Development and evaluation of the Adaptation Support Program in Early Pregnancy after the use of assisted reproductive technology

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Experiences of transition to motherhood among pregnant women following assisted reproductive technology: a qualitative systematic review

OBJECTIVE

This systematic review aimed to identify and synthesize available qualitative evidence regarding the experiences of the transition to motherhood among pregnant women following assisted reproductive technology.

INTRODUCTION

Pregnant women following assisted reproductive technology experience unique challenges to their identity when transitioning to motherhood. It is important that health care professionals understand the context and complexity of emotional adaptation to pregnancy following assisted reproductive technology.

INCLUSION CRITERIA

Any qualitative data from empirical studies that described experiences of the transition to motherhood during pregnancy among women who conceived through assisted reproductive technology were considered for inclusion.

METHODS

Several databases were searched for published and unpublished studies in English or Japanese from 1992 to 2019, including MEDLINE, CINAHL, PsycINFO, ProQuest Health and Medical Collection, Google Scholar, and Open Access Theses and Dissertations (in English); and Ichushi-Web, CiNii, and the Institutional Repositories Database (in Japanese). All included studies were assessed by two independent reviewers. Any disagreements were resolved through discussion. We used the recommended JBI approach to critical appraisal, data extraction, and data synthesis.

RESULTS

This review included seven studies that considered pregnant women's (n = 110) experiences of transition to motherhood following assisted reproductive technology, and were assessed as moderate to high quality (scores 7-10) based on the JBI critical appraisal checklist for qualitative research. All studies used qualitative methodologies or methods including phenomenology, narrative approach, qualitative description, and qualitative content analysis. There were two studies from Japan, one from Brazil, one from Iran, one from Israel, one from the UK, and one from the USA. In total, 51 supported findings were aggregated into 14 categories, and five synthesized findings: i) Pregnant women following assisted reproductive technology require support to decrease anxiety and improve their belief in pregnancy to internalize a maternal identity; ii) Pregnant women following assisted reproductive technology need reassurance of their lifestyles to ensure a safe passage through pregnancy because of ambivalent feelings about becoming a mother; iii) Pregnant women following assisted reproductive technology develop a maternal identity with affection for the fetus if they switch their mindset from infertility to pregnancy; iv) Pregnant women following assisted reproductive technology need to review their self-image of being infertile and prepare for childbirth or motherhood; v) Pregnancy following assisted reproductive technology contributes to the emergence of positive feelings and changing the women's sense of self and other personal relationships. Based on the ConQual approach, the confidence in the synthesized findings was rated as moderate to low.

CONCLUSIONS

The synthesized findings highlight the importance of understanding the uncertainty and ambivalent feelings women have about their pregnancy, delayed development of attachment to their fetus and formation of a maternal identity, alteration in their relationships, and the social context of pregnancy via assisted reproductive technology among pregnant women following assisted reproductive technology. Health care professionals need to be aware of the specific care needs relating to the unique pathway in the identity transition to motherhood following assisted reproductive technology for these women. More research on development and implementation of specific intervention programs for expectant mothers following assisted reproductive technology is needed.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42019138200.

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

OBJECTIVE

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

STUDY DESIGN

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

RESULTS

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

CONCLUSION

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

Experiences of transition to motherhood among pregnant women following assisted reproductive technology: a systematic review protocol of qualitative evidence

OBJECTIVE

This systematic review aims to identify and synthesize available qualitative evidence related to the experiences of transition to motherhood during pregnancy in women who conceived through assisted reproductive technology (ART).

INTRODUCTION

Women who conceived through ART experience pregnancy-specific anxiety and paradoxical feelings, and face unique challenges in their identity transition to motherhood. It is important for healthcare professionals working with these women to understand the context and complexity of this special path to parenthood, including the emotional adaptation to pregnancy following ART. A qualitative systematic review can provide the best available evidence to inform development of nursing interventions to meet the needs of pregnant women after ART.

INCLUSION CRITERIA

This review will consider any qualitative research data from empirical studies published from 1992-2019 in English or Japanese that described experiences of transition to motherhood during pregnancy in women who conceived with ART.

METHODS

This review will follow the JBI approach for qualitative systematic reviews. Databases that will be searched for published and unpublished studies include MEDLINE, CINAHL, PsycINFO, ProQuest Health & Medical Collection, Google Scholar and Open Access Theses and Dissertations (in English), and Ichushi-Web, CiNii and the Institutional Repositories Database (in Japanese). Titles and abstracts will be screened by two independent reviewers in full. The full-text of selected studies will be assessed in detail, and findings and their illustrations will be extracted and aggregated. Any disagreements between the reviewers that arise at each stage will be resolved through discussion, or by a third reviewer.