Effects of a psychological intervention on depression in infertile couples

OBJECTIVE: To determine factors affecting depression in infertile couples and the impact of a psychological intervention before or during infertility treatment. METHODS: In a cross-sectional study with 638 infertile couples assessed for depression, 140 couples with a member who had a Beck Depression Inventory (BDI) score of 17 or higher were randomized to receive psychological treatment either before or during infertility treatment. Logistic regression was performed to eliminate confounding factors. RESULTS: Depression was initially found in 48% of women and 23.8% of men. The mean+/-SD Beck scores fell from 18.7+/-9.7 to 10.7+/-5.8 (P<0.001) in the group psychologically treated before they received infertility treatment. CONCLUSION: The psychological intervention was found useful in alleviating depression in infertile couples before they received infertility treatment.     

Fecundity of Infertile Women with Minimal or Mild Endometriosis And Women with Unexplained Infertility

Objective: To assess whether infertile women with minimal or mild endometriosis have lower fecundity than women with unexplained infertility.

Design: Prospective cohort study.

Setting: Twenty-three infertility clinics across Canada.

Patient(s): Three hundred thirty-one infertile women aged 20–39 years.

Intervention(s): Diagnostic laparoscopy for infertility. Infertile women with minimal or mild endometriosis (n = 168) were compared with women with unexplained infertility (n = 263). Both groups were managed expectantly. The women were followed up for 36 weeks after the laparoscopy or, for those who became pregnant, for up to 20 weeks of the pregnancy.

Main Outcome Measure(s): Fecundity refers to the probability of becoming pregnant in the first 36 weeks after laparoscopy and carrying the pregnancy for ≥20 weeks. The fecundity rate is the number of pregnancies per 100 person-months.

Result(s): Fecundity was 18.2% in infertile women with minimal or mild endometriosis and 23.7% in women without endometriosis (log-rank test). The fecundity rate was 2.52 per 100 person-months in women with endometriosis and 3.48 per 100 person-months in women with unexplained infertility. The crude and adjusted fecundity rate ratios were 0.72 and 0.83 (95% confidence interval = 0.53–1.32), respectively.

Conclusion(s): The fecundity of infertile women with minimal or mild endometriosis is not significantly lower than that of women with unexplained infertility.     

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.     

Depression and anxiety among Polish infertile couples – an evaluative prevalence study

Aim. The aim of this study was to evaluate the influence of infertility on the severity of anxiety and depression in infertile couples.

Material and methods. This was a cross-sectional study of differences between infertile couples (206 women and 188 men) and fertile couples (n = 190) with symptoms of depression and anxiety, as measured by the Beck Depression Inventory and Beck Anxiety Inventory.

Results. Infertile women (35.44%) scored above the cut-off for severe symptoms of depression, compared with 19.47% of fertile women. In the case of anxiety evaluation there was significant total prevalence among infertile women (15.53%). In the male groups there was a comparable frequency of negative results for depression and anxiety and their intensity. Among Female Infertile, depression occurred most frequently in combined infertility, whilst among Male Infertile in male infertility, with a time-frame of 3–6 years causing the creation and severity of depressive symptoms.

Conclusion. The risk factors of depression and anxiety in infertility include: female sex, age over 30, lower level of education, lack of occupational activity, diagnosed male infertility and infertility duration of 3–6 years.     

Quality of life and sexual functioning of Polish infertile couples

Objectives To evaluate the influence of infertility on the quality of life (QoL) and sexual functioning of infertile couples.

Methods The research group consisted of 206 infertile couples and the control group of 190 fertile couples. A specific questionnaire was used as a research tool. It gathered information about socio-demographic features and infertility status, and included validated scales: Short Form-36 Health Survey, Female Sexual Function Index and International Index of Erectile Function.

Results The QoL parameters in all categories were generally lower for infertile women than for those of the control group. Clinical sexual dysfunctions were not significantly more common among infertile than fertile women (17.5% versus 12.1%, p = 0.13). Clinically relevant erectile dysfunctions were diagnosed in 23.9% of infertile men and in 13.7% of the controls. Male infertility had the most significant negative effect on men's sexual functioning.

Conclusions The risk groups for decreased QoL are infertile women and older subjects with lower education and occupationally inactive. Clinically relevant sexual disorders in the infertile population most frequently affect older men, with a lower educational level and with previously diagnosed male infertility.     

Coping with male infertility. Gender differences

Infertility is a stressor that affects the infertile couple. Coping of infertile couples with the unfulfilled desire for a child is affected by numerous variables. Depending on the diagnose is the patients were assigned to four groups: Group 1: female infertility (infertile women of fertile men), Group 2: infertility of the men, Group 3: infertility of both partners, Group 4: idiopathic sterility). One hundred and ten infertile couples were investigated with the Freiburg questionnaire of Coping with Illness. Compared to their partners, the women of infertile couples report a higher feature rating in the cales ”depressional coping” and ”self-distraction and self-stabilisation”. Women of infertile couples show lower feature ratings compared to the standardised collective of patients with chronic somatic disease only on the scale ”religiousness and search for meaning”. Involuntarily childless men activate all coping strategies to a smaller extent than the reference sample. The experience of infertility is greatly affected by gender and the associated role expectations. Received: 12 March 2001 / Accepted: 16 March 2001     

Subjective well-being in infertile couples

The subjective well-being of infertile couples is affected by numerous variables. One hundred and ten infertile couples were investigated using the von Zerssen symptom checklist. With the exception of sterile women of fertile men (group 1: female infertility), women and men in the overall randomized sample and the diagnostic groups (group 2: subfertility of the man; group 3: sterility of both partners; group 4: idiopathic sterility) report fewer general symptoms than the overall population of patients with somatic and psychiatric diseases. Subfertile men show lower rating in the symptom checklist than the norm. Involuntarily childless women express more symptoms than their partners.     

Subjective well-being in infertile couples

The subjective well-being of infertile couples is affected by numerous variables. One hundred and ten infertile couples were investigated using the von Zerssen symptom checklist. With the exception of sterile women of fertile men (group 1: female infertility), women and men in the overall randomized sample and the diagnostic groups (group 2: subfertility of the man; group 3: sterility of both partners; group 4: idiopathic sterility) report fewer general symptoms than the overall population of patients with somatic and psychiatric diseases. Subfertile men show lower rating in the symptom checklist than the norm. Involuntarily childless women express more symptoms than their partners.     

The psychosocial impact of infertility two years after completed surgical treatment

Twenty-four infertile couples were interviewed prior to and 2 years after the woman's reconstructive tubal operation. Their marital relationship, social and sexual life, mental health, possible solutions to the infertility problem and need of professional psychosocial counselling were studied. Moreover, various mental symptoms were recorded by means of a 'symptom checklist'. The personality characteristics were evaluated by the Eysenck Personality Inventory (EPI). The partners feelings for each other were worsening 2 years after the operation. There was also a tendency to a deterioration in the participants' opinion about their marital relationship, but no statistically significant change could be found. The women reported deterioration of sexual life and the men experienced an increased negative influence of the infertility problem on the marital relationship. The negative emotional and social effects of infertility were pronounced both before and 2 years after the surgical treatment. The participants' personality characteristics as regards neuroticism and extroversion had not changed. Most of the infertile couples found it difficult to work on their own towards a solution to the crisis of infertility during the 2 years following the surgical treatment.     

Emotional distress of infertile women in Turkey

OBJECTIVE: To determine the prevalence, severity and predictability of psychiatric symptoms of infertile women and the effects of infertility on marital and sexual relationships. METHODS: A semi-structured interview form, symptom check list, Beck Depression Inventory, State-Trait Anxiety Inventory and the Maudsley Marrital Questionnaire were utilized for 50 infertile women and 40 healthy women as a control group. RESULTS: Depression, anxiety and strength of psychological symptoms were significantly higher in the infertile group. Depression was decreased as the rate of employment, economic status and education increased. Infertility, infertility treatment, and marriage duration were positively correlated with depression and the strength of psychological symptoms. Sexual relationships were negatively affected the longer the duration of infertility treatment lasted. CONCLUSION: Special attention must be given to identifying psychiatric problems in infertile women. Relationship and sexual difficulties also appear central to infertility-related stress; targeting problems in these domains will have maximal therapeutic benefit.     

Ovarian stimulation and borderline ovarian tumors: a case-control study

Objective: To assess the risk of borderline ovarian cancer among infertile women treated with fertility drugs.

Design: Case-control study.

Setting: Nationwide data obtained from public registers and postal questionnaires.

Patient(s): All Danish women <60 years old with borderline ovarian cancer during the period 1989–1994 and randomly selected population controls. The analysis included 231 cases and 1,721 controls.

Intervention(s): None.

Main Outcome Measure(s): Influence of parity, infertility, and fertility drugs on the risk of borderline ovarian cancer after multivariate confounder control.

Result(s): The odds ratio (OR) for borderline ovarian cancer among infertile untreated nulliparous women compared with fertile nulliparous women was 1.9. The OR for borderline ovarian cancer among treated nulliparous women compared with untreated infertile nulliparous women was 1.5, and the OR among treated parous women compared with untreated infertile parous women was 1.5.

Conclusion(s): Among fertile women, the difference in the risk of borderline ovarian cancer between nulliparous women and parous women was not statistically significant. Nulliparous women who were infertile and who did not receive medical treatment had a twofold higher risk of borderline ovarian cancer than fertile nulliparous women. There was no statistically significant increase in the risk of borderline ovarian cancer among nulliparous women who were treated with fertility drugs compared with nulliparous untreated infertile women or among parous women who were treated with fertility drugs compared with parous untreated infertile women.     

The prevalence and predictability of depression in infertile women.

OBJECTIVE: To determine the prevalence, severity, and predictability of depression in infertile women compared with a control sample of healthy women. DESIGN: Subjects were assessed while waiting to see their physician: infertility patients before a visit with an infertility specialist and control subjects before seeing either a gynecologist or internist for a routine gynecological examination. Subjects completed a demographic form and two depression scales. SETTING: A group infertility practice affiliated with an academic medical center, a hospital-based gynecology practice, and a health maintenance organization internal medicine clinic. PARTICIPANTS: 338 infertile women and 39 healthy women. INTERVENTIONS: None. MAIN OUTCOME MEASURES: The Beck Depression Inventory and the Center for Epidemiological Studies Depression Scale. RESULTS: The infertile women had significantly higher depression scores and twice the prevalence of depression than the controls; women with a 2- to 3-year history of infertility had significantly higher depression scores compared with women with infertility durations of < 1 year or > 6 years; women with an identified causative factor for their infertility had significantly higher depression scores than women with unexplained or undiagnosed infertility. CONCLUSIONS: Depressive symptoms are common in infertile women. Psychological interventions aimed at reducing depressive symptoms need to be implemented, especially for women with a definitive diagnosis and for those with durations of 2 to 3 years of infertility.     

Carrier of numerical chromosome abnormalities in infertile married couples

OBJECTIVES: Genetic anomalies are one of many conditions causing infertility. DESIGN: The aim of the study was to define the frequency of numerical chromosome aberrations in infertile married couples. MATERIALS AND METHODS: Metaphasal chromosomes were analysed by G-T-G stration in 650 patients, i.e. 325 married couples. Chromosomes for testing had been obtained from peripheral blood lymphocytes. RESULTS: Of all women and men, numerical chromosome anomalies were found in 14 married couples (4.1%). The aberrations were connected with female factors in 8 couples (2.3%), and with male factors in 6 (1.8%). CONCLUSIONS: Results of the study indicate that diagnostic procedure for infertility should preferably include cytogenetic examinations as well.     

Vestibulodynia (former vulvar vestibulitis): personality in affected women

AIM: There are very few studies regarding the personality in women suffering from vestibulodynia. Our former results showed increased levels of depression and state anxiety in these women (and their partners). In order to optimize treatment of these patients we wanted to assess personality and its association with depression and anxiety. METHODS: Thirty women attending the vulva clinic for the first time were included at the time of diagnosis (vestibulodynia). The Temperament and Character Inventory (TCI) was administered to assess personality, Beck's Depression Inventory (BDI) to assess depression, State Anxiety Inventory (STAI-S) to assess anxiety, and a questionnaire to assess clinical results. RESULTS: Results showed that women with vestibulodynia have a personality profile with specific temperament and character traits. The results on the TCI temperament dimension characterized them as cautious, careful, insecure, and pessimistic. Results on the TCI character dimension indicated them to experience their own behavior and choices influenced out of their control or against their own will. The interaction of these factors may form a personality profile, resulting in an increased vulnerability in intimate relations and it could also be an important factor for state of depression and anxiety. CONCLUSIONS: The present results indicate the importance of identifying psychological factors in order to optimize the care of vestibulodynia patients and to relieve their symptoms and improve their situation. We therefore want to emphasize that vestibulodynia patients should always, in addition to medical examination and treatment, also be psychologically examined.     

Increased infertility with age in men and women

OBJECTIVE: To estimate the effects of aging on the percentage of outwardly healthy couples who are sterile (completely unable to conceive without assisted reproduction) or infertile (unable to conceive within a year of unprotected intercourse). METHODS: A prospective fecundability study was conducted in a sample of 782 couples recruited from 7 European centers for natural family planning. Women aged 18-40 years were eligible. Daily intercourse records were used to adjust for timing and frequency of intercourse when estimating the per-menstrual-cycle probability of conception. The number of menstrual cycles required to conceive a clinical pregnancy and the probability of sterility and infertility were derived from the estimated fecundability distributions for men and women of different ages. RESULTS: Sterility was estimated at about 1%; this percent did not change with age. The percentage infertility was estimated at 8% for women aged 19-26 years, 13-14% for women aged 27-34 years and 18% for women aged 35-39 years. Starting in the late 30s, male age was an important factor, with the percentage failing to conceive within 12 cycles increasing from an estimated 18-28% between ages 35 and 40 years. The estimated percentage of infertile couples that would be able to conceive after an additional 12 cycles of trying varied from 43-63% depending on age. CONCLUSION: Increased infertility in older couples is attributable primarily to declines in fertility rates rather than to absolute sterility. Many infertile couples will conceive if they try for an additional year.     

Quality of embryo does not affect the implantation rate of IVF-ET in infertile women with antisperm antibody

Objective: To determine whether low quality score of embryos and advanced maternal age affect the implantation rate in infertile women with sperm-immobilizing antibody.

Design: A retrospective study.

Setting: The IVF Unit of the Department of Obstetrics and Gynecology at Tokushima University Hospital.

Patient(s): Four infertile groups were studied: 20 women with sperm-immobilizing antibodies; 169 with tubal; 129 with male factor; and 72 with unexplained etiology.

Intervention(s): All women were hyperstimulated with GnRH analogue and scheduled ovarian stimulation with FSH and hMG for oocyte retrieval.

Main Outcome Measure(s): Relationship of quality of transferred embryos, implantation rate and maternal age among four groups of infertile couples.

Result(s): In the antisperm group, the fertilization rate (57.6%) and mean (±SD) score of transferred embryos (5.4 ± 1.9) were significantly lower than those in the tubal group (72.4% and 6.2 ± 1.9, respectively). However, the implantation rate in the antisperm group (23.6%) was significantly higher than those in other three groups (tubal, 8.6%; male factor, 9.5%; unexplained, 7.6%). With advancing maternal age, the implantation rate decreased in the three comparative groups. In contrast, the implantation rate in the antisperm group did not decrease with advancing maternal age.

Conclusion(s): Women with antisperm antibodies have several disadvantages to overcome in order to achieve successful IVF-ET, such as a low fertilization rate and poor quality of transferred embryos. However, a high implantation rate was observed in this group, even in women at advanced age. The occurrence of a cellular or humoral immune reaction against sperm may augment the uterine receptivity for the implantation of fertilized ova or blastocyst.     

Present concept of unexplained infertility.

Despite improvements in both diagnostic assessment and treatment of infertile couples, many couples still have no explanation for their infertility. Unexplained infertility (the failure to conceive of a couple in whom no definitive cause for infertility can be found) has an incidence of 10-20% in all infertile couples. The incidence varies with the population studied and with the criteria used. Unexplained infertility is not an absolute condition but rather a relative inability to conceive, and many of these couples may conceive without treatment. The treatment options for unexplained infertility are several and the treatment results are promising. Expectant management can be recommended if the woman is under 28-30 years of age and the infertility duration is less than 2-3 years. In vitro fertilization (IVF) has revolutionized the treatment of infertile couples, as well as profoundly increasing the basic understanding of human reproduction. IVF can be used as both a diagnostic and a therapeutic tool in couples with unexplained infertility. The pregnancy rates with IVF are good, at 40% per treatment cycle. In addition, the outcome of pregnancies among women with unexplained infertility is generally comparable to that of spontaneous and other pregnancies using assisted reproductive technologies.     

Long-term prognosis of infertile couples with normal basic investigations: a life-table analysis

The long-term prognosis of 58 untreated infertile couples with normal medical histories and physical examinations, and normal basic infertility investigations, including biphasic basal body temperature, hysterosalpingogram, postcoital test, and semen analysis, was studied using life-table analysis. Of these women, 34% were pregnant by six months, 76% by two years, and 87% by five years. These rates of conception were found to be significantly higher than those found in a large infertile population (P = .001). However, compared with the ideal fertile population, the study group for the first two years had a significantly lower conception rate (P = .001). It required two years for the study group to achieve a 74% fertility rate, whereas only nine months were required for the fertile group to achieve the same rate. The individualized approach for investigating the infertile couple is stressed.     

Reappraisal of the postcoital test: a controlled study

The test results of 34 couples, who were previously infertile, in whom a postcoital test (PCT) was performed during the cycle of conception were compared to the scores obtained in a group of patients with cervical factor only infertility (N = 55). Both the mucus scores and number of motile progressive sperm were significantly (P less than 0.001) higher in the previously infertile group compared to those with the cervical factor infertility. The present study suggests that overall, during the cycle of conception, women have PCT scores which are higher than those with cervical factor infertility.