Choices and motivations of infertile couples

How to minimize the dropout and crossover in an infertility trial?

Randomized controlled trials and intent-to-treat analyses are important for infertility clinical studies. Dropouts or crossovers during the study process will disrupt the randomization design and affect the intent-to-treat analysis. In this review, we have briefly introduced the occurrence of dropout and crossover from our previous Reproductive Medicine Network and other related studies and provided some experience obtained from these studies on how to minimize and reduce the occurrence of dropout and crossover for infertility randomized clinical studies.

Effect of Heartfulness meditation based integrative therapy on infertility outcomes: A retrospective case series evaluation

BACKGROUND

In Indian context, infertility is often a silent struggle. Despite the high prevalence of infertility in the country, the majority of couples do not share their struggles with family or friends due to social stigma, thus increasing their psychological vulnerability. Heartfulness meditation has shown to decrease stress, anxiety, loneliness and improve sleep along with quality of life.

OBJECTIVES

The current retrospective series evaluated the effectiveness of Heartfulness-based integrative therapy on infertility outcomes.

METHODS

The program consisted of a 5- day onsite lifestyle modification workshop and online follow up meditation sessions.

RESULTS

54 couples with infertility participated in the program with a mean age of 30.74 years (SD 5.04) for females and 34.03 years (SD 4.54) for males. 15 couples presented with male infertility, 16 couples presented with female infertility and in 5 couples both partners had infertility problems. Further, 18 couples had unexplained infertility. 24 couples conceived with 18 natural conceptions, five via assisted reproductive technology and one spontaneous abortion.

CONCLUSION

The program was beneficial in the cohort who utilized it as prescribed resulting in conception of 24 out of 54 couples. Future research investigating the causal relationship of Heartfulness meditation on fertility outcomes in a randomized control study could solidify this treatment method to be used independently or as an adjuvant therapy with assisted reproductive technologies.

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

Introduction

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

Methods

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

Results

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

Conclusion

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

Fertility awareness and subclinical infertility among women trying to get pregnant at home

Background

Recent studies on fertility awareness among the reproductive population have reported the lack of accurate knowledge about fertility and assisted reproductive technologies. However, there has been little information regarding women trying to get pregnant at home. The aim of this study was to explore the prevalence of subclinical infertility among women trying to get pregnant at home, and to evaluate awareness regarding infertility and reasons for not visiting infertility clinics among women who use pregnancy-assist mobile applications to help them conceive.

Methods

A total of 2084 Japanese women responded to this online survey. We selected 1541 women according to the study criteria. Based on the results of 61 questions, we evaluated knowledge regarding fertility, prevalence of subclinical infertility, and reasons for not visiting the clinic among the participants.

Results

Despite the desire to conceive, the participants had an apparent tendency to overestimate the age limit for childbearing. A total of 338 (21.9%) women answered that in general women aged > 45 years could get pregnant. Approximately 40% of the women had possible subclinical infertility and were unaware of the fact. Additionally, about 70% of the women considered themselves to have infertility problems. Women who were aware of the possibility of infertility hesitated to visit the clinic due to unfamiliarity with a gynecologist or clinic, and apprehensions about the gynecologic examination.

Conclusions

In our study, some women required treatment for infertility. Nonetheless, they hesitated to visit an infertility clinic. Sexual health education, together with proper accessibility to gynecology clinics, are necessary to reduce involuntary childlessness.

Factors associated with medical help-seeking for infertility in developed countries: A narrative review of recent literature

The reasons why people decide for or against seeking medical help for infertility are still far from clear. With advances in reproductive medicine, use of medically-assisted reproduction has increased over the last three decades. Over the same period, an appreciable amount of quantitative studies on the determinants of medical help-seeking for infertility has accumulated. However, to our knowledge this narrative review is the first to summarize and evaluate findings from these studies. This review includes 39 studies carried out in 11 countries, covering the period 1990-2019. We have identified five categories of determinants of help-seeking: socio-demographic variables, socio-economic factors, reproductive history, attitudes, and psychological factors. Each category consists of several variables. Considerable knowledge has accumulated on socio-economic variables, indicating that there is social inequality in access to treatments in several countries. Less is known about marital status, attitudes and psychological factors. Findings on the latter two mostly derive from two US surveys. Overall, the body of research appears heterogeneous and fragmented. Studies differ in central aspects of study design (definitions of the analysis sample and of help-seeking, type of analysis (bivariate or multivariate), set of variables included in multivariate studies) making comparisons of findings difficult. Low comparability is reinforced by country differences in the provision of treatment, legislation on access and treatment coverage. The majority of papers lack a theoretical foundation or reference to any theory. Using a theoretical framework to guide empirical research could help to overcome the problems described above. Single-country studies should include information on legal and cultural context. More studies from countries other than the US are needed as well as multi-country studies in order to develop a systematic understanding of how macro-level structures relate to decisions about medical help-seeking. This review should assist future researchers in their attempt to conduct studies on help-seeking for infertility.

Moral women, immoral technologies? Romanian women's perceptions of assisted reproductive technologies versus adoption

The present study explored how Romanian women perceive in-vitro fertilization (IVF), surrogacy, and adoption as alternative pathways to traditional parenthood. Previous studies suggested that both men and women generally prefer a full genetic link, followed by a partial genetic link and, finally, no genetic link (i.e. adoption). We explored these findings by testing a series of predictors in a sample of women aged 18-45-years. We found that adoption was the most preferred option among Romanian women, while surrogacy was the last. Older women, with children, rather non-religious, and in a steady relationship, had a more positive perception of IVF. Older women and less religious had a more positive perception of surrogacy as a pathway to parenthood. In hypothetical scenarios, the most preferred option was adoption, followed by IVF and surrogacy. Results are discussed within the Romanian context regarding various methods of ART.

Degrees of Medicalization: The Case of Infertility Health-Seeking

We examine responses to infertility among a sample of 2,361 women with infertility from the National Survey of Fertility Barriers. Latent class analysis uncovered seven latent classes of behavioral response which can be arranged in a rough continuum from least medicalized to most medicalized response. We then aggregated these seven categories into three schemas representing various degrees of medicalization. Women in each class combine treatment-seeking, knowledge-seeking, socio-emotional support seeking, and non-medical solution-seeking strategies. Even women pursuing the greatest degree of medicalization in their health-seeking (e.g., fertility treatments, assisted reproduction) made use of a variety of medical and non-medical health-seeking resources.

Imaginability of adoption, foster care, and life without a(nother) child and stress in women and men in fertility treatment

We study whether the imaginability of adoption, foster care, and life without a(nother) child protects from stress during fertility treatment. Data from a self-administered prospective cohort study of couples who had just started treatment were used (T1 = 441 respondents; T2 = 142 respondents). Most respondents cannot imagine alternatives to treatment. Adoption/foster care is preferred over life without children. Imaginability of alternatives is associated with lower fertility-related (T1) and treatment-related stress (T2). Experience of a pregnancy/birth does not moderate the association. Thus, the availability of alternatives to treatment turns out to be helpful in terms of self-regulation during fertility treatment.

Assisted reproductive technologies and the Iranian community attitude towards infertility

Since the late 1990s, assisted reproductive technologies (ARTs) have been legitimized in Iran through an official religious endorsement. Iran, under the dominant authority of the Shia sect, is now the most enthusiastic adopter of ARTs in the Muslim world, permitting all forms of treatments, including third party donation. This study examined the public perception of assisted conception and its influence on the adoption of these methods in Iran. The study was questionnaire-based and conducted in 2012 in Shiraz, the most populated city in the south of Iran. It included 405 Iranian residents selected through the cluster sampling method. The results indicated that respondents did not support all types of assisted reproduction. Amongst modern infertility treatment methods, IVF (using husband's sperm and wife's egg) was the most widely accepted. Gestational surrogacy and the use of donated gametes were less accepted. Demographic variables including gender, marital status, age, education and employment status were linked to significant differences in public opinion. It was concluded that members of the public require better information about gamete donation and surrogacy, as this could shape infertile couples' decision-making.

Hooked on a feeling? Exploring desires and 'solutions' in infertility accounts given by women with 'atypical' sex development

Sociocultural meanings accorded to infertility, and rapid developments in assisted reproductive technologies, have long been central concerns in feminist and social scientific research. However, knowledge is scarce concerning how individuals make sense of infertility when it is disclosed in adolescence, for example as the result of an 'atypical' sex development, rather than as a result of failed conception. This article examines how understandings of desires, kinship and 'solutions' take shape and are negotiated in the accounts women give of infertility resulting from 'atypical' sex development. Through a thematic analysis it demonstrates how the interviewees described their desire for relationships and connectedness, which they considered to be made possible through pregnant embodiment, and details how these desires connected to a preference for medical 'solutions'. Specifically, the article discusses how the interviewees' accounts exemplifies how biological kinship can be 'done' without giving precedence to genetics. By addressing the specificities of finding out about infertility as a result of 'atypical' sex development, it furthermore highlights gaps in the common medical definition of infertility. These findings underscore the urgency of examining how definitions of infertility obscure certain experiences and consequently limit affected individuals' access to support and treatment. In conclusion, it is suggested that the article contributes to a more positive discourse on infertility in feminist scholarship by teasing out the temporal dimensions of how affected individuals 'make active use' of assisted reproductive technologies to mitigate uncertainty and maintain hope, while at the same time renegotiating dominant norms of kinship.

Couples with non-obstructive azoospermia are interested in future treatments with artificial gametes

STUDY QUESTION

Would couples diagnosed with non-obstructive azoospermia (NOA) consider two future treatments with artificial gametes (AGs) as alternatives for testicular sperm extraction followed by ICSI (TESE-ICSI)?

SUMMARY ANSWER

Most couples with NOA (89%) would opt for treatment with AGs before attempting TESE-ICSI and/or after failed TESE-ICSI.

WHAT IS KNOWN ALREADY

Couples with NOA who undergo TESE-ICSI have a 25% chance of conceiving a child. Two future treatments that are being developed are 'ICSI with artificial sperm formed from somatic cells' (ICSI with AGs) and 'natural conception after autotransplantation of in vitro proliferated spermatogonial stem cells' (natural conception with AGs). It is unknown what treatment preferences patients have.

STUDY DESIGN, SIZE, DURATION

A cross-sectional survey conducted in 2012-2013, addressing all 921 couples diagnosed with NOA and treated with TESE-ICSI in Dutch fertility clinics between 2007 and 2012. The coded questionnaires were sent by mail and followed up with two reminders.

PARTICIPANTS/MATERIALS, SETTING, METHODS

We developed the questionnaire based on a literature review and previous qualitative interviews, and included treatment preference and the valuation of nine treatment characteristics. We assessed reliability of the questionnaires and calculated mean importance scores (MISs: 0-10) of each treatment characteristic. We assessed which patient and treatment characteristics were associated with a couple's hypothetical treatment preference using binominal regression.

MAIN RESULTS AND THE ROLE OF CHANCE

The vast majority (89%) of the 494 responding couples (response rate: 54%) would potentially opt for AGs as a first and/or a last resort treatment option. More specifically, as a first treatment couples were likely (67%) to prefer natural conception with AGs over TESE-ICSI and less likely to prefer ICSI with AGs over TESE-ICSI (34%). After failed TESE-ICSI, the majority of couples (75%) would want to attempt ICSI with AGs as a last resort option. The most important characteristics of treatment were safety for children (MIS: 8.2), pregnancy rates (MIS: 7.7) and curing infertility (MIS: 6.8). Costs, burden, naturalness and technological sophistication were of about equal importance (MIS: 3.1-4.0). The majority of patients rated conception at home and moral acceptability as not important (MIS: 1.7 and 0.8, respectively), but the importance attributed to these variables did still affect patients' likeliness to opt for AGs.

LIMITATIONS AND REASONS FOR CAUTION

Couples with NOA not opting for TESE-ICSI were not included and might have other perspectives. Couples' hypothetical choices for AGs might differ from their actual choices once data on the costs, safety and pregnancy rates become available from these new treatment options.

WIDER IMPLICATIONS OF THE FINDINGS

The interest of couples with NOA in potential future treatments with AGs encourages further pre-clinical research. Priority setting for research and future decision-making on clinical application of AGs should take all characteristics important to patients into account.

STUDY FUNDING/COMPETING INTERESTS

The authors report no financial or other conflict of interest relevant to the subject of this article.

Prevalence and factors associated with use of herbal medicine among women attending an infertility clinic in Uganda

Background

Infertility is a public health problem associated with devastating psychosocial consequences. In countries where infertility care is difficult to access, women turn to herbal medicines to achieve parenthood. The aim of this study was to determine the prevalence and factors associated with herbal medicine use by women attending the infertility clinic.

Methods

This was a cross-sectional study of 260 women attending the infertility clinic at Mulago hospital. The interviewer administered questionnaire comprised socio-demographic characteristics, infertility-related aspects and information on herbal medicine use. The main outcome measure was herbal medicines use for infertility treatment. Determinants of herbal medicine use were assessed using multivariable logistic regression.

Results

The majority (76.2%) of respondents had used herbal medicines for infertility treatment. The mean age of the participants was 28.3 years ± 5.5. Over 80% were married, 59.6% had secondary infertility and 2/3 of the married participants were in monogamous unions. In a multivariable model, the variables that were independently associated with increased use of herbal medicine among infertile patients were being married (OR 2.55, CI 1.24-5.24), never conceived (OR 4.08 CI 1.86-8.96) and infertility for less than 3 years (OR 3.52 CI 1.51-8.821). Factors that were associated with less use of herbal medicine among infertile women were being aged 30 years or less (OR 0.18 CI 0.07-0.46), primary and no education (OR 0.12 CI 0.05-0.46) and living with partner for less than three years (OR 0.39 CI 0.16-0.93).

Conclusions

The prevalence of herbal medicine use among women attending the infertility clinic was 76.2%. Herbal medicine use was associated with the participants’ age, level of education, marital status, infertility duration, nulliparity, and duration of marriage. Medical care was often delayed and the majority of the participants did not disclose use of herbal medicines to the attending physician. Health professionals should enquire about use of herbal medicines. This may help in educating the patients about the health risks of using herbal medicine and may reduce delays in seeking appropriate care. Collaboration of health professionals with herbal medicine practitioners would help identify the common herbal medicines used for infertility treatment, their potential benefits and harm.

Conceptualizing couples' decision making in PGD: emerging cognitive, emotional, and moral dimensions

OBJECTIVE

To illuminate and synthesize what is known about the underlying decision making processes surrounding couples' preimplantation genetic diagnosis (PGD) use or disuse and to formulate an initial conceptual framework that can guide future research and practice.

METHODS

This systematic review targeted empirical studies published in English from 1990 to 2008 that examined the decision making process of couples or individual partners that had used, were eligible for, or had contemplated PGD. Sixteen studies met the eligibility requirements. To provide a more comprehensive review, empirical studies that examined healthcare professionals' perceptions of couples' decision making surrounding PGD use and key publications from a variety of disciplines supplemented the analysis.

RESULTS

The conceptual framework formulated from the review demonstrates that couples' PGD decision making is composed of three iterative and dynamic dimensions: cognitive appraisals, emotional responses, and moral judgments.

CONCLUSION

Couples think critically about uncertain and probabilistic information, grapple with conflicting emotions, and incorporate moral perspectives into their decision making about whether or not to use PGD.

PRACTICE IMPLICATIONS

The quality of care and decisional support for couples who are contemplating PGD use can be improved by incorporating focused questions and discussion from each of the dimensions into counseling sessions.

Human infertility: is medical treatment enough? A cross-sectional study of a sample of Italian couples

OBJECTIVE

To explore infertile couples' well-being, needs and drop-out rates considering their previous gynaecological history, treatments and support received.

METHODS

Self-reported questionnaires and a telephone follow-up were used to gather data from a sample of 57 Italian couples undergoing first-step procedures for infertility treatment. The questions concerned socio-demographic and personality factors, global perspective on generation, childbearing motivation, intra-psychic and relational dimensions.

RESULTS

The study found a strong need for psychological and ethical counselling and showed that drop-out rates were related to psychological discontent. Among couples who had a longer history of infertility, those who had no previous treatments presented higher dyadic adjustment than those who had an history of previous treatments. Moreover, the study provides evidences of the stronger need for personal support for couples who had undergone previous treatments, and for psychological and ethical support for couples with previous generative failures. It also showed that there were beneficial effects to attending to couples' religious and ethical needs.

CONCLUSION

Professional care for those who are undergoing or have undergone fertility treatment should (i) embrace a broader and more comprehensive perspective to understand infertile couples' experience and should (ii) provide appropriate therapy to cope with these experiences.

The use of complementary and alternative fertility treatment in couples seeking fertility care: data from a prospective cohort in the United States

OBJECTIVE

To determine the prevalence of complementary and alternative medicine (CAM) use among couples seeking fertility care and to identify the predictors of CAM use in this population.

DESIGN

Prospective cohort study.

SETTING

Eight community and academic infertility practices.

PATIENT(S)

A total of 428 couples presenting for an infertility evaluation.

INTERVENTION(S)

Interviews and questionnaires.

MAIN OUTCOME MEASURE(S)

Prevalence of complementary and alternative medicine therapy.

RESULT(S)

After 18 months of observation, 29% of the couples had utilized a CAM modality for treatment of infertility; 22% had tried acupuncture, 17% herbal therapy, 5% a form of body work, and 1% meditation. An annual household income of > or = $200,000 (odds ratio 2.8, relative to couples earning <$100,000), not achieving a pregnancy (odds ratio 2.3), and a positive attitude toward CAM use at baseline were independently associated with CAM use.

CONCLUSION(S)

A substantial minority of infertile couples use CAM treatments. CAM was chosen most commonly by wealthier couples, those not achieving a pregnancy, and those with a baseline belief in the effectiveness of CAM treatments.

Australian women's use of complementary and alternative medicines to enhance fertility: exploring the experiences of women and practitioners

Background

Studies exploring the use of complementary and alternative medicine (CAM) to enhance fertility are limited. While Australian trends indicate that women are using CAM during pregnancy, little is known about women's use of CAM for fertility enhancement. With the rising age of women at first birth, couples are increasingly seeking assisted reproductive technologies (ART) to achieve parenthood. It is likely that CAM use for fertility enhancement will also increase, however this is not known. This paper reports on an exploratory study of women's use of CAM for fertility enhancement.

Methods

Three focus groups were conducted in Melbourne, Australia in 2007; two with women who used CAM to enhance their fertility and one with CAM practitioners. Participants were recruited from five metropolitan Melbourne CAM practices that specialise in women's health. Women were asked to discuss their views and experiences of both CAM and ART, and practitioners were asked about their perceptions of why women consult them for fertility enhancement. Groups were digitally recorded (audio) and transcribed verbatim. The data were analysed thematically.

Results

Focus groups included eight CAM practitioners and seven women. Practitioners reported increasing numbers of women consulting them for fertility enhancement whilst also using ART. Women combined CAM with ART to maintain wellbeing and assist with fertility enhancement. Global themes emerging from the women's focus groups were: women being willing to 'try anything' to achieve a pregnancy; women's negative experiences of ART and a reluctance to inform their medical specialist of their CAM use; and conversely, women's experiences with CAM being affirming and empowering.

Conclusions

The women in our study used CAM to optimise their chances of achieving a pregnancy. Emerging themes suggest the positive relationships achieved with CAM practitioners are not always attained with orthodox medical providers. Women's views and experiences need to be considered in the provision of fertility services, and strategies developed to enhance communication between women, medical practitioners and CAM practitioners. Further research is needed to investigate the extent of CAM use for fertility enhancement in Australia, and to explore the efficacy and safety of CAM use to enhance fertility, in isolation or with ART.

When and why do subfertile couples discontinue their fertility care? A longitudinal cohort study in a secondary care subfertility population

BACKGROUND

A substantial number of subfertile couples discontinues fertility care before achieving pregnancy. Most studies on dropouts are related to IVF. The aim here is to examine dropout rates at all stages of fertility care.

METHODS

We analysed a consecutive cohort of 1391 couples, referred to our secondary care hospital between January 2002 and December 2006. Discontinuation rates were studied at six stages. Stage I: immediately after first visit, Stage II: during diagnostic workup, Stage III: after finishing diagnostic workup but before treatment, Stage IV: during or after non-IVF treatment, Stage V: during IVF, Stage VI: after at least 3 cycles of IVF. Reasons to discontinue and spontaneous pregnancy rates after discontinuation were secondary outcomes.

RESULTS

In our cohort 319 couples dropped out of fertility care, 76.8%, [95% confidence interval (CI): 72.2-81.4] on their own initiative and 23.2% (95% CI: 18.6-27.8) on doctor's advice. Percentage (95% CI) of couples discontinuing per stage were: Stage I 6.0% (3.4-8.6), Stage II 3.4% (1.5-5.5), Stage III 35.7% (30.5-41.0), Stage IV 23.5% (18.9-28.2), Stage V 17.9% (13.7-22.1) and Stage VI 13.5% (9.7-17.2). Main reasons for dropout (%, 95% CI) were 'emotional distress' (22.3%, 17.7-26.8), 'poor prognosis' (18.8%, 14.5-23.1) and 'reject treatment' (17.2%, 13.1-21.4). The spontaneous ongoing pregnancy rate after discontinuation was 10% (6.7-13.3).

CONCLUSION

About half of the couples stopped before any fertility treatment was started and one-third stopped after at least one IVF cycle. The main reasons for withdrawal were emotional distress and poor prognosis. This insight may help to improve quality of patient care by making care more responsive to the needs and expectations of subfertile couples.

Country of birth and hospitalization for pelvic inflammatory disease, ectopic pregnancy, endometriosis, and infertility: a nationwide study of 2 million women in Sweden

OBJECTIVE

To examine the association between country of birth and hospitalization for pelvic inflammatory disease (PID), ectopic pregnancy (EP), endometriosis, and infertility.

DESIGN

Follow-up study.

SETTING

Sweden.

PARTICIPANT(S)

A total of 2,170,177 women living in Sweden at some point between 1990 and 2004, categorized into 10 different groups according to country of birth.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Hospitalization for PID, EP, endometriosis, and infertility.

RESULTS

For PID and infertility, all groups of foreign-born women exhibited significantly increased risks compared with Swedish-born women. The highest risks of PID were found among women from southern Europe, Eritrea/Ethiopia/Somalia, and other African countries, whereas the highest risks of infertility were found among women from Middle Eastern countries, other Asian countries, and other African countries. Compared with PID and infertility, country of birth was less associated with endometriosis and EP, although some differences were found. All relative risks were adjusted for age, time period, and the women's socioeconomic status.

CONCLUSION(S)

Even in a country like Sweden, which offers publicly financed treatment for infertility, differences based on country of birth exist. Although data on partners' income were not available to us, it is possible that other factors besides socioeconomic factors are present in the etiology of female health problems related to infertility.

Health-related quality of life in infertile couples receiving IVF or ICSI treatment

Background

Infertile couples might experience psychological distress and suffer from impaired health-related quality of life. This study aimed to examine health-related quality of life in infertile couples receiving either in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) treatment.

Methods

This was a cross-sectional study of quality of life in infertile couples attending to Vali-e-Asr Reproductive Health Research Center or Royan Institute for either IVF or ICSI treatment in Tehran, Iran. Health-related quality of life was assessed using the Short Form Health Survey (SF-36). Patients' demographic and clinical characteristics were also recorded. Data were analyzed to compare quality of life in infertile women and men and to indicate what variables predict quality of life in infertile couples.

Results

In all 514 women and 514 men (n = 1028) were studied. There were significant differences between women and men indicating that male patients had a better health-related quality of life. Also health-related quality of life was found to be better in infertility due to male factor. Performing logistic regression analysis it was found that female gender, and lower educational level were significant predictors of poorer physical health-related quality of life. For mental health-related quality of life in addition to female gender and lower educational level, younger age also was found to be a significant predictor of poorer condition. No significant results were observed for infertility duration or causes of infertility either for physical or mental health-related quality of life.

Conclusion

The findings suggest that infertility duration or causes of infertility do not have significant effects on health-related quality of life in infertile couples. However, infertile couples, especially less educated younger women, are at risk of a sub-optimal health-related quality of life and they should be provided help and support in order to improve their health-related quality of life.

Decision-making about seeking medical advice in an internet sample of women trying to get pregnant

INTRODUCTION

In light of the near universal desire to become a parent one would expect most people to seek medical advice if they were experiencing difficulties conceiving. Yet less than 55% do so and we sought to understand more about this paradox by comparing the psychosocial profile and decision-making of women not yet engaged in the medical process to that of those who had consulted.

METHODS

A Fertility Decision-Making Questionnaire was designed and posted on a website dedicated to women trying to conceive.

RESULTS

A total of 426 women completed the questionnaire, 56% had not yet consulted a doctor about conceiving (non-consulter, NC). Women who had sought treatment had more positive treatment beliefs, and a greater willingness to know if a problem existed, than those who had not yet consulted. Almost 20% of NC women already met the medical definition of infertility and this subgroup had a greater fear of discovering a problem and of being labelled infertile than other women in the study.

CONCLUSIONS

Seeking medical advice for fertility problems is mainly associated with what women know or want to know about their fertility and their emotional reactions to that knowledge. Negative reactions can substantially delay seeking help in 20% of women.

International estimates of infertility prevalence and treatment-seeking: potential need and demand for infertility medical care

INTRODUCTION The purpose of the present study was to review existing population surveys on the prevalence of infertility and proportion of couples seeking medical help for fertility problems. METHODS Population surveys, reporting the prevalence of infertility and proportion of couples seeking help in more and less developed countries, were reviewed. RESULTS Estimates on the prevalence of infertility came from 25 population surveys sampling 172 413 women. The 12-month prevalence rate ranged from 3.5% to 16.7% in more developed nations and from 6.9% to 9.3% in less-developed nations, with an estimated overall median prevalence of 9%. In 17 studies sampling 6410 women, the proportion of couples seeking medial care was, on average, 56.1% (range 42-76.3%) in more developed countries and 51.2% (range 27-74.1%) in less developed countries. The proportion of people actually receiving care was substantially less, 22.4%. Based on these estimates and on the current world population, 72.4 million women are currently infertile; of these, 40.5 million are currently seeking infertility medical care. CONCLUSIONS The current evidence indicates a 9% prevalence of infertility (of 12 months) with 56% of couples seeking medical care. These estimates are lower than those typically cited and are remarkably similar between more and less developed countries.

Donor gametes and embryos: who wants to know what about whom, and why?

Many treatments for infertility require the use of donated gametes or embryos. Arguments have been made that all parties involved (donors, recipients, and children) should have open access to information about one another. The present article reports a survey of attitudes of 77 donors and 327 recipients in the state of Western Australia. Donors and recipients endorsed a register of nonidentifying information, but were less keen on a register of identifying information. They believed that medical personnel should have access to such registers, and that donors and recipients (but not children) should have access to nonidentifying, but not identifying, information. Typically, the sort of information respondents wanted to access pertained to health status and physical characteristics. Overwhelmingly, both donors and recipients saw gamete and embryo donation as more like blood donation than like adoption.

Psychosocial aspects of surrogate motherhood

This review addresses the psychosocial research carried out on surrogacy triads (surrogate mothers, commissioning mothers and offspring) and shows that research has focused on a number of specific issues: attachment and disclosure to surrogate offspring; experiences, characteristics and motivations of surrogate mothers; and changes in profiles of the commissioning/intended mothers. Virtually all studies have used highly selected samples making generalizations difficult. There have been a notable lack of theory, no interventions and only a handful of longitudinal studies or studies comparing different populations. Few studies have specifically questioned the meaning of and need for a family or the influence and impact that professionals, treatment availability and financial factors have on the choices made for surrogate and intended mothers. Societal attitudes have changed somewhat; however, according to public opinion, women giving up babies still fall outside the acceptable remit. Surrogate and intended mothers appear to reconcile their unusual choice through a process of cognitive restructuring, and the success or failure of this cognitive appraisal affects people's willingness to be open and honest about their choices. Normal population surveys, on the contrary, are less accepting of third party reproduction; they have no personal need to reconsider and hence maintain their original normative cognitively consonant state.

Explaining disparities in treatment seeking: the case of infertility

OBJECTIVE

To present an integrated model of help-seeking, review empirical work in its support, and show its application to the explanation of racial and ethnic disparities in infertility help-seeking.

DESIGN

Review.

SETTING

None.

PATIENT(S)

None.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

None.

RESULT(S)

None.

CONCLUSION(S)

A help-seeking model provides a plausible explanation of observed disparities in infertility help-seeking. In addition to being related to income, race and ethnicity is related to prior experience with doctors, marital status, parity, knowledge and attitudes toward reproductive technology, and attitudes supporting spiritual rather than technological solutions to health problems.

Infertility: Testing a helpseeking model

This paper uses data from a study of 196 infertile women from the Midwestern US to examine a general theory of helpseeking behavior applied to infertility. All of these women report meeting the medical definition of infertility--12 months or more of regular intercourse without conception--at some point in their lives. Only 35 percent of this sample of infertile women identified themselves as having had fertility problems and only 40 percent had sought medical treatment. Drawing on prior theories of helpseeking, we examine the effects of symptom salience, life course cues, attitudes, predisposing factors, and enabling conditions on helpseeking. We posit a model in which a cognitive dimension (perceived infertility) mediates between these predictors and medical helpseeking. Symptom salience (experienced infertility while actively trying to get pregnant), low parity, and poor subjective health are significantly related to perceived infertility, which is, in turn, significantly associated with helpseeking for infertility. Supporting the conclusion that the cognitive dimension of identifying oneself as infertile is critical to helpseeking, the relationship of symptom salience to helpseeking is partially mediated by perceived problems. Internal health locus of control is associated with lower odds of helpseeking but not to perceived infertility.

Evaluation of a communication and stress management training programme for infertile couples

OBJECTIVE

This study evaluates a patient education programme focussed on improving communication and stress management skills among couples in fertility treatment.

METHODS

In total, 37 couples completed the intervention. Two teachers conducted all the five courses offered. The effectiveness regarding communication and infertility-related stress was assessed by questionnaires immediately before (time T1) and after the intervention (time T2). Seeking of information and professional support was assessed at a 12-month follow-up (time T3); response rates were: T1, 93.2%; T2, 85.1%; T3, 74.3%. Data were compared at baseline (T1) and at the 12-month follow-up (T3) with a prospective cohort of Danish people in fertility treatment.

RESULTS

There were no differences in infertility-related stress at base line between the two groups studied. We estimated the bi-directional changes in communication, e.g., changes from talking often to talking less frequently and vice versa. More intervention participants started to talk often with their partner about infertility and its treatment after the intervention compared to those who stopped to talk often. Women and men changed occurrence, frequency and content of communication with close other people. Among women marital benefit increased significantly. Infertility-related stress was not reduced significantly. Significantly more intervention participants than in the comparison group had contacted support groups, a psychologist and/or agencies for adoption at the 12-month follow-up.

CONCLUSION

The intervention resulted in important perceived improvement in the participants' competence to actively manage changes in marital communication and in communication in different social arenas.

PRACTICE IMPLICATIONS

We recommend fertility clinics to develop and evaluate different interventions for those fertility couples who ask for more psychosocial support.

Health-related quality of life and need for IVF in 1000 Italian infertile couples

BACKGROUND

A specific and still poorly investigated issue in the field of infertility is represented by the impact that the need for IVF techniques may have on health-related quality of life (HRQoL).

METHODS

A total of 1000 consecutive couples (1000 women and 1000 men) were invited to complete the Health Survey Short Form (SF-36) questionnaire separately, prior to initiating their first IVF attempt in our unit. Patients were also invited to report about demographic and clinical characteristics.

RESULTS

A total of 1936 (96.8%) agreed to participate. Male SF-36 scores were higher than those reported by women. Duration of infertility and previous IVF attempts significantly influenced HRQoL (P < 0.01). When scores were plotted in relation to the normative source of the Italian general population stratified by gender, corresponding age and geographical area, the subjective health profile did not significantly differ from the normative sample for both women and men.

CONCLUSION

The need for IVF did not seem to markedly influence subjective health status. Conversely, duration of infertility and failure to achieve a pregnancy through IVF might have a negative impact.

As tecnologias de reprodução assistida e as representações sociais de filho biológico

Foram investigadas as representações sociais de filho biológico em casais que se submeteram às tecnologias reprodutivas. Nossos objetivos foram analisar a trajetória de vida do casal a partir do momento em que foi constatada a infertilidade e identificar as representações sociais de filho biológico. Cinco casais da Grande Vitória, ES foram entrevistados e nenhum deles havia obtido êxito com relação à gravidez após o tratamento. As entrevistas semi-estruturadas foram realizadas individualmente. O roteiro seguiu o mesmo padrão para ambos os cônjuges, incluindo itens sobre a constatação da infertilidade, o tratamento realizado, o significado da maternidade, paternidade, casamento e filho biológico. A análise dos resultados apontou para um fortalecimento do vínculo no casamento após o diagnóstico de infertilidade e evidenciou a importância que os casais atribuem ao filho biológico. Os elementos de representações sociais que apareceram fortemente foram: "sangue do meu sangue", descendência, semelhança física e pressão social.

Adoption in the age of reproductive technology

The choice of adoption over genetic parenthood was investigated in 105 women retrospectively by questionnaire. Participants were divided into four groups: female/male subfertility; female subfertility; male subfertility; and female/male fertility. Half the sample (59/105) answered the question about the importance of a genetic link. Women who failed to adopt thought a genetic link was important, as did those who were less likely to disclose alternative reproductive conceptions to their child. First thoughts following diagnosis were more focused and actions more centered on adoption in the female/male subfertile group compared to the other groups. Communication of the child's origins was least prevalent in the female/male subfertile group, followed by the male subfertile group, although all groups would disclose adoption. The choice of adoption was determined by a number of factors, not all associated with infertility resolution. Although it is unlikely that resolution to infertility can be achieved in any population attempting to overcome infertility, the cognitive dissonance identified in this population is likely to be generalizable to those choosing other options to overcome infertility. Cultural and counselling acknowledgement of postmodern family theory principles is likely to ease cognitive consistency regarding the status of adoptive familyhood, and dispel the importance of reproductive options emphasizing a genetic link.

Unmet needs, beliefs and treatment-seeking for infertility among migrant Ghanaian women in the Netherlands

Studies on infertility in the Netherlands have little information on migrant Ghanaian women, even though Ghanaians are the third largest migrant group in Amsterdam. An exploratory study on the unmet needs, attitudes, and beliefs of migrant Ghanaian women with infertility problems living in the Netherlands, and the kinds of treatment they sought was undertaken in 1999. Qualitative data were collected from 12 women with primary or secondary infertility through narratives and 20 key informant interviews. The women described seeking treatment for infertility in Ghana, the Netherlands and other European countries, included use of infertility drugs, surgery, donor insemination and in vitro fertilisation. Illegal migrant women are not entitled to treatment paid by the national health system, and being of low income they cannot afford to pay directly for this or to obtain private health insurance. Herbalists and spiritual healers in both Amsterdam and Ghana were regularly consulted, especially for their willingness to address the social and spiritual aspects of infertility. To produce a pregnancy where male infertility was suspected, transfer of sexual rights to another man in the husband/partner's family, or a healer or priest, was a practical remedy that kept male infertility hidden. This study revealed difficulties experienced in clinical settings due to language barriers and cultural differences. Ghanaian women living in the Netherlands need much more information on the causes of infertility and their options.