Quality of life, coping strategies and support needs of women seeking Traditional Chinese Medicine for infertility and viable pregnancy in Australia: a mixed methods approach

Complementary, supportive and traditional practice experiences of infertile women in Türkiye: a qualitative study

BACKGROUND

In many societies, infertile couples use traditional practices.

OBJECTIVE

This study aimed to determine the complementary, supportive and traditional (CST) practices used by infertile women and their attitudes toward these practices.

METHODS

In this qualitative study, data were collected through individual interviews using a semi-structured form in December 2021. A total of 25 infertile women who applied to the in-vitro fertilization center of a hospital in Türkiye participated in the study. The findings were evaluated by thematic analysis.

RESULTS

The ages of the participants ranged from 25 to 49 years. Three main themes were obtained by the data analysis; "Reasons for using CST practices," "Complementary, supportive and traditional practices used" and "Opinions on the effect of CST practices."

CONCLUSION

Women resorted to complementary and supportive practices for economic reasons, seeking hope, and environmental pressure. Various herbal cures, dietary practices, and religious methods such as praying and prayer amulets, hacamat (cupping), leeches, and various bodily applications were identified as methods commonly used by women. Women were using these methods with the recommendations of people who are not health professionals. It is important to determine the beneficial methods and increase women's awareness of harmful practices. Additionally, although women use many methods for infertility treatment, it should also be noted that infertility is not a female-only problem. Consequently, childless women should be empowered with healthy coping skills.

Variations in folate prescriptions for patients with the MTHFR genetic polymorphisms: A case series study

Background

Over 48.5 million couples are reported with infertility worldwide. Health policy recommends folic acid in women of childbearing age, particularly in preconception and pregnancy which results in women purchasing over-the-counter prenatal multivitamins containing folic acid through pharmacies and other retail outlets. Emerging studies are investigating whether other forms of supplemental folate are more suitable, particularly for those with methylenetetrahydrofolate reductase (MTHFR) polymorphisms. This case series aimed to document variations in forms and dosage of folate prescribed by Australian practitioners to patients with diagnosed infertility and MTHFR polymorphisms.

Methods

Australian practitioners were invited to complete a retrospective case report form for patients that presented with unexplained infertility. This case report form documented the form and dose of folate that practitioners were prescribing to their infertility patient with MTHFR polymorphisms, together with their fertility history.

Results

Six practitioners submitted case information for 12 patients with diagnosed infertility and MTHFR polymorphisms. All patients had been advised by their practitioner to remove folic acid in supplemental form and were prescribed 5-methyltetrahydrofolate (5-MTHF) or a combination of 5-MTHF and folinic acid, at higher doses than the Australian recommended dose (mean daily maximum prescribed dose: 2325μg). Eleven patients conceived within the treatment period (average treatment of one year) and ten were reported as having a live birth.

Conclusion

This case series has highlighted clinical practices that vary from the recommendations by Australian policy. Further research is required to verify the clinical importance of variations in folate prescriptions for women with MTHFR polymorphisms and how folate recommendations may need to change depending on these polymorphisms. This has direct relevance to those prescribing at the pharmacy and retail level, specifically pharmacists and pharmacy assistants.

Mental health in women undergoing gynecological surgery at risk of infertility

Surgery for benign gynecologic conditions may lead to infertility complications. In a cross-sectional study we investigated depressive and anxiety symptoms, Quality of Life (QoL), and coping strategies in women with benign gynecologic conditions undergoing surgical treatment (G1, N = 45) compared with women that did not need surgery (G2, N = 43), through the Patient's Health Questionnaire, the Short Form Health Survey-12 items, the Self-Rating Anxiety State, and the Brief COPE. Statistical analyses showed that women in G1 had significant higher depressive (p=.04) and anxiety (p=.03) symptoms, and lower QoL (p=.01), than did those in G2. Moreover, women with more depressive or anxiety symptoms in both groups were more likely to present maladaptive coping modalities. A careful evaluation of the mental health of women undergoing gynecological surgery at risk of infertility should be included in the care for benign gynecologic conditions, in order to prevent psychosocial distress and alleviate the burden on QoL.

Association between infertility factors and perceived relationship quality in infertile couples

BACKGROUND

Infertility is a crisis in the life of couples that could affect their relationships. The present study was conducted to evaluate the relation between infertility factors and the quality of marital relationship in infertile couples who were referred to the Fertility and Infertility Center of Isfahan.

MATERIALS AND METHODS

The present study was conducted cross-sectional on 131 infertile couples who were referred to the Fertility and Infertility Center of Isfahan and had the inclusion criteria and were selected using convenient sampling method. Data gathering tool for the present study was Perceived Relationship Quality Components (PRQC). All the data were analyzed using SPSS software version 21. Analysis was conducted using descriptive and inferential statistics (independent t-test and one-way analysis of variance). The level of significance was set at 0.05 for all the statistical tests.

RESULTS

The mean score of PRQC for women and men was 84.05 and 88.46, respectively, and their difference was statistically significant. There was a significant relation between the score of PRQC in women (P = 0.028) and men (P = 0.030) with the infertility factor. Results showed that the mean score of perceived quality of different aspects of the marital relationship was significantly lower when the infertility factor was female (P < 0.05). In women aspects of "satisfaction" (P = 0.024) and "commitment" (P = 0.011) and in men aspect of "love" (P = 0.004) from the perceived aspects of relationship had a significant relation with the infertility factor.

CONCLUSIONS

Perceived quality of different aspects of marital relationship had a significant relation with infertility factor in infertile couples. Results of the present study showed that when infertility had female causes, the quality of relationship was more affected. Therefore, in infertility counseling, simultaneous counseling for both spouses with emphasis on women, along with treatments, should be considered.

Complementary and alternative medicine use in infertility: A review of infertile women's needs

The use of complementary and alternative medicine (CAM) is common in infertile women in different countries. The purpose of the current study was to review the infertile women's needs in relation to CAM use. This narrative review was conducted through searching English databases including Scopus, PubMed, Embase, Web of Science, Cochrane library as well as Persian databases consisted of SID, and Magiran. The used keywords included "CAM/therapy, needs, and Infertility." All studies published in English peer-reviewed journals from conception to October 2020, which examined the infertile women's needs in the field of CAM use were included in the review. In the process of data extraction, two researchers screened the title, abstract, and full text of the articles. Out of the 2166 articles reviewed, 29 articles including six qualitative and mixed methods studies, four review, and 19 quantitative studies met the inclusion criteria. The results showed that infertile women have different needs in six domains consisted of educational and informational needs, the need for psychological counseling, supportive needs, the need for CAM use counseling, the need to treatment consistent with women's culture and demands, and the need to the integration of CAM with conventional medicine. Awareness of infertile women's needs toward CAM use can help health policymakers and planners in designing and implementing counseling services in accordance with the demands and culture of infertile couples. It also helps to develop a coherent program to integrate the use of CAM in the classical infertility treatment.

Improving the health and treatment success rates of in vitro fertilization patients with traditional Chinese medicine: Need for more robust evidence and innovative approaches

Maximising access to and the success of fertility treatments should be a priority for global reproductive health, as should overall patient well-being. The demand for in vitro fertilization (IVF) and other assisted fertility treatments has increased over the past decade and is likely to further increase in years to come. Nevertheless, there is still considerable unmet demand for infertility support worldwide. Moreover, the high emotional, physical and financial burden experienced by individuals undergoing IVF cycles can be a risk for their mental and physical health, which in turn can influence treatment continuation and the likelihood of IVF success. Studies from various parts of the world show that most individuals undergoing IVF also use adjunct alternative medicines and procedures, the most common being traditional Chinese medicine (TCM). The complementary and synergistic role of TCM for individuals undergoing IVF is an area that merits further attention and research, both for its potential positive effects on IVF success rates and for its broader physical and mental health benefits. However, much of the existing evidence is not sufficiently robust or consistent for findings to be adopted with confidence. This commentary argues that much work must be done to understand the efficacy and clinical best practices for these integrated approaches. This can be achieved in part by developing more robust and clinically relevant randomized controlled trial protocols, collecting and triangulating evidence through a variety of study designs and methods, and strengthening the collection and pooling of clinic-level data.

Menstrual cycle characteristics as an indicator of fertility outcomes: evidence from prospective birth cohort study in China

OBJECTIVE

To evidently assess the applicability of regulate menstrual cycle (MC) characteristics in Traditional Chinese Medicine (TCM) as an indicator for fertility.

METHODS

A community-based prospective cohort study was conducted in China. Between January 2010 and December 2012, women who were willing to conceive within 2 years were enrolled in the study. Other than the MC length pattern, a well-adopted MC characteristic, menstrual blood color and clots were specifically concerned for women enrolled. All participants were followed up in 2 years by trained nurses. Pregnancy rate, fecundability odds ratio () and risk of miscarriage were assessed as fertility outcomes.

RESULTS

A total of 2109 women were effectively included in this cohort for analysis. Results show that women with irregular MC length were less likely to achieve conception (= 0.59; 95% = 0.45-0.77, < 0.001). Menstrual blood in bright red color was also associated with decline in likelihood of conception ( = 0.79; 95% = 0.63-0.98, = 0.04). Women with menstrual blood in light red were at higher risk of miscarriage ( = 2.39; 95% = 0.91-6.28, = 0.08). No significant impact was found between menstrual blood clots and fertility outcomes ( = 1.02, 95% = 0.83-1.25, = 0.88; = 1.26 95% = 0.77-2.07, = 0.35).

CONCLUSIONS

MC characteristics can be an effective and simple indicator for women's fertility. Increasing the knowledge of MC characteristics for women in reproductive ages would bring great benefits to their preconception health conditions.

Coping strategies mediate the association between stigma and fertility quality of life in infertile women undergoing in vitro fertilization-embryo transfer

BACKGROUND

The mediating role of coping strategies and its relationship with psychological well-being and quality of life has been considered in the literature. However, there is little research to explore the mechanism of coping strategies on stigma and fertility quality of life (FertiQoL) in infertile women undergoing In Vitro Fertilization Embryo Transfer (IVF-ET). The aim of this study was to examine the mediating effect of coping strategies on the relationship between stigma and fertility quality of life (FertiQoL) in Chinese infertile women undergoing In Vitro Fertilization Embryo Transfer (IVF-ET).

METHODS

In this cross-sectional study, a total of 768 infertile women undergoing IVF-ET were recruited from Assisted Reproductive Center of Shaanxi Province, China. The personal information, infertility stigma scale, coping strategy scale and FertiQoL scale were measured using a set of questionnaires. The multiple mediator model was performed using AMOS 21.0.

RESULTS

The model showed a significant negative direct effect between stigma on FertiQoL. There were significantly negative indirect effects of stigma on FertiQoL through active-avoidance, active-confronting and passive-avoidance, respectively. The meaning-based coping played a positive intermediary role. The model explained 69.4% of the variance in FertiQoL.

CONCLUSION

Active-avoidance coping strategy is the most important mediator factor between stigma and FertiQoL in infertile women undergoing IVF-ET treatment. Meaning-based coping strategy plays a positive mediating role between stigma and FertiQoL.

The effects of comprehensive nursing intervention on the negative emotions of patients with infertility

OBJECTIVE

To investigate the effects of comprehensive nursing intervention (CNI) on the negative emotions of patients with infertility.

METHODS

A total of 132 patients were recruited as the study cohort and randomly divided into an observation group (n=62) and a control group (n=70). The patients in both groups underwent routine treatment and nursing. In addition, the patients in the observation group were administered CNI. The quality of life (QOL) scores and depression levels of all the patients were evaluated after the intervention.

RESULTS

Before the CNI, the QOL scores and the anxiety and depression levels showed no significant differences between two the groups (P>0.05). After the intervention, the observation group showed much higher mild-depression and non-depression levels, higher mild-anxiety and non-anxiety levels and higher QOL and physiological function scores than the control group (all P<0.05).

CONCLUSION

CNI has an effect on the negative emotions of patients with infertility.

Infertility Stigma: A Qualitative Study on Feelings and Experiences of Infertile Women

Background:

Infertility stigma is a phenomenon associated with various psychological and social tensions especially for women. The stigma is associated with a feeling of shame and secrecy. The present study was aimed to explore the concept of infertility stigma based on the experiences and perceptions of infertile women.

Materials and Methods:

This qualitative conventional content analysis study was conducted in Isfahan Fertility and Infertility Center, Iran. Data were collected through in-depth interviews with 17 women who had primary infertility. All the interviews were recorded, transcribed and analyzed according to the steps suggested by Graneheim and Lundman. The Standards for Reporting Qualitative Research (SRQR) checklist was followed for this research.

Results:

Eight hundred thirty-six initial codes were extracted from the interviews and divided into 25 sub-categories, 10 categories, and four themes. The themes included “stigma profile, self-stigma, defensive mechanism and balancing”. Stigma profile was perceived in the form of verbal, social and same sex stigma. Self-stigma was experienced as negative feelings and devaluation. Defensive mechanism was formed from three categories of escaping from the stigma, acceptance and infertility behind the mask. Two categories; empowered women and pressure levers, created a balancing theme against the infertility stigma.

Conclusion:

Infertile women face social and self-stigma which threatens their psychosocial wellbeing and self-esteem. They use defensive response mechanisms and social support to mitigate these effects. Education focused on coping strategies might be helpful against infertility stigma.

Exploring Infertile Couples' Decisions to Disclose Donor Conception to The Future Child

Background

Despite significant advances in reproductive technology, using donor assisted reproductive technology is a double-edged sword that has numerous challenges. One of the most challenging issues for couples is whether or not to disclose this information to donor offspring. This study, therefore, explored infertile couples’ decision to dis- close donor conception to their future child.

Materials and Methods

This qualitative study was conducted using content analysis approach in 2012 in the Milad Infertility Centre, Mashhad, Iran. Data were collected through semi-structured interviews with 32 infertile persons including nine couples and 14 women who were selected by purposive sampling. Data were analysed by conven- tional qualitative content analysis adopted by Graneheim and Lundman using MAXQDA 2010 software.

Results

Two categories were emerged: ‘not to disclose information to the child’ and ‘to disclose information to the child’. The first category consisted of three subcategories: 1. child support from probable harms; 2.to maintain healthy family relationships; and 3. lack of a compelling reason to disclose this information. The second category embraced four subcategories: 1. awareness of the others; 2. emergence of new living conditions; 3. appreciation for the donor; and 4. honesty among family members. The main reason for not disclosing information was to protect the child from probable harm.

Conclusion

Although protecting children from possible harms was a major reason for infertile couples' secrecy, keeping this secret would not be always easy. Therefore, increasing public awareness about the donation process in order to change the beliefs of community and eliminate the infertile couples’ concerns would help them to overcome this problem. Additionally, long-term psychological counselling during and after the donation process is highly rec- ommended.

Relation of Religious Coping and Depression Levels in Infertile Women

Objective: Religious coping is known as one of the successful manners to cure depressed infertile women; however, research findings show that demographic factors (e.g., education level) have played an important role on the relationship between depression and religious coping scores. The goal of this study is to measure the influence of age, job status, and education level on both scores within Iranian infertile women. Method : In this cross sectional study, 1000 women (mean age, 35.96; range, 26-45), who are recruited from different hospitals of Shiraz (Iran), are selected via multistage cluster sampling method. The reliability and validity of the translated versions of the questionnaires have been confirmed. The correlation coefficient (Spearman method), adjusted linear regression coefficient, and ordinal regression coefficient of demographic features with the depression scores/levels (minimal, mild, moderate, and severe) and religious coping scores are determined. Results: A significant negative correlation is found between depression and religious compatibility scores in 1000 infertile women (ρ = -0.318, P = 0.000). In addition, the results have implied the existence of a significant correlation and linear relationship between religious coping and age and job status (P < 0.05). Furthermore, both correlation and ordinal regression of depression intensity with both job status and education level are found to be statistically meaningful (P < 0.05). Conclusion: The negative correlation between religious coping and depression scores has implied the positive role of religious coping in protecting infertile women from depression, especially among employed women. Nevertheless, the correlation of religious coping with education level is not strong enough due to the nonuniform distribution of variables through their range.

Effects of a Chinese Patent Medicine Gushen'antai Pills on Ongoing Pregnancy Rate of Hormone Therapy FET Cycles: A Multi-Center, Randomized, Double-Blind, Placebo-Controlled Clinical Trial

In the past decade, the number of frozen-thawed embryo transfer (FET) has increased dramatically with the expansion of surgical indications and the improvement of freezing related technologies. How to improve the success rate and reduce the adverse effects of FET is our research priorities. This study aimed to investigate the safety and effectiveness of Gushen'antai pills (GSATP) by measuring the ongoing pregnancy rate (OPR) in patients from FET and hormone therapy (HT) cycle. From November 2019 to May 2020, 5 Chinese hospitals conducted a multi-center, randomized, double-blind, placebo-controlled study. In total, 271 HT FET cycles in patients were randomly divided (1:1 ratio) to receive GSATP (6 g, tid) or placebo (6g, tid) for 12 weeks of pregnancy. Patients, clinicians, and researchers were blinded to treatment allocation. The primary endpoint was the OPR at week 12 of pregnancy. The secondary endpoints were vaginal bleeding or brown discharge rate, implantation rate (IR), clinical pregnancy rate (CPR) and abortion rate (AR). Adverse events were recorded during the treatment period. The results showed that the OPR remained higher in the GSATP group when compared to placebo group (56.62% vs. 44.44%, p = 0.045). Vaginal bleeding or brown discharge rate was lower in the GSATP group than the placebo group (10% vs. 23.08%, p = 0.032), while the IR (35.16% vs. 27.64%, p = 0.070), CPR (58.82% vs. 48.15%, p = 0.078), incidence of total adverse events (8.09% vs. 3.22%, p = 0.051) and AR (3.75% vs. 7.69%, p = 0.504) were similar between GSATP and placebo groups. Subgroup analysis showed that there were significant differences in CPR (74.19% vs. 54.17%, p = 0.004) and OPR (72.04% vs. 51.04%, p = 0.003) between GSATP group and Placebo group when the patient was younger than 35 years old. This multi-center, randomized, double-blinded, placebo-controlled clinical study showed for the first evidence that GSATP may have potential to improve the OPR and decrease vaginal bleeding or brown discharge rate in HT FET cycle patients.

Losses and Gains of Psychosocial Resources: Effects on Stress Among Women Undergoing Infertility Treatments and Participating in Social Network Systems

This theory-driven study assessed the association between infertility-related stress and perceived losses of psycho-social resources; and the buffering effect of resource gains and type of infertility (primary/secondary) on this relationship, among women who participate in online infertility-related social network systems (SNS). Ninety women participating in infertility-related SNS completed online questionnaires assessing resource losses and gains and stress levels. Results: Resource loss significantly predicted stress (β = .66, p < .001). Resource loss and the number of children were correlated negatively (r = -.22, p < .05). Residency was significantly related to resource loss (r = -.23, p < .05) and perceived stress (r = -.23, p < .05). Israeli participants reported lesser resource loss and lesser perceived stress, compared to participants from other countries. Surprisingly, neither resource gains related to SNS participation nor infertility-type served as moderators in the relationship between resource loss and stress. The association between resource loss and stress supports COR theory formulation of stress etiology. However, while participants noted significant resource gains from use of SNS, these did not buffer the effects of resource loss on stress. Thus, although it may be enticing to turn to SNS for social support, individuals with infertility need to be encouraged to use face-to-face social support too.

The Social Construction of Infertility Among Iranian Infertile Women: A Qualitative Study

BACKGROUND

Infertility is considered an important phenomenon in couples' life. Infertility and its treatment process influence all aspects of the individual's life. This study aimed to explain the psycho-social process of social construction of infertility among Iranian infertile women.

METHODS

This was a qualitative study using a grounded theory approach. The study setting was the Vali-e-Asr Fertility Health Research Center and Avicenna Fertility clinic in Tehran. The sampling started purposefully and it was continued theoretically. The data collection was performed by using 36 semi-structured interviews, observation and field notes with 27 women who suffered from primary and secondary infertility having no living child. The method suggested by Strauss and Corbin was used for data analysis.

RESULTS

Results indicate that "Concerns over life instability" and "being judged by others" were the participants' most important preoccupation. Attempts to stabilize life and get rid of being judged by others were key aspects of the social construction of infertility and the main strategies for resolving their preoccupation. This core concept explained the basic psychological-social process of infertility in relation to axial codes.

CONCLUSION

The results of the study show that various interactive factors affect the social construction of infertility among infertile women who focus on the central concept of attempts to stabilize life and get rid of being judged by others. Therefore, in order to achieve this goal, infertile women should be empowered by effective coping strategies.

Lifestyle and fertility: the influence of stress and quality of life on female fertility

There is growing evidence that lifestyle choices account for the overall quality of health and life (QoL) reflecting many potential lifestyle risks widely associated with alterations of the reproductive function up to the infertility. This review aims to summarize in a critical fashion the current knowledge about the potential effects of stress and QoL on female reproductive function. A specific literature search up to August 2017 was performed in IBSS, SocINDEX, Institute for Scientific Information, PubMed, Web of Science and Google Scholar. Current review highlights a close relationship in women between stress, QoL and reproductive function, that this association is more likely reported in infertile rather than fertile women, and that a vicious circle makes them to have supported each other. However, a precise cause-effect relationship is still difficult to demonstrate due to conflicting results and the lack of objective measures/instruments of evaluation.

Measurement and evaluation of quality of life and well-being in individuals having or having had fertility problems: a systematic review

OBJECTIVES

The aims of this study were: (1) to identify which measurement instruments are used in practice to assess the quality of life or well-being of individuals with and without (sub)fertility; (2) to describe the design and outcomes of studies comparing quality of life or well-being of individuals with and without fertility problems; and (3) to determine which of the outcomes of the identified studies could be used in cost-utility studies.

METHODS

A systematic literature review was performed of studies published before July 2018, using multiple databases. Included studies investigated (health-related) quality of life or well-being of individuals with fertility problems. The applied instruments were assessed, as were the outcomes and suitability for use in cost-utility studies.

RESULTS

Twenty-six studies met the inclusion criteria. Twelve distinct instruments of measurement were applied: two generic quality-of-life instruments, five generic well-being instruments and five disease-specific instruments. Most studies found negative associations in one or more domains assessing fertility problems and quality of life or well-being. However, two studies found the opposite. None of the studies reported outcomes relevant for cost-utility studies.

CONCLUSION

Quality of life and well-being related to having fertility problems are regularly studied. However, the reported information is not suitable for use in cost-utility studies. There is a clear need for studies investigating the impact of fertility problems on quality of life in a way that outcomes can be compared across studies and disease areas.

Evidence for the use of complementary and alternative medicines during fertility treatment: a scoping review

BACKGROUND

Complementary and alternative medicines (CAM) are sometimes used by individuals who desire to improve the outcomes of their fertility treatment and/or mental health during fertility treatment. However, there is little comprehensive information available that analyzes various CAM methods across treatment outcomes and includes information that is published in languages other than English.

METHOD

This scoping review examines the evidence for 12 different CAM methods used to improve female and male fertility outcomes as well as their association with improving mental health outcomes during fertility treatment. Using predefined key words, online medical databases were searched for articles (n = 270). After exclusion criteria were applied, 148 articles were analyzed in terms of their level of evidence and the potential for methodological and author bias.

RESULTS

Surveying the literature on a range of techniques, this scoping review finds a lack of high quality evidence that complementary and alternative medicine (CAM) improves fertility or mental health outcomes for men or women. Acupuncture has the highest level of evidence for its use in improving male and female fertility outcomes although this evidence is inconclusive.

CONCLUSION

Overall, the quality of the evidence across CAM methods was poor not only because of the use of research designs that do not yield conclusive results, but also because results were contradictory. There is a need for more research using strong methods such as randomized controlled trials to determine the effectiveness of CAM in relation to fertility treatment, and to help physicians and patients make evidence-based decisions about CAM use during fertility treatment.

Predictors of quality of life and psychological health in infertile couples: the moderating role of duration of infertility

PURPOSE

To investigate the influence of individual characteristics (age, gender, educational level, coping strategies), perceived couple's Dyadic Adjustment, type of diagnosis and duration of infertility on self-reported quality of life (QoL) and psychological health in infertile couples, examining the potential moderating role of duration of infertility.

METHODS

A questionnaire composed by socio-demographics, Coping Orientations to Problem Experienced, Dyadic Adjustment Scale, FertiQoL, State-Trait Anxiety Inventory and Edinburgh Depression Scale was submitted to 206 couples undergoing infertility treatments.

RESULTS

Female patients perceived significantly lower levels of QoL and higher levels of Anxiety and Depression. High Educational level and Social Support Coping strategy were associated with higher QoL and psychological health only in female patients. Problem Solving Coping strategy was associated with higher QoL and psychological health only in male patients. Positive Attitude and Avoidance/Distancing Coping strategies and perceived couple's Dyadic Adjustment were associated with higher QoL and psychological health in both male and female patients. Duration of infertility > 3 years was associated with a reduction of protective effects of all coping strategies but did not affect protective effects of Educational level and couple's Dyadic Adjustment.

CONCLUSIONS

Both positive/active and avoiding/distancing coping strategies are effective to promote QoL and psychological health in infertile couples, but they are all compromised by a long duration of infertility. Conversely, positive effects of educational level and couple's Dyadic Adjustment persist and should be emphasised in the definition of interventions to promote well-being in couples undergoing long-term treatments.

Quality of life in Turkish infertile couples and related factors

Infertility is a major life crisis affecting couples' psychosocial and physical health. We aimed to assess the quality of life in Turkish infertile couples. This cross-sectional survey was carried out in 127 infertile couples admitted to a University Hospital. The quality of life was measured using the fertility quality of life tool (FertiQoL) scale. Women had lower overall quality of life than men. Women and men who were married for fewer than 10 years had a significantly lower emotional score. Women who had a history of infertility treatment, men who have lived in the town or village men with primary infertility and men who have had primary education or lower, had lower scores for mind/body subscale. Social scores were found lower in women under the age of 30, women with middle or low income, men who were married for fewer than 10 years, men who did not have children for 5 years or more and men with primary infertility. The tolerability and environment scores were significantly higher in women who had been married more than once. We conclude that health care providers should be aware of the factors affecting the quality of life (QoL) and give counselling to improve couples' quality of life at infertility clinics.

Assessing the quality of life of infertile Chinese women: a cross-sectional study

OBJECTIVE

To assess QoL of infertile Chinese women and determine the specific factors adversely affecting QoL for improving the care and treatment compliance of infertile women.

MATERIALS AND METHODS

We conducted a cross-sectional study on a randomized, demographically matched, controlled population of infertile married Chinese women to determine their demographic, menstrual, family stress, and infertility characteristics and then applied the World Health Organization QoL Instrument (WHOQOL-100) to determine which factors would be associated with significant QoL differences between infertile women and their demographically matched fertile controls.

RESULTS

Infertile women showed lower QoL scores in the facets of spirituality/religion/personal beliefs, self-esteem, financial resources, and accessibility to and quality of health and social care, as well as increased pain and discomfort, while also experiencing positive QoL adjustments in terms of mobility, daily living activities, work capacity, sexual activity, freedom, physical safety, security, and transport.

CONCLUSION

Married infertile Chinese women had significantly lower overall and comprehensive QoL scores, as well as higher anxiety scores, compared with fertile controls.

The Characteristics of Women Who Use Complementary Medicine While Attempting to Conceive: Results from a Nationally Representative Sample of 13,224 Australian Women

BACKGROUND

Preconception is acknowledged globally as an important part of ensuring health for the next generation and is underpinned by principles of health promotion and preventive medicine. There is a demand for more holistic, preventive health care within preconception health services. Many women are also using complementary medicine during their reproductive years.

MATERIALS AND METHODS

This paper presents a longitudinal analysis of women's consultations with a complementary medicine practitioner while attempting to become pregnant, and the characteristics of women who choose to consult a complementary medicine practitioner during the preconception period. The cross-sectional and longitudinal analyses conducted in this study utilise data from the 1973 through 1978 cohort of the Australian Longitudinal Study on Women's Health (n = 13,224). Multivariate logistic regression models and generalized estimating equation models, with and without time lag, were used.

RESULTS

Women who identified as attempting to conceive were more likely to consult with an acupuncturist (adjusted odds ratio, 1.46) or a naturopath/herbalist (adjusted odds ratio, 1.30). Women who consulted with an acupuncturist were likely to be consulting with a specialist doctor (odds ratio, 3.73) and/or have previous fertility issues (odds ratio, 2.30). Women who consulted with a naturopath were more likely to report experiencing premenstrual tension (odds ratio, 2.30) but less likely to have had a previous miscarriage (odds ratio, 0.18).

CONCLUSIONS

Policymakers and other health professionals need to be aware that health professionals who are largely unregulated and structurally isolated from conventional health care may be actively contributing to women's reproductive and physical health during the preconception period.

A Review of Supportive Interventions Targeting Individuals or Couples Undergoing Infertility Treatment: Directions for the Development of Interventions

The purpose of this systematic review is to explore the types, content, and outcomes of different psychosocial approaches used in existing interventions for infertile individuals or couples. Relevant intervention studies published in English between 2000 and 2014 were searched using the electronic databases MEDLINE, PsycINFO, and CINHAL Plus. A total of 23 articles were identified and included in this review. Cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), and counseling were the most commonly adopted psychosocial interventions for infertile individuals or couples. After reviewing the various approaches, directions are given on the development of interventions for couples suffering from infertility.

Coping with infertility: a transcultural perspective

PURPOSE OF REVIEW

To review the most important and interesting articles in infertility published in the last year.

RECENT FINDINGS

This systematic review covers 60 studies published in journals or dissertations in Science Direct and PubMed in the last year, including those related to prevention and treatment as well as related psychosocial services in infertility. We also propose some suggestions about coping with infertility in China.

SUMMARY

Infertility is a multidisciplinary problem that requires medical, social, and political efforts to prevent and offer infertile patients the best diagnostic, therapeutic, and psychosocial services. Cultural factors should be taken into consideration when designing coping strategies.

Confocal mirco-Raman spectroscopic analysis of the antioxidant protection mechanism of the oligosaccharides extracted from Morinda officinalis on human sperm DNA

ETHNOPHARMACOLOGICAL RELEVENCE

Male infertility is a stressful and frustrating problem for the society, but a number of male infertility treatments are available as traditional Chinese medicine strategies which have been tried with variable success, while evidence is still limited on whether-or how much-herbs or supplements might help increase fertility, so the aim of this study was to investigate if the oligosaccharides extracted from Morinda officialis, a Chinese herb, is the active constituents to the fertility.

MATERIALS AND METHODS

In this study, we prepared the H2O2-demaged human sperm, cocultured with the oligosaccharides in vitro, then observed the changes of the DNA using confocal micro-Raman spectroscopy, and comparative analysis the differences of the spectra of different treated groups.

RESULTS

The results showed that the oligosaccharides extracted from Morinda officialis can keep the "Raman fingerprints" of the human sperm DNA almost the same as those of the control groups, but very different from the H2O2-induced groups, especially the intensity of bands at 787, 993, 1094, 1254, 1340, 1376, 1421, 1443, 1487, 1577 and 1662cm(-1) which could be as potential targets for the drugs finding, and further principal component analysis was successfully used to classify the Raman spectra of normal control and model groups.

CONCLUSION

This results suggested that the oligosaccharides can protect the DNA of human sperm from being damaged by H2O2, and which was one of the active constituents of Morinda officialis on treating infertility. It was also demonstrated that Morinda officialis as a tonifying and replenishing natural herb medicine can be used to enhance reproductive functions, and the Raman spectroscopy could be an applicable technology for screening active components in vitro from herbs.