Life satisfaction of women in early stages of fertility treatment

Mental health in women undergoing gynecological surgery at risk of infertility

Surgery for benign gynecologic conditions may lead to infertility complications. In a cross-sectional study we investigated depressive and anxiety symptoms, Quality of Life (QoL), and coping strategies in women with benign gynecologic conditions undergoing surgical treatment (G1, N = 45) compared with women that did not need surgery (G2, N = 43), through the Patient's Health Questionnaire, the Short Form Health Survey-12 items, the Self-Rating Anxiety State, and the Brief COPE. Statistical analyses showed that women in G1 had significant higher depressive (p=.04) and anxiety (p=.03) symptoms, and lower QoL (p=.01), than did those in G2. Moreover, women with more depressive or anxiety symptoms in both groups were more likely to present maladaptive coping modalities. A careful evaluation of the mental health of women undergoing gynecological surgery at risk of infertility should be included in the care for benign gynecologic conditions, in order to prevent psychosocial distress and alleviate the burden on QoL.

Is perceived inability to procreate associated with life satisfaction? Evidence from a German panel study

Most studies of the psychosocial consequences of infertility have focused on those who seek medical treatment, leaving a research gap regarding the psychosocial consequences of perceived inability to procreate in the general population. Moreover, most studies are cross-sectional and the results are thus likely affected by omitted variable bias. Inspired by aspects of the Theory of Conjunctural Action, this study analysed 10 waves of data from the German Family Panel (pairfam) for women and men using fixed effects panel regression and including time-varying control variables suggested by theory and research. This study found that both women and men experienced lower life satisfaction in years when they perceived an inability to procreate. This association was not affected by the inclusion of relevant time-varying control variables. Furthermore, the association between perceived barriers to procreation and life satisfaction was found to differ depending on life circumstances and gender. Women with partners and men without partners had lower life satisfaction when they perceived an inability to procreate compared with when they did not. Women and men who intended to have a(nother) child had lower life satisfaction when they perceived an inability to procreate compared with when they did not. The association, however, was only significant for men. Somewhat surprisingly, women who perceived an inability to procreate also had lower life satisfaction when they were not intending to have a(nother) child. This study makes an important contribution to research on the psychosocial consequences of perceived infertility, and provides insights into why some people may pursue assisted reproductive technology for family creation.

The associations between infertility-related stress, family adaptability and family cohesion in infertile couples

To explore the association between infertility-related stress, family adaptability and family cohesion in infertile couples and the determinants of infertility-related stress in infertile couples. Fertility Problem Inventory (FPI) and Family Adaptability and Cohesion Evaluation Scales (FACESII-CV) were used to measure the infertility-related stress and family adaptability and cohesion of infertile couples. T-test, ANOVA and multiple comparisons (LSD) were conducted to compare the FPI scores of different demographic characteristics subgroups. Stepwise multivariate linear regression was used to explore the determinants of infertility-related stress. Women had greater global stress than men (P < 0.001). Women scored higher on desired family adaptability, cohesion dissatisfaction and adaptive dissatisfaction than men (P = 0.039, P = 0.036, P = 0.008). FPI scores were higher in men and women who lived in rural (P < 0.001, P < 0.001). Family cohesion and education level was negatively correlated with infertility-related stress in men. Family adaptability and education level was negatively correlated with infertility-related stress in women. Healthcare providers should pay more attention and give more support to infertile couples who lived in rural or with low education level, and provide easier medical accessing for them. Moreover, healthcare providers should value more the family function and family support in intervention of reducing infertility-related stress.

Trajectories and predictors of anxiety and depression amongst infertile women during their first IVF/ICSI treatment cycle

PURPOSE

This study aimed to identify anxiety and depression trajectories of infertile women during first IVF treatment cycle and to examine whether the identified trajectories were associated with baseline psychological predictors, namely fertility-related stress, resilience, and illness perception.

METHODS

A longitudinal prospective study was conducted to assess anxiety and depression using the Chinese version of Self-Rating Anxiety Scale (SAS) and Self-Rating depression Scale (SDS) at four different time points: the day of first IVF/ICSI appointment (baseline/T1), the first day of ovarian stimulation (T2), the one day before oocyte retrieval (T3), and the day of fresh embryo transfer (T4). Final analysis was done on data obtained from 202 infertile women. Latent class growth mixed modeling was carried out to identify anxiety and depression trajectories. Multinomial logistic regressions were conducted to investigate predictors of trajectory membership.

RESULTS

Three different adjustment trajectories were identified amongst infertile women during their first IVF/ICSI treatment cycle. A total of 40.1 and 37.6% of women showed normal levels of anxiety and depression (resilient trajectories), respectively, 45.0 and 43.1% of women had recovery trajectories, and 14.9 and 19.3% of women had chronic anxiety and depression trajectories. Non-resilient trajectories were associated with relatively shorter duration of infertility, higher fertility-related stress, and lower resilience.

CONCLUSION

The results imply that it is possible to identify women in chronic or recovery trajectories on the day of first IVF/ICSI appointment, so that tailored prevention strategies integrated components that attenuate stress appraisal and strengthen resilience should be implemented to target those individuals.

Fertility patients under COVID-19: attitudes, perceptions and psychological reactions

STUDY QUESTION

What are the perceptions of infertility patients and the factors correlating with their psychological distress, following suspension of fertility treatments during the Corona Virus Disease-19 (COVID-19) pandemic?

SUMMARY ANSWER

Most patients preferred to resume treatment given the chance regardless of background characteristics; higher self-mastery and greater perceived social support were associated with lower distress, while feeling helpless was associated with higher distress.

WHAT IS KNOWN ALREADY

Infertility diagnosis and treatment frequently result in significant psychological distress. Recently published data have shown that clinic closure during the COVID-19 pandemic was associated with a sharp increase in the prevalence of anxiety and depression among infertile patients undergoing IVF and was perceived as an uncontrollable and stressful event. Personal resources play an important protective role in times of crisis, helping reduce levels of distress.

STUDY DESIGN, SIZE, DURATION

This cross-sectional questionnaire study included patients whose fertility treatment was suspended following the COVID-19 pandemic, in a tertiary hospital. The survey was delivered to 297 patients within 12 days at the beginning of April 2020.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The self-administered questionnaire included items addressing: (i) patients' demographic characteristics, (ii) anxiety related to COVID-19 infection risk and level of social support, (iii) patients' perceptions of the new guidelines and description of subsequently related emotions and (iv) two validated scales assessing levels of emotional distress and self-mastery. Multivariate analysis was conducted to assess factors alleviating or increasing emotional distress during the COVID-19 pandemic.

MAIN RESULTS AND THE ROLE OF CHANCE

There were 168 patients who completed the survey, giving a response rate of 57%. Study variables in the regression model explained 38.9% of the variance in psychological distress experienced by patients during treatment suspension. None of the background characteristics (e.g. age, marital status, parity, economic level or duration of treatments) had a significant contribution. Feeling helpless following the suspension of treatments was associated with higher distress (P < 0.01). Higher self-mastery and greater perceived social support were associated with lower distress (P < 0.01). Despite the ministry of health's decision, 72% of patients wished to resume treatment at the time of survey.

LIMITATIONS, REASONS FOR CAUTION

This was a cross-sectional study, thus information about patients' characteristics prior to the COVID-19 pandemic was not available. The length and implications of this pandemic are unknown. Therefore, the ability to draw conclusions about the psychological consequences of the crisis is limited at this point of time.

WIDER IMPLICATIONS OF THE FINDINGS

Personal resources play an important protective role in times of crisis, helping to reduce levels of distress. Study findings suggest that attention should be paid to strengthening and empowering patients' personal resources together with directly confronting and containing feelings of helplessness. In line with the European Society for Human Reproduction and Embryology (ESHRE) guidelines, especially at this time of high levels of distress, it is imperative to offer emotional support to reduce stress and concerns. Furthermore, as the pandemic is stabilizing, resumption of treatment should be considered as soon as appropriate according to local conditions.

STUDY FUNDING/COMPETING INTEREST(S)

This study was funded by the IVF unit of the Shamir Medical Center. All authors declare no conflicts of interest.

TRIAL REGISTRATION NUMBER

N/A.

Is infertility resolution associated with a change in women's well-being?

STUDY QUESTION

Is giving birth associated with improved subjective well-being among involuntarily childless women?

SUMMARY ANSWER

Resolution of infertility is associated with increased life satisfaction and self-esteem, but not with a decrease in depressive symptoms.

WHAT IS KNOWN ALREADY

Cross-sectional data and studies of treatment-seekers show that infertility is associated with lower subjective well-being. Childless women with infertility tend to report lower subjective well-being than women who experience secondary infertility, but a prospective study using a random sample of involuntarily childless women over time has not previously been conducted.

STUDY DESIGN, SIZE, DURATION

The sample for the current study includes all women without children who met medical criteria for infertility or perceived a fertility problem (N = 283) at baseline and who were interviewed in both waves (3 years apart) of the National Survey of Fertility Barriers (NSFB), in a random-digit dialing telephone survey. It is therefore possible to explore here whether there are differences in the association of infertility resolution and subjective well-being among women who do and do not perceive themselves as having a fertility problem.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Depressive symptoms (as measured by the Center for Epidemiologic Studies-Depression Scale), self-esteem (as measured by a modified version of the Rosenberg Self-esteem Scale) and life satisfaction (as measured by a modified version of the Satisfaction with Life Scale) were assessed for all 283 participants at both waves. For all three variables, change scores of 47 involuntarily childless women who resolved their infertility through a live birth were compared to the scores for the 236 women who remained childless. A number of variables shown to be associated with subjective well-being among infertile women were included as controls.

MAIN RESULTS AND THE ROLE OF CHANCE

No relationship between infertility resolution and change in depressive symptoms was observed (b = -0.04; P > 0.05). Involuntarily childless women who resolved their infertility improved in self-esteem (b = 0.74; P < 0.01) and life satisfaction (b = 1.06; P < 0.01).

LIMITATIONS, REASONS FOR CAUTION

Women were measured at only two time points. Only 47 women had a live birth between waves. While it is common practice to make causal interpretations based on panel data, such interpretations should be made with caution. In addition, the NSFB was conducted in the USA where medical expenditures are high and most fertility treatment expenses are not covered by insurance. Thus it may not be possible to generalize the findings to other modern industrialized societies.

WIDER IMPLICATIONS OF THE FINDINGS

Knowing that resolution of infertility is associated with improved subjective well-being is important for infertile couples and infertility professionals alike.

STUDY FUNDING/COMPETING INTEREST(S)

This research was supported in part by NICHD grant R01-HD044144 and NIGMS grant P20-GM109097 from the National Institutes of Health. The authors have no competing interests.

Change in Motherhood Status and Fertility Problem Identification: Implications for Changes in Life Satisfaction

OBJECTIVE

To determine whether the association between changes in life satisfaction and becoming a mother (or not) depends on fertility problem identification status.

BACKGROUND

Evidence and symbolic interactionist theory suggest that, for women who initially perceive a fertility barrier, gaining the valued identity "mother" should be associated with increases, and continuing to face a blocked goal (i.e. not becoming a mother) should be associated with decreases in life satisfaction.

METHOD

This study used the nationally representative two-wave National Survey of Fertility Barriers to conduct a change-score analysis with chained multiple imputation (MICE). The focal dependent variable was change in life satisfaction. Focal independent variables were Wave 1 life satisfaction, fertility problem identification status, and birth between waves, controlling for stability and change in relationship status, talking to a doctor about how to get pregnant, religiosity, social support, importance of parenthood, importance of leisure, importance of work success, and economic hardship.

RESULTS

Among women who perceived a fertility problem at both waves, becoming a mother was associated with increased life satisfaction and not becoming a mother was associated with decreased life satisfaction. Women who gained or lost a fertility problem perception between waves but did not have a live birth experienced a gain in life satisfaction between waves, suggesting the relevance of the duration of fertility problem perception for change in life satisfaction.

The effects of an expressive writing intervention on pregnancy rates, alexithymia and psychophysical health during an assisted reproductive treatment

Objective: World Health Organization reported that in developed countries one in four couples experience infertility with serious implications for the psychophysical well-being. Aim of this study was to evaluate the effects of Pennebaker's writing technique on pregnancy rates, alexithymia and psychophysical health during an assisted reproductive treatment (ART).Method: 91 women admitted for an ART were randomly divided into two groups: an experimental one (n = 46), where women wrote about their thoughts and emotions concerning the infertility experience, and a control group (n = 45) where women did not write. All subjects completed a socio-demographic questionnaire, the 20-item Toronto Alexithymia Scale and the Symptoms Checklist-90-R before and after the writing sessions.Results: A significant difference in pregnancy rates between the experimental group (n = 13) and the control group (n = 5) was found (χ² = 4.216; p < .04). A significant difference was also found between women who participated in the study (experimental + control= 91) and women who declined to participate, in the direction of more ART successes (n = 18 vs. n = 0) in the group of women who participated (χ² = 10.17; p < .01).Conclusions: The findings support the usefulness of the writing technique during ART in promoting treatment success.

Contributors to Women's Perceived Stress at the Start of Assisted Reproductive Technology

Clinicians are often called upon to treat the stress that accompanies Assisted Reproductive Technology (ART). In this study, we sought to examine the contribution of the internal resources of meaning in life and attachment style and the interpersonal resource of self-disclosure to her mother to a woman's level of perceived stress upon commencement of ART. In addition, we examined the association between age and perceived stress. The sample consisted of 180 Israeli women (106 aged 20-34; 74 aged 35-44) who completed a series of self-report questionnaires after their initial meeting with a fertility specialist. Regression analysis indicated that older age, lower attachment anxiety, higher perception of meaning in life, and greater self-disclosure to the mother were related to lower levels of perceived stress. Self-disclosure was also found to mediate the association between avoidant attachment and stress. The study highlights the importance of a woman's personal and interpersonal resources for reducing the experience of stress in the early stages of ART. The results have practical implications for the development of professional interventions seeking to enhance these resources among women embarking on fertility treatment.