The experience of infertility: a review of recent literature

Role of qualitative research in advancing fertility treatment services in Sub-Saharan Africa: A commentary

Qualitative research plays a significant role in understanding the causes and consequences of infertility in the Sub‐Saharan context.

Prevalence of infertility and the effect of covariates on survival time to pregnancy: A nationally representative population based cross sectional study

OBJECTIVE

This study sought to estimate population level prevalence of infertility and explored whether time to pregnancy is related to selected factors.

METHODS

This study's analysis was based on data collected from 2081 women who were sampled from participants of the 2016 Ethiopia Demographic and Health Survey based on risk of pregnancy criteria: age between 15 and 49 years, currently married or cohabitating, sexually active, not used contraception method during the 5 years before interview, not menopausal, and not pregnant. We used a current duration (CD) approach in which for each woman we calculated the length of time-at-risk of pregnancy (CD value) in months. A parametric survival model was fitted to CD values from which the median time to pregnancy (TTP) and prevalence of infertility were estimated. To explore variables associated with a longer TTP accelerated failure time, regression models were built to estimate time ratios.

RESULTS

The median TTP was 4 months (95% confidence interval [CI] 3.9-4.1). The 12-month prevalence of overall, primary, and secondary infertility were 29.5% (95% CI 27.50-31.47), 31.1% (95% CI 27.85-34.48), and 27.7% (95% CI 25.30-30.23), respectively. A longer TTP was observed for women aged 35 to 49 (P = 0.001), nulliparous (P = 0.00), when the usual residence of the husband is outside the home (P = 0.001), for women who want to give birth soon (P = 0.00), for cigarette smokers (P = 0.027), for rich women (P = 0.002), and for tertiary (P = 0.00) and primary educated women (P = 0.00).

CONCLUSION

This study suggests 30% of reproductive-age women experience infertility, which indicates that large numbers of Ethiopian women need fertility services.

'Nobody Has Ever Spoken to Me About PCD and Fertility Issues': Fertility Experiences of People With Primary Ciliary Dyskinesia and Their Family Caregivers

BACKGROUND

Primary ciliary dyskinesia (PCD) affects fertility in both females and males. To understand the impact and concerns among people with PCD and parents of affected children (family caregivers), we explored how they report their experiences with fertility.

METHODS

We used qualitative data from a questionnaire on fertility from Living with PCD, an international participatory study. In optional open-ended comment fields, participants shared their thoughts and experiences related to fertility. We adopted conventional content analysis and analysed the data inductively.

RESULTS

Out of 384 survey respondents, 206 (54%) provided free-text comments that we included in this analysis. We identified five categories illustrating participants' experiences with fertility: (1) challenging experiences of fertility care, ranging from insufficient fertility evidence to poor care from treating physicians, leading to an overall perception of inadequate care related to fertility; (2) PCD-related reproductive concerns, such as pregnancy risks, heritability of PCD and delayed PCD diagnosis; (3) non-PCD-related factors complicating fertility, such as challenges in accessing fertility treatment, age as a limiting factor for fertility and other diseases affecting fertility; (4) psychological impact of infertility, marked by emotional distress, grief and coping strategies; and (5) family caregivers as gatekeepers of fertility information, reflecting their role in managing, delaying, or shaping how and when children learn about fertility.

CONCLUSION

We need enhanced support and standardised reproductive counselling and healthcare for people with PCD to enable informed decisions on fertility and to reduce the fertility-related concerns and psychological impact faced by many.

PATIENT OR PUBLIC CONTRIBUTION

This participatory study was co-designed with people with PCD and a patient advisory group. Patients actively shaped research priorities, contributed to study design and questionnaire development, and played a key role in data interpretation and dissemination.

Navigating child adoption decision among women with infertility in Southern Ghana

The traditional Ghanaian society is pro-natal, with childbearing as the ultimate purpose of marriage. However, infertility may impede this purpose, leading to the need for child adoption among couples. This study explored child adoption decisions among women with infertility in Southern Ghana. A qualitative descriptive exploratory design was used. Purposive and snowball sampling techniques were used to recruit eligible participants. Overall, 14 women with infertility were interviewed. Analyses of the data were conducted using content analysis after audio-recorded interviews were transcribed verbatim. The findings suggested that to navigate the decision to adopt a child in Southern Ghana, there are key factors and environmental factors influencing the decision of these women. The study revealed that child adoption is associated with stigma, and some cultural beliefs, which were described as impediments to their decision-making process. The findings suggest that discrimination, stigma, and cultural beliefs, are the obstacles to child adoption in Southern Ghana. As a result, there is a need for community engagement, particularly with traditional and religious leaders, on child adoption issues in Ghana.

Dreaming of motherhood: experiences of women who have undergone fertility treatment

Objective

to describe the strategies used by women who have undergone assisted reproductive technologies (ART) to cope with the process of becoming mothers and to describe their relationships with their partners and healthcare professionals throughout this process.

Methods

This is a qualitative study based on grounded theory. Twenty women who had undergone ART in Spain were selected. Semi-structured interviews were used to collect the data. The analysis followed grounded theory methods.

Results

'Fighting for a dream: motherhood' is the main category describing women's struggles from their diagnosis of infertility to their successful pregnancy and delivery. This process makes it possible for them to fulfil their dream and become par-ents along with their partners. Three subcategories describe the different stages in the process: 'Accepting treatment: doing everything possible', 'Undergoing treatment: an emotional rollercoaster', and 'Reconsidering the dream: give up or gather strength to keep going?'

Conclusion

Women undergoing ART experience difficulties as they seek to achieve pregnancy, as there is no guarantee that they will be able to fulfil their greatest desire in life: motherhood. Women use a variety of coping strategies during ART and continue to seek emotional support from their peers and/or women who are experiencing the same situation.

Evaluating the therapeutic use of music to address anxiety for women undergoing gynaecological and fertility treatments

BACKGROUND

Music has been effectively used to address anxiety associated with medical treatments across broad applications. However, scant evidence exists about using music to reduce the significant anxiety experienced by women undergoing gynaecological procedures and fertility treatments. Such anxiety relates to the nature of procedures/examinations, invasiveness of the procedures, uncertainty around expectations, and intimate body part exposure, potentially affecting outcomes in triggering sympathetic nervous system responses. Music potentially contributes to anxiety management via known physiological and emotional effects. This funded collaborative project investigates therapeutic uses of music to address anxiety before and during gynaecology and fertility procedures, in order to assist participants with reducing their anxiety.

METHODS

Participants attending office, day surgery and other hospital procedures (N = 41) completed validated self-report surveys before and after procedures, listening to specific music via a purpose-designed Music Star. Additional contextual and qualitative data was sought to understand the nature of the experience for the women.

RESULTS

Results of this study indicated that the music intervention appeared to have a significant effect of reducing anxiety for women awaiting gynaecological and fertility procedures (p < .001, r = .82).

CONCLUSIONS

The use of music forms an acceptable intervention to decrease anxiety in this context and can enhance the experience of women during treatment. Such an increased use of music can provide anxiety management benefits to women undergoing gynaecological and fertility treatments, with these experiences suggesting potential educational benefits to support women through this extremely stressful and complex stage of their life.

Perceptions of Health System Professionals on Integrating Fertility Care into Reproductive Health Policy in China

Background: Infertility is a neglected global public health issue, particularly in the Global South, where policy interventions and research remain limited. In China, rising public demand and declining birth rates have renewed interest in integrating fertility care into reproductive health policies, though operational challenges and systemic gaps persist. Objectives: This study aims to explore the perceptions of health system professionals regarding the opportunities and barriers to integrating fertility care into China's reproductive health policy. Methods: This qualitative study involved 31 interviewees, including health system leaders (n = 5), health practitioners (n = 21), and civil society advocates (n = 5), from November 2023 to October 2024. The transcribed and anonymized data were thematically analyzed using MAXQDA version 2020, guided by the World Health Organization's health system building blocks framework. Results: Interviewees reported that integrating fertility care has markedly improved service accessibility and quality, driven by strong governmental leadership. They identified opportunities for further progress through focused government initiatives, expanded public-private partnerships, and the adoption of international best practices, while also noting obstacles such as operational challenges, systemic policy gaps, uneven resource distribution, and persistent cultural stigma. Conclusions: The findings underscore the need for a robust national policy framework, sustainable funding mechanisms, and enhanced primary healthcare capabilities, along with cultural advocacy and awareness campaigns to reduce stigma and foster equitable access.

Psychological and emotional profiles of Australian uterine transplant potential recipients: A comparison with international trials

INTRODUCTION

Uterus transplant (UTx) has emerged as a groundbreaking solution for individuals with uterine factor infertility (UFI). This study is the first in Australia to explore the psychosocial functioning of potential recipients assessed for the nation's initial UTx clinical trial and to compare their psychological profiles with those from international UTx trials.

MATERIAL AND METHODS

This is a mixed methods prospective study incorporating standardized psychological measures and semi-structured interviews. Conducted at a tertiary hospital in Sydney, Australia, the study involved 10 female Australian UTx potential recipients with UFI undergoing assessment for UTx surgery. Participants underwent comprehensive psychological evaluation using validated measures and in-depth semi-structured interviews. Quantitative measurement tools included the Hospital Anxiety and Depression Scale, Short Form-36 Health Survey, Fertility Quality of Life, and the Stanford Integrated Psychosocial Assessment for Transplantation. Thematic analysis was conducted on qualitative data from semi-structured interviews.

RESULTS

The Australian UTx potential recipients reported significantly higher Short Form-36 (SF-36) scores compared to the Australian general population in general health (p < 0.04), bodily pain (p < 0.02), social functioning (p < 0.02), and emotional well-being (p < 0.01). Compared with international UTx cohorts, the Australian UTx group showed comparable SF-36 outcomes, with minor variations observed for general health and physical function domains. Hospital Anxiety and Depression Scale scores revealed lower anxiety, but slightly higher depression levels compared to international UTx trial cohorts. Fertility quality-of-life scores were significantly higher in the Australian UTx group compared to women experiencing primary infertility across four domains (p < 0.001). Thematic analysis of interviews highlighted the complex emotional impact of infertility, strong family and social support, and the perception of UTx as a transformative opportunity to achieve wholeness and motherhood.

CONCLUSIONS

UTx represents a novel treatment option for women with UFI. This is the first qualitative study in Australia, it demonstrates the connection between women with UFI and their motivations for parenthood. These findings highlight the importance of tailored psychological assessments and establish a foundation for future research exploring the psychological characteristics of patient candidacy for UTxs.

The impact of infertility on the mental health of women undergoing in vitro fertilization treatment

BACKGROUND & PROBLEM

Infertility affects a substantial number of couples, posing physical, emotional, and psychological challenges. Infertile women experienced a sense of loss of control and planning of life with high stress and anxiety and they must deal with the uncertainty of treatment. The evolution of assisted reproductive techniques has provided hope for couples that struggle with infertility. The implementation of questionnaires assessing the mental health of women with infertility before, during, and after the IVF procedure proved to be useful tool to evaluate women who needs psychological support.

AIM

This study aims to explore the impact of infertility on the mental health of women undergoing IVF treatment.

METHODS

For the assessment of infertility on women's mental health, the CES-D Scale, the State-Trait Anxiety Inventory for Adults, and the Fertility Problem Inventory scale were given before or during the diagnostic evaluation of the infertility and before the initiation of infertility treatment (ovulation induction). To assess the effect of ART on the mental health of the participants, the fertility quality of life tool was applied at the end of the procedure.

FINDINGS

The current study found that the greater age, the greater educational level and not having experienced a miscarriage were significantly associated with better quality of life and decreased stress during the IVF procedure.

CONCLUSIONS

The application of psychological interventions can assist all women undergoing infertility treatment as a way to cope with the challenges associated with infertility treatment. IVF couples may need additional support during the procedure.

Effects of Religious Versus Non-religious Self-compassion Interventions on Anxiety and Quality of Life of Iranian Infertile Women: A Randomized Controlled Trial

Anxiety is one of the common psychological problems among infertile women, which affects their quality of life. The purpose of this study was to compare the effects of self-compassion intervention based on a religious and non-religious perspective regarding the anxiety and quality of life of infertile women. A randomized clinical trial design with experimental and control groups was used. A total of 78 infertile women who lived in Yazd province, Iran, were referred to Yazd reproductive sciences institute, were selected by available sampling and randomly assigned to two experimental and one control groups. The participants of the first experimental group received eight sessions of self-compassion-focused intervention based on religious instructions. The second experimental group received eight sessions of non-religious self-compassion intervention, while the control group was put on the waiting list. Data were collected using Quality of Life in Infertile Couples Questionnaire (QOLICQ) and Beck anxiety inventory (BDI) in the pretest, posttest and 2-month follow-up phases and then analyzed using repeated measures as well as one-way analysis of variance. The results showed as compared to control group at the posttest and follow-up phases, the quality of life (p < 0.001) and anxiety (p < 0.001) of infertile women increased and decreased, respectively, across both experimental groups. Comparison of experimental groups showed that although the difference between the two groups in the subscales of social relationships and sexual satisfaction was not significant, the gain scores of quality of life and anxiety were significantly greater in the first experimental group. These findings indicate that given the religious background of infertile women, religious self-compassion intervention can be relatively more effective in improving the quality of life and anxiety of infertile women than non-religious intervention.

Using interview excerpts to facilitate focus group discussion

The use of interviews and focus groups is well-established in the social science methods literature. However, discussion on how research can combine these two methods in creative ways is less common. While researchers are generally aware of the potential of focus groups for further probing issues that emerge in one-on-one interviews, few studies detail how this might be achieved in practice. In this article, we describe and reflect on a focus group elicitation strategy that uses individual interview excerpts to facilitate discussion in group settings. In our reflection, we draw on a study that investigated the sharing of embryo images in fertility treatment. The article contributes to the methods literature firstly, by reflecting on the novel use of individual interview material in focus groups and secondly, by discussing the re-enactment of interview excerpts as an effective audio elicitation tool to be used in the later stages of research.

Defining infertility: a qualitative interview study of patients and physicians

PURPOSE

To investigate if infertility patients and physicians apply a traditional biomedical model of disease in their conceptualisation of infertility, examine any contradictions and conflicts in conceptualisations, and examine areas of concordance and discordance between physicians and patients.

METHODS

Semi-structured interviews were conducted with 20 infertility patients and 18 infertility physicians between September 2010 and April 2012. Interviews were analysed qualitatively to determine physician and patient conceptualisations of infertility, reactions to the definition of infertility as a disease, and potential benefits and concerns related to application of a disease label to the condition.

RESULTS

Most physicians (n = 14/18) and a minority of patients (n = 6/20) were supportive of defining infertility as a disease. Many of the patients who agreed with classifying infertility as a disease expressed that they had not personally defined it as such previously. Physicians (n = 14) and patients (n = 13) described potential benefits of a disease label, including increases in research funding, insurance coverage, and social acceptability. Some patients (n = 10) described potential stigma as a negative consequence. When describing appraisals of infertility, both physicians (n = 7) and patients (n = 8) invoked religious/spiritual concepts. The potential for religious/spiritual appraisal to contribute to stigmatising or de-stigmatising infertility was discussed.

CONCLUSION

Our findings contradict the assumption that infertility physicians and patients are fully supportive of defining infertility as a disease. While potential benefits of the disease label were recognised by both groups, caution against potential for stigmatisation and unsolicited invocation of religion/spirituality suggest a more holistic model may be appropriate.

Representations of in vitro fertilization in the first cycle of IVF in women

Introduction

Women typically experience more intense stress related to infertility compared to men, which is partly connected to the importance that motherhood and parenthood have for women in most societies. Considering the dominance of pronatalism in the majority of cultures, it is not surprising that women, who are most often considered responsible for reproduction, suffer greater social and psychological pressure due to infertility.

Method

The study employs a social constructionist framework to explore how women facing infertility construct their notions of their first IVF treatment. Eleven women, aged 21-39, participated in the study and underwent semi-structured interviews. Thematic Analysis with a social constructionist epistemology was employed to investigate co-produced accounts of their first IVF.

Results

Four ways of representing IVF emerged from the women's statements about this procedure: IVF as a helpful step towards success; as a stressful journey into the unknown; as a game of chance; and as something I (do not) ask about.

Discussion

The representations of IVF identified allow us to understand the subject positions of our participants that determine their thoughts, emotions, and behavior. In the narratives of almost all participants, we encounter different, even contradictory positions. The results allow us to understand better the needs of women facing infertility and to try to develop a system of treatment that is going to meet these needs, and therefore prevent the psychological consequences caused by this bio-psycho-social crisis.

Policy-Induced Fertility Suppression and Marital Satisfaction: Evidence From a Natural Experiment in China

Having children is widely regarded as one of the most important benefits and purposes of marriage, particularly in societies that uphold traditional family values. Consequently, the suppression of fertility could have far-reaching implications for marital life that transcend childbearing itself. Previous studies have examined the impact of health-induced fertility suppression, but a gap remains in understanding how policy-induced fertility restrictions affect marital satisfaction. This study employs a nationally representative sample to examine whether Chinese couples' marital satisfaction improves when the potential marital utility on fertility is enhanced following the transition from the one-child to the universal two-child policy in China. Using a difference-in-differences design, the study finds that men who desire multiple children experience increased marital satisfaction after the policy change. Conversely, the same is not observed for women. Our study provides compelling evidence that the increase in marital satisfaction for husbands is driven by the improved evaluation of the marital fertility value rather than other unintended policy effects. Further, the policy-induced satisfaction improvement is more pronounced among men with more severely constrained or deeply ingrained fertility desires. The article discusses the broad impact of fertility policy on family life, the gender-imbalanced perception of this policy shift, and its theoretical and policy implications.

Psychiatric Considerations of Infertility

OBJECTIVE

Infertility, the inability to achieve pregnancy within a year despite normal attempts to conceive without contraception, causes psychosocial burden for individuals and couples. This review summarized the interrelationship between infertility and psychological stress and suggested various forms of psychological intervention for infertility.

METHODS

The PubMed, Google Scholar, and Korean Studies Information Service System databases were searched for English- and Korean-language articles published from 1990 to 2024.

RESULTS

Infertility leads to emotional distress from diagnosis to treatment. Also, psychological stress affects the trajectory of infertility. This distress may cause psychiatric illnesses, negatively affecting pregnancy. Psychotherapies, psychopharmacotherapies, and biological treatments can be used for the management of psychiatric illnesses in infertile patients. Digital therapeutics also have the potential to be a competitive treatment option.

CONCLUSION

Regular assessment and management of psychological stress in infertile couples are essential during the course of infertility treatment. Psychological intervention of infertile patients should be implemented according to a personalized plan that completely reflects the individual clinical characteristics.

Infertility Prevention and Health Promotion: The Role of Nurses in Public Health Initiatives

Infertility is a growing public health concern, affecting millions of individuals and couples worldwide. Despite advancements in medical treatments, prevention remains a critical strategy for reducing the burden of infertility. Nurses, as frontline healthcare providers, play a pivotal role in infertility prevention and health promotion, particularly through public health initiatives. This review aims to explore the diverse roles of nurses in infertility prevention and their contributions to public health strategies. A review of existing literature was conducted to examine the epidemiology of infertility, key risk factors, and the preventive measures that can be employed by nursing professionals. Emphasis is placed on the role of nurses in health education, screening, early detection, and community-based interventions, which are essential in reducing infertility rates. In addition, this review identifies barriers that impede effective nurse-led infertility prevention, such as disparities in access to care, cultural sensitivity challenges, and policy constraints. Evidence suggests that nurses are well-positioned to lead public health campaigns, conduct reproductive health counseling, and advocate for policy reforms to improve infertility prevention. The review concludes with recommendations for future research, suggesting enhanced nursing education and training, as well as the need for stronger integration of nurses into public health policy-making. This study underscores the critical role of nurses in promoting reproductive health and preventing infertility, advocating for their inclusion in comprehensive public health strategies aimed at addressing infertility on a global scale.

Yoga: As a Transformative Approach to Addressing Male Infertility and Enhancing Reproductive Health in Men: A Narrative Review

Infertility presents multifaceted challenges that encompass both physical and emotional burdens. Yoga, as a comprehensive system of mind-body medicine, serves as an effective intervention for managing male factor infertility, a complex lifestyle disorder with significant psychosomatic elements. This review explores the transformative role of yoga in addressing both the emotional and physical dimensions of infertility. By incorporating physical postures, breath control and meditation, yoga promotes emotional well-being and enhances reproductive health by improving the integrity of nuclear and mitochondrial genomes as well as the epigenome. In addition, yoga contributes to maintaining sperm telomere length through the regulation of seminal free radical levels and increased telomerase activity, which are crucial for optimal embryo cleavage and the development of high-quality blastocysts. Integrating yoga as an adjunctive therapeutic approach fosters a supportive intrauterine environment and facilitates physiological homoeostasis, thereby increasing the likelihood of successful fertilisation and implantation. Gentle asanas and flowing sequences promote relaxation, alleviate tension and cultivate emotional stability, while meditation aids in emotional healing and resilience during the infertility journey. Specific asanas, such as Baddha Konasana (bound angle pose), Bhujangasana (cobra pose) and Sarvangasana (shoulder stand), stimulate reproductive organs, enhance blood circulation and regulate hormone production. Pranayama techniques further support endocrine balance and overall vitality. Moreover, yoga provides a non-invasive strategy for managing fertility-related conditions leading to improved reproductive health and overall well-being. This review aims to elucidate the comprehensive role of yoga in improving male infertility, focusing on its impact on sperm nuclear and mitochondrial genomes, the epigenome and telomere health. In addition, it underscores the importance of self-care, open communication and shared experiences with partners. Practicing yoga regularly supports psychosocial well-being, promotes holistic healing, enhances physical and mental health and probably helps in improving reproductive health, thereby fostering resilience and self-efficacy throughout the journey of fertility and reproduction.

The Effect of Spiritual Health on Psychological Distress of Infertile Women: The Role of Perceived Social Support as a Mediator

Background

The objective of this study was to evaluate the model of spiritual health in relation to psychological distress among infertile women, with perceived social support as a mediator.

Method

In this study, structural equation modeling (SEM) was employed. The study population included all infertile women in Shiraz from which a sample of 250 individuals was selected using a targeted sampling method. The research data were collected by Spiritual Health questionnaire developed by Iranian Academy of Medical Sciences; Depression, Anxiety, and Stress Scale 21 (DASS-21); and Multidimensional Scale of Perceived Social Support (MSPSS). Data analysis was performed using SPSS and AMOS software.

Results

The results demonstrate that the direct impact of spiritual health on psychological distress and perceived social support was statistically significant. Furthermore, a significant indirect effect of spiritual health on psychological distress was identified through perceived social support.

Conclusion

According to the findings of this study, it may be beneficial to address aspects of spiritual health and social support to alleviate psychological distress among infertile women.

Searching for Love and Babies: A Qualitative Study on Online Social Support Among Women with Infertility

With the popularity of computer-mediated communication, accessing online social support has become more accessible for women confronting infertility, yet the role of such support for Chinese women remains understudied. This study investigates the online social support experiences of Chinese women navigating infertility within the framework of Cutrona and Suhr's social support. Employing netnography and semi-structured interviews alongside thematic analysis, the findings highlight challenges in informational support due to limitations in online information dissemination, with some degree of overlap observed between informational support and network support. Emotional support proves crucial and esteem support aids in mitigating self-blame among online forum members. Tangible assistance primarily involves expressed willingness to help. This research advances social support theory by exploring new areas, clarifying online support mechanisms using Daena Goldsmith's normative approach, highlighting sociocultural influences, and enhancing understanding of esteem support in the context of stigmatization.

Development of an infertility perception scale for women (IPS-W)

PURPOSE

The purpose of this study was to develop an Infertility Perception Scale for Women (IPS-W).

METHODS

Initial items were based on an extensive literature review and in-depth interviews with five infertile women and fifteen women not diagnosed with infertility. Forty-one items were derived from a pilot survey. Data were collected from 203 women who had experienced intrauterine insemination (IUI) and in-vitro fertilization (IVF) more than once. The data were analyzed to verify the reliability and validity of the scale.

RESULTS

Four factors containing 21 items were extracted from the exploratory factor analysis (EFA) to verify the construct validity. The four factors of infertility perception scale were perceived feelings, personal stigma, social stigma, and acceptance. These factors explained 59.3% of the total variance. The confirmatory factor analysis (CFA) confirmed a four-factor structure of the 21-item IPS-W. All fit indices were satisfactory (χ2/df ≤ 3, RMSEA < 0.08). These items were verified through convergent, discriminant, known group validity, concurrent validity testing. The internal consistency reliability was acceptable (Cronbach's α = 0.90).

CONCLUSION

The scale reflects the perception of infertility within the cultural context of Korea. The findings can help nurses provide support that is appropriate for individual circumstances by examining how women experiencing infertility perceive infertility.

Examining the association between coping strategies and perceived social support among Vietnamese infertile women undergoing IVF treatment

The purpose of the study was to examine the association between coping strategies and perceived social support among women diagnosed with infertility and undergoing IVF treatment. A total of 383 Vietnamese women were invited to participate in this study. Participants completed a questionnaire consisting of The Multidimensional Scale of Perceived Social Support, the Copenhagen Multi-centre Psychosocial Infertility coping scales and the Fertility Problem Inventory, and other relevant questions. The results reveal that coping strategies significantly predict some specific types of perceived social supports among women undergoing IVF treatment. Specifically, passive-avoidance coping (PAC) and active-avoidance coping (AAC) predicts a decrease in receiving support from family and friends, whereas active-confronting coping (ACC) predicts an increase in receiving support from these two sources of support. Women who demonstrate increased meaning-based coping (MBC) received all three sources of support including family, friends, and significant others support. Despite some limitations, this study is useful in understanding how coping strategies among women undergoing IVF treatment affects the social support received in the Vietnamese social context. It also emphasizes the importance of psychological support for women facing IVF treatment distress.

Making Sense of Memorable Messages About Infertility: Examining Message Valence by Theme and Sender

Fertility problems, often called infertility, have been defined as the inability to conceive or maintain pregnancy throughout one year of trying (World Health Organization, 2020). Because fertility problems can present unique medical, emotional, relational, and identity challenges, they are often difficult to talk about, and even well-intentioned messages can be perceived negatively. This study uses Communicated Sense-Making (CSM; Kellas & Kranstuber Horstman, 2015), particularly its mechanism of memorable messages, to explore what types of support-related messages people experiencing infertility find memorable. Results from semi-structured interviews (N = 54) indicate five supra-themes of memorable messages: (a) communicating solidarity; (b) attempting to minimize participants' stress; (c) communicating investment or interest in the patient's experience; (d) sharing expertise; and (e) absolving the patient of responsibility; we identify several sub-themes within each. We also explore patterns between message types, senders, and message valence: message themes were perceived as either positive, negative, or neutral based on the combination of sender and perceived intention. Theoretical and practical implications are discussed.

Influence of substance use on male reproductive health and offspring outcomes

The prevalence of substance use globally is rising and is highest among men of reproductive age. In Africa, and South and Central America, cannabis use disorder is most prevalent and in Eastern and South-Eastern Europe, Central America, Canada and the USA, opioid use disorder predominates. Substance use might be contributing to the ongoing global decline in male fertility, and emerging evidence has linked paternal substance use with short-term and long-term adverse effects on offspring development and outcomes. This trend is concerning given that substance use is increasing, including during the COVID-19 pandemic. Preclinical studies have shown that male preconception substance use can influence offspring brain development and neurobehaviour through epigenetic mechanisms. Additionally, human studies investigating paternal health behaviours during the prenatal period suggest that paternal tobacco, opioid, cannabis and alcohol use is associated with reduced offspring mental health, in particular hyperactivity and attention-deficit hyperactivity disorder. The potential effects of paternal substance use are areas in which to focus public health efforts and health-care provider counselling of couples or individuals interested in conceiving.

Enhancing cultural sensitivity in the implementation of the Fertility Quality of Life Tool in Sudan: a science diplomacy perspective

Background

Infertility is a global health challenge impacting quality of life, particularly in low and middle-income countries such as Sudan. The Fertility Quality of Life (FertiQoL) tool, a standardized questionnaire, is pivotal in assessing fertility-related quality of life. However, existing research on its utility has primarily been conducted in Global North and High-Income Countries, highlighting the need to shift away from neocolonialism to promote truly inclusive research and effective healthcare practices. Science diplomacy, through the adaptation and culturally sensitive implementation of research tools, can serve as a catalyst for addressing health disparities on a global scale. This study aims to assess methodological and cultural considerations that impact the implementation of the FertiQoL tool in Sudan, framed within the context of science diplomacy and neocolonialism. By investigating the challenges and opportunities of utilizing this tool in a non-Western cultural setting, we seek to contribute to the broader discussion on decolonizing global health research.

Methods

Utilizing an explanatory sequential design involving surveys and interviews, we conducted a study in a Sudanese fertility clinic from November 2017 to May 2018. A total of 102 participants were recruited using convenience sampling, providing socio-demographic, medical, and reproductive history data. The Arabic version of FertiQoL was administered, with 20 participants interviewed and 82 surveyed (40 self-administered and 42 provider-administered). We applied descriptive statistics, one-way ANOVA, thematic analysis, and triangulation to explore methodological and cultural nuances.

Results

Most participants were educated women who lived in urban areas. While the ANOVA results revealed no statistically significant differences in FertiQoL scores based on the mode of administration [core score (F(2,99) = 1.58, p = 0.21, η 2 = 0.03) and domain scores: emotional (F(2,99) = 1.85, p = 0.16, η 2 = 0.04); mind/body (F(2,99) = 1.95, p = 0.15, η 2 = 0.04); relational (F(2,99) = 0.18, p = 0.83, η 2 = 0.04); and social (F(2,99) = 1.67, p = 0.19, η 2 = 0.03)], qualitative insights unveiled vital cultural considerations. Interpretation challenges related to concepts like hope and jealousy emerged during interviews. Notably, the social domain of FertiQoL was found to inadequately capture the social pressures experienced by infertile individuals in Sudan, underscoring the importance of region-specific research. Despite these challenges, participants perceived FertiQoL as a comprehensive and valuable tool with broader utility beyond assessing fertility-related quality of life.

Conclusion

Our findings emphasize the significance of incorporating cultural sensitivity into the interpretation of FertiQoL scores when implementing it globally. This approach aligns with the principles of science diplomacy and challenges neocolonial structures by acknowledging the unique lived experiences of local populations. By fostering cross-cultural understanding and inclusivity in research, we can enhance the implementation of FertiQoL and pave the way for novel interventions, increased funding, and policy developments in the Global South, ultimately promoting equitable global health.

Irrational parenthood cognition and infertility stigma among infertile women: A cross-sectional study in Changsha, China

Background

Stigma is among the most prevalent and disturbing consequences of being infertile among women, yet it remains unknown whether fertility stigma is affected by irrational parenthood cognitions (IPC). The current study aimed to assess IPC, infertility stigma, and their interrelationship among a group of Chinese women referred to an infertility center in Changsha, Hunan, China.

Methods

A cross-sectional study was conducted among 376 women seeking treatment for infertility in Changsha City, China. Pearson correlation test was used to explore the association between IPC and infertility stigma, while multivariate linear regression was used to explore the independent influencing factors of infertility stigma.

Results

Participants had a mean score of 42.41 ± 13.03 for IPC and 62.89 ± 24.50 for ISS. IPC was highly correlated with infertility stigma with a large effect size (r = 0.55, p < 0.001). Multivariate linear regression showed that patients' infertility stigma was positively associated with IPC (β = 1.06, p < 0.001) while negatively associated with education (β = -5.4, p = 0.036) and disclosure of infertility (β = -8.39, p = 0.001) (R 2  = 36 %). In addition, various influencing factors were identified for the four dimensions of infertility stigma.

Conclusion

This study is the first to identify a positive association between irrational parenthood cognitions and infertility stigma among infertile women in China. Our findings provide useful guidance for the future development of effective anti-stigma intervention programs among infertile women.

Prevalence and help-seeking for infertility in a population with a low fertility rate

BACKGROUND

In Taiwan there has been limited research of epidemiological surveys on prevalence of infertility. This study aimed to provide the updated prevalence of primary infertility and of help-seeking among residents in Taiwan.

METHODS

Between February and March 2023, we conducted a cross-sectional population-based telephone survey of 1,297 men and women aged 20-49 years who were residing in Taiwan. We used computer-assisted telephone interviewing techniques to collect data regarding sociodemographic and reproductive characteristics. Using two approaches to defining infertility, we estimated the prevalence of infertility and the prevalence of help-seeking behaviors. Our analyses accounted for survey weighting.

RESULTS

The response rate was 27.9%. Among 1,297 respondents, 829 (63.9%) were married or cohabiting, including 404 men and 425 women. The prevalence of primary infertility using definition 1 was 5.6% (95% confidence interval [CI]: 4.2% - 7.4%); the prevalence of primary infertility using definition 2 was 6.7% (5.1% - 8.6%). Regarding professional help-seeking, 11.1% (9.2%-13.5%) had ever consulted a doctor about getting pregnant; 9.9% (8.1%-12.2%) had ever received diagnostic tests/treatment to help with conceiving; 2.6% (1.6% - 4.0%) were currently receiving diagnostic tests/treatment to help with conceiving.

CONCLUSION

Our nationwide survey of the prevalence of primary infertility in Taiwan suggests that the prevalence was not as high as what is often seen in the news reports (about 14%). These findings also suggest there may be a gap between those who are currently experiencing infertility and those who are currently being treated; hence, we call for raising awareness of infertility and improving access to infertility healthcare.

A Dyadic Study of Attachment, Coping, and Quality of Life in Couples Seeking Fertility Treatment

This study examined attachment insecurities, infertility-specific coping strategies, and quality of life (QoL) in 87 couples seeking fertility treatment. Partners completed self-report measures. Path analyses showed that women's and men's attachment anxiety were associated with their own lower QoL, whereas attachment avoidance was associated with their own and their partner's lower QoL. Adaptive coping in men and women were associated with women's higher QoL. Non-adaptive coping was associated with men and women's lower QoL. Coping strategies explained the associations between attachment and QoL. This highlights the importance of individual and dyadic factors for understanding QoL in couples seeking fertility treatment.

Alcohol and cannabis use among women with infertility: associations with psychiatric symptoms, attempts to conceive, and engagement in fertility treatment

Little is known about substance use among women with infertility, yet substance use has implications for fertility and pregnancy. The purpose was to estimate the prevalence of substance use among women with infertility and examine whether substance use was associated with psychiatric symptoms, active attempts to conceive, and engagement in fertility treatments. Eligible patients were from a single healthcare system who received a female infertility diagnosis within the past 2 years. Participants (n = 188) completed an online questionnaire regarding substance use, psychiatric symptoms, attempts to conceive, and fertility treatments. The prevalence of hazardous alcohol use, any cannabis use, and hazardous cannabis use were 30.3%, 30.9%, and 8.5%, respectively. Hazardous alcohol use was not associated with psychiatric symptoms (p > .05). Those with any cannabis use were more likely to have higher depression scores than those without (p = .02). Those with hazardous cannabis use were more likely to have higher depression scores (p = .001) and higher anxiety scores (p = .03). Substance use was not associated with actively trying to conceive. Those pursuing fertility treatments had a lower percentage engaging in hazardous alcohol use compared to those not pursuing fertility treatments (19.0% vs. 36.3%, p = .02). Substance use among women with infertility is common. Hazardous cannabis use was associated with greater psychiatric symptoms, suggesting that cannabis may be used to cope with distress. Pursuing fertility treatments may serve as a protective factor for hazardous alcohol use. Clinicians treating patients with infertility may want to screen for substance use.

Declining global fertility rates and the implications for family planning and family building: an IFFS consensus document based on a narrative review of the literature

BACKGROUND

Family-planning policies have focused on contraceptive approaches to avoid unintended pregnancies, postpone, or terminate pregnancies and mitigate population growth. These policies have contributed to significantly slowing world population growth. Presently, half the countries worldwide exhibit a fertility rate below replacement level. Not including the effects of migration, many countries are predicted to have a population decline of >50% from 2017 to 2100, causing demographic changes with profound societal implications. Policies that optimize chances to have a child when desired increase fertility rates and are gaining interest as a family-building method. Increasingly, countries have implemented child-friendly policies (mainly financial incentives in addition to public funding of fertility treatment in a limited number of countries) to mitigate decreasing national populations. However, the extent of public spending on child benefits varies greatly from country to country. To our knowledge, this International Federation of Fertility Societies (IFFS) consensus document represents the first attempt to describe major disparities in access to fertility care in the context of the global trend of decreasing growth in the world population, based on a narrative review of the existing literature.

OBJECTIVE AND RATIONALE

The concept of family building, the process by which individuals or couples create or expand their families, has been largely ignored in family-planning paradigms. Family building encompasses various methods and options for individuals or couples who wish to have children. It can involve biological means, such as natural conception, as well as ART, surrogacy, adoption, and foster care. Family-building acknowledges the diverse ways in which individuals or couples can create their desired family and reflects the understanding that there is no one-size-fits-all approach to building a family. Developing education programs for young adults to increase family-building awareness and prevent infertility is urgently needed. Recommendations are provided and important knowledge gaps identified to provide professionals, the public, and policymakers with a comprehensive understanding of the role of child-friendly policies.

SEARCH METHODS

A narrative review of the existing literature was performed by invited global leaders who themselves significantly contributed to this research field. Each section of the review was prepared by two to three experts, each of whom searched the published literature (PubMed) for peer reviewed full papers and reviews. Sections were discussed monthly by all authors and quarterly by the review board. The final document was prepared following discussions among all team members during a hybrid invitational meeting where full consensus was reached.

OUTCOMES

Major advances in fertility care have dramatically improved family-building opportunities since the 1990s. Although up to 10% of all children are born as a result of fertility care in some wealthy countries, there is great variation in access to care. The high cost to patients of infertility treatment renders it unaffordable for most. Preliminary studies point to the increasing contribution of fertility care to the global population and the associated economic benefits for society.

WIDER IMPLICATIONS

Fertility care has rarely been discussed in the context of a rapid decrease in world population growth. Soon, most countries will have an average number of children per woman far below the replacement level. While this may have a beneficial impact on the environment, underpopulation is of great concern in many countries. Although governments have implemented child-friendly policies, distinct discrepancies in access to fertility care remain.

Anxiety, depression, and infertility-specific distress among women with female factor infertility

This study aimed to evaluate whether anxiety, depression, and infertility-specific distress differ among women with female infertility who are trying to conceive and/or seeking infertility treatment. Women with diagnosed female factor infertility in the past 2 years (N = 188) completed demographic questions, and measures of infertility-specific distress, anxiety, and depression. The majority of the sample were actively trying to conceive (78.7%, n = 148) and approximately one third (33.5%, n = 63) were undergoing fertility treatment. Anxiety and depression scores did not differ based on trying to conceive or treatment-seeking, although these subgroups reported higher levels of need for parenthood and rejection of a childfree lifestyle. High levels of mood and anxiety are experienced by women with female infertility. Although infertility-specific distress is experienced more so by women with anxiety and depression, a substantial proportion of those without mental health conditions had high levels of distress, underscoring the need for screening and treatment.

Self-Perceived Infertility is Not Always Associated with Having Fewer Children: Evidence from German Panel Data

Proximate determinants theory considers infertility rates a risk factor for lower fertility rates, but the assumption that people who perceive infertility will have fewer children has not been tested. This study investigates the association of self-perceived infertility with the number of children people have had after 11 years. Infertility implies reduced chances of conception (rather than sterility), but people do not always consistently perceive infertility over time. If people who think they are infertile at one time can later report no infertility, then does self-perceived infertility necessarily lead to having fewer children? We answer this question by analyzing 11 waves of the German family panel (pairfam) data using negative binomial growth curve models for eight core demographic subgroups created by combinations of gender (men/women), parity (0/1+children), and initial age groups (25-27 and 35-37). Those who repeatedly perceived themselves to be infertile (three times or more) had fewer children than those who perceived themselves to be infertile once or twice in only four of eight gender by initial parity by age groups. Only in four groups did people who perceived themselves to be infertile once or twice have fewer children than those who never perceived themselves to be infertile in both the unadjusted and adjusted models. Thus, self-perceived infertility does not necessarily result in fewer children. Rather, the association depends upon life course context and gender.

The knowledge domain and emerging trends in the infertility field: A 67-year retrospective study

Infertility is a significant problem influencing many couples. Our purpose was to assess the field of infertility in Obstetrics and Gynecology from 1955 to 2022 reviewing 3575 documents found in the Web of Science database. Most articles were in the areas of Reproductive Biology, Fertility, Endometriosis & Hysterectomy, and Chromosome Disorders. We found publication has increased dramatically since 1989. Agarwal, Thomas, and Sharma; United States, England, and Canada; Fertility and Sterility, Human Reproduction, and AJOG were the most-cited authors, countries, and journals, respectively. We discovered five substantive clusters: male infertility factors, female infertility factors, causes and treatment of infertility, the consequence of infertility, and assisted reproductive techniques. Using bibliometric review (Co-citation analysis) six research areas were found: semen analysis and sperm morphology, regional differences in the psychological effects of infertility, unexplained infertility, endometriosis, diagnosis and treatment of infertility, and polycystic ovary syndrome. Despite advances in understanding infertility, further research is needed.

The social determinants of mental health disorders among women with infertility: a systematic review

INTRODUCTION

Infertility is associated with mental health disorders in women, even if a successful pregnancy resolves infertility. However, the link between social determinants of health (SDoH) and mental health in women with infertility is not well understood. We aimed to investigate the determinants thoroughly so that mental health screening and services can be tailored to suit women with infertility who are vulnerable to mental health disorders.

METHODOLOGY

All observational studies that included women participants of reproductive age with infertility and assessed social determinants associated with mental health disorders were searched using a combination of keywords from MEDLINE, EMBASE, CINAHL, PsycINFO, Scopus, and Web of Science databases and published in English. Two reviewers conducted screening, data extraction, quality assessment and risk of bias. The protocol was registered on PROSPERO (number CRD42022343962).

RESULTS

The systematic review included 32 studies out of 3405 screened articles from January 1st 2010 to 16th October 2023. Compared to women without infertility, the prevalence of mental health disorders, including anxiety, depression, psychological distress, and stress, is high among women with infertility, with the severity being influenced by social determinants-those with higher education, employment, higher personal or family income, private health insurance, higher social support, stronger religious beliefs, and higher spiritual well-being reported better mental health outcomes.

CONCLUSION

The study highlights the need for early detection, tailored interventions, and integrated and comprehensive support systems to address the mental health needs of women with infertility and improve their well-being.

Life satisfaction in parents after successful in vitro fertilization and natural pregnancy: a prospective longitudinal study from before pregnancy to 24 months after childbirth

Changes in psychological variables in couples after successful in-vitro fertilization (IVF) have rarely been investigated. This paper describes follow-up assessments of a previously published study investigating changes in life satisfaction, stress and worry related to childbirth in couples undergoing IVF and those with natural pregnancy. Questionnaire data were obtained in 75 IVF couples and 70 couples with natural pregnancy before pregnancy, and at 6 and 12 months postpartum; follow-up data were recorded 18 and 24 months postpartum. IVF couples had less favourable baseline scores for all variables than those with natural pregnancy. Their life satisfaction increased, stress and worry decreased, during the first year postpartum. Couples with natural pregnancy reported transient worsening in all variables during this period. During follow-up, all variables remained largely stable in both groups; while life satisfaction and stress no longer differed between groups, worry was lower in IVF couples at month 24. Gender differences were small in both groups. In IVF couples, negative impacts of infertility may fully abate after childbirth; in naturally conceiving couples, initial negative changes in wellbeing are reversed and stabilized during the child´s first 2 years. Both groups may benefit from psychological support at different times during pregnancy and parenthood.

Experience of mental health in women with Polycystic Ovary Syndrome: a descriptive phenomenological study

Purpose: This study aims to investigate the experiences, emotional coping strategies, and help-seeking needs of women with PCOS from their perspective, considering common psychological issues such as stress, anxiety, and depression that are prevalent among individuals with PCOS. Materials and Methods: The study recruited 14 women with PCOS for semi-structured interviews between October and November 2022, using a descriptive phenomenology method design. The interviews were analyzed using NVivo 12 software. Results: Four themes and eleven subthemes were derived from the semi-structured interviews: (1) Negative Mental Health Status; (2) Four Patterns of Emotion Regulation; (3) The Psychological Double-Edged Sword: Family Social Network; (4) Strong Demands for Psychological Counseling and Lifestyle Guidance. Conclusion: The study suggests that interventions should focus on fostering internalized self-efficacy and emotional expression, promoting constructive familial support, and providing psychological counseling and lifestyle recommendations to alleviate psychological distress experienced by women with PCOS.

Risk factors for infertility and barriers to treatment in Tanzania: a survey and medical records study

Background

The burden of infertility is serious for women in high-fertility countries.

Objectives

We sought to identify demographic, behavioral/environmental, and reproductive risk factors for various infertility factors (i.e., ovarian, tubal, uterine/cervical, male/other) among women seeking infertility treatment in central Tanzania; to determine the association between pelvic inflammatory disease (PID) and tubal factor infertility (TFI); and to identify barriers to infertility treatment by women's home regional zone.

Methods

We conducted a cross-sectional survey of women seeking infertility treatment in Dodoma, Tanzania from January-March 2020. We surveyed 168 participants aged 18-49 years and reviewed their medical records to confirm infertility status and potential risk factors. We estimated prevalence ratios for factors associated with infertility using logistic regression. Treatment barriers were compared by women's regional zone to see if barriers varied geographically.

Results

The median age of participants was 32 years (range: 18-48). Infertility factors did not vary greatly by patient demographics, behavioral/environmental, or reproductive risk factors. Approximately 31.48% of women had PID diagnoses. Those with PID had 1.94 (95% CI: 1.30, 2.90) times the prevalence of TFI diagnosis as those with other infertility factors, after adjusting for age, pesticide use, alcohol use, age at sexual debut, prior obstetric events, and family history of infertility. Logistical barriers to treatment, such as time and cost, were more frequently reported than emotional, stigma, or other barriers, regardless of regional zone.

Conclusions

PID was strongly associated with TFI after adjustment for confounders. Infertility treatment access due to cost remains a challenge in Tanzania.

Parenting, dyadic coping, and child emotion regulation in lesbian, gay, and heterosexual parent families through assisted reproduction

AIMS

The present study examined the associations between family structure, parenting, and dyadic coping and children's emotion regulation in lesbian, gay, and heterosexual parent families through assisted reproduction. It also explored differences in parenting dimensions and dyadic coping, based on parents' sexual orientation.

METHODS

Participants were 60 lesbian mothers through donor insemination, 50 gay fathers through surrogacy, and 42 heterosexual parents through gamete donation, all with a child aged 6-12 years (M = 8.67; SD = 2.16; 48.68% females) and residing in Italy. In each family, both parents reported parenting stress, parent - child relational self-efficacy, parental control, dyadic coping, and their perception of the child's emotion regulation.

RESULTS

Mixed models indicated no significant differences between family types in parenting stress and use of a controlling parenting style. However, lesbian mothers reported higher parent - child relational self-efficacy than heterosexual parents, and higher dyadic coping strategies than gay fathers. Also, children of gay fathers showed greater emotion regulation than children of heterosexual parents. Across family types, higher levels of parenting stress and dyadic coping, and lower levels of parent - child relational self-efficacy were associated with lower child emotion regulation.

CONCLUSION

Given that in middle childhood, across family types, better emotional regulation was associated with lower parenting stress and dyadic coping, and greater effectiveness in the parent - child relationship clinical work should focus on the parent's and couple's ability to cooperatively manage stressors while maintaining a balanced focus on their children's resources and autonomy.

Decision regret among couples experiencing infertility: a mixed methods longitudinal cohort study

BACKGROUND

Decisions for how to resolve infertility are complex and may lead to regret. We examined whether couples and individuals who sought a consultation from a reproductive specialist for infertility later expressed decisional regret about their family-building choices and whether regret was associated with parental role, family-building paths, or outcomes.

METHODS

This longitudinal mixed methods study included women and their partners who completed a questionnaire prior to their initial consultation with a reproductive specialist and 6 years later. The six-year questionnaire included the Ottawa Decision Regret Scale referencing "the decisions you made about how to add a child to your family." A score of 25+ indicates moderate-to-severe regret. Additional items invited reflections on family-building decisions, treatments, and costs. A systematic content analysis assessed qualitative themes.

RESULTS

Forty-five couples and 34 individuals participated in the six-year questionnaire (76% retention rate), Half (n = 61) of participants expressed no regret, which was similar by role (median 0 for women and supporting partners, F = .08; p = .77). One in 5 women and 1 in 7 partners expressed moderate-to-severe regret. Women who did not pursue any treatment had significantly higher regret (median 15; F = 5.6, p < 0.01) compared to those who pursued IVF (median 0) or other treatments (median 0). Women who did not add a child to their family had significantly higher regret (median 35; F = 10.1, p < 0.001) than those who added a child through treatment (median 0), through fostering/adoption (median 0), or naturally (median 5). Among partners, regret scores were not associated with family-building paths or outcomes. More than one-quarter of participants wished they had spent less money trying to add a child to their family. Qualitative themes included gratitude for parenthood despite the burdensome process of family-building as well as dissatisfaction or regret about the process. Results should be confirmed in other settings to increase generalizability.

CONCLUSION

This longitudinal study provides new insight into the burden of infertility. For women seeking parenthood, any of the multiple paths to parenthood may prevent future decision regret. Greater psychosocial, financial, and decision support is needed to help patients and their partners navigate family-building with minimal regret.

Women's lived experience of endometriosis-related fertility issues

OBJECTIVE

The aim of the present study is to conduct a qualitative investigation to provide a deeper understanding of women's views about endometriosis, fertility and their perception of reproductive options.

METHODS

Semi-structured interviews were conducted by two female psychiatrists, specialized in gynecology and obstetrical consultation-liaison psychiatry, trained in qualitative procedures, with experience in qualitative studies and in psychological support of women attending infertility consultations. No prior relationship with respondents was established before data collection. Interviews were tape-recorded and transcribed. Interviews lasted 45-75 minutes. The transcripts were then analysed using thematic content analysis.

RESULTS

Twenty-nine women were contacted. Twelve agreed to an interview at the hospital's infertility clinic. Eleven women with diverse sociodemographic characteristics were included. The key findings of thematic content analysis can be grouped into four topics: (1) Diagnostic announcement and initial delay; (2) Negative perceptions of initial care: pre-diagnosis phase; (3) Struggle with endometriosis and its treatment; (4) Issues related to health problems, fertility and reproductive options.

CONCLUSION

Our analysis of the interviews corroborates the distressing impact of the trivialization of pain and the uncertainty of or the long quest for diagnosis. The findings also stress various associated issues, from the diagnostic delay to the low success rates of fertility treatments. This qualitative analysis contributes to better understand the accumulation of negative emotions within the illness trajectory and the poor dyadic adjustment within the couple.

Psychosocial wellbeing shortly after allocation to a freeze-all strategy compared with a fresh transfer strategy in women and men: a sub-study of a randomized controlled trial

STUDY QUESTION

Is the psychosocial wellbeing affected in women and men shortly after allocation to a freeze-all strategy with postponement of embryo transfer compared to a fresh transfer strategy?

SUMMARY ANSWER

In general, psychosocial wellbeing (i.e. emotional reactions to the treatment, quality-of-life, infertility-related stress, and marital benefit) was similar in women and men allocated to a freeze-all versus those allocated to a fresh-transfer strategy 6 days after disclosure of treatment strategy (i.e. 4 days after oocyte retrieval), although women in the freeze-all group reported a slightly higher degree of depressive symptoms and mood swings compared to women in the fresh transfer group.

WHAT IS KNOWN ALREADY

The use of a freeze-all strategy, i.e. freezing of the entire embryo cohort followed by elective frozen embryo transfer in subsequent cycles has increased steadily over the past decade in assisted reproductive technology (ART). This strategy essentially eliminates the risk of ovarian hyperstimulation syndrome and has proven beneficial regarding some reproductive outcomes in subgroups of women. However, patients experience a longer time interval between oocyte retrieval and embryo transfer, hence a longer time to pregnancy, possibly adding additional stress to the ART treatment. So far, little focus has been on the possible psychosocial strains caused by postponement of embryo transfer.

STUDY DESIGN, SIZE, DURATION

This is a self-reported questionnaire based sub-study of a multicentre randomized controlled trial (RCT) including 460 women and 396 male partners initiating their first, second, or third treatment cycle of invitro fertilisation or intracytoplasmic sperm injection (ICSI) from May 2016 to September 2018. This sub-study was included in the primary project protocol and project plan for the RCT, as psychosocial wellbeing was considered a secondary outcome.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Women from eight public fertility clinics in Denmark and Sweden and one private clinic in Spain were randomized in a 1:1 ratio on the day of inclusion (menstrual cycle day 2 or 3) to either a freeze-all strategy with postponement of embryo transfer to a subsequent modified natural menstrual cycle or a fresh transfer strategy with embryo transfer in the hormone stimulated cycle. Treatment allocation was blinded until the day of the ovulation trigger. Women and their male partners were asked to complete a validated self-reported questionnaire 6 days after unblinding of treatment group allocation, corresponding to 4 days after oocyte retrieval, investigating their psychosocial wellbeing related to the treatment defined as emotional reactions to the treatment, quality-of-life, infertility-related stress, and marital benefit. The questionnaire included items from the Copenhagen Multi-Centre Psychosocial Infertility (COMPI) Fertility Problem Stress Scales and the COMPI Marital Benefit Measure.

MAIN RESULTS AND THE ROLE OF CHANCE

Baseline characteristics were comparable between the two groups for both women and men. In total, response rates were 90.7% for women and 90.2% for men. In the freeze-all group, 207 women and 179 men completed the questionnaire compared with 204 women and 178 men in the fresh transfer group. Men in the two treatment groups did not differ in any of the explored aspects of psychosocial wellbeing (i.e. emotional reactions to the treatment, quality-of-life, infertility-related stress, and marital benefit) 6 days after disclosure of treatment strategy. Women in the freeze-all group reported a slightly higher degree of depressive symptoms (P = 0.045) and mood swings (P = 0.001) (i.e. variables included in 'emotional reactions to treatment') compared to women in the fresh transfer group. When adjusted for multiple testing, depressive symptoms were no longer significantly different between the two groups. No additional differences in psychosocial wellbeing were found. Self-reported quality-of-life during treatment was also rated as similar between the two groups in both women and men, but was slightly lower than they would rate their quality-of-life when not in fertility treatment.

LIMITATIONS, REASONS FOR CAUTION

Although response rates were high, selection bias cannot be excluded. As this study was an RCT, we assume that psychosocial characteristics of the participants were equally distributed in the two groups, thus it is unlikely that the identified psychosocial differences between the freeze-all and fresh transfer group were present already at baseline. Furthermore, the questionnaire was completed as a one-time assessment 4 days after oocyte retrieval, thus not reflecting the whole treatment process, whereas an assessment after the full completed treatment cycle is needed to draw firm conclusions about the psychosocial consequences of the whole waiting period. However, a question posted that late would be highly biased on whether or not a pregnancy had been achieved.

WIDER IMPLICATIONS OF THE FINDINGS

The results indicate that individuals in the freeze-all group exhibited slightly higher levels of depressive symptoms and mood swings compared to those in the fresh transfer group. Nevertheless, it is important to note that any worries related to potential emotional strains stemming from delaying embryo transfer should not overshadow the adoption of a freeze-all approach in cases where it is clinically recommended. As long as patients are provided with comprehensive information about the treatment strategy before initiating the process, it is worth emphasising that other aspects of psychosocial wellbeing were comparable between the two groups.

STUDY FUNDING/COMPETING INTEREST(S)

The study is part of the Reprounion collaborative study, co-financed by the European Union, Interreg V Öresund-Kattegat-Skagerrak. L.P. reports financial support from Merck A/S. H.S.N. reports grants from Freya Biosciences ApS, Ferring Pharmaceuticals, BioInnovation Institute, Ministry of Education, Novo Nordic Foundation, Augustinus Fonden, Oda og Hans Svenningsens Fond, Demant Fonden, Ole Kirks Fond and Independent Research Fund Denmark and personal fees from Ferring Pharmaceuticals, Merck A/S, Astra Zeneca, Cook Medical, IBSA Nordic and Gedeon Richter. H.S.N is founder and chairman of the Maternity Foundation and co-developed the Safe Delivery App (non-profit). N.C.F. reports grants from Gedeon Richter, Merck A/S, Cryos International and financial support from Ferring Pharmaceuticals, Merck A/S and Gedeon Richter. N.C.F. is chairman in the steering committee for the guideline groups for The Danish Fertility Society (non-profit). P.H. reports honoraria from Merch A/S, IBSA Nordic and Gedeon Richter. A.L.M.E. reports grants and financial support from Merck A/S and Gedeon Richter. A.P. reports grants from Gedeon Richter, Ferring Pharmaceuticals, Merck A/S and personal fees from Preglem S.A., Novo Nordic Foundation, Ferring Pharmaceuticals, Gedeon Richter, Cryos International, Merch A/S, Theramex and Organon and the lend of embryoscope to the institution from Gedeon Richter. All other authors declare no conflict of interest.

TRIAL REGISTRATION NUMBER

Clinicaltrials.gov NCT02746562.

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

This review provides a systematic overview of the state of knowledge to date of psychosocial risk factors with a focus on anxiety, depressiveness, and (lack of) social support among involuntarily childless women and men prior to assisted reproduction. The databases PubMed, PubPsych, PsycINFO-Ebsco, and Web of Science were searched for relevant publications in English or German, and finally a total of 20 publications were included in the systematic review. Of these, 18 studies focused on depressiveness, 15 studies focused on anxiety, and 9 studies focused on social support. Half of the studies included both men and women, while the other half included only women. Due to the large heterogeneity of the study results as well as limitations, no clear conclusions can be drawn regarding a difference between the risk profiles of men and women with an unfulfilled desire to have children. However, it has been shown that infertile couples or women experience higher levels of stress in the form of depressiveness and anxiety compared to fertile participants. Furthermore, it was found that social support, regardless of gender difference, within the couple and from family and friends may be associated with a lower risk for depressiveness and anxiety.

"No One Asked Me If I'm Alright": A Mixed-Methods Study Exploring Information/Support Needs and Challenges Engaging Men Diagnosed With Male-Factor Infertility

There is limited research exploring men's experiences of infertility, and fewer previous studies have examined what information and support men desire after being diagnosed specifically with male-factor infertility. We conducted a mixed-methods study utilizing a combined sequential, concurrent design (online survey/semi-structured interviews). Survey outcomes (N =12) were analyzed using quantitative data analysis, while qualitative survey data (N = 5) was analyzed by reflexive thematic analysis. Heterosexual men (>18 years), fluent in English, diagnosed solely with male-factor infertility/sub-fertility, who required assisted reproductive treatment within Australia in the past 5 years were recruited online and through fertility clinics Australia-wide. Most men reported that their information and support needs were only somewhat, slightly or not at all met. Preferred information sources on male infertility were a dedicated online resource, app, or fertility doctor/specialist, while support was preferred from fertility specialists and partners. Three themes were identified from the qualitative analysis about men's experiences and support needs when diagnosed with male infertility (a) Ultimate threat to masculinity; (b) Holistic care, and (c) the power of words. The information-rich data collected provided valuable insights into men's experiences of male-factor infertility and important considerations to improve recruitment for future research. A diagnosis of male-factor infertility has the potential to be deeply impactful and difficult to navigate for men. Adequate and holistic information, recognition of emotional impacts, proactive offers of support and sensitive language are needed to improve men's experiences when undergoing assisted reproductive technology.

Accounting for complexity in healthcare innovation debates: Professional views on the use of new IVF treatments

Social scientists have long been interested in the forces and values driving healthcare innovation. The simultaneous rise of 20th century healthcare reforms, increased importance of evidence and upsurge in lay health activism have shaped modern medicine. On this backdrop, fertility care emerged in the 1970s. Recent developments reveal a contentious relationship between new fertility treatments and clinical evidence, with emerging technologies being used without conclusive evidence of effectiveness despite being sold to patients. Initial critiques of this phenomenon emphasise commercial interests as the culprit, suggesting that the problematic use of unproven treatments is mainly driven by the private sector. Here, we challenge this over-simplified view of IVF care. Drawing on a qualitative analysis of key documents and 43 in-depth professional interviews, this article identifies three main stakeholder approaches to new treatment adoption. We argue that viewpoints are anchored within three critical overarching 'modes of coordination' or core values in modern healthcare: efficiency, effectiveness and patient-centeredness. This analysis encourages a more contextualised overview of fertility care than previous literatures have afforded. The IVF case shows that an emphasis on private versus public clinic practices obscure similarities between the two along with the values motivating healthcare professionals' approaches to new treatments.

Investigating the Relationship between Spiritual Intelligence and Resilience in Infertile Couples in Isfahan: A Cross-Sectional Study

Background

Infertility is a psychological crisis for a couple, spouse, and their families. Due to the positive effects of spiritual intelligence on the positive adaptation and growth of the individual under difficult circumstances, this study was conducted to determine the relationship between spiritual intelligence and resilience in infertile couples in Isfahan.

Materials and Methods

This cross-sectional study was performed in 2020 on 162 infertile couples. Data were collected by the convenience sampling method from infertile couples referring to Infertility Centers in Isfahan through two standard questionnaires. Data analysis was performed using descriptive statistical methods for quantitative variables. The relationship between spiritual intelligence and resilience score was investigated using inferential statistical methods of Pearson's correlation coefficient and multiple linear regression. A p value of less than 0.05 was considered significant.

Results

The results showed that the mean age Standard Deviation (SD) of women and their spouses was 32.01 (5.86) and 36.30 (5.82) years, respectively. Pearson's correlation coefficient showed that there was a significant positive direct relationship between resilience score with total spiritual intelligence score (r = 0.36, p < 0.001) and its dimensions Critical Existential Thinking (CET) (r = 0.60, p < 0.001), personal meaning production (PMP) (r = 0.38, p < 0.001), Transcendental Awareness (TA) (r = 0.43, p < 0.001), and Conscious State Expansion (CSE) (r = 0.53, p < 0.001). The PMP (t = 6.38, p < 0.001) and the CSE (t = 2.15, p = 0.03) were significant predictors of resilience scores.

Conclusions

The result of our study showed that couples with a higher level of spiritual intelligence had a better understanding of the problems and harms of primary infertility and would cope with it more efficiently.

Reframing as recourse: How women approach and initiate the end of fertility treatment

Hopeful parents facing infertility dedicate significant sums of money, not to mention time, energy, and their own bodies, in the pursuit of biological parenthood via assisted reproductive technology (ART). Yet because the success rate of ART varies depending on a range of factors and resources remain finite, many undergoing treatment will not manage to biologically conceive. How do people who do not conceive with ART come to terms with this reality and the possibility that they may need to walk away from future treatments? Supplementing prior research that explores why women end treatment and what makes it difficult, this study draws upon 23 semi-structured, in-depth interviews to examine how women diagnosed with infertility consider and/or initiate discontinuation of treatment aimed at biological reproduction. I find that women employ three core reframing strategies as they approach the end of treatment: broadening their anticipatory future, adjusting their investment logic, and recentering and decentering the self. These rhetorical techniques not only illuminate the evolving interpretive work that undergirds the process of discontinuation, but also constitute a key mechanism facilitating the ending of treatment-linking cognition with social action and shedding light on the mechanics of decision reversals. Moreover, the practice of reframing challenges the pervasive assumption that discontinuation is wholly or chiefly disempowering to women.

Understanding the experiences of helplessness, fatigue and coping strategies among women seeking treatment for infertility - A qualitative study

BACKGROUND

Infertility impacts families and communities worldwide, affecting millions of people of reproductive age. The fertility rate in India is alarming. Fertility is valued in the majority of cultures, and having children is a fundamental motivation. The frustration and anger of an infertile woman affect her family, friends, and even her husband. This study aims to assess the factors that contribute to helplessness, fatigue, and coping strategies among women with infertility.

MATERIALS AND METHODS

An in-depth interview was conducted among ten participants, to collect information about the challenges faced by women experiencing infertility. The participants were selected using a purposive sampling technique and they had at least 1 year of experience with infertility. A phenomenological study was utilized and themes and sub-themes were developed. Data was collected by using a list of probing open-ended questions and analyzed by colaizzi method.

RESULTS

Women receiving infertility treatment over a long period of time disclosed that they are dealing with stressful situations in their lives. The experience left them feeling helpless in some stressful conditions. Due to a lack of both financial and emotional support from their family, when they are helpless, they are too worn out to continue their treatment. Some of these women are using different coping strategies to overcome their problems. We found seven common themes from this in-depth interview; 1) Lack of hope and support, 2) Spiritual resources, 3) Negative thoughts, 4) Social abstain, 5) Mental engagement, 6) Emotional concealment, and 7) Coping strategies.

CONCLUSION

This study provides social, emotion and spiritual condition of infertile women in society. The majority of these women struggle with having negative thoughts due to a lack of support, concern, and involvement from their families. These results highlight the need to promote coping strategies, importance of financial and emotional support from the family members.

Infertility-related stress and its relationship with emotional divorce among Iranian infertile people

BACKGROUND

Infertility affects different aspects of couples' lives, so it may cause problems in couples' emotional relationships by increasing marital conflicts. This study aimed to determine Infertility-related stress and its relationship with emotional divorce among Iranian infertile people.

METHODS

We conducted a cross-sectional observational study on 200 infertile people. The research environment was one of the well-equipped infertility centers in Tehran, Iran. Continuous sampling was employed. The data collection tools included a general information form, the Fertility Problem Inventory (FPI), and the Emotional Divorce Scale (EDS).

RESULTS

The findings revealed a significant direct relationship between infertility-related stress and all its subscales with emotional divorce in both infertile women and men. In infertile women, the most concern was the need for parenthood, while the lowest concerns were the relationship and sexual concerns. Multiple linear regression analysis indicated that social and relationship concerns predicted 44% of emotional divorce, with social concern being the more influential factor. In infertile men, the need for parenthood was the most significant concern, while relationship and social concerns were less prominent. Multiple linear regression analysis showed that relationship concern predicted 50% of emotional divorce in infertile men. In both infertile men and women, social and relationship concerns explained 45% of the variance in emotional divorce. Among these two variables, relationship concern had a more impact in predicting emotional divorce. Also, there was no statistically significant difference between women and men regarding infertility-related stress and its subscales, except for sexual concern.

CONCLUSION

The study highlights the importance of the need for parenthood as a main concern among infertile individuals. Increased infertility-related stress and its subscales contribute to higher levels of emotional divorce among this population. Additionally, relationship concern was the lowest concern in infertile people. But it significantly predicts emotional divorce among infertile individuals.

Stigma and mental health in endometriosis

This review provides an overview of patient experiences of endometriosis, endometriosis-related types and sources of stigma pertaining to menstruation, chronic pain, and infertility, and their impact on patients' mental health with particular implications for patient care. Because endometriosis is a complex disease with multifactorial etiology, complicated pathophysiology, and a spectrum of clinical features, diagnosis of endometriosis is typically a lengthy process, and many patients experience initial misdiagnosis. A hallmark symptom is severe menstrual pain with other symptoms including chronic pelvic pain, dysmenorrhea, and infertility. Prior research documents that the diagnostic odyssey, complex management, disabling and unpredictable nature of the disease, and painful symptom profile affect multiple life domains of patients, resulting in poor physical, social, and psychological functioning and clinically-significant rates of anxiety and depression for many. More recently, stigma has been recognized as a potent contributor to poor mental health in endometriosis patients, but existing research is limited and largely atheoretical. We identify major sources of stigma related to endometriosis, including menstrual stigma, chronic pain stigma, and infertility stigma, and their likely impact on patients and health care provision. An integrative theoretical approach is described to facilitate research on the prevalence and effects of endometriosis stigma and their explanatory mechanisms, highlighting specific well-validated psychological instruments to assess stigma. Implications for patient care are emphasized. Better understanding of stigma and mental health in people with endometriosis will enhance the standard of care for this patient population.

Factors affecting self-esteem and disease acceptance in patients from infertile couples

Introduction

Infertility has been diagnosed in millions of people around the world and is described as a complex medical, mental, and social problem that affects many aspects of life. The aim of the study was to extract the determining factors and the level of self-esteem and the degree of acceptance of the disease in infertile patients and to find differences between women and men in this aspect.

Methods

A total 456 patients (235 women and 221 men) from infertile couples participated in a cross-sectional study. To collect data a Personal Information Form (PIF), Rosenberg Self-Esteem Scale (SES), and Acceptance of Illness Scale (AIS) were used.

Results

The overall self-esteem score for the whole sample was 30.50 (15 ± 30) points and for acceptance of the disease 32.4 (8 ± 40) points. In the study group, men obtained a slightly higher level of self-esteem than women (31.00 vs. 30.04 points). Additionally, men had a higher level of acceptance of the disease (33.12 vs. 31.80) than women. Socio-demographic factors such as age and level of education had impact on scores SES and AIS. Clinical factors did not determine the results of SES and AIS, both in the overall sample and in the female and male groups.

Conclusion

Self-esteem in patients from infertile couples increases with age and level of education. There are also significant differences between women and men, i.e., positive correlations between the level of education and self-esteem in men and the degree of acceptance of the disease in women.

Loneliness during the Pregnancy-Seeking Process: Exploring the Role of Medically Assisted Reproduction

This study explores whether undergoing medically assisted reproduction (MAR) is associated with experiencing loneliness and whether this association varies by gender and having a live birth. Using two waves of the Generations and Gender Survey (n = 2,725) from countries in Central and Eastern Europe, we estimate the changes in levels of emotional and social loneliness among pregnancy seekers in heterosexual relationships and test if they vary by the mode of conception while controlling for individual sociodemographic characteristics. Individuals who underwent MAR experienced increased levels of social loneliness compared to individuals who were trying to conceive spontaneously. This association is entirely driven by respondents who did not have a live birth between the two observation periods, while the results did not differ by gender. No differences emerged in emotional loneliness. Our findings suggest that increased social loneliness during the MAR process might be attributable to infertility-related stress and stigma.