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Woodward JT, Cirino NH, Copland S, Davoudian T. Integrated Behavioral Health Care in Reproductive Medicine: How and Why to Include Mental Health Professionals in Infertility Care Teams. Clin Obstet Gynecol 2024; 67:222-232. [PMID: 38146084 DOI: 10.1097/grf.0000000000000829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
Despite fertility patients' reports of significant distress, few have access to integrated mental health care services. We elucidate the benefits and challenges of mental health integration in infertility practices from the perspective of both patients and providers. We outline specific models of integration, financial viability, and the first steps fertility clinics could take to improve their patients' access to these critical supports.
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Affiliation(s)
| | - Nicole H Cirino
- Department of Obstetrics & Gynecology, Baylor College of Medicine, Texas Children's Hospital, Pavilion for Women, Houston, Texas
| | - Susannah Copland
- Atlantic Reproductive Medicine Specialists, Raleigh, North Carolina
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Nam CS, Campbell KJ, Acquati C, Bole R, Adler A, Collins DJ, Collins E, Samplaski M, Anderson-Bialis J, Andino JJ, Asafu-Adjei D, Gaskins AJ, Bortoletto P, Vij SC, Orwig KE, Lundy SD. Deafening Silence of Male Infertility. Urology 2023; 182:111-124. [PMID: 37778476 DOI: 10.1016/j.urology.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/07/2023] [Accepted: 09/23/2023] [Indexed: 10/03/2023]
Abstract
Think about 6 loved ones of reproductive age in your life. Now imagine that 1 of these 6 individuals is suffering from infertility. Perhaps they feel alone and isolated, unable to discuss their heartbreak with their closest friends, family, and support network. Suffering in silence. In this editorial, we discuss the infertility journey through the lens of the patients, the providers, and the scientists who struggle with infertility each and every day. Our goal is to open a dialogue surrounding infertility, with an emphasis on dismantling the longstanding societal barriers to acknowledging male infertility as a disease. Through education, communication, compassion, and advocacy, together we can all begin to break the deafening silence of male infertility.
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Affiliation(s)
- Catherine S Nam
- Department of Urology, University of Michigan, Ann Arbor, MI
| | | | - Chiara Acquati
- Graduate College of Social Work, University of Houston, Houston, TX; Department of Clinical Sciences, Tilman J. Fertitta Family College of Medicine, University of Houston, Houston, TX; Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Raevti Bole
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Ava Adler
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - David J Collins
- Department of Urology, University of Southern California, Los Angeles, CA
| | - Erica Collins
- Department of Urology, University of Southern California, Los Angeles, CA
| | - Mary Samplaski
- Department of Urology, University of Southern California, Los Angeles, CA
| | | | - Juan J Andino
- Department of Urology, University of California Los Angeles, Los Angeles, CA
| | - Denise Asafu-Adjei
- Department of Urology, Department of Parkinson School of Health Sciences and Public Health, Loyola University Chicago Stritch School of Medicine, Chicago, IL
| | | | - Pietro Bortoletto
- Boston IVF, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Sarah C Vij
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Kyle E Orwig
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Scott D Lundy
- Glickman Urological and Kidney Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH.
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Tabatabaei F, Tahernia H, Ghaedi A, Bazrgar A, Khanzadeh S. Diagnostic significance of neutrophil to lymphocyte ratio in endometriosis: a systematic review and meta-analysis. BMC Womens Health 2023; 23:576. [PMID: 37936116 PMCID: PMC10631181 DOI: 10.1186/s12905-023-02692-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 10/06/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND The purpose of this systematic review and meta-analysis was to compile existing evidence on the significance of the NLR in predicting endometriosis in order to aid clinical decision-making and outcomes. METHODS We searched ProQuest, Web of Science, and PubMed for related studies published before January 2, 2023. Standardized mean difference (SMD) with a 95% confidence interval (CI) was reported for each outcome. Because a significant level of heterogeneity was found, we used the random-effects model to calculate pooled effects. We used Newcastle-Ottawa Scale (NOS) for quality assessment. RESULTS Overall, 18 article with were included in the analysis. A random-effect model revealed that patients with endometriosis had elevated levels of NLR compared to healthy controls (SMD = 0.79, 95% CI = 0.33 to 1.25, P < 0.001). Patients with endometriosis had elevated levels of NLR compared to those with other benign tumors (SMD = 0.85, 95% CI = 0.17 to 1.53, P = 0.014). In addition, NLR level of patients with stage III and IV endometriosis was not different from that of patients with stage I and II endometrioma (SMD = 0.30, 95% CI = -0.14 to 0.74, P = 0.18). However, NLR level was not different between endometriosis patients with and without peritoneal lesions (SMD = -0.12, 95% CI = -0.34to 0.10, P = 0.28), between patients with and without endometrioma (SMD = 0.20, 95% CI = -0.15 to 0.55, P = 0.26) and between endometriosis patients with and without deep lesions (SMD = 0.04, 95% CI = -0.20 to 0.28, P = 0.72). The pooled sensitivity of NLR was 0.67 (95% CI = 0.60-0.73), and the pooled specificity was 0.68 (95% CI, 0.62-0.73). CONCLUSIONS NLR might be utilized in clinics as a possible predictor to help clinicians diagnose endometriosis in affected women.
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Affiliation(s)
- Fatemeh Tabatabaei
- Department of Obstetrics and Gynaecology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Gynaecologic Laparoscopic Surgeries, Al-Zahra Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Arshin Ghaedi
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Aida Bazrgar
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shokoufeh Khanzadeh
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.
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Pilegaard SP, Schmidt L, Stormlund S, Koert E, Bogstad JW, Prætorius L, Nielsen HS, la Cour Freiesleben N, Sopa N, Klajnbard A, Humaidan P, Bergh C, Englund ALM, Løssl K, Pinborg A. Psychosocial wellbeing shortly after allocation to a freeze-all strategy compared with a fresh transfer strategy in women and men: a sub-study of a randomized controlled trial. Hum Reprod 2023; 38:2175-2186. [PMID: 37742131 DOI: 10.1093/humrep/dead188] [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: 07/08/2022] [Revised: 08/30/2023] [Indexed: 09/25/2023] Open
Abstract
STUDY QUESTION Is the psychosocial wellbeing affected in women and men shortly after allocation to a freeze-all strategy with postponement of embryo transfer compared to a fresh transfer strategy? SUMMARY ANSWER In general, psychosocial wellbeing (i.e. emotional reactions to the treatment, quality-of-life, infertility-related stress, and marital benefit) was similar in women and men allocated to a freeze-all versus those allocated to a fresh-transfer strategy 6 days after disclosure of treatment strategy (i.e. 4 days after oocyte retrieval), although women in the freeze-all group reported a slightly higher degree of depressive symptoms and mood swings compared to women in the fresh transfer group. WHAT IS KNOWN ALREADY The use of a freeze-all strategy, i.e. freezing of the entire embryo cohort followed by elective frozen embryo transfer in subsequent cycles has increased steadily over the past decade in assisted reproductive technology (ART). This strategy essentially eliminates the risk of ovarian hyperstimulation syndrome and has proven beneficial regarding some reproductive outcomes in subgroups of women. However, patients experience a longer time interval between oocyte retrieval and embryo transfer, hence a longer time to pregnancy, possibly adding additional stress to the ART treatment. So far, little focus has been on the possible psychosocial strains caused by postponement of embryo transfer. STUDY DESIGN, SIZE, DURATION This is a self-reported questionnaire based sub-study of a multicentre randomized controlled trial (RCT) including 460 women and 396 male partners initiating their first, second, or third treatment cycle of invitro fertilisation or intracytoplasmic sperm injection (ICSI) from May 2016 to September 2018. This sub-study was included in the primary project protocol and project plan for the RCT, as psychosocial wellbeing was considered a secondary outcome. PARTICIPANTS/MATERIALS, SETTING, METHODS Women from eight public fertility clinics in Denmark and Sweden and one private clinic in Spain were randomized in a 1:1 ratio on the day of inclusion (menstrual cycle day 2 or 3) to either a freeze-all strategy with postponement of embryo transfer to a subsequent modified natural menstrual cycle or a fresh transfer strategy with embryo transfer in the hormone stimulated cycle. Treatment allocation was blinded until the day of the ovulation trigger. Women and their male partners were asked to complete a validated self-reported questionnaire 6 days after unblinding of treatment group allocation, corresponding to 4 days after oocyte retrieval, investigating their psychosocial wellbeing related to the treatment defined as emotional reactions to the treatment, quality-of-life, infertility-related stress, and marital benefit. The questionnaire included items from the Copenhagen Multi-Centre Psychosocial Infertility (COMPI) Fertility Problem Stress Scales and the COMPI Marital Benefit Measure. MAIN RESULTS AND THE ROLE OF CHANCE Baseline characteristics were comparable between the two groups for both women and men. In total, response rates were 90.7% for women and 90.2% for men. In the freeze-all group, 207 women and 179 men completed the questionnaire compared with 204 women and 178 men in the fresh transfer group. Men in the two treatment groups did not differ in any of the explored aspects of psychosocial wellbeing (i.e. emotional reactions to the treatment, quality-of-life, infertility-related stress, and marital benefit) 6 days after disclosure of treatment strategy. Women in the freeze-all group reported a slightly higher degree of depressive symptoms (P = 0.045) and mood swings (P = 0.001) (i.e. variables included in 'emotional reactions to treatment') compared to women in the fresh transfer group. When adjusted for multiple testing, depressive symptoms were no longer significantly different between the two groups. No additional differences in psychosocial wellbeing were found. Self-reported quality-of-life during treatment was also rated as similar between the two groups in both women and men, but was slightly lower than they would rate their quality-of-life when not in fertility treatment. LIMITATIONS, REASONS FOR CAUTION Although response rates were high, selection bias cannot be excluded. As this study was an RCT, we assume that psychosocial characteristics of the participants were equally distributed in the two groups, thus it is unlikely that the identified psychosocial differences between the freeze-all and fresh transfer group were present already at baseline. Furthermore, the questionnaire was completed as a one-time assessment 4 days after oocyte retrieval, thus not reflecting the whole treatment process, whereas an assessment after the full completed treatment cycle is needed to draw firm conclusions about the psychosocial consequences of the whole waiting period. However, a question posted that late would be highly biased on whether or not a pregnancy had been achieved. WIDER IMPLICATIONS OF THE FINDINGS The results indicate that individuals in the freeze-all group exhibited slightly higher levels of depressive symptoms and mood swings compared to those in the fresh transfer group. Nevertheless, it is important to note that any worries related to potential emotional strains stemming from delaying embryo transfer should not overshadow the adoption of a freeze-all approach in cases where it is clinically recommended. As long as patients are provided with comprehensive information about the treatment strategy before initiating the process, it is worth emphasising that other aspects of psychosocial wellbeing were comparable between the two groups. STUDY FUNDING/COMPETING INTEREST(S) The study is part of the Reprounion collaborative study, co-financed by the European Union, Interreg V Öresund-Kattegat-Skagerrak. L.P. reports financial support from Merck A/S. H.S.N. reports grants from Freya Biosciences ApS, Ferring Pharmaceuticals, BioInnovation Institute, Ministry of Education, Novo Nordic Foundation, Augustinus Fonden, Oda og Hans Svenningsens Fond, Demant Fonden, Ole Kirks Fond and Independent Research Fund Denmark and personal fees from Ferring Pharmaceuticals, Merck A/S, Astra Zeneca, Cook Medical, IBSA Nordic and Gedeon Richter. H.S.N is founder and chairman of the Maternity Foundation and co-developed the Safe Delivery App (non-profit). N.C.F. reports grants from Gedeon Richter, Merck A/S, Cryos International and financial support from Ferring Pharmaceuticals, Merck A/S and Gedeon Richter. N.C.F. is chairman in the steering committee for the guideline groups for The Danish Fertility Society (non-profit). P.H. reports honoraria from Merch A/S, IBSA Nordic and Gedeon Richter. A.L.M.E. reports grants and financial support from Merck A/S and Gedeon Richter. A.P. reports grants from Gedeon Richter, Ferring Pharmaceuticals, Merck A/S and personal fees from Preglem S.A., Novo Nordic Foundation, Ferring Pharmaceuticals, Gedeon Richter, Cryos International, Merch A/S, Theramex and Organon and the lend of embryoscope to the institution from Gedeon Richter. All other authors declare no conflict of interest. TRIAL REGISTRATION NUMBER Clinicaltrials.gov NCT02746562.
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Affiliation(s)
- Sara Pind Pilegaard
- The Fertility Department, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lone Schmidt
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sacha Stormlund
- The Fertility Department, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- The Fertility Clinic, Department of Obstetrics and Gynaecology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Emily Koert
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jeanette Wulff Bogstad
- The Fertility Department, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lisbeth Prætorius
- The Fertility Clinic, Department of Obstetrics and Gynaecology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Henriette Svarre Nielsen
- The Fertility Clinic, Department of Obstetrics and Gynaecology, Copenhagen University Hospital, Hvidovre, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nina la Cour Freiesleben
- The Fertility Clinic, Department of Obstetrics and Gynaecology, Copenhagen University Hospital, Hvidovre, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Negjyp Sopa
- The Fertility Clinic, Department of Obstetrics and Gynaecology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Anna Klajnbard
- The Fertility Clinic, Department of Obstetrics and Gynaecology, Copenhagen University Hospital, Herlev, Denmark
| | - Peter Humaidan
- The Fertility Department, Skive Regional Hospital and Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Christina Bergh
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anne Lis Mikkelsen Englund
- The Fertility Clinic, Department of Obstetrics and Gynaecology, Zealand University Hospital, Køge, Denmark
| | - Kristine Løssl
- The Fertility Department, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Anja Pinborg
- The Fertility Department, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Thanscheidt CL, Wischmann T. Systematic Review: Risk Factors of Anxiety, Depressiveness, and (Lack of) Social Support in Women and Men Prior to Assisted Reproduction. Geburtshilfe Frauenheilkd 2023; 83:1350-1360. [PMID: 37928411 PMCID: PMC10624543 DOI: 10.1055/a-2166-4374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/19/2023] [Indexed: 11/07/2023] Open
Abstract
This review provides a systematic overview of the state of knowledge to date of psychosocial risk factors with a focus on anxiety, depressiveness, and (lack of) social support among involuntarily childless women and men prior to assisted reproduction. The databases PubMed, PubPsych, PsycINFO-Ebsco, and Web of Science were searched for relevant publications in English or German, and finally a total of 20 publications were included in the systematic review. Of these, 18 studies focused on depressiveness, 15 studies focused on anxiety, and 9 studies focused on social support. Half of the studies included both men and women, while the other half included only women. Due to the large heterogeneity of the study results as well as limitations, no clear conclusions can be drawn regarding a difference between the risk profiles of men and women with an unfulfilled desire to have children. However, it has been shown that infertile couples or women experience higher levels of stress in the form of depressiveness and anxiety compared to fertile participants. Furthermore, it was found that social support, regardless of gender difference, within the couple and from family and friends may be associated with a lower risk for depressiveness and anxiety.
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Affiliation(s)
| | - Tewes Wischmann
- Institut für Medizinische Psychologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
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Colombo C, Pistoljevic-Kristiansen N, Saupstad M, Bergenheim SJ, Spangmose AL, Klajnbard A, la Cour Freiesleben N, Løkkegaard EC, Englund AL, Husth M, Breth Knudsen U, Alsbjerg B, Prætorius L, Løssl K, Schmidt L, Pinborg A. Does luteal phase progesterone supplementation affect physical and psychosocial well-being among women undergoing modified natural cycle-FET? A sub-study of a randomized controlled trial. Hum Reprod 2023; 38:1970-1980. [PMID: 37634089 DOI: 10.1093/humrep/dead171] [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: 04/24/2023] [Revised: 07/27/2023] [Indexed: 08/28/2023] Open
Abstract
STUDY QUESTION Are there any differences in physical and psychosocial well-being among women undergoing modified natural cycle frozen embryo transfer (mNC-FET) with or without vaginal progesterone as luteal phase support (LPS)? SUMMARY ANSWER Women undergoing mNC-FET with vaginal progesterone supplementation were more likely to experience physical discomfort but there was no difference in psychosocial well-being between the two groups. WHAT IS KNOWN ALREADY mNC-FET can be carried out with or without vaginal progesterone as LPS, which has several side-effects. It is commonly known that fertility treatment can cause stress and psychosocial strain, however, most studies on this subject are conducted in fresh cycle regimes, which differ from NC-FET and results may not be comparable. STUDY DESIGN, SIZE, DURATION This is a sub-study of an ongoing RCT investigating whether progesterone supplementation has a positive effect on live birth rate in mNC-FET. The RCT is conducted at eight fertility clinics in Denmark from 2019 and is planned to end primo 2024. The sub-study is based on two questionnaires on physical and psychosocial well-being added to the RCT in August 2019. On the time of data extraction 286 women had answered both questionnaires. PARTICIPANTS/MATERIALS, SETTING, METHODS Women who had answered both questionnaires were included in the sub-study. Participants were equally distributed, with 143 in each of the two groups. Participants in both groups received the same questionnaires at two time-points: on cycle day 2-5 (baseline) and after blastocyst transfer. Participants in the progesterone group had administered progesterone for 7 days upon answering the second questionnaire. All items in the questionnaires were validated. Items on psychosocial well-being originate from the Copenhagen Multi-Centre Psychosocial Infertility-Fertility Problem Stress Scale (COMPI-FPSS) and from the Mental Health Inventory-5. MAIN RESULTS AND THE ROLE OF CHANCE Women receiving progesterone experienced more vaginal itching and/or burning than women in the non-progesterone group (P < 0.001). Women in the progesterone group also experienced more self-reported vaginal yeast infection, this was, however, not significant after adjustment for multiple testing (P/adjusted P = 0.049/0.881). No differences regarding psychosocial well-being were found between the two groups. Within the progesterone group, a shift toward feeling less 'downhearted and blue' was found when comparing response distribution at baseline and after blastocyst transfer (P < 0.001). LIMITATIONS, REASONS FOR CAUTION All items on physical symptoms were self-reported. The item on vaginal yeast infection was therefore not diagnosed by a doctor. Inclusion in the study required a few extra visits to the clinic, participants who felt more burdened by fertility treatment might have been more likely to decline participation. Women who experienced a lot of side-effects to progesterone prior to this FET cycle, might be less likely to participate. WIDER IMPLICATIONS OF THE FINDINGS Our results are in line with previous known side-effects to progesterone. Physical side-effects of progesterone should be considered before administration. STUDY FUNDING/COMPETING INTEREST(S) The RCT is fully supported by Rigshospitalet's Research Foundation and a grant from Gedeon Richter. Gedeon Richter were not involved in the design of protocol nor in the conduction of the study or analysis of results. A.P., L.P., and N.I.-C.F. report grants from Gedeon Richter, Ferring and Merck with no relations to this study. N.I.-C.F. has received travel support from Ferring, Merck A/S, & Gideon Richter, and is the head of the steering committee for the Danish Fertility Guidelines made by the members of from the Danish Fertility Society. A.P. reports consulting fees from Preglem, Novo Nordisk, Ferring, Gedeon Richter, Cryos, & Merck A/S, honoraria from Gedeon Richter, Ferring, Merck A/S, Theramex, and Organon, has received travel support from Gedeon Richter (payment to institution), participated on an advisory board for Preglem and was loaned an embryoscope from Gedeon Richter to their institution. A.L.S. has stock options for Novo Nordisk B A/S. B.A. have received unrestricted grant from Gedeon Richter Nordic and Merck and honoraria for lectures from Gedeon Richter, Merck, IBSA, and Marckyrl Pharma. TRIAL REGISTRATION NUMBER The RCT is registered on ClinicalTrials. gov (NCT03795220) and in EudraCT (2018-002207-34).
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Affiliation(s)
- Clara Colombo
- Faculty of Health and Medicine, The Fertility Department, Section 4071, The Juliane Marie Centre for Women, Children and Reproduction, University Hospital of Copenhagen, University of Copenhagen, Rigshospitalet, Copenhagen N, Denmark
| | - Nina Pistoljevic-Kristiansen
- Faculty of Health and Medicine, The Fertility Department, Section 4071, The Juliane Marie Centre for Women, Children and Reproduction, University Hospital of Copenhagen, University of Copenhagen, Rigshospitalet, Copenhagen N, Denmark
| | - Marte Saupstad
- Faculty of Health and Medicine, The Fertility Department, Section 4071, The Juliane Marie Centre for Women, Children and Reproduction, University Hospital of Copenhagen, University of Copenhagen, Rigshospitalet, Copenhagen N, Denmark
| | - Sara Johanna Bergenheim
- Faculty of Health and Medicine, The Fertility Department, Section 4071, The Juliane Marie Centre for Women, Children and Reproduction, University Hospital of Copenhagen, University of Copenhagen, Rigshospitalet, Copenhagen N, Denmark
| | - Anne Lærke Spangmose
- Faculty of Health and Medicine, The Fertility Department, Section 4071, The Juliane Marie Centre for Women, Children and Reproduction, University Hospital of Copenhagen, University of Copenhagen, Rigshospitalet, Copenhagen N, Denmark
| | - Anna Klajnbard
- Fertility Clinic, Copenhagen University Hospital-Herlev and Gentofte Hospital, Herlev, Denmark
| | - Nina la Cour Freiesleben
- Fertility Clinic, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ellen Christine Løkkegaard
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Fertility Clinic, Copenhagen University Hospital-North Zealand, Hillerød, Denmark
| | | | - Merete Husth
- Fertility Unit and Centre for Preimplantation Genetic Test, Aalborg University Hospital, Aalborg, Denmark
| | - Ulla Breth Knudsen
- Fertility Clinic, Horsens Regional Hospital and Institute of Clinical Medicine, Aarhus University, Horsens, Denmark
| | | | - Lisbeth Prætorius
- Fertility Clinic, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Kristine Løssl
- Faculty of Health and Medicine, The Fertility Department, Section 4071, The Juliane Marie Centre for Women, Children and Reproduction, University Hospital of Copenhagen, University of Copenhagen, Rigshospitalet, Copenhagen N, Denmark
| | - Lone Schmidt
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anja Pinborg
- Faculty of Health and Medicine, The Fertility Department, Section 4071, The Juliane Marie Centre for Women, Children and Reproduction, University Hospital of Copenhagen, University of Copenhagen, Rigshospitalet, Copenhagen N, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Van Muylder A, D'Hooghe T, Luyten J. Economic Evaluation of Medically Assisted Reproduction: A Methodological Systematic Review. Med Decis Making 2023; 43:973-991. [PMID: 37621143 DOI: 10.1177/0272989x231188129] [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] [Indexed: 08/26/2023]
Abstract
BACKGROUND Medically assisted reproduction (MAR) is a challenging application area for health economic evaluations, entailing a broad range of costs and outcomes, stretching out long-term and accruing to several parties. PURPOSE To systematically review which costs and outcomes are included in published economic evaluations of MAR and to compare these with health technology assessment (HTA) prescriptions about which cost and outcomes should be considered for different evaluation objectives. DATA SOURCES HTA guidelines and systematic searches of PubMed Central, Embase, WOS CC, CINAHL, Cochrane (CENTRAL), HTA, and NHS EED. STUDY SELECTION All economic evaluations of MAR published from 2010 to 2022. DATA EXTRACTION A predetermined data collection form summarized study characteristics. Essential costs and outcomes of MAR were listed based on HTA and treatment guidelines for different evaluation objectives. For each study, included costs and outcomes were reviewed. DATA SYNTHESIS The review identified 93 cost-effectiveness estimates, of which 57% were expressed as cost-per-(healthy)-live-birth, 19% as cost-per-pregnancy, and 47% adopted a clinic perspective. Few adopted societal perspectives and only 2% used quality-adjusted life-years (QALYs). Broader evaluations omitted various relevant costs and outcomes related to MAR. There are several cost and outcome categories for which available HTA guidelines do not provide conclusive directions regarding inclusion or exclusion. LIMITATIONS Studies published before 2010 and of interventions not clearly labeled as MAR were excluded. We focus on methods rather than which MAR treatments are cost-effective. CONCLUSIONS Economic evaluations of MAR typically calculate a short-term cost-per-live-birth from a clinic perspective. Broader analyses, using cost-per-QALY or BCRs from societal perspectives, considering the full scope of reproduction-related costs and outcomes, are scarce and often incomplete. We provide a summary of costs and outcomes for future research guidance and identify areas requiring HTA methodological development. HIGHLIGHTS The cost-effectiveness of MAR procedures can be exceptionally complex to estimate as there is a broad range of costs and outcomes involved, in principle stretching out over multiple generations and over many stakeholders.We list 21 key areas of costs and outcomes of MAR. Which of these needs to be accounted for alters for different evaluation objectives (determined by the type of economic evaluation, time horizon considered, and perspective).Published studies mostly investigate cost-effectiveness in the very short-term, from a clinic perspective, expressed as cost-per-live-birth. There is a lack of comprehensive economic evaluations that adopt a broader perspective with a longer time horizon. The broader the evaluation objective, the more relevant costs and outcomes were excluded.For several costs and outcomes, particularly those relevant for broader, societal evaluations of MAR, the inclusion or exclusion is theoretically ambiguous, and HTA guidelines do not offer sufficient guidance.
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Affiliation(s)
- Astrid Van Muylder
- Department Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium (AVM, JL); Research Group Reproductive Medicine, Department of Development and Regeneration, Organ Systems, Group Biomedical Sciences, KU Leuven (University of Leuven), Belgium (TD); Department of Obstetrics, Gynecology and Reproductive Sciences Yale School of Medicine, New Haven, CT, USA (TD); Global Medical Affairs Fertility, Research and Development, Merck Healthcare KGaA, Darmstadt, Germany (TD). The review was written at the Leuven Institute for Healthcare Policy. It was presented at the ESHRE 38th Annual Meeting (Milan 2022). The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Astrid Van Muylder and Jeroen Luyten have no conflicting interests to declare. The participation of Thomas D'Hooghe to this publication is part of his academic work; he does not see a conflict of interest as Merck KGaA was not involved in writing this article. The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: We acknowledge an internal funding from KU Leuven for this study. The funding agreement ensured the authors' independence in designing the study, interpreting the data, writing, and publishing the report. The following authors are employed by the sponsor: Astrid Van Muylder and Jeroen Luyten
| | - Thomas D'Hooghe
- Department Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium (AVM, JL); Research Group Reproductive Medicine, Department of Development and Regeneration, Organ Systems, Group Biomedical Sciences, KU Leuven (University of Leuven), Belgium (TD); Department of Obstetrics, Gynecology and Reproductive Sciences Yale School of Medicine, New Haven, CT, USA (TD); Global Medical Affairs Fertility, Research and Development, Merck Healthcare KGaA, Darmstadt, Germany (TD). The review was written at the Leuven Institute for Healthcare Policy. It was presented at the ESHRE 38th Annual Meeting (Milan 2022). The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Astrid Van Muylder and Jeroen Luyten have no conflicting interests to declare. The participation of Thomas D'Hooghe to this publication is part of his academic work; he does not see a conflict of interest as Merck KGaA was not involved in writing this article. The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: We acknowledge an internal funding from KU Leuven for this study. The funding agreement ensured the authors' independence in designing the study, interpreting the data, writing, and publishing the report. The following authors are employed by the sponsor: Astrid Van Muylder and Jeroen Luyten
| | - Jeroen Luyten
- Department Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium (AVM, JL); Research Group Reproductive Medicine, Department of Development and Regeneration, Organ Systems, Group Biomedical Sciences, KU Leuven (University of Leuven), Belgium (TD); Department of Obstetrics, Gynecology and Reproductive Sciences Yale School of Medicine, New Haven, CT, USA (TD); Global Medical Affairs Fertility, Research and Development, Merck Healthcare KGaA, Darmstadt, Germany (TD). The review was written at the Leuven Institute for Healthcare Policy. It was presented at the ESHRE 38th Annual Meeting (Milan 2022). The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Astrid Van Muylder and Jeroen Luyten have no conflicting interests to declare. The participation of Thomas D'Hooghe to this publication is part of his academic work; he does not see a conflict of interest as Merck KGaA was not involved in writing this article. The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: We acknowledge an internal funding from KU Leuven for this study. The funding agreement ensured the authors' independence in designing the study, interpreting the data, writing, and publishing the report. The following authors are employed by the sponsor: Astrid Van Muylder and Jeroen Luyten
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Zurlo MC, Cattaneo Della Volta MF, Vallone F. Paths towards parenthood after repeated treatment failures: a comparative study on predictors of psychological health outcomes in infertile couples persisting in treatments or opting for adoption. Front Psychol 2023; 14:1147926. [PMID: 37342643 PMCID: PMC10277654 DOI: 10.3389/fpsyg.2023.1147926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/10/2023] [Indexed: 06/23/2023] Open
Abstract
Introduction Infertility literature suggests widespread recourse to long-term medical treatments despite evidence of high stress, costs, and adverse effects of repeated treatment failures. However, there is a lack of research comparing predictors of stress and psychological health outcomes between members of infertile couples who - after repeated failures - persist in pursuing medical treatments (PT) with those who opted for quitting treatments and adopting (QTA). Basing on a transactional and multidimensional approach to infertility-related stress and health, the present study aims at exploring individual (socio-demographics; coping strategies) and situational (infertility-related parameters; infertility-related stressors; couple's dyadic adjustment dimensions) predictors of state-anxiety and depression in male and female partners of PT-infertile couples and of QTA-infertile couples. Methods Participants were both members of 176 couples with duration of infertility and a history of medical treatments for at least 3 years (76 PT-infertile couples, 100 QTA-infertile couples). The study variables were compared by study group across genders. Structural equation models (SEM) were used to test main and moderating effects of study variables on state-anxiety and depression by study group and across genders. Results Members of infertile couples quitting treatments and adopting (QTA) reported significantly lower levels of state-anxiety and depression, higher stress related to need for parenthood and rejection of childfree-lifestyle and lower stress related to social and couple's relationship concerns than those who persist in pursuing medical treatments (PT). Members of infertile couples quitting treatments and adopting (QTA) recurred to a greater extent to active coping strategies (problem-solving/social-support) and to a lower extent to passive coping strategies (avoiding/turning-to-religion), and they reported higher levels of dyadic adjustment. Specificities in main and moderating factors related to state-anxiety and depression by study group and across genders were found. Conclusion Findings should be addressed to provide a comprehensive assessment of both members of infertile couples facing repeated treatment failures to identify risks and resources and develop tailored evidence-based interventions.
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Affiliation(s)
- Maria Clelia Zurlo
- Dynamic Psychology Laboratory, Department of Political Sciences, University of Naples Federico II, Naples, Italy
- Department of Humanities, University of Naples Federico II, Naples, Italy
| | | | - Federica Vallone
- Dynamic Psychology Laboratory, Department of Political Sciences, University of Naples Federico II, Naples, Italy
- Department of Humanities, University of Naples Federico II, Naples, Italy
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9
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Antequera-Jurado R, Moreno-Rosset C, Ramírez-Uclés I. The specific psychosocial modulator factors of emotional adjustment in infertile individuals compared to fertile people. CURRENT PSYCHOLOGY 2023. [DOI: 10.1007/s12144-023-04436-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Certain psychological and social factors modulate emotional adjustment in infertility. The aims of this study were: analyse whether there are sex and group differences (infertile vs. fertile) in emotional adjustment, and personality, dispositional optimism, coping strategies, personal and interpersonal resources; observe the modulating role of these psychosocial variables in the emotional adjustment of infertile individuals compared to fertile ones; and determine if the modulator variables associated with emotional adjustment are specific to infertile people. Method: A cross-sectional study design was used with a sample of 139 heterosexual Spanish participants (84 infertile, 55 fertile). For the data analysis we performed correlations, multiple regression analysis, MANOVAS and ANOVAS. Results: The multivariate and univariate analyses showed that the infertile group exhibited greater emotional maladjustment, more personal resources, lesser degree of confrontive coping, social support seeking, positive reappraisal, and lower marital satisfaction than the fertile group. In addition, women (infertile and fertile) sought more social support seeking and the infertile ones made more use of self-controlling strategies. Multiple regression analyses showed that for all subjects the emotional adjustment was modulated by dispositional optimism and escape/avoidance. For infertile participants, the remaining significant modulating factors were personal resources and marital satisfaction, whereas, for the fertile group, they were openness and interpersonal resources. Conclusion: Infertile women and men showed no differences in emotional maladjustment, but levels were higher than in the fertile group. We found differences between infertile and fertile subjects in terms of modulating variables of emotional adjustment. For infertile participants, the development of personal resources and increased marital satisfaction are particularly important.
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Dias L, Willems SG, Luyten J, De Loecker P, D'Hooghe TM, Peeraer K, Dancet EAF. The need for longitudinal data on the value of fertility treatment for infertile patients' quality of life: A review and pilot study. Best Pract Res Clin Obstet Gynaecol 2023:102324. [PMID: 36948947 DOI: 10.1016/j.bpobgyn.2023.102324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 02/23/2023]
Abstract
Infertility threatens the life goal of parenthood and, hence, quality of life (QoL) of (wo)men, but the fertility clinic trajectory might be burdensome. This review of longitudinal studies and pilot longitudinal study examines the impact of the pre-in vitro fertilization (IVF) fertility clinic trajectory on patient-reported outcome measures (PROMs) for emotional well-being, including QoL. A publication found that the diagnostic workup decreases men's infertility-specific distress while publications disagree whether it decreases (wo)men's anxious and depressive reactions. Intrauterine insemination (IUI) was found to increase (wo)men's depressive reactions. Publications on infertility-specific, health-related, and overall QoL were missing. The pilot indicated that (wo)men's overall QoL is not affected by the diagnostic workup but is decreased by the time of the third IUI. Longitudinal studies on the impact of starting the fertility clinic trajectory on PROMs are needed as they are essential for patient-centered clinical decision-making and patient-centered policy-level decision-making.
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Affiliation(s)
- L Dias
- Fertiliteitscentrum Antwerpen, GZA Ziekenhuizen, Oosterveldlaan 24, 2610 Wilrijk, Belgium; Department of Development and Regeneration, University of Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - S G Willems
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35 Blok D - Bus 7001, 3000 Leuven, Belgium.
| | - J Luyten
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35 Blok D - Bus 7001, 3000 Leuven, Belgium.
| | - P De Loecker
- Fertiliteitscentrum Antwerpen, GZA Ziekenhuizen, Oosterveldlaan 24, 2610 Wilrijk, Belgium.
| | - T M D'Hooghe
- Department of Development and Regeneration, University of Leuven, Herestraat 49, 3000 Leuven, Belgium; Merck, United States.
| | - K Peeraer
- Department of Development and Regeneration, University of Leuven, Herestraat 49, 3000 Leuven, Belgium; Leuven University Fertility Centre, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - E A F Dancet
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35 Blok D - Bus 7001, 3000 Leuven, Belgium.
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11
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Lo SST, Wong GCY, Ng EHY, Chan CHY, Li RHW. Longitudinal study on sexual function and quality of life in infertile couples undergoing intrauterine insemination. J Sex Med 2023; 20:30-37. [PMID: 36897240 DOI: 10.1093/jsxmed/qdac013] [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: 07/01/2022] [Revised: 10/03/2022] [Accepted: 10/14/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Cross-sectional studies have shown that sexual dysfunction and poor quality of life were prevalent among couples undergoing assisted reproduction at specific time points, but nothing is known about how these outcomes change over the course of their intrauterine insemination (IUI) journey. AIM We investigated the longitudinal changes in sexual function and quality of life of infertile couples undergoing IUI. METHODS Sixty-six infertile couples completed an anonymous questionnaire at 3 time points: after IUI counseling (T1), 1 day before IUI (T2), and 2 weeks after IUI (T3). The questionnaire consisted of demographic data, Female Sexual Function Index (FSFI) or International Index of Erectile Function-5, and Fertility Quality of Life (FertiQoL). OUTCOMES Descriptive statistics, significance testing with the Friedman test, and post hoc analysis with the Wilcoxon signed rank test were used to compare changes in sexual function and quality of life at different time points. RESULTS Overall, 18 (26.1%), 16 (23.2%), and 12 (17.4%) women and 29 (42.0%), 37 (53.6%), and 31 (44.9%) men were at risk for sexual dysfunction at T1, T2, and T3, respectively. There were significant differences in mean FSFI scores in arousal (3.87, 4.06, 4.10) and orgasm (4.15, 4.24, 4.39) domains at T1, T2, and T3. After post hoc analysis, only the increase in mean orgasm FSFI scores between T1 and T3 was statistically significant. Men's FertiQoL scores remained high during IUI (74.33-75.63 out of 100). Men also scored significantly higher than women on all FertiQoL domains except environment at the 3 time points. Post hoc analysis showed significant improvement in women's FertiQoL domain scores between T1 and T2: mind-body, environment, treatment, and total. Women's FertiQoL score at T2 for the treatment domain was also significantly higher than that at T3. CLINICAL IMPLICATIONS Men should not be neglected during IUI as their erectile function got worse in the process, with half of the men being affected. Although women's quality of life showed some improvement during IUI, most of their scores were lower than men's. STRENGTHS AND LIMITATIONS The use of psychometrically validated questionnaires and a longitudinal approach are the major strengths; a small sample size and the lack of a dyadic approach are the major limitations. CONCLUSION During IUI, women's sexual performance and quality of life improved. The proportion of men having erectile problems was high for this age group, but men's FertiQoL scores remained good and were better than their partners' throughout IUI.
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Affiliation(s)
- Sue Seen-Tsing Lo
- Health Services Division, The Family Planning Association of Hong Kong, Hong Kong SAR, China
| | - Grace Ching-Yin Wong
- Health Services Division, The Family Planning Association of Hong Kong, Hong Kong SAR, China
| | - Ernest Hung-Yu Ng
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong SAR, China
| | - Celia Hoi-Yan Chan
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
| | - Raymond Hang-Wun Li
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong SAR, China
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12
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Salazar Mederos AM, Gutiérrez Hernández PR, Ortega González Y, Hess Medler S. Depressive ranges in infertile couples with male factor. Rev Int Androl 2023; 21:100324. [PMID: 36273995 DOI: 10.1016/j.androl.2021.02.011] [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: 09/07/2020] [Revised: 12/30/2020] [Accepted: 02/14/2021] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Depression is not uncommon among infertile couples. The objective of the study is to analyze factors that predict depression in these couples, when they are in Assisted Reproduction Techniques programs. MATERIALS AND METHOD We analyze the level of depression in couples referred from the Human Reproduction Unit to study the male factor using the Beck Depression Inventory and the clinical information contained in the SARAplus program. RESULTS Depressive ranges appear in approximately half of the participants. The degree of depression correlates in a statistically significant way between both members of the couple. Among the analyzed clinical factors, we observed relational tendency between depression and obesity and depression and smoking. CONCLUSIONS Depression in infertile couples is a fact. ART specialists should be on the lookout for symptoms of depression in order to provide patients psychological and psychiatric care and treatments, as part of the overall therapeutic framework for infertility.
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Affiliation(s)
| | - Pedro Ramón Gutiérrez Hernández
- Facultad de Ciencias de la Salud, Universidad de La Laguna, La Laguna, Santa Cruz de Tenerife, Spain; Servicio de Urología, Complejo Hospitalario Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain.
| | - Yanira Ortega González
- Facultad de Ciencias de la Salud, Universidad de La Laguna, La Laguna, Santa Cruz de Tenerife, Spain; Servicio de Urología, Complejo Hospitalario Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
| | - Stephany Hess Medler
- Facultad de Psicología y Logopedia, Universidad de La Laguna, La Laguna, Santa Cruz de Tenerife, Spain
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Erčulj VI, Žiberna A. The Role of Online Social Support in Patients Undergoing Infertility Treatment - A Comparison of Pregnant and Non-pregnant Members. HEALTH COMMUNICATION 2022; 37:1724-1730. [PMID: 33855925 DOI: 10.1080/10410236.2021.1915517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The role of social support in the online setting is explored in this study. For this purpose, the posts of infertility treatment patients participating in an infertility treatment online support group between 2002 and 2016 were retrieved. Members who contributed at least 100 words were divided into two groups according to the treatment outcome they reported (pregnancy). The association between the length of group membership, type of support provided, intensity of interaction, active support seeking, overall sentiment and the amount of sadness, anxiety and anger words and the treatment outcome was examined. The findings suggest that online social, in particular emotional, support acts as a buffer between the stressor and the treatment outcome. The expression of anger and initiating of communication by new members diminish this relationship.
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Affiliation(s)
- Vanja Ida Erčulj
- Faculty of Criminal Justice and Security, Department of Social Studies, Humanities, and Methodology, University of Maribor
| | - Aleš Žiberna
- Department of Social Informatics and Methodology, Faculty of Social Sciences, University of Ljubljana
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14
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Yamanaka-Altenstein M, Rauch-Anderegg V, Heinrichs N. The link between infertility-related distress and psychological distress in couples awaiting fertility treatment: a dyadic approach. HUM FERTIL 2022; 25:924-938. [PMID: 34232107 DOI: 10.1080/14647273.2021.1948112] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
While there is broad evidence to suggest that individual stress increases, and that high couple relationship quality reduces the risk for psychological distress, our understanding of these associations in couples dealing with infertility remains limited. In this cross-sectional study, we used dyadic data-analysis (Actor-Partner Interdependence Model; APIM) to examine the effects of infertility-related distress (experienced as an individual risk factor) and couple relationship quality (experienced as a couple-based resource), on psychological distress in a sample of 116 infertile couples. 59% of women and 23% of men reported clinical levels of psychological distress, 71% of women and 45% of men reported infertility-related distress, and 3% of participants reported low couple relationship quality. Infertility-related distress predicted psychological distress at the individual level ('actor effects') while men's infertility-related distress predicted women's psychological distress (partner effect'). Women without medically assisted reproduction (MAR) treatment exposure reported significantly higher couple relationship quality than women with MAR exposure, and men without treatment exposure reported significantly lower infertility-related distress than men with exposure. The level of psychological distress depended on whether both or neither of the partners, or only one partner reported infertility-related distress. Couple relationship quality was not associated with distress, which may imply that dyadic dimensions other than overall satisfaction could be relevant in supporting couples facing infertility.
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Affiliation(s)
| | | | - Nina Heinrichs
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Bremen, Bremen, Germany
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15
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Modarres M, Abunasri M, Alhani F, Ebrahimi E. The Effectiveness of Implementing Family-Centered Empowerment Model on Irrational Thoughts of Iranian Infertile Women: A Randomized Clinical Trial. J Caring Sci 2022; 11:224-231. [PMID: 36483691 PMCID: PMC9720503 DOI: 10.34172/jcs.2022.22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 04/03/2021] [Indexed: 08/01/2023] Open
Abstract
Introduction: Infertility is one of the main problems of the family and is one of the factors that determine the identity and personality of Iranian infertile women. Family-centered empowerment model is a step toward increasing the self-efficacy of patients and enabling them to take responsibility of their illness. This study aimed to determine the effectiveness of applying family-centered empowerment model on irrational thoughts of Iranian infertile women. Methods: This study was a randomized clinical trial conducted on 80 infertile women and their husbands that were randomly divided into two intervention and control groups. Irrational Parenthood Cognitions questionnaire was given to the intervention and control groups to complete before and 3 months after the intervention. Data were analyzed using SPSS Statistics for Windows, version 13.0 (SPSS Inc., Chicago, IL, USA). Results: The mean (SD) of irrational thoughts' scores in the control group before and after the study were 33.92 (5.98) and 33.20 (6.83) respectively, and in the intervention group were 34.55 (5.61) and 19.97 (3.52), respectively. The result of independent t-test showed a significant reduction in irrational thoughts of women in the intervention group after the family-centered empowerment model intervention. Conclusion: The family-centered empowerment model after three months of continuous implementation was able to effectively reduce the irrational thoughts about having children in infertile women.
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Affiliation(s)
- Maryam Modarres
- Department of Reproductive Health Midwifery, School of Nursing & Midwifery, Nursing and Midwifery Care Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Maryam Abunasri
- Department of Reproductive Health Midwifery, School of Nursing and Midwifery, University of Medical Sciences, Tehran, Iran
| | - Fatemeh Alhani
- School of Medical Science, Tarbiat Modares University, Tehran, Iran
| | - Elham Ebrahimi
- Department of Reproductive Health Midwifery, School of Nursing & Midwifery, Nursing and Midwifery Care Research Center, Tehran University of Medical Science, Tehran, Iran
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16
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Yao H, Chan CHY, Hou Y, Chan CLW. Ambivalence experienced by infertile couples undergoing IVF: a qualitative study. HUM FERTIL 2022:1-13. [PMID: 35850620 DOI: 10.1080/14647273.2022.2099314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The emotional consequences of infertility are well documented. However, relatively few studies have emphasized the dyadic emotional interaction within couples, despite infertility being a shared life event. This study adopted a dyadic (between two people) approach to explore the emotional complexity that infertile couples face. A descriptive qualitative study was conducted with 24 participants, including eight infertile couples and eight wives undergoing infertility treatments. Conjoint and individual interviews were conducted through purposive sampling in a large fertility centre in Tianjin, China, between June and August 2015. Thematic analysis identified two main themes: (i) 'decisional ambivalence', with subthemes of 'ambivalent attitudes towards treatment', 'uncertainty about treatment outcomes', and 'treatment-related lifestyle changes'; and (ii) 'relational ambivalence' which included subthemes of 'intergenerational ambivalence' and 'partner ambivalence'. Complex emotions of ambivalence among infertile couples were common as infertility clearly shattered their assumptive world on family formation. With complex entanglement of mixed emotions, ambivalence was intimately associated with cultural norms, social expectations, and active or over engagement of family members in Chinese societies. Since ambivalence could threaten mental and physical health during pregnancy, healthcare professionals should be prepared to assist infertile couples with identifying, articulating, and normalizing decisional and relational ambivalence during the treatment process.
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Affiliation(s)
- Hong Yao
- School of Ethnology and Sociology, Minzu University of China, Beijing, China
| | - Celia Hoi Yan Chan
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Yajie Hou
- China Population and Development Research Center, Beijing, China
| | - Cecilia Lai Wan Chan
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
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Barra F, La Rosa VL, Vitale SG, Commodari E, Altieri M, Scala C, Ferrero S. Psychological status of infertile patients who had in vitro fertilization treatment interrupted or postponed due to COVID-19 pandemic: a cross-sectional study. J Psychosom Obstet Gynaecol 2022; 43:145-152. [PMID: 33252292 DOI: 10.1080/0167482x.2020.1853095] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To explore the psychological status of infertile women and men who had in-vitro fertilization (IVF) treatment interrupted or postponed because of the COVID-19 emergency. MATERIALS AND METHODS An electronic survey (NCT04395755) was e-mailed between April and June 2020 to couples whose IVF treatments have been interrupted or postponed due to the COVID-19 pandemic. The presence and severity of symptoms suggestive of anxiety and/or depression were assessed using the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9). Subjects with preexisting psychiatric disorders were excluded. RESULTS Overall, 524 out of 646 patients completed the survey. The prevalence of anxiety and/or depression feelings was significantly higher in women, mainly if aged more than 35 years and with a previous IVF attempt. The occurrence of these psychological symptoms was significantly associated with the time spent on COVID-19 related news per day and partner with evidence of psychological disorder and, in females, with a diagnosis of poor ovarian reserve, diagnosis of endometriosis or uterine fibroids. CONCLUSIONS The psychological impact of the COVID-19 pandemic on the infertile couples who should have undergone IVF treatment has been significant. IVF centers should systematically offer these couples adequate psychological counseling to improve mental health.
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Affiliation(s)
- Fabio Barra
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy, Genoa
| | | | - Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Elena Commodari
- Department of Educational Sciences, University of Catania, Catania, Italy
| | - Michele Altieri
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy, Genoa
| | - Carolina Scala
- Division of Obstetrics and Gynecology, Gaslini Institute, Genoa, Italy.,Piazza della Vittoria 14 Srl, Piazza della Vittoria 14/26, Genoa, Italy
| | - Simone Ferrero
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy, Genoa.,Piazza della Vittoria 14 Srl, Piazza della Vittoria 14/26, Genoa, Italy
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Higher Risk of Anxiety and Depression in Women with Adenomyosis as Compared with Those with Uterine Leiomyoma. J Clin Med 2022; 11:jcm11092638. [PMID: 35566763 PMCID: PMC9099604 DOI: 10.3390/jcm11092638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/28/2022] [Accepted: 05/05/2022] [Indexed: 02/06/2023] Open
Abstract
The main symptoms of adenomyosis may adversely affect physical and mental health and quality of life (QOL). However, studies are few on this topic. This study evaluated the effect of adenomyosis on anxiety, depression, and QOL. Participants with adenomyosis (n = 90) or leiomyoma (n = 59) completed questionnaires, including the visual analog scale (VAS) for pain, Hospital Anxiety and Depression Scale (HADS), and Short Form (SF)-36. HADS anxiety and depression positive rates, physical (PCS) and mental (MCS) component summary scores, and eight subscale scores of SF-36 were compared between the two groups. Among patients with adenomyosis, the incidence of anxiety symptoms was 28.9% (control group, 10.2%; OR = 3.589, 95%CI: 1.375–9.367), with 10% of patients showing moderate-to-severe symptoms. The incidence of depressive symptoms was 14.4% (control group, 3.4%; OR = 4.812, 95%CI: 1.044–22.168). The case group had significantly lower PCS and MCS scores than the control group. In patients with adenomyosis, being employed (OR = 6.393, 95%CI: 1.153–35.440) and perianal pain (OR = 25.419, 95%CI: 2.504–258.024) were risk factors for anxiety, and perianal pain (OR = 15.208, 95%CI: 3.050–75.836) was a risk factor for depression. Compared with leiomyoma, adenomyosis is associated with a higher risk of anxiety and depression, with a poorer QOL.
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Pan Y, Wang S, Kang J, Cao T, Liu J, Zhang L, Niu S, Liu X. Association between generalized anxiety symptoms and semen quality in infertile men: A multicentre study in North China. Andrologia 2022; 54:e14449. [PMID: 35491407 DOI: 10.1111/and.14449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/06/2022] [Accepted: 04/11/2022] [Indexed: 11/28/2022] Open
Abstract
This study was conducted to investigate the generalized anxiety levels and its association with semen quality in infertile men. We recruited male patients who visited the infertility outpatient departments of three teaching hospitals in North China and evaluated their generalized anxiety symptoms using the self-administered 7-item generalized anxiety disorder (GAD-7) scale. Seminal analysis was performed as per WHO guidelines. A total of 378 infertile men (average age: 31.43 ± 5.85 years) were classified into the normal group (n = 174, 46%) and the anxiety group (n = 204, 54%) according to their GAD-7 scale score. The proportion of patients with hyperlipidaemia in the normal group was significantly higher than that in the anxiety group (14.9% vs. 5.9%, p = 0.004). The other demographic characteristics were not statistically different between both groups. Patients with abnormal GAD-7 scale scores had a significantly lower sperm count (202.48 vs. 166.80 million per ejaculate, p = 0.023), sperm concentration (54.75 vs. 46.54 million/ml, p = 0.033), and progressive motility (40.25 vs. 37.16, p = 0.020) than those with normal GAD-7 scale scores. Multivariate linear regression models revealed that anxiety was significantly negatively associated with sperm concentration (percent change = -9.79, 95%CI: -12.38 to -7.12, p < 0.001), total sperm count (percent change = -13.07, 95%CI: -16.05 to -9.84, p < 0.001), progressive motility (β = -1.41, 95%CI: -1.86 to -0.96, p < 0.001), total sperm motility (β = -1.73, 95%CI: -2.38 to -1.08, p < 0.001), and normal sperm morphology (β = -0.16, 95%CI: -0.28 to -0.04, p = 0.009), respectively. Taken together, generalized anxiety disorder could significantly influence the clinical semen quality in infertile men in North China, and psychological stress management might be helpful.
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Affiliation(s)
- Yang Pan
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Shangren Wang
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Jiaqi Kang
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Tingshuai Cao
- Department of Urology, Jinan Central Hospital, Cheelo College of Medicine, Shandong University, Jinan, China
| | - Jun Liu
- Department of Urology, Huxi Affiliated Hospital of Jining Medical College (Shanxian Central Hospital), Shanxian, China
| | - Lili Zhang
- Department of Laboratory Medicine, Huxi Affiliated Hospital of Jining Medical College (Shanxian Central Hospital), Shanxian, China
| | - Shuai Niu
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaoqiang Liu
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
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Nik Hazlina NH, Norhayati MN, Shaiful Bahari I, Nik Muhammad Arif NA. Worldwide prevalence, risk factors and psychological impact of infertility among women: a systematic review and meta-analysis. BMJ Open 2022; 12:e057132. [PMID: 35354629 PMCID: PMC8968640 DOI: 10.1136/bmjopen-2021-057132] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To assess the prevalence, risk factors and psychological impact of infertility among females. This review summarises the available evidence, effect estimates and strength of statistical associations between infertility and its risk factors. STUDY DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE, CINAHL and ScienceDirect were searched through 23 January 2022. ELIGIBILITY CRITERIA The inclusion criteria involved studies that reported the psychological impact of infertility among women. We included cross-sectional, case-control and cohort designs, published in the English language, conducted in the community, and performed at health institution levels on prevalence, risk factors and psychological impact of infertility in women. DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted and assess the quality of data using the Joanna Briggs Institute Meta-Analysis. The outcomes were assessed with random-effects model and reported as the OR with 95% CI using the Review Manager software. RESULTS Thirty-two studies with low risk of bias involving 124 556 women were included. The findings indicated the overall pooled prevalence to be 46.25% and 51.5% for infertility and primary infertility, respectively. Smoking was significantly related to infertility, with the OR of 1.85 (95% CI 1.08 to 3.14) times higher than females who do not smoke. There was a statistical significance between infertility and psychological distress among females, with the OR of 1.63 (95% CI 1.24 to 2.13). A statistical significance was noted between depression and infertility among females, with the OR of 1.40 (95% CI 1.11 to 1.75) compared with those fertile. CONCLUSIONS The study results highlight an essential and increasing mental disorder among females associated with infertility and may be overlooked. Acknowledging the problem and providing positive, supportive measures to females with infertility ensure more positive outcomes during the therapeutic process. This review is limited by the differences in definitions, diagnostic cut points, study designs and source populations. PROSPERO REGISTRATION NUMBER CRD42021226414.
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Affiliation(s)
- Nik Hussain Nik Hazlina
- Women's Health Development Unit, Universiti Sains Malaysia - Kampus Kesihatan, Kubang Kerian, Kelantan, Malaysia
| | - Mohd Noor Norhayati
- Department of Family Medicine, Universiti Sains Malaysia - Kampus Kesihatan, Kubang Kerian, Kelantan, Malaysia
| | - Ismail Shaiful Bahari
- Department of Family Medicine, Universiti Sains Malaysia - Kampus Kesihatan, Kubang Kerian, Kelantan, Malaysia
| | - Nik Ahmad Nik Muhammad Arif
- Women's Health Development Unit, Universiti Sains Malaysia - Kampus Kesihatan, Kubang Kerian, Kelantan, Malaysia
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21
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Emotional Support for Infertility Patients: Integrating Mental Health Professionals in the Fertility Care Team. WOMEN 2022. [DOI: 10.3390/women2010008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Patients seeking fertility treatment are at risk of experiencing psychological distress, with both women and men reporting higher levels of depression and anxiety during infertility treatment than patients in the general population. Multiple professional societies, fertility care providers, and patients have advocated for integrating mental health providers in the treatment of infertile patients in order to provide comprehensive patient-centered care. Research with other patient populations shows that embedding mental health professionals into clinics provides the greatest benefit to patients. Despite acknowledging the importance of mental health in infertility care, professional societies, such as ASRM and ESHRE, have not universally standardized recommendations or methods for imbedding mental health providers in the fertility team. This review article aims to serve as a resource for providers and patients to appraise the available literature on the importance of embedding mental health providers into the fertility treatment team and discusses feasible methods to develop this comprehensive care team.
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22
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Gürtin ZB, Jasmin E, Da Silva P, Dennehy C, Harper J, Kanjani S. Fertility treatment delays during COVID-19: Profiles, feelings and concerns of impacted patients. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2022; 14:251-264. [PMID: 35165660 PMCID: PMC8818556 DOI: 10.1016/j.rbms.2021.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/11/2021] [Accepted: 12/09/2021] [Indexed: 06/14/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic resulted in unprecedented measures across all health services around the globe, including the large-scale cessation of assisted reproductive technology treatment in Europe as clinics closed, causing disruption and delay to the fertility treatment of thousands of patients in the UK alone. This research explores how patients were impacted by the delay and disruption, and their feelings, concerns and reactions. A mixed-methods, anonymous, online questionnaire, live between 19 May and 30 June 2020, was used to target all fertility patients aged >18 years whose treatment had been impacted by COVID-19. In total, 709 people began the questionnaire and 501 completed it in the time available (70.7% completion rate). Patients reported feeling 'powerless/helpless' (78.3%), 'frustrated' (59.3%) and 'anxious' (54.7%) in response to the closure of fertility clinics. The majority were 'very concerned' about time passing and not knowing when they could start treatment again (79.0%), and the length of waiting lists when clinics reopened (70.9%). While 76.8% of respondents had some concerns around contracting COVID-19, 42.9% were 'not at all concerned' about undergoing in-vitro fertilization treatment during a pandemic. Variables such as funding source, duration of infertility, previous experience of fertility treatment, treatment stage and the presence of children were correlated with significant intragroup differences in the types of concerns reported. The large majority (72.7%) of respondents stated their eagerness to start treatment as soon as possible, and 9.4% said that they had already resumed treatment; only 6.0% of respondents wanted to wait due to concerns related to COVID-19.
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Affiliation(s)
- Zeynep B. Gürtin
- EGA Institute for Women’s Health, University College London, London, UK
| | - Ephia Jasmin
- University College London Hospitals NHS Trust, Reproductive Medicine Unit, London, UK
- Centre for Reproductive and Genetic Health, London, UK
| | - Philomena Da Silva
- University College London Hospitals NHS Trust, Reproductive Medicine Unit, London, UK
| | - Carmel Dennehy
- University College London Hospitals NHS Trust, Reproductive Medicine Unit, London, UK
- Centre for Reproductive and Genetic Health, London, UK
| | - Joyce Harper
- EGA Institute for Women’s Health, University College London, London, UK
| | - Shirin Kanjani
- University College London Hospitals NHS Trust, Reproductive Medicine Unit, London, UK
- Centre for Reproductive and Genetic Health, London, UK
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23
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Chamorro PP, Herruzo J, Pino MJ. Study on the Interdependent Relationship between the Marital Satisfaction Variable and the Psychosocial Impact of Infertility and Anxiety Disposition, According to Gender. JOURNAL OF SEX & MARITAL THERAPY 2021; 48:461-474. [PMID: 34873994 DOI: 10.1080/0092623x.2021.2008074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This study assessed the relationship between the marital satisfaction variable and the psychosocial impact of infertility and anxiety disposition, testing for possible gender-based differences. Comparisons performed on 87 couples did reveal differences and analyses disclosed that depression, anxiety and quality of life can influence the assessment each partner makes of their relationship, through an interdependent process. One partner's marital satisfaction can be influenced by those variables in the other partner. These findings indicate that psychosocial care for infertile couples must involve both partners and that they should be made aware of the effect of interdependence on marital satisfaction.
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Affiliation(s)
| | - Javier Herruzo
- Department of Psychology, University of Cordoba, Cordoba, Spain
| | - Maria J Pino
- Department of Psychology, University of Cordoba, Cordoba, Spain
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24
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Luca G, Parrettini S, Sansone A, Calafiore R, Jannini EA. The Inferto-Sex Syndrome (ISS): sexual dysfunction in fertility care setting and assisted reproduction. J Endocrinol Invest 2021; 44:2071-2102. [PMID: 33956331 PMCID: PMC8421318 DOI: 10.1007/s40618-021-01581-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 04/19/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE Infertility represents a peculiar social burden affecting more than 15% of couples, provoking it a real threat to the general quality of life and to the sexual health. The medicalization (diagnosis, therapy and follow up) of the lack of fertility is frequently a challenge in term of personal and couple's involvement. In particular, while the Assisted Reproductive Technology (ART) has allowed many infertile couples to achieve pregnancy, the therapeutic process faced by the couple bears a strong psychological stress that can affect the couple's quality of life, relationship and sexuality. Despite infertility affects both female and male sexual health, only recently the interest in the effects of ART on the couple's sexuality has grown, especially for women. METHODS A literature research on the sexual dysfunction in fertility care and particularly in ART setting was performed. RESULTS Literature largely found that intimacy and sexuality appear specifically impaired by intrusiveness of treatments and medical prescriptions. Moreover, there is a close relationship between emotional, psychological and sexual aspects, which can be integrated in the new concept of Inferto-Sex Syndrome (ISS) that can impair the ART treatment outcomes. Evidence demonstrates that the assessment of sexual function is necessary in couples undergoing diagnosis of infertility and ART. CONCLUSION A close relationship between infertility and sexuality, both in the female and male partners, was detected. ART treatments may heavily impact on the couple's psychosexual health. A couple-centred program for the integrated management of psychological and sexual dysfunction should be considered in the context of ART programs.
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Affiliation(s)
- G Luca
- Unit of Andrology and Endocrinology of Reproduction, Department of Experimental Medicine, University Medical School, 06129, Perugia, Italy
| | - S Parrettini
- Section of Endocrinology and Metabolism, Department of Medicine, Perugia, University Medical School, 06129, Perugia, Italy
| | - A Sansone
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier, 1, E Tower South. Floor 4, Room E413, 00133, Rome, Italy
| | - R Calafiore
- Section of Endocrinology and Metabolism, Department of Medicine, Perugia, University Medical School, 06129, Perugia, Italy
| | - E A Jannini
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier, 1, E Tower South. Floor 4, Room E413, 00133, Rome, Italy.
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25
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Cui C, Wang L, Wang X. Effects of Self-Esteem on the Associations Between Infertility-Related Stress and Psychological Distress Among Infertile Chinese Women: A Cross-Sectional Study. Psychol Res Behav Manag 2021; 14:1245-1255. [PMID: 34408509 PMCID: PMC8364430 DOI: 10.2147/prbm.s326994] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/04/2021] [Indexed: 11/23/2022] Open
Abstract
Background Anxiety and depression are the most common psychological causes of distress in infertile women. Our study aimed to evaluate the prevalence of depression and anxiety and investigate the effects of self-esteem on the association of infertility-related stress with depression and anxiety among infertile women. Methods This study was conducted between December 2017 and May 2018. Questionnaires containing Fertility Problem Inventory (FPI), Rosenberg self-esteem scale (RSES) and Hospital Anxiety and Depression Scale (HADS) were distributed among 536 female infertility patients in Shenyang, China. Hierarchical linear regression analyses were used to examine the mediating and moderating role of self-esteem. Baron and Kenny’s technique, asymptotic, and resampling strategies were used to confirm the mediating role of self-esteem on the associations between infertility-related stress with depression and anxiety. Results The prevalence of depression and anxiety was 27.9% and 42.2% among Chinese female infertility patients, respectively. Infertility-related stress was positively associated with depression and anxiety, whereas self-esteem was negatively associated with depression and anxiety. Additionally, the effects of infertility-related stress on depression and anxiety gradually decreased along with an increase in self-esteem. Meanwhile, self-esteem partially mediated the associations between infertility-related stress with depression and anxiety. Conclusion A high prevalence of psychological distress was found among infertile women. Self-esteem mediated and moderated the effects of infertility-related stress on depression and anxiety. Additionally, infertility-related stress and self-esteem were associated with psychological distress, which explained why infertile women had a higher prevalence of depression and anxiety. Therefore, interventions that focus on self-esteem may be effective and should be used as a resource to combat mental health problems.
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Affiliation(s)
- ChunYing Cui
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang North New Area, Shenyang, Liaoning, 110122, People's Republic of China
| | - Lie Wang
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang North New Area, Shenyang, Liaoning, 110122, People's Republic of China
| | - XiaoXi Wang
- Medical Basic Experimental Teaching Center, China Medical University, Shenyang North New Area, Shenyang, Liaoning, 110122, People's Republic of China
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26
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Gullo G, Cucinella G, Perino A, Gullo D, Segreto D, Laganà AS, Buzzaccarini G, Donarelli Z, Marino A, Allegra A, Maranto M, Carosso AR, Garofalo P, Tomaiuolo R. The Gender Gap in the Diagnostic-Therapeutic Journey of the Infertile Couple. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126184. [PMID: 34201025 PMCID: PMC8227607 DOI: 10.3390/ijerph18126184] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/28/2021] [Accepted: 06/04/2021] [Indexed: 11/19/2022]
Abstract
Medical procreation impairs both the biological and psychological lives of couples. However, male and female attitudes to infertility are different and require a different approach during the IVF journey. Thus, the gender impact assessment (GIA) method was used to analyse original studies present in the literature. We found some gender-related differences and, subsequently, possible outcomes of intervention to improve healthy reproduction management and prevent infertility. In particular, it became apparent that there was the need for an in-depth male infertility assessment and a gender-specific follow-up.
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Affiliation(s)
- Giuseppe Gullo
- Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, IVF UNIT, University of Palermo, 90146 Palermo, Italy; (G.G.); (G.C.); (A.P.); (M.M.)
| | - Gaspare Cucinella
- Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, IVF UNIT, University of Palermo, 90146 Palermo, Italy; (G.G.); (G.C.); (A.P.); (M.M.)
| | - Antonio Perino
- Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, IVF UNIT, University of Palermo, 90146 Palermo, Italy; (G.G.); (G.C.); (A.P.); (M.M.)
| | - Domenico Gullo
- Technical Panel on Gender Medicine-Sicily Regional Health Service, 90143 Palermo, Italy; (D.G.); (D.S.); (P.G.)
| | - Daniela Segreto
- Technical Panel on Gender Medicine-Sicily Regional Health Service, 90143 Palermo, Italy; (D.G.); (D.S.); (P.G.)
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy;
| | - Giovanni Buzzaccarini
- Department of Women’s and Children’s Health, Padova Hospital, University of Padova, 35128 Padova, Italy
- Correspondence:
| | - Zaira Donarelli
- Psychology Unit, Andros Day Surgery Clinic-Palermo, 90144 Palermo, Italy;
| | - Angelo Marino
- Reproductive Medicine Unit, Andros Day Surgery Clinic-Palermo, 90144 Palermo, Italy; (A.M.); (A.A.)
| | - Adolfo Allegra
- Reproductive Medicine Unit, Andros Day Surgery Clinic-Palermo, 90144 Palermo, Italy; (A.M.); (A.A.)
| | - Marianna Maranto
- Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, IVF UNIT, University of Palermo, 90146 Palermo, Italy; (G.G.); (G.C.); (A.P.); (M.M.)
| | - Andrea Roberto Carosso
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Turin, 10126 Turin, Italy;
| | - Piernicola Garofalo
- Technical Panel on Gender Medicine-Sicily Regional Health Service, 90143 Palermo, Italy; (D.G.); (D.S.); (P.G.)
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Fleury EADB, Approbato MS, Barbosa MA. Interactive Music Therapy on Stress Level Reduction in Women Submitted to IVF/ICSI. Prospective Randomized Study. JBRA Assist Reprod 2021; 25:209-214. [PMID: 33904665 PMCID: PMC8083862 DOI: 10.5935/1518-0557.20200068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 09/20/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To identify the effects of interactive music therapy on stress levels in women undergoing high complexity infertility treatments. METHODS Prospective randomized study involving 113 women treated in the Reproduction Human Laboratory of the Clinics Hospital of the Federal University of Goiás State, submitted to in vitro fertilization/intracytoplasmic sperm injection. We used Depression, Anxiety and Stress Scale, and Lipp's Stress Symptoms Inventory for Adults. In the Intervention Group, we used small and easy to play percussive musical instruments, a guitar, voice, and a recorder. We used interactive music therapy approach individually, applied before baseline ultrasound scan, oocyte pick-up, and embryo transfer. We analyzed the data using the R. Paired Student t-test to compare the results. RESULTS Comparison of the stress levels by Depression, Anxiety and Stress Scale between the groups in the final moment of data retrieval resulted in 23.13 (SD±10.51; n=32) in the Control Group and 16.12 (SD±7.87; n=33) in the Intervention Group, being statistically different (p=0.004). Also in Lipp's Stress Symptoms Inventory for Adults there was a significant stress reduction in 39% of the patients in the Intervention Group compared to a reduction of 14% in the patients of the Control Group (p=0.032). In this same measurement resulted that only 3% of the Intervention Group patients versus 23% of the Control Group patients (p=0.027) were in the exhaustion stage. CONCLUSION Interactive music therapy was effective for stress reduction in women during assisted reproduction techniques.
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Affiliation(s)
- Eliamar Aparecida de Barros Fleury
- Reproduction Human Laboratory. Obstetrics and Gynecology Dept.; Music and Scenic Arts School. Federal University of Goiás State, Goiânia, Brazil
| | - Mário Silva Approbato
- Reproduction Human Laboratory. Clinics Hospital. Obstetrics and Gynecology Dept. Faculty of Medicine. Federal University of Goiás State, Goiânia, Brazil
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28
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Kang X, Fang M, Li G, Huang Y, Li Y, Li P, Wang H. Family resilience is a protective buffer in the relationship between infertility-related stress and psychological distress among females preparing for their first in vitro fertilization-embryo transfer. PSYCHOL HEALTH MED 2021; 27:823-837. [PMID: 33874804 DOI: 10.1080/13548506.2021.1893767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The present study aimed to evaluate psychological distress and scrutinized whether family resilience plays a moderating role in the association between infertility-related stress and psychological distress among infertile females preparing for their first IVF-ET. A total of 492 infertile females completed self-reported measures including the Kessler 10 Psychological Distress Scale (K10), the fertility problem inventory (FPI), and the Family Resilience Assessment Scale (FRAS). The results showed 21 (65.2%) participants reported moderate or higher levels of psychological distress. While controlling for economic status, we found psychological distress to be positively linked to infertility-related stress (β=0.483, P<0.001), and negatively related to family resilience (β=-0.145, P=0.001). The simple slopes analysis showed that infertility-related stress had a weaker positive association with psychological distress for individuals at 1 SD (β = 0.443, P < 0.001) above the mean on family resilience compared to those at 1 SD (β = 0.537, P < 0.001) below the mean. Thus, it suggests that clinical practice should conduct family resilience-oriented interventions to facilitate family resilience among infertile females preparing for their first IVF-ET, with the goal to reduce psychological distress.
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Affiliation(s)
- Xiaofei Kang
- Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.,Department of Nursing, Center for Reproductive Medicine, Shandong University, Jinan, China
| | - Mei Fang
- Department of Nursing, Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Guopeng Li
- Department of Nursing, Center for Reproductive Medicine, Shandong University, Jinan, China
| | - Yuzhen Huang
- Department of Nursing, Center for Reproductive Medicine, Shandong University, Jinan, China
| | - Yuli Li
- Department of Health Psychology, School of Nursing, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Ping Li
- Department of Health Psychology, School of Nursing, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Hongmei Wang
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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Kato T, Sampei M, Saito K, Morisaki N, Urayama KY. Depressive symptoms, anxiety, and quality of life of Japanese women at initiation of ART treatment. Sci Rep 2021; 11:7538. [PMID: 33824373 PMCID: PMC8024276 DOI: 10.1038/s41598-021-87057-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 03/23/2021] [Indexed: 02/04/2023] Open
Abstract
Assisted reproductive technology (ART) treatment accounted for 6% of total births in 2017 and is increasing which places Japan among the top worldwide in number of treatments performed. Although ART treatment patients often experience heavy physical and psychological burden, few epidemiologic studies have been conducted in Japan. We examined mental health and health-related quality of life (QOL) among women at early stages of treatment. We recruited 513 women who have initiated ART treatment, either in-vitro fertilization or intracytoplasmic sperm injection, from four medical facilities in the Tokyo area and through web-based approaches. At baseline, we collected socio-demographic information and assessed depressive symptoms, anxiety, and QOL. Descriptive analyses were performed overall and stratified by factors such as age. Mild depressive symptoms or worse, assessed with Quick Inventory of Depressive Symptoms, were observed among 54% of participants. Mean score for State-Trait Anxiety Inventory was 52 with a standard deviation of 11 for the state, and 39% were categorized as high anxiety. QOL results, assessed with SF-12, showed the same negative tendency for social functioning and role (emotional), while general health and physical functioning were consistent with the national average. Young participants appeared to suffer mentally more than older participants (p < 0.01 for depressive symptoms). Our findings suggest that patients may be at high risk of depressive symptoms, high anxiety, and low QOL even from the early stages of ART treatment.
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Affiliation(s)
- Tsuguhiko Kato
- Department of Social Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan.
| | - Makiko Sampei
- Department of Social Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Kazuki Saito
- Department of Pediatrics, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Naho Morisaki
- Department of Social Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Kevin Y Urayama
- Department of Social Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan.,Graduate School of Public Health, St. Luke's International University, 3-6-2 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
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de Lacey S, Sanderman E, Smith CA. IVF, acupuncture and mental health: a qualitative study of perceptions and experiences of women participating in a randomized controlled trial of acupuncture during IVF treatment. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2021; 12:22-31. [PMID: 33204865 PMCID: PMC7653009 DOI: 10.1016/j.rbms.2020.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 07/06/2020] [Accepted: 08/24/2020] [Indexed: 06/11/2023]
Abstract
Infertility treatments such as in-vitro fertilization (IVF) are stressful and challenging to mental health and well-being. The use of alternative therapies adjunct to IVF treatment, such as acupuncture, is common and women hope to improve their chance of pregnancy and live birth. While many women engage in acupuncture adjunct to IVF in Australia, few qualitative studies of women's motivations and experiences have been conducted in this field. A qualitative study was nested within a randomized controlled trial of acupuncture during IVF treatment in order to explore women's perceptions of acupuncture, its effects in the context of IVF treatment, and how acupuncture is perceived in relation to the outcome of IVF. Fifty women randomized into both acupuncture and sham acupuncture groups were interviewed using a semi-structured format. In-depth interviews were transcribed, coded and categorized in a theoretical thematic analysis. Two primary themes emerged: 'psychological benefit' and 'perceived influence of acupuncture on fertility/medical outcome'. Regardless of randomization, women in both groups described similar psychological effects suggesting that a placebo effect was present. They were not convinced that acupuncture could enhance their treatment outcome through biomedical pathways. Rather, they perceived that acupuncture or sham acupuncture gave them a psychological advantage through increased relaxation, reduced psychological stress, and enhanced well-being and self-efficacy. In conclusion, there are significant features associated with a placebo effect in acupuncture that might be exploited to provide psychological benefit for women undertaking IVF.
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Affiliation(s)
- Sheryl de Lacey
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia
| | - Elizabeth Sanderman
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia
| | - Caroline A. Smith
- National Institute of Complementary Medicine, Western Sydney University, Sydney, NSW, Australia
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Courbiere B, Lacan A, Grynberg M, Grelat A, Rio V, Arbo E, Solignac C. Psychosocial and professional burden of Medically Assisted Reproduction (MAR): Results from a French survey. PLoS One 2020; 15:e0238945. [PMID: 32970695 PMCID: PMC7514013 DOI: 10.1371/journal.pone.0238945] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/26/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To evaluate the impact of infertility and Medically Assisted Reproduction (MAR) throughout all aspects of life among infertile women and men. MATERIALS AND METHODS An online survey included 1 045 French patients (355 men, 690 women) who were living or had lived the experience of infertility and MAR. The questionnaire included 56 questions on several domains: global feelings, treatment burden, rapport with medical staff, psychosocial impact, sexual life and professional consequences. RESULTS Respondents had experienced an average of 3.6 (95% CI: 3.3-3.9) MAR cycles: 5% (n = 46) were pregnant, 4% (n = 47) were waiting to start MAR, 50% (n = 522) succeeded in having a live birth following MAR, 19% (n = 199) were currently undergoing ART, and 21% (n = 221) dropped out of the MAR process without a live birth. Satisfaction rates regarding the received medical care were above 80%, but 42% of patients pointed out the lack of information about non-medical support. An important impact on sexual life was reported, with 21% of patients admitted having not had intercourse for several weeks or even several months. Concerning the impact on professional life, 63% of active workers currently in an MAR program (n = 185) considered that MAR had strong repercussions on the organization of their working life with 49% of them reporting a negative impact on the quality of their work, and 46% of them reporting the necessity to lie about missing work during their treatment. CONCLUSION Despite a high overall level of satisfaction regarding medical care, the burden of infertility and MAR on quality of life is strong, especially on sexuality and professional organization. Clinical staff should be encouraged to develop non-medical support for all patients at any stage of infertility treatment. Enterprises should be warned about the professional impact of infertility and MAR to help their employees reconcile personal and professional life.
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Affiliation(s)
- Blandine Courbiere
- Pôle Femmes-Parents-Enfants–Centre Clinico-Biologique d’AMP, AP-HM La Conception, Marseille, France
- CNRS, IRD, Aix Marseille Univ, Avignon Université, IMBE, Marseille, France
- * E-mail:
| | - Arnaud Lacan
- Kedge Business School, AMSE, CNRS, EHESS, UMR 7316, Marseille, France
| | - Michael Grynberg
- Department of Reproductive Medicine & Fertility Preservation, Hôpital Antoine Beclère, Clamart, France
| | - Anne Grelat
- Centre Mistral, Clinique Pasteur, Guilherand-Granges, France
| | - Virginie Rio
- Collectif bAMP, Association de patients de l’AMP et de personnes infertiles, Quincy sous Sénart, France
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Simionescu G, Ilie OD, Ciobica A, Doroftei B, Maftei R, Grab D, McKenna J, Dhunna N, Mavroudis I, Anton E. Mini-Review on the Possible Interconnections between the Gut-Brain Axis and the Infertility-Related Neuropsychiatric Comorbidities. Brain Sci 2020; 10:brainsci10060384. [PMID: 32560488 PMCID: PMC7349587 DOI: 10.3390/brainsci10060384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/09/2020] [Accepted: 06/15/2020] [Indexed: 12/26/2022] Open
Abstract
Both the gut-brain axis (GBA) and the hypothalamic–pituitary–adrenal (HPA) axis remain an intriguing yet obscure network with a strong influence over other systems of organs. Recent reports have sought to describe the multitude of harmful stressors that may impact the HPA axis along with the interconnections between these. This has improved our knowledge of how the underlying mechanisms working to establish homeostasis are affected. A disruption to the HPA axis can amplify the chances of gastrointestinal deficiencies, whilst also increasing the risk of a wide spectrum of neuropsychiatric disorders. Thus, the influence of microorganisms found throughout the digestive tract possess the ability to affect both physiology and behaviour by triggering responses, which may be unfavourable. This is sometimes the case in of infertility. Numerous supplements have been formulated with the intention of rebalancing the gut microflora. Accordingly, the gut flora may alter the pharmacokinetics of drugs used as part of fertility treatments, potentially exacerbating the predisposition for various neurological disorders, regardless of the age and gender.
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Affiliation(s)
- Gabriela Simionescu
- Department of Mother and Child Medicine, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No 16, 700115 Iasi, Romania; (G.S.); (D.G.); (E.A.)
- Clinical Hospital of Obstetrics and Gynecology “Cuza Voda”, Cuza Voda Street, No 34, 700038 Iasi, Romania;
- Origyn Fertility Center, Palace Street, No 3C, 700032 Iasi, Romania
| | - Ovidiu-Dumitru Ilie
- Department of Research, Faculty of Biology, “Alexandru Ioan Cuza” University, Carol I Avenue, No 11, 700505 Iasi, Romania; (O.-D.I.); (A.C.)
| | - Alin Ciobica
- Department of Research, Faculty of Biology, “Alexandru Ioan Cuza” University, Carol I Avenue, No 11, 700505 Iasi, Romania; (O.-D.I.); (A.C.)
| | - Bogdan Doroftei
- Department of Mother and Child Medicine, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No 16, 700115 Iasi, Romania; (G.S.); (D.G.); (E.A.)
- Clinical Hospital of Obstetrics and Gynecology “Cuza Voda”, Cuza Voda Street, No 34, 700038 Iasi, Romania;
- Origyn Fertility Center, Palace Street, No 3C, 700032 Iasi, Romania
- Correspondence:
| | - Radu Maftei
- Clinical Hospital of Obstetrics and Gynecology “Cuza Voda”, Cuza Voda Street, No 34, 700038 Iasi, Romania;
- Origyn Fertility Center, Palace Street, No 3C, 700032 Iasi, Romania
- Department of Morphostructural Sciences, Faculty of Medicine, University of Medicine and Pharmacy “Grigore. T. Popa” Iasi, University Street, No 16, 700115 Iasi, Romania
| | - Delia Grab
- Department of Mother and Child Medicine, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No 16, 700115 Iasi, Romania; (G.S.); (D.G.); (E.A.)
- Clinical Hospital of Obstetrics and Gynecology “Cuza Voda”, Cuza Voda Street, No 34, 700038 Iasi, Romania;
| | - Jack McKenna
- York Hospital, Wigginton Road Clifton, York YO31 8HE, UK;
| | - Nitasha Dhunna
- Mid Yorkshrie Hospitals NHS Trust, Pinderfields Hospital, Wakefield WF1 4DG, UK;
| | - Ioannis Mavroudis
- Leeds Teaching Hospitals NHS Trust, Great George St, Leeds LS1 3EX, UK;
- Laboratory of Neuropathology and Electron Microscopy, School of Medicine, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | - Emil Anton
- Department of Mother and Child Medicine, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No 16, 700115 Iasi, Romania; (G.S.); (D.G.); (E.A.)
- Clinical Hospital of Obstetrics and Gynecology “Cuza Voda”, Cuza Voda Street, No 34, 700038 Iasi, Romania;
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Gonen LD, Bokek-Cohen Y. The experience of being an in vitro fertilization (IVF) patient in a pro-natalist society - a form of emotional labor. SOCIAL WORK IN HEALTH CARE 2020; 59:273-299. [PMID: 32369421 DOI: 10.1080/00981389.2020.1749214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 02/24/2020] [Accepted: 03/23/2020] [Indexed: 06/11/2023]
Abstract
Israel is known as a highly pronatalist society. We conceptualize the pro-natalist state as the employer of in vitro fertilization (IVF) patients in the labor of procreation. We characterize the unique Israeli religio-cultural environment regarding infertility using the concepts of emotional labor, surface acting, deep acting, emotional dissonance, and burnout. One hundred and forty-two women and 62 men undergoing IVF in eight public IVF units were asked to describe their emotions on the Positive and Negative Affect Schedule (PANAS). We discuss the patients' emotional responses in light of the religio-cultural and the emotional labor context. Evidence was found for gender differences whereby women suffer more negative emotional outcomes than male partners of IVF patients. The pro-natalist state poses greater emotional stress for female IVF patients in comparison with that experienced by the male spouses of IVF patients. Consulting professionals should offer psycho-social care if necessary, focusing on strategies taken from emotional labor theory.
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Affiliation(s)
- Limor Dina Gonen
- Department of Economics and Business Administration, Ariel University , Ariel, Israel
| | - Ya'Arit Bokek-Cohen
- School of Nursing, Efrata Academic College , Tel Aviv, Israel
- School of Nursing, Tel Aviv Yaffo Academic College , Tel Aviv, Israel
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Hegyi BE, Kozinszky Z, Badó A, Dombi E, Németh G, Pásztor N. Anxiety and depression symptoms in infertile men during their first infertility evaluation visit. J Psychosom Obstet Gynaecol 2019; 40:311-317. [PMID: 30624134 DOI: 10.1080/0167482x.2018.1515906] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objective: To assess the psychological condition of men at the start of the infertility work-up. Methods: Men seeking an infertility evaluation for the first time were recruited. Depression and anxiety symptoms and subjective psychological burden were assessed with the Beck Depression Inventory (BDI), the Spielberger State-Trait Anxiety Inventory (STAI), and a visual analog scale (VAS). Results: Data from 113 patients were analyzed. The mean age of the patients was 33.3 (range: 23-54) years, whereas the mean duration of infertility was 16.3 (range: 0-96) months. Results from the BDI and STAI were 2.24 (SD: ±3.18) and 33.74 (SD: ±8.04). Mild depressive symptoms were found in 4.5% of patients, whereas anxiety reached an abnormal level in 4.9%. There were significant correlations between the results from the BDI score and the duration of infertility (p = .024), whereas the STAI and VAS scores showed no similar connection (p = .142 and p = .261, respectively). Among patients with infertility longer than 2 years, mild depressive symptoms occurred in 23.1%. Conclusion: Among men, the levels of depressive and anxiety symptoms were low at the start of the infertility work-up. Depressive symptom levels increased significantly with the duration of infertility, whereas anxiety levels and VAS scores did not demonstrate a similar correlation.
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Affiliation(s)
- Borbála Eszter Hegyi
- Department of Obstetrics and Gynecology, University of Szeged , Szeged , Hungary
| | - Zoltan Kozinszky
- Department of Obstetrics and Gynaecology, Blekinge Hospital, Landstinget Blekinge , Karlskrona , Sweden
| | - Attila Badó
- Department of Obstetrics and Gynecology, University of Szeged , Szeged , Hungary
| | - Edina Dombi
- Department of Obstetrics and Gynecology, University of Szeged , Szeged , Hungary
| | - Gábor Németh
- Department of Obstetrics and Gynecology, University of Szeged , Szeged , Hungary
| | - Norbert Pásztor
- Department of Obstetrics and Gynecology, University of Szeged , Szeged , Hungary
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Zurlo MC, Cattaneo Della Volta MF, Vallone F. The association between stressful life events and perceived quality of life among women attending infertility treatments: the moderating role of coping strategies and perceived couple's dyadic adjustment. BMC Public Health 2019; 19:1548. [PMID: 31752817 PMCID: PMC6873711 DOI: 10.1186/s12889-019-7925-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 10/16/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Research highlighted that Stressful Life Events have high incidence among infertile patients and significant impact on physical and medical parameters related to reproductive functions, but their potential role among factors influencing the infertile patients' perception of fertility-related Quality of Life (QoL) has not been explored. The present study aims to investigate the associations of Stressful Life Events (Stressful events in the family of origin, In family pre-existing pregnancy difficulties, Health problems in childhood) with perceived fertility-related QoL in women attending infertility treatments, examining the potential moderating role of adopted coping strategies and perceived couple's dyadic adjustment. METHODS A questionnaire consisting of Socio-demographics and Infertility-related characteristics, Stress-inducing events in the couples' lives Questionnaire (FLS), Coping Orientations to Problem Experienced (COPE), Dyadic Adjustment Scale (DAS), and Core and Treatment subscales of Fertility Quality of Life (FertiQoL) was administered to 266 women attending infertility treatments. A descriptive correlational design with cross-sectional comparison was used. Results Logistic Regression Analyses after adjusting for socio-demographic and infertility-related characteristics revealed that women who reported Stressful events in the family of origin and In family pre-existing pregnancy difficulties were more likely to report lower levels of perceived Core QoL, while women who reported Health problems in childhood were more likely to report lower levels of perceived Treatment QoL. Couple's dyadic adjustment and specific coping strategies were significantly associated with perceived Core and Treatment QoL and they also significantly moderated the associations between stressful life events and perceived QoL. CONCLUSIONS Data provided original evidence on the strong association between stressful life events and perceived fertility-related QoL also highlighting individual and couples' resources to define counselling interventions with women attending infertility treatments.
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Affiliation(s)
- Maria Clelia Zurlo
- Department of Political Sciences, University of Naples Federico II, Via L. Rodinò 22, 80138, Naples, Italy.
| | | | - Federica Vallone
- Department of Humanities, University of Naples Federico II, Via Porta di Massa 1, 80133, Naples, Italy
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Payne N, Seenan S, van den Akker O. Experiences of involuntary childlessness and treatment in the UK: what has changed in 20 years? HUM FERTIL 2019; 24:333-340. [DOI: 10.1080/14647273.2019.1687946] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Nicola Payne
- Department of Psychology, Middlesex University, London, UK
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Implementing a holistic approach to a radiographer-led Hysterosalpingogram (HSG) service: A review of impact and patient perception. Radiography (Lond) 2019; 25:365-373. [PMID: 31582246 DOI: 10.1016/j.radi.2019.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 05/05/2019] [Accepted: 05/12/2019] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Radiographer role development has touched boundaries across the multidisciplinary team and more recently branched into the field of gynaecology. Radiographers are now able to perform tasks that were traditionally performed by radiologists and gynaecologists to implement a radiographer-led Hysterosalpingogram (HSG) service. The aims of the study were to (i) implement a radiographer-led HSG service with a view to decreasing waiting times. (ii) To determine ladies perceptions and satisfaction levels. METHOD Local clinical guidelines were developed with the radiologist/gynaecologist and trainee HSG radiographers. A robust system of work was initiated which required maintaining comprehensive log books to record examinations performed and reports written. These were audited and compared with those of the radiologist. Audit cycles were monitored through Q Pulse to ensure good practise was maintained. Patient satisfaction surveys were developed and distributed to 100 consecutive ladies attending for HSG over a 6 month period from January-July 2017. RESULTS The radiographer-led service has increased the number of appointment slots offered for HSG's throughout the year as the service now runs every week. HSG's were performed by 5 staff members but now only require 3 staff. A 75% response rate was achieved from the questionnaire survey and shows high patient satisfaction levels. Ladies reported being better informed about their examination resulting in decreased anxiety, concerns and discomfort. CONCLUSION The implementation of this service has successfully reduced waiting lists for HSG examinations from 14 to 0 weeks. The Trust has saved £15,000 on staff salaries per annum since the service started.
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Bai CF, Sun JW, Li J, Jing WH, Zhang XK, Zhang X, Ma LL, Yue R, Cao FL. Gender differences in factors associated with depression in infertility patients. J Adv Nurs 2019; 75:3515-3524. [PMID: 31410867 DOI: 10.1111/jan.14171] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 06/09/2019] [Accepted: 08/06/2019] [Indexed: 12/25/2022]
Abstract
AIMS To clarify gender differences in the demographic variables and infertility problems associated with depression among men and women undergoing infertility treatment. DESIGN A cross-sectional study. METHODS We surveyed 380 women and 360 men undergoing infertility treatment at the reproductive medicine center of a hospital in China's Ningxia Province from March - September 2016. RESULTS For women, ethnicity, the number of clinic visits, social concern, and sexual concern were factors linked with depression symptoms. For men, treatment cost pressure and social concern were significantly associated with depression symptoms. CONCLUSION Psychological counseling and intervention programs should be integrated into in-vitro fertilization treatments and interventions should be targeted based on gender differences. IMPACT The provision of treatment-related sexual knowledge by nurses is indispensable for infertile participants. Mental health policies should be developed to facilitate the implementation of psychological services. Psychological counseling and intervention programs should be integrated into in vitro fertilization treatment to help men and women with infertility cope with psychological distress.
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Affiliation(s)
- Cai-Feng Bai
- School of Nursing, Shandong University, Jinan, P.R. China.,School of Nursing, Ningxia Medical University, Yinchuan, China
| | - Ji-Wei Sun
- School of Nursing, Shandong University, Jinan, P.R. China
| | - Jie Li
- School of Nursing, Shandong University, Jinan, P.R. China
| | - Wan-Hong Jing
- Reproductive Medicine Center, General Hospital of Ningxia Medical University, Yinchuan, P.R. China
| | - Xue-Kun Zhang
- School of Nursing, Soochow University, Suzhou, P.R. China
| | - Xuan Zhang
- School of Nursing, Shandong University, Jinan, P.R. China
| | - Li-Li Ma
- Reproductive Medicine Center, General Hospital of Ningxia Medical University, Yinchuan, P.R. China
| | - Rong Yue
- Reproductive Medicine Center, General Hospital of Ningxia Medical University, Yinchuan, P.R. China
| | - Feng-Lin Cao
- School of Nursing, Shandong University, Jinan, P.R. China
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Pozza A, Dèttore D, Coccia ME. Depression and Anxiety in Pathways of Medically Assisted Reproduction: The Role of Infertility Stress Dimensions. Clin Pract Epidemiol Ment Health 2019; 15:101-109. [PMID: 31819758 PMCID: PMC6882134 DOI: 10.2174/1745017901915010101] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 08/04/2019] [Accepted: 08/05/2019] [Indexed: 11/25/2022]
Abstract
Background: Depressive and anxious symptoms are common psychological reactions to infertility and Medically Assisted Reproduction (MAR). No study compared depressive and anxious symptoms and infertility stress dimensions across homologous and heterologous MAR, nor explored the specific role of the infertility stress dimensions in the two pathways. Homologous MAR may be associated with higher distress as the couple feel that the responsibility to reproduce and carry on the family line falls on them, and they feel inadequate if they are unable to bear children. Objective: We compared depressive/anxious symptoms and infertility stress dimensions between individuals undergoing homologous and heterologous MAR. We also explored the association between the infertility stress dimensions and depressive/anxious symptoms separately in two MAR pathways. Methods: Two-hundred twenty-six individuals participated [mean age = 39.71 years; 54.45% women]: 118 (52.2%) in homologous and 108 (47.8%) in heterologous MAR. The Fertility Problem Inventory, Beck Depression Inventory-II, and State and Trait Anxiety Inventory-Y form were administered. Results: Individuals in homologous MAR had higher depressive/state-trait anxious symptoms, general infertility stress, and infertility-related sexual concerns than those in heterologous MAR. In homologous MAR, social and sexual concerns were associated with depressive/trait anxious symptoms while gender had no effect. In heterologous MAR, male gender was associated with lower state anxious symptoms while infertility stress dimensions had no effect. Conclusion: Individuals in homologous MAR are a more distressed subgroup which requires a tailored supportive psychological intervention specifically on sexual and social concerns.
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Affiliation(s)
- Andrea Pozza
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Davide Dèttore
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Maria Elisabetta Coccia
- Department of Clinical and Experimental Biomedical Sciences, University of Florence, Florence, Italy
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Song Y, Ye W, Ye H, Xie T, Shen W, Zhou L. Serum testosterone acts as a prognostic indicator in polycystic ovary syndrome-associated kidney injury. Physiol Rep 2019; 7:e14219. [PMID: 31448581 PMCID: PMC6709419 DOI: 10.14814/phy2.14219] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/29/2019] [Accepted: 07/30/2019] [Indexed: 01/06/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is closely related with the onset and development of metabolic abnormalities. However, the correlation between PCOS and kidney injury has not been clarified, and the underlying mechanism remains unknown. Herein, we performed a prospective survey in 55 PCOS and 69 healthy participants. Furthermore, the correlation analyses between serum testosterone and renal functional manifestations of patients and healthy subjects, including urinary albumin to creatinine ratio (UACR), urinary κ-light chains (KapU), urinary λ-light chains (LamU), urinary α1-microglobulin (α1-MU), and urinary β2-microglobulin (β2-MU), were analyzed. Compared with that in normal subjects, the levels of serum testosterone and UACR were significantly higher in PCOS patients. Serum testosterone is significantly correlated with the disease severity of PCOS. Although urinary excretions of KapU, LamU, α1-MU, and β2-MU did not increase in PCOS patients, they had a significantly positive correlation with the extent of serum testosterone in PCOS patients. IN vitro, primary cultured human ovary granulosa cells (GCs) were isolated from the follicular fluid (FF) extracting from PCOS patients and controls. FF, especially which extracted from PCOS patients with a high expression of serum testosterone, significantly induced cell apoptosis and inflammation in human GCs. To examine the communication between PCOS and kidney injury, a human proximal tubular epithelial cell line (HKC-8) was cultured and administered FF. Interestingly, FF from PCOS patients with a higher level of serum testosterone induced fibrotic lesions in HKC-8 cells. These data suggest serum testosterone plays a critical role in PCOS and PCOS-associated kidney injury. Serum testosterone may serve as a promising indicator for kidney fibrotic injury outcomes in PCOS patients.
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Affiliation(s)
- Yali Song
- Center for Reproductive Medicine, Department of Obstetrics and GynecologyNanfang Hospital, Southern Medical UniversityGuangzhouChina
| | - Wenting Ye
- Center for Reproductive Medicine, Department of Obstetrics and GynecologyNanfang Hospital, Southern Medical UniversityGuangzhouChina
| | - Huiyun Ye
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of NephrologyNanfang HospitalSouthern Medical UniversityGuangzhouChina
| | - Tingting Xie
- Center for Reproductive Medicine, Department of Obstetrics and GynecologyNanfang Hospital, Southern Medical UniversityGuangzhouChina
| | - Weiwei Shen
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of NephrologyNanfang HospitalSouthern Medical UniversityGuangzhouChina
| | - Lili Zhou
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of NephrologyNanfang HospitalSouthern Medical UniversityGuangzhouChina
- Guangzhou Regenerative Medicine and Health Guangdong LaboratoryGuangzhouChina
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Pedro J, Vassard D, Malling GMH, Hougaard CØ, Schmidt L, Martins MV. Infertility-related stress and the risk of antidepressants prescription in women: a 10-year register study. Hum Reprod 2019; 34:1505-1513. [DOI: 10.1093/humrep/dez110] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 05/29/2019] [Indexed: 01/02/2023] Open
Abstract
Abstract
STUDY QUESTION
Is the first-time redeemed prescription of antidepressants predicted by the level of infertility-related stress in women seeking ART treatment?
SUMMARY ANSWER
Infertility-related stress in the personal and marital domains and general physical stress reactions were significant predictors of a first redeemed prescription of antidepressants after ART treatment in this 10-year follow-up cohort study.
WHAT IS KNOWN ALREADY
The literature has found inconsistent findings regarding the association between infertility-related stress and later psychological adjustment in fertility patients. The association between infertility-related stress and later prescription of antidepressants had never been explored in long-term cohort studies.
STUDY DESIGN, SIZE, DURATION
All women (n = 1169) who participated in the Copenhagen Cohort Multi-centre Psychosocial Infertility (COMPI) cohort study in the year 2000 (questionnaire data) were linked with the register-based Danish National ART-Couple (DANAC) I cohort, which includes women and their partners having received ART treatment from 1 January 1994 to 30 September 2009. The study population were among other national health and sociodemographic registers further linked with the Danish National Prescription Registry.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Women initiating ART treatment were followed until they had redeemed the first prescription of antidepressants or until 31 December 2009. Logistic regression analyses were conducted to test the association between general physical stress reactions and infertility-related stress in the personal, marital and social domains, respectively, and a future redeemed prescription of antidepressants. Age, education level, marital status, number of fertility treatments prior to study inclusion and female infertility diagnosis were included as covariates in the adjusted analyses. Further, the analysis was stratified according to childbirth or no childbirth during follow-up.
MAIN RESULTS AND THE ROLE OF CHANCE
The final sample consisted of 1009 women with a mean age of 31.8 years. At study inclusion, women had tried to conceive for an average of 3.45 years. At 10-year follow-up, a total of 13.7% of women had a first redeemed prescription of antidepressant medication. The adjusted odds ratio (OR) showed that high general physical stress predicted the later prescription of antidepressants (adjusted (adj) OR = 2.85, 95% confidence interval (CI) 1.96–4.16). Regarding infertility-related stress domains, high personal stress (adj OR = 2.14, 95% CI 1.46–3.13) and high marital stress (adj OR = 1.80, 95% CI 1.23–2.64) were significantly associated with the later prescription of antidepressants. Social stress was not significantly associated with the future redeemed prescription of antidepressants (adj OR = 1.10, 95% CI 0.76–1.61). Among women not having achieved childbirth during follow-up, the risk of a first-time prescription of antidepressants associated with infertility-specific stress was higher compared to the risk among women having childbirth during follow-up.
LIMITATIONS, REASONS FOR CAUTION
This study did not account for potential mediating factors, such as negative life events, which could be associated with the prescription of antidepressants. Second, we are not able to know if these women had sought psychological support during follow-up. Additionally, antidepressants might be prescribed for other health conditions than depressive disorders.
WIDER IMPLICATIONS OF THE FINDINGS
Our results suggest that women presenting high infertility-related stress in the personal and marital domains were at higher risk of redeemed first-time prescription of antidepressants after ART, independently of having delivered a child or not after initiation of ART treatment. Women would benefit from an initial screening specifically for high infertility-related stress. The COMPI Fertility Problem Stress Scales can be used by clinical staff in order to identify women in need of psychological support before starting ART treatments.
STUDY FUNDING/COMPETING INTEREST(S)
This study was supported by the Portuguese Foundation for Science and Technology (FCT) under an individual doctoral grant attributed to the first author (SFRH/BD/103234/2014). The establishment of the DANAC I cohort was funded by Rosa Ebba Hansen’s Fund. The COMPI Infertility Cohort project was supported by The Danish Health Insurance Fund (J.nr. 11/097–97), the Else and Mogens Wedell-Wedellsborgs Fund, the manager E. Danielsens and Wife’s Fund, the merchant L.F. Foghts Fund, the Jacob Madsen and Wife Olga Madsens Fund. The authors have no conflicts of interest.
TRIAL REGISTRATION NUMBER
NA
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Affiliation(s)
- Juliana Pedro
- Faculty of Psychology and Education Sciences, University of Porto, 4200-135 Porto, Portugal
- Centre for Psychology at University of Porto, 4200-135 Porto, Portugal
| | - Ditte Vassard
- Department of Public Health, University of Copenhagen, 1014 Copenhagen K, Denmark
| | | | | | - Lone Schmidt
- Department of Public Health, University of Copenhagen, 1014 Copenhagen K, Denmark
| | - Mariana Veloso Martins
- Faculty of Psychology and Education Sciences, University of Porto, 4200-135 Porto, Portugal
- Centre for Psychology at University of Porto, 4200-135 Porto, Portugal
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Stenyaeva NN, Chritinin DF, Chausov AA, Grigoriev VY, Sukhikh GT. [Psychopathological characterisitic of infertile women with sexual dysfunctions in assister reproductive technologies programs]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:51-58. [PMID: 31317890 DOI: 10.17116/jnevro201911905151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To study the psychopathological characteristics of infertile women with sexual disorders in assisted reproductive technologies (ART) programs to develop therapeutic and rehabilitative interventions and improve the quality of life of the couple. MATERIAL AND METHODS An open continuous comparative descriptive study of sexual health, psychopathological features and personality characteristics of 589 women with infertility seeking treatment using ART was performed in 2013-2017. Clinical-psychopathological, sexological and psychometric methods were used. RESULTS Non-psychotic mental disorders, predominantly anxiety disorders (28.0%), were identified in 58,9% of patients. Sexual dysfunctions of a disease level, among which prevailed disorder of libido (25.0%), were identified in 18.34% of patients. A high comorbidity of sexual dysfunctions and borderline mental disorders was detected (100% in patients with sexual dysfunctions versus 44.9% in patients without sexual disorders). an analysis of premorbid personality characteristics and severity of psychopathological symptoms based on the results of mpt, scl - 90 showed that patients with sexual disorders scored significantly lower on domains 'extroversion' and 'tolerance to frustration', while scores on 'esoteric tendencies', 'neuroticism', 'obsession', 'sensitivity', 'depression', 'anxiety', 'hostility' and 'psychoticism' were higher; significant positive and negative correlations between domains were noted. Increased or high levels of anhedonia assessed with scale SHAPS were found in 100% of patients, 43.8% had alexithymia according to TAS and 18.19% showed increased and high levels of asthenia (MFI-20). CONCLUSION Characteristics of the psychopathological structure of sexual dysfunctions in women with infertility in ART programs should be taken into account in the development of treatment and rehabilitation options and improvement of quality of life of the couple.
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Affiliation(s)
- N N Stenyaeva
- Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology Moscow, Russia
| | - D F Chritinin
- 'Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation', Moscow, Russia
| | - A A Chausov
- Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology Moscow, Russia
| | - V Yu Grigoriev
- Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology Moscow, Russia
| | - G T Sukhikh
- Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology Moscow, Russia; 'Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation', Moscow, Russia
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Galhardo A, Alves J, Moura-Ramos M, Cunha M. Infertility-related stress and depressive symptoms - the role of experiential avoidance: a cross-sectional study. J Reprod Infant Psychol 2019; 38:139-150. [PMID: 31046433 DOI: 10.1080/02646838.2019.1612046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: The current study aimed to explore the mediating role of experiential avoidance in the relationship between infertility-related stress (impact of infertility in women's life and representations about the importance of parenthood) and depressive symptoms.Background: Infertility is a stress inducing condition presenting many challenges to individuals facing this diagnosis, particularly to the ones who decide to pursue medical treatment. One of its consequences may be the experience of depressive symptoms which have also been associated with increased infertility-related stress. Moreover, experiential avoidance, conceptualised as an emotion regulation process, has also been connected to psychopathological symptoms, particularly depressive symptoms.Methods: The sample consisted of 124 women presenting an infertility diagnosis who were pursuing medical treatment for fertility problems. Participants were recruited through the national patients' association website and completed the following self-report instruments: a sociodemographic and clinical questionnaire, the Acceptance and Action Questionnaire-II (AAQ-II), the Fertility Problem Inventory (FPI) and the Depression, Anxiety and Stress Scales 21 (DASS-21).Results: Results showed that representations about the importance of parenthood were associated with depressive symptoms indirectly, throughout the association with the impact of infertility in women's life and use of experiential avoidance.Conclusions: Experiential avoidance can be considered a relevant emotion regulation process to be targeted in psychological intervention programs for women facing infertility.
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Affiliation(s)
- Ana Galhardo
- Instituto Superior Miguel Torga, Coimbra, Portugal.,Faculty of Psychology and Educational Sciences, University of Coimbra-CINEICC, Coimbra, Portugal
| | - Joana Alves
- Instituto Superior Miguel Torga, Coimbra, Portugal
| | - Mariana Moura-Ramos
- Faculty of Psychology and Educational Sciences, University of Coimbra-CINEICC, Coimbra, Portugal.,Coimbra Hospital and Universitary Centre-Reproductive Medicine Unit
| | - Marina Cunha
- Instituto Superior Miguel Torga, Coimbra, Portugal.,Faculty of Psychology and Educational Sciences, University of Coimbra-CINEICC, Coimbra, Portugal
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Kirca N, Pasinlioglu T. The effect of yoga on stress level in infertile women. Perspect Psychiatr Care 2019; 55:319-327. [PMID: 30657179 DOI: 10.1111/ppc.12352] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 12/11/2018] [Accepted: 01/06/2019] [Indexed: 12/25/2022] Open
Abstract
PURPOSE The aim of the present study was to examine the effects of planned yoga practices on stress levels in infertile women. DESIGN AND METHODS This randomized controlled study included 128 volunteer women who were registered at a private in vitro fertilization (IVF) clinic and received infertility treatment. The patients in the experimental group took part in the yoga program twice a week for 6 weeks. A personal information form and The Copenhagen Multi-center Psychosocial Infertility (COMPI) Fertility Problem Stress Scale were used to collect data. FINDINGS The differences between the mean scores of the control and experimental groups on the COMPI Fertility Problem Stress Scale at pre- and posttests were statistically significant (P < 0.05). PRACTICE IMPLICATIONS Because yoga practices may be effective in reducing stress in infertile women, these applications can be performed before treatment. It may reduce patients' stress and increase the success of the treatment. These findings indicate that yoga could reduce stress levels in infertile women.
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Affiliation(s)
- Nurcan Kirca
- Department of Obstetrics & Gynecological Nursing, Faculty of Nursing, Akdeniz University, Antalya, Turkey
| | - Turkan Pasinlioglu
- Department of Obstetrics & Gynecological Nursing, Faculty of Health Sciences, Sanko University, Gaziantep, Turkey
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46
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Donarelli Z, Salerno L, Lo Coco G, Allegra A, Marino A, Kivlighan DM. From telescope to binoculars. Dyadic outcome resulting from psychological counselling for infertile couples undergoing ART. J Reprod Infant Psychol 2018; 37:13-25. [DOI: 10.1080/02646838.2018.1548757] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Laura Salerno
- Psychology Unit, ANDROS Day Surgery Clinic, Palermo, Italy
| | - Gianluca Lo Coco
- Department of Psychology and Educational Sciences, University of Palermo, Palermo, Italy
| | - Adolfo Allegra
- Reproductive Medicine Unit, ANDROS Day Surgery Clinic, Palermo, Italy
| | - Angelo Marino
- Reproductive Medicine Unit, ANDROS Day Surgery Clinic, Palermo, Italy
| | - Dennis M. Kivlighan
- Department of Counseling, Higher Education, and Special Education, University of Maryland, College Park, USA
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Sakiyama T. Development and evaluation of the Adaptation Support Program in Early Pregnancy after the use of assisted reproductive technology. Jpn J Nurs Sci 2018; 16:286-299. [PMID: 30428501 DOI: 10.1111/jjns.12238] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 07/19/2018] [Accepted: 08/16/2018] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the feasibility, acceptability, and outcome of the Adaptation Support Program in Early Pregnancy after the use of assisted reproductive technology (ART). METHODS The participants were 57 primiparas who had undergone ART and had received the Adaptation Support Program. The data were gathered by using questionnaires before (Time 1), immediately after (Time 2), and 8 weeks after (Time 3) the intervention between August, 2014 and March, 2015. The data for the 40 women who gave valid answers were analyzed statistically. RESULTS Of the respondents, 75% gave a positive evaluation that the program met their expectations and >80% positively evaluated it for its convenience, problem-solving intentionality, satisfaction, and usefulness. The Anticipatory Anxiety for Loss Scale (AALS) and State-Trait Anxiety Inventory (STAI-J) scores decreased significantly at Times 2 and 3 and the Edinburgh Postnatal Depression Scale (EPDS) scores at Time 3. The Post-traumatic Growth Inventory-Japanese (PTGI-J) scores, showing growth as a result of infertility experience, increased significantly at Time 3. The Care Need Satisfaction Scale (CNSS) scores showed a positive correlation with the PTGI-J scores and negative correlations with the AALS and STAI-J, but did not correlate with the EPDS. CONCLUSION This program was evaluated positively. The AALS, PTGI-J, EPDS, and STAI showed significant change after the program and the AALS, PTGI-J, and STAI-J showed significant correlations with the CNSS.
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Affiliation(s)
- Takayo Sakiyama
- Department of Nursing, Ehime University Graduate of Medicine, Toon, Japan
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48
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Maroufizadeh S, Hosseini M, Rahimi Foroushani A, Omani-Samani R, Amini P. Application of the dyadic data analysis in behavioral medicine research: marital satisfaction and anxiety in infertile couples. BMC Med Res Methodol 2018; 18:117. [PMID: 30367603 PMCID: PMC6203997 DOI: 10.1186/s12874-018-0582-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 10/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dyadic data analysis (DDA) is increasingly being used to better understand, analyze and model intra- and inter-personal mechanisms of health in various types of dyads such as husband-wife, caregiver-patient, doctor-patient, and parent-child. A key strength of the DDA is its flexibility to take the nonindependence available in the dyads into account. In this article, we illustrate the value of using DDA to examine how anxiety is associated with marital satisfaction in infertile couples. METHODS This cross-sectional study included 141 infertile couples from a referral infertility clinic in Tehran, Iran between February and May 2017. Anxiety and marital satisfaction were measured by the anxiety subscale of the Hospital Anxiety and Depression Scale and 10-Item ENRICH Marital Satisfaction Scale, respectively. We apply and compare tree different dyadic models to explore the effect of anxiety on marital satisfaction, including the Actor-Partner Interdependence Model (APIM), Mutual Influence Model (MIM), and Common Fate Model (CFM). RESULTS This study demonstrated a practical application of the dyadic models. These dyadic models provide results that appear to give different interpretations of the data. The APIM analysis revealed that both men's and women's anxiety excreted an actor effect on their own marital satisfaction. In addition, women's anxiety exerted a significant partner effect on their husbands' marital satisfaction. In MIM analysis, in addition to significant actor effects of anxiety on marital satisfaction, women's reports of marital satisfaction significantly predicted men's marital satisfaction. The CFM analysis revealed that higher couple anxiety scores predicted lower couple marital satisfaction scores. CONCLUSION In sum, the study highlights the usefulness of DDA to explore and test the phenomena with inherently dyadic nature. With regard to our empirical data, the findings confirmed that marital satisfaction was influenced by anxiety in infertile couples at both individual and dyadic level; thus, interventions to improve marital satisfaction should include both men and women. In addition, future studies should consider using DDA when dyadic data are available.
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Affiliation(s)
- Saman Maroufizadeh
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.,Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Hosseini
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Abbas Rahimi Foroushani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Omani-Samani
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.
| | - Payam Amini
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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Martínez-Pampliega A, Cormenzana S, Martín S, Navarro L. Marital functioning and treatment outcome in couples undergoing assisted reproduction. J Adv Nurs 2018; 75:338-347. [PMID: 30187521 DOI: 10.1111/jan.13844] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 07/03/2018] [Accepted: 08/06/2018] [Indexed: 11/28/2022]
Abstract
AIM To investigate the relationship between the quality of marital functioning and communication, individual psychological symptomatology, and pregnancy achievement in couples undergoing assisted reproduction. BACKGROUND The results concerning marital functioning and the feasibility of pregnancy yield contradictory outcomes and the quality of the relationship of the couple undergoing assisted reproduction has not been analysed from systemic models. Our hypothesis is that when undergoing assisted reproduction treatment (ART), the couple's functioning and communication will be related to the pregnancy rate. DESIGN This study employs a cross-sectional design with couples receiving ART. METHODS Spanish heterosexual couples (N = 185) completed the self-report instruments. The data were collected from 2010 - 2015. All the couples completed at least one treatment process, or at least 1 year had gone by since beginning the treatment. RESULTS The association between couple relationship quality and the individual psychological symptomatology experienced during the assisted reproduction process was confirmed in men and women. Although both members of the couple experienced an increase of symptomatology, only men's symptomatology was statistically significantly linked to pregnancy achievement. CONCLUSION It is necessary to support the couple from the assisted reproduction centres, promoting cohesion, flexibility, and communication in the relationship. The intervention process should also be understood from a systemic perspective; that is, considering dyadic transactions as a systemic unit. Two aspects seem to be especially relevant for clinical nurses in ART: (a) the man's role is crucial for treatment success; (b) the woman's communication is crucial to the process.
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Affiliation(s)
- Ana Martínez-Pampliega
- Department of Social and Developmental Psychology, School of Psychology and Education, University of Deusto, Bilbao, Spain
| | - Susana Cormenzana
- Department of Social and Developmental Psychology, School of Psychology and Education, University of Deusto, Bilbao, Spain
| | - Sagrario Martín
- Quirón-Salud Bilbao, Assisted Reproduction Center, Bilbao, Spain
| | - Lucía Navarro
- Department of Social and Developmental Psychology, School of Psychology and Education, University of Deusto, Bilbao, Spain
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Panth N, Gavarkovs A, Tamez M, Mattei J. The Influence of Diet on Fertility and the Implications for Public Health Nutrition in the United States. Front Public Health 2018; 6:211. [PMID: 30109221 PMCID: PMC6079277 DOI: 10.3389/fpubh.2018.00211] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 07/09/2018] [Indexed: 12/25/2022] Open
Abstract
Despite growing evidence of the impact of diet on human fertility, few studies have examined the public health implications of this association in the United States (U.S.). This narrative review summarizes current scientific evidence on associations between dietary intake and fertility, discusses challenges in the public health landscape surrounding infertility, and proposes evidence-based recommendations to address these issues. Diets high in unsaturated fats, whole grains, vegetables, and fish have been associated with improved fertility in both women and men. While current evidence on the role of dairy, alcohol, and caffeine is inconsistent, saturated fats, and sugar have been associated with poorer fertility outcomes in women and men. Furthermore, women and men with obesity [body mass index (BMI) ≥ 30 kg/m2] have a higher risk of infertility. This risk is extended to women who are underweight (BMI <20 kg/m2). Diet and BMI influence outcomes during clinical treatment for infertility. Further, women in the U.S. who belong to an underrepresented minority group, have low income, or have low educational attainment, have significantly higher rates of infertility outcomes as compared to women who are non-Hispanic white, have high income, or have high educational attainment. Given this, it may be prudent to integrate nutrition counseling into both clinical guidelines for infertility as well as national dietary guidelines for individuals of reproductive age. Further studies on diet and reproductive health may enhance our ability to improve existing fertility programs across the U.S. and to deliver tailored care to women and men within at-risk groups.
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Affiliation(s)
- Neelima Panth
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States.,School of Medicine, Duke University, Durham, NC, United States
| | - Adam Gavarkovs
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Martha Tamez
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Josiemer Mattei
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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