1
|
Wischmann T. Psychological aspects of infertility. MED GENET-BERLIN 2024; 36:171-177. [PMID: 39263650 PMCID: PMC11388721 DOI: 10.1515/medgen-2024-2029] [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: 09/13/2024]
Abstract
The unfulfilled desire for children is a significant problem worldwide. The psychological effects of this development are usually underestimated, while the myth of "psychogenic infertility" stubbornly persists. This article first provides an overview of the basic facts on the subject before highlighting the psychological effects of both the diagnosis of infertility and the therapeutic options. Psychological aspects of "third-party" reproduction and further developments after childbirth or without a child are discussed, followed by a brief outline of the general and specific subject matter addressed in infertility counselling. The article concludes with reflections on the possible psychological consequences of further medical developments in this area.
Collapse
Affiliation(s)
- Tewes Wischmann
- Heidelberg University Hospital Institute of Medical Psychology Bergheimer Str. 20 69115 Heidelberg Germany
| |
Collapse
|
2
|
Petra T, Wischmann T, Mayer-Lewis B. Evaluation of infertility counselling in Germany. Arch Gynecol Obstet 2024; 309:1065-1073. [PMID: 38172455 DOI: 10.1007/s00404-023-07316-x] [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: 08/31/2023] [Accepted: 11/21/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE This paper reports on the first evaluation of infertility counselling in Germany. METHODS Sixty-nine infertility counsellors provided feedback via 524 survey sheets and 182 questionnaires were filled in by clients. RESULTS The results show a high level of satisfaction on behalf of the clients. They valued the emotional support, information, and exploration of family-building options with and without medical assistance and the counsellors' expertise. During counselling, coping with the emotional burden of infertility was an important issue, but in more than half of all counselling sessions, future parental issues were addressed. The group of clients seeking support can be described to be very heterogeneous, and counselling issues comprise a wide range of aspects. CONCLUSIONS This piece of research suggests that the following issues need to be considered to improve infertility counselling. Better integration of counselling in infertility clinics, more awareness for infertility counselling for other medical and non-medical professions Better funding for counselling so that its uptake is not dependent upon the financial resources of clients Awareness for new groups of clients and counselling issues such as single and transgender individuals, co-parenting families There is a need for more research and the development of counselling concepts.
Collapse
Affiliation(s)
- Thorn Petra
- Praxis für Paar- und Familientherapie, Langener Strasse 37, 64546, Moerfelden, Germany.
| | - Tewes Wischmann
- Institute of Medical Psychology, University Hospital Heidelberg, Bergheimer Str. 20, 69115, Heidelberg, Germany
| | - Birgit Mayer-Lewis
- Lutheran University of Applied Sciences-Evangelische Hochschule Nürnberg, Bärenschanzstraße 4, 90429, Nuremberg, Germany
| |
Collapse
|
3
|
Ribeiro S, Pedro J, Martins MV. Psychosocial experiences of involuntary definitive childless women: a comparative study based on reproductive status. Hum Reprod 2024; 39:559-568. [PMID: 38290160 DOI: 10.1093/humrep/deae001] [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: 12/06/2022] [Revised: 12/27/2023] [Indexed: 02/01/2024] Open
Abstract
STUDY QUESTION Do involuntary definitive childless women have lower psychosocial adjustment levels than women with infertility diagnoses actively trying to conceive and presumably fertile women? SUMMARY ANSWER Involuntary definitive childless women have lower levels of sexual functioning than infertile women actively trying to conceive and presumably fertile women, and higher levels of depression than presumably fertile women. WHAT IS KNOWN ALREADY Involuntary definitive childless defines those who wanted to become parents but were unable to do so. Studies have provided evidence about infertility and its psychosocial consequences, but there is a lack of knowledge about the impact of involuntary definitive childlessness, namely on sexual function, social support, marital satisfaction, and psychological adjustment. STUDY DESIGN, SIZE, DURATION This associative study was conducted between July 2021 and January 2022 for involuntary definitive childless women and between July 2016 and February 2018 for women with an infertility diagnosis actively trying to conceive as well as presumably fertile women. An online questionnaire announced in social media and gynaecology and fertility clinics was used. The inclusion criteria for all participants were being childless, in a heterosexual relationship and cohabiting for at least 2 years. Specific inclusion criteria for involuntary definitive childless women were: trying to conceive for at least 2 years; not achieving pregnancy because of biological and medical constraints; and not undergoing fertility treatment or being a candidate for adopting a child at time of the study. For women with an infertility diagnosis the inclusion criteria were: actively trying to conceive (naturally or through fertility treatments); having a primary fertility diagnosis; and aged between 22 and 42 years old. For presumably fertile women, the inclusion criteria were: having a parenthood wish in the future; and not knowing of any condition that could prevent them from conceiving. PARTICIPANTS/MATERIALS, SETTING, METHODS Out of 360 women completing the survey, only 203 were eligible for this study (60 involuntary definitive childless women, 78 women with an infertility diagnosis actively trying to conceive, and 65 presumably fertile women). All participants completed a questionnaire including sociodemographic and clinical data, the Female Sexual Function Index, the 2-Way Social Support Scale, the Relationship Assessment Scale, and Hospital Anxiety and Depression Scale. Binary logistic regression was performed to assess the relation between sexual function, social support, marital satisfaction, anxiety, depression, and reproductive status, adjusting for age, and cohabitation length. Presumably fertile women were used as a reference group. MAIN RESULTS AND THE ROLE OF CHANCE Women were 34.31 years old (SD = 5.89) and cohabited with their partners for 6.55 years (SD = 4.57). The odds ratio (OR) showed that involuntary definitive childless women had significantly lower sexual function than infertile women actively trying to conceive (OR = 0.88, 95% CI = 0.79-0.99) and presumably fertile women (OR = 34.89, 95% CI = 1.98-614.03), and higher depression levels than presumably fertile women (OR = 99.89, 95% CI = 3.29-3037.87). Women with an infertility diagnosis actively trying to conceive did not differ from presumably fertile women in sexual function, social support, marital satisfaction, anxiety, and depression. LIMITATIONS, REASONS FOR CAUTION The majority of childless women underwent fertility treatments, and childlessness for circumstantial reasons owing to lack of a partner was not included, therefore these results may not reflect the experiences of all women with an involuntary childless lifestyle. There was a time gap in the recruitment process, and only the definitive childlessness group filled out the questionnaire after the coronavirus disease 2019 pandemic. We did not ask participants if they self-identified themselves with the groups' terminology they were assigned to. WIDER IMPLICATIONS OF THE FINDINGS Our results emphasize the importance of future research to provide a more comprehensive understanding of the adjustment experiences of childless women and an awareness of the poor adjustment they might experience, highlighting the need to keep following women after unsuccessful treatments. Clinical practitioners must attend to these dimensions when consulting involuntary definitive childless women who might not have gone through treatments but also experience these adverse outcomes. STUDY FUNDING/COMPETING INTEREST(S) This study was partially supported by the Portuguese Foundation for Science and Technology. The authors declare that they have no conflict of interest. TRIAL REGISTRATION NUMBER N/A.
Collapse
Affiliation(s)
- Sara Ribeiro
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Juliana Pedro
- Centre for Reproductive Genetics A.Barros, Porto, Portugal
- Center for Psychology at University of Porto, Porto, Portugal
| | - Mariana Veloso Martins
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
- Center for Psychology at University of Porto, Porto, Portugal
| |
Collapse
|
4
|
Diagnostic evaluation of sexual dysfunction in the male partner in the setting of infertility: a committee opinion. Fertil Steril 2023; 120:967-972. [PMID: 37791930 DOI: 10.1016/j.fertnstert.2023.07.001] [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: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 10/05/2023]
Abstract
It is the responsibility of the clinician to assess for the presence of erectile dysfunction, ejaculatory dysfunction, or diminished libido in men presenting for evaluation of infertility. Referral to a reproductive urologist or other appropriate specialist with the requisite expertise in the evaluation and treatment of such conditions, including appropriate treatment of testosterone deficiency, is often warranted. This article replaces the article of the same name, last published in 2018.
Collapse
|
5
|
Saadedine M, Faubion SS, Kling JM, Kuhle C, Shufelt CL, Mara K, Enders F, Kapoor E. History of infertility and sexual dysfunction in midlife women: Is there a link? J Sex Med 2023; 20:1188-1194. [PMID: 37537692 PMCID: PMC10472170 DOI: 10.1093/jsxmed/qdad097] [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: 01/26/2023] [Revised: 05/16/2023] [Accepted: 06/26/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Infertility has been linked with an increased risk of sexual dysfunction in reproductive-aged women, with longer periods of infertility associated with a greater risk. AIM The study's aim was to examine whether a history of infertility treatment in women is linked to sexual dysfunction during midlife. METHODS The cross-sectional study was conducted among sexually active women, between the ages of 45 and 65 years, who sought consultation at the women's health clinics at a US tertiary care center. History of infertility treatment was assessed with a single question that asked participants if they were treated for infertility in the past. The association between a history of infertility treatment and sexual dysfunction-which was diagnosed by a combination of Female Sexual Function Index score ≤26.55 and Female Sexual Distress Scale-Revised score ≥11-was assessed in a multivariable logistic regression model that adjusted for multiple confounders. OUTCOMES The primary outcome was sexual dysfunction in midlife women. RESULTS The analysis included 5912 women, with a mean age of 54.1 years. Nearly 16% of women reported receiving treatment for infertility. More than half the women (55%) had sexual dysfunction: 56.3% of those with previous fertility treatments and 54.4% of those without any fertility treatment (P = .3). Receiving treatment for infertility in the younger years did not significantly increase the odds of sexual dysfunction in midlife in univariate (odds ratio, 1.08; 95% CI, 0.94-1.24; P = .3) and multivariable analyses (odds ratio, 1.11; 95% CI, 0.96-1.29; P = .17). CLINICAL IMPLICATIONS While infertility is known to be predictive of sexual dysfunction in women during their reproductive years, there was no association between a history of infertility treatment and sexual dysfunction in midlife women in the current study. STRENGTHS AND LIMITATIONS The study used validated questionnaires accounting for sexual complaints and distress and adjusted for multiple confounding factors. Limitations include the selection bias introduced by the study of women presenting for evaluation of sexual dysfunction, which may have been a result of factors stronger than the influence of infertility. Other limitations include the study's cross-sectional nature with suboptimal racial and ethnic representation. CONCLUSION Although infertility is commonly associated with female sexual dysfunction in women of reproductive age, the association was not present in midlife women in the current study.
Collapse
Affiliation(s)
- Mariam Saadedine
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL, 32224, United States
- Center for Women’s Health, Mayo Clinic, Rochester, MN, 55905, United States
| | - Stephanie S Faubion
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL, 32224, United States
- Center for Women’s Health, Mayo Clinic, Rochester, MN, 55905, United States
| | - Juliana M Kling
- Center for Women’s Health, Mayo Clinic, Rochester, MN, 55905, United States
- Division of Women’s Health Internal Medicine, Mayo Clinic, Scottsdale, AZ, 85259, United States
| | - Carol Kuhle
- Center for Women’s Health, Mayo Clinic, Rochester, MN, 55905, United States
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, 55905, United States
| | - Chrisandra L Shufelt
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL, 32224, United States
- Center for Women’s Health, Mayo Clinic, Rochester, MN, 55905, United States
| | - Kristin Mara
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, 55905, United States
| | - Felicity Enders
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, 55905, United States
| | - Ekta Kapoor
- Center for Women’s Health, Mayo Clinic, Rochester, MN, 55905, United States
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, 55905, United States
- Women’s Health Research Center, Mayo Clinic, Rochester, MN, 55905, United States
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, 55905, United States
| |
Collapse
|
6
|
Skedgel C, Cubi-Molla P, Mott D, Gameiro S, Boivin J, Al-Janabi H, Brazier J, Markert M, Andersson FL, Jofre-Bonet M. Unmet Parenthood Goals, Health-Related Quality of Life and Apparent Irrationality: Understanding the Value of Treatments for Infertility. PHARMACOECONOMICS - OPEN 2023; 7:337-344. [PMID: 36920719 PMCID: PMC10016171 DOI: 10.1007/s41669-023-00402-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 02/21/2023] [Indexed: 05/11/2023]
Abstract
An increasing number of prospective parents are experiencing infertility along with associated negative impacts on mental health and life satisfaction that can extend across a network of individuals and family members. Assistive reproductive technologies (ART) can help prospective parents achieve their parenthood goals but, like any health technology, they must demonstrate acceptable 'value for money' to qualify for public funding. We argue that current approaches to understanding the value of ART, including quality-adjusted life-year (QALY) gains based on changes in health-related quality of life (HRQOL) and, more often, cost per live birth, are too narrow to capture the full impact of unmet parenthood goals and ART. We see a fundamental disconnect between measures of HRQOL and broader measures of wellbeing associated with met and unmet parenthood goals. We also suggest that simple concepts such as 'patient' and 'carer' are of limited applicability in the context of ART, where 'spillovers' extend across a wide network of individuals, and the person receiving treatment is often not the infertile individual. Consideration of individual and societal wellbeing beyond HRQOL is necessary to understand the full range of negative impacts associated with unmet parenthood goals and the corresponding positive impacts of successful ART. We suggest moving towards a wellbeing perspective on value to achieve a fuller understanding of value and promote cross-sector allocative efficiency.
Collapse
Affiliation(s)
- Chris Skedgel
- Office of Health Economics, Goldings House, 2nd Floor, Hay's Galleria, 2 Hay's Lane, London, SE1 2HB, UK.
| | - Patricia Cubi-Molla
- Office of Health Economics, Goldings House, 2nd Floor, Hay's Galleria, 2 Hay's Lane, London, SE1 2HB, UK
| | - David Mott
- Office of Health Economics, Goldings House, 2nd Floor, Hay's Galleria, 2 Hay's Lane, London, SE1 2HB, UK
| | - Sofia Gameiro
- School of Psychology, University of Cardiff, Cardiff, UK
| | - Jacky Boivin
- School of Psychology, University of Cardiff, Cardiff, UK
| | - Hareth Al-Janabi
- Health Economics Unit, Institute of Applied Health Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
| | - John Brazier
- School of Health & Related Research, University of Sheffield, Sheffield, UK
| | | | | | - Mireia Jofre-Bonet
- Office of Health Economics, Goldings House, 2nd Floor, Hay's Galleria, 2 Hay's Lane, London, SE1 2HB, UK
| |
Collapse
|
7
|
Martins R, Connolly MP. Valuing live births from assisted reproduction: A health economics viewpoint. Best Pract Res Clin Obstet Gynaecol 2022; 85:149-158. [PMID: 36443158 DOI: 10.1016/j.bpobgyn.2022.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 12/14/2022]
Abstract
Infertility is a medical condition that can be overcome, thanks to advances in medically assisted reproductive (MAR) therapies. Despite the ultimate measure of MAR efficacy being the birth of a new human being, there are ethical and methodological questions as to which outcome best translates the value of MAR in cost-effectiveness analyses. Many authors favour cost per life birth outcomes instead of more traditional cost per quality-adjusted life years (QALYs), which raises generalizability issues for decision-makers. Nonetheless, infertility and infertility treatments substantially differ from other health conditions and health treatments, particularly in the way they affect the quality of life of the infertile couple. Collecting quality of life measures in infertility and pregnancy is also surrounded by challenges not easily overcome. We reflect on cost-effectiveness methods applied to MAR technologies, on ethical considerations for valuing a MAR-generated life, and on its broader societal value for consideration by decision-makers.
Collapse
Affiliation(s)
- Rui Martins
- Global Market Access Solutions, Health Economics Unit, St-Prex, Switzerland; University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Mark P Connolly
- Global Market Access Solutions, Health Economics Unit, St-Prex, Switzerland; Unit of Pharmacoepidemiology & Pharmacoeconomics, Department of Pharmacy, University of Groningen, Groningen, the Netherlands.
| |
Collapse
|
8
|
Heng FW, Shorey S. Experiences of endometriosis‐associated infertility among women and their partners: A qualitative systematic review. J Clin Nurs 2022; 31:2706-2715. [DOI: 10.1111/jocn.16145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/11/2021] [Accepted: 10/29/2021] [Indexed: 11/29/2022]
Affiliation(s)
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies Yong Loo Lin School of Medicine Level 2, Clinical Research Centre National University of Singapore Singapore City Singapore
| |
Collapse
|
9
|
Dastaran F, Maasoumi R, Foroozanfard F, Haghani S. The Effect of BETTER-Based Sex Counseling on Sexual Quality of Life in Infertile Women: a Randomized Controlled Clinical Trial. SEXUALITY AND DISABILITY 2022. [DOI: 10.1007/s11195-022-09759-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
10
|
Loloi J, Petrella F, Kresch E, Ibrahim E, Zini A, Ramasamy R. The Effect of Sperm DNA Fragmentation on Male Fertility and Strategies for Improvement: A Narrative Review. Urology 2022; 168:3-9. [PMID: 35705123 DOI: 10.1016/j.urology.2022.05.036] [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: 02/19/2022] [Revised: 05/22/2022] [Accepted: 05/31/2022] [Indexed: 11/17/2022]
Abstract
The inability to conceive due to male infertility is a complex issue with a wide variety of etiologies. Sperm DNA damage can be both a barrier to natural pregnancy and successful assisted reproductive technology (ART). The aim of this narrative review was to describe and highlight the effects of sperm DNA fragmentation and the most recent data on various treatment strategies to decrease sperm DNA damage. Finally, we proposed a management algorithm for couples undergoing ART with increased sperm DNA fragmentation.
Collapse
Affiliation(s)
- Justin Loloi
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | | | - Eliyahu Kresch
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL
| | - Emad Ibrahim
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL
| | - Armand Zini
- Department of Urology, McGill University, Montreal, Canada
| | - Ranjith Ramasamy
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL.
| |
Collapse
|
11
|
McQuillan J, Passet-Wittig J, Greil AL, Bujard M. Is perceived inability to procreate associated with life satisfaction? Evidence from a German panel study. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2022; 14:87-100. [PMID: 34877417 PMCID: PMC8627902 DOI: 10.1016/j.rbms.2021.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 08/13/2021] [Accepted: 09/24/2021] [Indexed: 05/19/2023]
Abstract
Most studies of the psychosocial consequences of infertility have focused on those who seek medical treatment, leaving a research gap regarding the psychosocial consequences of perceived inability to procreate in the general population. Moreover, most studies are cross-sectional and the results are thus likely affected by omitted variable bias. Inspired by aspects of the Theory of Conjunctural Action, this study analysed 10 waves of data from the German Family Panel (pairfam) for women and men using fixed effects panel regression and including time-varying control variables suggested by theory and research. This study found that both women and men experienced lower life satisfaction in years when they perceived an inability to procreate. This association was not affected by the inclusion of relevant time-varying control variables. Furthermore, the association between perceived barriers to procreation and life satisfaction was found to differ depending on life circumstances and gender. Women with partners and men without partners had lower life satisfaction when they perceived an inability to procreate compared with when they did not. Women and men who intended to have a(nother) child had lower life satisfaction when they perceived an inability to procreate compared with when they did not. The association, however, was only significant for men. Somewhat surprisingly, women who perceived an inability to procreate also had lower life satisfaction when they were not intending to have a(nother) child. This study makes an important contribution to research on the psychosocial consequences of perceived infertility, and provides insights into why some people may pursue assisted reproductive technology for family creation.
Collapse
Affiliation(s)
- Julia McQuillan
- Department of Sociology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | | | - Arthur L. Greil
- Liberal Arts and Sciences, Alfred University, Alfred, NY, USA
| | - Martin Bujard
- Federal Institute for Population Research, Wiesbaden, Germany
| |
Collapse
|
12
|
When ART fails: figures, experiences, interventions and a plea for the 'plan B'. J Assist Reprod Genet 2022; 39:195-199. [PMID: 34984598 PMCID: PMC8866578 DOI: 10.1007/s10815-021-02388-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/21/2021] [Indexed: 11/05/2022] Open
Abstract
Infertility is perceived by many of those affected by it as one of the most stressful episodes in life. Assisted reproduction can help only some of the people with a desire for children to experience the birth of a biological child. Most people who remain involuntarily childless eventually come to terms with the situation; their psychological well-being is not lastingly affected. However, they should envisage a ‘plan B’ as early as possible. The prospect of permanent childlessness should not be an unmentionable topic, neither for couples themselves nor for the doctors treating them.
Collapse
|
13
|
Vaughan DA, Goldman MB, Koniares KG, Nesbit CB, Toth TL, Fung JL, Reindollar RH. Long-term reproductive outcomes in patients with unexplained infertility: follow-up of the Fast Track and Standard Treatment Trial participants. Fertil Steril 2021; 117:193-201. [PMID: 34620454 DOI: 10.1016/j.fertnstert.2021.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate long-term reproductive outcomes in couples who were enrolled in a large randomized controlled trial that studied optimal treatment for unexplained infertility. DESIGN Telephone survey, administered between March 2019 and February 2020. SETTING Large urban university-affiliated fertility center. PATIENT(S) Couples who enrolled in the Fast Track and Standard Treatment Trial (FASTT). INTERVENTION(S) None. MAIN OUTCOMES MEASURE(S) Number of live births, methods of conception, adoption, and satisfaction regarding family size. RESULT(S) Of the 503 couples enrolled in FASTT, 311 (61.8%) were contacted and 286 (56.9%) consented to participate. The mean age and follicle-stimulating hormone level at the time of enrollment in FASTT were 33.1 ± 3.2 years and 6.8 ± 2.2 mIU/mL, respectively, for those who participated in this study. The mean age at follow-up was 49.5 ± 3.4 years. Of the 286 women, 194 (67.8%) had a live birth during the trial and 225 (78.7%) continued to try to conceive after FASTT. Of those who tried to conceive without treatment, 101 of 157 (64.3%) had a successful live birth, whereas 12 (5.3%) women had a live birth via intrauterine insemination and 82 (36.4%) via autologous oocyte in vitro fertilization. Overall, 182 (80.9%) women achieved a live birth after FASTT. CONCLUSION(S) The majority of couples were able to achieve a live birth after FASTT. Only 19 (6.6%) never achieved a live birth during their reproductive years. Moving to treatment sooner allows the opportunity to achieve >1 live birth, which is associated with increased satisfaction regarding family size. This further supports access to care and insurance coverage for infertility treatment.
Collapse
Affiliation(s)
- Denis A Vaughan
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts; Boston IVF, Waltham, Massachusetts.
| | - Marlene B Goldman
- Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire; Geisel School of Medicine, Hanover, New Hampshire
| | | | - Carleigh B Nesbit
- Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire; Geisel School of Medicine, Hanover, New Hampshire
| | - Thomas L Toth
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts; Boston IVF, Waltham, Massachusetts
| | - June L Fung
- Geisel School of Medicine, Hanover, New Hampshire
| | - Richard H Reindollar
- Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire; Geisel School of Medicine, Hanover, New Hampshire
| |
Collapse
|
14
|
Mohammadzadeh M, Lotfi R, Karimzadeh M, Kabir K. The Effect of Sexual Counseling Using BETTER Model on Sexual Function of Women with Infertility: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2021; 33:175-184. [PMID: 38596750 PMCID: PMC10903678 DOI: 10.1080/19317611.2020.1870608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 12/24/2020] [Accepted: 12/26/2020] [Indexed: 04/11/2024]
Abstract
Objective: Infertility can have adverse effects on sexuality of women. This study aims to examine the effect of sexual counseling based on the BETTER Model on the sexual function of Iranian women with infertility. Method: Eighty women with infertility were randomly assigned to either intervention or control groups. Female Sexual Function Index and Enrich Marital Satisfaction Scale were completed by participants at baseline and two months after. Results: All domains of FSFI (except for pain) were significantly increased (p < 0.001) after the intervention. Conclusions: Results showed that two sessions of sexual counseling can be used to improve the sexual health of infertile women.
Collapse
Affiliation(s)
| | - Razieh Lotfi
- Department of Midwifery, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Mansoureh Karimzadeh
- Department of preschool education, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Kourosh Kabir
- Department of Community Medicine, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| |
Collapse
|
15
|
Henriques A, Samorinha C, Ramos E, Silva S. Reproductive trajectories and social-biological dimensions in parenthood: Portuguese version of the Meaning of Parenthood scale. Porto Biomed J 2020; 5:e078. [PMID: 32734016 PMCID: PMC7386542 DOI: 10.1097/j.pbj.0000000000000078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/27/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Public meanings attributed to parenthood may shape individuals' family planning and how involuntary childlessness is supported by governmental policies. This study aimed to evaluate the influence of reproductive trajectories and gender in the meanings attributed to parenthood, and to assess the psychometric characteristics of the Portuguese version of the Meaning of Parenthood (MOP) scale. METHODS The sample comprised 754 participants: 246 young adults without children; 51 fathers and 159 mothers of adolescent children conceived spontaneously; and 149 infertile heterosexual couples. The scale was self-administered. Higher scores indicate attributing greater importance to parenthood to fulfill identity needs at individual, marital and social levels. Psychometric characteristics were analyzed through exploratory factor analysis; Cronbach alpha (α) assessed internal consistency. RESULTS Two dimensions of the MOP scale emerged, with good internal consistency (α ≥ 0.70): biological (importance of parenthood to fulfill reproductive needs as a biological being); social (importance of parenthood arising from social reproduction). Young adults attributed less importance to parenthood to fulfill both biological and social needs. The biological dimension was valued more than the social dimension in all subsamples; men highly valued the biological dimension compared to women. CONCLUSIONS Family planning needs to focus on a reasonable balance between biological and social dimensions of parenthood. The reinforcement of public policies providing the necessary conditions for human reproduction is essential to reverse declining fertility rates.
Collapse
Affiliation(s)
| | | | - Elisabete Ramos
- EPIUnit - Instituto de Saúde Pública
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Susana Silva
- EPIUnit - Instituto de Saúde Pública
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| |
Collapse
|
16
|
Kiesswetter M, Marsoner H, Luehwink A, Fistarol M, Mahlknecht A, Duschek S. Impairments in life satisfaction in infertility: Associations with perceived stress, affectivity, partnership quality, social support and the desire to have a child. Behav Med 2020; 46:130-141. [PMID: 30726170 DOI: 10.1080/08964289.2018.1564897] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Between 10% and 15% of couples in western society are affected by infertility. As a major source of psychological distress, infertility may be accompanied by a substantial decline in well-being, and mental symptoms including those of depression and anxiety. This study aimed to quantify impairments in life satisfaction in infertile couples and to identify psychosocial variables moderating these impairments. For this purpose, 228 infertile couples completed the Life Satisfaction Questionnaire (LSQ), Perceived Stress Questionnaire (PSQ), Positive and Negative Affect Schedule (PANAS), Penn State Worry Questionnaire (PSWQ), Partnership Questionnaire (PQ), Social Support Questionnaire, (SSQ) and Questionnaire on the Desire to Have a Child (QDC). Our sample scored below the norm of the general population on the LSQ sum score and various subscales, including those assessing social relationships, health, sexuality, leisure activities, and self-evaluation. Correlation and regression analysis revealed an inverse association of life satisfaction (LSQ) with stress (PSQ), negative affect (PANAS), and worry (PSWQ), and positive associations with positive affect (PANAS), partnership quality (PQ), social support (SSQ), and the strength of the desire to have a child (QDC). These findings support the notion of markedly reduced satisfaction with numerous life areas in the context of infertility. Psychosocial factors such as increased stress related to infertility treatment, affective impairments, partnership problems, lack of social support or social exclusion may contribute to this reduction. Psychological interventions aimed at controlling stress, strengthening partnerships, and improving social inclusion may be helpful in reducing the burden of infertility and improving the life satisfaction of affected couples.
Collapse
Affiliation(s)
- Manuel Kiesswetter
- Institute of Psychology, UMIT - University for Health Sciences Medical Informatics and Technology, Austria
| | - Heidi Marsoner
- Reference Center for Reproductive Medicine, General Hospital of Brunico, Italy
| | - Arne Luehwink
- Reference Center for Reproductive Medicine, General Hospital of Arco, Italy
| | | | | | - Stefan Duschek
- Institute of Psychology, UMIT - University for Health Sciences Medical Informatics and Technology, Austria
| |
Collapse
|
17
|
Shreffler KM, Greil AL, Tiemeyer SM, McQuillan J. Is infertility resolution associated with a change in women's well-being? Hum Reprod 2020; 35:605-616. [PMID: 32112095 PMCID: PMC7105324 DOI: 10.1093/humrep/dez297] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 12/11/2019] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Is giving birth associated with improved subjective well-being among involuntarily childless women? SUMMARY ANSWER Resolution of infertility is associated with increased life satisfaction and self-esteem, but not with a decrease in depressive symptoms. WHAT IS KNOWN ALREADY Cross-sectional data and studies of treatment-seekers show that infertility is associated with lower subjective well-being. Childless women with infertility tend to report lower subjective well-being than women who experience secondary infertility, but a prospective study using a random sample of involuntarily childless women over time has not previously been conducted. STUDY DESIGN, SIZE, DURATION The sample for the current study includes all women without children who met medical criteria for infertility or perceived a fertility problem (N = 283) at baseline and who were interviewed in both waves (3 years apart) of the National Survey of Fertility Barriers (NSFB), in a random-digit dialing telephone survey. It is therefore possible to explore here whether there are differences in the association of infertility resolution and subjective well-being among women who do and do not perceive themselves as having a fertility problem. PARTICIPANTS/MATERIALS, SETTING, METHODS Depressive symptoms (as measured by the Center for Epidemiologic Studies-Depression Scale), self-esteem (as measured by a modified version of the Rosenberg Self-esteem Scale) and life satisfaction (as measured by a modified version of the Satisfaction with Life Scale) were assessed for all 283 participants at both waves. For all three variables, change scores of 47 involuntarily childless women who resolved their infertility through a live birth were compared to the scores for the 236 women who remained childless. A number of variables shown to be associated with subjective well-being among infertile women were included as controls. MAIN RESULTS AND THE ROLE OF CHANCE No relationship between infertility resolution and change in depressive symptoms was observed (b = -0.04; P > 0.05). Involuntarily childless women who resolved their infertility improved in self-esteem (b = 0.74; P < 0.01) and life satisfaction (b = 1.06; P < 0.01). LIMITATIONS, REASONS FOR CAUTION Women were measured at only two time points. Only 47 women had a live birth between waves. While it is common practice to make causal interpretations based on panel data, such interpretations should be made with caution. In addition, the NSFB was conducted in the USA where medical expenditures are high and most fertility treatment expenses are not covered by insurance. Thus it may not be possible to generalize the findings to other modern industrialized societies. WIDER IMPLICATIONS OF THE FINDINGS Knowing that resolution of infertility is associated with improved subjective well-being is important for infertile couples and infertility professionals alike. STUDY FUNDING/COMPETING INTEREST(S) This research was supported in part by NICHD grant R01-HD044144 and NIGMS grant P20-GM109097 from the National Institutes of Health. The authors have no competing interests.
Collapse
Affiliation(s)
- Karina M Shreffler
- Human Development and Family Science, Oklahoma State University, Tulsa, OK, USA
| | - Arthur L Greil
- Emeritus of Sociology, Alfred University, Alfred, NY, USA
| | - Stacy M Tiemeyer
- Human Development and Family Science, Oklahoma State University, Tulsa, OK, USA
| | - Julia McQuillan
- Sociology, The University of Nebraska at Lincoln, Lincoln, NE, USA
| |
Collapse
|
18
|
Greil AL, McQuillan J, Burch AR, Lowry MH, Tiemeyer SM, Slauson-Blevins KS. Change in Motherhood Status and Fertility Problem Identification: Implications for Changes in Life Satisfaction. JOURNAL OF MARRIAGE AND THE FAMILY 2019; 81:1162-1173. [PMID: 32981967 PMCID: PMC7518405 DOI: 10.1111/jomf.12595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 06/05/2019] [Indexed: 05/22/2023]
Abstract
OBJECTIVE To determine whether the association between changes in life satisfaction and becoming a mother (or not) depends on fertility problem identification status. BACKGROUND Evidence and symbolic interactionist theory suggest that, for women who initially perceive a fertility barrier, gaining the valued identity "mother" should be associated with increases, and continuing to face a blocked goal (i.e. not becoming a mother) should be associated with decreases in life satisfaction. METHOD This study used the nationally representative two-wave National Survey of Fertility Barriers to conduct a change-score analysis with chained multiple imputation (MICE). The focal dependent variable was change in life satisfaction. Focal independent variables were Wave 1 life satisfaction, fertility problem identification status, and birth between waves, controlling for stability and change in relationship status, talking to a doctor about how to get pregnant, religiosity, social support, importance of parenthood, importance of leisure, importance of work success, and economic hardship. RESULTS Among women who perceived a fertility problem at both waves, becoming a mother was associated with increased life satisfaction and not becoming a mother was associated with decreased life satisfaction. Women who gained or lost a fertility problem perception between waves but did not have a live birth experienced a gain in life satisfaction between waves, suggesting the relevance of the duration of fertility problem perception for change in life satisfaction.
Collapse
Affiliation(s)
- Arthur L Greil
- Division of Social Sciences, Alfred University, 1 Saxon Drive, Alfred, NY 14802
| | - Julia McQuillan
- Department of Sociology, University of Nebraska, 709 Oldfather Hall. Lincoln, NE 68588-0324
| | - Andrea R Burch
- Division of Counseling and School Psychology, Alfred University, Alfred University, 1 Saxon Drive, Alfred, NY 14802
| | - Michele H Lowry
- Division of Social Sciences, Alfred University, 1 Saxon Drive, Alfred, NY 14802
| | - Stacy M Tiemeyer
- Department of Human Development and Family Science, Oklahoma State University, 2121 Main Hall, Tulsa, OK
| | | |
Collapse
|
19
|
Hubens K, Arons AMM, Krol M. Measurement and evaluation of quality of life and well-being in individuals having or having had fertility problems: a systematic review. EUR J CONTRACEP REPR 2018; 23:441-450. [PMID: 30499729 DOI: 10.1080/13625187.2018.1539161] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The aims of this study were: (1) to identify which measurement instruments are used in practice to assess the quality of life or well-being of individuals with and without (sub)fertility; (2) to describe the design and outcomes of studies comparing quality of life or well-being of individuals with and without fertility problems; and (3) to determine which of the outcomes of the identified studies could be used in cost-utility studies. METHODS A systematic literature review was performed of studies published before July 2018, using multiple databases. Included studies investigated (health-related) quality of life or well-being of individuals with fertility problems. The applied instruments were assessed, as were the outcomes and suitability for use in cost-utility studies. RESULTS Twenty-six studies met the inclusion criteria. Twelve distinct instruments of measurement were applied: two generic quality-of-life instruments, five generic well-being instruments and five disease-specific instruments. Most studies found negative associations in one or more domains assessing fertility problems and quality of life or well-being. However, two studies found the opposite. None of the studies reported outcomes relevant for cost-utility studies. CONCLUSION Quality of life and well-being related to having fertility problems are regularly studied. However, the reported information is not suitable for use in cost-utility studies. There is a clear need for studies investigating the impact of fertility problems on quality of life in a way that outcomes can be compared across studies and disease areas.
Collapse
Affiliation(s)
- Kimberley Hubens
- a Erasmus School of Health Policy & Management , Erasmus University Rotterdam , Rotterdam , the Netherlands
| | - Alexander M M Arons
- b Novartis , Arnhem , the Netherlands.,c Arons Consultancy , Rosmalen , the Netherlands
| | - Marieke Krol
- d IQVIA, Real World Evidence Solutions and Health Economic Outcomes Research , Amsterdam , the Netherlands
| |
Collapse
|
20
|
Diagnostic evaluation of sexual dysfunction in the male partner in the setting of infertility: a committee opinion. Fertil Steril 2018; 110:833-837. [PMID: 30316420 DOI: 10.1016/j.fertnstert.2018.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 07/11/2018] [Indexed: 11/20/2022]
Abstract
It is the responsibility of the clinician to assess for the presence of erectile dysfunction, ejaculatory dysfunction, or diminished libido related to hypoandrogenism among men presenting with a primary complaint of infertility. Referral to a reproductive urologist or other appropriate specialist with requisite expertise in the evaluation and treatment of such conditions is often warranted.
Collapse
|
21
|
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.
Collapse
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.
| |
Collapse
|
22
|
Martins MV, Vassard D, Hougaard CØ, Schmidt L. The impact of ART on union dissolution: a register-based study in Denmark 1994–2010. Hum Reprod 2018; 33:434-440. [DOI: 10.1093/humrep/dey002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 01/02/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mariana Veloso Martins
- University of Porto, Faculty of Psychology and Education Sciences, Rua Alfredo Allen, 4200-135 Porto, Portugal
- Center for Psychology at University of Porto, Rua Alfredo Allen, 4200-135 Porto, Portugal
| | - Ditte Vassard
- University of Copenhagen, Department of Public Health, Section of Social Medicine, Øster Farimagsgade 5, PO Box 2099, DK-1014 Copenhagen K, Denmark
| | - Charlotte Ørsted Hougaard
- University of Copenhagen, Department of Public Health, Section of Social Medicine, Øster Farimagsgade 5, PO Box 2099, DK-1014 Copenhagen K, Denmark
| | - Lone Schmidt
- University of Copenhagen, Department of Public Health, Section of Social Medicine, Øster Farimagsgade 5, PO Box 2099, DK-1014 Copenhagen K, Denmark
| |
Collapse
|
23
|
Leeners B, Wischmann T, Tschudin S. Unerfüllter Kinderwunsch und Sexualität. GYNAKOLOGISCHE ENDOKRINOLOGIE 2017. [DOI: 10.1007/s10304-017-0142-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
24
|
Koert E, Daniluk JC. When time runs out: reconciling permanent childlessness after delayed childbearing. J Reprod Infant Psychol 2017. [PMID: 29517370 DOI: 10.1080/02646838.2017.1320363] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study aimed to examine the experience of permanent childlessness after delayed childbearing. BACKGROUND More women are delaying childbearing while they pursue a career, gain financial stability and seek an appropriate partner. However, given that fertility declines with age, there is concern that more women will end up permanently, unintentionally childless after postponing childbearing. There is little known about this growing and invisible group. METHODS An interpretive phenomenological analysis was used to conduct the study. A purposive sample of 15 women who identified as being permanently childless after delaying childbearing participated in the study. Data were collected using in-depth semi-structured interviews. RESULTS Themes included feelings of grief, loss and isolation; a need to make sense of their childlessness; and a need to rebuild and refocus their lives and identities regardless of whether they had actually tried to conceive during their childbearing years. Women struggled with feelings of regret and the need to reconcile the reality of their choice to delay childbearing based on their values and beliefs about the ideal conditions within which to raise a child with feelings of powerlessness to pursue motherhood when they were likely still fertile. CONCLUSION Women who are permanently childless after delaying childbearing experience similar feelings to those who are childless after infertility and failed fertility treatments regardless of whether they tried to conceive during their reproductive years. However, this group has unique needs based on their feelings of regret, powerlessness and responsibility for their childlessness.
Collapse
Affiliation(s)
- Emily Koert
- a Department of Educational and Counselling Psychology , University of British Columbia , Vancouver , Canada
| | - Judith C Daniluk
- a Department of Educational and Counselling Psychology , University of British Columbia , Vancouver , Canada
| |
Collapse
|
25
|
The Trauma of Birth or Parenting a Child: Effect on Parents' Negative Emotion in China. Arch Psychiatr Nurs 2017; 31:211-216. [PMID: 28359435 DOI: 10.1016/j.apnu.2016.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 10/12/2016] [Accepted: 10/15/2016] [Indexed: 11/23/2022]
Abstract
The present study assessed negative emotions associated with the traumas of infertility and child rearing (child's disability or death) and the correlates of duration of trauma. The widely used Chinese Mental Health Scale was used to assess negative emotions in 294 individuals who experienced the aforementioned traumas and 124 who did not (control group). Results showed that individuals with infertility exhibited greater anxiety, depression, and solitude than the control group; bereaved parents and had greater solitude and fear than control group; and parents of children with disabilities had greater solitude than the control group. Parents who experienced the death of a child had more fear and physiological maladjustment than parents of a child with disabilities. In addition, individuals without parenting experience had higher scores on solitude, fear, and physiological disease than those with parenting experience. After controlling for demographic variables, the duration of trauma significantly negatively predicted depression in the infertile group and for bereaved parents. The results suggest that in order to prevent psychological and physiological health problems among infertile couples, parents of a disabled child, and parents who experience the death of child, family and community-based strategies should be developed and implemented.
Collapse
|
26
|
Seven out of 10 couples treated by IVF achieve parenthood following either treatment, natural conception or adoption. Reprod Biomed Online 2016; 33:560-567. [DOI: 10.1016/j.rbmo.2016.08.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 08/03/2016] [Accepted: 08/03/2016] [Indexed: 11/22/2022]
|
27
|
Jisha PR, Thomas I. Quality of Life and Infertility: Influence of Gender, Years of Marital Life, Resilience, and Anxiety. PSYCHOLOGICAL STUDIES 2016. [DOI: 10.1007/s12646-016-0358-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
28
|
Ferreira M, Sanchez ET, Gatimel N, Fajau C, Lesourd F, Bujan L, Mieusset R, Parinaud J, Leandri R. Parenthood and separation in couples 6 years after their first infertility consultation. Eur J Obstet Gynecol Reprod Biol 2016; 198:7-11. [DOI: 10.1016/j.ejogrb.2015.12.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Revised: 12/14/2015] [Accepted: 12/21/2015] [Indexed: 10/22/2022]
|
29
|
Vikström J, Josefsson A, Bladh M, Sydsjö G. Mental health in women 20-23 years after IVF treatment: a Swedish cross-sectional study. BMJ Open 2015; 5:e009426. [PMID: 26510732 PMCID: PMC4636640 DOI: 10.1136/bmjopen-2015-009426] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To assess self-perceived mental health in women treated with in vitro fertilisation (IVF) 20-23 years previously, while comparing them to a reference group, and to determine any differences in mental health between those who had given birth, those who had adopted a child, those who had given birth and adopted a child and those who remained childless. DESIGN A cross-sectional study. SETTING A Center of Reproductive Medicine (RMC) at a Swedish University hospital. PARTICIPANTS 520 women who had undergone at least one IVF cycle at the University Hospital in Linköping between 1986 and 1989. 504 of 520 women (97%) were eligible for follow-up. While 34 women declined, 93 per cent (n=470) of the women agreed to participate. The reference group consisted of 150 women of the Swedish population included in a study that was used to validate the Symptom CheckList (SCL)-90. INTERVENTIONS Follow-up was conducted in 2008-2009. The SCL-90 was used to measure the women's self-perceived mental health and a questionnaire specific for this study was used to retain demographic information. OUTCOME MEASURES The SCL-90 assesses 9 primary dimensions; somatisation, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation and psychoticism. There is also a global index of distress. RESULTS Women who had previously undergone IVF treatment were at increased risk of symptoms of depression (p=0.017), obsessive-compulsion (p=0.02) and somatisation (p≤0.001) when compared to a reference group. In addition, the women who have remained childless are at increased risk of symptoms of depression (p=0.009) and phobic anxiety (p=0.017). CONCLUSIONS The majority of the women who have been treated with IVF 20-23 years previously appear to be in good mental health. However, women who remain childless and/or without partner after unsuccessful infertility treatment constitute a vulnerable group even later on in life.
Collapse
Affiliation(s)
- J Vikström
- Faculty of Health Sciences, Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Department of Obstetrics and Gynecology in Linköping, County Council of Östergötland, Linköping, Sweden
| | - A Josefsson
- Faculty of Health Sciences, Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - M Bladh
- Faculty of Health Sciences, Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Department of Obstetrics and Gynecology in Linköping, County Council of Östergötland, Linköping, Sweden
| | - G Sydsjö
- Faculty of Health Sciences, Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Department of Obstetrics and Gynecology in Linköping, County Council of Östergötland, Linköping, Sweden
| |
Collapse
|
30
|
Gameiro S, Boivin J, Dancet E, de Klerk C, Emery M, Lewis-Jones C, Thorn P, Van den Broeck U, Venetis C, Verhaak CM, Wischmann T, Vermeulen N. ESHRE guideline: routine psychosocial care in infertility and medically assisted reproduction-a guide for fertility staff. Hum Reprod 2015; 30:2476-85. [PMID: 26345684 DOI: 10.1093/humrep/dev177] [Citation(s) in RCA: 159] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 06/11/2015] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Based on the best available evidence in the literature, what is the optimal management of routine psychosocial care at infertility and medically assisted reproduction (MAR) clinics? SUMMARY ANSWER Using the structured methodology of the Manual for the European Society of Human Reproduction and Embryology (ESHRE) Guideline Development, 120 recommendations were formulated that answered the 12 key questions on optimal management of routine psychosocial care by all fertility staff. WHAT IS ALREADY KNOWN The 2002 ESHRE Guidelines for counselling in infertility has been a reference point for best psychosocial care in infertility for years, but this guideline needed updating and did not focus on routine psychosocial care that can be delivered by all fertility staff. STUDY, DESIGN, SIZE, DURATION This guideline was produced by a group of experts in the field according to the 12-step process described in the ESHRE Manual for Guideline Development. After scoping the guideline and listing a set of 12 key questions in PICO (Patient, Intervention, Comparison and Outcome) format, thorough systematic searches of the literature were conducted; evidence from papers published until April 2014 was collected, evaluated for quality and analysed. A summary of evidence was written in a reply to each of the key questions and used as the basis for recommendations, which were defined by consensus within the guideline development group (GDG). Patient and additional clinical input was collected during the scoping and the review phase of the guideline development. PARTICIPANTS/MATERIALS, SETTING, METHODS The guideline group, comprising psychologists, two medical doctors, a midwife, a patient representative and a methodological expert, met three times to discuss evidence and reach consensus on the recommendations. MAIN RESULTS AND THE ROLE OF CHANCE THE GUIDELINE PROVIDES 120 recommendations that aim at guiding fertility clinic staff in providing optimal evidence-based routine psychosocial care to patients dealing with infertility and MAR. The guideline is written in two sections. The first section describes patients' preferences regarding the psychosocial care they would like to receive at clinics and how this care is associated with their well-being. The second section of the guideline provides information about the psychosocial needs patients experience across their treatment pathway (before, during and after treatment) and how fertility clinic staff can detect and address these. Needs refer to conditions assumed necessary for patients to have a healthy experience of the fertility treatment. Needs can be behavioural (lifestyle, exercise, nutrition and compliance), relational (relationship with partner if there is one, family friends and larger network, and work), emotional (well-being, e.g. anxiety, depression and quality of life) and cognitive (treatment concerns and knowledge). LIMITATIONS, REASONS FOR CAUTION We identified many areas in care for which robust evidence was lacking. Gaps in evidence were addressed by formulating good practice points, based on the expert opinion of the GDG, but it is critical for such recommendations to be empirically validated. WIDER IMPLICATIONS OF THE FINDINGS The evidence presented in this guideline shows that providing routine psychosocial care is associated with or has potential to reduce stress and concerns about medical procedures and improve lifestyle outcomes, fertility-related knowledge, patient well-being and compliance with treatment. As only 45 (36.0%) of the 125 recommendations were based on high-quality evidence, the guideline group formulated recommendations to guide future research with the aim of increasing the body of evidence.
Collapse
Affiliation(s)
- S Gameiro
- Cardiff Fertility Studies Research Group, School of Psychology, Cardiff University, CF10 3AT Cardiff, UK
| | - J Boivin
- Cardiff Fertility Studies Research Group, School of Psychology, Cardiff University, CF10 3AT Cardiff, UK
| | - E Dancet
- Leuven University Fertility Centre, University Hospitals Leuven, 3000 Leuven, Belgium Center for Reproductive Medicine, Women's and Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam 1105 AZ, The Netherlands
| | - C de Klerk
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus MC University Medical Centre, Rotterdam 3000 CA, The Netherlands
| | - M Emery
- Centre for Medically Assisted Procreation-CPMA, CH-1003 Lausanne, Switzerland
| | | | - P Thorn
- Practice for Couple and Family Therapy, 64546 Moerfelden, Germany
| | - U Van den Broeck
- Leuven University Fertility Centre, University Hospitals Leuven, 3000 Leuven, Belgium
| | - C Venetis
- Women's and Children's Health, St George Hospital, University of New South Wales, NSW 2217 Sydney, Australia
| | - C M Verhaak
- Department of Psychology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - T Wischmann
- Institute of Medical Psychology, Centre for Psychosocial Medicine, Heidelberg University Hospital, 69115 Heidelberg, Germany
| | - N Vermeulen
- European Society for Human Reproduction and Embryology, 1852 Grimbergen, Belgium
| |
Collapse
|
31
|
Boivin J, Gameiro S. Evolution of psychology and counseling in infertility. Fertil Steril 2015; 104:251-9. [PMID: 26092131 DOI: 10.1016/j.fertnstert.2015.05.035] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 05/20/2015] [Accepted: 05/28/2015] [Indexed: 11/29/2022]
Abstract
Five key paradigm shifts are described to illustrate the evolution of psychology and counseling in infertility. The first paradigm shift was in the 1930s when psychosomatic concepts were introduced in obstetrics and gynecology as causal factors to explain why some couples could not conceive despite the absence of organic pathology. In the second shift, the nurse advocacy movement of the 1970s stimulated the investigation of the psychosocial consequences of infertility and promoted counseling to help couples grieve childlessness when medical treatments often could not help them conceive. The third shift occurred with the advent of IVF, which created a demand for mental health professionals in fertility clinics. Mental health professionals assessed the ability of couples to withstand the demands of this new high technology treatment as well as their suitability as potential parents. The fourth shift, in the 1990s, saw reproductive medicine embrace the principles of evidence-based medicine, which introduced a much more rigorous approach to medical practice (effectiveness and safety) that extended to psychosocial interventions. The most recent paradigm shift, in the new millennium, occurred with the realization that compliance with protracted fertility treatment depended on the adoption of an integrated approach to fertility care. An integrated approach could reduce treatment burden arising from multiple sources (i.e., patient, clinic, and treatment). This review describes these paradigm shifts and reflects on future clinical and research directions for mental health professionals.
Collapse
Affiliation(s)
- Jacky Boivin
- Cardiff Fertility Studies Research Group, School of Psychology, Cardiff University, Cardiff, Wales, United Kingdom.
| | - Sofia Gameiro
- Cardiff Fertility Studies Research Group, School of Psychology, Cardiff University, Cardiff, Wales, United Kingdom
| |
Collapse
|
32
|
Outcome of assisted reproductive technology (ART) and subsequent self-reported life satisfaction. PLoS One 2014; 9:e112540. [PMID: 25393846 PMCID: PMC4231034 DOI: 10.1371/journal.pone.0112540] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 10/09/2014] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To compare life satisfaction between women with successful or unsuccessful outcome after assisted reproductive treatment (ART) by taking into account the time since the last ART. DESIGN Cohort study. SETTING Tertiary hospital. PATIENTS A total of 987 consecutive women who had undergone ART during 1996-2007 were invited and altogether 505 women participated in the study. INTERVENTIONS A postal enquiry with a life satisfaction scale. MAIN OUTCOME MEASURE Self-reported life satisfaction in respect to the time since the last ART. RESULTS In general, women who achieved a live birth after ART had a significantly higher life satisfaction than those who had unsuccessful ART, especially when compared in the first three years. The difference disappeared in the time period of 6-9 years after ART. The unsuccessfully treated women who had a child by some other means before or after the unsuccessful ART had comparable life satisfaction with successfully treated women even earlier. CONCLUSIONS Even if unsuccessful ART outcome is associated with subsequent lower level of life satisfaction, it does not seem to threaten the long-term wellbeing.
Collapse
|
33
|
Dolan P, Rudisill C. Babies in waiting: why increasing the IVF age cut-off might lead to fewer wanted pregnancies in the presence of procrastination. Health Policy 2014; 119:174-9. [PMID: 25445061 DOI: 10.1016/j.healthpol.2014.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 09/16/2014] [Accepted: 09/18/2014] [Indexed: 10/24/2022]
Abstract
Despite the best of intentions, we often act at the last minute when we are faced with a deadline. A recent recommendation by the English National Institute for Health and Clinical Excellence (NICE) to make In Vitro Fertilisation (IVF) available to women up to 42 years of age instead of 39 intends to offer more women the chance of pregnancy. Given what we know about behavioural responses to what is, in essence, a deadline, the policy could lead to procrastination and fewer wanted pregnancies. We examine how many women it would take to delay trying for a baby for this policy to result in fewer pregnancies. We take a cohort of 1000 women from age 34. If no women delay trying, the increased age on access to IVF results in 31 more pregnancies. Because of declining fertility with age, it would take only about a third of these women to delay trying for a baby until age 35 for there to be zero net benefits of increased IVF availability. If all women delayed by a year, the new policy will lead to 59 fewer pregnancies. We also estimate the implications for IVF treatment numbers as this has psychological and personal consequences. Our findings highlight how no policy sits in a behavioural vacuum and all policy decisions should consider the likely behavioural responses and incorporate them into their design and evaluation.
Collapse
Affiliation(s)
- Paul Dolan
- Department of Social Policy, London School of Economics & Political Science, UK
| | - Caroline Rudisill
- Department of Social Policy, London School of Economics & Political Science, UK.
| |
Collapse
|
34
|
Zare E, Bahrami N, Soleimani MA. Comparison of Self-esteem in Fertile and Infertile Women. ACTA ACUST UNITED AC 2014. [DOI: 10.29252/ijn.27.90.91.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
35
|
Gameiro S, van den Belt-Dusebout AW, Bleiker E, Braat D, van Leeuwen FE, Verhaak CM. Do children make you happier? Sustained child-wish and mental health in women 11-17 years after fertility treatment. Hum Reprod 2014; 29:2238-46. [DOI: 10.1093/humrep/deu178] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
36
|
Kjaer T, Albieri V, Jensen A, Kjaer SK, Johansen C, Dalton SO. Divorce or end of cohabitation among Danish women evaluated for fertility problems. Acta Obstet Gynecol Scand 2014; 93:269-76. [DOI: 10.1111/aogs.12317] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 12/06/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Trille Kjaer
- Department of Survivorship; Danish Cancer Society Research Center; Copenhagen Denmark
| | - Vanna Albieri
- Department of Statistics, Bioinformatics and Registry; Danish Cancer Society Research Center; Copenhagen Denmark
| | - Allan Jensen
- Department of Viruses, Lifestyle and Genes; Danish Cancer Society Research Center; Copenhagen Denmark
| | - Susanne K. Kjaer
- Department of Viruses, Lifestyle and Genes; Danish Cancer Society Research Center; Copenhagen Denmark
- Juliane Marie Center; Clinic of Gynecology; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - Christoffer Johansen
- Department of Survivorship; Danish Cancer Society Research Center; Copenhagen Denmark
| | - Susanne O. Dalton
- Department of Survivorship; Danish Cancer Society Research Center; Copenhagen Denmark
| |
Collapse
|
37
|
|
38
|
Wischmann T, Thorn P. (Male) infertility: what does it mean to men? New evidence from quantitative and qualitative studies. Reprod Biomed Online 2013; 27:236-43. [PMID: 23876974 DOI: 10.1016/j.rbmo.2013.06.002] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 04/30/2013] [Accepted: 06/11/2013] [Indexed: 11/16/2022]
Abstract
Scientific knowledge of the emotional repercussions of infertility on men remains limited and has only recently become the focus of social science research. Firstly, the current developments in research on the psychosocial impact of infertility on men through a search of the literature over the last 10 years are outlined in this paper. In the second section, issues raised in pretreatment counselling for men and their partner who consider donor insemination are described as this treatment typically raises many emotional issues. The results of more recent studies with sophisticated methodological design show that the emotional impact of infertility may be nearly balanced, suggesting that men do suffer as well and that they have to be addressed in infertility counselling too. The emotional and clinical aspects of donor insemination support the hypothesis that the emotional repercussions of infertility affect both sexes. In general, male factor infertility seems to be more stigmatized than other infertility diagnoses. Forthcoming studies have to differentiate between the psychological impact of infertility on women and men and their respective abilities to communicate easily about this distress. More studies on infertile men in non-Western societies need to be conducted in order to understand the cultural impact on infertility.
Collapse
Affiliation(s)
- Tewes Wischmann
- Institute of Medical Psychology, Centre for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany.
| | | |
Collapse
|
39
|
Salama S, Boitrelle F, Gauquelin A, Jaoul M, Albert M, Bailly M, Wainer R, Veluire M. Sexualité et infertilité. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.gyobfe.2012.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|