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Salari N, Babajani F, Hosseinian-Far A, Hasheminezhad R, Abdoli N, Haydarisharaf P, Mohammadi M. Global prevalence of major depressive disorder, generalized anxiety, stress, and depression among infertile women: a systematic review and meta-analysis. Arch Gynecol Obstet 2024; 309:1833-1846. [PMID: 38459997 DOI: 10.1007/s00404-024-07444-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/16/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND In recent years, the global prevalence of infertility has increased among women (Talmor and Dunphy, Best Pract Res Clin Obstet Gynaecol 29(4):498-506, 2015) and is considered as a public health concern. One of the impacts of infertility is mental health problems in the patients, which can lead to complications such as stress, anxiety, and depression. The aim of this study is to investigate the global prevalence of major depressive disorder, general anxiety, stress, and depression in infertile women through a systematic review and meta-analysis. METHODS To identify studies that have reported the prevalence of major depressive disorder, generalized anxiety, stress, and depression in infertile women, the PubMed, Scopus, Web of Science, Embase, ScienceDirect, and Google Scholar repositories were systematically searched. Articles published up until February 2023 were included, while no lower time limit was imposed in the search strategy. Heterogeneity of studies was examined using the I2 test and, thus, random-effects model was used to perform the analysis. Data analysis was conducted within the Comprehensive Meta-Analysis (v.2) software. RESULTS In the review of 44 studies with a sample size of 53,300 infertile female patients, the overall prevalence of major depressive disorder (clinical depression), generalized anxiety, stress, and depression was found to be 22.9%, 13.3%, 78.8%, and 31.6% respectively. It was also found that mental health complications are more prevalent among infertile women in Asia (continent). CONCLUSION Considering the prevalence of mental disorders among infertile women, health policymakers can use the results of the present meta-analysis to pay more attention to the mental health of infertile women and devise suitable interventions and programs to reduce and prevent the spread of psychological disorders among infertile women.
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Affiliation(s)
- Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Fateme Babajani
- Department of Clinical Psychology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Amin Hosseinian-Far
- Department of Business Systems and Operations, University of Northampton, Northampton, UK
| | - Razie Hasheminezhad
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nasrin Abdoli
- Department of Psychiatry, Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Parisa Haydarisharaf
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Mohammadi
- Cellular and Molecular Research Center, Gerash University of Medical Sciences, Gerash, Iran.
- Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.
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Woods BM, Bray LA, Campbell SB, Holland A, Mrug S, Ladores S. A phenomenological exploration of the mental health experiences of young women with diminished ovarian reserve. Res Nurs Health 2024; 47:220-233. [PMID: 37837429 DOI: 10.1002/nur.22347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/30/2023] [Accepted: 09/30/2023] [Indexed: 10/16/2023]
Abstract
Infertility is a reproductive disease affecting one in six individuals that renders an individual unable to conceive. One cause of infertility is diminished ovarian reserve (DOR), which reduces the quantity and/or quality of a female's oocyte pool. Although typically indicating normal ovarian aging during the late 30s and early 40s, DOR can also impact younger women, increasing their risk for psychological distress from an unexpected diagnosis of infertility. A phenomenological approach examined the mental health experiences and perceptions of infertility-related mental health care of young women with DOR. Women diagnosed with DOR by age 35 in the United States who experienced emotional distress during infertility were recruited from infertility-specific social media and via snowball sampling. Participants completed a demographic survey and semi-structured individual interview that was audio-recorded, transcribed verbatim, and analyzed using a phenomenological approach. Ten women ages 27-41 completed the study. On average, participants were 30 years of age at the time of DOR diagnosis (age range 25-35), primarily Caucasian (90%), and married (90%). Two main themes were found: (1) Young women with DOR feel like a "forgotten community" coping with an invisible disease; and (2) Not all fertility clinics are created equal. Participants perceived their diagnosis as devastating and hopeless and urged others to find a provider with ample experience treating patients with DOR. This study helped to understand how young women with DOR perceive their mental health and identified a significant need for advancing towards more holistic infertility healthcare that encompasses both physical and mental health.
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Affiliation(s)
- Brittany M Woods
- Department of Family, Community and Health Systems, University of Alabama at Birmingham School of Nursing, Birmingham, Alabama, USA
| | - Leigh Ann Bray
- Capstone College of Nursing, University of Alabama, Tuscaloosa, Alabama, USA
| | - Sukhkamal B Campbell
- Division of Reproductive Endocrinology & Infertility, University of Alabama at Birmingham Medicine, Birmingham, Alabama, USA
| | - Aimee Holland
- Department of Family, Community and Health Systems, University of Alabama at Birmingham School of Nursing, Birmingham, Alabama, USA
| | - Sylvie Mrug
- Department of Psychology, University of Alabama at Birmingham College of Arts and Sciences, Birmingham, Alabama, USA
| | - Sigrid Ladores
- Department of Family, Community and Health Systems, University of Alabama at Birmingham School of Nursing, Birmingham, Alabama, USA
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Malina A. The social infertility cycle model. HEALTH PSYCHOLOGY REPORT 2023; 12:183-196. [PMID: 39234021 PMCID: PMC11370734 DOI: 10.5114/hpr/170986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/24/2023] [Accepted: 08/12/2023] [Indexed: 09/06/2024] Open
Abstract
Infertility poses an immense challenge to contemporary society. Around one in six people worldwide trying to conceive a child are facing infertility. This situation exists in an age of great technological developments where advances in medicine have made infertility treatment widely available and increasingly effective. In this article, a model will be presented that aims to explain the individual and social functioning of individuals and couples undergoing infertility treatment using assisted reproductive methods. The model was developed on the basis of a series of studies carried out by the author and colleagues during 2015-2021. The social infertility cycle model was proposed as the outcome of further research steps that were taken. The model takes into consideration the factors and behaviours of couples with infertility that determine the quality of their everyday functioning as well as the effectiveness of infertility treatment. The successive steps of the research process will be outlined in the article along with a presentation of the developed model.
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Affiliation(s)
- Alicja Malina
- Department of Social Psychology, Faculty of Psychology, Kazimierz Wielki University, Bydgoszcz, Poland
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Kumar R, Dhillon HS, Hashim U, Dhillon GK, Sasidharan S. Anxiety and depression among couples undergoing treatment for infertility with assisted reproductive techniques at an Indian centre. THE NATIONAL MEDICAL JOURNAL OF INDIA 2023; 36:286-290. [PMID: 38759992 DOI: 10.25259/nmji_170_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
Background Infertility and its treatment are frequently associated with psychological distress. We assessed the prevalence of anxiety and depression in couples undergoing treatment for infertility with assisted reproductive techniques (ARTs). Methods We included 160 married couples undergoing treatment for infertility at an ART centre. The prevalence of anxiety and depression was assessed using the hospital anxiety and depression scale. Results The prevalence of anxiety and depression was 46.2% and 40.9%, respectively. Women had higher mean (SD) anxiety (10.76 [2.69]) and depression (9.86 [2.06]) scores; however, this gender difference was statistically significant only with respect to anxiety (p=0.02). The mean anxiety scores were highest among both genders when the cause of infertility was attributed to both partners and during the first year and 10 years after treatment. Men in the age groups of 20-24 years and 40-44 years and those with no prior treatment had a statistically significant association with the highest anxiety scores. The mean depression scores showed a statistically significant decline in both genders with increasing age. Among men, the mean depression scoreswere significantly higher in those with no prior treatment, male cause of infertility and during the first year and after 10 years of treatment. Conclusion The prevalence of anxiety and depression among infertile couples undergoing treatment with ART was almost twice as high as that in the general population. The mean anxiety scores were significantly associated with duration of treatment and gender-based attribution in both genders; however, age and prior treatment were associated with only men. The mean scores of depression were significantly associated with age in both genders, while duration of treatment, gender-based attribution and prior treatment were significantly associated only with men.
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Affiliation(s)
- Ravish Kumar
- Sukh Hospital, Sri Muktsar Sahib, Punjab 152026, India
| | | | - Uzma Hashim
- Department of Psychiatry, INHS Asvini, Mumbai, Maharashtra, India
| | | | - Shibu Sasidharan
- Department of Anaesthesiology and Critical Care, Level III Hospital, Goma, DRC, India
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Huttler A, Murugappan G, Stentz NC, Cedars MI. Reproduction as a window to future health in women. Fertil Steril 2023; 120:421-428. [PMID: 36641001 DOI: 10.1016/j.fertnstert.2023.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/16/2022] [Accepted: 01/05/2023] [Indexed: 01/13/2023]
Abstract
Cultivating awareness for reproduction as a window to future health presents an opportunity for early identification and modification of risk factors that can affect both individual and population-level morbidity and mortality. Infertility could serve as both a window into future health as well as a pathway to future pathology. The underlying mechanisms of infertility may share common pathways with long-term risk for health and well-being. Making this identification early in the disease process may improve opportunities for intervention, and deepen our understanding of long-term risk. Additionally, fertility treatments may increase individual risk. Only by making these associations and designing studies to understand how disease and treatment risk impact health can we truly fulfill our goal of building healthy families. The aim of this review is to discuss the short-term impact of fertility challenges and treatment, long-term associations of infertility with morbidity and mortality, and the role of parity in modifying these risk associations.
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Oluwayiose OA, Houle E, Whitcomb BW, Suvorov A, Rahil T, Sites CK, Krawetz SA, Visconti PE, Pilsner JR. Non-coding RNAs from seminal plasma extracellular vesicles and success of live birth among couples undergoing fertility treatment. Front Cell Dev Biol 2023; 11:1174211. [PMID: 37427387 PMCID: PMC10323426 DOI: 10.3389/fcell.2023.1174211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 06/12/2023] [Indexed: 07/11/2023] Open
Abstract
Background: Infertility remains a global health problem with male-factor infertility accounting for around 50% of cases. Understanding the molecular markers for the male contribution of live birth success has been limited. Here, we evaluated the expression levels of seminal plasma extracellular vesicle (spEV) non-coding RNAs (ncRNAs) in men of couples in relation with those with and without a successful live birth after infertility treatment. Method: Sperm-free spEV small RNA profiles were generated from 91 semen samples collected from male participants of couples undergoing assisted reproductive technology (ART) treatment. Couples were classified into two groups based on successful live birth (yes, n = 28) and (no, n = 63). Mapping of reads to human transcriptomes followed the order: miRNA > tRNA > piRNA > rRNA> "other" RNA > circRNA > lncRNA. Differential expression analysis of biotype-specific normalized read counts between groups were assessed using EdgeR (FDR<0.05). Result: We found a total of 12 differentially expressed spEV ncRNAs which included 10 circRNAs and two piRNAs between the live birth groups. Most (n = 8) of the identified circRNAs were downregulated in the no live birth group and targeted genes related to ontology terms such as negative reproductive system and head development, tissue morphogenesis, embryo development ending in birth or egg hatching, and vesicle-mediated transport. The differentially upregulated piRNAs overlapped with genomic regions including coding PID1 genes previously known to play a role in mitochondrion morphogenesis, signal transduction and cellular proliferation. Conclusion: This study identified novel ncRNAs profiles of spEVs differentiating men of couples with and without live birth and emphasizes the role of the male partner for ART success.
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Affiliation(s)
- Oladele A. Oluwayiose
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, School of Medicine, Wayne State University, Detroit, MI, United States
| | - Emily Houle
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, School of Medicine, Wayne State University, Detroit, MI, United States
| | - Brian W. Whitcomb
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, United States
| | - Alexander Suvorov
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, United States
| | - Tayyab Rahil
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Springfield, MA, United States
| | - Cynthia K. Sites
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Springfield, MA, United States
| | - Stephen A. Krawetz
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, School of Medicine, Wayne State University, Detroit, MI, United States
- Center for Molecular Medicine and Genetics, Wayne State School of Medicine, Detroit, MI, United States
| | - Pablo E. Visconti
- Department of Veterinary and Animal Sciences, University of Massachusetts Amherst, Amherst, MA, United States
| | - J. Richard Pilsner
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, School of Medicine, Wayne State University, Detroit, MI, United States
- Institute of Environmental Health Sciences, Wayne State University, Detroit, MI, United States
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Zurlo MC, Cattaneo Della Volta MF, Vallone F. 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. Front Psychol 2023; 14:1147926. [PMID: 37342643 PMCID: PMC10277654 DOI: 10.3389/fpsyg.2023.1147926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/10/2023] [Indexed: 06/23/2023] Open
Abstract
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.
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Affiliation(s)
- Maria Clelia Zurlo
- Dynamic Psychology Laboratory, Department of Political Sciences, University of Naples Federico II, Naples, Italy
- Department of Humanities, University of Naples Federico II, Naples, Italy
| | | | - Federica Vallone
- Dynamic Psychology Laboratory, Department of Political Sciences, University of Naples Federico II, Naples, Italy
- Department of Humanities, University of Naples Federico II, Naples, Italy
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Liu Z, Zheng Y, Wang B, Li J, Qin L, Li X, Liu X, Bian Y, Chen Z, Zhao H, Zhao S. The impact of sleep on in vitro fertilization embryo transfer outcomes: a prospective study. Fertil Steril 2023; 119:47-55. [PMID: 36435629 DOI: 10.1016/j.fertnstert.2022.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/08/2022] [Accepted: 10/11/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To prospectively examine the association between sleep quality before embryo transfer with pregnancy outcomes in a population with infertility. DESIGN Prospective observational cohort study. SETTING Center for Reproductive Medicine, Shandong University. PATIENT(S) From 7,847 women who enrolled from July 2019 to July 2020, 3,183 were eligible. INTERVENTION(S) Information about sleep, including sleep quality, sleep duration, and sleep chronology, were collected before embryo transfer using an integrated questionnaire. Sleep quality is quantified by the Pittsburgh Sleep Quality Index (PSQI) with a cut-point of 5 (PSQI >5 identifying poor sleep vs. PSQI ≤5 identifying good sleep). Average weekly sleep duration was calculated and divided into 5 groups (≤7, 7-8, 8-9, 9-10, and >10 h/d). In defining sleep chronotype, women with a sleep midpoint earlier than 2:30 AM were defined as morningness type, whereas those with a sleep midpoint later than 3:30 AM were defined as eveningness type, and the remainder were defined as an intermediate type. MAIN OUTCOME MEASURE(S) Rate of clinical pregnancy and live birth. RESULT(S) Compared with those reporting poor sleep quality, those reporting good sleep quality showed higher clinical pregnancy (69.3% vs. 65.1%) and live birth rates (50.5% vs. 45.7%). After adjusting for confounding factors, women who self-reported good sleep had a higher probability of acquiring clinical pregnancy (RR, 1.07; 95% confidence interval, 1.01-1.13) and of live birth (RR, 1.12; 95% confidence interval, 1.02-1.23). Women with the morningness chronotype had the lowest rates of clinical pregnancy and live birth and had the highest rate of miscarriage. Sleep duration was found to have no significant association with any outcomes. In the stratified analyses, the positive associations of good sleep quality with clinical pregnancy and live birth existed only among women younger than 35 years old or who had undergone fresh embryo transfer. CONCLUSION(S) Good sleep quality was positively associated with outcomes in in vitro fertilization embryo transfer (IVF-ET), particularly with clinical pregnancy and live birth. Poor sleep quality may be a risk factor for adverse IVF-ET outcomes for women <35 years old. Treating sleep disorders and providing sleep behavior guidance to patients receiving IVF-ET may improve pregnancy outcomes.
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Affiliation(s)
- Zheng Liu
- Center for Reproductive Medicine, Shandong University, Jinan, Shandong, People's Republic of China; Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, People's Republic of China; Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, People's Republic of China; Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, People's Republic of China; Shandong Technology Innovation Center for Reproductive Health, Jinan, Shandong, People's Republic of China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, People's Republic of China
| | - Yukun Zheng
- Center for Reproductive Medicine, Shandong University, Jinan, Shandong, People's Republic of China; Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, People's Republic of China; Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, People's Republic of China; Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, People's Republic of China; Shandong Technology Innovation Center for Reproductive Health, Jinan, Shandong, People's Republic of China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, People's Republic of China
| | - Bingyu Wang
- Center for Reproductive Medicine, Shandong University, Jinan, Shandong, People's Republic of China; Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, People's Republic of China; Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, People's Republic of China; Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, People's Republic of China; Shandong Technology Innovation Center for Reproductive Health, Jinan, Shandong, People's Republic of China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, People's Republic of China
| | - Jialin Li
- Center for Reproductive Medicine, Shandong University, Jinan, Shandong, People's Republic of China; Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, People's Republic of China; Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, People's Republic of China; Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, People's Republic of China; Shandong Technology Innovation Center for Reproductive Health, Jinan, Shandong, People's Republic of China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, People's Republic of China
| | - Lang Qin
- Center for Reproductive Medicine, Shandong University, Jinan, Shandong, People's Republic of China; Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, People's Republic of China; Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, People's Republic of China; Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, People's Republic of China; Shandong Technology Innovation Center for Reproductive Health, Jinan, Shandong, People's Republic of China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, People's Republic of China
| | - Xiao Li
- Center for Reproductive Medicine, Shandong University, Jinan, Shandong, People's Republic of China; Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, People's Republic of China; Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, People's Republic of China; Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, People's Republic of China; Shandong Technology Innovation Center for Reproductive Health, Jinan, Shandong, People's Republic of China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, People's Republic of China
| | - Xin Liu
- Center for Reproductive Medicine, Shandong University, Jinan, Shandong, People's Republic of China; Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, People's Republic of China; Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, People's Republic of China; Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, People's Republic of China; Shandong Technology Innovation Center for Reproductive Health, Jinan, Shandong, People's Republic of China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, People's Republic of China
| | - Yuehong Bian
- Center for Reproductive Medicine, Shandong University, Jinan, Shandong, People's Republic of China; Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, People's Republic of China; Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, People's Republic of China; Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, People's Republic of China; Shandong Technology Innovation Center for Reproductive Health, Jinan, Shandong, People's Republic of China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, People's Republic of China
| | - Zijiang Chen
- Center for Reproductive Medicine, Shandong University, Jinan, Shandong, People's Republic of China; Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, People's Republic of China; Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, People's Republic of China; Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, People's Republic of China; Shandong Technology Innovation Center for Reproductive Health, Jinan, Shandong, People's Republic of China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, People's Republic of China; Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, People's Republic of China; Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Han Zhao
- Center for Reproductive Medicine, Shandong University, Jinan, Shandong, People's Republic of China; Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, People's Republic of China; Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, People's Republic of China; Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, People's Republic of China; Shandong Technology Innovation Center for Reproductive Health, Jinan, Shandong, People's Republic of China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, People's Republic of China
| | - Shigang Zhao
- Center for Reproductive Medicine, Shandong University, Jinan, Shandong, People's Republic of China; Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, People's Republic of China; Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, People's Republic of China; Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, People's Republic of China; Shandong Technology Innovation Center for Reproductive Health, Jinan, Shandong, People's Republic of China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, People's Republic of China.
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Mínguez-Alarcón L, Hammer KC, Williams PL, Souter I, Ford JB, Rexrode KM, Hauser R, Chavarro JE. Self-reported history of comorbidities and markers of ovarian reserve among subfertile women. J Assist Reprod Genet 2022; 39:2719-2728. [PMID: 36322231 PMCID: PMC9790841 DOI: 10.1007/s10815-022-02643-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/19/2022] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To investigate whether history of comorbidities is associated with markers of ovarian reserve among subfertile women. METHODS This observational study includes 645 women seeking fertility care at the Massachusetts General Hospital who enrolled in the Environment and Reproductive Health (EARTH) study (2005-2019). Women completed a comprehensive questionnaire including medical diagnosis of comorbidities. Ovarian reserve markers including antral follicle count (AFC), assessed by transvaginal ultrasound, and circulating serum levels of day 3 FSH and AMH, are assessed by immunoassays. We fit linear regression models to evaluate the association between history of comorbidities and markers of ovarian reserve while adjusting for confounders. RESULTS Self-reported history of hypertension, cancer, and neurological disorders was negatively associated with AFC in unadjusted models and in adjusted models for age, smoking, physical activity, comorbidity count, and BMI. Adjusted mean AFC (95% CI) was lower among women with history of hypertension, compared to women with no self-reported history of hypertension (11.5 vs 15.6, p value 0.0001). In contrast, day 3 FSH levels were positively related to history of eating disorders in both unadjusted and adjusted models (10.8 vs. 7.43 IU/L, p value ≤ 0.0001). Self-reported history of other comorbidities was unrelated to AFC, day 3 FSH, and AMH levels. CONCLUSIONS History of hypertension, cancer, and neurological disorders was negatively associated with AFC, and eating disorders were positively related to day 3 FSH levels. The prevention of common comorbidities among women in reproductive age may help increase women's fertility given the declining birth rates and increasing use of assisted reproductive technologies in the past years.
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Affiliation(s)
- Lidia Mínguez-Alarcón
- Channing Division of Network Medicine, Harvard Medical School & Brigham and Women's Hospital, Boston, MA, USA.
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 665 Huntington Ave, Boston, MA, 02115, USA.
| | - Karissa C Hammer
- Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Paige L Williams
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Irene Souter
- Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jennifer B Ford
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 665 Huntington Ave, Boston, MA, 02115, USA
| | - Kathryn M Rexrode
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Russ Hauser
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 665 Huntington Ave, Boston, MA, 02115, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, MA, Boston, USA
| | - Jorge E Chavarro
- Channing Division of Network Medicine, Harvard Medical School & Brigham and Women's Hospital, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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10
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Simoni MK, Gilstad-Hayden K, Naqvi SH, Pal L, Yonkers KA. Progression of depression and anxiety symptoms in pregnancies conceived by assisted reproductive technology in the United States. J Psychosom Obstet Gynaecol 2022; 43:214-223. [PMID: 34472405 PMCID: PMC10116357 DOI: 10.1080/0167482x.2021.1971193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Women who utilize assisted-reproductive technology (ART) to achieve pregnancy experience unique circumstances before and during their pregnancy. This study aims to examine the progression of mental health in pregnant women who conceived via various methods of ART to understand gestational time periods of emotional stability or risk specific to these populations. METHODS Secondary analysis of the Yale Pink and Blue Study - a prospective cohort involving women from 137 obstetrical practices in the northeastern United States between 2005-2009. Depressive and anxiety symptoms among spontaneous, planned pregnancies were compared to ART pregnancies using the Edinburgh Postnatal Depression Scale (EPDS) and its anxiety subscale (EPDS-3A), respectively. Generalized Estimating Equations were used to compare group changes (EPDS and EPDS-3A score threshold ≥10) at timepoints of <17 weeks (T1), 28(±2) weeks (T2), and 8(±4) weeks postpartum (T3). RESULTS 1,466 spontaneous, planned pregnancies were compared to 191 pregnancies conceived via ART. Prevalence of depressive symptoms were similar between conception groups. Change in prevalence over time differed significantly between those groups (from T1 to T3 (β 0.59), as well as between spontaneous pregnancies compared to autologous gamete ART pregnancies (from T1 to T2 (β 0.48) and T1 to T3 (β 0.65). Course of anxiety did not differ between conception groups. CONCLUSIONS Women who conceive via ART have different rates of change in depressive symptoms throughout gestation compared to women with spontaneous pregnancies.
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Affiliation(s)
- Michael K Simoni
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, CT USA
| | | | - Syed H Naqvi
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, CT USA
| | - Lubna Pal
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, CT USA
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11
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Voigt P, Persily J, Blakemore JK, Licciardi F, Thakker S, Najari B. Sociodemographic differences in utilization of fertility services among reproductive age women diagnosed with cancer in the USA. J Assist Reprod Genet 2022; 39:963-972. [PMID: 35316438 PMCID: PMC9051007 DOI: 10.1007/s10815-022-02455-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/04/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To determine whether sociodemographic differences exist among female patients accessing fertility services post-cancer diagnosis in a representative sample of the United States population. METHODS All women ages 15-45 with a history of cancer who responded to the National Survey for Family Growth (NSFG) from 2011 to 2017 were included. The population was then stratified into 2 groups, defined as those who did and did not seek infertility services. The demographic characteristics of age, legal marital status, education, race, religion, insurance status, access to healthcare, and self-perceived health were compared between the two groups. The primary outcome measure was the utilization of fertility services. The complex sample analysis using the provided sample weights required by the NSFG survey design was used. RESULTS Five hundred forty-five women reported a history of cancer and were included in this study. Forty-three (7.89%) pursued fertility services after their cancer diagnosis. Using the NSFG sample weights, this equates to a population of 161,500.7 female cancer survivors in the USA who did utilize fertility services and 1,811,955.3 women who did not. Using multivariable analysis, household income, marital status, and race were significantly associated with women utilizing fertility services following a cancer diagnosis. CONCLUSIONS In this nationally representative cohort of reproductive age women diagnosed with cancer, there are marital, socioeconomic, and racial differences between those who utilized fertility services and those who did not. This difference did not appear to be due to insurance coverage, access to healthcare, or perceived health status.
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Affiliation(s)
- Paxton Voigt
- NYU Grossman School of Medicine, NY, New York, USA.
| | - Jesse Persily
- NYU Langone Department of Urology, New York, NY, USA
| | | | | | | | - Bobby Najari
- NYU Langone Department of Urology, New York, NY, USA
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12
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Spitzer TL, Trussell JC, Coward RM, Hansen KR, Barnhart KT, Cedars MI, Diamond MP, Krawetz SA, Sun F, Zhang H, Santoro N, Steiner AZ. Biomarkers of Stress and Male Fertility. Reprod Sci 2022; 29:1262-1270. [PMID: 35106743 PMCID: PMC9078052 DOI: 10.1007/s43032-022-00853-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 01/08/2022] [Indexed: 11/25/2022]
Abstract
To study if stress, as measured by salivary alpha-amylase and cortisol, negatively impacts male fertility, as measured by semen parameters, pregnancy, and live birth rates. Prospective, cohort study of men enrolled in the Males, Antioxidants, and Infertility (MOXI) trial. One-hundred twelve infertile men provided first-morning salivary and semen samples at baseline. Salivary samples were analyzed for alpha-amylase and cortisol. Couples attempted to conceive naturally (months 1-3) and with clomiphene citrate/intrauterine insemination (months 4-6). The association between stress-related biomarkers and semen parameters including DNA fragmentation was assessed using linear regression models adjusting for male age. Salivary levels were dichotomized at the 80th percentile. Pregnancy/live birth rates in couples in the upper quintile were compared to remaining subjects using chi-square testing. Salivary levels of alpha-amylase were not associated with semen parameters or DNA fragmentation. Salivary cortisol levels were not correlated with DNA fragmentation or normal morphology. For every 1-unit increase in salivary cortisol, total sperm count increased by 13.9 million (95% CI: 2.5, 25.3) and total motile sperm count increased by 9.9 million (95% CI: 3.2-16.6). Couple pregnancy rates and live birth rates did not differ for males in the highest quintile of alpha-amylase (27% and 28%, p = 0.96; 23% and 21%, p = 0.87) or cortisol (40% and 26%, p = 0.22; 35% and 19%, p = 0.12), compared to males with lower values. Physiologic measures of high stress may not harm but actually improve semen parameters among men with male-factor infertility.
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Affiliation(s)
- Trimble L Spitzer
- Department of Obstetrics and Gynecology, Naval Medical Center Portsmouth, 620 John Paul Jones Cir, Portsmouth, VA, 23708, USA.
| | - J C Trussell
- Department of Urology, State University of New York Upstate Medical University, 750 E Adams St, Syracuse, NY, 13210, USA
| | - R Matthew Coward
- Department of Urology, UNC School of Medicine, 2113 Physicians Office Building CB#7235, Chapel Hill, NC, 27599-7235, USA
- UNC Fertility, 7920 ACC Blvd #300, Raleigh, NC, 27617, USA
| | - Karl R Hansen
- Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, OK, 73104, USA
| | - Kurt T Barnhart
- Division of Reproductive Endocrinology and Infertility, University of Pennsylvania Medical Center, Philadelphia, PA, USA
| | - Marcelle I Cedars
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, CA, 94143, USA
| | - Michael P Diamond
- Department of Obstetrics and Gynecology, Augusta University, Augusta, GA, 30912, USA
| | - Stephen A Krawetz
- Department of Obstetrics and Gynecology, Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, 48202, USA
| | - Fangbai Sun
- Department of Biostatistics, Yale University School of Public Health, New Haven, CT, USA
| | - Heping Zhang
- Department of Biostatistics, Yale University School of Public Health, New Haven, CT, USA
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado, Denver, CO, 80204, USA
| | - Anne Z Steiner
- Department of Obstetrics and Gynecology, Duke University, Durham, NC, 27713, USA
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13
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Noël I, Dodin S, Dufour S, Bergeron MÈ, Lefebvre J, Maheux-Lacroix S. Evaluation of predictor factors of psychological distress in women with unexplained infertility. Ther Adv Reprod Health 2022; 16:26334941211068010. [PMID: 35386178 PMCID: PMC8977692 DOI: 10.1177/26334941211068010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 12/03/2021] [Indexed: 11/26/2022] Open
Abstract
Objective: The objective of this study was to establish the frequency of anxiety and
depressive symptoms among women diagnosed with unexplained infertility and
to identify risk factors. Methods: We conducted a descriptive cross-sectional study. Forty-two women from the
CHU de Quebec fertility clinic were recruited. Women completed the ‘Hospital
Anxiety and Depression Scale’ (HADS) self-administered questionnaire, used
to estimate prevalence of anxiety and depressive symptoms (score
≥ 8). Results: Overall, 55% (n = 23) of participants were identified with
anxiety or depressive symptoms according to the HADS questionnaire. Anxiety
symptoms were more frequent (55%) compared with depressive symptoms (10%).
According to a logistic regression model, being under 35 years old [odds
ratio (OR) = 16.6, confidence interval (CI): 1.9–25.0], never had a previous
spontaneous abortion (OR = 5.6, CI: 1.1–43.5) and never sought fertility
treatment (OR = 5.5, CI: 1.1–45.4) were associated with a higher risk of
anxiety and depressive symptoms. Conclusion: Anxiety and depressive symptoms are common among women with unexplained
infertility, and strategies should be developed to better support and treat
this high-risk population.
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Affiliation(s)
- Ingrid Noël
- Department of Obstetrics and Gynaecology, CHU of Québec – Université Laval, Quebec City, QC, Canada
| | - Sylvie Dodin
- Department of Obstetrics and Gynaecology, CHU of Québec – Université Laval, Quebec City, QC, Canada
| | - Stéphanie Dufour
- Department of Obstetrics and Gynaecology, CHU of Québec – Université Laval, Quebec City, QC, Canada
| | - Marie-Ève Bergeron
- Department of Obstetrics and Gynaecology, CHU of Québec – Université Laval, Quebec City, QC, Canada
| | - Jessica Lefebvre
- Department of Obstetrics and Gynaecology, CHU of Québec – Université Laval, Quebec City, QC, Canada
| | - Sarah Maheux-Lacroix
- Department of Obstetrics and Gynaecology, CHU de Québec – Université Laval Research Center, 2705 Boulevard Laurier, TR-10, Québec City, QC G1V 4G2, Canada
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14
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Casu G, Zaia V, Montagna E, de Padua Serafim A, Bianco B, Barbosa CP, Gremigni P. The Infertility-Related Stress Scale: Validation of a Brazilian-Portuguese Version and Measurement Invariance Across Brazil and Italy. Front Psychol 2022; 12:784222. [PMID: 35095671 PMCID: PMC8792459 DOI: 10.3389/fpsyg.2021.784222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/24/2021] [Indexed: 12/28/2022] Open
Abstract
Infertility constitutes an essential source of stress in the individual and couple's life. The Infertility-Related Stress Scale (IRSS) is of clinical interest for exploring infertility-related stress affecting the intrapersonal and interpersonal domains of infertile individuals' lives. In the present study, the IRSS was translated into Brazilian-Portuguese, and its factor structure, reliability, and relations to sociodemographic and infertility-related characteristics and depression were examined. A sample of 553 Brazilian infertile individuals (54.2% female, mean aged 36 ± 6 years) completed the Brazilian-Portuguese IRSS (IRSS-BP), and a subsample of 222 participants also completed the BDI-II. A sample of 526 Italian infertile individuals (54.2% female, mean aged 38 ± 6 years) was used to test for the IRSS measurement invariance across Brazil and Italy. Results of exploratory structural equation modeling (ESEM) indicated that a bifactor solution best represented the structure underlying the IRSS-BP. Both the general and the two specific intrapersonal and interpersonal IRSS-BP factors showed satisfactory levels of composite reliability. The bifactor ESEM solution replicated well across countries. As evidence of relations to other variables, female gender, a longer duration of infertility, and higher depression were associated with higher scores in global and domain-specific infertility-related stress. The findings offer initial evidence of validity and reliability of the IRSS-BP, which could be used by fertility clinic staff to rapidly identify patients who need support to deal with the stressful impact of infertility in the intrapersonal and interpersonal life domains, as recommended by international guidelines for routine psychosocial care in infertility settings.
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Affiliation(s)
- Giulia Casu
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Victor Zaia
- Postgraduate Program in Health Sciences, Centro Universitário FMABC, Santo André, Brazil
- Ideia Fértil Institute of Reproductive Health, Centro Universitário FMABC, Santo André, Brazil
| | - Erik Montagna
- Postgraduate Program in Health Sciences, Centro Universitário FMABC, Santo André, Brazil
| | - Antonio de Padua Serafim
- Neuropsychology Unit, Department and Institute of Psychiatry, University of São Paulo School of Medicine, São Paulo, Brazil
- Department of Psychology, Methodist University of São Paulo, São Bernardo do Campo, Brazil
| | - Bianca Bianco
- Postgraduate Program in Health Sciences, Centro Universitário FMABC, Santo André, Brazil
- Ideia Fértil Institute of Reproductive Health, Centro Universitário FMABC, Santo André, Brazil
| | - Caio Parente Barbosa
- Postgraduate Program in Health Sciences, Centro Universitário FMABC, Santo André, Brazil
- Ideia Fértil Institute of Reproductive Health, Centro Universitário FMABC, Santo André, Brazil
| | - Paola Gremigni
- Department of Psychology, University of Bologna, Bologna, Italy
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15
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Woods BM, Patrician PA, Fazeli PL, Ladores S. Infertility-related stress: A concept analysis. Nurs Forum 2021; 57:437-445. [PMID: 34873709 DOI: 10.1111/nuf.12683] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/08/2021] [Accepted: 11/29/2021] [Indexed: 11/30/2022]
Abstract
AIM To develop a clear definition of infertility-related stress using Rodgers' method of concept analysis. BACKGROUND Infertility affects approximately 13% of women in the United States. Though poorly defined in the literature, previous studies suggest infertility-related stressors contribute to psychological distress. DESIGN Rodgers' method of concept analysis guided the review, including sample and setting, literature search, and data analysis. DATA SOURCE PubMed, CINAHL, and PsycINFO were searched for relevant literature. REVIEW METHODS Following abstract, title, and text screenings, 21 articles were included and reported using the PRISMA-S checklist. Texts were analyzed and results informed the proposed definition of infertility-related stress. RESULTS Antecedents included infertility, desire for children, and fear of the unknown. Attributes were identity crisis, social isolation and stigma, sexual stress, and financial strain. Consequences included treatment dropout and marital strain. Anxiety, depression, and decreased quality of life were identified as both attributes and consequences. CONCLUSIONS Synthesized results informed a proposed definition of infertility-related stress. Improved understanding of infertility-related stress allows for measurement development and facilitates recognition of patients in need of additional support, while potentially reducing the impact on the health and well-being of infertile women.
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Affiliation(s)
- Brittany M Woods
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Patricia A Patrician
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Pariya L Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sigrid Ladores
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
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16
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Ozturk A, Aba YA, Sik BA. The relationship between stigma, perceived social support and depression in infertile Turkish women undergoing in vitro fertilization-embryo transfer. Arch Psychiatr Nurs 2021; 35:434-440. [PMID: 34561056 DOI: 10.1016/j.apnu.2021.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/03/2020] [Accepted: 05/02/2021] [Indexed: 10/21/2022]
Abstract
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.
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Affiliation(s)
- Ayfer Ozturk
- Department of Psychiatric Mental Health Nursing, Faculty of Health Science, Bartın University, Turkey
| | - Yılda Arzu Aba
- Bandırma Onyedi Eylül University, Faculty of Health Sciences, Department of Nursing, Turkey.
| | - Bulat Aytek Sik
- Istanbul Aydin University, Faculty of Medicine, Department of Obstetrics and Gynecology, Turkey
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17
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GÜNAKAN E, TOHMA A, ÖZÇÜRÜMEZ G, ÖNALAN G, COK T, ZEYNELOGLU H. Psychological Conditions Of Patients Whose Infertility Treatment Was Postponed Due To Novel Coronavirus Pandemic Lockdown. ACTA MEDICA ALANYA 2021. [DOI: 10.30565/medalanya.896586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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18
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Psychotropic medication use among women seeking assisted reproductive technology (ART) therapy: A cross-sectional study. J Affect Disord 2021; 292:386-390. [PMID: 34139412 DOI: 10.1016/j.jad.2021.05.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 05/11/2021] [Accepted: 05/31/2021] [Indexed: 11/22/2022]
Abstract
Background Infertility is associated with increased anxiety, depressive symptoms and mood disorders. Unfortunately, mental health is not often addressed in infertility treatment and infertile patients could be at higher risk of self-administration of not prescribed drugs or/and be exposed to alternative emotional treatments. Therefore, the aim of the present study is to investigate the use of psychotropic medication and to evaluate the frequency of psychiatric diagnosis among infertile women seeking assisted reproductive technology (ART) therapy. Methods All infertile women starting treatment at an ART clinic who agreed to participate in the study were included. Patients were submitted to a structured psychiatric interview, the Mini International Neuropsychiatric Interview (M.I.N.I.). Current and lifetime use of psychotropic medication were assessed. Results Ninety patients who agreed to participate completed the research protocol. A total of 12/90 were on current use of psychotropic medication.Thirty-six out of ninety patients had at least one psychiatric disorder. Mood disorders were detected in 19 of the 90. Anxiety disorders were highly frequent, reaching 27/90 of the patients, as agoraphobia the most common diagnosis (12/90). Limitations The study has several limitations, such as the absence of a control group of fertile patients and strict inclusion criteria, in which only subjects that spontaneously agreed to participate were enrolled. Conclusion Women suffering from infertility seeking ART treatment are at high risk for depression and anxiety disorders and a considerable number of them are in use of medication. Its implications on infertility treatments and offspring are uncertain.
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19
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Sadiq U, Rana F, Munir M. Marital Quality, Self-compassion and Psychological Distress in Women with Primary Infertility. SEXUALITY AND DISABILITY 2021. [DOI: 10.1007/s11195-021-09708-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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20
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Impact of transfer learning for human sperm segmentation using deep learning. Comput Biol Med 2021; 136:104687. [PMID: 34364259 DOI: 10.1016/j.compbiomed.2021.104687] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/18/2021] [Accepted: 07/23/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND OBJECTIVE Infertility affects approximately one in ten couples, and almost half of the infertility cases are due to the malefactor. To diagnose infertility and determine future treatment, a semen analysis is performed. Evaluation of sperm morphology is one of several steps in semen analysis, in which the shape and size of sperm parts are examined. The laboratories dedicated to this use traditional methods susceptible to errors. An alternative to replace the poor visual ability to assess sperm size and shape is to analyze sperm morphology with a computer's help. However, since the automatic sperm classification rates do not show an acceptable precision rate for use in the clinical setting, it is considered an exciting approach to focus efforts on improving the precision in sperm segmentation to extract the contour sperm before classification. This work aims to assess the utility of two image segmentation deep learning models for segmenting human sperm heads, acrosome, and nucleus. METHODS In this work, we evaluate the use of two well-known deep learning architectures (U-Net and Mask-RCNN) to segment parts of human sperm cells using data augmentation, cross-validation, hyperparameter tuning, and transfer learning. The experimental results are carried out using SCIAN-SpermSegGS, a public dataset with more than two hundred manually segmented sperm cells and widely used to validate segmentation methods of human sperm parts. RESULTS Experimental evaluation shows that U-net with transfer learning achieves up to 95% overlapping against hand-segmented masks for sperm head (0.96), acrosome (0.94), and nucleus (0.95), using Dice coefficient as the evaluation metric. These results outperform state-of-the-art sperm parts segmentation methods. CONCLUSIONS The impact of transfer learning is substantial, significantly improving the results of state-of-the-art methods with a higher Dice coefficient, less dispersion, and fewer cases where the model failed to segment sperm parts. These results represent a promising advance in the ultimate goal of performing computer-assisted morphological sperm analysis.
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21
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Lepard Tassin T, Seraji K, Simonson M, Chou C. Exploring genetic counselors' use of pedigree symbols to represent assisted reproductive technology. J Genet Couns 2021; 30:1773-1778. [PMID: 34235826 DOI: 10.1002/jgc4.1434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 04/21/2021] [Accepted: 04/25/2021] [Indexed: 11/08/2022]
Abstract
The standardized pedigree nomenclature recommendations created by the National Society of Genetic Counselors Pedigree Standardization Work Group contains some Assistive Reproductive Technology (ART) specific nomenclature. However, the work groups' recommendations lack instructions on how to document 'the number of embryos conceived, frozen, and implanted, along with their genetic testing history' (Bennett et al., 2008, p. 429). The purpose of this qualitative study was to determine if the current symbols are sufficient for what genetic counselors need in the ART field and how genetic counselors are addressing any gaps. Ten genetic counselors with ART counseling experience participated in semi-structured interviews. Participants reported using standard symbols and creating their own designs when standard symbols are not available for applicable ART situation. Thematic analysis identified seven reasons why participants felt that ART should be recorded on the medical pedigree. The 3 most common themes identified were: (1) medical assessment and facilitating development of a differential diagnosis, (2) clarity and continuity of documentation, and (3) psychosocial assessment of the family and fertility experience. All participants felt that the current nomenclature was not sufficient for their clinical practice and would support additional standard symbols. This study supports the need for development of further pedigree nomenclature inclusive of patients with ART experiences.
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Affiliation(s)
- Tiffany Lepard Tassin
- Department of Genetic Counseling, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Kynoosh Seraji
- Department of Genetic Counseling, University of Arkansas for Medical Sciences, Little Rock, AR, USA.,KRH Genetic Counseling, Kalispell Regional Healthcare, Kalispell, MT, USA
| | - Melinda Simonson
- Division of Gynecologic Oncology, Winthrop P Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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22
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Malina A, Roczniewska M, Pooley JA. Contact, moral foundations or knowledge? What predicts attitudes towards women who undergo IVF. BMC Pregnancy Childbirth 2021; 21:346. [PMID: 33933010 PMCID: PMC8088622 DOI: 10.1186/s12884-021-03810-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 04/19/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The willingness to try in vitro fertilization (IVF) as an infertility treatment, as well as its psychosocial consequences for couples, may be influenced by how they perceive the attitudes of general public towards this procedure. The focus of the current study was to identify predictors of attitudes towards mothers who underwent IVF to conceive a child. Three predictors were derived from attitude components: contact with someone who had undergone IVF (behavior), moral foundations (emotions), and the level of knowledge (cognition) about IVF. METHOD In total, 817 participants (118 male and 692 female, 7 unreported) from Poland took part in the study. Participants were asked whether they knew a person who underwent IVF, completed a Moral Foundation Questionnaire, and answered a pre-piloted IVF knowledge test. Attitudes towards women who utilised IVF were measured with a modified Bogardus Social Distance Scale. Data were analysed using hierarchical and logistic regression analyses. RESULTS The results showed that there was a weak link between previous contact with a person who underwent IVF and a positive attitude toward a woman who underwent IVF. The attitudes was also predicted by moral foundations: positively by care/harm and fairness/cheating foundations, and negatively by sanctity/degradation. Importantly, more knowledge about IVF was linked with a more positive attitude towards IVF, and this effect explained additional variance over and above moral foundations. CONCLUSIONS Our study implies the need of psychoeducation to prevent stigmatization of individuals who try IVF due to infertility.
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Affiliation(s)
- Alicja Malina
- Faculty of Psychology, Kazimierz Wielki University, Bydgoszcz, Poland
| | - Marta Roczniewska
- Faculty of Psychology in Sopot, SWPS University of Social Sciences and Humanities, Warszawa, Poland
- Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, Sweden
| | - Julie Ann Pooley
- School of Arts and Humanities, Edith Cowan University, Perth, Western Australia
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Li G, Jiang Z, Kang X, Ma L, Han X, Fang M. Trajectories and predictors of anxiety and depression amongst infertile women during their first IVF/ICSI treatment cycle. J Psychosom Res 2021; 142:110357. [PMID: 33508704 DOI: 10.1016/j.jpsychores.2021.110357] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 01/09/2021] [Accepted: 01/10/2021] [Indexed: 01/26/2023]
Abstract
PURPOSE This study aimed to identify anxiety and depression trajectories of infertile women during first IVF treatment cycle and to examine whether the identified trajectories were associated with baseline psychological predictors, namely fertility-related stress, resilience, and illness perception. METHODS A longitudinal prospective study was conducted to assess anxiety and depression using the Chinese version of Self-Rating Anxiety Scale (SAS) and Self-Rating depression Scale (SDS) at four different time points: the day of first IVF/ICSI appointment (baseline/T1), the first day of ovarian stimulation (T2), the one day before oocyte retrieval (T3), and the day of fresh embryo transfer (T4). Final analysis was done on data obtained from 202 infertile women. Latent class growth mixed modeling was carried out to identify anxiety and depression trajectories. Multinomial logistic regressions were conducted to investigate predictors of trajectory membership. RESULTS Three different adjustment trajectories were identified amongst infertile women during their first IVF/ICSI treatment cycle. A total of 40.1 and 37.6% of women showed normal levels of anxiety and depression (resilient trajectories), respectively, 45.0 and 43.1% of women had recovery trajectories, and 14.9 and 19.3% of women had chronic anxiety and depression trajectories. Non-resilient trajectories were associated with relatively shorter duration of infertility, higher fertility-related stress, and lower resilience. CONCLUSION The results imply that it is possible to identify women in chronic or recovery trajectories on the day of first IVF/ICSI appointment, so that tailored prevention strategies integrated components that attenuate stress appraisal and strengthen resilience should be implemented to target those individuals.
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Affiliation(s)
- Guopeng Li
- Center for reproductive medicine, Shandong University, Jingliu Road, Shizhong District, Jinan, Shandong 250000, People's Republic of China
| | - Zhenhua Jiang
- Center for reproductive medicine, Shandong University, Jingliu Road, Shizhong District, Jinan, Shandong 250000, People's Republic of China
| | - Xiaofei Kang
- Center for reproductive medicine, Shandong University, Jingliu Road, Shizhong District, Jinan, Shandong 250000, People's Republic of China
| | - Lijin Ma
- Center for reproductive medicine, Shandong University, Jingliu Road, Shizhong District, Jinan, Shandong 250000, People's Republic of China
| | - Xue Han
- Center for reproductive medicine, Shandong University, Jingliu Road, Shizhong District, Jinan, Shandong 250000, People's Republic of China
| | - Mei Fang
- Center for reproductive medicine, Shandong University, Jingliu Road, Shizhong District, Jinan, Shandong 250000, People's Republic of China; Center for reproductive medicine, Shandong provincial hospital affiliated to Shandong University, Jingliu Road, Shizhong District, Jinan, Shandong 250000, People's Republic of China..
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24
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Marom Haham L, Youngster M, Kuperman Shani A, Yee S, Ben-Kimhy R, Medina-Artom TR, Hourvitz A, Kedem A, Librach C. Suspension of fertility treatment during the COVID-19 pandemic: views, emotional reactions and psychological distress among women undergoing fertility treatment. Reprod Biomed Online 2021; 42:849-858. [PMID: 33558171 PMCID: PMC7816616 DOI: 10.1016/j.rbmo.2021.01.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/23/2020] [Accepted: 01/12/2021] [Indexed: 12/19/2022]
Abstract
RESEARCH QUESTION What are the views and emotional reactions of patients towards the suspension of fertility treatment during the COVID-19 pandemic, and what are the factors affecting their psychological distress? DESIGN A cross-sectional study conducted in an academic fertility centre. Online questionnaires were distributed between 18 April 2020 and 23 April 2020 to patients whose treatment cycle had been postponed or discontinued. The outcome measures included agreement with the reproductive society guidelines to postpone treatments; willingness to resume treatments, given the choice; patients' emotional reactions; and psychological distress level, measured by the Mental Health Inventory validated scale. A multivariate linear regression was conducted to identify factors associated with psychological distress. RESULTS Because of the small number of male respondents, only women were included in the analysis (n = 181). Forty-three per cent expressed disagreement with the guidelines and 82% were willing to resume treatments, given the choice. Sadness and anxiety were the most common emotional reactions expressed towards the guidelines. In the multivariate analysis, COVID-19-related anxiety (B = 0.145, P = 0.04) and disagreement with treatment suspension (B = -0.44, P = 0.001) were found to be significantly associated with patients' psychological distress. Background characteristics of patients did not contribute significantly to their distress. CONCLUSIONS Suspension of fertility treatment during the initial phase of the COVID-19 pandemic was associated with patients' negative emotional reactions. Anxiety related to COVID-19 and disagreement with treatment suspension were found to be significantly associated with psychological distress among women undergoing fertility treatment, regardless of their background characteristics. Our findings suggest the need to monitor the mental health of patients and provide psychological support should a shutdown of fertility care re-occur.
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Affiliation(s)
- Lilach Marom Haham
- CReATe Fertility Centre, Toronto, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada
| | - Michal Youngster
- IVF Unit, Department of Obstetrics & Gynecology, Shamir Medical Center, Zerifin, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Adi Kuperman Shani
- CReATe Fertility Centre, Toronto, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada
| | | | - Reut Ben-Kimhy
- IVF Unit, Department of Obstetrics & Gynecology, Meir (Sapir) Medical Center, Kfar-Saba, Israel; The Gender Studies Program, Bar-Ilan University, Ramat Gan, Israel
| | - Tamar R Medina-Artom
- Smokler Center for Health Policy Research, Myers-JDC-Brookdale Institute Jerusalem, Israel; The Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Ariel Hourvitz
- IVF Unit, Department of Obstetrics & Gynecology, Shamir Medical Center, Zerifin, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Alon Kedem
- IVF Unit, Department of Obstetrics & Gynecology, Shamir Medical Center, Zerifin, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Clifford Librach
- CReATe Fertility Centre, Toronto, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada; Institute of Medical Sciences, University of Toronto, Toronto, Canada; Department of Physiology, University of Toronto, Toronto, Canada.
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25
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Lee S, Hitt WC. Clinical Applications of Telemedicine in Gynecology and Women's Health. Obstet Gynecol Clin North Am 2021; 47:259-270. [PMID: 32451017 DOI: 10.1016/j.ogc.2020.02.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Telemedicine and telehealth (TM/TH) are the 2 terms used interchangeably focusing on the delivery of health care services at a long distance using telecommunication technology. TM/TH has several gynecologic applications, including the well-woman visits, preventive care, preconception counseling, family planning including contraception and medical abortion, infertility workup, teleradiology, cervical cancer screening and colposcopy, mental health, and telesurgery. The goals of TM/TH are not only improving quality of health care in patients and building a virtual community of physicians but also increasing convenience, efficacy, and decreasing medical cost. In gynecology, TM/TH plays an important role, especially in well-woman care.
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Affiliation(s)
- Siwon Lee
- Department of Obstetrics and Gynecology, Mount Sinai Medical Center, 4302 Alton Road, Suite 920, Miami Beach, FL 33140, USA
| | - Wilbur C Hitt
- Department of Obstetrics and Gynecology, Mount Sinai Medical Center, 4302 Alton Road, Suite 920, Miami Beach, FL 33140, USA.
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26
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Cao LB, Hao Q, Liu Y, Sun Q, Wu B, Chen L, Yan L. Anxiety Level During the Second Localized COVID-19 Pandemic Among Quarantined Infertile Women: A Cross-Sectional Survey in China. Front Psychiatry 2021; 12:647483. [PMID: 34366908 PMCID: PMC8339465 DOI: 10.3389/fpsyt.2021.647483] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 06/28/2021] [Indexed: 11/29/2022] Open
Abstract
Infertility usually causes mental health problems for patients and unfavorable emotions such as anxiety and depression can have an adverse effect on women's normal pregnancy. We aimed to compare the anxiety level between infertile female patients in quarantined and non-quarantined areas during the second wave of COVID-19 epidemic. A total of 759 infertile women were included in this cross-sectional study conducted through an online survey. Anxiety was measured by the State-Trait Anxiety Inventory (STAI) tool. Participants were divided into the quarantined group (QG) and non-quarantined group (Non-QG). Independent sample T-test and chi-square test were performed to examine the difference between the two groups. There was no significant difference in the average STAI score of the two groups of infertile women, but responses to the emotional state showed that women in the QG had a higher tendency to be anxious. Participants in QG spent more time paying attention to the dynamics of the epidemic every day, and their sleep (p < 0.01) and mood conditions were worse (p < 0.01) than in the Non-QG. The family relationship of QG is more tense than non-QG. Through the research on the infertility treatment information of the overall research population, it is found the average STAI-State (STAI-S) (p = 0.031) score and STAI-Trait (STAI-T) (p = 0.005) score of women who were infertile for more than 3 years were significantly higher than those of women with <2 years. The STAI-T score of infertile women who underwent in vitro fertilization (IVF) was higher than that of non-IVF women (p = 0.007), but no significant difference was observed with the STAI-S score. To conclude, although the second wave of quarantine during COVID-19 epidemic did not significantly increase anxiety in infertile women, it did lead to an increase in other negative emotions and worse family relationships. Patients with long-term infertility treatment and those who have had IVF are more anxious subgroups.
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Affiliation(s)
- Lian-Bao Cao
- School of Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qianjie Hao
- Department of Obstetrics and Gynecology, The Eighth People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Yan Liu
- Department of Obstetrics and Gynecology, The Eighth People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Qiang Sun
- Department of Obstetrics and Gynecology, Zaozhuang Municipal Hospital, Zhaozhuang, China
| | - Bing Wu
- Department of Obstetrics and Gynecology, The Eighth People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Lili Chen
- Department of Obstetrics and Gynecology, The Eighth People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Lei Yan
- School of Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Obstetrics and Gynecology, The Eighth People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
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27
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Lee SS, Sutter M, Lee S, Schiffman MR, Kramer YG, McCulloh DH, Licciardi F. Self-reported quality of life scales in women undergoing oocyte freezing versus in vitro fertilization. J Assist Reprod Genet 2020; 37:2419-2425. [PMID: 32794124 DOI: 10.1007/s10815-020-01916-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/03/2020] [Indexed: 12/17/2022] Open
Abstract
PURPOSE The objective of this study was to investigate stress levels among women undergoing elective oocyte cryopreservation by comparing their self-reported quality of life measures with women undergoing in vitro fertilization during the fertility treatment cycle. METHODS Patients undergoing oocyte retrieval at a single institution were offered a voluntary, anonymous, and written questionnaire. The survey was adapted and validated from the Fertility Quality of Life tool to assess self-reported fertility treatment-related problems and was tested for construct validity and reliability. Based on exploratory factor analyses, three subscales were created as follows: fertility treatment-related stress, tolerability, and environment. Relationships between patient characteristics and fertility treatment-related measures were examined with Fisher's exact test, ANOVA, and multivariate regression with significance p < 0.05. RESULTS A total of 461 patients (331 IVF, 130 egg freeze) were included in the analysis. Medically indicated egg freezing patients were excluded. Overall, both IVF and egg freeze patients reported stress during the current fertility cycle and there were no significant differences between IVF and egg freeze patients for any subscale scores. Three sets of generalized linear models were run and found age to be associated with fertility treatment-related stress and tolerability scores, with younger patients experiencing greater difficulties. Additionally, patients who underwent repeat cycles reported more fertility treatment-related stress. CONCLUSIONS Patients undergoing egg freezing have similar responses to quality of life questions as patients undergoing IVF. Repeat cycles and younger age contribute to perceptions of stress. This information supports developing stress reduction strategies for all women undergoing egg freezing.
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Affiliation(s)
- Sarah S Lee
- Department of Obstetrics and Gynecology, New York University School of Medicine, 550 First Avenue, NBV 9E-2, New York, NY, 10016, USA.
| | - Megan Sutter
- Department of Obstetrics and Gynecology, New York University School of Medicine, 550 First Avenue, NBV 9E-2, New York, NY, 10016, USA
| | - Shelley Lee
- New York University Fertility Center, 660 First Avenue, Fifth floor, New York, NY, 10016, USA
| | - Mindy R Schiffman
- New York University Fertility Center, 660 First Avenue, Fifth floor, New York, NY, 10016, USA
| | - Yael G Kramer
- New York University Fertility Center, 660 First Avenue, Fifth floor, New York, NY, 10016, USA
| | - David H McCulloh
- New York University Fertility Center, 660 First Avenue, Fifth floor, New York, NY, 10016, USA
| | - Frederick Licciardi
- Department of Obstetrics and Gynecology, New York University School of Medicine, 550 First Avenue, NBV 9E-2, New York, NY, 10016, USA
- New York University Fertility Center, 660 First Avenue, Fifth floor, New York, NY, 10016, USA
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28
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Malina A, Głogiewicz M, Piotrowski J. Supportive Social Interactions in Infertility Treatment Decrease Cortisol Levels: Experimental Study Report. Front Psychol 2019; 10:2779. [PMID: 31920828 PMCID: PMC6927458 DOI: 10.3389/fpsyg.2019.02779] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 11/26/2019] [Indexed: 11/22/2022] Open
Abstract
PURPOSE The aim of the research project was to analyze the importance of supportive social interactions in the process of infertility treatment. The acceptance rates of ART (Assisted Reproductive Technology) in Poland are lower than in western European countries and the social stigma of infertility exists. The research project draws attention to the issue of disclosure of fertility problems and the ability to seek support in Polish couples. METHODS An experimental study was conducted with 51 heterosexual couples who qualified for IVF. The participants were randomly divided into an experimental and control group. The first stage of the research procedure, with all the couples, was to extract a saliva (cortisol) sample as a biomarker for stress. In the second stage the control group viewed an informational (non-emotional) video about human embryology. The experimental group took part in a supportive social interaction process. In the supportive social interaction process, a maximum of five couples, were led through a broad general understanding of their IVF experience by an experienced group psychologist. The third stage of the research involved the second extraction of a saliva (cortisol) sample form all participants. In addition, demographic and medical history related to fertility was collected. RESULTS The statistical analysis indicates a significant decrease in the level of stress experienced after the supportive social interaction. The reported differences between the experimental group and the control group indicated a larger decrease of cortisol level for women and men. CONCLUSION In the current study, the hypothesis that taking part in supportive social interaction significantly lowers stress levels (measured via cortisol) of infertile couples (men and women) was supported. Further the project indicates that a supportive social interaction has a beneficial effect on infertile couple's health and well-being. The results of the study clearly point to the benefits of couples involved in infertility treatment to express and share their experience, and in doing so, provides measurable physiological and psychological benefits.
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Affiliation(s)
- Alicja Malina
- Department of Pedagogy and Psychology, Kazimierz Wielki University in Bydgoszcz, Bydgoszcz, Poland
| | - Małgorzata Głogiewicz
- Department of Obstetrics, Gynecology and Gynecological Oncology, Faculty of Health Sciences, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Jakub Piotrowski
- Department of Immunology, Faculty of Biology and Environment Protection, Nicolaus Copernicus University in Toruń, Torun, Poland
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29
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Maroufizadeh S, Omani-Samani R, Almasi-Hashiani A, Amini P, Sepidarkish M. The reliability and validity of the Patient Health Questionnaire-9 (PHQ-9) and PHQ-2 in patients with infertility. Reprod Health 2019; 16:137. [PMID: 31500644 PMCID: PMC6734346 DOI: 10.1186/s12978-019-0802-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 09/02/2019] [Indexed: 01/17/2023] Open
Abstract
Background Depression in patients with infertility often goes undiagnosed and untreated. The Patient Health Questionnaire-9 (PHQ-9) and its ultra-brief version (i.e. PHQ-2) are widely used measures of depressive symptoms. These scales have not been validated in patients with infertility. The aim of the present study was to examine the reliability and validity of the PHQ-9 and PHQ-2 in patients with infertility. Methods In this cross-sectional study, a total of 539 patients with infertility from a referral infertility clinic in Tehran, Iran completed the PHQ-9, along with other relevant scales: the WHO-five Well-being Index (WHO-5), the Hospital Anxiety and Depression Scale (HADS), and the Generalized Anxiety Disorder-7 (GAD-7). Factor structure and internal consistency of PHQ-9 were examined via confirmatory factor analysis (CFA) and Cronbach’s alpha, respectively. Convergent validity was evaluated by relationship with WHO-5, HADS and GAD-7. Results The mean total PHQ-9 and PHQ-2 scores were 8.47 ± 6.17 and 2.42 ± 1.86, respectively, and using a cut-off value of 10 (for PHQ-9) and 3 (for PHQ-2), the prevalence of depressive symptoms was 38.6 and 43.6%, respectively. The Cronbach’s alphas for PHQ-9 and PHQ-2 were, respectively, 0.851 and 0.767, indicating good internal consistency. The CFA results confirmed the one-factor model of the PHQ-9 (χ2/df = 4.29; CFI = 0.98; RMSEA = 0.078 and SRMR = 0.044). Both PHQ-9 and PHQ-2 showed moderate to strong correlation with the measures of WHO-5, HADS-depression, HADS-anxiety, and the GAD-7, confirming convergent validity. In univariate analysis, female sex, long infertility duration, and unsuccessful treatment were significantly associated with depression symptoms. Conclusion Both PHQ-9 and PHQ-2 are brief and easy to use measures of depressive symptoms with good psychometric properties that appear suitable for routine use in patients with infertility.
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Affiliation(s)
- Saman Maroufizadeh
- School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Reza Omani-Samani
- Department of Medical Ethics and Law, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Amir Almasi-Hashiani
- Department of Epidemiology, School of Health, Arak University of Medical Sciences, Arak, Iran
| | - Payam Amini
- Department of Biostatistics and Epidemiology, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Mahdi Sepidarkish
- Department of Biostatistics and Epidemiology, Babol University of Medical Sciences, Babol, Iran
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30
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Aisenberg Romano G, Fried Zaig I, Halevy A, Azem F, Amit A, Bloch M. Prophylactic SSRI treatment for women suffering from mood and anxiety symptoms undergoing in vitro fertilization-a prospective placebo-controlled study. Arch Womens Ment Health 2019; 22:503-510. [PMID: 30225529 DOI: 10.1007/s00737-018-0911-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 09/07/2018] [Indexed: 11/29/2022]
Abstract
To explore the mood protective effect of prophylactic SSRI treatment on women undergoing IVF suffering from moderate affective and anxiety symptoms. In a randomized double blind, placebo-controlled, parallel design study, 41 women diagnosed with an Adjustment Disorder, who were undergoing IVF treatments, were randomized into two groups; a study group (n = 22) administered escitalopram 10 mg/day, and a control group (n = 19) administered placebo for a total of 8 weeks before and during the IVF treatment cycle. Patients were assessed at the onset of drug treatment and at embryo transfer. The main outcome measure was the difference in mean score severity rating of depression and anxiety symptoms on the CES-D and Zung questionnaires between groups at the time of embryo transfer. Secondary outcome measures included the MHI rating subscales addressing aspects of psychological distress and coping. At the day of embryo transfer (6 weeks of drug treatment), the CES-D average score for the treatment group was 6.40 (6.71) and 27.47 (4.29) on the Zung Self-Rating Anxiety Scale, while the placebo group scored an average of 15.83 (8.69) and 33.17 (6.95) receptively. These findings were significant (p = .004, p = .015 receptively) and were endorsed by the scoring on the MHI questionnaire subscales. Short-term treatment with SSRI may serve as a prophylactic treatment against the perpetuation and possible worsening of depressive and anxiety symptoms in women undergoing IVF treatments. Further studies concerning pharmacological interventions in larger samples and studies addressing screening for psychological stress indicators in this population are warranted.
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Affiliation(s)
- Gabi Aisenberg Romano
- Department of Psychiatry, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel.
| | - Inbar Fried Zaig
- Department of Psychiatry, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel
| | - Anat Halevy
- Department of Psychiatry, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel
| | - Foad Azem
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel.,IVF Unit, Lis Women's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel
| | - Ami Amit
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel.,IVF Unit, Lis Women's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel
| | - Miki Bloch
- Department of Psychiatry, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
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31
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Huang MZ, Kao CH, Lin KC, Hwang JL, Puthussery S, Gau ML. Psychological health of women who have conceived using assisted reproductive technology in Taiwan: findings from a longitudinal study. BMC WOMENS HEALTH 2019; 19:97. [PMID: 31299964 PMCID: PMC6626344 DOI: 10.1186/s12905-019-0801-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 07/08/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Despite the increasing use of Assisted Reproductive Technology (ART) and the significant physical and emotional commitments that these treatments and procedures involve, only limited evidence exists regarding the psychological health of women who undergo ART. This study investigated the changes over time in the psychological health of women who have conceived using ART during the first, second, and third trimesters of pregnancy and during the postpartum period in Taiwan. METHODS A quantitative longitudinal study was conducted at a fertility centre in Taiwan. 158 pregnant women who had conceived using ART completed a web-based questionnaire that included the following instruments: State Anxiety Inventory, Edinburgh Postnatal Depression Scale, Modified Maternal Foetal Attachment Scale, Pregnancy Stress Rating Scale, Maternity Social Support Scale, Intimate Bond Measure, and Parenting Stress Index. The data were collected the first (9-12 weeks), second (19-22 weeks), third (28-31 weeks) trimesters of pregnancy and at 7-10 weeks postpartum. RESULTS Levels of anxiety and depression, which are both key indicators of psychological health, were highest during the first trimester, with scores of 42.30 ± 11.11 and 8.43 ± 4.44, respectively. After the first trimester, anxiety scores decreased and remained stable through the remainder of pregnancy, with scores of 38.03 ± 10.58 in the second and 38.39 ± 10.36 in the third trimester, but increased at two-months postpartum, attaining a score of 41.18 ± 11.68. Further, depression scores showed a similar pattern, declining to a mean of 7.21 ± 4.23 in the second and 6.99 ± 4.11 in the third trimester and then increasing to 8.39 ± 5.25 at two-months postpartum. Pregnancy stress and social support were found to be the most important predictors of change in psychological health during pregnancy and the postpartum period. CONCLUSION Psychological health was found to be poorest during the first trimester and at two-months postpartum. Moreover, pregnancy stress and social support were identified as key predictors of change in psychological health. The findings indicate a need for increased sensitivity among healthcare professionals to the psychological vulnerability of women who have conceived using ART as well as a need to introduce tailored interventions to provide appropriate psychological support to these women.
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Affiliation(s)
- Mei-Zen Huang
- Department of Nursing, National Tainan Junior College of Nursing, 78, Sec.2 Minzu Rd, Tainan City, Taiwan
| | - Chien-Huei Kao
- Department of Midwifery and Women Health Care, National Taipei University of Nursing and Health Sciences, 365, Ming-Te Road, Peitou, Taipei, Taiwan
| | - Kuan-Chia Lin
- Institute of Hospital and Health Care Administration, National Yang-Ming University, 155, Sec. 2, Linong Street, Taipei, Taiwan
| | - Jiann-Loung Hwang
- Department of Obstetrics and Gynecology, Taipei Medical University, 250, Wuxing Street, Taipei, Taiwan
| | - Shuby Puthussery
- School of Health Care Practice & Institute for Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Luton, Bedfordshire, LU2 8LE, UK
| | - Meei-Ling Gau
- Department of Midwifery and Women Health Care, National Taipei University of Nursing and Health Sciences, 365, Ming-Te Road, Peitou, Taipei, Taiwan.
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Palomba S, Daolio J, Romeo S, Battaglia FA, Marci R, La Sala GB. Lifestyle and fertility: the influence of stress and quality of life on female fertility. Reprod Biol Endocrinol 2018; 16:113. [PMID: 30501641 PMCID: PMC6275085 DOI: 10.1186/s12958-018-0434-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 10/24/2018] [Indexed: 12/13/2022] Open
Abstract
There is growing evidence that lifestyle choices account for the overall quality of health and life (QoL) reflecting many potential lifestyle risks widely associated with alterations of the reproductive function up to the infertility. This review aims to summarize in a critical fashion the current knowledge about the potential effects of stress and QoL on female reproductive function. A specific literature search up to August 2017 was performed in IBSS, SocINDEX, Institute for Scientific Information, PubMed, Web of Science and Google Scholar. Current review highlights a close relationship in women between stress, QoL and reproductive function, that this association is more likely reported in infertile rather than fertile women, and that a vicious circle makes them to have supported each other. However, a precise cause-effect relationship is still difficult to demonstrate due to conflicting results and the lack of objective measures/instruments of evaluation.
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Affiliation(s)
- Stefano Palomba
- Unit of Obstetrics and Gynecology, Grande Ospedale Metropolitano “Bianco – Melacrino - Morelli”, Reggio Calabria, Italy
| | - Jessica Daolio
- Center of Reproductive Medicine “P. Bertocchi” Department of Obstetrics and Gynecology, Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Sara Romeo
- Unit of Obstetrics and Gynecology, Grande Ospedale Metropolitano “Bianco – Melacrino - Morelli”, Reggio Calabria, Italy
| | - Francesco Antonino Battaglia
- Unit of Obstetrics and Gynecology, Grande Ospedale Metropolitano “Bianco – Melacrino - Morelli”, Reggio Calabria, Italy
| | - Roberto Marci
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Obstetrics and Gynecology, University Hospital of Geneva, Geneva, Switzerland
| | - Giovanni Battista La Sala
- Center of Reproductive Medicine and Surgery, Arcispedale Santa Maria Nuova (ASMN) - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Reggio Emilia, Italy
- University of Modena and Reggio Emilia, Modena, Italy
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Colaco S, Sakkas D. Paternal factors contributing to embryo quality. J Assist Reprod Genet 2018; 35:1953-1968. [PMID: 30206748 PMCID: PMC6240539 DOI: 10.1007/s10815-018-1304-4] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 08/30/2018] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Advancing maternal and paternal age leads to a decrease in fertility, and hence, many infertile couples opt for assisted reproductive technologies [ART] to achieve biological parenthood. One of the key determinants of achieving a live outcome of ART, embryo quality, depends on both the quality of the oocyte and sperm that have created the embryo. Several studies have explored the effect of oocyte parameters on embryo quality, but the effects of sperm quality on the embryo have not been comprehensively evaluated. METHOD In this review, we assess the effect of various genetic factors of paternal origin on the quality and development of the embryo. RESULTS The effects of sperm aneuploidy, sperm chromatin structure, deoxyribonucleic acid [DNA] fragmentation, role of protamines and histones, sperm epigenetic profile, and Y chromosome microdeletions were explored and found to negatively affect embryo quality. CONCLUSION We propose that careful assessment of spermatozoal parameters is essential to achieve embryo development and a healthy live birth. However, the heterogeneity in test results and the different approaches of assessing a single sperm parameter highlight the need for more research and the development of standardized protocols to assess the role of sperm factors affecting embryo quality.
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Affiliation(s)
- Stacy Colaco
- Molecular and Cellular Biology Laboratory, Indian Council of Medical Research-National Institute for Research in Reproductive Health, JM Street, Parel, Mumbai, 400012, India.
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Dawadi S, Takefman J, Zelkowitz P. Fertility patients demonstrate an unmet need for the provision of psychological information: A cross sectional study. PATIENT EDUCATION AND COUNSELING 2018; 101:1852-1858. [PMID: 30168420 DOI: 10.1016/j.pec.2018.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 06/19/2018] [Accepted: 06/24/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To examine the provision of information by health care providers (HCPs) to fertility patients about accessing psychological resources. METHODS This study utilized data from a cross-sectional survey of 659 male and female patients seeking fertility treatment at clinics in Toronto and Montreal. Regression analyses were used to assess if sociodemographic and treatment variables were associated with the receipt of information, the desire for information, the helpfulness of the information, and the likelihood that participants had sought counselling. RESULTS The majority of respondents (79.8%) said that their HCP had not given them information about accessing psychological resources. Of the patients who did not receive this information, most (60%) said that they wanted it. Regression analysis revealed that immigrants, women, and patients with higher perceived stress scores were significantly more likely to desire this information. Furthermore, having received this information was associated with increased odds of counselling seeking (odds ratio = 3.31, p = 0.013). CONCLUSION Fertility patients demonstrated an unmet need for information about accessing psychological resources, and HCPs may play an integral role in bridging this information gap. PRACTICE IMPLICATIONS To improve the patient-centeredness of fertility care, HCPs should be proactive in informing all patients about how to access psychological resources.
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Affiliation(s)
| | - Janet Takefman
- Department of Obstetrics and Gynecology, McGill, Montreal, Canada
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Cheung CWC, Saravelos SH, Chan TYA, Sahota DS, Wang CC, Chung PW, Li TC. A prospective observational study on the stress levels at the time of embryo transfer and pregnancy testing following in vitro fertilisation treatment: a comparison between women with different treatment outcomes. BJOG 2018; 126:271-279. [DOI: 10.1111/1471-0528.15434] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2018] [Indexed: 11/28/2022]
Affiliation(s)
- CWC Cheung
- Assisted Reproductive Technology Unit Department of Obstetrics and Gynaecology Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
| | - SH Saravelos
- Assisted Reproductive Technology Unit Department of Obstetrics and Gynaecology Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
| | - TYA Chan
- Department of Psychology The Chinese University of Hong Kong Hong Kong China
| | - DS Sahota
- Assisted Reproductive Technology Unit Department of Obstetrics and Gynaecology Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
| | - CC Wang
- Assisted Reproductive Technology Unit Department of Obstetrics and Gynaecology Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
| | - PW Chung
- Assisted Reproductive Technology Unit Department of Obstetrics and Gynaecology Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
| | - TC Li
- Assisted Reproductive Technology Unit Department of Obstetrics and Gynaecology Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
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Roussos-Ross D, Rhoton-Vlasak AS, Baker KM, Arkerson BJ, Graham G. Case-based care for pre-existing or new-onset mood disorders in patients undergoing infertility therapy. J Assist Reprod Genet 2018; 35:1371-1376. [PMID: 29860578 PMCID: PMC6086786 DOI: 10.1007/s10815-018-1222-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 05/22/2018] [Indexed: 10/14/2022] Open
Abstract
The inability to conceive is an immensely stressful event in a woman's life. Thus, it is no surprise that women with infertility have twice the rates of depressive symptoms as women without infertility. Incidence of depression in the general female population is approximately 20% compared to almost 40% in infertile females. Based on this information, we expect many individuals with infertility to have pre-existing mood disorders requiring ongoing treatment. In addition, we expect a subset of women to develop a mood disorder during infertility treatment due to related stressors. The reproductive endocrinology team must understand the impact of stress on pregnancy outcomes, the types of treatment options, and the safety and use of various medications. The goal of this case-based commentary is to summarize information on the relationship between stress and infertility and to offer a guide for a range of treatment options that include non-pharmacologic and pharmacologic therapies.
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Affiliation(s)
- Dikea Roussos-Ross
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, P.O. Box 100294, Gainesville, FL, 32610-0294, USA.
| | - Alice S Rhoton-Vlasak
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, P.O. Box 100294, Gainesville, FL, 32610-0294, USA
| | - Katherine M Baker
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, P.O. Box 100294, Gainesville, FL, 32610-0294, USA
| | - Brittany J Arkerson
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, P.O. Box 100294, Gainesville, FL, 32610-0294, USA
| | - Georgia Graham
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, P.O. Box 100294, Gainesville, FL, 32610-0294, USA
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Abstract
BACKGROUND Worldwide, women are found to suffer from depression significantly more than men. This has puzzled the scientists since no biological explanation can completely resolve the matter. METHOD Extant empirical work has been conducted to solve the mystery of the issue. However, most of the research has pivoted their attention to biology. Therefore, based on the previous literature from the disciplines of medicine, psychology and sociology, the author aimed at looking and reviewing the matter critically. Specifically, the present critical review aims at conceptualising the psychological, social and cultural factors in the context of gender difference in depression. DISCUSSION The work reveals that psychological variables such as women's unique attachment patterns, relational self-construal, as well as a macro-level issue like power dynamics based on gender, and the skewed division of labour play an important role in gender difference in depression. The work also suggests that focusing solely on biological underpinnings may result in losing the entire scenario; therefore, social and cultural issues that place women in a socially disadvantaged position are equally important.
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Affiliation(s)
- Sucharita Maji
- Department of Humanities & Social Sciences, Indian Institute of Technology Kanpur, UP, India
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The prevalence of anxiety and depression among people with infertility referring to Royan Institute in Tehran, Iran: A cross-sectional questionnaire study. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2018. [DOI: 10.1016/j.mefs.2017.09.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Haimovici F, Anderson JL, Bates GW, Racowsky C, Ginsburg ES, Simovici D, Fichorova RN. Stress, anxiety, and depression of both partners in infertile couples are associated with cytokine levels and adverse IVF outcome. Am J Reprod Immunol 2018. [PMID: 29528174 DOI: 10.1111/aji.12832] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PROBLEM Psychiatric disorders and stress in women have been associated with poor IVF outcome. We hypothesized that both partners in the infertile couples are emotionally affected, and cytokines in both may link psychological to reproductive outcome. METHOD OF STUDY Forty-five IVF couples completed questionnaires and visual analog scales for stress and psychiatric disorders and had cytokines measured in serum, semen, cervicovaginal, and follicular fluids. Multivariable analyses, t tests, maximum likelihood estimates, Spearman correlation, and data mining were applied. RESULTS Psychopathology was found in 72% of the couples. Female and male stress were associated with stress, anxiety, and depression in the respective partner, and with a lower likelihood of clinical pregnancy and live birth. Lower serum TGF-β and higher cervicovaginal IL-6 and IL-1β were associated with stress. In data decision trees, cytokines in relation to stress and depression in both partners were found indicative of IVF failure. CONCLUSION Infertile couples may benefit from psychiatric evaluation and treatment of both partners.
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Affiliation(s)
- Florina Haimovici
- Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Janis L Anderson
- Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Gordon W Bates
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Catherine Racowsky
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Elizabeth S Ginsburg
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Dan Simovici
- Department of Computer Science, UMass, Boston, MA, USA
| | - Raina N Fichorova
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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Crawford NM, Hoff HS, Mersereau JE. Infertile women who screen positive for depression are less likely to initiate fertility treatments. Hum Reprod 2018; 32:582-587. [PMID: 28073974 DOI: 10.1093/humrep/dew351] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 12/16/2016] [Indexed: 12/13/2022] Open
Abstract
STUDY QUESTION Are infertile women who screen positive for depression less likely to initiate infertility treatments? SUMMARY ANSWER Infertile women who screen positive for depression are less likely to initiate treatment for infertility. WHAT IS ALREADY KNOWN Infertility imposes a psychological burden on many couples. Depression and anxiety have been demonstrated in ~40% of infertile women, which is twice that of fertile women. Further, the psychological burden associated with infertility treatment has been cited as a major factor for discontinuation of infertility care. STUDY DESIGN, SIZE, DURATION Prospective, observational study in a clinical-based cohort of 416 women who completed a questionnaire after the new patient visit, from January 2013 until December 2014 inclusive. PARTICIPANTS/MATERIALS, SETTING, METHODS All new female infertility patients (n = 959) seen between January 2013 and December 2014 at University of North Carolina Fertility received an electronic questionnaire to screen for mental health disorders and to evaluate their perception of mental health disorders on infertility. MAIN RESULTS AND THE ROLE OF CHANCE Of 959 surveys sent, 416 women completed the questionnaire (43%). The prevalence screening positive for depression, using the NIH PROMIS screening tool, was 41%. Sixty-two percent of all women initiated infertility treatment, and of these, 81% did so within 4 months. In multivariate analysis, women who screened positive for depression had 0.55 times the odds of initiating treatment for infertility (95% CI: 0.31-0.95). Similarly, women who screened positive for depression had 0.58 times the odds of initiating infertility treatment within 4 months (95% CI: 0.35-0.97), which was the time of censoring from the most recent patient evaluated. Women who screened positive for depression were less likely to pursue treatment with oral medications or IVF (P = 0.01 and P = 0.03, respectively), as compared to women who did not screen positive for depression. LIMITATIONS, REASONS FOR CAUTION Questionnaire-based evaluations may result in a lower prevalence of psychological disorder as some participants feign emotional well-being. Although we did not identify differences in women who responded to our survey and those who did not, responder bias may still be present. In addition, infertility is a couple's disease. However, this study only included psychological evaluation of the female partner. We have no information about the women's previous treatment. WIDER IMPLICATIONS OF THE FINDINGS Screening for depression is important in the infertility patient population, as further evaluation and psychological interventions may improve compliance with fertility treatments, quality of life, and potentially, the overall chance of pregnancy. STUDY FUNDING/COMPETING INTERESTS None.
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Affiliation(s)
- Natalie M Crawford
- Department of Obstetrics and Gynecology, University of North Carolina, 4001 Old Campus Building, CB 7570, Chapel Hill, NC 27599, USA
| | - Heather S Hoff
- Department of Obstetrics and Gynecology, University of North Carolina, 4001 Old Campus Building, CB 7570, Chapel Hill, NC 27599, USA
| | - Jennifer E Mersereau
- Department of Obstetrics and Gynecology, University of North Carolina, 4001 Old Campus Building, CB 7570, Chapel Hill, NC 27599, USA
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Apfel RJ, Keylor RG. Psychoanalysis and infertility myths and realities. THE INTERNATIONAL JOURNAL OF PSYCHOANALYSIS 2017. [DOI: 10.1516/4089-jbcw-ynt8-qtcm] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Hoff HS, Crawford NM, Mersereau JE. Screening for Psychological Conditions in Infertile Women: Provider Perspectives. J Womens Health (Larchmt) 2017; 27:503-509. [PMID: 29185847 DOI: 10.1089/jwh.2017.6332] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To determine if reproductive specialists are screening new patients for depression or anxiety, explore possible reasons why providers are not screening, and assess physician's views about the impact of mental health disorders on fertility. MATERIALS AND METHODS Cross-sectional exploratory study in which 86 practicing reproductive physicians filled out a 20-question survey regarding mental health screening and perception of psychological disorders on reproduction. RESULTS The majority of infertility providers believe psychological conditions negatively impact pregnancy success (75%); however, most providers are not formally screening patients for depression or anxiety (28%). Providers who did not screen for depression were more likely to be uncomfortable assessing patients for mental health disorders and to work in a private practice setting. CONCLUSIONS This study finds that most infertility specialist respondents believe that mental health conditions negatively impact reproductive outcomes; however, few of these providers are screening for psychological disorders in infertile women. Reasons why providers are not screening infertility patients for psychological disorders include lack of time and unfamiliarity with recommendations for treatment of mental health conditions. Implementing a rapid screen for anxiety and depression and providing easily assessable succinct educational updates to fertility providers on current treatment options for mental health disorders may allow affected patients to be treated sooner, and ultimately, may improve fertility outcomes.
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Affiliation(s)
- Heather S Hoff
- Department of Obstetrics and Gynecology, University of North Carolina , Chapel Hill, North Carolina
| | - Natalie M Crawford
- Department of Obstetrics and Gynecology, University of North Carolina , Chapel Hill, North Carolina
| | - Jennifer E Mersereau
- Department of Obstetrics and Gynecology, University of North Carolina , Chapel Hill, North Carolina
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Connect the Dots—August 2017. Obstet Gynecol 2017; 130:461-462. [DOI: 10.1097/aog.0000000000002170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Maleki-Saghooni N, Amirian M, Sadeghi R, Latifnejad Roudsari R. Effectiveness of infertility counseling on pregnancy rate in infertile patients undergoing assisted reproductive technologies: A systematic review and meta-analysis. Int J Reprod Biomed 2017. [DOI: 10.29252/ijrm.15.7.391] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Lakatos E, Szigeti JF, Ujma PP, Sexty R, Balog P. Anxiety and depression among infertile women: a cross-sectional survey from Hungary. BMC WOMENS HEALTH 2017; 17:48. [PMID: 28738833 PMCID: PMC5525318 DOI: 10.1186/s12905-017-0410-2] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 07/19/2017] [Indexed: 11/10/2022]
Abstract
Background Infertility is often associated with a chronic state of stress which may manifest itself in anxiety-related and depressive symptoms. The aim of our study is to assess the psychological state of women with and without fertility problems, and to investigate the background factors of anxiety-related and depressive symptoms in women struggling with infertility. Methods Our study was conducted with the participation of 225 (134 primary infertile and 91 fertile) women, recruited in a clinical setting and online. We used the following questionnaires: Spielberger Trait Anxiety Inventory (STAI-T), Shortened Beck Depression Inventory (BDI) and Fertility Problem Inventory (FPI). We also interviewed our subjects on the presence of other sources of stress (the quality of the relationship with their mother, financial and illness-related stress), and we described sociodemographic and fertility-specific characteristics. We tested our hypotheses using independent-samples t-tests (M ± SD) and multiple linear regression modelling (ß). Results Infertile women were younger (33.30 ± 4.85 vs. 35.74 ± 5.73, p = .001), but had significantly worse psychological well-being (BDI = 14.94 ± 12.90 vs. 8.95 ± 10.49, p < .0001; STAI-T = 48.76 ± 10.96 vs. 41.18 ± 11.26, p < .0001) than fertile subjects. Depressive symptoms and anxiety in infertile women were associated with age, social concern, sexual concern and maternal relationship stress. Trait anxiety was also associated with financial stress. Our model was able to account for 58% of the variance of depressive symptoms and 62% of the variance of trait anxiety. Conclusions Depressive and anxiety-related symptoms of infertile women are more prominent than those of fertile females. The measurement of these indicators and the mitigation of underlying distress by adequate psychosocial interventions should be encouraged.
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Affiliation(s)
- Enikő Lakatos
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Nagyvárad tér 4, Budapest, H-1089, Hungary.
| | - Judit F Szigeti
- Department of Clinical Psychology, Semmelweis University, Tömő utca 25-29, Budapest, H-1083, Hungary
| | - Péter P Ujma
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Nagyvárad tér 4, Budapest, H-1089, Hungary
| | - Réka Sexty
- Institute of Medical Psychology, Centre for Psychosocial Medicine, Ruprecht-Karls University, Bergheimer Straße 20, D-69115, Heidelberg, Germany
| | - Piroska Balog
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Nagyvárad tér 4, Budapest, H-1089, Hungary
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Shin JJ, Jee BC, Kim H, Kim SH. Major Disease Prevalence and Menstrual Characteristics in Infertile Female Korean Smokers. J Korean Med Sci 2017; 32:321-328. [PMID: 28049245 PMCID: PMC5220000 DOI: 10.3346/jkms.2017.32.2.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 10/30/2016] [Indexed: 12/03/2022] Open
Abstract
We investigated the prevalence of smoking and factors associated with smoking in infertile Korean women. Smoking status, education, occupation, personal habits, past medical history, current illness, stress level, and menstrual characteristics were collected from self-report questionnaires. The Beck Depression Inventory (BDI) was used to assess the degree of depression. Data on the causes of infertility and levels of six reproductive hormones were collected from medical records. Among 785 women less than 42 years of age, the prevalence of current, secondhand, past, and never smokers were 12.7%, 45.7%, 0.9%, and 40.6%, respectively. Primary infertility was more frequent in secondhand smokers. Causes of infertility were similar among current, secondhand, and never smokers. Current smokers were less educated (P < 0.001) and more likely to consume alcohol than secondhand or never smokers (P < 0.001). Secondhand smokers slept less than current smokers (P = 0.041). Among several major diseases, only the prevalence of diabetes mellitus (4.0%) was significantly higher in current smokers than in secondhand smokers (0.0%, P = 0.002) or never smokers (0.6%, P = 0.031). The self-reported prevalence of depression, and the degree of depression were similar among women with different smoking statuses. There were no differences in menstrual characteristics or serum levels of six reproductive hormones between current, secondhand, and never smokers, even after excluding women with polycystic ovary syndrome. In conclusion, education/employment status, alcohol drinking, and the prevalence of primary infertility and diabetes mellitus were significantly different according to smoking status among infertile women.
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Affiliation(s)
- Jae Jun Shin
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Byung Chul Jee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Hoon Kim
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
| | - Seok Hyun Kim
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
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Yang B, Zhang J, Qi Y, Wang P, Jiang R, Li H. Assessment on Occurrences of Depression and Anxiety and Associated Risk Factors in the Infertile Chinese Men. Am J Mens Health 2017; 11:767-774. [PMID: 28413943 PMCID: PMC5675225 DOI: 10.1177/1557988317695901] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The prevalence of depression and anxiety in the Chinese male population with infertility is still uncertain. The prevalence of depression, anxiety, and a combination of both psychological symptoms was 20.8%, 7.8%, and 15.4%, respectively in 771 infertile Chinese men in the current study by the Mental Health Inventory–5 and the State–Trait Anxiety Inventory–Short Form questionnaires. Differences in demographics (age, education, and income) had no noticeable impact on the development of psychological symptoms. Clinical factors such as concomitant disorders (varicocele, epididymal cyst, and erectile dysfunction) were identified as risk factors associated with depressive symptoms (OR = 1.47; 95% CI [1.14, 1.90]; p < .001) and both depressive and anxiety symptoms (OR = 1.56; 95% CI [1.17, 2.08]; p < .001). An infertility duration over 2 years was associated with a high risk of anxiety symptoms (OR = 3.94; 95% CI [1.20, 12.93], p < .02). Other clinical conditions such as type of treatment and quality of sperm were not significant risk factors for psychological symptoms. This study provides evidence that Chinese men of reproductive age who suffer from infertility are vulnerable to psychological distress.
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Affiliation(s)
- Bin Yang
- 1 Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | | | - Yuxia Qi
- 2 Shandong Jiaotong Hospital, Jinan, Shandong, China
| | - Pu Wang
- 3 Heze Municipal Hospital, Heze, Shandong, China
| | | | - Hongjun Li
- 1 Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Psychosocial Vulnerability, Resilience Resources, and Coping with Infertility: A Longitudinal Model of Adjustment to Primary Ovarian Insufficiency. Ann Behav Med 2016; 50:272-84. [PMID: 26637185 DOI: 10.1007/s12160-015-9750-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND The infertility associated with primary ovarian insufficiency (POI) presents significant emotional challenges requiring psychosocial adjustment. Few investigations have explored the longitudinal process of adaptation to POI. PURPOSE This longitudinal investigation tests a model of adjustment to POI that includes separate psychosocial vulnerability and resilience resource factors. METHODS Among 102 women with POI, personal attributes reflective of vulnerability and resilience were assessed at baseline. Coping strategies were assessed 4 months later and measures of distress and well-being 12 months later. RESULTS As hypothesized, confirmatory factor analysis yielded separate, inversely correlated vulnerability and resilience resource factors at baseline, and distress and well-being factors at 12 months. Contrary to predictions, maladaptive and adaptive coping strategies were not bi-factorial. Moreover, a single stand-alone strategy, avoidance (i.e., refusing to acknowledge stress), mediated the association between baseline vulnerability and 12-month distress. CONCLUSIONS For women with POI, interventional studies targeted to reduce avoidance are indicated.
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Karaca N, Karabulut A, Ozkan S, Aktun H, Orengul F, Yilmaz R, Ates S, Batmaz G. Effect of IVF failure on quality of life and emotional status in infertile couples. Eur J Obstet Gynecol Reprod Biol 2016; 206:158-163. [PMID: 27693938 DOI: 10.1016/j.ejogrb.2016.09.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 09/09/2016] [Accepted: 09/13/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To investigate the effect of a previous IVF failure on the quality of life and emotional distress, in couples undergoing IVF treatment. Experiencing IVF failure might cause differences on the anxiety-depression and quality of life scores of the couples, compared to the ones who were undergoing IVF treatment for the first time. STUDY DESIGN This study included 64 couples who had previously experienced at least one IVF failure (Group 1) and 56 couples without history of IVF failure (Group 2) in a private Assisted Reproductive Center, Istanbul, Turkey. A sociodemographic data form, the FertiQoL International and Hospital Anxiety (HAD-A) and Depression scale (HAD-D) for evaluating the status of distress, were administered for the study. RESULT(S) FertiQoL scores were compared between the groups, the environment scale of the quality of life in treatment section was found to be significantly higher in Group 1 compared with Group 2 (p=0.009). The HAD-A and HAD-D scores did not differ significantly between the groups. Group-variables were investigated using multilevel analysis, the infertility duration and income level were found to have an effect on the subscales of quality of life (p=0.009 and p=0.001 respectively) in Group 2. Depression scores were higher in couples with infertility duration of below five years in Group 1 and Group 2 compared to couples with infertility duration of five years or above (MANOVA analysis). The level of education was found to affect the scores of HAD-D in Group 2, but not in Group 1 (p=0.011). The score of HAD-D was significantly affected by the family type only in Group 2 (p=0.009); the depression score of the couples living with a nuclear family was found to be higher compared with the couples living in a traditional family (p=0.021). CONCLUSION(S) Fertility-specific quality of life scores reveals better results regarding the orientation to the treatment environment in the couples with a previous IVF failure, compared to first IVF cycle couples. Treatment failure does not elevate the level of anxiety, while the effect on depression scores changes according to duration of infertility.
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Affiliation(s)
- Nilay Karaca
- Bezmialem Vakif University, School of Medicine, Department of Obstetric and Gynecology, Istanbul, Turkey.
| | - Aysun Karabulut
- Pamukkale University, School of Medicine, Department of Obstetric and Gynecology, Denizli, Turkey
| | - Sevgi Ozkan
- Pamukkale University, Denizli Health Services Vocational College, Denizli, Turkey
| | - Hale Aktun
- Medipol University, School of Medicine, Department of Obstetric and Gynecology, Istanbul, Turkey
| | | | - Rabiye Yilmaz
- Bezmialem Vakif University, School of Medicine, Department of Obstetric and Gynecology, Istanbul, Turkey
| | - Seda Ates
- Bezmialem Vakif University, School of Medicine, Department of Obstetric and Gynecology, Istanbul, Turkey
| | - Gonca Batmaz
- Bezmialem Vakif University, School of Medicine, Department of Obstetric and Gynecology, Istanbul, Turkey
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