Psychosocial characteristics of infertile couples: a study by the 'Heidelberg Fertility Consultation Service'

Partnership and relationship happiness in endometriosis related chronic pelvic pain: a multicenter case-control study

Introduction

Partnership is an important resource in dealing with endometriosis related chronic pain. Hence, our objective was to assess partnership in the context of endometriosis and its symptoms, considering the perspectives of both individuals involved.

Methods

The study was designed as a multi-center matched case-control study in Switzerland, Germany and Austria. Altogether 381 women with surgically/histologically confirmed endometriosis and 381 control women, 250 male partners of endometriosis-affected women and 229 of control women were evaluated. Partnership quality, partnership happiness, separation thoughts, and areas of conflict were evaluated through the Partnership Questionnaire and a validated list of conflict areas.

Results

Quality of partnership was rated as high by 60.1% of the women with endometriosis and 66.7% of the control women, as well as by 45.8 and 50.2% of their respective partners. Women with endometriosis mentioned separation thoughts, mostly related to sexual satisfaction, more often (34.9%/28.3%) and experienced more partnership-related conflicts than control women. Chronic pain, dyspareunia, dissatisfaction with sexuality, fatigue, and infertility were significantly associated with partnership conflicts. Fatigue and infertility but not pain experiences were related to lower partnership quality. Male partners in both groups reported separation thoughts equally often. In men, a high intensity of pain experienced by their partner was associated with reduced partnership happiness.

Conclusion

Given the significance of partnership in dealing with chronic diseases and the connection between symptoms of endometriosis and a decrease in partnership quality, it is essential to incorporate strategies that alleviate the negative impacts on relationships for both partners into medical support.

Clinical trial registration

identifier NCT02511626.

Lay understanding and experience of sexual intercourse among couples with infertility undergoing an assisted reproduction technology program: A qualitative study

Aim

To explore the perception and lay understanding of sexual intercourse and sexual life experiences among infertile couples before, during, and after undergoing an assisted reproduction technology (ART) program.

Method

The participants of this descriptive qualitative study were Indonesian couples with infertility who underwent an ART program. Semi-structured interviews were conducted between September and December 2022, and the participants' responses were recorded. Data were analyzed using a step-by-step analysis based on Braun's qualitative analysis. The study was reported based on the Consolidated Criteria for Reporting a Qualitative Research (COREQ) Checklist.

Results

Fifty participants were included, and five themes were developed before and two themes during or after the ART program. The couples' knowledge varied as they experienced sexual intercourse at different periods, such as before, during, and after the ART program. Many participants reported that ART affected their emotions and mood, leading to decreased desire to engage in sexual intercourse. However, some used sexual intercourse as a basis for creating optimism and confidence in having offspring. Furthermore, couples perceived that the purpose of sexual intercourse is not only to have offspring but also to improve communication, promote intimacy, and express affection. In contrast, some perceived the ART program as time consuming, preventing them from engaging in sexual activities. However, not all couples considered sexual activity solely as a means of procreation. They concluded that sexual behavior is not only determined by genetics.

Conclusion

Couples who underwent the ART program regardless of its effectiveness were aware that sexual interaction is not only for having children but also for preserving harmony and familial connection.

Evaluation of infertility counselling in Germany

PURPOSE

This paper reports on the first evaluation of infertility counselling in Germany.

METHODS

Sixty-nine infertility counsellors provided feedback via 524 survey sheets and 182 questionnaires were filled in by clients.

RESULTS

The results show a high level of satisfaction on behalf of the clients. They valued the emotional support, information, and exploration of family-building options with and without medical assistance and the counsellors' expertise. During counselling, coping with the emotional burden of infertility was an important issue, but in more than half of all counselling sessions, future parental issues were addressed. The group of clients seeking support can be described to be very heterogeneous, and counselling issues comprise a wide range of aspects.

CONCLUSIONS

This piece of research suggests that the following issues need to be considered to improve infertility counselling. Better integration of counselling in infertility clinics, more awareness for infertility counselling for other medical and non-medical professions Better funding for counselling so that its uptake is not dependent upon the financial resources of clients Awareness for new groups of clients and counselling issues such as single and transgender individuals, co-parenting families There is a need for more research and the development of counselling concepts.

Systematic Review: Risk Factors of Anxiety, Depressiveness, and (Lack of) Social Support in Women and Men Prior to Assisted Reproduction

This review provides a systematic overview of the state of knowledge to date of psychosocial risk factors with a focus on anxiety, depressiveness, and (lack of) social support among involuntarily childless women and men prior to assisted reproduction. The databases PubMed, PubPsych, PsycINFO-Ebsco, and Web of Science were searched for relevant publications in English or German, and finally a total of 20 publications were included in the systematic review. Of these, 18 studies focused on depressiveness, 15 studies focused on anxiety, and 9 studies focused on social support. Half of the studies included both men and women, while the other half included only women. Due to the large heterogeneity of the study results as well as limitations, no clear conclusions can be drawn regarding a difference between the risk profiles of men and women with an unfulfilled desire to have children. However, it has been shown that infertile couples or women experience higher levels of stress in the form of depressiveness and anxiety compared to fertile participants. Furthermore, it was found that social support, regardless of gender difference, within the couple and from family and friends may be associated with a lower risk for depressiveness and anxiety.

A Systematic Review and Meta-analysis of the Psychiatric Morbidities and Quality of Life Differences Between Men and Women in Infertile Couples

Infertility is often associated with diverse psychiatric morbidities and quality of life impairments. Hence, this meta-analysis aimed to compare stress, depression, anxiety and quality of life (QoL) among infertile men and women. We retrieved the relevant articles from multiple databases. For the statistical analyses, we used Comprehensive Meta-Analysis software v. 3.7 (Biostat Inc., Englewood, NJ). Standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated and displayed in forest plots. Among the 4123 articles identified, 35 studies met the inclusion criteria. Our results revealed that stress, depression, and anxiety were higher in infertile women compared to men. Similarly, infertile women presented a lower QoL than infertile men. Subgroup analysis revealed that the assessment tool used, study design, and geographical origin were a source of heterogeneity. This meta-analysis showed that psychological disturbances were higher in infertile women compared to men. Physicians need to consider this difference to enable couples to better understand and support each other.

Quality of Life among Couples with a Fertility Related Diagnosis

Fertility-related stress can negatively impact infertile couples' quality of life (QoL). Most previous studies have concentrated on the effects of stress and infertility on individual persons, especially women, though infertility affects the QoL of both spouses. Our research aimed to investigate the roles of infertility and stress in couples' quality of life as a single unit. The research sample consisted of 202 spouses, i.e., 101 couples, with a mean age of 39.5 years (SD = 4.9 years) undergoing fertility treatment at Athens Naval Hospital-Assisted Reproduction Unit. Data collection was completed via self-administered questionnaires: the FertiQoL International Questionnaire for measuring the quality of life in infertility and The Demographic Information and Medical History Questionnaire. Data collection was conducted between January and November 2022. Quantitative variables are expressed as mean values (standard deviation) and as median interquartile range, and qualitative variables are expressed as absolute and relative frequencies. Pearson's (r) and Spearman's (rho) correlations coefficients were used to explore the association of two continuous variables. Multiple linear regression analysis was used with dependence on the Ferti-QoL's subscales. The regression equation included terms for participants' demographics and information from their medical history. Adjusted regression coefficients (β) with standard errors (SE) were computed from the results of the linear regression analyses. All reported p values are two-tailed. Statistical significance was set to p < 0.05, and analyses were conducted using SPSS statistical software (version 22.0). We found that greater anxiety and depression were significantly associated with worse quality of life. Additionally, quality of life, according to Ferti-QoL, was significantly worse in women, participants with a high level of education, those with greater depressive symptoms, and those with greater state scores. Findings of this study highlight the need for implementing interventions of supportive care methods, counseling, stress reduction methods, and improving the fertility-related quality of life of infertile couples.

The Relationship between Attachment, Dyadic Adjustment, and Sexuality: A Comparison between Infertile Men and Women

Infertility impacts several life dimensions. Among them, sexuality is particularly affected; yet studies have mainly focused on infertile women. We aimed to explore infertile men's and women's experiences in sexual satisfaction, internal control, and anxiety, and the relationship between attachment, dyadic adjustment, and sexuality. The sample consisted of 129 infertile people (47.3% females, 52.7% males, Mage = 39 years) who fulfilled an ad hoc questionnaire, the Multidimensional Sexuality Questionnaire (MSQ), the Experiences in Close Relationship-Revised (ECR-R), and the Dyadic Adjustment Scale (DAS). We found a significant effect of type of infertility and infertility factors on sexual anxiety only in infertile men. As regards infertile women, dyadic adjustment predicted sexual satisfaction, anxious attachment decreased sexual internal control, and avoidant attachment reduced sexual anxiety. As regards infertile men, high dyadic adjustment increased sexual satisfaction and a high avoidant attachment predicted high levels of sexual internal control. There was no relationship between attachment, dyadic adjustment, and sexual anxiety for infertile men. From the results, it emerges how important is to consider both dyadic adjustment and attachment in studying how infertility impacts women's and men's lives.

Sexual dysfunction and disorders as a consequence of infertility: a systematic review and meta-analysis

BACKGROUND

Sexuality has a key impact on quality of life and on reproductive health. Infertility often results in sexual dysfunction. Despite this close association, addressing sexuality is not a standard component of infertility counselling, especially since in most countries sexual medicine is not a core element of specialist training. Even today, many doctors and patients consider discussing sexuality to be more challenging than other aspects of reproductive medicine. The present review addresses the complex consequences of infertility on sexuality.

OBJECTIVE AND RATIONALE

Our goals were: (i) to identify the prevalence of sexual problems resulting from infertility, (ii) to evaluate characteristics of sexual difficulties and disorders resulting from infertility and (iii) to analyse factors involved in the complex association between sexual problems and infertility.

SEARCH METHODS

A systematic search for publications containing keywords related to sexual disorders and infertility was performed via PubMed, Web of Science and Psyndex. A total of 170 manuscripts published between January 1966 and April 2021 were identified after verification of inclusion and exclusion criteria. The reference lists in these manuscripts were searched for further relevant literature. Studies were reviewed for quality-related methodological details.

OUTCOMES

Couples diagnosed with infertility have an increased risk of sexual disorders. Loss of sexual desire and erectile dysfunction are among the most frequent sexual disorders resulting from infertility. Currently available literature reflects only fragmentarily the complexity of the diverse interactions. Sexuality plays out against the backdrop of interactions among personal, cultural, infertility-related and sexuality-related factors. Considering this complexity, it is crucial to evaluate individual profiles as well as partnership interactions to avoid a negative impact of infertility on a couple's sexual life.

WIDER IMPLICATIONS

Identifying sexual disorders as relevant considerations in the context of infertility and exploring their impact during the entire course of diagnosis and treatment constitute an important contribution to comprehensively care for the couples concerned. Counselling should focus on preventing the onset and aggravation of sexual disorders. As sexuality represents a major component of quality of life and of partnership, such support may improve not only the current overall wellbeing but also the chances of a satisfactory long-term partnership and family life.

Changes in Life Satisfaction in Couples after Successful In vitro Fertilization and Natural Pregnancy

BACKGROUND

Previous research suggested reduced well-being and quality of life in couples with an unfulfilled desire to have a child. However, changes in psychological variables in infertile couples after successful in-vitro fertilization (IVF) have been scarcely investigated.

PURPOSE

This prospective study explored changes in life satisfaction, stress burden and habitual worry related to the birth of a child in couples undergoing IVF, and in those experiencing natural pregnancy.

METHODS

In total, 77 couples with successful IVF and 50 couples with natural pregnancy completed the Life Satisfaction Questionnaire, Perceived Stress Questionnaire and Penn State Worry Questionnaire; data were recorded before pregnancy (baseline) and 6 and 12 months after childbirth. Multi-level models were applied for data analysis.

RESULTS

Couples with IVF reported lower life satisfaction, and higher stress burden and worry, than those with natural pregnancy at baseline. Moreover, they showed a steep increase in life satisfaction at 6 and 12 months after childbirth, and decreased stress and worry. In couples with natural pregnancy, life satisfaction scores decreased, and those of stress and worry increased, at month 6 after childbirth and returned to initial state at month 12.

CONCLUSIONS

The group difference at baseline underlines the psychosocial burden of infertility. However, the increase in life satisfaction and decreases in stress and worry suggest that the burden is lessened after the birth of a child. The changes in couples with natural pregnancy reflect the impact of the typical challenges posed by childbirth and successful readjustment during the first year of the child´s life.

The needs of subfertile couples continuing to attempt natural conception: in-depth interviews

STUDY QUESTION

What are the experiences and the support and sexual advice needs of subfertile couples continuing to attempt natural conception after the diagnostic fertility work-up?

SUMMARY ANSWER

Exploration of the experiences of couples showed that couples would have appreciated fertility clinic staff embedding expectant management into the fertility clinic trajectory, supportive staff with female and male patient interactions and advice on common experiences of peers and on managing their lifestyle, distress and subfertility-related sexual challenges.

WHAT IS KNOWN ALREADY

Dutch and British professional guidelines advise newly diagnosed subfertile couples with a 'good prognosis' to continue to attempt natural conception and do not require fertility clinic staff to interact with patients. Fertility clinic staff and subfertile couples struggle to follow these guidelines as they feel an urgent need for action. Subfertile couples might benefit from sexual advice, as subfertility is negatively associated with sexual functioning, which is important for natural conception.

STUDY DESIGN SIZE DURATION

Twelve one-time in-depth interviews (2015-2017) were conducted with 10 heterosexual couples and 2 women whose partners did not participate, then the interviews were subjected to inductive content analysis, reaching inductive thematic saturation.

PARTICIPANTS/MATERIALS SETTING METHODS

The 22 interviewees had experienced 3-18 months of expectant management after their diagnostic fertility work-up in a Belgian or a Dutch tertiary fertility clinic. The face-to-face in-depth interviews explored positive and negative experiences and unmet needs. The transcribed interviews were subjected to inductive content analysis, by two researchers discussing initial disagreements.

MAIN RESULTS AND THE ROLE OF CHANCE

Couples would appreciate fertility clinic staff embedding expectant management in the fertility clinic trajectory, by starting off with reassuring couples that their very thorough diagnostic fertility work-up demonstrated their good chance of natural conception, and by involving couples in deciding on the duration of expectant management and by planning the follow-up appointment after expectant management up front. Couples had encountered sexual challenges during expectant management and had an interest in sexual advice, focused on increasing pleasure and partner bonding and preventing the rise of dysfunctions. The couples agreed that a (secured) website with evidence-based, non-patronizing text and mixed media would be an appropriate format for a novel support programme. Couples were keen for interactions with fertility clinic staff which addressed both partners of subfertile couples. Couples also valued advice on managing their lifestyle and distress and would have liked information on the experiences of their peers.

LIMITATIONS REASONS FOR CAUTION

Recall bias is plausible given the retrospective nature of this study. This explorative interview study was not designed for examining country or gender differences in experiences and needs but it did generate new findings on inter-country differences.

WIDER IMPLICATIONS OF THE FINDINGS

Rather than simply advising expectant management, fertility clinics are encouraged to offer couples who continue to attempt natural conception after their diagnostic fertility work-up, supportive patient-staff interactions with advice on common experiences of peers and on managing their lifestyle, distress and sexual challenges related to subfertility.

STUDY FUNDING/COMPETING INTERESTS

Funded by Flanders Research Foundation and the University of Amsterdam. There are no competing interests.

TRIAL REGISTRATION NUMBER

N/A.

Perdas, Luto e Sofrimento Mental em Mulheres no Climatério

Este trabalho tem por objetivo discutir que a maior incidência de adoecimento mental no climatério decorre principalmente das perdas experimentadas nesta etapa da vida. Para cumprir este objetivo, recorremos a uma análise qualitativa de viés psicanalítico, com base na experiência de pesquisadores envolvidos em um estudo transversal, com 130 mulheres climatéricas, com idade entre 45 e 65 anos. As principais queixas observadas foram organizadas em grupos por similaridade temática. Observou-se que, no período do climatério, o luto se instala por diferentes perdas percebidas pelas mulheres. A maioria dessas perdas está relacionada a questões de estética, de fertilidade, projeto de vida e as perdas sociais vivenciadas. Concluímos que o adoecimento mental observado no climatério pode ser o sintoma que se forma para denunciar um contexto de perdas. A compreensão dessas perdas e da instalação de um processo de luto pode permitir um olhar mais humano e cuidado mais eficiente.

Prevalence and correlates of infertility related psychological stress in women with infertility: a cross-sectional hospital based survey

Background

Psychological stress is commonly found among infertile women. Untreated stress can affect negatively the success of infertility treatment. Most of the available knowledge is generated from developed countries and is largely based on women undergoing In vitro fertilization (IVF) treatment. However, very little is known on infertile women from Ethiopia including other countries in East Africa. The aim of this study was to determine the prevalence of psychological stress and possible demographic-clinical correlates in Ethiopian women suffering from infertility.

Method

This cross sectional descriptive correlation study was conducted from May to August, 2021 involving 96 women undergoing a non-IVF treatment for infertility at Gandhi Memorial and Tikur Anbessa hospitals. The sampling was continuous and based on inclusion criteria that include infertility duration of a minimum one year, female sex and Ethiopian nationality. Data on Infertility related stress was collected using the Copenhagen Multi‐Centre Psychosocial Infertility-Fertility Problem Stress questionner administered by an interviewer. The socio demographic and clinical factors were collected using Amharic version of structured interviewer administered questionnaire and chart review. The analysis of relationship between infertility related stress and background variables was done with an independent sample t-test or one-way ANOVA statistics supplemented with effect size assessment.

Results

The prevalence of infertility related stress was overall 92.71% (95% CI, 87–98%). The personal, marital, and social subdomain mean scores (SD) were 2.74 (.80), 1.54 (.81) and 1.90 (.80), respectively. Infertility related stress was higher for those women who were: aged above 35, living in a cohabitation marital type, has no living children, and with 4–6 years duration of infertility (all P < 0.05). Whereas, there was insufficient evidence to suggest that infertility related stress varies by education, income, knowledge of cause of infertility or history of past treatment (all P > 0.05).

Conclusions

The prevalence of psychological stress among Ethiopia women having infertility was very high. The results provide preliminary evidence that infertility related stress is associated with age, marital status, motherhood status and duration of infertility. Responsible bodies need to avail psychological screening and services prioritizing women at higher risk of developing stress.

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.

Importance of Personality Factors in Determining the Psychological Consequences of Infertility: A Systematic Review

BACKGROUND AND PURPOSE

The diagnosis of infertility not only involves biological but the psychosocial links have also been established. Individual difference variables, such as personality and temperament have been found playing prominent role in modifying the psychological and biological aspects of infertility. This systematic review aimed to examine evidence-based research on the role of personality traits in determining vulnerability to stress in infertility, understand the gender-based differences, and deliver suggestions for future researches.

METHOD

The search for studies relating to the variables was accomplished using various electronic databases. The search was kept limited to a time span of about 20 years, that is, from January 2000 to April 2020. Additional researches were collected from library source and others were retrieved by contacting experts. Studies were selected on the basis of a predetermined inclusion and exclusion criteria, and quality of the studies was also taken into account.

RESULTS

The search of studies through above methods was fruitful in identifying 23 studies including six longitudinal and prospective studies, and 17 cross-sectional studies covering both individual- and model-based personality attributes related findings. The overall quality ratings of the studies ranged from fair to good.

CONCLUSION

The review revealed that personality factors such as neuroticism, harm avoidance, and psychoticism are the potential risk factors, whereas optimism has a protective impact in the context of fertility disorders. The long-term impact of personality on infertility needs further exploration. Trait modification interventions during the treatment of infertility were also suggested in the light of previous findings.

"When Love Does not bear a Fruit": Patterns and Prevalence of Sexual Difficulties in Infertile Men and Women as Predictors of Emotional Distress

Background

Self-identity, sexuality, and subfertility have multidirectional effects on each other. Subfertility is known to alter sexual esteem, threaten identity, body image, sexual attractivness, coital pleasure, and sexual satisfaction.

Objective

This study aimed to evaluate sexual difficulties as predictors of infertility-specific stress in patients undergoing fertility treatments and to assess the profile of sexual dysfunctions in participants.

Study Setting and Design

This cross-sectional study was conducted in a tertiary hospital setup of a medical college.

Methods

Three hundred married men and women diagnosed with infertility participated. The psychological evaluation test, international classification of diseases (10^th, CDDG), female sexual functioning index, and international index of erectile functioning were used as measures.

Statistical Analysis

Data were analyzed using SPSS (version 15, Chicago, USA). Chi-square test was used for univariate analysis between stress and presence of sexual dysfunctions in men and women. Medians, quartile, and cutoff scores were used to profile the sexual issues in participants.

Results

Prevalence of sexual dysfunctions since marriage was higher in women (75%) than men (60%). Ninety-two percent of women and 86% of men experienced emergence of sexual difficulties after the couple started treatments.

Conclusions

Sexual dysfunctions appear to be a consistent psychosocial concern for those awaiting conception. These appear to worsen during the treatments. Our findings suggest the need to sensitively approach and explore sexual anamnesis with the couple before recourse to medically assisted reproductive treatments. Psychological interventions for sexual issues in distressed patients before, during, and after treatments such as controlled ovarian hyperstimulation, intrauterine insemination, in vitro fertilization, and intracytoplasmic sperm injection are most needed.

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.

Male fertility as a marker for health

Male reproduction is a complex biological process, and male factor infertility is increasingly recognized as a biomarker for overall male health. Emerging data suggest associations between male reproduction and medical disease (genetic, infectious, chronic comorbid conditions), psychological disease, environmental exposures, dietary habits, medications and substances of abuse, and even socioeconomic factors. There is also evidence that a diagnosis of male fertility is associated with future disease risk including cancer, metabolic disease and mortality. As such, there is a growing view that the male fertility evaluation is an opportunity to improve a man's health beyond his immediate reproductive goals, and also highlights the necessity of a multidisciplinary approach.

Male age interferes with embryo growth in IVF treatment

STUDY QUESTION

Does male age affect embryo growth or quality in couples undergoing IVF treatment?

SUMMARY ANSWER

Advanced paternal age (APA) is negatively associated with the chance of an optimal eight-cell embryo on the third day of development.

WHAT IS KNOWN ALREADY

Literature shows that APA is associated with decreased sperm quality and fecundity. However, the effect of male age on embryo growth in an IVF setting remains inconclusive. Literature concerning male influences on IVF success is scarce and approaches used to analyse embryo outcomes differ by study.

STUDY DESIGN, SIZE, DURATION

This study was part of the longitudinal Epigenetic Legacy of Paternal Obesity (ELPO) study for which fathers and mothers were followed from pre-pregnancy until the birth of their child. Couples were recruited from April 2015 to September 2017. A total of 1057 embryos from 87 couples were studied.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Dutch-speaking couples planning to undergo an IVF treatment were recruited at the Leuven University Fertility Center in Flanders, Belgium. Anthropometrics were documented and compared to the general Flemish population. Semen characteristics, pregnancy rates and the following embryo characteristics were recorded: number of blastomeres, symmetry and percentage fragmentation. Statistical modelling was applied taking into account correlation of within-cycle outcomes and use of multiple cycles per couple.

MAIN RESULTS AND THE ROLE OF CHANCE

We observed a significant inverse association between APA and a key determinant for scoring of embryo quality: older men were less likely to produce an embryo of eight blastomeres at Day 3, compared to younger fathers; odds ratio for the effect of 1 year equals 0.960 (95% CI: 0.930-0.991; P = 0.011). Our finding remained significant after adjusting for female age and male and female BMI. Degree of fragmentation and symmetry were not significantly related to male age.

LIMITATIONS, REASONS FOR CAUTION

Because of the study's small sample size and its monocentric nature, a larger study is warranted to confirm our results. In addition, distribution of BMI and level of education were not representative of the general Flemish population. Although we corrected for BMI status, we do not exclude that obesity may be one of the determinants of infertility in our study population. Furthermore, it is known from other European countries that a higher education eases access to fertility treatment. Hence, caution should be taken when interpreting our findings from a fertility setting to the general population.

WIDER IMPLICATIONS OF THE FINDINGS

We suggest a heightened need for future research into male age and its potential effects on embryo growth, embryo quality and ART outcomes. Clinical decision-making and preventative public health programmes would benefit from a better understanding of the role of men, carried forward by the Paternal Origins of Health and Disease (POHaD) paradigm. We hope the current finding will encourage others to examine the role of the sperm epigenome in embryo development according to paternal age.

STUDY FUNDING/COMPETING INTEREST(S)

This work was supported by a research grant from KU Leuven University (OT/14/109). The authors declare no competing financial, professional or personal interests.

TRIAL REGISTRATION NUMBER

KU Leuven S57378 (ML11309), B322201523225.

The complex relationship between infertility and psychological distress (Review)

Infertility is defined as the inability to procreate, or carry or deliver a baby naturally. The majority of specialists describe infertility as being unable to get pregnant after having tried for at least one year. The relationship between infertility and psychological stress is complex. On the one hand, infertile couples are subject to greater stress and have a greater risk of developing psychological disorders compared with normal, healthy couples. On the other hand, high levels of psychological distress have been indicated to increase infertility. Therefore, in the present review, the main factors that may lead to increased stress in couples who try to conceive, psychological stress as the reason for infertility, and the therapies that can help decrease psychological distress and increase chances of pregnancy are underlined. In addition to the psychological side effects that may occur from infertility itself, a range of other side effects can be caused by hormones and drugs used to treat infertility. Additionally, problem during erection and ejaculation can cause of psychological distress, which can lead to infertility among men. Psychotherapy is the main intervention recommended for couples who suffer from any form of infertility. Ideally, counselling should begin before patients start any medical intervention to help with their infertility.

Mathematical Modeling and Simulation Provides Evidence for New Strategies of Ovarian Stimulation

New approaches to ovarian stimulation protocols, such as luteal start, random start or double stimulation, allow for flexibility in ovarian stimulation at different phases of the menstrual cycle. It has been proposed that the success of these methods is based on the continuous growth of multiple cohorts ("waves") of follicles throughout the menstrual cycle which leads to the availability of ovarian follicles for ovarian controlled stimulation at several time points. Though several preliminary studies have been published, their scientific evidence has not been considered as being strong enough to integrate these results into routine clinical practice. This work aims at adding further scientific evidence about the efficiency of variable-start protocols and underpinning the theory of follicular waves by using mathematical modeling and numerical simulations. For this purpose, we have modified and coupled two previously published models, one describing the time course of hormones and one describing competitive follicular growth in a normal menstrual cycle. The coupled model is used to test ovarian stimulation protocols in silico. Simulation results show the occurrence of follicles in a wave-like manner during a normal menstrual cycle and qualitatively predict the outcome of ovarian stimulation initiated at different time points of the menstrual cycle.

Impairments in life satisfaction in infertility: Associations with perceived stress, affectivity, partnership quality, social support and the desire to have a child

Between 10% and 15% of couples in western society are affected by infertility. As a major source of psychological distress, infertility may be accompanied by a substantial decline in well-being, and mental symptoms including those of depression and anxiety. This study aimed to quantify impairments in life satisfaction in infertile couples and to identify psychosocial variables moderating these impairments. For this purpose, 228 infertile couples completed the Life Satisfaction Questionnaire (LSQ), Perceived Stress Questionnaire (PSQ), Positive and Negative Affect Schedule (PANAS), Penn State Worry Questionnaire (PSWQ), Partnership Questionnaire (PQ), Social Support Questionnaire, (SSQ) and Questionnaire on the Desire to Have a Child (QDC). Our sample scored below the norm of the general population on the LSQ sum score and various subscales, including those assessing social relationships, health, sexuality, leisure activities, and self-evaluation. Correlation and regression analysis revealed an inverse association of life satisfaction (LSQ) with stress (PSQ), negative affect (PANAS), and worry (PSWQ), and positive associations with positive affect (PANAS), partnership quality (PQ), social support (SSQ), and the strength of the desire to have a child (QDC). These findings support the notion of markedly reduced satisfaction with numerous life areas in the context of infertility. Psychosocial factors such as increased stress related to infertility treatment, affective impairments, partnership problems, lack of social support or social exclusion may contribute to this reduction. Psychological interventions aimed at controlling stress, strengthening partnerships, and improving social inclusion may be helpful in reducing the burden of infertility and improving the life satisfaction of affected couples.

Psychiatric Disorders in Women Seeking Fertility Treatments: A Clinical Investigation in India

Fertility treatments began in several countries, including India, in the1970s. Despite various advancements in intra uterine insemination (IUI) and in vitro fertilization (IVF), empirical investigations on the psychological endurance and emotional tolerance of Indian women to such treatments are rather scarce. Thus, the aim of this study is to estimate the prevalence of psychiatric disorders in Indian women seeking fertility treatments. It is a cross-sectional study with three hundred women participants undergoing various treatments at the Manipal Assisted Reproductive Centre, Kasturba Medical College, Karnataka, India. Psychiatric disorders were assessed in women using the "ICD- 10 Classification of Mental and Behavioural Disorders" followed by descriptive data analysis. The results show that 78% of women have psychological issues and 45% of them have a diagnosable psychiatric condition. Adjustment Disorders, Anxiety Disorders and Mixed Anxiety and Depression Disorder are established as the top three categories of diagnoses. The findings of this study suggest that women have a high emotional stake in infertility treatments. The data highlights the need for modification of the existing treatment protocol (in Indian clinics) in ways that ensure the emotional wellbeing of patients.

Predictors for the Early Termination of a Psychological Intervention During Treatment with Assisted Reproductive Technologies

Introduction Assisted reproductive technologies are typically perceived by couples as being an emotional burden. The objective of the study "Positive Ausrichtung bei unerfülltem Kinderwunsch" [Positive adjustment in infertility] (PACI) is to examine the efficacy and acceptance of a smartphone-supported psychosocial intervention during infertility treatment. In this investigation, the early drop-out of study subjects from the study is of primary interest. The objective of the investigation was to find predictors for ending a psychological intervention prematurely. Materials and Methods There are data available from an eight-month randomised, controlled study in which 141 patients and their partners participated. Sociodemographic and fertility-related data were collected at the start of the study. The couples received the ScreenIVF questionnaire at two points in time. As part of a post-evaluation, a survey was conducted on the efficacy of the psychological online intervention. To analyse the data, a dyadic data structure was used in order to determine connections within the study subject couples between the selected stress indicators and the drop-out. In addition, a "risk score" as a possible predictor for the drop-out was tested. Results The descriptive observation of the sample indicates in this interim assessment that the study subjects recruited are less stressed patient couples. Actor-partner interdependence models indicate statistically significant connections between the stress indicators of anxiety, little social support and helplessness and an early drop-out. Conclusions The statistically significant effects found in this study with regard to the stress indicators in connection with drop-outs from psychosocial intervention studies indicate that it is advisable to continue to seek measures for people undergoing stressful medical treatments in order to motivate and support them and thus optimally utilise the opportunities of a medical treatment. The number of patients who endure their ART treatment may also increase as a result, which could lead in turn to increased patient satisfaction over the long term (and thus possibly to higher pregnancy rates).

The association between stressful life events and perceived quality of life among women attending infertility treatments: the moderating role of coping strategies and perceived couple's dyadic adjustment

BACKGROUND

Research highlighted that Stressful Life Events have high incidence among infertile patients and significant impact on physical and medical parameters related to reproductive functions, but their potential role among factors influencing the infertile patients' perception of fertility-related Quality of Life (QoL) has not been explored. The present study aims to investigate the associations of Stressful Life Events (Stressful events in the family of origin, In family pre-existing pregnancy difficulties, Health problems in childhood) with perceived fertility-related QoL in women attending infertility treatments, examining the potential moderating role of adopted coping strategies and perceived couple's dyadic adjustment.

METHODS

A questionnaire consisting of Socio-demographics and Infertility-related characteristics, Stress-inducing events in the couples' lives Questionnaire (FLS), Coping Orientations to Problem Experienced (COPE), Dyadic Adjustment Scale (DAS), and Core and Treatment subscales of Fertility Quality of Life (FertiQoL) was administered to 266 women attending infertility treatments. A descriptive correlational design with cross-sectional comparison was used. Results Logistic Regression Analyses after adjusting for socio-demographic and infertility-related characteristics revealed that women who reported Stressful events in the family of origin and In family pre-existing pregnancy difficulties were more likely to report lower levels of perceived Core QoL, while women who reported Health problems in childhood were more likely to report lower levels of perceived Treatment QoL. Couple's dyadic adjustment and specific coping strategies were significantly associated with perceived Core and Treatment QoL and they also significantly moderated the associations between stressful life events and perceived QoL.

CONCLUSIONS

Data provided original evidence on the strong association between stressful life events and perceived fertility-related QoL also highlighting individual and couples' resources to define counselling interventions with women attending infertility treatments.

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.

Role of religion, spirituality, and faith in assisted reproduction

Purpose: The purpose of this study is to evaluate the impact of the patient's faith, religion, and spirituality on the outcomes of intracytoplasmic sperm injection (ICSI) cycles. Materials and methods: Eight hundred and seventy-seven patients received a questionnaire containing information on faith, religiosity, and spirituality and the results of the questionnaires were correlated with ICSI outcomes. Patients stated to be Catholic (n = 476), spiritists (n = 93), Evangelical (n = 118), and other religion (n = 32), and 78 did not identify with any religious group. Results: A significant increase in fertilization, high-quality embryos, and pregnancy rate was found among Spiritists and Evangelicals. Patients who included the infertility diagnosis and treatment in their prayers showed an increased pregnancy rate, and those who reported their faith to be affected by the infertility diagnosis presented a decreased high-quality embryos rate. The high-quality embryos rate was increased among patients who answered that their faith contributed to their decision to undergo infertility treatment. The cycle's cancelation was negatively correlated with the frequency of religious meetings, and the frequency of prayers was positively correlated with the response to ovarian stimulation. Finally, belief in treatment success positively influenced the embryo quality. Conclusion: The findings suggest that spirituality plays a role in adjusting the psychological aspects of an infertile patient.

"In Cycles of Dreams, Despair, and Desperation:" Research Perspectives on Infertility Specific Distress in Patients Undergoing Fertility Treatments

"Emotional distress in infertility" is a broad expression that loosely denotes anxiety, depression, grief, crisis, depleting psychological well-being, and all forms of affective and interpersonal disturbances faced by individuals with infertility. The distress is usually associated with involuntary childlessness as it is an unwelcoming event. The developmental crisis associated with childlessness poses a threat to one's sense of self at all levels (individual, family and social). Distress may begin before or during treatments as a person experiences the loss of control over attaining parenthood, anxiety or dejection after the diagnosis, treatments, its complications particularly its limited success rates. This paper reviews the basic concepts, theoretical models related to infertility specific distress (ISD). It elaborates on the effects of individual and treatment-specific variables on ISD with special highlights gathered from the national and international research.

Marital functioning and treatment outcome in couples undergoing assisted reproduction

AIM

To investigate the relationship between the quality of marital functioning and communication, individual psychological symptomatology, and pregnancy achievement in couples undergoing assisted reproduction.

BACKGROUND

The results concerning marital functioning and the feasibility of pregnancy yield contradictory outcomes and the quality of the relationship of the couple undergoing assisted reproduction has not been analysed from systemic models. Our hypothesis is that when undergoing assisted reproduction treatment (ART), the couple's functioning and communication will be related to the pregnancy rate.

DESIGN

This study employs a cross-sectional design with couples receiving ART.

METHODS

Spanish heterosexual couples (N = 185) completed the self-report instruments. The data were collected from 2010 - 2015. All the couples completed at least one treatment process, or at least 1 year had gone by since beginning the treatment.

RESULTS

The association between couple relationship quality and the individual psychological symptomatology experienced during the assisted reproduction process was confirmed in men and women. Although both members of the couple experienced an increase of symptomatology, only men's symptomatology was statistically significantly linked to pregnancy achievement.

CONCLUSION

It is necessary to support the couple from the assisted reproduction centres, promoting cohesion, flexibility, and communication in the relationship. The intervention process should also be understood from a systemic perspective; that is, considering dyadic transactions as a systemic unit. Two aspects seem to be especially relevant for clinical nurses in ART: (a) the man's role is crucial for treatment success; (b) the woman's communication is crucial to the process.

The Role of Attachment Anxiety and Attachment Avoidance on the Psychosocial Well-being of Infertile Couples

This study's objective was to explore the mediating role of attachment orientation in infertile women and their partners as a mediator of the relationship between need for parenthood and psychosocial well-being. Ninety participants (45 couples) undergoing in vitro fertilization completed self-report questionnaires that assessed representations of the importance of parenthood, attachment orientations, and psychosocial well-being. Path analysis was used to examine the direct and indirect effects. The results indicated that women's attachment anxiety mediated the effect of need for parenthood on the psychological well-being of themselves and their partner. Although causality cannot be assumed, this study highlights the importance of considering attachment orientations and related strategies of emotion regulation in clinical settings and the need to address the meaning of parenthood for promoting couples' well-being.

Social stigma and familial attitudes related to infertility

Objective:

To determine the perceived social stigma and familial attitides and perception of sexuality in infertile couples attending infertility clinics.

Materials and Methods:

Infertile couples attending infertility clinics between the years of 2014 and 2015 were requested to complete detailed evaluation forms including questions related to the social stigma on their infertility, their familial attitudes, and perception of sexuality. Any partner of the infertile couple accepting to enroll in the study was given the evaluation forms. Their scores related to answers and demographics, and parameters related to infertility were analyzed.

Results:

A total 598 partners of infertile couples enrolled in the study, 58% represented 177 couples. Their infertility was primary in 98.3% and the duration of marriage and infertility was 9.81±5.58 and 9.76±5.53 years, respectively. The perception of social exclusion was present in 38% (p<0.001) of infertile couple, which was more significantly pronounced in female partners (p=0.013). Fifteen percent of the infertile couples thought themselves as isolated in public and losing value in public (p<0.001). However, sixty percent of infertile couples thought that they would achieve a notable place in community after having a baby (p<0.001). Infertility was accepted as a reason of divorce in only 13% of infertile couples (p<0.001). The majority of perticipnats, irrespective of sex, rejected that infertile women or men lost sexual appeal (86%; p<0.001).

Conclusions:

There is significant effect of infertility on familial attitudes and perception of sexuality of infertile couples. Unfortunately, there is significant negative social stigma on infertile couples.

A Partnership and Coping Enhancement Program for Couples Undergoing In Vitro Fertilization Treatment: An Intervention Study

This is a feasibility study to examine the effects of a partnership and coping enhancement program (PCEP) on improving the psychological well-being and marital functions of couples undergoing in vitro fertilization treatment. A total of 100 couples were recruited consecutively and assigned to a PCEP intervention group or a routine care control group. The couples in the PCEP group received an additional face-to-face, couple-based, 90-minute session on enhancing partnership and coping on the day of the embryo transfer (ET). The outcome measures were assessed at baseline (T0), 10 days after the ET (T1), and one month after the ET (T2). The level of anxiety of the women was lower in the intervention than in the control group at T1. Significant improvements in partnership and dyadic coping were seen in women at T2. The men of infertile couples reported a significant improvement in the scores for partnership at T2. The PCEP had no significant effects on marital satisfaction and marital adjustment for both the females and males of the infertile couples. The findings indicated that the PCEP is feasible and acceptable. Before a larger simple-size randomized controlled trial with participants drawn from multiple reproductive medical centers is conducted to further confirm its effectiveness.

Factor structure and psychometric properties of the Fertility Problem Inventory-Short Form

The study analyses factor structure and psychometric properties of the Italian version of the Fertility Problem Inventory–Short Form. A sample of 206 infertile couples completed the Italian version of Fertility Problem Inventory (46 items) with demographics, State Anxiety Scale of State-Trait Anxiety Inventory (Form Y), Edinburgh Depression Scale and Dyadic Adjustment Scale, used to assess convergent and discriminant validity. Confirmatory factor analysis was unsatisfactory (comparative fit index = 0.87; Tucker-Lewis Index = 0.83; root mean square error of approximation = 0.17), and Cronbach’s α (0.95) revealed a redundancy of items. Exploratory factor analysis was carried out deleting cross-loading items, and Mokken scale analysis was applied to verify the items homogeneity within the reduced subscales of the questionnaire. The Fertility Problem Inventory–Short Form consists of 27 items, tapping four meaningful and reliable factors. Convergent and discriminant validity were confirmed. Findings indicated that the Fertility Problem Inventory–Short Form is a valid and reliable measure to assess infertility-related stress dimensions.

Responding to Infertility: Lessons From a Growing Body of Research and Suggested Guidelines for Practice

Infertility is a common, yet often misunderstood, experience. Infertility is an important topic for family scientists because of its effects on families; its relevance to research in related areas, such as fertility trends and reproductive health; and its implications for practitioners who work with individuals and couples experiencing infertility. In this review, we focus on common misperceptions in knowledge and treatment of infertility and highlight insights from recent research that includes men, couples, and people with infertility who are not in treatment. The meaning of parenthood, childlessness, awareness of a fertility problem, and access to resources are particularly relevant for treatment seeking and psychosocial outcomes. On the basis of insights from family science research, we provide specific guidelines for infertility practice within broader social contexts such as trends in health care, education, employment, and relationships. Guidelines are presented across three areas of application: infertility education for individuals, families, and practitioners; steps to support the emotional well-being of those affected by infertility; and understanding of treatment approaches and their implications for individuals and couples.

Correlation of The Etiology of Infertility with Life Satisfaction and Mood Disorders in Couples who Undergo Assisted Reproductive Technologies

Background

This study compared common psychological symptoms and life satisfaction in husbands and wives according to infertility diagnosis.

Materials and Methods

We conducted this cross-sectional study on 248 infertile couples between November 1, 2014 and February 28, 2015 at Royan Institute, Tehran, Iran. Participants answered three questionnaires. First, they completed a demographic questionnaire followed by the Hospital Anxiety and Depression Scale (HADS, 14-item self-report instrument) composed of two sub-scales: anxiety (HADS-A) and depression (HADS-D). Participants also completed the Satisfaction with Life Scale (SLWS) comprised of 5 items. Both our questionnaires were validated for the Iranian population.

Results

In couples with male factor infertility, wives had a significantly higher mean score for anxiety compared to their husbands (P<0.001). When the cause of infertility was female factor, the wives appeared significantly more anxious (P<0.001) and depressed (P=0.004) than their husbands. Male patients, those with unknown and female factors, expressed greater satisfaction with life compared to other male patients (P=0.022). Significantly greater depression existed among the couples in which the wives’ educational levels was above their husbands (P=0.045).

Conclusion

Our findings showed that when the infertility etiology was male factor, female factors or unexplained, wives showed significantly higher anxiety than their husbands. In couples diagnosed with female factor infertility, wives showed significantly more depression than their husbands.

Desire for a child and eating disorders in women seeking infertility treatment

OBJECTIVES

The purpose of this study was to evaluate the prevalence of EDs in women seeking treatment for infertility, and to better characterize their clinical profile.

STUDY DESIGN

Sixty participants completed self-report measures that assessed EDs, desire for a child, body preoccupations, quality of life, anxiety and depression.

RESULTS

Ten patients (17%) met criteria for a past or current ED. We showed a significant association between greater body dissatisfaction and a more ambivalent desire for a child. Furthermore, an ED was associated with (i) a lower quality of life, and (ii) more anxiety disorders.

CONCLUSION

Screening for a history of ED in infertile women is recommended to plan for adapted care regarding infertility but also regarding ED and psychiatric comorbidities. Therefore, the assessment has to take into account the desire for a child and the body satisfaction, that are essential parts of the ED process on the one hand and infertility process on the other. This could help with the infertility treatment and the prevention of negative maternal and fetal outcomes.

A study of sociocultural factors on depression in Chinese infertile women from Hunan Province

OBJECTIVE

To explore the sociocultural factors influencing depression in Chinese infertile women in Hunan Province.

METHODS

A cross-sectional study was carried out. A total of 211 Chinese infertile women completed demographic details, a disease-related information questionnaire, a self-rating depression scale (SDS) and a social support rating scale (SSRS).

RESULTS

One hundred and seven (50.71%) of the participants were classified as depressed according to the self-rating depression scale. The average SDS index score was 50.06 ± 10.59. Using analysis of variance (ANOVA), Pearson correlation and a multivariable regression analysis, the results showed family type, feelings of discrimination, social support, feelings of shame and reproductive pressures were influential factors in depression among Chinese infertile women.

CONCLUSION

Sociocultural factors influence depression levels in Chinese female infertile patients. The unique aspects of Chinese culture may have a negative mental impact on the patients, and cultural factors should be taken into consideration in the development of coping strategies for Chinese infertile women.

To be or not to be [fertile], that is the question

Background

According to our literature analysis, there are no data focused on spermatozoa emotional representations in childless men and data on the emotional repercussions of a diagnosis of infertility on men are still scarce. Thus, in this work, we investigated what the presence or absence of spermatozoa in the semen symbolize for men.

Material and methods

To answer this question, 441 childless heterosexual men participated in an anonymous, prospective, Internet-based survey.

Results

In response to the question “What would having a high or normal sperm count symbolize for you?” the most frequent answer was “ability to father a child”. Men living with a partner were significantly more likely than single men to answer “ability to father a child” (p < 0.05) and less likely to answer “virility” and/or “ability to have an erection/ejaculation” (p = 0.001). In response to the question “If you found out that you had a low sperm count or no spermatozoa at all, how would you feel?”, most of the men stated that they would be disappointed. Men living with a partner were more likely to state that they would feel ashamed (p < 0.05) or guilty with regard to their partner (p < 0.0001).

Conclusions

These preliminary results should help us to improve (i) the way that male infertility is announced (it is easier to find the right words if one understands the possible importance of having a high sperm count) and (ii) the psychological, marital and sexual counselling provided to men with a diagnosis of infertility.

Gender differences in perception of psychosocial distress and coping mechanisms among infertile men and women in Saudi Arabia

The objective of the study was to evaluate the differences in psychosocial distress and coping mechanisms among infertile men and women in Saudi Arabia (SA). We performed a cross-sectional study of infertile patients (206 women and 200 men) attending infertility clinics in three referral hospitals in Riyadh, SA. A semi-structured questionnaire was developed to assess socio-demographic, clinical and psychosocial variables. Infertility-related psychosocial pressures were reported in 79 (39.7%) male and 97 (47.3%) female participants (p = 0.123). Males suffered more from intrusive questions and pressure to conceive, remarry or get divorced, while females were stressed more from psychological and emotional exhaustion, marital discord, attitudes of mothers-in-law or society, and persistent desire by the husband to have children. To cope with infertility, females engaged more in religious activities (p < 0.001) and spoke more to someone regarding their problems (p < 0.001). To solve their infertility problems, 50% tried to find solutions via the internet, and 38.5% of males and 51% of females reported using alternative medicines (p = 0.012). The patients with infertility in SA face multiple psychosocial stressors related to their infertility, and cope differently based on the gender and culture-specific knowledge of infertility. The female participants were significantly more affected from psychosocial stressors and the persistent desire by their spouse to have children.

Quality of Life in Infertile Menopausal Women; Development and Psychometric of an Instrument

INTRODUCTION

So far few studies have been designed to evaluate the quality of life instrument in infertile women.

AIM

The present study was decided to design a valid and reliable instrument to assess quality of life in Iranian infertile women in postmenopausal period.

MATERIALS AND METHODS

Both quantitative and qualitative research methods were applied. The process was divided into three main stages including: instrument development, instrument validity and instrument reliability. Instrument development used three main steps, including determining content domain, item generation and instrument construction. Instrument was validated using face validity, content validity and factor analysis. Both internal consistency and test-retest reliability methods were used to confirm the reliability of the questionnaire.

RESULTS

During content development, domain step obtained 83 items in all demission of life in infertile women. In the qualitative and quantitative face validity, 25 items had item impact less than 1.5 and were excluded from the questionnaire. In the content validity section, 17 items failure to obtain necessary score based on Lawshe formula, so were excluded from the questionnaire. Overall, 8 factors were extracted by factor analysis test. However, 67.38% of the total variance was explained by 4 factors, other 4 next factors explained the remaining 32.62% of the total variance. Totally, 34.01% of rotation variance was explained by first factor and 24.37% by second factor. In questionnaire internal consistency, 8 items had Cronbach's alpha 0.942.

CONCLUSION

Therefore, we recommend the use of present questionnaire as a valid tool to evaluate the quality of life in infertile women during postmenopausal period.

Prevalence of Psychiatric Morbidity in Females amongst Infertile Couples- A Hospital Based Report

INTRODUCTION

Infertility leads to significant stress among couple and the reaction to infertility differs among males and females.

AIM

To know the prevalence of psychiatric morbidity in infertile couples and compare the prevalence of various psychiatric disorders among husband and wife.

MATERIALS AND METHODS

A cross-sectional study was conducted on 50 couples diagnosed with infertility from outdoor clinics. Both male and female partner of couple were interviewed for detailed history and clinical examination was done. General Health Questionnaire (GHQ-12) was applied to detect any psychological strain in couples and in those with illness, final diagnosis were made on the basis of DSM -IV (TR). The data thus generated was subjected to appropriate Statistical Analysis.

RESULTS

Out of the 50 couples, 54% of females had psychiatric morbidity. The most common diagnosis amongst the female participants was MDD (Major Depressive Disorder) (18%), whereas the second most common diagnosis was GAD (Generalized Anxiety Disorder) (16%). Psychiatric morbidity was found in only 26% of males suffering with Adjustment Disorder being most common diagnosis (8%) and Dysthymia and MDD as the second most common diagnosis (6% each). Majority of patients having psychiatric morbidity were from age group 20-29 years. The difference between females and male counterparts was statistically significant.

CONCLUSION

Psychiatric morbidity was higher among female partners than male partners. The difference was statistically significant and the situation needs further workup.

The effect of anxiety and depression scores of couples who underwent assisted reproductive techniques on the pregnancy outcomes

OBJECTIVE

The aim of this study was to determine the effect of anxiety and depression scores of couples who underwent Assisted Reproductive Techniques (ART) on pregnancy outcomes.

METHOD

This study was conducted as a prospective and comparative study with 217 couples. The study data was collected by using a semi-structured questionnaire and the Turkish version of the State-Trait Anxiety Inventory (STAI), and Beck Depression Inventory (BDI). The questionnaire, STAI and BDI were applied to couples who initiated ART treatment. Couples' state anxiety scores were re-evaluated after embryo transfer (ET).

RESULTS

A significant relationship was found between the depression score of women and pregnancy outcome (p < 0.05). It was determined that anxiety scores for both men and women were higher before the ART procedure, but their anxiety scores decreased after ET (p < 0.05). Spouses of women with a negative pregnancy outcome had higher trait and state anxiety mean scores (p > 0.05) and lower depression scores (p <0.05) than spouses of women with a positive pregnancy outcome.

CONCLUSION

Study results indicated that the anxiety and depression scores of couples who had achieved a positive pregnancy result were lower than for couples with a negative result. The results of this study will contribute to the health professionals especially to the nurses who spend the most time with couples in providing consulting services and supporting psychological status of couples during ART process in Turkey.

Rectal indomethacin use in pain relief during hysterosalpingography: A randomized placebo controlled trial

AIM

To evaluate the effectiveness of a rectal nonsteroidal anti-inflammatory drug (indomethacin) for pain relief during a hysterosalpingography (HSG).

MATERIALS AND METHODS

This prospective, randomized study included 82 women divided randomly into two groups. The study group received self-administered rectal indomethacin, while the control group received a placebo before the procedure. Degrees of pain were evaluated using the visual analog scale (VAS) at four different steps during the procedure and 30 min afterwards. The anxiety-depression status of the patients was evaluated using a validated Turkish version of the Beck anxiety-depression form before the procedure.

RESULTS

There were no statistically significant differences in the demographic characteristics of patients. The mean pain scores during tenaculum application (step 2), cervical traction (step 3), contrast injection (step 4) and 30 min after the procedure, were significantly lower in the study than the control group (P < 0.05). Step 4 was the most painful in both groups (VAS scores 3.2 ± 0.6 study vs. 5.3 ± 1.1 control). The mean pain score in step 4 for patients with abnormal HSG results was significantly higher than in patients with normal HSG results (P < 0.05). The mean anxiety and depression scores immediately before the procedure were not statistically different between the groups (P = 0.610 and P = 0.129, respectively).

CONCLUSION

Our study demonstrated a significant reduction in pain in patients who received a single rectal dose of indomethacin; therefore, we recommend the use of rectal indomethacin for reducing pain during a HSG procedure.

The Experience of Chinese Couples Undergoing In Vitro Fertilization Treatment: Perception of the Treatment Process and Partner Support

Background

Couples undergoing In Vitro Fertilization (IVF) Treatment suffer as dyads from the stressful experience of the painful treatment and the fear that the IVF cycle will fail. They are likely to report that their marital relationship has become unstable due to the prolonged period of treatment.

Methods

This is a qualitative study that was conducted to explore the experiences that Chinese couples have had with IVF treatment, especially their perceptions of the process and the support between couples.

Results

The interviews revealed that couples suffered from the process, experiencing physical and emotional pain, struggling with the urgency and inflexibility of bearing a child, and experiencing disturbances in their daily routines and work. The participants described how they endured the hardships as a couple and how it affected their relationship. The couples felt that sharing feelings and supporting each other contribute to psychological well-being and improves the marital relationship. They also identified some unfavorable aspects in their partner relationship. They were ambivalent about receiving social support from friends and family members.

Conclusions

With the couples indicating that the support that they received from each other affected their experience during the treatment process, it is suggested that a supportive intervention that focuses on enhancing the partnership of the couples and dealing with their inflexibility on the issue of bearing a child might result in improvements in the psychological status and marital relationship of infertile couples undergoing IVF treatment.