Psychological aspects in couples with infertility

Mitigating Effect of Lepidium sativum Seeds Oil on Ovarian Oxidative Stress, DNA Abnormality and Hormonal Disturbances Induced by Acrylamide in Rats

Acrylamide (ACR), an industrial compound, causes both male and female reproductive toxicity. Lepidium sativum seeds (L. sativum) (Garden cress) are known for their health benefits as antioxidant, antiasthmatic, anticoagulant, anti-inflammatory, and analgesic agents. Therefore, this study aimed to investigate the phytochemistry and nutritional value of L. sativum seeds oil for attenuating the ovarian damage induced by acrylamide in rats. The phytochemical investigation of the seeds revealed the presence of vitamins, potassium, iron, sugar and amino acids. Twenty eight compounds from the unsaponifiable fraction and twenty three compounds from the saponifiable fraction were identified. Three sterols and two triterpenes were isolated and identified as β-sitosterol (1), ▵5-avenasterol (2), friedelanol (3), stigmasta-4, 22-dien-3-one (4), and ursolic acid (5). Treatment of acrylamide-induced rats with L. sativum seeds oil ameliorated prolactin (PRL), progesterone (P4), estradiol (E2), malondialdehyde (MDA), superoxide dismutase (SOD), glutathione (GSH), nitric oxide (NO), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF- α) with variable degrees. The histopathological findings of ovaries supported these results. In conclusion, compounds (3-5) were isolated for the first time from L. sativum seeds oil. The seeds oil attenuated the ovarian damage and could potentially be a new supplemental agent against female infertility.

Women's Narratives on Infertility as a Traumatic Event: An Exploration of Emotional Processing through the Referential Activity Linguistic Program

BACKGROUND

the diagnosis of infertility and its related treatment can be traumatic, leading to profound psychological distress and a variety of psychopathological symptoms. The primary objective of this study is to contrast the linguistic features of narratives from women undergoing Assisted Reproductive Treatment with those of women not undergoing any fertility treatment. This study examines the speech of both groups of individuals as an indicator of their capacity to cope with current and past distressing experiences.

METHOD

44 women (mean age 36.05; SD = 4.66) enrolled in a fertility medical center in Rome, and 43 control women (mean age 36.07; SD = 3.47) completed a socio-demographic questionnaire and a semi-structured interview designed to collect their memories of a neutral, a positive, and a negative event. This interview also aimed to investigate: (a) (for women with fertility difficulties) how they realized they and their partner had fertility problems and a description of an event when they talked about these difficulties with their partner; and (b) (for control group participants) the most difficult moment of their pregnancy and an event when they talked about it with their partner. The interviews were audio recorded and transcribed, and the text was analyzed using the referential process (RP) linguistic measures software.

RESULTS

Mann-Whitney non-parametric U tests for the independent samples showed several significant differences regarding the linguistic measures applied to the narratives of neutral, positive, negative, and difficult experiences in the form of a linguistic style, with more intellectualization and defenses in all the narratives associated with the women with fertility problems compared to the women in the control group.

CONCLUSIONS

the traumatic and painful experience of infertility and ART seems to characterize the whole mode of narrating life experiences. Present findings sustain the importance of helping women to elaborate on their experience and to understand and recognize the difficult feelings that are activated in relation to the difficulties of having a child.

Paths towards parenthood after repeated treatment failures: a comparative study on predictors of psychological health outcomes in infertile couples persisting in treatments or opting for adoption

Introduction

Infertility literature suggests widespread recourse to long-term medical treatments despite evidence of high stress, costs, and adverse effects of repeated treatment failures. However, there is a lack of research comparing predictors of stress and psychological health outcomes between members of infertile couples who - after repeated failures - persist in pursuing medical treatments (PT) with those who opted for quitting treatments and adopting (QTA). Basing on a transactional and multidimensional approach to infertility-related stress and health, the present study aims at exploring individual (socio-demographics; coping strategies) and situational (infertility-related parameters; infertility-related stressors; couple's dyadic adjustment dimensions) predictors of state-anxiety and depression in male and female partners of PT-infertile couples and of QTA-infertile couples.

Methods

Participants were both members of 176 couples with duration of infertility and a history of medical treatments for at least 3 years (76 PT-infertile couples, 100 QTA-infertile couples). The study variables were compared by study group across genders. Structural equation models (SEM) were used to test main and moderating effects of study variables on state-anxiety and depression by study group and across genders.

Results

Members of infertile couples quitting treatments and adopting (QTA) reported significantly lower levels of state-anxiety and depression, higher stress related to need for parenthood and rejection of childfree-lifestyle and lower stress related to social and couple's relationship concerns than those who persist in pursuing medical treatments (PT). Members of infertile couples quitting treatments and adopting (QTA) recurred to a greater extent to active coping strategies (problem-solving/social-support) and to a lower extent to passive coping strategies (avoiding/turning-to-religion), and they reported higher levels of dyadic adjustment. Specificities in main and moderating factors related to state-anxiety and depression by study group and across genders were found.

Conclusion

Findings should be addressed to provide a comprehensive assessment of both members of infertile couples facing repeated treatment failures to identify risks and resources and develop tailored evidence-based interventions.

The Late Effects of Cancer Treatment on Female Fertility and the Current Status of Fertility Preservation-A Narrative Review

Fertility counseling should be offered to all individuals of young reproductive age early in the patient's trajectory following a cancer diagnosis. Systemic cancer treatment and radiotherapy often have an inherent gonadotoxic effect with the potential to induce permanent infertility and premature ovarian failure. For the best chances to preserve a patient's fertility potential and to improve future quality of life, fertility preservation methods should be applied before cancer treatment initiation, thus multidisciplinary team-work and timely referral to reproductive medicine centers specialized in fertility preservation is recommended. We aim to review the current clinical possibilities for fertility preservation and summarize how infertility, as a late effect of gonadotoxic treatment, affects the growing population of young female cancer survivors.

Assisted Reproductive Treatments, Quality of Life, and Alexithymia in Couples

Infertility and related treatments can negatively affect a couple's wellbeing. The aim of this study was to evaluate couples starting assisted reproductive treatment, differences in alexithymia and quality of life levels between partners, and the association of these psychological dimensions within the couple's members. Data was collected in two fertility centres in Rome; 47 couples completed the Fertility Quality of Life (FertiQoL), the 20-item Toronto Alexithymia Scale (TAS-20), and a socio-demographic questionnaire. Data analysis showed a worsened quality of life in women compared with their partners, as well as higher externally oriented thinking in men compared with their spouses. Associations between alexithymia and quality of life levels between women and men emerged. According to the regression analysis, a better quality of life in women was predicted by a greater partner's capabilities in identifying and describing emotion as well as by a better partner's quality of life, whereas for men, a better quality of life was predicted by their spouse's higher levels of quality of life. This study highlights the protective role that couples can play in the perception of the negative impact that infertility can have on their partner's quality of life. Further investigations are needed for the development of specific therapeutic interventions for the promotion of the couples' wellbeing.

The Relationship between Attachment, Dyadic Adjustment, and Sexuality: A Comparison between Infertile Men and Women

Infertility impacts several life dimensions. Among them, sexuality is particularly affected; yet studies have mainly focused on infertile women. We aimed to explore infertile men's and women's experiences in sexual satisfaction, internal control, and anxiety, and the relationship between attachment, dyadic adjustment, and sexuality. The sample consisted of 129 infertile people (47.3% females, 52.7% males, Mage = 39 years) who fulfilled an ad hoc questionnaire, the Multidimensional Sexuality Questionnaire (MSQ), the Experiences in Close Relationship-Revised (ECR-R), and the Dyadic Adjustment Scale (DAS). We found a significant effect of type of infertility and infertility factors on sexual anxiety only in infertile men. As regards infertile women, dyadic adjustment predicted sexual satisfaction, anxious attachment decreased sexual internal control, and avoidant attachment reduced sexual anxiety. As regards infertile men, high dyadic adjustment increased sexual satisfaction and a high avoidant attachment predicted high levels of sexual internal control. There was no relationship between attachment, dyadic adjustment, and sexual anxiety for infertile men. From the results, it emerges how important is to consider both dyadic adjustment and attachment in studying how infertility impacts women's and men's lives.

Effect of depression and anxiety on sexual functioning in couples trying to conceive with and without an infertility diagnosis

OBJECTIVE

This study examined the effects of anxiety and depression on sexual functioning in couples trying to conceive, and tested the moderating role of infertility diagnosis on this association.

DESIGN

An online questionnaire was completed by 1453 individuals in a heterosexual relationship for more than one year. The final sample had 107 couples who were actively attempting a pregnancy (63 had an infertility diagnosis; 44 were presumably fertile). Data was analyzed with the Actor-Partner Interdependence Model (APIM).

MAIN OUTCOME MEASURES

Depression and anxiety symptoms were assessed by the Hospital Anxiety and Depression Scale (HADS), and male and female sexual functioning were assessed through the International Index of Erectile Function (IIEF) and the Female Sexual Function Index (FSFI), respectively.

RESULTS

Actor effects were found between depression and sexual functioning in both men (β= -.28, p= .003) and women (β= -.43, p < .001), with no significant partner effects. The moderation analysis showed that the relationship between depression and sexual functioning is stronger in infertile men than in presumably fertile men (β= -.29; p= .002).

CONCLUSION

Psychological interventions with couples trying to conceive should address the role of depression in sexual functioning, particularly in infertile men.

"We're in this together": Attachment insecurities, dyadic coping strategies, and relationship satisfaction in couples involved in medically assisted reproduction

Attachment is an important predictor of relationship satisfaction and attachment insecurities are a risk factor for couples under stress. Drawing from the Vulnerability-Stress-Adaptation model, we investigated whether dyadic coping strategies (DCS) would explain the links between attachment insecurities and relationship satisfaction in 97 couples involved in medically assisted reproduction (MAR). Path analyses revealed that for women and men, attachment insecurities (anxiety, avoidance) were associated with their own lower relationship satisfaction through their lower use of positive DCS. Attachment avoidance was also associated with participants' own lower relationship satisfaction through their own lower use of negative DCS. Men's attachment avoidance was also related to their partner's lower relationship satisfaction via their own and their partner's lower use of positive DCS. The findings suggest that promoting the use of positive DCS may be important to preserve relationship satisfaction in couples involved in MAR.

The Lack of Ireland’s Assisted Human Reproduction (AHR) Regulation Viewed under the Lens of the Patient’s Experience

Assisted Human Reproduction (AHR) treatment is unregulated in Ireland, although it is practised there. Within Europe, Ireland is one of the only European countries without any form of AHR-specific regulation. This study aims to investigate the experiences and viewpoints of Irish women undergoing AHR treatments and establish if the lack of legislation is affecting these experiences. A quantitative survey was carried out on women undergoing AHR treatment in Irish clinics. Patients highlighted a lack of information in terms of end-to-end care and poor information around treatments and success rates. Key issues highlighted included unanticipated high treatment costs and add-on treatment costs, lack of financial support from the government, no redress process in the event of dissatisfaction, and generally an overall feeling of a lack of support both from the AHR clinics and the Irish government. This study offers a real-time view of the Irish AHR system from the patient’s experience of AHR and under the lens of the lack of a legislative system. In early 2022, the Irish government announced that it would adopt its bill around AHR treatment and that subsidies for AHR treatment are to come into effect, which will alleviate some financial pressures on patients. Further studies of the legislation carried out post implementation will provide more information about the impact of having a legislated AHR process on the patients.

Investigating the association between infertility and psychological distress using Australian Longitudinal Study on Women's Health (ALSWH)

Infertility affects millions of people globally. Although an estimated 1 in 6 couples in Australia are unable to conceive without medical intervention, little is known about the mental health impacts of infertility. This study investigated how infertility impacts the mental health of women. The study used nationally representative Australian Longitudinal Study on Women's Health (ALSWH) data. We analysed data from survey periods 2-8 conducted every three years between 2000 and 2018 for 6582 women born in 1973-78. We used a Generalised Equation Modelling (GEE) method to investigate the association of primary, secondary and resolved fertility status and psychological distress over time. Multiple measures were used to measure psychological distress: the (1) the mental health index subscale of the 36-item short form survey (SF-36), (2) the Center for Epidemiological Studies Depression Scale (CESD-10), (3) the Goldberg Anxiety and Depression Scale (GADanx) anxiety subscale; and a (4) composite psychological distress variable. About a third (30%) of women reported infertility at any of the survey rounds; a steady increase over 18 years from 1.7% at round 2 to 19.3% at round 8. Half of the women reporting primary or secondary infertility reported psychological distress, with the odds of having psychological distress was higher in women reporting primary (odds ratio (OR) 1.24, 95% confidence interval (CI) 1.06-1.45), secondary (OR 1.27, 95% CI 1.10-1.46) or resolved infertility (OR 1.15, 95% CI 1.05-1.26) compared to women reporting normal fertility status. Women with partners, underweight or higher BMI, smoking, and high-risk alcohol use had higher odds of psychological distress, whereas women in paid work had significantly lower odds of psychological distress (p < 0.001). Diabetes, high blood pressure, asthma, and other chronic physical illness were independently associated with higher odds of psychological distress. Infertility has a significant impact on mental health even after it is resolved. Frequent mental health assessment and a holistic approach to address the lifestyle factors should be undertaken during the treatment of infertility.

A comparison of assisted human reproduction (AHR) regulation in Ireland with other developed countries

Background

Assisted human reproduction (AHR) treatment is not regulated in Ireland although it has been practiced since 1987. Thus, Ireland is one of the only European countries without any form of AHR specific regulation. This literature review research aimed to provide a comprehensive and comparative overview of AHR regulation and any associated literature to compare Ireland and other developed countries.

Methods

Systematic searches were conducted in several databases (Google Scholar, Web of Science, MEDLINE, SCOPUS and official government websites) utilising search strings in relation to AHR legislation for each country under review. A final review of 155 research articles were eligible after screening related to legislation in each country for inclusion. The findings were synthesised and summarised by legislation in each country.

Results

Different countries offer different levels of ART and IVF provision and services in terms of the type of services allowed, financial support, age, sex and eligibility of recipients. The UK’s oversight legislation combined with the Netherlands financial legislation section provides as being most effective hybrid model of best practice for adoption in Ireland.

Conclusions

This research concluded that there is no AHR legislation in any country that can be described as all-encompassing in terms of the services allowed, financial support and age of recipients. It was concluded that significant changes need to be made to the Irish draft legislation which is in limbo with the government for the last 3 years in order to meet Irish patient needs.

Ireland is one of the only European countries without any form of assisted human reproduction specific regulation. This research aimed to review of assisted human reproduction regulations to compare Ireland with other developed countries. There is no assisted reproduction legislation in any country that can be described as perfect. The UK’s legislation combined with the Netherlands financial legislation section is concluded as being most effective hybrid model of best practice for adoption in Ireland. It was concluded that significant changes need to be made to the Irish draft legislation which is in limbo with the government for the last 3 years.

The relationship between psychological coping and mood across the menstrual cycle among distressed women struggling to conceive

OBJECTIVES

Infertility is disproportionately associated with distress in women yet there has been limited research focusing on the relationship between coping strategies and fertility-monitoring techniques on distress in women struggling to conceive naturally.

METHODS

Fifty-eight distressed women with infertility were recruited via social media. Every second day women's depressive and anxious mood was assessed in the morning and again in the evening along with their psychological coping strategies, the use of fertility monitoring techniques, and Fertility Quality of Life emotion subscale, over the course of one full menstrual cycle.

RESULTS

During menstruation and statistically adjusting for morning depressive mood, active coping (β(SE) = -1.35 (0.36), p < .001) and behavioural engagement (β(SE) = -0.98 (0.35), p = .006) were associated with less depressive mood in the evening. Across all phases, social support seeking was associated with greater anxiety (β(SE) = 0.50 (0.20), p = .013) and lower emotional quality of life (β(SE) = -0.82 (0.32), p = .011). Use of fertility monitoring techniques was associated with heightened anxiety (M(SE) = 6.7 (0.2) vs. 5.9 (0.2), p < .001). The use of avoidance strategies (β(SE) = 3.22 (1.29), p = .016), endorsement of optimism (β(SE) = -4.72 (1.78), p = .011) and social support seeking (β(SE) = 3.09 (1.18), p = .012) throughout the cycle were significantly predictive of depression ratings following a negative pregnancy test, despite statistically adjusting for mean depression ratings throughout the menstrual cycle.

CONCLUSION

These findings highlight a number of cognitive and behavioural strategies that could be manipulated via psychological interventions to improve distress among women struggling to conceive.

The fertility assessment of normal cyclic Wistar rats following the administration of methanolic extract of Portulaca oleracea: an experimental study

Background

Purslane is a widely distributed shrub used for the treatment of different ailments. The increasing reproductive complications associated with herbal treatments have led to the need to critically evaluate the safety and/or reproductive potentials of commonly used plant extracts. This study investigated the reproductive effect of methanolic extracts of Portulaca oleracea (MEPO) in adult female Wistar rats.

Results

Group C showed a significant decrease both in relative ovarian weight (p = 0.000), and relative uterine weight (p = 0.037), when compared with the control. There were no significant (p ˃ 0.05) changes in the levels of follicle-stimulating hormone, luteinizing hormone, progesterone, and estradiol. When compared to the control, groups B and C showed abnormal estrous cycle and cycle arrest especially at the metestrus phase with mild congestion of a few blood vessels in the ovary and uterus.

Conclusions

MEPO may possess some anti-fertility effect, as it disrupts the estrous cycle of adult female Wistar rats; although it has no major effect on the reproductive hormones, uterus, and ovarian histology of adult female Wistar rats. However, high dose consumption should be taken with precaution.

What About Fertility Staff Emotions? An Explorative Analysis of Healthcare Professionals' Subjective Perspective

Infertility-related psychological research is traditionally oriented to analyze the wellbeing of couples undergoing Assisted Reproductive Technologies (ART), than to study the job-related effects on the healthcare fertility staff. This piece of research aims at understanding the subjective perspective of the fertility professionals and contribute to identify their emotional dynamics in their work environment. An in-depth explorative research study was conducted on 12 healthcare professionals of an Italian ART hospital clinic. Structured interviews with open-ended questions were administered to explore their deep feelings about their professional experience. Emotional text analysis was then conducted to analyze the textual corpus of their narratives to grasp their affective symbolizations. Statistical multidimensional techniques were used to detect some thematic domains (cluster analysis) and latent factors organizing the contraposition between them (multiple correspondence analysis). Five thematic domains were detected which refer to different emotional dimensions, as follows: performance anxiety (Cluster 1), ambivalence between omnipotence and powerlessness (Cluster 2), care burden (Cluster 3), feeling of duty (Cluster 4), and sense of interdependence (Cluster 5). Then, four latent factors were identified dealing with the laborious attempt to remedy, the realistic sense of limitation, the incumbent feeling of pressure and the restorative sense of justice, respectively. The results are discussed based on the existing literature and some useful recommendations for staff education, training and clinical supervision are provided accordingly.

Giving words to emotions: the use of linguistic analysis to explore the role of alexithymia in an expressive writing intervention

Expressive writing techniques are methods focusing on written emotional expression that require people to write about traumatic or difficult experiences, with the objective of promoting an elaboration of these events. The general aim of the study is to investigate the influence of alexithymia, a deficit in emotional regulation processes, on the effects of an expressive writing intervention, analyzing the writing protocols through the use of the Linguistic Inquiry and Word Count (LIWIC) and Referential Process (RP) linguistic measures via IDAAP software. Thirty-five women undergoing an assisted reproductive treatment participated in the study and filled out a sociodemographic questionnaire, the 20-item Toronto Alexithymia Scale. They also underwent three session of writing, following a request that they write about their emotions regarding their current situation. The women enrolled were divided into two groups: low alexithymia and high alexithymia, comprising individuals with a TAS-20 total score lower or higher than the mean, respectively. Analyses within the groups during the three writing sessions revealed that the women with low alexithymia reported a greater number of words expressing affectivity, sadness and future perspective, whereas no significances in the high alexithymia group emerged. Moreover, when analysing differences between the groups, high-alexithymia women reported lower scores in RP indexes and fewer words expressing sadness, future perspectives and we verbal. In conclusion, these preliminary findings may confirm the hypothesis that alexithymia affects the effectiveness of expressive writing through a difficulty in becoming involved in the writing process and a lack of symbolizing processes.

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.

The effects of an expressive writing intervention on pregnancy rates, alexithymia and psychophysical health during an assisted reproductive treatment

Objective: World Health Organization reported that in developed countries one in four couples experience infertility with serious implications for the psychophysical well-being. Aim of this study was to evaluate the effects of Pennebaker's writing technique on pregnancy rates, alexithymia and psychophysical health during an assisted reproductive treatment (ART).Method: 91 women admitted for an ART were randomly divided into two groups: an experimental one (n = 46), where women wrote about their thoughts and emotions concerning the infertility experience, and a control group (n = 45) where women did not write. All subjects completed a socio-demographic questionnaire, the 20-item Toronto Alexithymia Scale and the Symptoms Checklist-90-R before and after the writing sessions.Results: A significant difference in pregnancy rates between the experimental group (n = 13) and the control group (n = 5) was found (χ² = 4.216; p < .04). A significant difference was also found between women who participated in the study (experimental + control= 91) and women who declined to participate, in the direction of more ART successes (n = 18 vs. n = 0) in the group of women who participated (χ² = 10.17; p < .01).Conclusions: The findings support the usefulness of the writing technique during ART in promoting treatment success.

The effect of stigma on depression levels of Turkish women with infertility

PURPOSE

This study was conducted to determine the effect of stigma on depression levels of women with infertility in Turkey.

DESIGN AND METHODS

It was completed in the Infertility Polyclinic of the Health Research and Application Center in Eastern Turkey between 1 November 2017 and 31 January 2018. The population of the study consisted of all women who applied to the relevant unit between these dates and received infertility treatment. This study was completed with 121 infertile women. To gather data, the researchers used personal information questionnaires, Infertility Stigma Scale, and the Beck Depression Inventory.

FINDINGS

The mean score for the stigma level was 60.79 ± 2.03 and for depression, it was 28 ± 1.08. A positive significant relationship was found among the scales (P < 0.05). The levels of depression and stigma were moderate, and the stigma had a negative impact on depression.

PRACTICE IMPLICATIONS

Based on these results, nurses with counseling and trainer roles should be aware of the psychological issues faced by infertile individuals and psychiatric counseling should become a part of the diagnostic process for infertility treatment.

Extreme Desire for Motherhood: Analysis of Narratives From Women Undergoing Assisted Reproductive Technology (ART)

The problem of infertility and its consequent treatment (denoted as Assisted Reproductive Technology or ART) represent an increasing phenomenon, especially in industrialized countries. Confronting with one’s own procreative limitations can generate strong negative emotional reactions. This study aims at understanding how the desire for motherhood manifests itself in infertile women undergoing ART, studying their emotional and subjective perspective. An in-depth explorative research study was conducted on 17 infertile women attending an Italian hospital clinic for fertility treatment. Emotional text analysis was conducted to analyze the corpus of their interviews, allowing the identification of four thematic domains (clusters) which refer, respectively, to the following emotional dimensions: an inclination to self-sacrifice, seen as the price to be paid for the desired success of the treatment (Cluster 1), pursuit of inclusion in the world of procreative mothers (Cluster 2), precarious equilibrium between the deep desire for a baby and the withdrawal from the treatment (Cluster 3), surrender to any possible consequence in order to obtain the desired mother-child relationship (Cluster 4). The witness of the couples’ suffering for their condition of infertility and their strong desire for parenting can represent a source of high pressure for the fertility care staff, as they are the only ones responsible for the fulfillment of the great dream of biological parenthood. For these reasons, a multidisciplinary approach, which involves psychological as well as medical experts all working together, could benefit both the patients and the healthcare professionals and improve the quality of the reproductive healthcare services.

The Role of Dyadic Coping on the Marital and Emotional Adjustment of Couples With Infertility

Infertility is a challenging experience, affecting individual and couples' adjustment. However, the way the members of the couple support each other may affect the experience of infertility and their adjustment. This study aimed to investigate the role of dyadic coping by oneself and by the partner in the association between the impact of infertility and dyadic and emotional adjustment (anxiety and depression) to infertility. In this cross-sectional study, a total of 134 participants (67 couples with infertility) completed self-report questionnaires assessing infertility-related stress, dyadic coping, dyadic adjustment, and depression and anxiety symptoms. A path analysis examined the direct and indirect effects between the impact of infertility in one's life and dyadic and emotional adjustment. There is an indirect effect of the impact of infertility in one's life on dyadic adjustment through men's perceived dyadic coping efforts employed by the self (dyadic coping by oneself) and women's perceived dyadic coping efforts of the partner (dyadic coping by the partner). Regarding the emotional adjustment of infertile couples, infertility stress impact had an indirect effect only on depressive symptoms through men's dyadic coping by oneself. The results highlight the importance of men's dyadic coping strategies for the marital adjustment of couples as well as for men's emotional adjustment. Findings emphasize the importance of involving men in the fertility treatment process, reinforcing the dyadic nature of infertility processes.

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.

Sexual dysfunction in infertile women: A systematic review and meta-analysis

OBJECTIVE

This study aimed to assess the prevalence of sexual dysfunction and Female Sexual Function Index (FSFI) score in women with infertility.

STUDY DESIGN

A systematic search of the literature was conducted using PubMed, EMBASE, IBECS, and LILACS. The search was limited to articles published from January 2000 to September 2016, without language restriction. Data were analyzed using Stata 12.0. Random effects meta-analyses in weighted mean difference (WMD) were performed for six comparative studies (infertility versus fertility). Heterogeneity was estimated using I². Moreover, to explore the heterogeneity sources among the studies, meta-regression analyses were also performed. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation guidelines, and risk of bias, with a graphic funnel.

RESULTS

Meta-analysis was performed in 11 of 13 comparative studies. The result indicated a significant association between an increase in sexual dysfunction and infertility in women (WMD=-0.16, 95% confidence interval=-0.254 to -0.084, p<0.001), and high heterogeneity between studies was noted (I²=98.6%, p<0.000). Meta-regression analysis did not indicate heterogeneity (I²=0.00%). We also performed a meta-analysis of individual FSFI domains in 10 studies. Infertile women had problems with lubrication, orgasm, and satisfaction. Meta-regression analysis also showed that heterogeneity had no influence on the final results of all the analyses.

CONCLUSIONS

Infertility was associated with an increase in female sexual dysfunction. The most affected areas of sexual function were lubrication, orgasm, and satisfaction.

Difficulties Conceiving and Relationship Stability in Sub-Saharan Africa: The Case of Ghana

Little is known about the relationship between self-identified difficulties conceiving, biomedical infertility, and union instability in Sub-Saharan Africa. Previous research suggests that infertility increases the risk of psychological distress and marital conflict, encourages risky sexual behaviour, and deprives infertile individuals and couples of an important source of economic and social capital. Qualitative research has suggested that there may be a link between infertility and divorce; less is known about the implications of infertility for unmarried couples. In this paper, discrete-time hazard models are applied to 8 waves of secondary panel data from Ghana collected by the Population Council of New York and the University of Cape Coast (pooled n = 10,418) between 1998 and 2004. Results show a positive relationship between perceived difficulties conceiving and relationship instability for both married women and those in non-marital sexual unions; this relationship, however, does not hold for biomedical infertility. Future research should examine this relationship using nationally representative data in a cross-national comparison to determine whether results hold across the subcontinent.

Psychological Adjustment of Infertile Men Undergoing Fertility Treatments: An Association With Sperm Parameters

BACKGROUND

The difficulties in the psychological adaptation to the infertility diagnosis and assisted reproductive technology (ART) treatments have shown influence on the sperm quality. The biological and psychological aspects of infertility seem not to be independent.

OBJECTIVE

To analyze the impact of depressive symptoms, anxiety, dyadic adjustment and infertility stress on the sperm quality of the men proposed to ART first or repeated experience.

MATERIALS AND METHODS

This transversal study was conducted in the Medically Assisted Reproduction Unit of Centro Hospitalar de São João, in Porto, Portugal. 112 men with infertility diagnosis were included to initiate an ART cycle. Participants completed the Inventory State-Trait Anxiety-Form Y (STAI-Y), the Beck Depression Inventory-II (BDI-II), the Dyadic Adjustment Scale (DAS) and the Inventory of Fertility Problems (IFP) before the beginning of the treatment.

RESULTS

The state-anxiety had a negative linear impact on the slow progressive motility (p<0.05). However, depressive symptoms assumed a suppressor effect on this variable, enhancing its importance as a predictor.

CONCLUSION

Results show that psychopathological symptoms before an ART cycle can influence the sperm motility. However, this association seems to only be present in men undergoing first experience ART treatments. Thus, this research shows the need for mental health professionals to respond to emotional difficulties of the male gender, through the development of psychological interventions adjusted, so as to minimize the impact of exposure to ART treatments.

Is infertility really associated with higher levels of mental distress in the female population? Results from the North-Trøndelag Health Study and the Medical Birth Registry of Norway

OBJECTIVE

To explore the effect of ever having tried to conceive for more than 12 months on levels of anxiety and depressive symptoms and to investigate if symptom levels of anxiety and depression in infertile women who remain childless, or go on to have children, respectively, differ from symptom levels in mothers without reports of infertility.

METHODS

Analyses were based on information from 12 584 Norwegian women aged 19-45 years who participated in the North-Trøndelag Health Study from 1995 to 1997 and data from the Medical Birth Registry of Norway. Anxiety and depressive symptoms were measured by the Hospital Anxiety and Depression Scale.

RESULTS

Having tried to conceive for more than 12 months (ever) was weakly associated with higher levels of depressive symptoms. In the categorical analyses, women with resolved infertility had higher levels of anxiety symptoms (B = 0.25 (95% confidence interval (CI) = 0.04-0.47)) and voluntarily childfree had lower levels of depressive symptoms (B = -0.05 (95% CI = -0.50 to -0.21)) than mothers without infertility. However, women with current primary or current secondary infertility had levels of anxiety and depression not significantly different from mothers without infertility.

CONCLUSION

At the population level, and from a longitudinal perspective, unresolved infertility is less burdensome than findings from studies on women seeking help for infertility would suggest.

The Impact of Infertility on the Psychological Well-Being, Marital Relationships, Sexual Relationships, and Quality of Life of Couples: A Systematic Review

The purpose of this systematic review was to identify, with supporting evidence, the effect of infertility on couples. MEDLINE, PsycINFO, and CINHAL Plus articles were searched for relevant studies (2000-2014) published in English. Twenty articles were included in this review. The results showed that infertility affected couples in the following four aspects of their life: psychological well-being, marital relationships, sexual relationships, and quality of life. There is evidence that infertility has a negative effect on the psychological well-being and sexual relationships of couples, but the evidence is inconclusive for the effect on marital relationships and quality of life.

Missing Motherhood: Jordanian Women's Experiences with Infertility

Aim, Background, and Introduction. Bearing and rearing children are an important part of life in nearly all cultures and are a central role for Jordanian Muslim women. Infertility can create anxiety, stress, and depression for couples who are infertile. Women frequently bear the emotional stigma of a couple’s infertility. There is a paucity of literature focusing on Jordanian Muslim women experiencing infertility and failed assistive reproductive technology. Therefore, this study explored these women’s lived experience. Methods. Qualitative data were collected through interviews with 30 Jordanian Muslim women who experienced failed assistive reproductive technology for infertility. Perceptions of experiences with failed treatment of infertility were documented and analyzed. Results. Major themes were identified: missing out on motherhood and living with infertility, experiencing marital stressors, feeling social pressure, experiencing depression and disappointment, having treatment associated difficulties, appreciating support from family and friends, using coping strategies, and fear of an unknown future. Discussion, Conclusion, and Implications for Clinical Practice. Being infertile significantly influences the physical, emotional, social, and spiritual health of Jordanian Muslim women as well as their quality of life. Perceived social support and personal coping strategies were used by study participants to mediate failed attempts to conceive. Designing and implementing culturally appropriate interventions for Muslim women globally who are experiencing infertility are essential.