Fertility Problem Inventory Research Articles

Role of Marital Relationship Quality in Emotional Disturbance and Personal Growth of Women with Infertility: A Cross-Sectional Study.

Infertility is a stressful condition that can lead to either emotional disturbance or personal growth. Marital relationship is one of the factors affecting the consequences of infertility. This study aimed to explore the role of marital relationship quality in development of women's personal growth after experiencing infertility. In the cross-sectional study, 122 infertile women (mean age 28.79 ± 6.3) were invited to complete the survey, including ENRICH Marital Satisfaction Scale, Posttraumatic Growth, Fertility problem inventory, State-Trait Anxiety Inventory, and Beck Inventory Depression. Higher scores of quality of marital relationships were a protective factor against infertility stress and state/ trait anxiety. Additionally, infertility stress was a strong negative predictor of personal growth. Furthermore, infertile women with a high level of marital relationships may have more chances to experience personal growth rather than stress in infertility treatments. The study suggests that high quality of marital relationships may provide positive opportunities for women's personal growth after experiencing infertility.

Using CBT for Depression: A Case Study of a Patient with Depressive Disorder Due to a Medical Condition (Infertility)

Introduction: Infertility increases the risk for psychopathology more often in women, who can develop symptoms in mood disorders and chronic stress. Depression is one frequent psychological consequence of this medical condition and if it’s not being addressed accordingly, depressive symptoms can lead to delays in the onset of medical treatment, impairments in its outcomes and, likewise, poses a risk on the patient's mental health. Purpose: The purpose of this case study was to disseminate a specific example of how infertility affects mental health, offering a multidisciplinary approach from both traditional CBT and health psychology. In addition to this, the case study presents important cultural aspects regarding psychotherapeutic process and access to health care. Methodology: This is a descriptive and explanatory case study where multiple quantitative data sources have been used such as self-reported inventories: The Fertility Problem Inventory (FPI), Beck Depression Inventory (BDI) and The Coping Inventory for Stressful Situations (CISS), in addition to a semi-structured clinical interview. Results: Results showed an improvement in mood, acquisition of a more adaptive thinking style, healthy coping mechanisms and self-help strategies to support the patient post-therapy. The contribution of cultural orientation and wellbeing-centered recommendations are being discussed. Conclusion: The improvement of healthcare services relies on such presentations of case studies that can shift the focus in new directions of good clinical practices.

Therapist-guided internet-based cognitive behavioral therapy versus face-to-face CBT for depression/anxiety symptoms in infertile women with adjustment disorders: A randomized controlled trial

ABSTRACT Objective: The present study compared the effectiveness of ICBT to face-to-face CBT on the improvement of adjustment disorder symptoms in infertile women. Method: In a pragmatic, multi-center (public or private), single-blinded, non-inferior randomized controlled trial (RCT), 152 patients with AD (100 women in public center and 52 women in private canter) were assigned to ICBT and CBT. Primary outcomes were Adjustment Disorder New Module-20 (ADNM-20) and Hospital Anxiety and Depression (HADS). Secondary outcomes were the Fertility Problem Inventory (FPI) and Fertility Adjustment Scale (FAS). Results: “Peaceful mind” ICBT was feasible and accessible for delivering the treatment to infertile women with AD. At end-of-treatment, improvements in ICBT were non-inferior to CBT for symptoms of AD, anxiety, and depression. Additionally, the non-inferiority of ICBT to CBT was maintained at a three-month follow-up. Conclusions: ICBT was non-inferior to CBT in improving mental symptoms in infertile women with AD.

The Impact of the FertiStrong Mobile Application on Anxiety and Depression in Men: A Randomised Control Pilot Study.

Male factor accounts for up to half of all cases of infertility. Previously, research has focused on the psychological effects of infertility on female partners, but recent studies show negative consequences on male patients as well. Despite evidence that men are affected by infertility, there is limited studies focusing on coping methods for them. Determine if a cognitive-behavioral and relaxation mobile application, targeted at men experiencing infertility, could lead to decreases in psychological distress. Randomized controlled. Thirty-nine men participated in a randomized pilot study of the FertiStrong application. Participants completed a demographic form, the Hospital Anxiety and Depression Scale (HADS) and Fertility Problem Inventory (FPI) at baseline and one month follow-up. The intervention group downloaded the FertiStrong application and used it when needed. Control participants received routine infertility care. Normally distributed data is presented as mean+/- SD; Differences in proportions were tested using Chi-square test and within group comparison were performed using paired t-test. One participant was excluded, resulting in 38 participants, 19 in each group. There were no baseline differences in demographic characteristics (P>0.31). For the HADS anxiety domain, the control group had a small increase between baseline and follow up, while the intervention group had a small decrease. For the HADS depression domain, there was a slight increase in the controls. For the FPI, the control group had a two-point increase, from moderately stressed to extremely high while the intervention group had a five-point decrease, from extremely high to moderately high, but was not significant. Each FPI domain-specific score in the intervention group decreased and one, Rejection of Childfree lifestyle, was significant (P=0.03). The increase in stress level was significantly greater in the control group (P<0.02). Recruitment was challenging due to the short recruitment phase and the sample size was smaller than planned. However, there were several significant improvements noted in the intervention group and on all testing, the intervention group trended to less distress. More research is needed on convenient interventions for men experiencing infertility.

Women’s quality of sleep and in vitro fertilization success

Women undergoing in vitro fertilization (IVF) are emotionally challenged. Anxiety, depression, and sleep disturbances are common complaints. The impact of these symptoms on IVF outcome is however debated. In this study, we aimed at investigating whether sleep quality and psychological health can affect the chances of success of the procedure. Women undergoing IVF were recruited at the time of oocytes retrieval. Women’s sleep quality and psychological health was assessed using the Pittsburgh Sleep Quality Index (PSQI), the Fertility Problem Inventory (FPI), and the Hospital Anxiety and Depression Scale (HADS). Baseline characteristics and results of the three scales were compared between women who did and did not succeed. Overall, 263 women were included, of whom 81 had a clinical pregnancy (31%). As expected, successful women were younger, and their ovarian reserve was more preserved. FPI and HADS scores did not differ. Conversely, a statistically significant difference emerged for the PSQI score, the median [interquartile range] in pregnant and non-pregnant women being 4 [3–5] and 5 [3–7], respectively (p = 0.004). The crude and adjusted OR of pregnancy in women with a PSQI > 5 (indicating impaired sleep quality) was 0.46 (95% CI 0.25–0.86, p = 0.02) and 0.50 (95% CI: 0.26–0.94, p = 0.03), respectively. In conclusion, low sleep quality is common in women scheduled for IVF and could influence the success of the procedure.

Evaluation of the Psychological Status of Infertile Women

Background: The birth of progeny is one of the most satisfying events. The infertility is one of the major concerns of the modern world. Although there are variable physical causes of infertility but the psychological stress is considered as one of the main causes of infertility. Objective: The fertility problem inventory was used to evaluate the psychological status of the infertile women. The relationship between psychological problems and characteristics of infertility was also assessed. Study design: It is a prospective and questionnaire-based study conducted for the duration of one year on the women attended the gynecology and obstetrician department of Allama Iqbal Memorial Teaching Hospital Sialkot. The study was conducted from June 2021 to May 2022. Material and Methods: A two-month prospective, quantitative, descriptive, questionnaire-based study was conducted on women undergoing infertility therapy with the approval of the institution's ethical committee. The stress level were analyzed by Fertility Problem Inventory Questionnaire. Excel and Microsoft was used for tabulation of data. The collected data was stratified by statistical analysis. The SPSS was used for the analysis. For the categorical variables the t-test was performed. Results: The average age of the twenty three patients included in the study was 30 years. The severe level of infertility-related stress was observed in the almost 75% of the included patients. The other 25% were suffering from the moderate level of stress. Conclusion: The serious psychological morbidity was observed in approximately two-third of the participants. Psychological evaluation of the patients taking infertility therapy could be a consideration. Keywords: Psychological problems and infertility therapy.

Coping styles among Vietnamese people with infertility diagnosis: does type of infertility-related stress really matter?

ABSTRACT Objectives The present study aims to investigate whether each coping style used by Vietnamese people living with infertility diagnosis is associated with specific types of infertility-related stress (IRS). Methods In this cross-sectional design study, 997 patients with primary infertility diagnosis from three hospitals and two clinics in three regions of Vietnam completed questionnaire that consisted of Fertility Problem Inventory, the Copenhagen Multi-Centre Psychosocial Infertility and other questions. Four different linear regression analyses were performed on four coping styles. The five types of IRS and covariates were included in these models. Findings The results show that participants who experience all five types of IRS reported the dominant use of active-avoidance coping, while having four types of IRS, except for social concern, was associated with higher use of meaning-based coping. Utilising active-confronting coping was reported to be the outcome of experiencing increasing need for parenthood and decreasing rejection of child-free lifestyle. Choice of passive-avoidance coping was more common among those with increasing social concern and need for parenthood. Age and educational level impacted infertile people’s choice of avoidance coping strategies. Conclusions The results provide evidence to understand the direct impact of each type of IRS on infertile people’s choice of coping styles to better support them during their individual and family therapy.

P-726 Women’s quality of sleep and in vitro fertilization success

Abstract Study question Can sleep quality and psychological health of women undergoing In Vitro Fertilization (IVF) affect the chances of success of the procedure? Summary answer Psychological health doesn’t seem to affect IVF outcomes while sleep disturbances are common in women undergoing IVF and could influence the success of the procedure. What is known already IVF is saddled with a significant emotional burden causing anxiety, depression, and sleep disturbances. Baseline high levels of stress seem to be negatively associated with IVF success whereas studies evaluating the effect of anxiety and depression are discordant. Investigating sleep disorders in this setting is particularly attracting because of the significant association with anxiety and stress and because it is a simple information to collect. In addition, sleep disorders could negatively affect IVF success, as it does for natural conceptions, due to the well-established association between sleep and the hormonal system. Evidence on this issue is however scant and inconclusive. Study design, size, duration This is a single-center prospective cohort study designed to examine whether the sleep quality and psychological health of women undergoing IVF affect the chances of success of the procedure. Two hundred sixty-three women undergoing IVF between September to December 2019 were enrolled. Baseline characteristics and women’s sleep quality and psychological health were compared between women who did and did not have a live birth. Participants/materials, setting, methods Inclusion criteria were admission for oocyte pick-up. Women with neurologic or psychiatric disorders, obstructive sleep apnea syndrome, anatomical factors that can reduce embryo implantation and limited understanding of the Italian language were excluded. Women’s sleep quality and psychological health were assessed using the Pittsburgh Sleep Quality Index (PSQI), the Fertility Problem Inventory (FPI), and the Hospital Anxiety and Depression Scale (HADS). Main results and the role of chance Overall, 81 women had a live birth (31%). As expected, successful women were younger, and their ovarian reserve was more preserved. No significant group differences were detected for education, employment, parity, smoking status, body mass index and indication to IVF. FPI and HADS scores did not differ. Conversely, our findings revealed that sleep disturbances were associated with lower chances of live birth in IVF: a statistically significant difference emerged for the PSQI score, the median [interquartile range] in pregnant and non-pregnant women being 4 [3-5] and 5 [3-7], respectively (p = 0.004). The crude and adjusted OR of pregnancy in women with a PSQI &amp;gt;5 (indicating impaired sleep quality) was 0.46 (95%CI: 0.25-0.86, p = 0.02) and 0.50 (95%CI: 0.26-0.94, p = 0.03), respectively. Limitations, reasons for caution Data were collected during treatment, which did not allow to properly investigate the association between sleep quality, infertility, and IVF itself. Sleep quality was assessed using a self-reported sleep measure (although validated and extensively used by clinicians and researchers), which does not ensure the objectivity of observations. Wider implications of the findings The assessment of sleep quality throughout the treatment period should be included as an important part of multidisciplinary clinical management of women undergoing IVF. Sleep quality of candidate mothers should be promoted by the implementation of prevention programmes and targeted interventions. Trial registration number not applicable

Psychological Distress Among Infertility Patients: A Network Analysis.

BackgroundPsychological distress is common among infertility patients. Total scale scores are often used to represent the severity of anxiety, depression, or stress, which ignores important differences between specific symptoms, and relationships between symptoms. This study aimed to identify patterns of psychological distress experienced by infertility patients and to identify the most central symptoms of anxiety, depression, and stress.MethodFrom June to September 2016, 740 infertility patients were included in this cross-sectional study. Infertility patients were asked to complete the Generalized Anxiety Disorder-7, Patients Health Questionnaire-9 (PHQ-9), and Fertility Problem Inventory. Network analysis was used to examine the patterns of psychological distress in infertility patients and to test the most central symptoms of anxiety, depression, and stress.ResultsRestlessness was the most central symptom in infertility patients. “Feelings of guilt” had the highest strength among PHQ-9 symptoms. “Relationship concern stress” and “sexual concern stress” had the strongest connections in the network. Stability estimation indicated that the order of node strength centrality was more stable than the order of closeness and betweenness (the CS-coefficients were 0.75, 0.13, and 0.67, respectively). In addition, network structure and global strength were invariant across gender.LimitationsThe cross-sectional design did not permit identification of causal relationships. Patients in this study were recruited from one reproductive hospital; especially, most patients had low socioeconomic status, which limits generalizability of the findings.ConclusionThis study reinforces the need to better understand the underlying causes of psychological distress in infertile patients. A more detailed investigation of the relationship between these symptoms could provide information for psychosocial interventions aimed beyond “alleviating psychological distress.” We should consider the individual psychological symptom pattern and its potential causes in infertility patients instead of assuming a consistent psychological distress structure.

Does Infertility Stress Impair Sexual Function in Infertile Women and Men? A Cross-Sectional Study in Iran.

BackgroundThe issue of infertility is a worldwide challenge, estimated to affect around 50 million couples. This study aimed to evaluate the relationship between infertility stress and sexual function in men and women with infertility.MethodsIn this cross-sectional study, 300 men and women with infertility were recruited. A demographic questionnaire, the Fertility Problem Inventory, the Female Sexual Function Scale (FSFI), and the International Index of Erectile Function (IIEF) were used to collect data. Independent t-test, Chi-square, and linear and logistic regressions were used to assess the data.ResultsThe total score of sexual function in women and men was 22.18 ± 7.86 and 57.7 ± 17.8, respectively. Infertility duration and the ability to pay for the costs of infertility treatment had a significant relationship with sexual function in women. A significant association was found between communication concerns and sexual function scores in men with infertility. Infertile women had more sexual concerns, while infertile men had more communication concerns.ConclusionThis study showed that women with infertility had more infertility stress than men with infertility. Women with higher infertility duration and the inability to pay for the infertility treatment costs impaired sexual function. Women with infertility had more sexual concerns, while Men with infertility had more communication concerns. Policymakers need to consider strategies such as counseling for men and women with infertility to help them cope with their problems, especially their psychological problems. The lack of random enrollment of participants and lack of control group were the limitations of this study.

Stress and depression among infertile couples: A cross-sectional study from a government fertility clinic

Background: Infertility is usually associated with long-term stress, which can manifest as anxiety and depressive symptoms. The goal of this study is to look into the emotional well-being of couples dealing with infertility challenges, as well as to look into the causes of anxiety and despair in these couples.Methods: The research was conducted in a government clinic set up at New Delhi, India with the participation of two hundred couples (400 participants), who were attending there for treatment purposes. The Fertility Problem Inventory (FPI) and the Hamilton Depression Score (HAM-D) were utilized to develop the questionnaire. We also interviewed our subjects to find out more about their sociodemographic and fertility-related characteristics. To evaluate our hypotheses, we used independent-samples t-tests (M SD) and the chi-square test.The objective of the study: The study's goal was to assess the stress and sadness experienced by infertile couples who visited government infertility clinics, as well as to determine the independent variables that may have been associated with infertility. These characteristics included age, sex, educational qualification, profession, infertility period, and type of family.Results: Infertile women were younger (48% were in 26 to 30 years), while 40% of men were 31-35 years old. However, females experienced a much lower level of psychological well-being. Anxiety and depression in infertile couples were linked with age, marriage duration, social issues, sexual issues, and marital relationship tension. Financial stress was also associated with trait anxiety. Our method could explain 58 percent of the variance in depressive symptoms and 62 percent of the variance in anxiety-related symptoms.Conclusions: Symptoms of depression and anxiety in infertile couples were present prominently. It caused an impact on marital & sexual relationships. It is essential to encourage the monitoring of these markers as well as the treatment of underlying stress through suitable psychological therapies.

Infertility-related stress, social support, and coping of women experiencing infertility in Vietnam

BackgroundWomen with an infertility problem living in traditional and developing countries face extensive social pressure, infer-tility-related stress, and distress, which possibly affect their choices of coping strategies. The present study aims to investigate the impact of infertility-related stress and social support on coping of Vietnamese women who live with an infertility diagnosis.Participants and procedureA cross-sectional study was conducted with 192 women diagnosed with infertility at two hospitals in the north and central regions of Vietnam. Participants completed a questionnaire consisting of the Multidimensional Scale of Per-ceived Social Support, the Copenhagen Multi-centre Psychosocial Infertility coping scales and the Fertility Problem Inventory, and questions about their sociodemographic characteristics, infertility-related history, and key social rela-tionships. Four linear regression analyses were performed on four coping strategies: active-avoidance coping (AAC), active-confronting coping (ACC), passive-avoidance coping (PAC), and meaning-based coping (MBC).ResultsThe findings show that high infertility-related stress significantly predicted the use of avoidance coping strategies (AAC and PAC) among these women, while those with a high level of perceived social support tended to use ACC and MBC. None of the four linear regression models support the moderating role of social support in the relationship between infertility-related stress and coping styles.ConclusionsThe study findings show that levels of infertility-related stress and perceived social support have a direct effect on the choice of coping strategies among Vietnamese women diagnosed with infertility. The study results have practical implications in the Vietnamese context, including: (i) the development and adaptation of evidence-based and cultur-ally appropriate interventions and counselling strategies; and (ii) social policy advocacy to better support women diagnosed with infertility, their husbands, and both as couples.

Does infertility develop posttraumatic growth or anxiety/depressive symptoms? Roles of personality traits, resilience, and social support.

This study aimed to explore levels of posttraumatic growth (PTG) and anxiety/depressive symptoms and the role of personality traits, resilience, and social support as predictors of PTG in infertile men/women. In our cross-sectional study, 162 infertile individuals (40 men and 122 women) completed the research questionnaires, including PTG, State-Trait Anxiety Inventory, Fertility Problem Inventory, NEO Five-Factor Inventory, Perceived Social Support, Kobasa hardiness short 20-item, and Beck Inventory Depression (BDI-II). The prevalence of PTG was higher than that of anxiety/depressive symptoms (55.6% vs. 45.7%/40.7%). Neuroticism (β = 0.54 ± 0.25, p < 0.03), extroversion (β = 0.69 ± 0.26, p < 0.01), and resilience (β = 0.33 ± 0.12, p < 0.008) were positive predictors of PTG. Infertile men/women with high level of resilience, extroversion, and neuroticism may have more tendency toward personal growth rather than distress. Practitioners ought to direct counseling to promote factors of personal growth.

Re-examining Psychometric Properties of Fertility Problem Inventory: A Clinic-Based Study from India.

ABSTRACTBackground:The fertility problem inventory (FPI) is one of the most widely used measures that tap the diverse psychological problems faced by infertile couples. Research on translated versions of FPI has also reflected its high clinical significance.Aim:This research aimed to explore the psychometric properties and the clinical validity of the original 46-item FPI in an Indian sample.Setting and Design:This cross-sectional study was conducted in a tertiary hospital setup of a medical college.Materials and Methods:The original FPI was translated and pilot tested. The translated FPI was taken by 205 consenting infertile patients (113 women and 92 men). The psychometric properties of FPI were thus explored.Statistical Analysis:Exploratory factor analysis with minimum residual method of extraction followed by oblimin rotation was performed. Perceived Stress Scale was used to establish the convergent validity of the newly developed FPI-Kannada version (FPI-K). A cut-off score for the FPI-K was obtained separately for males and females using ROC analysis in which hamilton anxiety scale was used as the gold standard.Results:Only 32 items of the original FPI had factor loadings above 0.3 and overall six factors explained these items with a cumulative percentage variation of 32%. Overall Cronbach's alpha for FPI-K was 0.671 and it had a good convergent validity.Conclusions:The new FPI-K had 6 sub-domains and the clinical utility of same is discussed.

Pharmacotherapy or Psychotherapy? Selective Treatment Depression in The Infertile Women with Recurrent Pregnancy Loss: A Triple-Arm Randomized Controlled Trial.

Background:Recurrent pregnancy loss (RPL) and infertility are associated with significant psychiatric complications. The study aimed to investigate the effectiveness of cognitive behavioral therapy (CBT) and sertraline in the treatment of in depression, anxiety, and infertility stress of depressed infertile women with RPL in comparison with usual care.Materials and Methods:A triple-arm randomized controlled trial was carried out on the 60 depressed infertile women with RPL, a population of Infertility Center of Babol city, Iran, who were randomly assigned into three groups: pharmacotherapy with sertraline (n=20), psychotherapy with CBT (n=20), and a usual care as control group (n=20). The participants of psychotherapy received CBT sessions (90 minutes each) over 10 weeks. The participants in the pharmacotherapy group took 50 mg/day sertraline daily for 22 weeks. Outcomes were assessed using the Beck Depression Inventory (BDI-II), fertility problem inventory (FPI), and State-Trait Anxiety Inventory Form Y (STAI-Y) at the beginning of the trial, 10-weeks post-trial, and three months of follow-up. Using statistical package for the social sciences (SPSS) software, data were analyzed.Results:CBT considerably reduced the depression symptoms more than sertraline with a moderate effect size at the post-trial (g=0.11, 95% CI: -0.03 to -0.50). Sertraline showed reduced the scores of state-anxiety more considerably in comparison with control group by a large effect size of post-trial (g=-1.04, 95% CI: -1.70 to -0.38). CBT reduced the total scores of FPI more considerably than sertraline, with a large, small size at follow up-trial [95% CI=-0.03(-0.65, -0.58)]. Both CBT and sertraline were superior to the control group in reducing depression and infertility stress.Conclusion:Depression and infertility stress diminished under CBT and sertraline in depressed infertile women with RPL, with a signi.cant advantage of CBT. Sertraline was superior to CBT in reduction of anxiety (registration number: IRCT201304045931N3).

Psychological correlates in women with infertility

ABSTRACT&#x0D; Aims: To assess the psychological status of infertile women using the Fertility Problem Inventory and to identify any relationship between characteristics of infertility and the psychological problems.&#x0D; Methods: A prospective, quantitative, descriptive, questionnaire- based study with institutional ethics committee clearance was conducted for two months, on women undergoing infertility treatment. Fertility Problem Inventory Questionnaire was applied and stress levels analyzed. Data were tabulated into Microsoft Excel and statistical analysis was performed in terms of percentages and students t tests for categorical variables.&#x0D; Results: Thirty-two patients were studied in the time period with an average of 30.15 years. Seventy-five percent of the patients were found to be suffering from a moderately severe level of infertility-related stress. The remaining were suffering from a moderate level of infertility-related stress. The duration of marriage was found to have a significant correlation with the stress.&#x0D; Conclusions: Majority (two-thirds) of the study group were suffering from a serious psychological morbidity. Psychological evaluation of people seeking infertility treatment could be considered

PERMA model vs. integrative-behavioral couple therapy for fertility problems: A randomized clinical trial protocol.

BackgroundPsychological interventions may reduce fertility problems. Positive emotion, engagement, meaning, positive relationship and accomplishment (PERMA) is a cognitive intervention and integrative-behavioral couple therapy (IBCT) is a behavioral intervention. Appropriate mental interventions are important in infertility treatment.ObjectiveTo investigate the effect of the PERMA model vs. IBCT in reducing the fertility problems of couples.Materials and MethodsThe content of the interventions was developed and adjusted based on a literature review and the opinions of experts. In this three-arm parallel randomized clinical trial, 42 couples undergoing infertility treatment will be allocated randomly into three groups (n = 14 couples/each). Group 1 will receive the PERMA intervention, group 2 will receive the IBCT intervention, and group 3 as the control group will receive an infertility treatment training program intervention. The primary outcome will be the fertility problems, which will be measured by completing a fertility problem inventory at baseline, as well as in the 5 and 9 wk as a follow-up. Another primary outcome, satisfaction with the intervention, will also be assessed in the 5 and 9 wk. The secondry outcome will be a positive pregnancy test at wk 12. The interventions will be conducted through a combination of face-to-face and online via WhatsApp.ConclusionThis study will assess social, sexual, and parenthood concerns. A combination of online and face-to-face interventions will be appropriate given the COVID-19 pandemic. Couple's counseling may provide better counseling outcomes for fertility problems in comparison with group counseling. This study will try to optimize resilience during infertility treatment through learning better relationship and problem-solving skills, and may have an indirect impact on pregnancy rate, burden of infertility, and costs of treatment due to increased effectiveness.

The associations between infertility-related stress, family adaptability and family cohesion in infertile couples

To explore the association between infertility-related stress, family adaptability and family cohesion in infertile couples and the determinants of infertility-related stress in infertile couples. Fertility Problem Inventory (FPI) and Family Adaptability and Cohesion Evaluation Scales (FACESII-CV) were used to measure the infertility-related stress and family adaptability and cohesion of infertile couples. T-test, ANOVA and multiple comparisons (LSD) were conducted to compare the FPI scores of different demographic characteristics subgroups. Stepwise multivariate linear regression was used to explore the determinants of infertility-related stress. Women had greater global stress than men (P < 0.001). Women scored higher on desired family adaptability, cohesion dissatisfaction and adaptive dissatisfaction than men (P = 0.039, P = 0.036, P = 0.008). FPI scores were higher in men and women who lived in rural (P < 0.001, P < 0.001). Family cohesion and education level was negatively correlated with infertility-related stress in men. Family adaptability and education level was negatively correlated with infertility-related stress in women. Healthcare providers should pay more attention and give more support to infertile couples who lived in rural or with low education level, and provide easier medical accessing for them. Moreover, healthcare providers should value more the family function and family support in intervention of reducing infertility-related stress.

Comparing infertility-related stress in high fertility and low fertility countries

We surveyed 169 women seeking infertility treatment in Central Tanzania using an abbreviated version of the Fertility Problem Inventory (FPI) to measure infertility-related stress. We compared our FPI results to similar studies in another high fertility country (Ghana) and in three low fertility countries (the US, Canada, and Italy).Tanzanian women reported higher infertility-related stress than women in low-fertility countries but lower stress than Ghanaian women. Infertility-related stress is a serious concern for women in high-fertility countries, who experience greater pressure to have children. These findings underscore the need for increased access to infertility treatment and addressing community infertility norms.

P–475 The mediator role of infertility-related psychological inflexibility in the relationship between infertility-stress domains and psychopathological symptoms

Abstract Study question Does infertility-related psychological inflexibility play a role in the relationship between infertility-related stress domains and psychopathological symptoms (depression, anxiety)? Summary answer Infertility-related psychological inflexibility mediated the relationship between infertility-related stress domains and depression. There were no effects between infertility-related stress domains and anxiety symptoms. What is known already The emotional impact of infertility may include anxiety and depressive symptoms and these seem to be related to stress. Beliefs about the importance of parenthood (need for parenthood) and rejection of a childfree lifestyle, as well as the impact of infertility in several life areas (social, sexual, and relationship) are conceptually considered two infertility-related stress domains. Although the relationship between infertility-related stress and psychopathological symptoms has been previously recognized, the mechanism underlying this relationship remains undetermined. Psychological inflexibility has been pointed as a core transdiagnostic process contributing to the development and maintenance of several psychological difficulties. Study design, size, duration Cross-sectional study. Participants were recruited through the Associação Portuguesa de Fertilidade (patients’ association). Inclusion criteria were age (18 years or older) and an infertility medical diagnosis. Data were collected online through self-report instruments between June and December 2019. Participants/materials, setting, methods: A sample comprising 287 women pursuing infertility medical treatment (at different stages) completed online a sociodemographic questionnaire, the depression and anxiety subscales of the Depression, Anxiety and Stress Scales (DASS – 21), the Psychological Inflexibility Scale - Infertility (PIS-I), and the Fertility Problem Inventory (FPI). Descriptive and correlational analyses were computed through SPSS v. 26, and path analyses were estimated in AMOS (v. 24) with bootstrap procedures (2000 samples). Main results and the role of chance Correlation analyses revealed that FPI domains (importance of parenthood and impact on life domains), depressive and anxiety symptoms were significantly and positively associated with PIS-I. A mediation analysis was conducted to examine whether PIS-I mediated the effect of FPI domains on depressive and anxiety symptoms. Paths showing not to be statistically significant were removed. This model showed a good fit to the empirical data: χ2(4) = 1.59, p = .810, CMIN/DF = .40; TLI = 1.00; CFI = 1.00; RMSEA = .00, 95% CI = .00 to .06. The effect of the importance of parenthood on depressive symptoms revealed to be both direct (b = .03; SEb = .01; Z = 2.46; p = .014; β= .15) and partially mediated by the PIS-I (b = .31, 95% CI = .24 to .37, p = .018). The effect of the impact of infertility in several life areason depressive symptoms was fully mediated by PIS-I (b = .15, 95% CI = .10 to .21, p = .008). This model explained 43% of the total variance of depressive symptoms. No significant effects were found for anxiety symptoms. Limitations, reasons for caution Participants were at different stages of their fertility treatment. Data collection was completed online and this tends to recruit participants with more access to online platforms. Results rely on cross-sectional and self-report data. Wider implications of the findings: Results suggest the relevance of targeting processes encompassing psychological inflexibility, such as cognitive fusion, experiential avoidance, conceptualized self, conceptualized past and future, lack of values clarity, and inability to commit with values-driven actions, in psychological interventions designed for women with infertility. Trial registration number N/A.