Predictors of distress in women being treated for infertility

Lived experiences and coping strategies of persons seeking infertility treatment in the Kumasi metropolis: a descriptive phenomenological study

BACKGROUND

Women seeking fertility treatment face myriad challenges that they must adapt and adjust to daily. This aimed at exploring the experiences and coping strategies of such persons in the Kumasi. Metropolis.

METHODS

A qualitative approach was employed and a purposive sampling technique was used to select 19 participants. A semi-structured interview was used to collect data. The data collected were analyzed using Colaizzi's method of data analysis.

RESULTS

Persons living with infertility had emotional experiences of anxiety, stress, and depression. Socially, participants experienced isolation, stigma, societal pressure, and marital problems due to their inability to conceive. The key coping strategies adopted were spiritual (faith-based) and social support. Though formal child adoption can be an option, no participant preferred it as a coping strategy. Some participants also reported using herbal medicine before going to the fertility centre upon realizing that the approach was not helping in achieving their desired outcome.

CONCLUSION

Infertility is a source of suffering for most women diagnosed with it, resulting in significant negative experiences in their matrimonial homes, families, friends, and the community at large. Most participants rely on spiritual and social support as their immediate and basic coping strategies. Future research could evaluate the treatment and coping strategies and also determine the outcomes of other forms of treatment for infertility.

The value of motherhood and psychological distress among infertile women: The mediating role of coping strategies

Introduction

The present study investigated psychological distress and coping strategies among infertile women during the COVID-19 pandemic using a multi-dimensional model of infertility-related stress. We explored the associations between individual (i.e., age) and situational characteristics related to infertility (i.e., duration of infertility, cause of infertility, number of lost pregnancies, and assisted reproductive techniques [ART] status), and perceived-infertility-related factors (i.e., the perceived importance of motherhood).

Methods

Our total sample consisted of 193 women aged 20 to 46 (M= 33.23, SD = 4.58), out of which 102 were undergoing ART procedures (M = 33.60, SD = 4.23), and 91 were not (M= 32.81, SD = 4.94). Participants filled in questionnaires measuring psychological distress, coping strategies, and the importance of motherhood.

Results

Correlation analyses suggested that the importance of motherhood was positively associated with psychological distress and negative coping strategies. Mediation analysis results indicated that both in the overall sample and in the sample of women undergoing ART procedures, the negative self-perception fully mediated the link between the importance of motherhood on psychological distress. In the non-ART sample, we found a significant mediation effect of denial on the link between the importance of motherhood and psychological distress.

Discussion

We discuss the theoretical and practical implications of the present findings, focusing on the mental health-related consequences of the social stigma of infertility heightened by the pressure of parenthood.

The impact of stigma on mental health and quality of life of infertile women: A systematic review

Introduction

The stigma of not giving birth to children affects approximately 53. 08~64% of female infertility patients worldwide. This stigma not only causes harm to the mental health of these infertility patients, but also affects their quality of life, making them bear the adverse social consequences such as domestic violence, marriage breakdown, or even delay in receiving the treatment. Therefore, it is crucial to have a deep understanding of the patients' stigma and effective intervention in alleviating it.

Aims/Question

This study aims to discuss and summarize the stigma in infertile women and its impact on patients, and to provide a theoretical basis for the clinical treatment and nursing intervention of disease stigma in infertile female patients.

Methods

The literature search used four English databases (Cochrane Library, EMBASE, Web of Science, and PubMed) and two Chinese databases (CNKI and Wanfang). The search time of the literature ranges from the establishment of the library to 2022, with no language restriction.

Results

The review included 28 studies, with 20 cross-sectional studies and 8 qualitative studies. This study found that social support, living environment, education level, occupation, and fertility awareness were the major influencing factors of infertility stigma.

Conclusions

Infertility stigma can bring heavy mental pressure and psychological burden to female infertility patients and affect their quality of life. Therefore, effective and targeted psychological interventions should be developed to reduce the patients' stigma and improve their quality of life.

Implications for practice

Healthcare workers must develop targeted nursing interventions, provide professional counseling services to reduce the level of stigma in female infertility patients, alleviate fertility stress, and improve their quality of life.

The Effectiveness of Implementing Family-Centered Empowerment Model on Irrational Thoughts of Iranian Infertile Women: A Randomized Clinical Trial

Introduction: Infertility is one of the main problems of the family and is one of the factors that determine the identity and personality of Iranian infertile women. Family-centered empowerment model is a step toward increasing the self-efficacy of patients and enabling them to take responsibility of their illness. This study aimed to determine the effectiveness of applying family-centered empowerment model on irrational thoughts of Iranian infertile women. Methods: This study was a randomized clinical trial conducted on 80 infertile women and their husbands that were randomly divided into two intervention and control groups. Irrational Parenthood Cognitions questionnaire was given to the intervention and control groups to complete before and 3 months after the intervention. Data were analyzed using SPSS Statistics for Windows, version 13.0 (SPSS Inc., Chicago, IL, USA). Results: The mean (SD) of irrational thoughts' scores in the control group before and after the study were 33.92 (5.98) and 33.20 (6.83) respectively, and in the intervention group were 34.55 (5.61) and 19.97 (3.52), respectively. The result of independent t-test showed a significant reduction in irrational thoughts of women in the intervention group after the family-centered empowerment model intervention. Conclusion: The family-centered empowerment model after three months of continuous implementation was able to effectively reduce the irrational thoughts about having children in infertile women.

Associations between Stigma, Cognitive Appraisals, Coping Strategies and Stress Responses among Japanese Women Undergoing Infertility Treatment

The number of infertility treatment cycles in Japan is the highest worldwide. Studies have shown that stigma is a predictor of stress-related symptoms including anxiety and depression in women undergoing infertility treatment. Stress management to prevent stress-related symptoms may be crucial; however, few studies have examined the model of stigma and stress responses. Based on the stress-coping model, we hypothesized that stigma threatens the identity of such women and that coping failure increases stress responses. We aimed to explore the role of cognitive appraisals and coping strategies as mediators of the association between the stigma of infertility and stress responses. In December 2021, we conducted a cross-sectional study in Japan, in which 254 women undergoing infertility treatment completed a web-based survey. Hierarchical multiple regression analysis was conducted to analyze the associations between stigma, cognitive appraisals, coping strategies, and stress responses. The results showed that explanatory power increased with each additional variable in the following order: stigma, cognitive appraisals, and coping. Participants with a high level of stigma evaluated it as threatening, and used self-blame and venting coping strategies, and showed higher stress responses. Conversely, participants who used positive reframing coping strategies exhibited lower stress responses. Based on this, effective strategies to address stigma and stress responses are necessitated.

Association between Stigma and Anxiety, Depression, and Psychological Distress among Japanese Women Undergoing Infertility Treatment

Japan has the highest number of cases of infertility treatment in the world. Studies have indicated that women undergoing infertility treatment feel stigmatized and suffer from psychological symptoms such as anxiety and depression. However, in Japan, few studies have quantitatively examined the association between the stigma of infertility and psychological symptoms, and, to our knowledge, no study has examined its association using a scale with tested reliability and validity. This study aims to quantitatively examine the relationship between infertility stigma and anxiety, depression, and psychological distress among women undergoing infertility treatment, using a scale that has been validated for reliability and validity. The cross-sectional study was conducted in December 2021 through a web-based survey of 254 participants undergoing infertility treatment. A multiple regression analysis was performed to examine the relationship between stigma and anxiety, depression, and psychological distress. Stigma was a statistically significant predictor of anxiety, depression, and psychological distress (standardized β = 0.58, p < 0.001; β = 0.50, p < 0.001; β = 0.62, p < 0.001, respectively) after controlling for sociodemographic and infertility characteristics. Future studies should examine the causal relationship between stigma and anxiety, depression, and psychological distress and how to intervene to reduce stigma among women undergoing infertility treatment.

Development of the Japanese Version of the Infertility Stigma Scale: Examination of Its Reliability and Validity

The stigma of infertility negatively affects health, resulting in mental distress and poor quality of life. An appropriate scale is essential to examine the stigma experienced by infertile women and provide adequate interventions. Therefore, we developed a Japanese version of the Infertility Stigma Scale (ISS). After examining the content validity of this scale, we conducted an online survey of women undergoing fertility treatment to test the scale’s structural validity, internal consistency, intra-rater reliability, known-groups validity, convergent validity, and discriminant validity. A total of 254 participants were included in the analysis. The results of confirmatory factor analysis of four factors based on the original scale revealed the optimal fit. Cronbach’s alpha was 0.95 for the total score. Concerning test−retest analysis, the total score of the ISS and subscale had a high Spearman correlation coefficient (ρ = 0.61−0.88, p < 0.001). For convergent validity, the association between the ISS and social support, self-esteem, and family functioning was significantly negatively correlated. The results of the multitrait scaling analysis scale showed that correlations of all items exceeded 0.40, and scaling errors (7/81, 8.6%) were few. The Japanese version of the ISS was confirmed to have acceptable reliability and validity.

Infertility-related stress: A concept analysis

AIM

To develop a clear definition of infertility-related stress using Rodgers' method of concept analysis.

BACKGROUND

Infertility affects approximately 13% of women in the United States. Though poorly defined in the literature, previous studies suggest infertility-related stressors contribute to psychological distress.

DESIGN

Rodgers' method of concept analysis guided the review, including sample and setting, literature search, and data analysis.

DATA SOURCE

PubMed, CINAHL, and PsycINFO were searched for relevant literature.

REVIEW METHODS

Following abstract, title, and text screenings, 21 articles were included and reported using the PRISMA-S checklist. Texts were analyzed and results informed the proposed definition of infertility-related stress.

RESULTS

Antecedents included infertility, desire for children, and fear of the unknown. Attributes were identity crisis, social isolation and stigma, sexual stress, and financial strain. Consequences included treatment dropout and marital strain. Anxiety, depression, and decreased quality of life were identified as both attributes and consequences.

CONCLUSIONS

Synthesized results informed a proposed definition of infertility-related stress. Improved understanding of infertility-related stress allows for measurement development and facilitates recognition of patients in need of additional support, while potentially reducing the impact on the health and well-being of infertile women.

The relationship between stigma, perceived social support and depression in infertile Turkish women undergoing in vitro fertilization-embryo transfer

This study was conducted to determine the relationship between the perceived social support, stigmatization and depression in infertile women and the influencing factors. The study was conducted on 298 infertile women at a private hospital between March and September 2019 using a Personal Information Questionnaire, Infertility Stigma Scale (ISS), Beck Depression Inventory (BDI), and Multidimensional Scale of Perceived Social Support (MSPSS). BDI had a significantly positive correlation with ISS and negative correlation with MSPSS. And MSPSS had a significantly negative correlation with ISS. Infertility leads women to suffer various psychosocial problems. Nurses should be aware of these problems during diagnostic procedures for infertility treatment, which should also include psychiatric counseling.

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.

The relationship between gender perception levels and infertility distress of infertile women in a university hospital, Turkey

Purpose

This study was conducted to analyze the correlation between gender perception and infertility distress of infertile women.

Design/methodology/approach

This was a descriptive-analytical study conducted with 255 women receiving treatment in the in vitro fertilization unit of a medical faculty hospital in Turkey. Study data were collected using sociodemographic questions as well as the Perception of Gender Scale (PGS) and the Infertility Distress Scale (IDS).

Findings

It was found that the PGS mean score was 69.65 and the IDS mean score was 53.1. It was determined that there was a negative, moderate and significant correlation between gender perception and infertility distress levels of women in the infertility treatment process (r = −0.263, p < 0.001).

Originality/value

As a result of the study, a negative, moderate, significant correlation was detected between gender perception and infertility distress.

Medically Defined Infertility Versus Self-Perceived Fertility Problem: Implications of Survey Wording for Assessing Associations with Depressive Symptoms

Objective: To examine how measures of infertility based on medical criteria and based on self-perception relate to depressive symptoms among women with infertility. Background: Survey-based studies of depressive symptoms have used either measures of self-reported infertility based on meeting medical criteria or measures of self-perceived fertility problems, but seldom both. It is, therefore, not known which type of measure is more closely associated with depressive symptoms. Materials and Methods: Using ordinary least-squares multiple regression, this study compares associations between a measure of meeting medical criteria for infertility and a measure of self-perceived fertility problems with a common measure of depressive symptoms. Data come from the National Survey of Fertility Barriers, a population-based survey of 4,711 U.S. women. Results: Both meeting medical criteria for infertility and self-perception were associated with depressive symptoms after controlling for a number of relevant variables, but the coefficient for the self-perception measure was slightly higher than the coefficient for medical criteria. Conclusion: If possible, both medical criteria and self-perception measures should be used in studies of the consequences of infertility for psychosocial outcomes. If only one measure can be used, self-perception of a fertility problem is an acceptable measure.

Stress, stigma, violence experiences and social support of US infertile women

Objectives: Previous studies investigated the physical, psychological and sociological effects of infertility; however, stigma and violence experiences of infertile women haven't yet been studied in the US. The objective of the study is to examine the perceived stress, stigma, violence experiences, and social support of US infertile women and to compare with fertile women in order to understand the effects of infertility on stress levels, violence exposures, and support. Methods: The descriptive, cross-sectional study was conducted with fertile and infertile women who use social media for an online support group. A convenience sample of 786 women completed an online survey. Results: In the study, 41.6% of participants were fertile and 58.4% were infertile. We found infertile women experienced high levels of stigma and moderate stress. One in five infertile women has been exposed to emotional or physical violence. Compared to fertile women, infertile women had significantly higher perceived stress levels and were less likely to experience emotional or physical violence. Conclusion: These findings highlight that infertile women have experienced stigma and high levels of stress in a developed country. They are also exposed to emotional or physical violence, but surprisingly infertile women are less likely to report violence than fertile women.

Anxiety and depression among infertile women: a cross-sectional survey from Hungary

Background

Infertility is often associated with a chronic state of stress which may manifest itself in anxiety-related and depressive symptoms. The aim of our study is to assess the psychological state of women with and without fertility problems, and to investigate the background factors of anxiety-related and depressive symptoms in women struggling with infertility.

Methods

Our study was conducted with the participation of 225 (134 primary infertile and 91 fertile) women, recruited in a clinical setting and online. We used the following questionnaires: Spielberger Trait Anxiety Inventory (STAI-T), Shortened Beck Depression Inventory (BDI) and Fertility Problem Inventory (FPI). We also interviewed our subjects on the presence of other sources of stress (the quality of the relationship with their mother, financial and illness-related stress), and we described sociodemographic and fertility-specific characteristics. We tested our hypotheses using independent-samples t-tests (M ± SD) and multiple linear regression modelling (ß).

Results

Infertile women were younger (33.30 ± 4.85 vs. 35.74 ± 5.73, p = .001), but had significantly worse psychological well-being (BDI = 14.94 ± 12.90 vs. 8.95 ± 10.49, p < .0001; STAI-T = 48.76 ± 10.96 vs. 41.18 ± 11.26, p < .0001) than fertile subjects. Depressive symptoms and anxiety in infertile women were associated with age, social concern, sexual concern and maternal relationship stress. Trait anxiety was also associated with financial stress. Our model was able to account for 58% of the variance of depressive symptoms and 62% of the variance of trait anxiety.

Conclusions

Depressive and anxiety-related symptoms of infertile women are more prominent than those of fertile females. The measurement of these indicators and the mitigation of underlying distress by adequate psychosocial interventions should be encouraged.

An internet forum analysis of stigma power perceptions among women seeking fertility treatment in the United States

Infertility is a condition that affects nearly 30 percent of women aged 25-44 in the United States. Though past research has addressed the stigmatization of infertility, few have done so in the context of stigma management between fertile and infertile women. In order to assess evidence of felt and enacted stigma, we employed a thematic content analysis of felt and enacted stigma in an online infertility forum, Fertile Thoughts, to analyze 432 initial threads by women in various stages of the treatment-seeking process. We showed that infertile women are frequently stigmatized for their infertility or childlessness and coped through a variety of mechanisms including backstage joshing and social withdrawal. We also found that infertile women appeared to challenge and stigmatize pregnant women for perceived immoral behaviors or lower social status. We argue that while the effects of stigma power are frequently perceived and felt in relationships between infertile women and their fertile peers, the direction of the enacted stigma is related to social standing and feelings of fairness and reinforces perceived expressions of deserved motherhood in the United States.

Prevalence and predictors of major depressive disorder for fertility treatment patients and their partners

OBJECTIVE

To examine the prevalence and predictors of major depressive disorder (MDD) for women and their partners during the course of fertility treatment.

DESIGN

Prospective cohort study during an 18-month period. Participants completed interviews and questionnaires at baseline and at 4, 10, and 18 months of follow-up.

SETTING

Five community and academic fertility practices.

PATIENT(S)

A total of 174 women and 144 of their male partners who did not have a successful child-related outcome during the time frame of the study.

INTERVENTION(S)

No interventions administered.

MAIN OUTCOME MEASURE(S)

The MDD was assessed using the Composite International Diagnostic Interview Major Depression module, a structured diagnostic interview. Additional variables were assessed with self-report questionnaire measures.

RESULT(S)

Of the women 39.1% and of the men 15.3% met the criteria for MDD during the 18-month course of the study. A binary logistic covariate-adjusted model showed that, for both women and men, past MDD was a significant predictor of MDD during treatment. Past MDD further predicted significant risk for MDD during treatment after controlling for other well-established risk factors (i.e., baseline levels of depression, anxiety, and partner support).

CONCLUSION(S)

The MDD was highly prevalent for fertility treatment patients and their partners. Past MDD predicted risk for MDD during treatment, and it contributed to MDD risk more than other commonly assessed risk factors. This suggests that patients and their partners would benefit from being routinely assessed for a history of MDD before the start of treatment to best direct psychosocial support and interventions to those most in need.

Prospective study of depression and anxiety in female fertility preservation and infertility patients

OBJECTIVE

To prospectively assess anxiety, depression, coping, and appraisal in female fertility preservation (FP) patients compared with infertile patients.

DESIGN

Prospective pre- and post-treatment survey.

SETTING

Academic medical center.

PATIENT(S)

Forty-seven women with cancer (FP patients) and 91 age-matched infertile patients.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Depression, anxiety, coping, infertility-related stress, appraisal of treatment, and medical outcomes.

RESULT(S)

FP patients reported more symptoms of anxiety and depression than infertile patients, but infertile patients' symptoms worsened over time; 44% of FP and 14% of infertile patients' scores exceeded the clinical cutoff for depression before treatment. The interval between surveys and medical treatment data did not predict changes in mood symptoms. Coping strategies and infertility-related stress did not differ between groups, and avoidant coping predicted higher depression and anxiety scores.

CONCLUSION(S)

FP patients reported more anxiety and depression than infertile patients at enrollment in treatment, with more than one-third of FP patients reporting clinically significant depressive symptoms. However, infertile patients' anxiety and depressive symptoms increased across treatment. This increase was not related to time between registration for IVF and oocyte retrieval or the medical aspects of treatment. FP and infertile patients should be provided psychologic consultation before treatment to identify mood and anxiety symptoms and to refer patients for counseling as needed to prevent worsening of symptoms.

Relationship between infertility-related stress and emotional distress and marital satisfaction

The aim of this study was to evaluate the predictive effects of infertility-related stress on psychological distress and marital satisfaction. Structural equation modeling was used to estimate a nonrecursive model hypothesizing the impact of infertility-related stress on both emotional distress and marital dissatisfaction, which were supposed to have a reciprocal influence on each other. The model was estimated using data from a sample of 150 infertile patients (78 males and 72 females). Findings confirmed the predictive effects of infertility-related stress on both emotional and marital distress. However, infertility-related stress was found to have more impact on emotional distress than on marital satisfaction.

Variation in distress among women with infertility: evidence from a population-based sample

BACKGROUND

We examine variation in fertility-specific distress (FSD) and general distress according to different experiences of infertility among 1027 US women who have experienced infertility within the previous 10 years.

METHODS

General distress was measured by a short form of the Center for Epidemiological Studies-Depression. Multiple regression analysis was conducted on self-report data (based on a telephone interview) from a probability-based sample of US women aged 25-45 years. We compare women with infertility who have had a prior pregnancy (secondary infertility, n = 628) to women with infertility with no prior pregnancies (primary infertility, n = 399). We further distinguish between women with infertility who were actually 'trying' to become pregnant (the infertile with intent) with those who met the medical definition of infertile but did not describe themselves as trying to become pregnant (infertile without intent).

RESULTS

Both types of infertility (primary versus secondary) (β = 0.31*) and intentionality (infertile with and without intent) (β = 0.08*) are associated with FSD. These associations persist when we control for resource and demographic variables, life course variables, social support and social pressure variables. General distress does not vary by infertility type or intentionality.

CONCLUSIONS

Results reveal variation in women's recalled experiences of infertility and that FSD is more sensitive to effects of different experiences than general distress. Women with primary infertility who were explicitly trying to become pregnant at the time of the infertility episode stand out as a particularly distressed group. Caregivers should be aware that the emotional needs of women with primary infertility may differ from those with secondary infertility.

Psychometric properties and factor structure of the Fertility Problem Inventory in a sample of infertile women undergoing fertility treatment

OBJECTIVE

to examine the psychometric properties of the Fertility Problem Inventory (FPI) originally developed by Newton et al. (1999); as there are no data concerning the factorial structure of the FPI, a special focus is placed on construct validity through factor analysis.

SETTING

public hospital in Athens, Greece.

DESIGN

a cross-sectional study.

PARTICIPANTS

108 women undergoing fertility treatment with in-vitro fertilisation.

METHODS

the FPI was 'forward-backward' translated from English to Greek. The translated instrument was then administered to a set of infertile women for pilot testing. Principal axis factoring with promax rotation was used to test the factor structure of the FPI. Measures of anxiety State Trait Anxiety Inventory, depression (Center for Epidemiologic Studies--Depression Scale) and mood states Profile of Mood States were used to assess the convergent validity of the FPI. Cronbach's α was used to measure internal consistency of the FPI scales.

FINDINGS

exploratory factor analysis suggested four factors. The majority of relationship and sexual concern items grouped into one solid factor, named 'spousal concern'. The original scales of social concern, need for parenthood and rejection of childfree lifestyle were reproduced after rearranging nine cross-loading items. Construct validity was confirmed by computing correlations between the derived FPI scales and conceptually similar constructions of anxiety, depression and mood states. Internal consistency reliability was satisfactory.

CONCLUSION

the FPI was found to have a relatively stable factor structure and satisfactory reliability, and convergent and discriminant validity. The FPI may enable researchers and clinicians to apply a reliable measure that focuses on various/many dimensions of infertility-related stress.