Psychological disturbances and quality of life in obese and infertile women and men

Awareness, knowledge, and psycho-emotional aspect of infertility among women seeking fertility assistance at a tertiary care hospital in Chhattisgarh, a cross-sectional study

BACKGROUND

The lack of fundamental knowledge and awareness about the biological process of reproduction is low worldwide but has reportedly higher incidence rates in under-developed countries. Infertility can have a tremendous effect on a woman's psychological and social well-being, pushing her toward mental stress, anxiety, depression self-blame, self-isolation, feeling of worthlessness, and lack of interest in life. The present study was conducted to determine the level of knowledge and awareness regarding factors affecting fertility and also to ascertain the emotional status of females visiting the Obstetrics and Gynecology out-patient department for fertility assistance.

MATERIALS AND METHODS

A cross-sectional study was performed by using a questionnaire which had two parts; the first part had questions about awareness and knowledge of the subject of infertility, and the second part had 12 questions that assessed the psychological and emotional status of the participants, and it also explored prevailing myths about infertility based on a validated questionnaire.

RESULTS

There was a significant difference in mean knowledge score; those who were more educated had better knowledge of various aspects of infertility. The overall adequacy for knowledge and awareness revealed that only 62 (47.7%) of the participants had adequate knowledge (score >6) regarding female infertility. The mean score for knowledge among all the respondents was 6.61 ± 1.48. The overall emotional and psychological score suggested that 30 (23%) of the respondents were disturbed because of stress because of infertility.

CONCLUSION

Infertility can have a serious impact on the psychological well-being of females, and social pressure and stigma associated with childlessness can further worsen the physical and emotional well-being of couples, which needs to be addressed before starting treatment of infertility for a better response to treatment. The limited knowledge and prevailing mis-conceptions regarding infertility need to be sincerely dealt with to complement the medical treatment of infertility.

The impact of a group based, remotely delivered weight loss intervention in women with polycystic ovary syndrome on ovulation, quality of life and body composition

Background

Obesity and visceral adiposity are associated with anovulation. The most common cause of anovulatory infertility in women of reproductive age is polycystic ovary syndrome (PCOS). We conducted this formative study to examine the effects of a remotely delivered, group-based lifestyle program for women with overweight/obesity and PCOS on ovulation, PCOS related quality of life (PCOSQ) and body composition.

Methods

Women with anovulatory infertility caused by PCOS (N = 12) were enrolled in a 6-month high-intensity weight management intervention. Participants were asked to attend 45 min., group behavioral lifestyle sessions, delivered remotely by a registered dietitian weekly across the 6-mo. study and comply with a reduced energy diet, increased physical activity (225 min/wk.), and self-monitoring of weight, physical activity and diet. Diets consisted of five portion-controlled meals (three shakes + two entrees), at least five servings of fruits/vegetables, and ad libitum non-caloric beverages daily. Wilcoxon signed-rank tests were used to assess changes in outcomes across the intervention.

Results

Twelve women received the weight loss intervention (mean age = 32.7 ± 4.2 yrs., BMI = 36.8 ± 4.5 kg/m², 92% college educated), and 8 completed the intervention. Eight (67%) women reported ovulating during the intervention with an average time to ovulation of 57 ± 45 days. Women lost an average of 3.85 ± 5.94 kg (p = 0.02), decreased their BMI (−1.61 ± 1.09 kg/m²; p = 0.04), and waist circumference (−4.54 ± 3.03 cm; p = 0.04) over the 6-mo. intervention. Additionally, self-reported menstrual problems measured by PCOSQ significantly improved over the study (p = 0.03).

Conclusion

A multicomponent group-based, remotely delivered, lifestyle intervention delivered remotely is a feasible and potentially scalable option to achieve clinically relevant (>3%) weight loss in women with PCOS.

Clinical trial registration

www.clinicaltrials.gov, identifier: NCT03677362.

Can Weight Watchers (WW) Help Address Maternal Obesity? An Audit of Weight Change in Women of Childbearing Age and Mothers-To-Be, Referred into a Commercial Slimming Programme

Objectives

The scale of overweight and obesity amongst women of childbearing age or mothers to be, living in Wales, places a considerable burden on the NHS and public health. High BMI (over 30) during pregnancy increases the health risks for mother and baby. Policy advice recommends weight management services are available to help women lose weight before and whilst planning pregnancy. In parts of Wales, NHS partnerships with commercial companies provide weight management services for women considering or planning pregnancy. This study evaluates whether an established referral Weight Watchers (WW) programme, known to be effective in adults in England, can help mothers-to-be living in North Wales lose weight.

Methods

Analysis used routine data from 82 referrals to WW between June 2013 and January 2015. Participants received a referral letter inviting them to attend face-to-face group workshops combined with a digital experience. The programme encompassed healthy eating, physical activity and positive mind-set. Trained WW staff measured bodyweight before, during and at 12 weeks. On entry to the course, participants had a median age of 31.4 years (interquartile range (IQR) 28–34) with a median BMI of 36.8 kg/m² (IQR 33.3–43.7).

Results

Women completing the course (n = 34) had a median weight loss of 5.65 kg (IQR 0.45–10.85), equating to 5.7% (SD 3.46) of initial body weight. Intention-to-treat analysis (last observation carried forward), which included lapsed courses n = 66, showed a median weight loss of 3.6 kg (IQR − 2.53 to 9.73), equating to 3.7% (SD 3.62) of initial body weight. Overall, there was significant weight loss during the WW programme (Wilcoxon signed rank test Z = − 6.16; p < 0.001). Weight loss was significantly correlated with the number of workshops attended (Spearman correlation coefficient 0.61 p < 0.001). The proportion of all 82 participants (intention to treat, baseline observation carried forward) that achieved a weight loss of ≥ 5% initial weight was 30.5%.

Conclusions for Practice

Referral of obese mothers-to-be into WW can successfully achieve short-term weight loss, at or above 5%, in approximately one third of participants. The dose–response effect supports a causal inference. Successful weight loss at this critical life stage may provide women with the necessary motivation to initiate weight loss for healthy pregnancy, however further research is required.

Impact of polycystic ovary syndrome on eating behavior, depression and health related quality of life: A cross-sectional study in Riyadh

Background & objectives

Polycystic ovary syndrome (PCOS) is the most common endocrinal disorder, and the greatest cause of infertility in women. Despite availability of individual data on impact of multiple endocrinal, reproductive and even metabolic factors in PCOS individuals, the data on the co-existence of BED and depression in PCOS patients with its relationship on the quality of life in Saudi Arabian females is not found. Hence this study is aimed to elucidate the implication of PCOS on eating behaviour, induction of depression and general health quality in Saudi Arabian population of Riyadh.

Materials and methods

This is a cross-sectional study carried out in multiple health facilities of Riyadh from January to March 2019. The study samples (494) were recruited by convenience sampling and administered validated questionnaire by trained research participants. The data obtained was analysed by binary logistic regression using SPSS-IBM 25.

Results

Of the total 494 women participated in the study, 23.48% (116) were PCOS individuals. The odds of developing abnormal health related quality of (HRQ) in patients with PCOS was significantly (P = 0.000, OR = 3.472) high when compared to non-PCOS participants. The odds of showing high binge eating disorder (BED, P = 0.007, OR = 2.856) and depression (P = 0.000, OR = 2.497) scores in PCOS participants were significantly more than patients who were not having PCOS. Out of the three parameters studied, abnormal health related quality of life possessed a higher influence of PCOS compared to depression and abnormal eating behavior.

Interpretation & conclusion

In conclusion, the present study shows that women with PCOS are at a significant risk for depressive disorders, disorganized eating behavior and impaired quality of life. Therefore, necessary care and screening is required to minimize the impact of PCOS on already burdened individuals.

Effectiveness of Non-Pharmacological Interventions for Overweight or Obese Infertile Women: A Systematic Review and Meta-Analysis

Obesity is a well-known risk factor for infertility, and nonpharmacological treatments are recommended as effective and safe, but evidence is still lacking on whether nonpharmacological interventions improve fertility in overweight or obese women. The aim of this study was to systematically assess the current evidence in the literature and to evaluate the impact of nonpharmacological interventions on improving pregnancy-related outcomes in overweight or obese infertile women. Seven databases were searched for randomized controlled trials (RCTs) of nonpharmacological interventions for infertile women with overweight or obesity through August 16, 2019 with no language restriction. A meta-analysis was conducted of the primary outcomes. A total of 21 RCTs were selected and systematically reviewed. Compared to the control group, nonpharmacological interventions significantly increased the pregnancy rate (relative risk (RR), 1.37; 95% CI, 1.04–1.81; p = 0.03; I² = 58%; nine RCTs) and the natural conception rate (RR, 2.17, 95% CI, 1.41–3.34; p = 0.0004; I² = 19%, five RCTs). However, they had no significant effect on the live birth rate (RR, 1.36, 95% CI, 0.94–1.95; p=0.10, I² = 65%, eight RCTs) and increased the risk of miscarriage (RR: 1.57, 95% CI, 1.05–2.36; p = 0.03; I² = 0%). Therefore, nonpharmacological interventions could have a positive effect on the pregnancy and natural conception rates, whereas it is unclear whether they improve the live birth rate. Further research is needed to demonstrate the integrated effects of nonpharmacological interventions involving psychological outcomes, as well as pregnancy-related outcomes.

Impact of irregular marital cohabitation on quality of life and sexual dysfunction in infertile men from upper Egypt

OBJECTIVE

Irregular patterns of marital cohabitation are a common problem in upper Egypt due to employment conditions. The objective of this study was to investigate the effect of irregular marital cohabitation on the quality of life and sexual function of infertile men.

METHODS

In total, 208 infertile men were included and divided into two groups. The first group included 134 infertile men with an irregular pattern of marital cohabitation and the second group included 74 infertile men with a regular pattern of marital cohabitation. All subjects were assessed through a clinical evaluation, conventional semen analysis, the fertility quality of life (FertiQoL) questionnaire, the International Index of Erectile Function (IIEF-5) score, and the premature ejaculation diagnostic tool (PMEDT).

RESULTS

The two groups were compared in terms of conventional semen parameters, FertiQoL, IIEF-5 score, and PMEDT. Infertile men with an irregular pattern of marital cohabitation had significantly lower subscale and total FertiQoL and IIEF-5 scores. Additionally, they had significantly higher PMEDT scores. Erectile dysfunction and premature ejaculation were more common in them than in infertile men with a regular pattern of marital cohabitation.

CONCLUSION

Irregular patterns of marital cohabitation had an adverse effect on quality of life and sexual function in infertile men.

Sexual Function and Socio-Sexual Difficulties in Women with Polycystic Ovary Syndrome (PCOS)

Introduction PCOS is the most common endocrine syndrome in women of the reproductive age that has manifold effects on the life of affected women. Little scientific attention has been devoted to these womenʼs sexual lives.

Aim To investigate sexual quality of life in women with PCOS.

Methods The sample size was n = 44. Measures employed were: An extended list of sexual dysfunctions and perceived distress based on DSM-IV-TR, Female Sexual Function Index (FSFI), German Questionnaire on Feelings of Inadequacy in Social and Sexual Situations (FUSS), Rosenberg Self-Esteem Scale (RSE), Brief Symptom Inventory (BSI) subscale depression. The relationships of these components were examined including further variables (body mass index, degree of hirsutism using the Ferriman-Gallwey Score, wish for a child). An open question about what participants see as the source of their sexual problems was presented.

Results Only moderate impairment in sexual function was detected, but feelings of inadequacy in social and sexual situations were markedly elevated and positively correlated with the degree of hirsutism. Depression showed to be a major problem.

Conclusion Patients with PCOS should be screened for socio-sexual difficulties and emotional problems. Specialized psychological and sexological counselling can complement patient care.

Psychological burden among women with polycystic ovarian syndrome in Oman: a case-control study

Purpose

Previous studies in Euro-American populations have shown that women with polycystic ovarian syndrome (PCOS) have increased levels of “psychological burden”. While PCOS has been reported in Arab countries such as Oman, there is a dearth of studies of the occurrence of psychological burden among PCOS women in the Arab region. This study aimed to compare sociodemographic and clinical characteristics of PCOS women diagnosed with non-PCOS women and prevalence of severity of depression, anxiety and stress and to explore the association between PCOS and indices of psychological disturbances after adjusting for potential confounding factors.

Patients and methods

This hospital-based case–control study was conducted among women aged 16–49 years. The study included 52 women diagnosed with PCOS (as per Rotterdam 2003 criteria) and 60 control who were PCOS-free. The presence of psychological burden – depression, anxiety and stress – was quantified using Depression, Anxiety and Stress Scale-21 (DASS-21).

Results

The crude odds ratios (ORs) generated by logistic regression models indicated an increased risk of depression, anxiety and stress among women with PCOS compared to controls. The adjusted OR also indicated an increased risk of depression (OR =1.10; 95% confidence interval [CI] 0.50, 2.43), anxiety (OR =1.09; 95% CI 0.47, 2.52) and stress (OR =1.45; 95% CI 0.68, 3.12), However, no statistical differences were observed along the three psychological distresses (p>0.05) between the two study groups.

Conclusion

The study indicates that the presence of PCOS is associated with an increased risk of psychological burden. If this study will withstand further scrutiny, meeting psychological needs of such population would need to be contemplated.

Clinical, demographic and psychological characteristics of infertile male smokers in Northeast China

Objectives

To investigate clinical, demographic and psychological characteristics of infertile male smokers in northeast China.

Methods

Serum and semen samples were collected from infertile men. Semen analysis was performed according to conventional procedures. Serum follicle-stimulating hormone, luteinizing hormone and testosterone levels were quantified. Psychological anxiety and depression were evaluated by the self-rating anxiety scale (SAS) and self-rating depression scale (SDS), respectively.

Results

Both SDS and SAS scores were significantly higher in smokers (n = 704) than in nonsmokers (n = 372); in addition, sperm viability and motility were significantly lower in smokers than in nonsmokers. Spearman’s correlation coefficient analysis revealed significant positive correlations between duration of smoking and SDS and SAS scores, and between cigarettes smoked per day and SDS and SAS scores.

Conclusions

Cigarette smoking has a negative effect on sperm viability and motility, and is associated with increased SDS and SAS scores.

The influence of body weight on sexual function and quality of life in women with polycystic ovary syndrome

PURPOSE

To assess sexual function (SF) and quality of life (QOL) in women with polycystic ovary syndrome (PCOS).

METHODS

A cross-sectional study was conducted to assess 56 women with PCOS and 102 control women with regular menstrual cycles. To assess SF and QOL in Brazilian women with PCOS with Female Sexual Function Index (FSFI) and the WHOQOL-bref questionnaires.

RESULTS

Women with PCOS had a worse evaluation to arousal, lubrication, satisfaction, pain and total FSFI, and there was no difference in sexual desire and orgasm. Besides, they had a worse evaluation concerning health status than controls. The body mass index was inversely correlated to the QOL, especially to the physical, psychological, environment aspects and self-assessment of QOL, but it did not show correlation to the SF.

CONCLUSION

Women with PCOS had a worse sexual function and self-assessment of health condition in comparison to controls. The body weight as isolated symptom was correlated to the worsening in quality of life, but not with the worsening of sexual function.

Sexual dysfunction in patients with polycystic ovary syndrome and its affected domains

BACKGROUND

Polycystic Ovary Syndrome (PCOS) is presented with characteristic complications such as chronic an ovulation, obesity, and hyperandrogenism which can affect sexual function in women of reproductive age.

OBJECTIVE

Herein we evaluated the frequency and predisposing factors of sexual dysfunction in infertile PCOS patients.

MATERIALS AND METHODS

In this cross-sectional study, 130 married women with a definite diagnosis of PCOS who were referred due to infertility were recruited. They were evaluated concerning their sexual function in the domains of desire, arousal, lubrication, orgasm, satisfaction and pain with the female sexual function index (FSFI) questionnaire.

RESULTS

The frequency of sexual dysfunction was verified 57.7% in PCOS patients with the domains of desire and arousal being commonly affected in 99.2% and 98.5%of cases respectively. BMI had a significant effect on sexual desire and arousal (p=0.02) while the effect of hirsutism was significant on all domains (p<0.001 for total FSFI score) except for dyspareunia.

CONCLUSION

PCOS patients markedly suffer from sexual dysfunction as comorbidity. It seems appropriate to screen all PCOS patients for sexual function with a simple short questionnaire such as FSFI. Targeted interventions could be considered to help improve their quality of life along with other treatments.