Depression Among Infertile Men in the Gaza Strip, Palestine: The Neglected Aspect of Fertility Care

Background:

Infertility is a worldwide public health problem and affects psychological aspects of males’ and females’ life. However, the problem has not been well investigated in Palestine. Therefore, the purpose of this study was to determine prevalence and predictors of depression among infertile men in the Gaza strip.

Methods:

A cross-sectional study was carried out among three hundred eighty five infertile males from January to December 2019. Participants were selected from three main in-vitro fertilization (IVF) centers following simple random sampling. The Arabic version of Beck Depression Inventory was used. Descriptive and inferential analyses were performed using the SPSS V22. Binary analysis was done to determine independent variables and t-test and one-way ANOVA were conducted afterwards. Logistic regression was performed to determine independent factors associated with depression symptoms. The p-value of 0.05 or less was considered statistically significant.

Results:

Findings showed that 42.6% (164/385) of infertile men had at least one type of depression. Severe depression was presented in 16.6% (64/164) of participants, while 13.2% (51/164) and 12.7% (49/164) showed moderate and mild depression, respectively. Predictors for depression were duration of marriage (>8 years) (CI 95%: 1.099–2.615) and at least one IVF attempt (CI 95%: 0.373–0.873).

Conclusion:

It has been revealed that depression is prevalent among infertile men. Marriage of long duration and several failures in IVF attempts are predictors for depressions. Psychological counseling besides medical interventions seems to be an optimal strategy to alleviate psychological distress associated with infertility.

Fertility treatments and gastrointestinal morbidity of the offspring

BACKGROUND

Prevalence of pregnancies conceived following fertility treatments is high worldwide. While the impact of fertility treatments on short-term perinatal outcome is well established, long-term consequences are yet to be determined.

OBJECTIVE

To study the association between mode of conception and long-term gastrointestinal morbidity among children born following fertility treatments.

STUDY DESIGN

A population-based cohort analysis including all singleton deliveries occurring between 1991 and 2014 at a single regional tertiary medical center was performed. Fetuses with congenital malformations were excluded. A comparison was performed between children delivered following IVF, OI and spontaneous pregnancies. Hospitalizations up to the age of 18 years involving gastrointestinal morbidity were evaluated. Kaplan-Meier survival curve was used to compare cumulative morbidity incidence. A Cox regression model was used to control for confounders.

RESULTS

During the study period 242,187 singleton deliveries met the inclusion criteria; 1.1% following IVF (n = 2603), and 0.7% following OI (n = 1721). Hospitalization rates involving gastrointestinal morbidity were significantly higher in children conceived following IVF and OI (5.7%, 7.1% respectively) as compared with children conceived spontaneously (5.4%; p = 0.005). The Kaplan-Meier survival curve demonstrated a significantly higher cumulative incidence of gastrointestinal morbidity following IVF and OI (log rank p = 0.001). Using a Cox proportional hazards model, controlling for maternal age, preterm delivery, birthweight, maternal diabetes and hypertensive disorders in pregnancy, IVF (adjusted HR = 1.27, CI 1.08-1.50, p = 0.004), was noted as an independent risk factor for long-term pediatric gastrointestinal morbidity.

CONCLUSION

Singletons conceived by IVF appear to be at an increased risk for long-term gastrointestinal morbidity.

An integrative literature review of psychosocial factors in the transition to parenthood following non-donor-assisted reproduction compared with spontaneously conceiving couples

The paper reports an integrative literature review of research into the psychosocial factors which shape the transition to parenthood in couples following non-donor in vitro fertilization in comparison with those conceiving spontaneously. Nineteen papers of non-donor IVF and SC mothers and fathers were included. Differences between groups were reported for a range of psychosocial measures during the transition from pregnancy to parenthood including: the control couples feel they have over their lives (locus of control), parental adjustment and child behaviour, parental stress, parental investment in the child, self-esteem and self-efficacy, greater levels of protectiveness (separation anxiety) towards child, marital and family functioning, family alliance, marital satisfaction and communication, as well as anxiety, indirect aggression and lowered respect for the child. We have conceptualised these differences as three substantive themes which reflect psychosocial factors shaping transition to parenthood in parents after non-donor AR: namely social support, relationships and emotional well-being, which are in turn influenced by gender differences. These findings have implications for health care professionals' assessment of individual couples' support needs.

Anxiety and depressive symptoms, and stress biomarkers in pregnant women after in vitro fertilization: a prospective cohort study

STUDY QUESTION

Does in vitro fertilization (IVF) affect the course of anxiety and depressive symptoms as well as physiological stress from pregnancy to postpartum period?

SUMMARY ANSWER

IVF mothers have more anxiety symptoms and higher stress biomarker levels but fewer depression symptoms than natural conception mothers at the third trimester of pregnancy, but these differences are negligible during postpartum period.

WHAT IS KNOWN ALREADY

Cross-sectional studies have found an association between IVF and high stress levels during the prenatal period. There is, however, no follow-up study about the IVF effect on the mental health status from pregnancy to postpartum, adopting simultaneous measurement of self-reported symptoms and stress biomarkers.

STUDY DESIGN, SIZE, DURATION

This is a prospective cohort study. A total of 243 eligible women were recruited during the third trimester of pregnancy (60 women after successful IVF and 183 who conceived naturally). The recruitment was performed during a 12-month period, and the follow-up was carried out until 3 months after delivery.

PARTICIPANTS/MATERIALS, SETTING, METHODS

This study was performed in the Division of Obstetrics in a regional referral center. The State scale of the State-Trait Anxiety Inventory (STAI-S) and the Beck Depression Inventory-Sort Form (BDI/SF) were used as anxiety and depression indicators, respectively; salivary cortisol and α-amylase levels as stress biomarkers. Anxiety, depression and stress biomarkers were measured at the third trimester of pregnancy (T1), at 48 h after birth (T2) and at 3 months after birth (T3). Associations with IVF were assessed using ordinal mixed models for anxiety and depressive symptoms and linear quantile models for stress biomarkers.

MAIN RESULTS AND THE ROLE OF CHANCE

Relative to natural conception mothers, IVF mothers had higher STAI-S scores at T1 (P = 0.016, odds ratio (OR) = 2.46), and this difference remained steady from T1 to T2 (P = 0.37, OR = 0.70) and from T2 to T3 (P = 0.36, OR = 0.69). In the case of depressive symptoms, the IVF group obtained lower BDI/SF scores at T1 (P < 0.001, OR = 0.192). This difference was apparently reduced from T1 to T2 (P = 0.072, OR = 2.21) and remained constant from T2 to T3 (P = 0.107, OR = 2.09). It is important to note that whereas the mean BDI/SF score was not clinically significant for any group (it was lower than the cut-off 4), the mean STAI-S score of the IVF group at T1 was so (it was higher than the cut-off 19). As for stress biomarkers, IVF mothers had higher cortisol levels at T1 (P = 0.043, Δlog(cortisol) = 0.88) compared to natural conceptions. From T1 to T2 cortisol levels of both groups increased at the relatively same rate (P = 0.81, Δlog(cortisol) = -0.16). However, the progressions tended to be different from T2 to T3, with IVF mothers exhibiting a sharp decrease in cortisol levels (P = 0.059, Δlog(cortisol) = -0.94), while natural conceptions value remained steady. In the case of α-amylase, there were no statistically significant differences between both groups at T1 (P = 0.7, Δlog(α-amylase) = -0.095). On the contrary, while IVF mothers showed sustained α-amylase levels across the time, the progression was different in the natural conception group, who showed a decrease in α-amylase levels from T1 to T2 (P = 0.049, Δlog(α-amylase) = 0.596) and a non-significant increase from T2 to T3 (P = 0.53, Δlog(α-amylase) = -0.283).

LIMITATIONS REASON FOR CAUTION

Since this follow-up study has been carried out from the third trimester of pregnancy, the findings cannot be generalized to extremely preterm births.

WIDER IMPLICATIONS OF THE FINDINGS

IVF women may have lower depressive symptoms for being pregnant. However, due to the potential pregnancy complications associated with IVF, they may have higher physiological stress and clinically significant anxiety at the third trimester of pregnancy but not during postpartum. Taking into account that both prenatal high maternal cortisol levels and prenatal clinically significant anxiety increase the risk of disturbance in the fetal neurodevelopment, psychological therapy should be extended during pregnancy in IVF women.

STUDY FUNDING/COMPETING INTEREST(S)

MV funded by FIS PI17/0131 grant from the Instituto de Salud Carlos III (ISCIII) and RETICS funded by the PN 2018-2011, and the European Regional Development Fund, reference RD16/0022/0001; AG-B funded by a 'Juan Rodés' Grant (JR17/00003) from the ISCIII. CC-P funded by a 'Miguel Servet I' Grant (CP16/00082) from the ISCIII. Authors declare no competing interests.

COMFFETI, Combined Fresh and Frozen Embryo Transfers per Individual: A New Index of Quality Control for The Performance of emberyologic Labs in The Emerging Era of Segmentation of Cycle and Freeze-All Strategy

The efficacy of in vitro fertilization (IVF) for treating human infertility has only one final efficacy index and that is the achievement of a delivery. However, with the evolution of the freeze-all strategy, a new problem is arising for evaluating the performance of an embryological team. The aim of the study was to present a new representative index, combining fresh and frozen embryo transfer success rates. In this opinion article, apart from the effectiveness of managing fresh gametes and embryos, we wish to evaluate the efficacy of the processes of both freezing and thawing of the produced embryos. The reporting of pregnancy rates of an IVF unit in the past was primarily laying in the fresh embryo transfer (ET) pregnancy rates. Now with the most frequent utilization of freeze-all strategy, it does not seem logical to report only on poor prognosis patients as all the good cases are postponed for thawed cycles. Ongoing implementation of the freeze-all strategy has indicated the need to establish a new representative index that may combine the success of both fresh and frozen cycles performed in the same woman; an index that may not be biased by the policy of an IVF center towards or against the freeze-all strategy. This newly proposed index, which is referred to as COMFFETI (Combined Fresh & Frozen Embryo Transfers per Individual), describes the optimal way to report final reproductive outcomes in the present opinion article.

Lack of association between receiving ART treatment and parental psychological distress during pregnancy: Preliminary findings of the Japan Environment and Children's Study

In a nationwide population-based birth cohort study in Japan, pregnant women and their partners were evaluated for psychological distress as part of the first and second/third trimester health checks. Participants were divided into three groups: an infertility group receiving assisted reproductive technology (ART) treatment (239 mothers and 151 fathers); an infertility group receiving non-ART treatment (350 mothers and 215 fathers); and a spontaneous pregnancy group (8514 mothers and 5110 fathers). Data on maternal and child health as well as basic characteristics were collected via medical records and self-administered questionnaires. The Kessler Six-item Psychological Distress Scale was employed for eligible women and their partners. Multivariate logistic regression analysis was used to evaluate the association between psychological distress experienced during pregnancy and ART treatment, with adjustment for potential confounders such as basic health status and socio-economic status. The mothers who received ART treatment suffered less psychological distress than the mothers in the other two groups. In multivariate analysis adjusted for background characteristics, no significant association was observed between persistent maternal distress and ART treatment (adjusted odds ratio 0.79, 95% confidence interval 0.49-1.26). Higher socio-economic status among couples receiving ART treatment may explain, in part, the lack of association between ART treatment and parental distress during pregnancy.

Effect of the previous reproductive outcomes in subfertile women after in vitro fertilization (IVF) and/or intracytoplasmic sperm injection (ICSI) treatments on perinatal anxious and depressive symptomatology

INTRODUCTION

The present study aims to investigate the effects of previous reproductive outcomes on the levels of depression, anxiety and perceived social support in subfertile women who conceived after in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatment.

METHODS

A prospective cohort study was developed. Data were collected on subfertile patients who conceived after IVF/ICSI treatment. All demographic and clinical data were recorded. The Edinburgh Postnatal Depression Scale, the State-Trait Anxiety Inventory-Y and the Multidimensional Scale of Perceived Social Support at 22 and 32 weeks of gestation and 15 days after delivery were completed. Data were analyzed comparing patients who conceived at their first IVF/ICSI cycle, after one unsuccessful ARTs cycle, and after multiple unsuccessful IVF/ICSI cycles.

RESULTS

A significant increase in state anxiety and depression scores from 22 gestational weeks of gestation to 15 days after delivery was observed in patients who received multiple unsuccessful IVF/ICSI cycles compared with other groups. No significant difference in perceived social support was detected among groups. The differences in depression and anxiety scores remained consistent after controlling for perceived social support.

DISCUSSION

A history of unsuccessful IVF/ICSI treatments seems to leave women more vulnerable in facing the duties of the new parental role. Such possibility underlies the importance of the availability of a psychological support for these women, even after a successful medical treatment for infertility.

Satisfaction in life among fathers following fertility treatment

OBJECTIVE

The study aimed at (a) gaining a better understanding of how fertility history (ART/spontaneous) is associated with life satisfaction among new fathers; and (b) identifying personal and interpersonal risk factors for lower satisfaction in life during the transition to fatherhood.

DESIGN

This cross-sectional study comprised 172 Israeli fathers (76 who became fathers following ART and 96 following spontaneous pregnancy), who completed a series of self-report questionnaires 5-18 months after the birth of their first child.

RESULTS

No differences were found in life satisfaction between fathers in the two fertility history groups. Regression analysis indicated that younger age and higher economic status, as well as lower attachment anxiety and avoidance and better marital relationship, were associated with a higher level of life satisfaction among new fathers.

CONCLUSION

Although the life satisfaction of new fathers does not appear to be affected by their fertility history, it may be hampered by personal and interpersonal risk factors. These results have practical implications for professionals who come into contact with this population.

Assessment on Occurrences of Depression and Anxiety and Associated Risk Factors in the Infertile Chinese Men

The prevalence of depression and anxiety in the Chinese male population with infertility is still uncertain. The prevalence of depression, anxiety, and a combination of both psychological symptoms was 20.8%, 7.8%, and 15.4%, respectively in 771 infertile Chinese men in the current study by the Mental Health Inventory–5 and the State–Trait Anxiety Inventory–Short Form questionnaires. Differences in demographics (age, education, and income) had no noticeable impact on the development of psychological symptoms. Clinical factors such as concomitant disorders (varicocele, epididymal cyst, and erectile dysfunction) were identified as risk factors associated with depressive symptoms (OR = 1.47; 95% CI [1.14, 1.90]; p < .001) and both depressive and anxiety symptoms (OR = 1.56; 95% CI [1.17, 2.08]; p < .001). An infertility duration over 2 years was associated with a high risk of anxiety symptoms (OR = 3.94; 95% CI [1.20, 12.93], p < .02). Other clinical conditions such as type of treatment and quality of sperm were not significant risk factors for psychological symptoms. This study provides evidence that Chinese men of reproductive age who suffer from infertility are vulnerable to psychological distress.

[Relationships between psychological well-being, lifestyle factors and fertility]

INTRODUCTION

10 to 15% of the Hungarian fertile age population struggles with reproductivity problems. Previous researches have shown that psychological well-being and lifestyle factors play a pivotal role in overall health status, which is closely related to fertility.

AIM

The aim of the study was to examine fertility-related psychological and lifestyle factors in a Hungarian sample.

METHOD

194 women (115 infertile and 79 fertile) took part in the study. Standardized, validated questionnaires were used for the assessment of psychological factors and self-administered questions were used for exploring lifestyle factors.

RESULTS

The results show that infertile women are younger (33.98±4.89 vs. 36.43±5.81 years, p<0.005) and their psychological status is significantly worse compared to their fertile counterparts. The number of their depressive (BDI 14.00±12.21 vs. 7.79±9.17, p<0.005) and anxiety symptoms is higher (STAI-T 48.53±10.56 vs. 40.25±10.65, p<0.005) compared to fertile women. Findings related to lifestyle factors show that lower level of fluid consumption (1.71±0.67 vs. 1.95±0.68, p<0.05) and diet (31.30% vs. 18.42%, p<0.05) is significantly related to infertility. In this sample higher level of fluid consumption was associated with the fertile group (OR = 1.65, CI = 2.58-1.06), independently of body mass index and age.

CONCLUSIONS

The results confirm the findings of international researches showing that women struggling with infertility are in worse psychological condition than their fertile counterparts. The authors conclude that the findings demand further investigations and follow-up studies in order to more specifically determine the relationship between fluid consumption and fertility.

Effects of assisted reproductive technology and of women's quality of life on depressive symptoms in the early postpartum period: a prospective case-control study

This study explored the influence of both assisted reproductive technology (ART) and reduced quality of life (QoL) during pregnancy on postpartum blues (PPB). Sixty-three sub-fertile patients who conceived through ART and 72 women who naturally conceived were enrolled in this prospective study. At 22nd and 32nd gestational weeks, women completed the Edinburgh Postnatal Depression Scale (EPDS) and the Short-Form 36 (SF-36), to investigate depressive symptoms and QoL, respectively; EPDS was again used at 15 days after birth to assess PPB. At both time points, higher EPDS scores and lower mental well-being scores (SF-36) significantly predicted PPB. The number of previous ART cycles emerged as the strongest predictor, whereas no significant effect was observed for the conceiving method. The results suggest the usefulness of assessing QoL during pregnancy and considering previous ART failures in preventing PPB.