How do individual attachment patterns of both members of couples affect their perceived infertility stress? An actor–partner interdependence analysis

'I feel like I was born for something that my body can't do': a qualitative study on women's bodies within medicalized infertility in Italy

OBJECTIVE

In the context of infertility, women's bodies have a central physical, psychological, and social role. Medically assisted reproduction (MAR) treatment includes highly intrusive procedures targeting women's bodies. This study aimed to develop a preliminary understanding of women's core meanings around their bodies within their experiences of medicalized infertility in Italy.

DESIGN

104 Italian women dealing with infertility and MAR treatments answered open-ended questions, which were part of a broader online survey. A reflexive thematic analysis was performed.

RESULTS

Three themes were identified: (a) the paradox of the body: 'I feel like I was born for something that my body can't do'; (b) 'Something only mothers can do': meanings attributed to the physical body; (c) Internalized 'clinical gaze': medicalized body representations.

CONCLUSIONS

This work provides insights into the meanings assigned to their bodies by Italian women dealing with MAR. This study outlined women's ambivalence towards their bodies, describing them as 'fragmented' into parts and as 'deposits' of their reproductive hopes. Results suggest that Italian pronatalist culture may have potential fallouts for women's gendered sense of self and the integration between their biological and psychosocial body experiences. Study limitations, future research directions, and clinical implications are presented.

A Dyadic Study of Attachment, Coping, and Quality of Life in Couples Seeking Fertility Treatment

This study examined attachment insecurities, infertility-specific coping strategies, and quality of life (QoL) in 87 couples seeking fertility treatment. Partners completed self-report measures. Path analyses showed that women's and men's attachment anxiety were associated with their own lower QoL, whereas attachment avoidance was associated with their own and their partner's lower QoL. Adaptive coping in men and women were associated with women's higher QoL. Non-adaptive coping was associated with men and women's lower QoL. Coping strategies explained the associations between attachment and QoL. This highlights the importance of individual and dyadic factors for understanding QoL in couples seeking fertility treatment.

Romantic attachment, infertility-related stress, and positive body image of women dealing with infertility

Introduction

Infertility is a condition that can affect the physical, emotional, social, and relational well-being of women. Women's bodies seem to assume a crucial relevance as part of the experience of infertility and its treatments. An extended body of literature supports the role of romantic attachment orientations in facing infertility-related stress. However, the association between romantic attachment orientations, infertility-related stress, and women's body image has not been explored.

Methods

This cross-sectional study aimed to investigate the role of romantic attachment and infertility-related stress concerning positive body image in 113 women dealing with infertility. Data were analyzed with correlation and mediation path analyses.

Results

Results showed that high levels of attachment anxiety, attachment avoidance, and infertility-related stress were negatively associated with positive body image. Path analyses indicated that positive body image may be directly associated with romantic attachment anxiety. The negative association of attachment avoidance with body image appeared to be mediated by infertility-related stress.

Discussion

Findings suggest that romantic attachment insecurities and infertility-related stress are significantly associated with a worsened body image in infertile women. Implications for future research are discussed.

Family Cohesion and Sleep Disturbances During COVID-19: the Mediating Roles of Security and Stress

Despite the increase in proximity to one's family amid university closures during the COVID-19 pandemic, the mechanisms underlying how family cohesion influenced students' sleep remain understudied. Using a large sample of college students in China (N = 1,178) during the COVID-19 pandemic, the current study examined the serial mediating roles of sense of security and perceived stress on the effect of family cohesion on sleep disturbance. Generalized linear modeling serial mediation analysis with 1,000 resampled bootstrapping methods showed that sense of security and perceived stress were negatively and positively associated with sleep disturbance, respectively. Furthermore, sense of security and perceived stress fully mediated the indirect effect of family cohesion on sleep disturbances. Implications and conclusions are discussed.

Perceived Discrimination and Relationship Satisfaction Among Same-Sex Couples: The Role of Dyadic Stress and Sex

Based on the fact that most research drawn from the minority stress theory on the association between minority stress and relationship satisfaction has focused on an individual perspective rather than a dyadic perspective, and the limited evidence of the systemic transactional model (STM) explore the topics of same-sex couples. This study aims to combine both theories to examine the association between perceived discrimination and relationship satisfaction among lesbian, gay, and bisexual (LGB) people on both partners and test the potential mediating role of dyadic stress and sex difference in this association. Using an actor-partner interdependence mediation model (APIMeM), we analyzed data including a sample of 241 LGB couples (133 female and 108 male same-sex dyads). Results showed that perceived discrimination had no direct actor-partner effects on relationship satisfaction. APIMeM revealed significant indirect partner effects from perceived discrimination on both individuals' and their partners' relationship satisfaction through the partner's dyadic stress. Additionally, the effect of personal dyadic stress on a partner's relationship satisfaction was stronger for women compared to men. These findings demonstrated the utility of the minority stress theory and STM framework for understanding the risk of stressors in damaging LGBs' romantic relationships. Couple interventions should integrate knowledge from a dyadic perspective with attention to sex differences.

Quality of life and infertility stress in homologous and heterologous medically assisted reproduction: The role of common and specific psychopathological traits

PURPOSE

This study compared the quality of life/stress between individuals undergoing homologous and heterologous medically assisted reproduction (MAR) and explored the role of psychopathological traits.

DESIGN AND METHODS

Two hundred and twenty-six participants in homologous (52.2%) and heterologous MAR (47.8%) completed Symptom Checklist 90-R, Fertility Problem Inventory, and Fertility Quality of Life.

FINDINGS

The homologous group showed higher depressive/anxious and obsessive-compulsive traits, hostility and interpersonal detachment, and worse quality of life/stress than the heterologous one. In the homologous pathway, those with higher interpersonal detachment showed worse quality of life, in the heterologous one those with greater paranoid traits had greater stress.

PRACTICE IMPLICATIONS

Psychiatric nursing support should focus on interpersonal detachment in homologous and paranoid traits in heterologous MAR.

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.

Individual and Relational Well-Being at the Start of an ART Treatment: A Focus on Partners' Gender Differences

Infertility and ART treatments represent stressful experiences for the couples, impacting on the overall psychological well-being of partners as well as on their couple adjustment. Several variables were analyzed as risk factors for infertility-related distress. The impact of these experiences has been well-documented in both women and men, reporting important gender differences. The aim of this study was to assess gender differences in individual and relational well-being in infertile couples. Gender differences for psychological and medical variables predicting psychological distress were investigated. Two hundred and thirty couples who entered an ART program at a public hospital in Milan were recruited. Each partner completed the following scales: ScreenIVF, Dyadic Adjustment Scale, and Experience in Close Relationship Questionnaire. Findings revealed several gender differences with women reporting higher levels of both anxiety and depressive symptoms, anxiety and avoidance attachment, and helplessness, but lower levels of acceptance than men. Differences emerged also in factors predicting well-being: poor support predicted anxiety in men and depression in women. Furthermore, individual well-being was predicted only for men by attachment anxiety and previous treatment. Finally, in the women subsample, couple's adjustment was predicted by anxiety attachment, while in men predictors were helplessness and type of diagnosis. These results suggest the importance of implementing support interventions for couples which take into consideration the specific needs and fragility of each partner as well as focusing on enhancing a sense of partnership.

Success of assisted reproductive technology treatment and couple relationship: A pilot study on the role of romantic attachment

Infertility is a deeply distressing experience, which can threaten important personal and martial goals, frequently affecting the psychophysical health. A supportive relationship and a secure romantic attachment appear to reduce infertility stress, as well as play a relevant role in the success of assisted reproductive technology treatments. The principal aim of the study is to investigate the predictive effect of romantic attachment, couple characteristics, quality of life and age on assisted reproductive technology outcome. A total of 88 infertile women, enrolled in an assisted reproductive technology Centre of Rome, completed the Experience in Close Relationship-Revised, the Couple Relationship Inventory, the Fertility Quality of Life and a socio-demographic questionnaire. The participants completed the questionnaires at the beginning of the medical treatment. Data analyses showed significant associations among Experience in Close Relationship-Revised dimensions, Couple Relationship Inventory and Fertility Quality of Life Scales. Assisted reproductive technology outcome was negatively correlated to Experience in Close Relationship-Revised Avoidance and positively related to Couple Relationship Inventory Dependence. A multi-variable logistic regression revealed that Experience in Close Relationship-Revised Avoidance decreased the probability of pregnancy. The present findings partially confirmed the study hypotheses since several associations among couple characteristics, attachment anxiety and avoidance dimensions, infertility-related quality of life in infertile women were found. Furthermore, according to a definition of Avoidance, assisted reproductive technology positive outcome appears to be associated to lower levels of fear of dependence and interpersonal intimacy, and to a low need both for self-reliance and for reluctance to self-disclose within the romantic relationship. Further investigations are needed both to confirm this preliminary finding and for promoting focused therapeutic interventions for couples facing assisted reproductive technology.

Attachment and sexual functioning in women and men seeking fertility treatment

Objective: The purpose of the study was to examine the frequency of sexual difficulties and the associations among attachment insecurities (anxiety, avoidance) and sexual functioning (problems with sexual function, sexual dissatisfaction) in women and couples seeking fertility treatment. Methods: In a cross-sectional study, 88 Canadian women and 45 couples receiving fertility treatments completed self-reported measures of adult attachment and sexual functioning. Results: The frequency of problems in sexual function varied from 14.8% (pain) to 58.0% (desire) in women and from 6.7% (satisfaction with orgasm) to 28.9% (desire) in men. Among women, attachment-related avoidance predicted their low levels of sexual satisfaction (β = -0.30, p = .007) and sexual pain (β = 0.22, p = .044). Dyadic analyses revealed associations between men's attachment-related anxiety and their difficulties in reaching erection (β = 0.30, p = .042) and orgasm (β = 0.33, p = .009). Anxiety in women was related to their lubrication difficulties (β = 0.44, p = .006). One partner effect was found: men's avoidance was related to their partners' difficulty in achieving orgasms (β = 0.39, p = .045). Conclusions: Results support the pertinence of attachment theory and the relevance of using dyadic designs to understand sexuality in couples seeking fertility treatment.

Depression and Anxiety in Pathways of Medically Assisted Reproduction: The Role of Infertility Stress Dimensions

Background:

Depressive and anxious symptoms are common psychological reactions to infertility and Medically Assisted Reproduction (MAR). No study compared depressive and anxious symptoms and infertility stress dimensions across homologous and heterologous MAR, nor explored the specific role of the infertility stress dimensions in the two pathways. Homologous MAR may be associated with higher distress as the couple feel that the responsibility to reproduce and carry on the family line falls on them, and they feel inadequate if they are unable to bear children.

Objective:

We compared depressive/anxious symptoms and infertility stress dimensions between individuals undergoing homologous and heterologous MAR. We also explored the association between the infertility stress dimensions and depressive/anxious symptoms separately in two MAR pathways.

Methods:

Two-hundred twenty-six individuals participated [mean age = 39.71 years; 54.45% women]: 118 (52.2%) in homologous and 108 (47.8%) in heterologous MAR. The Fertility Problem Inventory, Beck Depression Inventory-II, and State and Trait Anxiety Inventory-Y form were administered.

Results:

Individuals in homologous MAR had higher depressive/state-trait anxious symptoms, general infertility stress, and infertility-related sexual concerns than those in heterologous MAR. In homologous MAR, social and sexual concerns were associated with depressive/trait anxious symptoms while gender had no effect. In heterologous MAR, male gender was associated with lower state anxious symptoms while infertility stress dimensions had no effect.

Conclusion:

Individuals in homologous MAR are a more distressed subgroup which requires a tailored supportive psychological intervention specifically on sexual and social concerns.

Application of the dyadic data analysis in behavioral medicine research: marital satisfaction and anxiety in infertile couples

BACKGROUND

Dyadic data analysis (DDA) is increasingly being used to better understand, analyze and model intra- and inter-personal mechanisms of health in various types of dyads such as husband-wife, caregiver-patient, doctor-patient, and parent-child. A key strength of the DDA is its flexibility to take the nonindependence available in the dyads into account. In this article, we illustrate the value of using DDA to examine how anxiety is associated with marital satisfaction in infertile couples.

METHODS

This cross-sectional study included 141 infertile couples from a referral infertility clinic in Tehran, Iran between February and May 2017. Anxiety and marital satisfaction were measured by the anxiety subscale of the Hospital Anxiety and Depression Scale and 10-Item ENRICH Marital Satisfaction Scale, respectively. We apply and compare tree different dyadic models to explore the effect of anxiety on marital satisfaction, including the Actor-Partner Interdependence Model (APIM), Mutual Influence Model (MIM), and Common Fate Model (CFM).

RESULTS

This study demonstrated a practical application of the dyadic models. These dyadic models provide results that appear to give different interpretations of the data. The APIM analysis revealed that both men's and women's anxiety excreted an actor effect on their own marital satisfaction. In addition, women's anxiety exerted a significant partner effect on their husbands' marital satisfaction. In MIM analysis, in addition to significant actor effects of anxiety on marital satisfaction, women's reports of marital satisfaction significantly predicted men's marital satisfaction. The CFM analysis revealed that higher couple anxiety scores predicted lower couple marital satisfaction scores.

CONCLUSION

In sum, the study highlights the usefulness of DDA to explore and test the phenomena with inherently dyadic nature. With regard to our empirical data, the findings confirmed that marital satisfaction was influenced by anxiety in infertile couples at both individual and dyadic level; thus, interventions to improve marital satisfaction should include both men and women. In addition, future studies should consider using DDA when dyadic data are available.

Sexual satisfaction, intimacy and relationship of couples undergoing infertility treatment

OBJECTIVE

To explore the infertility-related sexual and relationship concerns, sexual satisfaction and perceived intimacy of infertile couples.

BACKGROUND

Infertility is known to affect the psychosocial well-being of couples. Fertility treatment and the scheduled regime of sexual activities places further pressure on infertile couples.

METHODS

This was a cross-sectional study. Infertile couples who attended fertility clinics for treatment between November 2015 and March 2016 were invited. A total of 113 pairs of infertile women and men participated in the study as couples.

RESULTS

A significantly higher proportion of women than men reported that their partner did not understand how the problem of fertility affected them and had worries that they were drifting apart in their relationship. Significantly more men than women considered their sex life to be lacking in quality. In terms of perceived intimacy, more women than men reported that they had disclosed their feelings and negative emotions to their partner. The correlation analysis revealed significant positive correlations between sexual (dis)satisfaction and infertility-related sexual and relationship concerns in couples.

CONCLUSIONS

The results show that infertile couples suffer from infertility-related sexual and relationship concerns. An intervention study should be conducted to help these couples overcome such concerns.

The Role of Attachment Anxiety and Attachment Avoidance on the Psychosocial Well-being of Infertile Couples

This study's objective was to explore the mediating role of attachment orientation in infertile women and their partners as a mediator of the relationship between need for parenthood and psychosocial well-being. Ninety participants (45 couples) undergoing in vitro fertilization completed self-report questionnaires that assessed representations of the importance of parenthood, attachment orientations, and psychosocial well-being. Path analysis was used to examine the direct and indirect effects. The results indicated that women's attachment anxiety mediated the effect of need for parenthood on the psychological well-being of themselves and their partner. Although causality cannot be assumed, this study highlights the importance of considering attachment orientations and related strategies of emotion regulation in clinical settings and the need to address the meaning of parenthood for promoting couples' well-being.

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.