Is fertility-problem stress different? The dynamics of stress in fertile and infertile couples.

OBJECTIVE: To compare the dynamics of fertility-problem stress experienced by wives and husbands in infertile couples with the dynamics of stress from other sources experienced by members of couples presumed to be fertile. DESIGN: Relationships of stress to four marriage factors and four aspects of life quality (subjective well-being) are examined within a causal modeling framework using data from structured interviews. SETTING: Face-to-face interviews were conducted in study participants' homes. PARTICIPANTS: Wives and husbands from 157 couples with primary infertility and from 82 presumed-fertile couples were studied. MAIN OUTCOME MEASURES: Final outcome measures were four multi-item scales assessing life quality with regard to the marriage, own self-efficacy, own health and appearance, and life as a whole. Intervening outcome scales measured four marriage factors: marital conflict, sexual self-esteem, sexual dissatisfaction, and frequency of intercourse. RESULTS AND CONCLUSIONS: Higher levels of stress, regardless of whether that stress was from attempting to solve a fertility problem or another problem, were related to reduced marital functioning and decreased life quality. For husbands, the strengths of the linkages did not depend on the source of the stress. For wives, however, the causal model suggested that fertility-problem stress had stronger negative impacts on sense of sexual identity and self-efficacy than did stress from other problems (P less than 0.05). Stress from any source had more impact on the lives of wives than of husbands, more impact on satisfaction with self and general well-being than on satisfaction with the marriage or health, and affected life quality mostly indirectly through its impacts on the marriage factors.     

Gender Differences and Perceptions About Childbearing Among Infertile couples

Objective: To explore gender dierences and responses of in fertile couples to childbearing issues.
Design: Data analysis from the first wave of a larger three wave prospective panel study. Face-to-face tnterviews with both husbands and wives were conducted.
Setting: Husbands and wives were interviewed separately in their homes. One was generally interviewed immediately after the other.
Participants: One hundred sixty-one infert ile couples in southeastern Michigan were interviewed in 1988.
Measures: Variables of interest included the self recognized source of the fertility problem, the tmportance of children to individuals, stress associated with infertility treatment, the number of tests and treatments received, the acceptabiltty of indicated treatments, the length of time couples expected it would take to have a child, and the ideal and expected number of children.
Results: Women experienced signijcantly more stress from tests and treatment, placed greater importance on havtng children, were more accepting of indicated treatments, and wanted more children than men did.
Conclusions: Implications for nurses working with in fertile couples are discussed, including provision of emotional support, evaluation of perceptions of success, assessment of couples' expectations, and inclusion of husbands in decision making.     

Outcomes of Father Involvement in Pregnancy and Birth

: To test the assumption that father involvement in pregnancy and childbirth results in more positive birth and fathering experiences, 40 primiparous couples recruited from childbirth education classes and obstetricians were studied. About two weeks before their due dates each mother was asked to rate her marital closeness and her husband's interest in children. These couples were observed for one hour in mid-labor. Then mothers and fathers were interviewed about one week after the birth. Fathers who were more involved in terms of their wives’ reports of prenatal marital closeness gave generally more positive reports of the delivery and the new baby. Fathers who were involved in terms of their wives’ estimates of their interest in children were rated by observers as interacting with their wives less during labor. (BIRTH 10:1, Spring 1983)     

The development of infections of the genitourinary tract in the wives of infertile males and the possible role of spermatozoa in the development of salpingitis

Genitourinary tract infections developing in wives during marital life in 1,350 infertile couples were examined. Women married to men with a history of genital tract infection had a significantly higher incidence of vaginitis, urinary tract infection, salpingitis and genital herpes when compared with women whose husbands did not have genital tract infections before the marriage. Of the variables examined, the two factors that showed the most significant association with the tendency to develop salpingitis were the sperm count and the length of time the couple had been trying to achieve a pregnancy. The wives of azoospermic males did not have pelvic inflammatory disease develop but had the same incidence of infection of the lower part of the genital tract as the other studied groups. It is suggested that the bacterial flora of the seminal fluid can play a role in developing salpingitis in the female and that spermatozoa may be involved in delivering bacteria to the higher genital tract structures.     

Exploring couple attributes and attitudes and marital violence in Vietnam

Using a couple-centered approach, this study focuses on the relative attributes and attitudes of spouses as predictors of marital violence. Analysis of data from Vietnam showed that 37% of married women have ever been hit by their husbands. Regression results found that husbands with lower resources or status than their wives were more likely to have abused. Results also found that the association between husbands' gender attitudes and marital violence depends on the level of equity of wives'attitudes. The decline in violence among couples in which husbands expressed gender equitable attitudes was greater when wives also expressed equitable attitudes.     

Depression in primary versus secondary infertility egg recipients

Women with primary infertility and their husbands were significantly more depressed than women with secondary infertility and their husbands, and the difference in levels of depression of women compared with their husbands was significantly greater for primary than for secondary infertility. Depressive symptomology for childless individuals is greater for wives than for their husbands.     

Psychological aspects of donor insemination: evaluation and follow-up of recipient couples.

OBJECTIVE: To evaluate the utility of psychological screening for couples entering a donor insemination program. DESIGN: Each spouse completed questionnaires. A psychologist reviewed them and rated the psychological fitness of the couple for participation in the program. Follow-up questionnaires were sent to each couple at a mean of 11 months after entry into the program. SETTING: Applicants for donor insemination were studied in an infertility program in a large, tertiary referral center. PATIENTS, PARTICIPANTS: Consecutive applicants to enter the donor insemination program were required to participate in the initial evaluation. INTERVENTIONS: Couples judged by the psychologist to be at risk for a poor psychological outcome had an assessment and counseling interview with the psychologist before proceeding with insemination. MAIN OUTCOME MEASURES: Initially, the Stress and Infertility Questionnaire measured specific anxieties related to donor insemination, marital and sexual impact, and attitudes about confidentiality; the Brief Symptom Inventory measured psychological distress; and the Dyadic Adjustment Inventory assessed marital satisfaction. At follow-up, 48% of couples returned a modified version of the Stress and Infertility Questionnaire and the other two questionnaires. RESULTS: The psychologist's rating was predictive of pregnancy rates (59% for excellent candidates, 41% for acceptable couples, and 14% for couples psychologically at risk). At-risk couples were more likely to drop out of the program (50% versus only 20% of other couples). Sexual problems were reported by 59% of women and 53% of men. Couples believed that a child should not be told of the donor insemination (74% of wives and 80% of husbands). Initially, 64% of wives and 70% of husbands chose total secrecy with families or friends, and these attitudes shifted little over time. CONCLUSION: This screening procedure is cost-effective and suggests that psychological intervention should be attempted with at-risk couples.     

Mixed lymphocyte culture responses in infertile couples.

Twenty couples suffering from unexplained infertility have been tested in mixed leucocyte culture to determine if the wives were preimmunized against their husbands. The wives were tested against their husbands and four unrelated persons, and thymidine incorporation was measured on the third and fifth days of culture. No evidence was found that would indicate a preimmunization of the wife against her husband as an explanation for their infertility. A slight MLC stimulatory capacity was found in sera from infertile women.     

The pregnant couple

Although the husband's reactions to and feelings about his wife's pregnancy are frequently overlooked, his wife is always concerned about his perception of her. She often feels unattractive and is most interested in how satisfied her husband is with her pregnant body. The present study attempts to determine whether the husband or wife viewed the wife's body more positively, whether the husbands and wives could accurately predict each other's satisfaction or dissatisfaction with the pregnant body, and whether husbands' and wives' attitudes about important perinatal issues differed significantly. The data were analyzed by multivariate analysis of variance, comparing the husbands' and wives' satisfaction or dissatisfaction with the pregnant body. The body cathexis scale was used to measure such satisfaction and Osgood's semantic differential measured attitudes toward "pregnancy", "spouse", "unborn baby", and "labor and delivery". Findings show that husbands were more satisfied with their wives' pregnant bodies than the wives themselves were. The wives were not able to predict their husbands' levels of satisfaction, although the men accurately predicted their wives' responses. Husbands also tended to hold more positive attitudes toward perinatal issues.     

Sperm-agglutinating antibodies in 236 infertile couples

19 wives of 236 couples had positive sperm agglutination tests. (SPAT) 6 of the 19 belonged to the 70 couples (9.4%) with no no known cause for infertility; 11 belonged to the group of 154 couples (7.1%) with a known cause; and 2 to the 12 couples inadequately investigated (15.7%). 6 of these 19 women (31.6%) became pregnant without condon therapy; of these 6, 3 had no known cause for infertility and 3 had a known cause. 11 husbands had positive sperm aggluatination tests. 4 of these 11 were among the 70 couples (5.6%) with no known cause for infertility, while the other 7 were among the 154 couples (4.5%) with a known cause. 5 of their wives (45.5%) became pregnant without any treatment. Outcomes of 8 of 11 pregnancies were normal deliveries and no abortioons, which showed that positive SPAT had no apparent effect on the pregnancies. There was no relationship between postitive SPAT and history of venereal disease, allergy, autoimmune disease, abortioon, postcoital tests, or ABO imcompatability.     

上海市区新婚夫妇生育计划及其变化分析

本文通过对上海市区7,872对新婚夫妇的前瞻性调查,分析新婚夫妇在结婚登记和开始正常性生活时的生育计划及其变化的决定因素。结果显示,半数以上的夫妇于结婚登记一个月以后才开始正常性生活,在结婚登记时,有43.4%夫妇表示婚后不打算避孕,56.6%表示将使用避孕以推迟受孕时间。到正常性生活开始时,有25.5%的夫妇改变了原来的生育计划,15.2%提前了受孕时间,10.3%推迟了受孕时间。多因素Logistic回归分析结果表明,结婚登记与开始正常性生活间隔时间较长、夫妇初婚年龄较轻及妻子的避孕知识较贫乏、则夫妇容易改变生育计划。妻子避孕知识较丰富、夫妇初婚年龄较大、丈夫有兄弟、妻子是脑力劳动者、婚前接受过正规性教育及没有婚前性行为的夫妇,容易推迟其生育计划。     

育龄妇女婚前及婚后药物流产的利用及并发症情况的分析

目的:了解育龄妇女婚前、婚后对药物流产的利用情况及其并发症发生情况。方法:对北京、上海、成都3个中心因怀孕而在妇产科门诊就诊的妇女进行调查,内容包括一般人口学特征、药物流产史、药物流产相关健康结局等,共获得有1次药物流产史的妇女4931名。结果:婚前、婚后进行药物流产的对象比例分别为44.76%和55.24%,婚前药流者具有年龄较轻、文化程度偏低、选择在私人诊所进行药流的比例较高、孕周在7周以上者较多等特点。在调整了流产时的年龄、受教育程度、药流地点、流产时的孕周等因素后,婚前、婚后药物流产者流产后刮宫率、并发症发生率差异无统计学意义,OR值分别为0.94(0.81-1.08)和0.94(0.78-1.13)。结论:婚前药物流产者在年龄、药流地点、药流时孕周等方面具有一些与不良结局相关的特征,但未观察到婚姻状况与药物流产相关并发症的发生有关。     

Psychological status of in vitro fertilization patients during pregnancy: a longitudinal study

Objective: To determine whether women who get pregnant as a result of IVF differ psychologically from pregnant women who conceived naturally.

Design: Prospective, longitudinal study.

Setting: Healthy volunteers from outpatient infertility and obstetrics practices.

Patient(s): Seventy-four women who became pregnant via IVF and 40 women conceiving without medical intervention.

Intervention(s): Subjects completed self-report questionnaires about demographic and reproductive history, rewards and concerns of pregnancy, self-esteem, marital adjustment, depressive symptoms, and anxiety at 12 and 28 weeks’ gestational age.

Main Outcome Measure(s): Self-esteem, depression, and anxiety scores.

Result(s): There were no significant differences between groups on any of the outcome measures assessing psychological status at the two assessment times. Differences were found on specific items assessing the rewards and concerns of pregnancy. Within-group changes over time indicated that IVF women, not controls, showed an increase in self-esteem and a decrease in anxiety during pregnancy.

Conclusion(s): Pregnant IVF women are similar psychologically to women who become pregnant naturally on dimensions of self-esteem, depression, and anxiety at 12 and 28 weeks’ gestational age. The IVF group, not controls, reported improved self-esteem and decreased anxiety as the pregnancy progressed.     

Involuntary childlessness among the Shangana (Mozambique)

Although Mozambique's infertility prevalence is one of the highest in southern Africa, there are very few studies on the subject. Anthropological research carried out from September 2001 to February 2002 in the rural area of the Magude district revealed various cultural and behavioural patterns relevant to the problem of childlessness. These patterns are related to the sexual and marital norms of polygyny and to the system of patrilineality. Patrilineal descent, polygamy and massive male labour migration to South Africa have created a contradictory mix of situations involving women and their reproductive role in society. The pressure on women to become pregnant and give birth, combined with the prolonged absence of their migrant husbands, leads them into conditions of vulnerability, which impel them to seek partners outside the marriage in order to conceive. In this context, extra‐conjugal relations constitute the main channel for STDs, which are a major cause of infertility.     

Fathers' functional status during pregnancy and the early postnatal period

Objective

to determine the functional status of fathers whose wives were pregnant or in the early postnatal period.

Sample and setting

the research population comprised 3750 fathers whose wives were pregnant or in the early postnatal period, and who were registered at a primary health clinic in the province centre. The research sample comprised 275 husbands of women who were registered at these clinics and who were in at least their 28th week of a normal (not at-risk) pregnancy with a single fetus, or who were in the early postnatal period (6–8 weeks postnatal) following birth of a single baby between the 38th and 42nd week without complications. Due to fathers declining to participate in the study or unable to participate because of busy work schedules, the research was completed with 155 fathers-to-be and 93 fathers; in total, 90% of the target sample was reached. A sociodemographic survey and the Inventory of Functional Status—Fathers were used for data collection and to describe the functional abilities of fathers-to-be and fathers.

Findings

no statistically significant differences were found in functional status between the husbands of pregnant women and the husbands of women in the early postnatal period. Number of pregnancies was not significantly related to any of the seven subscales of fathers’ functional status; age of husband, length of marriage and occupation of wife were significantly related to one subscale; occupation of husband and health insurance were significantly related to two subscales; income status of husband and educational level of wife were significantly related to three subscales; and educational level of husband was significantly related to four subscales.

Conclusion

although there was no significant difference in functional status for the husbands of pregnant women and the husbands of postnatal women, sociodemographic factors were found to have an effect.     

不育夫妇的心理状态分析

对６５２例不盲妇女和其中４２５例妇女的丈夫进行心理咨询调查。结果显示：８０．０％以上的夫妇承受着不育所致的各种心理压力，最普遍的心情是不甘认可。女方的压力略显严重，但与其丈夫间差异无显著性。然而男方对这种精神压力的自我调节能力明显优于女方。对不育治疗的信心及预后的态度，男女比较差异尤显著性。农民和文化水平较低的不育夫妇心理压力更大。不育使１２．０％～１５．０％的夫妇性生活受到影响，７．０％～８．０％婚姻关系恶化甚至濒临破裂，８．６％因不育而家庭关系紧张。约３０．０％的妇女表示不育检查和治疗过程本身亦带来一定的精神紧张和心理负担。提示：对要求治疗的不育夫妇，除药物治疗外．精神上的同情理解及心理支持，是不可忽视的。     

Thyroid disease and female reproduction

Objective: To review the menstrual function and fertility in thyroid disease, mainly in hyperthyroidism and hypothyroidism. Also to register the consequences of ¹³¹I therapy, which is used widely in the treatment of Graves’ disease and thyroid cancer, on subsequent pregnancies and on fertility in these patients.

Design: A MEDLINE computer search was used to identify relevant studies. The type of menstrual disturbances and the status of fertility were recorded from all the studies found. Also, the fertility and genetic hazard of female patients with Graves’ disease and thyroid cancer who were treated with ¹³¹I were registered.

Result(s): Both hyperthyroidism and hypothyroidism may result in menstrual disturbances. Menstrual abnormalities are less common now than in previous series. In a recent study, we found that only 21.5% of 214 thyrotoxic patients had some type of menstrual disturbance, compared to 50 to 60% in some older series. The most common manifestations are hypomenorrhea and oligomenorrhea. According to the results of endometrial biopsies, most thyrotoxic women remain ovulatory. Moreover, the genetic hazard incident to radioiodine therapy in Graves’ disease and thyroid carcinoma is very small; exposure to ¹³¹I does not cause reduced fecundity, and the risk of loss of fertility is not a contraindication for its use in these patients. mIn hypothyroidism, the frequency of menstrual irregularities has very recently been reported to be 23.4% among 171 hypothyroid patients studied. This is much less than that reported in previous studies, which showed that 50 to 70% of hypothyroid female patients had menstrual abnormalities. The most common manifestation is oligomenorrhea. Severe hypothyroidism is commonly associated with failure of ovulation. Ovulation and conception can occur in mild hypothyroidism. These pregnancies are, however, often associated with abortions, stillbirths, or prematurity. The latter may be of greater clinical importance in infertile women with unexplained infertility.

Conclusion(s): These new data, mainly concerning menstrual abnormalities in hyperthyroidism and hypothyroidism, are inconsistent with what is generally believed and written in the classic thyroid textbooks and indicate that such opinions should be revised.     

Factors affecting the success of human blastocyst development and pregnancy following in vitro fertilization and embryo transfer

Objective: To determine the factors affecting blastocyst development and pregnancy after IVF and ET.

Design: Retrospective analysis of data arising from a clinical trial.

Setting: Private in vitro fertilization clinic.

Patient(s): Fifty-six patients aged ≤40 years, undergoing IVF procedures for infertility, recruited specifically for blastocyst transfer.

Intervention(s): All zygotes were cultured to days 5 or 6 after insemination, and one to four of the most advanced blastocysts were transferred to the patient’s uterus.

Main Outcome Measure(s): Development of zygotes to blastocysts in vitro and pregnancy and implantation rates after ET.

Result(s): Fifty-one percent of all zygotes developed to blastocysts. Significant positive correlation between the number of blastocysts formed was observed with the number of oocytes, pronuclear zygotes, and eight-cell embryos formed. There was a negative correlation with male factor infertility. By day 5 or 6, 93% of the patients had at least one blastocysts, and the clinical pregnancy rate per transfer was 43% and the implantation per embryo transferred was 25%. No other clinical factor significantly affected the number of blastocysts formed, pregnancy rate, or implantation rate.

Conclusion(s): The numbers of oocytes, zygotes, and normally developing embryos in culture significantly affects the production of blastocysts in vitro. Male infertility significantly reduces blastocyst production. The number and the quality of the blastocysts transferred significantly influences clinical pregnancy rate.