[What kind of support do couples expect when undergoing IVF treatment? Study and perspectives]

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 patients' perspective on fertility care: a systematic review

BACKGROUND

Patient-centered reproductive medicine (PCRM) is important for quality of care, and this is increasingly being recognized. However, its scientific basis is unclear. The main research questions addressed in this review are: 'How has the patients' perspective on fertility care been examined (method and quality)?' and 'What is the perspective of patients in developed countries on fertility care?'.

METHODS

A systematic search of electronic databases was conducted and inclusion criteria with respect to eligibility and quality were applied. The methodology of the studies was critically appraised; the findings of the studies were synthesized and organized according to: patients' value clarification and assessment of service quality and dimensions of patient-centeredness. Additionally data on patient preferences and determinants of patients' perspective on care were collected.

RESULTS

In 51 selected studies, patients' perspective on fertility care was examined with (few or many item) questionnaires and/or qualitative interviews. Significant methodological problems were observed. Fertility patients attached importance to seven out of eight dimensions of patient-centeredness (Picker institute) and two new dimensions 'fertility clinic staff' and 'skills' were developed. Overall, fertility patients want to be treated like human beings with a need for: medical skills, respect, coordination, accessibility, information, comfort, support, partner involvement and a good attitude of and relationship with fertility clinic staff. Patients' preferences between procedures and demographic, medical and psychological determinants of their perspective were defined.

CONCLUSIONS

Fertility patients have 'human needs' besides their need for medical care. Evidence on PCRM is available but significant methodological limitations call for the development and validation of a European questionnaire.

[The experience of in vitro fertilization procedure (IVF)]

OBJECTIVE

In vitro fertilization (IVF) is long and difficult. Psychopathologic consequences of IVF have been the object of a great deal of research but few have dealt with women experiences. This study examined women experiences through the analysis of qualitative data.

PATIENTS AND METHODS

Six women undergoing IVF took part in a semi-directive interview.

RESULTS

Qualitative analyses of interviews showed the variety of emotions that women experience during IVF. They experience despair, fear, solitude, unfairness, anxiety, anger, guilt but also hope and determination.

DISCUSSION AND CONCLUSION

The results of this study underline the need for specific support to help women with this emotional alternation.

Expérience de la grossesse et de l'accouchement chez 12 femmes ayant bénéficié d'une FIV

OBJECTIVE

Medical interventions during the perinatal period are psychologically difficult for women and research has shown this is true as well for in-vitro fertilization procedures (IVF). This study examined the impact of IVF and different medical interventions, common to both non-pathological pregnancies and IVF, through the analysis of both quantitative and qualitative data.

PATIENTS AND METHODS

Twelve women undergoing IVF evaluated their experience of pregnancy and birth using measures of post-partum depression, maternal self-esteem, and semi-directive interviews.

RESULTS

The results showed that the number of medical interventions is correlated with higher scores of post-partum depression as well as lowered scores in maternal self-esteem. Qualitative analyses of interviews showed that IVF has a complex and unique psychological impact.

DISCUSSION AND CONCLUSION

The results of this study underline the need for specific psychological support for women undergoing IVF treatment.

Cetrorelix in women with poor ovarian response in previous assisted reproduction cycles

Our aim was to compare a gonadotrophin-releasing hormone (GnRH) antagonist protocol with an analogue protocol using high dose gonadotrophins (rFSH) in women with poor ovarian response in order to optimise the management while undergoing assisted reproduction treatment. We recruited 31 consecutive patients over 5 months. The eligibility criteria for the study were: one or more previous cancelled cycle due to <or=3 follicles on day of hCG, or a total of >or=4,500 IU of rFSH. For the antagonist cycle regimen, we used daily 300 IU of rFSH from day 2 on the menses, and then from day 5 daily 0.25 mg of Cetrorelix until the day of human chorionic gonadotrophin (hCG) administration. We demonstrated that the use of an antagonist cycle was associated with a reduction in cancellation rates from 48% (agonist) to 10% (antagonist) (p < 0.039) allowing women to undergoing oocyte retrieval and embryo transfer with a non-significant improvement in the pregnancy rates.