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Bian C, Cao J, Chen K, Xia X, Yu X. Effectiveness of psychological interventions on pregnancy rates in infertile women undergoing assisted reproductive technologies: a meta-analysis of randomised controlled trials. Biotechnol Genet Eng Rev 2024; 40:4512-4531. [PMID: 37200381 DOI: 10.1080/02648725.2023.2213080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/08/2023] [Indexed: 05/20/2023]
Abstract
The purpose of this study was to assess the effects of psychological interventions on the pregnancy rates of infertile women undergoing assisted reproductive technology (ART). Using the electronic databases PubMed, EM Base, Cochrane Library, WOS, CNKI, WanFang Data, CSTJ, and CBM, a systematic literature search was conducted in the second week of August 2019. Randomized controlled trials (RCTs) on the effect of psychological interventions on the pregnancy rate of infertile women undergoing assisted reproductive technology were collected. There is no time limit for this search setting. The language is limited to Chinese or English. Two investigators independently screened the literature, extracted data, and assessed the risk of bias of the included studies, and then used Revman5.3 and STATA16.0 software for meta-analysis. A total of 25 randomized controlled trials were included in this meta-analysis, including 2098 patients in the experimental group and 2075 patients in the control group. There was a significant difference in the pregnancy rate between the two groups [RR=1.31, 95%CI(1.22,1.40)]. Subgroup analysis showed that this is also true of infertile women of different nationalities, different intervention timing and format. However, different psychological interventions may indeed have different effects. Current evidence suggests that psychological interventions may improve pregnancy rates in infertile women undergoing assisted reproductive technology. Limited by the quantity and quality of included studies, the above conclusions need to be verified by more high-quality studies. Our PROSPERO registration number is: CRD42019140666.
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Affiliation(s)
- Chaorong Bian
- Medical Service Division, Changzhou Children's Hospital Affiliated to Nantong University, Changzhou, Jiangsu, China
| | - Jie Cao
- Department of Intensive Care Rehabilitation, Yixing JORU Rehabilitation Hospital, Wuxi, Jiangsu, China
| | - Kejin Chen
- Changzhou maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, China
| | - Xiyang Xia
- Changzhou maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, China
| | - Xuexia Yu
- Changzhou maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, China
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Poulter MML, Balsom AA, Gordon JL. Pilot trial of a new self-directed psychological intervention for infertility-related distress. Pilot Feasibility Stud 2024; 10:111. [PMID: 39152484 PMCID: PMC11328509 DOI: 10.1186/s40814-024-01535-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 08/05/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND Now affecting one in six couples in Canada, infertility is defined as a lack of conception after 12 or more months of regular, unprotected heterosexual intercourse. Infertility is associated with immense psychological burden, particularly for individuals assigned female at birth. Yet existing psychological interventions are not specialized to this population and have been shown to be only marginally effective at relieving distress related to infertility. Thus, a new online self-directed psychological intervention was co-created with a panel of women experiencing infertility, and ultimately consisted of six 10-min video modules addressing the cognitive, emotional, and interpersonal aspects of infertility-related distress. METHODS In the current study, 21 women experiencing reduced quality of life related to infertility were recruited to participate in a one-arm pre-post pilot testing the feasibility, acceptability, and preliminary efficacy of the program. Participant adherence and retention were monitored, and participants rated the credibility of the program and the helpfulness of each module as well as provided feedback on the content and format of the program. Pre-to-post changes in fertility quality of life, anxious symptoms, depressive symptoms, and relationship satisfaction were examined. RESULTS The program modules were highly rated by participants, with average helpfulness ratings ranging from 7.5 to 8.2/10. Two participants became pregnant and therefore stopped prematurely, 79% of the remaining participants completed all six modules, and participants reported completing 52.8 (SD = 82.0) min of homework per week. Participants perceived the intervention as highly credible and generally approved of the format, length, and speed; however, 68% of participants had recommendations for additional content to be included in the intervention. While relationship satisfaction did not change significantly over time, large pre-to-post improvements in fertility quality of life, depression, and anxiety were observed (p < .001; Cohen's ds = 0.9-1.3). CONCLUSIONS This self-directed intervention was well received and has the potential to be highly effective in reducing infertility-related distress, informing future development and optimization. TRIAL REGISTRATION ClinicalTrials.gov, NCT05103982.
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Affiliation(s)
| | - Ashley A Balsom
- Department of Psychology, University of Regina, Regina, SK, Canada
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Szigeti F J, Kazinczi C, Szabó G, Sipos M, Ujma PP, Purebl G. 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. Hum Reprod 2024; 39:1735-1751. [PMID: 38852061 PMCID: PMC11291950 DOI: 10.1093/humrep/deae119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 04/20/2024] [Indexed: 06/10/2024] Open
Abstract
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.
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Affiliation(s)
- Judit Szigeti F
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
- Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis University, Budapest, Hungary
| | - Csaba Kazinczi
- Department of Clinical Psychology, Semmelweis University, Budapest, Hungary
- Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
| | - Georgina Szabó
- Doctoral School of Mental Health Sciences, Semmelweis University, Budapest, Hungary
- Department of Psychiatry, North Buda Saint John’s Hospital Centre and Outpatient Clinic, Budapest, Hungary
| | - Miklós Sipos
- Department of Obstetrics and Gynecology, Assisted Reproduction Centre, Semmelweis University, Budapest, Hungary
| | | | - György Purebl
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
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Szabo G, Szigeti F J, Sipos M, Varbiro S, Gonda X. Adherence to dietary recommendations mediates the effect of affective temperaments on infertility treatment outcomes. Sci Rep 2024; 14:12544. [PMID: 38822094 PMCID: PMC11143238 DOI: 10.1038/s41598-024-63343-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 05/28/2024] [Indexed: 06/02/2024] Open
Abstract
Affective temperaments have been shown to robustly affect infertility treatment success. However, identification of possible mediating factors through which they exert their influence is still lacking. A growing number of results suggest that adherence to recommended treatments may be such a mediator, on the one hand, because affective temperaments are known to influence adherence and, on the other hand, because non-adherence negatively influences the treatment outcome. Recommended treatment of infertility involves, beyond medications, dietary and lifestyle changes. The aim of this retrospective cohort study was to evaluate whether adherence to physician-prescribed diet and physical activity recommendations mediates the effect of affective temperaments on infertility treatment outcomes. Among 308 women who underwent infertility treatment in an Assisted Reproduction Center, affective temperaments, adherence to diet, adherence to physical exercise, and infertility treatment success (clinical pregnancy) were assessed besides detailed medical history and demographic parameters. Associations between affective temperaments, adherence to diet and recommended physical activity, and assisted reproduction outcomes were analyzed using generalized linear models and causal mediation analysis. Adherence to physical activity didn't have an effect, but diet adherence increased the odds of infertility treatment success by 130% suggesting its role as a potential mediator. Based on causal mediation analysis, higher depressive and anxious temperament scores were directly associated with 63% and 45% lower odds of achieving clinical pregnancy, respectively, with effects not mediated by diet adherence. Higher irritable temperament scores indirectly decreased the odds of achieving clinical pregnancy by 14%, mediated by diet adherence; while higher cyclothymic temperament scores decreased the odds of achieving clinical pregnancy both directly by 51% and indirectly, mediated by diet adherence by 11%. Our results suggest that diet adherence mediates the mechanism by which irritable and cyclothymic affective temperaments influence IVF treatment success. Since adherence is a modifiable risk factor of infertility treatment success, screening for affective temperaments may help to identify potentially high-risk non-adherent patient groups and offer patient-tailored treatment, which may help increase the chances of a successful pregnancy and live birth in women undergoing IVF treatment.
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Affiliation(s)
- Georgina Szabo
- Doctoral School of Mental Health Sciences, Semmelweis University, Budapest, Hungary
| | - Judit Szigeti F
- Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary
| | - Miklos Sipos
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Szabolcs Varbiro
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Xenia Gonda
- Department of Psychiatry and Psychotherapy, Semmelweis University, Gyulai Pal utca 2, Budapest, 1085, Hungary.
- NAP3.0-SE Neuropsychopharmacology Research Group, Hungarian Brain Research Program, Semmelweis University, Nagyvárad tér 4., Budapest, 1085, Hungary.
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Liao T, Gao Y, Yang X, Tang Y, Wang B, Yang Q, Gao X, Tang Y, He K, Shen J, Bao S, Pan G, Zhu P, Tao F, Shao S. Preconception depression reduces fertility: a couple-based prospective preconception cohort. Hum Reprod Open 2024; 2024:hoae032. [PMID: 38840940 PMCID: PMC11150884 DOI: 10.1093/hropen/hoae032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 05/06/2024] [Indexed: 06/07/2024] Open
Abstract
STUDY QUESTION Is preconception depression associated with time to pregnancy (TTP) and infertility? SUMMARY ANSWER Couples with preconception depression needed a longer time to become pregnant and exhibited an increased risk of infertility. WHAT IS KNOWN ALREADY Preconception depression in women contributes to impaired fertility in clinical populations. However, evidence from the general population-especially based on couples-is relatively scant. STUDY DESIGN SIZE DURATION A couple-based prospective preconception cohort study was performed in 16 premarital examination centers between April 2019 and June 2021. The final analysis included 16 521 couples who tried to conceive for ≤6 months at enrollment. Patients with infertility were defined as those with a TTP ≥12 months and those who conceived through ART. PARTICIPANTS/MATERIALS SETTING METHODS Couples' depression was assessed using the Patient Health Questionnaire-9 at baseline. Reproductive outcomes were obtained via telephone at 6 and 12 months after enrollment. Fertility odds ratios (FORs) and infertility risk ratios (RRs) in different preconception depression groups were analyzed using the Cox proportional-hazard models and logistic regression, respectively. MAIN RESULTS AND THE ROLE OF CHANCE Of the 16 521 couples analyzed, 10 834 (65.6%) and 746 (4.5%) couples achieved pregnancy within the first 6 months and between the 6th and 12th months, respectively. The median (P25, P75) TTP was 3.0 (2.0, 6.0) months. The infertility rate was 13.01%. After adjusting for potential confounders, in the individual-specific analyses, we found that preconception depression in women was significantly related to reduced odds of fertility (FOR = 0.947, 95% CI: 0.908-0.988), and preconception depression in either men or women was associated with an increased risk of infertility (women: RR = 1.212, 95% CI: 1.076-1.366; men: RR = 1.214, 95% CI: 1.068-1.381); in the couple-based analyses, we found that-compared to couples where neither partner had depression-the couples where both partners had depression exhibited reduced fertility (adjusted FOR = 0.904, 95% CI: 0.838-0.975). The risk of infertility in the group where only the woman had depression and both partners had depression increased by 17.8% (RR = 1.178, 95% CI: 1.026-1.353) and 46.9% (RR = 1.469, 95% CI: 1.203-1.793), respectively. LIMITATIONS REASONS FOR CAUTION Reporting and recall bias were unavoidable in this large epidemiological study. Some residual confounding factors-such as the use of anti-depressants and other medications, sexual habits, and prior depressive and anxiety symptoms-remain unaddressed. We used a cut-off score of 5 to define depression, which is lower than prior studies. Finally, we assessed depression only at baseline, therefore we could not detect effects of temporal changes in depression on fertility. WIDER IMPLICATIONS OF THE FINDINGS This couple-based study indicated that preconception depression in individuals and couples negatively impacts couples' fertility. Early detection and intervention of depression to improve fertility should focus on both sexes. STUDY FUNDING/COMPETING INTERESTS This work was supported by grants from the National Natural Science Foundation of China (No. 82273638) and the National Key Research and Development Program of China (No. 2018YFC1004201). All authors declare no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Tierong Liao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Yaya Gao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Xinliu Yang
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, China
| | - Yanlan Tang
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, China
| | - Baolin Wang
- Key Laboratory of Population Health Across Life Cycle, Ministry of Education of the People’s Republic of China, Anhui Medical University, Hefei, China
| | - Qianhui Yang
- Key Laboratory of Population Health Across Life Cycle, Ministry of Education of the People’s Republic of China, Anhui Medical University, Hefei, China
| | - Xin Gao
- Key Laboratory of Population Health Across Life Cycle, Ministry of Education of the People’s Republic of China, Anhui Medical University, Hefei, China
| | - Ying Tang
- Key Laboratory of Population Health Across Life Cycle, Ministry of Education of the People’s Republic of China, Anhui Medical University, Hefei, China
| | - Kunjing He
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Jing Shen
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Shuangshuang Bao
- Key Laboratory of Population Health Across Life Cycle, Ministry of Education of the People’s Republic of China, Anhui Medical University, Hefei, China
| | - Guixia Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Peng Zhu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Fangbiao Tao
- Key Laboratory of Population Health Across Life Cycle, Ministry of Education of the People’s Republic of China, Anhui Medical University, Hefei, China
| | - Shanshan Shao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
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Chen X, Hao X, Xie L, Liu X. A bidirectional causal relationship study between mental disorders and male and female infertility. Front Psychiatry 2024; 15:1378224. [PMID: 38699446 PMCID: PMC11064171 DOI: 10.3389/fpsyt.2024.1378224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/28/2024] [Indexed: 05/05/2024] Open
Abstract
Background The relation between mental disorders (MDs) and infertility can be reciprocal. But exactly which MD affects infertility remains controversial. Our aim was to use Mendelian randomization (MR) to explore bidirectional causality between 15 MDs and male infertility and female infertility. Methods The data of MDs, male infertility, and female infertility were derived from published genome-wide association studies (GWAS). The inverse variance weighted method was considered to be the main analytical approach. Sensitivity analysis was performed using MR-Egger, Cochran's Q, radial MR, and MR-PRESSO tests. Results Our results found that mood disorders (OR, 1.4497; 95% CI, 1.0093 - 2.0823; P = 0.0444) and attention deficit hyperactivity disorder (OR, 1.3921; 95% CI, 1.0943 - 1.7709; P = 0.0071) were positively correlated with male infertility, but obsessive-compulsive disorder (OR, 0.8208; 95% CI, 0.7146 - 0.9429; P = 0.0052) was negatively associated with male infertility. For females, anorexia nervosa (OR, 1.0898; 95% CI, 1.0070 - 1.1794; P = 0.0329), attention deficit hyperactivity disorder (OR, 1.1013; 95% CI, 1.0041 - 1.2079; P = 0.0406), and major depressive disorder (OR, 1.1423; 95% CI, 1.0213 - 1.2778; P = 0.0199) increased risk of infertility. In reverse relationship, female infertility increased the incidence of bipolar disorder (OR, 1.0009; 95% CI, 1.0001 - 1.0017; P = 0.0281). Conclusion We demonstrated the association between five MDs and male or female infertility. Female infertility was also found to be associated with an increased risk of one MD. We look forward to better designed epidemiological studies to support our results.
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Affiliation(s)
| | | | | | - Xiaoqiang Liu
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
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Sahraian K, Abdollahpour Ranjbar H, Namavar Jahromi B, Cheung HN, Ciarrochi J, Habibi Asgarabad M. Effectiveness of mindful self-compassion therapy on psychopathology symptoms, psychological distress and life expectancy in infertile women treated with in vitro fertilization: a two-arm double-blind parallel randomized controlled trial. BMC Psychiatry 2024; 24:174. [PMID: 38429659 PMCID: PMC10908010 DOI: 10.1186/s12888-023-05411-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 11/28/2023] [Indexed: 03/03/2024] Open
Abstract
OBJECTIVES Infertility is a prominent problem affecting millions of couples worldwide. Recently, there has been a hightened emphasis on elucidating the subtle linkages between infertility treatment leveraging assisted reproductive technology and the complex realm of psychological challenges, as well as efforts in implementation of psychological interventions.The Mindful Self-Compassion (MSC) program seeks to improve self-compassion, compassion for others, mindfulness, and life satisfaction while reducing depression, anxiety, and stress. In the current study, an MSC intervention was performed on infertile women (IW) undergoing in vitro fertilization (IVF) to assess the effectiveness of this intervention in reducing psychological distress and psychopathological symptoms and enhancing life expectancy. METHODS Fifty-seven IW undergoing IVF were randomly allocated to two groups: MSC (n = 29) or treatment as usual (TAU; n = 28). Participants in MSC met once a week for two hours for eight weeks and attended a half-day meditation retreat. The Synder's Hope questionnaire and the Revised 90-Symptom Checklist (SCL-90-R) were used as the primary outcome measures. Data were obtained before the intervention, immediately after the intervention, and two months post-intervention. Repeated measures of ANCOVA and paired t-tests in all assessment points were used to compare the MSC and the TAU groups in outcomes. RESULTS In the MSC group, hopelessness, anger-hostility, anxiety, interpersonal sensitivity difficulties, and depression were significantly reduced compared with the TAU group, and those improvements persisted at the two-month follow-up. Reliable change index revealed that the MSC group's gains were both clinically significant and durable. CONCLUSIONS MSC can facilitate higher life satisfaction and mental well-being for IW undergoing IVF by reducing psychological distress, psychopathological symptoms, and hopelessness. These encouraging findings call for more research into the effectiveness of mindfulness-based therapies in addressing psychological problems among IW undergoing IVF.
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Affiliation(s)
- Kimia Sahraian
- Department of Psychology, Higher Education Center of Eghlid, Eghlid, Iran
- Infertility Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Bahia Namavar Jahromi
- Infertility Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Obstetrics and Gynecology, School of Medical Science, Shiraz University of Medical Science, Shiraz, Iran
| | - Ho Nam Cheung
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
| | - Joseph Ciarrochi
- Institute for Positive Psychology and Education, Australian Catholic University, North Sydney, NSW, Australia
| | - Mojtaba Habibi Asgarabad
- Department of Psychology, Norwegian University of Science and Technology, 7491 Dragvoll, Trondheim, Norway.
- Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran.
- Department of Health Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran.
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Szabo G, Szigeti F J, Sipos M, Varbiro S, Gonda X. Affective temperaments show stronger association with infertility treatment success compared to somatic factors, highlighting the role of personality focused interventions. Sci Rep 2023; 13:21956. [PMID: 38081851 PMCID: PMC10713532 DOI: 10.1038/s41598-023-47969-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
Infertility has a multifactorial background, where, besides somatic factors, psychological contributors also play a role in development and outcome. While affective temperaments have been associated with development, course, and outcome as well as treatment success in various somatic conditions, their association with infertility and its treatment has not been investigated so far. The purpose of our retrospective cohort study was to evaluate the influence of affective temperaments on fertility treatment outcomes. Among 578 women who underwent infertility treatment in an Assisted Reproduction Centre in Budapest, Hungary, treatment success, detailed medical history, and demographic parameters were recorded, and the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Auto-questionnaire (TEMPS-A) was administered. Possible predictors of assisted reproduction outcome were analyzed using multivariate logistic regression models, followed by a receiver operating curve (ROC) analysis in order to define ideal affective temperament cut-off values for clinical applicability. Aside from age, BMI, and previous miscarriage, cyclothymic scores > 4 (OR = 0.51 CI 0.35-0.74, p < 0.001), depressive scores > 9 (OR = 0.59 CI 0.4-0.87, p = 0.009) and anxious scores > 9 (OR = 0.45 CI 0.31-0.66, p < 0.001) significantly decreased the odds of clinical pregnancy by 49%, 41% and 55%, respectively. Irritable and hyperthymic temperaments, as well as other somatic and socio-economic factors had no effect on infertility treatment outcomes. The results suggest that affective temperaments may be related to the outcome of infertility treatments. Thus, screening for affective temperaments may help identify high-risk patient groups and offer patient-tailored treatment, which may increase the chances of a successful pregnancy and live birth for women undergoing IVF treatment.
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Affiliation(s)
- Georgina Szabo
- Doctoral School of Mental Health Sciences, Semmelweis University, Budapest, Hungary
| | - Judit Szigeti F
- Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary
| | - Miklos Sipos
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Szabolcs Varbiro
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Xenia Gonda
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary.
- NAP3.0-SE Neuropsychopharmacology Research Group, Hungarian Brain Research Program, Semmelweis University, Gyulai Pál Street 2, 1085, Budapest, Hungary.
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9
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Ha JY, Park HJ, Ban SH. Efficacy of psychosocial interventions for pregnancy rates of infertile women undergoing in vitro fertilization: a systematic review and meta-analysis. J Psychosom Obstet Gynaecol 2023; 44:2142777. [PMID: 36480686 DOI: 10.1080/0167482x.2022.2142777] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE This study aimed to analyze the efficacy of psychosocial interventions for improving pregnancy rates in infertile women undergoing in vitro fertilization (IVF) treatment through a systematic review and meta-analysis. METHODS Twelve studies were included in the meta-analysis. To estimate the effect size, a meta-analysis of the studies was performed using RevMan 5.3. The possibility of publication bias was evaluated using funnel plots and Egger's method. RESULTS A statistically significant effect size (standardized mean difference [SMD] = 1.39; 95% confidence interval [CI] = 1.11-1.71; p = 0.004; I2 = 19%) was found for the 12 studies that investigated the effects of psychosocial interventions on clinical pregnancy rates. The psychosocial interventions that had a significant effect on pregnancy rates were mind-body interventions (SMD = 1.37; 95% CI = 1.01-1.85; p = 0.040; I2 = 0%) and cognitive behavioral therapy (SMD = 2.19; 95% CI = 1.17-4.13; p = 0.010). CONCLUSIONS The results suggest that psychosocial interventions affect pregnancy rates. Moreover, they indicate that mind-body interventions and cognitive behavioral therapy are beneficial for improving the pregnancy outcome in infertile women undergoing IVF.
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Affiliation(s)
- Ju-Young Ha
- College of Nursing, Pusan National University, Yangsan, Korea
| | - Hyo-Jin Park
- College of Nursing, Pusan National University, Yangsan, Korea
| | - Seon-Hwa Ban
- Korea Disease Control and Prevention Agency, Cheongju, Korea
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Fernández-Zapata WF, Cardona-Maya W. Male Infertility - What about Mental Health? REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:e620-e621. [PMID: 37944929 PMCID: PMC10635789 DOI: 10.1055/s-0043-1772471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/26/2023] [Indexed: 11/12/2023] Open
Affiliation(s)
| | - Walter Cardona-Maya
- Department of Microbiology and Parasitology, Universidad de Antioquia, Medellín, Colombia
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11
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Soleimani R, Ansari F, Hamzehgardeshi Z, Elyasi F, Moosazadeh M, Yazdani F, Shahidi M, Shiraghaei N, Karimi M, Hemati T, Pejmanmanesh M. Perceived stress reduction through an infertility coaching program: a randomized controlled clinical trial. Sci Rep 2023; 13:14511. [PMID: 37666933 PMCID: PMC10477300 DOI: 10.1038/s41598-023-41845-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 08/31/2023] [Indexed: 09/06/2023] Open
Abstract
Infertility has been recognized as a distressing experience among couples worldwide, cutting across various cultures. This present study was conducted to assess the impact of a supportive stress management program led by an infertility coach for women undergoing fertility treatment. This randomized controlled clinical trial study was performed on 60 infertile women undergoing assisted reproductive techniques at Maryam Infertility Center located in Sari in 2018. After random allocation in two groups, 30 individuals were in the intervention group and 30 in the control group. The intervention program was implemented according to the infertility coach's counseling protocol in six stages. The control group received only routine ward counseling. In order to measure stress, the Newton Infertility Stress Questionnaire was used firstly before intervention and then after oocyte puncture, embryo transfer, and pregnancy testing. Data analysis was performed using SPSS statistical software version 18 and Shapiro-Wilk, Chi-square, Mann-Whitney, independent t-test, Friedman test, Wilcoxon test, GEE test, and Cohen's effect size. Our analysis approach has also been based on the analysis of (ITT). The significance level was 0.05. The mean ± SD scores of infertility perceived stress before the intervention in the control was 146.16 ± 16.90 and the intervention group was 156.53 ± 9.31, after intervention at the time of oocyte puncture in the controls was 165.36 ± 8.98 and the intervention group was 155.83 ± 10.70, at the day of embryo transfer in the control group was 156.35 ± 14.45 and in the intervention group was 123.58 ± 22.9 and in the pregnancy test day in the control group was 185.76 ± 26.56 and in the intervention group was 127.61 ± 21.57 (P < 0.001). According to Friedman test, the mean of stress in three situations after the intervention showed a significant difference in reduction of the mean of stress (P < 0.001). In the control group, the stress score of the samples had an increasing trend, which was significant during the measurement steps based on Friedman test results (P < 0.001). In the intervention group, paired t-test results showed no significant comparing mean score of Newton's infertility stress before and after oocyte puncture day (P = 0.711), comparing the mean of stress before and after pregnancy test day (P = 0.003) and also comparing of mean stress before and after pregnancy on the day of embryo transfer according to Wilcoxon test (P < 0.001). And comparing mean stress before and after pregnancy test day, paired t-test (P = 0.001) showed significant statistical differences. According to the results of the GEE test, changes in stress scores over time were significant between the two groups (P < 0.001), as well as the effect of stress on oocyte puncture day (0.41), embryo transfer day (1.69), pregnancy test day (P < 0.001) (2.46) had a significant effect on the day of embryo transfer and pregnancy test day. Based on the results of this study, the infertility coach program demonstrated the ability to decrease the perceived stress related to infertility. Additionally, it showed potential in enhancing treatment outcomes, such as oocyte count and positive pregnancy results, among infertile women undergoing assisted reproductive techniques.Trial registration: Iranian Registry for Clinical Trial (the link to trial: https://www.irct.ir/trial/33357 ). Registered 11-11-2018.
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Affiliation(s)
- Roghoyeh Soleimani
- Student Research Committee, Nasibeh Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Fatemeh Ansari
- Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zeinab Hamzehgardeshi
- Sexual and Reproductive Health Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Forouzan Elyasi
- Psychiatry and Behavioral Sciences Research Center, Sexual and Reproductive Health Research Center, Addiction Institute, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahmood Moosazadeh
- Epidemiology, Gastrointestinal Cancer Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Maryam Shahidi
- IVF Ward, Hazrat-e Maryam Fertility Center (HMFC), Sari, Iran
| | | | - Mahtab Karimi
- IVF Ward, Hazrat-e Maryam Fertility Center (HMFC), Sari, Iran
| | - Tayebeh Hemati
- IVF Ward, The MOM Specialized Centre for Reproductive Health and Infertility, Tehran, Iran
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Chamorro PP, Pino MJ, Casas-Rosal JC, Herruzo J. A longitudinal comparative study of a multicouple group and single-couple psychosocial intervention while experiencing infertility. FAMILY PROCESS 2023; 62:557-575. [PMID: 36175066 DOI: 10.1111/famp.12820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 07/29/2022] [Accepted: 07/30/2022] [Indexed: 06/08/2023]
Abstract
This is a quasi-experimental, nonequivalent design study investigating the efficacy of multicouple group and single-couple intervention formats aimed at diminishing the psychosocial impact of infertility. The review studies carried out to date that have assessed this subject do not show consistent findings and although increasing the efficacy and efficiency of intervention formats more than justifies their analysis, there are no studies making this particular comparison. Eighty-seven infertile couples who were in assessment for their infertility and/or were close to undergoing some kind of assisted reproductive technology process participated in a psychosocial intervention either under the multicouple group or single-couple subconditions, or acted as controls. The variables of depression, anxiety, and fertility quality of life were used for evaluating psychosocial impact. Comparisons were made: (a) between the intervention condition and controls and (b) between the two subconditions. The results support the efficacy of the intervention both in the dyadic latent growth curve models analysis carried out and in the treatment effect calculation. Although in the comparison between the multicouple and single-couple format, some differences generally favoring the single format one were found, they were not conclusive. Therefore, the results are in line with review studies that did not find the group format to be more effective. Although this study provides valuable information, its limitations mean that further research needs to be carried out. When selecting the intervention format, therapists should also weigh up others aspects, such as the intervention goal, patient's needs and characteristics, reproductive history, and current stage of infertility.
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Whynott RM, Summers KM, Mejia RB, Segre LS, Ryan G, Pawlak SA. Creating affiliations, learning, and mindfulness for in vitro fertilization patients (CALM IVF): a clinical trial. F S Rep 2023; 4:61-71. [PMID: 36959953 PMCID: PMC10028477 DOI: 10.1016/j.xfre.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 01/09/2023] Open
Abstract
Objective Determine if group psychoeducational support can improve in vitro fertilization (IVF) patients' quality of life (QoL). Design Randomized controlled trial (NCT04048772). Setting University-affiliated IVF clinic. Patients Women (n = 76) and male partners undergoing initial autologous IVF cycle from August 2019, to December 2020. Interventions Couples were assigned to groups based on projected oocyte retrieval date. Groups were randomly assigned to the control or intervention arm. Clinic closures because of the COVID-19 pandemic delayed treatment for a portion of participants. Groups were conducted in person before and virtually during the pandemic. Main Outcome Measures The primary outcome was a change in fertility quality of life (FertiQoL) from baseline to 3 days after retrieval. Secondary outcomes were changes in depression (Patient Health Questionnaire 9), anxiety (Generalized Anxiety Disorder 7), resilience (Connor-Davidson Resilience scale), IVF knowledge scores, and the likelihood of return to treatment. Results Knowledge scores among women in Creating Affiliations, Learning, and Mindfulness (CALM) for IVF groups significantly increased compared with control (mean difference 13.19 [3.53 - 22.84]) before the pandemic. During the pandemic, women in CALM IVF had significant improvement in the social FertiQoL score compared with controls (10.42 [1.79 - 19.04]). Compared with controls, male CALM IVF participants had significantly greater improvement in total FertiQoL (mean difference 6.68 [0.39 - 12.98]), treatment FertiQoL (8.26 [0.69 - 15.82]), and resilience (Connor-Davidson 1.13 [0.54 - 1.72]). Immediate return to care did not significantly differ between arms. Conclusions For women undergoing IVF, group psychoeducational programs can improve IVF knowledge and social QoL during a pandemic. Participation in a group psychoeducational program can improve QoL and resilience in IVF dyad male partners. Clinical Trial Registration Number Trial registration NCT04048772.
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Affiliation(s)
- Rachel M. Whynott
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Washington, Seattle, Washington
- Reprint requests: Rachel Whynott, M.D., Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Washington, 4245 Roosevelt Way NE, 3rd Floor, Seattle, Washington 98105.
| | - Karen M. Summers
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Rachel B. Mejia
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Lisa S. Segre
- College of Nursing, University of Iowa, Iowa City, Iowa
| | - Ginny Ryan
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Washington, Seattle, Washington
| | - Stacey A. Pawlak
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa
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Kremer F, Ditzen B, Wischmann T. Effectiveness of psychosocial interventions for infertile women: A systematic review and meta-analysis with a focus on a method-critical evaluation. PLoS One 2023; 18:e0282065. [PMID: 36854039 PMCID: PMC9974119 DOI: 10.1371/journal.pone.0282065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/07/2023] [Indexed: 03/02/2023] Open
Abstract
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.
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Affiliation(s)
- Franziska Kremer
- Institute of Medical Psychology, Centre for Psychosocial Medicine, University Hospital, Heidelberg, Germany
- * E-mail:
| | - Beate Ditzen
- Institute of Medical Psychology, Centre for Psychosocial Medicine, University Hospital, Heidelberg, Germany
| | - Tewes Wischmann
- Institute of Medical Psychology, Centre for Psychosocial Medicine, University Hospital, Heidelberg, Germany
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Dube L, Bright K, Hayden KA, Gordon JL. Efficacy of psychological interventions for mental health and pregnancy rates among individuals with infertility: a systematic review and meta-analysis. Hum Reprod Update 2023; 29:71-94. [PMID: 36191078 DOI: 10.1093/humupd/dmac034] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/29/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Depression and anxiety are highly prevalent among individuals struggling with infertility. Thus, numerous psychological interventions have been adapted to infertility, with the aim of relieving distress as well as increasing pregnancy rates. OBJECTIVE AND RATIONALE This systematic review and meta-analysis aimed to identify all randomized controlled trials (RCTs) evaluating the effect of psychological interventions on infertility-related distress and pregnancy rates among individuals and/or couples with infertility and to analyse their overall effect. It also sought to examine potential treatment moderators, including intervention length, format and therapeutic approach. SEARCH METHODS An electronic search of 11 databases, including MEDLINE, EMBASE, PsycINFO and Cochrane Central Register of Controlled Trials, was performed for studies published until January 2022. The inclusion criteria were RCTs conducted on humans and published in English. Psychological outcomes of interest included anxiety, depression, infertility-related distress, wellbeing and marital satisfaction. The Cochrane Risk of Bias tool was used to assess study quality, and the Grading of Recommendations Assessment, Development and Evaluation was used to assess the overall quality of the research evidence. OUTCOMES There were 58 RCTs in total, including 54 which included psychological outcomes and 21 which assessed pregnancy rates. Studies originated from all regions of the world, but nearly half of the studies were from the Middle East. Although a beneficial effect on combined psychological outcomes was found (Hedge's g = 0.82, P < 0.0001), it was moderated by region (P < 0.00001) such that studies from the Middle East exhibited large effects (g = 1.40, P < 0.0001), while the effects were small among studies conducted elsewhere (g = 0.23, P < 0.0001). Statistically adjusting for study region in a meta-regression, neither intervention length, therapeutic approach, therapy format, nor participant gender (P > 0.05) moderated the effect of treatment. A beneficial treatment effect on pregnancy (RR (95% CI) = 1.25 (1.07-1.47), P = 0.005) was not moderated by region, treatment length, approach or format (P > 0.05). Largely due to the lack of high quality RCTs, the quality of the available evidence was rated as low to moderate. WIDER IMPLICATIONS This is the first meta-analysis of RCTs testing the effect of psychological interventions on infertility-related distress and pregnancy rates. These findings suggest that in most regions of the world, psychological interventions are associated with small reductions in distress and modest effects on conception, suggesting the need for more effective interventions. These findings must be considered in light of the fact that the majority of the included RCTs were deemed to be at high risk of bias. Rigorously conducted trials are needed.
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Affiliation(s)
- Loveness Dube
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - Katherine Bright
- Department of Outpatient Psychiatry, Alberta Health Services, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - K Alix Hayden
- Department of Libraries and Cultural Resources, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer L Gordon
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
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16
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Dar MA, Shah SB, Ahmad SN, Shora TN, Kumari P, Tailie JA. Psychiatric morbidity and quality of life in infertile females: a cross-sectional, case-controlled hospital-based study. MIDDLE EAST CURRENT PSYCHIATRY 2022. [DOI: 10.1186/s43045-022-00257-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Abstract
Background
Infertility is a huge global problem with a significant mental health burden. Infertility could become a source of continuous stress leading to psychosocial issues including stress, anxiety, depression, and low self-esteem in these women. A cross-sectional, case-controlled study was conducted between January 2021 and November 2021 to study the effect of infertility on mental health and quality of life. A semi-structured questionnaire was used for sociodemographic and clinical variables. The Oslo Social Support Scale-3 and FertiQol were used to study social support and quality of life respectively. Psychiatric morbidity was assessed using ICD-10 symptom checklist. A total of 56 cases and 102 controls were studied.
Results
The mean age of cases and controls was 30.4 ± 3.5 years and 31.9 ± 2.9 years, respectively. Young infertile females, primary infertility, and female factor for infertility were associated with higher psychiatric morbidity. Psychiatric morbidity was seen in 46.4% of infertile women. FertiQoL score for the infertile group was 64.61 ± 5 with the lowest score in the emotional domain (45.10) and mind-body domain (54.86) (p < 0.0001). The scores in the relational domain and social domain were higher (85.2 and 73.3, respectively). The scores in the mind-body domain and emotional domain were poor among the infertile women regardless of the presence of psychiatric morbidity (48.27 vs 59.80 and 43.57 vs 46.57) (p < 0.0001–0.04).
Conclusions
Our study emphasizes the role of more qualitative instruments like FertiQoL in studying the well-being of infertile women. Even in the absence of psychiatric morbidity, the QoL score could still predict mental well-being in fertility-related issues.
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17
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Levinson AL, Igonina TN, Rozhkova IN, Brusentsev EY, Amstislavsky SY. Psycho-emotional stress, folliculogenesis, and reproductive technologies: clinical and experimental data. Vavilovskii Zhurnal Genet Selektsii 2022; 26:431-441. [PMID: 36128573 PMCID: PMC9450030 DOI: 10.18699/vjgb-22-53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/21/2022] [Accepted: 03/31/2022] [Indexed: 11/19/2022] Open
Abstract
Modern life, especially in large cities, exposes people to a high level of noise, high density of population, disrupted sleeping, large amount of excessive and controversial information as well as to other negative factors; all this may cause chronic psycho-emotional stress. The latest publications often use the term “Syndrome of megalopolis”, which means disruption of sleeping, high anxiety, and altered reproductive function. Medical treatment of infertility may also be considered as a stress factor, especially when infertility lasts for years and is aggravated with emotional frustration. Long-lasting distress may worsen health in general and suppress reproductive function, in particular. The review presents the data on the effects of maternal stress on folliculogenesis, especially when assisted reproductive technologies (ARTs) are used. Clinical data are presented alongside data from laboratory animal experiments. Different maternal stress models are taken into account in respect of their inf luence on oocyte maturation and embryo development. The interfering of psycho-emotional stress and reproductive function is the focus of the review. In these situations, exogenous hormones compensate for the stress-related disruption of the hypothalamic-pituitary-gonadal axis. When ARTs are implemented, stress-induced disruption of oogenesis is realized not via a decrease in hypothalamic and pituitary hormones, but by other ways, which involve paracrine mechanisms described in this review. Based on the literature analysis, one may conclude that stress negatively affects oocyte maturation in the ovary and suppresses subsequent embryo development. The role of some ovarian paracrine factors, such as BDNF, GDF-9, HB-EGF, TNF-α, and some others has been elucidated
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Affiliation(s)
- A. L. Levinson
- Novosibirsk Center of Reproductive Medicine; Novosibirsk State University
| | - T. N. Igonina
- Institute of Cytology and Genetics of the Siberian Branch of the Russian Academy of Sciences
| | - I. N. Rozhkova
- Institute of Cytology and Genetics of the Siberian Branch of the Russian Academy of Sciences
| | - E. Yu. Brusentsev
- Institute of Cytology and Genetics of the Siberian Branch of the Russian Academy of Sciences
| | - S. Ya. Amstislavsky
- Institute of Cytology and Genetics of the Siberian Branch of the Russian Academy of Sciences; Novosibirsk State University
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Mahmoud MY, Labib K, Sileem SA, Mustafa FA, Hamed WM, Abd Elhamid A, Saleh DM, Alanwar A, Riad AAM, Abdelhakim AM, Abbas AM, Mohammed HM. The impact of music therapy on anxiety and pregnancy rate among infertile women undergoing assisted reproductive technologies: a systematic review and meta-analysis. J Psychosom Obstet Gynaecol 2022; 43:205-213. [PMID: 34546118 DOI: 10.1080/0167482x.2021.1977277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Objective: We aimed to perform a systematic review and meta-analysis to evaluate the effect of music therapy on anxiety and pregnancy rates among infertile women undergoing to perform assisted reproductive technologies (ART).Methods: Cochrane Library, PubMed, ISI web of science, and Scopus were searched from inception to May 2021. We included randomized controlled trials (RCTs) that compared music therapy (intervention group) to no music intervention (control group). Our primary outcomes were anxiety score using the State-Trait Anxiety Inventory (STAI) tool and pain score utilizing the Visual Analog Scale (VAS). Our secondary outcomes were the overall satisfaction score and clinical pregnancy rate. We extracted the available data from included studies and pooled them in a meta-analysis model using RevMan software. The overall quality of evidence was assessed through GRADEpro GDT software.Results: Seven RCTs with a total number of 793 patients were included in our study. Music therapy significantly reduced the anxiety score compared to control group (MD= -3.09, 95% CI [-5.57, -0.61], p = 0.01). Moreover, pain score was significantly improved after music treatment (MD= -2.93, 95% CI [-3.86, -2.00], p > 0.001). A significant improvement in the overall satisfaction score was found among music therapy group (MD= 1.51, 95% CI [0.40, 2.61], p = 0.008). Although more women in music therapy group experienced an increase in the clinical pregnancy rate in comparison with control group, the result was not statistically significant (RR= 1.08, 95% CI [0.94, 1.26], p = 0.28). The GRADEpro GDT tool showed a moderate quality of evidence for the evaluated outcomes.Conclusions: There is evidence of moderate quality that music therapy improves anxiety, pain, and satisfaction scores among infertile women undergoing ART. Moreover, it increases the clinical pregnancy rate but without statistical significance. More trials with a larger sample size are needed to investigate the influence of music therapy on the clinical outcomes of ART.
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Affiliation(s)
- Marwa Yahia Mahmoud
- Department of Obstetrics and Gynecology, Faculty of Medicine, Beni Suef University, Beni Suef, Egypt
| | - Kareem Labib
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Sileem Ahmed Sileem
- Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
| | - Faisal Ali Mustafa
- Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
| | - Wael M Hamed
- Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
| | - Ahmed Abd Elhamid
- Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
| | - Doaa M Saleh
- Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University for Girls, Cairo, Egypt
| | - Ahmed Alanwar
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Amr Ahmed Mahmoud Riad
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Ahmed M Abbas
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Heba M Mohammed
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
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Nayak H, Gerstl B, Sharma N, Appaneravanda LC, Gunasheela D. The Use of Integrative Medical Services to Address Psychological Concerns around Infertility in an Indian Academic Medical Centre. J Hum Reprod Sci 2022; 15:171-176. [PMID: 35928464 PMCID: PMC9345279 DOI: 10.4103/jhrs.jhrs_188_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 06/12/2022] [Accepted: 06/14/2022] [Indexed: 11/12/2022] Open
Abstract
Background Alternative and complementary therapies have been gaining popularity as ways to reduce anxiety in patients. Aim: This study aimed to assess whether yoga and meditation could decrease the severity of anxiety in Indian women diagnosed with infertility Study. Study Setting and Design: This was a retrospective data analysis of anxiety score of 354 women undergoing treatment at a tertiary infertility hospital between January 2016 and December 2018. Materials and Method: Women participated in group yoga, meditation and counselling therapy intervention during their treatment period. A self-reported questionnaire that used the Generalised Anxiety Disorder-7 criteria measured the participants’ severity of anxiety at the start of and again at the end of the intervention. Statistical Analysis: Demographic analysis and a two-tailed paired t-test were applied between groups. Results: The results indicated that there was a statistically significant mean reduction (7.3 ± 2.7) in the anxiety scores of the participants between entry (12.94 ± 2.65) and following exposure (5.39 ± 1.99) to the intervention (P < 0.0001). The mean reduction in scores remained similar between participants who received ≤6 sessions (7.50 ± 2.68) and participants who received >6 sessions (7.10 ± 2.64) (P > 0.05). Among the participants that experienced mild anxiety at baseline (n = 43), 72.1% (n = 31) reported experiencing minimal anxiety following the intervention (P < 0.0001). Among those that experienced moderate anxiety at baseline (n = 213), 32.4% (n = 69) reported experiencing minimal anxiety post-intervention (P < 0.0001). Participants who expressed severe anxiety at baseline (n = 94, 26.6%), reported experiencing minimal anxiety (13.8% [n = 13)], mild anxiety (81.9% [n = 77]) and moderate anxiety (4.3% [n = 4]) after exposure to the intervention (P < 0.0001). None of the participants reported experiencing severe anxiety post-intervention. Conclusion: The benefits of alternative anxiety-reduction therapies for women diagnosed with infertility have been demonstrated in this study. These therapies can be used to complement the routine treatment of such patients.
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Affiliation(s)
- Hita Nayak
- Department of Reproductive Medicine, Gunasheela Surgical and Maternity Hospital, Bengaluru, Karnataka, India
| | - Brigitte Gerstl
- Department of Reproductive Medicine, Gunasheela Surgical and Maternity Hospital, Bengaluru, Karnataka, India.,Department of Biostatistics, The Kirby Institute, University of New South Wales, Sydney, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
| | - Neha Sharma
- Department of Reproductive Medicine, Gunasheela Surgical and Maternity Hospital, Bengaluru, Karnataka, India
| | | | - Devika Gunasheela
- Department of Reproductive Medicine, Gunasheela Surgical and Maternity Hospital, Bengaluru, Karnataka, India
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20
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Psychischer Stress – Implikationen für Schwangerschaftseintritt und -verlauf. GYNAKOLOGISCHE ENDOKRINOLOGIE 2022. [DOI: 10.1007/s10304-022-00443-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Bi X, Feng L, Li C, Zhang H. Modeling Pregnancy Outcomes through Sequentially Nested Regression Models. J Am Stat Assoc 2022; 117:602-616. [PMID: 36090951 PMCID: PMC9454338 DOI: 10.1080/01621459.2021.2006666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The polycystic ovary syndrome (PCOS) is a most common cause of infertility among women of reproductive age. Unfortunately, the etiology of PCOS is poorly understood. Large scale clinical trials for Pregnancy in Polycystic Ovary Syndrome (PPCOS) were conducted to evaluate the effectiveness of treatments. Ovulation, pregnancy, and live birth are three sequentially nested binary outcomes, typically analyzed separately. However, the separate models may lose power in detecting the treatment effects and influential variables for live birth, due to decreased sample sizes and unbalanced event counts. It has been a long-held hypothesis among the clinicians that some of the important variables for early pregnancy outcomes may continue their influence on live birth. To consider this possibility, we develop an ℓ 0-norm based regularization method in favor of variables that have been identified from an earlier stage. Our approach explicitly bridges the connections across nested outcomes through computationally easy algorithms and enjoys theoretical guarantee of estimation and variable selection. By analyzing the PPCOS data, we successfully uncover the hidden influence of risk factors on live birth, which confirm clinical experience. Moreover, we provide novel infertility treatment recommendations (e.g., letrozole vs clomiphene citrate) for women with PCOS to improve their chances of live birth.
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22
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Zaami S, Driul L, Sansone M, Scatena E, Andersson KL, Marinelli E. ART Innovations: Fostering Women's Psychophysical Health between Bioethics Precepts and Human Rights. Healthcare (Basel) 2021; 9:healthcare9111486. [PMID: 34828532 PMCID: PMC8623993 DOI: 10.3390/healthcare9111486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 12/02/2022] Open
Abstract
Infertility is a highly relevant global issue affecting the reproductive health of at least 15% of reproductive-aged couples worldwide. The scope and severity of the infertility problem is even more prevalent in developing countries, mostly due to untreated reproductive tract infections (RTIs). Infertility, however, goes beyond the mere inability to procreate, but brings about profound psychological, social, and ethical implications of enormous magnitude. In vitro fertilization (IVF) and other assisted reproduction technologies (ARTs) have gradually become widespread therapeutic options. After all, the implementation of medically assisted reproductive procedures in order to overcome infertility is in keeping with the tenets of the reproductive rights agenda laid out at the International Conference on Population and Development (ICPD) in Cairo in 1994. Nonetheless, concerns still linger about how to implement and regulate such interventions in an ethically tenable fashion. The unremitting pace at which such techniques develop have upset the very notion of sexuality relating to reproduction as well as the concept of family itself. That rift risks causing a crisis in terms of bioethics sustainability and enforcement, which is bound to happen when science and innovation outpace the bioethical precepts on which we rely for essential guidance in medical practice. The authors argue in favor of an approach to regulation and policy-making that puts on the forefront a thorough assessment as to potential risks that such interventions might entail for foundational bioethics principles and inalienable human rights.
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Affiliation(s)
- Simona Zaami
- Department of Anatomical, Histological, Medicolegal and Orthopedic Sciences, Sapienza University of Rome, 00161 Rome, Italy;
- Correspondence:
| | - Lorenza Driul
- Clinic of Obstetrics and Gynecology, Hospital of Udine, DAME, University of Udine, 33100 Udine, Italy;
| | - Milena Sansone
- Department of Obstetrics and Gynecology, Sant’Eugenio Hospital, 00144 Rome, Italy;
| | - Elisa Scatena
- Department of Gynecology and Obstetrics, Santo Stefano Hospital, 59100 Prato, Italy;
| | - Karin Louise Andersson
- Department of Territory Health, Azienda Sanitaria Toscana Centro, 50012 Florence, Italy;
| | - Enrico Marinelli
- Department of Anatomical, Histological, Medicolegal and Orthopedic Sciences, Sapienza University of Rome, 00161 Rome, Italy;
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Hinkle M, Dodd J. A Systematic Review of Interventions Targeting Infertility-Related Distress: A Search for Active Ingredients. JOURNAL OF SEX & MARITAL THERAPY 2021; 48:167-193. [PMID: 34493164 DOI: 10.1080/0092623x.2021.1974623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Various psychological interventions have been developed to combat negative mental and physical health effects of infertility. However, it is unknown if there are common elements, or "active ingredients," between interventions. This review examined which active ingredients were present among psychological interventions targeting the impacts of infertility. Using a predetermined search strategy, 72 articles and 22 active ingredients were identified. Relaxation/stress management was found to be the most common treatment element. Future research should investigate which active ingredients are most effective for reducing infertility-related stressors so clinicians and researchers can create and implement treatments that contain essential and effective components.
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Affiliation(s)
- Madison Hinkle
- Department of Psychology, East Tennessee State University, Johnson City, TN, USA
| | - Julia Dodd
- Department of Psychology, East Tennessee State University, Johnson City, TN, USA
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24
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Abdollahpour S, Taghipour A, Mousavi Vahed SH, Latifnejad Roudsari R. The efficacy of cognitive behavioural therapy on stress, anxiety and depression of infertile couples: a systematic review and meta-analysis. J OBSTET GYNAECOL 2021; 42:188-197. [PMID: 34109898 DOI: 10.1080/01443615.2021.1904217] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Infertility is considered globally to be a stressful and hard experience that affects the couples psychologically, socially and individually. The aim of this study was to systematically review the effectiveness of cognitive behavioural therapy (CBT) on depression, stress and anxiety in infertile couples. In this systematic review and meta-analysis, databases were searched up to August 2019. Twelve articles were included in the meta-analysis and analysed with Comprehensive Meta-Analysis (CMA) v2. The results of pooled studies showed that the mean scores for depression and anxiety decreased in patients receiving CBT as compared to the control group. The results of three pooled studies showed no significant difference on stress in patients receiving CBT as compared to the control group. The findings of this study provides valuable suggestions for improving mental health status through applying CBT to manage anxiety and depression in infertile couples.
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Affiliation(s)
- Sedigheh Abdollahpour
- Department of Midwifery, Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Taghipour
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyedeh Houra Mousavi Vahed
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Robab Latifnejad Roudsari
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
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25
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Golshani F, Hasanpour S, Mirghafourvand M, Esmaeilpour K. Effect of cognitive behavioral therapy-based counseling on perceived stress in pregnant women with history of primary infertility: a controlled randomized clinical trial. BMC Psychiatry 2021; 21:278. [PMID: 34059016 PMCID: PMC8167953 DOI: 10.1186/s12888-021-03283-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Given the prevalence of infertility and consequences of stress, anxiety, and depression during pregnancy and after childbirth, this study aimed to determine the effect of group cognitive behavioral therapy (CBT)-based counseling on perceived stress (primary outcome), anxiety, depression, and quality of life (QoL) of pregnant women with a history of primary infertility. METHOD This controlled randomized clinical trial was conducted on 56 pregnant women with a history of primary infertility referred to Infertility Clinic of Al-Zahra Teaching Hospital of Tabriz. The participants were divided into the intervention (n = 28) and control (n = 28) groups using block randomization. The intervention group received group CBT-based counseling after the 14th week of the pregnancy: six in-person sessions and two telephone sessions once per week. The control group received routine care. The Perceived Stress Scale (PSS), Edinburgh Postnatal Depression Scale (EPDS), Van den Bergh's Pregnancy-Related Anxiety Questionnaire (PRAQ), and Quality of Life in Pregnancy (Gravidarum) (QOL-GRAV) were completed through interviews before and 4 weeks after the intervention by the researcher. RESULTS There was not any between-group difference in socio-demographic characteristics, except the gestational age and husband educational level (p > 0.05). Both of these variables were adjusted in ANCOVA. After the intervention, the mean scores of perceived stress (mean difference: - 7.3; confidence interval: 95%, from - 0.9 to - 5.6; p < 0.001) and anxiety (mean difference:-14.7; confidence interval: 95%. from - 20.6 to - 8.8; p < 0.001) were significantly lower in the intervention group. The mean depression score in the intervention group was lower than the control; however, this between-group difference was not significant (mean difference: - 1.95; confidence interval: 95% from - 3.9 to 0.2; p = 0.052). The mean score of quality of life in pregnancy was significantly higher in the intervention group than the control (mean difference: - 5.4; confidence interval: 95% from 3.4 to 7.4; p < 0.001). CONCLUSION CBT counseling can affect the perceived stress, anxiety, and quality of life of pregnant women with a history of primary infertility. As a result, this counseling approach is recommended along with other counseling approaches to improve the mental health of pregnant women with a history of infertility. TRIAL REGISTRATION IRCT Registration Number: IRCT20111219008459N12 , registered on 10/11/ 2018.
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Affiliation(s)
- Farideh Golshani
- Student Research Committee Department of Midwifery, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shirin Hasanpour
- Women’s Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mojgan Mirghafourvand
- Midwifery Department, Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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26
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Dreischor F, Laan ETM, Apers S, Repping S, van Lunsen RHW, Lambalk CB, D' Hooghe TM, Goddijn M, Custers IM, Dancet EAF. The stepwise development of an interactive web-based sex education programme for subfertile couples: the Pleasure & Pregnancy programme. Hum Reprod 2021; 35:1839-1854. [PMID: 32649754 DOI: 10.1093/humrep/deaa106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 02/27/2020] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION Can we develop a web-based sex education programme (programme running in a web browser) that addresses the needs of subfertile couples who are advised expectant management for at least 6 months? SUMMARY ANSWER The 'Pleasure & Pregnancy' programme addresses couples' needs, is likely to improve couples' sexual functioning, and is subsequently hypothesised to improve the chance of natural pregnancy. WHAT IS KNOWN ALREADY According to professional guidelines (e.g. the Netherlands and UK) couples with unexplained subfertility and a good chance of natural pregnancy, should be advised at least 6 months of expectant management. Adherence to expectant management is challenging as couples and gynaecologist prefer a more active approach. Targeting sexuality may be useful as subfertility is a risk factor for decreased sexual functioning. STUDY DESIGN, SIZE, DURATION A novel programme was developed according to the three steps of the Medical Research Councils' (MRC) framework. First, relevant literature was explored. Second, an interdisciplinary expert panel developed a theory (based on a systematic literature review and patient interviews) on how the chance of natural conception can be improved. Third, the expected process and outcomes were modelled. PARTICIPANTS/MATERIALS, SETTING, METHODS Two licenced clinical sexologists, two gynaecologists, a clinical embryologist and two midwife-researchers, all from Belgium and the Netherlands, proposed components for the sex education programme. PubMed was searched systematically for randomised controlled trials (RCTs) evaluating the proposed components in different patient populations. The needs of 12 heterosexual Dutch or Belgian couples who were advised expectant management were explored with in-depth interviews. The content and delivery characteristics of the novel programme were described in detail with the aid of 'Intervention Taxonomy'. To model the outcomes, a protocol for an RCT was designed, registered and submitted for publication. MAIN RESULTS AND THE ROLE OF CHANCE To help maintain or improve sexual functioning, mainly pleasure, and hence increase pregnancy rates, the web-based Pleasure & Pregnancy programme contains a combination of psychosexual education and couple communication, mindfulness and sensate focus exercises. Information on the biology of conception and interaction with fertility clinic staff and peers were added based on couples' needs to increase potential acceptability. LIMITATIONS AND REASON FOR CAUTION This paper outlines the development phase of a sex education programme according to the MRC-framework. Whether the Pleasure & Pregnancy programme actually is acceptable, improves sexual functioning, increases pregnancy rates and is cost-effective remains to be determined. WIDER IMPLICATIONS OF THE FINDINGS No previous interactive web-based sex education programme has aimed to increase the natural pregnancy rate of subfertile couples by targeting their sexual pleasure. The Pleasure & Pregnancy programme addresses couples' needs and its effect on sexual functioning and pregnancy rate is plausible but remains to be demonstrated by an RCT which is currently ongoing. STUDY FUNDING/COMPETING INTEREST(S) Funding was provided by The Netherlands Organisation for Health Research and Development (ZonMw), Flanders Research Foundation and the University of Amsterdam. C.B.L. is editor-in-chief of Human Reproductionbut was blinded to all parts of the peer review process. The remaining authors have no conflict of interest to report. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- F Dreischor
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Amsterdam University Medical Center (UMC), University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - E T M Laan
- Department of Sexology and Psychosomatic Obstetrics and Gynaecology, Amsterdam University Medical Center (UMC), 1105 AZ Amsterdam, The Netherlands
| | - S Apers
- Department of Development and Regeneration, University of Leuven (KU Leuven), 3000 Leuven, Belgium
| | - S Repping
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Amsterdam University Medical Center (UMC), University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - R H W van Lunsen
- Department of Sexology and Psychosomatic Obstetrics and Gynaecology, Amsterdam University Medical Center (UMC), 1105 AZ Amsterdam, The Netherlands
| | - C B Lambalk
- Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - T M D' Hooghe
- Department of Development and Regeneration, University of Leuven (KU Leuven), 3000 Leuven, Belgium
| | - M Goddijn
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Amsterdam University Medical Center (UMC), University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.,Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - I M Custers
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Amsterdam University Medical Center (UMC), University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - E A F Dancet
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Amsterdam University Medical Center (UMC), University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.,Department of Development and Regeneration, University of Leuven (KU Leuven), 3000 Leuven, Belgium.,Research Foundation of Flanders, Belgium
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27
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Zhou R, Cao YM, Liu D, Xiao JS. Pregnancy or Psychological Outcomes of Psychotherapy Interventions for Infertility: A Meta-Analysis. Front Psychol 2021; 12:643395. [PMID: 33868114 PMCID: PMC8044306 DOI: 10.3389/fpsyg.2021.643395] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The pregnancy and psychological status of infertile couples has always been a concern, but there is no clear evidence for the efficacy of psychotherapy for infertile couples. This study aimed to summarize the current evidence of the effects of psychotherapy on psychological and pregnancy outcomes for infertile couples. Method: We searched Ovid MEDLINE, Ovid EMbase, The Cochrane Library, and Web of Science (ISI) for articles published from 1946 to June 26, 2020. The pregnancy outcomes, psychological outcomes, and acceptability were involved in the study. Results: Overall, 29 studies with a combined total of 3,522 adult participants were included in the meta-analysis. Compared with a placebo, psychotherapy was associated with the pregnancy rate [risk ratio (RR) = 1.43, 95% CI [1.07, 1.93]], total psychological scales associated with infertility [standardized mean difference (SMD) = −0.33 95% CI [−0.63, −0.02]], subsymptoms of psychological scores using the 28-item version of GHQ (including social function [MD = −3.10, 95% CI [−4.30, −1.90]] and depression [MD = −3.90, 95% CI [−5.36, −2.44]], and depression [MD = 3.60, 95% CI [2.25, 4.95]] using the 14-item version of Hospital Anxiety and Depression Scale, but it had no statistically significant association with the other outcomes. In the stratified analyses, the pregnancy rate using assisted reproduction, cognitive behavioral therapy (CBT), and the integrative body–mind–spirit (BMS); total psychological scales associated with infertility using other treatments and more than a month; and anxiety using BMS had significant statistical significance. The funnel plots of all outcomes were approximately symmetrical, and no significant publication bias was found. Conclusions: The study showed that psychotherapy can lead to improvements in the pregnancy rate for infertile patients, especially for patients receiving assisted fertility. In addition, it may help improve total psychological scales associated with infertility and depression. CBT and BMS play an important role in improving rate of pregnancy, and BMS is associated with reducing anxiety. Although psychological interventions had limited effects on the pregnancy outcomes of infertility, our study still recommended that psychotherapies, in particular CBT and BMS, were applied to the therapeutic regimen for infertility, especially for patients receiving assisted fertility.
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Affiliation(s)
- Rong Zhou
- Department of Reproductive Medicine Center, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Yu-Ming Cao
- The Second Clinical College of Wuhan University, Wuhan, China
| | - Dan Liu
- Department of Obstetrics and Gynecology, Wuhan Ninth Hospital, Wuhan, China
| | - Jing-Song Xiao
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
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28
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Katyal N, Poulsen CM, Knudsen UB, Frederiksen Y. The association between psychosocial interventions and fertility treatment outcome: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2021; 259:125-132. [PMID: 33677371 DOI: 10.1016/j.ejogrb.2021.02.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/28/2021] [Accepted: 02/13/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Does psychosocial intervention affect pregnancy outcomes in women and couples undergoing assisted reproductive technology (ART) treatment?. DESIGN A systematic review and meta-analysis of Randomized Controlled Trials (RCTs) evaluating the efficacy of psychosocial intervention on pregnancy outcomes in women and couples undergoing ART treatment. The primary outcome was Pregnancy Rates. Secondary outcomes were Live Birth Rate (LBR) and Abortion Rate (AR). MATERIALS AND METHODS Databases searched were Pubmed, PsycINFO, Embase, CINAHL and The Cochrane Library. 1439 records were screened, 15 were eligible and included in the meta-analyses (N = 2434). Data was extracted using the Covidence software. Effect sizes were reported as relative risks with 95% confidence-intervals and p-values. RESULTS A positive association was found between psychosocial intervention and pregnancy rates (RR = 1.12 CI=(1.01;1.24), p = 0.033). Long-duration interventions and mind-body intervention types were found to be associated with increased pregnancy rates (RR 1.21, CI= (1.04;1.43), p = 0.017) and (RR = 1.25, CI= (1.00;1.55), p = 0.046) respectively. Q and I2tests suggested no to low heterogeneity. Funnel plots, Trim and Fill analyses and Fail-safe numbers were applied to adjust for possible publication bias. CONCLUSIONS Our findings suggest a positive association between psychosocial interventions, particularly long-duration interventions, and pregnancy rate in infertile women and couples in ART treatment. The findings are in line with findings from other reviews and meta-analyses exploring the same topic. More good quality RCTs need to be performed to increase the quality of guidance for infertile women and couples. The effect of psychosocial interventions on LBR and AR remain to be examined.
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Affiliation(s)
- Nitasha Katyal
- Department of Health, Aarhus University, 8000 Aarhus C, Denmark.
| | | | - Ulla Breth Knudsen
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus C, Denmark; The Fertility Clinic, Horsens Regional Hospital, 8700 Horsens, Denmark
| | - Yoon Frederiksen
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark; the Sexology Unit, Aarhus University Hospital Psychiatry, 8200 Aarhus N, Denmark
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29
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Ha JY, Ban SH. Effects of Mind-Body Programs on Infertile Women: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Asian Nurs Res (Korean Soc Nurs Sci) 2021; 15:77-88. [PMID: 33607300 DOI: 10.1016/j.anr.2021.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 01/23/2021] [Accepted: 02/08/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE This study was to systematically review randomized controlled trials and conduct a meta analysis. The results of randomized controlled trials were integrated and analyzed to assess the effects of mind-body programs on anxiety, depression, quality of life, and pregnancy rate in infertile women. METHODS Using electronic databases (i.e., Research Information Sharing Service, Korean Studies Information Service System, Korean Medical Database, National Digital Science Library, Cochrane Library, PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, and PsycARTICLES), 10 of 2,259 studies were included for meta-analysis. To estimate the effect size, a meta-analysis of the studies was performed using RevMan 5.3. RESULTS The mind-body program was effective in relieving anxiety [standardized mean difference (SMD) = -3.44; 95% confidence interval (CI) = -5.94, -0.95; p = .007; I2 = 69%] and depression (SMD = -5.79; 95% CI = -10.36, -1.22; p = .010; I2 = 86%). Furthermore, it was effective in enhancing the quality of life (SMD = 7.40; 95% CI = 2.92, 11.88; p = .001; I2 = 53%) and pregnancy rate (SMD = 2.06; 95% CI = 1.08, 3.95; p = .030; I2 = 73%). The mind-body program was found to relieve anxiety and depression in infertile women and improve their quality of life, thereby positively affecting the pregnancy rate. CONCLUSION The mind-body program was found to relieve anxiety and depression in infertile women and improve their quality of life, thereby positively affecting the pregnancy rate. The mind-body program needs to be considered to a wider audience for positive effects on emotions and pregnancy outcomes of infertile women.
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Affiliation(s)
- Ju-Young Ha
- College of Nursing, Pusan National University, Busan, Republic of Korea
| | - Seon-Hwa Ban
- College of Nursing, Pusan National University, Busan, Republic of Korea.
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30
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Rasoulzadeh Bidgoli M, Latifnejad Roudsari R, Montazeri A. The effectiveness of a collaborative infertility counseling (CIC) on pregnancy outcome in women undergoing in vitro fertilization: a randomized trial. BMC Pregnancy Childbirth 2020; 20:728. [PMID: 33238907 PMCID: PMC7687779 DOI: 10.1186/s12884-020-03417-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 11/12/2020] [Indexed: 11/29/2022] Open
Abstract
Background The optimal objective of infertility treatments is to increase pregnancy rate. The aim of this study was to assess the effectiveness of a collaborative counseling program on pregnancy rate in women undergoing in vitro treatment. Methods This was a parallel group randomized trial on a sample of 60 women attending to an infertility research center affiliated to Mashhad University of Medical Sciences for fertility treatment. Women were randomly assigned to an intervention or a control group. Then, a five-session program offered to the intervention group while the control group received nothing expect the usual care. The primary outcome for the study was positive pregnancy test at the end of study. Statistical analyses including independent samples t-test were performed to explore the data. Results The outcome analysis showed that there were no significant differences in pregnancy rate between the intervention and the control groups (P = 0.298). Also, there were no significant differences in follicle and embryo numbers between two groups. However, a significant difference was observed between two groups in terms of oocyte numbers where the intervention group had more oocyte (P = 0.014). Conclusion Overall the findings indicated that the collaborative infertility counseling did not improve treatment success in infertile women undergoing in vitro fertilization. Trial registration IRCT201110267915N1. Registered 2014.07.25-Retrospectively registered (http://en.irct.ir/trial/8359).
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Affiliation(s)
- Mahboobeh Rasoulzadeh Bidgoli
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, Iran. .,Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | - Robab Latifnejad Roudsari
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Montazeri
- Population Health Research Group, Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran. .,Faculty of Humanity Sciences, University of Science and Culture, Tehran, Iran.
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31
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Courbiere B, Lacan A, Grynberg M, Grelat A, Rio V, Arbo E, Solignac C. Psychosocial and professional burden of Medically Assisted Reproduction (MAR): Results from a French survey. PLoS One 2020; 15:e0238945. [PMID: 32970695 PMCID: PMC7514013 DOI: 10.1371/journal.pone.0238945] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/26/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To evaluate the impact of infertility and Medically Assisted Reproduction (MAR) throughout all aspects of life among infertile women and men. MATERIALS AND METHODS An online survey included 1 045 French patients (355 men, 690 women) who were living or had lived the experience of infertility and MAR. The questionnaire included 56 questions on several domains: global feelings, treatment burden, rapport with medical staff, psychosocial impact, sexual life and professional consequences. RESULTS Respondents had experienced an average of 3.6 (95% CI: 3.3-3.9) MAR cycles: 5% (n = 46) were pregnant, 4% (n = 47) were waiting to start MAR, 50% (n = 522) succeeded in having a live birth following MAR, 19% (n = 199) were currently undergoing ART, and 21% (n = 221) dropped out of the MAR process without a live birth. Satisfaction rates regarding the received medical care were above 80%, but 42% of patients pointed out the lack of information about non-medical support. An important impact on sexual life was reported, with 21% of patients admitted having not had intercourse for several weeks or even several months. Concerning the impact on professional life, 63% of active workers currently in an MAR program (n = 185) considered that MAR had strong repercussions on the organization of their working life with 49% of them reporting a negative impact on the quality of their work, and 46% of them reporting the necessity to lie about missing work during their treatment. CONCLUSION Despite a high overall level of satisfaction regarding medical care, the burden of infertility and MAR on quality of life is strong, especially on sexuality and professional organization. Clinical staff should be encouraged to develop non-medical support for all patients at any stage of infertility treatment. Enterprises should be warned about the professional impact of infertility and MAR to help their employees reconcile personal and professional life.
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Affiliation(s)
- Blandine Courbiere
- Pôle Femmes-Parents-Enfants–Centre Clinico-Biologique d’AMP, AP-HM La Conception, Marseille, France
- CNRS, IRD, Aix Marseille Univ, Avignon Université, IMBE, Marseille, France
- * E-mail:
| | - Arnaud Lacan
- Kedge Business School, AMSE, CNRS, EHESS, UMR 7316, Marseille, France
| | - Michael Grynberg
- Department of Reproductive Medicine & Fertility Preservation, Hôpital Antoine Beclère, Clamart, France
| | - Anne Grelat
- Centre Mistral, Clinique Pasteur, Guilherand-Granges, France
| | - Virginie Rio
- Collectif bAMP, Association de patients de l’AMP et de personnes infertiles, Quincy sous Sénart, France
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Gaitzsch H, Benard J, Hugon-Rodin J, Benzakour L, Streuli I. The effect of mind-body interventions on psychological and pregnancy outcomes in infertile women: a systematic review. Arch Womens Ment Health 2020; 23:479-491. [PMID: 31897607 DOI: 10.1007/s00737-019-01009-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 11/07/2019] [Indexed: 11/25/2022]
Abstract
Preliminary evidence suggests that mind-body interventions, including mindfulness-based interventions and yoga, may be effective in reducing mental health difficulties and psychological distress in infertile patients undergoing fertility treatments. We systematically reviewed and synthesized current medical literature of the effectiveness of mind-body interventions in reducing the severity of psychological distress and improving marital function and pregnancy outcomes in infertile women/couple. Databases including PsychINFO, PubMed, EMBASE, and the Cochrane Library were searched for relevant studies. Manual searches were conducted in relevant articles. We included 12 studies that met the inclusion criteria. Four studies were randomized controlled trials (RCT), 4 non-randomized controlled trial (NRCT), and 4 uncontrolled studies (UCT). Participation in a mind-body intervention was associated with reduced anxiety trait and depression scores. The reduction was of low or moderate amplitude in most studies. Our review offers evidence for the effectiveness of mind-body interventions in reducing anxiety state and depression in infertile women and a possible improvement in pregnancy rate. Further RCTs with a precise timing of intervention are needed.
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Affiliation(s)
- Hélène Gaitzsch
- Unit for Reproductive Medicine and Gynecological Endocrinology, Department for Gynecology and Obstetrics, University Hospitals of Geneva and the Faculty of Medicine of the University of Geneva, 30 boulevard de la Cluse, 1205, Geneva, Switzerland
| | - Julie Benard
- Unit for Reproductive Medicine and Gynecological Endocrinology, Department for Gynecology and Obstetrics, University Hospitals of Geneva and the Faculty of Medicine of the University of Geneva, 30 boulevard de la Cluse, 1205, Geneva, Switzerland
| | | | - Lamyae Benzakour
- Division for Liaison Psychiatry and Crisis Intervention, Department of Mental Health, University Hospitals of Geneva, 30 boulevard de la Cluse, 1205, Geneva, Switzerland
| | - Isabelle Streuli
- Unit for Reproductive Medicine and Gynecological Endocrinology, Department for Gynecology and Obstetrics, University Hospitals of Geneva and the Faculty of Medicine of the University of Geneva, 30 boulevard de la Cluse, 1205, Geneva, Switzerland.
- Hélène Gaitzsch Medical Resident Unit for Reproductive Medicine and Gynecological Endocrinology, Department for Gynecology and Obstetrics, University Hospitals of Geneva, 30 boulevard de la Cluse, 1205, Geneva, Switzerland.
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Lorzadeh N, Kazemirad N, Kazemirad Y. Human immunodeficiency: Extragonadal comorbidities of infertility in women. IMMUNITY INFLAMMATION AND DISEASE 2020; 8:447-457. [PMID: 32621331 PMCID: PMC7416027 DOI: 10.1002/iid3.327] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 06/21/2020] [Indexed: 12/12/2022]
Abstract
Introduction Infertility is mediated by several changes system‐wide. These changes are likely to cause other systems‐related pathologies, such as changes in systemic immune response, particularly inflammatory response can lead to cardiovascular diseases and breast cancer. Methods These morbidities can exist immediately or years after the diagnosis of infertility. Therefore, understanding the mechanism is important to move toward therapeutic interventions. Results Several extragonadal pathologies are reported due to infertility, as well as, how these might also contribute to reproductive disabilities. Detailed evidence are still not present that can give stronger result. Conclusion This review highlights some of the most frequent comorbidities that are seen in infertile women, hence requiring a need for complete clinical screening and care, as well as diagnosis and treatment in early stages.
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Affiliation(s)
- Nahid Lorzadeh
- Department of Obstetrics and Gynecology, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Nastaran Kazemirad
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Sõritsa D, Mäestu E, Nuut M, Mäestu J, Migueles JH, Läänelaid S, Ehrenberg A, Sekavin A, Sõritsa A, Salumets A, Ortega FB, Altmäe S. Maternal physical activity and sedentary behaviour before and during in vitro fertilization treatment: a longitudinal study exploring the associations with controlled ovarian stimulation and pregnancy outcomes. J Assist Reprod Genet 2020; 37:1869-1881. [PMID: 32578030 DOI: 10.1007/s10815-020-01864-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 06/16/2020] [Indexed: 01/05/2023] Open
Abstract
PURPOSE To evaluate the association of objectively measured physical activity (PA) and sedentary behaviour before and during in vitro fertilization (IVF) with controlled ovarian stimulation (COS) and pregnancy outcomes. METHODS This longitudinal study involved 107 infertile women undergoing IVF treatment. PA and sedentary behaviour were measured for 14 consecutive days using accelerometry as follows: (1) before IVF treatment, (2) during IVF at the implantation time, immediately after embryo transfer, and (3) after positive pregnancy test. Total screen time was assessed by questionnaires. COS results were measured as the number of oocytes and embryos obtained, and the study outcomes included positive hCG, clinical pregnancy, and live birth. RESULTS Compared with baseline activity levels, women significantly reduced their PA and increased sedentary behaviour during IVF (p ≤ 0.001). Higher average PA, light PA, and ratio between breaks in every ≥ 30-min blocks of sedentary time showed positive associations, while sedentary time, number, and time accumulated in blocks of ≥ 30 min of sedentary time associated negatively with oocyte and embryo counts (all p < 0.05). Women with high total screen time during non-work days (≥ 7 h) obtained 4.7 oocytes (p = 0.005) and 2.8 embryos (p = 0.008) less in COS. PA and sedentary behaviour before and during IVF did not affect the positive hCG, clinical pregnancy, and live birth outcomes. CONCLUSION Our study results suggest that higher time spent in PA and lower time spent in sedentary behaviour before entering assisted reproduction is associated with better COS outcomes, while activity levels before and during IVF do not affect the implantation, pregnancy, and live birth outcomes.
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Affiliation(s)
- Deniss Sõritsa
- Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu, 51014, Tartu, Estonia
- Elite Clinic, 50407, Tartu, Estonia
| | - Evelin Mäestu
- Faculty of Medicine, Institute of Sport Sciences and Physiotherapy, University of Tartu, 51014, Tartu, Estonia
| | - Margit Nuut
- Tartu University Hospital's Women's Clinic, 51014, Tartu, Estonia
| | - Jarek Mäestu
- Faculty of Medicine, Institute of Sport Sciences and Physiotherapy, University of Tartu, 51014, Tartu, Estonia
| | - Jairo H Migueles
- PROFITH 'PROmoting FITness and Health through physical activity' Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18071, Granada, Spain
| | - Siret Läänelaid
- Department of Family Medicine, Faculty of Medicine, University of Tartu, 50411, Tartu, Estonia
- Tartu Health Care College, 50411, Tartu, Estonia
| | - Aivar Ehrenberg
- Tartu University Hospital's Women's Clinic, 51014, Tartu, Estonia
| | - Aire Sekavin
- Tartu University Hospital's Women's Clinic, 51014, Tartu, Estonia
| | | | - Andres Salumets
- Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu, 51014, Tartu, Estonia
- Competence Centre on Health Technologies, 50410, Tartu, Estonia
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, FI-00029 HUS, Helsinki, Finland
| | - Francisco B Ortega
- PROFITH 'PROmoting FITness and Health through physical activity' Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18071, Granada, Spain
- Department of Biosciences and Nutrition, NOVUM, Karolinska Institutet, 14183, Huddinge, Sweden
| | - Signe Altmäe
- Competence Centre on Health Technologies, 50410, Tartu, Estonia.
- Department of Biochemistry and Molecular Biology, Faculty of Sciences, University of Granada, Avda. Fuente Nueva S/N, 18071, Granada, Spain.
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.
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Clifton J, Parent J, Seehuus M, Worrall G, Forehand R, Domar A. An internet-based mind/body intervention to mitigate distress in women experiencing infertility: A randomized pilot trial. PLoS One 2020; 15:e0229379. [PMID: 32187236 PMCID: PMC7080396 DOI: 10.1371/journal.pone.0229379] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 02/04/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To determine if an internet-based mind/body program would lead to participants experiencing infertility (1) being willing to be recruited and randomized and (2) accepting and being ready to engage in a fertility-specific intervention. Secondary exploratory goals were to examine reduced distress over the course of the intervention and increased likelihood to conceive. METHODS This was a pilot randomized controlled feasibility trial with a between-groups, repeated measure design. Seventy-one women self-identified as nulliparous and meeting criteria for infertility. Participants were randomized to the internet-based version of the Mind/Body Program for Fertility or wait-list control group and asked to complete pre-, mid- and post-assessments. Primary outcomes include retention rates, number of modules completed, and satisfaction with intervention. Secondary exploratory outcomes sought to provide preliminary data on the impact of the program on distress (anxiety and depression) and self-reported pregnancy rates relative to a quasi-control group. RESULTS The retention, adherence, and satisfaction rates were comparable to those reported in other internet-based RCTs. Although time between pre- and post-assessment differed between groups, using intent-to-treat analyses, women in the intervention group (relative to the wait-list group) had significant reduction in distress (anxiety, p = .003; depression, p = .007; stress, p = .041 fertility-social, p = .018; fertility-sexual, p = .006), estimated as medium-to-large effect sizes (ds = 0.45 to 0.86). The odds of becoming pregnant was 4.47 times higher for the intervention group participants as compared to the wait-list group, OR 95% CI [1.56, 12.85], p = .005 and occurred earlier. The findings suggest that the research design and program specific to this population are feasible and acceptable. Replication efforts with an active control group are needed to verify distress reduction and conception promotion findings.
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Affiliation(s)
- Jessica Clifton
- Department of Psychological Sciences, The University of Vermont, Burlington, Vermont, United States of America
| | - Justin Parent
- Department of Psychology, Florida International University, Miami, Florida, United States of America
| | - Martin Seehuus
- Department of Psychological Sciences, The University of Vermont, Burlington, Vermont, United States of America
- Department of Psychology, Middlebury College, Middlebury, Vermont, United States of America
| | - Garyn Worrall
- Department of Medicine, Larner College of Medicine at The University of Vermont, Burlington, Vermont, United States of America
| | - Rex Forehand
- Department of Psychological Sciences, The University of Vermont, Burlington, Vermont, United States of America
| | - Alice Domar
- Boston IVF, Waltham, Massachusetts, United States of America
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts, United States of America
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The Effect of Cognitive Behavioral Therapy on Anxiety and Depression in Iranian Infertile Women: A Systematic and Meta-Analytical Review. IRANIAN JOURNAL OF PSYCHIATRY AND BEHAVIORAL SCIENCES 2020. [DOI: 10.5812/ijpbs.96715] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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First trimester depression and/or anxiety disorders increase the risk of low birthweight in IVF offspring: a prospective cohort study. Reprod Biomed Online 2019; 39:947-954. [DOI: 10.1016/j.rbmo.2019.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/07/2019] [Accepted: 09/05/2019] [Indexed: 01/18/2023]
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Dancet EAF, D'Hooghe TM, Dreischor F, van Wely M, Laan ETM, Lambalk CB, Repping S, Custers IM. The 'Pleasure&Pregnancy' web-based interactive educational programme versus expectant management in the treatment of unexplained subfertility: protocol for a randomised controlled trial. BMJ Open 2019; 9:e025845. [PMID: 31289062 PMCID: PMC6615847 DOI: 10.1136/bmjopen-2018-025845] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Many subfertile couples are diagnosed with (relatively) unexplained subfertility and a good prognosis. National professional guidelines (eg, the Netherlands and UK) advise 'expectant management (EM)' for 6-12 months, in which no interaction with healthcare staff is offered. Underpowered studies indicate that face-to-face sex-counselling increases the ongoing pregnancy rates of these couples. In patients with other conditions, web-based interactive educational programmes have the same effect on sexual functioning as face-to-face sex counselling. The 'Pleasure&Pregnancy randomised controlled trial (RCT)' will examine in couples with unexplained subfertility and a good prognosis whether a new web-based interactive educational programme results in a higher chance of naturally conceiving an ongoing pregnancy within 6 months as compared with EM. METHODS AND ANALYSIS A multicentre RCT with cost-effectiveness analysis will include heterosexual couples diagnosed with (relatively) unexplained subfertility and a good prognosis in Dutch and Belgian secondary or tertiary fertility clinics. Couples will be randomised between 6 months of EM and 6 months of the Pleasure&Pregnancy-programme. This new web-based interactive educational programme includes eight progressive modules of information (on the biology of conception and pleasurable sex) and sensate focus, couple communication and mindfulness exercises. Couples are offered interaction with their coaches via email and can take part in three moderated chat sessions with peers. The primary outcome of this RCT is the probability of naturally conceiving an ongoing pregnancy within 6 months after randomisation. Secondary outcomes include time-to-pregnancy, live birth rate, costs, sexual functioning and personal and relational well-being. Analysis will be according to intention to treat. ETHICS AND DISSEMINATION This study has been approved by the Medical Ethical Committees of the Academic Medical Centre (the Netherlands) and the Leuven University Hospital (Belgium). The findings of this RCT will be disseminated through presentations at international scientific meetings and peer-reviewed publications. TRAIL REGISTRATION NUMBER NTR5709; Pre-results.
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Affiliation(s)
- Eline A F Dancet
- Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium
- Postdoctoral fellow, Research Foundation - Flanders, Belgium
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Thomas M D'Hooghe
- Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium
| | - Felicia Dreischor
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Madelon van Wely
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Ellen T M Laan
- Department of Sexology and Psychosomatic Obstetrics/Gynecology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Cornelius B Lambalk
- Department of Obstetrics and Gynaecology, Reproduction and Development, Amsterdam University Medical Centre, Free University of Amsterdam, Amsterdam, The Netherlands
| | - Sjoerd Repping
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Inge M Custers
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Schick M, Roesner S, Germeyer A, Moessner M, Bauer S, Ditzen B, Wischmann T. Smartphone-supported Positive Adjustment Coping Intervention (PACI) for couples undergoing fertility treatment: a randomised controlled trial protocol. BMJ Open 2019; 9:e025288. [PMID: 31289056 PMCID: PMC6629398 DOI: 10.1136/bmjopen-2018-025288] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Infertility generally counts as a profound crisis in the lives of couples and as an emotionally stressful experience. For couples undergoing fertility treatment, this is especially true of the waiting period following embryo transfer, which couples say is the most stressful period during treatment. However, at this specific phase, psychosocial counselling is not always available on the spot. The aim of this randomised controlled trial (RCT) study was to test the Positive Adjustment Coping Intervention (PACI), a low-dose, smartphone-supported psychological intervention for women and men undergoing fertility treatment. METHODS AND ANALYSIS The effectiveness of PACI is tested by means of a prospective two-arm RCT. During the 14-day waiting period between oocyte puncture/oocyte thawing and pregnancy test, participants are randomly assigned to one of the two groups, and both women and men receive daily text messages on their smartphones. One group receives text messages with statements reflecting positive-adjustment coping attitudes, the other group messages containing cognitive distractions. The primary outcome of this study is the reduction of psychosocial burden during the waiting period of reproductive treatment. Furthermore, we want to assess whether there are differences between the interventions in a pre-post assessment. The secondary outcomes are information on perceived effectiveness and practicability of the intervention one month after the waiting period. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Ethics Committee of Heidelberg University Faculty of Medicine (S-074/2017). Study findings are planned for dissemination via peer-reviewed journal articles and at national and international conferences. TRIAL REGISTRATION NUMBER NCT03118219; Pre-results. PROTOCOL VERSION Version 2.0 dated 18/02/2019.
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Affiliation(s)
- Maren Schick
- Institute of Medical Psychology, University Hospital Heidelberg, Center for Psychosocial Medicine, Heidelberg, Germany
| | - Sabine Roesner
- Department of Gynecologic Endocrinology and Fertility Disorders, University Women's Hospital Heidelberg, Heidelberg, Germany
| | - Ariane Germeyer
- Department of Gynecologic Endocrinology and Fertility Disorders, University Women's Hospital Heidelberg, Heidelberg, Germany
| | - Markus Moessner
- Center for Psychotherapy Research, University Hospital Heidelberg, Center for Psychosocial Medicine, Heidelberg, Germany
| | - Stephanie Bauer
- Center for Psychotherapy Research, University Hospital Heidelberg, Center for Psychosocial Medicine, Heidelberg, Germany
| | - Beate Ditzen
- Institute of Medical Psychology, University Hospital Heidelberg, Center for Psychosocial Medicine, Heidelberg, Germany
| | - Tewes Wischmann
- Institute of Medical Psychology, University Hospital Heidelberg, Center for Psychosocial Medicine, Heidelberg, Germany
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Bai CF, Cui NX, Xu X, Mi GL, Sun JW, Shao D, Li J, Jiang YZ, Yang QQ, Zhang X, Cao FL. Effectiveness of two guided self-administered interventions for psychological distress among women with infertility: a three-armed, randomized controlled trial. Hum Reprod 2019; 34:1235-1248. [PMID: 31242506 DOI: 10.1093/humrep/dez066] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 04/03/2019] [Indexed: 12/19/2022] Open
Abstract
Abstract
STUDY QUESTION
What is the effect of two guided self-administered interventions on psychological distress in women undergoing IVF or ICSI?
SUMMARY ANSWER
A brief mindfulness intervention significantly reduced depression and improved sleep quality, while the gratitude journal intervention showed no significant effect on any outcome variables.
WHAT IS KNOWN ALREADY
Mindfulness and gratitude journal interventions have been found to be beneficial in reducing negative affect and improving well-being. However, there are very few mental health professionals who implement such interventions in low- and middle-income countries. Therefore, two guided self-administered interventions for women with infertility were designed to help them cope with their psychological distress.
STUDY DESIGN, SIZE, DURATION
A three-armed, randomized controlled trial was designed to evaluate the mindfulness and gratitude journal interventions for women undergoing IVF/ICSI. Between May 2016 and November 2017, at the reproductive center in a public hospital, 234 women were randomly assigned to the brief mindfulness group (BMG, n = 78), gratitude journal group (GJG, n = 78) or control group (CG, n = 78). The inclusion criteria were being a woman undergoing her first cycle of IVF, having at least junior middle school education and having no biological or adopted children.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Female infertility patients (n = 346) were approached, and 112 did not meet the inclusion criteria. All three randomized groups completed questionnaires on the day of down-regulation (T1), the day before embryo(s) transfer (T2), and 3 days before the pregnancy test (T3). The BMG completed four sessions and listened to a 20-minute audio daily, including guided mindfulness breathing and body scan. The GJG completed four sessions and wrote three gratitude journals daily. The CG received routine care. A generalized estimating equation was used in an intention-to-treat analysis. The primary outcome was depression. Secondary outcomes were anxiety, sleep quality, infertility-related stress, mindfulness and gratitude.
MAIN RESULTS AND THE ROLE OF CHANCE
Participants of the BMG showed decreased depression (mean difference (MD) = −1.69, [−3.01, −0.37], d = 0.44) and improved sleep quality (MD = −1.24, [−1.95, −0.39], d = 0.43) compared to the CG, but the effect was not significant for anxiety, Fertility Problem Inventory totals, mindfulness, gratitude scores or pregnancy rates. The BMG showed a significant reduction in depression and improvement in sleep quality between T1 and T2, a continuous significant reduction between T1 and T3 and no reduction between T2 and T3. There were no significant effects on any of the variables for the GJG.
LIMITATIONS, REASONS FOR CAUTION
The inclusion criteria may result in bias because some participants with low education were excluded and only women with infertility were included. A low compliance rate occurred in the gratitude journals group. Moreover, men were not included in this study. Further research should consider including spouses of the target population.
WIDER IMPLICATIONS OF THE FINDINGS
The brief mindfulness intervention was beneficial in decreasing depression and improving sleep quality. Implementation of guided self-administered mindfulness could make the psychological counseling service more accessible for patients with infertility in resource-poor settings. The efficiency and feasibility of the gratitude journal intervention needs to be investigated further.
STUDY FUNDING/COMPETING INTEREST(S)
This study was funded by the National Social Science Foundation (17BSH054). The authors have no conflicts of interest.
TRIAL REGISTRATION NUMBER
ChiCTR-IOR-16008452.
TRIAL REGISTRATION DATE
9 May 2016
DATE OF FIRST PATIENT’S ENROLMENT
15 May 2016.
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Affiliation(s)
- Cai-Feng Bai
- School of Nursing, Shandong University, No. 44 Wenhua Xi Road, Jinan 250012, China
- School of Nursing, Ningxia Medical University, 1160 Sheng Li Street, Yinchuan 750004, China
| | - Nai-Xue Cui
- School of Nursing, Shandong University, No. 44 Wenhua Xi Road, Jinan 250012, China
| | - Xian Xu
- Reproductive Medicine Center, General Hospital of Ningxia Medical University, 804 Sheng Li Street, Yinchuan 750004, China
| | - Guang-li Mi
- Nursing Department, General Hospital of Ningxia Medical University, 804 Sheng Li Street, Yinchuan 750004, China
| | - Ji-Wei Sun
- School of Nursing, Shandong University, No. 44 Wenhua Xi Road, Jinan 250012, China
| | - Di Shao
- School of Health Care Management, Shandong University, No. 44 Wenhua Xi Road, Jinan 250012, China
| | - Jie Li
- School of Nursing, Shandong University, No. 44 Wenhua Xi Road, Jinan 250012, China
| | - Yin-Zhi Jiang
- Reproductive Medicine Center, General Hospital of Ningxia Medical University, 804 Sheng Li Street, Yinchuan 750004, China
| | - Qian-Qian Yang
- School of Nursing, Shandong University, No. 44 Wenhua Xi Road, Jinan 250012, China
| | - Xuan Zhang
- School of Nursing, Shandong University, No. 44 Wenhua Xi Road, Jinan 250012, China
| | - Feng-Lin Cao
- School of Nursing, Shandong University, No. 44 Wenhua Xi Road, Jinan 250012, China
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Arpin V, Brassard A, El Amiri S, Péloquin K. Testing a New Group Intervention for Couples Seeking Fertility Treatment: Acceptability and Proof of Concept. JOURNAL OF SEX & MARITAL THERAPY 2019; 45:303-316. [PMID: 30712479 DOI: 10.1080/0092623x.2018.1526836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This study tested the acceptability and preliminary efficacy of a novel group intervention for couples seeking fertility treatment. Twenty-nine couples completed psychological, relational, and sexual outcome measures pre- and post-intervention. Repeated-measures ANOVAs revealed significant reductions in terms of depressive symptoms, rejection of childfree lifestyle, and stress related to the need for parenthood. The results also revealed improvements in marital benefits and fertility-related emotional and relational quality of life. Couples' high participation rates and reported treatment satisfaction indicate adequate acceptability. These results support the preliminary success of the intervention in reducing the psychological and relational burden for couples undergoing fertility treatment.
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Affiliation(s)
- Virginie Arpin
- a Departement de psychologie , Université de Montréal , Montréal , QC , Canada
| | - Audrey Brassard
- b Psychology , Universite de Sherbrooke , Sherbrooke , QC , Canada
| | - Sawsane El Amiri
- a Departement de psychologie , Université de Montréal , Montréal , QC , Canada
| | - Katherine Péloquin
- a Departement de psychologie , Université de Montréal , Montréal , QC , Canada
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Galhardo A, Cunha M, Pinto-Gouveia J. A 7-year follow-up study of the Mindfulness-Based Program for Infertility: Are there long-term effects? Clin Psychol Psychother 2019; 26:409-417. [PMID: 30812065 DOI: 10.1002/cpp.2362] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/23/2019] [Accepted: 02/25/2019] [Indexed: 11/06/2022]
Abstract
The Mindfulness-Based Program for Infertility (MBPI) was developed for people facing infertility and proved effective in cultivating mindfulness skills, improving infertility self-efficacy, and decreasing depression, shame, entrapment, and defeat feelings. Fifty-five women attended the MBPI sessions and completed self-report measures of depression, anxiety, mindfulness, and experiential avoidance at post-MBPI (T1), 6-month follow-up (T2), and 7-year follow-up (T3). There were significant direct time effects regarding experiential avoidance (F = 3.81; p < 0.033; ηp 2 = 0.08), the mindfulness facets describing (F = 3.54; p = 0.037; ηp 2 = 0.13), acting with awareness (F = 6.87; p = 0.002; ηp 2 = 0.22), nonjudging of inner experience (F = 10.66; p < 0.001; ηp 2 = 0.31), and depressive symptoms (F = 4.85; p = 0.020; ηp 2 = 0.10). There was an increase in the describing facet from T1 to T3 (p = 0.036). The act with awareness facet increased from T1 to T2 (p = 0.010) and from T1 to T3 (p = 0.007), as well as the nonjudging of inner experience facet (T1 to T2 [p = 0.030] and T1 to T3 [p = 0.002]). Experiential avoidance decreased from T1 to T3 (p = 0.022) and depressive symptoms from T1 to T2 (p = 0.019). Post-MBPI scores were maintained at T2 and T3 concerning anxiety symptoms and the observing and no-reactivity mindfulness facets. There were long-term effects of MBPI on mindfulness and experiential avoidance. Moreover, therapeutic gains were maintained regarding depression and anxiety symptoms, independently of the reproductive outcome.
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Affiliation(s)
- Ana Galhardo
- Department of Psychology, Instituto Superior Miguel Torga, Coimbra, Portugal.,CINEICC - Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Marina Cunha
- Department of Psychology, Instituto Superior Miguel Torga, Coimbra, Portugal.,CINEICC - Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - José Pinto-Gouveia
- CINEICC - Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
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An Analysis of Differences in the Number of Children for Female and Male Plastic Surgeons. Plast Reconstr Surg 2019; 143:315-326. [DOI: 10.1097/prs.0000000000005097] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Donarelli Z, Salerno L, Lo Coco G, Allegra A, Marino A, Kivlighan DM. From telescope to binoculars. Dyadic outcome resulting from psychological counselling for infertile couples undergoing ART. J Reprod Infant Psychol 2018; 37:13-25. [DOI: 10.1080/02646838.2018.1548757] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Laura Salerno
- Psychology Unit, ANDROS Day Surgery Clinic, Palermo, Italy
| | - Gianluca Lo Coco
- Department of Psychology and Educational Sciences, University of Palermo, Palermo, Italy
| | - Adolfo Allegra
- Reproductive Medicine Unit, ANDROS Day Surgery Clinic, Palermo, Italy
| | - Angelo Marino
- Reproductive Medicine Unit, ANDROS Day Surgery Clinic, Palermo, Italy
| | - Dennis M. Kivlighan
- Department of Counseling, Higher Education, and Special Education, University of Maryland, College Park, USA
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Abstract
The relationship between stress and infertility has been debated for years. Women with infertility report elevated levels of anxiety and depression, so it is clear that infertility causes stress. What is less clear, however, is whether or not stress causes infertility. The impact of distress on treatment outcome is difficult to investigate for a number of factors, including inaccurate self-report measures and feelings of increased optimism at treatment onset. However, the most recent research has documented the efficacy of psychological interventions in lowering psychological distress as well as being associated with significant increases in pregnancy rates. A cognitive-behavioral group approach may be the most efficient way to achieve both goals. Given the distress levels reported by many infertile women, it is vital to expand the availability of these programs.
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Affiliation(s)
| | - Alice D Domar
- Boston IVF, Waltham, Massachusetts USA; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts, USA; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston Massachusetts, USA
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Fliegner M, Richter-Appelt H, Krupp K, Brucker SY, Rall K, Brunner F. Living with permanent infertility: A German study on attitudes toward motherhood in individuals with Complete Androgen Insensitivity Syndrome (CAIS) and Mayer-Rokitansky-Küster-Hauser Syndrome (MRKHS). Health Care Women Int 2018; 39:1295-1315. [PMID: 30362901 DOI: 10.1080/07399332.2018.1490739] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
In this study the authors examined the issue of permanent infertility in two diagnoses of the diverse sex developments (DSD) spectrum: Complete Androgen Insensitivity Syndrome (CAIS) and Mayer-Rokitansky-KÏster-Hauser Syndrome (MRKHS). The participants with CAIS (n = 12) was older, showed a lower wish for a child and was less distressed about their infertility compared to participants with MRKHS (n = 49). Our data indicated an "indifferent" attitude toward motherhood in CAIS and an "ambivalent" attitude in MRKHS. Depression was frequent in both. Infertility is a source of distress. However, the two groups seem to cope in different ways. Comprehensive medical information and psychological support should be provided.
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Affiliation(s)
| | - Hertha Richter-Appelt
- a University Medical Center Hamburg-Eppendorf, Institute for Sex Research and Forensic Psychiatry , Hamburg , Germany
| | - Kerstin Krupp
- a University Medical Center Hamburg-Eppendorf, Institute for Sex Research and Forensic Psychiatry , Hamburg , Germany
| | - Sara Y Brucker
- b Tübingen University Hospital, Center for Women's Health , Tübingen , Germany
| | - Katharina Rall
- b Tübingen University Hospital, Center for Women's Health , Tübingen , Germany
| | - Franziska Brunner
- a University Medical Center Hamburg-Eppendorf, Institute for Sex Research and Forensic Psychiatry , Hamburg , Germany
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Neter E, Goren S. Infertility Centrality in the Woman's Identity and Goal Adjustment Predict Psychological Adjustment Among Women in Ongoing Fertility Treatments. Int J Behav Med 2018; 24:880-892. [PMID: 29143252 DOI: 10.1007/s12529-017-9693-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Some of the women that go through repeated fertility treatments will not adjust well to the treatments and will experience increased distress. The present study examined how centrality of the fertility problem in the woman's identity and dispositional goal adjustment (disengagement and reengagement) are associated with the woman's psychological adjustment. These issues are examined in a context of a pro-natal society (Israel) where parenthood is a major life goal. METHODS One hundred ninety-three women in ongoing fertility treatments filled out questionnaires, and follow-up on their psychological well-being was carried out after 3 months (N = 130). RESULTS Women who perceived their fertility problem as more central to their identity experienced greater distress (β = 0.34, p < 0.01) and less well-being (β = - 0.31, p < 0.01). Concurrently, high ability for goal disengagement was a resource that protected women from these feelings. Women high on goal disengagement who were low on goal reengagement experienced greater distress (β of interaction = - 0.24, p < 0.01), probably because they remained with feelings of emptiness and lack of purpose. These findings were found in both cross-sectional and longitudinal analyses. Finally, the models predicting well-being and distress at T2 using centrality, goal adjustment, and T1 well-being/distress explained 42 and 47.5% of the variance, respectively. CONCLUSIONS Much research and therapeutic attention has been invested in coping with fertility treatments, while the options of reducing investment in treatments and finding alternative goals did not receive adequate attention. This study discusses these issues and their possible clinical implications especially in a pro-natal context.
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Purewal S, Chapman SCE, van den Akker OBA. Depression and state anxiety scores during assisted reproductive treatment are associated with outcome: a meta-analysis. Reprod Biomed Online 2018; 36:646-657. [PMID: 29622404 DOI: 10.1016/j.rbmo.2018.03.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 03/07/2018] [Accepted: 03/08/2018] [Indexed: 10/17/2022]
Abstract
This meta-analysis investigated whether state anxiety and depression scores during assisted reproductive technology (ART) treatment and changes in state anxiety and depression scores between baseline and during ART treatment are associated with treatment outcome. PubMed, PsycInfo, Embase, ScienceDirect, Web of Science and Scopus were searched and meta-analytic data analysed using random effects models to estimate standardized mean differences. Eleven studies (2202 patients) were included. Women who achieved pregnancy had significantly lower depression scores during treatment than women who did not become pregnant (-0.302; 95% CI: -0.551 to -0.054, z = -2.387, P = 0.017; I2 = 77.142%, P = 0.001). State anxiety scores were also lower in women who became pregnant (-0.335; 95% CI: -0.582 to -0.087, z = -2.649, P = 0.008; I2 = 81.339%, P = 0.001). However, changes in state anxiety (d = -0.056; 95% CI: -0.195 to 0.082, z = -0.794; I2 = 0.00%) and depression scores (d = -0.106; 95% CI: -0.296 to 0.085, z = -1.088; I2 = 0.00%) from baseline to treatment were not associated with ART outcome. Clinics should aim to promote better psychosocial care to help patients manage the psychological and physical demands of ART treatment, giving realistic expectations.
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Affiliation(s)
- Satvinder Purewal
- Institute of Psychology, Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, WV1 1AD, UK.
| | - Sarah C E Chapman
- Department of Pharmacy and Pharmacology, University of Bath, Claverton Down Road, Bath, BA2 7AY, UK
| | - Olga B A van den Akker
- Department of Psychology, Faculty of Science and Technology, Middlesex University, London, NW4 4BT, UK
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Rao M, Zeng Z, Tang L. Maternal physical activity before IVF/ICSI cycles improves clinical pregnancy rate and live birth rate: a systematic review and meta-analysis. Reprod Biol Endocrinol 2018; 16:11. [PMID: 29415732 PMCID: PMC5803901 DOI: 10.1186/s12958-018-0328-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 01/29/2018] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE This meta-analysis was aimed to evaluate the association between maternal physical activity before IVF/ICSI cycles and reproductive outcomes. METHODS We searched databases of PubMed, EMBASE and Web of Science electronic databases, and ongoing trials up to November 2017 to identify studies that focused on the relationship between maternal physical activity before IVF/ICSI cycles and reproductive outcomes, including implantation rate, clinical pregnancy rate, miscarriage rate and live birth rate. Odds ratio (OR) with 95% confidence intervals, were calculated to assess the results of each outcome. RESULTS Eight published studies encompassing 3683 infertile couples undergoing IVF/ICSI treatment were included into the analysis. There was an increasing, but not statistically significant, trend in implantation rate for physically active women when compared with physically inactive women (OR = 1.95, 95% CI 0.99-3.83, I2 = 77%). No significant difference was found in miscarriage rate between physically active women and physically inactive women (OR = 0.76, 95% CI 0.41-1.44, I2 = 49%). However, rates of clinical pregnancy and live births in physically active women were significantly higher than those in physically inactive women (OR = 1.96, 95% CI 1.40, 2.73, I2 = 42% and OR = 1.95, 95% CI 1.06-3.59, I2 = 82%, respectively). Subgroup analysis helped to confirm these results. CONCLUSIONS Female physical activity before IVF/ICSI cycles was associated with increased rates of clinical pregnancy and live births, whereas only a small but not statistically significant increase was found in implantation rate, and no effect was shown on miscarriage rate.
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Affiliation(s)
- Meng Rao
- Department of reproduction and genetics, the First Affiliated Hospital of Kunming Medical University, No. 295 Xi Chang road, Kunming, 650032, China
| | - Zhengyan Zeng
- Department of Neurology, the First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China
| | - Li Tang
- Department of reproduction and genetics, the First Affiliated Hospital of Kunming Medical University, No. 295 Xi Chang road, Kunming, 650032, China.
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50
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Abstract
SummaryThe World Health Organization (WHO) has indicated that 8–12% of couples worldwide experience infertility, and in recent years the number seeking treatment has dramatically increased. The diagnosis and therapy put a heavy psychological and physical burden on most patients, female and male. The incidence of depression in couples presenting for infertility treatment is significantly higher than in comparable fertile couples. Anxiety is significantly higher in infertile couples than in the general population. Professionals have become aware of the importance of providing educational interventions to address patients' fears and concerns, and to better prepare patients for the demands of treatment. Health professionals should follow a patient-centred approach to provide for the specific needs of the couple. Women in general have a positive attitude to seeking psychological help in the form of cognitive-behavioural therapy, couples counselling and infertility counselling.Learning Objectives•Learn about the incidence rates of infertility and its impact on the mental health of the couple.•Know about infertility treatment and its psychological impact.•Learn about the different management strategies that can be helpful in the treatment of mental illness associated with infertility.
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