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Miller-Matero LR, Joseph-Mofford G, Abdole L, Loree AM, Vanderziel A, Vagnini KM, Hecht LM. Alcohol and cannabis use among women with infertility: associations with psychiatric symptoms, attempts to conceive, and engagement in fertility treatment. Arch Womens Ment Health 2024; 27:259-264. [PMID: 38082004 DOI: 10.1007/s00737-023-01408-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/30/2023] [Indexed: 03/13/2024]
Abstract
Little is known about substance use among women with infertility, yet substance use has implications for fertility and pregnancy. The purpose was to estimate the prevalence of substance use among women with infertility and examine whether substance use was associated with psychiatric symptoms, active attempts to conceive, and engagement in fertility treatments. Eligible patients were from a single healthcare system who received a female infertility diagnosis within the past 2 years. Participants (n = 188) completed an online questionnaire regarding substance use, psychiatric symptoms, attempts to conceive, and fertility treatments. The prevalence of hazardous alcohol use, any cannabis use, and hazardous cannabis use were 30.3%, 30.9%, and 8.5%, respectively. Hazardous alcohol use was not associated with psychiatric symptoms (p > .05). Those with any cannabis use were more likely to have higher depression scores than those without (p = .02). Those with hazardous cannabis use were more likely to have higher depression scores (p = .001) and higher anxiety scores (p = .03). Substance use was not associated with actively trying to conceive. Those pursuing fertility treatments had a lower percentage engaging in hazardous alcohol use compared to those not pursuing fertility treatments (19.0% vs. 36.3%, p = .02). Substance use among women with infertility is common. Hazardous cannabis use was associated with greater psychiatric symptoms, suggesting that cannabis may be used to cope with distress. Pursuing fertility treatments may serve as a protective factor for hazardous alcohol use. Clinicians treating patients with infertility may want to screen for substance use.
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Affiliation(s)
- Lisa R Miller-Matero
- Henry Ford Health, Behavioral Health, 1 Ford Place, 5E, Detroit, MI, 48202, USA.
- Henry Ford Health, Center for Health Policy and Health Services Research, Detroit, MI, USA.
| | | | - Lana Abdole
- Henry Ford Health, Behavioral Health, 1 Ford Place, 5E, Detroit, MI, 48202, USA
| | - Amy M Loree
- Henry Ford Health, Center for Health Policy and Health Services Research, Detroit, MI, USA
| | - Alyssa Vanderziel
- Henry Ford Health, Center for Health Policy and Health Services Research, Detroit, MI, USA
| | - Kaitlyn M Vagnini
- Henry Ford Health, Behavioral Health, 1 Ford Place, 5E, Detroit, MI, 48202, USA
- Henry Ford Health, Center for Health Policy and Health Services Research, Detroit, MI, USA
| | - Leah M Hecht
- Henry Ford Health, Center for Health Policy and Health Services Research, Detroit, MI, USA
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Hecht LM, Joseph-Mofford G, Iacobelli R, Ahmed M, Haley E, Loree AM, Miller-Matero LR. Anxiety, depression, and infertility-specific distress among women with female factor infertility. J Health Psychol 2024:13591053241235092. [PMID: 38413845 DOI: 10.1177/13591053241235092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Abstract
This study aimed to evaluate whether anxiety, depression, and infertility-specific distress differ among women with female infertility who are trying to conceive and/or seeking infertility treatment. Women with diagnosed female factor infertility in the past 2 years (N = 188) completed demographic questions, and measures of infertility-specific distress, anxiety, and depression. The majority of the sample were actively trying to conceive (78.7%, n = 148) and approximately one third (33.5%, n = 63) were undergoing fertility treatment. Anxiety and depression scores did not differ based on trying to conceive or treatment-seeking, although these subgroups reported higher levels of need for parenthood and rejection of a childfree lifestyle. High levels of mood and anxiety are experienced by women with female infertility. Although infertility-specific distress is experienced more so by women with anxiety and depression, a substantial proportion of those without mental health conditions had high levels of distress, underscoring the need for screening and treatment.
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de Vries CEJ, Veerman-Verweij EM, van den Hoogen A, de Man-van Ginkel JM, Ockhuijsen HDL. The psychosocial impact of male infertility on men undergoing ICSI treatment: a qualitative study. Reprod Health 2024; 21:26. [PMID: 38374039 PMCID: PMC10877778 DOI: 10.1186/s12978-024-01749-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/27/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Male infertility is in 20-70% of cases the cause of a couple's infertility. Severe forms of male infertility are best treated with Intracytoplasmic Sperm Injection (ICSI). The psychosocial impact of infertility and ICSI on men is unclear because the focus is socially, clinically, and scientifically on women. However, there is evidence that it can affect the psychological well-being of men, but these studies are mainly quantitative. Qualitative research needed to explore the experiences of infertile men in-depth is limited. Therefore, the objective of this study was to clarify the psychosocial consequences of male infertility on men undergoing ICSI to understand their experiences with reproduction problems more comprehensively. METHODS In this generic qualitative study, men who were undergoing or had undergone ICSI after a male factor infertility diagnosis were included. A purposive sample with maximum variation was sought in a fertility clinic of one university medical centre in the Netherlands. Data were collected through individual face-to-face semi-structured interviews. Thematic analysis was used to identify themes from the data. RESULTS Nineteen Dutch men were interviewed. The mean duration of the interviews was 90 min. An everyday contributing backpack was identified as the main theme, as men indicated that they always carried the psychosocial consequences of infertility and ICSI with them. Different world perspective, Turbulence of emotions, Changing relation, and Selective sharing were the psychosocial consequences that men were most affected by. Moreover, men indicated that they were Searching for contribution during ICSI because the focus was entirely on the woman. CONCLUSION Men with male infertility experience psychosocial problems due to infertility and ICSI treatment. Healthcare professionals need to recognize the impact of infertility on men and create room for a role for them during ICSI.
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Affiliation(s)
- Carmen E J de Vries
- Department of Reproductive Health, University Medical Center Utrecht, 100 Heidelberglaan, 3584 CX, Utrecht, The Netherlands
- Department of Cardiology and Cardiothoracic Surgery, Erasmus University Medical Center, 40 Dr. Molenwaterplein, 3015 GD, Rotterdam, The Netherlands
| | - Esther M Veerman-Verweij
- Department of Reproductive Health, University Medical Center Utrecht, 100 Heidelberglaan, 3584 CX, Utrecht, The Netherlands
| | - Agnes van den Hoogen
- Department of Reproductive Health, University Medical Center Utrecht, 100 Heidelberglaan, 3584 CX, Utrecht, The Netherlands
| | - Janneke M de Man-van Ginkel
- Department of Nursing Science, University Medical Center Leiden, 2 Albinusdreef, 2333 ZA, Leiden, The Netherlands
| | - Henriëtta D L Ockhuijsen
- Department of Reproductive Health, University Medical Center Utrecht, 100 Heidelberglaan, 3584 CX, Utrecht, The Netherlands.
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Bagade T, Mersha AG, Majeed T. The social determinants of mental health disorders among women with infertility: a systematic review. BMC Womens Health 2023; 23:668. [PMID: 38093258 PMCID: PMC10720205 DOI: 10.1186/s12905-023-02828-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Infertility is associated with mental health disorders in women, even if a successful pregnancy resolves infertility. However, the link between social determinants of health (SDoH) and mental health in women with infertility is not well understood. We aimed to investigate the determinants thoroughly so that mental health screening and services can be tailored to suit women with infertility who are vulnerable to mental health disorders. METHODOLOGY All observational studies that included women participants of reproductive age with infertility and assessed social determinants associated with mental health disorders were searched using a combination of keywords from MEDLINE, EMBASE, CINAHL, PsycINFO, Scopus, and Web of Science databases and published in English. Two reviewers conducted screening, data extraction, quality assessment and risk of bias. The protocol was registered on PROSPERO (number CRD42022343962). RESULTS The systematic review included 32 studies out of 3405 screened articles from January 1st 2010 to 16th October 2023. Compared to women without infertility, the prevalence of mental health disorders, including anxiety, depression, psychological distress, and stress, is high among women with infertility, with the severity being influenced by social determinants-those with higher education, employment, higher personal or family income, private health insurance, higher social support, stronger religious beliefs, and higher spiritual well-being reported better mental health outcomes. CONCLUSION The study highlights the need for early detection, tailored interventions, and integrated and comprehensive support systems to address the mental health needs of women with infertility and improve their well-being.
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Affiliation(s)
- Tanmay Bagade
- School of Medicine and Public Health, College of Health, Medicine, and Wellbeing, The University of Newcastle, Callaghan, NSW, 2285, Australia.
| | - Amanual Getnet Mersha
- School of Medicine and Public Health, College of Health, Medicine, and Wellbeing, The University of Newcastle, Callaghan, NSW, 2285, Australia
| | - Tazeen Majeed
- School of Medicine and Public Health, College of Health, Medicine, and Wellbeing, The University of Newcastle, Callaghan, NSW, 2285, Australia
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Li QL, Wang C, Cao KX, Zhang L, Xu YS, Chang L, Liu ZH, Yang AJ, Xue YX. Sleep characteristics before assisted reproductive technology treatment predict reproductive outcomes: a prospective cohort study of Chinese infertile women. Front Endocrinol (Lausanne) 2023; 14:1178396. [PMID: 37908752 PMCID: PMC10614022 DOI: 10.3389/fendo.2023.1178396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 09/06/2023] [Indexed: 11/02/2023] Open
Abstract
Sleep disorders affect mental and physical health. Infertile women undergoing assisted reproductive technology (ART) treatment are prone to sleep disorders. Sleep condition, its influencing factors, and the association between sleep condition and ART treatment outcomes before treatment have not been explored within a population with a large sample size. Therefore, we investigated the sleep characteristics of 1002 Chinese infertile women before ovulation induction and investigated the influencing factors (negative and positive psychological factors, demographics, and fertility characteristics). We also examined whether sleep conditions before treatment predicted reproductive outcomes. We found that 24.1% of participants reported poor sleep quality. Women with primary infertility reported poorer sleep than women with secondary infertility. Negative psychological factors, including depression, anxiety, and perceived stress were associated with poor sleep, whereas positive affect was linked with good sleep. Adverse sleep characteristics, including poor subjective sleep quality, sleep disturbances, and poor sleep efficiency, decreased the quantity and quality of oocytes retrieved, fertilization rates, and clinical pregnancy rates. This study indicates that before ART treatment, a large number of females with infertility suffer from sleep problems, which are affected by psychological factors and infertility type, and unhealthy sleep characteristics may impair treatment outcomes. Our findings highlight the importance of screening and treatment for sleep disorders before the enrollment of ART treatment in infertile women.
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Affiliation(s)
- Qian-Ling Li
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- Center for Reproductive Medicine, Affiliated Hospital of Jining Medical University, Jining, China
| | - Chao Wang
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Peking University International Hospital, Beijing, China
| | - Ke-Xin Cao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- Department of Pharmacology, School of Basic Medical Sciences, Peking University, Beijing, China
| | - Lin Zhang
- Center for Reproductive Medicine, Affiliated Hospital of Jining Medical University, Jining, China
| | - Yun-Shuai Xu
- Department of Psychiatry, Shandong Daizhuang Hospital, Jining, China
| | - Liang Chang
- Henan Key Laboratory of Medical Tissue Regeneration, School of Basic Medical Sciences, Xinxiang Medical University, Xinxiang, China
| | - Zhen-Hui Liu
- Center for Reproductive Medicine, Affiliated Hospital of Jining Medical University, Jining, China
| | - Ai-Jun Yang
- Center for Reproductive Medicine, Affiliated Hospital of Jining Medical University, Jining, China
| | - Yan-Xue Xue
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- Chinese Institute for Brain Research, Beijing, China
- Key Laboratory for Neuroscience, Ministry of Education/National Health Commission, Peking University, Beijing, China
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Zhang M, Xing J, Zhao S, Chen H, Yin X, Zhu X. Engineered extracellular vesicles in female reproductive disorders. Biomed Pharmacother 2023; 166:115284. [PMID: 37572637 DOI: 10.1016/j.biopha.2023.115284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/28/2023] [Accepted: 08/04/2023] [Indexed: 08/14/2023] Open
Abstract
Biologically active and nanoscale extracellular vesicles (EVs) participate in a variety of cellular physiological and pathological processes in a cell-free manner. Unlike cells, EVs not only do not cause acute immune rejection, but are much smaller and have a low risk of tumorigenicity or embolization. Because of their unique advantages, EVs show promise in applications in the diagnosis and treatment of reproductive disorders. As research broadens, engineering strategies for EVs have been developed, and engineering strategies for EVs have substantially improved their application potential while circumventing the defects of natural EVs, driving EVs toward clinical applications. In this paper, we will review the engineering strategies of EVs, as well as their regulatory effects and mechanisms on reproductive disorders (including premature ovarian insufficiency (POI), polycystic ovarian syndrome (PCOS), recurrent spontaneous abortion (RSA), intrauterine adhesion (IUA), and endometriosis (EMS)) and their application prospects. This work provides new ideas for the treatment of female reproductive disorders by engineering EVs.
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Affiliation(s)
- Mengxue Zhang
- Reproductive Medicine Center, The Fourth Affiliated Hospital of Jiangsu University, 20 Zhengdong Road, Zhenjiang, Jiangsu 212001, PR China; Institute of Reproductive Sciences, Jiangsu University, 20 Zhengdong Road, Zhenjiang, Jiangsu 212001, PR China; Department of Central Laboratory, The Fourth Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212001, China
| | - Jie Xing
- Reproductive Medicine Center, The Fourth Affiliated Hospital of Jiangsu University, 20 Zhengdong Road, Zhenjiang, Jiangsu 212001, PR China; Institute of Reproductive Sciences, Jiangsu University, 20 Zhengdong Road, Zhenjiang, Jiangsu 212001, PR China; Department of Central Laboratory, The Fourth Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212001, China
| | - Shijie Zhao
- Reproductive Medicine Center, The Fourth Affiliated Hospital of Jiangsu University, 20 Zhengdong Road, Zhenjiang, Jiangsu 212001, PR China; Institute of Reproductive Sciences, Jiangsu University, 20 Zhengdong Road, Zhenjiang, Jiangsu 212001, PR China; Department of Central Laboratory, The Fourth Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212001, China
| | - Hui Chen
- Department of Central Laboratory, The Fourth Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212001, China
| | - Xinming Yin
- Department of Central Laboratory, The Fourth Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212001, China
| | - Xiaolan Zhu
- Reproductive Medicine Center, The Fourth Affiliated Hospital of Jiangsu University, 20 Zhengdong Road, Zhenjiang, Jiangsu 212001, PR China; Institute of Reproductive Sciences, Jiangsu University, 20 Zhengdong Road, Zhenjiang, Jiangsu 212001, PR China.
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Shayesteh-Parto F, Hasanpoor-Azghady SB, Arefi S, Amiri-Farahani L. Infertility-related stress and its relationship with emotional divorce among Iranian infertile people. BMC Psychiatry 2023; 23:666. [PMID: 37700231 PMCID: PMC10496378 DOI: 10.1186/s12888-023-05159-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 08/31/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Infertility affects different aspects of couples' lives, so it may cause problems in couples' emotional relationships by increasing marital conflicts. This study aimed to determine Infertility-related stress and its relationship with emotional divorce among Iranian infertile people. METHODS We conducted a cross-sectional observational study on 200 infertile people. The research environment was one of the well-equipped infertility centers in Tehran, Iran. Continuous sampling was employed. The data collection tools included a general information form, the Fertility Problem Inventory (FPI), and the Emotional Divorce Scale (EDS). RESULTS The findings revealed a significant direct relationship between infertility-related stress and all its subscales with emotional divorce in both infertile women and men. In infertile women, the most concern was the need for parenthood, while the lowest concerns were the relationship and sexual concerns. Multiple linear regression analysis indicated that social and relationship concerns predicted 44% of emotional divorce, with social concern being the more influential factor. In infertile men, the need for parenthood was the most significant concern, while relationship and social concerns were less prominent. Multiple linear regression analysis showed that relationship concern predicted 50% of emotional divorce in infertile men. In both infertile men and women, social and relationship concerns explained 45% of the variance in emotional divorce. Among these two variables, relationship concern had a more impact in predicting emotional divorce. Also, there was no statistically significant difference between women and men regarding infertility-related stress and its subscales, except for sexual concern. CONCLUSION The study highlights the importance of the need for parenthood as a main concern among infertile individuals. Increased infertility-related stress and its subscales contribute to higher levels of emotional divorce among this population. Additionally, relationship concern was the lowest concern in infertile people. But it significantly predicts emotional divorce among infertile individuals.
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Affiliation(s)
- Fatemeh Shayesteh-Parto
- Department of Midwifery and Reproductive, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Seyedeh Batool Hasanpoor-Azghady
- Department of Midwifery and Reproductive, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
| | - Soheila Arefi
- Monoclonal Antibody Department, Avicenna Research Institute, Tehran, Iran
| | - Leila Amiri-Farahani
- Department of Midwifery and Reproductive, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
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Matsushima M, Yamada H, Kondo N, Arakawa Y, Tabuchi T. Married women's decision to delay childbearing, and loneliness, severe psychological distress, and suicidal ideation under crisis: online survey data analysis from 2020 to 2021. BMC Public Health 2023; 23:1642. [PMID: 37641039 PMCID: PMC10464056 DOI: 10.1186/s12889-023-16476-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 08/08/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has affected every aspect of our lives, including the decision to become pregnant. Existing literature suggests that infertility and the decision to delay childbearing at a younger age are associated with a lower level of well-being and regrets when women start to desire a baby. Thus, the decision to delay childbearing due to the pandemic could negatively affect the well-being of women. This study focuses on how pregnancy decisions affect the well-being of women during the COVID-19 pandemic. METHODS From the Japan COVID-19 and Society Internet Survey, a nationally representative web-based survey, 768 observations of married women aged 18 to 50 years who had the intention of getting pregnant during the pre-pandemic period (conducted in 2020 and 2021) were used. Loneliness, severe psychological distress, and suicidal ideation were used as well-being indicators. For pooled data, a generalised estimated equation (GEE) model was used to estimate how pregnancy decision related to well-being indicators. For a sub-analysis, the sample was divided by the survey year and a Poisson regression model was used. RESULTS The GEE analysis showed an association between delaying childbearing and severe psychological distress, with the prevalence ratio (PR) being 2.06 [95% CI (1.40-3.03)]. Furthermore, loneliness and suicidal ideation that occurred after the beginning of the pandemic were significantly related to the decision to delay childbearing-1.55 [95% CI (1.03,2.34)] and 2.55 [95% CI (1.45-4.51)], respectively. Moreover, these PRs were larger for 2021 compared to 2020. CONCLUSION During the COVID-19 pandemic, approximately one-fifth of married women who had childbearing intentions before the pandemic decided to postpone pregnancy. They exhibited a deteriorated mental health state. Furthermore, the negative associations were larger in 2021 compared to 2020. Loneliness has negative consequences for both mental and physical health, as well as elevated severe psychological distress and suicidal ideation among those who decided to postpone pregnancy. Therefore, the current results should not be overlooked by society.
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Affiliation(s)
- Midori Matsushima
- Faculty of Humanities and Social Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba Ibaraki, 305-8577, Japan.
| | | | - Naoki Kondo
- Department of Social Epidemiology, Graduate School of Medicine, University of Kyoto, Kyoto, Japan
| | - Yuki Arakawa
- Departments of Health and Social Behavior, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
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Grace B, Shawe J, Stephenson J. Exploring fertility knowledge amongst healthcare professional and lay population groups in the UK: a mixed methods study. HUM FERTIL 2023:1-10. [PMID: 36600193 DOI: 10.1080/14647273.2022.2153349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
As the average age of first-time parents continues to rise, there has been a concerted effort by educators, policy makers and several reproductive health groups to improve fertility awareness. This study explored fertility knowledge of lay men and women and healthcare professionals (HCPs) using the same test instrument, providing a new and unique perspective compared with previous studies. Results were obtained from 1082 survey respondents: 347 HCPs, 319 men and 413 women, 105 of whom were trying to conceive (TTC). A total of 35 interviewees were purposively sampled to include 9 HCPs, 13 men and 13 women from the reproductive age range and of varying ethnic and educational backgrounds. Interview data were transcribed and analysed using the framework method. The proportion of HCPs correctly answering the survey knowledge questions was 47.1 (95% CI = 41.7%, 52.5%) compared to 44.4% for women (95% CI = 38.9%, 50.1%); 49.9% (95% CI = 39.0, 59.9%) for women TTC; and 32.5% (95% CI = 27.1%, 37.9%) for men. HCPs were ranked as the most trusted source for seeking fertility information. Overall HCPs did not demonstrate better fertility knowledge than lay participants, with inconsistencies regarding where responsibility lies for providing the right information to patients. HCPs need to improve their knowledge about fertility to help improve patient's fertility awareness.
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Affiliation(s)
- Bola Grace
- Department of Sexual and Reproductive Health, Faculty of Population Health Sciences, UCL Institute for Women's Health, University College London, London, UK
| | - Jill Shawe
- Faculty of Health, University of Plymouth, Plymouth, UK.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Judith Stephenson
- Department of Sexual and Reproductive Health, Faculty of Population Health Sciences, UCL Institute for Women's Health, University College London, London, UK
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Sheikh IA, Beg MA, Hamoda TAAM, Mandourah HMS, Memili E. Androgen receptor signaling and pyrethroids: Potential male infertility consequences. Front Cell Dev Biol 2023; 11:1173575. [PMID: 37187621 PMCID: PMC10175798 DOI: 10.3389/fcell.2023.1173575] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 04/10/2023] [Indexed: 05/17/2023] Open
Abstract
Infertility is a global health concern inflicting a considerable burden on the global economy and a severe socio-psychological impact. Approximately 15% of couples suffer from infertility globally, with a male factor contribution of approximately 50%. However, male infertility remains largely unexplored, as the burden of infertility is mostly assigned to female people. Endocrine-disrupting chemicals (EDCs) have been proposed as one of the factors causing male infertility. Pyrethroids represent an important class of EDCs, and numerous studies have associated pyrethroid exposure with impaired male reproductive function and development. Therefore, the present study investigated the potentially toxic effects of two common pyrethroids, cypermethrin and deltamethrin, on androgen receptor (AR) signaling. The structural binding characterization of cypermethrin and deltamethrin against the AR ligand-binding pocket was performed using Schrodinger's induced fit docking (IFD) approach. Various parameters were estimated, such as binding interactions, binding energy, docking score, and IFD score. Furthermore, the AR native ligand, testosterone, was subjected to similar experiments against the AR ligand-binding pocket. The results revealed commonality in the amino acid-binding interactions and overlap in other structural parameters between the AR native ligand, testosterone, and the ligands, cypermethrin and deltamethrin. The estimated binding energy values of cypermethrin and deltamethrin were very high and close to those calculated for AR native ligand, testosterone. Taken together, the results of this study suggested potential disruption of AR signaling by cypermethrin and deltamethrin, which may result in androgen dysfunction and subsequent male infertility.
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Affiliation(s)
- Ishfaq Ahmad Sheikh
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
- *Correspondence: Ishfaq Ahmad Sheikh,
| | - Mohd Amin Beg
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | | | - Erdogan Memili
- College of Agriculture and Human Sciences, Prairie View A&M University, Prairie View, TX, United States
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Fragoulakis V, Mantis A, Christoforidis N, Dovas D, Deftereos S, Lainas T, Mantoudis E, Paraschos T, Sakellariou D, Makrakis E. Follitropin Alpha for assisted reproduction: an analysis based on a non-interventional study in Greece. Curr Med Res Opin 2022; 38:2227-2235. [PMID: 36193626 DOI: 10.1080/03007995.2022.2131303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To conduct an economic evaluation estimating the cost per live birth after controlled ovarian stimulation (COS) using Follitropin Alpha (Gonal-F), in the Greek National Health System setting. A secondary objective was to predict the live birth rateof the In Vitro Fertilization (IVF) procedure. METHODS A single arm, multi-center, prospective, non-interventional study was conducted on which economic, efficacy and safety data were collected by six of the largest IVF centers. The participants were 350 female patients. Three statistical methods were employed for the analysis of the study outcomes, namely (a) Generalized Linear Modeling for the estimation of the costs of IVF treatment, (b) multivariable logistic regression and (c) an Artificial Neural Network (ANN) model for live birth prediction. RESULTS The mean total cost of IVF therapy per patient was estimated at €3728 (95% CI: €3679-€3780), while the total cost per live birth was €14,872 (95% CI: €12,441-€17,951). The live birth rate after 3 complete IVF cycles was estimated at 22.9%, while the percentage of those suffering from OHSS was limited at 0.57%. In logistic regression, the Ovarian Sensitivity Index (OSI) was a factor found to be positively associated with live birth (OR 7.39, 95% CI: 1.84-29.71). For the ANN, important predictors included number of gestational sacs and the duration of infertility. CONCLUSION The present study constitutes the largest single-arm study based on real data in Greece to date. The cost of IVF treatment and the cost per live birth are not insignificant in this NHS setting. The live birth rate, cost per oocyte, and the cost per live birth are in line with literature. OSI was a main contributing factor to the accurate prediction of the live birth rate, while age and BMI were found to be negatively correlated.
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Affiliation(s)
| | - Andreas Mantis
- School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
| | | | | | | | - Tryfwnas Lainas
- Eugonia - Assisted Reproduction Unit Konstantinou Ventiri 7 (HILTON), Athens, Greece
| | - Evripidis Mantoudis
- Medically Assisted Reproduction Unit and Cryopreservation Bank, "Gennima", Athens, Greece
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Tabatabaee A, Fallahi A, Shakeri B, Baghi V, Ghanei Gheshlagh R. Marital satisfaction in Iranian infertile women: A systematic review and meta-analysis. Front Public Health 2022; 10:1027005. [PMID: 36504968 PMCID: PMC9732573 DOI: 10.3389/fpubh.2022.1027005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/16/2022] [Indexed: 11/27/2022] Open
Abstract
Background Infertility is a severe crisis in life that, in addition to creating psychological problems and disrupting a parent's identity and role, negatively impacts couples' marital satisfaction. Different studies in this field have reported different results, so this systematic review and meta-analysis was conducted to estimate the marital satisfaction standard score among infertile Iranian women. Method The databases of PubMed, Scopus, Web of Science, Embase, Scientific Information Database, and MagIran were searched without a time limit. We used the meta-analysis and a random-effects model to estimate the marital satisfaction pooled score. The heterogeneity of studies was examined with the I 2 index and Cochrane's Q test. The correlation between the pooled score with the publication year and the mean age of women was evaluated using meta-regression. We assessed the publication bias by the Egger test. Results Seventeen studies with a sample size of 2,421 people were analyzed. The marital satisfaction pooled score of infertile women was 49% (95% CI: 39-60%). The marital satisfaction score in region 1 of the country (54, 95% CI: 42.7-65.3%) was higher than in other regions (45, 95% CI: 40-58%). Also, the marital satisfaction pooled score based on the Enrich scale (54, 95% CI: 39-69%) was higher than the score reported on other scales (45, 95% CI: 29-61%). Publication bias was not significant. Conclusion Infertile women have moderate to low marital satisfaction, rooted in the culture and context of Iranian society. It seems necessary to provide measures to strengthen marital satisfaction, strengthen family relationships and prevent family disintegration in these women.
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Affiliation(s)
- Amir Tabatabaee
- Department of Nursing, Islamic Azad University, Quchan Branch, Quchan, Iran
| | - Arezoo Fallahi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Bahre Shakeri
- Faculty of Nursing and Midwifery, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Vajiheh Baghi
- Besat Hospital, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Reza Ghanei Gheshlagh
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran,*Correspondence: Reza Ghanei Gheshlagh
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Fertility-related quality of life in subfertile women undergoing tubal testing with transvaginal hydrolaparoscopy or hysterosalpingography. Eur J Obstet Gynecol Reprod Biol 2022; 274:19-22. [PMID: 35561566 DOI: 10.1016/j.ejogrb.2022.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 02/19/2022] [Accepted: 04/09/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Both subfertility and its management can have significant impact on quality of life (QoL). Tubal patency testing as part of the fertility work-up, is considered to cause more physical complaints and stress than other tests. Pain scores for HSG are higher than for THL, but acceptability of the procedures was found to be comparable. Fertility-related QoL has not yet been studied in women undergoing tubal patency testing. STUDY DESIGN We performed a standardized questionnaire study alongside a previously reported randomized controlled trial comparing THL and HSG in subfertile women, in which 24-month live birth rates occurred in 58.5% versus 55.4%, respectively. We randomly assigned 300 subfertile women to THL or HSG between May 2013 and October 2016. Women were eligible if they were undergoing a fertility work-up with an indication for evaluation of tubal patency. Fertility-related QoL was measured six weeks after the procedure with the validated FertiQoL questionnaire. The scores for the Core scale and subscales between THL and HSG were compared using Mann-Whitney-U test and multiple linear regression analysis. RESULTS The questionnaire was completed by 84 women in the THL group (56%) and 96 women in the HSG group (64%). Core scores were 74.6 ± 12.8 for THL and 73.4 ± 12.4 for HSG (p = 0.39). Scores for the Emotional domain were 64.5 ± 19.0 for THL versus 66.0 ± 16.3 (p = 0.67) for HSG. Scores for the 'Mind-body' domain for THL were 76.9 ± 15.6 versus 74.1 ± 18.0 for HSG (p = 0.42), while scores for the Relational domain were 79.2 ± 12.9 for THL and 76.9 ± 15.6 for HSG (p = 0.21). Scores for the Social domain for THL were 77.9 ± 15.1 versus 76.7 ± 14.1, (p = 0.42). The multiple linear regression analysis showed only a statistical significant positive effect of older age on the score for the Emotional domain (p = 0.015). CONCLUSION In a preselected group of women with low risk for tubal pathology we did not find differences in fertility-related QoL between tubal patency testing with THL versus HSG.
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Grace B, Shawe J, Johnson S, Usman NO, Stephenson J. The ABC of reproductive intentions: a mixed-methods study exploring the spectrum of attitudes towards family building. HUMAN REPRODUCTION (OXFORD, ENGLAND) 2022. [PMID: 35238351 DOI: 10.1093/humrep/deac036/6541644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
STUDY QUESTION What are the intentions of men and women of reproductive age in the UK regarding reproduction and family building? SUMMARY ANSWER We identified six main categories of people; Avoiders, Betweeners, Completers, Desirers, Expectants and Flexers, for whom reproduction education strategies should be tailored differently to suit intentions. WHAT IS KNOWN ALREADY Several studies have highlighted poor fertility awareness across men and women of reproductive age. As the average age of first-time parents continues to rise, there has been a concerted effort from educators, healthcare professionals, charities, reproductive health groups and government policymakers, to improve fertility awareness. In order to ensure that these messages are effective and to deploy the best strategies, it is important to understand people's reproductive health needs. This study therefore aimed to explore different reproductive intentions to aid tailoring of information to help individuals and couples achieve their family building desires. STUDY DESIGN, SIZE, DURATION We conducted a mixed-method study via a UK-wide cross-sectional survey with 1082 participants and semi-structured interviews of 20 women and 15 men who agreed to follow-up interviews. Interviews lasted an hour on average. Ethics approval from UCL Research Ethics Committee. PARTICIPANTS/MATERIALS, SETTING, METHODS Survey participants were recruited nationwide via online newspaper and social media adverts. Interviewees were purposely sampled to include men and women from the reproductive age range (18-45 years), varying ethnicity and education background. Survey data were analysed using the Minitab statistical software package. Interview data were transcribed and analysed using the framework method. MAIN RESULTS AND THE ROLE OF CHANCE From the survey and interviews, we identified six key categories of people, grouped alphabetically, in a user-friendly manner to highlight a spectrum of reproductive intentions: Avoiders describes respondents who have no children and do not want to have children in the future; Betweeners describes those who already have child(ren) and want more in the future but are not actively trying to conceive; Completers describes those who have child(ren) but do not want more; Desirers describes those who are actively trying to conceive or plan to have child(ren) in the future; Expectants describes those who were pregnant at the time of the study; and Flexers describes those who may or may not already have and are unsure but or open to having child(ren) in the future. Analysis of survey data identified the following proportions in our study: Avoiders, 4.7%; Betweeners, 11.3%; Completers, 13.6%; Desirers, 36.9%; Expectants, 4.1%; and Flexers 28.4% and 2.4% preferring not to answer. There was one 'other' group from qualitative analysis, who would like to have children in the future but were unsure whether they could or had changing views. We recommend classifying as 'Desirers' or 'Flexers' for the purposes of fertility education. A majority of the survey population were trying to get pregnant; were pregnant; or planning to have a child in the future-whether actively, passively or simply open to the idea, with interviews providing deep insights into their family building decision-making. LIMITATIONS, REASONS FOR CAUTION Due to the online recruitment method, there may be a bias towards more educated respondents. WIDER IMPLICATIONS OF THE FINDINGS We developed a user-friendly, alphabetical categorization of reproductive intentions, which may be used by individuals, healthcare professionals, educators, special interest groups, charities and policymakers to support and enable individuals and couples in making informed choices to achieve their desired intentions, if and when they choose to start a family. STUDY FUNDING/COMPETING INTEREST(S) There was no external funding for this study. The authors report no competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- B Grace
- Department of Sexual and Reproductive Health, UCL Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK
| | - J Shawe
- Faculty of Health, University of Plymouth, Devon, UK.,SW Clinical School, Royal Cornwall Hospital, Truro, UK
| | - S Johnson
- QIAGEN Manchester Ltd, Manchester, UK
| | - N O Usman
- Department of Community Medicine, Kaduna State University, Kaduna, Nigeria
| | - J Stephenson
- Department of Sexual and Reproductive Health, UCL Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK
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Jing X, Gu W, Xu X, Yan C, Jiao P, Zhang L, Li X, Wang X, Wang W. Stigma predicting fertility quality of life among Chinese infertile women undergoing in vitro fertilization-embryo transfer. J Psychosom Obstet Gynaecol 2022; 43:35-41. [PMID: 32633181 DOI: 10.1080/0167482x.2020.1778665] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To investigate stigma and fertility quality of life (FertiQoL) and identify predictors of FertiQoL in Chinese infertile women undergoing in vitro fertilization-embryo transfer (IVF-ET). METHODS A descriptive correlational design was adopted to investigate the association between stigma and FertiQoL in 588 infertile women undergoing IVF-ET. The personal information questionnaire, Infertility Stigma Scale (ISS) and FertiQoL tool were used to measure study variables. RESULTS The mean scores of ISS and FertiQoL were 62.59 (SD = 21.58) and 63.64 (SD = 13.72), respectively. There were significant differences of ISS scores among participants with different educational level, residence, occupation, religious belief, financial condition, age group, duration of infertility and infertility treatment, while significant differences of the FertiQoL scores were found in participants with different insurance status, determinism of etiology, infertile type, duration of infertility treatment and cycles of IVF-ET. Pearson's correlation analysis showed stigma was negatively correlated with FertiQoL (r = -0.081 to -0.669, p < .05). The self-devaluation (β = -0.290, p < .001), social withdrawal (β = -0.237, p < .001), family stigma (β = -0.217, p < .001) and insurance status (β = 0.066, p=.035) were identified as the significant predictor of FertiQoL accounting for 43.5% of variance. CONCLUSIONS The stigma was significantly associated with FertiQoL in infertile women undergoing IVF-ET with higher level of stigma predicting poorer FertiQoL. More psychological support should be provided to infertile women to reduce stigma and improve FertiQoL.
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Affiliation(s)
- Xiaoyu Jing
- School of Nursing, Xi'an Jiaotong University, Xi'an, PR China
| | - Wei Gu
- School of Nursing, Xi'an Jiaotong University, Xi'an, PR China
| | - Xiuli Xu
- Northwest Women's and Children's Hospital, Xi'an, PR China
| | | | - Peijuan Jiao
- School of Nursing, Xi'an Jiaotong University, Xi'an, PR China
| | - Lu Zhang
- School of Nursing, Xi'an Jiaotong University, Xi'an, PR China
| | - Xiaomei Li
- School of Nursing, Xi'an Jiaotong University, Xi'an, PR China
| | - Xiaoqin Wang
- School of Nursing, Xi'an Jiaotong University, Xi'an, PR China
| | - Wenru Wang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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16
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Grace B, Shawe J, Johnson S, Usman NO, Stephenson J. OUP accepted manuscript. Hum Reprod 2022; 37:988-996. [PMID: 35238351 PMCID: PMC9071225 DOI: 10.1093/humrep/deac036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 02/02/2022] [Indexed: 11/26/2022] Open
Abstract
STUDY QUESTION What are the intentions of men and women of reproductive age in the UK regarding reproduction and family building? SUMMARY ANSWER We identified six main categories of people; Avoiders, Betweeners, Completers, Desirers, Expectants and Flexers, for whom reproduction education strategies should be tailored differently to suit intentions. WHAT IS KNOWN ALREADY Several studies have highlighted poor fertility awareness across men and women of reproductive age. As the average age of first-time parents continues to rise, there has been a concerted effort from educators, healthcare professionals, charities, reproductive health groups and government policymakers, to improve fertility awareness. In order to ensure that these messages are effective and to deploy the best strategies, it is important to understand people’s reproductive health needs. This study therefore aimed to explore different reproductive intentions to aid tailoring of information to help individuals and couples achieve their family building desires. STUDY DESIGN, SIZE, DURATION We conducted a mixed-method study via a UK-wide cross-sectional survey with 1082 participants and semi-structured interviews of 20 women and 15 men who agreed to follow-up interviews. Interviews lasted an hour on average. Ethics approval from UCL Research Ethics Committee. PARTICIPANTS/MATERIALS, SETTING, METHODS Survey participants were recruited nationwide via online newspaper and social media adverts. Interviewees were purposely sampled to include men and women from the reproductive age range (18–45 years), varying ethnicity and education background. Survey data were analysed using the Minitab statistical software package. Interview data were transcribed and analysed using the framework method. MAIN RESULTS AND THE ROLE OF CHANCE From the survey and interviews, we identified six key categories of people, grouped alphabetically, in a user-friendly manner to highlight a spectrum of reproductive intentions: Avoiders describes respondents who have no children and do not want to have children in the future; Betweeners describes those who already have child(ren) and want more in the future but are not actively trying to conceive; Completers describes those who have child(ren) but do not want more; Desirers describes those who are actively trying to conceive or plan to have child(ren) in the future; Expectants describes those who were pregnant at the time of the study; and Flexers describes those who may or may not already have and are unsure but or open to having child(ren) in the future. Analysis of survey data identified the following proportions in our study: Avoiders, 4.7%; Betweeners, 11.3%; Completers, 13.6%; Desirers, 36.9%; Expectants, 4.1%; and Flexers 28.4% and 2.4% preferring not to answer. There was one ‘other’ group from qualitative analysis, who would like to have children in the future but were unsure whether they could or had changing views. We recommend classifying as ‘Desirers’ or ‘Flexers’ for the purposes of fertility education. A majority of the survey population were trying to get pregnant; were pregnant; or planning to have a child in the future—whether actively, passively or simply open to the idea, with interviews providing deep insights into their family building decision-making. LIMITATIONS, REASONS FOR CAUTION Due to the online recruitment method, there may be a bias towards more educated respondents. WIDER IMPLICATIONS OF THE FINDINGS We developed a user-friendly, alphabetical categorization of reproductive intentions, which may be used by individuals, healthcare professionals, educators, special interest groups, charities and policymakers to support and enable individuals and couples in making informed choices to achieve their desired intentions, if and when they choose to start a family. STUDY FUNDING/COMPETING INTEREST(S) There was no external funding for this study. The authors report no competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- B Grace
- Department of Sexual and Reproductive Health, UCL Institute for Women’s Health, Faculty of Population Health Sciences, University College London, London, UK
- Correspondence address. UCL EGA Institute for Women’s Health, Faculty of Population Health Sciences, Room 236 Medical School Building, University College London, 74 Huntley Street, London WC1E 6AU, UK. E-mail:
| | - J Shawe
- Faculty of Health, University of Plymouth, Devon, UK
- SW Clinical School, Royal Cornwall Hospital, Truro, UK
| | - S Johnson
- QIAGEN Manchester Ltd, Manchester, UK
| | - N O Usman
- Department of Community Medicine, Kaduna State University, Kaduna, Nigeria
| | - J Stephenson
- Department of Sexual and Reproductive Health, UCL Institute for Women’s Health, Faculty of Population Health Sciences, University College London, London, UK
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Woods BM, Patrician PA, Fazeli PL, Ladores S. Infertility-related stress: A concept analysis. Nurs Forum 2021; 57:437-445. [PMID: 34873709 DOI: 10.1111/nuf.12683] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/08/2021] [Accepted: 11/29/2021] [Indexed: 11/30/2022]
Abstract
AIM To develop a clear definition of infertility-related stress using Rodgers' method of concept analysis. BACKGROUND Infertility affects approximately 13% of women in the United States. Though poorly defined in the literature, previous studies suggest infertility-related stressors contribute to psychological distress. DESIGN Rodgers' method of concept analysis guided the review, including sample and setting, literature search, and data analysis. DATA SOURCE PubMed, CINAHL, and PsycINFO were searched for relevant literature. REVIEW METHODS Following abstract, title, and text screenings, 21 articles were included and reported using the PRISMA-S checklist. Texts were analyzed and results informed the proposed definition of infertility-related stress. RESULTS Antecedents included infertility, desire for children, and fear of the unknown. Attributes were identity crisis, social isolation and stigma, sexual stress, and financial strain. Consequences included treatment dropout and marital strain. Anxiety, depression, and decreased quality of life were identified as both attributes and consequences. CONCLUSIONS Synthesized results informed a proposed definition of infertility-related stress. Improved understanding of infertility-related stress allows for measurement development and facilitates recognition of patients in need of additional support, while potentially reducing the impact on the health and well-being of infertile women.
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Affiliation(s)
- Brittany M Woods
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Patricia A Patrician
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Pariya L Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sigrid Ladores
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Järvholm S, Bokström H, Enskog A, Hammarling C, Dahm-Kähler P, Brännström M. Striving for motherhood after uterus transplantation: a qualitative study concerning pregnancy attempts, and the first years of parenthood after transplantation. Hum Reprod 2021; 37:274-283. [PMID: 34865019 DOI: 10.1093/humrep/deab260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 10/31/2021] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION How do women experience attempts to become pregnant, and the first years of motherhood, after uterus transplantation (UTx)? SUMMARY ANSWER Women who try to become pregnant after UTx experience the general strains typically associated with infertility and childlessness, such as failure of embryo transfer (ET), and specific worries about graft survival but when they become mothers they essentially feel like other mothers, with the associated rewards and stresses. WHAT IS KNOWN ALREADY UTx has proven to be a successful treatment for absolute uterine factor infertility (AUFI). Although UTx seems to have a positive effect on self-image there is a lack of knowledge about how women who have received uterine grafts experience pregnancy attempts, pregnancy itself and the first years of motherhood. STUDY DESIGN, SIZE, DURATION This prospective cohort study included the seven participants in the first UTx trial who had experienced surgically successful grafts. Pregnancy was attempted using ET 12 months after transplantation. Structured interviews were performed once a year for 5 years after transplantation. PARTICIPANTS/MATERIALS, SETTING, METHODS Six of the seven participants (mean age 29.3 years at UTx) had AUFI owing to the congenital absence of the uterus, while the seventh woman had undergone a hysterectomy. Post-transplantation, yearly interviews (2013-2018) were performed, comprising a total of 34 interviews. Interview data were analysed thematically. MAIN RESULTS AND THE ROLE OF CHANCE All seven participants achieved pregnancy during the study period and six became mothers. Experiencing the previously unimaginable was classed as an overarching theme with the following underlying themes: The yoke of childlessness; Going through the impossible and Motherhood as surreal and normal. The results showed that the women who try to achieve motherhood after UTx generally describe their situation as manageable and present strains comparable to other women undergoing infertility treatments. LIMITATIONS, REASONS FOR CAUTION The fact that all participants came from one centre is a limitation. WIDER IMPLICATIONS OF THE FINDINGS There are real psychological strains in motherhood after UTx, such as the concern the women expressed relating to health of the child and the effects of immunosuppressants. These findings are in line with those of other women who became pregnant after transplantation of organs other than the uterus. The results show that extra psychological support and attention should be given to those with repeated pregnancy failures or unsuccessful outcomes. In the cases where women became mothers, attention needs to be given to the possible worries connected to the UTx, but in other respects, they should be treated like any mother-to-be. STUDY FUNDING/COMPETING INTEREST(S) Funding was received from the Jane and Dan Olsson Foundation for Science; Knut and Alice Wallenberg Foundation. A.L.F. grant from the Swedish state under an agreement between the government and the county councils; Swedish Research Council. The authors have no competing interests. TRIAL REGISTRATION NUMBER NCT01844362.
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Affiliation(s)
- Stina Järvholm
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hans Bokström
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders Enskog
- Department of Anaesthesia and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Catrina Hammarling
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Pernilla Dahm-Kähler
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mats Brännström
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Stockholm IVF-EUGIN, Stockholm, Sweden
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Gullo G, Cucinella G, Perino A, Gullo D, Segreto D, Laganà AS, Buzzaccarini G, Donarelli Z, Marino A, Allegra A, Maranto M, Carosso AR, Garofalo P, Tomaiuolo R. The Gender Gap in the Diagnostic-Therapeutic Journey of the Infertile Couple. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126184. [PMID: 34201025 PMCID: PMC8227607 DOI: 10.3390/ijerph18126184] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/28/2021] [Accepted: 06/04/2021] [Indexed: 11/19/2022]
Abstract
Medical procreation impairs both the biological and psychological lives of couples. However, male and female attitudes to infertility are different and require a different approach during the IVF journey. Thus, the gender impact assessment (GIA) method was used to analyse original studies present in the literature. We found some gender-related differences and, subsequently, possible outcomes of intervention to improve healthy reproduction management and prevent infertility. In particular, it became apparent that there was the need for an in-depth male infertility assessment and a gender-specific follow-up.
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Affiliation(s)
- Giuseppe Gullo
- Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, IVF UNIT, University of Palermo, 90146 Palermo, Italy; (G.G.); (G.C.); (A.P.); (M.M.)
| | - Gaspare Cucinella
- Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, IVF UNIT, University of Palermo, 90146 Palermo, Italy; (G.G.); (G.C.); (A.P.); (M.M.)
| | - Antonio Perino
- Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, IVF UNIT, University of Palermo, 90146 Palermo, Italy; (G.G.); (G.C.); (A.P.); (M.M.)
| | - Domenico Gullo
- Technical Panel on Gender Medicine-Sicily Regional Health Service, 90143 Palermo, Italy; (D.G.); (D.S.); (P.G.)
| | - Daniela Segreto
- Technical Panel on Gender Medicine-Sicily Regional Health Service, 90143 Palermo, Italy; (D.G.); (D.S.); (P.G.)
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy;
| | - Giovanni Buzzaccarini
- Department of Women’s and Children’s Health, Padova Hospital, University of Padova, 35128 Padova, Italy
- Correspondence:
| | - Zaira Donarelli
- Psychology Unit, Andros Day Surgery Clinic-Palermo, 90144 Palermo, Italy;
| | - Angelo Marino
- Reproductive Medicine Unit, Andros Day Surgery Clinic-Palermo, 90144 Palermo, Italy; (A.M.); (A.A.)
| | - Adolfo Allegra
- Reproductive Medicine Unit, Andros Day Surgery Clinic-Palermo, 90144 Palermo, Italy; (A.M.); (A.A.)
| | - Marianna Maranto
- Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, IVF UNIT, University of Palermo, 90146 Palermo, Italy; (G.G.); (G.C.); (A.P.); (M.M.)
| | - Andrea Roberto Carosso
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Turin, 10126 Turin, Italy;
| | - Piernicola Garofalo
- Technical Panel on Gender Medicine-Sicily Regional Health Service, 90143 Palermo, Italy; (D.G.); (D.S.); (P.G.)
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Kool EM, van der Graaf R, Bos AME, Fauser BCJM, Bredenoord AL. Fair allocation of cryopreserved donor oocytes: towards an accountable process. Hum Reprod 2021; 36:840-846. [PMID: 33394023 DOI: 10.1093/humrep/deaa356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 11/17/2020] [Indexed: 11/14/2022] Open
Abstract
A growing number of people desire ART with cryopreserved donor oocytes. The allocation of these oocytes to couples and mothers to be is a 2-fold process. The first step is to select a pool of recipients. The second step is to decide who should be treated first. Prioritizing recipients is critical in settings where demand outstrips supply. So far, the issue of how to fairly allocate cryopreserved donor oocytes has been poorly addressed. Our ethical analysis aims to support clinics involved in allocation decisions by formulating criteria for recipient selection irrespective of supply (Part I) and recipient prioritization in case supply is limited (Part II). Relevant criteria for recipient selection are: a need for treatment to experience parenthood; a reasonable chance for successful treatment; the ability to safely undergo an oocyte donation pregnancy; and the ability to establish a stable and loving relationship with the child. Recipients eligible for priority include those who: have limited time left for treatment; have not yet experienced parenthood; did not undergo previous treatment with cryopreserved donor oocytes; and contributed to the supply of donor oocytes by bringing a donor to the bank. While selection criteria function as a threshold principle, we argue that the different prioritization criteria should be carefully balanced. Since specifying and balancing the allocation criteria undoubtedly raises a moral dispute, a fair and legitimate allocation process is warranted (Part III). We argue that allocation decisions should be made by a multidisciplinary committee, staffed by relevant experts with a variety of perspectives. Furthermore, the committees' reasoning behind decisions should be transparent and accessible to those affected: clinicians, donors, recipients and children born from treatment. Insight into the reasons that underpin allocation decisions allows these stakeholders to understand, review and challenge decisions, which is also known as accountability for reasonableness.
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Affiliation(s)
- E M Kool
- Department of Medical Humanities, University Medical Center, Julius Centre, Utrecht, The Netherlands
| | - R van der Graaf
- Department of Medical Humanities, University Medical Center, Julius Centre, Utrecht, The Netherlands
| | - A M E Bos
- Department of Reproductive Medicine and Gynecology, University Medical Centre, Utrecht, The Netherlands
| | - B C J M Fauser
- Department of Reproductive Medicine and Gynecology, University Medical Centre, Utrecht, The Netherlands
| | - A L Bredenoord
- Department of Medical Humanities, University Medical Center, Julius Centre, Utrecht, The Netherlands
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Kang X, Fang M, Li G, Huang Y, Li Y, Li P, Wang H. Family resilience is a protective buffer in the relationship between infertility-related stress and psychological distress among females preparing for their first in vitro fertilization-embryo transfer. PSYCHOL HEALTH MED 2021; 27:823-837. [PMID: 33874804 DOI: 10.1080/13548506.2021.1893767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The present study aimed to evaluate psychological distress and scrutinized whether family resilience plays a moderating role in the association between infertility-related stress and psychological distress among infertile females preparing for their first IVF-ET. A total of 492 infertile females completed self-reported measures including the Kessler 10 Psychological Distress Scale (K10), the fertility problem inventory (FPI), and the Family Resilience Assessment Scale (FRAS). The results showed 21 (65.2%) participants reported moderate or higher levels of psychological distress. While controlling for economic status, we found psychological distress to be positively linked to infertility-related stress (β=0.483, P<0.001), and negatively related to family resilience (β=-0.145, P=0.001). The simple slopes analysis showed that infertility-related stress had a weaker positive association with psychological distress for individuals at 1 SD (β = 0.443, P < 0.001) above the mean on family resilience compared to those at 1 SD (β = 0.537, P < 0.001) below the mean. Thus, it suggests that clinical practice should conduct family resilience-oriented interventions to facilitate family resilience among infertile females preparing for their first IVF-ET, with the goal to reduce psychological distress.
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Affiliation(s)
- Xiaofei Kang
- Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.,Department of Nursing, Center for Reproductive Medicine, Shandong University, Jinan, China
| | - Mei Fang
- Department of Nursing, Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Guopeng Li
- Department of Nursing, Center for Reproductive Medicine, Shandong University, Jinan, China
| | - Yuzhen Huang
- Department of Nursing, Center for Reproductive Medicine, Shandong University, Jinan, China
| | - Yuli Li
- Department of Health Psychology, School of Nursing, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Ping Li
- Department of Health Psychology, School of Nursing, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Hongmei Wang
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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Kolanska K, Dabi Y, Dechartres A, Cohen J, Ben Kraiem Y, Selleret L, Mathieu d'Argent E, Placais L, Cheloufi M, Johanet C, Rosefort A, Bornes M, Suner L, Delhommeau F, Ledée N, Chabbert Buffet N, Darai E, Antoine JM, Fain O, Kayem G, Mekinian A. Unexplained recurrent miscarriages: predictive value of immune biomarkers and immunomodulatory therapies for live birth. Am J Reprod Immunol 2021; 86:e13425. [PMID: 33772927 DOI: 10.1111/aji.13425] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 03/01/2021] [Accepted: 03/09/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Recurrent miscarriages are defined as three or more early miscarriages before 12 weeks of gestation. The aim of this study was to describe a cohort of women with unexplained recurrent miscarriages, evaluate several potential biomarkers of immune origin, and describe the outcome of pregnancies under immunomodulatory therapies. METHODS Women having a history of at least 3 early miscarriages without any etiology were recruited from 3 university hospitals. RESULTS Among 101 women with recurrent miscarriages, overall, 652 pregnancies have been included in the analysis. Women which experienced miscarriages were older (33.3 ± 5.4 versus 31.9 ± 6.7; p = 0.03), with history of more pregnancies (4 (2-6) versus 3.5 (1-5.75); p 0.0008), and less frequently the same partner (406 (74%) versus 79 (86%); p=0.01). There was no difference in the level and frequencies of biomarkers of immune origin (NK, lymphocyte, gamma globulins and blood cytokine levels and endometrial uNK activation status), except the higher rates of positive antinuclear antibodies in women with live birth (12 (13%) versus 36 (7%); p=0.03). Among the 652 pregnancies, 215 (33%) have been treated and received either aspirin/low weighted molecular heparin (LMWH) and/or combined to different lines of immunomodulatory treatment. Patients with pregnancy under treatment had a significantly higher rate of cumulative live birth rate than those with untreated ones (43.0% vs 34.8%; p = 0.04). When compared to patients with untreated pregnancies, patients with steroids during the pregnancy had twice more chances to obtain live birth (OR 2.0, CI95% 1.1 - 3.7, p = 0.02). CONCLUSIONS Unexplained recurrent miscarriages could have improved obstetrical outcome under immunomodulatory therapies and in particular steroids.
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Affiliation(s)
- Kamila Kolanska
- Sorbonne Université Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, AP-HP, Faculté de Médecine Sorbonne Université, Paris, France
| | - Yohann Dabi
- Sorbonne Université Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, AP-HP, Faculté de Médecine Sorbonne Université, Paris, France
| | | | - Jonathan Cohen
- Sorbonne Université Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, AP-HP, Faculté de Médecine Sorbonne Université, Paris, France
| | - Yasmine Ben Kraiem
- Sorbonne Université Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, AP-HP, Faculté de Médecine Sorbonne Université, Paris, France
| | - Lise Selleret
- Sorbonne Université Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, AP-HP, Faculté de Médecine Sorbonne Université, Paris, France
| | - Emmanuelle Mathieu d'Argent
- Sorbonne Université Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, AP-HP, Faculté de Médecine Sorbonne Université, Paris, France
| | - Leo Placais
- Sorbonne Université Service de Gynécologie Obstétrique, Hôpital Armand-Trousseau, Paris, France
| | | | - Catherine Johanet
- Sorbonne Université AP-HP, Hôpital Saint Antoine, Service d'Immunologie, Faculté de Médecine Sorbonne Université, Paris, France
| | - Audrey Rosefort
- Sorbonne Université Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, AP-HP, Faculté de Médecine Sorbonne Université, Paris, France
| | - Marie Bornes
- Sorbonne Université Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, AP-HP, Faculté de Médecine Sorbonne Université, Paris, France
| | - Ludovic Suner
- Sorbonne Université AP-HP, Hôpital Saint Antoine, Service d'Immunologie, Faculté de Médecine Sorbonne Université, Paris, France
| | - Francois Delhommeau
- Sorbonne Université AP-HP, Hôpital Saint Antoine, Service d'Immunologie, Faculté de Médecine Sorbonne Université, Paris, France
| | | | - Nathalie Chabbert Buffet
- Sorbonne Université Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, AP-HP, Faculté de Médecine Sorbonne Université, Paris, France
| | - Emile Darai
- Sorbonne Université Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, AP-HP, Faculté de Médecine Sorbonne Université, Paris, France
| | - Jean Marie Antoine
- Sorbonne Université Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, AP-HP, Faculté de Médecine Sorbonne Université, Paris, France
| | - Olivier Fain
- Sorbonne Université Service de Gynécologie Obstétrique, Hôpital Armand-Trousseau, Paris, France
| | - Gilles Kayem
- Sorbonne Université AP-HP, Hôpital Saint Antoine, Service de Hématologie biologique, Faculté de Médecine Sorbonne Université, Paris, France
| | - Arsène Mekinian
- Sorbonne Université Service de Gynécologie Obstétrique, Hôpital Armand-Trousseau, Paris, France.,Sorbonne Université AP-HP, Hôpital Saint Antoine, Service de Médecine Interne et Inflammation-Immunopathology-Biotherapy Department (DMU I3, Faculté de Médecine Sorbonne Université, Paris, France
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Kolanska K, Bendifallah S, Cohen J, Placais L, Selleret L, Johanet C, Suner L, Delhommeau F, Chabbert-Buffet N, Darai E, Antoine JM, Kayem G, Fain O, Mathieu d'Argent E, Mekinian A. Unexplained recurrent implantation failures: Predictive factors of pregnancy and therapeutic management from a French multicentre study. J Reprod Immunol 2021; 145:103313. [PMID: 33774529 DOI: 10.1016/j.jri.2021.103313] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 03/01/2021] [Accepted: 03/17/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Recurrent implantation failure is defined as the absence of pregnancy after at least three transfers of good-quality embryos after in vitro fecundation/intracytoplasic sperm injection. AIM The aim of this study was to describe a multicentre cohort of women with unexplained RIF, to analyse the factors associated with clinical pregnancy and to evaluate the immunomodulatory therapies efficacy. METHODS Women were consecutively recruited from university departments with unexplained RIF. RESULTS Sixty-four women were enrolled with mean age 36 ± 3 years. The rates of clinical pregnancy in 64 women were compared in untreated and treated cycles and according to therapies used during the last prospectively followed embryo transfer. A clinical pregnancy after the transfer was noted in 56 % pregnancies on intralipids and in 50 % on prednisone, versus 5 % in untreated ones (p < 0.001). The 340 embryo transfers of these 64 women resulted in 68 clinical pregnancies and 18 live births. Clinical pregnancies were significantly more frequent in treated versus untreated embryo transfers (44 % vs 9 %; p < 0.001) with odds ratio at 8.13 (95 % CI 4.49-14.72, p < 0.0001). Cumulative pregnancy rates were higher for steroid-treated transfers than for untreated transfers when considering overall transfers before and after using steroids and also only those under steroids. Cumulative pregnancy rates were not different from steroid- and intralipid-treated embryo transfers CONCLUSIONS: In this multicentre study of women with unexplained RIF, use of immunomodulatory treatments before embryo transfer resulted in higher clinical pregnancy. Randomised, well-designed studies in well-defined population of RIF women are necessary to confirm our preliminary data.
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Affiliation(s)
- Kamila Kolanska
- Sorbonne Université, APHP, Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, AP-HP, 4 rue de la Chine, 75020, Paris, Faculté de Médecine Sorbonne Université, France
| | - Sofiane Bendifallah
- Sorbonne Université, APHP, Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, AP-HP, 4 rue de la Chine, 75020, Paris, Faculté de Médecine Sorbonne Université, France
| | - Jonathan Cohen
- Sorbonne Université, APHP, Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, AP-HP, 4 rue de la Chine, 75020, Paris, Faculté de Médecine Sorbonne Université, France
| | - Leo Placais
- Sorbonne Université, APHP, Service de Médecine Interne, Département Hospitalo-Universitaire Inflammation-Immunopathologie-Biotherapie (DMU i3), F-75012, Paris, France
| | - Lise Selleret
- Sorbonne Université, APHP, Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, AP-HP, 4 rue de la Chine, 75020, Paris, Faculté de Médecine Sorbonne Université, France
| | - Catherine Johanet
- Sorbonne Université, AP-HP, Hôpital Saint Antoine, Service de Hématologie biologique, Faculté de Médecine Sorbonne Université, F-75012, Paris, France; France AP-HP, Hôpital Saint Antoine, Service d'Immunologie, Faculté de Médecine Sorbonne Université, F-75012, Paris, France
| | - Ludovic Suner
- Sorbonne Université, AP-HP, Hôpital Saint Antoine, Service de Hématologie biologique, Faculté de Médecine Sorbonne Université, F-75012, Paris, France; France AP-HP, Hôpital Saint Antoine, Service d'Immunologie, Faculté de Médecine Sorbonne Université, F-75012, Paris, France
| | - Francois Delhommeau
- Sorbonne Université, AP-HP, Hôpital Saint Antoine, Service de Hématologie biologique, Faculté de Médecine Sorbonne Université, F-75012, Paris, France; France AP-HP, Hôpital Saint Antoine, Service d'Immunologie, Faculté de Médecine Sorbonne Université, F-75012, Paris, France
| | - Nathalie Chabbert-Buffet
- Sorbonne Université, APHP, Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, AP-HP, 4 rue de la Chine, 75020, Paris, Faculté de Médecine Sorbonne Université, France
| | - Emile Darai
- Sorbonne Université, APHP, Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, AP-HP, 4 rue de la Chine, 75020, Paris, Faculté de Médecine Sorbonne Université, France
| | - Jean-Marie Antoine
- Sorbonne Université, APHP, Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, AP-HP, 4 rue de la Chine, 75020, Paris, Faculté de Médecine Sorbonne Université, France
| | - Gilles Kayem
- Sorbonne Université, Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Trousseau, AP-HP, 26, rue du Docteur-Arnold-Netter, 75012, Paris, France; Université Pierre-et-Marie-Curie, 4, place Jussieu, 75005, Paris, France; Inserm UMR 1153 équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), centre de recherche épidémiologie et statistique, Sorbonne Paris cité, 75005, Paris, France
| | - Olivier Fain
- Sorbonne Université, APHP, Service de Médecine Interne, Département Hospitalo-Universitaire Inflammation-Immunopathologie-Biotherapie (DMU i3), F-75012, Paris, France
| | - Emmanuelle Mathieu d'Argent
- Sorbonne Université, APHP, Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, AP-HP, 4 rue de la Chine, 75020, Paris, Faculté de Médecine Sorbonne Université, France
| | - Arsène Mekinian
- Sorbonne Université, APHP, Service de Médecine Interne, Département Hospitalo-Universitaire Inflammation-Immunopathologie-Biotherapie (DMU i3), F-75012, Paris, France.
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Khodakarami B, Masoumi SZ, Shayan A, Ahmadnia H, Dastgerdian F, Rabiei S. The Effect of Counseling on Stress in Infertile Women Admitted to an Infertility Center in Hamadan City, Iran. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2021. [DOI: 10.2174/2666082216999200905134548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Infertility can result in many problems for couples. In most cases, the stress
and anxiety of treating infertility can reduce fertility and affect marital disputes. The provision of
counseling and informing can reduce stress and improve couples’ relationships and positively influence
infertility treatment in many cases. The present study, therefore, was conducted to evaluate the
effect of counseling on the stress of infertile women admitted to an infertility center in Hamadan
City, Iran.
Methods:
The present study was performed as a two-group randomized clinical trial with two pretest
and posttest stages on 104 eligible women admitted to Fatemieh Hospital in Hamadan during
2017-18. Members of the intervention group received group counseling with a cognitive-behavioral
approach to stress reduction in four 1-h sessions during the 4 weeks. Data were obtained using
demographic characteristics and Harry’s Stress Assessment questionnaires. Data were analyzed
using SPSS 21 software, paired and independent t-test, and analysis of covariance at a significance
level of < 0.05.
Results:
Mean stress scores were 181.82 ± 15.9 and 189.11 ± 2.1 in the pre-intervention stage, and
174.6 ± 29.6 and in the test group 78.10 ± 1.3 in the post-intervention phase in the test and control
groups, respectively. High-stress levels were observed in both groups before the intervention. Independent
t-test revealed that mean stress scores were significantly different in the two groups at both
pre- and post-intervention stages (P < 0.05). The paired t-test indicated a significantly reduced stress
score in the intervention group (P < 0.05).
Conclusion:
Stress management counseling in infertile women can play a positive and effective role
in stress mitigation and promotion of their mental health. Therefore, the effect of this counseling can
be more reliably emphasized on improving the effectiveness of infertility treatment.
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Affiliation(s)
- Batul Khodakarami
- Department of Midwifery, Mother and Child Care Research Center, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Seyedeh Zahra Masoumi
- Department of Midwifery, Mother and Child Care Research Center, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Arezoo Shayan
- Department of Midwifery, Mother and Child Care Research Center, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Hasan Ahmadnia
- Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Fatemeh Dastgerdian
- Department of Midwifery, Mother and Child Care Research Center, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Sogra Rabiei
- Clinical Research Development Unit of Fatemieh Hospital, Hamadan University of Medical Sciences, Hamadan, Iran
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Ben-Kimhy R, Youngster M, Medina-Artom TR, Avraham S, Gat I, Marom Haham L, Hourvitz A, Kedem A. Fertility patients under COVID-19: attitudes, perceptions and psychological reactions. Hum Reprod 2021; 35:2774-2783. [PMID: 32877507 PMCID: PMC7499650 DOI: 10.1093/humrep/deaa248] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/24/2020] [Indexed: 01/17/2023] Open
Abstract
STUDY QUESTION What are the perceptions of infertility patients and the factors correlating with their psychological distress, following suspension of fertility treatments during the Corona Virus Disease-19 (COVID-19) pandemic? SUMMARY ANSWER Most patients preferred to resume treatment given the chance regardless of background characteristics; higher self-mastery and greater perceived social support were associated with lower distress, while feeling helpless was associated with higher distress. WHAT IS KNOWN ALREADY Infertility diagnosis and treatment frequently result in significant psychological distress. Recently published data have shown that clinic closure during the COVID-19 pandemic was associated with a sharp increase in the prevalence of anxiety and depression among infertile patients undergoing IVF and was perceived as an uncontrollable and stressful event. Personal resources play an important protective role in times of crisis, helping reduce levels of distress. STUDY DESIGN, SIZE, DURATION This cross-sectional questionnaire study included patients whose fertility treatment was suspended following the COVID-19 pandemic, in a tertiary hospital. The survey was delivered to 297 patients within 12 days at the beginning of April 2020. PARTICIPANTS/MATERIALS, SETTING, METHODS The self-administered questionnaire included items addressing: (i) patients' demographic characteristics, (ii) anxiety related to COVID-19 infection risk and level of social support, (iii) patients' perceptions of the new guidelines and description of subsequently related emotions and (iv) two validated scales assessing levels of emotional distress and self-mastery. Multivariate analysis was conducted to assess factors alleviating or increasing emotional distress during the COVID-19 pandemic. MAIN RESULTS AND THE ROLE OF CHANCE There were 168 patients who completed the survey, giving a response rate of 57%. Study variables in the regression model explained 38.9% of the variance in psychological distress experienced by patients during treatment suspension. None of the background characteristics (e.g. age, marital status, parity, economic level or duration of treatments) had a significant contribution. Feeling helpless following the suspension of treatments was associated with higher distress (P < 0.01). Higher self-mastery and greater perceived social support were associated with lower distress (P < 0.01). Despite the ministry of health's decision, 72% of patients wished to resume treatment at the time of survey. LIMITATIONS, REASONS FOR CAUTION This was a cross-sectional study, thus information about patients' characteristics prior to the COVID-19 pandemic was not available. The length and implications of this pandemic are unknown. Therefore, the ability to draw conclusions about the psychological consequences of the crisis is limited at this point of time. WIDER IMPLICATIONS OF THE FINDINGS Personal resources play an important protective role in times of crisis, helping to reduce levels of distress. Study findings suggest that attention should be paid to strengthening and empowering patients' personal resources together with directly confronting and containing feelings of helplessness. In line with the European Society for Human Reproduction and Embryology (ESHRE) guidelines, especially at this time of high levels of distress, it is imperative to offer emotional support to reduce stress and concerns. Furthermore, as the pandemic is stabilizing, resumption of treatment should be considered as soon as appropriate according to local conditions. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by the IVF unit of the Shamir Medical Center. All authors declare no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Reut Ben-Kimhy
- IVF Unit, Department of Obstetrics and Gynecology, Meir (Sapir) Medical Center, Kfar-Saba, Israel.,The Gender Studies Program, Bar-Ilan University, Ramat Gan, Israel
| | - Michal Youngster
- IVF Unit, Department of Obstetrics and Gynecology, Shamir Medical Center, Zerifin, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tamar R Medina-Artom
- Smokler Center for Health Policy Research, Myers-JDC-Brookdale Institute, Jerusalem, Israel.,The Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Sarit Avraham
- IVF Unit, Department of Obstetrics and Gynecology, Shamir Medical Center, Zerifin, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Itai Gat
- IVF Unit, Department of Obstetrics and Gynecology, Shamir Medical Center, Zerifin, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Sperm Bank & Andrology Unit, Shamir Medical Center, Zerifin, Israel
| | | | - Ariel Hourvitz
- IVF Unit, Department of Obstetrics and Gynecology, Shamir Medical Center, Zerifin, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Alon Kedem
- IVF Unit, Department of Obstetrics and Gynecology, Shamir Medical Center, Zerifin, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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McQuillan J, Greil AL, Rybińska A, Tiemeyer S, Shreffler KM, Colaner CW. Is a dyadic stressor experienced as equally distressing by both partners? The case of perceived fertility problems. JOURNAL OF SOCIAL AND PERSONAL RELATIONSHIPS 2021; 38:342-362. [PMID: 38486941 PMCID: PMC10939084 DOI: 10.1177/0265407520953903] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
Using data from a population survey, this article explores whether perceptions of having a fertility problem among 926 U.S. couples in heterosexual relationships (women aged 25-45 and male partners) are associated with distress. Most couples did not perceive a fertility problem (58%). In almost a third (30%) of the couples, only women perceived a fertility problem; in 4%, only the men; and in nearly a fifth (19%), both perceived a problem. Adjusted for characteristics associated with fertility problems and depressive symptoms, those who perceived a problem exhibited significantly more depressive symptoms than those who did not. Fertility problems are sometimes experienced as individual because in some couples only one partner perceives a problem or has higher distress in response to their own rather than to their partners' perceived problems. For women, fertility problems are experienced as a couple phenomenon because women were more distressed when both partners perceive a problem. The perception of fertility problems is gendered in that women were more likely to perceive a problem than men. Furthermore, men are most distressed when they perceive a problem and their partner does not.
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Affiliation(s)
| | | | - Anna Rybińska
- Duke University Sanford School of Public Policy, USA
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Gameiro S, El Refaie E, de Guevara BB, Payson A. Women from diverse minority ethnic or religious backgrounds desire more infertility education and more culturally and personally sensitive fertility care. Hum Reprod 2020; 34:1735-1745. [PMID: 31411328 DOI: 10.1093/humrep/dez156] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 05/15/2019] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION What are the views, experiences and healthcare needs of infertile women from a minority ethnic or religious background living in Wales? SUMMARY ANSWER Women from ethnic and religious minority backgrounds consider that their communities have highly pronatalistic attitudes and stigmatize infertility, and express the need for more infertility education (for themselves and their communities), as well as more socio-culturally and interpersonally sensitive fertility care. WHAT IS ALREADY KNOWN Some people from minority ethnic or religious groups perceive pressure to conceive from their communities, experience social costs when they are unable to have children and stressful interactions with the fertility healthcare system while attempting to conceive. STUDY DESIGN, SIZE, DURATION This study was based on a one-day drawing workshop to collect visual (artwork produced by participants) and textual (all conversations and discussions during the workshop) data about the participants' views and experiences of infertility and their fertility care needs. PARTICIPANTS/MATERIALS, SETTING, METHODS Participants were nine adult women with a minority ethnic or religious status living in Wales, UK, who were experiencing or had experienced infertility in the past. The workshop comprised five activities: (i) small and large group discussion of infertility-related drawings, (ii) lide-based lecture consisting of an introduction to the basics of drawing objects and people and (iii) thoughts and feelings, (iv) free drawing session and (v) group sharing. Audio recordings of the workshop were transcribed verbatim. Textual data was analysed with thematic analysis. Risk for bias was addressed via individual coding by two authors followed by joint presentation and discussion of results with the research team and participants. MAIN RESULTS AND THE ROLE OF CHANCE Forty-one themes were identified and grouped into eight distinct higher order themes. These themes described the emotional, relational and social burden of infertility experienced by women, which they perceived to result from their communities' highly pronatalistic attitudes and stigmatization of infertility. Themes also captured women's adaptive coping strategies and critical attitude towards pronatalist ideologies. Lastly, themes captured their overall positive evaluation of their fertility health care, their desire for more infertility education (for themselves and their communities) and for culturally competent and interpersonally sensitive care. LIMITATIONS, REASONS FOR CAUTION Our participants were a small, non-random sample recruited in collaboration with a local charity, which may mean that all participants were well integrated in their communities. Analysis focused on capturing commonalities in participants' experiences and this may sometimes result in homogenising diverse experiences. WIDER IMPLICATIONS OF THE FINDINGS More education about the infertility experiences of minority ethnic and religious groups at the community and healthcare delivery level may translate into lessened negative attitudes towards infertility and more culturally competent care, which can be beneficial for women. STUDY FUNDING/COMPETING INTEREST(S) This research was funded by Welsh Crucible. The authors have no conflict of interests to declare.
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Affiliation(s)
- Sofia Gameiro
- School of Psychology, Cardiff University, Cardiff, United Kingdom
| | - Elisabeth El Refaie
- School of English, Communication and Philosophy, Cardiff University, Cardiff, United Kingdom
| | | | - Alida Payson
- School of Journalism, Media and Cultural Studies, Cardiff University, Cardiff, United Kingdom
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Lowry MH, Greil A, McQuillan J, Burch A, Shreffler K. Medically Defined Infertility Versus Self-Perceived Fertility Problem: Implications of Survey Wording for Assessing Associations with Depressive Symptoms. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2020; 1:232-240. [PMID: 33786485 PMCID: PMC7784821 DOI: 10.1089/whr.2020.0032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 05/07/2020] [Indexed: 11/13/2022]
Abstract
Objective: To examine how measures of infertility based on medical criteria and based on self-perception relate to depressive symptoms among women with infertility. Background: Survey-based studies of depressive symptoms have used either measures of self-reported infertility based on meeting medical criteria or measures of self-perceived fertility problems, but seldom both. It is, therefore, not known which type of measure is more closely associated with depressive symptoms. Materials and Methods: Using ordinary least-squares multiple regression, this study compares associations between a measure of meeting medical criteria for infertility and a measure of self-perceived fertility problems with a common measure of depressive symptoms. Data come from the National Survey of Fertility Barriers, a population-based survey of 4,711 U.S. women. Results: Both meeting medical criteria for infertility and self-perception were associated with depressive symptoms after controlling for a number of relevant variables, but the coefficient for the self-perception measure was slightly higher than the coefficient for medical criteria. Conclusion: If possible, both medical criteria and self-perception measures should be used in studies of the consequences of infertility for psychosocial outcomes. If only one measure can be used, self-perception of a fertility problem is an acceptable measure.
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Affiliation(s)
- Michele H. Lowry
- Division of Social Sciences, Alfred University, Alfred, New York, USA
| | - A.L. Greil
- Division of Social Sciences, Alfred University, Alfred, New York, USA
| | - J. McQuillan
- Department of Sociology, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - A. Burch
- Division of Counseling and School Psychology, Alfred University, Alfred, New York, USA
| | - K.M. Shreffler
- Human Development and Family Science, Oklahoma State University, Tulsa, Oklahoma, USA
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Greil AL, Johnson KM, McQuillan J, Shreffler KM, Leyser-Whalen O, Lowry M. Does Self-Identifying as Having a Health Problem Precede Medical Contact? The Case of Infertility. SOCIOLOGICAL FOCUS 2020; 53:236-253. [PMID: 33100410 PMCID: PMC7577283 DOI: 10.1080/00380237.2020.1782792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Studies of medical help-seeking presume that self-identifying as having a health problem precedes medical contact, but this ordering of the identity-behavior relationship has not been systematically examined. We used longitudinal data from the National Survey of Fertility Barriers (2004 to 2010) on 412 women with infertility to document the temporal relationship between self-identifying as having a fertility problem and making medical contact. The symbolic interactionist perspective suggests that infertility will be perceived as identity disruption and that in response women will align self-identity and medical behavior over time. Cross-tabulation analysis indicated that more women do self-identify as having a fertility problem first (24 percent) as opposed to making medical contact first (5.5 percent). There was also a tendency toward aligning self-identification and behavior over time. Latent class analyses revealed six patterns: 1) consistently involved, 2) early consulters, 3) consistently uninvolved, 4) consistent perceivers, 5) medical dropouts, and 6) early perceivers. Strong fertility intent and primary infertility, two identity-relevant characteristics, had the strongest associations with latent class membership. The relationship between self-identification and medical help-seeking is thus dynamic and complex.
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Rothwell E, Lamb B, Johnson E, Gurtcheff S, Riches N, Fagan M, Sabatello M, Johnstone E. Patient perspectives and experiences with in vitro fertilization and genetic testing options. Ther Adv Reprod Health 2020; 14:2633494119899942. [PMID: 32518912 PMCID: PMC7254585 DOI: 10.1177/2633494119899942] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 12/18/2019] [Indexed: 12/31/2022] Open
Abstract
Objective: Decision-making and patient experiences with embryo selection during in vitro fertilization often include genetic testing options. The purpose of this study was to gain insight about the experiences and perspectives of women using in vitro fertilization and genetic technologies. Methods: Interviews (n = 37) were conducted among female patients who had undergone in vitro fertilization, underwent expanded carrier screening, and were offered pre-implantation genetic testing for aneuploidy between July 2016 and July 2017. The interviews were transcribed and a content analysis was conducted on the transcripts. Results: Categories that emerged from the data analysis included unexpected outcomes, uncertainty, unanticipated emotional consequences, too much emphasis on the woman’s contributions and questions about embryo viability. Patient experiences with genetic technologies during in vitro fertilization played a significant role within these results. Conclusion: The emotional and psychological impacts of infertility during in vitro fertilization were the primary concerns discussed by participants. Future research is needed to identify ways to help manage unexpected outcomes and continuous uncertainty, including the increasing use of genetic technologies, to not add to the psychological burden of infertility. There is a need to explore more support options or counseling services for patients struggling with infertility during in vitro fertilization treatment.
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Affiliation(s)
- Erin Rothwell
- Associate Vice President for Research, Integrity and Compliance, The University of Utah, 75 South 2000 East, Salt Lake City, UT 84112, USA
| | - Brandy Lamb
- Department of Obstetrics and Gynecology, The University of Utah, Salt Lake City, UT, USA
| | - Erin Johnson
- Department of Obstetrics and Gynecology, The University of Utah, Salt Lake City, UT, USA
| | | | - Naomi Riches
- Department of Obstetrics and Gynecology, The University of Utah, Salt Lake City, UT, USA
| | - Melinda Fagan
- Department of Philosophy, The University of Utah, Salt Lake City, UT, USA
| | - Maya Sabatello
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Erica Johnstone
- Department of Obstetrics and Gynecology, The University of Utah, Salt Lake City, UT, USA
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Adachi T, Endo M, Ohashi K. Regret over the delay in childbearing decision negatively associates with life satisfaction among Japanese women and men seeking fertility treatment: a cross-sectional study. BMC Public Health 2020; 20:886. [PMID: 32513145 PMCID: PMC7282077 DOI: 10.1186/s12889-020-09025-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 06/01/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Currently, in developed countries, increasing numbers of women and men are delaying childbearing but begin seeking fertility treatment later in life. Some women undergoing infertility treatment develop negative feelings such as depression associated with low life satisfaction and regret over the delay in childbearing. We therefore examine the association of life satisfaction with regret over the delay in childbearing decision and infertility-related factors among Japanese women and men seeking fertility treatment. METHODS This cross-sectional study included 253 women and 196 men referred to fertility facilities in Japan from July to December 2018. Participants completed a questionnaire on life satisfaction, regret over the delay in childbearing decision, infertility-related factors and sociodemographic characteristics. Life satisfaction was measured using the Satisfaction with Life Scale (SWLS), and the degree of regret over delay in childbearing decision was measured on a 7-point Likert scale. Multiple linear regressions, conducted separately by sex, were used to analyze the association of life satisfaction with regret over the delay in childbearing decision and infertility-related factors. RESULTS Of the 253 women and 196 men, 102 (40.3%) women and 43 (21.9%) men answered "strongly agree" regarding their regret over the delay in childbearing decision. Among women, life satisfaction was negatively associated with regret (β = - 0.155, 95% CI [- 0.938, - 0.093], p = 0.017), use of assisted reproduction technology (ART) (β = - 0.135, 95% CI [- 2.977, - 0.020], p = 0.047). In contrast, previous live birth was positively associated with life satisfaction (β = 0.134, 95% CI [0.122, 3.739], p = 0.037). In men, we found no significant association of life satisfaction with regret over the delay in childbearing decision and infertility-related factors. CONCLUSIONS Regret over the delay in childbearing decision is negatively associated with life satisfaction among Japanese women seeking fertility treatment. It may be important for women to make better informed decision regarding the timing of childbearing to not regret later in life. Health professionals should address regret over the delay in childbearing decision during fertility treatment and explore ways to spread information on fertility awareness.
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Affiliation(s)
- Tomoko Adachi
- Division of Health Science, Graduate School of Medicine, Osaka University, 1-7, Suita, Osaka, 565-0871, Japan.
| | - Masayuki Endo
- Division of Health Science, Graduate School of Medicine, Osaka University, 1-7, Suita, Osaka, 565-0871, Japan
| | - Kazutomo Ohashi
- Division of Health Science, Graduate School of Medicine, Osaka University, 1-7, Suita, Osaka, 565-0871, Japan
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Ra AG, Evans PJ, Awasthi A, Srinivas-Shankar U. Pituitary hyperplasia with Sertoli cell-only and 47,XYY syndromes: an uncommon triad. BMJ Case Rep 2020; 13:13/5/e233100. [PMID: 32414773 DOI: 10.1136/bcr-2019-233100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report the case history of a 32-year-old man with no phenotypical abnormalities who presented with infertility. Semen analysis revealed azoospermia and testicular biopsy confirmed Sertoli cell-only (SCO) syndrome. Karyotyping revealed 47,XYY and pituitary hyperplasia was found on MRI pituitary. In our patient, 47,XYY karyotype is likely to have given rise to SCO syndrome that in turn resulted in pituitary hyperplasia. The patient was evaluated by various members of the multidisciplinary team including the pituitary surgeon, endocrinologist and andrologist. The patient's partner successfully delivered a healthy baby via in vitro fertilisation with donor sperm. This triad of diagnoses (SCO syndrome, 47,XYY karyotype and pituitary hyperplasia) has not been reported previously. SCO syndrome should be considered in the presence of azoospermia, elevated follicle-stimulating hormone, low inhibin-B and normal testosterone levels. Our case report also highlights the importance of excluding genetic causes of infertility even when the patient has no phenotypical abnormalities.
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Affiliation(s)
- Amelle Geurim Ra
- Arrowe Park Hospital, Wirral, UK .,St George's Hospital, London, UK
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Grunberg P, Miner S, Zelkowitz P. Infertility and perceived stress: the role of identity concern in treatment-seeking men and women. HUM FERTIL 2020; 25:117-127. [DOI: 10.1080/14647273.2019.1709667] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Paul Grunberg
- Department of Psychology, McGill University, Montreal, Canada
| | - Skye Miner
- Department of Sociology, McGill University, Montreal, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Phyllis Zelkowitz
- Department of Psychology, McGill University, Montreal, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
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Beaujouan É, Reimondos A, Gray E, Evans A, Sobotka T. Declining realisation of reproductive intentions with age. Hum Reprod 2019; 34:1906-1914. [DOI: 10.1093/humrep/dez150] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 05/28/2019] [Indexed: 12/15/2022] Open
Abstract
Abstract
STUDY QUESTION
What is the likelihood of having a child within 4 years for men and women with strong short-term reproductive intentions, and how is it affected by age?
SUMMARY ANSWER
For women, the likelihood of realising reproductive intentions decreased steeply from age 35: the effect of age was weak and not significant for men.
WHAT IS KNOWN ALREADY
Men and women are postponing childbearing until later ages. For women, this trend is associated with a higher risk that childbearing plans will not be realised due to increased levels of infertility and pregnancy complications.
STUDY DESIGN, SIZE, DURATION
This study analyses two waves of the nationally representative Household, Income and Labour Dynamics in Australia (HILDA) survey. The analytical sample interviewed in 2011 included 447 men aged 18–45 and 528 women aged 18–41. These respondents expressed a strong intention to have a child in the next 3 years. We followed them up in 2015 to track whether their reproductive intention was achieved or revised.
PARTICIPANTS/MATERIALS, SETTINGS, METHODS
Multinomial logistic regression is used to account for the three possible outcomes: (i) having a child, (ii) not having a child but still intending to have one in the future and (iii) not having a child and no longer intending to have one. We analyse how age, parity, partnership status, education, perceived ability to conceive, self-rated health, BMI and smoking status are related to realising or changing reproductive intentions.
MAIN RESULTS AND THE ROLE OF CHANCE
Almost two-thirds of men and women realised their strong short-term fertility plans within 4 years. There was a steep age-related decline in realising reproductive intentions for women in their mid- and late-30s, whereas men maintained a relatively high probability of having the child they intended until age 45. Women aged 38–41 who planned to have a child were the most likely to change their plan within 4 years. The probability of realising reproductive intention was highest for married and highly educated men and women and for those with one child.
LIMITATIONS, REASONS FOR CAUTION
Our study cannot separate biological, social and cultural reasons for not realising reproductive intentions. Men and women adjust their intentions in response to their actual circumstances, but also in line with their perceived ability to have a child or under the influence of broader social norms on reproductive age.
WIDER IMPLICATIONS OF THE FINDINGS
Our results give a new perspective on the ability of men and women to realise their reproductive plans in the context of childbearing postponement. They confirm the inequality in the individual consequences of delayed reproduction between men and women. They inform medical practitioners and counsellors about the complex biological, social and normative barriers to reproduction among women at higher childbearing ages.
STUDY FUNDING/COMPETING INTEREST(S)
This research was partly supported by a Research School of Social Sciences Visiting Fellowship at the Australian National University and an Australian Research Council Discovery Project (DP150104248). Éva Beaujouan’s work was partly funded by the Austrian Science Fund (FWF) project ‘Later Fertility in Europe’ (Grant agreement no. P31171-G29). This paper uses unit record data from the HILDA Survey. The HILDA Project was initiated and is funded by the Australian Government Department of Social Services (DSS) and is managed by the Melbourne Institute of Applied Economic and Social Research (Melbourne Institute). The findings and views reported in this paper, however, are those of the authors and should not be attributed to either DSS or the Melbourne Institute. The authors have no conflicts of interest.
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Affiliation(s)
- Éva Beaujouan
- Vienna University of Economics and Business (Wittgenstein Centre for Demography and Global Human Capital), Vienna, Austria
| | - Anna Reimondos
- School of Demography, Australian National University, Canberra, Australia
| | - Edith Gray
- School of Demography, Australian National University, Canberra, Australia
| | - Ann Evans
- School of Demography, Australian National University, Canberra, Australia
| | - Tomáš Sobotka
- Vienna Institute of Demography (Austrian Academy of Sciences) (Wittgenstein Centre for Demography and Global Human Capital), Vienna, Austria
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35
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Oncofertility: Meeting the Fertility Goals of Adolescents and Young Adults With Cancer. ACTA ACUST UNITED AC 2019; 24:328-335. [PMID: 30480578 DOI: 10.1097/ppo.0000000000000344] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Adolescents and young adults aged 15 to 39 years who are diagnosed with cancer (AYA survivors) undergo a range of therapies for cancer cure but subsequently may be at risk of treatment-related infertility, and for female AYA survivors, adverse pregnancy outcomes. Future fertility is important to AYA survivors. Meeting their fertility goals requires awareness of this importance, knowledge of cancer treatment-related fertility risks, appropriate fertility counseling on these risks, and access to fertility care. Epidemiologic and dissemination and implementation research are needed to estimate more precise risks of traditional and novel cancer therapies on fertility and pregnancy outcomes and improve the delivery of fertility care.
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36
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Galhardo A, Alves J, Moura-Ramos M, Cunha M. Infertility-related stress and depressive symptoms - the role of experiential avoidance: a cross-sectional study. J Reprod Infant Psychol 2019; 38:139-150. [PMID: 31046433 DOI: 10.1080/02646838.2019.1612046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: The current study aimed to explore the mediating role of experiential avoidance in the relationship between infertility-related stress (impact of infertility in women's life and representations about the importance of parenthood) and depressive symptoms.Background: Infertility is a stress inducing condition presenting many challenges to individuals facing this diagnosis, particularly to the ones who decide to pursue medical treatment. One of its consequences may be the experience of depressive symptoms which have also been associated with increased infertility-related stress. Moreover, experiential avoidance, conceptualised as an emotion regulation process, has also been connected to psychopathological symptoms, particularly depressive symptoms.Methods: The sample consisted of 124 women presenting an infertility diagnosis who were pursuing medical treatment for fertility problems. Participants were recruited through the national patients' association website and completed the following self-report instruments: a sociodemographic and clinical questionnaire, the Acceptance and Action Questionnaire-II (AAQ-II), the Fertility Problem Inventory (FPI) and the Depression, Anxiety and Stress Scales 21 (DASS-21).Results: Results showed that representations about the importance of parenthood were associated with depressive symptoms indirectly, throughout the association with the impact of infertility in women's life and use of experiential avoidance.Conclusions: Experiential avoidance can be considered a relevant emotion regulation process to be targeted in psychological intervention programs for women facing infertility.
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Affiliation(s)
- Ana Galhardo
- Instituto Superior Miguel Torga, Coimbra, Portugal.,Faculty of Psychology and Educational Sciences, University of Coimbra-CINEICC, Coimbra, Portugal
| | - Joana Alves
- Instituto Superior Miguel Torga, Coimbra, Portugal
| | - Mariana Moura-Ramos
- Faculty of Psychology and Educational Sciences, University of Coimbra-CINEICC, Coimbra, Portugal.,Coimbra Hospital and Universitary Centre-Reproductive Medicine Unit
| | - Marina Cunha
- Instituto Superior Miguel Torga, Coimbra, Portugal.,Faculty of Psychology and Educational Sciences, University of Coimbra-CINEICC, Coimbra, Portugal
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37
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Li X, Ye L, Tian L, Huo Y, Zhou M. Infertility-Related Stress and Life Satisfaction among Chinese Infertile Women: A Moderated Mediation Model of Marital Satisfaction and Resilience. SEX ROLES 2019. [DOI: 10.1007/s11199-019-01032-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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38
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Shlomo SB, Taubman – Ben-Ari O, Skvirsky V, Azuri Y, Weissman A, Horowitz E. Subjective well-being of women at the beginning of fertility treatment: the role of medical variables, attachment orientation and supportive relationship with the mother. J Reprod Infant Psychol 2019; 37:358-369. [DOI: 10.1080/02646838.2019.1578867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Shirley Ben Shlomo
- The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel
| | - Orit Taubman – Ben-Ari
- The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel
| | - Vera Skvirsky
- The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel
| | - Yoseph Azuri
- The Sackler Faculty of Medicine, Tel Aviv University, Ramat Gan, Israel
- Maccabi Healthcare, Tel Aviv, Israel
| | - Ariel Weissman
- The Sackler Faculty of Medicine, Tel Aviv University, Ramat Gan, Israel
- Maccabi Healthcare, Tel Aviv, Israel
| | - Eran Horowitz
- The Sackler Faculty of Medicine, Tel Aviv University, Ramat Gan, Israel
- Maccabi Healthcare, Tel Aviv, Israel
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Ehsan Z, Yazdkhasti M, Rahimzadeh M, Ataee M, Esmaelzadeh-Saeieh S. Effects of Group Counseling on Stress and Gender-Role Attitudes in Infertile Women: A Clinical Trial. J Reprod Infertil 2019; 20:169-177. [PMID: 31423420 PMCID: PMC6670266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Infertility stress can have a devastating impact on the lives of couples and influence their physical and psychological health. The purpose of this study was to investigate the effects of group counseling on female stress and gender-role attitudes in infertile women. METHODS The present study is a randomized clinical trial conducted on 90 infertile women referred to Rooyesh Infertility Treatment Center in the city of Karaj, Iran. The convenience sampling method was used. Samples were divided into intervention and control groups through four-block random allocations. Accordingly, the intervention group received five-session group counselling and the control group only received routine care. Newton's fertility problem inventory (FPI) and gender role questionnaire (GRQ) were used for collecting data before, after, and one month after the intervention. The significance level was set at 0.05. RESULTS The result showed a significant relationship between gender role attitude and stress in infertile women (p=0.03) and indirect association between of them (r=0.13). And also repeated measures test indicated that length of time had affected the total scores of infertility stress (p<0.001) and gender role attitude scores (p= 0.001) and there was a significant difference between the two groups in infertility stress scores (p<0.001) and gender role attitude scores (p=0.001). CONCLUSION Group counseling can be used in stress reduction and also improved gender role attitude of infertile women.
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Affiliation(s)
- Zeinab Ehsan
- Student Research Committee, School of Medical Sciences, Alborz University of Medical Sciences, Karaj, Iran
| | - Mansooreh Yazdkhasti
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Mitra Rahimzadeh
- Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Mina Ataee
- Department of Obstetrics and Gynecology, Clinical Research Development Center of Kamali Hospital, School of Medical Sciences, Alborz University of Medical Sciences, Karaj, Iran
| | - Sara Esmaelzadeh-Saeieh
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran,Corresponding Author: Sara Esmaelzadeh-Saeieh, Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran, E-mail:
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40
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Donarelli Z, Salerno L, Lo Coco G, Allegra A, Marino A, Kivlighan DM. From telescope to binoculars. Dyadic outcome resulting from psychological counselling for infertile couples undergoing ART. J Reprod Infant Psychol 2018; 37:13-25. [DOI: 10.1080/02646838.2018.1548757] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Laura Salerno
- Psychology Unit, ANDROS Day Surgery Clinic, Palermo, Italy
| | - Gianluca Lo Coco
- Department of Psychology and Educational Sciences, University of Palermo, Palermo, Italy
| | - Adolfo Allegra
- Reproductive Medicine Unit, ANDROS Day Surgery Clinic, Palermo, Italy
| | - Angelo Marino
- Reproductive Medicine Unit, ANDROS Day Surgery Clinic, Palermo, Italy
| | - Dennis M. Kivlighan
- Department of Counseling, Higher Education, and Special Education, University of Maryland, College Park, USA
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41
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Dawadi S, Takefman J, Zelkowitz P. Fertility patients demonstrate an unmet need for the provision of psychological information: A cross sectional study. PATIENT EDUCATION AND COUNSELING 2018; 101:1852-1858. [PMID: 30168420 DOI: 10.1016/j.pec.2018.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 06/19/2018] [Accepted: 06/24/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To examine the provision of information by health care providers (HCPs) to fertility patients about accessing psychological resources. METHODS This study utilized data from a cross-sectional survey of 659 male and female patients seeking fertility treatment at clinics in Toronto and Montreal. Regression analyses were used to assess if sociodemographic and treatment variables were associated with the receipt of information, the desire for information, the helpfulness of the information, and the likelihood that participants had sought counselling. RESULTS The majority of respondents (79.8%) said that their HCP had not given them information about accessing psychological resources. Of the patients who did not receive this information, most (60%) said that they wanted it. Regression analysis revealed that immigrants, women, and patients with higher perceived stress scores were significantly more likely to desire this information. Furthermore, having received this information was associated with increased odds of counselling seeking (odds ratio = 3.31, p = 0.013). CONCLUSION Fertility patients demonstrated an unmet need for information about accessing psychological resources, and HCPs may play an integral role in bridging this information gap. PRACTICE IMPLICATIONS To improve the patient-centeredness of fertility care, HCPs should be proactive in informing all patients about how to access psychological resources.
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Affiliation(s)
| | - Janet Takefman
- Department of Obstetrics and Gynecology, McGill, Montreal, Canada
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Böttcher B, Fessler S, Friedl F, Toth B, Walter MH, Wildt L, Riedl D. Health-related quality of life in patients with polycystic ovary syndrome: validation of the German PCOSQ-G. Arch Gynecol Obstet 2018; 297:1027-1035. [PMID: 29249009 PMCID: PMC5849657 DOI: 10.1007/s00404-017-4623-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 12/06/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE Patients with polycystic ovary syndrome (PCOS) report a decreased health-related quality of life (HRQOL) and higher levels of psychological distress. Validated questionnaires are necessary to assess the impact of PCOS on patients' lives. The aim of the present study was to evaluate the German "Polycystic Ovary Syndrome Questionnaire" (PCOSQ-G). METHODS The psychometric properties of the PCOSQ-G were investigated in PCOS patients with item-total correlation, internal consistency and test-retest reliability. Correlations with the Short-Form-36 Health Survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS-D) were calculated to evaluate the validity of the PCOSQ-G. Discriminatory validity was investigated through a receiver operating characteristic curve and independent sample t tests compared with healthy controls. RESULTS Good psychometric properties were found for most items. Acceptable to high internal consistency was found for the total score (α = 0.94-0.95) and all subscales (α = 0.70-0.97). High test-retest reliability was found for the total score (0.86) and all subscales (0.81-0.90). The validity analyses showed that the PCOSQ-G total score was positively correlated with both SF-36 summary scales and was negatively correlated with both HADS subscales. Patients reported significantly lower values for the PCOSQ-G total score (p < 0.001) and all subscales, and the PCOSQ-G discriminated well between patients and healthy controls (AUC = 0.81, p < 0.001). CONCLUSIONS PCOSQ-G is a reliable and valid tool to assess the HRQOL in patients with PCOS and can be used in future clinical research. Patients with PCOS exhibited an impaired HRQOL, which indicates the need for psychosomatic counseling.
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Affiliation(s)
- B Böttcher
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - S Fessler
- Department of Psychology, University of Innsbruck, Bruno-Sander-Haus, Innrain 52f, 6020, Innsbruck, Austria
| | - F Friedl
- Department of Psychology, University of Innsbruck, Bruno-Sander-Haus, Innrain 52f, 6020, Innsbruck, Austria
| | - B Toth
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - M H Walter
- Department of Psychology, University of Innsbruck, Bruno-Sander-Haus, Innrain 52f, 6020, Innsbruck, Austria
| | - L Wildt
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - D Riedl
- University Clinic of Medical Psychology, Medical University Innsbruck, Schöpfstr. 23a, 6020, Innsbruck, Austria.
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Skvirsky V, Taubman – Ben-Ari O, Shlomo SB, Azuri J, Horowitz E. Are mothers a source of support for women entering fertility treatment? Health Care Women Int 2018; 39:719-733. [DOI: 10.1080/07399332.2018.1424170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Vera Skvirsky
- The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University, Ramat Gan, Israel
| | - Orit Taubman – Ben-Ari
- The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University, Ramat Gan, Israel
| | - Shirley Ben Shlomo
- The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University, Ramat Gan, Israel
| | - Joseph Azuri
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Maccabi Healthcare, Tel Aviv, Israel
| | - Eran Horowitz
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Maccabi Healthcare, Tel Aviv, Israel
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Jenkins S, Ives J, Avery S, Draper H. Who gets the gametes? An argument for a points system for fertility patients. BIOETHICS 2018; 32:16-26. [PMID: 29194680 PMCID: PMC5767753 DOI: 10.1111/bioe.12411] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 04/28/2017] [Accepted: 09/14/2017] [Indexed: 06/07/2023]
Abstract
This paper argues that the convention of allocating donated gametes on a 'first come, first served' basis should be replaced with an allocation system that takes into account more morally relevant criteria than waiting time. This conclusion was developed using an empirical bioethics methodology, which involved a study of the views of 18 staff members from seven U.K. fertility clinics, and 20 academics, policy-makers, representatives of patient groups, and other relevant professionals, on the allocation of donated sperm and eggs. Against these views, we consider some nuanced ways of including criteria in a points allocation system. We argue that such a system is more ethically robust than 'first come, first served', but we acknowledge that our results suggest that a points system will meet with resistance from those working in the field. We conclude that criteria such as a patient's age, potentially damaging substance use, and parental status should be used to allocate points and determine which patients receive treatment and in what order. These and other factors should be applied according to how they bear on considerations like child welfare, patient welfare, and the effectiveness of the proposed treatment.
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Quality of life and psychosocial and physical well-being among 1,023 women during their first assisted reproductive technology treatment: secondary outcome to a randomized controlled trial comparing gonadotropin-releasing hormone (GnRH) antagonist and GnRH agonist protocols. Fertil Steril 2017; 109:154-164. [PMID: 29175067 DOI: 10.1016/j.fertnstert.2017.09.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 09/12/2017] [Accepted: 09/18/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To compare self-reported quality of life, psychosocial well-being, and physical well-being during assisted reproductive technology (ART) treatment in 1,023 women allocated to either a short GnRH antagonist or long GnRH agonist protocol. DESIGN Secondary outcome of a prospective phase 4, open-label, randomized controlled trial. Four times during treatment a questionnaire on self-reported physical well-being was completed. Further, a questionnaire on self-reported quality of life and psychosocial well-being was completed at the day of hCG testing. SETTING Fertility clinics at university hospitals. PATIENT(S) Women referred for their first ART treatment were randomized in a 1:1 ratio and started standardized ART protocols. INTERVENTION(S) Gonadotropin-releasing hormone analogue; 528 women allocated to a short GnRH antagonist protocol and 495 women allocated to a long GnRH agonist protocol. MAIN OUTCOME MEASURE(S) Self-reported quality of life, psychosocial well-being, and physical well-being based on questionnaires developed for women receiving ART treatment. RESULT(S) Baseline characteristics were similar, and response rates were 79.4% and 74.3% in the GnRH antagonist and GnRH agonist groups, respectively. Self-reported quality of life during ART treatment was rated similar and slightly below normal in both groups. However, women in the GnRH antagonist group felt less emotional (adjusted odds ratio [AOR] 0.69), less limited in their everyday life (AOR 0.74), experienced less unexpected crying (AOR 0.71), and rated quality of sleep better (AOR 1.55). Further, women receiving GnRH agonist treatment felt worse physically. CONCLUSION(S) Women in a short GnRH antagonist protocol rated psychosocial and physical well-being during first ART treatment better than did women in a long GnRH agonist protocol. However, the one item on self-reported general quality of life was rated similarly. CLINICAL TRIAL REGISTRATION NUMBER NCT00756028.
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Ben Shlomo S, Skvirsky V, Taubman-Ben-Ari O, Azuri Y, Horowitz E. Mental health of women entering fertility treatment: What role do age and internal resources play? Stress Health 2017; 33:470-476. [PMID: 27885806 DOI: 10.1002/smi.2733] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 10/07/2016] [Accepted: 10/17/2016] [Indexed: 11/06/2022]
Abstract
Drawing on Lazarus and Folkman's (1984) model of stress and coping, the study aimed at (a) examining the associations between the mental health of women entering fertility treatment and their internal resources (hope and two aspects of self-consciousness: reflection and rumination); (b) indicating whether mental health is associated with age (above or below 35), and whether this association is mediated by the internal resources. The sample consisted of 137 women (76 aged 20-34; 61 aged 35-44) at the start of fertility treatment who completed a series of self-report questionnaires. Results indicated that younger women reported higher distress and rumination than older women. Higher hope was associated with greater well-being, and higher rumination was associated with greater distress. Furthermore, hope and rumination were found to mediate the association between age and mental health. These findings highlight the importance of developing age-based interventions for women entering fertility treatment, aimed at strengthening their resilience to effectively cope with the demanding process ahead.
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Affiliation(s)
- Shirley Ben Shlomo
- The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University, Ramat Gan, Israel
| | - Vera Skvirsky
- The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University, Ramat Gan, Israel
| | - Orit Taubman-Ben-Ari
- The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University, Ramat Gan, Israel
| | - Yoseph Azuri
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Maccabi Healthcare, Tel Aviv, Israel
| | - Eran Horowitz
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Maccabi Healthcare, Tel Aviv, Israel
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Shreffler KM, Greil AL, McQuillan J. Responding to Infertility: Lessons From a Growing Body of Research and Suggested Guidelines for Practice. FAMILY RELATIONS 2017; 66:644-658. [PMID: 29422703 PMCID: PMC5798475 DOI: 10.1111/fare.12281] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
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.
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Grinstein-Cohen O, Katz A, Sarid O. Religiosity: Its Impact on Coping Styles Among Women Undergoing Fertility Treatment. JOURNAL OF RELIGION AND HEALTH 2017; 56:1032-1041. [PMID: 28025759 DOI: 10.1007/s10943-016-0344-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The Israeli worldview places great significance on childbearing. This could create emotional and ethical difficulties for women coping with fertility issues in addition to their treatments. This study examined the relations between coping strategies and level of religiosity in 159 women undergoing infertility treatment. Statistically significant relations were found between the problem-solving coping style and religious observance (p < 0.01) and religious beliefs (p < 0.05). An inverse correlation was found between the emotional coping style and religious beliefs (p < 0.001). Health professionals should recognize the patient's coping styles and understand the patient's religious belief system as part of an ongoing fertility treatment.
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Affiliation(s)
- O Grinstein-Cohen
- Department of Nursing, Recanati School of Community Health, Ben Gurion University of the Negev, Beer-Sheva, Israel.
| | - A Katz
- Department of Nursing, Recanati School of Community Health, Ben Gurion University of the Negev, Beer-Sheva, Israel
- Labor and Delivery Room, Soroka Medical Center, Beer-Sheva, Israel
| | - O Sarid
- The Spitzer Department of Social Work, Ben Gurion University of the Negev, Beer-Sheva, Israel
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KARIMZADEH M, SALSABILI N, AKBARI ASBAGH F, TEYMOURI R, POURMAND G, SOLEIMANIEH NAEINI T. Psychological Disorders among Iranian Infertile Couples Undergoing Assisted Reproductive Technology (ART). IRANIAN JOURNAL OF PUBLIC HEALTH 2017; 46:333-341. [PMID: 28435819 PMCID: PMC5395529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Worldwide, infertility affects 10%-15% of couples and most of them seek medical help including Assisted Reproductive Technology (ART) treatments. Undergoing ART treatments create many physical and emotional burdens. This study examined the psychological consequences of infertility in Iranian infertile males and females as well as their spouses, unlike previous studies that examined mainly females with infertility. METHODS Subjects in this descriptive analytical design were recruited from the IVF Department of Mirza Koochak Khan Hospital and the Rouyesh Infertility Treatment Center of Tehran, Iran between Aug 2014 and Sep 2015. Overall, 256 couples (64% response rate), consisting of 78 infertile male and their spouses and 50 infertile female and their spouses, were included in this research. The psychological disorders were measured by the Persian version of Symptoms Checklist-90-Revised and Cattle Inventory. RESULTS Psychological disorders of infertile couples are significantly associated with increasing age, higher education, longer duration of infertility and unemployment (P<0.05). Prevalence of anxiety, depression, hypochondriasis and paranoia in infertile females and spouses of infertile males were significantly higher than husbands of infertile females (P<0.05). Obsession was more sever in infertile females was significantly greater than infertile males (P=0.01). Depression was significantly lower in infertile males than their spouses (P=0.016). CONCLUSION Iranian infertile females and spouses of infertile males experienced more psychological disorders than infertile males and spouses of infertile females. These results may be due to the impact of cultural beliefs and gender roles in Iranian society. Anxiety, depression, obsession, paranoia and hypochondriasis should be addressed before any ART treatments.
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Affiliation(s)
- Mansoureh KARIMZADEH
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Nasser SALSABILI
- Dept. of IVF, Mirza Koochak Khan Hospital, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Firouzeh AKBARI ASBAGH
- Dept. of Obstetrics and Gynecology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Robab TEYMOURI
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Golamreza POURMAND
- Urology Research Center, Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Tahereh SOLEIMANIEH NAEINI
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran,Corresponding Author:
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Fertility Treatment, Use of in Vitro Fertilization, and Time to Live Birth Based on Initial Provider Type. J Am Board Fam Med 2017; 30:230-238. [PMID: 28379830 PMCID: PMC5533589 DOI: 10.3122/jabfm.2017.02.160184] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 10/09/2016] [Accepted: 10/17/2016] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To explore the relationship between the type of clinician (generalist vs subspecialist) initially seen by infertile women, the treatment received, and the time to pregnancy. METHODS We analyzed mixed-mode questionnaire data from 867 women with primary infertility enrolled into a retrospective cohort through population- and fertility clinic-based sampling. We compared women presenting first to generalist providers with women presenting first to fertility subspecialists, with the main outcomes of receiving in vitro fertilization (IVF), time to pregnancy, and live birth. RESULTS The first contact for most (84%) women with infertility was a generalist provider. Only 8% of women sought care first from a fertility subspecialist, and these women were older and had been trying longer to conceive. Women who presented first to a generalist provider were less likely to receive IVF (adjusted odds ratio, 0.48; 95% confidence interval, 0.28-0.82), were equally likely to achieve pregnancy, and had similar times to pregnancy (adjusted hazard ratio, 1.11; 95% confidence interval, 0.80-1.53) compared with women who presented first to a subspecialist. CONCLUSIONS Generalist providers are frequently the first point of care for women with difficulty conceiving and are uniquely positioned to promote the balanced management of infertility.
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