Alexithymia in infertile women

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

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

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

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

Eating disorders and sexuality: A quantitative study in a French medically assisted procreation course

OBJECTIVE

Among medically assisted procreation (MAP) patients, the prevalence of eating disorders (ED), clinical or subclinical, current or past, is considerable. In addition to metabolic repercussions, the literature suggests that these patients present with more sexual dysfunction, leading to anxiety. This quantitative research on a population of women consulting a MAP department for unexplained or ovulatory infertility proposed to study the sexuality of this population by comparing the sexuality of patients suffering from or having suffered from an ED to the sexuality of the non-ED group.

METHOD

Patients (n = 61) filled out the Eating Disorder Examination Questionnaire (EDE-Q), the Brief Index of Sexual Functioning for Women (BISF-W), the ED Whole Life Research Questionnaire, the Hospital Anxiety and Depression Scale (HADS) and the Kansas Marital Satisfaction Scale (KMSS).

RESULTS

We found a prevalence of 54% of ED, current or past. Even though these patients reported the same prevalence of sexual intercourse, they had significantly more physical problems (e.g., anorgasmia, vaginismus, headache) affecting their sexuality (p = .01) than the non-ED group, after adjusting for depression. Approximately 10% of the study population reported no intravaginal intercourse during the last month.

DISCUSSION

This study provides evidence for the existence of more sexual dysfunction in patients who have a fertility disorder and have ED or a history of ED. Future research should evaluate the results of psychological or sexological care that may be more suitable for the infertility of these patients.

Alexithymia, Stress and Depression in Infertile Women: a Case Control Study

Background:

Alexithymia and stress are two main psychological factors which affect not only fertility, but also the outcome of assisted reproductive technology treatment.

Objective:

The primary aim of this study was to compare the levels of alexithymia and stress between infertile women undergoing assisted reproductive treatment and women with no fertility issues. The present study aims to: (i) explore the relation between alexithymia and infertility, (ii) investigate whether women with infertility problems show elevated levels of alexithymia compared to women with no fertility problems, and (iii) compare stress levels between women undergoing assisted reproductive technology treatment and women with no fertility problems.

Methods:

A case control trial was conducted. In total, data from 177 women were collected. The control group consisted of 102 women with no fertility problems, whilst the study group included 75 women undergoing assisted reproductive program. In order to measure the levels of alexithymia and the fertility-related stress among women in both groups and compare the results, validated questionnaires were distributed to every participant. Self-report instruments were used to measure alexithymia (TAS-20), fertility-related stress (FPI), depressive symptomatology (CES-D) and anxiety (STAI). Univariate and bivariate statistical analyses were used.

Results:

The mean values of alexithymia, anxiety and depressive symptomatology were higher in women with lower educational background and not within a marriage than in women with higher education and within marriage. Additionally, infertile women had similar levels of alexithymia, anxiety and depressive symptomatology compared to women with no fertility problems.

Conclusion:

Results from the present study suggest that infertile women show similar levels of alexithymia and stress in comparison to women who have not been confronted with fertility problems. Our study findings are in accordance with many previous published studies that have concluded that alexithymia rates are similar between group of patients and group of healthy individuals. However, future studies should aim to investigate the prevalence of alexithymia in infertile women with idiopathic and non-idiopathic infertility as well as to assess the levels of alexithymia in infertile women that are not in a fertility treatment.

Prevalence of lifetime eating disorders in infertile women seeking pregnancy with pulsatile gonadotropin-releasing hormone therapy

OBJECTIVES

Relationships between weight and fertility are well known. The aim of this study is to assess the prevalence of lifetime eating disorder (ED) in a sample of infertile women seeking a specific infertility treatment, pulsatile gonadotropin-releasing hormone (pGnRH) treatment, and to compare it to the prevalence of lifetime ED in a sample of infertile women seeking other types of assisted reproductive technology (ART) treatments.

DESIGN

Non-randomized, observational study including infertile female patients. Two-group design including consecutive women treated with GnRH pump (pGnRH) or with other types of ART.

SETTING

Multi-centric infertility centers, France METHODS: Twenty one consecutive women treated with pGnRH treatment were compared to 21 consecutive women receiving other types of infertility treatment. Diagnosis of ED was based on DSM-IV and the Composite International Diagnostic Interview (CIDI).

RESULTS

Twenty patients (95.2%) from the sample of women treated with pulsatile GnRH treatment and 5 patients (23.8%) from the patients receiving other types of infertility treatment met the criteria of lifetime ED diagnosis (p < 0.000).

CONCLUSION

This study highlights the fact that the prevalence of ED is considerably higher in women receiving GnRH pulsatile treatment, when compared to women receiving other kinds of infertility treatment. In our study population ED were under-diagnosed, particularly in women receiving pulsatile GnRH treatment. Fertility clinicians should use reliable diagnostic tools to identify promptly ED in women presenting with hypothalamic amenorrhea and difficulties in conceiving. Level III: Evidence obtained from well-designed cohort or case-control analytic studies.

Alexithymia, infertility-related stress and quality of life in women undergoing an assisted reproductive treatment

The investigation of the association between alexithymia and quality of life in infertility is a relatively neglected area of research. The aim of this study was to evaluate the association between alexithymia and infertility-related quality of life in women during Assisted Reproductive Treatment. Data were collected in a clinic in Rome, 93 infertile women completed the 20-item Toronto Alexithymia Scale (TAS-20), the Fertility Quality of Life (FertiQoL) questionnaire and a socio-demographic questionnaire. TAS-20 total and two factors-Difficulty in Identifying Feelings (DIF) and Difficulty in Describing Feelings (DDF)-showed significant negative correlations with the overall questionnaire and with both Core and Treatment modules of FertiQoL. The regression model explained the 43% variance in FertiQol overall scores (R² = 0.43; adjusted R² = .38); a significant effect was reported for the number of previous attempts (beta = 0.20; p < .04), TAS-20 DIF (beta = -0.47; p < .001) and TAS-20 Externally Orientated Thinking (EOT) (beta = 0.20; p < .04); after applying Benjamini-Hochberg correction procedure only TAS-20 DIF maintained its significance. Alexithymia is associated with a worsened quality of life in infertile women; specifically, low difficulties in identifying feelings were associated to higher quality of life. Further investigations are needed also to develop specific therapeutic interventions aimed to promote emotional abilities in infertile people.

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

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

Iranian women's experiences of infertility: A qualitative study

Background

There are concerns and diverse experiences related to infertility and childlessness. The lived experience of infertile people from various cultures needs to be explored.

Objective

The aim of this qualitative study was to explore Iranian women experiences of their infertility.

Materials and Methods

The data comprised interviews about fertility issues in the Persian language with eighteen women, aged 17-45 yr old, who agreed to be interviewed at the Mottahari Infertility Treatment Clinic, affiliated to the Urmia University of Medical Sciences about their fertility problems. They were approached by the researchers at the time of their first visit. The verbatim transcribed interviews were analyzed using deductive conventional content analysis.

Results

The experiences of the informants were conceptualized into four major themes: 1) Shock (subthemes: Disbelief and Denial); 2) Reaction (subthemes: Distress, Guilt, Loss of self-esteem and Sexual reluctance); 3) Processing (subthemes: Internal processing, Avoidance, Marriage at risk, External processing, Stigma caused by the family and Stigma caused by the community) and 4) Reorientation (subthemes: Forgetting, Marriage to saving marriage and Sexual consent).

Conclusion

Infertility can be a challenging condition. Considering that infertility-related issues affect Iranian women more contextual factors is necessary. So, culturally sensitive and gender specific protocols are suggested to provide suitable and about culturally sensitive and gender-specific protocols is a necessity in order to provide suitable care to infertile women.

Stress, Depression, Sexual Function, and Alexithymia in Infertile Females with and without Polycystic Ovary Syndrome: A Case-Control Study

Background

Infertile females experience some types of distress such as social stress, depression, and sexual dysfunction that may be exacerbated by polycystic ovary syndrome (PCOS). The current study aimed at comparing psychological profile of infertile females with PCOS with that of women without PCOS with respect to four domains: infertility stress, depression, sexual dysfunction, and alexithymia.

Materials and Methods

The current case-control study was conducted on 240 infertile females (120 with PCOS and 120 without PCOS) in Fatemeh Azahra Infertility and Reproductive Health Research Center (Babol, Iran) from 2016 to 2017. The following questionnaires were used to collect data: the fertility problem inventory (FPI), the female sexual function index (FSFI), the Beck depression inventory-II (BDI-II), and the Toronto alexithymia scale (TAS-20).

Results

Females with PCOS had higher FPI total scores than the ones without PCOS (120.68 ± 29.42 vs. 112.83 ± 30.94). Of the subscales of infertility stress, the mean scores of social stress and rejection of a future life without a child were higher in females with PCOS than the ones without PCOS (P<0.05). Also, the mean total scores of alexithymia symptoms (TAS-20) in females with PCOS were significantly higher than those of the ones without PCOS (59.83 ± 11.36 vs. 55.69 ± 11.52). There was no significant difference between the two groups regarding the mean scores of depression symptoms and sexual function.

Conclusion

Infertile females with PCOS experienced higher levels of infertility stress and inability to distinguish and describe their feelings compared with the ones without PCOS. It is suggested that infertility care providers should provide more psychosocial support for infertile females with PCOS.

Alexithymia in Women with Deep Endometriosis? A Pilot Study

Objectives

The aim of the study was to evaluate the presence of alexithymia in a group of patients with endometriosis and chronic pelvic pain, and compare the results obtained, with those for a group of healthy controls.

Methods

Forty-one patients with pain and surgical diagnosis of deep endometriosis and 40 healthy controls were recruited for the study. All subjects were assessed using the Toronto Alexithymia Scale (TAS-20). Moreover, the intensity of chronic pelvic pain and dysmenorrhea in patients was evaluated using a modified version of the Biberoglu-Behrman pain scale. In addition, the patients' state of general health was investigated with the SF-36.

Results

A positive score for alexithymia was achieved in 14.6% (n = 6) of patients with endometriosis, while the condition was absent in the control group. Alexithymia was indeterminate in 29.3% (n = 12) and 12.5% (n = 5) of patients and controls, respectively, and absent in 56.1% (n = 22) and 87.5% (n = 35). Intergroup differences were significant for 3 factors evaluated by the TAS-20.

Discussion

The present study underlined how women with endometriosis are significantly more alexithymic compared with controls.

Psychological disturbances and quality of life in obese and infertile women and men

Anovulatory cycles and endometriosis are the main causes of female infertility. The most frequently anovulatory cycles are related to polycystic ovary syndrome (PCOS) commonly associated with obesity and hormonal disturbances in the course of obesity. Recently published studies revealed that infertility affects about one in six couples during their lifetime and is more frequent in obese. Obesity is also associated with male infertility related to erectile dysfunction, hormonal disturbances and lower semen quality. Any of these above mentioned disorder is the important risk factor of psychological disturbances and poor quality of life among women and men in the reproductive age. On the other hand the mood disorders may exacerbate the hormonal disturbances and worsen the effectiveness of infertility management. Infertility, its therapy with accompanying psychological disturbances may also significantly affect the partners relationships. The review summarize the results described in the current literature on the association between obesity and infertility and psychological disturbances as well as their impact on quality of life and sexual functioning in women and men. Moreover, the impact of infertility and psychological disturbances on partners relationships is discussed.

Alexithymia is positively associated with the outcome of in vitro fertilization (IVF) treatment

The goal was to examine prospectively the relation of psychological factors to the outcome after in vitro fertilization (IVF) in a sample of Greek women. Previous studies investigating the relation of IVF outcome to anxiety and depression have yielded contradictory results; other psychological dimensions have not been studied. 81 women who followed an IVF program during a 6-mo. period were prospectively evaluated. Demographic and gynecological data were assessed and women completed questionnaires measuring anxiety, depression, narcissistic traits, over-dependency, self-esteem, hostility, and alexithymia. Multiple logistic regression analysis showed that successful IVF outcome correlated with more alexithymic characteristics and younger age. Correlation between alexithymia and successful IVF outcome is demonstrated. This might be explained by the "operational" nature of IVF techniques, to which alexithymic individuals would respond better.