Assisted Reproductive Technologies Present – 1991 2013

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 !


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



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


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


**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


1 st1 st 3 rd3 rd

1 st1 st 3 rd3 rd

140140140140

+Failure-Success

+Failure-Success

+Failure-Success


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


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


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


IVF outcomeIVF outcomeIVF outcomeIVF outcome

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


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







PregnantPregnant(n=7)(n=7) tt -test -testtt -test -test



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


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







PregnantPregnant(n=23)(n=23) tt -test -testtt -test -test



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


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


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



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



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


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


Inti

mac

yIn

tim

acy

Inti

mac

yIn

tim

acy

4444


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


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)


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


..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



..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)


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


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



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


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.


Should Fertilization Treatment Start with Should Fertilization Treatment Start with Reducing Stress?Reducing Stress?

Campagne D.M.Campagne D.M.


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


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


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


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


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)



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)


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



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

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


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


Assisted Reproductive Technologies Present – 1991 2013

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