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Kaptein AA, Harper JC, Dool GVD, Schoonenberg M, Smeenk J, Daneshpour H, Troost M, van Wijk LM, Tielen N, Smit E, Laven J, Hoek A, Boivin J. Business case for psychosocial interventions in clinics: potential for decrease in treatment discontinuation and costs. Reprod Biomed Online 2024; 49:104113. [PMID: 39043044 DOI: 10.1016/j.rbmo.2024.104113] [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: 02/06/2024] [Revised: 05/07/2024] [Accepted: 05/10/2024] [Indexed: 07/25/2024]
Abstract
RESEARCH QUESTION From a value-based healthcare (VBHC) perspective, does an assessment of clinical outcomes and intervention costs indicate that providing cognitive behavioural therapy (CBT) or mindfulness to women seeking fertility treatment add value compared with no such intervention? DESIGN Proof-of-concept business case based on a VBHC perspective that considers clinical outcomes and costs. Potential effects on psychological and fertility outcomes were based on existing research. Cost outcomes were estimated with a costing model for the Dutch fertility treatment setting. RESULTS Thirty-two studies were identified; 13 were included. Women who received CBT had 12% lower anxiety, 40% lower depression and 6% higher fertility quality of life; difference in clinical pregnancy rates was six percentage points (CBT [30.2%]; control [24.2%]); difference in fertility discontinuation rates was 10 percentage points (CBT [5.5%]; control [15.2%]). Women who received training in mindfulness had 8% lower anxiety, 45% lower depression and 21% higher fertility quality of life; difference in mean clinical pregnancy rate was 19 percentage points (mindfulness [44.8%]; control [26.0%]). Potential total cost savings was about €1.2 million per year if CBT was provided and €11 million if mindfulness was provided. Corresponding return on investment for CBT was 30.7%, and for mindfulness 288%. Potential cost benefits are influenced by the assumed clinical pregnancy rates; such data related to mindfulness were limited to one study. CONCLUSIONS The provision of CBT or mindfulness to women seeking fertility treatment could add value. Higher quality primary studies are needed on the effect of mindfulness on clinical pregnancy rates.
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Affiliation(s)
- Ad A Kaptein
- Department of Medical Psychology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Joyce C Harper
- UCL Institute for Women's Health, 86-96 Chenies Mews, London, England WC1E 6HX, UK
| | | | | | - Jesper Smeenk
- Center for Reproduction Brabant - Gynaecology, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, The Netherlands
| | - Hirad Daneshpour
- KPMG Health, Laan van Langerhuize 1, 1186 DS Amstelveen, The Netherlands
| | - Meike Troost
- KPMG Health, Laan van Langerhuize 1, 1186 DS Amstelveen, The Netherlands
| | - Lise M van Wijk
- Ferring B.V., Polarisavenue 130, 2132 JX Hoofddorp, The Netherlands
| | - Naomi Tielen
- Ferring B.V., Polarisavenue 130, 2132 JX Hoofddorp, The Netherlands
| | - Ellen Smit
- Ferring B.V., Polarisavenue 130, 2132 JX Hoofddorp, The Netherlands
| | - Joop Laven
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Annemieke Hoek
- Department of Obstetrics and Gynaecology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO 30001, 9700 RB Groningen, The Netherlands
| | - Jacky Boivin
- School of Psychology, Cardiff University, 70 Park Place, Cardiff, Wales, CF10 3AT, UK.
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Szigeti F J, Kazinczi C, Szabó G, Sipos M, Ujma PP, Purebl G. The clinical effectiveness of the Mind/Body Program for Infertility on wellbeing and assisted reproduction outcomes: a randomized controlled trial in search for active ingredients. Hum Reprod 2024; 39:1735-1751. [PMID: 38852061 PMCID: PMC11291950 DOI: 10.1093/humrep/deae119] [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: 12/19/2023] [Revised: 04/20/2024] [Indexed: 06/10/2024] Open
Abstract
STUDY QUESTION Does the Mind/Body Program for Infertility (MBPI) perform better, due to certain distinctive elements, than a partly matched support group in improving the wellbeing and medically assisted reproduction (MAR) outcomes of women with elevated distress levels in a clinical setting? SUMMARY ANSWER While robust enhancements occurred in the wellbeing overall, the cognitive behavioural and formalized stress management elements of the MBPI allowed a significantly stronger improvement in trait anxiety, but not in other mental health and MAR outcomes, compared with a support group. WHAT IS KNOWN ALREADY Mind-body psychological programmes adjacent to MAR have been found to improve women's mental states and possibly increase chances of pregnancy. However, not enough is known about the programme's effectiveness among patients with elevated distress levels in routine clinical settings, nor is it clear which of its particular ingredients are specifically effective. STUDY DESIGN, SIZE, DURATION A pre-post design, single-centre, randomized controlled trial was performed between December 2019 and October 2022 (start and end of recruitment, respectively). The sample size (n = 168) was calculated to detect superiority of the MBPI in improving fertility-related quality of life. Randomization was computer-based, with random numbers concealing identities of patients until after allocation. PARTICIPANTS/MATERIALS, SETTING, METHODS The trial was conducted at a large university teaching hospital. A total of 168 patients were randomly assigned to the mind-body (MBPI) group (n = 84) and the fertility support (FS) control group (n = 84). Patients received a 10-week, 135-min/week group intervention, with the FS group following the same format as the MBPI group, but with a less restricted and systematic content, and without the presumed effective factors. The number of patients analysed was n = 74 (MBPI) and n = 68 (FS) for post-intervention psychological outcomes, and n = 54 (MBPI) and n = 56 (FS) for pregnancy outcomes at a 30-month follow-up. MAIN RESULTS AND THE ROLE OF CHANCE Significant improvements occurred in both groups in all psychological domains (adjusted P < 0.001), except for treatment-related quality of life. Linear mixed-model regression analysis did not reveal significantly greater pre-post improvements in the MBPI group than in the FS group in fertility-related quality of life (difference in differences (DD) = 4.11 [0.42, 7.80], d = 0.32, adjusted P = 0.124), treatment-related quality of life (DD = -3.08 [-7.72, 1.55], d = -0.20, adjusted P = 0.582), infertility-specific stress (DD = -2.54 [-4.68, 0.41], d = -0.36, adjusted P = 0.105), depression (DD = -1.16 [3.61, 1.29], d = -0.13, adjusted P = 0.708), and general stress (DD = -0.62 [-1.91, 0.68], d = -0.13, adjusted P = 0.708), but it did show a significantly larger improvement in trait anxiety (DD = -3.60 [-6.16, -1.04], d = -0.32, adjusted P = 0.042). Logistic regression showed no group effect on MAR pregnancies, spontaneous pregnancies, or live births. LIMITATIONS, REASONS FOR CAUTION The follow-up only covered MAR-related medical outcomes and no psychological variables, and their rates were not equal in the two groups. Biological factors other than age, aetiology, and duration of infertility may have confounded the study results. Loss to follow-up was between 5% and 10%, which may have led to some bias. WIDER IMPLICATIONS OF THE FINDINGS The psychologically and medically heterogeneous sample, the normal clinical setting and the low attrition rate all raise the external validity and generalizability of our study. The MBPI works not only in controlled conditions, but also in routine MAR practice, where it can be introduced as a cost-effective, low-intensity psychological intervention, within the framework of stepped care. More studies are needed to further identify its active ingredients. STUDY FUNDING/COMPETING INTEREST(S) The authors received no financial support for the research, authorship, and/or publication of this article. The authors have no conflict of interest to disclose. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT04151485. TRIAL REGISTRATION DATE 5 November 2019. DATE OF FIRST PATIENT’S ENROLMENT 15 December 2019.
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Affiliation(s)
- Judit Szigeti F
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
- Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis University, Budapest, Hungary
| | - Csaba Kazinczi
- Department of Clinical Psychology, Semmelweis University, Budapest, Hungary
- Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
| | - Georgina Szabó
- Doctoral School of Mental Health Sciences, Semmelweis University, Budapest, Hungary
- Department of Psychiatry, North Buda Saint John’s Hospital Centre and Outpatient Clinic, Budapest, Hungary
| | - Miklós Sipos
- Department of Obstetrics and Gynecology, Assisted Reproduction Centre, Semmelweis University, Budapest, Hungary
| | | | - György Purebl
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
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Szigeti F J, Sexty RE, Szabó G, Kazinczi C, Kéki Z, Sipos M, Ujma PP, Purebl G. The SCREENIVF Hungarian version is a valid and reliable measure accurately predicting possible depression in female infertility patients. Sci Rep 2024; 14:12880. [PMID: 38839780 PMCID: PMC11153651 DOI: 10.1038/s41598-024-63673-w] [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: 11/19/2023] [Accepted: 05/31/2024] [Indexed: 06/07/2024] Open
Abstract
Infertility patients, often in high distress, are entitled to being informed about their mental status compared to normative data. The objective of this study was to revalidate and test the accuracy of the SCREENIVF, a self-reported tool for screening psychological maladjustment in the assisted reproduction context. A cross-sectional, questionnaire-based online survey was carried out between December 2019 and February 2023 in a consecutive sample of female patients (N = 645, response rate 22.9%) in a university-based assisted reproduction center in Hungary. Confirmatory factor analysis and cluster and ROC analyses were applied to test validity, sensitivity and specificity in relation to Beck Depression Inventory (BDI) scores. Model fit was optimal (chi-square = 630.866, p < 0.001; comparative fit index = 0.99; root-mean-square error of approximation = 0.018 (90% CI 0.013-0.023); standardized-root-mean-square-residual = 0.044), and all dimensions were reliable (α > 0.80). A specific combination of cutoffs correctly predicted 87.4% of BDI-scores possibly indicative of moderate-to-severe depression (χ2(1) = 220.608, p < 0.001, Nagelkerke R2 = 0.462, J = 66.4). The Hungarian version of the SCREENIVF is a valid and reliable tool, with high accuracy in predicting BDI-scores. Low response rate may affect generalizability. The same instrument with different cutoffs can serve various clinical goals.
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Affiliation(s)
- Judit Szigeti F
- Institute of Behavioral Sciences, Semmelweis University, Üllői út 26, 1085, Budapest, Hungary.
- Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis University, Üllői út 26, 1085, Budapest, Hungary.
| | - Réka E Sexty
- Department of Psychology, University of Graz, Dachgeschoß - 2, Stock, 2, 8010, Graz, Austria
| | - Georgina Szabó
- Doctoral School of Mental Health Sciences, Semmelweis University, Üllői út 26, 1085, Budapest, Hungary
- Department of Psychiatry, North Buda Saint John's Hospital Center and Outpatient Clinic, Diós Árok 1-3, 1125, Budapest, Hungary
| | - Csaba Kazinczi
- Department of Clinical Psychology, Semmelweis University, Budapest, Hungary
- Doctoral School of Clinical Medicine, University of Szeged, 6722, Szeged, Hungary
| | - Zsuzsanna Kéki
- Directorate for Human Reproduction, National Directorate General for Hospitals, Buda-part tér 2, BudaPart Gate Irodaház A. ép. 406, 1117, Budapest, Hungary
| | - Miklós Sipos
- Department of Obstetrics and Gynecology, Assisted Reproduction Center, Semmelweis University, Üllői út 26, 1085, Budapest, Hungary
| | - Péter Przemyslaw Ujma
- Institute of Behavioral Sciences, Semmelweis University, Üllői út 26, 1085, Budapest, Hungary
| | - György Purebl
- Institute of Behavioral Sciences, Semmelweis University, Üllői út 26, 1085, Budapest, Hungary
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Sullivan CB, Stevenson E, Yalcinkaya T, Coates C. Improved Screening for Depression in Patients Initiating Fertility Treatment. Nurs Womens Health 2024; 28:205-212. [PMID: 38518809 DOI: 10.1016/j.nwh.2023.11.008] [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: 08/01/2023] [Revised: 11/04/2023] [Accepted: 02/20/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVE To improve screening for depression in patients who are initiating fertility treatment at a reproductive endocrinology and infertility (REI) center by screening all patients at their initial visit using the Patient Health Questionnaire-9 (PHQ-9). DESIGN This quality improvement project was conducted using a plan-do-study-act cycle implemented with a postintervention study design. SETTING/LOCAL PROBLEM A medium-size REI center in a mid-Atlantic U.S. metropolitan area where screening for mental health status in patients initiating fertility treatments was not occurring. PARTICIPANTS Patients who were scheduled in person with REI providers for a new patient consult regarding fertility were declared eligible. INTERVENTION/MEASUREMENTS The PHQ-9 was administered by providers at initial consults for patients seeking fertility treatments from October 2022 to February 2023. Three cycles of the plan-do-study-act model were used to execute change. For all patients who scored 5 to 9 (mild depression), conversations regarding counseling referrals occurred. For all patients who scored ≥10 (moderate to severe depression), a referral for counseling and medication management was generated. Data were analyzed via descriptive statistics. RESULTS A total of 115 participants were included. A screening rate of 84.3% (n = 97) was achieved for patients initiating treatment. Of the 97 screened, 21 patients had a score of ≥5; 19 were given a referral for counseling. However, none of the patients attended a counseling session or started medication prescribed by their primary care provider during the 2-month follow-up period. Barriers identified included costs, personal preferences, and access to services. CONCLUSION The PHQ-9 screening tool was implemented at an REI clinic to improve the frequency of mental health screenings and provide necessary referrals. However, additional follow-up is needed to ensure patients are receiving appropriate mental health care.
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Szabo G, Szigeti F J, Sipos M, Varbiro S, Gonda X. Adherence to dietary recommendations mediates the effect of affective temperaments on infertility treatment outcomes. Sci Rep 2024; 14:12544. [PMID: 38822094 PMCID: PMC11143238 DOI: 10.1038/s41598-024-63343-x] [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: 11/21/2023] [Accepted: 05/28/2024] [Indexed: 06/02/2024] Open
Abstract
Affective temperaments have been shown to robustly affect infertility treatment success. However, identification of possible mediating factors through which they exert their influence is still lacking. A growing number of results suggest that adherence to recommended treatments may be such a mediator, on the one hand, because affective temperaments are known to influence adherence and, on the other hand, because non-adherence negatively influences the treatment outcome. Recommended treatment of infertility involves, beyond medications, dietary and lifestyle changes. The aim of this retrospective cohort study was to evaluate whether adherence to physician-prescribed diet and physical activity recommendations mediates the effect of affective temperaments on infertility treatment outcomes. Among 308 women who underwent infertility treatment in an Assisted Reproduction Center, affective temperaments, adherence to diet, adherence to physical exercise, and infertility treatment success (clinical pregnancy) were assessed besides detailed medical history and demographic parameters. Associations between affective temperaments, adherence to diet and recommended physical activity, and assisted reproduction outcomes were analyzed using generalized linear models and causal mediation analysis. Adherence to physical activity didn't have an effect, but diet adherence increased the odds of infertility treatment success by 130% suggesting its role as a potential mediator. Based on causal mediation analysis, higher depressive and anxious temperament scores were directly associated with 63% and 45% lower odds of achieving clinical pregnancy, respectively, with effects not mediated by diet adherence. Higher irritable temperament scores indirectly decreased the odds of achieving clinical pregnancy by 14%, mediated by diet adherence; while higher cyclothymic temperament scores decreased the odds of achieving clinical pregnancy both directly by 51% and indirectly, mediated by diet adherence by 11%. Our results suggest that diet adherence mediates the mechanism by which irritable and cyclothymic affective temperaments influence IVF treatment success. Since adherence is a modifiable risk factor of infertility treatment success, screening for affective temperaments may help to identify potentially high-risk non-adherent patient groups and offer patient-tailored treatment, which may help increase the chances of a successful pregnancy and live birth in women undergoing IVF treatment.
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Affiliation(s)
- Georgina Szabo
- Doctoral School of Mental Health Sciences, Semmelweis University, Budapest, Hungary
| | - Judit Szigeti F
- Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary
| | - Miklos Sipos
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Szabolcs Varbiro
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Xenia Gonda
- Department of Psychiatry and Psychotherapy, Semmelweis University, Gyulai Pal utca 2, Budapest, 1085, Hungary.
- NAP3.0-SE Neuropsychopharmacology Research Group, Hungarian Brain Research Program, Semmelweis University, Nagyvárad tér 4., Budapest, 1085, Hungary.
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Chen X, Hao X, Xie L, Liu X. A bidirectional causal relationship study between mental disorders and male and female infertility. Front Psychiatry 2024; 15:1378224. [PMID: 38699446 PMCID: PMC11064171 DOI: 10.3389/fpsyt.2024.1378224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/28/2024] [Indexed: 05/05/2024] Open
Abstract
Background The relation between mental disorders (MDs) and infertility can be reciprocal. But exactly which MD affects infertility remains controversial. Our aim was to use Mendelian randomization (MR) to explore bidirectional causality between 15 MDs and male infertility and female infertility. Methods The data of MDs, male infertility, and female infertility were derived from published genome-wide association studies (GWAS). The inverse variance weighted method was considered to be the main analytical approach. Sensitivity analysis was performed using MR-Egger, Cochran's Q, radial MR, and MR-PRESSO tests. Results Our results found that mood disorders (OR, 1.4497; 95% CI, 1.0093 - 2.0823; P = 0.0444) and attention deficit hyperactivity disorder (OR, 1.3921; 95% CI, 1.0943 - 1.7709; P = 0.0071) were positively correlated with male infertility, but obsessive-compulsive disorder (OR, 0.8208; 95% CI, 0.7146 - 0.9429; P = 0.0052) was negatively associated with male infertility. For females, anorexia nervosa (OR, 1.0898; 95% CI, 1.0070 - 1.1794; P = 0.0329), attention deficit hyperactivity disorder (OR, 1.1013; 95% CI, 1.0041 - 1.2079; P = 0.0406), and major depressive disorder (OR, 1.1423; 95% CI, 1.0213 - 1.2778; P = 0.0199) increased risk of infertility. In reverse relationship, female infertility increased the incidence of bipolar disorder (OR, 1.0009; 95% CI, 1.0001 - 1.0017; P = 0.0281). Conclusion We demonstrated the association between five MDs and male or female infertility. Female infertility was also found to be associated with an increased risk of one MD. We look forward to better designed epidemiological studies to support our results.
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Affiliation(s)
| | | | | | - Xiaoqiang Liu
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
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Bueno-Sánchez L, Alhambra-Borrás T, Gallego-Valadés A, Garcés-Ferrer J. Psychosocial Impact of Infertility Diagnosis and Conformity to Gender Norms on the Quality of Life of Infertile Spanish Couples. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:158. [PMID: 38397648 PMCID: PMC10888361 DOI: 10.3390/ijerph21020158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024]
Abstract
Epidemiological data show that human reproductive disorders are a common problem worldwide, affecting almost one in six people of reproductive age. As a result, infertility has been identified by the World Health Organization as a public health disease. Reproductive problems can take a heavy toll on the psychosocial well-being of couples suffering from infertility. This is especially true for women, who tend to be the ones who undergo the most treatment. The main objective of the present study is to find out whether a sex-based infertility diagnosis influences the quality of life of couples with infertility. Also, we aim to find out whether the degree of adherence to gender norms influences their quality of life. A cross-sectional study was conducted using the Fertility Quality of Life Questionnaire (FertiQoL) and the Conformity to Feminine and Masculine Norms Inventories in a sample of 219 infertile Spanish couples (438 participants). The results show that, in all cases, regardless of the degree of conformity to gender norms and whether the infertility diagnosis was of female or male origin, women have lower scores on the self-perceived quality of life. This suggests that being female is already a psychosocial risk factor when assessing the psychosocial consequences of infertility.
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Affiliation(s)
- Lidia Bueno-Sánchez
- Polibienestar Research Institute, Universitat de València, 46022 València, Spain; (T.A.-B.); (A.G.-V.); (J.G.-F.)
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Iranifard E, Yas A, Mansouri Ghezelhesari E, Taghipour A, Mahmoudinia M, Latifnejad Roudsari R. Treatment suspension due to the coronavirus pandemic and mental health of infertile patients: a systematic review and meta-analysis of observational studies. BMC Public Health 2024; 24:174. [PMID: 38218778 PMCID: PMC10787415 DOI: 10.1186/s12889-023-17628-x] [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: 06/29/2023] [Accepted: 12/31/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Access to fertility treatments is considered a reproductive right, but because of the quarantine due to the coronavirus pandemic most infertility treatments were suspended, which might affect the psychological and emotional health of infertile patients. Therefore, this study was conducted to review the mental health of infertile patients facing treatment suspension due to the coronavirus pandemic. METHODS This study was conducted based on the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guideline. The Web of Science, PubMed, Embase, Scopus, and Cochrane library databases were searched by two independent researchers, without time limitation until 31 December 2022. All observational studies regarding the mental health of infertile patients facing treatment suspension including anxiety, depression, and stress were included in the study. Qualitative studies, editorials, brief communications, commentaries, conference papers, guidelines, and studies with no full text were excluded. Quality assessment was carried out using Newcastle-Ottawa Scale by two researchers, independently. The random effects model was used to estimate the pooled prevalence of mental health problems. Meta-regression and subgroup analysis were used to confirm the sources of heterogeneity. RESULTS Out of 681 studies, 21 studies with 5901 infertile patients were systematically reviewed, from which 16 studies were included in the meta-analysis. The results of all pooled studies showed that the prevalence of anxiety, depression, and stress in female patients was 48.4% (95% CI 34.8-62.3), 42% (95% CI 26.7-59.4), and 55% (95% CI 45.4-65), respectively. Additionally, 64.4% (95% CI 50.7-76.1) of patients wished to resume their treatments despite the coronavirus pandemic. CONCLUSION Treatment suspension due to the coronavirus pandemic negatively affected the mental health of infertile patients. It is important to maintain the continuity of fertility care, with special attention paid to mental health of infertile patients, through all the possible measures even during a public health crisis.
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Affiliation(s)
- Elnaz Iranifard
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Atefeh Yas
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Ali Taghipour
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Epidemiology, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Malihe Mahmoudinia
- Maternal and Neonatal Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Obstetrics and Gynecology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Robab Latifnejad Roudsari
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
- Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.
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Warne E, Oxlad M, Best T. Consulting patients and providers of assisted reproductive technologies to inform the development of a group psychological intervention for women with infertility. PEC INNOVATION 2023; 3:100206. [PMID: 37711398 PMCID: PMC10497790 DOI: 10.1016/j.pecinn.2023.100206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/27/2023] [Accepted: 08/29/2023] [Indexed: 09/16/2023]
Abstract
Objective To consult providers and women patients of Assisted Reproductive Technologies regarding their preferences for the format, duration and content in the development of a group psychological intervention. Methods Providers and current and past women patients of Assisted Reproductive Technologies completed an online cross-sectional survey comprising items about session content, number, frequency, timing, format, delivery mode and inclusion of experiential practice of psychological strategies to promote well-being. Results Eight providers, 51 current women patients and 51 women who previously underwent Assisted Reproductive Technologies participated. Sixty-two percent of participants indicated a group psychological program would be helpful; and 34% thought it may be helpful. Face-to-face was the preferred delivery mode (42%). Seventy-one percent preferred 60-min sessions held fortnightly (64%), with six sessions most acceptable (24%). Most respondents (74%) felt group participants would likely complete at-home practice. Detailed thematic content from participants highlighted a complex range of consumer challenges. Relevant behaviour change techniques were verified, with those to be included identified as: feedback and monitoring, regulation, self belief, reward and threat, natural consequences, identity, support, shaping knowledge, and comparison of outcomes. Conclusion Providers and patients were supportive of the development of a group psychological intervention to provide support for women undergoing Assisted Reproductive Technologies. Innovation The results of this study provide insight informing the co-design of a group psychological program for women with infertility.
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Affiliation(s)
- Emma Warne
- School of Psychology, University of Adelaide, Adelaide 5000, Australia
| | - Melissa Oxlad
- School of Psychology, University of Adelaide, Adelaide 5000, Australia
| | - Talitha Best
- Central Queensland University, School of Health, Medical and Applied Science, NeuroHealth Lab, Appleton Institute, Brisbane, Australia
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Whynott RM, Summers KM, Mejia RB, Segre LS, Ryan G, Pawlak SA. Creating affiliations, learning, and mindfulness for in vitro fertilization patients (CALM IVF): a clinical trial. F S Rep 2023; 4:61-71. [PMID: 36959953 PMCID: PMC10028477 DOI: 10.1016/j.xfre.2023.01.002] [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: 09/07/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 01/09/2023] Open
Abstract
Objective Determine if group psychoeducational support can improve in vitro fertilization (IVF) patients' quality of life (QoL). Design Randomized controlled trial (NCT04048772). Setting University-affiliated IVF clinic. Patients Women (n = 76) and male partners undergoing initial autologous IVF cycle from August 2019, to December 2020. Interventions Couples were assigned to groups based on projected oocyte retrieval date. Groups were randomly assigned to the control or intervention arm. Clinic closures because of the COVID-19 pandemic delayed treatment for a portion of participants. Groups were conducted in person before and virtually during the pandemic. Main Outcome Measures The primary outcome was a change in fertility quality of life (FertiQoL) from baseline to 3 days after retrieval. Secondary outcomes were changes in depression (Patient Health Questionnaire 9), anxiety (Generalized Anxiety Disorder 7), resilience (Connor-Davidson Resilience scale), IVF knowledge scores, and the likelihood of return to treatment. Results Knowledge scores among women in Creating Affiliations, Learning, and Mindfulness (CALM) for IVF groups significantly increased compared with control (mean difference 13.19 [3.53 - 22.84]) before the pandemic. During the pandemic, women in CALM IVF had significant improvement in the social FertiQoL score compared with controls (10.42 [1.79 - 19.04]). Compared with controls, male CALM IVF participants had significantly greater improvement in total FertiQoL (mean difference 6.68 [0.39 - 12.98]), treatment FertiQoL (8.26 [0.69 - 15.82]), and resilience (Connor-Davidson 1.13 [0.54 - 1.72]). Immediate return to care did not significantly differ between arms. Conclusions For women undergoing IVF, group psychoeducational programs can improve IVF knowledge and social QoL during a pandemic. Participation in a group psychoeducational program can improve QoL and resilience in IVF dyad male partners. Clinical Trial Registration Number Trial registration NCT04048772.
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Affiliation(s)
- Rachel M. Whynott
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Washington, Seattle, Washington
- Reprint requests: Rachel Whynott, M.D., Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Washington, 4245 Roosevelt Way NE, 3rd Floor, Seattle, Washington 98105.
| | - Karen M. Summers
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Rachel B. Mejia
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Lisa S. Segre
- College of Nursing, University of Iowa, Iowa City, Iowa
| | - Ginny Ryan
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Washington, Seattle, Washington
| | - Stacey A. Pawlak
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa
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11
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Kremer F, Ditzen B, Wischmann T. Effectiveness of psychosocial interventions for infertile women: A systematic review and meta-analysis with a focus on a method-critical evaluation. PLoS One 2023; 18:e0282065. [PMID: 36854039 PMCID: PMC9974119 DOI: 10.1371/journal.pone.0282065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/07/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Approximately seven to nine percent of couples of reproductive age do not get pregnant despite regular and unprotected sexual intercourse. Various psychosocial interventions for women and men with fertility disorders are repeatedly found in the literature. The effects of these interventions on outcomes such as anxiety and depression, as well as on the probability of pregnancy, do not currently allow for reliable generalisable statements. This review includes studies published since 2015 performing a method-critical evaluation of the studies. Furthermore, we suggest how interventions could be implemented in the future to improve anxiety, depression, and pregnancy rates. METHOD The project was registered with Prospero (CRD42021242683 13 April 2021). The literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Six databases were searched and 479 potential studies were discovered. After reviewing the full texts, ten studies were included for the synthesis. Not all studies reported the three outcomes: four studies each for depression, three for anxiety and nine studies for pregnancy rates were included in the meta-analysis, which was conducted using the Comprehensive meta-analysis (CMA) software. RESULTS Psychosocial interventions do not significantly change women's anxiety (Hedges' g -0,006; CI: -0,667 to 0,655; p = 0,985), but they have a significant impact on depression in infertile women (Hedges' g -0,893; CI: -1,644 to -0,145; p = 0,026). Implementations of psychosocial interventions during assisted reproductive technology (ART) treatment do not increase pregnancy rates (odds ratio 1,337; 95% CI 0,983 to 1,820; p = 0,064). The methodological critical evaluation indicates heterogeneous study design and samples. The results of the studies were determined with different methods and make comparability difficult. All these factors do not allow for a uniform conclusion. METHODOLOGICAL CRITICAL EVALUATION Study design (duration and timing of intervention, type of intervention, type of data collection) and samples (age of women, reason for infertility, duration of infertility) are very heterogeneous. The results of the studies were determined with different methods and make comparability difficult. All these factors do not allow for a uniform conclusion. CONCLUSION In order to be able to better compare psychosocial interventions and their influence on ART treatment and thus also to achieve valid results, a standardised procedure to the mentioned factors is necessary.
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Affiliation(s)
- Franziska Kremer
- Institute of Medical Psychology, Centre for Psychosocial Medicine, University Hospital, Heidelberg, Germany
- * E-mail:
| | - Beate Ditzen
- Institute of Medical Psychology, Centre for Psychosocial Medicine, University Hospital, Heidelberg, Germany
| | - Tewes Wischmann
- Institute of Medical Psychology, Centre for Psychosocial Medicine, University Hospital, Heidelberg, Germany
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12
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Dube L, Bright K, Hayden KA, Gordon JL. Efficacy of psychological interventions for mental health and pregnancy rates among individuals with infertility: a systematic review and meta-analysis. Hum Reprod Update 2023; 29:71-94. [PMID: 36191078 DOI: 10.1093/humupd/dmac034] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/29/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Depression and anxiety are highly prevalent among individuals struggling with infertility. Thus, numerous psychological interventions have been adapted to infertility, with the aim of relieving distress as well as increasing pregnancy rates. OBJECTIVE AND RATIONALE This systematic review and meta-analysis aimed to identify all randomized controlled trials (RCTs) evaluating the effect of psychological interventions on infertility-related distress and pregnancy rates among individuals and/or couples with infertility and to analyse their overall effect. It also sought to examine potential treatment moderators, including intervention length, format and therapeutic approach. SEARCH METHODS An electronic search of 11 databases, including MEDLINE, EMBASE, PsycINFO and Cochrane Central Register of Controlled Trials, was performed for studies published until January 2022. The inclusion criteria were RCTs conducted on humans and published in English. Psychological outcomes of interest included anxiety, depression, infertility-related distress, wellbeing and marital satisfaction. The Cochrane Risk of Bias tool was used to assess study quality, and the Grading of Recommendations Assessment, Development and Evaluation was used to assess the overall quality of the research evidence. OUTCOMES There were 58 RCTs in total, including 54 which included psychological outcomes and 21 which assessed pregnancy rates. Studies originated from all regions of the world, but nearly half of the studies were from the Middle East. Although a beneficial effect on combined psychological outcomes was found (Hedge's g = 0.82, P < 0.0001), it was moderated by region (P < 0.00001) such that studies from the Middle East exhibited large effects (g = 1.40, P < 0.0001), while the effects were small among studies conducted elsewhere (g = 0.23, P < 0.0001). Statistically adjusting for study region in a meta-regression, neither intervention length, therapeutic approach, therapy format, nor participant gender (P > 0.05) moderated the effect of treatment. A beneficial treatment effect on pregnancy (RR (95% CI) = 1.25 (1.07-1.47), P = 0.005) was not moderated by region, treatment length, approach or format (P > 0.05). Largely due to the lack of high quality RCTs, the quality of the available evidence was rated as low to moderate. WIDER IMPLICATIONS This is the first meta-analysis of RCTs testing the effect of psychological interventions on infertility-related distress and pregnancy rates. These findings suggest that in most regions of the world, psychological interventions are associated with small reductions in distress and modest effects on conception, suggesting the need for more effective interventions. These findings must be considered in light of the fact that the majority of the included RCTs were deemed to be at high risk of bias. Rigorously conducted trials are needed.
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Affiliation(s)
- Loveness Dube
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - Katherine Bright
- Department of Outpatient Psychiatry, Alberta Health Services, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - K Alix Hayden
- Department of Libraries and Cultural Resources, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer L Gordon
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
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13
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Levinson AL, Igonina TN, Rozhkova IN, Brusentsev EY, Amstislavsky SY. Psycho-emotional stress, folliculogenesis, and reproductive technologies: clinical and experimental data. Vavilovskii Zhurnal Genet Selektsii 2022; 26:431-441. [PMID: 36128573 PMCID: PMC9450030 DOI: 10.18699/vjgb-22-53] [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: 01/24/2022] [Revised: 03/21/2022] [Accepted: 03/31/2022] [Indexed: 11/19/2022] Open
Abstract
Modern life, especially in large cities, exposes people to a high level of noise, high density of population, disrupted sleeping, large amount of excessive and controversial information as well as to other negative factors; all this may cause chronic psycho-emotional stress. The latest publications often use the term “Syndrome of megalopolis”, which means disruption of sleeping, high anxiety, and altered reproductive function. Medical treatment of infertility may also be considered as a stress factor, especially when infertility lasts for years and is aggravated with emotional frustration. Long-lasting distress may worsen health in general and suppress reproductive function, in particular. The review presents the data on the effects of maternal stress on folliculogenesis, especially when assisted reproductive technologies (ARTs) are used. Clinical data are presented alongside data from laboratory animal experiments. Different maternal stress models are taken into account in respect of their inf luence on oocyte maturation and embryo development. The interfering of psycho-emotional stress and reproductive function is the focus of the review. In these situations, exogenous hormones compensate for the stress-related disruption of the hypothalamic-pituitary-gonadal axis. When ARTs are implemented, stress-induced disruption of oogenesis is realized not via a decrease in hypothalamic and pituitary hormones, but by other ways, which involve paracrine mechanisms described in this review. Based on the literature analysis, one may conclude that stress negatively affects oocyte maturation in the ovary and suppresses subsequent embryo development. The role of some ovarian paracrine factors, such as BDNF, GDF-9, HB-EGF, TNF-α, and some others has been elucidated
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Affiliation(s)
- A. L. Levinson
- Novosibirsk Center of Reproductive Medicine; Novosibirsk State University
| | - T. N. Igonina
- Institute of Cytology and Genetics of the Siberian Branch of the Russian Academy of Sciences
| | - I. N. Rozhkova
- Institute of Cytology and Genetics of the Siberian Branch of the Russian Academy of Sciences
| | - E. Yu. Brusentsev
- Institute of Cytology and Genetics of the Siberian Branch of the Russian Academy of Sciences
| | - S. Ya. Amstislavsky
- Institute of Cytology and Genetics of the Siberian Branch of the Russian Academy of Sciences; Novosibirsk State University
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14
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Casale M, Carlqvist A. Is social support related to better mental health, treatment continuation and success rates among individuals undergoing in-vitro fertilization? Systematic review and meta-analysis protocol. PLoS One 2021; 16:e0252492. [PMID: 34061903 PMCID: PMC8168841 DOI: 10.1371/journal.pone.0252492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 05/15/2021] [Indexed: 11/19/2022] Open
Abstract
Infertility and its treatment via in-vitro fertilization (IVF) represent a global health area of increasing importance. However, the physical and psychological burden of IVF can negatively impact psychological wellbeing, as well as treatment retention and success. Social support has been found to have positive health effects among populations facing health-related stressors worldwide, and its potential protective role for IVF patients merits further attention. We present a protocol for a systematic review of peer-reviewed published studies quantitatively investigating associations between social support and i) mental health; ii) the decision to (dis)continue with IVF treatment cycles and; iii) IVF success (pregnancy and birth rates); among individuals who are undertaking or have undertaken IVF cycles. Studies will be included if they work with human subjects, provide correlation coefficients between measures of social support and at least one of the outcomes of interest, and are in the English language. Social support may derive from both naturally occurring networks and more formalized sources or interventions. The protocol for this systematic review was developed according to the PRISMA-P guidelines. Ten health-, psychology- and sociology-related databases will be searched using composite search terms that include keywords for ‘IVF’ and ‘social support’. To assess methodological quality, the authors will use a modified version of the Newcastle-Ottawa Scale. Should three or more moderate or good quality studies be identified for any one outcome of interest, correlation meta-analyses, using the Hedges-Olkin method, will be conducted to pool effect sizes and heterogeneity will be assessed. Should the number, quality and characteristics of eligible studies not allow for reliable quantitative synthesis, the authors will limit the analysis to qualitative synthesis, with a focus on implications of findings for future research and programming.
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Affiliation(s)
- Marisa Casale
- Department of Social Policy and Intervention, University of Oxford, Barnett House, Oxford, United Kingdom
- School of Public Health, University of the Western Cape, Bellville, South Africa
- * E-mail: ,
| | - Anna Carlqvist
- Department of Social Policy and Intervention, University of Oxford, Barnett House, Oxford, United Kingdom
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