Post on 12-Jan-2016
description
Assisted Reproductive Technologies
Present – 1991 2013
Assisted Reproductive Technologies
Present – 1991 2013
Clinical developments and progress Novel laboratory techniques
Improvement in take home baby rates Reduction in multiple pregnancy rates ,Ethics, LawPsychologyPhilosophy &
of ART
Clinical developments and progress Novel laboratory techniques
Improvement in take home baby rates Reduction in multiple pregnancy rates Ethics, Law, Psychology & Philosophy
of ART
In Vitro Fertilization and the Right to Reproduce
In Vitro Fertilization and the Right to Reproduce
Suzzane Uniacke
Bioethics; 1:241-254, 1987
Suzzane Uniacke
Bioethics; 1:241-254, 1987
ConclusionsConclusions
The United Nations Declaration of Human Rights includes the right to found a family for women and men.It will seem greatly to strengthen the case of a particular procedure that it aims not simply to alleviate distress, but also to fulfill a fundamental human right.Robert Edwards and Patrick Steptoe have already cited the Declaration for men and women as a justification for their work
The United Nations Declaration of Human Rights includes the right to found a family for women and men.It will seem greatly to strengthen the case of a particular procedure that it aims not simply to alleviate distress, but also to fulfill a fundamental human right.Robert Edwards and Patrick Steptoe have already cited the Declaration for men and women as a justification for their work
Psychological Adjustment to Infertility and Psychological Adjustment to Infertility and its Treatment : Male and Female Responses its Treatment : Male and Female Responses
at Different Stages at IVF/ET Treatmentat Different Stages at IVF/ET Treatment
Beaurepaire J et alBeaurepaire J et al
J. Psychosom . Res. 38:229-240, 1994J. Psychosom . Res. 38:229-240, 1994
Psychological Adjustment to Infertility and Psychological Adjustment to Infertility and its Treatment : Male and Female Responses its Treatment : Male and Female Responses
at Different Stages at IVF/ET Treatmentat Different Stages at IVF/ET Treatment
Beaurepaire J et alBeaurepaire J et al
J. Psychosom . Res. 38:229-240, 1994J. Psychosom . Res. 38:229-240, 1994
ResultsResultsResultsResults
Study GroupsStudy GroupsStudy GroupsStudy Groups Anxiety & DepressionAnxiety & DepressionWomen MenWomen Men
Anxiety & DepressionAnxiety & DepressionWomen MenWomen Men
First IVF cycleFirst IVF cycle
(N= 113)(N= 113)
* * Repeat IVF cycleRepeat IVF cycle
(N= 217)(N= 217)
First IVF cycleFirst IVF cycle
(N= 113)(N= 113)
* * Repeat IVF cycleRepeat IVF cycle
(N= 217)(N= 217)
30%30%
25%25%
30%30%
25%25%
30%30%
15%15%
30%30%
15%15%
* Statistically significant* Statistically significant* Statistically significant* Statistically significant
ConclusionsConclusionsConclusionsConclusions
Evaluation of emotional distress in relationEvaluation of emotional distress in relationto stage of IVF / ET treatment cycle indicatedto stage of IVF / ET treatment cycle indicatedthat a major difficulty faced by both men andthat a major difficulty faced by both men andwomen regardless of stage of treatment waswomen regardless of stage of treatment wasanxietyanxiety. Anxiety is well known to occur in. Anxiety is well known to occur inresponse to perceived threat of some loss.response to perceived threat of some loss.It is not difficult to see this occurring withinIt is not difficult to see this occurring withinthe IVF / ET context (uncertainty of treatmentthe IVF / ET context (uncertainty of treatmentoutcome, physical reactions to drugs, juggling outcome, physical reactions to drugs, juggling the demands of career and treatment, etc.).the demands of career and treatment, etc.).Depression on the other hand results fromDepression on the other hand results fromactual loss !actual loss !
Evaluation of emotional distress in relationEvaluation of emotional distress in relationto stage of IVF / ET treatment cycle indicatedto stage of IVF / ET treatment cycle indicatedthat a major difficulty faced by both men andthat a major difficulty faced by both men andwomen regardless of stage of treatment waswomen regardless of stage of treatment wasanxietyanxiety. Anxiety is well known to occur in. Anxiety is well known to occur inresponse to perceived threat of some loss.response to perceived threat of some loss.It is not difficult to see this occurring withinIt is not difficult to see this occurring withinthe IVF / ET context (uncertainty of treatmentthe IVF / ET context (uncertainty of treatmentoutcome, physical reactions to drugs, juggling outcome, physical reactions to drugs, juggling the demands of career and treatment, etc.).the demands of career and treatment, etc.).Depression on the other hand results fromDepression on the other hand results fromactual loss !actual loss !
ConclusionsConclusionsConclusionsConclusions
Our study has attempted to move beyondOur study has attempted to move beyondevaluating male and female differences per se,evaluating male and female differences per se,to considering the context in which theseto considering the context in which thesedifferences may take on significance in termsdifferences may take on significance in termsof understanding the psychosocial adjustmentof understanding the psychosocial adjustmentof IVF couples. of IVF couples. Men and women differ in howMen and women differ in howthey cope, and there are differences inthey cope, and there are differences inpsychological states, dependent on the stagepsychological states, dependent on the stageof IVF treatment. These issues may haveof IVF treatment. These issues may haveimplications for psychological support in IVFimplications for psychological support in IVFtreatment programstreatment programs
Our study has attempted to move beyondOur study has attempted to move beyondevaluating male and female differences per se,evaluating male and female differences per se,to considering the context in which theseto considering the context in which thesedifferences may take on significance in termsdifferences may take on significance in termsof understanding the psychosocial adjustmentof understanding the psychosocial adjustmentof IVF couples. of IVF couples. Men and women differ in howMen and women differ in howthey cope, and there are differences inthey cope, and there are differences inpsychological states, dependent on the stagepsychological states, dependent on the stageof IVF treatment. These issues may haveof IVF treatment. These issues may haveimplications for psychological support in IVFimplications for psychological support in IVFtreatment programstreatment programs
Impact of the In - Vitro - FertilizationImpact of the In - Vitro - FertilizationProcess on Emotional, Physical and Process on Emotional, Physical and
Relational VariablesRelational Variables
Boivin J. et alBoivin J. et al
Human Reprod. 4:903-907, 1996Human Reprod. 4:903-907, 1996
Impact of the In - Vitro - FertilizationImpact of the In - Vitro - FertilizationProcess on Emotional, Physical and Process on Emotional, Physical and
Relational VariablesRelational Variables
Boivin J. et alBoivin J. et al
Human Reprod. 4:903-907, 1996Human Reprod. 4:903-907, 1996
Stress
Physical discomfortOptimism
Social support
Phase/StagePhase/StagePhase/StagePhase/Stage
0.20.2--0.20.2--
0.60.60.60.6
0.40.40.40.4
0.20.20.20.2
0000
Follicular/Follicular/StimulationStimulationFollicular/Follicular/
StimulationStimulationOvulatory/Ovulatory/Retrieval-Retrieval-TransferTransfer
Ovulatory/Ovulatory/Retrieval-Retrieval-TransferTransfer
Luteal/Luteal/Waiting Waiting PeriodPeriod
Luteal/Luteal/Waiting Waiting PeriodPeriod
Dif
fere
nce
Sco
reD
iffe
ren
ce S
core
Dif
fere
nce
Sco
reD
iffe
ren
ce S
core
Mean Difference Between In Vitro-Fertilization and No-Treatment Daily Mean Difference Between In Vitro-Fertilization and No-Treatment Daily Scores as a Function of the Phase-Stage of the Cycle and the Type of Reaction Scores as a Function of the Phase-Stage of the Cycle and the Type of Reaction
Mean Difference Between In Vitro-Fertilization and No-Treatment Daily Mean Difference Between In Vitro-Fertilization and No-Treatment Daily Scores as a Function of the Phase-Stage of the Cycle and the Type of Reaction Scores as a Function of the Phase-Stage of the Cycle and the Type of Reaction
ConclusionsConclusions
These findings suggest that the emotional These findings suggest that the emotional impact of IVF might be mostly pronounced impact of IVF might be mostly pronounced during the actual treatment process than is during the actual treatment process than is generally assumed from studies focusing generally assumed from studies focusing on the impact of treatment failure.on the impact of treatment failure.Variables such as optimism and physical Variables such as optimism and physical discomfort which have previously discomfort which have previously received less attention in the literature received less attention in the literature significantly affected IVF treatment significantly affected IVF treatment
These findings suggest that the emotional These findings suggest that the emotional impact of IVF might be mostly pronounced impact of IVF might be mostly pronounced during the actual treatment process than is during the actual treatment process than is generally assumed from studies focusing generally assumed from studies focusing on the impact of treatment failure.on the impact of treatment failure.Variables such as optimism and physical Variables such as optimism and physical discomfort which have previously discomfort which have previously received less attention in the literature received less attention in the literature significantly affected IVF treatment significantly affected IVF treatment
An Increased Vulnerability to Stress An Increased Vulnerability to Stress is Associated with a Poor Outcome of is Associated with a Poor Outcome of
IVF TreatmentIVF Treatment
Facchinetti F. et alFacchinetti F. et al
Fertil. Steril. 67:309-314, 1997Fertil. Steril. 67:309-314, 1997
An Increased Vulnerability to Stress An Increased Vulnerability to Stress is Associated with a Poor Outcome of is Associated with a Poor Outcome of
IVF TreatmentIVF Treatment
Facchinetti F. et alFacchinetti F. et al
Fertil. Steril. 67:309-314, 1997Fertil. Steril. 67:309-314, 1997
**EE22(pg/mL)(pg/mL)
**P (ng/mL)P (ng/mL)No. of folliclesNo. of folliclesMature oocytesMature oocytesFertilized oocytesFertilized oocytesETsETs
**EE22(pg/mL)(pg/mL)
**P (ng/mL)P (ng/mL)No. of folliclesNo. of folliclesMature oocytesMature oocytesFertilized oocytesFertilized oocytesETsETs
SuccessSuccess(n=16)(n=16)
SuccessSuccess(n=16)(n=16)
FailureFailure(n=33)(n=33)FailureFailure(n=33)(n=33)
PPPP
18471847++69691.81.8++1.31.3
10.910.9++5.45.42.3.2.3.++2.62.63.83.8++2.62.62.62.6++1.01.0
18471847++69691.81.8++1.31.3
10.910.9++5.45.42.3.2.3.++2.62.63.83.8++2.62.62.62.6++1.01.0
16361636++42421.61.6++1.21.29.49.4++7.27.21.8.1.8.++1.61.62.52.5++1.41.42.12.1++0.90.9
16361636++42421.61.6++1.21.29.49.4++7.27.21.8.1.8.++1.61.62.52.5++1.41.42.12.1++0.90.9
NS#NS#NSNSNSNSNSNS
0.0380.0380.0490.049
NS#NS#NSNSNSNSNSNS
0.0380.0380.0490.049
* Conversion factors to SI units are so follows: E2, 3.671;P, 3.180* Conversion factors to SI units are so follows: E2, 3.671;P, 3.180 NS#, not significantNS#, not significant* Conversion factors to SI units are so follows: E2, 3.671;P, 3.180* Conversion factors to SI units are so follows: E2, 3.671;P, 3.180 NS#, not significantNS#, not significant
Hormonal and Clinical Parameters in Patients Submitted to IVF-Hormonal and Clinical Parameters in Patients Submitted to IVF-ET Obtaining a Pregnancy (Success) or Not (Failure)ET Obtaining a Pregnancy (Success) or Not (Failure)
Hormonal and Clinical Parameters in Patients Submitted to IVF-Hormonal and Clinical Parameters in Patients Submitted to IVF-ET Obtaining a Pregnancy (Success) or Not (Failure)ET Obtaining a Pregnancy (Success) or Not (Failure)
No. of wordsNo. of wordsNo. of colorsNo. of colorsNo. of colors-wordsNo. of colors-wordsExpected CWExpected CWInterferenceInterference
No. of wordsNo. of wordsNo. of colorsNo. of colorsNo. of colors-wordsNo. of colors-wordsExpected CWExpected CWInterferenceInterference
SuccessSuccessSuccessSuccess FailureFailureFailureFailure PPPP
99.399.3++16.516.583.183.1++19.419.4
48.148.1++774444++6.66.64.14.1++4.84.8
99.399.3++16.516.583.183.1++19.419.4
48.148.1++774444++6.66.64.14.1++4.84.8
117.0117.0++14.314.377.377.3++13.413.449.449.4++8.38.346.2.46.2.++4.54.53.13.1++4.54.5
117.0117.0++14.314.377.377.3++13.413.449.449.4++8.38.346.2.46.2.++4.54.53.13.1++4.54.5
0.00040.0004NSNSNSNSNSNSNSNS
0.00040.0004NSNSNSNSNSNSNSNS
Values are means Values are means ++ SD SDValues are means Values are means ++ SD SD
Performance on the Stroop Color and Word Conflict in Women Becoming Pregnant (Success) or Not (Failure) After IVF-ET
Performance on the Stroop Color and Word Conflict in Women Becoming Pregnant (Success) or Not (Failure) After IVF-ET
Changes in SBP, DBP, and HR in infertile women submitted to the Stroop Color and Word Test . Patients showing a biochemical pregnancy are reported in soli lines, whereas patients failing to conceive are reported in dotted Lines.1st, 2nd, and 3rd, measurements made after reading the three sheets of the test. R measurements made 10 minutes after the end of testing
Changes in SBP, DBP, and HR in infertile women submitted to the Stroop Color and Word Test . Patients showing a biochemical pregnancy are reported in soli lines, whereas patients failing to conceive are reported in dotted Lines.1st, 2nd, and 3rd, measurements made after reading the three sheets of the test. R measurements made 10 minutes after the end of testing
5050
6060
7070
8080
9090
BaselineBaseline 2 nd2 ndsheetsheet
RecoveryRecovery
+
++
+
Diastolic Blood PressureDiastolic Blood PressuremmHgmmHgmmHgmmHg
100100100100
95959595
85858585
90909090
80808080
75757575
70707070BaselineBaseline 2 nd2 nd
sheetsheetRecoveryRecovery
+
+
+
Heart RateHeart Ratebeats / minbeats / minbeats / minbeats / min
130130130130
120120120120
110110110110
100100100100BaselineBaseline 1 st1 st 2 nd2 nd2 nd2 nd
sheetsheet3 rd3 rd RecoveryRecovery
+
Systolic Blood PressureSystolic Blood PressuremmHgmmHgmmHgmmHg
ResultsResultsResultsResults
1 st1 st 3 rd3 rd
1 st1 st 3 rd3 rd
140140140140
+Failure-Success
+Failure-Success
+Failure-Success
ConclusionsConclusions
The findings of the present study demonstrating a negative correlation between stress susceptibility and outcome of IVF-ET treatment. This gives further substantiation to the idea that programs of psychological support to infertile couples would increase the success of Assisted Reproduction Techniques
The findings of the present study demonstrating a negative correlation between stress susceptibility and outcome of IVF-ET treatment. This gives further substantiation to the idea that programs of psychological support to infertile couples would increase the success of Assisted Reproduction Techniques
Coping Style and Depression Level Coping Style and Depression Level Influence Outcome in In-vitro Influence Outcome in In-vitro
FertilizationFertilization
Demyttenaere K. et alDemyttenaere K. et al
Fertil. Steril. 69:1026-1033, 1998Fertil. Steril. 69:1026-1033, 1998
Coping Style and Depression Level Coping Style and Depression Level Influence Outcome in In-vitro Influence Outcome in In-vitro
FertilizationFertilization
Demyttenaere K. et alDemyttenaere K. et al
Fertil. Steril. 69:1026-1033, 1998Fertil. Steril. 69:1026-1033, 1998
Psychometric characteristicsPsychometric characteristics
Score(mean +SD)
Score(mean +SD)
Zung Depression ScaleUtrechtse Coping list Active coping Palliative coping Avoiding Social support seeking Depressive coping Expression of negative emotions Comforting ideas
Zung Depression ScaleUtrechtse Coping list Active coping Palliative coping Avoiding Social support seeking Depressive coping Expression of negative emotions Comforting ideas
52.5+9.8
17.8+2.918.5+3.315.2+3.215.2+3.711.8+2.66.4+1.6
13.6+2.4
52.5+9.8
17.8+2.918.5+3.315.2+3.215.2+3.711.8+2.66.4+1.6
13.6+2.4
Psychometric Characteristics (Zung Depression Scale and Psychometric Characteristics (Zung Depression Scale and Utrechtse Coping List) of the 98 Investigated WomenUtrechtse Coping List) of the 98 Investigated Women
Psychometric Characteristics (Zung Depression Scale and Psychometric Characteristics (Zung Depression Scale and Utrechtse Coping List) of the 98 Investigated WomenUtrechtse Coping List) of the 98 Investigated Women
Psychometric Psychometric variablevariable
Psychometric Psychometric variablevariable
IVF outcomeIVF outcomeIVF outcomeIVF outcome
Not pregnantNot pregnant(n=75)(n=75)
Not pregnantNot pregnant(n=75)(n=75)
PregnantPregnant(n=23)(n=23)
PregnantPregnant(n=23)(n=23) tt -test -testtt -test -test P valueP valueP valueP value
Zung Depression ScaleZung Depression ScaleUtrechtse Coping listUtrechtse Coping list Active coping scoreActive coping score Palliative coping scorePalliative coping score Avoiding scoreAvoiding score Social support seekingSocial support seeking scorescore Depressive coping scoreDepressive coping score Expression of negative Expression of negative emotions scoreemotions score Comforting ideas scoreComforting ideas score
Zung Depression ScaleZung Depression ScaleUtrechtse Coping listUtrechtse Coping list Active coping scoreActive coping score Palliative coping scorePalliative coping score Avoiding scoreAvoiding score Social support seekingSocial support seeking scorescore Depressive coping scoreDepressive coping score Expression of negative Expression of negative emotions scoreemotions score Comforting ideas scoreComforting ideas score
52.452.4++10.110.1
17.817.8++2.82.818.118.1++3.13.115.115.1++3.13.115.215.2++3.73.7
1.81.8++2.52.56.66.6++1.51.5
13.513.5++2.52.5
52.452.4++10.110.1
17.817.8++2.82.818.118.1++3.13.115.115.1++3.13.115.215.2++3.73.7
1.81.8++2.52.56.66.6++1.51.5
13.513.5++2.52.5
52.852.8++8.88.8
17.817.8++3.53.519.819.8++3.63.615.415.4++3.43.415.315.3++3.63.6
11.511.5++2.92.95.75.7++1.61.6
13.913.9++2.12.1
52.852.8++8.88.8
17.817.8++3.53.519.819.8++3.63.615.415.4++3.43.415.315.3++3.63.6
11.511.5++2.92.95.75.7++1.61.6
13.913.9++2.12.1
-0.19-0.19
-0.03-0.03-2.17-2.17-0.36-0.36-0.17-0.17
0.390.392.442.44
-0.64-0.64
-0.19-0.19
-0.03-0.03-2.17-2.17-0.36-0.36-0.17-0.17
0.390.392.442.44
-0.64-0.64
0.850.85
0.970.970.030.030.720.720.870.87
0.700.700.010.01
0.520.52
0.850.85
0.970.970.030.030.720.720.870.87
0.700.700.010.01
0.520.52
Note: The scores are given as means Note: The scores are given as means ++SDSDNote: The scores are given as means Note: The scores are given as means ++SDSD
Psychometric Variables (Zung Depression Scale and Utrechtse Coping List) in the Total Study Group (n=98)
According to IVF Outcome
Psychometric Variables (Zung Depression Scale and Utrechtse Coping List) in the Total Study Group (n=98)
According to IVF Outcome
Psychometric Psychometric variablevariable
Psychometric Psychometric variablevariable
IVF outcomeIVF outcomeIVF outcomeIVF outcome
Not pregnantNot pregnant(n=32)(n=32)
Not pregnantNot pregnant(n=32)(n=32)
PregnantPregnant(n=7)(n=7)
PregnantPregnant(n=7)(n=7) tt -test -testtt -test -test
Zung Depression ScaleZung Depression ScaleUtrechtse Coping listUtrechtse Coping list Active coping scoreActive coping score Palliative coping scorePalliative coping score Avoiding scoreAvoiding score Social support seekingSocial support seeking scorescore Depressive coping scoreDepressive coping score Expression of negative Expression of negative emotions scoreemotions score Comforting ideas scoreComforting ideas score
Zung Depression ScaleZung Depression ScaleUtrechtse Coping listUtrechtse Coping list Active coping scoreActive coping score Palliative coping scorePalliative coping score Avoiding scoreAvoiding score Social support seekingSocial support seeking scorescore Depressive coping scoreDepressive coping score Expression of negative Expression of negative emotions scoreemotions score Comforting ideas scoreComforting ideas score
54.754.7++9.39.3
17.717.7++3.13.118.318.3++3.63.615.815.8++3.33.314.814.8++3.63.6
13.213.2++2.42.46.86.8++1.31.3
13.713.7++2.52.5
54.754.7++9.39.3
17.717.7++3.13.118.318.3++3.63.615.815.8++3.33.314.814.8++3.63.6
13.213.2++2.42.46.86.8++1.31.3
13.713.7++2.52.5
46.746.7++6.06.0
17.617.6++4.24.218.618.6++3.63.616.816.8++1.91.914.614.6++4.44.4
10.110.1++1.81.85.85.8++2.02.0
13.613.6++2.52.5
46.746.7++6.06.0
17.617.6++4.24.218.618.6++3.63.616.816.8++1.91.914.614.6++4.44.4
10.110.1++1.81.85.85.8++2.02.0
13.613.6++2.52.5
2.872.87
0.100.10-0.17-0.17-1.10-1.100.170.17
3.783.781.601.60
0.170.17
2.872.87
0.100.10-0.17-0.17-1.10-1.100.170.17
3.783.781.601.60
0.170.17
0.010.01
0.920.920.870.870280280.870.87
0.0030.0030.120.12
0.870.87
0.010.01
0.920.920.870.870280280.870.87
0.0030.0030.120.12
0.870.87
Note: The scores are given as means Note: The scores are given as means ++SDSDNote: The scores are given as means Note: The scores are given as means ++SDSD
PP valuevaluePP valuevalue
Psychometric Variables (Zung Depression Scale andPsychometric Variables (Zung Depression Scale and Utrechtse Coping List) in the Subgroup of Women with aUtrechtse Coping List) in the Subgroup of Women with a
Female Indication for IVF (n=39) According to IVF OutcomeFemale Indication for IVF (n=39) According to IVF Outcome
Psychometric Variables (Zung Depression Scale andPsychometric Variables (Zung Depression Scale and Utrechtse Coping List) in the Subgroup of Women with aUtrechtse Coping List) in the Subgroup of Women with a
Female Indication for IVF (n=39) According to IVF OutcomeFemale Indication for IVF (n=39) According to IVF Outcome
Psychometric Psychometric variablevariable
Psychometric Psychometric variablevariable
IVF outcomeIVF outcomeIVF outcomeIVF outcome
Not pregnantNot pregnant(n=75)(n=75)
Not pregnantNot pregnant(n=75)(n=75)
PregnantPregnant(n=23)(n=23)
PregnantPregnant(n=23)(n=23) tt -test -testtt -test -test
Zung Depression ScaleZung Depression ScaleUtrechtse Coping listUtrechtse Coping list Active coping scoreActive coping score Palliative coping scorePalliative coping score Avoiding scoreAvoiding score Social support seekingSocial support seeking scorescore Depressive coping scoreDepressive coping score Expression of negative Expression of negative emotions scoreemotions score Comforting ideas scoreComforting ideas score
Zung Depression ScaleZung Depression ScaleUtrechtse Coping listUtrechtse Coping list Active coping scoreActive coping score Palliative coping scorePalliative coping score Avoiding scoreAvoiding score Social support seekingSocial support seeking scorescore Depressive coping scoreDepressive coping score Expression of negative Expression of negative emotions scoreemotions score Comforting ideas scoreComforting ideas score
49.549.5++10.210.2
17.617.6++2.42.418.118.1++2.72.715.015.0++2.72.715.215.2++3.83.8
10.510.5++1.81.86.26.2++1.61.6
13.413.4++2.52.5
49.549.5++10.210.2
17.617.6++2.42.418.118.1++2.72.715.015.0++2.72.715.215.2++3.83.8
10.510.5++1.81.86.26.2++1.61.6
13.413.4++2.52.5
57.057.0++7.97.9
18.318.3++3.23.220.520.5++3.43.415.115.1++3.93.916.016.0++3.53.5
12.412.4++3.33.35.65.6++1.51.5
14.314.3++1.81.8
57.057.0++7.97.9
18.318.3++3.23.220.520.5++3.43.415.115.1++3.93.916.016.0++3.53.5
12.412.4++3.33.35.65.6++1.51.5
14.314.3++1.81.8
-2.77-2.77
-0.82-0.82-2.31-2.31-0.04-0.04-0.66-0.66
-2.70-2.701.241.24
-1.53-1.53
-2.77-2.77
-0.82-0.82-2.31-2.31-0.04-0.04-0.66-0.66
-2.70-2.701.241.24
-1.53-1.53
0.0090.009
0.420.420.030.030.970.970.520.52
0.010.010.230.23
0.130.13
0.0090.009
0.420.420.030.030.970.970.520.52
0.010.010.230.23
0.130.13
Note: The scores are given as means Note: The scores are given as means ++SDSDNote: The scores are given as means Note: The scores are given as means ++SDSD
PP valuevaluePP valuevalue
Psychometric Variables (Zung Depression Scale and UtrechtsePsychometric Variables (Zung Depression Scale and Utrechtse Coping List) in the Subgroup of Women with a Male IndicationCoping List) in the Subgroup of Women with a Male Indication
for IVF (n=52) According to IVF Outcomefor IVF (n=52) According to IVF Outcome
Psychometric Variables (Zung Depression Scale and UtrechtsePsychometric Variables (Zung Depression Scale and Utrechtse Coping List) in the Subgroup of Women with a Male IndicationCoping List) in the Subgroup of Women with a Male Indication
for IVF (n=52) According to IVF Outcomefor IVF (n=52) According to IVF Outcome
ConclusionsConclusions
Moreover, the expression of Moreover, the expression of negative emotionsnegative emotions is is positively correlated positively correlated with with depressive depressive symptomatology symptomatology when the when the indications for IVF is indications for IVF is female subfertility female subfertility (emotions are transformed into (emotions are transformed into quality directed against the women herself) but is quality directed against the women herself) but is negatively correlated with depressive negatively correlated with depressive symptomology when the indication for IVF is symptomology when the indication for IVF is male subfertilitymale subfertility (the emotions are transformed (the emotions are transformed into into anger directed toward the male partner)anger directed toward the male partner)
Moreover, the expression of Moreover, the expression of negative emotionsnegative emotions is is positively correlated positively correlated with with depressive depressive symptomatology symptomatology when the when the indications for IVF is indications for IVF is female subfertility female subfertility (emotions are transformed into (emotions are transformed into quality directed against the women herself) but is quality directed against the women herself) but is negatively correlated with depressive negatively correlated with depressive symptomology when the indication for IVF is symptomology when the indication for IVF is male subfertilitymale subfertility (the emotions are transformed (the emotions are transformed into into anger directed toward the male partner)anger directed toward the male partner)
Psychological Reactions During In–Vitro Psychological Reactions During In–Vitro Fertilization: Similar Response Pattern in Fertilization: Similar Response Pattern in
Husbands and WivesHusbands and Wives
Boivin J. et alBoivin J. et al
Human Reprod. 13:3262-3267, 1998Human Reprod. 13:3262-3267, 1998
Psychological Reactions During In–Vitro Psychological Reactions During In–Vitro Fertilization: Similar Response Pattern in Fertilization: Similar Response Pattern in
Husbands and WivesHusbands and Wives
Boivin J. et alBoivin J. et al
Human Reprod. 13:3262-3267, 1998Human Reprod. 13:3262-3267, 1998
Distress level as a function of in vitroDistress level as a function of in vitro fertilization (IVF) stage and sexfertilization (IVF) stage and sexDistress level as a function of in vitroDistress level as a function of in vitro
fertilization (IVF) stage and sexfertilization (IVF) stage and sexOptimismOptimism level as a function of inlevel as a function of in
vitro-fertilization (IVF) stage and sevitro-fertilization (IVF) stage and sexx
OptimismOptimism level as a function of inlevel as a function of in vitro-fertilization (IVF) stage and sevitro-fertilization (IVF) stage and sexx
F
ert
iliz
ati
on
Fe
rtil
iza
tio
n
Fe
rtil
iza
tio
nF
ert
iliz
ati
on-- 11
Re
trie
va
lR
etr
iev
al
-- 11 R
etr
iev
al
Re
trie
va
l
Da
ys
1-7
Da
ys
1-7
Da
ys
1-7
Da
ys
1-7
Re
trie
va
lR
etr
iev
al
Re
trie
va
lR
etr
iev
al
Da
ys
8D
ay
s 8
++D
ay
s 8
Da
ys
8++
-- 11 R
etr
iev
al
Re
trie
va
l-- 11
Re
trie
va
lR
etr
iev
al
Da
ys
1-7
Da
ys
1-7
Da
ys
1-7
Da
ys
1-7
Re
trie
va
lR
etr
iev
al
Re
trie
va
lR
etr
iev
al
Fe
rtil
iza
tio
nF
ert
iliz
ati
on
F
ert
iliz
ati
on
Fe
rtil
iza
tio
n
Da
ys
8D
ay
s 8
++D
ay
s 8
Da
ys
8++
ResultsResults
StageStageStageStage
HM
GH
MG
HM
GH
MG
11
1.51.5
1.751.75
1.251.25
Women
Men
HC
GH
CG
HC
GH
CG
Tra
ns
fer
Tra
ns
fer
Tra
ns
fer
Tra
ns
fer
Ou
tco
me
Ou
tco
me
Ou
tco
me
Ou
tco
me
Dis
tres
sD
istr
ess
Dis
tres
sD
istr
ess
3.13.1
33
2.92.9
2.82.8
2.72.7
2.62.6
2.52.5
Women
Men
HM
GH
MG
HM
GH
MG
HC
GH
CG
HC
GH
CG
Tra
ns
fer
Tra
ns
fer
Tra
ns
fer
Tra
ns
fer
Ou
tco
me
Ou
tco
me
Ou
tco
me
Ou
tco
me
StageStageStageStage
Op
tim
ism
Op
tim
ism
Op
tim
ism
Op
tim
ism
22
F
ert
iliz
ati
on
Fe
rtil
iza
tio
n
Fe
rtil
iza
tio
nF
ert
iliz
ati
on
Intimacy level as a function of in vitroIntimacy level as a function of in vitro fertilization (IVF) stage and sexfertilization (IVF) stage and sex
Intimacy level as a function of in vitroIntimacy level as a function of in vitro fertilization (IVF) stage and sexfertilization (IVF) stage and sex
Fatigue level as a function of inFatigue level as a function of in vitro fertilization (IVF) stage and sexvitro fertilization (IVF) stage and sexFatigue level as a function of inFatigue level as a function of in
vitro fertilization (IVF) stage and sexvitro fertilization (IVF) stage and sex-- 11
Re
trie
va
lR
etr
iev
al
-- 11 R
etr
iev
al
Re
trie
va
l
Da
ys
1-7
Da
ys
1-7
Da
ys
1-7
Da
ys
1-7
Re
trie
va
lR
etr
iev
al
Re
trie
va
lR
etr
iev
al
Da
ys
8D
ay
s 8
++D
ay
s 8
Da
ys
8++
-- 11 R
etr
iev
al
Re
trie
va
l-- 11
Re
trie
va
lR
etr
iev
al
Da
ys
1-7
Da
ys
1-7
Da
ys
1-7
Da
ys
1-7
Re
trie
va
lR
etr
iev
al
Re
trie
va
lR
etr
iev
al
Fe
rtil
iza
tio
nF
ert
iliz
ati
on
F
ert
iliz
ati
on
Fe
rtil
iza
tio
n
Da
ys
8D
ay
s 8
++D
ay
s 8
Da
ys
8++
ResultsResults
HM
GH
MG
HM
GH
MG
3.53.5
3.3.
2.52.5
22
1.51.5
11
Women
Men
HC
GH
CG
Tra
ns
fer
Tra
ns
fer
Tra
ns
fer
Tra
ns
fer
Ou
tco
me
Ou
tco
me
Ou
tco
me
Ou
tco
me
StageStageStageStageF
atig
ue
Fat
igu
eF
atig
ue
Fat
igu
e
3.753.753.753.75
3.53.53.53.5
3.253.253.253.25
3333
Women
Men
HM
GH
MG
HM
GH
MG
HC
GH
CG
HC
GH
CG
Tra
ns
fer
Tra
ns
fer
Tra
ns
fer
Tra
ns
fer
Ou
tco
me
Ou
tco
me
Ou
tco
me
Ou
tco
me
StageStageStageStage
Inti
mac
yIn
tim
acy
Inti
mac
yIn
tim
acy
4444
ConclusionsConclusionsConclusionsConclusions
Couples responded in a similar way to IVF, Couples responded in a similar way to IVF, indicating that indicating that different approaches different approaches to psychological to psychological care for men and women may care for men and women may not be warranted not be warranted during that actual treatment during that actual treatment cycle. cycle. We propose the most important psychological We propose the most important psychological determinant of reactions during IVF is the determinant of reactions during IVF is the uncertainty of treatment proceduresuncertainty of treatment procedures
Couples responded in a similar way to IVF, Couples responded in a similar way to IVF, indicating that indicating that different approaches different approaches to psychological to psychological care for men and women may care for men and women may not be warranted not be warranted during that actual treatment during that actual treatment cycle. cycle. We propose the most important psychological We propose the most important psychological determinant of reactions during IVF is the determinant of reactions during IVF is the uncertainty of treatment proceduresuncertainty of treatment procedures
ConclusionsConclusionsConclusionsConclusions
Spouses appear to be equally sensitive Spouses appear to be equally sensitive to this uncertainty and both appear to this uncertainty and both appear to respond to it with to respond to it with ambivalent feelings ambivalent feelings involving distress and more positive feelings involving distress and more positive feelings of hope and emotional closenessof hope and emotional closeness
Spouses appear to be equally sensitive Spouses appear to be equally sensitive to this uncertainty and both appear to this uncertainty and both appear to respond to it with to respond to it with ambivalent feelings ambivalent feelings involving distress and more positive feelings involving distress and more positive feelings of hope and emotional closenessof hope and emotional closeness
Treatment-Related Stresses and Treatment-Related Stresses and Depression in Couples Undergoing ART Depression in Couples Undergoing ART
Treatment by IVF or ICSITreatment by IVF or ICSI
Beutel M. et alBeutel M. et al
Andrologia 31:27-35, 1999Andrologia 31:27-35, 1999
Treatment-Related Stresses and Treatment-Related Stresses and Depression in Couples Undergoing ART Depression in Couples Undergoing ART
Treatment by IVF or ICSITreatment by IVF or ICSI
Beutel M. et alBeutel M. et al
Andrologia 31:27-35, 1999Andrologia 31:27-35, 1999
18181818
16161616
14141414
12121212
10101010
8888
6666
4444
2222
0000
8.58.5
4.9
WomenMen
No pregnantNo pregnant(n=211 couples)(n=211 couples)
No pregnantNo pregnant(n=211 couples)(n=211 couples)
PregnantPregnant(n=39 couples)(n=39 couples)
PregnantPregnant(n=39 couples)(n=39 couples)
DeliveryDelivery(n=31 couples)(n=31 couples)
DeliveryDelivery(n=31 couples)(n=31 couples)
Dep
ress
ion
Sco
re (
D-S
)D
epre
ssio
n S
core
(D
-S)
Dep
ress
ion
Sco
re (
D-S
)D
epre
ssio
n S
core
(D
-S)
(1;2)***
Presented are means and standard deviations. Groups are compared by two-way ANOVA Presented are means and standard deviations. Groups are compared by two-way ANOVA (outcome by sex): Main effects for (1) outcome F (2) =6.67; and F(1)=32.93; interaction. (outcome by sex): Main effects for (1) outcome F (2) =6.67; and F(1)=32.93; interaction. N.S. Additional Students t-tests between the group “not pregnant” and “delivery” N.S. Additional Students t-tests between the group “not pregnant” and “delivery” were significant (P<0.05) for women; t(65)=2.49 and men: t(68)=2.60; *** p<0.001were significant (P<0.05) for women; t(65)=2.49 and men: t(68)=2.60; *** p<0.001
Presented are means and standard deviations. Groups are compared by two-way ANOVA Presented are means and standard deviations. Groups are compared by two-way ANOVA (outcome by sex): Main effects for (1) outcome F (2) =6.67; and F(1)=32.93; interaction. (outcome by sex): Main effects for (1) outcome F (2) =6.67; and F(1)=32.93; interaction. N.S. Additional Students t-tests between the group “not pregnant” and “delivery” N.S. Additional Students t-tests between the group “not pregnant” and “delivery” were significant (P<0.05) for women; t(65)=2.49 and men: t(68)=2.60; *** p<0.001were significant (P<0.05) for women; t(65)=2.49 and men: t(68)=2.60; *** p<0.001
6.46.4
7.67.6
6.46.4
4.0
Effect of Treatment Outcome and Sex Depression Score (D-S) Presented are Means and Standard Deviations
Effect of Treatment Outcome and Sex Depression Score (D-S) Presented are Means and Standard Deviations
Only couples without pregnancy or delivery are included. Presented are means and Only couples without pregnancy or delivery are included. Presented are means and standard deviations. Groups are compared by two-way ANOVA (outcome by sex): standard deviations. Groups are compared by two-way ANOVA (outcome by sex): Main effects for (1) number F (2) =3.85; and F(2) sex :F(1) =25.93; interaction. N.S. Main effects for (1) number F (2) =3.85; and F(2) sex :F(1) =25.93; interaction. N.S. *** p<0.001; * p<0.005*** p<0.001; * p<0.005
Only couples without pregnancy or delivery are included. Presented are means and Only couples without pregnancy or delivery are included. Presented are means and standard deviations. Groups are compared by two-way ANOVA (outcome by sex): standard deviations. Groups are compared by two-way ANOVA (outcome by sex): Main effects for (1) number F (2) =3.85; and F(2) sex :F(1) =25.93; interaction. N.S. Main effects for (1) number F (2) =3.85; and F(2) sex :F(1) =25.93; interaction. N.S. *** p<0.001; * p<0.005*** p<0.001; * p<0.005
2222
2020
1818
1616
1414
1212
1010
88
66
44
22
00
8.38.3 7.97.9
11.111.1
(1:2)*** WomenMen
1 treatment cycle1 treatment cyclen=89 couplesn=89 couples
1 treatment cycle1 treatment cyclen=89 couplesn=89 couples
Dep
ress
ion
Sco
re (
D-S
)D
epre
ssio
n S
core
(D
-S)
Dep
ress
ion
Sco
re (
D-S
)D
epre
ssio
n S
core
(D
-S)
>> 3 treatment cycles 3 treatment cyclesn=31 couplesn=31 couples
>> 3 treatment cycles 3 treatment cyclesn=31 couplesn=31 couples
2 treatment cycles2 treatment cyclesn=91 couplesn=91 couples
2 treatment cycles2 treatment cyclesn=91 couplesn=91 couples
5.15.14.94.9
6.86.8
Effect of the Number of Unsuccessful Treatment Cycles and Effect of the Number of Unsuccessful Treatment Cycles and Sex Depression Score (D-S) Sex Depression Score (D-S)
Effect of the Number of Unsuccessful Treatment Cycles and Effect of the Number of Unsuccessful Treatment Cycles and Sex Depression Score (D-S) Sex Depression Score (D-S)
ConclusionsConclusionsConclusionsConclusions
The treatment outcome had a significant The treatment outcome had a significant impact on the depression scores for women impact on the depression scores for women and men.and men. In cases where the women had In cases where the women had already delivered, both partners had the already delivered, both partners had the lowest depression scores. lowest depression scores. For men and For men and women depression scores increased withwomen depression scores increased witha higher number of unsuccessful treatment a higher number of unsuccessful treatment cyclescycles
The treatment outcome had a significant The treatment outcome had a significant impact on the depression scores for women impact on the depression scores for women and men.and men. In cases where the women had In cases where the women had already delivered, both partners had the already delivered, both partners had the lowest depression scores. lowest depression scores. For men and For men and women depression scores increased withwomen depression scores increased witha higher number of unsuccessful treatment a higher number of unsuccessful treatment cyclescycles
Evaluations of Emotional Reactions and Evaluations of Emotional Reactions and Coping Behaviors as Well as Correlated Coping Behaviors as Well as Correlated Factors for Infertile Couples Receiving Factors for Infertile Couples Receiving
Assisted Reproduction Assisted Reproduction
Hsu. Y.L & Kuo B.JHsu. Y.L & Kuo B.J
J. Nursing Res. 10:291-301, 2002J. Nursing Res. 10:291-301, 2002
Evaluations of Emotional Reactions and Evaluations of Emotional Reactions and Coping Behaviors as Well as Correlated Coping Behaviors as Well as Correlated Factors for Infertile Couples Receiving Factors for Infertile Couples Receiving
Assisted Reproduction Assisted Reproduction
Hsu. Y.L & Kuo B.JHsu. Y.L & Kuo B.J
J. Nursing Res. 10:291-301, 2002J. Nursing Res. 10:291-301, 2002
Infertile treatment factors:Infertile treatment factors: treatment durationtreatment duration treatment frequencytreatment frequency infertility causeinfertility cause
Infertile treatment factors:Infertile treatment factors: treatment durationtreatment duration treatment frequencytreatment frequency infertility causeinfertility cause
Emotional reactionsEmotional reactionsof infertile couplesof infertile couplesreceiving assistedreceiving assistedreproductivereproductivetechnologies technologies
Emotional reactionsEmotional reactionsof infertile couplesof infertile couplesreceiving assistedreceiving assistedreproductivereproductivetechnologies technologies
CopingCopingbehaviorsbehaviorsCopingCopingbehaviorsbehaviors
Demographic Variables:Demographic Variables: sex age education levelsex age education level existing number of childrenexisting number of children
Demographic Variables:Demographic Variables: sex age education levelsex age education level existing number of childrenexisting number of children
Conceptual Framework Diagram: Conceptual Framework Diagram: Evaluation of Evaluation of Emotional Reactions and Coping Behaviors with Emotional Reactions and Coping Behaviors with Related Factors for Infertility Couples Receiving Related Factors for Infertility Couples Receiving Assisted Reproductive Technologies Assisted Reproductive Technologies
Conceptual Framework Diagram: Conceptual Framework Diagram: Evaluation of Evaluation of Emotional Reactions and Coping Behaviors with Emotional Reactions and Coping Behaviors with Related Factors for Infertility Couples Receiving Related Factors for Infertility Couples Receiving Assisted Reproductive Technologies Assisted Reproductive Technologies
POMS total scalePOMS total scalePOMS total scalePOMS total scale
rrrr
ConfrontingConfrontingDistancingDistancingSelf-ControlSelf-ControlSeeking Social SupportSeeking Social SupportAccepting ResponsibilityAccepting ResponsibilityEscape-AvoidanceEscape-AvoidancePlanful Problem SolvingPlanful Problem SolvingPositive ReappraisalPositive ReappraisalTotal ScaleTotal Scale
ConfrontingConfrontingDistancingDistancingSelf-ControlSelf-ControlSeeking Social SupportSeeking Social SupportAccepting ResponsibilityAccepting ResponsibilityEscape-AvoidanceEscape-AvoidancePlanful Problem SolvingPlanful Problem SolvingPositive ReappraisalPositive ReappraisalTotal ScaleTotal Scale
..40**40**-.03-.03 .17.17 .11.11
.51**.51** .64**.64**
.02.02-.05-.05
.32**.32**
..40**40**-.03-.03 .17.17 .11.11
.51**.51** .64**.64**
.02.02-.05-.05
.32**.32**
*p<.05 **p<.01*p<.05 **p<.01*p<.05 **p<.01*p<.05 **p<.01
VariablesVariablesVariablesVariables
Correlation Between Emotional Reactions and Coping Correlation Between Emotional Reactions and Coping Behavior for Infertile Husbands Receiving Assisted Behavior for Infertile Husbands Receiving Assisted
Reproductive Technologies (N=120 Males)Reproductive Technologies (N=120 Males)
Correlation Between Emotional Reactions and Coping Correlation Between Emotional Reactions and Coping Behavior for Infertile Husbands Receiving Assisted Behavior for Infertile Husbands Receiving Assisted
Reproductive Technologies (N=120 Males)Reproductive Technologies (N=120 Males)
POMS total scalePOMS total scalePOMS total scalePOMS total scale
rrrr
ConfrontingConfrontingDistancingDistancingSelf-ControlSelf-ControlSeeking Social SupportSeeking Social SupportAccepting ResponsibilityAccepting ResponsibilityEscape-AvoidanceEscape-AvoidancePlanful Problem SolvingPlanful Problem SolvingPositive ReappraisalPositive ReappraisalTotal ScaleTotal Scale
ConfrontingConfrontingDistancingDistancingSelf-ControlSelf-ControlSeeking Social SupportSeeking Social SupportAccepting ResponsibilityAccepting ResponsibilityEscape-AvoidanceEscape-AvoidancePlanful Problem SolvingPlanful Problem SolvingPositive ReappraisalPositive ReappraisalTotal ScaleTotal Scale
..46**46**-.00-.00
.36**.36**-.07-.07
.65**.65** .65**.65**
-.09-.09 -.30*-.30* .36*.36*
..46**46**-.00-.00
.36**.36**-.07-.07
.65**.65** .65**.65**
-.09-.09 -.30*-.30* .36*.36*
*p<.05 **p<.01*p<.05 **p<.01*p<.05 **p<.01*p<.05 **p<.01
VariablesVariablesVariablesVariables
Correlation Between Emotional Reactions and Coping Correlation Between Emotional Reactions and Coping Behavior for Infertile Wives Receiving AssistedBehavior for Infertile Wives Receiving Assisted Reproductive Technologies (N=120 Females)Reproductive Technologies (N=120 Females)
Correlation Between Emotional Reactions and Coping Correlation Between Emotional Reactions and CopingBehavior for Infertile Wives Receiving AssistedBehavior for Infertile Wives Receiving Assisted Reproductive Technologies (N=120 Females)Reproductive Technologies (N=120 Females)
ConclusionsConclusionsConclusionsConclusions
This research indicated that, for infertile This research indicated that, for infertile couples receiving ART treatment couples receiving ART treatment there are there are differences in emotional reactions between differences in emotional reactions between men and women.men and women.
This research indicated that, for infertile This research indicated that, for infertile couples receiving ART treatment couples receiving ART treatment there are there are differences in emotional reactions between differences in emotional reactions between men and women.men and women.
Based on the fact that there are differences Based on the fact that there are differences in the coping behaviors adopted by infertile in the coping behaviors adopted by infertile couples receiving ART treatment, couples receiving ART treatment, medical medical staff can acknowledge the individual staff can acknowledge the individual differencesdifferences in the coping behaviors adopted in the coping behaviors adopted by infertile couples facing treatmentby infertile couples facing treatment
Based on the fact that there are differences Based on the fact that there are differences in the coping behaviors adopted by infertile in the coping behaviors adopted by infertile couples receiving ART treatment, couples receiving ART treatment, medical medical staff can acknowledge the individual staff can acknowledge the individual differencesdifferences in the coping behaviors adopted in the coping behaviors adopted by infertile couples facing treatmentby infertile couples facing treatment
ConclusionsConclusionsConclusionsConclusions
The research results show that emotional The research results show that emotional reactions and negative reactions and negative coping behaviors of coping behaviors of infertile couples receiving ART treatments are infertile couples receiving ART treatments are correlated significantly.correlated significantly.
The emotional reactions of infertile couples The emotional reactions of infertile couples receiving ART treatments varied with receiving ART treatments varied with different different fundamental properties and infertility treatment fundamental properties and infertility treatment factorsfactors
The research results show that emotional The research results show that emotional reactions and negative reactions and negative coping behaviors of coping behaviors of infertile couples receiving ART treatments are infertile couples receiving ART treatments are correlated significantly.correlated significantly.
The emotional reactions of infertile couples The emotional reactions of infertile couples receiving ART treatments varied with receiving ART treatments varied with different different fundamental properties and infertility treatment fundamental properties and infertility treatment factorsfactors
Personality Factors and Emotional Personality Factors and Emotional Responses to Pregnancy Among IVF Responses to Pregnancy Among IVF
Couples in Early Pregnancy: Couples in Early Pregnancy: a Comparative Studya Comparative Study
Hjelmstedt A. et alHjelmstedt A. et al
Acta Obstet. Gynecol. Scand. 82:152-161, 2003Acta Obstet. Gynecol. Scand. 82:152-161, 2003
Personality Factors and Emotional Personality Factors and Emotional Responses to Pregnancy Among IVF Responses to Pregnancy Among IVF
Couples in Early Pregnancy: Couples in Early Pregnancy: a Comparative Studya Comparative Study
Hjelmstedt A. et alHjelmstedt A. et al
Acta Obstet. Gynecol. Scand. 82:152-161, 2003Acta Obstet. Gynecol. Scand. 82:152-161, 2003
Year of ageYear of age Mean Mean ++SDSD RangeRangeEducation (%)Education (%) Primary educationPrimary education Secondary educationSecondary education College/universityCollege/universityNumber of women with Number of women with previous miscarriages previous miscarriages and /or ectopic and /or ectopic pregnanciespregnancies
Number of womenNumber of women with previous with previous abortionsabortions
Number of men with Number of men with children by a children by a previous partnerprevious partner
Year of ageYear of age Mean Mean ++SDSD RangeRangeEducation (%)Education (%) Primary educationPrimary education Secondary educationSecondary education College/universityCollege/universityNumber of women with Number of women with previous miscarriages previous miscarriages and /or ectopic and /or ectopic pregnanciespregnancies
Number of womenNumber of women with previous with previous abortionsabortions
Number of men with Number of men with children by a children by a previous partnerprevious partner
StatisticsStatisticsStatisticsStatisticsControlsControls(n=43)(n=43)
ControlsControls(n=43)(n=43)
Men Men IVFIVF
(n=55)(n=55)
Men Men IVFIVF
(n=55)(n=55)
32.332.3++2.12.129-3629-36
3.53.538.638.657.957.92020
33
32.332.3++2.12.129-3629-36
3.53.538.638.657.957.92020
33
WomenWomenIVFIVF
(n=57)(n=57)
WomenWomenIVFIVF
(n=57)(n=57)
x= 41.49, d.f.=2x= 41.49, d.f.=2NSNS
x=8.93, d.f.=1x=8.93, d.f.=1p<0.01p<0.01
X=27.54, d.f.=1X=27.54, d.f.=1p<0.0001p<0.0001
x= 41.49, d.f.=2x= 41.49, d.f.=2NSNS
x=8.93, d.f.=1x=8.93, d.f.=1p<0.01p<0.01
X=27.54, d.f.=1X=27.54, d.f.=1p<0.0001p<0.0001
ControlsControls(n=39)(n=39)
ControlsControls(n=39)(n=39)
StatisticsStatisticsStatisticsStatistics
31.2+1.831.2+1.829-3629-36
2.32.327.927.969.869.8
44
2222
31.2+1.831.2+1.829-3629-36
2.32.327.927.969.869.8
44
2222
t -value=2.87t -value=2.87p-value =<0.01p-value =<0.01t -value=2.87t -value=2.87
p-value =<0.01p-value =<0.0134.034.0++2.12.1
27-5127-51
7.27.249.149.143.643.6
55
34.034.0++2.12.127-5127-51
7.27.249.149.143.643.6
55
33.133.1++2.82.827-3927-39
0020.520.579.579.5
55
33.133.1++2.82.827-3927-39
0020.520.579.579.5
55
t -value=1.33t -value=1.33NSNS
X=12.85, d.f.=1X=12.85, d.f.=1P-value<0.01P-value<0.01
X=1.59,d.f.=1X=1.59,d.f.=1NSNS
t -value=1.33t -value=1.33NSNS
X=12.85, d.f.=1X=12.85, d.f.=1P-value<0.01P-value<0.01
X=1.59,d.f.=1X=1.59,d.f.=1NSNS
Background Data Collected in Pregnancy Week 13 for the Women who had Background Data Collected in Pregnancy Week 13 for the Women who had Undergone IVF (IVF Women) and their Male Partners (IVF Men) and for the Women Undergone IVF (IVF Women) and their Male Partners (IVF Men) and for the Women
who had Conceived Naturally (Control Women) and their Male Partners in the who had Conceived Naturally (Control Women) and their Male Partners in the Control Group (Control Men)Control Group (Control Men)
Background Data Collected in Pregnancy Week 13 for the Women who had Background Data Collected in Pregnancy Week 13 for the Women who had Undergone IVF (IVF Women) and their Male Partners (IVF Men) and for the Women Undergone IVF (IVF Women) and their Male Partners (IVF Men) and for the Women
who had Conceived Naturally (Control Women) and their Male Partners in the who had Conceived Naturally (Control Women) and their Male Partners in theControl Group (Control Men)Control Group (Control Men)
AmbivalenceAmbivalence
Anxiety about Anxiety about loosing the loosing the pregnancypregnancy
Anxiety related Anxiety related to the health of to the health of the babythe baby
AmbivalenceAmbivalence
Anxiety about Anxiety about loosing the loosing the pregnancypregnancy
Anxiety related Anxiety related to the health of to the health of the babythe baby
-0.11-0.11
0.090.09
0.040.04
-0.11-0.11
0.090.09
0.040.04
Women (n=51)Women (n=51)RR22
Women (n=51)Women (n=51)RR22
p-value p-value p-value p-value Men (n=51)Men (n=51)RR22
Men (n=51)Men (n=51)RR22
p-value p-value p-value p-value
<0.05<0.05
<0.05<0.05
NSNS
<0.05<0.05
<0.05<0.05
NSNS
0.020.02
0.040.04
0.110.11
0.020.02
0.040.04
0.110.11
NSNS
NSNS
<0.05<0.05
NSNS
NSNS
<0.05<0.05
Multivariate regression analyzes between the Infertility Raction Scale Total Multivariate regression analyzes between the Infertility Raction Scale Total Scores (Independent variable) and the Scores of Ambivalence and Anxiety Scores (Independent variable) and the Scores of Ambivalence and Anxiety
related to the Pregnancy Scales (Dependent Variables) for the IVF Women and related to the Pregnancy Scales (Dependent Variables) for the IVF Women and the IVF Menthe IVF Men
Multivariate regression analyzes between the Infertility Raction Scale Total Multivariate regression analyzes between the Infertility Raction Scale Total Scores (Independent variable) and the Scores of Ambivalence and Anxiety Scores (Independent variable) and the Scores of Ambivalence and Anxiety
related to the Pregnancy Scales (Dependent Variables) for the IVF Women and related to the Pregnancy Scales (Dependent Variables) for the IVF Women andthe IVF Menthe IVF Men
ConclusionsConclusionsConclusionsConclusions
This study showed that during early pregnancy both This study showed that during early pregnancy both IVF women and IVF men seem to be more anxious IVF women and IVF men seem to be more anxious about loosing the pregnancy compared with couples about loosing the pregnancy compared with couples who have conceived naturally. who have conceived naturally. It is likely that the It is likely that the degree of degree of prior infertility distress prior infertility distress affects how IVF affects how IVF subjects subjects respond emotionally to their pregnancy. respond emotionally to their pregnancy. It seems that couples who have conceived after IVF It seems that couples who have conceived after IVF need additional emotional support in early pregnancy need additional emotional support in early pregnancy even though they score within the normal range on even though they score within the normal range on global anxiety. Possible ways of reducing with the IVF global anxiety. Possible ways of reducing with the IVF and antenatal clinics during early pregnancy stress and antenatal clinics during early pregnancy stress management programs or support groups. management programs or support groups. Further Further studies are needed to investigate the effectiveness studies are needed to investigate the effectiveness of such interventions of such interventions
This study showed that during early pregnancy both This study showed that during early pregnancy both IVF women and IVF men seem to be more anxious IVF women and IVF men seem to be more anxious about loosing the pregnancy compared with couples about loosing the pregnancy compared with couples who have conceived naturally. who have conceived naturally. It is likely that the It is likely that the degree of degree of prior infertility distress prior infertility distress affects how IVF affects how IVF subjects subjects respond emotionally to their pregnancy. respond emotionally to their pregnancy. It seems that couples who have conceived after IVF It seems that couples who have conceived after IVF need additional emotional support in early pregnancy need additional emotional support in early pregnancy even though they score within the normal range on even though they score within the normal range on global anxiety. Possible ways of reducing with the IVF global anxiety. Possible ways of reducing with the IVF and antenatal clinics during early pregnancy stress and antenatal clinics during early pregnancy stress management programs or support groups. management programs or support groups. Further Further studies are needed to investigate the effectiveness studies are needed to investigate the effectiveness of such interventions of such interventions
Should Fertilization Treatment Start with Should Fertilization Treatment Start with Reducing Stress?Reducing Stress?
Campagne D.M.Campagne D.M.
Human Reprod. 21:1651-1658, 2006Human Reprod. 21:1651-1658, 2006
Should Fertilization Treatment Start with Should Fertilization Treatment Start with Reducing Stress?Reducing Stress?
Campagne D.M.Campagne D.M.
Human Reprod. 21:1651-1658, 2006Human Reprod. 21:1651-1658, 2006
Stressful Event Psychological FactorsStressful Event Psychological Factors ))Coping , Habituation, ResilienceCoping , Habituation, Resilience ( (
Stressful Event Psychological FactorsStressful Event Psychological Factors ))Coping , Habituation, ResilienceCoping , Habituation, Resilience ( (
StressStressStressStress
Paraventricular NucleusParaventricular NucleusParaventricular NucleusParaventricular Nucleus
CRHCRHCRHCRH VasopresinVasopresinVasopresinVasopresin
SympatheticSympatheticSystem System SympatheticSympatheticSystem System
AdrenalAdrenalCortexCortexAdrenalAdrenalCortexCortex
EndorphinEndorphin EndorphinEndorphin
GnRH PulseGnRH Pulse GnRH PulseGnRH Pulse
LH, FSHLH, FSH LH, FSHLH, FSH
OvaryOvary OvaryOvaryAdrenalAdrenalMedulaMedulaAdrenalAdrenalMedulaMedula
AdrenalineAdrenalineAdrenalineAdrenaline CortisolCortisolCortisolCortisol EstradiolEstradiolProgesteroneProgesterone
EstradiolEstradiolProgesteroneProgesterone
Behavioral ActivationBehavioral ActivationBehavioral ActivationBehavioral ActivationMetabolic Metabolic
Cardiovascular Cardiovascular ActivationActivation
Metabolic Metabolic Cardiovascular Cardiovascular
ActivationActivationHPHP
ActivationActivationHPHP
ActivationActivationHPGHPG
InhibitionInhibition
HPGHPGInhibitionInhibition
Autonomic SystemAutonomic SystemAutonomic SystemAutonomic System
ACTHACTH ACTHACTH
Reduction of feelings of helplessness, though coping Reduction of feelings of helplessness, though coping with infertilitywith infertility
Changes in sexual behaviorChanges in sexual behavior
Modification of negative cognitions as to infertilityModification of negative cognitions as to infertility
Overcoming deficiencies in knowledge about fertilityOvercoming deficiencies in knowledge about fertilityImproving marital communication skills Improving marital communication skills
Reduction of feelings of helplessness, though coping Reduction of feelings of helplessness, though coping with infertilitywith infertility
Changes in sexual behaviorChanges in sexual behavior
Modification of negative cognitions as to infertilityModification of negative cognitions as to infertility
Overcoming deficiencies in knowledge about fertilityOvercoming deficiencies in knowledge about fertilityImproving marital communication skills Improving marital communication skills
Short–Term Goals for Male and Female Fertility Short–Term Goals for Male and Female Fertility Patients Patients (Pook et al. 1999)(Pook et al. 1999)
Short–Term Goals for Male and Female Fertility Short–Term Goals for Male and Female Fertility Patients Patients (Pook et al. 1999)(Pook et al. 1999)
Markers for StressMarkers for StressMarkers for StressMarkers for Stress
AdrenalineAdrenalineNoradrenalineNoradrenalineACTHACTHAmylaseAmylaseDehydroepiandrosteroneDehydroepiandrosteroneCortisolCortisolEstrogenEstrogenProlactinProlactinProgesterone/allopregnanoloneProgesterone/allopregnanoloneLHLHVasopressinVasopressinNK cellsNK cellsCardiovascular reactionCardiovascular reactionto provoked stressto provoked stressDepression (even subclinical)Depression (even subclinical)High active copingHigh active copingHigh avoidanceHigh avoidanceHigh expression of emotionHigh expression of emotionState anxietyState anxietyState –anxiety self –reportState –anxiety self –reportTrait anxietyTrait anxietyTrait –anxiety self -reportTrait –anxiety self -report
AdrenalineAdrenalineNoradrenalineNoradrenalineACTHACTHAmylaseAmylaseDehydroepiandrosteroneDehydroepiandrosteroneCortisolCortisolEstrogenEstrogenProlactinProlactinProgesterone/allopregnanoloneProgesterone/allopregnanoloneLHLHVasopressinVasopressinNK cellsNK cellsCardiovascular reactionCardiovascular reactionto provoked stressto provoked stressDepression (even subclinical)Depression (even subclinical)High active copingHigh active copingHigh avoidanceHigh avoidanceHigh expression of emotionHigh expression of emotionState anxietyState anxietyState –anxiety self –reportState –anxiety self –reportTrait anxietyTrait anxietyTrait –anxiety self -reportTrait –anxiety self -report
Substance/methodSubstance/methodSubstance/methodSubstance/methodRelevance for Relevance for acute/chronicacute/chronic
stress stress
Relevance for Relevance for acute/chronicacute/chronic
stress stress
Relevance as Relevance as stress marker for stress marker for
IVF outcome IVF outcome
Relevance as Relevance as stress marker for stress marker for
IVF outcome IVF outcome
HighHighHighHighHighHighVariableVariableHighHighVariableVariableVariableVariableProbableProbableVariableVariableProbableProbableHighHighHighHighHighHigh
HighHighHighHighHighHighHighHighHighHighQuestionedQuestionedSomeSomeQuestionedQuestioned
HighHighHighHighHighHighVariableVariableHighHighVariableVariableVariableVariableProbableProbableVariableVariableProbableProbableHighHighHighHighHighHigh
HighHighHighHighHighHighHighHighHighHighQuestionedQuestionedSomeSomeQuestionedQuestioned
High (at OR, ET)High (at OR, ET)High (only at ET)High (only at ET)HighHighQuestionedQuestioned??Site - dependentSite - dependent??ProbableProbableQuestionedQuestionedProbableProbable??HighHighHighHigh
HighHighProbableProbableProbableProbableHighHighHighHighQuestionedQuestionedSomeSomeQuestionedQuestioned
High (at OR, ET)High (at OR, ET)High (only at ET)High (only at ET)HighHighQuestionedQuestioned??Site - dependentSite - dependent??ProbableProbableQuestionedQuestionedProbableProbable??HighHighHighHigh
HighHighProbableProbableProbableProbableHighHighHighHighQuestionedQuestionedSomeSomeQuestionedQuestioned
Diagnosis of FertilityDiagnosis of Fertility
Establish male and female chronic and acute stress levels with validated Establish male and female chronic and acute stress levels with validated questionnairesquestionnaires
If over thresholdsIf over thresholdsIntensive stress reduction techniques for 3 monthsIntensive stress reduction techniques for 3 months
Establish stress levels and referral to fertility clinicEstablish stress levels and referral to fertility clinic
Establish male and female chronic and acute stress levels with Establish male and female chronic and acute stress levels with psychological and biological assayspsychological and biological assays
If over thresholdsIf over thresholdsIntensive stress reduction through psychological and adjuvant/dietary Intensive stress reduction through psychological and adjuvant/dietary
treatments for 3 monthstreatments for 3 months
When and if reduction is obtained: initiation fertility treatment with When and if reduction is obtained: initiation fertility treatment with concurrent male and female stress managementconcurrent male and female stress management
Diagnosis of FertilityDiagnosis of Fertility
Establish male and female chronic and acute stress levels with validated Establish male and female chronic and acute stress levels with validated questionnairesquestionnaires
If over thresholdsIf over thresholdsIntensive stress reduction techniques for 3 monthsIntensive stress reduction techniques for 3 months
Establish stress levels and referral to fertility clinicEstablish stress levels and referral to fertility clinic
Establish male and female chronic and acute stress levels with Establish male and female chronic and acute stress levels with psychological and biological assayspsychological and biological assays
If over thresholdsIf over thresholdsIntensive stress reduction through psychological and adjuvant/dietary Intensive stress reduction through psychological and adjuvant/dietary
treatments for 3 monthstreatments for 3 months
When and if reduction is obtained: initiation fertility treatment with When and if reduction is obtained: initiation fertility treatment with concurrent male and female stress managementconcurrent male and female stress management
Protocols to include patient selection according toProtocols to include patient selection according toexisting chronic stress levels and response to acuteexisting chronic stress levels and response to acutestressors stressors Preliminary treatment to reduce anxiety and depression Preliminary treatment to reduce anxiety and depression before fertilization cycles are initiatedbefore fertilization cycles are initiated
Cognitive-behaviural therapyCognitive-behaviural therapyRelaxation training Relaxation training Differential orientation as to infertilityDifferential orientation as to infertilityFertility sabbatical permitFertility sabbatical permit
Frozen back-up semen samples taken at low-stress Frozen back-up semen samples taken at low-stress moments outside the fertilization cycle moments outside the fertilization cycle Further refinement of fertilization techniques, such as Further refinement of fertilization techniques, such as removal of the acrosome before ICSIremoval of the acrosome before ICSI (Morozimi and (Morozimi and Yanagimachi, 2005)Yanagimachi, 2005)
Establishing individual baselines and specific Establishing individual baselines and specific stress markersstress markersEstablishing thresholds for referringEstablishing thresholds for referringMonitoring for stress before and during fertility treatment Monitoring for stress before and during fertility treatment
Protocols to include patient selection according toProtocols to include patient selection according toexisting chronic stress levels and response to acuteexisting chronic stress levels and response to acutestressors stressors Preliminary treatment to reduce anxiety and depression Preliminary treatment to reduce anxiety and depression before fertilization cycles are initiatedbefore fertilization cycles are initiated
Cognitive-behaviural therapyCognitive-behaviural therapyRelaxation training Relaxation training Differential orientation as to infertilityDifferential orientation as to infertilityFertility sabbatical permitFertility sabbatical permit
Frozen back-up semen samples taken at low-stress Frozen back-up semen samples taken at low-stress moments outside the fertilization cycle moments outside the fertilization cycle Further refinement of fertilization techniques, such as Further refinement of fertilization techniques, such as removal of the acrosome before ICSIremoval of the acrosome before ICSI (Morozimi and (Morozimi and Yanagimachi, 2005)Yanagimachi, 2005)
Establishing individual baselines and specific Establishing individual baselines and specific stress markersstress markersEstablishing thresholds for referringEstablishing thresholds for referringMonitoring for stress before and during fertility treatment Monitoring for stress before and during fertility treatment
Interventions for Stress Control and Fertility TreatmentInterventions for Stress Control and Fertility Treatment Interventions for Stress Control and Fertility TreatmentInterventions for Stress Control and Fertility Treatment
Procedural meansProcedural means
Psychological meansPsychological means
Technical meansTechnical means
NeurobiologicalNeurobiologicalmeans means
Procedural meansProcedural means
Psychological meansPsychological means
Technical meansTechnical means
NeurobiologicalNeurobiologicalmeans means
ConclusionsConclusionsConclusionsConclusions
The available evidence dictates that fertility The available evidence dictates that fertility treatment protocol should treatment protocol should indicate stress indicate stress management and stress reduction,management and stress reduction, as a factor as a factor of of major importance consensus major importance consensus should be should be reached as to established protocol of reached as to established protocol of stress stress management management
The available evidence dictates that fertility The available evidence dictates that fertility treatment protocol should treatment protocol should indicate stress indicate stress management and stress reduction,management and stress reduction, as a factor as a factor of of major importance consensus major importance consensus should be should be reached as to established protocol of reached as to established protocol of stress stress management management
ConclusionsConclusionsConclusionsConclusions
Stress reduction is non invasive less Stress reduction is non invasive less expensive and ethically acceptable way of expensive and ethically acceptable way of improving fertility.improving fertility. The professional in The professional in reproductive medicine should always reproductive medicine should always test for test for chronic stress before initiating fertility chronic stress before initiating fertility treatment and adjust selection and treatment treatment and adjust selection and treatment protocol accordinglyprotocol accordingly
Stress reduction is non invasive less Stress reduction is non invasive less expensive and ethically acceptable way of expensive and ethically acceptable way of improving fertility.improving fertility. The professional in The professional in reproductive medicine should always reproductive medicine should always test for test for chronic stress before initiating fertility chronic stress before initiating fertility treatment and adjust selection and treatment treatment and adjust selection and treatment protocol accordinglyprotocol accordingly
Comparison of Multiple Psychological Comparison of Multiple Psychological Distress Measures Between Man and Distress Measures Between Man and
Women Preparing for In Vitro FertilizationWomen Preparing for In Vitro Fertilization
Wichman Ch. L. et alWichman Ch. L. et al
Fertil. Steril. 95:717-721, 2011Fertil. Steril. 95:717-721, 2011
Comparison of Multiple Psychological Comparison of Multiple Psychological Distress Measures Between Man and Distress Measures Between Man and
Women Preparing for In Vitro FertilizationWomen Preparing for In Vitro Fertilization
Wichman Ch. L. et alWichman Ch. L. et al
Fertil. Steril. 95:717-721, 2011Fertil. Steril. 95:717-721, 2011
Demographic InformationDemographic Information Demographic InformationDemographic Information
160 (100%)160 (100%)00
32.7 (4.6)32.7 (4.6)32.032.0
29.0,36.029.0,36.0
24.0-48.024.0-48.0
3(1.9)3(1.9)
130(81.3)130(81.3)0(0)0(0)
11(6.9)11(6.9)16(10.0)16(10.0)
160 (100%)160 (100%)00
32.7 (4.6)32.7 (4.6)32.032.0
29.0,36.029.0,36.0
24.0-48.024.0-48.0
3(1.9)3(1.9)
130(81.3)130(81.3)0(0)0(0)
11(6.9)11(6.9)16(10.0)16(10.0)
PatientPatient(n=160)(n=160)PatientPatient(n=160)(n=160)
PartnerPartner(n=160)(n=160)PartnerPartner(n=160)(n=160)
Paired DifferencePaired Difference(Patient –Partner)(Patient –Partner)Paired DifferencePaired Difference(Patient –Partner)(Patient –Partner)
Wilcoxon Signed Wilcoxon Signed Rank Test, Rank Test,
Two-Sided P value Two-Sided P value
Wilcoxon Signed Wilcoxon Signed Rank Test, Rank Test,
Two-Sided P value Two-Sided P value
00160(100%)160(100%)
35.0 (7.3)35.0 (7.3)34.034.0
30.0,38.030.0,38.0
22.0-69.022.0-69.0
3(1.9)3(1.9)
106(66.3)106(66.3)3(1.9)3(1.9)8(5)8(5)
40(25.0)40(25.0)
00160(100%)160(100%)
35.0 (7.3)35.0 (7.3)34.034.0
30.0,38.030.0,38.0
22.0-69.022.0-69.0
3(1.9)3(1.9)
106(66.3)106(66.3)3(1.9)3(1.9)8(5)8(5)
40(25.0)40(25.0)
-2.4(5.8)-2.4(5.8)-1.0-1.0
-2.4(5.8)-2.4(5.8)-1.0-1.0
<.001<.001<.001<.001
GenderGender FemaleFemale MaleMaleAge Age Mean (SD)Mean (SD) Median Median Interquartile rangeInterquartile range (25(25thth, 75, 75th th percentiles)percentiles)Range Range Race (%)Race (%) Black of African Black of African AmericanAmerican CaucasianCaucasian OtherOther AsianAsian Unknown or chose not Unknown or chose not to discloseto disclose
GenderGender FemaleFemale MaleMaleAge Age Mean (SD)Mean (SD) Median Median Interquartile rangeInterquartile range (25(25thth, 75, 75th th percentiles)percentiles)Range Range Race (%)Race (%) Black of African Black of African AmericanAmerican CaucasianCaucasian OtherOther AsianAsian Unknown or chose not Unknown or chose not to discloseto disclose
Back Depression Inventory (%)Back Depression Inventory (%) NormalNormal Mild Mild ModerateModerateState-Trait Anxiety Inventory-State score (%)State-Trait Anxiety Inventory-State score (%) NormalNormal Mild Mild ModerateModerateSate –Trait Anxiety Inventory –Trait score (%)Sate –Trait Anxiety Inventory –Trait score (%) NormalNormal MildMild ModerateModerateState –Trait Anger Inventory- State score (%)State –Trait Anger Inventory- State score (%) Not reportedNot reported Normal Normal MildMild ModerateModerate SevereSevere
Back Depression Inventory (%)Back Depression Inventory (%) NormalNormal Mild Mild ModerateModerateState-Trait Anxiety Inventory-State score (%)State-Trait Anxiety Inventory-State score (%) NormalNormal Mild Mild ModerateModerateSate –Trait Anxiety Inventory –Trait score (%)Sate –Trait Anxiety Inventory –Trait score (%) NormalNormal MildMild ModerateModerateState –Trait Anger Inventory- State score (%)State –Trait Anger Inventory- State score (%) Not reportedNot reported Normal Normal MildMild ModerateModerate SevereSevere
151 (94.4)151 (94.4)8(5)8(5)
1(0.6)1(0.6)
137(85.6)137(85.6)20 (12.5)20 (12.5)
3(1.9)3(1.9)
149(93.1)149(93.1)10(6.3)10(6.3)1(0.6)1(0.6)
33153(97.5)153(97.5)
2(1.3)2(1.3)2(1.3)2(1.3)0(0)0(0)
151 (94.4)151 (94.4)8(5)8(5)
1(0.6)1(0.6)
137(85.6)137(85.6)20 (12.5)20 (12.5)
3(1.9)3(1.9)
149(93.1)149(93.1)10(6.3)10(6.3)1(0.6)1(0.6)
33153(97.5)153(97.5)
2(1.3)2(1.3)2(1.3)2(1.3)0(0)0(0)
151 (96.3)151 (96.3)4(2.5)4(2.5)2(1.3)2(1.3)
146(91.3)146(91.3)11(6.9)11(6.9)3(1.9)3(1.9)
145 (90.6)145 (90.6)13(8.1)13(8.1)2(1.3)2(1.3)
44153(98.1)153(98.1)
1(0.6)1(0.6)1(0.6)1(0.6)1(0.6)1(0.6)
151 (96.3)151 (96.3)4(2.5)4(2.5)2(1.3)2(1.3)
146(91.3)146(91.3)11(6.9)11(6.9)3(1.9)3(1.9)
145 (90.6)145 (90.6)13(8.1)13(8.1)2(1.3)2(1.3)
44153(98.1)153(98.1)
1(0.6)1(0.6)1(0.6)1(0.6)1(0.6)1(0.6)
PatientPatient(n=160)(n=160)PatientPatient(n=160)(n=160)
PartnerPartner(n=160)(n=160)PartnerPartner(n=160)(n=160)
Severity of Psychological Distress by MeasureSeverity of Psychological Distress by MeasureSeverity of Psychological Distress by MeasureSeverity of Psychological Distress by Measure
State –Trait Anger Inventory – State –Trait Anger Inventory – Trait score (%)Trait score (%) Not reported Not reported NormalNormal MildMild ModerateModerateImpact of Events Scale (%)Impact of Events Scale (%) Not reported Not reported NormalNormal MildMild Moderate Moderate SevereSeverePerceived Stress Scale (%)Perceived Stress Scale (%) Not reportedNot reported Normal Normal MildMild ModerateModerate SevereSevere
State –Trait Anger Inventory – State –Trait Anger Inventory – Trait score (%)Trait score (%) Not reported Not reported NormalNormal MildMild ModerateModerateImpact of Events Scale (%)Impact of Events Scale (%) Not reported Not reported NormalNormal MildMild Moderate Moderate SevereSeverePerceived Stress Scale (%)Perceived Stress Scale (%) Not reportedNot reported Normal Normal MildMild ModerateModerate SevereSevere
33152(96.8)152(96.8)
4(2.5)4(2.5)1(0.6)1(0.6)
4453(34)53(34)
69(44.2)69(44.2)26(16.7)26(16.7)
8(5.1)8(5.1)
33142(90.4)142(90.4)
12(7.6)12(7.6)3(1.9)3(1.9)0(0)0(0)
33152(96.8)152(96.8)
4(2.5)4(2.5)1(0.6)1(0.6)
4453(34)53(34)
69(44.2)69(44.2)26(16.7)26(16.7)
8(5.1)8(5.1)
33142(90.4)142(90.4)
12(7.6)12(7.6)3(1.9)3(1.9)0(0)0(0)
PartnerPartner(n=160)(n=160)PartnerPartner(n=160)(n=160)
66147(95.5)147(95.5)
5(3.2)5(3.2)2(1.3)2(1.3)
3378(49.7)78(49.7)64(40.8)64(40.8)14(8.9)14(8.9)1(0.6)1(0.6)
33139(88.5)139(88.5)16(10.2)16(10.2)
1(0.6)1(0.6)1(0.6)1(0.6)
66147(95.5)147(95.5)
5(3.2)5(3.2)2(1.3)2(1.3)
3378(49.7)78(49.7)64(40.8)64(40.8)14(8.9)14(8.9)1(0.6)1(0.6)
33139(88.5)139(88.5)16(10.2)16(10.2)
1(0.6)1(0.6)1(0.6)1(0.6)
Severity of Psychological Distress by MeasureSeverity of Psychological Distress by MeasureSeverity of Psychological Distress by MeasureSeverity of Psychological Distress by Measure
PatientPatient(n=160)(n=160)PatientPatient(n=160)(n=160)
ConclusionsConclusionsConclusionsConclusions
Women consistently scored higher on multiple Women consistently scored higher on multiple measures of psychological distress than their measures of psychological distress than their male partners male partners in the context of preparing for in the context of preparing for IVF. Comparison of infertility-specific distress IVF. Comparison of infertility-specific distress scores yielded the largest statistically and scores yielded the largest statistically and clinically clinically significant difference compared with significant difference compared with traditional measures of general depression and traditional measures of general depression and anxiety symptomsanxiety symptoms
Women consistently scored higher on multiple Women consistently scored higher on multiple measures of psychological distress than their measures of psychological distress than their male partners male partners in the context of preparing for in the context of preparing for IVF. Comparison of infertility-specific distress IVF. Comparison of infertility-specific distress scores yielded the largest statistically and scores yielded the largest statistically and clinically clinically significant difference compared with significant difference compared with traditional measures of general depression and traditional measures of general depression and anxiety symptomsanxiety symptoms
ResultsResultsResultsResults
ResultsResultsResultsResults
ResultsResultsResultsResults
ResultsResultsResultsResults
ConclusionsConclusionsConclusionsConclusions
Take Home MessagesTake Home MessagesTake Home MessagesTake Home Messages
ART investigation and treatment brought usART investigation and treatment brought us to a new era of psychological – gender to a new era of psychological – gender oriented difficultiesoriented difficulties
The number of gender oriented controlledThe number of gender oriented controlled studies dealing with ART is very limitedstudies dealing with ART is very limited
The interest in psychological aspects of menThe interest in psychological aspects of men and women suffering from infertility is growingand women suffering from infertility is growing in the last decadein the last decade
ART investigation and treatment brought usART investigation and treatment brought us to a new era of psychological – gender to a new era of psychological – gender oriented difficultiesoriented difficulties
The number of gender oriented controlledThe number of gender oriented controlled studies dealing with ART is very limitedstudies dealing with ART is very limited
The interest in psychological aspects of menThe interest in psychological aspects of men and women suffering from infertility is growingand women suffering from infertility is growing in the last decadein the last decade
Take Home MessagesTake Home MessagesTake Home MessagesTake Home Messages
Some aspects of anger, anxiety and depressionSome aspects of anger, anxiety and depression during infertility treatment were found similarduring infertility treatment were found similar to men and womento men and women
The vulnerability to stress among women isThe vulnerability to stress among women is associated with a poor outcome of IVFassociated with a poor outcome of IVF treatmenttreatment
The adverse psychological responses amongThe adverse psychological responses among men and women during treatment dependsmen and women during treatment depends on the cause of infertilityon the cause of infertility
Some aspects of anger, anxiety and depressionSome aspects of anger, anxiety and depression during infertility treatment were found similarduring infertility treatment were found similar to men and womento men and women
The vulnerability to stress among women isThe vulnerability to stress among women is associated with a poor outcome of IVFassociated with a poor outcome of IVF treatmenttreatment
The adverse psychological responses amongThe adverse psychological responses among men and women during treatment dependsmen and women during treatment depends on the cause of infertilityon the cause of infertility
There is a full indication that infertility couplesThere is a full indication that infertility couples should be supported psychologically in variousshould be supported psychologically in various phases of therapyphases of therapy
This support in some subgroups shouldThis support in some subgroups should continue into and during early pregnancycontinue into and during early pregnancy
The support should be very professional andThe support should be very professional and gender oriented in various infertility subgroupsgender oriented in various infertility subgroups
There is a correlation between this supportThere is a correlation between this support and positive outcome of ART treatmentand positive outcome of ART treatment
There is a full indication that infertility couplesThere is a full indication that infertility couples should be supported psychologically in variousshould be supported psychologically in various phases of therapyphases of therapy
This support in some subgroups shouldThis support in some subgroups should continue into and during early pregnancycontinue into and during early pregnancy
The support should be very professional andThe support should be very professional and gender oriented in various infertility subgroupsgender oriented in various infertility subgroups
There is a correlation between this supportThere is a correlation between this support and positive outcome of ART treatmentand positive outcome of ART treatment
Take Home MessagesTake Home MessagesTake Home MessagesTake Home Messages