Psychosocial evaluation in an IVF/GIFT program in Hong Kong

Psychosocial trends in couples prior to commencement of in vitro fertilisation (IVF) treatment

Facing infertility and undergoing fertility treatment can create emotional turmoil in couples' lives. It is essential for fertility therapy providers to assess the coping and communication strategies of couples before treatment in order to provide appropriate support. We performed a two time point (year 2003 & year 2009) cross-sectional study of patients attending our services to undergo in vitro fertilisation. All couples attending the Human Assisted Reproduction Ireland Unit, a tertiary referral academic centre at the Rotunda Hospital, were requested to complete a psychosocial questionnaire before commencing the treatment. The questions assessed couples' understanding of their own infertility, family background and support, relationship traits and stress levels prior to commencing fertility treatment. A total of 180 patients participated in the study. Our findings showed that within a 6-year time span, couples' attitudes have changed significantly. Compared to 6 years ago, couples now have a better understanding of infertility and are seeking treatment quicker. Interestingly, we showed higher stress levels nowadays with fewer couples following routine stress management. We also identified specific gender differences in that women have a more open attitude in discussing infertility and seeking more support from friends and family compared to men.

Should fertilization treatment start with reducing stress?

In the past few decades, new and more efficient techniques to help solve fertility problems have become widely available throughout the developed world. These techniques include hormonal stimulation, ICSI, gamete intra-Fallopian transfer (GIFT) and IVF, and their cost is, on average, considerable. There is substantial initial evidence that the psychological disposition of the parents-to-be influences their fertility and thus the outcome of fertilization techniques. Many fertility treatments include consultation with a psychologist and do try to keep the stress produced by the treatment itself to a minimum, using concurrent therapy. However, the accumulating evidence points to the need to program medical fertility treatment, bearing in mind both chronic and acute stress levels, and to treat for their reduction before commencing the (actual) fertility treatment. There is ample evidence that lower stress levels mean better female and male natural fertility, though there is as yet no conclusive experimental evidence that lower stress levels result in better fertility treatment outcome. However, first reducing stress may diminish the number of treatment cycles needed before pregnancy is obtained, may prepare the couple for an initial failure of treatment or even make the more invasive techniques unnecessary. Primary psychological treatment for trait and state stress, being a less invasive method than IVF, ICSI or GIFT, is to be applied whenever indicated. Also, treatment and therapy to reduce stress, and in so doing enhance fertility, do not provoke the ethical and religious objections raised by infertility treatments.

Female and male lifestyle habits and IVF: what is known and unknown

There is no greater tribute to the importance and efficacy of IVF than the fact that >1 x 10(6) babies have been born to infertile couples since its clinical introduction in 1978. Despite enormous advances regarding the technical aspects of the IVF procedure, the parents' contribution has virtually been ignored when considering aspects that influence success rates. This systematic review focuses on the effects of female and male lifestyle habits (specifically: smoking, alcohol and caffeine use, and psychological stress) on the reproductive endpoints of IVF (i.e. oocyte aspiration, fertilization, embryo transfer, achievement of a pregnancy, live birth delivery, and perinatal outcomes, e.g. low birthweight, multiple gestations). What is currently known in the field of lifestyle habits and IVF? There is compelling evidence that smoking has a negative influence on IVF outcomes, whereas for stress, the evidence is suggestive but insufficient due to the heterogeneity of studies. The evidence for the effects of alcohol and caffeine on IVF is inadequate, and therefore unknown, due to the scarcity of studies.

A prospective study of stress among women undergoing in vitro fertilization or gamete intrafallopian transfer

OBJECTIVE

To evaluate whether baseline or procedural stress during in vitro fertilization (IVF) or gamete intrafallopian transfer (GIFT) affects pregnancy or live birth delivery rates.

DESIGN

Prospective study.

SETTING

Seven clinics in Southern California between 1993 and 1998.

PATIENT(S)

One hundred and fifty-one women completed two questionnaires.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

The number of oocytes aspirated and fertilized, the number of embryos transferred, the achievement of a pregnancy, live birth delivery, and infant outcomes.

RESULT(S)

Positive-affect negative-affect score at baseline negatively influenced the number of oocytes retrieved and embryos transferred. A higher expectation of pregnancy was associated with greater numbers of oocytes fertilized and embryos transferred. At baseline, the risk of no live birth was 93% lower for women who had the highest positive-affect score compared to those with the lowest score. Furthermore, the score on the Infertility Reaction Scale was related to negative outcomes in live birth delivery, infant birth weight, and multiple births. During the time of the procedure, the PANAS and Bipolar Profile of Moods States results were related to the number of oocytes fertilized and embryos transferred; stress did not affect pregnancy or delivery.

CONCLUSION(S)

Baseline (acute and chronic) stress affected biologic end points (i.e., number of oocytes retrieved and fertilized), as well as pregnancy, live birth delivery, birth weight, and multiple gestations, whereas (procedural) stress only influenced biologic end points.

Perceived support and counselling needs in relation to in vitro fertilization

This paper reports findings from a study investigating perceived support and desire for support in a sample of 101 men and 117 women who were consecutive referrals to an in vitro fertilization (IVF) clinic. Both men and women perceived their partners as providing the most support and there were only small gender differences in the extent to which other people were perceived as supportive. There were also only modest gender differences in the types of support participants felt to be desirable and both men and women felt that support would be most desirable after a failed IVF cycle. Both men and women also felt that a routinely provided information booklet about the practical aspects of IVF would improve knowledge of and passage through an IVF cycle. There was a tendency for women who expressed a desire for some form of counselling or support to obtain higher General Health Questionnaire scores. Implications of the results for counselling provision are discussed.

Coping strategies and psychological adjustment of couples presenting for IVF

The study was designed to examine the extent to which the psychological profiles of couples entering an IVF programme were influenced by evidence of previous fertility, the history of fertility investigations, the diagnosis made, and the coping strategies adopted. A sample of 152 couples was administered a number of standardized psychological instruments and a coping strategies questionnaire. They showed little variation from the normative range on the standardized measures. There was little evidence of differences between couples referred for primary or secondary infertility, between those with some evidence of fertility and those with none, or between different diagnostic groups. In relation to coping strategy, for women at least, taking direct action appears to be effective if it is associated with some degree of acceptance of one's position. For males, the picture is less clear, though direct action and acceptance again appear to be effective coping strategies.

Coping: an essential element of nursing

How well a person copes is central in determining his or her well-being, no matter how ill he or she is. Without an accurate appreciation of what coping is and how it may be facilitated, attempts to help patients may be both ineffective and harmful. But the subject is multifaceted and poses many problems for clinicians and researchers alike. This paper attempts to synthesize available knowledge on coping from various disciplines and apply it to life as nurses know it.

Infertility and assisted reproduction

The inability to have children is a considerable cause of human distress. There is little evidence to suggest that the vast majority of infertile couples differ in their premorbid psychological make-up from their fertile contemporaries. There is understandable grief in response to their loss of the ability to have children and in vulnerable people this may be profound. There is little known of the long-term outcome of such couples, but it seems likely that for some it will be a devastating experience that will affect their life-time mental health. There are a large proportion of couples with unexplained infertility, but there is little evidence that this diagnosis is particularly associated with psychological factors, although research continues into possible links between stress and hormones that affect the reproductive system, such as prolactin. Artificial insemination and IVF have particular problems, not only due to conception occurring out of normal sexual intercourse. In artificial insemination using donor sperm the problems of a genetically different father has similarities with the debate about egg donation for IVF. These technical procedures are undoubtedly stressful but generally, as for other treatments, if they are successful the rewards appear to outweigh any misgivings of the couples involved. There is a need for further research as to whether psychological factors are causative in infertility as the absence of any link might indeed be reassuring to couples. We would also benefit from knowing the long-term outcome of couples for whom treatment is not successful.