ESHRE guideline: routine psychosocial care in infertility and medically assisted reproduction-a guide for fertility staff

A Systematic Review of Telemedicine Solutions to Provide Psychological Interventions for Women Receiving Fertility Treatments

Introduction: Infertility and assisted reproduction treatment (ART) are frequently accompanied by the experience of emotional disorders. Psychological interventions are available for infertile populations, but the barriers of current face-to-face models of care difficult their dissemination. This systematic review (PROSPERO: CRD4202340179) aims to summarize how technologies are used in telemedicine psychological programs to manage emotional disorders in women undergoing fertility treatments. Methods: Searches were conducted in December 2023 in six different databases. Two independent researchers conducted the searches, extracted the information, and assessed the quality of the studies (NHLBI tool). Results: Nineteen studies including 2,520 participants met eligibility criteria. Interventions were provided mostly to women who were undergoing in vitro fertilization/intracytoplasmic sperm injection (n = 11). Emotional disorders most frequently addressed were anxiety and depression (n = 11). The majority of the psychological programs were based on cognitive-behavioral therapy (n = 6), emotional writing (n = 3), acceptance and commitment therapy (n = 3), or positive reappraisal (n = 3). Many interventions were based on the use of internet (n = 5), diaries (n = 3), self-administered manuals (n = 2), short message service (n = 1), or face-to-face sessions (n = 5) supported by the inclusion of phone calls, emails, or audios. There is a lack of preventive interventions (n = 1). Conclusions: To the best of our knowledge, this is the first systematic review that explores the use of all kinds of technologies to provide psychological interventions to manage emotional disorders during ART. Results derived from this work may guide the development of future telemedicine services to provide psychological interventions.

A video clip detailing the patient journey on the day of oocyte retrieval in addition to the standard of care: a randomized controlled trial

STUDY QUESTION

Can a video clip detailing the patient journey decrease women's anxiety on the day of their first oocyte retrieval?

SUMMARY ANSWER

The video clip does not affect women's anxiety on the day of their first oocyte retrieval.

WHAT IS KNOWN ALREADY

IVF triggers anxious reactions in women and men, with peaks of anxiety on the day of (especially the first) oocyte retrieval as shown by reliable questionnaires and biomarkers of distress. Several trials showed that videos with preparatory information reduce women's and men's anxiety for out-patient procedures.

STUDY DESIGN, SIZE, DURATION

This monocentric open-label randomized controlled trial (RCT) randomized (computerized 1:1 allocation) 190 heterosexual couples about to start their first IVF cycle during a 24 months' recruitment period (2018-2020). In addition to the standard of care offered to both the intervention group and the control group, the intervention group received a video clip, the day prior to their first oocyte retrieval, detailing the patient journey on the day of oocyte retrieval. After completion of the RCT, 35 additional couples were recruited as part of a qualitative process evaluation (QPE).

PARTICIPANTS/MATERIALS, SETTING, METHODS

Upon arrival at a private secondary care fertility centre in Belgium for their first oocyte retrieval, women and men independently filled out the State module of the 'State-Trait Anxiety Inventory' (STAI) and the 'Infertility-Specific Distress Scale' (IDS) and evaluated the novel intervention, if applicable. In addition, clinical and discontinuation outcomes were extracted from couples' electronic medical records 24 months later. The data of 155 couples (76-79/group) were subjected to an intention-to-treat analysis. The 35 couples taking part in the QPE filled out two questionnaires assessing knowledge and, if applicable, took part in an in-depth interview on their experience watching the video clip, immediately before their first oocyte retrieval.

MAIN RESULTS AND THE ROLE OF CHANCE

The video clip did not affect women's anxiety on the day of oocyte retrieval (mean STAI-State score intervention group = 42.7 ± 8.1 vs control group = 42.1 ± 8.5, P = 0.68). Men who watched the video clip were, however, significantly less anxious than men who did not watch it (35.8 (±6.4) vs 38.2 (±7.6), P = 0.034). Surprisingly, infertility-specific distress was higher among women and men who watched the video clip, as compared to women and men who did not watch the video clip (mean Infertility-specific Distress (IDS) scale score for women, 25.8 (±4.9) vs 24.3 (±4.6), P = 0.051; men, 22.6 (±5.0) vs 20.8 (±4.7), P = 0.023). The QPE clarified that watching the video clip did not increase knowledge about what would happen but that some women and men found the visualization of invasive procedural steps more confrontational than the earlier received, abstract, written, and verbal information. All but one woman and all men in the intervention group would recommend the video clip to friends and family going through IVF. The intervention and control groups did not differ regarding secondary clinical and discontinuation outcomes.

LIMITATIONS, REASONS FOR CAUTION

Due to the nature of the intervention it was not possible to blind the participants. Furthermore, we did not have an attention control group, which could have separated plausible benefits of the intervention from attentional effects, although limiting performance bias in educational intervention studies is difficult as study personnel cannot be blinded. Of note, this RCT was partially conducted during the COVID-19 pandemic; thus, postponement of the oocyte retrieval and plausible side effects of the pandemic itself might have impacted our results, but group differences are corrected by the randomized controlled design of our trial.

WIDER IMPLICATIONS OF THE FINDINGS

Providing additional procedural information is interesting for clinics as patients recommended the video clip and as it decreased men's anxiety on the day of couples' first oocyte retrieval. The effect of the intervention was observed in a Dutch-speaking population, and investigating beneficial effects of the video clip in non-native speakers and patients with a lower education or literacy level may be of interest, as they are more prone to health information overload and often benefit from visual rather than verbal or written information.

STUDY FUNDING/COMPETING INTEREST(S)

This research was supported by the Research Council of the KU Leuven (C14/18/106; project of J.V., K.P., and E.A.F.D.) and it is an Investigator Sponsored Study for Merck N.V./S.A., an affiliate of Merck KGaA, Darmstadt, Germany. Merck N.V./S.A. had no ultimate authority nor any other role in the design, data collection, data management, data analysis, data processing, data interpretation, and on the decision to submit this study for publication. T.M.D. is vice president and Head of Global Medicine Affairs Fertility, Research and Development, Merck Healthcare KGaA, Darmstadt, Germany. He is also a visiting professor in Reproductive Medicine and Biology at KU Leuven, Belgium and an adjunct professor at the Department of Obstetrics and Gynecology at the University of Yale, New Haven, USA. Neither his corporate role nor his academic roles represent a conflict of interest with respect to the work done by him for this study. The other co-authors have no conflict of interest.

TRIAL REGISTRATION NUMBER

This trial is registered at clinicaltrials.gov as NCT03717805.

TRIAL REGISTRATION DATE

10 October 2018.

DATE OF FIRST PATIENT’S ENROLMENT

29 October 2018.

From hope to hesitation: why couples fail to return for infertility treatment after the first consultation

STUDY QUESTION

What are the key factors that influence couples' decision not to return for fertility treatment after their first consultation?

SUMMARY ANSWER

Advanced maternal age, lower ovarian reserve, and eligibility for heterologous fertilization are primary determinants of non-return among couples.

WHAT IS KNOWN ALREADY

Previous research highlights the psychological, financial, and demographic reasons behind high dropout rates in IVF, yet a comprehensive understanding of the factors driving non-return, particularly at the first consultation, is still lacking and warrants further study.

STUDY DESIGN, SIZE, DURATION

This single-center observational study, incorporating both retrospective and prospective components, analyzed couples consulting at Humanitas Research Hospital from 2012 to 2021. The retrospective review spanned 24 773 couples from 2012 to 2021, among whom 6174 did not return. The prospective cohort included 986 couples who failed to return out of a total of 3214 couples who had their first consultation in 2021.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Participants included couples seeking their first fertility consultation at a specialized fertility center. Retrospective data were extracted from internal records to assess personal, demographic, and biological factors (anti-Mullerian hormone [AMH] and FSH levels) contributing to non-return, while non-returning patients in the prospective arm completed a telephone questionnaire in addition to data extraction from internal records.

MAIN RESULTS AND THE ROLE OF CHANCE

Between 2012 and 2021, 24.92% of couples did not return after the initial consultation, with older age and diminished ovarian reserve as significant predictors. Of 3214 couples in 2021, 986 (30.68%) did not return after their first consultation. All 986 patients were contacted, and the response rate was 85.1%. Non-returning women were significantly older (37.1 vs. 35.6 years) and exhibited lower AMH levels (1.87 vs. 2.83 ng/ml) and higher FSH levels (13.13 vs. 8.19 mIU/ml). Primary reasons for non-return included eligibility for gamete donation (34.09%), spontaneous pregnancy (29.20%), and transferring treatment to another center (18.71%). Other contributing factors were existing parenthood (11.43%), psychological distress (9.65%), and dissatisfaction with the doctor (7.39%). These findings highlight the multifaceted nature of treatment discontinuation and underscore the importance of comprehensive support to mitigate non-return risk.

LIMITATIONS, REASONS FOR CAUTION

This study is limited by its single-center design: generalizability may vary based on differences in patient demographics and healthcare settings across regions and countries. Additionally, the prospective analysis may be affected by selection bias, as those non-returning patients who could not be reached might have provided meaningfully different answers.

WIDER IMPLICATIONS OF THE FINDINGS

These findings align with current literature while providing new insights into non-return for fertility treatment. The study underscores the need for tailored support and counseling to address the challenges faced by the couples, potentially enhancing treatment adherence and outcomes.

STUDY FUNDING/COMPETING INTEREST(S)

This research received no specific funding. The authors report no conflicts of interest.

TRIAL REGISTRATION NUMBER

clinicaltrials.gov NCT06344585.

The cultural representations and symbolizations emerging from Italian psychologists working in multidisciplinary assisted reproduction teams: A linguistic analysis with the emotional text mining

This study aims to explore the perspectives of Italian psychologists who work in assisted reproductive treatment (ART) centres regarding their roles within multidisciplinary teams. Twenty-eight psychologists were interviewed, recorded and their transcribed text was analysed using emotional text mining. The analysis revealed four clusters representing the psychologists' cultural symbolizations of their works: 'Clinical Practice with the patient', 'Placing Psychology within the Treatment', 'Psychologist's Loneliness' and; 'Collusion with Medicine'. The symbolic representations emerging clearly highlighted a lack of integration of psychology within the medical field. Psychologists expressed emotional and practical difficulties in trying to integrate their role, including a desire to provide psychological assistance, feelings of loneliness and concerns about jeopardizing their professional opportunities, which are intertwined with the medical field. Present findings underscore the importance of integrating psychology within ART centres and multidisciplinary teams and of establishing operational guidelines for psychologists. These steps are crucial for reaching integration of psychologists within the medical setting.

Determinants of the economic burden of ART on the Italian NHS: insights from the Lombardy region

With the rising spread of Assisted Reproductive Technology (ART), it becomes imperative to understand the determinants of resource utilization in ART versus spontaneous pregnancies to enhance policies directed to pregnancy care. The focus of our study is to examine the costs associated with ART from the perspective of the Italian NHS and to investigate in depth the contributing social and clinical factors.Using the healthcare informative system of Lombardy, a Region of Northern Italy, we gathered individual-level information for a cohort of women who experienced either spontaneous pregnancies or pregnancies following ART from 2007 until 2020. The information covered multiple healthcare services, and we used a propensity score matching technique to match couples of ART/No ART women based on a comprehensive set of confounders. We then applied statistical tests and regression models to identify the impact of ART on the reported cost differences.Our cohort was composed of 44652 women and results revealed significantly higher costs for ART pregnancies, especially in terms of hospital admissions (additional 1611€, 95% CI 1558-1666) and drug prescriptions (additional 216 €, CI 95% 204-228) occurring before delivery. In-depth analysis showed for ART pregnancies, i) a higher likelihood of incurring expenses related to complications and ii) higher costs associated with two established clinical practices that lack scientific evidence supporting their efficacy.Our study sheds light on the complex interplay of clinical and social factors influencing the ART burden, emphasizing the importance of tailored support and evidence-based practices in optimizing outcomes and resource allocation.

FSH/LH co-stimulation in Advanced Maternal Age (AMA) and hypo-responder patients - Arabian gulf delphi consensus group

Background

In a global effort to assess expert perspectives on the use of recombinant gonadotropins, recombinant human luteinizing hormone (r-hLH) and recombinant human follicle-stimulating hormone (r-hFSH), a consensus meeting was held in Dubai. The key aim was to address three critical questions: What are the factors that influence follicle response to gonadotropins? Which categories of patients are most likely to benefit from LH supplementation? And what are the optimal management strategies for these patients?

Methods

A panel of thirty-six experts reviewed and refined the initial statements and references proposed by the Scientific Coordinator. Consensus was defined as agreement or disagreement by more than two-thirds (66%) of the panel members for each statement.

Results

Thirty-five statements were formulated, of which thirty-one reached consensus. For patients with Hypo-Response to Gonadotropin Stimulation (20 statements), all identified risk factors, including advanced age, high BMI, and chronic conditions, achieved unanimous agreement. Diagnostic approaches, such as the inclusion of POSEIDON criteria and hormone level monitoring, were endorsed by the majority, with over 90% agreement. Management strategies, particularly individualized stimulation protocols and optimized scheduling, garnered broad consensus, with only one statement falling short of the threshold. Additionally, in cases of severe FSH and LH deficiency, combining r-hFSH with r-hLH was found to improve pregnancy rates and cost efficiency compared to human menopausal gonadotropin (hMG). For patients with Advanced Maternal Age (AMA) (15 statements), there was strong agreement on the use of oral contraceptive pills and estrogen priming. Recommendations concerning antagonist protocols and dosing of r-hLH and r-hFSH also achieved high levels of consensus. Significant agreement supported r-hLH supplementation and a tailored approach to luteal phase support. However, there were mixed opinions on the route of progesterone administration, with some experts expressing neutral or disagreeing views. Despite these differences, unanimous consensus was reached on markers of treatment success, particularly live birth rates, pregnancy rates, and embryo development, underscoring the importance of these outcomes in evaluating treatment efficacy.

Conclusion

This consensus provides a practical clinical perspective to a wide range of global professionals on the strategies employed during key phases of Assisted Reproductive Technology (ART) treatment. To further improve outcomes, incorporating additional clinical insights on ART approaches, alongside existing guidelines and policies, may offer valuable guidance for optimizing patient care.

Government subsidy for infertility treatment: Impact on quality of life for infertile women undergoing in vitro fertilization-embryo transfer

BACKGROUND

Infertility and the economic burden of treatment can impose considerable psychosocial stress with negative consequences for the quality of life for all involved. The objective of this study was to determine the effects of government subsidies for infertility treatment on the quality of life among infertile women undergoing in vitro fertilization-embryo transfer.

METHODS

Infertile women undergoing in intro fertilization-embryo transfer were recruited from the Assisted Reproductive Technology Center at National Cheng Kung University Hospital, Taiwan, between 2019 and 2022. This study examined the issue of fertility using the FertiQoL survey, which measures the quality of life among individuals facing the struggles associated with infertility. Generalized estimating equation analysis was used to examine the relationship between government subsidies and pregnancy outcomes and quality of life following infertility treatment.

RESULTS

This study analyzed 497 infertile women with 727 embryo transfer cycles. The mean core domain and total FertiQoL scores of subsidy recipients were significantly higher (2.68 score increase, p = 0.026 and 2.38 score increase, p = 0.026, respectively) than those of women who did not receive a subsidy. We also observed a negative correlation between the provision of subsidies and the likelihood of clinical pregnancy (odds ratio = 0.57, 95% confidence interval: [0.35, 0.93], p = 0.03) and ongoing (odds ratio = 0.56, 95% confidence interval: [0.33, 0.95], p = 0.03).

CONCLUSIONS

The government subsidy for infertility treatment was negatively correlated with clinical and live birth rates while positively correlated with quality of life.

The elephant in the room: a study on the dialogue about sexuality during Assisted Reproductive Technology visits

Despite ongoing medical advancements in infertility treatment, the significant impact of sexuality on this journey often goes unaddressed. The present research aims to examine sexual conversations during ART visits, including who initiate the conversation and their content.This quali-quantitative study delves into analyzed video-recorded ART visits to explore how "sex" conversations are broached during healthcare interactions. Our findings reveal a strikingly low proportion of utterances related to sexuality, accounting for only 1.3% of the total 14,372 utterances analyzed. Sex utterances were mainly introduced by physicians (72%), while regarding those introduced by the couple, 64% were reported by men. From the qualitative analysis on the utterances emerged three distinct levels of communication about sex: explicit, almost explicit, and implicit. While physicians and males exhibit an almost balanced distribution across the 3 levels, female patients primarily respond to explicit and almost explicit communication initiated by physicians. The low percentage of sexual utterances underscores the rarity of these conversations during ART interactions, despite the clinical field where sexual health should deserve a crucial attention. Opening the door to conversations about sexuality could help to create a safe and supportive space for patients to talk about sex, with a potential impact on well-being and quality of care during the ART process.

A randomized controlled trial on the impact of a specialized training program on anxiety and perceived pain in infertile women undergoing hysterosalpingography

Hysterosalpingography (HSG) is a minimally invasive procedure that can be painful. This study aimed to examine the impact of a tailored training program on anxiety and perceived pain intensity in infertile women undergoing HSG. This research was a clinical trial involving 86 infertile women who were candidates for HSG and conducted at the radiology department of the Royan Infertility Center in Tehran, Iran, between November 22, 2021, to March 11, 2023.The participants were divided into two groups:43 women in the intervention group and 43 women in the control group. The randomization of the samples was carried out using a random number table. The women in the intervention group received two face-to-face group training sessions. Data were collected using valid questionnaires. Additionally, the heart rate and blood pressure of the participants were recorded. Data analysis showed the training intervention was significantly associated with reducing anxiety levels, perceived pain, systolic blood pressure, diastolic blood pressure, and heart rate in women undergoing HSG (p < 0.05). These findings support the use of structured training interventions to improve the overall experience and outcomes for patients undergoing HSG.Trial Registration Number: IRCT20150905023897N4.

Predictors of partnership and sexual satisfaction and dyadic effects in couples affected by endometriosis and infertility

PURPOSE

Endometriosis and infertility are associated with impaired partnership and sexuality of the patients, but also of their male partners. Also, endometriosis is one of the most common causes of infertility, resulting in a large overlap of both pathologies. The aim of this study was to determine the association of different predictors of partnership and sexual satisfaction and dyadic effects in couples with endometriosis and infertility.

METHODS

A cross-sectional study was conducted with n = 62 women with endometriosis and n = 46 partners, including a total of n = 44 couples, some of whom were affected by infertility. The questionnaire included items on partnership, sexuality, depression, social support, and desire for a child. Multiple linear regression and the actor-partner-interdependence-model were used for analysis.

RESULTS

Significant dyadic effects only occurred in couples with both endometriosis and infertility. Depression showed a significant negative actor effect in men for partnership satisfaction and a negative actor and partner effect in women for sexuality satisfaction (p < .05). For women, social support showed a significant positive actor effect for partnership satisfaction (p < .05), age showed a significant actor and partner effect for sexuality satisfaction (p < .05).

CONCLUSION

The results show a significant association of endometriosis and infertility with partnership and sexuality satisfaction. Infertility could be a decisive factor. However, the large overlapping of both endometriosis und infertility in many couples support the importance of further studies to differentiate between the both effects.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00014362 on the 29.03.2018.

Empowering nurses and midwives: the evidence-base for the Nurses and Midwives Certification Programme of ESHRE†

STUDY QUESTION

How were the logbook and curriculum for the Nurses and Midwives Certification Programme of ESHRE developed?

SUMMARY ANSWER

The logbook and corresponding curriculum for the ESHRE Nurses and Midwives Certification Programme were based on an extensive literature review, an international expert panel, and a survey of Belgian and Dutch nurses and midwives (N&M) working in reproductive medicine (RM).

WHAT IS KNOWN ALREADY

ESHRE has been running a certification programme for N&M working in RM since 2015. To the best of our knowledge, clinical practice guidelines for nursing/midwifery care within RM are lacking as is consensus on role descriptors of N&M working in RM.

STUDY DESIGN, SIZE, DURATION

The Nurses and Midwives Certification Committee (NMCC), established by the ESHRE Executive Committee in 2012, decided to gather background information by: (i) systematically reviewing the literature on the tasks of N&M working in RM, (ii) consulting and surveying an expert panel of international senior N&M, and (iii) surveying Belgian and Dutch N&M working in RM across different clinics. Finally, the NMCC developed a logbook and curriculum fostering a more expanded theoretic background.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The NMCC comprised four N&M, one clinical embryologist, and one gynaecologist (both in an advisory capacity). The Medline database was searched for papers relating to the tasks of N&M working in RM, by entering a search string in PubMed. In an attempt to capture insight into the tasks and roles of N&M working in RM, the NMCC subsequently surveyed N&M experts across nine countries (Denmark, Finland, France, Norway, Slovenia, Sweden, Turkey, Ukraine, and the UK), and 48 Belgian and Dutch N&M working in RM.

MAIN RESULTS AND THE ROLE OF CHANCE

There were 36 papers on the tasks of N&M working in RM originating from 13 countries (in Asia, Oceania, Europe, and North America), identified. Initially, 43 tasks in which N&M working in RM participated, were identified by literature only (n = 5), the international expert panel only (n = 4), Belgian and Dutch N&M working in RM only (n = 5), or a combination of two (n = 13) or three (n = 16) of these sources. The number and composition of tasks included in the logbook were adapted yearly based on novel insights by the NMCC. In response to the annual review, the extended role of N&M working in RM is now reflected in the 2024 version by 73 tasks. Seven specialist tasks (i.e. embryo transfer) were performed independently by N&M working in RM in some countries, while in other countries N&M merely had an 'assisting' role. Candidates are also expected to submit a mature ethical reflection on one clinical case. To support applicants throughout the certification process, the NMCC developed a curriculum in line with all tasks of N&M working in RM.

LIMITATIONS, REASONS FOR CAUTION

The literature review was not completed prior to consulting the international expert panel or surveying the Belgian and Dutch N&M working in RM.

WIDER IMPLICATIONS OF THE FINDINGS

The differences in tasks and roles of N&M working in RM across and within countries, clinics and individuals illustrated by the literature review, the international expert panel, and the surveyed Belgian and Dutch N&M working in RM suggest an opportunity for structured professional development. Further research is required to elicit the post-certification experience of N&M working in RM and its impact on their professional development.

STUDY FUNDING/COMPETING INTEREST(S)

The expert panel meeting was funded by ESHRE and the literature review and surveys were supported by Leuven University (Belgium) and the postdoctoral fellowship of the Research Foundation Flanders of E.A.F.D. H.K. received consulting fees and honoraria from Gedeon Richter, Finox and MEDEA, and travel support from Gedeon Richter and Finox. The other authors declare no conflict of interest.

TRIAL REGISTRATION NUMBER

N/A.

Decoding the Epigenetics of Infertility: Mechanisms, Environmental Influences, and Therapeutic Strategies

Infertility is a complex condition caused by a combination of genetic, environmental, and lifestyle factors. Recent advances in epigenetics have highlighted the importance of epigenetic changes in fertility regulation. This review aims to provide a comprehensive overview of the epigenetic mechanisms involved in infertility, with a focus on DNA methylation, histone modification, and non-coding RNAs. We investigate the specific epigenetic events that occur during gametogenesis, with a focus on spermatogenesis and oogenesis as distinct processes. Furthermore, we investigate how environmental factors such as diet, stress, and toxin exposure can influence these epigenetic changes, potentially leading to infertility. The second part of the review explores epigenetic changes as therapeutic targets for infertility. Emerging therapies that modulate epigenetic marks present promising opportunities for fertility restoration, particularly in spermatogenesis. By summarizing current research findings, this review emphasizes the importance of understanding epigenetic contributions to infertility. Our discussion aims to lay the groundwork for future research directions and clinical applications in reproductive health.

The impact of an adapted SPIKES protocol vs routine care in the delivery of bad news to IVF patients: an exploratory pilot multicenter randomized controlled trial

PURPOSE

Determine if the SPIKES method was associated with less distress and more compassion than current modes of delivering negative pregnancy test results to patients undergoing in vitro fertilization.

METHODS

Twenty-seven nurses from two centers were randomized to use the modified SPIKES script or continue their standard of care; 136 patients with a negative hCG following embryo transfer were included. SPIKES nurses received 1 h of training by a study psychologist; nurses in the control group were instructed to deliver the news as done previously. Patients who underwent embryo transfer and received a call by a participating nurse with a negative test result received an email invitation on the following day.

RESULTS

Control patients reported significantly less distress than SPIKES patients; 33% of SPIKES patients reported that they had felt "extremely sad," compared to 15.2% of the control patients (p = 0.01). Perceived compassion did not differ between the groups (all p ≥ 0.22).

CONCLUSION

Patients who received a negative pregnancy test result from the nurses who received a brief training and a script on how to deliver bad news via the modified SPIKES protocol reported significantly more distress than patients receiving negative results from nurses utilizing their standard of care. It is unclear whether a modified SPIKES method to deliver negative pregnancy test results will benefit patients undergoing in vitro fertilization.

TRIAL REGISTRATION

Clinical trials.gov NCT04917445.

Psychological aspects of infertility

The unfulfilled desire for children is a significant problem worldwide. The psychological effects of this development are usually underestimated, while the myth of "psychogenic infertility" stubbornly persists. This article first provides an overview of the basic facts on the subject before highlighting the psychological effects of both the diagnosis of infertility and the therapeutic options. Psychological aspects of "third-party" reproduction and further developments after childbirth or without a child are discussed, followed by a brief outline of the general and specific subject matter addressed in infertility counselling. The article concludes with reflections on the possible psychological consequences of further medical developments in this area.

Psychometric properties of the Spanish version of the FertiQoL measure in couples undergoing infertility treatment

BACKGROUND

Both the diagnosis and the process of undergoing fertility treatment have a considerable negative effect on a person's quality of life (QoL). The evaluation of this effect is essential to offer comprehensive and high-quality care. The FertiQoL questionnaire is the most widely used instrument to evaluate QoL in people with fertility issues.

OBJECTIVE

This study is aimed at examining the dimensionality, validity and reliability of the Spanish version of the FertiQoL questionnaire in a sample of Spanish heterosexual couples undergoing fertility treatment.

METHODS

FertiQoL was administered to 500 people (50.2% women; 49.8% men; average age 36.1 years) recruited from a public Assisted Reproduction Unit in Spain. In this cross-sectional study, Confirmatory Factor Analysis (CFA) was used to analyse the dimensionality, validity and reliability of FertiQoL. Discriminant and convergent validity were assessed using the Average Variance Extracted (AVE), and model reliability was shown by Composite Reliability (CR) and Cronbach's alpha.

RESULTS

CFA's results support the 6-factor solution of the original FertiQoL (RMSEA and SRMR <0.09; CFI and TLI >0.9). However, several items had to be eliminated due to their low factorial weights - in particular, items Q4, Q5, Q6, Q11, Q14, Q15 and Q21. Moreover, FertiQoL showed good reliability (CR >0.7) and validity (AVE >0.5).

CONCLUSION

The Spanish version of FertiQoL is a reliable and valid instrument in measuring QoL in heterosexual couples undergoing fertility treatment. The CFA confirms the original 6-factors model but indicates that by eliminating some items the psychometric properties could improve. However, further research is recommended to address some of the measurement issues.

Business case for psychosocial interventions in clinics: potential for decrease in treatment discontinuation and costs

RESEARCH QUESTION

From a value-based healthcare (VBHC) perspective, does an assessment of clinical outcomes and intervention costs indicate that providing cognitive behavioural therapy (CBT) or mindfulness to women seeking fertility treatment add value compared with no such intervention?

DESIGN

Proof-of-concept business case based on a VBHC perspective that considers clinical outcomes and costs. Potential effects on psychological and fertility outcomes were based on existing research. Cost outcomes were estimated with a costing model for the Dutch fertility treatment setting.

RESULTS

Thirty-two studies were identified; 13 were included. Women who received CBT had 12% lower anxiety, 40% lower depression and 6% higher fertility quality of life; difference in clinical pregnancy rates was six percentage points (CBT [30.2%]; control [24.2%]); difference in fertility discontinuation rates was 10 percentage points (CBT [5.5%]; control [15.2%]). Women who received training in mindfulness had 8% lower anxiety, 45% lower depression and 21% higher fertility quality of life; difference in mean clinical pregnancy rate was 19 percentage points (mindfulness [44.8%]; control [26.0%]). Potential total cost savings was about €1.2 million per year if CBT was provided and €11 million if mindfulness was provided. Corresponding return on investment for CBT was 30.7%, and for mindfulness 288%. Potential cost benefits are influenced by the assumed clinical pregnancy rates; such data related to mindfulness were limited to one study.

CONCLUSIONS

The provision of CBT or mindfulness to women seeking fertility treatment could add value. Higher quality primary studies are needed on the effect of mindfulness on clinical pregnancy rates.

Preventing violence and enhancing mental health among clients of an invitro fertilization clinic in Jordan: results of a pre/post pilot test of the use of cognitive behavioral therapy

INTRODUCTION

Infertility increases women's risk of intimate partner violence (IPV). Cognitive behavioral therapy (CBT) is commonly used to treat mental health problems among fertility treatment seeking patients. CBT has not been tested for its potential to reduce IPV in this population. We pilot test the use of CBT to prevent IPV and improve patients' mental health in a fertility clinic in Jordan.

METHODS

Of 38 eligible fertility-treatment seeking couples, 16 consented and underwent up to 11 CBT sessions (average = 9) over 3 months. Interviews at baseline and 16 weeks post intervention (endline) assessed IPV, quality of life, social support, coping, and fear of spouse. Wilcoxon signed-rank and McNemar's tests were used to assess change in outcomes.

RESULTS

At baseline, women's rates of IPV, depression, and anxiety were 75%, 87.5%, and 75% respectively, whereas men's rates of depression and anxiety were each 80%. Average baseline post-traumatic stress disorder (PTSD) symptoms for men and women were 3.3 and 2.7 respectively out of 5. IPV decreased 25% after treatment, and women reported less spousal fear. For both men and women, depression, anxiety, and PTSD symptoms decreased and social support and fertility quality of life improved.

CONCLUSION

Psychosocial support should be standard of care for the treatment of infertility given the burden of mental health problems and IPV and the utility of CBT in this patient population. Co-design with couples is needed to identify strategies to bolster participation along with population-based interventions to combat the stigma of infertility and mental health service use and enhance women's status.

Molecular Factors Predicting Ovarian Chemotoxicity in Fertile Women: A Systematic Review

Background: Recent advances in cancer diagnosis and treatment have significantly improved survival rates among women of reproductive age facing cancer. However, the potential iatrogenic loss of fertility caused by chemotherapeutic agents underscores the need to understand and predict chemotherapy-induced ovarian damage. This study addresses this gap by systematically reviewing the literature to investigate genetic markers associated with chemotherapy-induced ovarian failure (CIOF). Objective: The primary objective is to identify genetic markers linked to CIOF, contributing to a comprehensive understanding of the factors influencing fertility preservation in female cancer survivors. Methods: A systematic review was conducted using PubMed, EMBASE, Web of Science, Scopus, and OVID electronic databases from inception through December 2023. Studies were included if they featured genomic assessments of genes or polymorphisms related to CIOF in women with histologically confirmed tumors. Exclusion criteria comprised in vitro and animal studies, reviews, and pilot studies. The resulting four human-based studies were scrutinized for insights into genetic influences on CIOF. Results: Of the 5179 articles initially identified, four studies met the inclusion criteria, focusing on alkylating agents, particularly cyclophosphamide, and anthracyclines. Su et al. explored CYP3A41B variants, revealing modified associations with CIOF based on age. Charo et al. investigated GSTA1 and CYP2C19 polymorphisms, emphasizing the need to consider age and tamoxifen therapy in assessing associations. Oktay et al. delved into the impact of BRCA mutations on anti-Müllerian hormone (AMH) levels post-chemotherapy, supported by in vitro assays. Van der Perk et al. focused on childhood cancer survivors and revealed significant associations of CYP3A43 and CYP2B6*2 SNPs with AMH levels. Conclusions: This systematic review analyzes evidence regarding genetic markers influencing CIOF, emphasizing the complex interplay of age, specific genetic variants, and chemotherapy regimens. The findings underscore the need for a personalized approach in assessing CIOF risk, integrating genetic markers with traditional ovarian reserve testing. The implications of this study extend to potential advancements in fertility preservation strategies, offering clinicians a comprehensive baseline assessment for tailored interventions based on each patient's unique genetic profile. Further research is essential to validate these findings and establish a robust framework for integrating genetic markers into clinical practice.

Fertility clinics have a duty of care towards patients who do not have children with treatment

In medically assisted reproduction (MAR) success has mostly been measured in terms of achieving (healthy) livebirths. We argue this focus is too narrow and that success should be measured in terms of alleviating patient suffering caused by an unfulfilled child wish. The major implication is that clinics must better tailored care to effectively support patients who do not have child(ren) with treatment. First, we argue that clinics have a duty of care towards patients for whom MAR does not result in children because this is a common treatment outcome, because treatment is burdensome and creates new losses for patients, and because the field has the necessary expertise to provide support and it is part of patient-centred care. Then, we examine concerns about the adequacy of addressing the possibility that treatment may end without children, namely, that this may hinder patients' hope and put them off doing treatment, and that it may be perceived as a sign of clinical incompetence, as well as concerns about the required skill set. We end with a set of research-informed recommendations to promote healthy adjustment to ending fertility treatment without children. These focus on the need to reconceptualize 'success' and 'failure' in MAR, to promote open discussion about the possibility of treatment not resulting in children and encourage patients to develop 'plan(s) B', to support patients who end treatment without children, and to create the organizational structures needed to support clinics and healthcare professionals in this endeavour.

The clinical effectiveness of the Mind/Body Program for Infertility on wellbeing and assisted reproduction outcomes: a randomized controlled trial in search for active ingredients

STUDY QUESTION

Does the Mind/Body Program for Infertility (MBPI) perform better, due to certain distinctive elements, than a partly matched support group in improving the wellbeing and medically assisted reproduction (MAR) outcomes of women with elevated distress levels in a clinical setting?

SUMMARY ANSWER

While robust enhancements occurred in the wellbeing overall, the cognitive behavioural and formalized stress management elements of the MBPI allowed a significantly stronger improvement in trait anxiety, but not in other mental health and MAR outcomes, compared with a support group.

WHAT IS KNOWN ALREADY

Mind-body psychological programmes adjacent to MAR have been found to improve women's mental states and possibly increase chances of pregnancy. However, not enough is known about the programme's effectiveness among patients with elevated distress levels in routine clinical settings, nor is it clear which of its particular ingredients are specifically effective.

STUDY DESIGN, SIZE, DURATION

A pre-post design, single-centre, randomized controlled trial was performed between December 2019 and October 2022 (start and end of recruitment, respectively). The sample size (n = 168) was calculated to detect superiority of the MBPI in improving fertility-related quality of life. Randomization was computer-based, with random numbers concealing identities of patients until after allocation.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The trial was conducted at a large university teaching hospital. A total of 168 patients were randomly assigned to the mind-body (MBPI) group (n = 84) and the fertility support (FS) control group (n = 84). Patients received a 10-week, 135-min/week group intervention, with the FS group following the same format as the MBPI group, but with a less restricted and systematic content, and without the presumed effective factors. The number of patients analysed was n = 74 (MBPI) and n = 68 (FS) for post-intervention psychological outcomes, and n = 54 (MBPI) and n = 56 (FS) for pregnancy outcomes at a 30-month follow-up.

MAIN RESULTS AND THE ROLE OF CHANCE

Significant improvements occurred in both groups in all psychological domains (adjusted P < 0.001), except for treatment-related quality of life. Linear mixed-model regression analysis did not reveal significantly greater pre-post improvements in the MBPI group than in the FS group in fertility-related quality of life (difference in differences (DD) = 4.11 [0.42, 7.80], d = 0.32, adjusted P = 0.124), treatment-related quality of life (DD = -3.08 [-7.72, 1.55], d = -0.20, adjusted P = 0.582), infertility-specific stress (DD = -2.54 [-4.68, 0.41], d = -0.36, adjusted P = 0.105), depression (DD = -1.16 [3.61, 1.29], d = -0.13, adjusted P = 0.708), and general stress (DD = -0.62 [-1.91, 0.68], d = -0.13, adjusted P = 0.708), but it did show a significantly larger improvement in trait anxiety (DD = -3.60 [-6.16, -1.04], d = -0.32, adjusted P = 0.042). Logistic regression showed no group effect on MAR pregnancies, spontaneous pregnancies, or live births.

LIMITATIONS, REASONS FOR CAUTION

The follow-up only covered MAR-related medical outcomes and no psychological variables, and their rates were not equal in the two groups. Biological factors other than age, aetiology, and duration of infertility may have confounded the study results. Loss to follow-up was between 5% and 10%, which may have led to some bias.

WIDER IMPLICATIONS OF THE FINDINGS

The psychologically and medically heterogeneous sample, the normal clinical setting and the low attrition rate all raise the external validity and generalizability of our study. The MBPI works not only in controlled conditions, but also in routine MAR practice, where it can be introduced as a cost-effective, low-intensity psychological intervention, within the framework of stepped care. More studies are needed to further identify its active ingredients.

STUDY FUNDING/COMPETING INTEREST(S)

The authors received no financial support for the research, authorship, and/or publication of this article. The authors have no conflict of interest to disclose.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov NCT04151485.

TRIAL REGISTRATION DATE

5 November 2019.

DATE OF FIRST PATIENT’S ENROLMENT

15 December 2019.

Current state and practical recommendations on reproductive mental health: a narrative review

Emotional disorders (EDs) are highly prevalent during the reproductive period, including pregnancy, postpartum, and women undergoing fertility treatments. International guidelines are increasingly suggesting the need to evaluate, prevent, and treat EDs in those women. The main aim of this narrative review is to summarize current practice in the field of EDs management during fertility treatments, pregnancy, and the postpartum and to propose a new technology-based model of care that helps to provide psychological care to all women who are in these periods. Four different databases (Pubmed, Scopus, Science Direct, Web of Science) were consulted. Selected keywords were related with infertility, pregnancy, postpartum, EDs, assessment, prevention, treatment, and technologies. We identified 1603 studies and 43 were included in this review. According to these studies, different face-to-face protocols already exist to manage EDs in women undergoing fertility treatments, pregnant or at the postpartum. We noticed an increased interest in developing technology-based solutions to overcome the limitations of traditional mental healthcare services. However, we also detected some issues in the use of technologies (i.e. increased attention to the postpartum or the lack of transdiagnostic approaches). Our results evidenced that there is still a need to develop modern, well-designed, and conceptually-relevant ICT-based programs to be used in women undergoing fertility treatments, pregnant or at the postpartum.

Anxiety in couples undergoing IVF: evidence from E-Freeze randomised controlled trial

STUDY QUESTION

What are the risk factors and impacts of anxiety in women and men in heterosexual couples undergoing IVF as part of a randomised trial, with a delay in embryo transfer in one arm?

SUMMARY ANSWER

Duration of infertility, ethnicity, and male partner's anxiety levels were associated with women's anxiety at the start of treatment, while initial anxiety score, partner's anxiety score at embryo transfer, ethnicity, and clinic location were associated with women's anxiety levels at embryo transfer; although women undergoing IVF were more anxious than their partners for slightly different reasons, their self-reported state anxiety was not associated with achieving clinical pregnancy, nor with switching from delayed frozen embryo transfer to fresh embryo transfer in an IVF trial.

WHAT IS KNOWN ALREADY

Use of IVF treatment continues to rise and patients undergoing IVF are anxious. Participating in a randomised controlled trial (RCT) with uncertainty of arm randomisation might increase their anxiety, while a delay in treatment may add further to anxiety.

STUDY DESIGN SIZE DURATION

A mixed methods study was conducted using data from the multi-centre E-Freeze RCT cohort conducted across 13 clinics in the UK from 2016 to 2019. A regression analysis on anxiety scores of couples undergoing the IVF trial and a qualitative analysis of participant questionnaires were performed.

PARTICIPANTS/MATERIALS SETTING METHODS

Six hundred and four couples participating in the E-Freeze trial, who had at least one useable State-Trait Anxiety Inventory (STAI) State Anxiety subscale (STAI-S) standardised self-report questionnaire for at least one of the partners, were included in the study. STAI-S scores were measured at consent for trial (T1) and again at embryo transfer (T2). Linear and log-binomial regression were used to explore the association between characteristics and STAI-S scores, and the associations between STAI-S scores and non-compliance and clinical pregnancy, respectively. Responses to the open text question were qualitatively analysed inductively using content analysis.

MAIN RESULTS AND THE ROLE OF CHANCE

Women's STAI-S scores at T1 (consent) were associated with their ethnicity, duration of infertility, and their male partner's STAI-S score at T1. Women's STAI-S scores at T2 (embryo transfer) were associated with their ethnicity, location of fertility clinic, their STAI-S score at consent, and their male partner's STAI-S score at embryo transfer. The adjusted coefficient (95% CI) for women's STAI-S scores at T2 was -4.75 (-7.29, -2.20, P < 0.001) for ethnic minority versus White, -2.87 (-4.85, -0.89, P = 0.005) for Scotland versus England, 0.47 (0.37, 0.56, P < 0.001) for each point increase in their own score at T1, and 0.30 (0.21, 0.40, P < 0.001) for each point increase in their male partner's score at T2. On average, women had higher STAI-S scores than men at both time points, and a larger increase of scores between the two time points. However, women's STAI-S scores were not associated with either non-compliance with trial allocation in the 'freeze-all' trial arm, or with chances of pregnancy. Both partners, but particularly women, described feeling anxious about the outcome of IVF, with women carrying the added worry of believing that feeling stressed might itself affect the outcome. Participants highlighted the important role of support from staff in helping them to manage their anxiety.

LIMITATIONS REASONS FOR CAUTION

Data were not available on education level or social support, which might influence anxiety scores. Men's baseline characteristics were not collected.

WIDER IMPLICATIONS OF THE FINDINGS

Identifying couples at increased risk of emotional distress may be improved by using standardised anxiety measures at the start of the fertility treatment. Women can be reassured that their self-reported state anxiety does not affect their chances of achieving clinical pregnancy through IVF, and this may help to reduce anxiety levels. The psychological wellbeing and experiences of couples undergoing IVF could be supported by patient-centred care: making information about the whole process of treatment and choices available to both partners in accessible formats; ensuring interactions with staff are kind and supportive; and acknowledging and addressing the different concerns of women undergoing IVF and their partners.

STUDY FUNDING/COMPETING INTERESTS

This study was an NIHR HTA (National Institute for Health and Care Research Health Technology Assessment) funded study. There are no conflicts of interest to declare.

TRIAL REGISTRATION NUMBER

ISRCTN registry: ISRCTN61225414.

The SCREENIVF Hungarian version is a valid and reliable measure accurately predicting possible depression in female infertility patients

Infertility patients, often in high distress, are entitled to being informed about their mental status compared to normative data. The objective of this study was to revalidate and test the accuracy of the SCREENIVF, a self-reported tool for screening psychological maladjustment in the assisted reproduction context. A cross-sectional, questionnaire-based online survey was carried out between December 2019 and February 2023 in a consecutive sample of female patients (N = 645, response rate 22.9%) in a university-based assisted reproduction center in Hungary. Confirmatory factor analysis and cluster and ROC analyses were applied to test validity, sensitivity and specificity in relation to Beck Depression Inventory (BDI) scores. Model fit was optimal (chi-square = 630.866, p < 0.001; comparative fit index = 0.99; root-mean-square error of approximation = 0.018 (90% CI 0.013-0.023); standardized-root-mean-square-residual = 0.044), and all dimensions were reliable (α > 0.80). A specific combination of cutoffs correctly predicted 87.4% of BDI-scores possibly indicative of moderate-to-severe depression (χ2(1) = 220.608, p < 0.001, Nagelkerke R2 = 0.462, J = 66.4). The Hungarian version of the SCREENIVF is a valid and reliable tool, with high accuracy in predicting BDI-scores. Low response rate may affect generalizability. The same instrument with different cutoffs can serve various clinical goals.

Improved Screening for Depression in Patients Initiating Fertility Treatment

OBJECTIVE

To improve screening for depression in patients who are initiating fertility treatment at a reproductive endocrinology and infertility (REI) center by screening all patients at their initial visit using the Patient Health Questionnaire-9 (PHQ-9).

DESIGN

This quality improvement project was conducted using a plan-do-study-act cycle implemented with a postintervention study design.

SETTING/LOCAL PROBLEM

A medium-size REI center in a mid-Atlantic U.S. metropolitan area where screening for mental health status in patients initiating fertility treatments was not occurring.

PARTICIPANTS

Patients who were scheduled in person with REI providers for a new patient consult regarding fertility were declared eligible.

INTERVENTION/MEASUREMENTS

The PHQ-9 was administered by providers at initial consults for patients seeking fertility treatments from October 2022 to February 2023. Three cycles of the plan-do-study-act model were used to execute change. For all patients who scored 5 to 9 (mild depression), conversations regarding counseling referrals occurred. For all patients who scored ≥10 (moderate to severe depression), a referral for counseling and medication management was generated. Data were analyzed via descriptive statistics.

RESULTS

A total of 115 participants were included. A screening rate of 84.3% (n = 97) was achieved for patients initiating treatment. Of the 97 screened, 21 patients had a score of ≥5; 19 were given a referral for counseling. However, none of the patients attended a counseling session or started medication prescribed by their primary care provider during the 2-month follow-up period. Barriers identified included costs, personal preferences, and access to services.

CONCLUSION

The PHQ-9 screening tool was implemented at an REI clinic to improve the frequency of mental health screenings and provide necessary referrals. However, additional follow-up is needed to ensure patients are receiving appropriate mental health care.

The therapeutic effects of rFSH versus uFSH/uHMG on ovarian stimulation in women undergoing assisted reproductive technology: a meta-analysis of randomized controlled trials

PURPOSE

This systematic review and meta-analysis aimed to compare the therapeutic effects of rFSH versus uFSH/uHMG on ovarian stimulation in women undergoing assisted reproductive technology.

METHODS

The databases of PubMed, Embase, and the Cochrane Library were systematically searched to retrieve data on eligible trials from inception until July 2022. The relative risks (RRs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs) were applied to assess categorical and continuous outcomes, and the pooled results were calculated using the random-effects model. Sensitivity, subgroup, and publication bias analyses were also performed.

RESULTS

Forty-eight trials that enrolled 10,127 women were included in this quantitative meta-analysis. There were no significant differences between rFSH and uFSH/uHMG in the clinical pregnancy rate (RR: 1.01; 95% CI 0.95-1.07; P = 0.760), live birth rate (RR: 0.98; 95% CI 0.91-1.06; P = 0.665), multiple pregnancy rate (RR: 0.92; 95% CI 0.77-1.09; P = 0.320), miscarriage rate (RR: 1.17; 95% CI 0.94-1.46; P = 0.151), and the incidence of ovarian hyperstimulation syndrome (RR: 1.25; 95% CI 0.91-1.70; P = 0.164). In addition, the administration of rFSH was associated with a higher number of oocyte retrieval compared with that of uFSH/uHMG (WMD: 0.61; 95% CI 0.03-1.20; P = 0.038), while no significant differences were found between rFSH and uFSH/uHMG in the dosage of gonadotrophin (WMD: 14.80; 95% CI - 136.97 to 166.57; P = 0.848) and the duration of ovarian stimulation (WMD: - 0.26; 95% CI - 0.62 to 0.10; P = 0.152). Thus, the exploratory analyses revealed several potential differences in the effects of rFSH versus uFSH/uHMG on ovarian stimulation.

CONCLUSION

The administration of rFSH significantly increased the number of oocytes retrieved, whereas there were no significant differences between the efficacies of rFSH and uFSH/uHMG for pregnancy outcomes.

The effect of positive psychotherapy-based training on psychological well-being and hope level in women receiving infertility: experimental study

BACKGROUND

Infertility is a multidimensional problem, which negatively affects the mental health of couples, especially women. Therefore this study was conducted to determine the effect of positive psychotherapy (PPT)-based training on psychological well-being and hope level of women receiving infertility treatment.

METHOD

The research was carried out in two Research Hospitals OGPH between November 2019 and December 2020 as an experimental model with pre-test-post-test control groups. Sample size for the study was determined by using the G.Power 3.1.9.2 program. The study was completed with 104 women (62 in the control group, 42 in the experimental group) receiving infertility treatment. The infertile women who were included in the study were determined by using the computer-assisted simple random sampling method. 8-session PPT-based training was provided for the women in the experimental group while no intervention was applied to the women in the control group. The trainings were carried out as individual and face-to-face training with the women in the experimental group.

RESULTS

After the PPT-based training, it was determined that the psychological well-being and hope levels of the women in the experimental group increased compared to the women in the control group.

CONCLUSION

In the study, it was found out that PPT-based training has a positive effect on increased psychological well-being and hope levels of infertile women.

Does extreme psychological burden (Hamas terrorist attack on October 7th, 2023) affect in vitro fertilization outcome?

OBJECTIVE

We aim to investigate the effect of extreme emotional and psychological trauma following Hamas terrorist attack on October 7th, 2023, on IVF cycle outcome.

PATIENTS AND METHODS

The study population consisted of all couples undergoing 2 consecutive IVF attempts with ovum pick-up in our institute, before and during the week of October 8th to 12th, 2023. Embryological/ laboratory variables of the IVF cycles were assessed and compared between the patients' IVF cycle before and those that underwent OPU during the spoken week.

RESULTS

Twenty-three couples were eligible for analysis. There were no differences between the cycles in the length of ovarian stimulation, total dose of gonadotropin used, and the peak estradiol and progesterone levels. Furthermore, while no differences were observed in the number of oocytes and mature oocytes retrieved or fertilization rate, the mean number of top-quality embryos per OPU (1.1 ± 1.7 vs. 2.2 ± 2.9; p < 0.02) and ratio of top-quality embryos per number of fertilized oocytes (0.5 ± 0.3 vs. 0.7 ± 0.2; p < 0.01) were significantly lower during the spoken week. Semen total motile count was significantly reduced during the spoken week.

CONCLUSIONS

In the present study, we are witness to the effect of acute emotional and psychological trauma on IVF outcome, as reflected by its detrimental effect on sperm and embryo quality.

Reliability and validity of the Chinese version of the COMPI Fertility Problem Stress Scale-Short Form for infertile women

OBJECTIVE

To translate and culturally adapt the COMPI Fertility Problem Stress Scale-Short form (COMPI-FPSS-SF) and to test its reliability and validity in China.

METHODS

The cross-sectional study adopted Brislin's translation model to translate, synthesize, back-translate, and cross-culturally adapt the COMPI-FPSS-SF for the Chinese setting. A total of 279 infertile women were invited to participate in the study to test the reliability and validity of the scale between March and June 2021.

RESULTS

It was verified that the Chinese version of the COMPI-FPSS-SF has three domains with nine items. The Cronbach's α coefficient of the total scale was 0.907, and the coefficient for each dimension ranged from 0.760 to 0.855. The test-retest validity was 0.891. The exploratory factor analysis extracted three common factors with eigenvalues of 4.499, 1.124, and 1.011 and a cumulative variance contribution of 73.706. The validity factor analysis showed good results for the three-factor structure fit. The criterion-related validity with the Fertility Inventory Short-Form Scale was 0.649. The above analysis revealed statistically significant differences (P < 0.001).

CONCLUSIONS

The Chinese version of the COMPI-FPSS-SF can be used for the assessment of fertility-related stress in infertility patients in China with good reliability and validity.

Emotional risk factors before in vitro fertilization among infertile couples in daily clinical practice in Sari in 2020-2022

BACKGROUND AND AIM

The relationship between psychological factors and treatment outcomes with assisted reproductive technology has sparked considerable debate. This study aims to investigate the emotional risk factors in couples seeking infertility treatment using assisted reproductive technology in Sari, Iran, from 2020 to 2022.

MATERIALS AND METHODS

This research is a cross-sectional study and emotional risk factors and other related factors were examined using the Persian version of the SCREENIVF demographic, social, and clinical status questionnaire, social, and clinical status questionnaire before using Assisted reproductive technology in 460 infertile couples selected from infertility treatment centers in Sari City, Iran. The samples were randomly selected using a table of random numbers. Data analysis was performed using SPSS version 22 software.

RESULTS

The mean age of the male and female participants were 31.70 ± 5.71 and 35.22 ± 5.48, respectively. The results regarding emotional risk factors and other related factors revealed that the variables of remarriage (P = 0.048) and exposure of spouse to emotional risk factors (P = 0.001), history of depression disorder (P = 0.007), and history of anxiety disorder (P = 0.009) were significantly correlated with the exposure of women to emotional risk factors. Furthermore, men's exposure to emotional risk factors was significantly correlated with primary education (P = 0.026) and diploma (P = 0.043) levels, age (P = 0.006), and wife's exposure to emotional risk factors (P = 0.001).

CONCLUSION

By identifying infertile couples who are at risk of emotional risk factors, healthcare professionals can provide appropriate support and interventions to mitigate the emotional challenges associated with infertility. This proactive approach can significantly enhance couples undergoing infertility treatment's well-being and mental health.

Psychological distress, vaccine, and booster acceptance in women considering or undergoing fertility treatments during the Omicron surge of the COVID-19 pandemic

OBJECTIVE

Follow-up study to evaluate perceptions of COVID-19 vaccination and booster with psychological distress during the COVID-19 pandemic and Omicron surge in women considering or undergoing fertility treatment.

MATERIALS AND METHODS

Cross-sectional anonymous survey (N = 2558) from a single academic fertility center. Five hundred forty patients completed the survey (response rate = 21.1%). Participants were randomized 1:1 to a one-page evidence-based graphic with information and benefits regarding COVID-19 vaccination. Mental health and vaccine hesitancy were assessed via the Patient Health Questionnaire Depression (PHQ-8), the Generalized Anxiety Disorder (GAD-7) scales, and the Medical Mistrust Index (MMI).

RESULTS

Majority of participants were nulliparous, fully vaccinated with a booster dose, with > 1 year of infertility and mild to moderate distress. Patients with vaccine hesitancy had higher medical mistrust scores (r = .21,  p < .001). Higher MMI scores were not associated with vaccination during pregnancy. Participants that had higher PHQ-8 and GAD-7 scores were more likely to believe the omicron variant would cause delay in fertility treatments, would have impact on fertility outcome, and were more likely exhibiting medical system distrust (p < .001). Participants who received educational material were more likely to know pregnant women with COVID-19 had increased risk of death, stillbirth, and preterm birth (p < .05).

CONCLUSION

The majority of women in this study were vaccinated and had received their booster dose but also with clinically significant levels of depression. Patients with higher levels of distress and greatest medical mistrust demonstrated a concern that the Omicron variant would delay treatment, lead to suboptimal fertility outcomes, and COVID-19 vaccination would impact risk of miscarriages.

Addressing the Rehabilitation Needs of Women Experiencing Infertility in Ethiopia: Time for Action

The psychological, social, and financial disabilities caused by infertility are significant for women, particularly those living in low- and middle-income countries such as Ethiopia. Although rehabilitation can be an important form of support for such women, infertility is frequently overlooked as a disability or potential target of rehabilitation interventions. This study aimed to determine what rehabilitation-related services and supports are available for women experiencing infertility in Ethiopia. We used an Interpretive Description design. We purposefully selected fourteen rehabilitation, medical, and policy service providers from diverse institutions across three geographical locations. We used semi-structured questions during our in-person and telephone interviews. The data were analyzed using reflexive thematic analysis with the assistance of NVivo. We identified five main themes, including (a) policies related to infertility, (b) the concept that disabilities are physically visible fails to recognize infertility, (c) the need for rehabilitation services for women with infertility, (d) the importance of wellness services for women experiencing infertility, and (e) the role of religion in rehabilitation services. In conclusion, it is essential to strengthen the policies around infertility, incorporate rehabilitation services in fertility care, and view infertility as a disabling condition for women who experience it in Ethiopia.

The Effect of Positive Psychotherapy-Based Training on Stigma and Self-Efficacy in Women Receiving Infertility Treatment

BACKGROUND

Infertility has increased in recent years. Infertility can cause many mental problems. The place of psychoeducation based on positive psychotherapy (PPT) is important in coping with mental problems.

AIMS

The aim of this study is to determine the effect of PPT-based training on stigma and self-efficacy in women receiving infertility treatment.

METHODS

This experimental study with randomized control group was completed with 64 women receiving infertility treatment. While the women in the experimental group received an 8-session PPT-based training, no intervention was applied to those in the control group.

RESULTS

A statistically significant difference was observed (p= .001) between the stigma and self-efficacy levels of the experimental group after the PPT-based training.

CONCLUSIONS

It was found that the PPT-based training was effective in decreasing stigma level of the women who received infertility treatment and increasing their self-efficacy level.

Evaluation of infertility counselling in Germany

PURPOSE

This paper reports on the first evaluation of infertility counselling in Germany.

METHODS

Sixty-nine infertility counsellors provided feedback via 524 survey sheets and 182 questionnaires were filled in by clients.

RESULTS

The results show a high level of satisfaction on behalf of the clients. They valued the emotional support, information, and exploration of family-building options with and without medical assistance and the counsellors' expertise. During counselling, coping with the emotional burden of infertility was an important issue, but in more than half of all counselling sessions, future parental issues were addressed. The group of clients seeking support can be described to be very heterogeneous, and counselling issues comprise a wide range of aspects.

CONCLUSIONS

This piece of research suggests that the following issues need to be considered to improve infertility counselling. Better integration of counselling in infertility clinics, more awareness for infertility counselling for other medical and non-medical professions Better funding for counselling so that its uptake is not dependent upon the financial resources of clients Awareness for new groups of clients and counselling issues such as single and transgender individuals, co-parenting families There is a need for more research and the development of counselling concepts.

Psychological consequences of a diagnosis of infertility in men: a systematic analysis

Almost half of infertility cases involve male infertility. Understanding the consequence of a diagnosis of male infertility, as a sole or partial contributor to the couples' infertility, to the mental health of men is required to ensure clinical care meets their psychological needs. The aim of this systematic analysis was to synthesize the evidence regarding whether men diagnosed with male factor infertility experience greater psychological distress than (1) men described as fertile and (2) men in couples with other infertility diagnoses. Online databases were searched using a combination of Medical Subject Headings (MeSH) headings and keywords relating to male infertility and psychological distress. The search yielded 1016 unique publications, of which 23 were included: 8 case-control, 14 prospective cohort, and 1 data linkage studies. Seven aspects of psychological distress were identified depression, anxiety, self-esteem, quality of life, fertility-related stress, general psychological stress or well-being, and psychiatric conditions. Case-control studies reported that men with male factor infertility have more symptoms of depression, anxiety and general psychological distress, worse quality of some aspects of life, and lower self-esteem than controls. When men with male factor infertility were compared to men in couples with other causes of infertility, there were few differences in the assessed aspects of psychological distress. Despite methodological limitations within the studies, this systematic analysis suggests that the experience of infertility, irrespective of its cause, negatively affects men's mental health and demonstrates the need for assisted reproduction technology (ART) providers to consider men undergoing assisted reproduction as individuals with their own unique support needs.

Consulting patients and providers of assisted reproductive technologies to inform the development of a group psychological intervention for women with infertility

Objective

To consult providers and women patients of Assisted Reproductive Technologies regarding their preferences for the format, duration and content in the development of a group psychological intervention.

Methods

Providers and current and past women patients of Assisted Reproductive Technologies completed an online cross-sectional survey comprising items about session content, number, frequency, timing, format, delivery mode and inclusion of experiential practice of psychological strategies to promote well-being.

Results

Eight providers, 51 current women patients and 51 women who previously underwent Assisted Reproductive Technologies participated. Sixty-two percent of participants indicated a group psychological program would be helpful; and 34% thought it may be helpful. Face-to-face was the preferred delivery mode (42%). Seventy-one percent preferred 60-min sessions held fortnightly (64%), with six sessions most acceptable (24%). Most respondents (74%) felt group participants would likely complete at-home practice. Detailed thematic content from participants highlighted a complex range of consumer challenges. Relevant behaviour change techniques were verified, with those to be included identified as: feedback and monitoring, regulation, self belief, reward and threat, natural consequences, identity, support, shaping knowledge, and comparison of outcomes.

Conclusion

Providers and patients were supportive of the development of a group psychological intervention to provide support for women undergoing Assisted Reproductive Technologies.

Innovation

The results of this study provide insight informing the co-design of a group psychological program for women with infertility.

What are antenatal maternity care needs of women who conceived through fertility treatment?: a mixed methods systematic review

BACKGROUND

Existing research indicates that pregnant women who conceived through fertility treatment might experience more stress and anxiety compared to women who conceived spontaneously. Therefore, these women might have additional antenatal care needs.

METHODS

A search for both quantitative and qualitative studies was performed in PubMed, PsycINFO, CINAHL and MEDLINE through May 2021, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. 21 articles met the inclusion criteria. After methodological quality appraisal using the Mixed Methods Appraising Tool, 15 studies were included in the review.

RESULTS

Analysis of the studies identified behavioral, relational/social, emotional, and cognitive needs and women's preference about maternity care. Women who conceived through fertility treatment reported lower social and physical functioning scores and elevated levels of anxiety and depression compared to women who conceived spontaneously. They reported difficulties adjusting to pregnancy and experienced a care gap between discharge from the fertility clinic and going to local maternity care services for their first consultation, and a care gap postpartum.

CONCLUSIONS

Women who conceived through fertility treatment have additional antenatal care needs. We recommend to offer these women more frequent check-ins, and to pay attention to the impact of their infertility and treatment on their pregnancy.

Systematic Review: Risk Factors of Anxiety, Depressiveness, and (Lack of) Social Support in Women and Men Prior to Assisted Reproduction

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.

Optimizing the "Time to pregnancy" in women with multiple sclerosis: the OPTIMUS Delphi survey

Background

The debate on how to manage women affected by multiple sclerosis (MS) during reproductive age is still open, as is the issue of fertility in such patients. Main issue regard the identification of the optimal window for pregnancy and how to deal with medical therapy before and during conception. The aim of this Delphi consensus was to collect the opinions of a multidisciplinary group, involving reproductive medicine specialists and neurologists with experience in the management of multiple sclerosis women with reproductive desire.

Methods

Four experts plus scientific coordinators developed a questionnaire distributed online to 10 neurologists and later discussed the responses and amended a list of statements. The statements were then distributed via an online survey to 23 neurologists (comprising the first 10), who voted on their level of agreement/disagreement with each statement. Consensus was achieved if agreement or disagreement with a statement exceeded 66%.

Results

Twenty-one statements reached consensus after two rounds of voting, leading to the following main recommendations: (1) Fertility evaluation should be suggested to wMS, in case of the need to shorten time to pregnancy and before treatment switch in women on DMTs contraindicated in pregnancy, particularly in case of highly active disease and age > 35 years. (2) ART should not be discouraged in wMS, but the use of DMTs until pregnancy confirmation should be suggested; ART may be considered in order to reduce time to pregnancy in MS women with a reduced ovarian reserve and/or age > 35 years, but in case of an expected poor ART prognosis and the need for more than one ART cycle, a switch to a high-efficacy DMD before ART should be offered. (3) Oocyte cryopreservation may be considered in women with reduced ovarian reserve, with unpredictable time to complete diagnostic workup and achieve disease control; a risk/cost-benefit analysis must be performed in women >35 years, considering the diminished ovarian reserve.

Conclusion

This consensus will help MS neurologists to support family planning in wMS, respecting MS therapeutic needs while also taking into account the safety and impact of advancing age on fertility.

A blended preconception lifestyle programme for couples undergoing IVF: lessons learned from a multicentre randomized controlled trial

STUDY QUESTION

What is the effect of a blended preconception lifestyle programme on reproductive and lifestyle outcomes of couples going through their first 12 months of IVF as compared to an attention control condition?

SUMMARY ANSWER

This randomized controlled trial (RCT) was stopped prematurely because of the coronavirus disease 2019 (Covid-19) pandemic but the available data did not suggest that a blended preconception lifestyle programme could meaningfully affect time to ongoing pregnancy or other reproductive and lifestyle outcomes.

WHAT IS KNOWN ALREADY

Increasing evidence shows associations between a healthy lifestyle and IVF success rates. Lifestyle programmes provided through a mobile phone application have yet to be evaluated by RCTs in couples undergoing IVF.

STUDY DESIGN SIZE DURATION

A multicentre RCT (1:1) was carried out. The RCT started in January 2019 and was prematurely stopped because of the Covid-19 pandemic, leading to a reduced sample size (211 couples initiating IVF) and change in primary outcome (cumulative ongoing pregnancy to time to ongoing pregnancy).

PARTICIPANTS/MATERIALS SETTING METHODS

Heterosexual couples initiating IVF in five fertility clinics were randomized between an attention control arm and an intervention arm for 12 months. The attention control arm received treatment information by mobile phone in addition to standard care. The intervention arm received the blended preconception lifestyle (PreLiFe)-programme in addition to standard care. The PreLiFe-programme included a mobile application, offering tailored advice and skills training on diet, physical activity and mindfulness, in combination with motivational interviewing over the telephone. The primary outcome was 'time to ongoing pregnancy'. Secondary reproductive outcomes included the Core Outcome Measures for Infertility Trials and IVF discontinuation. Changes in the following secondary lifestyle outcomes over 3 and 6 months were studied in both partners: diet quality, fruit intake, vegetable intake, total moderate to vigorous physical activity, sedentary behaviour, emotional distress, quality of life, BMI, and waist circumference. Finally, in the intervention arm, acceptability of the programme was evaluated and actual use of the mobile application part of the programme was tracked. Analysis was according to intention to treat.

MAIN RESULTS AND THE ROLE OF CHANCE

A total of 211 couples were randomized (105 control arm, 106 intervention arm). The hazard ratio of the intervention for time to ongoing pregnancy was 0.94 (95% CI 0.63 to 1.4). Little to no effect on other reproductive or lifestyle outcomes was identified. Although acceptability of the programme was good (6/10), considerable proportions of men (38%) and 9% of women did not actively use all the modules of the mobile application (diet, physical activity, or mindfulness).

LIMITATIONS REASONS FOR CAUTION

The findings of this RCT should be considered exploratory, as the Covid-19 pandemic limited its power and the actual use of the mobile application was low.

WIDER IMPLICATIONS OF THE FINDINGS

This is the first multicentre RCT evaluating the effect of a blended preconception lifestyle programme for women and their partners undergoing IVF on both reproductive and lifestyle outcomes. This exploratory RCT highlights the need for further studies into optimal intervention characteristics and actual use of preconception lifestyle programmes, as well as RCTs evaluating effectiveness.

STUDY FUNDING/COMPETING INTERESTS

Supported by the Research foundation Flanders (Belgium) (FWO-TBM; reference: T005417N). No competing interests to declare.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov Identifier: NCT03790449.

TRIAL REGISTRATION DATE

31 December 2018.

DATE OF FIRST PATIENT’S ENROLMENT

2 January 2019.

Belgian Fertility Clinic Staff Value Healthy Lifestyle Promotion but Lack Access to a Structured Lifestyle Modification Programme: An Observational Study

OBJECTIVES

Guidelines advise promoting a healthy lifestyle among patients with fertility problems as the lifestyle of women and men proved to be associated with their fertility. Australian fertility nurses were shown to lack access to structured lifestyle modification programmes, although they value healthy lifestyle promotion. This study aimed to examine whether gynaecologists also value promoting a healthy lifestyle and whether structured lifestyle modification programmes are available in Belgian fertility clinics.

DESIGN

An observational study was conducted among health care professionals (HCPs) working in Belgian fertility clinics.

PARTICIPANTS/MATERIALS, SETTING, METHODS

An Australian questionnaire on attitudes and practices related to promoting a healthy lifestyle among patients with fertility problems was reciprocally back-to-back translated and three open-ended questions were added. All HCPs of Belgian fertility clinics, including gynaecologists, fertility nurses/midwives, psychologists, and embryologists, were invited by e-mail to complete the questionnaire online. Responses to closed and open-ended questions were analysed with, respectively, descriptive statistics and qualitative thematic analysis. Finally, differences in perspectives between different groups of HCPs were explored.

RESULTS

A total of 50 fertility nurses/midwives, 42 gynaecologists, and 19 other HCPs completed the survey (n = 111). Regarding attitudes, all respondents valued informing patients about the impact of lifestyle on fertility. The vast majority of HCPs (n = 96; 86%) stated that fertility clinics have the responsibility to address unhealthy lifestyles prior to offering fertility treatment. Fertility nurses/midwives were significantly more likely than gynaecologists to state that fertility clinics have this responsibility (p = 0.040). Regarding practices, the patient's lifestyle was most commonly discussed by the gynaecologist (n = 107; 96%) during the first appointment (n = 105; 95%). The lifestyle factors that were being addressed, according to the vast majority of respondents, were smoking, weight, age, alcohol, and recreational drugs. Only three HCPs (from three different clinics) stated that their clinic offered a structured lifestyle modification programme. HCPs explained that they lacked the resources and expertise for offering a structured lifestyle modification programme.

LIMITATIONS

Response rates were limited, but the responding Belgian gynaecologists and fertility nurses/midwives confirmed the findings of the previous study in Australian fertility nurses.

CONCLUSIONS

HCPs working in Belgian fertility clinics value healthy lifestyle promotion but lack access to structured lifestyle modification programmes to implement in their daily clinical practice. Future studies should focus on developing and evaluating structured lifestyle modification programmes for patients with fertility problems.

The Effect of Age on Semen Quality Among Male Partners of Infertile Couples: An Observational Study in a Tertiary Care Center in Eastern India

INTRODUCTION

Male infertility contributes to a significant proportion of infertility cases, and advanced paternal age has been suggested to affect semen quality and fertility. However, the relationship between age and semen quality remains inconclusive, with conflicting findings reported in the literature. This study aimed to investigate the effect of age on semen quality among male partners of infertile couples in a tertiary care center in eastern India.

METHODS

A cross-sectional observational study was conducted, involving 390 male participants aged 21-50 years, who were referred to the andrology laboratory for semen analysis between January 2019 and December 2022. Participants were categorized into three age groups (21-30, 31-40, and 41-50 years). Semen parameters, including sperm concentration, semen volume, motility, and morphology, were assessed according to the World Health Organization guidelines.

RESULTS

Among the participants, no significant differences were observed in semen volume, motility, and morphology across different age groups. However, a statistically significant difference in sperm concentration among the three age groups was observed (p = 0.022). Spearman correlation analysis revealed a positive correlation between age and sperm concentration (r = 0.124, p = 0.013) as well as total sperm count (r = 0.10, p = 0.049).

CONCLUSION

In this study, no significant decline in semen quality with age was found among male partners of infertile couples aged 21-50 years. These findings highlight the complex relationship between age and semen quality and emphasize the need for further research to better understand the underlying mechanisms and provide more conclusive evidence regarding the impact of age on male fertility.

Effectiveness of a mixed lifestyle program in couples undergoing assisted reproductive technology: a study protocol

BACKGROUND

The desire for fertility is the manifestation of yearning for immortality. Infertility and assisted reproductive technology (ART) expose couples to great affective, anxiety, stress, and financial burden. Increasing evidence emphasize the impact of lifestyle on infertility. One of the most crucial factors affecting the fertility process is the nutrition patterns, the amount and quality of physical activities, emotional problems management; modulate stressors, relief from anxiety, and the living conditions of couples. Most ART treatment interventions in Iran are not integrated into lifestyle programs. Therefore, this research will investigate the impact of mixed fertility health-promoting programs in couples who use ARTs.

METHODOLOGY/DESIGN

This study entails three steps. The first step includes the systematic review of literature on a health-promoting lifestyle in infertile couples undergoing ARTs, a systematic review of observational studies and interventions in couple's lifestyle, then, a systematic review of qualitative studies on infertility in couples and their lifestyle, and in the final step couple's life style literature systematically will evaluate in Iran. In case of failure to obtain the required results from systematic reviews, cross-sectional studies will be carried out to determine the lifestyle of infertile couples receiving ARTs. In the second stage, by holding a panel of experts, an intervention is planned based on the results of the previous stages in order to improve the lifestyle of couples. In the final step, the designed intervention will be administered as a random clinical trial-on ART candidates, in intervention or control groups in one of Iran University of Medical Sciences hospitals. Afterward, the data's will be evaluated by using standard questionnaires, that include health-promoting lifestyle questionnaire (HPLII), Beck's depression inventory (BDI), international physical activity questionnaire-short form (IPAQ-SF), and food frequency questionnaire (FFQ). The statistical analysis will be carried out in SPSS software. During the study, subjects meeting the inclusion criteria were randomly selected and randomized into the intervention and control groups. The health-promoting lifestyle training program will be executed for the intervention group while the standard care program is administered to the control group. The content of this program will be obtained from the consensus opinions of the expert panel. The program includes diet recommendations, physical activity, and stress management. Appropriate time, frequency, duration and number of activities will be considered. Communication with subjects will be possible through private meeting special comfort room. Support to the participants will also be through clinical visits social media, SMS and phone calls. Nutritional changes, physical activity amount, anxiety and stress level, abdominal circumference (AC), and body mass index (BMI) will be measured after the completion of the specified time interval. The initial outcome includes examining chemical pregnancy (2 weeks after the transmission) and clinical pregnancy by ultrasound (6 weeks after). The secondary outcome will be live birth rate. Retrieved oocyte and embryo numbers will also be reported.

DISCUSSION

Health-promoting lifestyle programs are essential in assisted reproductive technologies to improve pregnancy results and live birth. These programs in association with in-vitro fertilization (IVF) influence the outcome of fertilization. In addition, enhancing parental health leads to healthy pregnancy outcome. Despite the frequency of lifestyle risk factors, employing proper methods helps reduce anxiety and stress, modify dietary patterns, and perform qualitatively and quantitatively balanced physical activities. In addition, having coping skills and mental health management methods, in nowadays modern world challenges seems crucial and effective in solving fertility problems and reducing them before pregnancy.

Psychological Aspects of Infertility - Results from an Actor-Partner Interdependence Analysis

Introduction For some patients, undergoing medical treatment for infertility is a cause of major emotional stress which the couple needs to deal with together; it can be said that infertility is a shared stressor. From the literature it is known that a subjectively perceived sense of self-efficacy supports the patient's ability to cope adaptively with an illness. As the basis for this study, we assumed that high levels of self-efficacy are associated with low psychological risk scores (e.g., for anxiety or depressiveness), both in the patient themselves and in their partner. Accordingly, in infertility patients, targeted support to promote helpful self-efficacy expectations could represent a new counselling strategy that could enable psychologically vulnerable patients to better cope with the treatment procedure and treatment failures of medically assisted reproduction, making these patients less at risk with regard to psychosocial factors. Methods 721 women and men attending five fertility centers in Germany (Heidelberg, Berlin), Austria (Innsbruck), and Switzerland (St. Gallen, Basel) completed the SCREENIVF-R questionnaire to identify psychological risk factors for amplified emotional problems, as well as the ISE scale to measure self-efficacy. Using paired t-tests and the actor-partner interdependence model, we analyzed the data of 320 couples. Results Considering the study participants as couples, women had a higher risk score than men for four out of five risk factors (depressiveness, anxiety, lack of acceptance, helplessness). In all of the risk areas, it was possible to identify a protective effect from self-efficacy on the patient's own risk factors (actor effect). There was a negative correlation between the men's self-efficacy level and the women's feelings of depressiveness and helplessness (partner effect, man → woman). The women's self-efficacy levels had a positive correlation with acceptance and access to social support in the men (partner effect, woman → man). Conclusion Because infertility is generally something that a couple has to deal with together, future studies should focus on couples as the unit of analysis instead of just analyzing the men and women separately. In addition, couples therapy should be the gold standard in psychotherapy for infertility patients.

ESHRE good practice recommendations on recurrent implantation failure

STUDY QUESTION

How should recurrent implantation failure (RIF) in patients undergoing ART be defined and managed?

SUMMARY ANSWER

This is the first ESHRE good practice recommendations paper providing a definition for RIF together with recommendations on how to investigate causes and contributing factors, and how to improve the chances of a pregnancy.

WHAT IS KNOWN ALREADY

RIF is a challenge in the ART clinic, with a multitude of investigations and interventions offered and applied in clinical practice, often without biological rationale or with unequivocal evidence of benefit.

STUDY DESIGN SIZE DURATION

This document was developed according to a predefined methodology for ESHRE good practice recommendations. Recommendations are supported by data from the literature, if available, and the results of a previously published survey on clinical practice in RIF and the expertise of the working group. A literature search was performed in PubMed and Cochrane focussing on 'recurrent reproductive failure', 'recurrent implantation failure', and 'repeated implantation failure'.

PARTICIPANTS/MATERIALS SETTING METHODS

The ESHRE Working Group on Recurrent Implantation Failure included eight members representing the ESHRE Special Interest Groups for Implantation and Early Pregnancy, Reproductive Endocrinology, and Embryology, with an independent chair and an expert in statistics. The recommendations for clinical practice were formulated based on the expert opinion of the working group, while taking into consideration the published data and results of the survey on uptake in clinical practice. The draft document was then open to ESHRE members for online peer review and was revised in light of the comments received.

MAIN RESULTS AND THE ROLE OF CHANCE

The working group recommends considering RIF as a secondary phenomenon of ART, as it can only be observed in patients undergoing IVF, and that the following description of RIF be adopted: 'RIF describes the scenario in which the transfer of embryos considered to be viable has failed to result in a positive pregnancy test sufficiently often in a specific patient to warrant consideration of further investigations and/or interventions'. It was agreed that the recommended threshold for the cumulative predicted chance of implantation to identify RIF for the purposes of initiating further investigation is 60%. When a couple have not had a successful implantation by a certain number of embryo transfers and the cumulative predicted chance of implantation associated with that number is greater than 60%, then they should be counselled on further investigation and/or treatment options. This term defines clinical RIF for which further actions should be considered. Nineteen recommendations were formulated on investigations when RIF is suspected, and 13 on interventions. Recommendations were colour-coded based on whether the investigations/interventions were recommended (green), to be considered (orange), or not recommended, i.e. not to be offered routinely (red).

LIMITATIONS REASONS FOR CAUTION

While awaiting the results of further studies and trials, the ESHRE Working Group on Recurrent Implantation Failure recommends identifying RIF based on the chance of successful implantation for the individual patient or couple and to restrict investigations and treatments to those supported by a clear rationale and data indicating their likely benefit.

WIDER IMPLICATIONS OF THE FINDINGS

This article provides not only good practice advice but also highlights the investigations and interventions that need further research. This research, when well-conducted, will be key to making progress in the clinical management of RIF.

STUDY FUNDING/COMPETING INTERESTS

The meetings and technical support for this project were funded by ESHRE. N.M. declared consulting fees from ArtPRED (The Netherlands) and Freya Biosciences (Denmark); Honoraria for lectures from Gedeon Richter, Merck, Abbott, and IBSA; being co-founder of Verso Biosense. He is Co-Chief Editor of Reproductive Biomedicine Online (RBMO). D.C. declared being an Associate Editor of Human Reproduction Update, and declared honoraria for lectures from Merck, Organon, IBSA, and Fairtility; support for attending meetings from Cooper Surgical, Fujifilm Irvine Scientific. G.G. declared that he or his institution received financial or non-financial support for research, lectures, workshops, advisory roles, or travelling from Ferring, Merck, Gedeon-Richter, PregLem, Abbott, Vifor, Organon, MSD, Coopersurgical, ObsEVA, and ReprodWissen. He is an Editor of the journals Archives of Obstetrics and Gynecology and Reproductive Biomedicine Online, and Editor in Chief of Journal Gynäkologische Endokrinologie. He is involved in guideline developments and quality control on national and international level. G.L. declared he or his institution received honoraria for lectures from Merck, Ferring, Vianex/Organon, and MSD. He is an Associate Editor of Human Reproduction Update, immediate past Coordinator of Special Interest Group for Reproductive Endocrinology of ESHRE and has been involved in Guideline Development Groups of ESHRE and national fertility authorities. D.J.M. declared being an Associate Editor for Human Reproduction Open and statistical Advisor for Reproductive Biomedicine Online. B.T. declared being shareholder of Reprognostics and she or her institution received financial or non-financial support for research, clinical trials, lectures, workshops, advisory roles or travelling from support for attending meetings from Ferring, MSD, Exeltis, Merck Serono, Bayer, Teva, Theramex and Novartis, Astropharm, Ferring. The other authors had nothing to disclose.

DISCLAIMER

This Good Practice Recommendations (GPR) document represents the views of ESHRE, which are the result of consensus between the relevant ESHRE stakeholders and are based on the scientific evidence available at the time of preparation. ESHRE GPRs should be used for information and educational purposes. They should not be interpreted as setting a standard of care or be deemed inclusive of all proper methods of care, or be exclusive of other methods of care reasonably directed to obtaining the same results. They do not replace the need for application of clinical judgement to each individual presentation, or variations based on locality and facility type. Furthermore, ESHRE GPRs do not constitute or imply the endorsement, or favouring, of any of the included technologies by ESHRE.

The Italian Society of Andrology and Sexual Medicine (SIAMS), along with ten other Italian Scientific Societies, guidelines on the diagnosis and management of erectile dysfunction

PURPOSE

Erectile dysfunction (ED) is one of the most prevalent male sexual dysfunctions. ED has been in the past mistakenly considered a purely psycho-sexological symptom by patients and doctors. However, an ever-growing body of evidence supporting the role of several organic factors in the pathophysiological mechanisms underlying ED has been recognized.

METHODS

The Italian Society of Andrology and Sexual Medicine (SIAMS) commissioned an expert task force involving several other National Societies to provide an updated guideline on the diagnosis and management of ED. Derived recommendations were based on the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system.

RESULTS

Several evidence-based statements were released providing the necessary up-to-date guidance in the context of ED with organic and psychosexual comorbidities. Many of them were related to incorrect lifestyle habits suggesting how to associate pharmacotherapies and counseling, in a couple-centered approach. Having the oral therapy with phosphodiesterase type 5 inhibitors as the gold standard along with several other medical and surgical therapies, new therapeutic or controversial options were also discussed.

CONCLUSIONS

These are the first guidelines based on a multidisciplinary approach that involves the most important Societies related to the field of sexual medicine. This fruitful discussion allowed for a general agreement on several recommendations and suggestions to be reached, which can support all stakeholders in improving couple sexual satisfaction and overall general health.

Discussing the possibility of fertility treatment being unsuccessful as part of routine care offered at clinics: patients' experiences, willingness, and preferences

STUDY QUESTION

Are patients willing to discuss the possibility of treatment being unsuccessful as part of routine care offered at clinics, and what are the factors associated with this willingness?

SUMMARY ANSWER

Nine in every 10 patients are willing to discuss this possibility as part of routine care, with willingness being associated with higher perceived benefits, lower barriers, and stronger positive attitudes towards it.

WHAT IS KNOWN ALREADY

Fifty-eight percent of patients who complete up to three cycles of IVF/ICSI in the UK do not achieve a live birth. Offering psychosocial care for unsuccessful fertility treatment (PCUFT), defined as assistance and guidance on the implications of treatment being unsuccessful, could reduce the psychosocial distress patients experience when it happens, and promote positive adjustment to this loss. Research shows 56% of patients are willing to plan for an unsuccessful cycle, but little is known about their willingness and preferences towards discussing the possibility of definitive unsuccessful treatment.

STUDY DESIGN, SIZE, DURATION

The study was of cross-sectional design, comprising a theoretically driven and patient-centred bilingual (English, Portuguese) mixed-methods online survey. The survey was disseminated via social media (April 2021-January 2022). Eligibility criteria included being aged 18 or older, waiting to or undergoing an IVF/ICSI cycle, or having completed a cycle within the previous 6 months without achieving a pregnancy. Out of 651 people accessing the survey, 451 (69.3%) consented to participate. From these, 100 did not complete 50% of the survey questions, nine did not report on the primary outcome variable (willingness), and 342 completed the survey (completion rate 75.8%, 338 women).

PARTICIPANTS/MATERIALS, SETTING, METHODS

The survey was informed by the Health Belief Model (HBM) and Theory of Planned Behaviour (TPB). Quantitative questions covered sociodemographic characteristics and treatment history. Quantitative and qualitative questions gathered data on past experiences, willingness, and preferences (with whom, what, how and when) to receive PCUFT, as well as theory-informed factors hypothesized to be associated with patients' willingness to receive it. Descriptive and inferential statistics were used on quantitative data about PCUFT experiences, willingness, and preferences, and thematic analysis was applied to textual data. Two logistic regressions were used to investigate the factors associated with patients' willingness.

MAIN RESULTS AND THE ROLE OF CHANCE

Participants were, on average, 36 years old and most resided in Portugal (59.9%) and the UK (38.0%). The majority (97.1%) were in a relationship for around 10 years, and 86.3% were childless. Participants were undergoing treatment for, on average, 2 years [SD = 2.11, range: 0-12 years], with most (71.8%) having completed at least one IVF/ICSI cycle in the past, almost all (93.5%) without success. Around one-third (34.9%) reported having received PCUFT. Thematic analysis showed participants received it mainly from their consultant. The main topic discussed was patients' low prognosis, with the emphasis being put on achieving a positive outcome. Almost all participants (93.3%) would like to receive PCUFT. Reported preferences indicated that 78.6% wanted to receive it from a psychologist/psychiatrist/counsellor, mostly in case of a bad prognosis (79.4%), emotional distress (73.5%), or difficulties in accepting the possibility of treatment being unsuccessful (71.2%). The preferred time to receive PCUFT was before initiating the first cycle (73.3%), while the preferred format was in an individual (mean = 6.37, SD = 1.17; in 1-7 scale) or couple (mean = 6.34, SD = 1.24; in 1-7 scale) session. Thematic analysis showed participants would like PCUFT to provide an overview of treatment and all possible outcomes tailored to each patient's circumstances and to encompass psychosocial support, mainly focused on coping strategies to process loss and sustain hope towards the future. Willingness to receive PCUFT was associated with higher perceived benefit of building psychosocial resources and coping strategies (odds ratios (ORs) 3.40, 95% CI 1.23-9.38), lower perceived barrier of triggering negative emotions (OR 0.49, 95% CI 0.24-0.98), and stronger positive attitudes about PCUFT being beneficial and useful (OR 3.32, 95% CI 2.12-5.20).

LIMITATIONS, REASONS FOR CAUTION

Self-selected sample, mainly composed of female patients who had not yet achieved their parenthood goals. The small number of participants unwilling to receive PCUFT reduced statistical power. The primary outcome variable was intentions, and research shows a moderate association between intentions and actual behaviour.

WIDER IMPLICATIONS OF THE FINDINGS

Fertility clinics should provide patients with early opportunities to discuss the possibility of their treatment being unsuccessful as part of routine care. PCUFT should focus on minimizing suffering associated with grief and loss by reassuring patients they can cope with any treatment outcome, promoting coping resources, and signposting to additional support.

STUDY FUNDING/COMPETING INTEREST(S)

M.S.-L. holds a doctoral fellowship from the Portuguese Foundation for Science and Technology, I.P. [Fundação para a Ciência e a Tecnologia] (FCT; SFRH/BD/144429/2019). R.C. holds a post-doctoral fellowship supported by the European Social Fund (ESF) and FCT (SFRH/BPD/117597/2016). The EPIUnit, ITR and CIPsi (PSI/01662) are also financed by FCT through the Portuguese State Budget, in the scope of the projects UIDB/04750/2020, LA/P/0064/2020 and UIDB/PSI/01662/2020, respectively. Dr Gameiro reports consultancy fees from TMRW Life Sciences and Ferring Pharmaceuticals A/S, speaker fees from Access Fertility, SONA-Pharm LLC, Meridiano Congress International and Gedeon Richter, grants from Merck Serono Ltd, an affiliate of Merck KgaA, Darmstadt, Germany.

TRIAL REGISTRATION NUMBER

N/A.

Factors that affect career success of nurses who practice in assisted reproductive technology

to examine the relationship between career success and work environment of nurses who practice in assisted reproductive technology and to identify factors that affect career success. a cross-sectional study conducted in 53 fertility centres in 26 provinces in mainland China. Data were collected using a demographic data questionnaire, a specialised nursing competence questionnaire, the Career-Success Scale, and the Nursing Work Environment Scale. Descriptive and inferential statistics were applied. 597 assisted reproductive technology nurses participated in our survey, and 555 valid questionnaires were collected. Theoverall mean scores for career success and work environment were 3.75 [standard deviation (SD) = 1.01] and 3.42 (SD = 0.77) respectively. There was a strong positive correlation between career success and work environment (r = 0.742, p < 0.01). Multiple regression showed that attending academic conferences, psychological care, professional development, support and care, salary, and welfare were significant factors that influence career success. attending academic conferences, psychological care, and work environment are positively related to career success. Administrators should consider ways to address these factors.

Factors that affect career success of nurses who practice in assisted reproductive technology

to examine the relationship between career success and work environment of nurses who practice in assisted reproductive technology and to identify factors that affect career success. a cross-sectional study conducted in 53 fertility centres in 26 provinces in mainland China. Data were collected using a demographic data questionnaire, a specialised nursing competence questionnaire, the Career-Success Scale, and the Nursing Work Environment Scale. Descriptive and inferential statistics were applied. 597 assisted reproductive technology nurses participated in our survey, and 555 valid questionnaires were collected. Theoverall mean scores for career success and work environment were 3.75 [standard deviation (SD) = 1.01] and 3.42 (SD = 0.77) respectively. There was a strong positive correlation between career success and work environment (r = 0.742, p < 0.01). Multiple regression showed that attending academic conferences, psychological care, professional development, support and care, salary, and welfare were significant factors that influence career success. attending academic conferences, psychological care, and work environment are positively related to career success. Administrators should consider ways to address these factors.

The effect of the approach based on the Neuman Systems Model on stress and coping in women receiving intrauterine insemination treatment: A randomized controlled trial

This randomized controlled study was conducted to determine the effect of the approach based on the Neuman Systems Model (NSM) on stress and coping in women receiving intrauterine insemination (IUI) treatment. The study participants consisted of 62 women. Data was collected using a personal information form, the COMPI Fertility Problem Stress Scale, and the COMPI Coping Strategy Scale. Women in the intervention group had lower stress levels in their personal and marital domain post-test median scores than those in the control group. Women in the intervention group also had lower active-avoidance coping method and higher meaning-based coping method post-test mean scores. The NSM-based approach is beneficial in decreasing stress and positively affects women to cope with stress. Both infertility and its treatments are stressful. Health care professionals have important responsibilities for reducing the stress of infertile women and strengthening infertile women's ability to cope. The NSM-based approach is considered to have positive effects on stress and the ability of women to cope who receive IUI treatments. In addition, IUI is a widely applied method which is used before switching to assisted reproductive techniques. If this treatment fails, the stress coping techniques learned during this treatment can be used in later treatment processes. We conducted this study to investigate the effects of the NSM-based approach on stress and coping strategies in women receiving IUI treatment.

Effectiveness of psychosocial interventions for infertile women: A systematic review and meta-analysis with a focus on a method-critical evaluation

BACKGROUND

Approximately seven to nine percent of couples of reproductive age do not get pregnant despite regular and unprotected sexual intercourse. Various psychosocial interventions for women and men with fertility disorders are repeatedly found in the literature. The effects of these interventions on outcomes such as anxiety and depression, as well as on the probability of pregnancy, do not currently allow for reliable generalisable statements. This review includes studies published since 2015 performing a method-critical evaluation of the studies. Furthermore, we suggest how interventions could be implemented in the future to improve anxiety, depression, and pregnancy rates.

METHOD

The project was registered with Prospero (CRD42021242683 13 April 2021). The literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Six databases were searched and 479 potential studies were discovered. After reviewing the full texts, ten studies were included for the synthesis. Not all studies reported the three outcomes: four studies each for depression, three for anxiety and nine studies for pregnancy rates were included in the meta-analysis, which was conducted using the Comprehensive meta-analysis (CMA) software.

RESULTS

Psychosocial interventions do not significantly change women's anxiety (Hedges' g -0,006; CI: -0,667 to 0,655; p = 0,985), but they have a significant impact on depression in infertile women (Hedges' g -0,893; CI: -1,644 to -0,145; p = 0,026). Implementations of psychosocial interventions during assisted reproductive technology (ART) treatment do not increase pregnancy rates (odds ratio 1,337; 95% CI 0,983 to 1,820; p = 0,064). The methodological critical evaluation indicates heterogeneous study design and samples. The results of the studies were determined with different methods and make comparability difficult. All these factors do not allow for a uniform conclusion.

METHODOLOGICAL CRITICAL EVALUATION

Study design (duration and timing of intervention, type of intervention, type of data collection) and samples (age of women, reason for infertility, duration of infertility) are very heterogeneous. The results of the studies were determined with different methods and make comparability difficult. All these factors do not allow for a uniform conclusion.

CONCLUSION

In order to be able to better compare psychosocial interventions and their influence on ART treatment and thus also to achieve valid results, a standardised procedure to the mentioned factors is necessary.