Development and validation of an Infertility Stigma Scale for Chinese women

Relationship between stigma and infertility-related stress among couples undergoing AID: The mediating role of communication patterns

Infertility can be stressful for infertile couples. This study aims to examine the intra-dyadic associations between stigma, communication patterns, and infertility-related stress in couples undergoing artificial insemination by donor semen (AID). This cross-sectional study was conducted from January to April 2021. Two hundred and three couples undergoing AID were recruited from a reproductive centre in China. All of the couples completed a two-item stigma questionnaire, Communication Pattern Questionnaire, and Fertility Problem Inventory. The actor-partner interdependence mediation analysis was performed using AMOS 23.0. The analysis demonstrated significant actor-actor effects for couples undergoing AID. More specifically, higher levels of stigma among wives and husbands were associated with more negative communication patterns, thereby increasing their own infertility-related stress. Simultaneously, there was a significant partner-actor effect among infertile wives, demonstrating that the husband's stigma can affect his wife's infertility-related stress by influencing her communication patterns. Couples undergoing AID experience increased infertility-related stress when they have high levels of stigma and negative communication patterns, and husbands' stigma is correlated to wives' communication patterns. Therefore, dyadic interventions aiming to improving stigma and enhancing positive communication may be conducive to reducing infertility-related stress.

Development of an infertility perception scale for women (IPS-W)

PURPOSE

The purpose of this study was to develop an Infertility Perception Scale for Women (IPS-W).

METHODS

Initial items were based on an extensive literature review and in-depth interviews with five infertile women and fifteen women not diagnosed with infertility. Forty-one items were derived from a pilot survey. Data were collected from 203 women who had experienced intrauterine insemination (IUI) and in-vitro fertilization (IVF) more than once. The data were analyzed to verify the reliability and validity of the scale.

RESULTS

Four factors containing 21 items were extracted from the exploratory factor analysis (EFA) to verify the construct validity. The four factors of infertility perception scale were perceived feelings, personal stigma, social stigma, and acceptance. These factors explained 59.3% of the total variance. The confirmatory factor analysis (CFA) confirmed a four-factor structure of the 21-item IPS-W. All fit indices were satisfactory (χ2/df ≤ 3, RMSEA < 0.08). These items were verified through convergent, discriminant, known group validity, concurrent validity testing. The internal consistency reliability was acceptable (Cronbach's α = 0.90).

CONCLUSION

The scale reflects the perception of infertility within the cultural context of Korea. The findings can help nurses provide support that is appropriate for individual circumstances by examining how women experiencing infertility perceive infertility.

Irrational parenthood cognition and infertility stigma among infertile women: A cross-sectional study in Changsha, China

Background

Stigma is among the most prevalent and disturbing consequences of being infertile among women, yet it remains unknown whether fertility stigma is affected by irrational parenthood cognitions (IPC). The current study aimed to assess IPC, infertility stigma, and their interrelationship among a group of Chinese women referred to an infertility center in Changsha, Hunan, China.

Methods

A cross-sectional study was conducted among 376 women seeking treatment for infertility in Changsha City, China. Pearson correlation test was used to explore the association between IPC and infertility stigma, while multivariate linear regression was used to explore the independent influencing factors of infertility stigma.

Results

Participants had a mean score of 42.41 ± 13.03 for IPC and 62.89 ± 24.50 for ISS. IPC was highly correlated with infertility stigma with a large effect size (r = 0.55, p < 0.001). Multivariate linear regression showed that patients' infertility stigma was positively associated with IPC (β = 1.06, p < 0.001) while negatively associated with education (β = -5.4, p = 0.036) and disclosure of infertility (β = -8.39, p = 0.001) (R 2  = 36 %). In addition, various influencing factors were identified for the four dimensions of infertility stigma.

Conclusion

This study is the first to identify a positive association between irrational parenthood cognitions and infertility stigma among infertile women in China. Our findings provide useful guidance for the future development of effective anti-stigma intervention programs among infertile women.

Oral preexposure prophylaxis uptake, adherence, and persistence during periconception periods among women in South Africa

OBJECTIVE

We developed the Healthy Families-PrEP intervention to support HIV-prevention during periconception and pregnancy. We evaluated preexposure prophylaxis (PrEP) use with three objective measures.

DESIGN

This single-arm intervention study enrolled women in KwaZulu-Natal, South Africa, who were HIV-uninfected, not pregnant, in a relationship with a partner with HIV or unknown-serostatus, and with pregnancy plans. PrEP was offered as part of a comprehensive HIV prevention intervention. Participants were followed for 12 months.

METHODS

We evaluated periconception PrEP uptake and adherence using quarterly plasma tenofovir concentrations. We modeled factors associated with PrEP uptake and high plasma tenofovir (past day dosing). Patterns of use were analyzed using electronic pillcap data. Dried blood spots to measure intracellular tenofovir product (past 2 months dosing) were analyzed for a subset of women.

RESULTS

Three hundred thirty women with median age 24 (IQR: 22-27) years enrolled. Partner HIV-serostatus was unknown by 96% ( N  = 316); 60% (195) initiated PrEP. High plasma tenofovir concentrations were seen in 35, 25, 22, and 20% of samples at 3, 6, 9, and 12 months, respectively. Similar adherence was measured by pillcap and dried blood spots. In adjusted models, lower income, alcohol use, and higher HIV stigma were associated with high plasma tenofovir. Eleven HIV-seroconversions were observed (incidence rate: 4.04/100 person-years [95% confidence interval: 2.24-7.30]). None had detectable plasma tenofovir.

CONCLUSION

The Healthy Families-PrEP intervention supported women in PrEP use. We observed high interest in periconception PrEP and over one-third adhered to PrEP in the first quarter; one-fifth were adherent over a year. High HIV incidence highlights the importance of strategies to reduce HIV incidence among periconception women.

CLINICAL TRIAL NUMBER

NCT03194308.

Combined traditional Chinese medicine therapy for the treatment of infertility with polycystic ovary syndrome: A network meta-analysis of randomized controlled trials

BACKGROUND

Polycystic ovary syndrome (PCOS) infertility has attracted great attention from researchers due to its high incidence. Numerous studies have shown that Chinese medicine is effective in treating this disease, but there is a wide variety of Chinese medicine therapies available, and there is a lack of comparative evaluation of the efficacy of various Chinese medicine combination therapies in the clinic, which requires further in-depth exploration. This study aims to evaluate the efficacy of a combined traditional Chinese medicine (TCM) therapy for the treatment of infertility with PCOS using network meta-analysis (NMA).

METHODS

In PubMed, web of Science, Cochrane Library, Embase, China Knowledge Network, Wanfang Data, VIP Database, China Biomedical Literature Database (SinoMed) databases, searchs were conducted for information about the randomized controlled trials (RCTs) of combined TCM therapy for the treatment of infertility with PCOS. Quality evaluation was performed using the Cochrane 5.3 risk of bias assessment tool, and NMA using Stata 16.0.

RESULTS

This study comprised 28 RCTs using 8 combined TCM therapies in total. The results of the NMA showed that moxibustion + herbal, fire acupuncture + herbal, acupuncture + herbal, electroacupuncture + herbal, and acupoint application + herbal improved the clinical pregnancy rate better than acupuncture, herbal, and western medicines monotherapy (P < .05). Additionally, ear point pressure + herbal enema + herbal, acupuncture and moxibustion + herbal, fire acupuncture + herbal, and acupuncture + herbal improved the ovulation rate better than acupuncture, herbal, and western medicines monotherapy (P < .05). Moxibustion + herbal, fire acupuncture + herbal, and acupuncture + herbal are the 3 most effective therapies for improving the clinical pregnancy rate. Fire acupuncture + herbal, acupuncture + herbal, and ear point pressure + herbal enema + herbal are the 3 most effective therapies for improving the ovulation rate.

CONCLUSION

The combined TCM therapy demonstrated better efficacy for the treatment of infertility with PCOS compared to acupuncture, herbal, and western medicines monotherapy. However, the optimal treatment therapy varied depending on the outcome indicators. Further large sample, high-quality, and standardized RCTs are needed to verify these findings.

The Stigma and Infertility-Related Stress of Chinese Infertile Women: A Cross-Sectional Study

OBJECTIVES

This study was conducted to investigate the stigma status of infertile women in China and to determine the influencing factors.

METHODS

366 infertile women from the gynecological and reproductive departments of two tertiary hospitals completed socio-demographic questionnaires, the Infertility Stigma Scale (ISS) and the Mandarin Fertility Problem Inventory (M-FPI).

RESULTS

The scores of stigma and infertility-related stress in infertile women were (52.51 ± 17.74) and (150.03 ± 17.51), respectively. Multiple regression analysis found that location of residence, regarding children as the most important thing in life, talking to others about infertility and infertility-related stress were the main influencing factors of stigma in infertile women, which explained 17.3% of the total variance.

CONCLUSIONS

In the current study, the level of stigma in women with infertility was at the middle range. Location of residence, regarding children as the most important thing in life, whether to talk with others about infertility and infertility-related stress were the four main influencing factors of stigma.

Analysis of predictors of clinical pregnancy and live birth in patients with RIF treated with IVF-ET technology: a cohort study based on a propensity score approach

Objective

To investigate the predictors of clinical pregnancy and live birth rate in patients with recurrent embryo implantation failure (RIF) treated with in vitro fertilization-embryo transfer (IVF-ET) technique.

Method

This retrospective cohort study was conducted in Jinjiang District Maternal and Child Health Hospital, Chengdu City, Sichuan Province, China. Patients were recruited who were enrolled at this hospital between November 1, 2019 and August 31, 2022, and who met the following criteria: a frozen embryo transfer (FET) at day 5 or 6 blastocyst stage was performed and the number of transfer cycles was not less than two. We collected information on age, height, weight, number of embryo transfer cycles, and information related to clinical outcomes. We used the group of patients who underwent ERA testing as the study group and those who underwent FET only as the control group, and matched baseline characteristics between the two groups by propensity score to make them comparable. We compared the differences in clinical outcomes between the two groups and further explored predictors of pregnancy and live birth using survival analysis and COX regression modeling.

Results

The success rate of clinical pregnancy in RIF patients was 50.74% and the live birth rate was 33.09%. Patients in the FET group were less likely to achieve clinical pregnancy compared to the ERA group (HR = 0.788, 95%CI 0.593-0.978, p < 0.05). Patients with >3 previous implantation failures had a lower probability of achieving a clinical pregnancy (HR = 0.058, 95%CI 0.026-0.128, p < 0.05) and a lower likelihood of a live birth (HR = 0.055, 95%CI 0.019-0.160, p < 0.05), compared to patients with ≤3 previous implantation failures. Patients who had two embryos transferred were more likely to achieve a clinical pregnancy (HR = 1.357, 95%CI 1.079-1.889, p < 0.05) and a higher likelihood of a live birth (HR = 1.845, 95%CI 1.170-2.910, p < 0.05) than patients who had a single embryo transfer. Patients with concomitant high-quality embryo transfer were more likely to achieve a clinical pregnancy compared to those without high-quality embryo transfer (HR = 1.917, 95%CI 1.225-1.863, p < 0.05).

Conclusion

Not receiving an ERA, having >3 previous implantation failures, using single embryo transfer and not transferring quality embryos are predictors for clinical pregnancy in patients with RIF. Having>3 previous implantation failures and using single embryo transfer were predictors for live birth in patients with RIF.

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.

Correlation among irrational parenthood cognitions, fertility stress, and social support in patients with repeated implantation failure and the mediating effect of fertility stress: a cross-sectional survey

PURPOSE

This study investigated the relationships among irrational conceptions of parenthood, fertility stress, and social support, as well as the mediating effect of fertility stress, in patients with repeated implantation failure.

METHODS

Patients who underwent assisted reproductive technology due to repeated implantation failure at the Reproductive Centre at Women's Hospital between January 2020 and August 2022 were selected using cross-sectional research and convenience sampling. A total of 129 patients with recurrent implantation failure were investigated using the Irrational Parenthood Cognitions Questionnaire (IPCQ), Fertility Problem Inventory (FPI), and Social Support Rating Scale (SSRS).

RESULTS

The differences in irrational parenthood cognitions, fertility, stress, and social support among patients with repeated implantation failure in the education and yearly household income subgroups were statistically significant (P<0.001). Pearson correlation analysis revealed that irrational parenthood cognitions were favorably correlated with all measures of reproductive stress (r=0.384 to 0.664, all P<0.01) and negatively correlated with social support (r=-0.310, p<0.01). The fertility stress of patients with repeated implantation failure fit the structural equation model of irrational parenthood cognitions and social support well [X2/df=2.04, Comparative Fit Index (CFI)=0.944, Tucker-Lewis (TLI)=0.905, Root Mean Squared Error of Approximation (RMSEA)=0.090]. The bootstrap test results revealed that the mediating effect of the 95% CI ranged between -0.506 and -0.109, and the interval did not contain 0. Fertility stress had a strong mediating effect on the relationship between irrational parenthood cognitions and social support.

CONCLUSIONS

The mediating effect of reproductive stress on the relationship between irrational parenthood cognitions and social support in patients with repeated implantation failure was significant. It is important for medical and nursing staff to address physical and psychological illnesses and develop effective intervention strategies from the perspectives of fertility stress, social support, and cultural background, with the ultimate goal of improving mental health.

Women living with infertility in Iran: A qualitative content analysis of perception of dignity

BACKGROUND

Globally, infertility is known as a major problem which can ruin a couple's relationship. In recent years, many studies have addressed the causes of infertility, the outcomes of treatments for infertility, and the effects of infertility on couples' mental health; however, the concept of dignity of women living with infertility has never been examined in depth.

OBJECTIVE

This study aimed to explore the dignity of women living with infertility in Iran.

DESIGN

This qualitative research was conducted via conventional content analysis approach.

METHODS

This qualitative study was conducted in Iran from February to December 2022. In this research, the data were collected through face-to-face semi-structured in-depth interviews with 23 women living with infertility selected via purposive sampling. The interviews were continued until reaching the data saturation point. Data analysis was performed simultaneously with data collection. The interviews were recorded, transcribed, and analyzed through Graneheim and Lundman style content analysis, with data management done using the MAXQDA software. To achieve the accuracy and validity of the study, the four-dimension criteria by Lincoln and Guba, namely credibility, dependability, conformability, and transformability, were considered and used.

RESULTS

Analysis of the qualitative data yielded three themes and eight subthemes. The three main themes were (1) overcoming identity crises (overcoming dysthymia, coping with unaccomplished motherhood), (2) respect for personal identity (respect for confidentiality; respect for beliefs, values, and attitudes; avoidance of stigma and pity), and (3) compassion-focused therapy (sympathizing, mental and spiritual support, and enhancement of life skills).

CONCLUSION

Dignity of women living with infertility encompasses overcoming identity crises, respect for personal identity, and compassion therapy. The policymakers and administrators in the healthcare system can use the findings of this study to create a proper clinical environment toward preserving the dignity of women living with infertility.

Transcutaneous electrical acupoint stimulation benefits postoperative pain relief of oocyte retrieval: A randomized controlled trial

BACKGROUND

Transvaginal oocyte retrieval is frequently followed by adverse events related to anesthesia and the procedure. Some research showed that transcutaneous electrical acupoint stimulation (TEAS) can relieve intraoperative pain and postoperative nausea.

OBJECTIVE

This study examined whether TEAS can alleviate pain and relieve adverse symptoms after oocyte retrieval.

DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS

Altogether 128 patients were randomly divided into the TEAS group and the mock TEAS group. The two groups received a 30-minute-long TEAS or mock TEAS treatment that began 30 min after oocyte retrieval.

MAIN OUTCOME MEASURES

The primary outcome was the visual analog scale (VAS) pain score. Secondary outcomes were pressure pain threshold, McGill score, pain rating index (PRI), present pain intensity (PPI), VAS stress score, VAS anxiety score, and postoperative adverse symptoms.

RESULTS

The baseline characteristics of the two groups were comparable (P > 0.05). The VAS pain scores of the TEAS group were lower than those of the mock TEAS group at 60 and 90 min after oocyte retrieval (P < 0.05). The McGill score, PRI and PPI in the TEAS group were significantly lower than those in the control group at 60 min after oocyte retrieval (P < 0.05). However, the two groups had equivalent beneficial effects regarding the negative emotions, such as nervousness and anxiety (P > 0.05). The TEAS group was superior to the mock TEAS group for relieving postoperative adverse symptoms (P < 0.05).

CONCLUSION

TEAS treatment can relieve postoperative pain and postoperative adverse symptoms for patients undergoing oocyte retrieval. Please cite this article as: Liu LY, Su Y, Wang RR, Lai YY, Huang L, Li YT, Tao XY, Su MH, Zheng XY, Huang SC, Wu YN, Yu SY, Liang FR, Yang J. Transcutaneous electrical acupoint stimulation benefits postoperative pain relief of oocyte retrieval: A randomized controlled trial. J Integr Med. 2024; 22(1): 32-38.

Experience of mental health in women with Polycystic Ovary Syndrome: a descriptive phenomenological study

Purpose: This study aims to investigate the experiences, emotional coping strategies, and help-seeking needs of women with PCOS from their perspective, considering common psychological issues such as stress, anxiety, and depression that are prevalent among individuals with PCOS. Materials and Methods: The study recruited 14 women with PCOS for semi-structured interviews between October and November 2022, using a descriptive phenomenology method design. The interviews were analyzed using NVivo 12 software. Results: Four themes and eleven subthemes were derived from the semi-structured interviews: (1) Negative Mental Health Status; (2) Four Patterns of Emotion Regulation; (3) The Psychological Double-Edged Sword: Family Social Network; (4) Strong Demands for Psychological Counseling and Lifestyle Guidance. Conclusion: The study suggests that interventions should focus on fostering internalized self-efficacy and emotional expression, promoting constructive familial support, and providing psychological counseling and lifestyle recommendations to alleviate psychological distress experienced by women with PCOS.

Patient and clinician perspectives on shared decision-making in infertility treatment: A qualitative study

OBJECTIVES

To explore the considerations and barriers to implementing shared decision-making (SDM) in infertility treatment among female infertility patients, their male spouses, and fertility clinicians.

METHODS

Participants were recruited from a reproductive medicine hospital in China's Shandong Province using purposive sampling. One-on-one interviews were held with female infertility patients and their spouses. In addition, a focus group discussion was conducted with fertility clinicians. Data analysis was subjected to open, axial, and selective coding.

RESULTS

Nineteen female infertility patients and 10 male spouses were interviewed one-on-one. Five clinicians participated in the focus group discussion. Most female patients wanted to participate in the decision-making process, and that spouses and fertility clinicians supported SDM. Furthermore, key barriers were identified from the perspectives of multiple stakeholders, including communication difficulties, psychological pressure on female patients, patient preferences, multiple treatment stages, male spousal participation, clinician-patient trust, and subjective patient factors.

CONCLUSIONS/PRACTICE IMPLICATIONS

This study explored the considerations of and barriers to implementing SDM in infertility treatment. Key barriers were identified from the perspectives of multiple stakeholders. Based on the findings, clinicians should encourage patients and their spouses to actively participate in decision-making, and provide objective and realistic guidance.

Mediating role of relational aggression in the association between infertility stigma and marital relationship distress in infertile women

Infertility is a multifaceted problem that can cause significant impairments with emotional, social, and psychological consequences, including problems in the marital relationship. This study aimed to mediate the role of relational aggression in the association between infertility stigma and marital relationship distress in infertile women. The research method was descriptive and path analysis. The statistical population of the study consisted of all infertile women who were referred to infertility centers and obstetrics and gynecology medical centers in Tehran in 2021 (July to October), and due to lack of full access to them, 300 people were selected by available sampling method who participated in the research through an online questionnaire. Data were collected using the Marital Self-Reporting Questionnaire, Infertility Stigma, and Relational Aggression Questionnaire. Data analysis was performed using structural equation modeling. The results showed that the causal model of the relationship between infertility stigma, relational aggression, and marital relationship distress in infertile women was confirmed based on different fitting indices. Infertility stigma and associated aggression directly affect the marital turmoil of infertile women. On the other hand, infertility stigma indirectly affects infertile women's marital distress through relational aggression (P < .05). Therefore, the infertility stigma and relational aggression play an important role in marital distress in infertile women, and targeting these two components in psychological therapies can effectively reduce marital chaos.

Traditional Chinese medicine Dingkun pill to increase fertility in women with a thin endometrium-a prospective randomized study

Objective

The aim of this study is to optimize the treatment methods of infertility, which is suggested to be mainly caused by thin endometrium, using a special form of traditional Chinese medicine, the Dingkun pill (DKP), to increase the beneficial endometrial effect of conventional hormone/progestogen therapy.

Methods

A total of 307 patients visiting our specialized gynecological endocrinology department because of infertility, which we suggested to be caused by thin endometrium [endometrial thickness (EMT) < 7 mm], were randomly assigned to the experimental group and the control group. The experimental group was treated with estradiol + sequential dydrogesterone + DKP (every day); the control group received hormonal treatment without the Chinese medicine. All patients were monitored in terms of follicle diameter, EMT, and endometrial type every 2 days from the 8th to the 10th day of the menstrual cycle until ovulation day during three menstrual cycles. Serum progesterone levels on 7-8 days after ovulation were measured, and the cumulative pregnancy rate during three menstrual cycles between the two groups was compared.

Results

EMT on ovulation day in the experimental group was significantly higher than that in the control group (7.88 vs. 7.15 mm; p < 0.001). The proportion of type A and type B endometrium in total was significantly higher in the experimental group than that in the control group (83.2% vs. 77.7%; p < 0.05). Progesterone levels were significantly higher in the experimental group than those in the control group (10.874 vs. 10.074 ng/mL; p < 0.001). The cumulative pregnancy rate, the main outcome of the study, was significantly higher in the experimental group than that in the control group (29.2% vs. 15.7%; p < 0.05).

Conclusion

DKP added to conventional estrogen/progestogen therapy can significantly improve EMT and luteal function in patients attending due to infertility. Because this regimen increased the cumulative pregnancy rate in our study, we conclude that DKP can be used to increase the so-called "thin endometrium infertility".

Stigma and mental health in endometriosis

This review provides an overview of patient experiences of endometriosis, endometriosis-related types and sources of stigma pertaining to menstruation, chronic pain, and infertility, and their impact on patients' mental health with particular implications for patient care. Because endometriosis is a complex disease with multifactorial etiology, complicated pathophysiology, and a spectrum of clinical features, diagnosis of endometriosis is typically a lengthy process, and many patients experience initial misdiagnosis. A hallmark symptom is severe menstrual pain with other symptoms including chronic pelvic pain, dysmenorrhea, and infertility. Prior research documents that the diagnostic odyssey, complex management, disabling and unpredictable nature of the disease, and painful symptom profile affect multiple life domains of patients, resulting in poor physical, social, and psychological functioning and clinically-significant rates of anxiety and depression for many. More recently, stigma has been recognized as a potent contributor to poor mental health in endometriosis patients, but existing research is limited and largely atheoretical. We identify major sources of stigma related to endometriosis, including menstrual stigma, chronic pain stigma, and infertility stigma, and their likely impact on patients and health care provision. An integrative theoretical approach is described to facilitate research on the prevalence and effects of endometriosis stigma and their explanatory mechanisms, highlighting specific well-validated psychological instruments to assess stigma. Implications for patient care are emphasized. Better understanding of stigma and mental health in people with endometriosis will enhance the standard of care for this patient population.

The risk factors of progestational anxiety, depression, and sleep disturbance in women with recurrent pregnancy loss: A cross-sectional study in China

Background

The risk factors of progestational anxiety, depression, and sleep disturbance in women with a history of recurrent pregnancy loss (RPL) remain controversial, additional study is needed to investigate the incidence and risk factors of progestational anxiety, depression, and sleep quality in RPL women.

Methods

A cross-sectional study was conducted among 663 non-pregnant RPL women in Northeast China from October 2019 to July 2022. We assessed the state of anxiety, depression, and sleep quality before pregnancy using structured questionnaires, including sociodemographic characteristics, state-trait anxiety scale (STAI), center for epidemiological survey, depression scale (CES-D), Pittsburgh sleep quality index (PSQI), and symptom self-rating scale (SCL-90). Logistic regression was used to evaluate the association between sleep quality and anxiety, depression. Pearson’s correlation was used to evaluate the correlation between anxiety and depression. Multivariate logistic regression analysis was used to find the risk factors of depression symptoms. The receiver operating characteristic curve (ROC) was used to evaluate the predictive value of the model.

Results

The incidence of state anxiety, trait anxiety, depression, and sleep disturbance in RPL women were 60.3, 51.7, 33.9, and 31.2%, respectively. The level of anxiety and depression in RPL women varied at different stages of treatment. In a longitudinal study (25 pairs), we found the level of state anxiety and trait anxiety were significantly lower after the cause was identified. Sleep disturbance is positively correlated with anxiety and depression. Logistic regression showed that the number of miscarriages ≥4 (Odds ratio (OR) = 2.268, 95%CI 1.300–3.956), Low household family income (OR = 1.613, 95%CI 1.036–2.513/OR = 2.361, 95%CI 1.095–5.092), interval since last miscarriage &lt;6 months (OR = 2.154, 95%CI 1.246–3.726) and sleep disturbance (OR = 5.523, 95%CI 3.542–8.614) were associated with the occurrence of depressive symptoms. At the same time, anxiety can be used as a predictor of depression.

Conclusion

Recurrent pregnancy loss women have a certain degree of anxiety, depression, and sleep disturbance. Education level, interval since the last miscarriage &lt;6 months, and sleep disturbance are risk factors for anxiety and depression. A history of pregnancy loss after 14 weeks and no living birth are also closely related to anxiety. Therefore, it is necessary to pay close attention to the psychological state of RPL women and provide appropriate psychosocial support to reduce the occurrence of negative emotions.

Resilience of infertile families undergoing in vitro fertilization: An application of the double ABC-X model

BACKGROUND

Family resilience plays a crucial role in protecting the mental health and family stability of infertile patients. However, information associated with infertile families resilience is scarce. The double ABC-X model provides a roadmap for this, helps organize knowledge, and lays the foundation for knowledge development.

AIMS

To describe the current situation of family resilience of infertile women, and to test the predictive theoretical model of family resilience based on infertility stigma, individual resilience, coping style, and posttraumatic growth.

DESIGN

A cross-sectional study.

METHODS

A convenience sample of 372 infertile women undergoing in vitro fertilization were recruited between April and August 2020. The Chinese-Family Resilience Assessment Scale, Infertility Stigma Scale, Simplified Coping Style Questionnaire, Chinese version of Connor-Davidson Resilience Scale, and Chinese version of Post Traumatic Growth Inventory were used to measure family resilience, infertility stigma, individual resilience, coping style, and posttraumatic growth. Structural equation models were used to analyze the relationship among these variables.

RESULTS

The results showed that family resilience was related to infertility stigma, positive coping, and individual resilience. Moreover, the path analysis indicated that positive coping and individual resilience mediated the effects of infertility stigma on family resilience.

CONCLUSIONS

A high level of stigma among infertile women should be identified. Interventions for targeting positive coping and individual resilience might ultimately increase their family resilience.

Understanding the Relationship Between Peer Support and Grief/Growth in Chinese Shidu Parents: The Roles of Internalized Stigma and Stigma Resistance

In China, families who have lost their only child are called shidu families. Support from similar others, or peer support, can help bereaved individuals adapt by reducing negative consequences and promoting positive changes. However, no research has examined the mechanism that mediates the effect of peer support on postloss adaptation. This article investigates the mediating roles of internalized stigma and stigma resistance in the relationship between peer support and grief/growth among Chinese shidu parents. In total, 208 shidu parents completed the required measurements. Structural equation modeling was used to analyze the data. The results showed that peer support was negatively related to grief symptoms and positively linked with posttraumatic growth by reducing internalized stigma. The mediating effect existed only for informational support. The mediating role of stigma resistance was not significant. These findings provide valuable information for the mechanism of peer support and promote the development of interventions.

Evaluating health-related quality of life and subjective wellbeing among infertility patients: a cross-sectional study in mainland China

PURPOSE

This study aimed to explore the health-related quality of life (HRQoL) and subjective wellbeing (SWB) of infertility patients in mainland China and to investigate the relationships between HRQoL and SWB instruments in infertility patients.

METHODS

We conducted this cross-sectional study in the Hospital for Reproductive Medicine Affiliated of Shandong University between April 2019 and November 2019. Participants self-completed the five-level EQ-5D (EQ-5D-5L) questionnaire, the Assessment of Quality of Life (AQoL)-8D, and the WHO-5 wellbeing index (WHO-5). The agreements between EQ-5D-5L and AQoL-8D were assessed employing intraclass correlation coefficient (ICC) and Bland-Altman plots. Exploratory factor analysis (EFA) was conducted to examine the difference in descriptive systems among the three instruments.

RESULTS

We analyzed a valid sample of 618 infertility patients (84.4%). The mean scores of the total EQ-5D-5L, AQoL-8D, and WHO-5 were 0.96 (95%CI 0.96, 0.96), 0.80 (95%CI 0.79, 0.81), and 16.92 (95%CI 16.52, 17.31), respectively. Patients diagnosed with primary infertility had significantly lower HRQoL and SWB than those with secondary infertility. The ICC of EQ-5D-5L and AQoL-8D was 0.14. The AQoL-8D (r = 0.625) was more strongly correlated with WHO-5 than with the EQ-5D-5L (r = 0.262). The EFA results indicated that HRQoL instruments and the WHO-5 instruments were complementary rather than substitutable.

CONCLUSIONS

Poorer HRQoL and SWB were found that primary than secondary infertility patients. There exists a poor agreement between EQ-5D-5L and AQoL-8D and the difference in the psychosocial components may explain the difference. Measuring both HRQoL and SWB could provide complementary information for infertility patients.

The impact of stigma on mental health and quality of life of infertile women: A systematic review

Introduction

The stigma of not giving birth to children affects approximately 53. 08~64% of female infertility patients worldwide. This stigma not only causes harm to the mental health of these infertility patients, but also affects their quality of life, making them bear the adverse social consequences such as domestic violence, marriage breakdown, or even delay in receiving the treatment. Therefore, it is crucial to have a deep understanding of the patients' stigma and effective intervention in alleviating it.

Aims/Question

This study aims to discuss and summarize the stigma in infertile women and its impact on patients, and to provide a theoretical basis for the clinical treatment and nursing intervention of disease stigma in infertile female patients.

Methods

The literature search used four English databases (Cochrane Library, EMBASE, Web of Science, and PubMed) and two Chinese databases (CNKI and Wanfang). The search time of the literature ranges from the establishment of the library to 2022, with no language restriction.

Results

The review included 28 studies, with 20 cross-sectional studies and 8 qualitative studies. This study found that social support, living environment, education level, occupation, and fertility awareness were the major influencing factors of infertility stigma.

Conclusions

Infertility stigma can bring heavy mental pressure and psychological burden to female infertility patients and affect their quality of life. Therefore, effective and targeted psychological interventions should be developed to reduce the patients' stigma and improve their quality of life.

Implications for practice

Healthcare workers must develop targeted nursing interventions, provide professional counseling services to reduce the level of stigma in female infertility patients, alleviate fertility stress, and improve their quality of life.

Effect of Teach-back and Douyin platform short video health education in women receiving infertility treatment

Objective

To evaluate the effect of intervention by Teach-back and Douyin platform short video health education on stigma, reproductive quality of life, family intimacy and family adaptability in women receiving infertility treatment.

Methods

This study is a quasi-experimental study. The intervention period is 6 weeks, and the study was implemented between January 2022 and August 2022. A total of 80 women (40 in the control group and 40 in the observation group) receiving infertility treatment were included in the study. The control group was given routine health education intervention, and the observation group was given Teach-back and Douyin platform short video health education on the basis of routine health education. The Chinese version of the Infertility Stigma Scale, the Infertility Quality of Life Questionnaire and the Family Intimacy and Adaptability Scale were used to evaluate the effects before and after the intervention.

Results

After the intervention, the total score of stigma in the observation group was significantly lower and lower than that of the control group (P < 0.05) and the total score of reproductive quality of life in the observation group was significantly higher than that of the control group (P < 0.05). The dissatisfaction score of family intimacy in the observation group was significantly lower than that of the control group (P < 0.05), and the dissatisfaction score of family adaptability in the observation group was significantly lower than that of the control group (P < 0.05).

Conclusion

Teach-back and Douyin platform short video health education can reduce the stigma in women receiving infertility treatment and improve their reproductive quality of life, family intimacy and family adaptability.

Development and psychometric properties of Female Infertility Stigma Instrument (ISI-F): A sequential mixed method study

BACKGROUND

Infertility stigma is a hidden burden that overshadows the dimensions of reproductive and sexual health in infertile women. The aim of this study was to develop and evaluate the psychometric properties of the Female Infertility Stigma Instrument (ISI-F).

METHODS

This mixed method study with sequential exploratory design was conducted in qualitative and quantitative phases. In the first phase, the initial item pool of the Female Infertility Stigma Instrument (ISI-F) was generated using in-depth interviews. In the quantitative phase, psychometric properties of the ISI-f including content, face and construct validity, as well as reliability (internal consistency and stability) were assessed. Exploratory factor analysis was performed on the collected data from 300 infertile women for evaluation of construct validity. Data was analyzed using SPSS version 20. This study has followed the Mixed Methods Article Reporting Standards checklist.

RESULTS

The final version of ISI-F had 20 items. Total CVI and CVR were 0.94 and 0.87, respectively. Explanatory factor analysis identified 3 main factors that explained 54.013% of the variance. These factors consisted of stigma profile (7 items), self-stigma (6 items) and escaping from stigma (7 items). Internal consistency and stability of the ISI-F has been approved by Cronbach's alpha, McDonald's Omega (0.909, 0.916) and Intraclass Correlation Coefficient (ICC = 0.878).

CONCLUSION

The Female Infertility Stigma Instrument (ISI-F) is a valid and reliable tool for evaluation of the perceived female infertility stigma, that was developed in this study.

[The Reliability and Validity of Korean Version of the Infertility Stigma Scale (K-ISS)]

PURPOSE

This study aimed to translate the Infertility Stigma Scale (ISS) into Korean and to evaluate its reliability and validity in the Korean context.

METHODS

Data were collected from 350 women who underwent in vitro fertilization (IVF). Data were analyzed using SPSS WIN 25.0 and AMOS 22.0. Content validity was analyzed using the item-level content validity index (I-CVI) and scale-level content validity index/averaging (S-CVI/Ave). The preliminary survey was conducted on 20 women who had experienced IVF at least once to check the level of understanding of the tool and the time required to fill out the questionnaire. Exploratory and confirmatory factor analyses were used to test construct validity. Additionally, hypothesis-testing construct validity were tested. Cronbach's α was used to assess the reliability.

RESULTS

The Korean-ISS (K-ISS) consists of 25 items, excluding two items from the original ISS questionnaire. Exploratory factor analysis identified four factors, which explained 75.6% of the total variance. The four distinct factors were infertility stigma with self-devaluation (56.8%), public stigma (8.1%), social withdrawal (6.5%), and family stigma (4.2%). In the confirmatory factor analysis, the 25 items in the four-factor structure were validated (χ²/df ≤ 3, RMSEA ≤ 10). The hypothesis-testing construct validity of K-ISS against FPI (r = .58~.71, p < .001) and FQI (r = -.49~-.65, p < .001) was tested and found to be significant. The internal consistency reliability of the K-ISS, assessed using Cronbach's α, was .97.

CONCLUSION

The K-ISS has satisfactory construct validity and reliability; therefore, it can help minimize the negative impact of stigma by measuring the stigma associated with women experiencing infertility.

Marital satisfaction in Iranian infertile women: A systematic review and meta-analysis

Background

Infertility is a severe crisis in life that, in addition to creating psychological problems and disrupting a parent's identity and role, negatively impacts couples' marital satisfaction. Different studies in this field have reported different results, so this systematic review and meta-analysis was conducted to estimate the marital satisfaction standard score among infertile Iranian women.

Method

The databases of PubMed, Scopus, Web of Science, Embase, Scientific Information Database, and MagIran were searched without a time limit. We used the meta-analysis and a random-effects model to estimate the marital satisfaction pooled score. The heterogeneity of studies was examined with the I ² index and Cochrane's Q test. The correlation between the pooled score with the publication year and the mean age of women was evaluated using meta-regression. We assessed the publication bias by the Egger test.

Results

Seventeen studies with a sample size of 2,421 people were analyzed. The marital satisfaction pooled score of infertile women was 49% (95% CI: 39-60%). The marital satisfaction score in region 1 of the country (54, 95% CI: 42.7-65.3%) was higher than in other regions (45, 95% CI: 40-58%). Also, the marital satisfaction pooled score based on the Enrich scale (54, 95% CI: 39-69%) was higher than the score reported on other scales (45, 95% CI: 29-61%). Publication bias was not significant.

Conclusion

Infertile women have moderate to low marital satisfaction, rooted in the culture and context of Iranian society. It seems necessary to provide measures to strengthen marital satisfaction, strengthen family relationships and prevent family disintegration in these women.

Comparison of Clinical Pregnancy Outcomes after Fresh and Frozen Embryo Transfer

Objectives. To analyze the clinical outcomes of the patients who underwent fresh or frozen embryo transfer, as well as the neonatal outcomes. Methods. We conducted a retrospective analysis of women who underwent in vitro fertilization with fresh and frozen embryo transfer from January 2019 to January 2021. All of the included embryo transfers resulted in live births at ≥28 weeks of gestation. All of the patients were divided into two groups according to the assisted reproductive technique that was used (fresh embryo transfer group ( $n=101$ ) and frozen embryo transfer group ( $n=125$ )). Both groups were divided into subgroups based on a maternal age of ≥35 years. Result(s). Between the two groups, only the cesarean section rate was higher in the frozen transfer group, while no differences were shown for other outcomes. There were significant differences in the gestational hypertension and postpartum hemorrhage rates based on the subgroup comparison. No significant differences were detected in the offspring. Conclusions. Comparing fresh and frozen embryo transfers did not reveal any significant superiority. Venerable age exerts an apparent influence on pregnancy complications. Frozen embryo transfer is not always the best choice.

Associations between Stigma, Cognitive Appraisals, Coping Strategies and Stress Responses among Japanese Women Undergoing Infertility Treatment

The number of infertility treatment cycles in Japan is the highest worldwide. Studies have shown that stigma is a predictor of stress-related symptoms including anxiety and depression in women undergoing infertility treatment. Stress management to prevent stress-related symptoms may be crucial; however, few studies have examined the model of stigma and stress responses. Based on the stress-coping model, we hypothesized that stigma threatens the identity of such women and that coping failure increases stress responses. We aimed to explore the role of cognitive appraisals and coping strategies as mediators of the association between the stigma of infertility and stress responses. In December 2021, we conducted a cross-sectional study in Japan, in which 254 women undergoing infertility treatment completed a web-based survey. Hierarchical multiple regression analysis was conducted to analyze the associations between stigma, cognitive appraisals, coping strategies, and stress responses. The results showed that explanatory power increased with each additional variable in the following order: stigma, cognitive appraisals, and coping. Participants with a high level of stigma evaluated it as threatening, and used self-blame and venting coping strategies, and showed higher stress responses. Conversely, participants who used positive reframing coping strategies exhibited lower stress responses. Based on this, effective strategies to address stigma and stress responses are necessitated.

Association between Stigma and Anxiety, Depression, and Psychological Distress among Japanese Women Undergoing Infertility Treatment

Japan has the highest number of cases of infertility treatment in the world. Studies have indicated that women undergoing infertility treatment feel stigmatized and suffer from psychological symptoms such as anxiety and depression. However, in Japan, few studies have quantitatively examined the association between the stigma of infertility and psychological symptoms, and, to our knowledge, no study has examined its association using a scale with tested reliability and validity. This study aims to quantitatively examine the relationship between infertility stigma and anxiety, depression, and psychological distress among women undergoing infertility treatment, using a scale that has been validated for reliability and validity. The cross-sectional study was conducted in December 2021 through a web-based survey of 254 participants undergoing infertility treatment. A multiple regression analysis was performed to examine the relationship between stigma and anxiety, depression, and psychological distress. Stigma was a statistically significant predictor of anxiety, depression, and psychological distress (standardized β = 0.58, p < 0.001; β = 0.50, p < 0.001; β = 0.62, p < 0.001, respectively) after controlling for sociodemographic and infertility characteristics. Future studies should examine the causal relationship between stigma and anxiety, depression, and psychological distress and how to intervene to reduce stigma among women undergoing infertility treatment.

Breast Cancer Stigma Scale: A Reliable and Valid Stigma Measure for Patients With Breast Cancer

Purpose

This study aims to develop and validate a stigma scale for Chinese patients with breast cancer.

Methods

Patients admitted to the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, for breast cancer treatment participated in this study. Development of the Breast Cancer Stigma Scale involved the following procedures: literature review, interview, and applying a theoretical model to generate items; the Breast Cancer Stigma Scale's content validity was assessed by a Delphi study (n = 15) and feedback from patients with breast cancer (n = 10); exploratory factor analysis (n = 200) was used to assess the construct validity; convergent validity was assessed with the Social Impact Scale (n = 50); internal consistency Cronbach's α (n = 200), split-half reliability (n = 200), and test-retest reliability (N = 50) were used to identify the reliability of the scale.

Results

The final version of the Breast Cancer Stigma Scale consisted of 15 items and showed positive correlations with the Social Impact Scale (ρ = 0.641, P < 0.001). Exploratory factor analysis (EFA) revealed four components of the Breast Cancer Stigma Scale: self-image impairment, social isolation, discrimination, and internalized stigma, which were strongly related to our perceived breast cancer stigma model and accounted for 69.443% of the total variance. Cronbach's α for the total scale was 0.86, and each subscale was 0.75-0.882. The test-retest reliability with intra-class correlation coefficients of the total scale was 0.947 (P < 0.001), and split-half reliability with intra-class correlation coefficients of the total scale was 0.911 (P < 0.001). The content validity index (CVI) was 0.73-1.0.

Conclusion

The newly developed Breast Cancer Stigma Scale offers a valid and reliable instrument for assessing the perceived stigma of patients with breast cancer in clinical and research settings. It may be helpful for stigma prevention in China.

Risk factors for infertility treatment-associated harassment among working women: a Japan-Female Employment and Mental health in assisted reproductive technology (J-FEMA) study

PURPOSE

This study aims to elucidate the risk factors of infertility treatment-associated harassment (I-harassment) among Japanese working women.

METHODS

The study participants were 1103 female patients who enrolled in the Japan-Female Employment and Mental Health in artificial reproductive technology (J-FEMA) study. Of the 1727 female patients, 1103 female patients were working during the initiation of infertility treatment and were still working during the survey. Risk factors for I-harassment were analyzed using a multivariable logistic regression model.

RESULTS

In this study, 82 female patients (7.4%) experienced I-harassment. The risk was significantly higher in those who had more in vitro fertilization (IVF) cycles than those who had fewer IVF cycles (OR, 1.06; 95% CI, 1.01-1.10). Similarly, those who disclosed their infertility treatment to their workplace were at significantly higher risk for I-harassment than those who did not (OR, 1.80; 95% CI, 1.03-3.15).

CONCLUSION

This study found that 7.4% of female patients experienced I-harassment after infertility treatment initiation. Those female patients who "experienced more IVF cycles," and "disclosed their infertility treatment in their workplace" should be carefully followed up by healthcare professionals to prevent I-harassment.

Effect of family stress on life satisfaction among female workers during the COVID-19 epidemic in China: Exploring the roles of anxiety symptoms and age

The study aimed to investigate the level of life satisfaction (LS) among Chinese female workers after resuming work during the COVID-19 epidemic, and to further explore the potential mediating and moderating roles in the association between family stress and LS. Self-reported questionnaires were completed by 10,175 participants. Results showed that the level of LS decreased. The family stress had a negative effect on LS, and the effect was mediated by anxiety symptoms. Additionally, age moderated the direct and indirect effects within this relationship. Interventions aiming to improve LS should consider these aspects and younger workers should be given special attention.

Anxiety and social support needs of Chinese women receiving a high-risk screening result for Down syndrome

OBJECTIVE

This study aimed to investigate the prevalence of anxiety symptoms and the associations between social support and anxiety symptoms among Chinese pregnant women receiving a high-risk screening result for Down syndrome.

METHOD

A cross-sectional study was conducted in Guangzhou, China, from September 2020 to July 2021 among 260 Chinese pregnant women receiving a high-risk screening result for Down syndrome. Measures included the Self-Rating Anxiety Scale (SAS) and the Social Support Rating Scale.

RESULTS

The prevalence of anxiety symptoms (SAS ≥50) was 30.8%. Advanced age (≥35 years), education ≤ high school, pregnancy following in vitro fertilization, and low level of social support were predictors of anxiety symptoms.

CONCLUSION

The results suggest that early routine screening for anxiety symptoms should be carried out among Chinese pregnant women receiving a high-risk screening result for Down syndrome. The importance of social support and the role it can play in decreasing anxiety should be discussed with patients.

Development and validation of the health-related quality of life instrument for Chinese infertile couples: a mixed-methods study protocol

BACKGROUND

Infertility and its treatment have negative impacts on a couple's marital relationship, sexual life, psychological state and interpersonal relationships, causing personal distress. Health-related quality of life (HRQoL) has become an important component of health outcomes. HRQoL instruments developed in western culture are not always appropriate for use in China due to cultural differences. Probably due to the unique concept of fertility in China, infertility patients can be looked down upon and the family may  feel shameful. This study aims to develop a HRQoL instrument for infertile couples based on the Chinese social and cultural setting.

METHODS

Complementary mixed methods will be used to develop a new HRQoL instrument for Chinese infertile couples. The study consists of four stages: the first stage will involve a systematic review and qualitative interviews to construct draft candidate items. In the second stage, quantitative research [e.g., exploratory factor analysis (EFA), item response theory (IRT)] and cognitive interviews will be used for item selection. The third stage will be instrument validation, in which classical test theory (CTT) and IRT will be applied. In the final stage, the minimal clinically important difference (MCID) will be calculated by using distribution-based methods and anchor-based methods (e.g., logistic regression, receiver operating characteristic curve).

DISCUSSION

The new HRQoL instrument for Chinese infertile couples will be developed, which will provide a standard and effective HRQoL instrument in clinical outcome assessment and health outcome measurement.

Development of the Japanese Version of the Infertility Stigma Scale: Examination of Its Reliability and Validity

The stigma of infertility negatively affects health, resulting in mental distress and poor quality of life. An appropriate scale is essential to examine the stigma experienced by infertile women and provide adequate interventions. Therefore, we developed a Japanese version of the Infertility Stigma Scale (ISS). After examining the content validity of this scale, we conducted an online survey of women undergoing fertility treatment to test the scale’s structural validity, internal consistency, intra-rater reliability, known-groups validity, convergent validity, and discriminant validity. A total of 254 participants were included in the analysis. The results of confirmatory factor analysis of four factors based on the original scale revealed the optimal fit. Cronbach’s alpha was 0.95 for the total score. Concerning test−retest analysis, the total score of the ISS and subscale had a high Spearman correlation coefficient (ρ = 0.61−0.88, p < 0.001). For convergent validity, the association between the ISS and social support, self-esteem, and family functioning was significantly negatively correlated. The results of the multitrait scaling analysis scale showed that correlations of all items exceeded 0.40, and scaling errors (7/81, 8.6%) were few. The Japanese version of the ISS was confirmed to have acceptable reliability and validity.

Stigma predicting fertility quality of life among Chinese infertile women undergoing in vitro fertilization-embryo transfer

OBJECTIVE

To investigate stigma and fertility quality of life (FertiQoL) and identify predictors of FertiQoL in Chinese infertile women undergoing in vitro fertilization-embryo transfer (IVF-ET).

METHODS

A descriptive correlational design was adopted to investigate the association between stigma and FertiQoL in 588 infertile women undergoing IVF-ET. The personal information questionnaire, Infertility Stigma Scale (ISS) and FertiQoL tool were used to measure study variables.

RESULTS

The mean scores of ISS and FertiQoL were 62.59 (SD = 21.58) and 63.64 (SD = 13.72), respectively. There were significant differences of ISS scores among participants with different educational level, residence, occupation, religious belief, financial condition, age group, duration of infertility and infertility treatment, while significant differences of the FertiQoL scores were found in participants with different insurance status, determinism of etiology, infertile type, duration of infertility treatment and cycles of IVF-ET. Pearson's correlation analysis showed stigma was negatively correlated with FertiQoL (r = -0.081 to -0.669, p < .05). The self-devaluation (β = -0.290, p < .001), social withdrawal (β = -0.237, p < .001), family stigma (β = -0.217, p < .001) and insurance status (β = 0.066, p=.035) were identified as the significant predictor of FertiQoL accounting for 43.5% of variance.

CONCLUSIONS

The stigma was significantly associated with FertiQoL in infertile women undergoing IVF-ET with higher level of stigma predicting poorer FertiQoL. More psychological support should be provided to infertile women to reduce stigma and improve FertiQoL.

Psychological Resilience as the Mediating Factor Between Stigma and Social Avoidance and Distress of Infertility Patients in China: A Structural Equation Modeling Analysis

Background

Stigma, social avoidance and distress may seriously affect the quality of life of infertility patients. Psychological resilience has been proved to effectively combat psychological stress. This study aimed to explore the mediating role of psychological resilience between stigma and social avoidance and distress (SAD) in females with an unfulfilled wish for a child.

Methods

Stigma Scale, Social Avoidance and Distress Scale (SADS), and Psychological Resilience Scale were used to evaluate 266 females with infertility. Structural equation model was used to test the mediating effect of psychological resilience on the relationship between stigma and SAD.

Results

The SADS, stigma scores, and psychological resilience scores of 266 females with infertility were 13.36 ± 5.77, 77.84 ± 16.91, and 58.84 ± 12.24 points, respectively. The stigma scores were positively correlated with SADS, and negatively correlated with psychological resilience scores. The psychological resilience scores were negatively correlated with SADS. Psychological resilience played a partially mediating role between the stigma and SAD of infertility patients, and the mediating effect accounted for 25.5% of the total effect.

Conclusion

Psychological resilience had a partial mediating effect on the relationship between stigma and SAD, and could reduce the negative effect of stigma on the development of SADS. Therefore, positive psychological interventions improving psychological resilience might help to reduce stigma and improve SAD in infertility patients.

Coping strategies mediate the association between stigma and fertility quality of life in infertile women undergoing in vitro fertilization-embryo transfer

BACKGROUND

The mediating role of coping strategies and its relationship with psychological well-being and quality of life has been considered in the literature. However, there is little research to explore the mechanism of coping strategies on stigma and fertility quality of life (FertiQoL) in infertile women undergoing In Vitro Fertilization Embryo Transfer (IVF-ET). The aim of this study was to examine the mediating effect of coping strategies on the relationship between stigma and fertility quality of life (FertiQoL) in Chinese infertile women undergoing In Vitro Fertilization Embryo Transfer (IVF-ET).

METHODS

In this cross-sectional study, a total of 768 infertile women undergoing IVF-ET were recruited from Assisted Reproductive Center of Shaanxi Province, China. The personal information, infertility stigma scale, coping strategy scale and FertiQoL scale were measured using a set of questionnaires. The multiple mediator model was performed using AMOS 21.0.

RESULTS

The model showed a significant negative direct effect between stigma on FertiQoL. There were significantly negative indirect effects of stigma on FertiQoL through active-avoidance, active-confronting and passive-avoidance, respectively. The meaning-based coping played a positive intermediary role. The model explained 69.4% of the variance in FertiQoL.

CONCLUSION

Active-avoidance coping strategy is the most important mediator factor between stigma and FertiQoL in infertile women undergoing IVF-ET treatment. Meaning-based coping strategy plays a positive mediating role between stigma and FertiQoL.

The relationship between stigma, perceived social support and depression in infertile Turkish women undergoing in vitro fertilization-embryo transfer

This study was conducted to determine the relationship between the perceived social support, stigmatization and depression in infertile women and the influencing factors. The study was conducted on 298 infertile women at a private hospital between March and September 2019 using a Personal Information Questionnaire, Infertility Stigma Scale (ISS), Beck Depression Inventory (BDI), and Multidimensional Scale of Perceived Social Support (MSPSS). BDI had a significantly positive correlation with ISS and negative correlation with MSPSS. And MSPSS had a significantly negative correlation with ISS. Infertility leads women to suffer various psychosocial problems. Nurses should be aware of these problems during diagnostic procedures for infertility treatment, which should also include psychiatric counseling.

Anxiety, depression and social support across pregnancy in women with a history of recurrent miscarriage: A prospective study

AIM

Women with a history of recurrent miscarriage are a vulnerable population. This study aimed to examine changes and relationships among anxiety, depression and social support across three trimesters of pregnancy in women with a history of recurrent miscarriage.

METHODS

A prospective, longitudinal study was employed. A convenience sample of 166 pregnant women with a history of recurrent miscarriage completed the measures at their 6-12, 20-24 and 32-36 gestational weeks.

RESULTS

The prevalence of anxiety at early, middle and late pregnancy was 47.6%, 36.1% and 32.5%, respectively, whereas that of depression was 38%, 34.3% and 31.3%, respectively. Social support scores increased from early pregnancy to middle pregnancy then remained in late pregnancy. There were correlations among anxiety, depression and social support across pregnancy.

CONCLUSIONS

Anxiety and depression were highly prevalent in pregnant women with a history of recurrent miscarriage, especially in early pregnancy when the level of social support was the lowest. Social support is an essential buffer against anxiety and depression throughout the pregnancy.

Infertility Stigma: A Qualitative Study on Feelings and Experiences of Infertile Women

Background:

Infertility stigma is a phenomenon associated with various psychological and social tensions especially for women. The stigma is associated with a feeling of shame and secrecy. The present study was aimed to explore the concept of infertility stigma based on the experiences and perceptions of infertile women.

Materials and Methods:

This qualitative conventional content analysis study was conducted in Isfahan Fertility and Infertility Center, Iran. Data were collected through in-depth interviews with 17 women who had primary infertility. All the interviews were recorded, transcribed and analyzed according to the steps suggested by Graneheim and Lundman. The Standards for Reporting Qualitative Research (SRQR) checklist was followed for this research.

Results:

Eight hundred thirty-six initial codes were extracted from the interviews and divided into 25 sub-categories, 10 categories, and four themes. The themes included “stigma profile, self-stigma, defensive mechanism and balancing”. Stigma profile was perceived in the form of verbal, social and same sex stigma. Self-stigma was experienced as negative feelings and devaluation. Defensive mechanism was formed from three categories of escaping from the stigma, acceptance and infertility behind the mask. Two categories; empowered women and pressure levers, created a balancing theme against the infertility stigma.

Conclusion:

Infertile women face social and self-stigma which threatens their psychosocial wellbeing and self-esteem. They use defensive response mechanisms and social support to mitigate these effects. Education focused on coping strategies might be helpful against infertility stigma.

Fertility quality of life (FertiQoL) among Chinese women undergoing frozen embryo transfer

Background

Women undergoing infertility treatment have poor quality of life. This may cause them to withdraw from or refuse treatment. Women undergoing frozen embryo transfer have a treatment interval. The aim of this study was to investigate the status quo of the fertility quality of life in women undergoing frozen embryo transfer and analyse its predictors.

Methods

A cross-sectional survey was conducted from August 2019 to August 2020 among women undergoing frozen embryo transfer in a tertiary hospital reproductive centre in Beijing, China. The survey collected demographic characteristics and treatment data and included the fertility problem inventory, the fertility quality of life scale (FertiQoL) and the state-trait anxiety scale. Multiple linear stepwise regression was used to explore the predictors of fertility quality of life.

Results

In total, 1062 women completed the survey. Participants reported that they had high levels of fertility-related stress and anxiety during treatment. They also had lower fertility-related quality of life, and the Treatment FertiQoL scored the lowest. The regression results showed that social concern, trait anxiety, duration of treatment and age were risk factors for diminished fertility quality of life.

Conclusion

Chinese women undergoing frozen embryo transfer have relatively poor quality of life. The potential predictors of fertility quality of life include social concern, trait anxiety, duration of treatment and age.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-021-01325-1.

The social stigma of infertile women in Zhejiang Province, China: a questionnaire-based study

BACKGROUND

Infertile women often face stigmatization worldwide. This study aimed to investigate the stigma against infertile women in China and to analyze its influencing factors.

METHODS

Of 270 women who were randomly selected from patients receiving adjuvant fertility treatment in Zhejiang Province, China, 254 successfully completed the general information questionnaire, disease information questionnaire, and Chinese version of the infertility stigma scale (ISS). The ISS contained 27 positively worded items, each of which was graded on a 5-point Likert-type scale.

RESULTS

The total stigma score of female infertility patients was 66.39 ± 21.96. By dividing the number of items, the average score for each ISS item was 2.13 ± 0.81, indicating the presence of stigma. Among the four ISS factors, the social withdrawal score was the highest (2.64 ± 1.05), whereas the family stigma score was the lowest (1.88 ± 0.88). Multiple stepwise regression analysis further revealed that the duration of infertility and monthly income were important predictors of the stigma of infertile women.

CONCLUSIONS

Infertile women experience moderate to high levels of stigma in Zhejiang, China. Thus, supportive psychological interventions and public education are required to change patients' cognition and assist patients in coping with negative experiences.

Comparative efficacy and safety of complementary and alternative therapies for tubal obstructive infertility: A protocol for network meta-analysis

BACKGROUND

Infertility is a kind of global disease. Fallopian tubal obstruction is one of the most important causes of female infertility. Complementary and alternative therapies are effective in treating tubal obstructive infertility, but there is no study on a comprehensive comparison among them. So, the purpose of this paper is to evaluate the efficacy and safety of different complementary and alternative therapies for tubal obstructive infertility.

METHODS

We will search for randomized controlled trials (RCTs) from the following databases: PubMed, Cochrane Library, EMBASE, Web of Science, Chinese Biomedical Literature Database (SinoMed), Chinese National Knowledge Infrastructure (CNKI), Wanfang database, and VIP database. We will assess the risk of bias of the included studies with the Cochrane tool, and the strength of evidence with the GRADE approach. Both pairwise meta-analyses and network meta-analyses will be performed to examine the relative efficacy and safety of complementary and alternative therapies in the treatment of tubal obstructive infertility.

CONCLUSION

Our findings will provide clear evidence based on current available studies, which may lead to some proposals for both patients and researchers.

INPLASY REGISTRATION NUMBER

INPLASY202110076.

Influence of age, stigma and social support on male temporary ejaculation failure on IVF oocyte retrieval day

OBJECTIVE

To explore the social and psychological factors associated with male Temporary Ejaculation Failure (TEF) during In Vitro Fertilization (IVF), with the goal of providing a theoretical basis for clinical intervention and treatment.

METHODS

The study included 75 TEF patients and 223 non-TEF patients undergoing IVF treatment at the center of reproduction and genetics of Integrated Chinese and Western medicine in the Affiliated Hospital of Shandong University of Traditional Chinese Medicine from May 2019 to May 2020. A questionnaire survey was then administered to the study subjects. The questionnaires included general information, Perceived Stress Scale (PSS), Stigma Questionnaire, Perceived Social Support Scale (PSSS), and Positive Psychological Capital Questionnaire (PPQ). Logistic regression analysis was then used to analyze the social psychological factors associated with the research objectives.

RESULTS

Comparison of social demographic factors and clinical data between TEF group and non-TEF group: there were significant differences in the age and educational level between the two groups (P< 0.05), and the average age of the TEF group (37.01±7.11) was significantly higher than that of the non-TEF group (34.89±6.24). In addition, patients with high school or technical secondary school education levels had the lowest probability of TEF(X²=7.662, P=0.022). 2. The difference of related social and psychological factors between the two groups: the scores of perceived stress (17.57±6.51) and stigma (4.52±3.87) in the TEF group were significantly higher than those in the non-TEF group, which were (15.50±5.00, P< 0.05) and (2.61±3.52, P< 0.05), respectively. On the other hand, the scores of social support (55.31±14.04) and psychological capital (121.73±25.93) in the TEF group were significantly lower than those in the non-TEF group, which were (60.74±10.93, P< 0.05) and (130.31±17.32, P< 0.05), respectively. Results Obtained after conducting univariate logistic regression analysis indicated that age (OR=1.051, P=0.016), perceived stress (OR=1.073, P=0.005), stigma (OR=1.139, P< 0.001), family support (OR=0.901, P< 0.001), friend support (OR=0.932, P=0.023), other support (OR=0.915, P=0.004), self-efficacy (OR=0.947, P=0.009), resilience (OR=0.947, P=0.013), hope (OR=0.930, P=0.002), and optimism (OR=0.953, P=0.032) can all significantly affect male TEF.4. Moreover, the multivariate logistic regression analysis results indicated that age (OR=1.071, P=0.002) and stigma (OR=1.132, P=0.003) can positively predict TEF, while family support (OR=0.877, P=0.012) can negatively predict TEF.

CONCLUSIONS

The results obtained in this study have indicated that age and stigma are independent risk factors for male TEF, while family support is a protective factor of TEF. Analyzing the treatment of TEF from a socio-psychological perspective provides a new intervention target for effectively reducing its incidence, thereby helping to improve the success rate of IVF.

Women and Infertility in a Pronatalist Culture: Mental Health in the Slums of Mumbai

Background

Infertility is a global problem, with high prevalence in India. As a pronatalist society, infertility is particularly problematic in India, causing stigma, shame, and blame especially for women. Infertility consequences for women include discrimination, social exclusion, and abandonment, putting them at high risk for mental health distress. Furthermore, mental health is highly stigmatized and specialized care is largely unavailable. Despite the cultural importance of childbearing, research on infertility distress and resulting mental health sequelae is lacking, particularly among low-income women. The purpose of this study is to assess mental health, using validated scales, among Mumbai slum-dwelling women with a history of infertility.

Methods

We conducted a mixed-method, cross-sectional study. A focus group discussion with community health workers (n = 7) informed the development of a comprehensive survey. The survey consisted of validated scales whenever possible, in addition to questions pertaining to women’s sociodemographic and reproductive history. After rigorous forward and back translation, the surveys were conducted as face-to-face structured interviews due to low literacy levels and the research naiveté of our respondents. Interviews were conducted by culturally, linguistically, gender-matched, trained research assistants.

Results

Mumbai slum-dwelling women of reproductive age suffering from infertility (N = 74) participated. Most (85%) women and their husbands (66%) reported previous infertility testing. Participants had elevated mental health distress (anxiety and depression symptomology) largely explained by general health, length of marriage, and coping strategy employed.

Conclusion

Women facing the double stigma of mental health and infertility need innovative programs to address their challenges.

Support or stressor? The community as a predictor of perceptions of infertility

Perceptions of women experiencing infertility may influence their coping and psychological adjustment. This study examined the influence of community pressure and support on the perception of fertility problems among 156 women in religious Jewish societies in Israel, undergoing fertility treatment. Regression analyses indicated that perceptions of pressure from the community were associated with more problematic consequences and problem severity and timeline, while perceptions of community support were simultaneously associated with lower levels of loss of control and higher levels of problematic consequences. Thus, social work interventions should consider ways to increase support, while reducing the stress resulting from it.

Inpatient Suicide Second Victim Experience and Support Tool: Psychometric properties of a scale for nurses who experienced inpatient suicide at Chinese general hospitals

This study describes a psychometric scale, the Inpatient Suicide Second Victim Experience and Support Tool, for evaluating physical and psychological distress with a focus on resources for supporting the needs of nursing professionals. Our study defines "second victim" as a nurse who experiences inpatient suicide while on shift. We conducted a cross-sectional study among non-psychiatric nurses to examine the psychometrics of the scale. A total of 731 participants were recruited from eight Chinese general hospitals for this research. Data were analyzed by exploratory factor analysis and confirmatory factor analysis to examine the reliability and validity of the scale. The results indicated adequate indices resulting in 21 items. The final structure for the scale was categorized into five domains: psychosomatic distress, support from family and friends, work-related support, organizational support, and professional self-efficacy. The total variance explained was 69.06%. Cronbach's alpha was 0.869 overall, and ranged from 0.626 to 0.914 for the five dimensions. The test-retest reliability of 0.792 for the entire scale was also acceptable. The scale shows promise for use by healthcare organizations to identify second victims and promote necessary organizational support interventions in Chinese hospitals.

The role of gender and self-esteem as moderators of the relationship between stigma and psychological distress among infertile couples

To determine if perceived stigma is positively associated with psychological distress, and examine if self-esteem has a moderating effect on the relationship between stigma and psychological distress among infertile Chinese couples. 369 infertile couples completed questionnaires including socio-demographic and clinical characteristics, stigma, self-esteem, and psychological distress. Stigma had a significant, positive association with psychological distress (r = 0.461, P < 0.01). Self-esteem moderated the association between stigma and psychological distress differently for men compared to women. Stigma had a positive, moderate association with psychological distress in men with high self-esteem compared to men with low self-esteem (t = 3.232, P < 0.01). However, there was no significant difference in the relationship between stigma and psychological distress between women with high and low self-esteem, tests of the simple slopes showed that non-significant difference of slopes between the two groups (t = -0.017, P = 0.987). The results indicate that self-esteem buffers the net effect of stigma on psychological distress in men but not women. Future research should focus on interventions that use self-esteem as a way to decrease the negative association of stigma with psychological distress, especially among men who are infertile and have low self-esteem.