Male psychological adaptation to unsuccessful medically assisted reproduction treatments: a systematic review

Stress Biomarkers Transferred Into the Female Reproductive Tract by Seminal Plasma Are Associated with ICSI Outcomes

This study aimed to determine whether male stress is related to seminal stress biomarkers and pregnancy achievement in women exposed to their partner's seminal plasma (SP) in the intracytoplasmic sperm injection (ICSI) cycle. In this pilot prospective study, 20 couples undergoing ICSI, as well as 5 fertile sperm donors and 10 saliva donors, were investigated. Women were exposed to their partner's SP via unprotected sexual intercourse during the ICSI cycle and intravaginal application on the day of ovum pick-up (Day-OPU). Semen samples were collected from male partners by masturbation on the Day-OPU. Saliva and serum samples were collected prior to masturbation. Body fluids were frozen at - 80 °C until assayed. Biomarkers of activity of the sympathetic adrenomedullary axis (salivary alpha-amylase and adrenaline), sympathetic neural axis (noradrenaline and dopamine), hypothalamic-pituitary-adrenal (HPA) system (cortisol), and immune system (C-reactive protein and interleukin (IL)-18) were estimated to examine their association with SP composition and clinical pregnancy achievement. The clinical pregnancy rate was 45.0%. In the unsuccessful ICSI group, blunted levels of salivary and serum cortisol were found compared to the successful ICSI group and the fertile sperm donors. With regard to seminal markers, decreased cortisol level and elevated noradrenaline, noradrenaline/cortisol ratio, and lL-18 levels were strongly associated with ICSI failure (areas under the ROC curves were, 0.813, 0.848, 0.899, and 0.828, respectively). These findings confirm that stress response systems activity affects SP composition, which in turn is associated with ICSI outcomes in women exposed to their partner's SP during an ICSI cycle.

Experiences of men undergoing assisted reproductive technology: A qualitative systematic review

BACKGROUND

Many infertile couples undergo assisted reproductive technology (ART) to increase pregnancy chances, with many of them experiencing psychosocial distress. Although research has been performed on women's experiences of ART, there is limited focus on men.

OBJECTIVE

This systematic review consolidated and synthesized men's experiences with ART to better understand their needs and challenges to support them.

SEARCH STRATEGY

Nine electronic databases were searched from the inception date until November 2022.

SELECTION CRITERIA

This review included published and unpublished primary studies with qualitative methodologies exploring men's experiences with ART.

DATA COLLECTION AND ANALYSIS

The screening of studies, methodological assessment, data extraction, and analysis were conducted by two reviewers independently. The data were thematically synthesized.

MAIN RESULTS

Fifteen studies were included. An overarching theme of "despair to destiny" was identified, with four synthesized themes: (1) "the roller coaster ride," (2) "what made it from bad to worse?", (3) "what kept men going?", and (4) "hopeful for the future."

CONCLUSION

Men undergoing ART experienced struggles, a transition of emotions, and a need for support as they attempted to cope with unknowns while remaining hopeful for future outcomes. There is a need for health care interventions and policies to address the issue to improve the well-being of male ART patients. Interventions should be tailored to the specific support groups that cater to the emotional and informational needs of male ART patients. Future research should focus on the influence of cultural sensitivities on men's ART experiences, to tailor support programs to address their psychological needs during ART.

Emotional Intelligence and Breast Cancer: A Systematic Review

Emotional Intelligence (EI), defined as the ability to perceive, identify, understand, and regulate emotional states is related to health outcomes. In this line, some studies examined this personal resource in the cancer area and, specifically, in breast cancer. Also, the different models and measures have led to a categorisation considering the various construct-method pairings of EI. Despite the increased number of studies about EI in the breast cancer context, there are no systematic reviews that summarise the results obtained in the different investigations. Objectives: Hence, the present review aims: to identify and describe the measures that have been used for assessing EI within this field, and to summarise the main results regarding EI in terms of its predictors and outcomes, considering the instruments used to assess it. Methods: The PRISMA guidelines were followed. Database search was conducted in WOS, Scopus, Pubmed, and PSYCArticles. Results: A total of 156 articles were found and 21 met the eligibility criteria. On one hand, one of the most used instruments was the TMMS-24 framed within the self-report ability EI, followed by those framed within the self-report mixed EI. None of the studies measured EI by the performance-based ability EI perspective. On the other hand, EI was related to other variables such as psychological well-being, quality of life, resilience, workability, anxiety, and depression. The majority of the studies were cross-sectional, and some of them included an intervention. Conclusions: This review provides a comprehensive overview of the existing studies concerning EI in the context of breast cancer, highlighting some of its characteristics regarding design, participants, used measures, and related variables. Also, the obtained results can improve the clinical practice and the understanding of the EI as an influencing factor in the health and quality of life of breast cancer populations.

Fertility education: recommendations for developing and implementing tools to improve fertility literacy†

Many recent societal trends have led to the need for fertility education, including the age at which individuals become parents, the development of new reproductive technologies, and family diversity. Fertility awareness has emerged as a concept very recently and is increasingly gaining recognition. However, fertility education is often neglected as there is no consensus on the appropriate content, target populations, or on who should provide it. This article attempts to provide an overview of the use of interventions to improve fertility education. We emphasize the importance of delivering evidence-based information on fertility and reproductive health through various methods while providing guidelines for their standardization and systematization. Recommendations are provided to aid the development and implementation of fertility education tools, including: the establishment of a comprehensive understanding of the target populations; the incorporation of theories of behavioural change; the inclusion of the users' perspectives and the use of participatory research; and the use of specific guidelines for increasing engagement. By following these recommendations, it is expected that fertility education resources can contribute to improving fertility literacy, empowering individuals and couples to make informed reproductive decisions, and ultimately reducing the incidence of infertility and need for fertility treatment.

Assisted Reproductive Technology and Cardiovascular Outcomes in Parents and Offspring

BACKGROUND

The impact of assisted reproductive technology (ART) on the cardiovascular system is unclear.

METHODS

We conducted a retrospective longitudinal cohort study of 1,001,593 pregnancies conceived naturally or through ART from 2008 to 2019 in Québec to assess the association of ART with cardiovascular disease in families. The exposure measure was ART. The outcome included severe maternal cardiovascular morbidity, congenital heart defects in offspring, and long-term risk of cardiovascular hospitalisation in mothers, fathers, and offspring during 11 years of follow-up. We estimated the association between ART and cardiovascular outcomes with the use of adjusted log-binomial regression (risk ratio, 95% confidence interval [CI]) and Cox proportional hazards regression models (hazard ratio [HR]).

RESULTS

Compared with natural conception, ART was associated with 2.04 times the risk of severe cardiovascular morbidity in mothers (95% CI 1.86-2.23) and 1.38 times the risk of congenital heart defects in offspring (95% CI 1.26-1.50). ART was not associated with the risk of maternal cardiovascular hospitalisation following pregnancy (HR 1.03, 95% CI 0.88-1.21). However, ART was associated with an increased risk of paternal cardiovascular hospitalisation (HR 1.24, 95% CI 1.11-1.38) and offspring cardiovascular hospitalisation (HR 1.27, 95% CI 1.01-1.61), mainly due to an increased risk of hypertension.

CONCLUSIONS

ART is associated with only a small increase in the risk of cardiovascular complications in families. Parents and offspring may be reassured that ART likely has no major impact on the cardiovascular system.

Coping, social support and medical factors on psychosocial impact in couples experiencing infertility

This study assessed dyadically the relationship between psychosocial impact of infertility experienced by 87 couples and individual coping strategies, perceived social support and some medical factors. Although problem-focused strategies emerged as positive, certain side effects on partner were revealed. Social support was related to psychosocial outcomes in a positive way, cognitive component of coping strategies resulted as a prominent factor on individual's adjustment as well as the partner's role. Findings suggest the convenience of promoting the awareness about the effects of each partner's feelings, behaviors and beliefs on his/her individual's well-being in this field due to the interdependent context in which they are. Infertility counselors may foster this process by evaluating and educating to them about the functionality of these factors.

Factors associated with anxiety and depression in men undergoing fertility investigations: a cross-sectional study

BACKGROUND

Infertility is a real public health issue because of its medical, socio-cultural, and financial impact. It does also have heavy psychological consequences on both partners. This study aimed to assess levels of anxiety and depression among men undergoing infertility investigation and to identify their associated factors.

METHODS

We conducted a cross-sectional study in the Laboratory of Cytogenetics and Reproductive Biology of Fattouma Bourguiba University Teaching Hospital (Monastir, Tunisia) between August 30th, 2020, and March 16th, 2021. Anxiety and depression levels were assessed using the valid Arab version of the Hospital Anxiety and Depression scale (HAD). Semen parameters were analyzed and interpreted according to 2021 World Health Organization (WHO) guidelines.

RESULTS

A total of 282 men were included in the current study. The mean HAD-D (depression) and HAD-A (anxiety) scores were of 6.56 ± 3.07 (IQR [4-8]) and 7.94 ± 3.73 (IQR[5-10]) respectively. Univariate analysis showed that patients having two or more comorbidities were nearly five times more likely to be anxious than those without or with only one comorbidity (ORc = 4.71; p = 0.007). Furthermore, single patients were about four times more anxious than those in couple having primary or secondary infertility (ORc = 3.85; p = 0.027). With regards to semen parameters, patients having hypospermia were more than two times anxious compared with those with normal semen volume (ORc = 2.33; p = 0.034). As for depression, we observed that patients with an infertility history lasting for a year or more have a nine times greater risk of depression (ORc = 9.848; p = 0.007). With regards to semen parameters, patients exhibiting two or more semen abnormalities, teratozoospermia and increased MAI were more depressed (ORc = 2.478; p = 0.036; ORc = 2.549: p = 0.023; ORc = 2.762; p = 0.036). Furthermore, we found a negative correlation between HAD-A scores and patient's age.

CONCLUSIONS

We pointed out through the current study the associated factors with anxiety and depression in patients under fertility management to precociously identify those who need psychological counseling and hence to better manage infertility issues.

The Impact of the FertiStrong Mobile Application on Anxiety and Depression in Men: A Randomised Control Pilot Study

Background

Male factor accounts for up to half of all cases of infertility. Previously, research has focused on the psychological effects of infertility on female partners, but recent studies show negative consequences on male patients as well. Despite evidence that men are affected by infertility, there is limited studies focusing on coping methods for them.

Aims

Determine if a cognitive-behavioral and relaxation mobile application, targeted at men experiencing infertility, could lead to decreases in psychological distress.

Settings and Design

Randomized controlled.

Materials and Methods

Thirty-nine men participated in a randomized pilot study of the FertiStrong application. Participants completed a demographic form, the Hospital Anxiety and Depression Scale (HADS) and Fertility Problem Inventory (FPI) at baseline and one month follow-up. The intervention group downloaded the FertiStrong application and used it when needed. Control participants received routine infertility care.

Statistical Analysis Used

Normally distributed data is presented as mean+/- SD; Differences in proportions were tested using Chi-square test and within group comparison were performed using paired t-test.

Results

One participant was excluded, resulting in 38 participants, 19 in each group. There were no baseline differences in demographic characteristics (P>0.31). For the HADS anxiety domain, the control group had a small increase between baseline and follow up, while the intervention group had a small decrease. For the HADS depression domain, there was a slight increase in the controls. For the FPI, the control group had a two-point increase, from moderately stressed to extremely high while the intervention group had a five-point decrease, from extremely high to moderately high, but was not significant. Each FPI domain-specific score in the intervention group decreased and one, Rejection of Childfree lifestyle, was significant (P=0.03). The increase in stress level was significantly greater in the control group (P<0.02).

Conclusion

Recruitment was challenging due to the short recruitment phase and the sample size was smaller than planned. However, there were several significant improvements noted in the intervention group and on all testing, the intervention group trended to less distress. More research is needed on convenient interventions for men experiencing infertility.

Effect of depression and anxiety on sexual functioning in couples trying to conceive with and without an infertility diagnosis

OBJECTIVE

This study examined the effects of anxiety and depression on sexual functioning in couples trying to conceive, and tested the moderating role of infertility diagnosis on this association.

DESIGN

An online questionnaire was completed by 1453 individuals in a heterosexual relationship for more than one year. The final sample had 107 couples who were actively attempting a pregnancy (63 had an infertility diagnosis; 44 were presumably fertile). Data was analyzed with the Actor-Partner Interdependence Model (APIM).

MAIN OUTCOME MEASURES

Depression and anxiety symptoms were assessed by the Hospital Anxiety and Depression Scale (HADS), and male and female sexual functioning were assessed through the International Index of Erectile Function (IIEF) and the Female Sexual Function Index (FSFI), respectively.

RESULTS

Actor effects were found between depression and sexual functioning in both men (β= -.28, p= .003) and women (β= -.43, p < .001), with no significant partner effects. The moderation analysis showed that the relationship between depression and sexual functioning is stronger in infertile men than in presumably fertile men (β= -.29; p= .002).

CONCLUSION

Psychological interventions with couples trying to conceive should address the role of depression in sexual functioning, particularly in infertile men.

Effects of trying to conceive using an every-other-day strategy versus fertile window monitoring on stress: a 12-month randomized controlled trial

STUDY QUESTION

Can animation videos on how to optimize the chances of pregnancy influence stress, anxiety, depression and sexual functioning of individuals trying to conceive (TTC)?

SUMMARY ANSWER

There were no differences between those educated to have intercourse every other day, on the fertile window and a control group (CG), and depression and sexual dysfunction significantly increased over time for all arms.

WHAT IS KNOWN ALREADY

Recent findings indicate that time to pregnancy can be significantly shortened by targeting the fertile period, but some reproductive care guidelines recommend instead the practice of intercourse every other day on the basis that it is less stressful to the couple. Evidence to support guidelines on how to preserve well-being and psychosocial adjustment and optimize pregnancy chances is lacking.

STUDY DESIGN, SIZE, DURATION

We conducted a prospective, double-blinded, three-arm randomized controlled trial between July 2016 and November 2019. Participants were randomized to either not having any stimulus (CG) or visualizing a short animated video explaining how to improve chances of pregnancy by having intercourse every other day (EOD group), or by monitoring the fertile window (FWM group). Assessments were made before the intervention (T0), and 6 weeks (T1), 6 months (T2) and 12 months after (T3), with follow-ups censored in case of pregnancy.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Participants were childless individuals of reproductive age actively TTC and not diagnosed or unaware of a condition that could prevent spontaneous pregnancy. Individuals were excluded from recruitment if they had previous children or had a condition preventing spontaneous pregnancy. Our primary outcome was stress and secondary outcomes included anxiety, depression, sexual functioning and pregnancy. Primary analyses were performed according to intention-to-treat principle.

MAIN RESULTS AND THE ROLE OF CHANCE

Of the 450 randomized participants 127 were educated to use an every-other-day strategy, 135 to monitor the fertile window, and 134 received no intervention. Groups were similar regarding demographics and months TTC. Repeated measures analysis revealed that there were no significant interaction effects of psychological and sexual well-being between groups over time (P > 0.05). Significant time effects were revealed for stress (F(3,855) = 4.94, P < 0.01), depression (F(3,855) = 14.22, P < 0.01) and sexual functioning (time effects P values <0.001 for female sexual functioning dimensions and <0.002 for male dimensions), but not for anxiety (F(2,299) = 0.51, P > 0.05). Stress levels lowered after 6 months (P < 0.001) and returned to baseline levels at the 1-year follow-up. Depressive symptomatology significantly increased at 6 weeks (P = 0.023), and again 1 year after (P = 0.001). There were also significant decreases in all female sexual functioning dimensions (desire, satisfaction, arousal, pain, orgasm and lubrication). In men, there were significant variations in orgasm, intercourse satisfaction and erectile function, but not desire and sexual satisfaction. Revealed pregnancy rates were 16% for participants in the EOD group, 30% for the FWM group and 20% for the CG. Pregnancies were not significantly different between arms: EOD vs FWM (odds ratio (OR) 2.32; 95% CI 0.92-5.83); EOD vs CG (OR 0.74; 95% CI 0.30-1.87); and FWM vs CG (OR 1.71; 95% CI 0.70-4.18).

LIMITATIONS, REASONS FOR CAUTION

Participants were recruited after transitioning to procreative sex. The study might be prone to bias as almost 30% of our sample fulfilled the chronological criterion for infertility, and other reproductive strategies could have been tried over time before recruitment.

WIDER IMPLICATIONS OF THE FINDINGS

Our data suggest that stress does not arise from feeling pressured on the fertile period and that advice on timing of intercourse might have to be personalized. The increasing levels of depression and sexual dysfunction over a year emphasize the crucial role of preconception care and fertility counseling in promoting psychological and sexual well-being.

STUDY FUNDING/COMPETING INTEREST(S)

This work was supported by European Union Funds (FEDER/COMPETE-Operational Competitiveness Programme) and by national funds (FCT-Portuguese Foundation for Science and Technology) under the projects PTDC/MHC-PSC/4195/2012 and SFRH/BPD/85789/2012.

TRIAL REGISTRATION NUMBER

NCT02814006.

TRIAL REGISTRATION DATE

27 June 2016.

DATE OF FIRST PATIENT’S ENROLLMENT

19 July 2016.

Paramedical counselling in infertility treatment: its effects on anxio-depressive symptom severity, perceived stress and self-esteem

Aims

The importance of contributing psychological factors and stress-control in female infertility is well documented, but research on their role in male infertility is scarce. The present study aimed to evaluate the effects of a novel paramedical counselling on anxio-depressive symptom severity, perceived stress and self-esteem in infertile men participating in an infertility treatment programme.

Methods

Patients were recruited from clinics of University of Szeged, Hungary between 2019 May and 2020 December, and were sorted into control (n = 51) and experimental (n = 57) groups, where patients in the experimental group received a 5-session paramedical counselling in extension to their medical treatment. The levels of anxio-depressive symptom severity, perceived stress and self-esteem were measured prior to and after receiving paramedical counselling. The control group scored lower in regards of the severity of depressive symptom, and showed an increase of self-esteem, while the experimental group resulted in a significant decrease of anxio-depressive scores with the elevation of the level of self-esteem.

Results

Our results indicate that joining an infertility treatment programme alone had a positive role in reducing depressive symptoms and in the increase of self-esteem among infertile men, but receiving additional paramedical counselling throughout the treatment programme resulted in the decrease of anxio-depressive symptoms, besides the elevation of the level of self-esteem, with a significantly higher decrease in the state anxiety compared to not receiving this additional paramedical counselling.

Conclusions

Thus, it would be advisable for infertility treatment programmes to incorporate screening for psychological vulnerability and implement additional paramedical counselling to alleviate these confounding symptoms detrimental to conceiving.

Which classification system could empower the understanding of caesarean section rates in Greece? A review of systematic reviews

INTRODUCTION

Worldwide there is an alarming increase in the caesarean delivery rate which has become a controversial topic. However, the reasons for this tendency are not clear. For example, in Greece alone, rates increased by almost 50% from 1983 to 1996. In order to better understand the causes of this phenomenon, we need to examine closely what groups of women undergo caesarean section (CS). To achieve this, it is essential to use a system that will enable us to monitor and compare caesarean delivery rates. Such a classification system should be easily adopted by obstetricians, midwives, and public health services.

METHODS

A review search of electronic databases concerning medical care was held from December 2020 to January 2021 in order to find systematic reviews which describe either theoretical or practical CS classification systems.

RESULTS

The most common classification systems fall into three main categories based on indication, urgency and maternal-based characteristics. According to users the highest rated classification system was women-based classifications in general. In particular the Robson Ten Group Classification System was considered to be the most valid to meet current local and international standards. The Robson classification system is praised for its robustness, simplicity, flexibility, and reproducibility.

CONCLUSIONS

The right implementation of the Robson Ten Group Classification System can facilitate an in-depth analysis of the main groups that increase CS rates and can be used to both review and monitor delivery practices both in Greece and abroad.

A Prospective Study of Male Depression, Psychotropic Medication Use, and Fecundability

We examined the associations of male depression and psychotropic medication use with fecundability in a North American preconception cohort study (2013–2020). Men aged ≥21 years completed a baseline questionnaire with questions on history of diagnosed depression, the Major Depression Inventory (MDI), and psychotropic medication use. Pregnancy status was updated via bimonthly female follow-up questionnaires until pregnancy or 12 menstrual cycles, whichever occurred first. Analyses were restricted to 2,398 couples attempting conception for ≤6 menstrual cycles at entry. We fit proportional probabilities models to estimate fecundability ratios (FRs) and 95% confidence intervals (CIs), adjusting for age (male and female), education, (male and female), race/ethnicity, physical activity, alcohol intake, body mass index, smoking, and having previously impregnated a partner. Nearly 12% of participants reported a depression diagnosis; 90.6% had low depressive symptoms (MDI <20), 3.5% had mild symptoms (MDI: 20–24), 2.7% had moderate symptoms (MDI: 25–29), and 3.3% had severe symptoms (MDI: ≥30). A total of 8.8% of participants reported current use of psychotropic medications. History of depression was associated with slightly reduced fecundability, although this result was also reasonably compatible with chance (FR = 0.89; 95% CI: [0.76, 1.04]). FRs for mild, moderate, and severe compared with low depressive symptoms were 0.89 (95% CI: [0.66, 1.21]), 0.90 (95% CI: [0.62, 1.31]), and 0.88 (95% CI: [0.65, 1.20]), respectively. This indicates little evidence of a dose–response relationship for depressive symptoms with fecundability, although estimates were imprecise. Current psychotropic medication use mediated 44% of the association between depressive symptoms and fecundability.

Motherhood and assisted reproduction in a religious context: Genes, stigma and supports in Utah, United States

Six percent of cisgender (i.e. not transgender) women aged 15-44 are considered infertile in the United States, and 12% are unable to carry a pregnancy to term. For those who yearn to create a family despite these circumstances, assisted reproductive technology (ART) is an often-utilised resource. Though faith-based institutions have been referenced as a source of support for involuntarily childless adults, it is unclear how religious doctrine, especially that which prizes 'traditional' gender roles and genetic parenthood, may be a catalyst for distress. More research is needed to understand how the socio-cultural environment affects those who are unable to conceive without assistance. Therefore, the purpose of this research study was to understand the lived experiences of women who have utilised assisted reproduction in a particularly pronatalist, religious cultural context in the United States. From March to September 2017, in-depth interviews were conducted with 10 cisgender women who had utilised ART. Data analysis was conducted in NVivo 10 and consisted of line-by-line analysis, identifying themes, coding categories and developing matrices to uncover relationships between themes and categories. The quest for motherhood was truly a journey for the study participants who experienced rumination and self-blame due to their inability to become pregnant. This was rooted in their socio-cultural context. Thus, the study findings suggest that culture and stigma are linked with women's distress regarding their inability to become pregnant and results in distancing from other women. Genetic parenthood was prized initially, but this desire decreased over time. While past research suggests that infertility strains relationships, our study found that the turmoil of infertility and assisted reproduction actually strengthened couple relationships. Counselling was described as particularly helpful, but it is needed throughout the assisted reproduction process. The inclusion of religion and spirituality, for those who identify as such, in counselling would be beneficial.

The efficacy of cognitive behavioural therapy on stress, anxiety and depression of infertile couples: a systematic review and meta-analysis

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.

Infertility-Related Stress and Psychological Health Outcomes in Infertile Couples Undergoing Medical Treatments: Testing a Multi-dimensional Model

The study aims to propose and test a multi-dimensional infertility-related stress model including socio-demographic and fertility-related characteristics, infertility-related stress dimensions, coping strategies and couple's dyadic adjustment dimensions as predictors of anxiety and depression among partners of couples undergoing infertility treatments. Both members of 250 infertile couples filled out a questionnaire consisting of Socio-demographics (Age; Educational level; Employment status), Fertility-related characteristics (Type of diagnosis; Duration of infertility), Fertility Problem Inventory-Short Form, Coping Orientations to Problem Experienced-New Italian Version, Dyadic Adjustment Scale, State-Trait Anxiety Inventory-Y and Edinburgh Depression Scale. Hierarchical Multiple Linear Regressions indicated that the proposed predictive models for anxiety and depression were significant and had good levels of fit with the data. Gender differences emerged in predictor variables. Findings provide valid predictive models that could be adopted to assess psychological health in infertile patients and to develop evidence-based and tailored counselling interventions at centres for assisted reproduction.

The Etiology of Infertility Affects Fertility Quality of Life of Males Undergoing Fertility Workup and Treatment

This panel study explored the effects of male, female, mixed, or idiopathic factor of infertility on the fertility quality of life (FertiQoL) in involuntarily childless males undergoing fertility workup for the first time. A convenience sample of 255 married males (age range = 22–51 years, mean = 30.24 years), 254 (99.6%) of whom suffered from primary infertility were assessed (1) at the baseline, before their initial fertility evaluation (T1); (2) before their second andrological appointment, 2–3 months after diagnostic disclosure (T2); and (3) before subsequent treatment-related/ follow-up appointments (T3, T4). The timing of psychological assessment was strictly related to andrological appointments and routine medical procedures. Respondents completed Emotional, Mind–Body, Relational, and Social subscales of the Polish version of FertiQoL and a baseline demographic survey. The research demonstrated that the FertiQoL scores across the Emotional, Mind–Body, and Relational subscales markedly decreased after the diagnostic disclosure, particularly in the subgroups with male and concurrent male and female factor. Social subscale scores in all subgroups remained stable after the diagnostic disclosure (at T2) but significantly decreased in the follow-up (at T3 and T4). Significant differences in FertiQoL scores associated with respondents’ infertility factor could be demonstrated at each time point. The study identifies the FertiQoL in unintentionally childless males is significantly affected by their factor of infertility and evolves across the pathway of treatment-related/follow-up appointments.

Adjustment toward infertility mediates the relationship between coping, depression and anxiety in men: A confirmatory analysis

OBJECTIVE

The aim of the present study was to develop a theoretical framework for the relationships between coping, adjustment toward infertility, depression and anxiety and to present a confirmatory analysis of the developed theoretical framework in men who, together with their spouses, were candidates for assisted reproductive technology (ART) treatment.

STUDY DESIGN

This cross-sectional study was conducted on 212 men selected from the couples who were candidate for ART. Depression and anxiety, adjustment toward infertility, and coping strategies were assessed using self-report questionnaire. Statistical analysis was performed using the plug-in application PROCESS macro and AMOS software.

RESULTS

The results showed that higher depression and anxiety scores were related to lower adjustment to infertility. Higher adjustment score was associated with lower self-blame, self-focused rumination, active confronting and avoidance coping strategies scores significantly. In the depression and anxiety pathway models, the positive relationship between active confronting and elf-focused rumination coping strategies were mediated by adjustment. However, the effect of active confronting on depression and anxiety was significant only with mediating role of adjustment. The direct and indirect relationship of self-focused rumination and the indirect relationship of active confronting with depression and anxiety had a good fitness (CMIN/ DF = .419).

CONCLUSION

The self-focused rumination and active confronting coping strategies, having negative association with adjustment to infertility, and may increase depression and anxiety in men undergoing ART; however, higher adjustment is associated with decreased depression and anxiety. Therefore, mental health programs for men undergoing ART may need to focus on improving the skills of adaptive coping strategies.

Stress and Anxiety Levels in Couples who Undergo Fertility Treatment: a Review of Systematic Reviews

Background:

Infertility is an issue that affects many parameters peoples’ lives, as individuals and as couples. Besides the physical and economic impact of infertility on the couples, there is a significant reflection of infertility on their mental health and well-being, which follows them from the moment of the diagnosis up until the end of their treatment.

Objective:

The aim of this review was to investigate whether psychological factors such as stress, anxiety or depression have an impact on the assisted reproduction treatment outcome and whether the use of supporting methods may help couples to minimize their fertility related stress, anxiety and depression and improve the treatment outcome.

Methods:

After a systematic search of the electronic databases, fourteen studies were included in this umbrella review. The included studies were systematic reviews and meta-analyses published between January 2015 and February 2020. The population of interest was women, men or couples facing infertility and undergoing fertility treatment. The included studies assessed the relationship between stress and anxiety in couples undergoing fertility treatment and the outcome of the treatment, the psychological state and psychological adjustment of the couples after a negative result and the impact of interventional methods for reducing stress, anxiety or depression on the psychological state of the couples undergoing treatment and their pregnancy outcomes.

Results:

This review fails to provide a certain answer to our research hypothesis due to conflicting results in the included studies. However, it has been observed that couples who reported better psychological state or have been treated with an interventional method for psychological support, were more likely to adjust better to the treatment procedure and the outcome as well.

Conclusion:

Psychological support and consultation during assisted reproduction treatment is highly recommended by researchers and clinicians.

Neurophysiology of cognitive behavioural therapy, deep breathing and progressive muscle relaxation used in conjunction with ART treatments: a narrative review

BACKGROUND

Infertility is defined as the failure to achieve clinical pregnancy after 12 months of regular unprotected intercourse. It could be due to male or female factors, each requiring different treatment options. ART treatment exposes couples to numerous psychological stressors. Therefore, it has been recommended by the ESHRE Psychology and Counselling Guideline Development Group recently that psychosocial support should be offered as a complementary therapy during infertility treatments. In this context, the efficiency of different psychological interventions, such as cognitive behaviour therapy (CBT), deep breathing (DB), and progressive muscle relaxation (PMR), was evaluated in several clinical trials in terms of couples' mental health and pregnancy outcomes.

OBJECTIVE AND RATIONALE

The neurophysiology of CBT, DB and PMR, which are used in interventional studies, in both men and women undergoing ART, has not yet been fully elucidated. This review represents a comprehensive report, aiming to collate novel insights into the neurobiological processes and physiological mechanisms that occur during the practice of CBT, DB and PMR.

SEARCH METHODS

PubMed, Google Scholar and Cochrane Library were interrogated to conduct this comprehensive literature review. The search was carried out using combinations of MeSH terms and keywords: infertility, assisted reproductive techniques, IVF, ICSI, emotions, psychological stress, cognitive behavioural therapy, mind-body therapies and relaxation. Relevant information related to the mechanism of action of stress management techniques were obtained from original articles and reviews published in English without taking into consideration the time of publication. Moreover, as it was not the major focus of the review, only recent systematic reviews (2015-2019) pinpointing the effects of psychological interventions on infertility treatment outcomes were also retrieved from the above-mentioned databases.

OUTCOMES

CBT, DB and PMR may modify the activity of stress-related brain regions such as the prefrontal cortex, amygdala, hypothalamus and hippocampus, as demonstrated by functional MRI and electroencephalogram studies. Furthermore, applying these techniques was associated with mood improvements and a decline in stress biomarkers, and, hypothetically, reducing stress biomarkers attenuates the stress-induced effects on ART outcomes.

WIDER IMPLICATIONS

Increasing the knowledge of fertility staff, researchers and physicians regarding the mechanisms of action of these stress management techniques has several advantages. For instance, understanding the underlying neurophysiological pathways would assist practitioners to engage ART couples in the practice of these techniques. Also, it may enhance the quality of the support programmes and psychological research. Accordingly, this will ensure that these interventions reach their full potential and therefore improve clinical outcomes.

A qualitative study of factors influencing male participation in fertility research

BACKGROUND

Although fertility is a couple-based outcome, fertility studies typically include far fewer males than females. We know little about which factors facilitate or inhibit male participation in fertility research. In this study we aimed to explore factors that influence male participation in fertility research among North American couples trying to conceive.

METHODS

We conducted a qualitative research study of male participation in Pregnancy Study Online (PRESTO), a prospective preconception cohort of couples actively trying to conceive in Canada and the United States. Between January-August 2019, we carried out 14 online one-on-one in-depth interviews and one online focus group of males and females with varying levels of participation. The in-depth interviews included females who enrolled in PRESTO but declined to invite their male partners to participate (n = 4), males who enrolled in PRESTO (n = 6), and males who declined to participate in PRESTO (n = 4). The focus group included 10 males who enrolled in PRESTO. We analyzed the transcriptions using inductive content analysis.

RESULTS

Male and female participants perceived that fertility is a women's health issue and is a difficult topic for men to discuss. Men expressed fears of infertility tied to masculinity. However, men were motivated to participate in fertility research to support their partners, provide data that could help others, and to learn more about their own reproductive health.

CONCLUSIONS

Male participation in fertility studies will improve our understanding of male factors contributing to fertility and reproductive health issues. Results indicate a need for more education and health communication on male fertility to normalize male participation in fertility and reproductive health research. Men are much less likely than women to participate in research on fertility and pregnancy. However, it is important for men to participate in fertility research so that we gain a better understanding of male factors that impact fertility and pregnancy outcomes. In this qualitative study, we interviewed men and women from Canada and the United States who were trying to become pregnant to understand why men choose to participate in fertility research, why men choose not to participate in fertility research, and why women choose not to invite their male partners to participate in fertility research. We found that both men and women believe fertility is a woman's health issue. Men find it difficult to talk about pregnancy and fertility and have fears of infertility tied to masculinity. However, men are motivated to participate in fertility research to support their partners, to help others, and to learn more about their own reproductive health.

Individual and Relational Well-Being at the Start of an ART Treatment: A Focus on Partners' Gender Differences

Infertility and ART treatments represent stressful experiences for the couples, impacting on the overall psychological well-being of partners as well as on their couple adjustment. Several variables were analyzed as risk factors for infertility-related distress. The impact of these experiences has been well-documented in both women and men, reporting important gender differences. The aim of this study was to assess gender differences in individual and relational well-being in infertile couples. Gender differences for psychological and medical variables predicting psychological distress were investigated. Two hundred and thirty couples who entered an ART program at a public hospital in Milan were recruited. Each partner completed the following scales: ScreenIVF, Dyadic Adjustment Scale, and Experience in Close Relationship Questionnaire. Findings revealed several gender differences with women reporting higher levels of both anxiety and depressive symptoms, anxiety and avoidance attachment, and helplessness, but lower levels of acceptance than men. Differences emerged also in factors predicting well-being: poor support predicted anxiety in men and depression in women. Furthermore, individual well-being was predicted only for men by attachment anxiety and previous treatment. Finally, in the women subsample, couple’s adjustment was predicted by anxiety attachment, while in men predictors were helplessness and type of diagnosis. These results suggest the importance of implementing support interventions for couples which take into consideration the specific needs and fragility of each partner as well as focusing on enhancing a sense of partnership.

Psychosocial and professional burden of Medically Assisted Reproduction (MAR): Results from a French survey

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.

Partners' perspective in endometriosis research and treatment: A systematic review of qualitative and quantitative evidence

OBJECTIVE

To summarize the available qualitative and quantitative evidence regarding the impact of endometriosis on women's partners.

METHODS

A systematic electronic search of PubMed and PsycINFO was conducted. All the available evidence regarding partners' psychological condition, quality of life, social and intimate relationships, and sexuality was included, and a narrative synthesis of the findings was provided.

RESULTS

Of 127 studies retrieved through electronic search, only 5 (3 qualitative/semi-qualitative and 2 quantitative studies) matched the inclusion criteria and were included in our review. In total, participants were 399 male partners. Endometriosis negatively affects partners' psychological wellbeing and quality of life, with significant individual differences. Partners of women with endometriosis may experience isolation and lack of engagement in treatment decision-making. Partners also experience the economic burden of the disease, with negative consequences on work functioning and daily life. Sexuality is also negatively affected, although with contradictory findings. Positive aspects of personal and relationship growth were also reported.

CONCLUSION

Endometriosis is an important cause of physical and psychological pain for women, but it may also have a negative impact on their partners. Although the effects of other chronic diseases on partners and caregivers have been largely explored, the small number of articles included in this review indicates that this topic remains understudied in endometriosis research. Endometriosis should be investigated and managed within a systemic framework, with a specific focus on the complex dynamic interaction between individual, relational, sociocultural and environmental factors.

Patient perspectives and experiences with in vitro fertilization and genetic testing options

Objective:

Decision-making and patient experiences with embryo selection during in vitro fertilization often include genetic testing options. The purpose of this study was to gain insight about the experiences and perspectives of women using in vitro fertilization and genetic technologies.

Methods:

Interviews (n = 37) were conducted among female patients who had undergone in vitro fertilization, underwent expanded carrier screening, and were offered pre-implantation genetic testing for aneuploidy between July 2016 and July 2017. The interviews were transcribed and a content analysis was conducted on the transcripts.

Results:

Categories that emerged from the data analysis included unexpected outcomes, uncertainty, unanticipated emotional consequences, too much emphasis on the woman’s contributions and questions about embryo viability. Patient experiences with genetic technologies during in vitro fertilization played a significant role within these results.

Conclusion:

The emotional and psychological impacts of infertility during in vitro fertilization were the primary concerns discussed by participants. Future research is needed to identify ways to help manage unexpected outcomes and continuous uncertainty, including the increasing use of genetic technologies, to not add to the psychological burden of infertility. There is a need to explore more support options or counseling services for patients struggling with infertility during in vitro fertilization treatment.

Depression among men in ART treatment: a register-based national cohort study

STUDY QUESTION

Are male factor infertility or remaining childless risk factors for unipolar depression among men in assisted reproductive technology (ART) treatment?

SUMMARY ANSWER

Male factor infertility was not associated with a significantly increased risk of unipolar depression and men remaining childless did not have a significantly increased risk of developing unipolar depression compared to men in ART treatment who became fathers.

WHAT IS KNOWN ALREADY

Men in medically assisted reproduction due to male factor infertility are more distressed and have more negative emotions such as feelings of loss, stigma and low self-esteem compared to men in fertility treatment due to other infertility diagnosis. Stress is in general a risk factor for depression. However, previous studies show conflicting results whether male factor infertility is a risk factor for depression.

STUDY DESIGN, SIZE, DURATION

This national, register-based cohort study consisted of 37 913 cohabitant male partners of women in ART treatment recorded in the Danish IVF register (1994–2009). Via a national register, the men’s personal identification number data were linked to the Danish Psychiatric Central Research Register (PCRR) (1969–2009) which records psychiatric diagnoses including unipolar depression, based on the ICD-8 and ICD-10 classification system.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The full cohort of male partners (n = 37 913) was included in the initial analysis on prevalence of unipolar depression before or after ART treatment initiation. The association between male factor infertility and unipolar depression diagnosis after initiating ART treatment was analysed with Cox regression analysis in a sub-study population of men with the exclusion of men having a depression prior to ART treatment or not having full data on educational level and infertility diagnosis (n = 34 817).

MAIN RESULTS AND THE ROLE OF CHANCE

Overall, 1.2% (n = 446) of the men were diagnosed with unipolar depression either before initiating ART treatment (n = 146) or during follow-up (n = 300). In all, 76.0% of men with depression prior to or after ART treatment achieved fatherhood compared to 82.3% of men without depression (P < 0.001). In the sub-study population (n = 34 817, which included 266 men with a unipolar depression diagnosis), male factor infertility was not associated a significantly increased risk of depression (adjusted hazard ratio (aHR) = 1.04, 95% CI: 0.79–1.36, P = 0.804), and ART-treated men who remained childless did not have a significantly increased risk of developing depression compared to ART treated men who became fathers (aHR = 1.13, 95% CI: 0.87–1.48, P = 0.355).

LIMITATIONS, REASONS FOR CAUTIONS

Only severe cases of depression are recorded and included in this national register-based study given that only men with clinically diagnosed unipolar depression recorded in a psychiatric hospital (in-patient and out-patient) are included in the Danish PCRR. It is difficult to completely rule out an association between the exposures and depression as this outcome is so rare, and therefore the results are still statistically uncertain despite a large cohort. Furthermore, only men in ART treatment were included in this study, and caution should be taken in generalising findings to the total population of men in all areas of medically assisted reproduction or infertile men who have not sought treatment.

WIDER IMPLICATIONS OT THE FINDINGS

This large national cohort study suggests that despite evidence showing that male factor infertility is a potential severe stressor for men, which can increase psychological distress and negative emotions, infertile men in ART treatment and men remaining childless after ART are not at a significantly increased risk of developing clinically diagnosed unipolar depression.

STUDY FUNDING/COMPETING INTERESTS

C.S.S. was funded by unrestricted research grants received by Lone Schmidt from The Danish Health Insurance Foundation (J.nr. 2008B105) and Merck Sharp & Dohme (MSD). The sponsors had no influence on how data were retrieved and analysed or on the conclusions of the study. C.S.S. and L.S. have declared conflicts of interests; the remaining co-authors have no conflicts of interests to declare.

TRIAL REGISTRATION NUMBER

Not applicable.

The Risk of Psychiatric Morbidity and Course of Distress in Males Undergoing Infertility Evaluation Is Affected by Their Factor of Infertility

This panel study aimed to explore the effects of male, female, mixed or idiopathic factor of infertility on the course of clinical distress and possible psychiatric morbidity in involuntarily childless males undergoing fertility evaluation for the first time. A sample of 255 males completed the General Health Questionnaire-28 (GHQ-28) (a) at the baseline, before their initial fertility evaluation (T₁); (b) before their second andrological appointment 2-3 months after diagnostic disclosure (T₂); and (c) before subsequent treatment-related/follow-up appointments (T₃, T₄) to be screened for clinically significant distress and risk for psychiatric morbidity. Then they were dichotomized as non-cases and cases. The timing of psychological testing was strictly related to andrological appointments and medical procedures. The research demonstrated that the baseline prevalence of clinical distress and psychiatric morbidity in all the subgroups was similar to reference values, but then significantly surged after the diagnostic disclosure, particularly in male and mixed factor respondents. However, the percentage of clinically distressed mixed or idiopathic factor of infertility respondents remained stable after diagnostic disclosure and during the entire follow-up. The prevalence of clinically significant distress and risk for psychiatric morbidity in the male factor of infertility, female factor of infertility, and mixed factor subgroups decreased during the follow-up but remained higher than at the baseline. The study identifies that the course of distress and risk of psychiatric morbidity of males is significantly affected by their factor of infertility and changes across the pathway of treatment-related/follow-up appointments.

Scaffold-based tissue engineering approaches in treating infertility

Tissue engineering and the use of scaffolds have shown high therapeutic potentialities about male and female infertility. Nowadays, many couples are suffering from infertility problems. There are different causes for infertility including chemotherapy (for male and female), uterine injuries, and intrauterine adhesions. Extra-cellular matrix in tissue engineering provides a supportive medium for blood or lymphatic vessels making it a suitable substrate for cell implantation and growth. Dominant successes in this branch have been in use of patient-derived primary cells, these cells loaded in scaffolds and used to generate tissue for re-implantation. However, this method has limitations, because of the invasive nature of cell collection, also the cells patient-derived may be not healthy and become the source of disease. Therefore, use of stem cells, including embryonic stem (ES) cells, bone marrow mesenchymal stem cells (BM-MSCs) and umbilical cord-derived mesenchymal stem cells (UC-MSCs) have been considered. Cell/scaffold systems have a substantial role in fertility organs or agents repair or regeneration. This review summarizes the novel scaffold-based tissue engineering approaches to treat infertility.

Applying the Adaptive Leadership Framework for Chronic Illness to understand how American and British men navigate the infertility process

In this article, we sought to understand the adaptive challenges and work faced by men with male factor infertility. Using a prospective qualitative study in private (the United States) and academic (the United Kingdom) urology clinics, we recruited seven American and five British men with primary infertility after their urology consultation for male factor infertility between December 2015 and April 2017. Individual in-depth qualitative interviews were conducted shortly after male factor infertility urology consultation and then two additional interviews at about 3 and 6 months. We found three themes related to adaptive challenges faced during fertility treatment: avoidance (not disclosing, avoided social network), uncertainty (about ability to have a child, fertility-related information, and male factor infertility status), and affective symptoms (sadness, shock, disbelief, denial, about not achieving fatherhood, and poor outcomes). Four themes about adaptive work included focusing on goal (having clear, actionable steps; knowledge received from urologist; exhausted all options; focus on parenthood), support from partner (relationship and communication), support from health care team (provision of emotional support, increased comfort with staff over time, disclosure of knowing others with same condition), and acquired information (understanding issue, support from urologist, seeking information). We concluded that men with male factor infertility face adaptive challenges including avoidance, uncertainty, and affective symptoms. To manage during the treatment process, they use adaptive work including focusing on the goal, receiving support from their partner and health care team, and acquiring information. Although qualitative results cannot be generalized to larger populations, they might be applicable to men with male factor infertility during infertility treatment.

How does stress, depression and anxiety affect patients undergoing treatment?

PURPOSE OF REVIEW

To review latest findings about the impact of fertility care on emotional distress and effect of distress on treatment outcome.

RECENT FINDINGS

Treatment failure and long agonist protocols are associated with increased emotional distress during treatment. Screening tools can be used to identify men and women at risk of emotional maladjustment at the start of fertility treatment and people unlikely to need emotional support during or after treatment. There are inconclusive results about the association between emotional distress and outcome of fertility treatment. Systematic review of studies evaluating the effect of psychological and educational interventions on anxiety, depression and live birth (or ongoing pregnancy) are uninformative because of clinical heterogeneity and risk of bias.

SUMMARY

ART is emotionally demanding, patients that adapt more poorly can be identified in advance. Fertility staff should follow good practice guidelines to provide patients with support during treatment.

Examining the Role of Dyadic Coping on the Marital Adjustment of Couples Undergoing Assisted Reproductive Technology (ART)

A couple is considered to be infertile if unable to conceive after 12 months of unprotected sexual intercourse. An extended body of literature supports that infertility and infertility treatments contribute to emotional, social, sexual, and relational issues that can have a negative impact on each partner's well-being and on the couple relationship. Recent findings suggest that a dyadic approach should be used when working with couples coping with these stressors. However, most research to date has focused on the association between infertility and individual's psychological outcomes, rather than on the experience of infertility-related stress and coping from a relational perspective. Consequently, assuming that infertility is a dyadic stressor and that the ability of the partners to cope with this experience is the result of both individual and relational coping strategies, this study aimed to investigate dyadic coping and marital adjustment among couples at the beginning of an Assisted Reproductive Technology (ART) treatment. A sample of 167 heterosexual couples (N = 334) undergoing ART treatment at the fertility clinic of a large hospital in Milan from January to December 2017 was recruited. Each participant completed self-reported questionnaires examining marital adjustment (Dyadic Adjustment Scale) and dyadic coping (Dyadic Coping Questionnaire). Demographics and clinical variables were also collected. Data were analyzed using the Actor Partner Interdependence Model (APIM), testing the effect of each partner's dyadic coping style on their own and their partner's marital adjustment. Results revealed that both women and partners' scores on positive dyadic coping styles (common, emotion-focused, problem-focused, and delegated dyadic coping) contributed to higher marital adjustment. This result suggests that couples unable to engage in this type of reciprocal supportive behaviors and those unsatisfied with their coping efforts may be more vulnerable while undergoing ART treatments. Furthermore, findings highlighted some gender differences for stress communication and negative dyadic coping suggesting the presence of specific dynamics within couples facing an ART treatment. Implications for clinical practice and future research are discussed.

Mindfulness-based program for stress reduction in infertile women: Randomized controlled trial

Infertile women often experience chronic stress, which may have a negative impact on general well-being and may increase the burden of infertility. In this open-label, parallel, randomized controlled trial, infertile women aged 18-50 years (median 37 years) were assigned to an 8-week mindfulness-based program (MBP) or no intervention. The primary outcome was stress severity measured by the Lipp's Stress Symptoms Inventory (ISSL). Data were analyzed by modified intent-to-treat principle, which included all cases available to follow-up regardless of adherence to the intervention (62 participants from the MBP group and 37 from the control group). The median number of symptoms of chronic stress recorded in the past month decreased from six (interquartile range 2 to 9) before the MBP to two (interquartile range 1 to 4) after the intervention (p < 0.001, repeated measures analysis of variance with Time × Group interaction). Depressive symptoms also decreased after MBP, whereas general well-being improved (p < 0.01 for both outcomes). Hair cortisol and serum brain-derived neurotrophic factor (BDNF) did not change significantly between preintervention and postintervention. None of the outcomes changed significantly in the control group. MBP was effective in reducing stress and depressive symptoms while increasing general well-being in infertile women.

Can men be trusted in population-based surveys to report couples' medical care for infertility?

BACKGROUND

Men are usually excluded from surveys on reproductive health as some works have cast doubts on their ability to accurately report information on reproduction. Recent papers challenged this viewpoint, arguing that the quality of men's reports depends strongly on use of an appropriate study design. We aimed to explore the relevance of evaluating couples' use of medical care for infertility based on men's interviews in a population-based survey.

METHODS

The study was based on the last French sexual and reproductive health study (Fecond) conducted by phone interviews among a population-based sample of 2863 men and 4629 women aged 20-49 years.

RESULTS

Among respondents who had ever tried to have a child, the use of infertility medical care by couples (i.e. by the respondents and/or their partners) within the previous 15 years was 16% (95%CI 14 to 18%) based on men's reports and 17% (95%CI 15 to 18%) based on women's reports (p = 0.43). Men's and women's reports were remarkably concordant on most items (infertility duration, treatment). The main discrepancy concerned male medical checkup, which was reported much more often by male respondents than female respondents (86% vs. 57%, p < 0.001 for sperm analysis, 56% vs. 27%, p < 0.001 for male genital examination).

CONCLUSIONS

It is time to trust men to report couples' infertility medical care in reproductive surveys, as they provide information remarkably concordant with that provided by women. Conversely, women may poorly report the infertility checkups of their male partner.

"In Cycles of Dreams, Despair, and Desperation:" Research Perspectives on Infertility Specific Distress in Patients Undergoing Fertility Treatments

"Emotional distress in infertility" is a broad expression that loosely denotes anxiety, depression, grief, crisis, depleting psychological well-being, and all forms of affective and interpersonal disturbances faced by individuals with infertility. The distress is usually associated with involuntary childlessness as it is an unwelcoming event. The developmental crisis associated with childlessness poses a threat to one's sense of self at all levels (individual, family and social). Distress may begin before or during treatments as a person experiences the loss of control over attaining parenthood, anxiety or dejection after the diagnosis, treatments, its complications particularly its limited success rates. This paper reviews the basic concepts, theoretical models related to infertility specific distress (ISD). It elaborates on the effects of individual and treatment-specific variables on ISD with special highlights gathered from the national and international research.

What do people know about fertility? A systematic review on fertility awareness and its associated factors

INTRODUCTION

Recent evidence indicates that reproductive-age people have inadequate fertility awareness (FA) concerning fertility, infertility risk factors, and consequences of delaying childbearing. However, no study has tried to summarize these studies and to clarify the variables associated with FA, namely the role of gender, age, education, and reproductive status on FA.

METHODS

A literature search up to February 2017 was conducted using the EBSCO, Web of Science, Scielo, and Scopus electronic databases with combinations of keywords and MeSH terms (e.g. 'awareness' OR 'health knowledge, attitudes, practice' AND 'fertility'; 'fertile period'; 'assisted reprod*').

RESULTS

Seventy-one articles met the eligibility criteria and were included. The main results showed that participants report low-to-moderate FA. Higher levels of FA were shown by women, highly educated individuals, people who reported difficulties with conceiving, and those who had planned their pregnancies. Having or desiring to have children was not related to FA level. An inconsistent association between study participant age and FA was observed, with some studies indicating that older participants had higher FA, but others found an opposite result or did not find any association.

CONCLUSION

The current findings suggest that interventions to increase FA are warranted, especially those targeting men, people with low education, and in family planning settings. Interventions and campaigns should be customized to meet individuals' needs regarding FA. Because of the high heterogeneity regarding the assessment of FA, these conclusions must be interpreted with caution.

Low semen quality and experiences of masculinity and family building

INTRODUCTION

Infertility is a concern for men and women. There is limited knowledge on how male factor infertility affects the couple in fertility treatment. The aim of this study was to explore how severe male factor infertility affects men's sense of masculinity, the couple's relationship and intentions about family formation.

MATERIAL AND METHODS

Semi-structured qualitative interview study at the Fertility Clinic at Copenhagen University Hospital, Hvidovre, Denmark. Ten men with very poor semen quality initiating fertility treatment were interviewed between November 2014 and May 2015. Data were analyzed using qualitative content analysis.

RESULTS

Three themes were identified: "Threatened masculinity", "Being the strong one: impact on the couple" and "Consideration of family building options: a chapter not willing to start". The men felt that they could not fulfill their role as a man. Some couples had conflicts and discussions because the women in general wanted to talk more about infertility than the men. The men focused on having a biological child. They wanted to focus on achieving biological parenthood and postpone consideration of other family building options such as adoption or the use of semen donation in order to become a parent.

CONCLUSIONS

The consequence of severe male factor infertility was a threatened sense of masculinity. Fertility specialists and nurses should recognize the impact of male infertility and create space to give their patients an opportunity to verbalize their concerns and questions related to male factor infertility and the different challenges that the couple faces during the fertility treatment.

Spirituality, infertility-related stress, and quality of life in Brazilian infertile couples: Analysis using the actor-partner interdependence mediation model

Infertility has a stressful impact on both partners, with adverse effects on the quality of life of infertile couples. Spirituality is a meaning-based strategy that can protect couples against infertility's negative impact on quality of life, but analysis of this mediator relationship in infertile couples has not been reported. We adopted a dyadic approach and used the actor-partner interdependence mediation model to examine whether and how women's and men's spirituality was associated with their own and their partners' infertility-related stress and quality of life. In 2014, 152 infertile couples starting their first fertility treatment at a private clinic in Brazil were recruited and completed self-reports of spirituality, infertility-related stress, and quality of life. Results indicated that women's and men's level of spirituality was positively associated with their own quality of life directly and indirectly, by reducing their own infertility-related stress. Their spirituality was associated with an increase in their partners' quality of life only indirectly, by reducing their partners' infertility-related stress. Findings highlight the importance of assessing and promoting spirituality as a coping resource that infertile women and men might use to deal with the stress of infertility and reduce its adverse effects on quality of life.

Quality of life and psychosocial and physical well-being among 1,023 women during their first assisted reproductive technology treatment: secondary outcome to a randomized controlled trial comparing gonadotropin-releasing hormone (GnRH) antagonist and GnRH agonist protocols

OBJECTIVE

To compare self-reported quality of life, psychosocial well-being, and physical well-being during assisted reproductive technology (ART) treatment in 1,023 women allocated to either a short GnRH antagonist or long GnRH agonist protocol.

DESIGN

Secondary outcome of a prospective phase 4, open-label, randomized controlled trial. Four times during treatment a questionnaire on self-reported physical well-being was completed. Further, a questionnaire on self-reported quality of life and psychosocial well-being was completed at the day of hCG testing.

SETTING

Fertility clinics at university hospitals.

PATIENT(S)

Women referred for their first ART treatment were randomized in a 1:1 ratio and started standardized ART protocols.

INTERVENTION(S)

Gonadotropin-releasing hormone analogue; 528 women allocated to a short GnRH antagonist protocol and 495 women allocated to a long GnRH agonist protocol.

MAIN OUTCOME MEASURE(S)

Self-reported quality of life, psychosocial well-being, and physical well-being based on questionnaires developed for women receiving ART treatment.

RESULT(S)

Baseline characteristics were similar, and response rates were 79.4% and 74.3% in the GnRH antagonist and GnRH agonist groups, respectively. Self-reported quality of life during ART treatment was rated similar and slightly below normal in both groups. However, women in the GnRH antagonist group felt less emotional (adjusted odds ratio [AOR] 0.69), less limited in their everyday life (AOR 0.74), experienced less unexpected crying (AOR 0.71), and rated quality of sleep better (AOR 1.55). Further, women receiving GnRH agonist treatment felt worse physically.

CONCLUSION(S)

Women in a short GnRH antagonist protocol rated psychosocial and physical well-being during first ART treatment better than did women in a long GnRH agonist protocol. However, the one item on self-reported general quality of life was rated similarly.

CLINICAL TRIAL REGISTRATION NUMBER

NCT00756028.

Sex differences in depression during pregnancy and the postpartum period

Women have a lifetime risk of major depression double that of men but only during their reproductive years. This sex difference has been attributed partially to activational effects of female sex steroids and also to the burdens of pregnancy, childbirth, and parenting. Men, in contrast, have a reproductive period difficult to delineate, and research on the mental health of men has rarely considered the effects of fatherhood. However, the couple goes through a number of potentially stressing events during the reproductive period, and both mothers and fathers are at risk of developing peripartum depression. This Review discusses the literature on maternal and paternal depression and the endocrine changes that may predispose a person to depression at this stage of life, with specific focus on the hypothalamus–pituitary axis, oxytocin, and testosterone levels in men. Important findings on sex differences in the neural correlates of maternal and paternal behavior have emerged, highlighting the relevance of the emotional brain in mothers and the sociocognitive brain in fathers and pointing toward the presence of a common parents' brain. Additionally, sex differences in neurogenesis and brain plasticity are described in relation to peripartum depression. © 2016 The Authors. Journal of Neuroscience Research Published by Wiley Periodicals, Inc.

Assisted reproductive technology treatments and quality of life: a longitudinal study among subfertile women and men

PURPOSE

Quality of life (QoL) may represent a comprehensive indicator for the assessment of the psychological impact of complex clinical conditions, such as infertility. Infertile women have a worse QoL compared to both infertile men and non-infertile controls. However, the initial phases of infertility treatments have been frequently investigated using cross-sectional study designs. This prospective longitudinal study aimed at assessing the health-related QoL change across different phases of assisted reproductive technology (ART) treatments in subfertile women and men.

METHODS

Eighty-five subfertile women and men undergoing ART cycles were assessed at the beginning of the ovarian stimulation, during oocyte retrieval before discharging, and around 14 days after the embryo transfer. QoL was assessed through the Short Form 36.

RESULTS

Irrespective of the cause of infertility, work status, and age, QoL levels decreased from the first to the third assessment, and women scored significantly lower than men to each QoL indicator. Additionally, a higher number of previous ART failures had a negative impact on QoL, irrespective of gender and the phase of treatment. ART outcome marginally affected women's QoL across time.

CONCLUSION

Infertile women have a worse QoL throughout all phases of ARTs compared to men, and this difference increases in infertile patients with more than one previous ART failure.

Comparison of three infertility-specific measures in men and women going through assisted reproductive technology treatment

We compared the psychometric properties of COMPI Fertility Problem Stress Scales, Fertility Problem Inventory, and Fertility Quality of Life Tool in 293 patients enrolled for assisted reproductive technology. COMPI Fertility Problem Stress Scales and Fertility Problem Inventory subscales presented higher internal consistency. COMPI Fertility Problem Stress Scales differentiated best between its domains. Fertility Problem Inventory revealed better concurrent validity. Fertility Quality of Life Tool presented better fit. While discrimination for depression was similar between measures, Fertility Quality of Life Tool was better at discriminating anxiety. Results suggest that while all compared measures are reliable and valid in assessing the psychosocial adjustment to infertility, the choice of measure should be based according to the assessment goals.

Men's knowledge of their own fertility: a population-based survey examining the awareness of factors that are associated with male infertility

STUDY QUESTION

How knowledgeable are men about the medical, environmental and psychological factors that are associated with male infertility?

SUMMARY ANSWER

Men, across most demographic groups, have limited knowledge of the various factors that are associated with male infertility.

WHAT IS KNOWN ALREADY

Few surveys have focused on men's knowledge of their own fertility. Studies of both men and women have found that men are comparatively less knowledgeable about issues of fertility and reproductive health.

STUDY DESIGN, SIZE, DURATION

A regionally representative sample of Canadian men completed a web-based survey of male fertility and reproductive health, over a 2-month period in 2015.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Men, aged 18-50 years, were recruited for the study. There were 701 male participants, with a mean age of 34.1 years. Each participant was asked to identify factors associated with male infertility; fertility knowledge was assessed through two open-ended questions and a comprehensive list of risk factors and attendant health issues.

MAIN RESULTS AND THE ROLE OF CHANCE

Men were only able to identify 51% of the risk factors and 45% of the health issues associated with male infertility. Men were most aware of the modifiable risk factors for infertility (e.g. sexually transmitted infections, smoking cigarettes), relative to their knowledge of fixed risk factors (e.g. delayed puberty, size of testicles) and the attendant health issues (e.g. cardiovascular disease, diabetes). The overall level of fertility knowledge did not vary by most demographic characteristics (e.g. age, education, employment, income), though men from ethnic minority groups displayed moderately greater awareness. Additionally, younger men, those with lower incomes and those who had no desire to have future biological children were more likely to identify themselves as unaware of associations with infertility in the open-ended questions. Self-reported knowledge was significantly associated with higher overall knowledge scores. More than half of the sample expressed an interest in obtaining information about male fertility and reproductive health, with the majority of these men indicating that medical professionals and online sources were their preferred methods for receiving information.

LIMITATIONS, REASONS FOR CAUTION

Participants were self-selected and required to have Internet access in order to participate. This may affect the generalizability of results.

WIDER IMPLICATIONS OF THE FINDINGS

Previous studies of fertility knowledge have either omitted men from their samples or when men have been included, they were asked about general fertility or women's fertility. This is the first large-scale survey that focuses solely on men's knowledge of male fertility. Insight into the areas where men's knowledge may be lacking can inform strategies for disseminating fertility-related information and improving men's fertility awareness. Public health initiatives should tailor campaigns to educate men about the lesser known associations with male infertility, particularly those that are most prevalent and preventable through lifestyle modification.

STUDY FUNDING/COMPETING INTERESTS

The study was funded by a grant from CIHR TE1-138296. No competing interests.

Prevalence of Infertility Problems among Iranian Infertile Patients Referred to Royan Institute

BACKGROUND

Few studies have been conducted on the infertility problems in Iran. This study aimed to investigate the prevalence of infertility problems and related factors in Iranian infertile patients.

MATERIALS AND METHODS

In this cross sectional study, 405 infertile patients referred to Royan Institute, Tehran, Iran, between 2014 and 2015, were selected by simple random sampling. Participants completed the Fertility Problem Inventory (FPI) including 46 questions in five domains (social concern, sexual concern, relationship concern, rejection of parenthood, and need for parenthood). Mean difference between male and female was verified using independent-samples Student's t test. A generalized linear model (GLM) was also used for testing the effect of variables on the fertility problems. Data was analyzed using Stata software version 13.

RESULTS

The mean age (SD) of participants was 31.28 (5.42). Our results showed that 160 infertile men (95.23%) were classified as very high prevalence of infertility problems. Among infertile women, 83 patients (35.02%) were as very high prevalence of infertility problems, and 154 patients (64.98%) were as high prevalence. Age (P<0.001), sex (P<0.001), a history of abortion (P=0.009), failure of previous treatment (P<0.001), and education (P=0.014) had a significant relationship with FPI scores.

CONCLUSION

Bases on the results of current study, an younger male with lower education level, history of abortion and history of previous treatments failure experienced more infertility problems.