Evolution of psychology and counseling in infertility

Business case for psychosocial interventions in clinics: potential for decrease in treatment discontinuation and costs

RESEARCH QUESTION

From a value-based healthcare (VBHC) perspective, does an assessment of clinical outcomes and intervention costs indicate that providing cognitive behavioural therapy (CBT) or mindfulness to women seeking fertility treatment add value compared with no such intervention?

DESIGN

Proof-of-concept business case based on a VBHC perspective that considers clinical outcomes and costs. Potential effects on psychological and fertility outcomes were based on existing research. Cost outcomes were estimated with a costing model for the Dutch fertility treatment setting.

RESULTS

Thirty-two studies were identified; 13 were included. Women who received CBT had 12% lower anxiety, 40% lower depression and 6% higher fertility quality of life; difference in clinical pregnancy rates was six percentage points (CBT [30.2%]; control [24.2%]); difference in fertility discontinuation rates was 10 percentage points (CBT [5.5%]; control [15.2%]). Women who received training in mindfulness had 8% lower anxiety, 45% lower depression and 21% higher fertility quality of life; difference in mean clinical pregnancy rate was 19 percentage points (mindfulness [44.8%]; control [26.0%]). Potential total cost savings was about €1.2 million per year if CBT was provided and €11 million if mindfulness was provided. Corresponding return on investment for CBT was 30.7%, and for mindfulness 288%. Potential cost benefits are influenced by the assumed clinical pregnancy rates; such data related to mindfulness were limited to one study.

CONCLUSIONS

The provision of CBT or mindfulness to women seeking fertility treatment could add value. Higher quality primary studies are needed on the effect of mindfulness on clinical pregnancy rates.

A Cross-Sectional Study of Mental Illnesses Among Infertile Women in Saudi Arabia

BACKGROUND

Infertility is a global issue and carries significant mental health implications. Data on mental health among infertile women in Saudi Arabia are limited.

OBJECTIVE

This study aimed to assess the prevalence and severity of depression, anxiety, and stress among infertile women in Saudi Arabia.

METHODS

This analytical cross-sectional study included women of reproductive age visiting governmental hospitals in Jeddah, Saudi Arabia. The participants were asked to fill out a pre-structured questionnaire, which included the Depression, Anxiety, and Stress Scale (DASS-21) to assess their mental health status. Data analysis was conducted using IBM SPSS Statistics, Version 29.0 (released 2023, IBM Corp., Armonk, NY). The three outcome variables derived from the DASS-21 were categorized into five distinct groups for descriptive purposes.

RESULTS

In this study, infertile women had significantly higher median scores for depression (18), anxiety (15), and stress (20) compared to fertile women who had median scores of 8, 8, and 10 for depression, anxiety, and stress, respectively. The differences between these two groups were statistically significant (p-value < 0.001). Furthermore, employed infertile women reported higher median scores for depression (87), anxiety (84.5), and stress (84.5) compared to unemployed women. In addition, infertile women with a monthly income of 10,001-20,000 SAR had notably higher median scores for depression (89.56), anxiety (90.22), and stress (89.94) compared to other income groups. These differences were statistically significant (p-values < 0.05).

CONCLUSION

Infertility significantly contributes to mental health issues among women in Saudi Arabia. The findings highlight the need for targeted psychological interventions alongside infertility treatment to enhance the quality of life of these women.

Adherence to dietary recommendations mediates the effect of affective temperaments on infertility treatment outcomes

Affective temperaments have been shown to robustly affect infertility treatment success. However, identification of possible mediating factors through which they exert their influence is still lacking. A growing number of results suggest that adherence to recommended treatments may be such a mediator, on the one hand, because affective temperaments are known to influence adherence and, on the other hand, because non-adherence negatively influences the treatment outcome. Recommended treatment of infertility involves, beyond medications, dietary and lifestyle changes. The aim of this retrospective cohort study was to evaluate whether adherence to physician-prescribed diet and physical activity recommendations mediates the effect of affective temperaments on infertility treatment outcomes. Among 308 women who underwent infertility treatment in an Assisted Reproduction Center, affective temperaments, adherence to diet, adherence to physical exercise, and infertility treatment success (clinical pregnancy) were assessed besides detailed medical history and demographic parameters. Associations between affective temperaments, adherence to diet and recommended physical activity, and assisted reproduction outcomes were analyzed using generalized linear models and causal mediation analysis. Adherence to physical activity didn't have an effect, but diet adherence increased the odds of infertility treatment success by 130% suggesting its role as a potential mediator. Based on causal mediation analysis, higher depressive and anxious temperament scores were directly associated with 63% and 45% lower odds of achieving clinical pregnancy, respectively, with effects not mediated by diet adherence. Higher irritable temperament scores indirectly decreased the odds of achieving clinical pregnancy by 14%, mediated by diet adherence; while higher cyclothymic temperament scores decreased the odds of achieving clinical pregnancy both directly by 51% and indirectly, mediated by diet adherence by 11%. Our results suggest that diet adherence mediates the mechanism by which irritable and cyclothymic affective temperaments influence IVF treatment success. Since adherence is a modifiable risk factor of infertility treatment success, screening for affective temperaments may help to identify potentially high-risk non-adherent patient groups and offer patient-tailored treatment, which may help increase the chances of a successful pregnancy and live birth in women undergoing IVF treatment.

Consulting patients and providers of assisted reproductive technologies to inform the development of a group psychological intervention for women with infertility

Objective

To consult providers and women patients of Assisted Reproductive Technologies regarding their preferences for the format, duration and content in the development of a group psychological intervention.

Methods

Providers and current and past women patients of Assisted Reproductive Technologies completed an online cross-sectional survey comprising items about session content, number, frequency, timing, format, delivery mode and inclusion of experiential practice of psychological strategies to promote well-being.

Results

Eight providers, 51 current women patients and 51 women who previously underwent Assisted Reproductive Technologies participated. Sixty-two percent of participants indicated a group psychological program would be helpful; and 34% thought it may be helpful. Face-to-face was the preferred delivery mode (42%). Seventy-one percent preferred 60-min sessions held fortnightly (64%), with six sessions most acceptable (24%). Most respondents (74%) felt group participants would likely complete at-home practice. Detailed thematic content from participants highlighted a complex range of consumer challenges. Relevant behaviour change techniques were verified, with those to be included identified as: feedback and monitoring, regulation, self belief, reward and threat, natural consequences, identity, support, shaping knowledge, and comparison of outcomes.

Conclusion

Providers and patients were supportive of the development of a group psychological intervention to provide support for women undergoing Assisted Reproductive Technologies.

Innovation

The results of this study provide insight informing the co-design of a group psychological program for women with infertility.

Affective temperaments show stronger association with infertility treatment success compared to somatic factors, highlighting the role of personality focused interventions

Infertility has a multifactorial background, where, besides somatic factors, psychological contributors also play a role in development and outcome. While affective temperaments have been associated with development, course, and outcome as well as treatment success in various somatic conditions, their association with infertility and its treatment has not been investigated so far. The purpose of our retrospective cohort study was to evaluate the influence of affective temperaments on fertility treatment outcomes. Among 578 women who underwent infertility treatment in an Assisted Reproduction Centre in Budapest, Hungary, treatment success, detailed medical history, and demographic parameters were recorded, and the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Auto-questionnaire (TEMPS-A) was administered. Possible predictors of assisted reproduction outcome were analyzed using multivariate logistic regression models, followed by a receiver operating curve (ROC) analysis in order to define ideal affective temperament cut-off values for clinical applicability. Aside from age, BMI, and previous miscarriage, cyclothymic scores > 4 (OR = 0.51 CI 0.35-0.74, p < 0.001), depressive scores > 9 (OR = 0.59 CI 0.4-0.87, p = 0.009) and anxious scores > 9 (OR = 0.45 CI 0.31-0.66, p < 0.001) significantly decreased the odds of clinical pregnancy by 49%, 41% and 55%, respectively. Irritable and hyperthymic temperaments, as well as other somatic and socio-economic factors had no effect on infertility treatment outcomes. The results suggest that affective temperaments may be related to the outcome of infertility treatments. Thus, screening for affective temperaments may help identify high-risk patient groups and offer patient-tailored treatment, which may increase the chances of a successful pregnancy and live birth for women undergoing IVF treatment.

Quality of life among female childhood cancer survivors with and without premature ovarian insufficiency

PURPOSE

Due to an increase in survival, a growing population of childhood cancer survivors (CCS) is present. However, female CCS are at risk of developing premature ovarian insufficiency (POI) after cancer treatment. POI involves a decreased chance of conceiving and the increased infertility state has a large impact on affected individuals' health and mental life. The objective of this study was to investigate health state and well-being among female CCS with and without POI and healthy controls (HC).

METHODS

Female CCS treated in southern Sweden between 1964 and 2008 were included. Each patient was matched with a HC. The final study population included 167 female CCS and 164 HC that were examined between October 2010 and January 2015 at the Reproductive Medicine Centre at Skåne University Hospital in Malmö, Sweden. All participants, except for two HCs, answered an EQ-5D-3L questionnaire for measuring health state including a visual analogue scale (VAS) for estimating well-being.

RESULTS

There were 22 CCS with POI, none of the HC had POI. The mean health state differed among groups (unadjusted: P = 0.002; adjusted: P = 0.007). A difference in mean experienced well-being among groups was noted (unadjusted: P = 0.003; adjusted: P = 0.012). Lowest well-being was found in the CCS group with POI (P = 0.024).

CONCLUSIONS

Female CCS have a significantly decreased health state and well-being. Female CCS with POI additionally have the lowest self-estimated well-being.

IMPLICATIONS FOR CANCER SURVIVORS

Female CCS with POI should be identified early in order to give them adequate information and support.

Counselling challenges associated with donor conception and surrogacy treatments - time for debate

Fertility counselling services have had to respond to significant developments in fertility treatments in recent years, prompting increasingly complex personal and professional ethical challenges. This Commentary focuses on those rising from donor conception and/or surrogacy. The profile of those seeking such treatments has changed to include growing numbers of same sex couples, single people, people who are transitioning or have done, people seeking posthumous use of gametes, and people using cross-border services. Alongside, awareness has grown of life-span implications, the impact of commercial DNA testing, and the need for 'later-life' support. Responses vary internationally and the time for debate is overdue. Who should provide fertility counselling and how? Should specialist qualifications, training, continuing professional development, and regulation be required? Should counsellors play a role in assessing suitability to parents? What aspects of different contractual arrangements and conflicts of interest need attention? Has the time come for counselling to be mandatory as part of pre-treatment pathways? What should be the relationship between fertility counsellors and multi-disciplinary clinic teams? How might fertility counsellors be represented nationally and internationally? What should be their relationship to 'later life' professional support? What place should professional knowledge hold in the evidence base?

Do reproductive history and information given through genetic counselling influence patients' decisions on mosaic embryo transfer?

OBJECTIVE

To assess patients' and embryonic characteristics that may have an influence on the decision to transfer a mosaic embryo.

METHOD

Single centre retrospective cohort study including 1247 PGT-A cycles. Demographic and clinical factors associated with a decision to transfer a mosaic embryo were studied. Female age, number of previous cycles, previous availability of euploid embryos, history of miscarriages and parity as well as percentage of mosaicism, type of anomaly and chromosome risk were studied in relation to decision-making. Outcomes after mosaic embryo transfer were assessed.

RESULTS

To date, in 7.9% of cycles (99/1247), patients have had to make a decision on the fate of their mosaic embryos. In 23.2% of cycles (23/99), patients decided to transfer. In most cases (79.8%; 79/99), patients underwent genetic counselling before the decision. None of the variables analysed were associated with the patients' decision, although parity and the high-degree mosaicism (>50%) seemed to be negatively associated with the decision to transfer (18.2% vs. 29.8%, p = 0.294; 10% vs. 32.2%, p = 0.052).

CONCLUSIONS

Neither reproductive history nor information on mosaic embryo characteristics through counselling seems to be determinative for patients when deciding to transfer a mosaic embryo. Promising and increasing data on clinical outcomes after mosaic embryo transfer will be of utmost importance to soften risk perception regarding mosaic embryos and give a better, simplified and more evidence-based counselling.

Enhancing interprofessional collaboration and interprofessional education in women's health

This article is from the 'To The Point' series from the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee. The purpose of this review is to provide an understanding of the differing yet complementary nature of interprofessional collaboration and interprofessional education as well as their importance to the specialty of Obstetrics and Gynecology. We provide a historical perspective of how interprofessional collaboration and interprofessional education have become key aspects of clinical and educational programs, enhancing both patient care and learner development. Opportunities to incorporate interprofessional education within women's health educational programs across organizations are suggested. This is a resource for medical educators, learners, and practicing clinicians from any field of medicine or any health-care profession.

Global Research Trends on Infertility and Psychology From the Past Two Decades: A Bibliometric and Visualized Study

Objectives

The aim of this study was to evaluate the global scientific output of research on infertility and psychology; explore the current status and trends in this field through the cooperation of authors, countries, and institutions; shed light on the direction of clinical infertility research in the future, and provide inspiration for targeted diagnosis and treatment of infertility.

Methods

Research publications on infertility and psychology from the past two decades were retrieved from the Web of Science Core Collection (WoSCC). Bibliometric analyses were performed using VOSviewer software and the bibliometrix R package. Network maps were generated to evaluate the collaborations between different authors, countries, institutions, and keywords.

Results

A total of 151 articles related to the study of infertility and psychology were identified. We observed a gradual increase in the number of publications from 2001 to 2021, and the trend has been relatively stable in the past eight years. Human Reproduction (England), as the leading journal publishing the most papers (29 articles), was cited in the most journals (1208 times). Boivin J was the most prolific author (16 articles), with the largest number of citations (890 times) and the highest h-index (14) during the past decades. Boivin J was also the leader with the highest publication frequency and more active cooperation with other top authors. The United Kingdom (34 papers) and Cardiff University (25 articles) contributed the most publications and were the leading contributors in this field. Active cooperation between countries and between institutions was observed, and analyses of articles and references were also shown. The main hot topics included matters related to women (39 times), in-vitro salt (31 times), infertility (30 times), couples (25 times), and impact (24 times).

Conclusion

Our study results provide a comprehensive overview of the development of scientific literature, allowing relevant authors and research teams to recognize the current research status in this field. At the same time, infertility and psychology may soon become hotspots and should be closely monitored.

Paramedical counselling in infertility treatment: its effects on anxio-depressive symptom severity, perceived stress and self-esteem

Aims

The importance of contributing psychological factors and stress-control in female infertility is well documented, but research on their role in male infertility is scarce. The present study aimed to evaluate the effects of a novel paramedical counselling on anxio-depressive symptom severity, perceived stress and self-esteem in infertile men participating in an infertility treatment programme.

Methods

Patients were recruited from clinics of University of Szeged, Hungary between 2019 May and 2020 December, and were sorted into control (n = 51) and experimental (n = 57) groups, where patients in the experimental group received a 5-session paramedical counselling in extension to their medical treatment. The levels of anxio-depressive symptom severity, perceived stress and self-esteem were measured prior to and after receiving paramedical counselling. The control group scored lower in regards of the severity of depressive symptom, and showed an increase of self-esteem, while the experimental group resulted in a significant decrease of anxio-depressive scores with the elevation of the level of self-esteem.

Results

Our results indicate that joining an infertility treatment programme alone had a positive role in reducing depressive symptoms and in the increase of self-esteem among infertile men, but receiving additional paramedical counselling throughout the treatment programme resulted in the decrease of anxio-depressive symptoms, besides the elevation of the level of self-esteem, with a significantly higher decrease in the state anxiety compared to not receiving this additional paramedical counselling.

Conclusions

Thus, it would be advisable for infertility treatment programmes to incorporate screening for psychological vulnerability and implement additional paramedical counselling to alleviate these confounding symptoms detrimental to conceiving.

Validation of the Portuguese Version of the Fertility Adjustment Scale

There is an urgent need to provide healthcare professionals and midwives with validated tools as to improve fertility adjustment and promote well-being of couples with infertility. The purpose of this study was to test validity of the Fertility Adjustment Scale among people undergoing assisted reproductive techniques. A cross-sectional and methodological study was conducted, and a total of 104 Portuguese adults undergoing fertility treatment were recruited through fertility-related websites. The Fertility Adjustment Scale was administered along with the Spiritual Well-Being Questionnaire and the Resilience Scale for adults as a measure of concurrent validity. Scores revealed the sample’s lack of adjustment to fertility. A significant correlation with measures of resilience provided evidence of convergent validity. There was a significant association of fertility adjustment with time of consultation and the cause of infertility. A Fertility Adjustment Scale with six items is a reliable tool that offers early recognition of patients’ difficulties in adaptation to fertility problems during assisted reproductive techniques, which could be beneficial in not only an early recognition of healthcare intervention but of a more individualized approach to such patients.

Emotional Support for Infertility Patients: Integrating Mental Health Professionals in the Fertility Care Team

Patients seeking fertility treatment are at risk of experiencing psychological distress, with both women and men reporting higher levels of depression and anxiety during infertility treatment than patients in the general population. Multiple professional societies, fertility care providers, and patients have advocated for integrating mental health providers in the treatment of infertile patients in order to provide comprehensive patient-centered care. Research with other patient populations shows that embedding mental health professionals into clinics provides the greatest benefit to patients. Despite acknowledging the importance of mental health in infertility care, professional societies, such as ASRM and ESHRE, have not universally standardized recommendations or methods for imbedding mental health providers in the fertility team. This review article aims to serve as a resource for providers and patients to appraise the available literature on the importance of embedding mental health providers into the fertility treatment team and discusses feasible methods to develop this comprehensive care team.

Development of Holistic Health Care Interventions for Women With Infertility: A Nominal Group Technique

Infertility care is often directed by a biomedical approach rather than a holistic approach, especially in African countries. This article explores the opinions of health care providers regarding holistic health care interventions in managing women with infertility in Ghana. Data were retrieved using a qualitative design and nominal group technique with a purposive sample of 12 health care providers in Ghana. Data were analyzed through thematic analysis. Health care providers explored various psychological, educational, spiritual, social, and medical interventions to ensure women diagnosed with infertility receive holistic treatment and attain optimal health.

Improving IUI success by performing modified slow-release insemination and a patient-centred approach in an insemination programme with partner semen: a prospective cohort study

Background

Pregnancy rates after in vitro fertilisation (IVF) treatment continue to improve, while intrauterine insemination (IUI) programmes show no such trend. There is a need to improve success rates with IUI to retain it as a viable option for couples who prefer avoiding IVF as a first line treatment.

Objective

To investigate if a modified slow-release insemination (SRI) increases the clinical pregnancy rate (CPR) after intrauterine insemination (IUI) with partner semen.

Materials and Methods

This was a prospective cohort study in a Belgian tertiary fertility centre. Between July 2011 and December 2018, we studied data from an ongoing prospective cohort study including 989 women undergoing 2565 IUI procedures for unexplained or mild/moderate male infertility. These data were analysed in order to study the importance of different covariates influencing IUI success. Generalised estimating equations (GEEs) were used for statistical analysis. Results of two periods (2011-2015, period 1 and 2016-2018, period 2) were examined and compared. From January 2016 (period 2) onwards, a standardised SRI procedure instead of bolus injection of sperm was applied. The primary outcome parameter was the difference in clinical pregnancy rate (CPR) per cycle between period 1 (bolus IUI) and period 2 (modified SRI). Secondary outcome results included all other parameters significantly influencing CPR after IUI.

Results

Following the application of modified SRI the CPR increased significantly, from 9.03% (period 1) to 13.52% (period 2) (p = 0.0016). Other covariates significantly influencing CPR were partner’s age, smoking/ non-smoking partner, BMI patient, ovarian stimulation protocol and Inseminating Motile Count (after semen processing).

Conclusion

The intentional application of modified slow-release of processed semen appears to significantly increase CPRs after IUI with homologous semen. Future studies should investigate whether SRI, patient-centred measures, or a combination of both, are responsible for this improvement.

Psychological Impact of Infertility. Directions for the Development of Interventions

Introduction: Infertility represents a major health problem that oftentimes is experienced as a crisis situation. Because it interposes with achieving an important life goal, that of having children, its implications on the psycho-emotional level are robust. Purpose: The present article aimed at exploring the multidimensional effects of infertility on mental health, as well as suitable psychological intervention strategies for patients both at an individual and couple level. Methodology: An extensive literature review was conducted to select the most relevant information. Articles included were searched in PubMed, Google Scholar and other similar databases within a seven years interval (2014-2021) to assure the up-to-date quality of the paper. The main criteria of inclusion were: studies about the consequences of infertility on mental health, epidemiology, risk and protective factors, psychological models for infertility, psychological evaluation, established instruments, psycho-social and therapeutic interventions, intervention protocols used in public health for infertility patients. Results and Discussion: Infertility is often experienced as a crisis situation, in which the most common consequences are visible at the level of mood disorders (e.g. anxiety, depression, marked distress) and at the social level (stigma, divorce, social isolation, financial difficulties). Psychological counseling is needed throughout medical treatment and therapeutic interventions (e.g. cognitive-behavioral therapy) have shown favorable results in managing the emotional balance of the individual/couple and reducing the risk of psychopathology. Conclusions: Research highlights the beneficial effects of psychological interventions on reducing levels of stress related to infertility, anxiety and depressive symptoms and on improving the quality of life and couple dynamics

Effects of immediate versus delayed frozen embryo transfer in high responder patients undergoing freeze-all cycles

Background

Frozen embryo transfer (FET) can greatly improve the pregnancy outcomes for high responder patients. However, it is not known whether the timing of FET is a risk factor on pregnancy outcomes in high responder patients undergoing freeze-all cycles.

Methods

A retrospective cohort study to compare the pregnancy outcomes of the immediate and delayed FET groups in high responder patients undergoing freeze-all cycles. The two groups were defined as that FET took place either within the first menstrual cycle following oocyte retrieval or afterwards. Propensity score matching was used to make the potential risk factors of the two groups comparable. Multivariable regression analysis was used to study the effect of the timing of FET on pregnancy outcomes in the entire cohort and propensity score-matched cohort, even in different controlled ovarian hyperstimulation protocol cohorts as subgroup analysis.

Results

We obtained 1130 patients in immediate FET group and 998 patients in delayed FET group, and the average age of the two groups were 30.30 and 30.63. We showed that the immediate FET group were equivalent to delayed FET group in the entire cohort [clinical pregnancy rate (CPR), 61.0% versus 63.4%, adjusted odd ratio (OR), 0.939, 95% confidence interval (CI), 0.781–1.129; spontaneous abortion rate (SAR), 10.1% versus 12.6%, adjusted OR, 0.831, 95% Cl (0.628–1.098); live birth rate (LBR), 49.9% versus 49.2%, adjusted OR, 1.056, 95% Cl (0.883–1.263)]. The same results were obtained by χ² test in the propensity score-matched cohort (CPR, 60.5% versus 63.5%; SAR, 11.6% versus 12.3%; LBR, 48% versus 49.3%) (P > 0.05). Subgroup analysis indicated that pregnancy outcomes of immediate FET were no difference to delayed FET in gonadotropin-releasing hormone agonist (GnRH-a) protocol (P > 0.05). The SAR of the immediate FET group were lower than that of the delayed FET group in GnRH antagonist protocol (adjusted OR, 0.645, 95% CI, 0.430–0.966) (P < 0.05), no differences were observed in CPR and LBR (P > 0.05).

Conclusions

The pregnancy outcomes of immediate FET were no difference to delayed FET in high responder population undergoing freeze-all cycles.

An Epistemological Perspective of Integrated Multidisciplinary Treatment When Dealing With Infertile Women With a Parenthood Goal: The Importance of Matterpsychic Perspective

This article proposes a multidisciplinary work perspective on couples who undergo assisted reproductive technology (ART) treatments, with particular attention paid to the treatment of women. The epistemological references underlying a vision of infertility and sterility that respect the psyche–soma unity of the person are illustrated: the biopsychosocial model and the psychoneuroimmunology and psychosomatic contemporary models of health and illness. Based on clinical experience in a private and institutional setting, different steps in the course of treatment are described with the related areas of psychological work: from the search for pregnancy to the choice of adhering to an ART treatment, to conception, up to delivery and beyond. The implications of the work are targeted at a better qualification of psychological interventions in this specific multidisciplinary area.

The effectiveness of a collaborative infertility counseling (CIC) on pregnancy outcome in women undergoing in vitro fertilization: a randomized trial

Background

The optimal objective of infertility treatments is to increase pregnancy rate. The aim of this study was to assess the effectiveness of a collaborative counseling program on pregnancy rate in women undergoing in vitro treatment.

Methods

This was a parallel group randomized trial on a sample of 60 women attending to an infertility research center affiliated to Mashhad University of Medical Sciences for fertility treatment. Women were randomly assigned to an intervention or a control group. Then, a five-session program offered to the intervention group while the control group received nothing expect the usual care. The primary outcome for the study was positive pregnancy test at the end of study. Statistical analyses including independent samples t-test were performed to explore the data.

Results

The outcome analysis showed that there were no significant differences in pregnancy rate between the intervention and the control groups (P = 0.298). Also, there were no significant differences in follicle and embryo numbers between two groups. However, a significant difference was observed between two groups in terms of oocyte numbers where the intervention group had more oocyte (P = 0.014).

Conclusion

Overall the findings indicated that the collaborative infertility counseling did not improve treatment success in infertile women undergoing in vitro fertilization.

Trial registration

IRCT201110267915N1. Registered 2014.07.25-Retrospectively registered (http://en.irct.ir/trial/8359).

'Luckily, I don't believe in statistics': survey of women's understanding of chance of success with futile fertility treatments

RESEARCH QUESTION

Why are women who face poor prognoses for success in assisted reproductive technology (ART) treatment choosing to pursue procedures using their own eggs, despite receiving information that their chances of success are very low.

DESIGN

Cross-sectional study based on an anonymous questionnaire distributed to women aged between 43 and 45 years, undergoing ART using their own oocytes, at six public outpatient fertility clinics and three public in-hospital IVF units in Israel between 2015 and 2016. The main outcome measure was personal estimation of chance to achieve a live birth after the current ART treatment cycle and the cumulative estimated rate after all the treatment cycles the patient intended to undergo.

RESULTS

Response rate was 70.0%, with 91 participants of mean age 43.8 ± 0.7 years. Participants estimated their delivery rates after the next ART treatment cycle at 49.0 ± 31.8% (response rate 93.4%) and their cumulative delivery rates after all the ART treatments they would undergo at 57.7 ± 36.3% (response rate 90.1%). This is significantly higher than the predicted success rates of 5% and 15%, respectively (both P < 0.001), which are based on national register data. Nearly one-half of patients rated themselves as having a better than average chance of conception (47.3%).

CONCLUSION

Women do not pursue futile treatments because they lack information. Despite being informed of the low success rates of conception using ART treatments, many patients of advanced maternal age have unrealistically high expectations from ART, essentially ignoring their estimated prognosis when deciding on treatment continuation. Future work should examine the psychological reasons behind continuing futile fertility treatments.

[Nursing needs assessment scale for women with infertility: development and validation]

Purpose

High-quality nursing care must be provided for women with infertility, and their nursing care needs must be identified. Although scales have been developed to assess infertility-related stress, quality of life, and psychosocial status, there is a lack of scales that assess the nursing care needs of women with infertility. The purpose of this study was to develop a needs assessment scale for nursing care in women with infertility and to verify its reliability and validity.

Methods

The 250 subjects in this study were women with infertility recruited from four hospitals. The scale was developed following the framework of DeVellis, through a literature review, in-depth interviews, development of preliminary items, verification of content validity, development of secondary items, verification of construct validity, and extraction of the final items. Date were analyzed using item analysis, factor analysis, confirmatory factor analysis, Pearson correlation coefficients, and Cronbach's alpha. Reliability was tested using Cronbach's alpha, and validity was evaluated using item analysis, exploratory factor analysis, and criterion validity.

Results

The final version of the nursing needs assessment scale for woman with infertility consisted of 18 items. Four factors (physical and psychological nursing needs, needs for information regarding treatment, needs for infertility-related understanding and concern, and supportive needs) explained 66.0% of the total variance. Cronbach's alpha was .92 for the overall instrument and ranged from .88 to .91 for the subscales.

Conclusion

These results suggest that this needs assessment scale for nursing care in women with infertility demonstrated acceptable validity and reliability and contained items suitable for assessing the level of nursing care needed by women with infertility.

The Risk of Psychiatric Morbidity and Course of Distress in Males Undergoing Infertility Evaluation Is Affected by Their Factor of Infertility

This panel study aimed to explore the effects of male, female, mixed or idiopathic factor of infertility on the course of clinical distress and possible psychiatric morbidity in involuntarily childless males undergoing fertility evaluation for the first time. A sample of 255 males completed the General Health Questionnaire-28 (GHQ-28) (a) at the baseline, before their initial fertility evaluation (T₁); (b) before their second andrological appointment 2-3 months after diagnostic disclosure (T₂); and (c) before subsequent treatment-related/follow-up appointments (T₃, T₄) to be screened for clinically significant distress and risk for psychiatric morbidity. Then they were dichotomized as non-cases and cases. The timing of psychological testing was strictly related to andrological appointments and medical procedures. The research demonstrated that the baseline prevalence of clinical distress and psychiatric morbidity in all the subgroups was similar to reference values, but then significantly surged after the diagnostic disclosure, particularly in male and mixed factor respondents. However, the percentage of clinically distressed mixed or idiopathic factor of infertility respondents remained stable after diagnostic disclosure and during the entire follow-up. The prevalence of clinically significant distress and risk for psychiatric morbidity in the male factor of infertility, female factor of infertility, and mixed factor subgroups decreased during the follow-up but remained higher than at the baseline. The study identifies that the course of distress and risk of psychiatric morbidity of males is significantly affected by their factor of infertility and changes across the pathway of treatment-related/follow-up appointments.

Adaptive coping strategies in male infertility, paramedical counselling as a way of support

Aims: In the last decades, the number of infertile males increased worldwide which gained more focus. The extent to which a person or a couple is able to cope adaptively with the problem of infertility depends on the combined effect of several variables. Our aim was to apply counselling among males suffering from infertility problems. During the therapy - besides providing information - we aim to elaborate the effects of the treatment and experiences, to process information, to develop adaptive coping strategies against stress and to indirectly or directly change health behaviours influencing reproduction.Methods: Only patients with male factor infertility were involved. They were divided into an observed group (n = 57) and a control (n = 51) group after a thorough physical examination and assessment of their reactions to, and awareness of, the disease.Results: The group that received the interventions had an intense awareness of the diagnosis and aims and nature of the indicated treatment. They employed purposeful problem-solving coping strategies, reported being satisfied with the infertility treatment.Conclusions: The counselling of clients with infertility problems a more favourable mental well-being can be established by the active participation of professional helpers. Patients might receive effective, targeted and problem-specific help.Abbreviations: ART: Assisted Reproductive Technology.

The relationship of the psychological coping and adjustment strategies of infertile women with the success of assisted reproductive technology

Background

The success of assisted reproductive techniques plays a very important role in the quality of life of infertile couples and decreases the negative behavior states of infertility.

Objective

This study aimed at determining the relationship between psychological coping and adjustment strategies with the success of assisted reproductive technology (ART).

Materials and Methods

This correlational study was conducted on 204 women visiting Milad Infertility Center in Mashhad during 2015-2016. The research instruments included Fertility Adjustment Scale and Infertility Coping Strategies Scale. The positive result of two pregnancy tests within 48 hours was considered as the success of ART.

Results

The mean and standard division score of adjustment in the group achieved treatment success (34.3±8.2) exceeded the group failed (33.6±8.8), the difference was not statistically significant (p= 0.381). Also, there was no significant difference between groups in the median and interquartile range of total coping strategies 81 (13) vs. 79.5 (12.25), (p= 0.369). Based on the logistic regression model for one increased transferred embryo, the chance of getting pregnant is 1.3 times, and for each unit increase in FSH level, the chance of ART success decreases 18%.

Conclusion

The results of this study showed that there is no relationship between psychological coping and adjustment strategies with ART success. However, the number of transferred fetus and tirthday FSH are introduced as factors that are related to the success of ART.

Development of Nurses&apos; Practical Educational Needs Scale for Women with Infertility

PURPOSE

To develop nurses' educational needs scale for woman with infertility.

METHODS

A total of 201 nurses in charge of infertility health services in 4 infertility hospitals and 1 public health center were enrolled for this study. The scale was developed through literature review, in-depth interview, development of preliminary items, verification of content validity, development of secondary items, verification of construct validity, and extraction of final items. Data were analyzed using item analysis, exploratory factor analysis, Pearson's correlation coefficients, and Cronbach's α.

RESULTS

Nurses' educational needs scale for women with infertility consisted of 41 items. Three factors (education for disease and symptom of infertility, supporting and counselling for infertility patients, and education for daily life of infertile patients) explained 63.7% of the total variance. CONCLUSIONS: Nurses' educational needs scale for woman with infertility demonstrated acceptable validity and reliability. Its items could be used to assess the level of educational needs for nurses in charge of infertility health services.

Role of Mental Health Practitioner in Infertility Clinics: A Review on Past, Present and Future Directions

A large body of literature has emerged over the past four decades which highlights the need to address emotional needs in infertility and integrates psychological services within routine fertility care. Evidenced-based guidelines in most countries propagate that the mental health expert (MHP) plays a vital role as a team member in reducing the impact of infertility on the lives of patients, across all stages of treatment. In accordance with these global developments, inclusion of psychosocial care in fertility treatments is an upcoming trend in our nation. This review article brings forth the traditional role of MHP in infertility, compares patient-centered care with counseling, and elaborates on the guidelines on determinants of patient needs and suitability for structured psychological interventions. It also highlights the evidence-based studies on the application of psychotherapy in infertility.

Association Between Infertility and Sexual Dysfunction in Men and Women

INTRODUCTION

The relation between infertility and sexual dysfunction can be reciprocal. Causes of sexual dysfunction that affect fertility include erectile dysfunction, Peyronie's disease (abnormal penile curvature), low libido, ejaculatory disorders in men, and genito-pelvic pain/penetration disorder (GPPPD) and low sexual desire in women.

AIM

To review the association between infertility and sexual dysfunction and discuss current management strategies to address sexual disorders in couples with infertility.

METHODS

Peer-reviewed publications from PubMed published from 1980 through February 2016 were identified that related to sexual dysfunction and infertility in men and women.

MAIN OUTCOME MEASURES

Pathophysiology and management approach of erectile dysfunction, Peyronie's disease, low libido, ejaculatory disorders in men, and GPPPD and low sexual desire in women and how each etiology contributes to sexual dysfunction and infertility in the couple.

RESULTS

Treating the infertile couple with sexual dysfunction involves addressing underlying conditions such as psychogenic erectile dysfunction, low testosterone, Peyronie's disease in men, and GPPPD and low sexual desire in women. Psychogenic erectile dysfunction can be successfully treated with phosphodiesterase inhibitors. Low testosterone is often identified in men with infertility, but testosterone therapy is contraindicated in men attempting conception. Men with Peyronie's disease have a new treatment option to address their penile curvature-collagenase Clostridium histolyticum injection directly into the penile plaque. GPPPD is a broad disorder that includes vulvodynia and vaginismus and can be treated with topical lubricants and moisturizers. We must address psychosocial factors in women with low sexual desire. Flibanserin and transdermal testosterone (off-label) are novel therapies for women with low sexual desire.

CONCLUSION

Sexual dysfunction in a couple with infertility is a complex issue. Management of infertility and sexual dysfunction should involve appropriate medical therapy and addressing the psychosocial concerns of the couple.

Addressing the emotional barriers to access to reproductive care

Health care professionals make the medical care of infertility patients a priority, with the goal of achieving a singleton pregnancy for each. Patients who never seek out care, who do not return for treatment after the diagnostic workup, or who drop out of treatment are rarely noticed. Yet this is the outcome for the majority of patients, and the primary reason after financial for treatment termination is the emotional aspect. Attending to the psychological needs of our patients must become a higher priority, to provide all patients true access to care.

Women show a higher level of anxiety during IVF treatment than men and hold different concerns: a cohort study

PURPOSE

The aim of the present study was to determine levels of anxiety during the course of IVF treatment and gender differences in treatment anxiety.

METHODS

This was a prospective cohort study set in a university affiliated, tertiary care IVF program. 119 women and 82 men entering the clinic to undergo IVF treatment filled out questionnaires containing the Spielberger state-trait-anxiety-inventory (STAI) as well as further items on specific stress triggers.

RESULTS

Women and men undergoing IVF have higher levels of anxiety than the average population in Germany. Overall, female patients show significantly higher values (mean ± SD) for state and trait anxiety (47.4 ± 11.0 and 40.1 ± 9.85) than their male partners (41.4 ± 9.66 and 35.3 ± 8.57, p < 0.01). Over the course of several IVF cycles, average STAI scores increased for both genders. When asked about specific stress factors on a 4-point scale from 'not at all' to 'very much so', women report as their main anxiety the failure to achieve a successful pregnancy, scoring significantly higher on questions like 'obtaining a negative pregnancy test' (3.24 ± 0.82, p < 0.01) and 'disclosure of infertility' (3.02 ± 1.10, p < 0.001). Their male partners are more concerned about the health risks the women have to take such as 'side effects of ovarian stimulation' (2.55 ± 0.77, p = 0.002) and 'bleeding or infection after the oocyte aspiration' (2.58 ± 0.84, p = 0.007). Both genders indicated to be very little worried about multiple pregnancies after IVF.

CONCLUSIONS

Women show a higher level of anxiety during IVF treatment and hold different concerns. Neither of the sexes appears to be familiar with the risks associated with multiple pregnancies, a matter that should better be addressed.