Supportive Social Interactions in Infertility Treatment Decrease Cortisol Levels: Experimental Study Report

Testing the efficacy of a narrative short film in educating the public about providing emotional support to individuals with fertility problems

BACKGROUND

To educate the public on how best to support people with fertility problems, a narrative short film "Ten Things Not to Say to Someone Struggling with Infertility" was created, depicting the impact that helpful versus unhelpful dialogue has on someone with fertility problems.

METHODS

Before and after watching the video, 419 participants from the public were presented with a hypothetical vignette describing a woman experiencing fertility problems and asked about the likelihood that they would endorse a series of helpful and unhelpful statements when communicating with the protagonist. Pre and post endorsement of helpful versus unhelpful statements were compared, as were self-perceived knowledge about the mental health aspects of fertility problems, confidence in providing emotional support to someone with fertility problems, and empathy for the protagonist.

RESULTS

Participants endorsed fewer unhelpful statements after the video relative to before (M(SD) = 2.2(2.3) vs. 1.3(2.3), p < .001) and fewer participants endorsed at least one unhelpful statement (72% to 47%, p < .001). Self-perceived knowledge of fertility problems, confidence in providing support, and empathy increased at post-test (ps < .001; Cohen's d = .56-.83) indicating medium-large effects.

CONCLUSIONS

A narrative short film appears to be an effective dissemination strategy for sensitizing the public to the emotional struggles of individuals experiencing fertility problems.

The hormonal mechanism of the effects of meperidine, sertraline, tianeptine, and their combinations on reproductive functions in female rats

BACKGROUND

Infertility caused by drugs that inhibit serotonin reuptake has been attributed to serotonin toxicity. Serotonin has been linked to cause a rise in prolactin and cortisol. This study examined the effects of meperidine, sertraline, tianeptine and combinations on female rat reproductive function.

METHODS

Female rats were split into 8 groups (n=7): healthy control (HG), meperidine (MG), sertraline (SG), tianeptine (TG), meperidine+sertraline (MSG), meperidine+tianeptine (MTG), sertraline+tianeptine (STG), meperidine+sertraline+tianeptine (MSTG). Meperidine (20 mg/kg, 2×1) was injected intramuscularly. Sertraline (30 mg/kg, 1×1) and tianeptine (5 mg/kg, 1×1) were given orally. The HG received distilled water as solvent. Treatments continued for 20 days. Then, adult males were added to the rat groups and drug treatment continued for another five days. Blood samples were collected on day 26 for biochemical tests.

RESULTS

Total oxidant status (TOS) and total antioxidant status (TAS) were not statistically significant between groups (p>0.05). Meperidine (p<0.001) and sertraline (p<0.001) alone increased prolactin levels in comparison to HG and tianeptine inhibited the increase (p<0.001). While meperidine increased corticosterone levels versus HG (p<0.001), sertraline and tianeptine were close to HG (p>0.05). Number of infertile animals was 6 for meperidine, 3 for sertraline, and none for tianeptine. While the duration of pregnancy in MG (15 days) and SG (15 days) was longer compared to HG (2.86 days), no change was observed in TG (2.5 days).

CONCLUSION

Tianeptine and other serotonin re-uptake stimulants may be useful in the treatment of reproductive dysfunction and infertility due to serotonin re-uptake inhibitor treatment.

Relationships between couple collaboration, well-being, and psychological health of infertile couples undergoing assisted reproductive treatment

BACKGROUND

Social problems related to infertility are associated with a significant psychological burden for the involved couple. Previous studies have shown the positive effects of couple interactions on the psychological health of these couples; however, the specific conditions of participating in assisted reproductive treatments (ART) might influence the effect of couple collaboration. Therefore, the present study aimed to evaluate the relationship between couple collaboration, well-being during infertility, and the psychological indicators of infertile couples undergoing fertility treatment.

METHODS

This cross-sectional study was conducted on 200 ART volunteer couples. Couple collaboration and well-being during infertility were evaluated using a validated researcher-made questionnaire, and the level of depression, anxiety, and stress was evaluated using the DASS-21 questionnaire in both couples. Statistical analysis was performed using the plug-in application PROCESS macro for SPSS and AMOS software.

RESULTS

The results showed that couple collaboration was correlated with the level of depression, anxiety, and stress. Moreover, depression, anxiety, and stress levels were correlated with well-being during infertility. The direct and indirect effect of couple collaboration on the depression level was significant; however, the direct effect of couple collaboration on the level of anxiety and stress was not significant, and the effect of couple collaboration on these indicators was mediated by well-being during infertility. The fit index of the equation modelling showed a good fit of the relationship path between the variables of couple collaboration, well-being during infertility, and psychological indicators (CMIN = 4.196, p = 0.260).

CONCLUSION

The results of this study show that the specific conditions of participating in ART may affect the direct effects of couple interaction on an infertile couple's levels of anxiety and stress. These results suggest that in order to develop mental health programs for infertile couples, strategies based on couple collaboration that are associated with higher well-being during infertility should be developed and presented.

The Stigma and Infertility-Related Stress of Chinese Infertile Women: A Cross-Sectional Study

OBJECTIVES

This study was conducted to investigate the stigma status of infertile women in China and to determine the influencing factors.

METHODS

366 infertile women from the gynecological and reproductive departments of two tertiary hospitals completed socio-demographic questionnaires, the Infertility Stigma Scale (ISS) and the Mandarin Fertility Problem Inventory (M-FPI).

RESULTS

The scores of stigma and infertility-related stress in infertile women were (52.51 ± 17.74) and (150.03 ± 17.51), respectively. Multiple regression analysis found that location of residence, regarding children as the most important thing in life, talking to others about infertility and infertility-related stress were the main influencing factors of stigma in infertile women, which explained 17.3% of the total variance.

CONCLUSIONS

In the current study, the level of stigma in women with infertility was at the middle range. Location of residence, regarding children as the most important thing in life, whether to talk with others about infertility and infertility-related stress were the four main influencing factors of stigma.

Relationship between stigma and infertility-related stress among couples undergoing AID: The mediating role of communication patterns

Infertility can be stressful for infertile couples. This study aims to examine the intra-dyadic associations between stigma, communication patterns, and infertility-related stress in couples undergoing artificial insemination by donor semen (AID). This cross-sectional study was conducted from January to April 2021. Two hundred and three couples undergoing AID were recruited from a reproductive centre in China. All of the couples completed a two-item stigma questionnaire, Communication Pattern Questionnaire, and Fertility Problem Inventory. The actor-partner interdependence mediation analysis was performed using AMOS 23.0. The analysis demonstrated significant actor-actor effects for couples undergoing AID. More specifically, higher levels of stigma among wives and husbands were associated with more negative communication patterns, thereby increasing their own infertility-related stress. Simultaneously, there was a significant partner-actor effect among infertile wives, demonstrating that the husband's stigma can affect his wife's infertility-related stress by influencing her communication patterns. Couples undergoing AID experience increased infertility-related stress when they have high levels of stigma and negative communication patterns, and husbands' stigma is correlated to wives' communication patterns. Therefore, dyadic interventions aiming to improving stigma and enhancing positive communication may be conducive to reducing infertility-related stress.

Current global status of male reproductive health

BACKGROUND

The widespread interest in male reproductive health (MRH), fueled by emerging evidence, such as the global decline in sperm counts, has intensified concerns about the status of MRH. Consequently, there is a pressing requirement for a strategic, systematic approach to identifying critical questions, collecting pertinent information, and utilizing these data to develop evidence-based strategies. The methods for addressing these questions and the pathways toward their answers will inevitably vary based on the variations in cultural, geopolitical, and health-related contexts. To address these issues, a conjoint ESHRE and Male Reproductive Health Initiative (MRHI) Campus workshop was convened.

OBJECTIVE AND RATIONALE

The three objectives were: first, to assess the current state of MRH around the world; second, to identify some of the key gaps in knowledge; and, third, to examine how MRH stakeholders can collaboratively generate intelligent and effective paths forward.

SEARCH METHODS

Each expert reviewed and summarized the current literature that was subsequently used to provide a comprehensive overview of challenges related to MRH.

OUTCOMES

This narrative report is an overview of the data, opinions, and arguments presented during the workshop. A number of outcomes are presented and can be summarized by the following overarching themes: MRH is a serious global issue and there is a plethora of gaps in our understanding; there is a need for widespread international collaborative networks to undertake multidisciplinary research into fundamental issues, such as lifestyle/environmental exposure studies, and high-quality clinical trials; and there is an urgent requirement for effective strategies to educate young people and the general public to safeguard and improve MRH across diverse population demographics and resources.

LIMITATIONS REASONS FOR CAUTION

This was a workshop where worldwide leading experts from a wide range of disciplines presented and discussed the evidence regarding challenges related to MRH. While each expert summarized the current literature and placed it in context, the data in a number of areas are limited and/or sparse. Equally, important areas for consideration may have been missed. Moreover, there are clear gaps in our knowledge base, which makes some conclusions necessarily speculative and warranting of further study.

WIDER IMPLICATIONS

Poor MRH is a global issue that suffers from low awareness among the public, patients, and heathcare professionals. Addressing this will require a coordinated multidisciplinary approach. Addressing the significant number of knowledge gaps will require policy makers prioritizing MRH and its funding.

STUDY FUNDING/COMPETING INTERESTS

The authors would like to extend their gratitude to ESHRE for providing financial support for the Budapest Campus Workshop, as well as to Microptic S.L. (Barcelona) for kindly sponsoring the workshop. P.B. is the Director of the not-for-profit organization Global Action on Men's Health and receives fees and expenses for his work, (which includes the preparation of this manuscript). Conflicts of interest: C.J.D.J., C.L.R.B., R.A.A., P.B., M.P.C., M.L.E., N.G., N.J., C.K., AAP, M.K.O., S.R.-H., M.H.V.-L.: ESHRE Campus Workshop 2022 (Travel support-personal). C.J.D.J.: Cambridge University Press (book royalties-personal). ESHRE Annual Meeting 2022 and Yale University Panel Meeting 2023 (Travel support-personal). C.L.R.B.: Ferring and IBSA (Lecture), RBMO editor (Honorarium to support travel, etc.), ExSeed and ExScentia (University of Dundee), Bill & Melinda Gates Foundation (for research on contraception). M.P.C.: Previously received funding from pharmaceutical companies for health economic research. The funding was not in relation to this work and had no bearing on the contents of this work. No funding from other sources has been provided in relation to this work (funding was provided to his company Global Market Access Solutions). M.L.E.: Advisor to Ro, Doveras, Next, Hannah, Sandstone. C.K.: European Academy of Andrology (Past president UNPAID), S.K.: CEO of His Turn, a male fertility Diagnostic and Therapeutic company (No payments or profits to date). R.I.M.: www.healthymale.org.au (Australian Government funded not for profit in men's health sector (Employed as Medical Director 0.2 FET), Monash IVF Pty Ltd (Equity holder)). N.J.: Merck (consulting fees), Gedeon Richter (honoraria). S.R.-H.: ESHRE (Travel reimbursements). C.N.: LLC (Nursing educator); COMMIT (Core Outcomes Measures for Infertility Trials) Advisor, meeting attendee, and co-author; COMMA (Core Outcomes in Menopause) Meeting attendee, and co-author; International Federation of Gynecology and Obstetrics (FIGO) Delegate Letters and Sciences; ReproNovo, Advisory board; American Board of Urology Examiner; American Urological Association Journal subsection editor, committee member, guidelines co-author Ferring Scientific trial NexHand Chief Technology Officer, stock ownership Posterity Health Board member, stock ownership. A.P.: Economic and Social Research Council (A collaborator on research grant number ES/W001381/1). Member of an advisory committee for Merck Serono (November 2022), Member of an advisory board for Exceed Health, Speaker fees for educational events organized by Mealis Group; Chairman of the Cryos External Scientific Advisory Committee: All fees associated with this are paid to his former employer The University of Sheffield. Trustee of the Progress Educational Trust (Unpaid). M.K.O.: National Health and Medical Research Council and Australian Research Council (Funding for research of the topic of male fertility), Bill and Melinda Gates Foundation (Funding aimed at the development of male gamete-based contraception), Medical Research Future Fund (Funding aimed at defining the long-term consequences of male infertility). M.H.V.-L.: Department of Sexual and Reproductive Health and Research (SRH)/Human Reproduction Programme (HRP) Research Project Panel RP2/WHO Review Member; MRHI (Core Group Member), COMMIT (member), EGOI (Member); Human Reproduction (Associate Editor), Fertility and Sterility (Editor), AndroLATAM (Founder and Coordinator).

The social infertility cycle model

Infertility poses an immense challenge to contemporary society. Around one in six people worldwide trying to conceive a child are facing infertility. This situation exists in an age of great technological developments where advances in medicine have made infertility treatment widely available and increasingly effective. In this article, a model will be presented that aims to explain the individual and social functioning of individuals and couples undergoing infertility treatment using assisted reproductive methods. The model was developed on the basis of a series of studies carried out by the author and colleagues during 2015-2021. The social infertility cycle model was proposed as the outcome of further research steps that were taken. The model takes into consideration the factors and behaviours of couples with infertility that determine the quality of their everyday functioning as well as the effectiveness of infertility treatment. The successive steps of the research process will be outlined in the article along with a presentation of the developed model.

Evaluation the relationship between social health and stress of assisted reproductive techniques in infertile women

BACKGROUND

Fertility is highly valued in most cultures. In contrast, infertility as a crisis has the potential to threaten the stability of individuals, relationships, and communities. Many infertile people are at risk in the early stages of infertility treatment for health and mental health problems and severe stress. The present study was conducted to assess the relationship between the social health of infertile women and the stress of infertility treatment.

MATERIALS AND METHODS

This study was performed descriptively longitudinal correlation on 2020 women in infertility canters in Isfahan. Data collection tool in this study was three parts questionnaire. The first contained demographic information, the second was stress, and the third was the social health dimension questionnaire. Analyze the data was performed using the descriptive statistical methods for the quantitative variables Pearson correlation coefficient. P < 0.05 was considered significant.

RESULTS

The results showed that the mean standard deviation (SD) of social health was 155.1 (16.46), and the mean (SD) score of treatment stress was 22.91 (7.93). Pearson correlation coefficient showed that treatment stress score was not significantly related to overall social health score and its dimensions (P > 0.05).

CONCLUSIONS

In this study, no statistically significant relationship was identified between these two variables. Probably, due to the living conditions of the people of our country in these years and the existence of stress and their great concern about economic issues, etc. The results were not observed contrary to the researcher's expectations.

Closeness-inducing discussions with a romantic partner increase cortisol and testosterone

Despite progress in understanding the social neuroendocrinology of close relationship processes, most work has focused on negative experiences, such as relationship conflict or stress. As a result, much less is known about the neuroendocrine implications of positive, emotionally intimate relationship experiences. In the current study, we randomly assigned 105 dating or married couples to a 30-minute semi-structured discussion task that was designed to elicit either high or low levels of closeness. Participants provided pre- and post-task saliva samples (to assess cortisol and testosterone) and post-task reports of self-disclosure, closeness, attraction, positive and negative affect, and stress. Participants found the discussion conditions comparably positive and enjoyable, but those in the high-closeness condition reported that they disclosed marginally more and felt marginally closer to their partners than those in the low-closeness condition. Participants also showed larger increases in cortisol and testosterone during the high (versus low) closeness discussion, and self-reported disclosure mediated these increases in cortisol and testosterone. Self-reported closeness and other theoretically plausible mediators, such as sexual attraction and excitement, did not mediate changes in either hormone. Taken together, the current findings contribute to our understanding of neuroendocrine changes associated with emotionally intimate relationship experiences. We consider possible explanations for the hormone changes we observed and offer directions for future research on the neuroendocrine implications of close relationship experiences.

Contact, moral foundations or knowledge? What predicts attitudes towards women who undergo IVF

BACKGROUND

The willingness to try in vitro fertilization (IVF) as an infertility treatment, as well as its psychosocial consequences for couples, may be influenced by how they perceive the attitudes of general public towards this procedure. The focus of the current study was to identify predictors of attitudes towards mothers who underwent IVF to conceive a child. Three predictors were derived from attitude components: contact with someone who had undergone IVF (behavior), moral foundations (emotions), and the level of knowledge (cognition) about IVF.

METHOD

In total, 817 participants (118 male and 692 female, 7 unreported) from Poland took part in the study. Participants were asked whether they knew a person who underwent IVF, completed a Moral Foundation Questionnaire, and answered a pre-piloted IVF knowledge test. Attitudes towards women who utilised IVF were measured with a modified Bogardus Social Distance Scale. Data were analysed using hierarchical and logistic regression analyses.

RESULTS

The results showed that there was a weak link between previous contact with a person who underwent IVF and a positive attitude toward a woman who underwent IVF. The attitudes was also predicted by moral foundations: positively by care/harm and fairness/cheating foundations, and negatively by sanctity/degradation. Importantly, more knowledge about IVF was linked with a more positive attitude towards IVF, and this effect explained additional variance over and above moral foundations.

CONCLUSIONS

Our study implies the need of psychoeducation to prevent stigmatization of individuals who try IVF due to infertility.

Comparison of Early-Stage Mothers and Childless Women Seeking Pregnancy: Experienced Stress, Resilience and Satisfaction with Relationship with the Partner

Introduction: The birth of a child is a significant turning point in the life of a woman. It is a source of personal fulfilment, but also a great challenge. On the other hand, the inability to conceive a child in a natural way results in a serious distortion of a woman’s psychic balance. Becoming a mother is an indicator of personal fulfilment and the source of social acceptation. Therefore, both becoming a mother and the inability to conceive a child in a natural way may be seen as stressful factors that impact a woman’s life. Aim of the study: The research project aimed to analyze the differences in stress, resilience and satisfaction with relationship and sexual satisfaction between early-stage mothers, i.e., women having a child and childless women seeking pregnancy. Sample: The study involved 80 women—40 mothers and 40 infertile women. The mean age of the mothers was 31.10 yrs (SD = 3.76) and of the childless women seeking pregnancy—31.48 yrs (SD = 3.35). Both groups were homogenous with regards to education, place of residence, the form and time of their relationship with partners. Method: The perceived stress was measured with the Perceived Stress Scale PSS—Polish adaptation by Juczyński and Ogińska-Bulik. Resilience was measured with Personal Adaptation Scale (LIRS-pl)—Polish adaptation by Malina, Pooley and Harms. The quality of the relationship was measured using the Quality of Relationship Inventory (QRI) adapted to Polish version by Suwalska-Barancewicz, Liberska and Izdebski and the sexual satisfaction was measured with the Sexual Satisfaction Questionnaire by Nomejko and Dolińska-Zygmunt. Results and conclusions: Statistical analyses indicate that the participating women differ in the level of perceived stress (higher among childless women seeking pregnancy; t = 2.721; p = 0.008), the depth/intensity of the relationship (higher among childless women seeking pregnancy; t = 2.376; p = 0.020) and conflict (higher among mothers; t = −2.829; p = 0.006). This research project proved that infertility and its consequences are not only negative. The research has shown that lower levels of relationship conflicts and greater commitment occur more frequently among infertile women than among mothers. Regardless of the observed differences in the studied sample, it is noteworthy that the compared groups are also similar to some extent. They neither differed in the level of personal resilience nor perceived support. Therefore, although the two experienced issues seem to be different, they may appear psychologically similar to some extent.

Satisfaction with Life, Emotions, and Identity Processes in Polish First-Time Mothers and Fathers and Their Child's Age

The experiences of women regarding conception, the birth of the first child, and care of an infant in the perinatal period have long attracted the attention of researchers, but the knowledge about the experiences of men entering the role of fathers for the first time is still insufficient. The aim of the research was to identify the level of satisfaction with life, emotions and identity formation of first-time parents depending on the gender and age of the child. Seventy-five pairs of Polish first-time parents participated in the study. The research used the SUPIN scale (Polish adaptation of Positive and Negative Affect Schedule), the Satisfaction with Life Scale (SWLS), the Dimension of Identity Development Scale (DIDS), and a questionnaire prepared by the authors. On the basis of the conducted research, it can be concluded that there is a similarity of satisfaction with life, experienced emotions, and identity processes of first-time mothers and fathers, as well as the importance of the child’s age for the specificity of developmental changes in women and men. Understanding development changes which include identity, emotional functioning, and life satisfaction of first-time parents can provide bases for creating supporting programs in the case that problems in undertaking the role of a parent emerge.

Experiences of Women with Male Factor Infertility under In Vitro Fertilization

Purpose: This study attempts to explore the experiences of infertility among women with male factor infertility. Methods: From April to July 2018, nine women with experience of male factor infertility and assistant reproductive technology were interviewed. The transcribed data were qualitatively analyzed to identify major themes and sub-themes representing participants' experiences with male factor infertility. Results: The analysis indicated that the women's infertility experiences were structured into five theme clusters: "Difficult to accept the situation", "Confused inside", "Destroyed relationships due to blaming and anger", "Desire social support", and "Embracing hurt feelings and regaining strength". Conclusions: Intervention programs are needed to closely investigate the psychological status of women with male factor infertility and help with their physical and psychological well-being. Efforts to address infertility through effective governmental support for infertility, a strategy for promoting the social recognition of infertility, and the health professional's persistent interest and collaboration, are discussed.