usual (TAU; n = 28). Participants in MSC met once a week for two hours for eight weeks and attended a half-day meditation retreat. The Synder's Hope questionnaire and the Revised 90-Symptom Checklist (SCL-90-R) were used as the primary outcome measures. Data were obtained before the intervention, immediately after the intervention, and two months post-intervention. Repeated measures of ANCOVA and paired t-tests in all assessment points were used to compare the MSC and the TAU groups in outcomes. RESULTS In the MSC group, hopelessness, anger-hostility, anxiety, interpersonal sensitivity difficulties, and depression were significantly reduced compared with the TAU group, and those improvements persisted at the two-month follow-up. Reliable change index revealed that the MSC group's gains were both clinically significant and durable. CONCLUSIONS MSC can facilitate higher life satisfaction and mental well-being for IW undergoing IVF by reducing psychological distress, psychopathological symptoms, and hopelessness. These encouraging findings call for more research into the effectiveness of mindfulness-based therapies in addressing psychological problems among IW undergoing IVF.
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Affiliation(s)
- Kimia Sahraian
- Department of Psychology, Higher Education Center of Eghlid, Eghlid, Iran
- Infertility Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Bahia Namavar Jahromi
- Infertility Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Obstetrics and Gynecology, School of Medical Science, Shiraz University of Medical Science, Shiraz, Iran
| | - Ho Nam Cheung
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
| | - Joseph Ciarrochi
- Institute for Positive Psychology and Education, Australian Catholic University, North Sydney, NSW, Australia
| | - Mojtaba Habibi Asgarabad
- Department of Psychology, Norwegian University of Science and Technology, 7491 Dragvoll, Trondheim, Norway.
- Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran.
- Department of Health Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran.
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5
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Boudreau G, Brassard A, Beaulieu N, Audet A, Péloquin K. Attachment and Sexual Functioning in Couples Seeking Fertility Treatment: The Role of Infertility-Specific Coping Strategies. JOURNAL OF SEX & MARITAL THERAPY 2024; 50:395-412. [PMID: 38254305 DOI: 10.1080/0092623x.2024.2302019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Couples facing infertility often experience sexual difficulties. Yet, little is known about the factors associated with these difficulties. We examined whether infertility-related coping strategies explain the associations between attachment insecurities (anxiety, avoidance) and sexual function and satisfaction in 97 couples seeking fertility treatment. Anxiety was associated with one's lower sexual satisfaction and function via self-neglect coping strategies. Anxiety was also associated with the partner's lower sexual satisfaction via self-blame coping. Avoidance was associated with lower partner support-seeking and sexual satisfaction. These findings support the roles of attachment and coping in the experience of sexual difficulties among couples seeking fertility treatment.
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Affiliation(s)
- Gabrielle Boudreau
- Department of Psychology, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Audrey Brassard
- Department of Psychology, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Noémie Beaulieu
- Department of Psychology, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Ariane Audet
- Department of Psychology, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Katherine Péloquin
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
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6
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Lahoti U, Pajai S, Shegekar T, Juganavar A. Exploring the Landscape of Social Egg Freezing: Navigating Medical Advancements, Ethical Dilemmas, and Societal Impacts. Cureus 2023; 15:e47956. [PMID: 38034211 PMCID: PMC10685323 DOI: 10.7759/cureus.47956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
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.
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Affiliation(s)
- Udit Lahoti
- Obstretics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sandhya Pajai
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Tejas Shegekar
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anup Juganavar
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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7
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Zabak S, Varma A, Bansod S, Pohane MR. Exploring the Complex Landscape of Delayed Childbearing: Factors, History, and Long-Term Implications. Cureus 2023; 15:e46291. [PMID: 37915872 PMCID: PMC10616531 DOI: 10.7759/cureus.46291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 09/30/2023] [Indexed: 11/03/2023] Open
Abstract
This review article delves into the intricate landscape of delayed childbearing, shedding light on the factors influencing individuals' decisions to postpone parenthood. In a world undergoing rapid social, economic, and technological transformations, the concept of when and why to become a parent has evolved significantly. We explore historical trends, societal norms, psychological dynamics, policy implications, and prospects surrounding delayed childbearing. This review underscores the diverse influences shaping this trend, from economic considerations and changing cultural perspectives to advancements in reproductive technologies and the complexities of work-life balance. By examining the emotional dimensions and long-term consequences, we comprehensively understand the implications for individuals, families, and societies. As we conclude, we emphasize the importance of addressing challenges and embracing opportunities to create a supportive environment for those navigating the complex decisions tied to delayed childbearing.
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Affiliation(s)
- Siddharth Zabak
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ashish Varma
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Spandan Bansod
- Department of Obstetrics and Gynecology, Smt. Radhikabai Meghe Memorial College of Nursing, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Meera R Pohane
- Medical Surgical Nursing, Shalinitai Meghe College of Nursing, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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8
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Mental health of UK firefighters. Sci Rep 2023; 13:62. [PMID: 36627314 PMCID: PMC9832123 DOI: 10.1038/s41598-022-24834-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 11/21/2022] [Indexed: 01/12/2023] Open
Abstract
Exposure to trauma, high-stress situations, and disrupted sleep are well known risk factors affecting firefighters' mental health. Little is known about the association between firefighters' exposure to fire contaminants and mental health disorders. The UK Firefighter Contamination Survey assessed firefighters' health and capacity for occupational exposure to contaminants. Participants were invited to anonymously complete its 64 questions online. Logistic regression analyses assessed the associations between self-reported mental health disorders and proxies of contaminant exposure. Results found that firefighters who notice soot in their nose/throat for more than a day after attending fires (Odds Ratio (OR) = 1.8, 1.4-2.4), and those who remain in their personal protective equipment (PPE) for over 4 h after fires (OR = 1.9, 1.2-3.1), were nearly twice as likely to report mental health disorders. Significantly increased odds ratios for all three outcomes of interest (anxiety, depression and/or any mental health disorders) were also found among firefighters who take PPE home to clean. Sleeping problems were reported by 61% of firefighters. These firefighters were 4.2 times more likely to report any mental health disorder (OR = 4.2, 3.7-4.9), 2.9 times more likely to report anxiety (OR = 2.9, 2.4-3.5) and 2.3 times more likely to report depression (OR = 2.3, 1.9-2.8) when compared to firefighters who did not report sleep issues. Effective decontamination measures within UK Fire and Rescue Services, together with firefighters' wellness, may play a crucial role in protecting firefighters' mental health.
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9
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Péloquin K, Boucher S, Benoit Z, Jean M, Beauvilliers L, Carranza-Mamane B, Brassard A. "We're in this together": Attachment insecurities, dyadic coping strategies, and relationship satisfaction in couples involved in medically assisted reproduction. JOURNAL OF MARITAL AND FAMILY THERAPY 2023; 49:92-110. [PMID: 36047353 DOI: 10.1111/jmft.12608] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 08/11/2022] [Accepted: 08/16/2022] [Indexed: 06/15/2023]
Abstract
Attachment is an important predictor of relationship satisfaction and attachment insecurities are a risk factor for couples under stress. Drawing from the Vulnerability-Stress-Adaptation model, we investigated whether dyadic coping strategies (DCS) would explain the links between attachment insecurities and relationship satisfaction in 97 couples involved in medically assisted reproduction (MAR). Path analyses revealed that for women and men, attachment insecurities (anxiety, avoidance) were associated with their own lower relationship satisfaction through their lower use of positive DCS. Attachment avoidance was also associated with participants' own lower relationship satisfaction through their own lower use of negative DCS. Men's attachment avoidance was also related to their partner's lower relationship satisfaction via their own and their partner's lower use of positive DCS. The findings suggest that promoting the use of positive DCS may be important to preserve relationship satisfaction in couples involved in MAR.
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Affiliation(s)
| | - Stéphanie Boucher
- Psychology Department, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Zoé Benoit
- Psychology Department, Université de Montréal, Montreal, Quebec, Canada
| | - Mireille Jean
- Psychology Department, Université de Montréal, Montreal, Quebec, Canada
| | | | - Belina Carranza-Mamane
- Department of Obstetrics and Gynecology, GREI Division, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Audrey Brassard
- Psychology Department, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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10
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Gietel-Basten S, Rotkirch A, Sobotka T. Changing the perspective on low birth rates: why simplistic solutions won't work. BMJ 2022; 379:e072670. [PMID: 36379520 PMCID: PMC10915774 DOI: 10.1136/bmj-2022-072670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Stuart Gietel-Basten
- Hong Kong University of Science and Technology, Kowloon, Hong Kong SAR, People's Republic of China
- Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Anna Rotkirch
- Population Research Institute, Väestöliitto, Family Federation of Finland, Helsinki, Finland
| | - Tomáš Sobotka
- Vienna Institute of Demography, Wittgenstein Centre for Demography and Global Human Capital (IIASA, OeAW, University of Vienna), Vienna, Austria
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11
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Eichenberg C, Huss J, Küsel C, Hertlein K. Desire to Have Children and the Internet: Aspects for Psychosomatic Practice. JOURNAL OF COUPLE & RELATIONSHIP THERAPY 2022. [DOI: 10.1080/15332691.2022.2136810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Christiane Eichenberg
- Medical Faculty, Institute of Psychosomatics, Sigmund Freud University, Vienna, Austria
| | - Jessica Huss
- Department of Psychology, University of Kassel, Kassel, Germany
| | - Cornelia Küsel
- Computer Science Department, Universität der Bundeswehr München, Munich, Germany
| | - Katherine Hertlein
- Department of Psychiatry and Behavioral Health, Kirk Kerkorian School of Medicine, University of Las Vegas, Las Vegas, Nevada, USA
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12
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Anderson D, Kumar D, Divya D, Zepeda JL, Razzak AN, Hasoon J, Viswanath O, Kaye AD, Urits I. Mental Health in Non-Oncologic Urology Patients. Health Psychol Res 2022; 10:38352. [PMID: 36168643 PMCID: PMC9501847 DOI: 10.52965/001c.38352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
This article is a literature review of mental health concerns in non-oncologic urology patients. Pathologies represented in this review include Peyronie's Disease (PD), erectile dysfunction (ED), urinary incontinence and urinary tract infections (UTI), infertility, benign prostatic hyperplasia (BPH), kidney stones, and urinary retention. While there has been great interventional focus as of late for urogenitary malignancies (i.e. prostate cancer awareness with the Movember campaign), literature studies and intervention focused on non-oncologic urology patients has been limited. As such, we conducted a review on urology patients with non-oncologic pathologies as an effort to increase clinician awareness of mental health concerns among such patients, increase the comfort level for clinician communication on socially sensitive topics surrounding pathologies, and review ongoing interventions conducted within these pathologies. We outlined different ongoing Mental Health Illness (MHI) needs and treatments for various pathologies. Patients with non-cancerous urologic pathologies had lower quality of life and higher incidence of MHI than the general population. As such, in line with the American Urological Association recommendations, psychological and social support from peers, therapists, and healthcare providers further prove to be crucial for some subpopulations. The review also yielded pathology specific interventions such as group therapy for ED patients. Given the higher incidence of MHI in the patient population after the Covid-19 pandemic, MHI awareness in the sphere of non-oncologic urology treatment continues to be crucial when creating a collaborative treatment platform for patients.
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Affiliation(s)
| | - Devesh Kumar
- School of Medicine, Medical College of Wisconsin
| | - Divya Divya
- School of Medicine, University of Missouri- Kansas City
| | | | | | - Jamal Hasoon
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Omar Viswanath
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School; Valley Anesthesiology and Pain Consultants, Envision Physician Services; Department of Anesthesiology, University of Arizona College of Medicine Phoenix; Department of Anesthesiology, Creighton University School of Medicine
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Shreveport
| | - Ivan Urits
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School; Department of Anesthesiology, Louisiana State University Health Shreveport
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13
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Zhu H, Shi L, Wang R, Cui L, Wang J, Tang M, Qian H, Wei M, Wang L, Zhou H, Xu W. Global Research Trends on Infertility and Psychology From the Past Two Decades: A Bibliometric and Visualized Study. Front Endocrinol (Lausanne) 2022; 13:889845. [PMID: 35903282 PMCID: PMC9317298 DOI: 10.3389/fendo.2022.889845] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives The aim of this study was to evaluate the global scientific output of research on infertility and psychology; explore the current status and trends in this field through the cooperation of authors, countries, and institutions; shed light on the direction of clinical infertility research in the future, and provide inspiration for targeted diagnosis and treatment of infertility. Methods Research publications on infertility and psychology from the past two decades were retrieved from the Web of Science Core Collection (WoSCC). Bibliometric analyses were performed using VOSviewer software and the bibliometrix R package. Network maps were generated to evaluate the collaborations between different authors, countries, institutions, and keywords. Results A total of 151 articles related to the study of infertility and psychology were identified. We observed a gradual increase in the number of publications from 2001 to 2021, and the trend has been relatively stable in the past eight years. Human Reproduction (England), as the leading journal publishing the most papers (29 articles), was cited in the most journals (1208 times). Boivin J was the most prolific author (16 articles), with the largest number of citations (890 times) and the highest h-index (14) during the past decades. Boivin J was also the leader with the highest publication frequency and more active cooperation with other top authors. The United Kingdom (34 papers) and Cardiff University (25 articles) contributed the most publications and were the leading contributors in this field. Active cooperation between countries and between institutions was observed, and analyses of articles and references were also shown. The main hot topics included matters related to women (39 times), in-vitro salt (31 times), infertility (30 times), couples (25 times), and impact (24 times). Conclusion Our study results provide a comprehensive overview of the development of scientific literature, allowing relevant authors and research teams to recognize the current research status in this field. At the same time, infertility and psychology may soon become hotspots and should be closely monitored.
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Affiliation(s)
- Hongkun Zhu
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Lingli Shi
- Department of Reproduction, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Rong Wang
- Department of Laboratory Medicine, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Lijuan Cui
- Department of Pathology, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Jiahui Wang
- Department of Reproduction, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Mengyu Tang
- Department of Reproduction, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Haiqing Qian
- Department of Reproduction, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Minggang Wei
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Lihong Wang
- Department of Reproduction, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Huifang Zhou
- Department of Gynaecology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Wenting Xu
- Nanjing University of Chinese Medicine, Nanjing, China
- Department of Reproduction, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
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Szatmári A, Helembai K, Zádori J, Kovács I. Paramedical counselling in infertility treatment: its effects on anxio-depressive symptom severity, perceived stress and self-esteem. Heliyon 2022; 8:e09827. [PMID: 35800247 PMCID: PMC9254525 DOI: 10.1016/j.heliyon.2022.e09827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 04/05/2022] [Accepted: 06/24/2022] [Indexed: 11/24/2022] Open
Abstract
Aims The importance of contributing psychological factors and stress-control in female infertility is well documented, but research on their role in male infertility is scarce. The present study aimed to evaluate the effects of a novel paramedical counselling on anxio-depressive symptom severity, perceived stress and self-esteem in infertile men participating in an infertility treatment programme. Methods Patients were recruited from clinics of University of Szeged, Hungary between 2019 May and 2020 December, and were sorted into control (n = 51) and experimental (n = 57) groups, where patients in the experimental group received a 5-session paramedical counselling in extension to their medical treatment. The levels of anxio-depressive symptom severity, perceived stress and self-esteem were measured prior to and after receiving paramedical counselling. The control group scored lower in regards of the severity of depressive symptom, and showed an increase of self-esteem, while the experimental group resulted in a significant decrease of anxio-depressive scores with the elevation of the level of self-esteem. Results Our results indicate that joining an infertility treatment programme alone had a positive role in reducing depressive symptoms and in the increase of self-esteem among infertile men, but receiving additional paramedical counselling throughout the treatment programme resulted in the decrease of anxio-depressive symptoms, besides the elevation of the level of self-esteem, with a significantly higher decrease in the state anxiety compared to not receiving this additional paramedical counselling. Conclusions Thus, it would be advisable for infertility treatment programmes to incorporate screening for psychological vulnerability and implement additional paramedical counselling to alleviate these confounding symptoms detrimental to conceiving.
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Barra F, La Rosa VL, Vitale SG, Commodari E, Altieri M, Scala C, Ferrero S. Psychological status of infertile patients who had in vitro fertilization treatment interrupted or postponed due to COVID-19 pandemic: a cross-sectional study. J Psychosom Obstet Gynaecol 2022; 43:145-152. [PMID: 33252292 DOI: 10.1080/0167482x.2020.1853095] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To explore the psychological status of infertile women and men who had in-vitro fertilization (IVF) treatment interrupted or postponed because of the COVID-19 emergency. MATERIALS AND METHODS An electronic survey (NCT04395755) was e-mailed between April and June 2020 to couples whose IVF treatments have been interrupted or postponed due to the COVID-19 pandemic. The presence and severity of symptoms suggestive of anxiety and/or depression were assessed using the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9). Subjects with preexisting psychiatric disorders were excluded. RESULTS Overall, 524 out of 646 patients completed the survey. The prevalence of anxiety and/or depression feelings was significantly higher in women, mainly if aged more than 35 years and with a previous IVF attempt. The occurrence of these psychological symptoms was significantly associated with the time spent on COVID-19 related news per day and partner with evidence of psychological disorder and, in females, with a diagnosis of poor ovarian reserve, diagnosis of endometriosis or uterine fibroids. CONCLUSIONS The psychological impact of the COVID-19 pandemic on the infertile couples who should have undergone IVF treatment has been significant. IVF centers should systematically offer these couples adequate psychological counseling to improve mental health.
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Affiliation(s)
- Fabio Barra
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy, Genoa
| | | | - Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Elena Commodari
- Department of Educational Sciences, University of Catania, Catania, Italy
| | - Michele Altieri
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy, Genoa
| | - Carolina Scala
- Division of Obstetrics and Gynecology, Gaslini Institute, Genoa, Italy.,Piazza della Vittoria 14 Srl, Piazza della Vittoria 14/26, Genoa, Italy
| | - Simone Ferrero
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy, Genoa.,Piazza della Vittoria 14 Srl, Piazza della Vittoria 14/26, Genoa, Italy
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16
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Vioreanu AM. Psychological Impact of Infertility. Directions for the Development of Interventions. Ment Health (Lond) 2021. [DOI: 10.32437/mhgcj.v4i1.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction: Infertility represents a major health problem that oftentimes is experienced as a crisis situation. Because it interposes with achieving an important life goal, that of having children, its implications on the psycho-emotional level are robust.
Purpose: The present article aimed at exploring the multidimensional effects of infertility on mental health, as well as suitable psychological intervention strategies for patients both at an individual and couple level.
Methodology: An extensive literature review was conducted to select the most relevant information. Articles included were searched in PubMed, Google Scholar and other similar databases within a seven years interval (2014-2021) to assure the up-to-date quality of the paper. The main criteria of inclusion were: studies about the consequences of infertility on mental health, epidemiology, risk and protective factors, psychological models for infertility, psychological evaluation, established instruments, psycho-social and therapeutic interventions, intervention protocols used in public health for infertility patients.
Results and Discussion: Infertility is often experienced as a crisis situation, in which the most common consequences are visible at the level of mood disorders (e.g. anxiety, depression, marked distress) and at the social level (stigma, divorce, social isolation, financial difficulties). Psychological counseling is needed throughout medical treatment and therapeutic interventions (e.g. cognitive-behavioral therapy) have shown favorable results in managing the emotional balance of the individual/couple and reducing the risk of psychopathology.
Conclusions: Research highlights the beneficial effects of psychological interventions on reducing levels of stress related to infertility, anxiety and depressive symptoms and on improving the quality of life and couple dynamics
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Rezamahaleh FA, Khadivzadeh T, Asgharinekah SM, Esmaeili H. The effect of face-to-face and telephone counseling on the desire for adoption in infertile couples. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:164. [PMID: 34250098 PMCID: PMC8249970 DOI: 10.4103/jehp.jehp_964_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/10/2020] [Indexed: 06/13/2023]
Abstract
BACKGROUND Fertility is always one of the most important functions of the family. Having a child equals growing up and entering the adult world. Adoption is one of the methods that can be considered to treat infertility. One of the duties of health professionals, especially midwives, is to advise and educate infertile people, which helps them in a way beyond medical treatment. Therefore, this study was conducted to determine the effect of face-to-face and telephone counseling on the desire for adoption in infertile couples. MATERIALS AND METHODS The present study was a two-group counseling intervention study that was performed on 34 infertile couples referred to Mashhad Infertility Center. Infertile couples were randomly assigned to face-to-face and telephone counseling groups. All participants completed the Adoption Adoption Questionnaire at the beginning and end of the study. Data were analyzed by spss16 software. RESULTS The mean score of propensity to adopt in the face-to-face counseling group 2 weeks after the intervention was significantly higher than before the intervention. Furthermore, the mean score of desire for adoption in the telephone counseling group increased significantly 2 weeks after the intervention compared to before (P < 0.001). Adoption scores varied in the face-to-face counseling group at 3.15 and in the telephone counseling group at 3.23. There was no statistically significant difference between the two groups (P < 0.885). The most common reason for not wanting to adopt was hope for self-treatment and having children (70.6% women and 67.6% men). The most common reason for accepting an adopted child was the strong need to have a child (23.5% in women and 23.5% in men). CONCLUSION According to the results of this study, counseling can increase people's awareness of the conditions of adoption and thus increase the desire of people to accept the adopted child. For this reason, considering adoption counseling sessions for infertile couples who have been receiving infertility treatment for a long time but have not become pregnant can help the couple decide.
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Affiliation(s)
- Fateme Ahmadi Rezamahaleh
- MSc of Counselin in Midwifery, Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Talat Khadivzadeh
- Associate Professor, Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Mohsen Asgharinekah
- Associate Professor, Department of Educational and Counseling Psychology, Faculty of Education and Psychology, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Habibollah Esmaeili
- PH.D in Biostatistics, Professor, Social Department of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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18
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Zurlo MC, Cattaneo Della Volta MF, Vallone F. Infertility-Related Stress and Psychological Health Outcomes in Infertile Couples Undergoing Medical Treatments: Testing a Multi-dimensional Model. J Clin Psychol Med Settings 2021; 27:662-676. [PMID: 31471847 DOI: 10.1007/s10880-019-09653-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The study aims to propose and test a multi-dimensional infertility-related stress model including socio-demographic and fertility-related characteristics, infertility-related stress dimensions, coping strategies and couple's dyadic adjustment dimensions as predictors of anxiety and depression among partners of couples undergoing infertility treatments. Both members of 250 infertile couples filled out a questionnaire consisting of Socio-demographics (Age; Educational level; Employment status), Fertility-related characteristics (Type of diagnosis; Duration of infertility), Fertility Problem Inventory-Short Form, Coping Orientations to Problem Experienced-New Italian Version, Dyadic Adjustment Scale, State-Trait Anxiety Inventory-Y and Edinburgh Depression Scale. Hierarchical Multiple Linear Regressions indicated that the proposed predictive models for anxiety and depression were significant and had good levels of fit with the data. Gender differences emerged in predictor variables. Findings provide valid predictive models that could be adopted to assess psychological health in infertile patients and to develop evidence-based and tailored counselling interventions at centres for assisted reproduction.
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Affiliation(s)
- Maria Clelia Zurlo
- Department of Political Sciences, University of Naples Federico II, Via L. Rodinò 22, 80138, Naples, Italy.
| | | | - Federica Vallone
- Department of Humanities, University of Naples Federico II, Naples, Italy
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19
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Warchol-Biedermann K. The Etiology of Infertility Affects Fertility Quality of Life of Males Undergoing Fertility Workup and Treatment. Am J Mens Health 2021; 15:1557988320982167. [PMID: 33834914 PMCID: PMC8040574 DOI: 10.1177/1557988320982167] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
This panel study explored the effects of male, female, mixed, or idiopathic factor of infertility on the fertility quality of life (FertiQoL) in involuntarily childless males undergoing fertility workup for the first time. A convenience sample of 255 married males (age range = 22–51 years, mean = 30.24 years), 254 (99.6%) of whom suffered from primary infertility were assessed (1) at the baseline, before their initial fertility evaluation (T1); (2) before their second andrological appointment, 2–3 months after diagnostic disclosure (T2); and (3) before subsequent treatment-related/ follow-up appointments (T3, T4). The timing of psychological assessment was strictly related to andrological appointments and routine medical procedures. Respondents completed Emotional, Mind–Body, Relational, and Social subscales of the Polish version of FertiQoL and a baseline demographic survey. The research demonstrated that the FertiQoL scores across the Emotional, Mind–Body, and Relational subscales markedly decreased after the diagnostic disclosure, particularly in the subgroups with male and concurrent male and female factor. Social subscale scores in all subgroups remained stable after the diagnostic disclosure (at T2) but significantly decreased in the follow-up (at T3 and T4). Significant differences in FertiQoL scores associated with respondents’ infertility factor could be demonstrated at each time point. The study identifies the FertiQoL in unintentionally childless males is significantly affected by their factor of infertility and evolves across the pathway of treatment-related/follow-up appointments.
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20
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Mosconi L, Crescioli G, Vannacci A, Ravaldi C. Communication of Diagnosis of Infertility: A Systematic Review. Front Psychol 2021; 12:615699. [PMID: 33815202 PMCID: PMC8015870 DOI: 10.3389/fpsyg.2021.615699] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 02/02/2021] [Indexed: 11/22/2022] Open
Abstract
Background: When infertility is diagnosed, physicians have the difficult task to break bad news. Their communication skills play a central role in improving patients' coping abilities and adherence to infertility treatments. However, specific guidelines and training courses on this topic are still lacking. The aim of the present study is to provide some practical advice for improving breaking bad news in infertility diagnosis through a systematic literature review of qualitative and quantitative studies. Methods: Electronic searches were performed in the MEDLINE, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Psychology and Behavioral Sciences Collection databases. All articles focusing on the communication of the diagnosis of infertility were included. The main findings of each included article were then summarized. Results: Literature search identified 11,838 references that were screened for eligibility. Full texts of 81 articles were retrieved, and their analysis led to the inclusion of 4 articles, which treated the theme of communication of infertility only partially. The main addressed aspects concerning the communication of the infertility diagnosis were the following: (i) the value that patients give to healthcare professionals' communication skills; (ii) the importance of giving clear information on diagnostic procedures and treatments in order to decrease patients' anxiety; and (iii) the importance of involving both partners. Conclusions: This review pointed out that the communication of the infertility diagnosis is still underinvestigated. Specific guidelines are currently not available, but other protocols could be used. Taking into account the principal aspects of communication highlighted with this review, in this study, we suggested an adaptation of the original SPIKES protocol that could be used by healthcare professionals for the communication of the infertility status.
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Affiliation(s)
- Laura Mosconi
- CiaoLapo Foundation for Perinatal Health, Prato, Italy
| | - Giada Crescioli
- Perinatal Research Laboratory (PeaRL), University of Florence, Florence, Italy.,Section of Pharmacology and Toxicology, Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Alfredo Vannacci
- CiaoLapo Foundation for Perinatal Health, Prato, Italy.,Perinatal Research Laboratory (PeaRL), University of Florence, Florence, Italy.,Section of Pharmacology and Toxicology, Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Claudia Ravaldi
- CiaoLapo Foundation for Perinatal Health, Prato, Italy.,Perinatal Research Laboratory (PeaRL), University of Florence, Florence, Italy.,Section of Pharmacology and Toxicology, Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
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21
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Umeh U, Maduakolam I, Ndubuisi I, Onyekachi-Chigbu A. Coping strategies of infertility clients attending gynecological clinic in South-eastern Nigeria. NIGERIAN JOURNAL OF MEDICINE 2021. [DOI: 10.4103/njm.njm_124_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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22
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Park J, Shin N. Effect of an Infertility Counseling Education Program on Education Satisfaction and Counseling Competency of Nurses. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:469580211059997. [PMID: 34866442 PMCID: PMC8655238 DOI: 10.1177/00469580211059997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The purpose of this study is to investigate the effects of an infertility counseling education program on education satisfaction and counseling competency of nurses. The study used a one-group pretest-posttest design. Participants were 135 nurses in Korea. Data on demographic characteristics on education satisfaction, and counseling competency were collected. After participating in the infertility counseling education program, the level of counseling competency increased significantly over that before participating in the infertility counseling education program. The infertility counseling education program improved the counseling competency of the participating nurses. Use of such an infertility counseling education program is recommended when nurses counsel patients facing infertility. It is necessary to repeat this study in the future to clarify the effects of these counseling education programs.
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Affiliation(s)
- Jummi Park
- Department of Nursing, Namseoul University, Cheonan, South Korea
| | - Nayeon Shin
- Bundang CHA Medical Center, CHA University, Gyeonggido, South Korea
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23
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Mahadeen AI, Hamdan-Mansour AM, Habashneh SA, Dardas LA. Sexual Satisfaction Among Infertile Couples: Demographics and Psychosocial Health Factors. J Psychosoc Nurs Ment Health Serv 2020; 58:40-47. [PMID: 32853392 DOI: 10.3928/02793695-20200812-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/26/2020] [Indexed: 11/20/2022]
Abstract
The purpose of the current study was to explore sexual satisfaction among infertile couples in Jordan and its associations with psychosocial and sociodemographic factors. Using a descriptive correlational design, 248 infertile couples from outpatient clinics were recruited and filled out a questionnaire on sexual satisfaction, in addition to perceived social support, depressive symptoms, psychological stress, coping skills, optimism, life satisfaction, and sociodemographics. Sexual satisfaction was significantly and positively correlated with perceived social support, optimism, life satisfaction, and coping. Stronger association was observed between sexual satisfaction and optimism. No difference was found in sexual satisfaction in relation to participants' gender, age, working status, or education. This study highlights the importance of building mental health nurses' competence to provide education and counseling on sexuality to improve the quality of life of infertile couples and optimize their sexual wellness. The most recent guidelines for psychosocial care for infertile couples are discussed. [Journal of Psychosocial Nursing and Mental Health Services, 58(9), 40-47.].
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24
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Kayabaşi Ö, Yaman Sözbir Ş. The relationship between quality of life, perceived stress, marital satisfaction in women conceived through ART. J Reprod Infant Psychol 2020; 40:108-117. [PMID: 32602747 DOI: 10.1080/02646838.2020.1788211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND The stress experienced during pregnancy and the decrease in marital satisfaction affects the quality of life of the woman negatively. OBJECTIVE This study conducted to determine the quality of life and the relationship with perceived stress and marital satisfaction in pregnant women with ART. METHODS This study is a descriptive and corelational study. The study sample consisted of 120 pregnant women with ART. The patient descriptive form, the Married Life Scale (SWML), The Perceived Stress Scale (PSS) and The Fertility Quality of Life (FertiQoL) were used for data collection in this study. RESULTS The mean of the total score of PSS was 16.38 ± 4,721, the mean score of SWML was 23.03 ± 4.42 and the mean of the total score of FertiQoL was 81,25 ± 17,56. There was a moderate negative correlation (r = -0,551, p = 0,001) between the total score of the FertiQol and the total score of PSS and there was a moderate positive correlation (r = 0,452, p = 0,001) between FertiQol total score and SWML. CONCLUSION This study found that the rate of perceived stress affected the quality of life negatively and marital satisfaction affected the quality of life positively in pregnant women with ART.
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Affiliation(s)
- Özlem Kayabaşi
- Faculty of Health Sciences, Nursing Department, Ob/Gyn Nursing, Gazi University, Ankara, Turkey
| | - Şengül Yaman Sözbir
- Faculty of Health Sciences, Nursing Department, Ob/Gyn Nursing, Gazi University, Ankara, Turkey
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25
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Warchol-Biedermann K. The Risk of Psychiatric Morbidity and Course of Distress in Males Undergoing Infertility Evaluation Is Affected by Their Factor of Infertility. Am J Mens Health 2020; 13:1557988318823904. [PMID: 30819064 PMCID: PMC6440055 DOI: 10.1177/1557988318823904] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
This panel study aimed to explore the effects of male, female, mixed or idiopathic factor of infertility on the course of clinical distress and possible psychiatric morbidity in involuntarily childless males undergoing fertility evaluation for the first time. A sample of 255 males completed the General Health Questionnaire-28 (GHQ-28) (a) at the baseline, before their initial fertility evaluation (T1); (b) before their second andrological appointment 2-3 months after diagnostic disclosure (T2); and (c) before subsequent treatment-related/follow-up appointments (T3, T4) to be screened for clinically significant distress and risk for psychiatric morbidity. Then they were dichotomized as non-cases and cases. The timing of psychological testing was strictly related to andrological appointments and medical procedures. The research demonstrated that the baseline prevalence of clinical distress and psychiatric morbidity in all the subgroups was similar to reference values, but then significantly surged after the diagnostic disclosure, particularly in male and mixed factor respondents. However, the percentage of clinically distressed mixed or idiopathic factor of infertility respondents remained stable after diagnostic disclosure and during the entire follow-up. The prevalence of clinically significant distress and risk for psychiatric morbidity in the male factor of infertility, female factor of infertility, and mixed factor subgroups decreased during the follow-up but remained higher than at the baseline. The study identifies that the course of distress and risk of psychiatric morbidity of males is significantly affected by their factor of infertility and changes across the pathway of treatment-related/follow-up appointments.
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26
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Szatmári A, Helembai K, Zádori J, Dudás IE, Fejes Z, Drótos G, Rafael B. Adaptive coping strategies in male infertility, paramedical counselling as a way of support. J Reprod Infant Psychol 2020; 39:457-474. [PMID: 32043383 DOI: 10.1080/02646838.2020.1724918] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Aims: In the last decades, the number of infertile males increased worldwide which gained more focus. The extent to which a person or a couple is able to cope adaptively with the problem of infertility depends on the combined effect of several variables. Our aim was to apply counselling among males suffering from infertility problems. During the therapy - besides providing information - we aim to elaborate the effects of the treatment and experiences, to process information, to develop adaptive coping strategies against stress and to indirectly or directly change health behaviours influencing reproduction.Methods: Only patients with male factor infertility were involved. They were divided into an observed group (n = 57) and a control (n = 51) group after a thorough physical examination and assessment of their reactions to, and awareness of, the disease.Results: The group that received the interventions had an intense awareness of the diagnosis and aims and nature of the indicated treatment. They employed purposeful problem-solving coping strategies, reported being satisfied with the infertility treatment.Conclusions: The counselling of clients with infertility problems a more favourable mental well-being can be established by the active participation of professional helpers. Patients might receive effective, targeted and problem-specific help.Abbreviations: ART: Assisted Reproductive Technology.
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Affiliation(s)
- Angelika Szatmári
- Faculty of Health Sciences and Social Studies, University of Szeged, Szeged, Hungary
| | - Kornélia Helembai
- Faculty of Health Sciences and Social Studies, University of Szeged, Szeged, Hungary
| | - János Zádori
- Center for Assisted Reproduction, Kaáli Institute, Szeged, Hungary
| | - Ilona Eva Dudás
- Faculty of Medicine, Department of Psychiatry, University of Szeged, Szeged, Hungary
| | - Zsuzsanna Fejes
- Faculty of Medicine, Department of Radiology, University of Szeged, Szeged, Hungary
| | - Gergely Drótos
- Institute of Psychology, University of Szeged, Budapest, Hungary
| | - Beatrix Rafael
- Institute of Psychology, University of Szeged, Szeged, Hungary.,Department of Medical Rehabilitation and Physical Medicine, University of Szeged, Szeged, Hungary
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27
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Bonte D, Ferrer-Buitrago M, Dhaenens L, Popovic M, Thys V, De Croo I, De Gheselle S, Steyaert N, Boel A, Vanden Meerschaut F, De Sutter P, Heindryckx B. Assisted oocyte activation significantly increases fertilization and pregnancy outcome in patients with low and total failed fertilization after intracytoplasmic sperm injection: a 17-year retrospective study. Fertil Steril 2019; 112:266-274. [PMID: 31133387 DOI: 10.1016/j.fertnstert.2019.04.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 03/07/2019] [Accepted: 04/02/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To investigate the extent to which assisted oocyte activation (AOA) improves clinical outcomes in patients diagnosed with oocyte activation deficiencies (OADs). DESIGN Retrospective cohort study comparing AOA cycles and previous intracytoplasmic sperm injection (ICSI) cycles in couples experiencing low or total failed fertilization after ICSI. Importantly, the sperm-related oocyte-activating capacity was examined in all patients before AOA with the use of the mouse oocyte activation test (MOAT). SETTING Infertility center at a university hospital. PATIENT(S) A total of 122 couples with a history of low or total failed fertilization after ICSI. INTERVENTION(S) ICSI, MOAT, AOA, and embryo transfer. MAIN OUTCOME MEASURE(S) Fertilization, pregnancy, and live birth rates. RESULT(S) MOAT revealed 19 patients with a sperm-related OAD (MOAT group 1), 56 patients with a diminished sperm-related oocyte-activating capacity (MOAT group 2), and 47 patients with a suspected oocyte-related OAD (MOAT group 3). AOA (191 cycles) significantly improved fertilization, pregnancy, and live birth rates in all MOAT groups compared with previous ICSI attempts (243 cycles). Fertilization rates after AOA were significantly different among MOAT groups 1 (70.1%), 2 (63.0%), and 3 (57.3%). Between MOAT group 1 and 3, significant differences in pregnancy (49.0% vs. 29.4%) and live birth (41.2% vs. 22.1%) rates were observed. In total, 225 embryo transfers resulted in 60 healthy live births following AOA. CONCLUSION(S) Patients undergoing diagnostic testing before AOA show a significant improvement in clinical outcomes compared with previous cycles. Our findings highlight that AOA should be reserved for patients with clear OADs.
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Affiliation(s)
- Davina Bonte
- Ghent Fertility and Stem Cell Team (G-FaST), Department for Reproductive Medicine, Ghent University Hospital, Ghent, Belgium.
| | - Minerva Ferrer-Buitrago
- Ghent Fertility and Stem Cell Team (G-FaST), Department for Reproductive Medicine, Ghent University Hospital, Ghent, Belgium
| | - Lien Dhaenens
- Ghent Fertility and Stem Cell Team (G-FaST), Department for Reproductive Medicine, Ghent University Hospital, Ghent, Belgium
| | - Mina Popovic
- Ghent Fertility and Stem Cell Team (G-FaST), Department for Reproductive Medicine, Ghent University Hospital, Ghent, Belgium
| | - Vanessa Thys
- Ghent Fertility and Stem Cell Team (G-FaST), Department for Reproductive Medicine, Ghent University Hospital, Ghent, Belgium
| | - Ilse De Croo
- Ghent Fertility and Stem Cell Team (G-FaST), Department for Reproductive Medicine, Ghent University Hospital, Ghent, Belgium
| | - Stefanie De Gheselle
- Ghent Fertility and Stem Cell Team (G-FaST), Department for Reproductive Medicine, Ghent University Hospital, Ghent, Belgium
| | - Nathalie Steyaert
- Ghent Fertility and Stem Cell Team (G-FaST), Department for Reproductive Medicine, Ghent University Hospital, Ghent, Belgium
| | - Annekatrien Boel
- Ghent Fertility and Stem Cell Team (G-FaST), Department for Reproductive Medicine, Ghent University Hospital, Ghent, Belgium
| | - Frauke Vanden Meerschaut
- Ghent Fertility and Stem Cell Team (G-FaST), Department for Reproductive Medicine, Ghent University Hospital, Ghent, Belgium
| | - Petra De Sutter
- Ghent Fertility and Stem Cell Team (G-FaST), Department for Reproductive Medicine, Ghent University Hospital, Ghent, Belgium
| | - Björn Heindryckx
- Ghent Fertility and Stem Cell Team (G-FaST), Department for Reproductive Medicine, Ghent University Hospital, Ghent, Belgium
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Sahraeian M, Lotfi R, Qorbani M, Faramarzi M, Dinpajooh F, Ramezani Tehrani F. The Effect of Cognitive Behavioral Therapy on Sexual Function in Infertile Women: A Randomized Controlled Clinical Trial. JOURNAL OF SEX & MARITAL THERAPY 2019; 45:574-584. [PMID: 30912475 DOI: 10.1080/0092623x.2019.1594476] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Infertility and its consequences can have effects on various aspects of a couple's life and also in their marital relationships. This study aimed to investigate the effect of cognitive behavioral therapy (CBT) on sexual function in infertile women. The participants included 52 infertile women randomly assigned to intervention and control groups. A group-based, six-session sexual counseling using a CBT approach was also performed for the intervention group. Sexual functions of the participants in both groups were then assessed via the Female Sexual Function Index (FSFI) at three points in time. The findings revealed no statistically significant difference in the baseline FSFI mean scores of both groups. A significant difference was also reported for FSFI mean scores in the intervention group (29.35 ± 2.71) in comparison with those in the control group (25.84 ± 2.52) (p < 0.001) one month after intervention, with an effect size of 0.32. The mean scores of all the sexual-function domains, including sexual desire (p < 0.001), arousal (p < 0.001), lubrication (p < 0.001), orgasm (p < 0.001), satisfaction (p < 0.001), and pain (p < 0.001), among the participants in the intervention group had also significantly increased following CBT implementation. The results of this study could be used to promote sexual health in infertile women.
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Affiliation(s)
- Maryam Sahraeian
- Student Research Committee, Alborz University of Medical Sciences , Karaj , Iran (the Islamic Republic of)
| | - Razieh Lotfi
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences , Karaj , Iran (the Islamic Republic of)
| | - Mostafa Qorbani
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences , Karaj , Iran (the Islamic Republic of)
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences , Tehran , Iran
| | - Mahbobeh Faramarzi
- Infertility and Health Reproductive Research Center, Health Research Institute, Babol University of Medical Sciences , Babol , Iran (the Islamic Republic of)
| | - Fatemeh Dinpajooh
- Midwifery and Reproductive Health Department, School of Nursing and Midwifery, Alborz University of Medical Sciences , karaj , Iran (the Islamic Republic of)
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences , Tehran , Iran (the Islamic Republic of)
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Heredia A, Padilla F, Castilla JA, Garcia-Retamero R. Effectiveness of a psychological intervention focused on stress management for women prior to IVF. J Reprod Infant Psychol 2019; 38:113-126. [PMID: 30990057 DOI: 10.1080/02646838.2019.1601170] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: To evaluate the effectiveness of a psychological intervention focused on stress management in women who are candidates for in vitro fertilisation (IVF).Method: Pre-post study with two groups (n = 26). The psychological intervention group (IG) received a 90-minute session that included psychoeducation, relaxation training and coping skills. The control group (CG) did not receive any psychological intervention. All participants later underwent IVF. In the initial and final evaluations, state anxiety, emotional imbalance, adaptive resources and quality of life were measured. In the initial evaluation, demographic and clinical variables were also measured.Results: In the IG, the final evaluation reflected: (1) decreased levels of anxiety and emotional imbalance; (2) the perception of enhanced quality of life. Moreover, among the participants who received the psychological intervention and later achieved a successful IVF, the level of anxiety appeared to have decreased more strongly.Conclusions: A brief intervention focused on stress management can benefit the psychological adjustment of women who are candidates for IVF, reducing the anxiety they may experience in this regard. However, our conclusions are based on a small sample, and so should be considered with caution. Nevertheless, these results are promising and highlight the advisability of further research.
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Affiliation(s)
- Ana Heredia
- U. Reproducción, UGC Laboratorio clínico y UGC Obstetricia y Ginecología, HU Virgen de las Nieves, Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,Doctoral Programme in Psychology, Graduate School of Health Sciences, University of Granada, Granada, Spain
| | - Francisca Padilla
- Department of Experimental Psychology, Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, Granada, Spain
| | - Jose Antonio Castilla
- U. Reproducción, UGC Laboratorio clínico y UGC Obstetricia y Ginecología, HU Virgen de las Nieves, Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Rocio Garcia-Retamero
- Department of Experimental Psychology, Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, Granada, Spain
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Liker K, Black L, Weil J, Bruce J, Bereknyei Merrell S, Bivona S, Ormond KE. Challenges of infertility genetic counseling: Impact on counselors' personal and professional lives. J Genet Couns 2019; 28:626-640. [PMID: 30821877 DOI: 10.1002/jgc4.1106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 01/27/2019] [Accepted: 01/28/2019] [Indexed: 11/07/2022]
Abstract
Infertility genetic counselors (GCs) work with patients struggling to become pregnant who desire genetic testing of embryos and preconception genetic testing or carrier screening. Because personal and professional challenges have not been examined in this relatively new genetic counseling specialty, we investigated the difficulties infertility GCs face in their professional roles. Past and present infertility GCs in patient-facing roles were recruited through the National Society of Genetic Counselors. Purposive sampling ensured participants were diverse in clinical setting, reproductive history, and other demographics. Nineteen participants completed a semi-structured interview, at which time data saturation occurred. Thematic analysis revealed infertility GCs consider their patients more emotionally stressed than patients in other specialties. Infertility GCs relate easily to patients, build long-term patient relationships, and feel invested in the reproductive successes of patients. Participants reported heightened concern for their own fertility, leading to high personal uptake of preconception genetic and fertility tests. Participants described discomfort when counseling while visibly pregnant and reluctance to disclose their own reproductive histories. Further research is needed on the complex interactions of GCs' personal and professional lives. Peer support groups and professional dialogue about the personal effects of the role may be beneficial for infertility GCs.
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Affiliation(s)
- Karina Liker
- Department of Genetics, Stanford University School of Medicine, Stanford, California
| | - Lauri Black
- Pacific Reproductive Genetic Counseling, Pacifica, California
| | - Jon Weil
- Department of Biological Sciences, California State University Stanislaus, Turlock, California
| | - Janine Bruce
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Sylvia Bereknyei Merrell
- Department of Surgery, Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE), Stanford University School of Medicine, Stanford, California
| | - Stephanie Bivona
- Department of Genetics, Stanford University School of Medicine, Stanford, California
| | - Kelly E Ormond
- Department of Genetics, Stanford University School of Medicine, Stanford, California
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California
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Li Y, Zhang X, Shi M, Guo S, Wang L. Resilience acts as a moderator in the relationship between infertility-related stress and fertility quality of life among women with infertility: a cross-sectional study. Health Qual Life Outcomes 2019; 17:38. [PMID: 30770738 PMCID: PMC6377764 DOI: 10.1186/s12955-019-1099-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 01/24/2019] [Indexed: 02/08/2023] Open
Abstract
Background Infertility-related stress can seriously impact the fertility quality of life (QoL) of infertile women. Resilience, as a coping resource, can effectively combat psychological stress. This study aimed to evaluate the fertility QoL of infertile women and to examine whether resilience moderates the association of infertility-related stress with fertility QoL. Methods This cross-sectional study was conducted in northeast of China from December 2017 to February 2018. Out of 559 women outpatients with infertility, 498 (89.1%) completed self-reported questionnaires including the FertiQoL Scale, Fertility Problem Inventory (FPI) and Connor-Davidson Resilience Scale (CD-RISC). Hierarchical multiple regression analysis and simple slope analysis were applied to explore the influencing factors related to fertility QoL as well as to examine the moderating effect of resilience on the association of infertility-related stress with fertility QoL. Results The mean FertiQoL score was 64.54 ± 16.90 among the participants. Household monthly income and causes of infertility were significantly related to fertility QoL. In addition, infertility-related stress was negatively related to fertility QoL, and resilience was positively associated with fertility QoL, explaining 36.3% of the variance. Resilience moderated the association of infertility-related stress with fertility QoL. Specifically, the effect of infertility-related stress on fertility QoL varied by low(1 SD below the mean, B = - 0.496, β = - 0.714, P < 0.001), mean (B = - 0.293, β = - 0.422, P < 0.001) and high (1 SD above the mean, B = - 0.090, β = - 0.130, P < 0.001) levels of resilience. The higher resilience was, the weaker the effect of infertility-related stress on fertility QoL was. Conclusions Overall, women with infertility in China had relatively low FertiQoL scores. Resilience influenced the association of infertility-related stress with fertility QoL. Infertile patients’ psychological status must be addressed and adequate resilience-based interventions such as mindfulness-based skills should be provided to improve fertility QoL of women with infertility.
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Affiliation(s)
- Yifei Li
- Department of Social Medicine, School of Public Health, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122, China
| | - Xin Zhang
- Department of Social Medicine, School of Public Health, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122, China
| | - Meng Shi
- English Department, School of Fundamental Sciences, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122, China
| | - Shuaishuai Guo
- Reproductive Medicine Center, Shenyang Women's and Children's Hospital, No.87 Danan Road, Shenhe Area, Shenyang, 110000, China.
| | - Lie Wang
- Department of Social Medicine, School of Public Health, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122, China.
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Ehsan Z, Yazdkhasti M, Rahimzadeh M, Ataee M, Esmaelzadeh-Saeieh S. Effects of Group Counseling on Stress and Gender-Role Attitudes in Infertile Women: A Clinical Trial. J Reprod Infertil 2019; 20:169-177. [PMID: 31423420 PMCID: PMC6670266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Infertility stress can have a devastating impact on the lives of couples and influence their physical and psychological health. The purpose of this study was to investigate the effects of group counseling on female stress and gender-role attitudes in infertile women. METHODS The present study is a randomized clinical trial conducted on 90 infertile women referred to Rooyesh Infertility Treatment Center in the city of Karaj, Iran. The convenience sampling method was used. Samples were divided into intervention and control groups through four-block random allocations. Accordingly, the intervention group received five-session group counselling and the control group only received routine care. Newton's fertility problem inventory (FPI) and gender role questionnaire (GRQ) were used for collecting data before, after, and one month after the intervention. The significance level was set at 0.05. RESULTS The result showed a significant relationship between gender role attitude and stress in infertile women (p=0.03) and indirect association between of them (r=0.13). And also repeated measures test indicated that length of time had affected the total scores of infertility stress (p<0.001) and gender role attitude scores (p= 0.001) and there was a significant difference between the two groups in infertility stress scores (p<0.001) and gender role attitude scores (p=0.001). CONCLUSION Group counseling can be used in stress reduction and also improved gender role attitude of infertile women.
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Affiliation(s)
- Zeinab Ehsan
- Student Research Committee, School of Medical Sciences, Alborz University of Medical Sciences, Karaj, Iran
| | - Mansooreh Yazdkhasti
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Mitra Rahimzadeh
- Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Mina Ataee
- Department of Obstetrics and Gynecology, Clinical Research Development Center of Kamali Hospital, School of Medical Sciences, Alborz University of Medical Sciences, Karaj, Iran
| | - Sara Esmaelzadeh-Saeieh
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran,Corresponding Author: Sara Esmaelzadeh-Saeieh, Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran, E-mail:
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Sauvé MS, Péloquin K, Brassard A. Moving forward together, stronger, and closer: An interpretative phenomenological analysis of marital benefits in infertile couples. J Health Psychol 2018; 25:1532-1542. [DOI: 10.1177/1359105318764283] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Some couples find in infertility the bonding opportunities that reinforce their relationship. Using an interpretative phenomenological analysis, this study examined marital benefits in three couples seeking fertility treatment. Interviews revealed five types of benefits: being engaged in a shared hardship, feeling closer to one another, feeling reassured in the relationship, developing a satisfying communication and support behaviors, and having faith in the couple’s capacity to face adversity. A dyadic analysis also illustrated how marital benefits developed in each couple. Marital benefits nourished marital satisfaction, thus underscoring their importance to help couples cope through fertility treatment.
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Abstract
SummaryThe World Health Organization (WHO) has indicated that 8–12% of couples worldwide experience infertility, and in recent years the number seeking treatment has dramatically increased. The diagnosis and therapy put a heavy psychological and physical burden on most patients, female and male. The incidence of depression in couples presenting for infertility treatment is significantly higher than in comparable fertile couples. Anxiety is significantly higher in infertile couples than in the general population. Professionals have become aware of the importance of providing educational interventions to address patients' fears and concerns, and to better prepare patients for the demands of treatment. Health professionals should follow a patient-centred approach to provide for the specific needs of the couple. Women in general have a positive attitude to seeking psychological help in the form of cognitive-behavioural therapy, couples counselling and infertility counselling.Learning Objectives•Learn about the incidence rates of infertility and its impact on the mental health of the couple.•Know about infertility treatment and its psychological impact.•Learn about the different management strategies that can be helpful in the treatment of mental illness associated with infertility.
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Patel A, Sharma PSVN, Kumar P. Role of Mental Health Practitioner in Infertility Clinics: A Review on Past, Present and Future Directions. J Hum Reprod Sci 2018; 11:219-228. [PMID: 30568350 PMCID: PMC6262662 DOI: 10.4103/jhrs.jhrs_41_18] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
A large body of literature has emerged over the past four decades which highlights the need to address emotional needs in infertility and integrates psychological services within routine fertility care. Evidenced-based guidelines in most countries propagate that the mental health expert (MHP) plays a vital role as a team member in reducing the impact of infertility on the lives of patients, across all stages of treatment. In accordance with these global developments, inclusion of psychosocial care in fertility treatments is an upcoming trend in our nation. This review article brings forth the traditional role of MHP in infertility, compares patient-centered care with counseling, and elaborates on the guidelines on determinants of patient needs and suitability for structured psychological interventions. It also highlights the evidence-based studies on the application of psychotherapy in infertility.
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Affiliation(s)
- Ansha Patel
- Department of Psychiatry, Kasturba Medical College, Manipal, Karnataka, India
| | - P S V N Sharma
- Department of Psychiatry, Kasturba Medical College, Manipal, Karnataka, India
| | - Pratap Kumar
- Department of Obstetrics and Gynaecology, Kasturba Medical College, Manipal, Karnataka, India
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Liddon L, Kingerlee R, Barry JA. Gender differences in preferences for psychological treatment, coping strategies, and triggers to help-seeking. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2017; 57:42-58. [PMID: 28691375 DOI: 10.1111/bjc.12147] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 06/06/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE There is some evidence that men and women deal with stress in different ways; for example, a meta-analysis found that women prefer to focus on emotions as a coping strategy more than men do. However, sex differences in preferences for therapy is a subject little explored. DESIGN A cross-sectional online survey. METHOD Participants (115 men and 232 women) were recruited via relevant websites and social media. The survey described therapies and asked participants how much they liked each. Their coping strategies and help-seeking behaviour were assessed too. RESULTS Survey data were analysed using multiple linear regression. After familywise adjustment of the alpha for multiple testing to p < .0125, and controlling for other relevant variables, men liked support groups more than women did (β = -.163, p < .010), used sex or pornography to cope with stress more than women did (Exp[B] = .280, p < .0002), and thought that there is a lack of male-friendly options more than women did (Exp[B] = .264, p < .002). The majority of participants expressed no preference for the sex of their therapist, but of those who did, men were only slightly more likely to prefer a female therapist whereas women were much more likely to prefer females (p < .0004). Even after familywise adjustment, there were still more significant findings than would be expected by chance (p < .001, two-tailed). CONCLUSIONS Although there are many similarities in the preferences of men and women regarding therapy, our findings support the hypothesis that men and women show statistically significant differences of relevance to clinical psychologists. PRACTITIONER POINTS Men are less inclined than women to seek help for psychological issues This study demonstrates that men and women show significant differences in some aspects of therapy, coping behaviour, and help-seeking It is possible that men would be more inclined to seek help if therapies catered more for men's preferences Practitioners can learn to improve the success of their practice by taking the gender of clients into account.
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Affiliation(s)
| | | | - John A Barry
- Clinical, Educational and Health Psychology, University College London, UK
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38
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Pedro A, Faroa BD. Exploring the lived experiences of infertility treatment and care by involuntarily childless women. JOURNAL OF PSYCHOLOGY IN AFRICA 2017. [DOI: 10.1080/14330237.2017.1321855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Athena Pedro
- Department of Psychology, Faculty of Community and Health Sciences, University of the Western Cape, South Africa
| | - Brendon D. Faroa
- Department of Psychology, Faculty of Community and Health Sciences, University of the Western Cape, South Africa
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Abstract
Purpose
A significant minority of veterans have poor mental health outcomes but their needs are not always well managed by the NHS. The purpose of this paper is to explore veterans’ experiences of NHS mental healthcare in Norfolk and Suffolk to identify ways of improving services.
Design/methodology/approach
Interviews were conducted with 30 veterans. Template analysis was undertaken to explore key themes in the interview transcripts.
Findings
Participants were reluctant to seek help but were more likely to engage with a veteran-specific service. Those whose symptoms were military related reported better experiences when accessing treatment that was military sensitive.
Research limitations/implications
This was a local study and the findings do not necessarily reflect the views of the wider veteran community. Most participants who received military sensitive treatment were referred to the study by NHS providers, which could account for their positive feedback.
Social implications
The development of dedicated mental health services may encourage more veterans to seek support, helping to improve patient outcomes. There is a need for further research to determine the effectiveness of dedicated services and identify how they should be deployed.
Originality/value
Where academic interest has generally centred on the aetiology of mental health conditions within the military, this study focussed upon service user experience. The findings contributed to NHS England’s recent decision to extend its network of dedicated services in 12 areas of the country to cover veterans across England from April 2017.
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Sobral MP, Costa ME, Schmidt L, Martins MV. COMPI Fertility Problem Stress Scales is a brief, valid and reliable tool for assessing stress in patients seeking treatment. Hum Reprod 2016; 32:375-382. [PMID: 27979919 DOI: 10.1093/humrep/dew315] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 10/27/2016] [Accepted: 11/15/2016] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION Are the Copenhagen Multi-Centre Psychosocial Infertility research program Fertility Problem Stress Scales (COMPI-FPSS) a reliable and valid measure across gender and culture? SUMMARY ANSWER The COMPI-FPSS is a valid and reliable measure, presenting excellent or good fit in the majority of the analyzed countries, and demonstrating full invariance across genders and partial invariance across cultures. WHAT IS KNOWN ALREADY Cross-cultural and gender validation is needed to consider a measure as standard care within fertility. The present study is the first attempting to establish comparability of fertility-related stress across genders and countries. STUDY DESIGN SIZE, DURATION Cross-sectional study. First, we tested the structure of the COMPI-FPSS. Then, reliability and validity (convergent and discriminant) were examined for the final model. Finally, measurement invariance both across genders and cultures was tested. PARTICIPANTS/MATERIALS, SETTING, METHODS Our final sample had 3923 fertility patients (1691 men and 2232 women) recruited in clinical settings from seven different countries: Denmark, China, Croatia, Germany, Greece, Hungary and Sweden. Participants had a mean age of 34 years and the majority (84%) were childless. MAIN RESULTS AND THE ROLE OF CHANCE Findings confirmed the original three-factor structure of the COMPI-FPSS, although suggesting a shortened measurement model using less items that fitted the data better than the full version model. While data from the Chinese and Croatian subsamples did not fit, all other counties presented good fit (χ2/df ≤ 5.4; comparative fit index ≥ 0.94; root-mean-square error of approximation ≤ 0.07; modified expected cross-validation index ≤ 0.77). In general, reliability, convergent validity, and discriminant validity were observed in all subscales from each country (composite reliability ≥ 0.63; average variance extracted ≥ 0.38; squared correlation ≥ 0.13). Full invariance was established across genders, and partial invariance was demonstrated across countries. LIMITATIONS REASONS FOR CAUTION Generalizability regarding the validation of the COMPI-FPSS cannot be made regarding infertile individuals not seeking treatment, or non-European patients. This study did not investigate predictive validity, and hence the capability of this instrument in detecting changes in fertility-specific adjustment over time and predicting the psychological impact needs to be established in future research. WIDER IMPLICATIONS OF THE FINDINGS Besides extending knowledge on the psychometric properties of one of the most used fertility stress questionnaire, this study demonstrates both research and clinical usefulness of the COMPI-FPSS. STUDY FUNDING/COMPETING INTERESTS This study was supported by European Union Funds (FEDER/COMPETE-Operational Competitiveness Program, and by national funds (FCT-Portuguese Foundation for Science and Technology) under the projects PTDC/MHC-PSC/4195/2012 and SFRH/BPD/85789/2012). There are no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Maria P Sobral
- Faculty of Psychology and Education Sciences, University of Porto, 4200-135 Porto, Portugal
| | - Maria E Costa
- Faculty of Psychology and Education Sciences, University of Porto, 4200-135 Porto, Portugal.,Center for Psychology at University of Porto, 4200-135 Porto, Portugal
| | - Lone Schmidt
- Department of Public Health, University of Copenhagen, Section of Social Medicine, 1014 København K, Denmark
| | - Mariana V Martins
- Faculty of Psychology and Education Sciences, University of Porto, 4200-135 Porto, Portugal .,Center for Psychology at University of Porto, 4200-135 Porto, Portugal
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Raes I, Ravelingien A, Pennings G. Donor Conception Disclosure: Directive or Non-Directive Counselling? JOURNAL OF BIOETHICAL INQUIRY 2016; 13:369-379. [PMID: 27116204 DOI: 10.1007/s11673-015-9686-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 06/17/2015] [Indexed: 06/05/2023]
Abstract
It is widely agreed among health professionals that couples using donor insemination should be offered counselling on the topic of donor conception disclosure. However, it is clear from the literature that there has long been a lack of agreement about which counselling approach should be used in this case: a directive or a non-directive approach. In this paper we investigate which approach is ethically justifiable by balancing the two underlying principles of autonomy (non-directive approach) and beneficence (directive approach). To overrule one principle in favour of another, six conditions should be fulfilled. We analyse the arguments in favour of the beneficence principle, and consequently, a directive approach. This analysis shows that two conditions are not met; the principle of autonomy should not be overridden. Therefore, at this moment, a directive counselling approach on donor conception disclosure cannot be ethically justified.
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Affiliation(s)
- Inez Raes
- Bioethics Institute Ghent (BIG), Department of Philosophy and Moral Science, Ghent University, Blandijnberg 2, B-9000, Gent, Belgium.
| | - An Ravelingien
- Bioethics Institute Ghent (BIG), Department of Philosophy and Moral Science, Ghent University, Blandijnberg 2, B-9000, Gent, Belgium
| | - Guido Pennings
- Bioethics Institute Ghent (BIG), Department of Philosophy and Moral Science, Ghent University, Blandijnberg 2, B-9000, Gent, Belgium
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Bokaie M, Simbar M, Ardekani SMY, Majd HA. Women's beliefs about infertility and sexual behaviors: A qualitative study. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2016; 21:379-84. [PMID: 27563321 PMCID: PMC4979261 DOI: 10.4103/1735-9066.185579] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Infertility is a reproductive health problem and its prevalence is increasing in developing countries. This problem has some significant effects on the sexual behaviors of infertile women, especially during infertility treatment periods. Discovering the existing beliefs in the field of sexual and reproductive health and also determining the misconceptions would define the educational needs for providing sexual health programs for infertile women. Women should be able to distinguish risky behaviors from healthy behaviors that falsely have been marked as infertility-related behaviors. This qualitative study was conducted to determine women's beliefs about infertility and sexual behaviors among Iranian infertile women. Materials and Methods: The present study was a qualitative conventional content analysis study conducted on 15 infertile women and 8 key informants until reaching data saturation. Guba and Lincoln evaluative criteria were used for ensuring rigor of the study. Results: Data analysis defined three classes of beliefs that directly or indirectly affected sexual behaviors in infertile women: 1) Cultural, religious, or ethnic beliefs, 2) believing in the effect of diet on infertility, and 3) effect of the type of intercourse on getting pregnant. Conclusions: Three themes of religious, cultural, and ethnic beliefs, believing in the effect of diet on infertility, and the effect of the type of intercourse were the most important factors indicating sexual behaviors among infertile women. It seems that cultural and social matters are the most effective factors on sexual behaviors of infertile Iranian women.
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Affiliation(s)
- Mahshid Bokaie
- Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoumeh Simbar
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Hamid Alavi Majd
- Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Domar AD. Creating a collaborative model of mental health counseling for the future. Fertil Steril 2015; 104:277-80. [DOI: 10.1016/j.fertnstert.2015.05.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 05/19/2015] [Accepted: 05/19/2015] [Indexed: 10/23/2022]
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Najafi M, Soleimani AA, Ahmadi K, Javidi N, Kamkar EH. The Effectiveness of Emotionally Focused Therapy on Enhancing Marital Adjustment and Quality of Life among Infertile Couples with Marital Conflicts. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2015; 9:238-46. [PMID: 26246883 PMCID: PMC4518493 DOI: 10.22074/ijfs.2015.4245] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Accepted: 05/03/2014] [Indexed: 11/17/2022]
Abstract
Background The purpose of this study is to investigate the efficacy of emotionally fo-
cused therapy (EFT-C) on promoting marital adjustment of infertile couples with marital
conflicts by improving quality of life. Materials and Methods This is a semi-experimental study with a pre- and post–test
design in which 30 infertile couples (60 individuals) were chosen by purposive sampling.
Couples were randomly divided into two groups, sample and control, of 15 couples each.
Next, couples in the sample population answered questionnaires for marital adjustment,
sexual satisfaction and quality of life after which they received 10 sessions of EFT-C. Results Pre- and post-tests showed that EFT-C had a significant effect on marital adjust-
ment and quality of life. Conclusion According to the results, EFT-C had a significant, positive effect on en-
hancement of marital adjustment. Life quality of infertile couples significantly increased
via application of EFT-C. This approach improved the physical, psychological and social
relationships of infertile couples and enhanced their social environment.
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Affiliation(s)
- Maryam Najafi
- Department of Psychology, University of Science and Culture, Tehran, Iran
| | | | - Khodabakhsh Ahmadi
- Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Nasirudin Javidi
- Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran ; Department of Psychology, Family Therapy, Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Wischmann T, Schilling K, Toth B, Rösner S, Strowitzki T, Wohlfarth K, Kentenich H. Sexuality, Self-Esteem and Partnership Quality in Infertile Women and Men. Geburtshilfe Frauenheilkd 2014; 74:759-763. [PMID: 25221344 DOI: 10.1055/s-0034-1368461] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 04/17/2014] [Accepted: 04/23/2014] [Indexed: 10/24/2022] Open
Abstract
Introduction: Infertile couples often report quality-of-life impairments, especially in terms of sexuality, self-esteem and partnership quality. So far, there have been no systematic studies of the sex lives and behaviour of infertile women and men before and after the emergence of their mutual desire for a child. Materials and Methods: From February 2010 to August 2010 all couples starting treatment either at Heidelberg University's Women's Hospital or at the Fertility Center Berlin were asked to fill out the Self-Esteem and Relationship Questionnaire (SEAR). A total of n = 158 women and n = 153 men participated in the study. Results: Decreasing tendencies were observable for both partners in the domains Sexual Relationship Satisfaction and Confidence and in the subscales Self-Esteem and Overall Relationship Satisfaction. There were especially clear indications of a loss of spontaneous sexuality during the experience of infertility. We were also able to establish that infertility has a negative impact on women's self-esteem. Discussion: The results of this study indicate that SEAR can be used as a feasible instrument for identifying infertile women and men whose infertility has a negative effect on their relationship quality and/or sex lives.
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Affiliation(s)
- T Wischmann
- Institute of Medical Psychology, University Hospital Heidelberg, Heidelberg
| | - K Schilling
- Institute of Medical Psychology, University Hospital Heidelberg, Heidelberg
| | - B Toth
- Gynaecological Endocrinology and Reproductive Medicine, Heidelberg University Women's Hospital, Heidelberg
| | - S Rösner
- Gynaecological Endocrinology and Reproductive Medicine, Heidelberg University Women's Hospital, Heidelberg
| | - T Strowitzki
- Gynaecological Endocrinology and Reproductive Medicine, Heidelberg University Women's Hospital, Heidelberg
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Goldfarb S, Mulhall J, Nelson C, Kelvin J, Dickler M, Carter J. Sexual and reproductive health in cancer survivors. Semin Oncol 2014; 40:726-44. [PMID: 24331193 DOI: 10.1053/j.seminoncol.2013.09.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
As patients live longer after cancer diagnosis and treatment, attention to symptoms and quality of life (QoL) are of increasing importance both during treatment and throughout survivorship. Two complications of multi-modal cancer treatment that can profoundly affect both men and women are sexual dysfunction and infertility. Survivors at highest risk for treatment-related sexual dysfunction are those with tumors that involve the sexual or pelvic organs and those whose treatment affects the hormonal systems mediating sexual function. Sexual dysfunction may not abate without appropriate intervention. Therefore, early identification and treatment strategies are essential. Likewise, multiple factors contribute to the risk of infertility from cancer treatment and many cancer patients of reproductive age would prefer to maintain their fertility, if possible. Fortunately, advances in reproductive technology have created options for young newly diagnosed patients to preserve their ability to have a biologic child. This paper will focus on the sexual and reproductive problems encountered by cancer survivors and discuss some treatment options.
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Affiliation(s)
- Shari Goldfarb
- Departments of Medicine and Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY.; Department of Medicine, Weill Cornell Medical College, New York, NY..
| | - John Mulhall
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Christian Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Joanne Kelvin
- Office of Physician-In-Chief Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Maura Dickler
- Department of Medicine, Weill Cornell Medical College, New York, NY.; Department of Medicine Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Jeanne Carter
- Departments of Surgery and Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY
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Peterson BD, Sejbaek CS, Pirritano M, Schmidt L. Are severe depressive symptoms associated with infertility-related distress in individuals and their partners? Hum Reprod 2013; 29:76-82. [DOI: 10.1093/humrep/det412] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Abstract
Little is known about the counselling needs of infertile men. Recent research has shown that suffering from involuntary childlessness may be nearly equally distributed between women and men, but men have more difficulty in communicating this emotional crisis, usually preferring an instrumental grieving style to regain a sense of control, whereas their female partners are often characterised by an intuitive grieving style such as the expression of feelings. When the specific counselling needs of infertile men are addressed adequately in an appropriate setting in the course of infertility counselling, high uptake rates can be achieved. In this paper, typical issues regarding infertility counselling for men are described and proposals to improve the psychosocial status of infertile men are given.
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Affiliation(s)
- Tewes Wischmann
- Heidelberg University Hospital, Centre for Psychosocial Medicine, Institute of Medical Psychology, Heidelberg, Germany.
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Ravelingien A, Pennings G. The right to know your genetic parents: from open-identity gamete donation to routine paternity testing. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2013; 13:33-41. [PMID: 23557045 DOI: 10.1080/15265161.2013.776128] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Over the years a number of countries have abolished anonymous gamete donation and shifted toward open-identity policies. Donor-conceived children are said to have a fundamental "right to know" the identity of their donor. In this article, we trace the arguments that underlie this claim and question its implications. We argue that, given the status attributed to the right to know one's gamete donor, it would be discriminatory not to extend this right to naturally conceived children with misattributed paternity. One way to facilitate this would be through routine paternity testing at birth. While this proposal is likely to raise concerns about the conflicting interests and rights of other people involved, we show that similar concerns apply to the context of open-identity gamete donation. Unless one can identify a rational basis for treating the two groups differently, one's stance toward both cases should be the same.
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Affiliation(s)
- An Ravelingien
- Bioethics Institute Ghent (BIG), Ghent University, Dept. of Philosophy, Blandijnberg 2, B-9000 Ghent, Belgium.
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