Results from a prospective, randomized, controlled study evaluating the acceptability and effects of routine pre-IVF counselling

Relevance of Positive Dyadic Coping for Couples Undergoing Assisted Reproduction Treatments: A Systematic Review

The present study investigates the impact of positive dyadic coping strategies on the physical and mental health of couples undergoing assisted reproductive treatments (ART). A systematic literature search was conducted in databases, including ProQuest, PubMed, Scopus, and Web of Science, adhering to the PRISMA guidelines. From an initial pool of 1061 studies, 23 were selected for final analysis, encompassing a total of 7079 participants. The findings indicate that positive dyadic coping may significantly enhance mental health, couple adjustment and satisfaction, self-esteem, and quality of life in couples undergoing ART. The quality of the included studies was rated as moderate to high. The study concludes that integrating positive dyadic coping strategies into psychological intervention programs and providing psychological support within the healthcare system may be essential for couples undergoing ART.

Is the Beck Depression Inventory (BDI) a Useful Tool for Predicting IVF Success?

Background and Objectives: Infertility is a global problem. The interaction between depression and infertility seems bidirectional, and depression may negatively influence IVF outcomes. The Beck Depression Inventory (BDI) is one of the most extensively used instruments for diagnosing depression. The aim of this study was to assess the dynamics of depression in patients undergoing IVF utilizing the BDI. Materials and Methods: This prospective cohort study was conducted at the Clinic for Gynecology and Obstetrics of the University Clinical Center of Serbia in Belgrade, Serbia during the year 2019. Both partners in the IVF program were required to complete the paper-based BDI 5 to 10 days before starting ovarian stimulation, within the 48 h preceding oocyte aspiration and four weeks after embryo transfer. We sought to identify potential predictors of a favorable IVF outcome by using logistic regression modeling. Results: Our study enrolled 86 couples. The overall IVF efficacy in our cohort was 18.6%. A statistically significant logistic regression model (p = 0.001) managed to explain 47.6% of the variability. Increasing patient age, the presence of depression (BDI > 16) and the number of failed IVF cycles were found to be significant negative predictors of ongoing IVF success. Conclusions: Depression is more common in patients undergoing IVF than in the general population. Depression might increase the odds of IVF failure, lending credence to the idea that depression screening using BDI should be a routine part of the IVF process.

Efficacy of psychological interventions for mental health and pregnancy rates among individuals with infertility: a systematic review and meta-analysis

BACKGROUND

Depression and anxiety are highly prevalent among individuals struggling with infertility. Thus, numerous psychological interventions have been adapted to infertility, with the aim of relieving distress as well as increasing pregnancy rates.

OBJECTIVE AND RATIONALE

This systematic review and meta-analysis aimed to identify all randomized controlled trials (RCTs) evaluating the effect of psychological interventions on infertility-related distress and pregnancy rates among individuals and/or couples with infertility and to analyse their overall effect. It also sought to examine potential treatment moderators, including intervention length, format and therapeutic approach.

SEARCH METHODS

An electronic search of 11 databases, including MEDLINE, EMBASE, PsycINFO and Cochrane Central Register of Controlled Trials, was performed for studies published until January 2022. The inclusion criteria were RCTs conducted on humans and published in English. Psychological outcomes of interest included anxiety, depression, infertility-related distress, wellbeing and marital satisfaction. The Cochrane Risk of Bias tool was used to assess study quality, and the Grading of Recommendations Assessment, Development and Evaluation was used to assess the overall quality of the research evidence.

OUTCOMES

There were 58 RCTs in total, including 54 which included psychological outcomes and 21 which assessed pregnancy rates. Studies originated from all regions of the world, but nearly half of the studies were from the Middle East. Although a beneficial effect on combined psychological outcomes was found (Hedge's g = 0.82, P < 0.0001), it was moderated by region (P < 0.00001) such that studies from the Middle East exhibited large effects (g = 1.40, P < 0.0001), while the effects were small among studies conducted elsewhere (g = 0.23, P < 0.0001). Statistically adjusting for study region in a meta-regression, neither intervention length, therapeutic approach, therapy format, nor participant gender (P > 0.05) moderated the effect of treatment. A beneficial treatment effect on pregnancy (RR (95% CI) = 1.25 (1.07-1.47), P = 0.005) was not moderated by region, treatment length, approach or format (P > 0.05). Largely due to the lack of high quality RCTs, the quality of the available evidence was rated as low to moderate.

WIDER IMPLICATIONS

This is the first meta-analysis of RCTs testing the effect of psychological interventions on infertility-related distress and pregnancy rates. These findings suggest that in most regions of the world, psychological interventions are associated with small reductions in distress and modest effects on conception, suggesting the need for more effective interventions. These findings must be considered in light of the fact that the majority of the included RCTs were deemed to be at high risk of bias. Rigorously conducted trials are needed.

Bedarfsorientierte kognitiv-behaviorale Intervention für Paare mit Infertilität (FERTIFIT): Eine Pilotstudie zur Entwicklung, Durchführbarkeit und Akzeptanz

Einleitung Weltweit schwankt die Prävalenz für Infertilität zwischen 4–17% und in westlichen Ländern ist rund eins von sieben Paaren mit Kinderwunsch betroffen. Das Erleben einer Infertilität ist mit einer erhöhten Wahrscheinlichkeit für psychische und partnerschaftliche Belastungen assoziiert, wobei sich Partner einer Paarbeziehung in ihrem Befinden gegenseitig beeinflussen. Dennoch ist die Versorgungslücke für betroffene Paare groß. In dieser Pilotstudie wird eine praktikabel umsetzbare, bedarfsorientierte und kognitiv-verhaltenstherapeutische Intervention für Paare mit Infertilität vorgestellt, die die partnerschaftliche Bewältigung typischer Problembereiche fördern und einer zunehmenden Belastung entgegenwirken soll.

Material und Methoden Insgesamt nahmen 21 heterosexuelle Paare an dieser Studie mit Eigen-Warte-Kontrollgruppendesign teil. Die Intervention beinhaltete bedarfsabhängig 5–10 paartherapeutische Sitzungen. Die psychische und infertilitätsbedingte Belastung, die Partnerschaftsqualität, sowie die Anwendung von individuellen und partnerschaftlichen Ressourcen wurden zu vier Messzeitpunkten (M1=vor Wartekontrollphase, M2=vor Intervention, M3=nach Intervention, M4=nach Katamnese) mittels Fragebögen erhoben.

Ergebnisse Bei Frauen besserten sich die psychische und infertilitätsbedingte Belastung, und sie griffen auf mehr Ressourcen zurück, die zum Wohlbefinden und zur aktiven Problembewältigung und Emotionsregulation beitragen. Während des Interventionszeitraumes kam es bei Männern zu einem zunehmenden Erleben hilfreicher Unterstützung, und sowohl bei Männern als auch bei Frauen zu einem häufigeren Einsatz partnerschaftlicher Copingstrategien. Die Evaluation zeigte, dass die Teilnehmenden sehr zufrieden waren mit der Intervention insgesamt und mit der erhaltenen Unterstützung.

Diskussion Die Befunde deuten auf eine gute Durchführbarkeit und Akzeptanz dieser Intervention in der psychotherapeutischen Praxis hin und liefern erste Hinweise auf mögliche erwünschte Effekte, die allerdings aufgrund des Studiendesigns und der vorliegenden Limitationen nicht eindeutig auf die Intervention zurückgeführt werden können.

Schlussfolgerung Die Stärke der vorliegenden Studie liegt in der Vorstellung eines in der psychotherapeutischen Praxis gut anwendbaren paartherapeutischen Konzepts, das bedarfsgerecht angeboten werden kann. Für die Überprüfung der gefundenen Effekte ist eine anschließende größer angelegte klinische Studie mit randomisiert-kontrolliertem Design notwendig.

Preconception lifestyle advice for people with infertility

BACKGROUND

Infertility is a prevalent problem that has significant consequences for individuals, families, and the community. Modifiable lifestyle factors may affect the chance of people with infertility having a baby. However, no guideline is available about what preconception advice should be offered. It is important to determine what preconception advice should be given to people with infertility and to evaluate whether this advice helps them make positive behavioural changes to improve their lifestyle and their chances of conceiving.

OBJECTIVES

To assess the safety and effectiveness of preconception lifestyle advice on fertility outcomes and lifestyle behavioural changes for people with infertility.

SEARCH METHODS

We searched the Cochrane Gynaecology and Fertility Group Specialised Register of controlled trials, CENTRAL, MEDLINE, Embase, PsycINFO, AMED, CINAHL, trial registers, Google Scholar, and Epistemonikos in January 2021; we checked references and contacted field experts to identify additional studies.

SELECTION CRITERIA

We included randomised controlled trials (RCTs), randomised cross-over studies, and cluster-randomised studies that compared at least one form of preconception lifestyle advice with routine care or attention control for people with infertility.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures recommended by Cochrane. Primary effectiveness outcomes were live birth and ongoing pregnancy. Primary safety outcomes were adverse events and miscarriage. Secondary outcomes included reported behavioural changes in lifestyle, birth weight, gestational age, clinical pregnancy, time to pregnancy, quality of life, and male factor infertility outcomes. We assessed the overall quality of evidence using GRADE criteria.

MAIN RESULTS

We included in the review seven RCTs involving 2130 participants. Only one RCT included male partners. Three studies compared preconception lifestyle advice on a combination of topics with routine care or attention control. Four studies compared preconception lifestyle advice on one topic (weight, alcohol intake, or smoking) with routine care for women with infertility and specific lifestyle characteristics. The evidence was of low to very low-quality. The main limitations of the included studies were serious risk of bias due to lack of blinding, serious imprecision, and poor reporting of outcome measures. Preconception lifestyle advice on a combination of topics versus routine care or attention control Preconception lifestyle advice on a combination of topics may result in little to no difference in the number of live births (risk ratio (RR) 0.93, 95% confidence interval (CI) 0.79 to 1.10; 1 RCT, 626 participants), but the quality of evidence was low. No studies reported on adverse events or miscarriage. Due to very low-quality evidence, we are uncertain whether preconception lifestyle advice on a combination of topics affects lifestyle behavioural changes: body mass index (BMI) (mean difference (MD) -1.06 kg/m², 95% CI -2.33 to 0.21; 1 RCT, 180 participants), vegetable intake (MD 12.50 grams/d, 95% CI -8.43 to 33.43; 1 RCT, 264 participants), alcohol abstinence in men (RR 1.08, 95% CI 0.74 to 1.58; 1 RCT, 210 participants), or smoking cessation in men (RR 1.01, 95% CI 0.91 to 1.12; 1 RCT, 212 participants). Preconception lifestyle advice on a combination of topics may result in little to no difference in the number of women with adequate folic acid supplement use (RR 0.98, 95% CI 0.95 to 1.01; 2 RCTs, 850 participants; I² = 4%), alcohol abstinence (RR 1.07, 95% CI 0.99 to 1.17; 1 RCT, 607 participants), and smoking cessation (RR 1.01, 95% CI 0.98 to 1.04; 1 RCT, 606 participants), on low quality evidence. No studies reported on other behavioural changes. Preconception lifestyle advice on weight versus routine care Studies on preconception lifestyle advice on weight were identified only in women with infertility and obesity. Compared to routine care, we are uncertain whether preconception lifestyle advice on weight affects the number of live births (RR 0.94, 95% CI 0.62 to 1.43; 2 RCTs, 707 participants; I² = 68%; very low-quality evidence), adverse events including gestational diabetes (RR 0.78, 95% CI 0.48 to 1.26; 1 RCT, 317 participants; very low-quality evidence), hypertension (RR 1.07, 95% CI 0.66 to 1.75; 1 RCT, 317 participants; very low-quality evidence), or miscarriage (RR 1.50, 95% CI 0.95 to 2.37; 1 RCT, 577 participants; very low-quality evidence). Regarding lifestyle behavioural changes for women with infertility and obesity, preconception lifestyle advice on weight may slightly reduce BMI (MD -1.30 kg/m², 95% CI -1.58 to -1.02; 1 RCT, 574 participants; low-quality evidence). Due to very low-quality evidence, we are uncertain whether preconception lifestyle advice affects the percentage of weight loss, vegetable and fruit intake, alcohol abstinence, or physical activity. No studies reported on other behavioural changes. Preconception lifestyle advice on alcohol intake versus routine care Studies on preconception lifestyle advice on alcohol intake were identified only in at-risk drinking women with infertility. We are uncertain whether preconception lifestyle advice on alcohol intake affects the number of live births (RR 1.15, 95% CI 0.53 to 2.50; 1 RCT, 37 participants; very low-quality evidence) or miscarriages (RR 1.31, 95% CI 0.21 to 8.34; 1 RCT, 37 participants; very low-quality evidence). One study reported on behavioural changes for alcohol consumption but not as defined in the review methods. No studies reported on adverse events or other behavioural changes. Preconception lifestyle advice on smoking versus routine care Studies on preconception lifestyle advice on smoking were identified only in smoking women with infertility. No studies reported on live birth, ongoing pregnancy, adverse events, or miscarriage. One study reported on behavioural changes for smoking but not as defined in the review methods.

AUTHORS' CONCLUSIONS

Low-quality evidence suggests that preconception lifestyle advice on a combination of topics may result in little to no difference in the number of live births. Evidence was insufficient to allow conclusions on the effects of preconception lifestyle advice on adverse events and miscarriage and on safety, as no studies were found that looked at these outcomes, or the studies were of very low quality. This review does not provide clear guidance for clinical practice in this area. However, it does highlight the need for high-quality RCTs to investigate preconception lifestyle advice on a combination of topics and to assess relevant effectiveness and safety outcomes in men and women with infertility.

Pregnancy or Psychological Outcomes of Psychotherapy Interventions for Infertility: A Meta-Analysis

Background: The pregnancy and psychological status of infertile couples has always been a concern, but there is no clear evidence for the efficacy of psychotherapy for infertile couples. This study aimed to summarize the current evidence of the effects of psychotherapy on psychological and pregnancy outcomes for infertile couples.

Method: We searched Ovid MEDLINE, Ovid EMbase, The Cochrane Library, and Web of Science (ISI) for articles published from 1946 to June 26, 2020. The pregnancy outcomes, psychological outcomes, and acceptability were involved in the study.

Results: Overall, 29 studies with a combined total of 3,522 adult participants were included in the meta-analysis. Compared with a placebo, psychotherapy was associated with the pregnancy rate [risk ratio (RR) = 1.43, 95% CI [1.07, 1.93]], total psychological scales associated with infertility [standardized mean difference (SMD) = −0.33 95% CI [−0.63, −0.02]], subsymptoms of psychological scores using the 28-item version of GHQ (including social function [MD = −3.10, 95% CI [−4.30, −1.90]] and depression [MD = −3.90, 95% CI [−5.36, −2.44]], and depression [MD = 3.60, 95% CI [2.25, 4.95]] using the 14-item version of Hospital Anxiety and Depression Scale, but it had no statistically significant association with the other outcomes. In the stratified analyses, the pregnancy rate using assisted reproduction, cognitive behavioral therapy (CBT), and the integrative body–mind–spirit (BMS); total psychological scales associated with infertility using other treatments and more than a month; and anxiety using BMS had significant statistical significance. The funnel plots of all outcomes were approximately symmetrical, and no significant publication bias was found.

Conclusions: The study showed that psychotherapy can lead to improvements in the pregnancy rate for infertile patients, especially for patients receiving assisted fertility. In addition, it may help improve total psychological scales associated with infertility and depression. CBT and BMS play an important role in improving rate of pregnancy, and BMS is associated with reducing anxiety. Although psychological interventions had limited effects on the pregnancy outcomes of infertility, our study still recommended that psychotherapies, in particular CBT and BMS, were applied to the therapeutic regimen for infertility, especially for patients receiving assisted fertility.

Adaptive coping strategies in male infertility, paramedical counselling as a way of support

Aims: In the last decades, the number of infertile males increased worldwide which gained more focus. The extent to which a person or a couple is able to cope adaptively with the problem of infertility depends on the combined effect of several variables. Our aim was to apply counselling among males suffering from infertility problems. During the therapy - besides providing information - we aim to elaborate the effects of the treatment and experiences, to process information, to develop adaptive coping strategies against stress and to indirectly or directly change health behaviours influencing reproduction.Methods: Only patients with male factor infertility were involved. They were divided into an observed group (n = 57) and a control (n = 51) group after a thorough physical examination and assessment of their reactions to, and awareness of, the disease.Results: The group that received the interventions had an intense awareness of the diagnosis and aims and nature of the indicated treatment. They employed purposeful problem-solving coping strategies, reported being satisfied with the infertility treatment.Conclusions: The counselling of clients with infertility problems a more favourable mental well-being can be established by the active participation of professional helpers. Patients might receive effective, targeted and problem-specific help.Abbreviations: ART: Assisted Reproductive Technology.

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.

COMPI Fertility Problem Stress Scales is a brief, valid and reliable tool for assessing stress in patients seeking treatment

STUDY QUESTION

Are the Copenhagen Multi-Centre Psychosocial Infertility research program Fertility Problem Stress Scales (COMPI-FPSS) a reliable and valid measure across gender and culture?

SUMMARY ANSWER

The COMPI-FPSS is a valid and reliable measure, presenting excellent or good fit in the majority of the analyzed countries, and demonstrating full invariance across genders and partial invariance across cultures.

WHAT IS KNOWN ALREADY

Cross-cultural and gender validation is needed to consider a measure as standard care within fertility. The present study is the first attempting to establish comparability of fertility-related stress across genders and countries.

STUDY DESIGN SIZE, DURATION

Cross-sectional study. First, we tested the structure of the COMPI-FPSS. Then, reliability and validity (convergent and discriminant) were examined for the final model. Finally, measurement invariance both across genders and cultures was tested.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Our final sample had 3923 fertility patients (1691 men and 2232 women) recruited in clinical settings from seven different countries: Denmark, China, Croatia, Germany, Greece, Hungary and Sweden. Participants had a mean age of 34 years and the majority (84%) were childless.

MAIN RESULTS AND THE ROLE OF CHANCE

Findings confirmed the original three-factor structure of the COMPI-FPSS, although suggesting a shortened measurement model using less items that fitted the data better than the full version model. While data from the Chinese and Croatian subsamples did not fit, all other counties presented good fit (χ²/df ≤ 5.4; comparative fit index ≥ 0.94; root-mean-square error of approximation ≤ 0.07; modified expected cross-validation index ≤ 0.77). In general, reliability, convergent validity, and discriminant validity were observed in all subscales from each country (composite reliability ≥ 0.63; average variance extracted ≥ 0.38; squared correlation ≥ 0.13). Full invariance was established across genders, and partial invariance was demonstrated across countries.

LIMITATIONS REASONS FOR CAUTION

Generalizability regarding the validation of the COMPI-FPSS cannot be made regarding infertile individuals not seeking treatment, or non-European patients. This study did not investigate predictive validity, and hence the capability of this instrument in detecting changes in fertility-specific adjustment over time and predicting the psychological impact needs to be established in future research.

WIDER IMPLICATIONS OF THE FINDINGS

Besides extending knowledge on the psychometric properties of one of the most used fertility stress questionnaire, this study demonstrates both research and clinical usefulness of the COMPI-FPSS.

STUDY FUNDING/COMPETING INTERESTS

This study was supported by European Union Funds (FEDER/COMPETE-Operational Competitiveness Program, and by national funds (FCT-Portuguese Foundation for Science and Technology) under the projects PTDC/MHC-PSC/4195/2012 and SFRH/BPD/85789/2012). There are no conflicts of interest to declare.

TRIAL REGISTRATION NUMBER

N/A.

Comparison of three infertility-specific measures in men and women going through assisted reproductive technology treatment

We compared the psychometric properties of COMPI Fertility Problem Stress Scales, Fertility Problem Inventory, and Fertility Quality of Life Tool in 293 patients enrolled for assisted reproductive technology. COMPI Fertility Problem Stress Scales and Fertility Problem Inventory subscales presented higher internal consistency. COMPI Fertility Problem Stress Scales differentiated best between its domains. Fertility Problem Inventory revealed better concurrent validity. Fertility Quality of Life Tool presented better fit. While discrimination for depression was similar between measures, Fertility Quality of Life Tool was better at discriminating anxiety. Results suggest that while all compared measures are reliable and valid in assessing the psychosocial adjustment to infertility, the choice of measure should be based according to the assessment goals.

The Partnership and Coping Enhancement Programme for couples undergoing in vitro fertilization treatment: the development of a complex intervention in China

PURPOSE

Couples as dyads suffer from the diagnosis of infertility and related treatment. These couples commonly experience emotional and physical pain and tension in their marital lives. The purpose of this study is to report on the process of developing a potentially feasible and effective complex intervention for couples undergoing in vitro fertilization treatment in China.

METHODS

The Medical Research Council (MRC) framework for developing and evaluating the complex intervention was adopted to guide the development of the Partnership and Coping Enhancement Programme (PCEP). In developing the PCEP, three steps were taken, namely, (1) identifying evidence by conducting literature reviews, a concept analysis and a qualitative study; (2) identifying/developing a theory-in this case, a preliminary Endurance with Partnership Conceptual Framework (P-EPCF) was proposed; and (3) modelling the process and outcomes of the PCEP.

RESULTS

The PCEP that was developed is targeted mainly at the domains of the partnership mediators of stress in the P-EPCF. It consists of two sections-partnership and coping-and will be delivered to infertile couples on the day of embryo transfer. The main focuses of the programme are to facilitate mutual sharing and support in infertile couples, and to improve their individual and dyadic coping strategies while undergoing IVF treatment, especially in the period when they are waiting for the results of a pregnancy test and after the disclosure of a negative treatment outcome. The programme is couple-based, consisting of experience sharing, psychoeducation, meditation exercise, skill practise and supplemental written materials.

CONCLUSIONS

The Partnership and Coping Enhancement Programme (PCEP) for couples undergoing in vitro fertilization treatment was developed according to the guideline of the MRC framework. It is recommended that a pilot study be conducted to evaluate its feasibility and to model the process and outcomes of the programme.

Effectiveness of Nursing Counseling on Coping and Depression in Women Undergoing in Vitro Fertilization

The purpose of present study was to evaluate the effectiveness of counseling provided by nurses on depression and coping strategies of infertile women undergoing in vitro fertilization ( N = 67). Of the 84 women who were interviewed, 30 were accepted as a comparison group, and 37 were included in the study group. The study group women were given counseling in addition to routine nursing care services, including group education and individual interviews about treatment and coping strategies. The nurses also provided support by accompanying the women during the invasive procedures. The Beck Depression Inventory and Jalowiec's Coping Strategies Form were used for measurements. All the women were using emotional coping and had moderate depression prior to the study. There was no statistically significant difference between the comparison and study groups before or after the counseling with respect to depression and coping strategies. Parameters to evaluate the efficacy of counseling are discussed.

A Review of Supportive Interventions Targeting Individuals or Couples Undergoing Infertility Treatment: Directions for the Development of Interventions

The purpose of this systematic review is to explore the types, content, and outcomes of different psychosocial approaches used in existing interventions for infertile individuals or couples. Relevant intervention studies published in English between 2000 and 2014 were searched using the electronic databases MEDLINE, PsycINFO, and CINHAL Plus. A total of 23 articles were identified and included in this review. Cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), and counseling were the most commonly adopted psychosocial interventions for infertile individuals or couples. After reviewing the various approaches, directions are given on the development of interventions for couples suffering from infertility.

Psychological and educational interventions for subfertile men and women

BACKGROUND

Approximately one-fifth of all subfertile couples seeking fertility treatment show clinically relevant levels of anxiety, depression, or distress. Psychological and educational interventions are frequently offered to subfertile couples, but their effectiveness, both in improving mental health and pregnancy rates, is unclear.

OBJECTIVES

To assess the effectiveness of psychological and educational interventions for subfertile couples on psychological and fertility treatment outcomes.

SEARCH METHODS

We searched (from inception to 2 April 2015) the Cochrane Gynaecology and Fertility Group Specialised Register of Controlled Trials, the Cochrane Central Register of Controlled Trials (CENTRAL; Issue 2, 2015), MEDLINE, EMBASE, PsycINFO, EBSCO CINAHL, DARE, Web of Science, OpenGrey, LILACS, PubMed, and ongoing trials registers. We handsearched reference lists and contacted experts in the field.

SELECTION CRITERIA

We included published and unpublished randomised controlled trials (RCTs), cluster randomised trials, and cross-over trials (first phase) evaluating the effectiveness of psychological and educational interventions on psychological and fertility treatment outcomes in subfertile couples.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed trial risk of bias and extracted data. We contacted study authors for additional information. Our primary outcomes were psychological measures (anxiety and depression) and fertility rates (live birth or ongoing pregnancy). We assessed the overall quality of the evidence using GRADE criteria.As we did not consider the included studies to be sufficiently similar to permit meaningful pooling, we summarised the results of the individual studies by presenting the median and interquartile range (IQR) of effects as well as the minimum and maximum values. We calculated standardised mean differences (SMDs) for continuous variables and odds ratios (ORs) for dichotomous outcomes.

MAIN RESULTS

We included 39 studies involving 4925 participants undergoing assisted reproductive technology. Studies were heterogeneous with respect to a number of factors, including nature and duration of interventions, participants, and comparator groups. As a result, we judged that pooling results would not result in a clinically meaningful estimate of a treatment effect. There were substantial methodological weaknesses in the studies, all of which were judged to be at high risk of bias for one or more quality assessment domains. There was concern about attrition bias (24 studies), performance bias for psychological outcomes (27 studies) and fertility outcomes (18 studies), and detection bias for psychological outcomes (26 studies). We therefore considered study-specific estimates of intervention effects to be unreliable. Thirty-three studies reported the outcome mental health. Only two studies reported the outcome live birth, and both of these had substantial attrition. One study reported ongoing pregnancy, again with substantial attrition. We have combined live birth and ongoing pregnancy in one outcome. Psychological outcomesStudies utilised a variety of measures of anxiety and depression. In all cases a low score denoted benefit from the intervention.SMDs for anxiety were as follows: psychological interventions versus attentional control or usual care: median (IQR) = -0.30 (-0.84 to 0.00), minimum value -5.13; maximum value 0.84, 17 RCTs, 2042 participants; educational interventions versus attentional control or usual care: median = 0.03, minimum value -0.38; maximum value 0.23, 4 RCTs, 330 participants.SMDs for depression were as follows: psychological interventions versus attentional control or usual care: median (IQR) = -0.45 (-0.68 to -0.08), minimum value -3.01; maximum value 1.23, 12 RCTs, 1160 participants; educational interventions versus attentional control or usual care: median = -0.33, minimum value -0.46; maximum value 0.17, 3 RCTs, 304 participants. Fertility outcomesWhen psychological interventions were compared with attentional control or usual care, ORs for live birth or ongoing pregnancy ranged from minimum value 1.13 to maximum value 10.05. No studies of educational interventions reported this outcome.

AUTHORS' CONCLUSIONS

The effects of psychological and educational interventions on mental health including distress, and live birth or ongoing pregnancy rates is uncertain due to the very low quality of the evidence. Existing trials of psychological and educational interventions for subfertility were generally poorly designed and executed, resulting in very serious risk of bias and serious inconsistency in study findings. There is a need for studies employing appropriate methodological techniques to investigate the benefits of these treatments for this population. In particular, attentional control groups should be employed, that is groups receiving a treatment that mimics the amount of time and attention received by the treatment group but is not thought to have a specific effect upon the participants, in order to distinguish between therapeutic and non-specific effects of interventions. Where attrition cannot be minimised, appropriate statistical techniques for handling drop-out must be applied. Failure to address these issues in study design has resulted in studies that do not provide a valid basis for answering questions about the effectiveness of these interventions.

The effects of psychosocial interventions on the mental health, pregnancy rates, and marital function of infertile couples undergoing in vitro fertilization: a systematic review

PURPOSE

The purpose of this study was to examine the effects of psychosocial interventions on the mental health, pregnancy rates, and marital function of infertile couples undergoing in vitro fertilization (IVF), as determined through RCT studies.

METHODS

Using the electronic databases PubMed, EMBase, Cochrane Library, CINAHL, PsycInfo, and CAJ, a systematic literature search was conducted in July 2015. MeSH terms, key words, and free words such as "infertility," "fertilization in vitro," "psychotherapy," "intervention," "anxiety," "depression," and "marital satisfaction" were used to identify all potential studies. The quality of the studies that were included was assessed using the risk of bias assessment tool developed by the Cochrane Back Review Group. Descriptive analysis was adopted to synthesize the results.

RESULTS

A total of 20 randomized controlled trials were included in this review. There were reports of positive effects on the anxiety levels, pregnancy rates, or marital function of infertile couples in six studies that adopted different psychosocial approaches, including mind body intervention (Eastern body-mind-spirit, Integrative body-mind-spirit, and Mind/body intervention), cognitive behavioral therapy, group psychotherapy, and harp therapy. However, there were methodological or practical issues related to measurement points and attrition rates in these studies. None of these interventions were found to be efficacious in relieving the depression or stress of individuals or couples undergoing IVF treatment. None of the included studies tackled or measured the mental health status of the couples during the most stressful time of waiting for the pregnancy results of their treatment.

CONCLUSIONS

A complex intervention, based on sound evidence, should be developed targeting both females and males of infertile couples undergoing IVF treatment, particularly during the stressful period of waiting for the results of the pregnancy test result and after failed cycles.

Negative life events have detrimental effects on in-vitro fertlization outcome

The aim of this study was to investigate the effect of negative life events on in-vitro-fertilization (IVF) outcome. Depression and negative life events were measured using Beck Depression Inventory (BDI) and List of Recent Events in 83 women attending the IVF clinic of a tertiary research and education hospital with the diagnosis of unexplained infertility between January 2013 and August 2013. Demographic features, stimulation parameters, depression scores, and negative life events of pregnant and non-pregnant participants were compared and the relation between negative life events, depression scores, and IVF outcome was investigated. Women who did not achieve a pregnancy experienced more negative life events than women who became pregnant (77.2% vs. 23.1%) (p > 0.001). The number of patients with moderate-to-severe depression (BDI scores > 16) was higher in the non-pregnant group than pregnant group (49.1% vs. 26.9%), however the difference was not statistically significant (p = 0.057). Clinical pregnancy showed a significant moderate negative correlation with the number of negative life events (r = -0.513, p = 0.001), but the correlation between clinical pregnancy and BDI scores was not statistically significant (r = -0.209, p = 0.059). Stressful life events have a negative influence on the quality of life, which eventually affects in IVF outcome, possibly through maladaptive lifestyle behavior.

Efficacy of psychosocial interventions for psychological and pregnancy outcomes in infertile women and men: a systematic review and meta-analysis

OBJECTIVE

To evaluate the evidence on the efficacy of psychosocial interventions for improving pregnancy rates and reducing distress for couples in treatment with assisted reproductive technology (ART).

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

PsycINFO, PubMed, EMBASE, CINAHL, Web of Science and The Cochrane Library between 1978 and April 2014.

STUDY SELECTION

Studies were considered eligible if they evaluated the effect of any psychosocial intervention on clinical pregnancy and/or distress in infertile participants, used a quantitative approach and were published in English.

DATA EXTRACTION

Study characteristics and results were extracted and the methodological quality was assessed. Effect sizes (ES; Hedges g) were pooled using a random effects model. Heterogeneity was assessed using the Q statistic and I(2), and publication bias was evaluated using Egger's method. Possible moderators and mediators were explored with meta-analyses of variances (ANOVAs) and meta-regression.

RESULTS

We identified 39 eligible studies (total N=2746 men and women) assessing the effects of psychological treatment on pregnancy rates and/or adverse psychological outcomes, including depressive symptoms, anxiety, infertility stress and marital function. Statistically significant and robust overall effects of psychosocial intervention were found for both clinical pregnancy (risk ratio=2.01; CI 1.48 to 2.73; p<0.001) and combined psychological outcomes (Hedges g=0.59; CI 0.38 to 0.80; p=0.001). The pooled ES for psychological outcomes were generally larger for women (g: 0.51 to 0.73) than men (0.13 to 0.34), but the difference only reached statistical significance for depressive symptoms (p=0.004). Meta-regression indicated that larger reductions in anxiety were associated with greater improvement in pregnancy rates (Slope 0.19; p=0.004). No clear-cut differences were found between effects of cognitive-behavioural therapy (CBT; g=0.84), mind-body interventions (0.61) and other intervention types (0.50).

CONCLUSIONS

The present meta-analysis suggests that psychosocial interventions for couples in treatment for infertility, in particular CBT, could be efficacious, both in reducing psychological distress and in improving clinical pregnancy rates.

Outcomes for patients with the same disease treated inside and outside of randomized trials: a systematic review and meta-analysis

BACKGROUND

It is unclear whether participation in a randomized controlled trial (RCT), irrespective of assigned treatment, is harmful or beneficial to participants. We compared outcomes for patients with the same diagnoses who did ("insiders") and did not ("outsiders") enter RCTs, without regard to the specific therapies received for their respective diagnoses.

METHODS

By searching the MEDLINE (1966-2010), Embase (1980-2010), CENTRAL (1960-2010) and PsycINFO (1880-2010) databases, we identified 147 studies that reported the health outcomes of "insiders" and a group of parallel or consecutive "outsiders" within the same time period. We prepared a narrative review and, as appropriate, meta-analyses of patients' outcomes.

RESULTS

We found no clinically or statistically significant differences in outcomes between "insiders" and "outsiders" in the 23 studies in which the experimental intervention was ineffective (standard mean difference in continuous outcomes -0.03, 95% confidence interval [CI] -0.1 to 0.04) or in the 7 studies in which the experimental intervention was effective and was received by both "insiders" and "outsiders" (mean difference 0.04, 95% CI -0.04 to 0.13). However, in 9 studies in which an effective intervention was received only by "insiders," the "outsiders" experienced significantly worse health outcomes (mean difference -0.36, 95% CI -0.61 to -0.12).

INTERPRETATION

We found no evidence to support clinically important overall harm or benefit arising from participation in RCTs. This conclusion refutes earlier claims that trial participants are at increased risk of harm.

The impact of a self-administered coping intervention on emotional well-being in women awaiting the outcome of IVF treatment: a randomized controlled trial

STUDY QUESTION

What is the effect of the positive reappraisal coping intervention (PRCI) on anxiety in women awaiting the outcome of an IVF/ICSI cycle?

SUMMARY ANSWER

Women reported significantly more anxiety during the waiting period than before treatment, but the use of the PRCI did not significantly reduce anxiety during the waiting period.

WHAT IS KNOWN ALREADY

Waiting for the outcome of IVF/ICSI treatment after embryo transfer is one of the most stressful periods of fertility treatments. At present, no evidence-based coping interventions are available to assist women though this waiting period. The PRCI has been designed to address this unmet need by promoting positive reappraisal coping.

STUDY DESIGN, SIZE, DURATION

A three-armed randomized controlled trail (RCT) was designed to evaluate the PRCI in women undergoing IVF/ICSI. Data were collected between October 2010 and June 2012. A total of 377 participants were randomized to receive either the PRCI and emotional monitoring, emotional monitoring only, or routine care. Only the PRCI-monitoring group received the coping intervention, comprising an explanatory leaflet and ten statements to be read at least once in the morning and once in the evening.

PARTICIPANT, MATERIALS, SETTING, METHODS

To capture the general impact of the PRCI, all three groups completed questionnaires at three time points: just before the waiting period (time 1: stimulation phase), on Day 10 of the 14-day waiting period (time 2: waiting period) and 6 weeks after the start of the waiting period (time 3: 6-week follow-up). In addition, to capture the specific impacts of the PRCI on the days of the waiting period, the PRCI-monitoring group and the monitoring-control group also rated their emotions and reactions daily, for the 14-day waiting period.

MAIN RESULTS AND THE ROLE OF CHANCE

Of the women who agreed to participate and who met eligibility criteria, 377 were randomized. All study participants reported significantly more anxiety and depression during the waiting period than before treatment (P < 0.001). The mean difference in anxiety between time 1 versus time 2 was 1.465 (95% CI 1.098–1.832). The mean difference in depression between time 1 versus time 2 was 0.514 (95% CI 0.215–0.813). Use of the PRCI did not significantly reduce anxiety or depression, or daily negative emotions during the waiting period. However, patients randomized to the PRCI reported significantly more positive emotions during the waiting period (P < 0.001) than the monitoring-control group, and reported the intervention to be easy to use, and as having a positive psychological effect. No significant differences were found between the groups in treatment outcome.

LIMITATIONS, REASONS FOR CAUTION

The lack of difference observed in the present study for anxiety levels between the PRCI and the monitoring-control group could have been due to the effects of monitoring itself or its ability to attenuate or obscure the effects of the PRCI intervention in unknown ways. A randomized group of women who used only the PRCI without daily monitoring would provide more insight.

WIDER IMPLICATIONS OF THE FINDINGS

The PRCI was shown to help women reinterpret the demands of the waiting period in a more positive way. These results are consistent with previous studies showing that positive reappraisal coping is a useful strategy for unpredictable and uncontrollable situations represented by a medical waiting period. This simple low cost self-help coping intervention increases positive affect during the waiting period in an IVF/ICSI treatment. STUDY FUNDING/COMPETENT INTEREST(S): The Women and Baby Division of the University Medical Centre Utrecht funded the study. The authors have no conflicting interest(s).

TRIAL REGISTRATION NUMBER

The study is registered at the Clinical Tials.gov (NCT01701011).

The effect of complementary and alternative medicine on subfertile women with in vitro fertilization

About 10-15% of couples have difficulty conceiving at some point in their reproductive lives and thus have to seek specialist fertility care. One of the most commonly used treatment options is in vitro fertilization (IVF) and its related expansions. Despite many recent technological advances, the average IVF live birth rate per single initiated cycle is still only 30%. Consequently, there is a need to find new therapies to promote the efficiency of the procedure. Many patients have turned to complementary and alternative medical (CAM) treatments as an adjuvant therapy to improve their chances of success when they undergo IVF treatment. At present, several CAM methods have been used in infertile couples with IVF, which has achieved obvious effects. However, biologically plausible mechanisms of the action of CAM for IVF have not been systematically reviewed. This review briefly summarizes the current progress of the impact of CAM on the outcomes of IVF and introduces the mechanisms.

A randomized controlled trial of the effects of nursing care based on Watson's Theory of Human Caring on distress, self-efficacy and adjustment in infertile women

AIMS

To investigate the effects of nursing care based on the Theory of Human Caring on distress caused by infertility, perceived self-efficacy and adjustment levels.

BACKGROUND

Infertility leads to individual, familial and social problems. Nursing care standards for women affected by infertility have yet to emerge.

DESIGN

A randomized controlled trial.

METHODS

This study was conducted from May 2010-February 2011, with 105 Turkish women with infertility (intervention group: 52, control group: 53). We collected data using the Infertility Distress Scale, the Turkish-Infertility Self Efficacy Scale Short Form and the Turkish-Fertility Adjustment Scale. The intervention group received nursing care based on the Theory of Human Caring. Data were analysed using t-tests, chi-square tests and intention-to-treat analyses.

RESULTS

The intervention and control groups significantly differed with regard to infertility distress, self-efficacy and adjustment levels. The intervention group's mean self-efficacy score increased by seven points and adjustment score decreased by seven points (in a positive direction). In addition, there was a significant reduction in infertility distress scores in the intervention group, but there was no change in the control group.

CONCLUSION

Nursing care based on the Theory of Human Caring decreased the negative impact of infertility in women receiving infertility treatment and increased self-efficacy and adjustment.

Psychological Characteristics of Tunisian Infertile Men

Objective: To compare psychological characteristics between controls and infertile men undergoing assisted reproductive technologies (ART) in the Unit of Reproductive Medicine (UMR) in the Department of Obstetrics and Gynecology at “Farhat Hached” Hospital in Sousse, Tunisia, and controls. Study design: We conducted a case–control study of psychological profile in men with primary infertility. Recruitment was done during period from January to May 2009. A consecutive sample of 100 infertile men before fertility treatment and a control group of 100 men, who have at least one child and no known history of infertility, were constituted. Scores of general psychopathology, depression, anxiety, and self-esteem were evaluated using respectively the Symptom Check-List (SCL-90-R), the Hospital Anxiety and Depression Scale (HAD-S), and the Rosenberg Self-Esteem Scale (RSES). Assessment was performed among infertile couples before starting a new infertility treatment cycle. Results: Score of psychotic symptoms (SCL-90-R) were higher among infertile men when compared to controls (.23 ± .29 vs. .11 ± .15; p < 10−3). Infertile also had higher anxiety (5.74 ± 3.65 vs. 4.14 ± 3.45; p = .002) and depression (3.65 ± 2.97 vs. 2.56 ± 2.35; p = .005) scores in HADS subscales than controls. Besides, they ranged more in cases and doubtful cases of depression and reported lower self-esteem than did controls. Conclusion: The stress associated with infertility had a negative impact on men’s psychological health. These findings emphasize the need of psychological support with medical interventions for infertility.

Couples’ Resolution of an Infertility Diagnosis Before Undergoing in Vitro Fertilization

Although the use of assisted reproductive technology has today become more familiar, the suffering associated with the experience of infertility remains. This study assesses the emotional resolution of couples faced with an infertility diagnosis by examining their narratives. Fifty-seven couples were recruited from fertility clinics to participate in a semistructured interview prior to in vitro fertilization. Two aspects of the couples’ reactions to the infertility diagnosis were assessed: (1) each individual’s capacity to acknowledge the emotional reality of the diagnosis (diagnosis resolution) and (2) the couple’s ability to construct a shared meaning of the infertility diagnosis experience (narrative co-construction). Associations between these aspects and self-reported marital satisfaction, infertility-related stress, and diagnosis-related variables were analyzed. 73.7% of women and 61.4% of men had acknowledged the emotional reality of the diagnosis, and their scores for narrative co-construction were comparable to reference samples. Marital satisfaction, but not infertility-related stress, was associated with diagnosis resolution and narrative co-construction. The results indicate the importance of detecting couples with fewer individual and marital resources needed to face the reality of the diagnosis. A couple’s capacity to perceive the infertility diagnosis as a shared problem is also essential for dealing with this common life event.

The transition of care from fertility specialists to obstetricians: maternal adjustment and postpartum depressive symptoms

AIM

This study examines the transition from fertility to obstetrical care of women who conceived through IVF.

MATERIALS & METHODS

33 women filled out questionnaires before IVF, during pregnancy and after birth on infertility stress, maternal adjustment and depressive symptoms. During pregnancy, they participated in an interview about their emotional experiences regarding the transition. Responses were sorted into three categories: Autonomy, Dependence and Avoidance.

RESULTS

Exploratory results show that 51.5% of women had no difficulties making the transition (Autonomy), 21.2% had become dependent (Dependence) and 27.3% had distanced themselves from the specialists (Avoidance). Women who became dependent had more trouble adjusting to motherhood and more depressive symptoms.

CONCLUSION

Difficulty making the transition may be linked to decreased ability to adjust to motherhood and more postpartum depressive symptoms.

Effect of counseling on quality of marital relationship of infertile couples: a randomized, controlled trial (RCT) study

BACKGROUND

Infertility is a major cause of marital problems and sexual dissatisfaction. This study was conducted to determine the effects of counseling on infertile couple's marital relationship and sexual satisfaction.

MATERIALS AND METHODS

This study was performed as a randomized controlled trial (RCT) in which 100 infertile couples (200 participants) who visited Reproductive Health Research Center Tehran, Iran were randomly assigned into two groups: intervention (n = 50 couples, 50 wives and 50 husbands) and control (n = 50 couples, 50 wives and 50 husbands). Intervention was defined as three counseling sessions per week, each lasting 60-90 min. Counseling in the intervention group was conducted separately for each couple. Demographic characteristics and marital and sexual satisfaction were investigated using three questionnaires through interviews. The outcomes, including changes in marital satisfaction and sexual satisfaction, were compared between the two groups 3 months later.

RESULTS

Based on the data collected 3 months after the intervention period, the mean scores of marital and sexual satisfaction in intervention and control groups for wives were 49.62 ± 11.09 versus 54.97 ± 12.64 (P = 0.036) and 36.00 ± 8.37 versus 40.04 ± 7.69 (P = 0.019), respectively. Respective scores for husbands were 45.48 ± 9.55 versus 50.08 ± 11.43 (P = 0.042) and 33.37 ± 7.09 versus 36.63 ± 6.52 (P = 0.025), respectively. It should be noted that higher scores in questionnaires inspecting marital and sexual satisfaction indicate lower satisfaction.

CONCLUSIONS

Infertility counseling improves marital and sexual satisfaction in infertile couples.

An exploration of women's psychosocial support needs in the context of assisted reproduction

This article explores the nature of psychosocial support needs and service provision in the context of assisted reproduction. Using qualitative data from a doctoral research project, the views of non-metropolitan women in Australia are presented along with a review of literature and an overview of participants' actual sources of, and needs in relation to, formal and informal support. It is argued that while social workers and other human service professionals have played a consistent role in providing psychosocial support to service users, the overarching approach to service provision remains biomedical in focus. This often adversely affects the overall quality of service provision. On this basis, social workers are urged to maintain their focus on human rights, respect, and multidimensional approaches to supporting women and their partners before, during, and after reproductive technology service use.

A hierarchy of needs? Embryo donation, in vitro fertilisation and the provision of infertility counselling

OBJECTIVE

The aim of the paper is to examine how those working in, using and regulating assisted conception clinics discussed infertility counselling and its provision within the context of embryo donation and in vitro fertilisation.

METHOD

35 participants were recruited for semi-structured, face-to-face interviews. All data were analysed using thematic analysis.

RESULTS

The thematic analysis revealed recurring themes based upon the portrayals of infertility counselling, embryo donation and in vitro fertilisation.

CONCLUSIONS

This paper suggests that an implicit hierarchy exists around those using assisted conception techniques and their infertility counselling requirements, which was dependent upon the assisted conception technique used. As a result, some people using assisted conception techniques felt that their needs had been overlooked due to this covert hierarchy.

PRACTICE IMPLICATIONS

Those working in, using or regulating assisted conception clinics should not view infertility counselling as restricted to treatments involving donation, or solely for people within the clinical system.

Does emotional support during the luteal phase decrease the stress of in vitro fertilization?

OBJECTIVE

To determine if phone calls between ET and pregnancy test, decrease stress levels as determined by the Perceived Stress Scale (PSS).

DESIGN

Randomized controlled trial.

SETTING

Academic medical center.

PATIENT(S)

Women undergoing a first fresh cycle of assisted reproductive technology using autologous oocytes with a day 2 or 3 ET.

INTERVENTION(S)

Phone calls from specialized social workers or standard of care.

MAIN OUTCOME MEASURE(S)

Primary outcome was the change in PSS score from day of ET compared with 10 days after ET; secondary outcome was perceived patient benefit.

RESULT(S)

A total of 131 patients were randomized to the intervention (n = 66) or control (n = 65) group. No differences were seen in the final PSS score or the change in PSS score between groups. At the completion of the study, the intervention group was more likely to report that participating in this study was helpful (65.9% vs. 21.4%), as well as to recommend emotional support during an IVF cycle (95.4% vs. 78.6%).

CONCLUSION(S)

Although we observed no significant change in PSS score, first-cycle IVF patients felt that increased emotional support was needed during the waiting period between ET and pregnancy test. Additional research should be conducted to determine the best interventions for this time period.

L’entretien psychologique systématique pour les couples optant pour l’IAD: huit ans d’expérience clinique dans une législation prévoyant la levée de l’anonymat du donneur

La loi sur la procréation médicalement assistée (LPMA) est entrée en vigueur en Suisse en 2001. La PMA est subordonnée au bien de l’enfant, et seul un couple marié peut recourir au don de sperme. Concernant l’insémination artificielle avec sperme de donneur (IAD), la loi a prévu que l’enfant âgé de 18 ans révolu peut obtenir des données concernant l’identité du donneur, et même, en cas d’intérêt légitime, il a le droit d’obtenir toutes les données relatives au donneur. Il est précisé également qu’une assistance psychologique doit être offerte aux couples avant, pendant et après un traitement. L’Unité de médecine de la reproduction (UMR) et le Centre de procréation médicalement assistée (CPMA) à Lausanne ont développé depuis une douzaine d’années une assistance psychologique ajustée à chaque couple appelée « bilan des ressources ». Dans le cas des demandes d’IAD, des questions spécifiques sont discutées, entre autres: faut-il parler à son entourage, à l’enfant de l’origine de sa conception, comment et quand en parler ? Ces questions peuvent aussi être abordées dans des groupes de couples concernés par le sujet de manière fructueuse. Notre expérience nous montre que ces entretiens psychologiques systématiques aident les couples à cheminer tranquillement dans leur réflexion sur le thème du secret, de l’attachement, du droit de l’enfant à savoir d’où il vient.

Stimulation day-six serum estradiol: a predictive indicator for the probability of embryo cryopreservation in IVF/ICSI cycles

OBJECTIVE

To evaluate the predictive value of stimulation day six serum estradiol (E2) for the probability of embryo cryopreservation after fresh embryo transfer in intracytoplasmic sperm injection (ICSI) cycles.

SUBJECTS AND METHODS

The study included 282 ICSI cycles for different causes of infertility, provided that the age of the female partner was <40 years and her basal follicle stimulating hormone <10 IU/L.

SETTING

Alexandria IVF/ICSI center.

MAIN OUTCOME MEASURES

Primary outcome measures are stimulation day-six serum E2, and rate of embryo cryopreservation, after transfer of three good-quality embryos. Secondary outcome measures are pregnancy rate per fresh embryo transfer, and other intermediate variables of the ICSI cycle.

RESULTS

Patients were stratified into three groups according to day-six serum E2 levels: Group I with values <400 pg/mL; Group II, between 400 and 900; and Group III with values >900. The mean number of oocytes retrieved was 6.3, 8.9, and 12.4; the mean number of obtained embryos was 3.3, 4.8, and 6.7; and pregnancy rates were 18.1, 36.2, and 44.7% in the three groups, respectively. Rate of embryo cryopreservation, after transfer of three good-quality embryos was 70.7% in Group III, and 26.5% in Group I. (P = 0.01). The negative predictive value of day-six E2 <400 pg/mL for freezing was 83% while day-six serum E2 >900 pg/mL has a sensitivity of 55%, specificity of 72% and positive predictive value of 50% for embryo freezing.

CONCLUSION

Higher stimulation day-six estradiol was associated with a higher probability of cryopreservation, and a higher pregnancy rate.

The efficacy of psychological interventions for infertile patients: a meta-analysis examining mental health and pregnancy rate

BACKGROUND

Psychological interventions for infertile patients seek to improve mental health and increase pregnancy rates. The aim of the present meta-analysis was to examine if psychological interventions improve mental health and pregnancy rate among infertile patients. Thus, controlled studies were pooled investigating psychological interventions following the introduction of assisted reproductive treatments (ART).

METHODS

The databases of Medline, PsycINFO, PSYNDEX, Web of Science and the Cochrane Library were searched to identify relevant articles published between 1978 and 2007 (384 articles). Included were prospective intervention studies on infertile patients (women and men) receiving psychological interventions independent of actual medical treatment. The outcome measures were mental health and pregnancy rate. A total of 21 controlled studies were ultimately included in a meta-analysis comparing the efficacy of psychological interventions. Effect sizes (ES) were calculated for psychological measures and risk ratios (RR) for pregnancy rate.

RESULTS

The findings from controlled studies indicated no significant effect for psychological interventions regarding mental health (depression: ES 0.02, 99% CI: -0.19, 0.24; anxiety: ES 0.16, 99% CI: -0.10, 0.42; mental distress: ES 0.08, 99% CI: -0.10, 0.51). Nevertheless, there was evidence for the positive impact of psychological interventions on pregnancy rates (RR 1.42, 99% CI: 1.02, 1.96). Concerning pregnancy rates, significant effects for psychological interventions were only found for couples not receiving ART.

CONCLUSIONS

Despite the absence of clinical effects on mental health measures, psychological interventions were found to improve some patients' chances of becoming pregnant. Psychological interventions represent an attractive treatment option, in particular, for infertile patients who are not receiving medical treatment.

Anxiety and depression have no influence on the cancellation and pregnancy rates of a first IVF or ICSI treatment

BACKGROUND

After many years of research, the impact of psychological distress on the IVF treatment outcome is still unclear. This study aimed to determine the influences of anxiety and depression before and during IVF or ICSI treatment on the cancellation and pregnancy rates of inductees.

METHODS

In a multicentre prospective cohort study, we assessed anxiety and depression at baseline and the procedural anxiety level one day before oocyte retrieval, with the short versions of the State Anxiety Inventory (STAI) and the Beck Depression Inventory-Primary Care (BDI-PC). The effect of baseline anxiety and depression on the cancellation and pregnancy rates of 783 women in their first IVF or ICSI treatment was evaluated. We also determined if a change in anxiety from the start of treatment until just before oocyte retrieval affects the pregnancy rate. The predictive value of distress was assessed while controlling for several factors in subfertility treatment.

RESULTS

Neither baseline nor procedural anxiety, nor depression affected the ongoing pregnancy rates, with odds ratios (ORs) of 1.04 (95% CI 0.82-1.33), 0.96 (95% CI 0.77-1.20) and 0.85 (95% CI 0.65-1.10), respectively. Neither did the anxiety gain score affect the pregnancy rate, OR 1.08 (95% CI 0.83-1.41). A cancellation of treatment could not be predicted by either anxiety or depression, OR 1.16 (95% CI 0.83-1.63) and 0.85 (95% CI 0.59-1.22), respectively.

CONCLUSIONS

Inductees in IVF treatment can be reassured that anxiety and depression levels before and during treatment have no significant influence on the cancellation and pregnancy rates.

Psychosocial characteristics of women and men attending infertility counselling

BACKGROUND

Little is known about the psychosocial characteristics of infertile couples seeking psychological help. This study describes couples attending infertility counselling.

METHODS

Questionnaires pertaining to socio-demographic factors, motives for wanting a child, lay aetiology of their infertility, dimensions of life and partnership satisfaction, and a complaints list were completed by 974 women and 906 men. Of those who indicated an openness to counselling, almost half actually attended infertility counselling, and two groups, 'no counselling' (358 women and 292 male partners) and 'taking up counselling' (275 women and 243 male partners), were therefore compared.

RESULTS

More couples with stressful life events were found in the counselling group. For women taking up counselling, psychological distress, in the form of suffering from childlessness and depression as well as subjective excessive demand (as a potential cause for infertility), was higher in comparison to women not counselled. The higher distress for men in the counselling group was indicated by relative dissatisfaction with partnership and sexuality and by accentuating the women's depression.

CONCLUSIONS

Infertile couples seeking psychological help are characterized by high levels of psychological distress, primarily in women. The women's distress seems to be more important for attending infertility counselling than that of the men.

Which issues concerning multiple pregnancies should be addressed during psychosocial counselling?

The global rise in multiple pregnancy rates due to assisted reproductive technology has led to the development of various strategies to diminish these rates without jeopardising pregnancy. Policies at treatment centres may include the option of fetal reduction, although each centre is subject to national laws and its own guidelines. However, personal opinions and goals may also influence practice. The development of clinical decisions, therefore, is complex and subject to change. Primary prevention is the best way to reduce multiple births. For preventative psychosocial counselling, some centres employ counsellors, but if not, this becomes the physician's task. An in-depth assessment is required to define how many embryos to transfer and what risk of multiple birth is acceptable to patients. Counselling should address the following: the relationship between pregnancy rate, multiple pregnancy rate and the number of embryos transferred; benefits and risks of multiple pregnancy; and possibilities for primary and secondary prevention. Patients should voice how they feel facing these issues; which issues are worrisome; how they anticipate these possibilities; and what psychosocial support exists that could be mobilized. In summary, psychosocial counselling reinforces the partnership between couples and the assisted reproductive technology team, allowing for primary prevention and informed consent on multiple pregnancy issues.

Outcomes of patients who participate in randomized controlled trials compared to similar patients receiving similar interventions who do not participate

BACKGROUND

Some people believe that patients who take part in randomised controlled trials (RCTs) face risks that they would not face if they opted for non-trial treatment. Others think that trial participation is beneficial and the best way to ensure access to the most up-to-date physicians and treatments. This is an updated version of the original Cochrane review published in Issue 1, 2005.

OBJECTIVES

To assess the effects of patient participation in RCTs ('trial effects') independent both of the effects of the clinical treatments being compared ('treatment effects') and any differences between patients who participated in RCTs and those who did not. We aimed to compare similar patients receiving similar treatment inside and outside of RCTs.

SEARCH STRATEGY

In March 2007, we searched The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, The Cochrane Methodology Register, SciSearch and PsycINFO for potentially relevant studies. Our search yielded 7586 new references. In addition, we reviewed the reference lists of relevant articles.

SELECTION CRITERIA

Randomized studies and cohort studies with data on clinical outcomes of RCT participants and similar patients who received similar treatment outside of RCTs.

DATA COLLECTION AND ANALYSIS

At least two review authors independently assessed studies for inclusion, assessed study quality and extracted data.

MAIN RESULTS

We identified 30 new non-randomized cohort studies (45 comparisons): no new RCTs were found. This update now includes five RCTs (yielding 6 comparisons) and 80 non-randomized cohort studies (130 comparisons), with 86,640 patients treated in RCTs and 57,205 patients treated outside RCTs. In the randomised studies, patients were invited to participate in an RCT or not; these comparisons provided limited information because of small sample sizes (a total of 412 patients) and the nature of the questions they addressed. When the results of RCTs and non-randomized cohorts that reported dichotomous outcomes were combined, there were 98 comparisons; there was also heterogeneity (P < 0.00001, I(2) = 42.2%) between studies. No statistical significant differences were found for 85 of the 98 comparisons. Eight comparisons reported statistically significant better outcomes for patients treated within RCTs, and five comparisons reported statistically significant worse outcomes for patients treated within RCTs. There was significant heterogeneity (P < 0.00001, I(2) = 58.2%) among the 38 continuous outcome comparisons. No statistically significant differences were found for 30 of the 38 comparisons. Three comparisons reported statistically significant better outcomes for patients treated within RCTs, and five comparisons reported statistically significant worse outcomes for patients treated within RCTs.

AUTHORS' CONCLUSIONS

This review indicates that participation in RCTs is associated with similar outcomes to receiving the same treatment outside RCTs. These results challenge the assertion that the results of RCTs are not applicable to usual practice.

Implications of psychosocial support in infertility--a critical appraisal

OBJECTIVE

Various psychosocial interventions have been recommended for infertile persons, but it remains unclear what their implications are, and if some of them might even be harmful under certain circumstances.

METHODS

A survey is given of papers concerning the usefulness of psychosocial support in infertility.

RESULTS

Providing procedural information concerning the technical aspects of infertility investigation probably facilitates coping with infertility and with assisted reproductive techniques. This information can be given in the form of booklets or educational films. Using the Internet is a fast and easy way to obtain information on infertility and its treatment, but with the risk of getting wrong or misleading information. Telephone counseling can be helpful in providing specific information about the infertility workup but it cannot replace face-to-face counseling on distressing psychosocial issues. Attendance at support groups can be recommended to strengthen coping abilities. Psychosocial counseling and psychotherapy are definitely effective in reducing negative affect, mostly within a short period of time (less than 10 sessions). Pregnancy rates are unlikely to be affected by psychosocial interventions.

CONCLUSION

Infertility counseling and support groups seem to be the most efficient psychosocial interventions in infertility. Therefore, infertility counseling should be available at all stages of medical therapy, and it should be free of charge for the persons attending it. Course, content and goals of the infertility counseling should be made transparent. The efficacy of support groups has to be evaluated more systematically. Several methodological questions have to be solved yet, and the generalizability of these results is still restricted.

Mood disorders and fertility in women: a critical review of the literature and implications for future research

A medline literature review of fertility and mood disorder articles published since 1980 was performed in order to critically review the literature regarding a relationship between mood disorders, fertility and infertility treatment. Previous studies suggests that mood disorders, both in the bipolar and unipolar spectrum, may be associated with decreased fertility rates. Most studies report that women seeking treatment for infertility have an increased rate of depressive symptoms and possibly major depression (none showed evaluated mood elevations). Many, but not all, studies found that depressive symptoms may decrease the success rate of fertility treatment. Treatments for infertility may independently influence mood through their effects on estrogen and progesterone, which have been shown to influence mood through their actions on serotonin. Studies are limited in scope and confounding variables are many, limiting the strength of the results. In conclusion, a range of existing studies suggests that fertility and mood disorders are related in a complex way. Future studies should use clinical interviews and standardized and validated measures to confirm the diagnosis of mood disorders and control for the variables of medication treatment, desire for children, frequency of sexual intercourse, age, FSH levels, menstrual cycle regularity in assessing an interrelationship between mood disorders and fertility.

Infertility, assisted reproductive technology, and adverse pregnancy outcomes: executive summary of a National Institute of Child Health and Human Development workshop

The National Institute of Child Health and Human Development held a workshop on September 12-13, 2005, to summarize the risks for adverse pregnancy outcomes after assisted reproductive technology (ART), develop an approach to counseling couples regarding these risks, and establish a research agenda. Although the majority of ART children are normal, there are concerns about the increased risk for adverse pregnancy outcomes. More than 30% of ART pregnancies are twins or higher-order multiple gestations (triplets or greater) and more than one half of all ART neonates are the products of multifetal gestations, with an attendant increase in prematurity complications. Assisted reproductive technology singleton pregnancies also demonstrate increased rates of perinatal complications-small for gestational age infants, preterm delivery, and perinatal mortality-as well as maternal complications, such as preeclampsia, gestational diabetes, placenta previa, placental abruption, and cesarean delivery. Although it is not possible to separate ART-related risks from those secondary to the underlying reproductive pathology, the overall increased frequency of obstetric complications, including preterm birth and small for gestational age neonates, should be discussed with the couple. Significant gaps in knowledge were identified, and the basic science and clinical and epidemiologic research required to address these gaps is outlined.