Emotional adaptation following successful in vitro fertilization

Infertility psychological distress in women undergoing assisted reproductive treatment: A grounded theory study

BACKGROUND

While there exists an ample body of research in international contexts focused on the characterization and quantification of infertility psychological distress, the level of scholarly scrutiny directed towards this phenomenon within the context of China remains scant.

AIMS AND OBJECTIVES

To investigate the formation and developmental processes of psychological distress associated with infertility and infertility treatment among women within the Chinese cultural context and to construct a theoretical framework that elucidates this phenomenon.

DESIGN

Qualitative approach with grounded theory methodology.

METHODS

This study was conducted within the reproductive medicine department of a tertiary-level hospital located in central China from May to August 2023. Twenty-seven women who experienced infertility and underwent assisted reproductive treatment (ART) were interviewed. The interview sessions spanned durations ranging from 20 min to 1 h and 35 min. Data analysis included open coding, axial coding and selective coding. The study is reported using the COREQ checklist.

RESULTS

The infertility psychological distress experienced by women undergoing ART is a socially constructed phenomenon influenced by a dynamic interplay of forces that construct and conciliate it. The formation and progression of infertility psychological distress are rooted in the process of self-construction. A Middle-Ranged Theory titled 'self-reconstruction under the dome of infertility and infertility treatment' (SUDIT theory) was developed to explain this phenomenon. Within this framework, infertility psychological distress manifests across three distinct phases under the gambling of the constructive force and conciliative force: (1) distress of disrupting the former self; (2) distress linked to the struggling present self; and (3) the renewed-self harmonized with distress.

CONCLUSIONS

It is imperative for healthcare professionals and policymakers to acknowledge the socially constructed nature of infertility psychological distress, and proactively implement measures aimed at ameliorating it.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Antenatal predictors of postnatal maternal attachment and competence after assisted conception-a prospective cohort study in South India

The aim of this study is to examine the influence of antenatal factors such as anxiety, depression, perceived stress, marital satisfaction, maternal antenatal attachment, and social support on postnatal maternal attachment and competence in women who received assisted reproductive treatment. A prospective longitudinal cohort design was adopted with two groups-50 women who received assisted reproductive treatment and 50 women who had natural conception. Both the groups were assessed using self-report measures over three time points: T1, 7th month of pregnancy; T2, 2 weeks postpartum; and T3, 3 months postpartum. A final sample of 44 women who had assisted conception and 47 women who had natural conception completed assessments across all three time points. Descriptive, bivariate analyses, and stepwise multiple linear regression analyses were carried out. In the assisted conception group, maternal antenatal attachment, depression, and marital satisfaction significantly predicted postnatal maternal-infant attachment. Perceived social support, depression, and duration of marriage significantly predicted postnatal maternal competence. In the naturally conceived group, maternal antenatal attachment and social support significantly predicted postnatal maternal-infant attachment; perceived stress significantly predicted postnatal maternal competence. Antenatal depressive symptoms and relational factors significantly influenced postnatal maternal attachment and competence highlighting the need for screening and targeted psychological interventions during pregnancy.

The association between conception history and subsequent postpartum depression and/or anxiety: Evidence from the Clinical Practice Research Datalink 1991-2013

BACKGROUND

Infertility, and fertility treatment, are associated with psychological distress that may influence subsequent mental health including postpartum depression and anxiety.

METHODS

Data for women who had a livebirth between 1991 and 2013 were drawn from the Clinical Practice Research Datalink. Conception history prior to their first recorded birth was categorised as 'no fertility problems', 'untreated subfertility', ovulation induction (OI), and assisted reproductive technologies (ART). Depression and/or anxiety in the 12 months postpartum were identified using records of diagnoses, symptoms, and prescriptions. Prevalence was compared, and odds ratios estimated using multivariable logistic regression.

RESULTS

Of 235,127 mothers, 31,947 (13.6%) had evidence of postpartum depression and/or anxiety. Mothers in the ART group had 22% lower odds of postnatal depression and/or anxiety compared to mothers in the fertile group (OR 0.78; 95% CI [0.70-0.86]; p < 0.0001). Accounting for prior mental health, lifestyle, sociodemographic and pregnancy-related factors reduced the strength of the association (aOR 0.87; 95% CI [0.78-0.97]; p = 0.01). There were no significant associations observed in the untreated subfertility or OI groups.

LIMITATIONS

As in any analysis of routine data, the quality of recording is important and some information was unavailable (e.g. education, social support).

CONCLUSIONS

Women with a history of subfertility, OI or ART treatment were not at increased risk of postpartum depression and/or anxiety compared to those with no fertility problems. It is important to explore whether women who underwent ART are less likely to experience depression/anxiety or do not seek help when needed, with implications for their health and care.

Reliability and Validity of the PHQ-8 in First-Time Mothers who Used Assisted Reproductive Technology

STUDY QUESTION

Is the Patient Health Questionnaire-8 (PHQ-8) a valid and reliable measure of depression in first-time mothers who conceived via ART?

SUMMARY ANSWER

The results from this study provide initial support for the reliability and validity of the PHQ-8 as a measure of depression in mothers who have conceived using ART.

WHAT IS KNOWN ALREADY

Women who achieved a clinical pregnancy using ART experience many stressors and may be at an increased risk of depression. The PHQ-8 is a brief measure designed to detect the presence and severity of depressive symptoms. It has been validated in many populations; however, it has not been validated for use in this population.

STUDY DESIGN, SIZE, DURATION

This is a cross-sectional study of 171 first-time mothers in the USA, recruited through Amazon’s Mechanical Turk (MTurk).

PARTICIPANTS/MATERIALS, SETTING, METHODS

The reliability of the PHQ-8 was measured through a Cronbach’s alpha, the convergent validity was measured through the correlation between the PHQ-8 and the Generalized Anxiety Disorder-7 (GAD-7) measure of anxiety symptoms, and the structural validity was measured through a Confirmatory Factor Analysis.

MAIN RESULTS AND THE ROLE OF CHANCE

The Cronbach’s alpha for the total PHQ-8 was acceptable (α = 0.922). The correlation between the PHQ-8 and the GAD-7 was large (r = 0.88) indicating good convergent validity. Ultimately, a bifactor model provided the best model fit (χ2(13) = 23.8, P = 0.033; Comparative Fit Index = 0.987; Root Mean Square Error of Approximation = 0.07, Tucker–Lewis Index = 0.972).

LIMITATIONS, REASONS FOR CAUTION

The results are limited by: the predominantly white and well-educated sample, a lack of causation between the use of artificial reproductive technology and depressive symptoms, including mothers with children up to 5 years old, convergent validity being based on associations with a related construct instead of the same construct, lack of test-retest reliability, divergent validity and criterion-related validity, data collected through MTurk, and the fact that the measures used were all self-report and therefore may be prone to bias.

WIDER IMPLICATIONS OF THE FINDINGS

Consistent with previous literature, a bifactor model for the PHQ-8 was supported. As such, when assessing depression in first-time mothers who conceived via ART, using both the PHQ-8 total score and subdomain scores may yield the most valuable information. The results from this study provide preliminary support for the reliability and validity of the PHQ-8 as a measure of depression in first-time mothers who conceived using ART.

STUDY FUNDING/COMPETING INTEREST(S)

No specific funding was used for the completion of this study. Throughout the study period and manuscript preparation, the authors were supported by the department funds at Baylor University. The authors declare that they have no conflicts of interest.

TRIAL REGISTRATION NUMBER

N/A.

Experiences of transition to motherhood among pregnant women following assisted reproductive technology: a qualitative systematic review

OBJECTIVE

This systematic review aimed to identify and synthesize available qualitative evidence regarding the experiences of the transition to motherhood among pregnant women following assisted reproductive technology.

INTRODUCTION

Pregnant women experience unique challenges to their identity when transitioning to motherhood following assisted reproductive technology. It is important that health care professionals understand the context and complexity of emotional adaptation to pregnancy following assisted reproductive technology.

INCLUSION CRITERIA

Any qualitative data from empirical studies that described experiences of the transition to motherhood during pregnancy among women who conceived through assisted reproductive technology were considered for inclusion.

METHODS

Several databases were searched for published and unpublished studies in English or Japanese from 1992 to 2019, including MEDLINE, CINAHL, PsycINFO, ProQuest Health and Medical Collection, Google Scholar, and Open Access Theses and Dissertations (in English); and Ichushi-Web, CiNii, and the Institutional Repositories Database (in Japanese). All included studies were assessed by two independent reviewers. Any disagreements were resolved through discussion. We used the recommended JBI approach to critical appraisal, data extraction, and data synthesis.

RESULTS

This review included seven studies that considered pregnant women's (n = 110) experiences of transition to motherhood following assisted reproductive technology. The studies were assessed as moderate to high quality (scores 7-10) based on the JBI critical appraisal checklist for qualitative research. All studies used qualitative methodologies or methods including phenomenology, narrative approach, qualitative description, and qualitative content analysis. There were two studies from Japan, one from Brazil, one from Iran, one from Israel, one from the UK, and one from the USA. In total, 51 supported findings were aggregated into 14 categories, and five synthesized findings: i) Pregnant women following assisted reproductive technology require support to decrease anxiety and improve their belief in pregnancy to internalize a maternal identity; ii) Pregnant women following assisted reproductive technology need reassurance of their lifestyles to ensure a safe passage through pregnancy because of ambivalent feelings about becoming a mother; iii) Pregnant women following assisted reproductive technology develop a maternal identity with affection for the fetus if they switch their mindset from infertility to pregnancy; iv) Pregnant women following assisted reproductive technology need to review their self-image of being infertile and prepare for childbirth or motherhood; v) Pregnancy following assisted reproductive technology contributes to the emergence of positive feelings and changing the women's sense of self and other personal relationships. Based on the ConQual approach, the confidence in the synthesized findings was rated as moderate to low.

CONCLUSIONS

The synthesized findings highlight the importance of understanding the uncertainty and ambivalent feelings women have about their pregnancy, delayed development of attachment to their fetus and formation of a maternal identity, alteration in their relationships, and the social context of pregnancy via assisted reproductive technology among pregnant women following assisted reproductive technology. Health care professionals need to be aware of the specific care needs of these women relating to the unique pathway in the identity transition to motherhood following assisted reproductive technology. More research on development and implementation of specific intervention programs for expectant mothers following assisted reproductive technology is needed.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42019138200.

First-time mothers' experiences of foetal reduction in pregnancy following assisted reproductive technology treatment in Taiwan: a qualitative study

BACKGROUND

Foetal reduction-removal of one or more foetuses to reduce the number of foetuses in multiple conceptions-is a procedure used for improving pregnancy outcomes following assisted reproductive technology (ART) treatment. While there is a recognition of the importance of understanding the experiences of women who undergo foetal reduction to offer appropriate help and support, studies that provide relevant insights are sparse. Our aim was to gain an in-depth understanding about first-time mothers' experiences of foetal reduction following ART treatment in Taiwan.

METHODS

We adopted a qualitative design based on a phenomenological approach for this study. In-depth semi-structured interviews were conducted with seven first-time mothers who underwent foetal reduction following ART treatment at a fertility centre in Taipei, Taiwan. All interviews were recorded, transcribed and analysed using the Colaizzi strategy.

RESULTS

The views and experiences relating to foetal reduction reflected five key themes: hesitation, ambivalence and distress; the guilt of knowingly terminating a life; rituals and ceremonies to ease the sense of guilt; persuading oneself to consider the 'big picture'; and wishing for a reunion in next pregnancy. Mothers often regretted that they took clinical advice to implant multiple embryos and then having had to resort to foetal reduction. There was a sense of hesitation, ambivalence and distress reflected in the views from all participants. They believed that they ended the fetuses' lives knowingly and expressed strong feelings of guilt. Mothers often tried to persuade themselves to look at foetal reduction within the 'big picture' of the overall pregnancy outcome. Losing their unborn babies was as an unforgettable incident for most mothers, and they wished for a reunion with the lost baby in the next pregnancy.

CONCLUSION

Findings indicate the need for ART providers to undertake a more sensitive approach that involves detailed discussions with women and their families to tailor the embryo transfer processes to suit individual needs. Women who undergo foetal reduction should be provided with tailored interventions towards enhancing their coping strategies before and after foetal reduction taking into account the cultural and religious context.

Psychological burden prediction based on demographic variables among infertile men with sexual dysfunction

There has been increasing interest in the psycho-socio-relational and sexual disorders of infertility, as the risk of psychological burden among infertile men with sexual dysfunctions is significant. The purpose of this study was to develop and to validate a predictive model to estimate individual psychological burden among infertile men with sexual dysfunction and study the association between them. Comprehensive data were collected for infertile men (n = 480) who sought treatment for infertility in a reproductive medicine center between June 2012 and December 2013. Using independent predictors of psychological burden from the least absolute shrinkage and selection operator, univariable and multivariable analyses were developed into two models. Predictive accuracy was compared between the models. We explored the association between sexual dysfunction and psychological burden. A total of 480 patients were analyzed using 10-fold cross-validation. Independent predictors of psychological burden were incorporated into a model to measure anxiety (corrected-area under curve (AUC): 77.3%) and a model to measure depression (corrected-AUC: 70.2%). Anxiety and depression were both associated with erectile dysfunction (P < 0.05), with anxiety demonstrating the strongest association. Only anxiety was associated with premature ejaculation (P < 0.05). Premature ejaculation was not found to be associated with depression (P > 0.05). Predictive models for psychological burden among infertile men with sexual dysfunction are presented, and we found that there is an association between psychological burden and sexual dysfunction. According to the models, proper counseling and treatment of sexual dysfunction in infertile men may reduce the psychological burden, help attain natural pregnancy, and improve the quality of life.

O Desenvolvimento da Relação do Casal diante do Sucesso da Reprodução Assistida,,

Resumo Investigamos o desenvolvimento da relação coparental e conjugal durante o processo de transição para a parentalidade no contexto da reprodução assistida, a partir de um estudo de caso coletivo longitudinal. Realizamos uma análise narrativa das entrevistas respondidas por três casais na gestação, no terceiro mês do bebê e em seu primeiro ano. Quando um dos cônjuges já tem filhos pode haver uma assimetria no enfrentamento do tratamento e da transição para a parentalidade. Pode haver, ainda, um deslocamento dos temas de conflito, embora estes tendam a ser abordados com as mesmas estratégias presentes na história do casal. Identificamos indícios da coparentalidade já no tratamento, havendo uma diferenciação crescente entre conjugalidade e coparentalidade.

First-time mothers' experiences of pregnancy and birth following assisted reproductive technology treatment in Taiwan

BACKGROUND

Assisted reproductive technology (ART) treatment tends to involve significant physical and emotional commitments that can impact maternal, infant, and family health and well-being. An in-depth understanding of experiences is necessary to provide adequate support for women and their families during pregnancy and transition to parenthood following ART treatment. The aim of this study was to explore first-time mothers' experiences of pregnancy and transition to parenthood following successful ART treatment in Taiwan.

METHOD

Twelve first-time mothers who conceived and gave live birth using ART treatment were purposively selected from a fertility centre in Taipei, Taiwan. Women's experiences in pregnancy and in their transition to motherhood were explored using semi-structured in-depth interviews. All interviews were recorded, transcribed, and analysed using the Colaizzi strategy.

RESULTS

The mothers' accounts reflected three main themes: 'being different from mothers who became pregnant naturally', 'ensuring health and safety of the foetus', and 'welcoming new lives with excitement'. The difference mothers felt about themselves was evident in four subthemes: becoming pregnant after a long wait, feeling vulnerable during pregnancy, relying on family's assistance and support, and worrying about the impact of ART on health. The theme on 'ensuring health and safety of the foetus' encompassed three subthemes: activities to protect the unborn baby, monitoring foetal movement constantly to maintain peace of mind, and receiving foetal reduction for the sake of the pregnancy. Narratives around 'welcoming new lives with excitement' reflected four subthemes: overcoming hardship for worthwhile results, realising one's life and dreams, proving to be fertile enough to give birth, and return to normal life track.

CONCLUSION

Findings indicate the need for educational and psychosocial interventions to support women and their families physically and psychologically during ART treatment. The stigma related to infertility and the psychosocial support from family are aspects to consider while planning intervention programmes.

Are There Differences in Marital-Role Quality between Women and Their Male Partners Who Conceived Via IVF and Those Who Did Not?

OBJECTIVES

Marital-role quality (MRQ) is a predictor of mental well-being, sexual intimacy, and maternal attachment. Data on differences in MRQ during pregnancy between women and their male partners who conceived spontaneously or via IVF are inconclusive. This study compared MRQ across pregnancy in these two groups.

METHODS

The sample's two groups: (a) 26 women and 26 male partners who conceived via IVF; and (b) 25 women and 20 male partners who conceived spontaneously. All 97 participants completed a MRQ scale during each trimester of pregnancy. Trajectory analyses were conducted to test for between-group differences in the changes in subscales across pregnancy within dyads.

RESULTS

Scores did not reveal any significant differences in subscales in those who conceived via IVF compared to non-IVF groups across the three trimesters in each dyad. The observed effect sizes were small, with exception that males in the non-IVF comparison group had greater concerns during the first trimester than did males in the IVF group (Cohen d= 0.51, moderate effect size).

CONCLUSIONS

Though the IVF population perceives pregnancy differently and experiences more anxiety than those who conceive spontaneously, their marital-role quality during pregnancy does not seem to be affected. Their perceptions before conception and in early parenting are worthy of investigation.

Couples' psychological adjustment to twin parenthood: mode of conception (spontaneous versus assisted reproduction) and gender differences

Aim

To examine whether mode of conception and gender are associated with parents’ psychological adjustment across the transition to twin parenthood.

Background

There is limited knowledge on the psychological adjustment of couples to twin parenthood during pregnancy and early postpartum, especially for fathers. The available research suggests that first-time mothers of twins conceived by assisted reproduction techniques (ART) may experience lower psychosocial well-being than mothers of spontaneously conceived (SC) twins.

Methods

A total of 41 couples expecting twins, 25 of whom conceived spontaneously and 16 conceived by assisted reproduction techniques, completed measures of depressive and anxiety symptoms, marital relationship, attitudes to sex, and attitudes to pregnancy and the baby.

Findings

ART parents showed a decline in marital relationship quality, no changes in attitudes to pregnancy and the baby and no changes in attitudes to sex over the postpartum. In contrast, SC parents did not change their perception of the marital relationship, reported more positive attitudes to pregnancy and the baby, and more positive attitudes to sex over the postpartum. Compared with the other groups (SC mothers and fathers, ART fathers), ART mothers exhibited a higher increase in depressive and anxiety symptoms from pregnancy to postpartum and only anxiety symptoms exhibited a decline trend over the postpartum. These findings suggest that ART parents may experience more psychological difficulties during the transition to twin parenthood than SC parents. ART mothers, in particular, appear to be more at risk of high levels of postpartum depressive symptoms.

Lack of association between receiving ART treatment and parental psychological distress during pregnancy: Preliminary findings of the Japan Environment and Children's Study

In a nationwide population-based birth cohort study in Japan, pregnant women and their partners were evaluated for psychological distress as part of the first and second/third trimester health checks. Participants were divided into three groups: an infertility group receiving assisted reproductive technology (ART) treatment (239 mothers and 151 fathers); an infertility group receiving non-ART treatment (350 mothers and 215 fathers); and a spontaneous pregnancy group (8514 mothers and 5110 fathers). Data on maternal and child health as well as basic characteristics were collected via medical records and self-administered questionnaires. The Kessler Six-item Psychological Distress Scale was employed for eligible women and their partners. Multivariate logistic regression analysis was used to evaluate the association between psychological distress experienced during pregnancy and ART treatment, with adjustment for potential confounders such as basic health status and socio-economic status. The mothers who received ART treatment suffered less psychological distress than the mothers in the other two groups. In multivariate analysis adjusted for background characteristics, no significant association was observed between persistent maternal distress and ART treatment (adjusted odds ratio 0.79, 95% confidence interval 0.49-1.26). Higher socio-economic status among couples receiving ART treatment may explain, in part, the lack of association between ART treatment and parental distress during pregnancy.

Observed Mother- and Father-Child Interaction Differences in Families with Medically Assisted Reproduction-Conceived Twins and Singletons

Increased medically assisted reproduction (MAR) use to treat infertility has resulted in a growing twin birth rate. Little is known about parent-child relationships for twin relative to singleton children in middle childhood. This study fills this gap by examining parent-child relationships in 57 families with eighty 6- to 12-year-old MAR twin and singleton children using observational data (warm and supportive communication, control, and hostility). Nested ANCOVAs indicate that while mothers exhibit similar interactional behaviors toward twins and singletons, fathers have less optimum behaviors toward twins relative to singletons. Twins displayed less engaged behavior with mothers and fathers relative to singletons. Given the vitality of parent-child relationships for family and child adjustment, future studies should examine determinants and outcomes of twin-singleton relationship differences to bolster twins' and their families' functioning.

Responding to Infertility: Lessons From a Growing Body of Research and Suggested Guidelines for Practice

Infertility is a common, yet often misunderstood, experience. Infertility is an important topic for family scientists because of its effects on families; its relevance to research in related areas, such as fertility trends and reproductive health; and its implications for practitioners who work with individuals and couples experiencing infertility. In this review, we focus on common misperceptions in knowledge and treatment of infertility and highlight insights from recent research that includes men, couples, and people with infertility who are not in treatment. The meaning of parenthood, childlessness, awareness of a fertility problem, and access to resources are particularly relevant for treatment seeking and psychosocial outcomes. On the basis of insights from family science research, we provide specific guidelines for infertility practice within broader social contexts such as trends in health care, education, employment, and relationships. Guidelines are presented across three areas of application: infertility education for individuals, families, and practitioners; steps to support the emotional well-being of those affected by infertility; and understanding of treatment approaches and their implications for individuals and couples.

Anxiety and depression symptoms among sub-fertile women, women pregnant after infertility treatment, and naturally pregnant women

BACKGROUND

Infertility has been associated with psychological distress, but whether these symptoms persist after achieving pregnancy via assisted reproductive technology (ART) remains unclear. We compared the prevalence of anxiety and depressive symptoms between women seeking for infertility treatment and women who conceived after ART or naturally.

METHODS

Four hundred and sixty-eight sub-fertile non-pregnant women, 2972 naturally pregnant women and 143 women pregnant after ART completed a questionnaire in this cross-sectional study. The Anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A≥8) and Edinburgh Postnatal Depression Scale (EPDS≥12) were used for assessing anxiety and depressive symptoms, respectively. Multivariate Poisson regression models with robust variance were applied to explore associations with anxiety and depressive symptoms.

RESULTS

The prevalence of anxiety and depressive symptoms among sub-fertile, non-pregnant women (57.6% and 15.7%, respectively) were significantly higher compared to women pregnant after ART (21.1% and 8.5%, respectively) and naturally pregnant women (18.8% and 10.3%, respectively). History of psychiatric diagnosis was identified as an independent risk factor for both anxiety and depressive symptoms. The presence of at least one unhealthy lifestyle behavior (daily tobacco smoking, weekly alcohol consumption, BMI≥25, and regular physical exercise<2h/week) was also associated with anxiety (Prevalence Ratio, PR: 1.24; 95%CI: 1.09-1.40) and depressive symptoms (PR: 1.25; 95%CI: 1.04-1.49).

CONCLUSIONS

Women pregnant after ART showed no difference in anxiety and depressive symptoms compared to naturally pregnant women. However, early psychological counseling and management of unhealthy lifestyle behaviors for sub-fertile women may be advisable, particularly for women with a previous history of psychiatric diagnosis.

Psychosocial needs of women and their partners after successful assisted reproduction treatment in Barcelona

It is assumed that pregnancy and parenthood after a period of infertility are unproblematic and gratifying. However, a review of the literature highlights the complexity of the psychological and social consequences of pregnancy, childbirth and parenting after successful treatment with assisted reproductive technology. These experiences, including those following the creation of new forms of non-genetic and/or social parenthood, require investigation in order to understand how women and their partners integrate their journey from infertility to pregnancy and parenthood after successful assisted reproductive treatment. This paper presents results derived from qualitative interviews with 30 pregnant women and 21 couples after assisted reproductive treatment (repeated rounds of individual interviews with the study participants) conducted from July 2010 to April 2014 as part of a larger ethnographic study exploring the psychosocial needs of women and partners following assisted reproductive treatment in Barcelona's. The transcribed text was coded into categories of either predetermined or emergent topics. Prior studies have found that couples who achieve pregnancy after infertility may experience higher levels of anxiety in relation to pregnancy. This anxiety can be linked with a higher risk of complications during pregnancy after assisted reproductive treatment compared with spontaneous conception. However, the evidence concerning adjustment to pregnancy and parenthood is inconclusive. This study highlights the necessity for participants to give meaning to these treatments, given the variability that exists in perceptions of infertility and pregnancy after successful assisted reproductive treatment.

Paternal mental health trajectory classes and early fathering experiences

A father’s mental health is important for family well-being, but research is scarce on paternal symptoms during the transition to fatherhood. This study identified fathers’ latent mental health trajectory classes from the pre- to postnatal period and examined their associations with early fathering experiences. It further analysed, whether a family’s infertility history was associated with mental health trajectory classes and moderated their effects on fathering experiences. Finnish fathers ( N = 773) reported psychological distress (General Health Questionnaire; GHQ-36) and depressive symptoms (Beck Depression Inventory; BDI-13) in pregnancy (T1), and at 2 months (T2) and 12 months (T3) postpartum. They further reported their fathering experience (Parenting Stress Index; PSI-36) at T2 and T3. Results revealed five paternal mental health trajectory classes, differing in timing and course of symptoms across the pre- and postpartum: stable low (79%) and moderate increasing (9%) levels of symptoms, and prenatal (5%), early fatherhood (3%) and heterogeneous high levels of (4%) problems. The trajectory classes were associated with fathering experiences within parental, interactive and child domains, across the child’s first year. The stable low levels of symptoms-class showed the most positive experiences and the heterogeneous high levels of problems-class the most negative ones; mental health problems in the early fatherhood-class reported negative fathering experience, but only when the child was 2 months old. A family’s infertility history neither showed any significant association with trajectory classes nor moderated their impact on early fathering, supporting the growing evidence that infertility treatments do not place an additional burden on early fatherhood.

Client perspectives of midwifery care in the transition from subfertility to parenthood: a qualitative study in the Netherlands

BACKGROUND

Pregnancy, childbirth and the postpartum period after fertility treatment are considered "normal" in the Netherlands, with no indication of an increased obstetric risk, and can therefore be monitored by a primary care midwife. However, there is little evidence on the experiences of couples and women who finally get pregnant after fertility treatment and a lack of training for midwives exists on this subject. The aim of this study was to map the midwifery care needs of the subfertile client with past fertility problems.

METHODS

In 2011, we interviewed two couples and seven women who conceived through fertility treatment and received primary midwifery care at some point during their pregnancies. This explorative, qualitative study was based on the interpretivist/constructivist paradigm.

RESULTS

Although the participants are not representative of all subfertile clients, the findings of our qualitative study highlight the needs of women and their partners who have become pregnant through fertility treatment including help from the primary care midwife in understanding the likely course of their pregnancy, more psychosocial support and acknowledgement of the fertility treatment history, and more consultations and frequent ultrasound scans than usual to confirm pregnancy.

CONCLUSIONS

Our study points out that the women who have become pregnant through fertility treatment and their partners communicate seemingly paradoxical prenatal care needs. It can help maternity care providers to optimally meet the care needs of subfertile clients and empower them during their transition from subfertility to parenthood.

The Quality of Life in Pregnant Women Conceiving Through in Vitro Fertilization

Objective

The aim was to determine whether pregnant women conceiving through in vitro fertilization (IVF) differ from those conceiving spontaneously in terms of psychological well-being and the quality of life.

Methods

In a prospective study we included 75 women conceived after IVF and 78 who conceived spontaneously in the same time period (control group). All the women were sent a self-report questionnaire about demographic and reproductive history, health, pregnancy concerns, containing Subjective Quality of Life Scale (QLS), Positive and Negative Affect Schedule (PANAS), the Psychological Well-Being Scale (PWB), Beck Depression Inventory (BDI), and Zung Self-Assessment Anxiety Scale (SAS); obstetric and newborn’s data were obtained from medical records. Response rate was 66.6% in the IVF and 83.3% in control group.

Results

The mean women’s age was 33.8 years in the IVF, and 32.5 years in the control group (NS). There were no significant differences between groups on the most of the outcome measures assessing psychological status. IVF mothers were just less satisfied in “friend/acquaintances” (P=0.03), a higher percentage had sexual problems prior to conception (P=0.03); the length of hospitalization during pregnancy was longer (P=0.02), and the preterm delivery rate was higher (P=0.01). Withingroup changes over gestation time indicated that IVF women, not controls, showed an increase in positive affect (P=0.04) and purpose in life (P=0.05).

Conclusions

IVF women are inclined to social isolation. Despite more medical problems during pregnancy, they reported improved positive emotions and purpose in life as the pregnancy progressed.

Health-related quality of life in pregnancy and postpartum among women with assisted conception in Canada

OBJECTIVE

To study the effects of mode of conception (spontaneous vs. assisted) on health-related quality of life (HRQoL) throughout pregnancy and in the postpartum period.

DESIGN

Secondary analysis of data from the All Our Babies cohort.

SETTING

Not applicable.

PATIENT(S)

A total of 243 women with assisted conception and 3,309 women with spontaneous conception.

INTERVENTION(S)

Short Form 12 (SF-12) health survey administered by means of questionnaires at <25 weeks, 34-36 weeks of gestation, and 4 months postpartum.

MAIN OUTCOME MEASURE(S)

Changes in the SF-12 Physical (PCS) and Mental (MCS) Component Summary scores from pregnancy to postpartum.

RESULT(S)

The PCS scores were lower during pregnancy and at <25 weeks and 34-36 weeks of gestation among women with assisted conception, but were equivalent to those of women with spontaneous conception by 4 months postpartum. The MCS scores were higher at <25 weeks among women with assisted conception, but by 34-36 weeks of gestation and at 4 months postpartum they were similar regardless of the method of conception. Analysis of covariance showed no significant differences for the changes in PCS and MCS scores from pregnancy to postpartum between assisted and spontaneous conception groups, after adjusting for covariates.

CONCLUSION(S)

Women with assisted conception may report lower physical and better mental health during pregnancy than women with spontaneous conception. At 4 months postpartum, there were no differences in self-reported HRQoL between modes of conception. Women with assisted conception may benefit from support and reassurance that perception of suboptimal health may improve over pregnancy and into the postpartum period.

Paradox of Modern Pregnancy: A Phenomenological Study of Women's Lived Experiences from Assisted Pregnancy

The purpose of our study was describing the meaning of pregnancy through Assisted Reproductive Technologies (ARTs). A qualitative design with hermeneutic phenomenology approach was selected to carry out the research. Semistructured in-depth interviews were conducted with 12 women who experienced assisted pregnancy. Three themes emerged from women's experience including finding peace in life, paradoxical feelings, and struggling to realize a dream. We concluded that pregnancy is the beginning of a new and hard struggle for women with fertility problems. The findings of our study resulted in helpful implications for the health care professionals managing assisted pregnancies.

Coping with infertility: Comparison of coping mechanisms and psychological immune competence in fertile and infertile couples

This study compared coping strategies and psychological immunity of parents with a child conceived with assisted reproductive technology (n = 84) and parents with a naturally conceived child (n = 84) in a Hungarian fertility-age population. Results showed that in vitro fertilization parents are able to control their emotions in a better way than comparison couples. They interpret trials as challenges and consider themselves more worthy than the members of the control group. Our research confirms that consideration and management of psychological factors in treating infertility have an important preventive role to play.

Individualised care for women with assisted conception pregnancies and midwifery practice implications: An analysis of the existing research and current practice

OBJECTIVE

the aim is to explore the psychosocial needs of women who are pregnant after assisted conception, specifically in vitro Fertilisation and whether their needs are being addressed within the current maternity care service.

DESIGN

critical review of the literature using a narrative approach.

FINDINGS AND KEY CONCLUSIONS

15 papers were identified. These included both qualitative and quantitative studies, literature reviews and surveys. The findings of this limited narrative review imply that women who undergo assistive reproductive techniques to achieve pregnancy have higher levels of anxiety in pregnancy and may have some difficulties in the transition to parenthood leading to perinatal morbidity. It appears that for this group of women it is important that their history in achieving pregnancy is known to the care providers, to enable the alleviation of some of the anxieties they face. Various aspects of antenatal care have been identified as possible areas which if addressed may reduce these levels of anxiety leading to a reduction in perinatal morbidity.

IMPLICATIONS FOR PRACTICE

currently, there is insufficient evidence to suggest that providing specialist midwifery care reduces morbidity in these women. However, maternity service providers should consider offering additional antenatal and postnatal services to meet the needs of this group in advance of further research in this area.

Assessment of Anxiety in Pregnancy Following Assisted Reproductive Technology (ART) and Associated Infertility Factors in Women Commencing Treatment

Background:

Successful pregnancy is the ultimate goal of almost all couples. However, this pleasant event is usually accompanied psychological and behavioral changes and can result in stress in women, particularly women who pregnant by assisted reproductive technology methods (ARTs).

Objectives:

This study aims to determine the anxiety level during pregnancy and its relation with infertility factors in women who has been pregnant by Assisted Reproduction Technology (ART) methods.

Patients and Methods:

A total number of 100 ARTs pregnant women who came to three infertility centers in Tehran from August to November 2009 participated in this descriptive cross sectional study. The rational for selecting the subjects was their availability to the researcher at the time of the research. Anxiety was measured by Beck Anxiety Inventory and for obtaining the infertility data, a questionnaire designed by the researcher was given to the subjects. Data were statistically analyzed using the inferential statistic of chi-square.

Results:

Study results showed that 34 % of subjects were anxious (moderate and sever levels in total). There are significant relations between infertility duration, history of treatment failure and anxiety level (P = 0.03) (P = 0.02). There were no statistically significant relationships with regard to other variables.

Conclusions:

Infertility duration and history of treatment failure in ARTs pregnant women are two factors that affect the anxiety level during pregnancy.

Outcomes for women and infants following assisted conception: implications for perinatal education, care, and support

Assisted conception is becoming an increasingly more common treatment option for women and couples who experience fertility problems. Links have been made in the literature between assisted conception and a greater incidence of pregnancy or birth complications, low birth weight or premature babies, and babies with congenital abnormalities. In addition, evidence suggests that the experience of assisted conception may influence the development of early mothering relationships and impact parenting adjustment. Although this commentary article does not strategically review all available literature, it provides an overview of the health issues that women and families undergoing assisted conception have experienced or may experience. Through raising awareness and promoting discussion of these issues, practitioners will be better equipped to provide informed education and support.

Preterm birth and Assisted Reproductive Technology/ART: maternal emotional wellbeing and quality of mother-newborn interaction during the first three months of life

OBJECTIVE

Assisted Reproductive Technology (ART) and premature birth are stressful and difficult experiences for women. No research to date has examined the impact of ART on mother-child relationship in instances of preterm delivery. This study explored the psychological status of preterm infants' ART-mothers and the quality of mother-infant dyadic interaction, up to child age of three months (Corrected Age = CA).

METHOD

Forty-one ART-dyads and 53 Spontaneous Pregnancy (SP) dyads were enrolled. Mother and child were assessed at 5 to 7 days after birth (T1), at child discharge from hospital (T2), at one month after discharge (T3); and at 3 months CA (T4). The following measures were administered to the mothers: the Gordon Personal Profile Inventory, the Beck Anxiety Inventory, the Beck Depression Inventory, and the Parenting Stress Index S-F. Mother-child interaction was coded by using the Nursing Child Assessment Feeding Scale.

RESULTS

At childbirth, the control group mothers showed a higher level of anxiety than the ART-mothers did, but at T2, T3, T4, both groups' parenting stress levels were below threshold. Conversely, ART mothers more frequently provided suitable stimulation for their child's socio-emotional and cognitive development than the control group did. No significant between-group differences were observed in the mothers' capacity to respond to their children's distress, nor in sensitivity to child cues. Both infant groups showed equal ability to send clear signals and to respond to parent-provided care.

CONCLUSIONS

ART and SP mothers with premature infants showed no differences in degree of emotional burden experienced during the neonatal period. Yet, dyadic interaction was qualitatively better in ART dyads than in SP dyads.

Maternal pre- and postnatal mental health trajectories and child mental health and development

Pregnancy and early motherhood involve uncertainty and change, which can evoke mental health problems. We identified maternal mental health trajectories in pre- and postnatal period, and examined their association with later child mental health and development. Finnish mothers reported psychological distress (General Health Questionnaire [GHQ-36]) and depressive (Beck Depression Inventory [BDI-13]) symptoms in pregnancy (T1; N = 788) and two months (T2; N = 657) and 12 months (T3; N = 545) postpartum. Both parents accounted their child’s mental health (Behavior Assessment System for Children [BASC]) and social (Social Skills Rating System [SSRS], Child Behavior Scale [CBS]) and cognitive development (Five to Fifteen [FTF]) when the child was 7–8 years old (T4; N = 485). We identified five trajectories depicting unique timing and course of maternal mental health from pregnancy into 1 year of mothering: Stable low levels of mental health symptoms (75%) and prenatal (6%), early postpartum (9%) and late postpartum (6%) mental health problems. The fifth trajectory, heterogeneous high levels of mental health problems (4%) was an unclassified post hoc class, combining mothers with chronic high or highly variable mental health profiles. Results show some trajectory-related timing effects on children’s mental health and cognitive development. The trajectories of early postpartum and heterogeneous high levels of mental health problems predicted higher level of internalizing symptoms as compared to stable low-levels trajectory. The heterogeneous high-levels trajectory predicted higher levels of problems in executive functions than the stable low and late postpartum trajectories, and in memory tasks than children in other trajectories. We discuss the timing and course of maternal mental health from the viewpoint of infant and child development.

Subjective well-being and adaptation to life events: a meta-analysis

Previous research has shown that major life events can have short- and long-term effects on subjective well-being (SWB). The present meta-analysis examines (a) whether life events have different effects on affective and cognitive well-being and (b) how the rate of adaptation varies across different life events. Longitudinal data from 188 publications (313 samples, N = 65,911) were integrated to describe the reaction and adaptation to 4 family events (marriage, divorce, bereavement, childbirth) and 4 work events (unemployment, reemployment, retirement, relocation/migration). The findings show that life events have very different effects on affective and cognitive well-being and that for most events the effects of life events on cognitive well-being are stronger and more consistent across samples. Different life events differ in their effects on SWB, but these effects are not a function of the alleged desirability of events. The results are discussed with respect to their theoretical implications, and recommendations for future studies on adaptation are given.

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

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

Desafios para a maternidade no contexto da reprodução medicamente assistida: terceiro mês do bebê

O desgaste físico e emocional decorrente das técnicas de reprodução medicamente assistida, pode conferir à maternidade um caráter específico, com repercussões ainda pouco conhecidas. Por meio deste estudo com três mulheres que engravidaram por técnicas reprodutivas, buscou-se conhecer o processo de tornar-se mãe no contexto da reprodução medicamente assistida, com medidas coletadas aos três meses do bebê. Os resultados apontaram que a transição para a maternidade foi vivida por essas mulheres com sentimento de incapacidade de cuidar adequadamente de seu bebê e medo de que ele não sobrevivesse, sendo que o nascimento pré-termo, já temido desde a gestação, tornou real a possibilidade de perda do bebê e a vivência dessa etapa, um desafio. Entretanto, observou-se que superado esse período inicial, o medo da perda do bebê diminuiu, dando espaço para o estabelecimento da crença de que essas mães são capazes de garantir a sobrevivência de seus bebês.

The experience of infertility: a review of recent literature

About 10 years ago Greil published a review and critique of the literature on the socio-psychological impact of infertility. He found at the time that most scholars treated infertility as a medical condition with psychological consequences rather than as a socially constructed reality. This article examines research published since the last review. More studies now place infertility within larger social contexts and social scientific frameworks although clinical emphases persist. Methodological problems remain but important improvements are also evident. We identify two vigorous research traditions in the social scientific study of infertility. One tradition uses primarily quantitative techniques to study clinic patients in order to improve service delivery and to assess the need for psychological counselling. The other tradition uses primarily qualitative research to capture the experiences of infertile people in a sociocultural context. We conclude that more attention is now being paid to the ways in which the experience of infertility is shaped by social context. We call for continued progress in the development of a distinctly sociological approach to infertility and for the continued integration of the two research traditions identified here.

Reprodução assistida e relação conjugal durante a gravidez e após o nascimento do bebê: uma revisão da literatura

A chegada de um bebê inicia um período de desafios e mudanças para o casal. Quando a gravidez é alcançada a partir da reprodução assistida, soma-se aos desafios já característicos desse período o impacto das experiências próprias a esse contexto. Neste trabalho, são revisadas e discutidas pesquisas que investigaram a relação de casais que recorreram à reprodução assistida, durante a gravidez e os dois primeiros anos do bebê. A revisão da literatura indica semelhanças entre esses casais e aqueles que conceberam naturalmente. No entanto, essas pesquisas tendem a basear-se na avaliação de variáveis específicas, como as relacionadas à satisfação conjugal e a características sociodemográficas, bem como pela ausência de um enfoque desenvolvimental que investigue a história prévia desse casal e suas famílias de origem. Esse enfoque, aliado a uma abordagem que privilegie a descrição das experiências desses casais, poderia contribuir para a compreensão desse contexto.

The practice gap in the care of women following successful infertility treatments: Unasked research questions in midwifery and nursing

The aim of this paper is to highlight the gap between existing research evidence and nursing and midwifery practices in caring for women following successful in vitro fertilization (IVF) and gamete intrafallopian transfer (GIFT), and to suggest directions for research within these disciplines. We argue that although the number of couples in the UK experiencing fertility problems has risen, 1.4% of all births in the UK are as the result of infertility treatments (HFEA, 2005/2006); yet there is little research into the experiences of motherhood for women who successfully achieve pregnancy following IVF or GIFT. Consequently, there is negligible research evidence for nurses and midwives practicing in this area, and British healthcare staff appear to be unaware of the specific needs of infertile women during pregnancy, birth and early motherhood. In this paper we review the existing literature on this group of women, which falls into three areas: studies into the psychosocial development of the child conceived via IVF/GIFT/donor insemination; comparative studies into experiences of women following successful infertility treatment and women who conceive naturally; and studies into the experiences of women following successful IVF treatment. We review this literature to argue for research into the needs of infertile women following successful IVF/GIFT, to inform evidence for practice.

Antenatal mood and fetal attachment after assisted conception

OBJECTIVE

Australian women conceiving with ART are at fourfold risk of admission to early parenting treatment programs compared with those conceiving spontaneously. This study aimed to identify prevalence and determinants of antenatal mood disturbance and other risks for early parenting difficulties after assisted conception.

DESIGN

A prospective longitudinal investigation from conception to 18 months postpartum using telephone interviews and self-report questionnaires.

SETTING

Melbourne IVF and Royal Women's Hospital Reproductive Services, Victoria, Australia.

PATIENT(S)

A consecutive cohort of English-speaking women with ultrasound-confirmed ART-conceived pregnancies.

MAIN OUTCOME MEASURE(S)

Standardized psychometric measures of mood, quality of marital relationship, mother-to-fetus emotional attachment, and personality.

INTERVENTION(S)

None.

RESULT(S)

Of the 288 women with confirmed pregnancies, 239 were contactable, and 183 (77%) were recruited, 95% of whom completed both early and late pregnancy assessments. Participants were socioeconomically advantaged, had very good pregnancy health, exceptional marital relationships, normal personality styles, and intense affectionate attachment to the fetus. Very few (<5%) had clinically significant mood disturbance in late pregnancy.

CONCLUSION(S)

There were low rates of antenatal mood disturbance and other risk factors for postpartum depression. Pregnancy and motherhood might be idealized after ART conception, and preparation for the realities of infant care might then be insufficient.