Family planning and psychosocial support for infertile couples

Aims The study was set up to analyze the psychological/emotional needs of women who undergo treatment for in vitro fertilization (IVF) and to emphasize the importance of the psychosocial support that family planning centers can provide to them.

Method?This was a cohort study with closed questions. A total of 235 infertile women participating in an IVF program were studied. The statistical analysis of the findings was conducted by the Statistical Package for Social Sciences.

Results?The psychosocial support and the scientific information provided to those women who participate in IVF programs are insufficient. In order to succeed in an IVF program, the women must be assisted by a doctor with much medical experience. The study shows that 59.3% of the women studied sought more medical information and another 32.5% sought emotional support. These percentages varied with reference to education, age and origin. These kinds of services must be provided by family planning centers.     

Effectiveness of a peer support intervention for antenatal depression: a feasibility study

ABSTRACT

Objective

A feasibility study for a randomised controlled trial to assess the acceptability, recruitment, feasibility and effectiveness of a peer support intervention for women with antenatal depression. The key premise of peer support is based upon the trust and empathetic understanding engendered by common experiences.     

Concerns about treatment for infertility in a probability-based sample of US women

ABSTRACT

Objective: Many women experience infertility as distressing, but only about half of US women seek medical services. It is unknown whether concerns about fertility treatment are related to receiving fertility treatment or to distress levels.

Methods: Using the nationally representative National Survey of Fertility Barriers, we constructed a nine-item scale measuring fertility treatment concerns. The analytical sample for this study included 1218 women who said that they were trying to become pregnant and who were asked questions regarding treatment concerns. We conducted multiple regression analysis to discover factors associated with treatment concerns and whether treatment concerns were associated with depressive symptoms and fertility-specific distress. We used logistic regression to determine whether treatment concerns were associated with receiving fertility tests.

Results: Desiring a(nother) child, infertility stigma, higher family income, higher economic hardship and claiming a Hispanic identity were associated with higher levels of treatment concerns than those in the comparison groups. Having friends and family with children and having private health insurance were associated with lower levels of concern. Treatment concerns were not associated with receiving fertility tests. Higher levels of treatment concern were associated with higher levels of fertility-specific distress and depressive symptoms. Higher infertility stigma was related both directly and indirectly to higher levels of fertility-specific distress and depressive symptoms.

Conclusion: For US women, fertility treatment concerns are not associated with whether women pursue fertility testing, but they are associated with higher levels of fertility-specific and general distress.     

Infertility support sought from local government: preliminary survey of needs among people who attended public lecture

Purpose

Support both from medical centers and from local government is indispensable to the growing number of infertile couples who are seeking treatment after advances in medical technology.

Methods

A self-administered questionnaire survey of the demand for infertility support was conducted among those who attended a public lecture offered by Aichi Prefecture, asking specifically about their requests for Aichi Prefectural government aid.

Results

The survey results indicated that information was obtained about financial support by administrative and infertility support programs in Aichi Prefecture. Because most people usually received this information at medical institutions, local government coordinated with medical institutions. Men and women were found to have different demands for infertility support—while women typically sought psychological support, for example counseling, men usually sought learning opportunities in study groups. In particular, women sought opportunities to interact with interested parties, which suggested that the establishment of peer activities would be a helpful form of support.

Conclusions

We need collaboration of government services with medical institutions, support, and investigation to form an infertility network that accepts sex differences.     

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.     

General psychopathology,anxiety, depression and self-esteem in couples undergoing infertility treatment: a comparative study between men and women

Objective

To compare measures of psychological distress between men and women undergoing ART in the Unit of Reproductive Medicine “UMR” in the Department of Obstetrics and Gynecology at “Farhat Hached” Hospital in Sousse, Tunisia.

Study design

We conducted a gender comparative study of psychological profile in infertile couples. Recruitment was done during period from January to May 2009. 100 infertile couples with primary infertility were recruited. Scores of general psychopathology, depression, anxiety and self-esteem were evaluated. We administrated questionnaires on psychological factors among infertile couples before starting a new infertility treatment cycle. Psychological factors included the symptom check-list (SCL-90-R), the hospital anxiety and depression scale (HAD-S) and the Rosenberg self-esteem scale (RSE).

Result(s)

Infertile women had higher scores than their spouses in the three global scores of the SCL-90-R and in several items such as somatisation, obsessive symptoms, interpersonal sensitivity and phobias. Scores of HADS were higher among women for both depression and anxiety. Scores of self-esteem were lower among women.

Conclusion(s)

Women endorsed higher psychological distress than men across multiple symptoms domains: general psychopathology, anxiety, depression and self esteem.     

Chlamydia trachomatis in subfertile couples undergoing an in vitro fertilization program: a prospective study

OBJECTIVES: The objectives were to estimate the prevalence of Chlamydia trachomatis infection in subfertile couples and to study the relationship between markers of C. trachomatis infection and male infertility as well as pregnancy rates after in vitro fertilization (IVF). STUDY DESIGN: All consecutive couples consulting for infertility and IVF in Pellegrin Hospital were screened for C. trachomatis by direct (PCR test) and serological methods. RESULTS: Two hundred and seventy-seven couples were included in the study (mean age in years: 35 for men, 32 for women; mean duration of infertility: 4 years). The most frequent indication for IVF was tubal factor in 33%, endometriosis in 6%, dysovarian function in 12%, male infertility in 36% and others in 13%. C. trachomatis PCR was positive in 1.2% of men, 95% confidence interval (CI95%): (0.2%; 3.3%) and in 2.7% of women, CI95%: (1.1%; 5.5%). When combining all chlamydial markers, 17.3% of men, CI95%: (12.7%; 22.8%) and 20.4% of women, CI95%: (15.6%; 25.9%) had at least one positive marker. The presence of positive markers was not associated with altered semen characteristics. Couples with positive markers had a pregnancy rate of 23.1% (12 out of 52) compared with 20.2% (24 out of 119) among those with negative markers. CONCLUSION: In this population, the presence of past or current C. trachomatis infection was associated with neither semen characteristics nor outcome of IVF in subfertile couples.     

Effects of infertility on gender differences in marital relationship and quality of life: a case-control study of Turkish couples

Objectives

Although there are many studies trying to evaluate the effect of infertility on marital relations (MR) and quality of life (QoL) in developed counties, there have been no studies in Turkey. As in many societies around the world, lack of pregnancy and the resulting childlessness are often highly stigmatized, leading to profound social suffering for infertile couples in Turkey.

Study Design

This study was planned as a case–control study in order to investigate the effects of infertility on MR and QoL. It was conducted among 58 primary infertile and 51 fertile couples. The Dyadic Adjustment Scale (DAS) and the World Health Organization QoL Scale (WHOQOL-BREF) were applied at the infertility department of the Istanbul University's faculty of medicine. The t-test, Mann–Whitney U, ANOVA and Pearson's correlation coefficient were used.

Results

The socio-demographic properties were similar for both groups. The QoL average score was higher for the infertile group. There were no gender differences in QoL for infertile couples. The total DAS score was higher than the cut-off score for both groups (114.44 ± 18.53 for infertile, 110.29 ± 18.28 for fertile couples; p > 0.05). Infertile women's DAS and QoL scores were higher than the fertile women's (p < 0.05). Other than in the social domain, all QoL scores were higher for infertile men than fertile men (p < 0.05). There was a positive correlation between the DAS and QoL scores.

Conclusions

It was determined that infertility did not have a negative impact on MR and QoL measurements. There were no gender differences.     

Experiences with a specific screening instrument to identify psychosocial support needs in breast cancer patients

Objective

In order to determine the need for professional psychosocial support in breast cancer patients, we used the physician-administered Basic Documentation for Psycho-Oncology (PO-Bado), which is an expert rating scale containing 12 items belonging to somatic and psychological problems. Furthermore, we investigated sociodemographic and medical predictors of somatic and psychological distress and need for psychosocial support.

Study design

From 2/2005 to 09/2007, n = 333 consecutive patients with breast cancer were included in the study. The majority of the patients suffered from early-stage breast cancer. The mean age of the participants was 59.9 years (SD = 12.6, range 24–92). Two physicians rated patients’ psychosocial distress and evaluated their need for psychosocial support according to the PO-Bado guidelines.

Results

Exhaustion/tiredness was the item rated highest in the physical distress dimension. In the psychological distress dimension, the items anxiety/worries/tension and grief/despondency/depression obtained the highest mean. Younger age and a history of psychiatric/psychotherapeutic treatment in the past were associated with higher current distress. Women who planned to undergo mastectomy were rated as showing more somatic distress than women for whom breast conserving therapy was planned, but the two groups did not differ with regard to psychological distress. Objective cancer-related variables (tumour size and grading) were not associated with distress. Need for professional psychosocial support was seen in 23% of the patients. Previous psychiatric/psychotherapeutic treatment was the only variable associated with current need for psychosocial support. Forty-six percent of the patients with need for psychosocial support accepted the counselling offered.

Conclusions

The structured assessment of breast cancer patients’ psychosocial distress with the interviewer-administered PO-Bado assists the physician to arrive at a detailed expert evaluation. This might help to improve the psychosocial care of breast cancer patients.     

Assessing infertility-related stress: the factor structure of the Fertility Problem Inventory in Italian couples undergoing infertility treatment

Abstract

The factor structure of the Fertility Problem Inventory (FPI) and its invariance across gender were examined in Italian couples undergoing infertility treatment. About 1000 subjects (both partners of 500 couples) completed two questionnaires prior to commencing infertility treatment at a private Clinic in Palermo, Italy. Confirmatory Factor Analysis demonstrated that the original factor structure of the FPI was partially confirmed. Two correlated factors (Infertility Life Domains and Importance of Parenthood) were obtained via a post hoc Exploratory Factor Analysis. Finally, the invariance of this factor structure across gender was confirmed. The study supported the relevance of two interrelated factors specific to infertility stress which could help clinicians to focus on the core infertility-related stress domains of infertile couples.     

Communicating social support online: a new classification dichotomy for exploring coping in interaction concerning infertility

Objective: This study explores how social support is utilised in the context of an online infertility support group. Background: Social support is often studied to decipher how those with health concerns cope through communication and interaction. Method: Online socially supportive messages (N = 200) were examined using a hybrid approach (i.e. deductive and inductive) to thematic analysis. Results: Analysis developed a dichotomy of social support (i.e. normative and transformative themes). This dichotomy creates a new theoretical framework for evaluating social support with implications for cognitive coping strategy. The normative and emotional themes were the most frequently represented in the studied context demonstrating overall network-level positivity. Messages did not demonstrate tangible support. Conclusion: Expected characteristics of emotional and informational support were demonstrated, but the forum included no tangible support. The support messages also possessed latent characteristics that should be further studied to understand implications for forum participant coping.     

Patient-centered infertility care from an Arab perspective: A review study

Background

Patient-centeredness was listed as the sixth quality element by the Institute of Medicine in 2001. Cultural differences should be acknowledged when defining patient-centeredness. Although there are numerous sources of literature that studied patient-centered infertility care, few include members of the Arab population.

Condition,disease, disability: how the label used to describe infertility may affect public support for fertility treatment coverage

Journal of Assisted Reproduction and Genetics - To assess public attitudes towards fertility treatment coverage and whether attitudes are influenced by infertility labels. Cross-sectional, web...     

Endurance with partnership: a preliminary conceptual framework for couples undergoing in vitro fertilisation treatment

Background/objectives: Infertility affects both women and men in the physical, emotional, existential, and interpersonal realms. When couples seek in vitro fertilisation (IVF) treatment, they further suffer from the difficulties of the treatment and the uncertainty of its outcome. The aim of this study was to develop a preliminary conceptual framework for couples undergoing IVF treatment to give health professionals a better understanding of the experiences of such couples, and to guide the development of an intervention.

Methods: The process of identifying frameworks adopted in intervention studies confirmed that there is no established framework for infertile couples undergoing IVF treatment. A skeletal framework identified from previous studies provides an internal structure for the proposed framework for couples undergoing IVF treatment, filled out with concepts drawn from a concept analysis and a qualitative study, knitting the structure together.

Results: This preliminary framework is the Endurance with Partnership Conceptual Framework (P-EPCF). It consists of four domains: the impacts of infertility and stressors, dyadic mediators, dyadic moderators and dyadic outcomes. According to the P-EPCF, the impacts of infertility and IVF treatment can be mediated by the couples’ partnership and dyadic coping. Improvements in the psychological well-being and marital functioning of IVF couples can then be expected.

Conclusions: The P-EPCF would be potentially valuable in guiding the development of a complex, couple-based intervention, which could focus on enhancing the partnership of couples and their coping strategies.     

Women want proactive psychosocial support from midwives during transition to motherhood: a qualitative study

Objective

to explore low-risk pregnant women's views on their preferences for psychosocial support from midwives during their transition to motherhood.

Design

a qualitative design with focus-group interviews and thematic analysis of the discussions.

Settings and respondents

21 Dutch participants were included in three focus groups. Groups 1 (n=7) and 3 (n=8) consisted of pregnant women from four semi-urban midwifery practices, and group 2 (n=6) included participants from three urban midwifery practices.

Findings

the women wanted to take responsibility for their own well-being during pregnancy. In addition to informal support, they explicitly expressed a need for professional support from their midwives when undergoing the transition to motherhood. They wanted informational and emotional support from their midwives that addressed psychological and physical changes during pregnancy. They expressed a strong desire to be informed during pregnancy of how to prepare physically and psychologically for birth, recovery and motherhood. They also wanted help with sifting and interpreting information and, ultimately, wanted to make their own choices.

Key conclusions and implications for practice

during their transition to motherhood, healthy low-risk pregnant women want attentive, proactive, professional psychosocial support from midwives. They expect their midwives to oversee the transition period and to be capable of supporting them in dealing with changes in pregnancy and in preparing for birth and motherhood.     

Luteal phase support with progesterone in intrauterine insemination: a prospective randomized study

Objective: To determine the effect of vaginal progesterone as luteal support on pregnancy outcomes in infertile patients who undergo ovulation induction with gonadotropins and intrauterine insemination (IUI). Design: Prospective randomized trial. Setting: Tertiary referral center. Patient(s): About 398 patients with primary infertility were treated during 893 ovarian stimulation and IUI cycles from February 2010 to September 2012. Methods: All patients underwent ovarian stimulation with gonadotropins combined with IUI. Patients in the supported group received vaginal micronized progesterone capsules 200?mg once daily from the day after insemination until next menstruation or continuing for up to 8 weeks of pregnancy. Women allocated in the control group did not receive luteal phase support. Main outcome measure(s): Livebirth rate, clinical pregnancy rate and early miscarriage rate per cycle. Result(s): Of the 893 cycles, a total of 111 clinical pregnancies occurred. There were no significant differences between supported with progesterone and unsupported cycle in terms of livebirth rate (10.2% versus 8.3%, respectively, with a p value?=?0.874) and clinical pregnancy rate (13.8% compared with 11.0% in unsupported cycle with a p value?=?0.248). An early miscarriage rate of 3.6% was observed in the supported cycles and 2.7% in the unsupported cycles, with no significant differences between the groups (p value?=?0.874). Conclusion(s): In infertile patients treated with mildly ovarian stimulation with recombinant gonadotropins and IUI, luteal phase support with vaginal progesterone is not associated with higher livebirth rate or clinical pregnancy rate compared with patients who did not receive any luteal phase support.     

The mind/body program for infertility: a new behavioral treatment approach for women with infertility

There is increasing evidence that a behavioral treatment approach might be efficacious in the treatment of the emotional aspects of infertility and may lead to increased conception rates. The first 54 women to complete a behavioral treatment program based on the elicitation of the relaxation response showed statistically significant decreases in anxiety, depression, and fatigue as well as increases in vigor. In addition, 34% of these women became pregnant within 6 months of completing the program. These findings established a role for stress reduction in the long-term treatment of infertility. They further suggest that behavioral treatment should be considered for couples with infertility before or in conjunction with reproductive technologies such as intrauterine insemination and gamete intrafallopian transfer.