Psychological screening and the success of donor insemination

What do you know about reproductive medicine?--results of a German representative survey

OBJECTIVE

The use of reproductive medical treatments has become increasingly routine in recent years. This paper reports on a study of how different aspects of modern reproductive medicine are perceived by the German population.

DESIGN

Findings from a nationally representative sample of 2110 men and women aged 18 to 50 are presented. Participants responded to a questionnaire seeking self-report information about attitudes and knowledge regarding different aspects of reproductive medicine.

RESULTS

The majority of respondents had already heard or read something about reproductive medicine; knowledge gaps were prevalent in men and individuals with lower levels of education. The decrease in female fertility usually was underestimated, whereas both the number of involuntarily childless couples and the success rate of reproductive medical treatment were overestimated. One-third of participants would make use of reproductive medicine to have their own child.

CONCLUSION

This study revealed inadequacies in the knowledge of the German general population regarding reproductive medicine. Despite the low interest and poor knowledge of the topic, a broad acceptance of reproductive medical methods was reported. The results illustrate the need for adequate information transfer regarding female fertility as well as success rate and risks of reproductive medical interventions.

Stress, distress and outcome of assisted reproductive technology (ART): a meta-analysis

BACKGROUND

A number of studies have investigated the relationship between psychological factors such as stress and distress (measured as anxiety and depression) and outcomes of assisted reproductive technology (ART). The results, however, are inconsistent, and the strength of any associations remains to be clarified. We conducted a systematic review and meta-analysis of the results of studies reporting on the associations between stress, anxiety, and depression and ART outcomes.

METHODS

Prospective studies reporting data on associations between stress or distress in female patients and ART outcome were identified and evaluated by two independent researchers according to an a priori developed codebook. Authors were contacted in cases of insufficient data reporting. Stress was defined as perceived stress, work-related stress, minor life events or major life events, and distress was defined as anxiety or depression.

RESULTS

A total of 31 prospective studies were included. Small, statistically significant, pooled effect sizes were found for stress [ESr, effect size correlation) = -0.08; P = 0.02, 95% confidence interval (CI): -0.15, -0.01], trait anxiety (ESr = -0.14; P = 0.02, 95% CI: -0.25, -0.03) and state anxiety (ESr = -0.10, P = 0.03, 95% CI: -0.19, -0.01), indicating negative associations with clinical pregnancy rates. A non-significant trend (Esr = -0.11, P = 0.06) was found for an association between depression and clinical pregnancy. For serum pregnancy tests and live birth rates, associations between trait anxiety or state anxiety were not significant. The fail safe number did not exceed the suggested criterion in any analyses, between-study heterogeneity was considerable and the mean age, mean duration of infertility and percentage of first time ART attenders in the study samples were found to moderate several of the associations.

CONCLUSIONS

Small but significant associations were found between stress and distress and reduced pregnancy chances with ART. However, there were a limited number of studies and considerable between-study heterogeneity. Taken together, the influence of stress and distress on ART outcome may appear somewhat limited.

Psychosomatic approaches to obstetrics, gynaecology and andrology--a review

This review aims to clarify the scope and clinical importance of psychosomatic approaches to obstetrics, gynaecology and andrology. This gradually expanding sub-specialty covers a wide domain of complex disease conditions that can be managed more effectively if the various biological, psychological and social aspects are recognised at the start and concurrent treatment initiated. The current need to practise biopsychosocial management of disease conditions is highlighted along with a description of what this would involve. The nine-field psychosomatic approach, which can be applied to everyday clinical encounters, has been illustrated. Clinical applications of the psychosomatic approach are discussed for various conditions including chronic pelvic pain, eating disorders, tokophobia, post-traumatic stress disorder, depression, menstrual disorders, infertility, bereavement and testicular cancer. Cultural considerations and the need for further research are also briefly discussed.

Infertility-related stress in men and women predicts treatment outcome 1 year later

OBJECTIVE

To examine the separate and joint effects of male and female fertility problem (FP) stress and the source of stress (e.g., personal, social, marital) on treatment outcome.

DESIGN

Prospective, epidemiological cohort design.

SETTING

Fertility clinics in Denmark.

PATIENT(S)

Eight hundred eighteen couples who were about to begin a new course of treatment.

INTERVENTION(S)

An FP stress inventory was administered at the start of treatment, and the treatment outcome was evaluated 12 months later.

MAIN OUTCOME MEASURE(S)

Number of treatment cycles in 12-month study period and treatment outcome (i.e., success, no success).

RESULT(S)

Fertility problem stress was associated with a poorer treatment outcome in women (pooled within-groups [WGr] correlation,WGr = .517) and men (WGr = .392) with the effect significantly more pronounced for women (z = 3.19, P<.001). Fertility problem stress arising in the personal and marital domain showed greater associations with treatment outcome than did FP stress from the social domain. Logistic regression indicated that women who reported more marital distress required more treatment cycles to conceive (median 3) than women reporting less marital distress (median 2) (odds ratio [OR] = 1.20: Model chi2(3) = 77.21, P<.001).

CONCLUSION(S)

The findings provide evidence that infertility-related stress has direct and indirect effects on treatment outcome.

Semen providers and their three families

BACKGROUND

In 1985 the Swedish government introduced legislation that required all semen providers to furnish identifying information on themselves which would then be made available to their biological/provider offspring when they are deemed to have 'sufficient maturity'. The purpose of the legislation was to protect the child's rights and needs. The aim of this paper is to examine the degree to which semen providers have considered the implications of their decision to donate upon their three families; their birth family, the family they form with their partner, and the recipient family.

METHODS

Thirty semen providers from two Swedish clinics were sent self-completion questionnaires collecting both quantitative and qualitative information. The initial response rate was 100%. Questions requested demographic information; the degree to which semen providers had consulted with or advised their partners, family, existing offspring and acquaintances about their semen donation; views and attitudes of semen providers towards donor offspring, anonymity, information sharing, payments to semen providers, community acceptance of DI and semen providers, experience of donation, recruitment/screening procedures.

RESULTS

Almost all respondents had told their partners that they were providing semen, however, a much smaller proportion had told their birth families. Almost two thirds of semen providers were positive or very positive about the prospect of meeting their offspring at some time in the future, with older men expressing more enthusiasm.

CONCLUSIONS

The findings suggest that semen providers have only partially considered and addressed the full implications of having semen provider offspring. The age of semen providers could be influential in determining some attitudes and views.

Cultural similarities in psychological reactions to infertility

A 74-item especially developed and validated questionnaire for Iranian culture was administered three times to 37 Iranian infertile couples and 10 fertile couples acting as control group, namely, initial consultation, during treatment, and on completion of treatment. In view of parallel data also reported for Western patients interest centered on the results of two out of the five factors measured by the questionnaire, i.e., Psychological Stress and Social Behaviour. Analysis generally showed significantly high stress and social withdrawal for the patient group, particularly at initial consultation and after an unsuccessful treatment cycle as compared to the control group. Moreover, men whose partners eventually conceived scored significantly lower on stress than men whose partners did not conceive. Similar results have also been reported for Western infertile patients. The implications of the findings are discussed.

Donor insemination, the impact on family and child development

The practice of donor insemination (DI) has undergone major changes in the past 20 years. Attention was paid to the long-term psychological effects, the pleas for openness became stronger over the years and the use of anonymous donors became subject to public debate in several countries. The present article reviews what empirical research there is into DI families and their children. Over the years follow up studies have appeared sporadically and in spite of the varying quality of the research methods, preliminary findings have emerged. Research into the confidentiality issue in DI couples revealed that 47-92% of the DI parents intended to keep the donor origin secret from their children. DI couples just starting treatment more often intended to tell their children the DI origin than those who already had children. It is, however, too early to tell whether the public pleas for more openness did affect attitudes of the DI patients themselves. Research into the psychological well-being of DI parents and children failed to reveal major psychological problems. DI parents appeared to be well adjusted and to have stable marital relationships. DI children did not show significantly more emotional disturbances than controls. The quality of the parent-child relationship was better in the DI group than in the controls of naturally conceived parents.