Perception of diagnosis and openness of patients about infertility

The perception of the diagnosis of infertility and the openness of patients about infertility was investigated among 108 infertile couples. Husbands and wives answered a structured questionnaire. The perception of diagnosis was in 38% of the cases different from the medical diagnosis. Patients perceived the diagnosis of male infertility more frequently, and the diagnosis of female infertility less frequently, than these diagnoses were made. Also there are significant differences in the perception of diagnosis between husbands and wives. Among the respondents there is a tendency to ascribe the diagnosis of infertility to themselves. It is important that physicians make sure that the patients have understood the received information. Family and friends are in almost all cases informed about the infertility problem, colleagues and acquaintances in about 60% of the cases, neighbors in about 40% of the cases. The reaction to openness is positive. Husbands are less open about male infertility than about female infertility. A selective choice of confidants and a subtle way of conveying the information generally lead to a positive reaction to the disclosure of infertility.     

Behavioral and psychological consequences of unemployment in blue-collar couples

The behavioral and psychological consequences of involuntary unemployment in blue-collar couples were investigated using Scanzoni's (1972) dynamic model of marital exchange. Thirty-one couples in which the husband had been laid off for at least 3 months were compared with 32 couples in which the husband was employed full time, in terms of exchange behaviors, psychological well-being, and marital satisfaction. As predicted, unemployed husbands reported lower psychological well-being and marital satisfaction, while their wives reported lower marital satisfaction. Unemployed husbands had not significantly altered their exchange behaviors, perhaps due in part to their traditional attitudes toward marital roles which continue to render the contemporary marital exchange relatively inflexible. Level of expressive behavior was by far the most powerful predictor of marital satisfaction for husbands and wives alike. Incongruity in attitudes toward marital roles between traditional husbands and modern wives may constitute both a preexisting source of dissatisfaction and a risk factor following unemployment. These results partially support Scanzoni's model but suggest that the negative consequences of unemployment in blue-collar couples appear first in the psychological as opposed to the behavioral domain.     

Spouse-pair similarity on the California Psychological Inventory with reference to husband's coronary heart disease

The present article reports on the results of several comparisons between 45 adult males with diagnosed coronary heart disease (cases) and their wives and 50 adult males without coronary heart disease (noncases) and their wives recruited from the Western Collaborative Group Study. The California Psychological Inventory and a life satisfaction inventory were administered to the couples in the two types of families. Results indicate that although both sets of husbands and wives fell within the well-functioning range on the CPI, wives of cases were significantly more dominant and less flexible than wives of noncase husbands. Case husbands were significantly more dominant than noncase husbands. No mean differences existed between case and noncase husbands and wives on a variety of life satisfaction measures. Computation of spouse-pair correlations revealed a pattern of overall dissimilarity across the CPI scales for case couples and overall similarity for the noncase couples. The only scale on which case spouse pairs were significantly similar was one measuring depression. Noncase couples were significantly more similar than case couples on scales measuring sociability, self-acceptance, and socialization. Previous findings from the research literature in the fields of personality, cardiac rehabilitation, and assortative mating are used to generate three competing hypotheses relating the present findings to cross spouse disease associations.     

Marriage duration, marital adjustment and psychological symptoms: a cross-sectional study

One hundred and nine couples completed questionnaire measures of psychological symptoms, personality, and marital adjustment. They were divided into groups of short, intermediate, and long marriage duration. Psychological symptoms and marital adjustment remained fairly stable over time, although wives scored significantly worse than husbands on most measures in the intermediate duration group. In the short marriages, half the variance in marital satisfaction was predicted by the partner's marital questionnaire score, but when this variable was eliminated from the regression equation, psychological symptoms (phobic anxiety in wives and depression in husbands) were the main predictors of marital satisfaction. In the intermediate group, hostility levels were the main predictors of marital satisfaction. In the long marriages, marital satisfaction was predicted mainly by personality factors (assertiveness in husbands and personal flexibility in wives) and by levels of generalized anxiety. The findings suggest that couples who constructively resolve difficulties in expressing hostility within marriage are more likely to remain married than those who fail to do so.     

Adult attachment stance and spouses' marital perceptions during the transition to parenthood

The relationship between adult attachment and marital perceptions was examined in couples making the transition to parenthood. The Adult Attachment Interview was administered to spouses prenatally, and marital perceptions were assessed prenatally and 3, 12, and 24 months postnatally. The couples were also observed during a marital interaction task. Spouses were assigned to groups based on their attachment security (secure/insecure) and mean level (low/high) of negative emotional escalation in their marital interactions. A series of two-way (attachment security by negative emotional escalation) repeated multivariate analyses of variance, followed by univariate analyses, revealed that insecure husbands and the wives of insecure husbands exhibited different patterns in their marital perceptions than secure husbands and the wives of secure husbands when in high negative escalation marriages. Insecure husbands and the wives of insecure husbands in high negative escalation marriages reported greater declines in positive marital perceptions or less positive marital perceptions overall across the two-year postnatal period than secure husbands and wives of secure husbands in similarly high conflict marriages. Such differences between secure and insecure husbands (and their wives) were not apparent in low negative escalation marriages. Findings are discussed in terms of the protective effect a secure attachment may convey upon spouses during stressful periods in their marriage.     

First IVF treatment--short-term impact on psychological well-being and the marital relationship

BACKGROUND: The aim of this study was to assess infertile couples' short-term emotional responses to their first IVF treatment (the women's and men's emotional reactions and their experiences of the marital relationship at different stages of the first treatment) and to relate these responses to the outcome of the IVF treatment. METHODS: The study was part of a prospective, longitudinal study where 117 couples participated. The women and men answered questionnaires separately concerning psychological and social factors at three occasions: before, during and 1 month after treatment. RESULTS: Women's and men's emotional reactions related to first IVF treatment were dependent on whether they achieved a pregnancy or not. Those who failed to become pregnant rated their emotional well-being worse, whereas those who became pregnant rated their emotional well-being better than before treatment started. The women reported stronger emotional reactions about their infertility than their husbands. However, the men reacted in the same emotional pattern as their wives when pregnancy was not achieved. A majority reported that the marital relationship improved during treatment. CONCLUSION: Couples undergoing their first IVF treatment are as a group well adjusted and manage to handle the short-term emotional strain under treatment. The determining factor for short-term emotional response of treatment was whether pregnancy was achieved.     

Coping with infertility: a body-mind group intervention programme for infertile couples

BACKGROUND: The recognition of the distressing character of infertility diagnosis and treatment has led to the development of several psychosocial interventions for infertile couples. At the Leuven University Fertility Centre, a body-mind marital group intervention was developed to help infertile couples cope with the distress related to infertility. METHODS AND RESULTS: This treatment programme was originally adapted from a mind-body approach, but integrated concepts and techniques from body-oriented therapy, art therapy and multi-family group therapy. In this paper, the therapeutic foundations, treatment goals and practical implications of the mind-body marital group intervention are outlined. Further, the treatment procedure is explained in detail and illustrated by clinical vignettes. CONCLUSIONS: Although the first clinical impressions about the usefulness of the body-mind group programme in fertility clinics seem promising, further research is needed to assess its effectiveness.     

Gender Differences in Coping with Infertility: A Meta-Analysis

Infertility is a stressor that affects both husbands and wives. The literature suggests that infertility is more stressful for women, although most studies have not included men/husbands. If the experience of infertility is different for women and men, the next question is whether women and men cope differently. Meta-analytic procedures were used to review the empirical evidence (1966-1995) on gender differences in coping with infertility among heterosexual married couples; all studies used a standardized coping measure [The Ways of Coping Checklist - Revised (Folkman et al., 1986)]. Significant gender differences were found for half the strategies studied: Women used the strategies of Seeking Social Support, Escape-Avoidance, Planful Problem-Solving, and Positive Reappraisal to a greater degree than their partners. The findings suggest that coping at both the individual and the couple level be considered in the treatment of infertile couples and that gender be considered before planning an intervention.     

Sequential interactions in the marital communication of depressed men and women

Despite studies showing patterns of sequential interaction between depressed wives and their husbands, no published research has contrasted sequential interactions of depressed husbands and their wives. This study compared problem-solving interactions of 49 couples with a depressed husband, 41 with a depressed wife, and 50 normal controls. Interactions were coded using the Marital Interaction Coding System. Although no clear patterns of sequential interaction distinguished couples with a depressed wife from normal control couples, results suggested a unique pattern of interaction between depressed husbands and their spouses, whereby positive communications from the husband resulted in decreased positivity and increased negativity from their wives. Given the importance of positivity for promoting effective problem solving, this pattern appears to have important implications for couples' long-term marital satisfaction and husbands' mood regulation.     

Infertility treatment and marital relationships: a 1-year prospective study among successfully treated ART couples and their controls

BACKGROUND: Evidence about the effects of infertility and assisted reproduction technique (ART) on marital relationships is discrepant. Here, we examined the impact of ART on marital relationships. The roles of life stressors, infertility and treatment characteristics in predicting marital relations were also evaluated. METHODS: Subjects: 367 couples with singleton IVF/ICSI pregnancies. Controls: 379 couples with spontaneous singleton pregnancies. Women and men were assessed when the child was 2 months (T2) and 12 months old (T3). They further reported stressful life events at T2 and depression in pregnancy. RESULTS: No between-group differences were found in marital satisfaction and dyadic cohesion. Dyadic consensus deteriorated from T2 to T3 only among control women. Sexual affection was low among control men at T2 and stressful life events decreased it further. Depression during pregnancy predicted deteriorated marital relations only in control couples. Several unsuccessful treatment attempts were associated with good dyadic consensus and cohesion among ART women. Spontaneous abortions and multiple parity predicted poor marital satisfaction in ART women, whereas long duration of infertility and multiple parity predicted poor marital relations in ART men. CONCLUSIONS: Successful ART does not constitute a risk for marital adjustment. The shared stress of infertility may even stabilize marital relationships.     

Psychosocial characteristics of infertile couples: a study by the 'Heidelberg Fertility Consultation Service'

BACKGROUND: The aim of the study was to identify differences in psychological characteristics between couples with fertility disorders, especially idiopathic infertility, and a representative sample. MATERIAL AND METHODS: A total of 564 couples was examined using psychological questionnaires pertaining to sociodemographic factors, motives for wanting a child, dimensions of life satisfaction and couple relationships, physical and psychic complaints, and a personality inventory. RESULTS: Specific to our sample was the high educational level of the couples, and the large number with idiopathic infertility (27% of all diagnoses). There were no remarkable differences in psychological variables between the infertile couples and a representative sample, except that the infertile women showed higher scores on the depression and anxiety scales. Couples with idiopathic infertility showed no remarkable differences in the questionnaire variables compared with couples with other medical diagnoses of infertility. CONCLUSIONS: A typical psychological profile for infertile couples could not be identified using standardized psychometric rating methods. This may be an effect of the specific characteristics of our sample. For some couples, the infertility crisis can be seen as a cumulative trauma, which indicates that these couples have a marked need for infertility counselling.     

Marital norm,reality and satisfaction in middle-aged couples: why are wives less satisfied than husbands?

The purpose of this study was to investigate recent changes in marital norm and reality in middle-aged couples, and how marital reality, as perceived by oneself, was associated with their demographic variables, as well as their marital satisfaction. A questionnaire was administered, and 277 pairs of middle-aged, nuclear-family couples participated. Main findings were as follows. First, factor analysis of marital reality variables extracted three factors: love each other, respect for the husband's life style, and respect for wife's life style. Second, concerning the wife's education and income, 'respect for the wife's life style' was highest among highly educated double income couples. Third, 'love each other' was the most important predictor of marital satisfaction for both husbands and wives. Finally, 'respect for the husband's the life style' was associated with husband's satisfaction, while that for the wife's was not with wife's marital satisfaction.     

Sexual satisfaction among middle-aged couples: correlation with frequency of intercourse and health status

The central hypothesis of this investigation is that the greater the sexual satisfaction that a couple reports from their sexual relationship, the better will be their adjustment to the changes that occur during middle age, as reflected in their reported health status and health behaviour. Forty-seven married couples, of North African Jewish origin, were investigated, the women being in the age range 48-53 yr. The findings regarding reported frequency of sexual intercourse and sexual satisfaction of women and men separately showed that a great majority of both men (87%) and women (74%) reported a decrease in sexual activity over the 5 yr preceding the study. Most of the men (56%) said the change was due to the aging process, whereas the women's responses were more varied and included aging, worries and decrease in sexual interest or desire. Eighty percent of the men reported satisfaction in their sexual relationship with their wives, but only 43% of the women stated that they were satisfied. A significant correlation was found, for women only, between the degree of satisfaction and the change in frequency of intercourse. Among the women there was also a positive correlation between general life satisfaction and sexual satisfaction. The hypothesis in regard to mutual (couple) sexual satisfaction was not confirmed in the men. It was validated in the women in regard to only two of the four criteria used - their perception of their health status and of their well-being. The women perceived the sexual satisfaction of their husbands much more accurately than the husbands perceived that of their wives.     

Anxiety,depression and anger suppression in infertile couples: a controlled study

BACKGROUND: Although several authors have suggested an important pathogenic role for psychosocial factors in 'functional' infertility, the extent to which depression, anxiety and expressed emotional patterns correlate to infertility is not yet clear. METHODS: This study included 156 infertile couples (recruited at intake) and 80 fertile couples, whose personal characteristics were recorded. They were examined using scales for the evaluation of the degree of psychopathology [Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Rating Scale (HAM-D)], and anger expression [State-Trait Anger Expression Inventory (STAXI)]. The 156 infertile couples were then subdivided into groups based on the cause of infertility ('organic', 'functional' or 'undetermined'). The psychometric evaluation was double-blind with respect to the causes of infertility. RESULTS: Differences emerged in the degree of psychopathology between 'organic' and 'functional' infertile subjects and fertile controls. In women, logistic regression identified three variables able to predict the diagnosis subtype; these variables are HAM-A, HAM-D, and tendency toward anger suppression. In men, anger did not emerge as a predictor for diagnosis, whereas HAM-A and HAM-D did. CONCLUSIONS: The 'functional' infertile subjects of this sample showed particular psychopathological and psychological features, independent from the stress reaction following the identification of the cause of infertility.     

Spousal Support Satisfaction as a Modifier of Physiological Responses to Marital Conflict in Younger and Older Couples

We investigated linkages between spousal support satisfaction and affective, cortisol, and blood pressure responses to conflict in two samples, 85 newlyweds and 31 older couples, married an average of 42 years. Couples were admitted to a hospital research unit and provided self-reports regarding the support received from their spouses. After a baseline period, couples engaged in a 30-min conflict discussion during which time blood was drawn for cortisol assessment. After the conflict, newlyweds' blood pressure was measured. Among newlywed wives, greater spousal support satisfaction was associated with smaller changes in negative affect and cortisol responses to conflict. Notably, newlywed wives and husbands demonstrated lower blood pressure after conflict when spousal support satisfaction was higher. In contrast, older husbands (but not wives) exhibited greater cortisol responses when spousal support satisfaction was lower. These relationships provide a window on mechanisms linking marriage and health for men and women across the life span.     

Hostility and cardiovascular reactivity during marital interaction.

OBJECTIVE: Prior studies demonstrate that hostile persons respond to social stressors with heightened cardiovascular responses. This study examined the effects of individual differences in hostility and two experimentally manipulated social stressors on cardiovascular reactivity during marital interaction. METHODS: Sixty couples participated in a discussion task under conditions of high or low evaluative threat and while either agreeing or disagreeing with each other. Individual differences in hostility were assessed with the Buss-Perry Aggression Questionnaire. Participants' appraisal of their spouses' behavior during the interaction task was assessed with a standardized measure. Systolic and diastolic blood pressure and heart rate responses were recorded. RESULTS: Among husbands, hostility was associated with greater systolic blood pressure reactivity under high, but not low, threat. Appraisals suggested that this might be due to husbands' efforts to assert dominance in the interaction. Wives' hostility scores were unrelated to cardiovascular reactivity, but wives disagreeing with hostile husbands showed greater heart rate reactivity. CONCLUSIONS: Heightened cardiovascular reactivity to stressful marital interactions among hostile men provides additional evidence of the viability of this psychophysiologic mechanism as a link between hostility and health. The lack of effects among wives suggests sex differences in the social psychophysiology of hostility. Interpersonal concepts and methods are useful in the study of psychosocial risk factors and mechanisms.     

Online psychoeducational support for infertile women: a randomized controlled trial

BACKGROUND: The study goal was to develop and test the effectiveness of a brief online education and support program for female infertility patients. METHODS: A randomized-controlled trial was conducted. Using a Solomon-four group design, 190 female patients were recruited from three US fertility centers and were randomized into two experimental and two no-treatment control groups. The psychological outcomes assessed included infertility distress, infertility self-efficacy, decisional conflict, marital cohesion and coping style. Program dosage and satisfaction were also assessed at four weeks follow-up. RESULTS: Women exposed to the online program significantly improved in the area of social concerns (P = 0.038) related to infertility distress, and felt more informed about a medical decision with which they were contending (P = 0.037). Trends were observed for decreased global stress(P = 0.10), sexual concerns (P = 0.059), distress related to child-free living (P = 0.063), increased infertility self-efficacy (P = 0.067) and decision making clarity (P = 0.079). A dosage response was observed in the experimental groups for women who spent >60 min online for decreased global stress (P = 0.028) and increased self efficacy (P = 0.024). CONCLUSIONS: This evidence-based eHealth program for women experiencing infertility suggests that a web-based patient education intervention can have beneficial effects in several psychological domains and may be a cost effective resource for fertility practices.     

Clustering of male infertility in the families of couples treated with intracytoplasmic sperm injection

Intracytoplasmic sperm injection (ICSI) is an effective treatment modality for male factor infertility, but it could promote the transgenerational transmission of genetic defects causing gametogenic failure. Cytogenetic and molecular techniques permit the diagnosis of some infertility-causing genetic aberrations, but many more probably evade detection with currently available technology. The analysis of the recurrence pattern of infertility in infertile couples' families could define the importance of heritable factors in the pathogenesis of human infertility. We have subjected 621 consecutive infertile couples treated with ICSI in a single institution to a comprehensive genetic workup including documentation of the family history, karyotyping and various DNA tests. In all, 1302 fertile couples served as controls. Of the infertile couples 6.4% were shown to have a fertility problem with a definite genetic basis. Male, but not female fertility problems displayed a distinct pattern of familial aggregation. In addition, the infertile couples had fewer siblings than the fertile controls, a finding compatible with suboptimal fertility already among the infertile couples' parents. In summary, our data indicate that male factor infertility should be considered a potentially heritable condition. The recurrence risk for infertility in the offspring of couples treated with ICSI might be substantial.     

Cardiovascular Reactivity and Initiate/Avoid Patterns of Marital Communication: A Test of Gottman's Psychophysiologic Model of Marital Interaction

Gottman's (1990, 1991; Gottman and Levenson, 1988) psychophysiologic model of marital interaction was tested in 60 married couples. Participants were classified as avoiders or initiators of relationship problem discussions by trained coders observing videotaped semistructured interviews. Blood pressure (BP) and heart rate reactivity was assessed during the cold pressor test, during a mental math test, while watching a marital argument on video, and during a conjoint interview. As hypothesized, avoiders had significantly greater systolic BP reactivity during the interview. Additionally, husbands who interacted with avoider wives had significantly greater diastolic and systolic BP reactivity than did husbands of initiator wives. Initiator husbands, in particular, who were married to avoider wives had greater systolic BP reactivity. These results both support Gottman's psychophysiologic model and suggest modifications of it.     

Types of marital closeness and mortality risk in older couples

OBJECTIVE: This study examines the impact of marital closeness on survival over 6 years in a community-dwelling sample of 305 older couples. METHOD: Closeness is defined as 1) naming one's spouse as a confidant or source of emotional support (vs. not naming) and 2) being named by spouse on at least one of the two dimensions (vs. not being named). The survival effects of both naming and being named are examined in Cox proportional hazard regressions, controlling for sociodemographic, health status, and behavioral variables. RESULTS: Husbands who were named by their wives but did not name them were least likely to have died after 6 years. Compared with them, husbands in marriages with the other three styles of closeness were from 3.30 to 4.68 times more likely to be dead. Wives' results showed the same pattern of effects, with the same marital style being most protective as for husbands, but the effects were weaker. However, wives' results were strongly moderated by parenting status: those who had ever had children who were in the marital closeness pattern of wife naming husband but not being named by him were highly protected. Compared with these wives, others who had had children were from 8.26 to 10.95 times less likely to be alive after 6 years. CONCLUSIONS: The same pattern of marital closeness most benefited husbands and those wives who had had children. These findings are not explained adequately by social support or marital role theory although they fit the latter more closely.