Development and validation of the Infertility Self-Efficacy scale

Oocyte freezing intention for non-medical reasons: the interplay with childbearing intention, age and self efficacy

In recent years, the possibility for healthy women to consider or undertake oocyte freezing for non-medical reasons (OFNMR) allows women who want to have biological children, to enable motherhood at a later time, while protecting against age-related fertility decline. The present study explored the intended OFNMR among healthy Israeli women by looking at the interplay of age, childbearing intention and general self-efficacy - a personal resource. Two hundred fifty-one Israeli women were recruited through social networks and online forums related to women's issues in general. Participants completed self-report questionnaires addressing socio-demographic data, childbearing intention, general self-efficacy, and OFNMR intention. The results revealed that the association between women's age and OFNMR intention was insignificant. However, childbearing intention moderated the association between women's age and OFNMR intention. Specifically, the association between age and OFNMR intention was positive and significant for women with childbearing intention while for women without childbearing intention, it was negative and significant. General self-efficacy was not found to be associated with OFNMR intention. The current study shed light on the role of childbearing intention in the context of fertility decisions, especially among women who verbalize their intention for OFNMR. Routine discussion between health-care professionals and women regarding childbearing intentions is recommended, especially with women nearing age-related decline in fertility.

The effect of supportive counseling on self-esteem of infertile women after in vitro fertilization (IVF) failure: a randomized controlled trial study

BACKGROUND

The unsuccessful treatment of infertility can lead to heightened levels of negative emotions, which are often associated with various psychological consequences. These consequences may include a decrease in self-confidence, feelings of loneliness, reduced self-esteem, and even discontinuation of treatment. Therefore, it is crucial to implement interventions that can help improve these consequences for women who have experienced IVF failure. The present study aimed to examine the effect of supportive counseling on self-esteem of infertile women after IVF failure.

METHODS

this randomized clinical trial study was conducted on 63 infertile women after IVF failure, referred to Milad Infertility Center in Mashhad in 2021. In the intervention group, the researcher provided individual supportive counseling sessions. These sessions took place over a span of four weeks, with each session lasting 60 min (One session every week). Data collection was conducted both before and one month after the study using Eysenck self-esteem Questionnaire. Data were analyzed using SPSS25, as well as statistical tests such as chi-square, independent t-test, Paired t-test and Mann-Whitney tests. A significance level of less than 5% was considered.

RESULTS

The study found no significant difference in mean scores of self-esteem between the two groups before the study (p = 0.823). However, after one month, the intervention group had significantly higher self-esteem scores (24.3 ± 18.55) compared to the control group (21.74 ± 5.62) (p = 0.043) Moreover, Based on the Within-group comparison, there was a 2.43 ± 3.24 point increase in self-esteem scores of the intervention group after one month, while the control group showed a -0.33 ± 3.72 point decrease.

CONCLUSION

Supportive counseling was found to be effective in improving self-esteem following IVF failure. As a result, it can be recommended as an effective, affordable, and low-risk counseling approach for women who have experienced IVF failure. By offering supportive counseling, it is possible to help prevent and alleviate the psychological consequences associated with IVF failure.

TRIAL REGISTRATION

This research project was registered at the Iranian Registry of Clinical Trials with code IRCT20210407050883N1- Date of registration 2021-05-25.

A Chinese version of the infertility self-efficacy scale: Reliability and validity assessment

Objective

To translate, cross-culturally adapt and test the reliability and validity of a Chinese version of the Infertility Self-Efficacy scale.

Methods

The Infertility Self-Efficacy (ISE) scale was translated into Chinese using forward and backward translations, expert consultation, cognitive interviews and a pilot study. To test the scale's reliability and validity, 515 infertile women in two hospitals were recruited to evaluate the Chinese version of the scale. Content validity was assessed by means of expert consultation. Exploratory factor and confirmatory factor analyses were performed using SPSS 26.0 and Amos 24.0. Reliability tests of the scale included Cronbach's alpha coefficient, split-half reliability and test-retest reliability.

Results

The Chinese version of the ISE scale contains 16 items and one dimension. Content validity of the scale was 0.96. Results of exploratory factor analysis suggested that the one factor model was suitable for the scale, and factor loading of all items was greater than 0.4. Model fitting parameters of confirmatory factor analysis of the ISE scale were χ2/df = 2.710, Root Mean Square Error Approximation (RMSEA) = 0.079, Standardized Root Mean Square Residual (SRMR) = 0.042, Comparative Fit Index (CFI) = 0.953, and Tucker-Lewis Index (TLI) = 0.939. Cronbach's alpha coefficient of the Chinese ISE was 0.980; split-half coefficient was 0.972 and retest reliability was 0.848 (P < 0.01).

Conclusion

The Chinese ISE scale is a reliable and valid instrument to evaluate the self-efficacy of infertile Chinese women.

The Effect of Positive Psychotherapy-Based Training on Stigma and Self-Efficacy in Women Receiving Infertility Treatment

BACKGROUND

Infertility has increased in recent years. Infertility can cause many mental problems. The place of psychoeducation based on positive psychotherapy (PPT) is important in coping with mental problems.

AIMS

The aim of this study is to determine the effect of PPT-based training on stigma and self-efficacy in women receiving infertility treatment.

METHODS

This experimental study with randomized control group was completed with 64 women receiving infertility treatment. While the women in the experimental group received an 8-session PPT-based training, no intervention was applied to those in the control group.

RESULTS

A statistically significant difference was observed (p= .001) between the stigma and self-efficacy levels of the experimental group after the PPT-based training.

CONCLUSIONS

It was found that the PPT-based training was effective in decreasing stigma level of the women who received infertility treatment and increasing their self-efficacy level.

Fertility education: recommendations for developing and implementing tools to improve fertility literacy†

Many recent societal trends have led to the need for fertility education, including the age at which individuals become parents, the development of new reproductive technologies, and family diversity. Fertility awareness has emerged as a concept very recently and is increasingly gaining recognition. However, fertility education is often neglected as there is no consensus on the appropriate content, target populations, or on who should provide it. This article attempts to provide an overview of the use of interventions to improve fertility education. We emphasize the importance of delivering evidence-based information on fertility and reproductive health through various methods while providing guidelines for their standardization and systematization. Recommendations are provided to aid the development and implementation of fertility education tools, including: the establishment of a comprehensive understanding of the target populations; the incorporation of theories of behavioural change; the inclusion of the users' perspectives and the use of participatory research; and the use of specific guidelines for increasing engagement. By following these recommendations, it is expected that fertility education resources can contribute to improving fertility literacy, empowering individuals and couples to make informed reproductive decisions, and ultimately reducing the incidence of infertility and need for fertility treatment.

Effect of Stress on Each of the Stages of the IVF Procedure: A Systematic Review

The aim of this systematic review was to examine if chronic or acute stress, measured by questionnaires or physiological biomarkers, has a separate impact on each different stage in the IVF process. A systematic search of peer-reviewed literature was performed in three databases with keywords. Preselection included 46 articles, and in all, 36 articles were included. Most studies concluded that stress has a negative effect on IVF treatment. The egg retrieval time point was most affected by chronic and acute stress. Through this research, there may be an association between chronic stress and the fertilization stage. Only chronic stress impacted the embryo transfer stage and further evidence suggested that stress decreased during this stage. The pregnancy rate stage was weakly associated with stress. Follicular cortisol was found to affect three stages. Chronic and acute stress significantly and negatively affected the egg retrieval time point. Chronic stress was associated with a lesser extent with the fertilization point, and no significant relationship between acute stress and the embryo transfer and pregnancy rate stages were found. Follicular cortisol was found to affect the process. This review contributes to the research of the relationship between stress and IVF success.

Development and validation of a perceived abortion self-efficacy scale: results from Bolivia, Nepal and Nigeria

The objective of this research was to develop and assess the validity of a scale to measure perceived abortion self-efficacy (PASE). Perceived abortion self-efficacy is defined as an individual's perceived confidence in their ability to carry out the tasks necessary to end a pregnancy safely and successfully. During the first phase of this study between February and April 2018, we conducted qualitative research using in-depth interviews and focus group discussions with women in Bolivia, Nepal, and Nigeria to explore domains of PASE. Using the qualitative data, we prepared a draft set of measures with 31 items. In October and November 2018, the second phase of the study included field testing 31 draft items with a convenience sample of approximately 1200 women across the three study countries. Exploratory factor analysis was conducted to identify an appropriate scale structure, resulting in a 15-item, 3-factor model. The three factors represent the concepts of enlisting social resources, accessing information and care, and resilience. In the third and final phase in September and October 2019, the validity of the 15 scale items was assessed. The scale was administered to a new sample of approximately 400 women in each country. Confirmatory factor analyses were conducted to test model fit for the scale structure identified during the second phase. The results from this study suggest that the final PASE scale has considerable potential to be a valid measure of PASE. The new 15-item PASE scale presented in this paper can be used to evaluate programmes or interventions designed to improve women's PASE and to assess the state of PASE in populations.

Psychological Aspects of Infertility - Results from an Actor-Partner Interdependence Analysis

Introduction For some patients, undergoing medical treatment for infertility is a cause of major emotional stress which the couple needs to deal with together; it can be said that infertility is a shared stressor. From the literature it is known that a subjectively perceived sense of self-efficacy supports the patient's ability to cope adaptively with an illness. As the basis for this study, we assumed that high levels of self-efficacy are associated with low psychological risk scores (e.g., for anxiety or depressiveness), both in the patient themselves and in their partner. Accordingly, in infertility patients, targeted support to promote helpful self-efficacy expectations could represent a new counselling strategy that could enable psychologically vulnerable patients to better cope with the treatment procedure and treatment failures of medically assisted reproduction, making these patients less at risk with regard to psychosocial factors. Methods 721 women and men attending five fertility centers in Germany (Heidelberg, Berlin), Austria (Innsbruck), and Switzerland (St. Gallen, Basel) completed the SCREENIVF-R questionnaire to identify psychological risk factors for amplified emotional problems, as well as the ISE scale to measure self-efficacy. Using paired t-tests and the actor-partner interdependence model, we analyzed the data of 320 couples. Results Considering the study participants as couples, women had a higher risk score than men for four out of five risk factors (depressiveness, anxiety, lack of acceptance, helplessness). In all of the risk areas, it was possible to identify a protective effect from self-efficacy on the patient's own risk factors (actor effect). There was a negative correlation between the men's self-efficacy level and the women's feelings of depressiveness and helplessness (partner effect, man → woman). The women's self-efficacy levels had a positive correlation with acceptance and access to social support in the men (partner effect, woman → man). Conclusion Because infertility is generally something that a couple has to deal with together, future studies should focus on couples as the unit of analysis instead of just analyzing the men and women separately. In addition, couples therapy should be the gold standard in psychotherapy for infertility patients.

The effect of self-compassion-based programs for infertility (SCPI) on anxiety and depression among women pursuing fertility treatment: a three-armed, randomised controlled trial

PURPOSE

To examine the effects of self-compassion training using videos (SCV) versus self-compassion training using digital stories (SC-DS) as compared to a control group (CG) on reducing anxiety and depression symptoms among women pursuing fertility treatment.

METHODS

A three-armed, randomised controlled trial randomly assigned 200 eligible women to SCV(n = 65), SC-DS (n = 67), and CG (n = 68). All three randomised groups completed questionnaires immediately after randomisation (T1), after completing the interventions (T2), and 10 weeks after the interventions (T3). A generalised estimation equation was used with the intention-to-treat analysis. The primary outcomes were anxiety and depression, and secondary outcomes were self-compassion, infertility self-efficacy, and pregnancy rates.

RESULTS

SCV and SC-DS participants experienced a significant reduction in anxiety and depression from T1 to T2 and from T1 to T3 (p < 0.001; d > 0.8). SCV and SC-DS participants experienced a significant increase in self-compassion and infertility self-efficacy from T1 to T2 and from T1 to T3 (p < 0.001; d > 0.8). SC-DS seemed to be superior to SCV and CG. No significant differences were found among the three groups in pregnancy rates. SCV and SC-DS participants rated self-compassion training programs positively and said they would highly recommend them to others.

CONCLUSION

These findings suggest that SCV and SC-DS were effective in reducing anxiety and depression and increasing self-compassion and infertility self-efficacy. Online flexible self-compassion interventions could make psychological support more accessible for women undergoing fertility treatment in resource-poor settings.

TRIAL REGISTRATION

(ChiCTR2100046065) [12/04/2021].

Learning from Online Video Education (LOVE) improves confidence in fertility treatments: a randomized controlled trial

Fertility treatments like in vitro fertilization (IVF) or oocyte cryopreservation (OC) require the daily use of injectable gonadotropins and has been associated with treatment burden and attrition from fertility treatment. We conducted a randomized clinical trial to determine (1) whether educational videos about fertility medications improved infertility self-efficacy scale (ISES), fertility quality of life treatment (FertiQoL-T), and Perceived stress scale (PSS) scores and (2) if such videos improved confidence and reduced medication errors during a first ovarian stimulation cycle. Participants were given access to an online portal with randomized access to either placebo control videos focused on an orientation to IVF or experimental videos that reviewed the preparation and administration of medications used during ovarian stimulation in addition to the placebo videos. Participants completed pre and post-treatment questionnaires. 368 patients enrolled and 257 participants completed the study. There were no differences in ISES, FertiQoL-T or PSS scores between the two groups in an intention-to-treat (p = 0.18, 0.72, and 0.92, respectively) or per-protocol analysis (p = 0.11, 0.38, and 0.37, respectively). In the per protocol analysis, participants who watched experimental videos were four-fold more likely to report confidence administering medications OR 4.70 (95% CI: 2.10, 11.1; p < 0.01) and were 63% less likely to make medication errors OR 0.37 (95% CI: 0.14, 0.90; p = 0.03). Participants had similar likelihoods of rating videos as helpful and recommending videos to others (p = 0.06 and 0.3, respectively). Educational videos about fertility medications may not influence psychological well-being but might improve confidence in medication administration and reduce medication errors. Trial registration number: NCT02979990.

Psychological effect of COVID-19 pandemic among women undergoing infertility care, a French cohort - PsyCovART Psychological effect of COVID-19: PsyCovART

Purpose: To assess psychological state of women who experienced postponement of ART care during the first COVID-19 wave in a French public ward of reproductive medicine.

Methods: An online anonymous survey was emailed between July and August 2020 to all women whose infertility care, including the first consultation for infertility, have been delayed at the beginning of the COVID-19 pandemic. Anxiety, depression, and stress were assessed using Hospital Anxiety and Depression Scale (HADS) and Perceived Stress Scale (PSS-10). Feelings about COVID-19 outbreak, lockdown and suspension of fertility care were assessed by Multiple-Choice Questions and Visual Analog Scales.

Results: 435 women answered to the survey (response rate 34.6%). Mean levels of the HADS-A (anxiety), HADS-D (depression) and PSS10 were respectively 7.58(±3.85), 4.51(±3.48), and 27(±6.75). Prevalence of stress was 50.8% and almost half of women presented clear or suggestive anxiety symptoms (respectively 21.6% and 25.7%). Stress and anxiety rates were much higher than those expected in infertile population. Increased stress was observed in women above 35 years and those stopped ‘in cycle’ or during pre-treatment for in-vitro fertilization or frozen embryo transfer. Patient with history of depression or anxiety had a higher prevalence of perceived stress (p = 0.0006). Postponement was perceived as ‘unbearable’ for women experiencing stress (p = 0.0032). After the first wave of pandemic, pregnancy desire remained the same and 84.3% of women wanted to resume fertility care as soon as possible.

Conclusion: Stopping fertility care during the COVID-19 pandemic had a significant psychological impact on women with an increase of stress, and anxiety. Psychological counseling should always be offered especially during this difficult period.

Self-efficacy, coping strategies and quality of life in women and men requiring assisted reproductive technology treatments for anatomical or non-anatomical infertility

OBJECTIVE

To examine the magnitude and the predictors of emotional reactions to an infertility diagnosis, comparing women and men who were clinically diagnosed with an anatomical cause of infertility or non-anatomical cause of infertility.

STUDY DESIGN

Cross-sectional study involving a total of 133 adults waiting for infertility treatment at the IVF and Infertility Unit of the S. Orsola University Hospital in Bologna (Italy). Of these, 107 patients (55 with anatomical causes of infertility and 52 with non-anatomical causes of infertility; response rate: 80%) took part to the study. After providing informed written consent, each participant was asked to complete the Infertility Self-efficacy Scale, the Fertility Quality of Life, and the Brief Coping Orientation to Problem Experienced, which they returned at their second access to the Unit. Differences between the groups were analyzed through a series of univariate ANOVA, whereas a multiple regression analysis was used to jointly examine the predictors of fertility quality of life.

RESULTS

Results showed both gender related and diagnosis related differences. Women had statistically significant lower scores than men on the Infertility Self-Efficacy Scale and on the global, emotional, and mind-body subscales of the Fertility Quality of Life, while they scored significantly higher on the emotion focused and socially supported subscales of the Coping Orientation to Problem Experienced. Independently of gender, patients with non-anatomical causes of infertility scored poorly than patients with anatomical causes of infertility on the relational subscale of the Fertility Quality of Life and on the Avoidant scale of the Brief Coping Orientation to Problem Experienced. Hierarchical multiple regression analyses revealed that higher levels of self-efficacy and a lower use of avoidant coping strategies predicted a more positive quality of life over and above gender and cause of infertility.

CONCLUSION

This study partly confirms data on gender differences in experiencing the psychological burden of infertility and adds some new information, particularly with respect to the prediction of quality of life indicators over and above infertility cause.

Gender Differences in Self-Efficacy, Resilience, and Social Support among Infertile Iranian Couples: A Dyadic Approach

The article's abstract is not available.  

Perceived Social Support and Life Satisfaction in Infertile Women Undergoing Treatment: A Moderated Mediation Model

Perceived social support is positively related to life satisfaction in infertile women. Whereas, the underlying mechanism of this relationship is unclear. The present study aimed to investigate whether self-compassion mediated the relationship of perceived social support with life satisfaction and whether infertility self-efficacy moderated the relationship between perceived social support and self-compassion in infertile women. A total of 290 infertile women in mainland China undergoing treatment completed an online survey assessing perceived social support, life satisfaction, self-compassion, and infertility self-efficacy. The results supported the mediation model that perceived social support was associated with life satisfaction via self-compassion. Besides, infertility self-efficacy moderated the relationship between perceived social support and self-compassion. Specifically, perceived social support displayed a stronger predictive effect on self-compassion when infertile women had higher level of infertility self-efficacy.

Infertility Related Quality of Life and Self-Efficacy among Infertile Couples: A Dyadic Approach

The article's abstract is not available.  

Social support, self-efficacy, cognitive coping and psychological distress in infertile women

PURPOSE

The aims of this research were to investigate the relationship of social support, self-efficacy and cognitive coping with psychological distress, as well as, to determine the mediating role of self-efficacy and cognitive coping between social support and psychological distress in infertile women of Pakistan.

METHODS

This cross-sectional study was conducted to recruit 158 infertile women from six hospitals of Lahore, Pakistan. A demographic questionnaire, multidimensional scale of perceived social support, infertility self-efficacy scale, coping strategies questionnaire and depression anxiety stress scale were used to assess the study variables.

RESULTS

The results found that significant other, family and friends support was negatively associated with depression, anxiety and stress, however, no relationship was found between friends support and anxiety. Self-efficacy and active-practical coping had negative, whereas, avoidance-focused coping had positive relationship with depression, anxiety and stress. Active-distractive coping was negatively and religious-focused coping was positively associated with depression. Mediation analyses revealed that self-efficacy mediated the effect of social support on depression, anxiety and stress, but no mediation was found between friends support and anxiety. Moreover, avoidance-focused coping mediated the link between social support and depression, as well as, between significant other support and anxiety.

CONCLUSION

Social support, self-efficacy, active-practical coping and active-distractive coping had significant negative associations with psychological distress. Hence, structured programs should be developed to enhance societal acceptance and to reduce the negative attitude of people towards infertility.

The Effect of Nursing Consultation Based on Orem's Theory of Self-care and Bandura's Concept on Infertility Stress

INTRODUCTION

Infertility is one of the most stressful experiences in a couple's life. Several approaches have been proposed to manage infertility stress during the medically assisted technology process.

OBJECTIVE

The objective was to examine the effect of nursing consultation on the stress experienced by infertile couples before starting infertility treatment.

MATERIALS AND METHODS

This cross-sectional study was conducted from November 2017 to November 2018 among 120 infertile couples (240 patients) for whom stress was assessed. One hundred and thirteen patients of them who had a high infertility stress level were invited to participate in this randomized study (57 were assigned to the control group and 56 were included in the intervention group). The intervention group received nursing consultation based on Orem's theory and Bandura's concept in addition to the routine nursing care. Perceived Stress Scale-10 (PSS-10) and General Self-Efficacy Scale (GSES) were used before and after nursing intervention.

STATISTICAL ANALYSIS

The Chi-square test followed by a paired t-test and independent t-test was used for data analysis by SPSS software (version 20).

RESULTS AND DISCUSSION

There were no statistically significant differences before nursing intervention between the two groups in terms of PSS-10 (t = 1.18, P = 0.23) and GSES (t = -0.40, P = 0.689) scores, but a significant difference emerged in the intervention group following the nursing intervention: a reduction of the PSS score (t = -8.91, P = 0.000) and an increase in the GSES score (t = -5.25, P = 0.000, with 95% confidence interval (CI)).

CONCLUSION

Nursing consultation has been shown to be beneficial in decreasing perceived stress and increased self-efficacy for infertile couples undergoing assisted reproductive technologies.

The high-risk human papillomavirus continuum along the female reproductive tract and its relationship to infertility and endometriosis

RESEARCH QUESTION

Is there an association between the presence of sexually transmitted pathogens in the lower (LGT) and upper (UGT) female genital tract with endometriosis and infertility?

DESIGN

Case-control study with 60 women submitted to gynaecological laparoscopic surgery. Samples from the UGT and LGT were collected and analysed by single polymerase chain reaction (PCR) for human papillomavirus (HPV) and by multiplex PCR for other sexually transmitted infections (STI). Patients were initially divided into two clinical groups: infertile patients (n = 25) with conjugal infertility and fertile control patients (n = 35). After the surgical findings patients were further divided for additional analysis: an endometriosis group (n = 29) and non-endometriosis control group (n = 31).

RESULTS

Sixty per cent of patients were positive for DNA-HPV in some of the genital tract sites sampled. Infertile patients were associated with high-risk HPV (hrHPV) positivity in the UGT sites (P = 0.027). The endometriosis group was associated with hrHPV positivity in the LGT and UGT sites (P = 0.0002 and P = 0.03, respectively). Only hrHPV types were detected in the UGT in both groups. It may be that there is a hrHPV infection continuum, from LGT to UGT, in infertile and endometriosis patients. No association was observed among the other seven STI studied.

CONCLUSIONS

This study shows both an association between hrHPV infections in the UGT with infertility and endometriosis, and a possible hrHPV infection continuum, from LGT to UGT. Larger studies are needed to fully investigate the role of hrHPV as a cause of endometriosis and infertility.

Evaluation of Factors Associated with Sexual Function in Infertile Women

Background

Infertility is a major and problem influencing different aspects of couples life, especially those of women. Sexual dysfunction is the silent partner of infertility. This study aimed to identify the above-mentioned factors to make necessary decisions and perform efficient interventions to improve the sexual health of infertile women. This study investigated the factors influencing sexual dysfunction in infertile women in Mashhad, Iran.

Materials and Methods

This cross-sectional study was conducted on 85 infertile women visiting governmental Infertility Clinic and Research Center in Mashhad, Iran. The convenience sampling method was used in this study. The research tools included a demographic and infertility information form, a sexual self-efficacy questionnaire based on Schwarzer’s General Self-Efficacy Scale, Female Sexual Function Index (FSFI), and Evaluation and Nurturing Relationship Issues, Communication, and Happiness (ENRICH) Marital Satisfaction Scale. The descriptive statistical tests and logistic regression method were used to analyze data.

Results

The mean age of women was 31.18 ± 5.56 years old. The majority of participants (36.7%) had higher educa- tions, and 60% of them were housewives. Most of their husbands (49.4%) were self-employed. The mean period of infertility awareness was 6.02 ± 4.47 years, and the mean period of infertility treatment was 4.11 ± 4.46 years. The following variables influenced the sexual function of infertile women: sexual self-efficacy, sexual satisfaction, marital satisfaction, the educational level of both wife and husband, income, satisfaction with spouse appearance, and the high costs of infertility treatment.

Conclusion

The findings indicated that some factors such as sexual self-efficacy, marital satisfaction, sexual satisfac- tion, education, and cost of infertility treatment are associated with sexual function in infertile women.

Sleep in women undergoing in vitro fertilization: a pilot study

OBJECTIVE

Sleep disturbances are thought to be frequent in women undergoing IVF despite minimal research of this hypothesis. Our goal was to longitudinally assess sleep duration and disturbances in women undergoing IVF and assess impact of habitual sleep duration on oocytes retrieved, an important outcome in IVF.

METHODS

Actigraphy and questionnaire batteries containing sleep and psychometric instruments were performed prior to and throughout 24 IVF cycles.

RESULTS

TST <7 h was present in 46%, 57%, 69%, and 42% of baseline, stimulation, post-oocyte retrieval, and post-embryo transfer recordings. ESS >10 was noted in 24%, 33%, and 36% of cycles during baseline, stimulation, and post-embryo transfer. PSQI >5 was noted in 57%, 43%, and 29% of cycles during baseline, stimulation, and post-embryo transfer. TST (F = 2.95, p = 0.04) and ESS (F = 4.36, p = 0.02) were the only sleep metrics in which a significant main effect of time was found by mixed models analysis. The final linear regression model chosen by stepwise selection to best explain the variability in oocytes retrieved included anti-mullerian hormone, day three follicle stimulating hormone, and baseline TST and explained 40% of the variance in oocytes retrieved (adjusted R² = 0.40, p = 0.03). Although not statistically significant, a trend towards a linear association between baseline TST and oocytes retrieved was seen with an increase of oocytes retrieved by 1.5 for every hour increase in TST (p = 0.09).

CONCLUSIONS

This is the first study to describe, with subjective and objective measures, sleep disturbances present throughout the IVF cycle. Importantly, a trend towards a linear relationship between TST and oocytes retrieved was found in this pilot study. Sleep may be a modifiable target to improve outcomes in women undergoing IVF and further investigations are needed.

A Review of Supportive Interventions Targeting Individuals or Couples Undergoing Infertility Treatment: Directions for the Development of Interventions

The purpose of this systematic review is to explore the types, content, and outcomes of different psychosocial approaches used in existing interventions for infertile individuals or couples. Relevant intervention studies published in English between 2000 and 2014 were searched using the electronic databases MEDLINE, PsycINFO, and CINHAL Plus. A total of 23 articles were identified and included in this review. Cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), and counseling were the most commonly adopted psychosocial interventions for infertile individuals or couples. After reviewing the various approaches, directions are given on the development of interventions for couples suffering from infertility.

Assessing infertility-related stress: the factor structure of the Fertility Problem Inventory in Italian couples undergoing infertility treatment

The factor structure of the Fertility Problem Inventory (FPI) and its invariance across gender were examined in Italian couples undergoing infertility treatment. About 1000 subjects (both partners of 500 couples) completed two questionnaires prior to commencing infertility treatment at a private Clinic in Palermo, Italy. Confirmatory Factor Analysis demonstrated that the original factor structure of the FPI was partially confirmed. Two correlated factors (Infertility Life Domains and Importance of Parenthood) were obtained via a post hoc Exploratory Factor Analysis. Finally, the invariance of this factor structure across gender was confirmed. The study supported the relevance of two interrelated factors specific to infertility stress which could help clinicians to focus on the core infertility-related stress domains of infertile couples.

A Model of Clinical Intervention in the Maternity Ward: The Breastfeeding and Bonding EMDR Protocol

Breastfeeding is one of the main manifestations of the bond that a mother builds with her newborn baby. Literature on psychological support for mothers in the early stages of breastfeeding is limited and interventions often do not pinpoint the actual roots of the difficulties. Breastfeeding difficulties may cause emotional distress to women and this can impact significantly on bonding and the perinatal period may turn into a state of crisis. Therefore, it is essential for the clinical psychologist to intervene selectively and in a prompt, effective way, especially when working in a maternity ward. This article suggests a model of intervention: the Breastfeeding and Bonding EMDR Protocol. This protocol, created ad hoc for breastfeeding, combines the work with eye movement desensitization and reprocessing (EMDR) on recent events, the standard protocol and the installation of resources. The hospital case study presented here thoroughly illustrates the various stages of the protocol and the peculiarity and functionality of EMDR regarding breastfeeding and bonding issues in the immediate postpartum period. Prevention is the paramount subject of the model of clinical intervention on breastfeeding hereafter presented.

Development and validation of an Infertility Stigma Scale for Chinese women

OBJECTIVE

To develop and validate a scale of stigma for infertile Chinese women.

METHOD(S)

Infertile women admitted to the Xiangya Hospital, the Second Xiangya Hospital, and the Third Xiangya Hospital of Central South University for treatment were approached to participate in this study. The Infertility Stigma Scale (ISS) development involved: [1] item generation based on literature, interview (experts/patients: N=5/N=20) and related scale; [2] pre-test questionnaire formation with both experts' ratings (N=9) and infertile women's feedbacks (N=30); [3] the component structure assessed by principal components analysis with varimax rotation (N=334); [4] convergent validity assessed with Social Support Rating scale, Self-Esteem scale, Family APGAR Index (N=334); and [5] reliability identified by internal consistency Cronbach's α (N=334), split-half reliability (N=334), test-retest reliability (N=20).

RESULT(S)

This study yielded a 27-item ISS with 4 factors (self-devaluation, social withdrawal, public stigma, and family stigma). Exploratory factor analysis indicated that these 4 factors accounted for 58.17% of total variances. The Cronbach's α, split-half coefficient and test-retest correlation coefficient for the whole scale was 0.94, 0.90, and 0.91, respectively. The associations of the ISS with other measures suggested good convergent validity. The Content Validity Index (CVI) was 0.92.

CONCLUSION(S)

The ISS appears to be a reliable and valid measure to assess levels of stigma experienced by infertile Chinese women. It may be a useful tool to help identify infertile women at greater risks of distress.

Evolution of psychology and counseling in infertility

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

Resilience and social support promote posttraumatic growth of women with infertility: the mediating role of positive coping

According to previous research, clinical experience with individuals facing infertility has demonstrated that positive psychological changes can arise from the struggle involved (Paul et al., 2010), which is called posttraumatic growth (PTG). However, little knowledge has been gained about the relationships between PTG and its facilitating factors. The present study examined whether resilience and social support could predict PTG in women with infertility. The role of positive coping as a potential mediator was also assessed. Using a cross-sectional design, all members of a convenience sample of 182 women with infertility completed self-report measures of PTG, resilience, perceived social support, positive coping and background information. It was found that resilience, social support and positive coping positively correlated with PTG, which explained 34.0% of the total variance. The results suggested that positive coping partially mediated the impact of resilience on PTG while it totally mediated the relationship between social support and PTG. These findings demonstrated that, in clinical settings, improving positive coping in women with infertility may be helpful for the attainment of PTG.

A Meta-Synthesis of Health-Related Self-Efficacy Instrumentation: Problems and Suggestions

Background and Purpose: Self-efficacy, a central construct in health interventions, has been measured in various contexts. The absence of any published meta-review of self-efficacy instrumentation led to the current meta-synthesis that reports and evaluates the instrumentation processes. Methods: A systematic search resulted in 39 self-efficacy instrumentation studies, which were evaluated for the aspects of conceptual bases, health contexts, operational definition, instrumentation procedures, reliability and scale length, and item content. Results: Primarily based in Bandura’s social cognitive theory, these studies reported self-efficacy instrumentation for developing new scales and modifying/validating measures for illness management, healthy behavior adoption/maintenance, disease/risk prevention, and aging management. Trait-like, specific-domain, and situation approaches were used for generating item content. Problems in some studies include non-efficacy items, a lack of systematic instrumentation procedures, item content too general for specific-domain self-efficacy, and measurement inefficiency. Conclusions: The piecemeal fashion of self-efficacy instrumentation has resulted in incomparable self-efficacy measures of similar domains of health functioning. A trans-domain framework, thus, is warranted. Suggestions are provided for solving other problems in self-efficacy instrumentation.

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

AIMS

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

BACKGROUND

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

DESIGN

A randomized controlled trial.

METHODS

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

RESULTS

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

CONCLUSION

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

Cultural Validation of the Turkish Version of the Infertility Self-Efficacy Scale–Short Form (TISE-SF)

Purpose: To translate and test the psychometric properties of the Turkish version of the Infertility Self-Efficacy Scale–Short Form (TISE-SF). Methods: The convenience sample consisted of 120 infertile women. A psychometric research design was used with content and construct validity and reliability. Results: Cronbach’s alpha of .78 showed moderate reliability, whereas item–total correlations ranged from .30 to .54. Factor analysis extracted a single component, explaining 40.3% of the variance. Kendall W showed agreement with each expert regarding the appropriateness of the items, confirming the content validity of the translated TISE-SF. Conclusion: The results supported the construct validity and reliability of the TISE-SF for measuring infertility self-efficacy in a population of Turkish women. Implications: Evaluating infertile women’s perception of self-efficacy with the TISE-SF may be useful in clinical studies in Turkey. TISE-SF can be used by professionals as a counseling tool to help guide women in managing their treatments at infertility centers.

Stress and anxiety scores in first and repeat IVF cycles: a pilot study

Background

The role of stress in reproduction, particularly during treatment for infertility, has been of considerable interest; however, few studies have objectively measured stress and anxiety over the course of the IVF cycle or compared the experience of first-time and repeat patients.

Methods

This prospective cohort pilot study enrolled 44 women undergoing IVF at a university-based clinic to complete the State-Trait Anxiety Inventory (STAI), Perceived Stress Scale (PSS) and Infertility Self-Efficacy Scale (ISES) at three time points prior to ovarian stimulation (T1), one day prior to oocyte retrieval (T2), and 5–7 days post embryo transfer (T3).

Results

Mean STAI State scores were significantly elevated at all three time points (p<0.01). STAI State and PSS mean values did not change over time and did not differ in first-time vs. repeat patients. Self-efficacy (ISES) scores declined over time, with a greater decline for repeat patients. Of the 36 women who completed a cycle, 15 achieved clinical pregnancy. Using logistic regression modeling, all scores at T2 were correlated with pregnancy outcome with lower scores on the STAI State and PSS and higher scores on the ISES associated with higher pregnancy rates.

Conclusions

Stress and anxiety levels remained elevated across all cycles. Women with lower stress and anxiety levels on the day prior to oocyte retrieval had a higher pregnancy rate. These results emphasize the need to investigate stress reduction modalities throughout the IVF cycle.

Acupuncture to improve live birth rates for women undergoing in vitro fertilization: a protocol for a randomized controlled trial

BACKGROUND

IVF is a costly treatment option for women, their partners, and the public. Therefore new therapies that improve reproductive and health outcomes are highly desirable. There is a growing body of research evaluating the effect of acupuncture administered during IVF, and specifically on the day of embryo transfer (ET). Many trials are heterogeneous and results inconsistent. There remains insufficient evidence to determine if acupuncture can enhance live birth rates when used as an adjunct to IVF treatment.The study will determine the clinical effectiveness of acupuncture with improving the proportion of women undergoing IVF having live births. Other objectives include: determination of the cost effectiveness of IVF with acupuncture; and examination of the personal and social context of acupuncture in IVF patients, and examining the reasons why the acupuncture may or may not have worked.

METHODS

We will conduct a randomized controlled trial of acupuncture compared to placebo acupuncture.Inclusion criteria include: women aged less than 43 years; undergoing a fresh IVF or ICSI cycle; and restricted to women with the potential for a lower live birth rate defined as two or more previous unsuccessful ETs; and unsuccessful clinical pregnancies of quality embryos deemed by the embryologist to have been suitable for freezing by standard criteria. Women will be randomized to acupuncture or placebo acupuncture. Treatment is administered on days 6 to 8 of the stimulated cycle and two treatments on the day of ET. A non-randomized cohort of women not using acupuncture will be recruited to the study. The primary study outcome is the proportion of women reporting a live birth. Secondary outcomes include the proportion of women reporting a clinical pregnancy miscarriage prior to 12 weeks, quality of life, and self-efficacy. The sample size of the study is 1,168 women, with the aim of detecting a 7% difference in live births between groups (P = 0.05, 80% power).

DISCUSSION

There remains a need for further research to add significant new knowledge to defining the exact role of certain acupuncture protocols in the management of infertility requiring IVF from a clinical and cost-effectiveness perspective.

CLINICAL TRIAL REGISTRATION

Australian and New Zealand Clinical Trial Registry ACTRN12611000226909.

Protective emotional regulation processes towards adjustment in infertile patients

Little is known about emotional regulation processes of psychological flexibility/acceptance, self-compassion, and coping styles in infertility and the way they may exert a protective function towards depression. The aim of the current study was to explore how these emotion regulation processes are related to depression and to the sense of self-efficacy to deal with infertility in infertile patients. Gender differences were also considered. One hundred couples without known fertility problems and 100 couples with an infertility diagnosis completed the instruments: Beck Depression Inventory, Coping Styles Questionnaire, Acceptance and Action Questionnaire, Self-Compassion Scale and Infertility Self-efficacy Scale. Infertile couples presented statistically significantly higher scores on depression and lower scores in psychological flexibility/acceptance and self-compassion than the control group. This pattern was particularly identified in women who also tended to use less an emotional/detached coping style and to perceive themselves as less confident to deal with infertility than men. Multiple regression analysis showed that psychological flexibility/acceptance was a significant predictor of depressive symptoms in men and women with infertility. Emotional regulation processes, such as psychological flexibility/acceptance and self-compassion, seem to be relevant to the understanding of depressive symptoms and psychological adjustment to infertility, suggesting that these issues should be addressed in a therapeutic context with these couples.

Tackling burden in ART: an integrated approach for medical staff

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

Testing the psychometric properties of Mandarin version of the fertility problem inventory (M-FPI) in an infertile Chinese sample

The Fertility Problem Inventory (FPI) is an instrument to measure infertility-related stress, and has been widely used in a range of clinical settings. It has been translated into several languages, however there is no validated Mandarin version. The present study tests the psychometric properties of the Mandarin version of FPI (M-FPI). A hospital sample of 223 infertile Chinese couples (223 men and 223 women) completed the M-FPI along with other measures including demographics, Hospital Anxiety and Depression Scale, and Marlowe-Crowne Social Desirability Scale, which were used to assess the reliability and validity of the Mandarin version of FPI. Results showed that the M-FPI was best reduced to a five? factor solution, and all 46 items of the M-FPI showed moderate to high internal consistency. In addition, the test of convergent and discriminant validity from this study indicated satisfactory results. These results indicate that the M-FPI as an instrument is reliable and valid for use with infertile Chinese couples in clinical assessment.

Development and validation of the stressful life event questionnaire

OBJECTIVES

This study evaluates the development of the stressful life event (SLE) questionnaire and tests the validity and reliability of it.

METHOD

In total, 3,951 adults aged over 18 years completed the SLE questionnaire. The General Health Questionnaire (GHQ-12) was used to further validate the SLE questionnaire.

RESULTS

Eleven domains, including home life, financial problems, social relation, personal conflict, job conflict, educational concerns, job security, loss and separation, sexual life, daily life, and health concerns were obtained by factor analysis. Correlation coefficient was moderately significant among domains of the SLE questionnaire and moderately between the SLE questionnaire and GHQ-12 score, as well. The results of the discriminate validity analysis were promising. In addition, standardized Cronbach'-α was 92%.

CONCLUSION

The resultant SLE questionnaire is, therefore, suggested to be potential for the stress measurement in both community and primary care setting.

Psychometric properties and factor structure of the Fertility Problem Inventory in a sample of infertile women undergoing fertility treatment

OBJECTIVE

to examine the psychometric properties of the Fertility Problem Inventory (FPI) originally developed by Newton et al. (1999); as there are no data concerning the factorial structure of the FPI, a special focus is placed on construct validity through factor analysis.

SETTING

public hospital in Athens, Greece.

DESIGN

a cross-sectional study.

PARTICIPANTS

108 women undergoing fertility treatment with in-vitro fertilisation.

METHODS

the FPI was 'forward-backward' translated from English to Greek. The translated instrument was then administered to a set of infertile women for pilot testing. Principal axis factoring with promax rotation was used to test the factor structure of the FPI. Measures of anxiety State Trait Anxiety Inventory, depression (Center for Epidemiologic Studies--Depression Scale) and mood states Profile of Mood States were used to assess the convergent validity of the FPI. Cronbach's α was used to measure internal consistency of the FPI scales.

FINDINGS

exploratory factor analysis suggested four factors. The majority of relationship and sexual concern items grouped into one solid factor, named 'spousal concern'. The original scales of social concern, need for parenthood and rejection of childfree lifestyle were reproduced after rearranging nine cross-loading items. Construct validity was confirmed by computing correlations between the derived FPI scales and conceptually similar constructions of anxiety, depression and mood states. Internal consistency reliability was satisfactory.

CONCLUSION

the FPI was found to have a relatively stable factor structure and satisfactory reliability, and convergent and discriminant validity. The FPI may enable researchers and clinicians to apply a reliable measure that focuses on various/many dimensions of infertility-related stress.

Online psychoeducational support for infertile women: a randomized controlled trial

BACKGROUND

The study goal was to develop and test the effectiveness of a brief online education and support program for female infertility patients.

METHODS

A randomized-controlled trial was conducted. Using a Solomon-four group design, 190 female patients were recruited from three US fertility centers and were randomized into two experimental and two no-treatment control groups. The psychological outcomes assessed included infertility distress, infertility self-efficacy, decisional conflict, marital cohesion and coping style. Program dosage and satisfaction were also assessed at four weeks follow-up.

RESULTS

Women exposed to the online program significantly improved in the area of social concerns (P = 0.038) related to infertility distress, and felt more informed about a medical decision with which they were contending (P = 0.037). Trends were observed for decreased global stress(P = 0.10), sexual concerns (P = 0.059), distress related to child-free living (P = 0.063), increased infertility self-efficacy (P = 0.067) and decision making clarity (P = 0.079). A dosage response was observed in the experimental groups for women who spent >60 min online for decreased global stress (P = 0.028) and increased self efficacy (P = 0.024).

CONCLUSIONS

This evidence-based eHealth program for women experiencing infertility suggests that a web-based patient education intervention can have beneficial effects in several psychological domains and may be a cost effective resource for fertility practices.

Psychosocial aspects of andrologic disease

This article reviews the research relating to the psychosocial aspects of andrologic disease, focusing on infertility, hypospadias, and erectile dysfunction because these diseases draw out the key areas of psychosocial interest. This is the case with the development of men who have andrologic disease and the problems they face developing relationships. Psychosocial issues are often about the perceptions that men and women have regarding androgenic disorders rather than the disorder itself. Psychological problems include anxiety, depression, and social phobias. In more serious cases, psychological problems can affect masculinity, selfhood, and identity. Clinical psychologists and other psychotherapists can offer some assistance regarding these perceptions, but where there are problems relating to personality and coping styles, these may be more difficult to overcome. More research is required to understand the specific psychosocial consequences of androgenic disorders.