Whose fault is it? Blame predicting psychological adjustment and couple satisfaction in couples seeking fertility treatment

Predictors of partnership and sexual satisfaction and dyadic effects in couples affected by endometriosis and infertility

PURPOSE

Endometriosis and infertility are associated with impaired partnership and sexuality of the patients, but also of their male partners. Also, endometriosis is one of the most common causes of infertility, resulting in a large overlap of both pathologies. The aim of this study was to determine the association of different predictors of partnership and sexual satisfaction and dyadic effects in couples with endometriosis and infertility.

METHODS

A cross-sectional study was conducted with n = 62 women with endometriosis and n = 46 partners, including a total of n = 44 couples, some of whom were affected by infertility. The questionnaire included items on partnership, sexuality, depression, social support, and desire for a child. Multiple linear regression and the actor-partner-interdependence-model were used for analysis.

RESULTS

Significant dyadic effects only occurred in couples with both endometriosis and infertility. Depression showed a significant negative actor effect in men for partnership satisfaction and a negative actor and partner effect in women for sexuality satisfaction (p < .05). For women, social support showed a significant positive actor effect for partnership satisfaction (p < .05), age showed a significant actor and partner effect for sexuality satisfaction (p < .05).

CONCLUSION

The results show a significant association of endometriosis and infertility with partnership and sexuality satisfaction. Infertility could be a decisive factor. However, the large overlapping of both endometriosis und infertility in many couples support the importance of further studies to differentiate between the both effects.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00014362 on the 29.03.2018.

Psychological impact of the COVID-19 pandemic on infertile patients: A systematic review and meta-analysis

The present study aimed to examine the psychological impact of the COVID-19 pandemic on infertile patients. We adopted a comparison design and searched articles published from 1 September 2016 to 31 December 2019 as the control group, while articles published from 1 January 2020 to 31 April 2023 were treated as the pandemic group. Specifically, Web of Science, PubMed, Medline, PsycArticle, CNKI and PsycINFO were searched to identify potential eligible records. Risk of bias was assessed, and random-effects meta-analyses were conducted to estimate the prevalence of specific mental health problems. Forty studies with a total of 19,480 participants were included in the analysis. The pooled prevalence of anxiety in the pandemic group was significantly higher than that in the control group. The depression and stress prevalence in the pandemic group was higher than that in the control group, yet did not reach statistical significance. A subgroup analysis revealed region differences with developed countries exhibiting higher rates of anxiety and depression in the pandemic group, but the result was the opposite in the control group. Physiological factors, psychological factors and social factors correlated with infertile patients' mental health were identified. The COVID-19 pandemic had a significant negative impact on infertile patients' mental health, emphasizing the importance of ways to mitigate the risks during the pandemic.

A Dyadic Study of Attachment, Coping, and Quality of Life in Couples Seeking Fertility Treatment

This study examined attachment insecurities, infertility-specific coping strategies, and quality of life (QoL) in 87 couples seeking fertility treatment. Partners completed self-report measures. Path analyses showed that women's and men's attachment anxiety were associated with their own lower QoL, whereas attachment avoidance was associated with their own and their partner's lower QoL. Adaptive coping in men and women were associated with women's higher QoL. Non-adaptive coping was associated with men and women's lower QoL. Coping strategies explained the associations between attachment and QoL. This highlights the importance of individual and dyadic factors for understanding QoL in couples seeking fertility treatment.

Attachment and Sexual Functioning in Couples Seeking Fertility Treatment: The Role of Infertility-Specific Coping Strategies

Couples facing infertility often experience sexual difficulties. Yet, little is known about the factors associated with these difficulties. We examined whether infertility-related coping strategies explain the associations between attachment insecurities (anxiety, avoidance) and sexual function and satisfaction in 97 couples seeking fertility treatment. Anxiety was associated with one's lower sexual satisfaction and function via self-neglect coping strategies. Anxiety was also associated with the partner's lower sexual satisfaction via self-blame coping. Avoidance was associated with lower partner support-seeking and sexual satisfaction. These findings support the roles of attachment and coping in the experience of sexual difficulties among couples seeking fertility treatment.

Deafening Silence of Male Infertility

Think about 6 loved ones of reproductive age in your life. Now imagine that 1 of these 6 individuals is suffering from infertility. Perhaps they feel alone and isolated, unable to discuss their heartbreak with their closest friends, family, and support network. Suffering in silence. In this editorial, we discuss the infertility journey through the lens of the patients, the providers, and the scientists who struggle with infertility each and every day. Our goal is to open a dialogue surrounding infertility, with an emphasis on dismantling the longstanding societal barriers to acknowledging male infertility as a disease. Through education, communication, compassion, and advocacy, together we can all begin to break the deafening silence of male infertility.

The effects of male anxiety and depression on IVF outcomes

STUDY QUESTION

What are the effects of male anxiety and depression on IVF outcomes?

SUMMARY ANSWER

Men with anxiety had lower final total motile sperm counts (fTMSC) during IVF compared to men without anxiety; however, there were no differences in live birth rates (LBRs).

WHAT IS KNOWN ALREADY

Studies have shown that male anxiety causes low sperm motility, worse sperm morphology, and increased DNA fragmentation, which are known to be influential factors on fertilization rates and embryo quality during IVF. However, data are lacking on whether there is a direct association between male anxiety and/or depression and IVF outcomes.

STUDY DESIGN, SIZE, DURATION

This was a survey-based, retrospective cohort study completed at a single, large hospital-affiliated fertility center with 222 respondents who underwent IVF with or without ICSI. The study was conducted between 6 September 2018 and 27 December 2022.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Male partners of couples who underwent IVF or IVF/ICSI completed a Hospital Anxiety and Depression Scale (HADS) questionnaire. They were separated into two groups for both anxiety (HADS-A ≥ 8 or HADS-A < 8) and depression (HADS-D ≥ 8 or HADS-D < 8). Men with an elevated HADS-A or HADS-D score ≥8 were considered to have anxiety or depression, respectively. The primary outcome was LBR. Secondary outcomes included semen parameters at the time of IVF, cycle outcomes, pregnancy outcomes, and prevalence of erectile dysfunction and low libido.

MAIN RESULTS AND THE ROLE OF CHANCE

There were a total of 222 respondents, of whom 22.5% had a HADS-A ≥ 8 and 6.5% had a HADS-D ≥ 8. The average age of respondents was 37.38 ± 4.90 years old. Antidepressant use was higher in the respondents with a HADS-A or HADS-D ≥ 8 (P < 0.05). Smoking use was similar between groups for both HADS-A and HADS-D (P > 0.05). When adjusted for male BMI, antidepressant use and smoking, men with a HADS-A or HADS-D ≥ 8 had similar rates of erectile dysfunction (adjusted relative risk (aRR) = 1.12 (95% CI 0.60, 2.06)) and low libido (aRR = 1.70 (95% CI 0.91, 3.15)) compared to those with a HADS-A or HADS-D ≤ 8. Men with a HADS-A ≥ 8 were more likely to have a lower fTMSC on the day of oocyte retrieval (11.8 ≥ 8 vs 20.1 < 8, adjusted ß = -0.66 (95% CI -1.22, -0.10)). However, the LBR per embryo transfer (ET) was similar between the HADS-A groups (43.2% ≥8 vs 45.1% <8, adjusted relative risk = 0.90 (95% CI 0.65, 1.06)). Although depression was uncommon in the entire cohort, the HADS-D groups were clinically similar for fTMSC (18.7 ≥ 8 vs 16.0 < 8) and LBR per ET (46.7% ≥8 vs 45.4% <8).

LIMITATIONS, REASONS FOR CAUTION

Limitations of our study are the survey-based design, the lack of sperm morphology assessment at the time of IVF, our inability to fully assess the HADS-D ≥ 8 cohort due to the small sample size and the large Caucasian demographic.

WIDER IMPLICATIONS OF THE FINDINGS

Couples undergoing IVF have an increased likelihood of suffering from anxiety and/or depression. There is currently a debate on whether or not men should be treated with antidepressants while attempting to conceive due to potential detrimental effects on sperm quality. Our study shows that, regardless of antidepressant use, couples with men who did or did not report anxiety and/or depression have similar LBRs when undergoing IVF. Therefore, it is important to assess both partners for mental health and to not withhold treatment due to a concern about a potential impact of antidepressants or anxiety/depression on sperm quality.

STUDY FUNDING/COMPETING INTEREST(S)

There was no funding to report for this study. Z.W. is a contributing author for UptoDate. S.S.S. is on the advisory board for Ferring Pharmaceuticals. E.G. was a medical consultant for Hall-Matson Esq, Teladoc, and CRICO and is a contributing author for UptoDate. The remaining authors have nothing to report.

TRIAL REGISTRATION NUMBER

N/A.

Mediating role of relational aggression in the association between infertility stigma and marital relationship distress in infertile women

Infertility is a multifaceted problem that can cause significant impairments with emotional, social, and psychological consequences, including problems in the marital relationship. This study aimed to mediate the role of relational aggression in the association between infertility stigma and marital relationship distress in infertile women. The research method was descriptive and path analysis. The statistical population of the study consisted of all infertile women who were referred to infertility centers and obstetrics and gynecology medical centers in Tehran in 2021 (July to October), and due to lack of full access to them, 300 people were selected by available sampling method who participated in the research through an online questionnaire. Data were collected using the Marital Self-Reporting Questionnaire, Infertility Stigma, and Relational Aggression Questionnaire. Data analysis was performed using structural equation modeling. The results showed that the causal model of the relationship between infertility stigma, relational aggression, and marital relationship distress in infertile women was confirmed based on different fitting indices. Infertility stigma and associated aggression directly affect the marital turmoil of infertile women. On the other hand, infertility stigma indirectly affects infertile women's marital distress through relational aggression (P < .05). Therefore, the infertility stigma and relational aggression play an important role in marital distress in infertile women, and targeting these two components in psychological therapies can effectively reduce marital chaos.

Blame others but hurt yourself: blaming or sympathetic attitudes toward victims of COVID-19 and how it alters one's health status

OBJECTIVE

This study explored the relationship between blame/sympathy and blamer's/sympathizer's perceived health status.

DESIGN

We recruited participants via an online survey platform. Study 1 was a cross-sectional study using data (N = 3304, Mage = 28.22, SDage = 7.92, and 39.3% female) collected from 30 provinces, municipalities, and autonomous regions of China on February 3, 2020. Study 2 used the daily diary method collecting data from February 4 to 9, 2020. Sample (N = 2456, Mage = 28.49, SDage = 7.49, and 39.4% were female) was obtained by inviting participants in Study 1 on the same platform.

MAIN OUTCOME MEASURES

Self-reported health status and life satisfaction.

RESULTS

In Study 1, blame was negatively associated with perceived health status, while sympathy was positively associated with it. Negative emotions and risk perception are the underlying mechanisms, but neither of them has effects on the relationship between sympathy and perceived health status. Study 2 replicated these results using multilevel analysis.

CONCLUSION

The results highlight the importance of people's attitudes on perceived health status. While sympathy is positively related to perceived health status, blaming has a negative association with perceived health status. Negative emotions and risk perceptions are the underlying mechanisms.

Spouse's coping strategies mediate the relationship between women's coping strategies and their psychological health among infertile couples

Social problems and suffering from the treatment process for infertile couples, especially for women, require the couples to cope with them to balance the infertility crisis. According to the close interactions of the couples with each other, the objective of the present study was to explore a theoretical framework for the relationships between women's coping strategies, spouses' coping strategies, and women's psychological health in infertile couples who were candidates for assisted reproductive technology (ART). This cross-sectional study was carried out on 212 couples undergoing ART. The couples' coping strategies were evaluated using a validated self-report questionnaire. The women's psychological health was assessed using a 21-item stress, anxiety, and depression scale (DASS-21). Statistical analysis was performed using the plug-in application PROCESS macro for SPSS. The direct effect of the women's self-blame and self-focused rumination strategies (p < .0001), and the indirect effect of the women's self-blame on stress and depression by mediating spouses' self-blame and self-focused rumination strategies, was significant. The indirect effect of the women's self-focused rumination on the anxiety and depression levels by mediating spouses' self-blame strategy was significant. The women's self-blame and self-focused rumination strategies had a negative effect on the women's psychological health who were undergoing ART. This negative effect was mediated by the spouse's coping strategies.

Complex factors related to marital and sexual satisfaction among couples undergoing infertility treatment: A cross-sectional study

Objectives

This study assesses complex factors related to marital and sexual satisfaction among couples undergoing infertility treatment.

Methods

This cross-sectional study was conducted with 140 couples who visited fertility centers in Iran, between September 2015 and July 2016. Data collection was done by Marital and Sexual Satisfaction Questionnaires and were analyzed by the IBM SPSS 26 software.

Results

There was a significant difference between wives and husbands in the MSQ total scores (p = 0.027). However, there was no significant difference between wives and husbands in the SSQ total scores (p = 0.398). Sexual satisfaction and decision-maker in life among wives and husbands were significant predictors of MSQ. The kind of treatment, cause of infertility and BMI among wives and kinds of treatment, cause of infertility, and decision-maker among husbands were also significant predictors of SSQ.

Conclusion

The findings of this study showed that there is a difference between the understanding of marital and sexual satisfaction in wives and their husbands. Healthcare providers need to pay more attention to these differences.

Predictors and incidence of depression and anxiety in women undergoing infertility treatment: A cross-sectional study

The global incidence of infertility is increasing year by year, and the association between infertility and mental illness has been widely concerned. The aim of this study was to investigate the incidence of anxiety and depression in infertile women in China and explore the risk factors which might lead to anxiety and depression. From January 2020 to December 2020, female infertile patients who received assisted reproduction technology (ART) treatment at West China Second Hospital were recruited and a total of 1712 eligible female patients were finally enrolled in this study. Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionaire-9 (PHQ-9) were used to evaluate the patients' psychological status. The reliability of all scales was evaluated by Cronbach's α and Spearman-Brown half coefficient, and Kaiser-Meyer-Olkin (KMO) value was calculated by factor analysis to evaluate validity. Univariate and multivariate logistic regression analysis were applied for assessing independent risk factors of anxiety and depression, respectively. The incidence of anxiety and depression in infertile women were 25.2% and 31.3%, respectively. Cronbach's α coefficients and Spearman-Brown half-fold coefficients of GAD-7 and PHQ-9 were 0.870, 0.825, 0.852 and 0.793, respectively. Univariate and multivariate logistic regression analysis showed that education level (junior college degree or above, OR:1. 6, 95% CI: 1.2-2.1, P = 0.003), somatic symptoms (severe somatic symptoms, OR:15.2, 95%CI: 5.6-41.3, P<0.001), sleep quality (poor sleep quality, OR:9.3, 95% CI:4.7-18.4, P<0.001) were independent risk factors for anxiety. And age>35 years old, moderate and severe somatic symptoms and poor sleep quality were independent risk factors for depression. Somatic symptoms and poor sleep quality are both the risk factors of anxiety and depression symptoms of infertile woman. And high educated (junior college degree or above) patients are more likely to be complicated with anxiety symptoms, while elderly patients (age>35) are prone to be complicated with depression symptoms.

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

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

A dyadic approach to depression, resilience and quality of life on marital adjustment among infertile couples in Karachi, Pakistan: A cross-sectional study

BACKGROUND

Infertility is a major reproductive health problem in Pakistan. It has the potential to cause serious negative impact on a couple's marital life and psychological health.

AIM

This study aimed to assess the factors associated with maladjustment among infertile couples.

METHOD

An analytical cross-sectional design was employed. Validated scales were used to assess marital adjustment, depression, resilience and quality of life among infertile couples. Purposive sampling was employed to enrol 334 infertile couples from a private infertility medical centre, of Karachi, Pakistan.

RESULTS

Among couples, marital adjustment scores were comparable, but resilience and quality of life were significantly low among wives whereas depression was significantly high among wives compared with husbands. Wives' marital adjustment was positively correlated with husband's resilience and quality of life and negatively related with his depression. After employing adjusted actor-partner interdependence modelling, wives' own depression and resilience had significant effect on their marital adjustment and their partner's resilience, depression and quality of life did not have any impact on their outcome. On the contrary, wives' resilience had a significant effect in increasing the marital adjustment of their husband.

CONCLUSION

This study highlights the need to promote psychological support (resilience building skills) or couples' therapy to all those couples undergoing infertility treatment.

From generalist to specialist: A qualitative study of the perceptions of infertility patients

Few studies explore in-depth accounts of women's and men's experiences with, and transitions between, obstetrician/gynaecologists (OB/GYNs) and reproductive endocrinologists during infertility diagnostic and treatment processes. This study examined this subject matter with data from qualitative, in-depth, semi-structured interviews. Between April 2007 and March 2008, the first author interviewed 20 women and eight men from a large midwestern metropolitan area in the USA who had used, or were in the process of using, any fertility treatment in the 5 years preceding the interview. Six couples and 16 individuals were interviewed, resulting in narratives of 22 distinct infertility journeys. The main complaints made by respondents about OB/GYNs were that they were insufficiently concerned with providing timely treatment and that they paid insufficient attention to male partners. Women felt that their concerns were taken more seriously by reproductive endocrinologists, but complained of insensitivity, depersonalization and misinformation, and were suspicious of a profit orientation.

Perceived Partner's Self-Control and Social Support Effects on Relationship Satisfaction in Couples Experiencing Infertility or Miscarriage: Dyadic Analyses

The process that infertile couples and those after a miscarriage go through is unpredictable and difficult to control; therefore, it is associated with a lowered sense of control for both partners. Uncontrolled stress creates a higher level of anxiety, which is associated not only with a lower quality of life but also with worse results from infertility treatment and higher risks of miscarriage. The aim of this study was to analyze the relationship between the partner’s perceived self-control and marital satisfaction in the context of the partners’ coping strategies. The actor-partner interdependence model was applied to 90 heterosexual married couples. Our results show that men who perceive their wives as being more self-controlled and women who are perceived by their husbands as being more self-controlled feel more satisfied in their relationships. The effect of a partner’s perceived self-control on satisfaction with the relationship was weaker when controlled for the length of marriage. It also appeared to be moderated through the spouses’ use of social support. We conclude that the effects of the partner’s perceived self-control and social support are strong for marital satisfaction in the context of infertility and miscarriage.

Depression Among Infertile Men in the Gaza Strip, Palestine: The Neglected Aspect of Fertility Care

Background:

Infertility is a worldwide public health problem and affects psychological aspects of males’ and females’ life. However, the problem has not been well investigated in Palestine. Therefore, the purpose of this study was to determine prevalence and predictors of depression among infertile men in the Gaza strip.

Methods:

A cross-sectional study was carried out among three hundred eighty five infertile males from January to December 2019. Participants were selected from three main in-vitro fertilization (IVF) centers following simple random sampling. The Arabic version of Beck Depression Inventory was used. Descriptive and inferential analyses were performed using the SPSS V22. Binary analysis was done to determine independent variables and t-test and one-way ANOVA were conducted afterwards. Logistic regression was performed to determine independent factors associated with depression symptoms. The p-value of 0.05 or less was considered statistically significant.

Results:

Findings showed that 42.6% (164/385) of infertile men had at least one type of depression. Severe depression was presented in 16.6% (64/164) of participants, while 13.2% (51/164) and 12.7% (49/164) showed moderate and mild depression, respectively. Predictors for depression were duration of marriage (>8 years) (CI 95%: 1.099–2.615) and at least one IVF attempt (CI 95%: 0.373–0.873).

Conclusion:

It has been revealed that depression is prevalent among infertile men. Marriage of long duration and several failures in IVF attempts are predictors for depressions. Psychological counseling besides medical interventions seems to be an optimal strategy to alleviate psychological distress associated with infertility.

The Relationship Between Infertility, Stress, and Quality of Life with Posttraumatic Stress Disorder in Infertile Women

Background:

The infertility experience and its treatment are accompanied by the symptoms of posttraumatic stress disorder (PTSD). The aim of this study was determining the relationship between posttraumatic stress disorder and quality of life and the infertile women’s stress.

Methods:

In this descriptive-analytic study, 172 infertile women were divided in four groups. Convenience sampling was done and eligible infertile women referred to Qafqaz Infertility Center in Iran were included in the study. The data was collected between January and March 2019 through posttraumatic stress disorder checklist, The Fertility Quality of Life (FertiQoL) questionnaire, and Newton's infertility stress questionnaire. Pearson correlation, linear regression analysis, and two-way analysis of variance (ANOVA) were applied for data analysis with a significance level of 0.05.

Results:

The results of two-way analysis of variance (ANOVA) revealed that there was no significant relationship between the type of treatment (p=0.548) and the reception of psychological intervention (p=0.450). In addition, the results of Pearson correlation showed that there was an inverse significant relationship between the total score of posttraumatic stress disorder and quality of life (r=−0.91, p<0.001) and a direct relationship between the total score of posttraumatic stress disorder and level of stress (r=0.56, p<0.001).

Conclusion:

The results of this study showed that 41.3% of the infertile women had the symptoms of posttraumatic stress disorder. Due to the relationships of posttraumatic stress disorder with the quality of life and infertility stress, providing regular designed psychological interventions is recommended for infertile individuals.

Study on the Interdependent Relationship between the Marital Satisfaction Variable and the Psychosocial Impact of Infertility and Anxiety Disposition, According to Gender

This study assessed the relationship between the marital satisfaction variable and the psychosocial impact of infertility and anxiety disposition, testing for possible gender-based differences. Comparisons performed on 87 couples did reveal differences and analyses disclosed that depression, anxiety and quality of life can influence the assessment each partner makes of their relationship, through an interdependent process. One partner's marital satisfaction can be influenced by those variables in the other partner. These findings indicate that psychosocial care for infertile couples must involve both partners and that they should be made aware of the effect of interdependence on marital satisfaction.

Sexual Function and Satisfaction in Couples with Infertility: A Closer Look at the Role of Personal and Relational Characteristics

BACKGROUND

Research to date suggests that couples undergoing assisted reproductive technology (ART) are at a high risk of experiencing sexual difficulties.

AIM

This dyadic cross-sectional study aimed to provide a better understanding of the infertility-specific personal (ie, emotional, mind-body) and relational stressors associated with the sexual desire, orgasm, arousal, and sexual satisfaction of infertile couples seeking ART.

METHODS

The sample included 185 mixed-sex infertile couples seeking ART. Participants completed online the Fertility Quality of Life tool and either the Female Sexual Function Index or the International Index of Erectile Function. Data were analyzed using path analyses based on the Actor-Partner Interdependence Model.

OUTCOMES

Individuals' own and their partners' sexual function (desire, orgasm, arousal domains) and sexual satisfaction.

RESULTS

For men and women, infertility-related emotional stressors were associated with their own and their partner's lower sexual desire. For women, experiencing greater infertility-related emotional stressors was also associated with their partner's lower sexual satisfaction. While experiencing greater infertility-related mind-body stressors was not associated with men and women's own sexual desire, arousal, orgasm, and satisfaction, for women, it was associated with their partner's lower sexual arousal. Lastly, for men and women, infertility-related relational stressors were associated with their own lower sexual arousal, as well as with their own and their partner's lower sexual satisfaction. For women, experiencing greater relational stressors was also associated with their own lower sexual desire and orgasm.

CLINICAL IMPLICATIONS

Interventions addressing the emotional, mind-body, and relational spheres of infertile couples seeking ART may help facilitate improvements in sexual function and satisfaction and better serve their needs.

STRENGTHS & LIMITATIONS

This study included a large sample of couples. Our sample was heterogeneous with regards to couples' cause of infertility and treatment stage. The use of an infertility-related measure allowed us to better capture personal and relational stressors specific to couples seeking ART. Given the cross-sectional design of our study, causality between infertility-related stressors and sexual function and satisfaction cannot be inferred. Our sample included predominantly White, mixed-sex individuals with a high level of education, which may reduce the generalizability of our findings.

CONCLUSION

Couples' subjective experience of infertility and treatment (personal and relational stressors) seems to be strongly associated with their sexual health, allowing us to identify potential targets of intervention with couples seeking ART. S.E. Amiri, A Brassard, N.O. Rosen, et al. Sexual Function and Satisfaction in Couples with Infertility: A Closer Look at the Role of Personal and Relational Characteristics. J Sex Med 2021;18:1984-1997.

Exploring how mothers of a child with a genetic disorder experience their couple relationship in a low socio-economic setting

Having a child with a genetic disorder directly impacts a couple's relationship due to increased care demands. Most research on couple relationships in the context of having a child with a disability has been done in well-resourced, developed countries. In South Africa, the black South African population has been historically disadvantaged resulting in high rates of unemployment and poverty, and disruption of the family system. The purpose of this study was to explore the impact of having a child with a genetic disorder on the couple relationship in a low socio-economic setting. Thirteen black South African mothers of a child with a confirmed or suspected genetic disorder participated in the study. All participants were recruited while waiting to be seen for a follow-up appointment by a medical geneticist at a Genetic Clinic in Johannesburg, South Africa between 2016 and 2019. Data were collected through semi-structured interviews lasting between 25 and 60 min and analyzed using thematic content analysis. Findings showed that mothers of a child with a genetic disorder in this low socio-economic setting frequently felt unsupported and carried the responsibility of childcare alone. The majority of participants wanted more tangible and emotional support from their partners and without this support they felt isolated and alone. The participants used many different coping strategies to deal with the distress of having a child with a genetic disorder but most frequently they described using 'acceptance'. Participants' partners were more often reported to use escape-avoidance strategies such as abandonment, denying paternity, withdrawal, and partner-blame. We suggest that mothers of a child with a genetic disorder should consult with a genetic counselor in addition to a medical geneticist to enable the provision of emotional support.

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.

Adjustment toward infertility mediates the relationship between coping, depression and anxiety in men: A confirmatory analysis

OBJECTIVE

The aim of the present study was to develop a theoretical framework for the relationships between coping, adjustment toward infertility, depression and anxiety and to present a confirmatory analysis of the developed theoretical framework in men who, together with their spouses, were candidates for assisted reproductive technology (ART) treatment.

STUDY DESIGN

This cross-sectional study was conducted on 212 men selected from the couples who were candidate for ART. Depression and anxiety, adjustment toward infertility, and coping strategies were assessed using self-report questionnaire. Statistical analysis was performed using the plug-in application PROCESS macro and AMOS software.

RESULTS

The results showed that higher depression and anxiety scores were related to lower adjustment to infertility. Higher adjustment score was associated with lower self-blame, self-focused rumination, active confronting and avoidance coping strategies scores significantly. In the depression and anxiety pathway models, the positive relationship between active confronting and elf-focused rumination coping strategies were mediated by adjustment. However, the effect of active confronting on depression and anxiety was significant only with mediating role of adjustment. The direct and indirect relationship of self-focused rumination and the indirect relationship of active confronting with depression and anxiety had a good fitness (CMIN/ DF = .419).

CONCLUSION

The self-focused rumination and active confronting coping strategies, having negative association with adjustment to infertility, and may increase depression and anxiety in men undergoing ART; however, higher adjustment is associated with decreased depression and anxiety. Therefore, mental health programs for men undergoing ART may need to focus on improving the skills of adaptive coping strategies.

Is a dyadic stressor experienced as equally distressing by both partners? The case of perceived fertility problems

Using data from a population survey, this article explores whether perceptions of having a fertility problem among 926 U.S. couples in heterosexual relationships (women aged 25-45 and male partners) are associated with distress. Most couples did not perceive a fertility problem (58%). In almost a third (30%) of the couples, only women perceived a fertility problem; in 4%, only the men; and in nearly a fifth (19%), both perceived a problem. Adjusted for characteristics associated with fertility problems and depressive symptoms, those who perceived a problem exhibited significantly more depressive symptoms than those who did not. Fertility problems are sometimes experienced as individual because in some couples only one partner perceives a problem or has higher distress in response to their own rather than to their partners' perceived problems. For women, fertility problems are experienced as a couple phenomenon because women were more distressed when both partners perceive a problem. The perception of fertility problems is gendered in that women were more likely to perceive a problem than men. Furthermore, men are most distressed when they perceive a problem and their partner does not.

Individual and Relational Well-Being at the Start of an ART Treatment: A Focus on Partners' Gender Differences

Infertility and ART treatments represent stressful experiences for the couples, impacting on the overall psychological well-being of partners as well as on their couple adjustment. Several variables were analyzed as risk factors for infertility-related distress. The impact of these experiences has been well-documented in both women and men, reporting important gender differences. The aim of this study was to assess gender differences in individual and relational well-being in infertile couples. Gender differences for psychological and medical variables predicting psychological distress were investigated. Two hundred and thirty couples who entered an ART program at a public hospital in Milan were recruited. Each partner completed the following scales: ScreenIVF, Dyadic Adjustment Scale, and Experience in Close Relationship Questionnaire. Findings revealed several gender differences with women reporting higher levels of both anxiety and depressive symptoms, anxiety and avoidance attachment, and helplessness, but lower levels of acceptance than men. Differences emerged also in factors predicting well-being: poor support predicted anxiety in men and depression in women. Furthermore, individual well-being was predicted only for men by attachment anxiety and previous treatment. Finally, in the women subsample, couple's adjustment was predicted by anxiety attachment, while in men predictors were helplessness and type of diagnosis. These results suggest the importance of implementing support interventions for couples which take into consideration the specific needs and fragility of each partner as well as focusing on enhancing a sense of partnership.

Effectiveness of psychological interventions on mental health, quality of life and relationship satisfaction for individuals and/or couples undergoing fertility treatment: a systematic review and meta-analysis protocol

INTRODUCTION

Infertility is a global public health problem affecting men, women and couples worldwide. The medical implications of infertility are often of primary focus in healthcare settings, but the experience of infertility also has a considerable social, emotional and psychological impact. Interventions aimed at alleviating psychological symptoms in individual and/or couples undergoing fertility treatment requires a systematic and comprehensive review of the literature to determine the efficacy of psychological interventions. The objective of this review is to evaluate the effectiveness, feasibility and acceptability of psychological interventions for individuals and/or couples seeking fertility to treat anxiety, depression, distress, quality of life and relationship satisfaction, as well as improve pregnancy rates.

METHODS AND ANALYSIS

The search strategy will involve 11 databases, including MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily (Ovid), EMBASE (Ovid), PsycINFO (Ovid), Cochrane Central Register of Controlled Trials (OVID), The Cumulative Index to Nursing and Allied Health Literature (CINAHL) with Full Text (EBSCO), Social Work Abstracts (EBSCO), SocINDEX with Full Text (EBSCO), Academic Search Complete (EBSCO), Family & Society Studies Worldwide (EBSCO), Family Studies Abstracts (EBSCO) and Scopus. These databases will be searched from their inception to September 2019. Independent reviewers will search peer-reviewed published studies through electronic databases and additional sources, will extract the data and assess the methodological quality. Random-effects meta-analysis will be carried out by calculating effect sizes as Cohen's d indices. Heterogeneity will be examined by the I2 and the Q statistics.

ETHICS AND DISSEMINATION

The current review does not require ethics approval. The results will be disseminated through publications in peer-reviewed journals.

PROSPERO REGISTRATION NUMBER

CRD42019133757.

Concerns about treatment for infertility in a probability-based sample of US women

Objective: Many women experience infertility as distressing, but only about half of US women seek medical services. It is unknown whether concerns about fertility treatment are related to receiving fertility treatment or to distress levels.Methods: Using the nationally representative National Survey of Fertility Barriers, we constructed a nine-item scale measuring fertility treatment concerns. The analytical sample for this study included 1218 women who said that they were trying to become pregnant and who were asked questions regarding treatment concerns. We conducted multiple regression analysis to discover factors associated with treatment concerns and whether treatment concerns were associated with depressive symptoms and fertility-specific distress. We used logistic regression to determine whether treatment concerns were associated with receiving fertility tests.Results: Desiring a(nother) child, infertility stigma, higher family income, higher economic hardship and claiming a Hispanic identity were associated with higher levels of treatment concerns than those in the comparison groups. Having friends and family with children and having private health insurance were associated with lower levels of concern. Treatment concerns were not associated with receiving fertility tests. Higher levels of treatment concern were associated with higher levels of fertility-specific distress and depressive symptoms. Higher infertility stigma was related both directly and indirectly to higher levels of fertility-specific distress and depressive symptoms.Conclusion: For US women, fertility treatment concerns are not associated with whether women pursue fertility testing, but they are associated with higher levels of fertility-specific and general distress.

Anxiety and depression symptoms in infertile men during their first infertility evaluation visit

Objective: To assess the psychological condition of men at the start of the infertility work-up. Methods: Men seeking an infertility evaluation for the first time were recruited. Depression and anxiety symptoms and subjective psychological burden were assessed with the Beck Depression Inventory (BDI), the Spielberger State-Trait Anxiety Inventory (STAI), and a visual analog scale (VAS). Results: Data from 113 patients were analyzed. The mean age of the patients was 33.3 (range: 23-54) years, whereas the mean duration of infertility was 16.3 (range: 0-96) months. Results from the BDI and STAI were 2.24 (SD: ±3.18) and 33.74 (SD: ±8.04). Mild depressive symptoms were found in 4.5% of patients, whereas anxiety reached an abnormal level in 4.9%. There were significant correlations between the results from the BDI score and the duration of infertility (p = .024), whereas the STAI and VAS scores showed no similar connection (p = .142 and p = .261, respectively). Among patients with infertility longer than 2 years, mild depressive symptoms occurred in 23.1%. Conclusion: Among men, the levels of depressive and anxiety symptoms were low at the start of the infertility work-up. Depressive symptom levels increased significantly with the duration of infertility, whereas anxiety levels and VAS scores did not demonstrate a similar correlation.

Spontaneous pregnancies in patients with at least one failed IVF cycle after the management of autoimmune disorders, hereditary thrombophilia, and methylation disorders

Objective:

This study aimed to describe the impact on achieving spontaneous pregnancy of treating patients with at least one failed in-vitro fertilization (IVF) cycle for autoimmune disorders, hereditary thrombophilia, and methylation disorders.

Methods:

Fifty-three patients who met the enrollment criteria seen between January 2007 and October 2017 were included in this retrospective cohort study. The patients were retrospectively assessed for the presence of hereditary thrombophilia, methylenetetrahydrofolate reductase (MTHFR) polymorphisms, serum vitamin B12/folate/homocysteine levels, and autoimmune antibody positivity. The required data were extracted from the institutional patient database. Statistical analyses were performed on Statistical Package for the Social Sciences (SPSS.22^®). The Kolmogorov-Smirnov test was used to evaluate the distribution of the data, and since the data did not following a normal distribution, proportions and median (minimum-maximum) values were used.

Results:

The 53 patients included in the study had singleton pregnancies. The distribution of autoantibodies was as follows: thyroid peroxidase (n=17); antithyroglobulin (n=11); double-stranded DNA (n=4); antinuclear (n=8); anti-smooth muscle (n=1); and anticardiolipin IgG and IgM (n=1). Autoimmune diseases included Hashimoto's thyroiditis (n=23); SLE (n=7); Behcet's disease (n=1); Sjogren's syndrome (n=1); ulcerative colitis (n=1); and anti-phospholipid antibody syndrome (n=1). Ten patients had heterozygous Factor V Leiden thrombophilia; two had homozygous Factor 5 Leiden thrombophilia; and three had the prothrombin 20210A heterozygous mutation. Twenty-eight patients were positive for autoantibodies and hereditary thrombophilia and/or MTHFR polymorphisms.

Conclusions:

Evaluation and management of hereditary thrombophilia, MTHFR gene polymorphisms, and/or autoimmune conditions may be beneficial for patients with unexplained infertility.

Examining the Role of Dyadic Coping on the Marital Adjustment of Couples Undergoing Assisted Reproductive Technology (ART)

A couple is considered to be infertile if unable to conceive after 12 months of unprotected sexual intercourse. An extended body of literature supports that infertility and infertility treatments contribute to emotional, social, sexual, and relational issues that can have a negative impact on each partner's well-being and on the couple relationship. Recent findings suggest that a dyadic approach should be used when working with couples coping with these stressors. However, most research to date has focused on the association between infertility and individual's psychological outcomes, rather than on the experience of infertility-related stress and coping from a relational perspective. Consequently, assuming that infertility is a dyadic stressor and that the ability of the partners to cope with this experience is the result of both individual and relational coping strategies, this study aimed to investigate dyadic coping and marital adjustment among couples at the beginning of an Assisted Reproductive Technology (ART) treatment. A sample of 167 heterosexual couples (N = 334) undergoing ART treatment at the fertility clinic of a large hospital in Milan from January to December 2017 was recruited. Each participant completed self-reported questionnaires examining marital adjustment (Dyadic Adjustment Scale) and dyadic coping (Dyadic Coping Questionnaire). Demographics and clinical variables were also collected. Data were analyzed using the Actor Partner Interdependence Model (APIM), testing the effect of each partner's dyadic coping style on their own and their partner's marital adjustment. Results revealed that both women and partners' scores on positive dyadic coping styles (common, emotion-focused, problem-focused, and delegated dyadic coping) contributed to higher marital adjustment. This result suggests that couples unable to engage in this type of reciprocal supportive behaviors and those unsatisfied with their coping efforts may be more vulnerable while undergoing ART treatments. Furthermore, findings highlighted some gender differences for stress communication and negative dyadic coping suggesting the presence of specific dynamics within couples facing an ART treatment. Implications for clinical practice and future research are discussed.

Moving forward together, stronger, and closer: An interpretative phenomenological analysis of marital benefits in infertile couples

Some couples find in infertility the bonding opportunities that reinforce their relationship. Using an interpretative phenomenological analysis, this study examined marital benefits in three couples seeking fertility treatment. Interviews revealed five types of benefits: being engaged in a shared hardship, feeling closer to one another, feeling reassured in the relationship, developing a satisfying communication and support behaviors, and having faith in the couple’s capacity to face adversity. A dyadic analysis also illustrated how marital benefits developed in each couple. Marital benefits nourished marital satisfaction, thus underscoring their importance to help couples cope through fertility treatment.