Emotional aspects ofin vitrofertilization procedures: Review

The Relationship between the Infertility Specialist and the Patient during the COVID-19 Pandemic

The doctor-patient relationship is fundamental in the treatment of infertility, due to the emotional implications of fertilization procedures. However, insufficient data are available specifically for this relationship. The general objective of the study is to establish the associations between the fundamental concepts that define the doctor-patient relationship: communication, empathy, trust, collaboration, compliance and satisfaction. A cross-sectional study was conducted between May and June 2020 and followed the methods of a quantitative analysis, collecting the data using questionnaires. The research plan was specific to path analysis with the mediation effect, in which the hypotheses were tested. The research group consisted of 151 women diagnosed with infertility, voluntarily recruited through online support communities. Findings demonstrate that affective empathy mediates the relationship between communication and trust in the doctor. In conclusion, this study draws attention to the importance of basic concepts in the relationship of infertility specialists with infertile patients. Thus, it is necessary for health care providers in assisted human reproduction to participate in programs for the continuous training of empathic communication skills, given the sensitivity of this diagnosis.

Women's emotional adjustment to IVF: a systematic review of 25 years of research

This review provides an overview of how women adjust emotionally to the various phases of IVF treatment in terms of anxiety, depression or general distress before, during and after different treatment cycles. A systematic scrutiny of the literature yielded 706 articles that paid attention to emotional aspects of IVF treatment of which 27 investigated the women's emotional adjustment with standardized measures in relation to norm or control groups. Most studies involved concurrent comparisons between women in different treatment phases and different types of control groups. The findings indicated that women starting IVF were only slightly different emotionally from the norm groups. Unsuccessful treatment raised the women's levels of negative emotions, which continued after consecutive unsuccessful cycles. In general, most women proved to adjust well to unsuccessful IVF, although a considerable group showed subclinical emotional problems. When IVF resulted in pregnancy, the negative emotions disappeared, indicating that treatment-induced stress is considerably related to threats of failure. The concurrent research reviewed, should now be underpinned by longitudinal studies to provide more information about women's long-term emotional adjustment to unsuccessful IVF and about indicators of risk factors for problematic emotional adjustment after unsuccessful treatment, to foster focused psychological support for women at risk.

Psychosocial aspects of surrogate motherhood

This review addresses the psychosocial research carried out on surrogacy triads (surrogate mothers, commissioning mothers and offspring) and shows that research has focused on a number of specific issues: attachment and disclosure to surrogate offspring; experiences, characteristics and motivations of surrogate mothers; and changes in profiles of the commissioning/intended mothers. Virtually all studies have used highly selected samples making generalizations difficult. There have been a notable lack of theory, no interventions and only a handful of longitudinal studies or studies comparing different populations. Few studies have specifically questioned the meaning of and need for a family or the influence and impact that professionals, treatment availability and financial factors have on the choices made for surrogate and intended mothers. Societal attitudes have changed somewhat; however, according to public opinion, women giving up babies still fall outside the acceptable remit. Surrogate and intended mothers appear to reconcile their unusual choice through a process of cognitive restructuring, and the success or failure of this cognitive appraisal affects people's willingness to be open and honest about their choices. Normal population surveys, on the contrary, are less accepting of third party reproduction; they have no personal need to reconsider and hence maintain their original normative cognitively consonant state.

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.

In vitro fertilization: a long-term follow-up after treatment failure

There is a considerable body of psychological research on women presenting for in vitro fertilization (IVF), but relatively little on the long-term adjustment of such women after unsuccessful treatment. This study examined the adjustment (4--9 years after treatment) of a sample (n = 76) of women whose treatment had failed. At follow-up, it was found that eight (10.53%) of the women had conceived naturally and 16 (21.05%) had become adoptive parents. In comparison with population norms, the women who had not subsequently conceived or adopted (n = 52) were found to rate themselves as more highly stressed (P < 0.001), but rated themselves as higher in self-esteem (P < 0.001). However, when women who remained childless after unsuccessful IVF were compared with those who subsequently conceived or adopted, the former group rated themselves as more stressed (P < 0.05), more depressed (P < 0.001) and with a lower satisfaction with life (P < 0.005) and lower self-esteem (P < 0.05). Women who wished to adopt but were unable to do so made a major contribution to this negative pattern. The study indicates that infertility long after failed IVF treatment contributes to psychological dysfunction. It highlights the need to prepare women better for treatment failure and to ensure appropriate counselling is available when further IVF treatment is no longer appropriate.

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.

Factors influencing the decision to use or discard cryopreserved embryos

BACKGROUND

Couples' reasons for discarding supernumerary fertilized cryopreserved embryos and gender differences in attitudes toward the frozen embryos were investigated among Swedish couples undergoing in vitro fertilization (IVF) at a private clinic. At the time of the study Swedish law stipulated that couples could keep their frozen embryos for a maximum of one year, with the possibility of an extension based on individual requests.

METHODS

A questionnaire with structured and unstructured questions was sent to 124 women and 124 men who had entered the IVF treatment and obtained supernumerary embryos from 1 January 1994 to 1 March 1995. Eighty-two women and 74 men completed the questionnaire.

RESULTS

After a mean storage time of 25.3 (+/-11.0) months 22 (26.8%) of the responding couples had their embryos discarded. The reasons were mainly practical, such as a positive outcome of IVF and a legally too short storage time. Comparisons between women and men showed that fewer women (13;17.6%) than men (20;27%) had been uncertain during the IVF treatment about using the frozen embryos at a later date and that men more often than women expressed anxieties about possible effects of the freezing procedure on the potential child (p=0.009).

CONCLUSION

A positive outcome of the original IVF treatment and a short maximum legal time of cryopreservation were the most common reasons why couples discarded their embryos. The men more often than women expressed anxieties about possible effects on a potential child. The results emphasize the need for giving detailed information to the couples about cryopreserved embryos and children born by this method.

Psychosocial adjustment to unsuccessful IVF and GIFT treatment

Twenty-one couples for whom in vitro fertilisation (IVF) or GIFT treatment failed were followed-up 15-30 months after treatment and compared with 20 couples for whom IVF had been successful. Current mental health status, quality of life and marital adjustment were assessed via standardised questionnaires. In addition, couples' experiences of IVF/GIFT treatment were explored via a semi-structured interview. Questionnaire results showed that unsuccessful IVF/GIFT recipients cannot be distinguished from general population norms. However, these couples reported more emotional distress relative to those whom treatment had worked and females in particular indicated a lower quality of life. Couples who had at least one child prior to IVF/GIFT treatment tended to show greater emotional distress at follow-up. Both groups gave similar accounts of the positive and negative aspects of IVF/GIFT treatment, but the unsuccessful group felt less supported by the IVF Unit staff and were less satisfied with the counseling they received. The data indicate that post-treatment counseling may be particularly important for facilitating positive reconstructions of the IVF experience when treatment is unsuccessful.

What is stressful about in vitro fertilization?

The present work was designed to explore whether psychological stress is more related to concerns about the actual physical pain or fear of treatment during in vitro fertilization. Analysis of data for 12 middle-class women from Iran showed that the greatest psychological stress during treatment was associated with worries about the outcome of different stages of treatment rather than fear and pain of the actual procedure.

Prime factors for seeking infertility treatment amongst Iranian patients

This paper reports a survey of prime factors for seeking infertility treatment amongst 14 Iranian couples and discusses the implications of the findings in relation to issues related to infertility treatment and the need for comparative research on patients from diverse socioeconomic and cultural backgrounds.