The effect of treatment on pregnancy among couples with unexplained infertility.

Our objective was to determine the effect of treatment on the likelihood of pregnancy among couples with unexplained infertility. We used a nonrandomized, prospective, multicentered cohort analytic study, with mean follow-up time of 14.5 months (range, 0.5-46 months). The subjects were 470 couples who attended infertility clinics affiliated with medical schools in Canada, in whom no abnormality was found after investigation. They were drawn from a total of 2,106 couples registered from April 1, 1984 to March 31, 1987. Of these, 130 couples were selected for treatment at the discretion of the care givers; 340 couples were not treated. Selection for treatment resulted in imbalance between the groups: the treated couples had a longer mean duration of infertility (48 vs. 36 months), and were more likely to have had a laparoscopy as part of the investigation (72% vs. 48%). No specific protocol of treatment was used. Treatments most commonly used were clomiphene (87); gonadotropins (31); intrauterine insemination (20); IVF or GIFT (16); bromocriptine (12); 43 couples had two treatments, and 11 had three treatments. The only important determinants of treatment (logistic regression) were time under observation and laparoscopy status. Duration of infertility was only a minor determinant of treatment. Crude, unadjusted pregnancy rates were 25% for the treated group and 34% for the untreated group. The early occurrence of pregnancy in the untreated couples accounted for much of this difference. After adjustment for baseline differences between the groups and times to and under treatment with proportional hazards analysis, the cumulative probability of pregnancy is 2.0 (95% CI 1.3 to 3.1) times as high with treatment.(ABSTRACT TRUNCATED AT 250 WORDS)     

Infertility, infertility treatment, and fetal growth restriction

OBJECTIVE: To examine the association between infertility, with or without treatment, and fetal growth, as well as perinatal and infant mortality. METHODS: From the Danish National Birth Cohort (1997-2003), we identified 51,041 singletons born of fertile couples (time to pregnancy 12 months or less), 5,787 born of infertile couples conceiving naturally (time to pregnancy more than 12 months), and 4,317 born after treatment. We defined small for gestational age (SGA) as the lowest 5% of birth weight by sex and gestational age. RESULTS: Crude estimates suggested an increased risk of perinatal mortality and SGA among infertile couples (treated and untreated), but the odds ratios (ORs) of perinatal mortality among infertile couples were attenuated after adjustment for maternal age and body mass index (1.32, 95% confidence interval [CI] 0.95-1.84 among untreated and 1.26, 95% CI 0.86-1.85 among treated couples). The elevated risk of SGA among infertile couples persisted after adjustment for maternal age, parity, and smoking (OR 1.24, 95% CI 1.10-1.40 among untreated, and OR 1.40, 95% CI 1.23-1.60 among treated). The risk of SGA increased with time to pregnancy, and a longer time to pregnancy was associated with a small reduction in birth weight across the whole distribution. CONCLUSION: The increased risk of SGA observed among infertile couples with or without infertility treatment suggests that infertility may be a risk factor for intrauterine growth restriction. Treatment per se may have little effect on fetal growth. A small-to-moderate increased risk of perinatal mortality in infertile couples cannot be ruled out due to the small number of cases. LEVEL OF EVIDENCE: II.     

The Partnership and Coping Enhancement Programme for couples undergoing in vitro fertilization treatment: the development of a complex intervention in China

Purpose

Couples as dyads suffer from the diagnosis of infertility and related treatment. These couples commonly experience emotional and physical pain and tension in their marital lives. The purpose of this study is to report on the process of developing a potentially feasible and effective complex intervention for couples undergoing in vitro fertilization treatment in China.

Methods

The Medical Research Council (MRC) framework for developing and evaluating the complex intervention was adopted to guide the development of the Partnership and Coping Enhancement Programme (PCEP). In developing the PCEP, three steps were taken, namely, (1) identifying evidence by conducting literature reviews, a concept analysis and a qualitative study; (2) identifying/developing a theory—in this case, a preliminary Endurance with Partnership Conceptual Framework (P-EPCF) was proposed; and (3) modelling the process and outcomes of the PCEP.

Results

The PCEP that was developed is targeted mainly at the domains of the partnership mediators of stress in the P-EPCF. It consists of two sections—partnership and coping—and will be delivered to infertile couples on the day of embryo transfer. The main focuses of the programme are to facilitate mutual sharing and support in infertile couples, and to improve their individual and dyadic coping strategies while undergoing IVF treatment, especially in the period when they are waiting for the results of a pregnancy test and after the disclosure of a negative treatment outcome. The programme is couple-based, consisting of experience sharing, psychoeducation, meditation exercise, skill practise and supplemental written materials.

Conclusions

The Partnership and Coping Enhancement Programme (PCEP) for couples undergoing in vitro fertilization treatment was developed according to the guideline of the MRC framework. It is recommended that a pilot study be conducted to evaluate its feasibility and to model the process and outcomes of the programme.

     

Emotional and psychosocial factors in follow-up of women after IVF-ET treatment. A pilot investigation

One hundred and fifty-six women who enrolled for treatment in an in vitro fertilization (IVF-ET) program were interviewed, 15 months (mean interval) after the last program contact. Perceptions of treatment stress, decisions about further treatment and the extent of resolution of the infertility crisis were investigated. Standard self-report instruments were used to assess emotional status, self-esteem and marital adjustment. The results showed that only about half the couples who did not achieve pregnancy had decided to terminate treatment. Resolution of infertility was significantly correlated with coping with infertility and with the decision to abandon treatment. Although most patients described treatment as extremely stressful, this did not itself result in emotional distress or dysfunction following treatment, and psychiatric syndromes were infrequent. A deeper understanding of the interactions of these identified factors would help all couples who confront unwanted infertility.     

Dyadic coping and dyadic adjustment in couples with women with high depressive symptoms during pregnancy

ABSTRACT

Objective: The present study aimed to compare dyadic coping (DC) and dyadic adjustment in couples in which the woman was experiencing high levels of depressive symptoms and in couples in which the woman presented minimal or no depressive symptoms.

Background: Pregnancy may be considered a situation of dyadic stress, during which the presence of high levels of depressive symptoms may impair the ways couples cope together with stress; however, this topic has not yet been studied.

Methods: Pregnant women and their partners (n = 289 couples) completed the Edinburgh Postnatal Depression Scale, the Dyadic Coping Inventory, and the Revised Dyadic Adjustment Scale during the second trimester of pregnancy.

Results: Couples in which the woman was experiencing high levels of depressive symptoms (n = 57) reported less DC enacted by oneself and by the partner (particularly, less supportive and more negative DC), common DC and overall d5yadic adjustment, compared to couples in which the woman was not experiencing high levels of depressive symptoms (n = 232).

Conclusion: These findings highlight the need to assess couples’ dyadic adjustment and DC strategies, which is particularly important when women screened positive for high levels of depressive symptoms during pregnancy.     

Psychosocial adjustment of couples to first-time parenthood at advanced maternal age: an exploratory longitudinal study

Objective: This study aimed to describe the psychosocial adjustment of primiparous women of advanced age and their partners (AMA group) compared to their younger counterparts (comparison group) from the third trimester of pregnancy to six months postpartum and to explore the psychosocial adjustment of the AMA group, depending on infertility history. Background: First-time parenthood at advanced maternal age (AMA) is a growing reproductive trend; however, few longitudinal studies have explored the psychosocial adjustment of couples from pregnancy to the first postpartum months, considering the distinct trajectories that precede this reproductive behaviour. Methods: Fifty-eight couples in the AMA group (≥35 years at the time of delivery) and 41 couples in the comparison group (20–34 years) were consecutively recruited in a Portuguese urban referral hospital. Both partners responded to the Brief Symptom Inventory-18, the EUROHIS-QoL-8 and the Dyadic Adjustment Scale – Revised during the third trimester of pregnancy (T1), at one month (T2) and six months postpartum (T3). Couples also completed visual analogue scales to assess parenting difficulty, competence and gratification at T2 and T3. Results: The psychosocial adjustment of the AMA group and the comparison group over time was more similar than different. Within the AMA group, perceived parenting difficulty decreased over time for previously infertile couples but remained stable for previously fertile couples. Conclusion: Healthcare providers should avoid stereotypical views and normalise the psychosocial adjustment over the transition to first-time parenthood at AMA. Antenatal psychoeducational interventions should promote realistic expectations about the demands of early parenting, especially among previously infertile couples.     

Dyadic coping,marital adjustment and quality of life in couples during pregnancy: an actor–partner approach

ABSTRACT

Objective: This study aimed to examine the impact of dyadic coping on the quality of life of couples during pregnancy and to explore the potential mediating role of marital adjustment on this association.

Background: According to the systemic transactional model, pregnancy can be characterised as a situation of dyadic stress because it affects both members of the couple. However, the impact of dyadic coping on couples’ quality of life during pregnancy is unexplored. Also, the potential mediating role of marital adjustment on this association remains understudied.

Methods: Participants were 320 pregnant women and their partners (N = 640) who completed the Dyadic Coping Inventory, the Dyadic Adjustment Scale and the World Health Organisation Quality of Life instrument. Data were analysed using the actor–partner interdependence mediation model.

Results: Results showed that there was an intrapersonal indirect effect of dyadic coping on quality of life through marital adjustment. Moreover, an interpersonal indirect effect was found with fathers’ dyadic coping being associated with mothers’ quality of life through mothers’ marital adjustment.

Conclusions: These findings highlight the importance of assessing dyadic coping strategies of couples during pregnancy and targeting them in the psychological support offered to couples as a way of improving their marital adjustment, and consequently, their quality of life.     

Pregnancies during and after homologous intrauterine insemination cycles

Results of intrauterine insemination (IUI) in 39 couples are presented. Indications were male subfertility, cervical factor, unexplained infertility and immunological factor. The patients received a total of 119 treatment cycles. Nine pregnancies were achieved (23.1%) during IUI treatment. The monthly fecundity rate (MFR) during treatment was 7.6%. After stopping IUI, within a follow-up of 1 year 13 pregnancies occurred. Seven pregnancies occurred spontaneously without invasive treatment methods. The MFR was calculated to be 4.8% for this group. We conclude that couples with IUI treatment do achieve pregnancies more quickly, but IUI does not influence a patient's eventual chance to become pregnant.     

What does having a fertility problem mean to couples?

The meaning of fertility problems for couples and how partners differed in their appraisals of their fertility problems were the main areas of interest in this research. Ten couples recruited via an infertility clinic took part in semi‐structured interviews, which were analysed using inductive thematic analysis. Two super‐ordinate themes emerged: ‘Expectations of life – “What's it all about?”’ highlighted the lifecycle expectations people have and the reflections infertile couples undertake about parenthood and their relationship. ‘Dealing with ongoing fertility problems – “When it doesn't happen how we expect”’ presented perceptions of fertility treatment alongside differing responses to ongoing infertility, with feelings of resentment and acceptance emerging. Communication was revealed to play an important yet complex role in the experience of continued fertility problems. Gender differences were highlighted in the meaning of infertility and the importance of biological parenthood and also in the amount, nature and purpose of communication. The implications for research and counselling which is focused on ‘couples’ are discussed.     

Protective emotional regulation processes towards adjustment in infertile patients

Little is known about emotional regulation processes of psychological flexibility/acceptance, self-compassion, and coping styles in infertility and the way they may exert a protective function towards depression. The aim of the current study was to explore how these emotion regulation processes are related to depression and to the sense of self-efficacy to deal with infertility in infertile patients. Gender differences were also considered. One hundred couples without known fertility problems and 100 couples with an infertility diagnosis completed the instruments: Beck Depression Inventory, Coping Styles Questionnaire, Acceptance and Action Questionnaire, Self-Compassion Scale and Infertility Self-efficacy Scale. Infertile couples presented statistically significantly higher scores on depression and lower scores in psychological flexibility/acceptance and self-compassion than the control group. This pattern was particularly identified in women who also tended to use less an emotional/detached coping style and to perceive themselves as less confident to deal with infertility than men. Multiple regression analysis showed that psychological flexibility/acceptance was a significant predictor of depressive symptoms in men and women with infertility. Emotional regulation processes, such as psychological flexibility/acceptance and self-compassion, seem to be relevant to the understanding of depressive symptoms and psychological adjustment to infertility, suggesting that these issues should be addressed in a therapeutic context with these couples.     

Ejaculatory incompetence and infertility

Ejaculatory incompetence is a relatively uncommon cause of infertility but a potentially treatable one. We report on 11 men with anejaculation, 2 of whom presented with complaints of sexual dysfunction and 9 with infertility. Psychologic factors were considered the major cause in all patients. Sexual counseling was carried out in four couples; in three of these couples, subsequent intravaginal ejaculation occurred. Two couples achieved pregnancy by intravaginal ejaculation. Two of another three couples achieved pregnancy by artificial insemination with the husbands' semen (AIH); therefore, four of seven couples achieved pregnancy by either sexual therapy or AIH. These data indicate that ejaculatory incompetence should be inquired after in cases of infertility and that sexual therapy as opposed to prolonged psychoanalysis or AIH is an effective form of treatment.     

Prenatal attachment in pregnancy following assisted reproductive technology: a literature review

ABSTRACT

Objective: To summarise the literature on prenatal attachment in pregnancies following Assisted Reproductive Technology (ART).

Background: Prenatal attachment can predict the quality of the postpartum parent–infant relationship and is linked to perinatal mental health of the parents and their adjustment to the parental role. It might be expected prenatal attachment will be influenced by fertility treatment such as ART, but there are contradictory results.

Methods: In this review, studies with a cross-sectional and longitudinal design, published in 1990–2019 were included. A search was conducted in MEDLINE/PubMed, EMbase, Web of Science and Scopus, and using the Google Scholar search engine. A total of 17 articles were found which met the inclusion criteria and after these articles were reviewed using the STROBE-checklist, 15 articles were included in the study.

Results: In most couples who conceived following ART, the level of prenatal attachment was either similar to or higher than in couples who conceive without ART.

Conclusions: The findings challenge the idea that infertility problems affect attachment in pregnancies following ART. However, ART- couples may be more susceptible to anxiety due to pregnancy loss and support may be better focused on the pregnancy-related anxiety in these couples rather than any attachment intervention.     

Current trends in adoption as seen in an infertility center

Fifty infertile couples who were successful in adopting a child either during or following their infertility evaluation and treatment completed questionnaires concerning their experiences during the process of adoption. Their success in adopting young children at reasonable cost and within a short time was surprising, and the data are presented.     

Lesbian couples as therapeutic donor insemination recipients: do they differ from other patients?

Reports were based on 23 lesbian couples seeking therapeutic donor insemination (TDI). Seventeen single women and 14 heterosexual couples with known infertility, due to vasectomy, were recipient controls. No group differences were found on self-esteem, psychiatric symptomatology or dyadic adjustment, except that lesbians reported greater dyadic cohesion than heterosexuals. Lesbians and single women were likely to disclose their use of TDI to others and had planned to disclose this to any child conceived; married couples were divided on this issue. Groups were alike in what they wanted to know about the donor (principally health variables and medical history), and in their concerns about the use of TDI (genetic and medical history). Groups differed in the reasons they elected to use TDI, with lesbian couples and single women choosing TDI affirmatively, and married couples accepting it as a last resort.     

Quality of life after adopting compared with childbirth with or without assisted reproduction

Objective. This study compares quality of life among couples who had adopted a child 4-5.5 years previously with couples whose conception was spontaneous, as well as with couples who had successful or unsuccessful in vitro fertilization (IVF) treatment. Design. Cross-sectional study. Setting. Tertiary level university hospital. Sample. From the following groups, 979 responses were obtained: adoption; successful IVF; unsuccessful IVF-living with children; unsuccessful IVF-living without children; and childbirth after spontaneous conception (controls). Methods. Quality of life was studied with the Psychological General Well Being (PGWB) and Sense of Coherence (SOC) instruments. Demographic, socio-economic and health data were obtained with additional questionnaires. Multiple variance analysis was applied. Main outcome measures. The PGWB and SOC scores. Results. After adjustment for seven confounders, the adoption group had higher PGWB scores than the unsuccessful IVF-living without children and the controls and higher SOC scores than all other groups. The unsuccessful IVF-living without children had lower PGWB and SOC scores than all other groups. The PGWB and SOC scores among controls did not differ from those with successful IVF or unsuccessful IVF-living with children. Conclusions. Adjusted PGWB and SOC scores revealed a high quality of life in the adoption group. However, the group unsuccessful IVF-living without children had low quality of life scores. Quality of life appears to be independent of the outcome of IVF treatment as long as there are children in the family.     

Lesbian couples as therapeutic donor insemination recipients: Do they differ from other patients?

Reports were based on 23 lesbian couples seeking therapeutic donor insemination (TDI). Seventeen single women and 14 heterosexual couples with known infertility, due to vasectomy, were recipient controls. No group differences were found on self-esteem, psychiatric symptomatology or dyadic adjustment, except mat lesbians reported greater dyadic cohesion than heterosexuals. Lesbians and single women were likely to disclose their use of TDI to others and had planned to disclose this to any child conceived; married couples were divided on this issue. Groups were alike in what they wanted to know about the donor (principally health variables and medical history), and in their concerns about the use of TDI (genetic and medical history). Groups differed in the reasons they elected to use TDI, with lesbian couples and single women choosing TDI affirmatively, and married couples accepting it as a last resort.     

The cervical factor of infertility and intrauterine insemination

Results with intrauterine insemination in 25 couples are presented. The indication for this procedure was a cervical factor of infertility. After an extensive fertility survey in both partners, intrauterine insemination was performed four to seven times per cycle with up to 0.8 ml fresh semen per insemination. Only the first ejaculatory spurt was used. Prophylactic antibiotics were given to all female partners during the insemination period. Within a mean of 6 months 13 couples reported pregnancies (52%). Except for one midtrimester abortion that was probably due to obstetrical reasons, the abortion rate was 33.3%. There were no side effects related to the insemination procedure. Our data indicate that, with appropriate safeguards, intrauterine insemination should be regarded as a safe and effective method for the treatment of the cervical factor of infertility.     

Psychological factors related to donor insemination

OBJECTIVE: To survey a sample of couples who had completed therapeutic donor insemination (TDI) regarding several psychological variables. DESIGN: Couples who had conceived through TDI in the past 7 years completed a retrospective survey. PARTICIPANTS: Thirty-five of seventy couples returned completed questionnaires. MEASURES: Demographic questionnaire, TDI, and confidentiality questionnaire (created for this study), Dyadic Adjustment Scale. RESULTS: The majority of the subjects told at least one person about the TDI but 81% of subjects who told someone reported that, if they had to do it over again, they would tell no one. Eighty-six percent reported that they have not and will not tell the child. Time from diagnosis to beginning TDI was not correlated with marital adjustment after TDI. Overall, the couples reported average marital adjustment. For both men and women, the biggest concern was the genetic/medical history of the donor. Most couples did not have psychological counseling, but 39% thought it should be mandatory. CONCLUSIONS: Retrospectively, most couples regretted telling others about TDI. Most couples do not plan to tell the TDI child about its genetic origin. The major concern about TDI is the genetic and medical background of the donor. Psychological counseling should be available to couples undergoing TDI.     

Clinical characteristics and assisted reproductive technology outcomes in infertile foreign brides: comparison with native brides in south Taiwan

ObjectiveThis study was conducted to determine if differences in clinical characteristics, embryonic development, and pregnancy outcomes exist between infertile foreign and native brides undergoing assisted reproductive technology (ART) treatment in a foreign-bride-immigrating country of Taiwan.Material and MethodsA retrospective, case-control design was use to recruit consecutive infertile women seeking ART treatment for study. The treatment protocol consisted of controlled ovarian hyperstimulation with down-regulation and gonadotropin and ART method with conventional in vitro fertilization or intracytoplasmic sperm injection. Among the 1083 ART treatment cycles, 97 (9%) were from foreign brides and 986 (91%) from native brides. Records of those who received transfer of fresh embryos obtained by using husband sperm for fertilization were collected for analysis. A case-control design with adjustment of bride age was used to select the records of 86 infertile foreign and 172 native brides for the study. Infertility cause, bride age, retrieved oocyte number and maturity, fertilization rate, embryo score, and post-embryo transfer results were assessed.ResultsThe foreign bride couples had significantly greater infertility due to tubal (36%) and combination (8.1%) factors than native bride couples (20.3% and 4.1%, respectively). Days of gonadotropin stimulation, number of oocytes retrieved, fertilization rate, embryo score, implantation rate, or clinical pregnancy rate, and live birth rate did not differ between the two groups.ConclusionThe cause of infertile foreign bride couples requiring ART treatment had a higher percentage of tubal and combination factors, but similar ART outcomes.     

Counselling lesbian couples: requests for donor insemination on social grounds

Fertility centres are increasingly involved in dealing with requests from lesbian couples for donor insemination (DI). Data were collected on 95 Belgian lesbian couples who applied for DI. The majority of couples were well integrated in a social environment (family, friends and work) that consisted mainly of heterosexuals. They tended to be open about their homosexuality and most couples considered the social environment to be tolerant towards their homosexual orientation. Couples who considered alternatives to DI would have liked to have had more information on the donor and were more inclined to introduce a 'godfather' who would take special interest in the child. Couples who considered DI to be the best solution considered the absence of a father to be less of a problem for the child and wished to have no information at all as regards the donor. Approximately half the couples considered their family a two-mother unit. For the other couples, the family unit consisted of a mother and her partner who shared parental responsibility for the child equally. The issues that are considered important to cope with and on which lesbian couples should be counselled are presented in the discussion.