Fertility Quality Of Life Research Articles

Characteristics, experiences and actions taken by women to address delayed conception: A mixed-methods cross-sectional study protocol

The impact of infertility on mental, emotional, physical and sexual health is grave, particularly in a pronatalist society. Literature is replete with evidence of wide ranging psychosocial consequences of infertility in women, indicating the need for identifying the gaps and designing appropriate context specific interventions to improve access and utilization of services. Data that are accessible, primarily from infertility clinics and women visiting hospitals for infertility treatment; information from community settings is rare. This is a protocol paper for a study to understand women's experiences and actions taken by them to cope with delayed conception. Mixed-methods cross-sectional design is used to obtain deep insights into the experiences of delayed conception, coping mechanisms, medical assistance and other help sought. Information is also being obtained on socio-demographic profile, fertility intentions, fertility quality of life, general medical history, obstetric, gynecological and sexual history, substance use and mental health status. A sample of 1530 women will be administered 4 modules of a quantitative survey. Focus group discussions, about four or till saturation point, will be conducted using purposive sampling. The study is recruiting from a population of women who previously participated in the 'Women and Infants Integrated Interventions for Growth Study (WINGS) and failed to conceive during 18 months follow up period. Data collected through questionnaire will be assembled, cleaned, analyzed and reported. The findings will be disseminated through reports with the ethics review committee, government entities, academic and research publications. This study will provide insights on the experiences and coping strategies of women with delayed conception in the study community. Results will assist in designing appropriate interventions to meet the holistic health and psychosocial needs of women with delayed conception and promote sexual and reproductive health within the broader framework of Sustainable Development Goals and Universal health coverage. Trial registration number: CTRI/2020/03/023955.

Coping strategies mediate the association between stigma and fertility quality of life in infertile women undergoing in vitro fertilization-embryo transfer

BackgroundThe mediating role of coping strategies and its relationship with psychological well-being and quality of life has been considered in the literature. However, there is little research to explore the mechanism of coping strategies on stigma and fertility quality of life (FertiQoL) in infertile women undergoing In Vitro Fertilization Embryo Transfer (IVF-ET). The aim of this study was to examine the mediating effect of coping strategies on the relationship between stigma and fertility quality of life (FertiQoL) in Chinese infertile women undergoing In Vitro Fertilization Embryo Transfer (IVF-ET).MethodsIn this cross-sectional study, a total of 768 infertile women undergoing IVF-ET were recruited from Assisted Reproductive Center of Shaanxi Province, China. The personal information, infertility stigma scale, coping strategy scale and FertiQoL scale were measured using a set of questionnaires. The multiple mediator model was performed using AMOS 21.0.ResultsThe model showed a significant negative direct effect between stigma on FertiQoL. There were significantly negative indirect effects of stigma on FertiQoL through active-avoidance, active-confronting and passive-avoidance, respectively. The meaning-based coping played a positive intermediary role. The model explained 69.4% of the variance in FertiQoL.ConclusionActive-avoidance coping strategy is the most important mediator factor between stigma and FertiQoL in infertile women undergoing IVF-ET treatment. Meaning-based coping strategy plays a positive mediating role between stigma and FertiQoL.

Influence of a patient education and care program on women undergoing non-assisted reproductive technology fertility treatment.

PurposeTo determine the influence of a patient education and care program on the quality of life (QOL) of female patients undergoing non‐assisted reproductive technology (ART) fertility treatment.MethodsParticipants completed the MOS 36‐Item Short‐Form Health Survey and fertility QOL (FertiQoL) questionnaires at baseline and at 3, 6, and 12 months of treatment. The responses of patients who underwent three sessions of the program (at baseline, 3 months, and 6 months of treatment) were compared with those of patients who did not receive the program.ResultsThis study compared 69 patients who received an additional care program with 104 patients in the control group, all from 13 facilities. Treatment FertiQoL responses (p = 0.004) and treatment tolerability (p = 0.043) differed between the program and control groups at 3 months using the repeated measures mixed model. The cost of treatment per pregnancy was lower in the program group than in the control group.ConclusionThe patient education and care program provided by reproductive fertility specialists or fertility nurses during non‐ART fertility programs improves patient satisfaction.

P–486 Psychological determinants of the decision to attend couples infertility counselling

Abstract Study question May specific psychological variables related to the experience of infertility have a predicting effect over the decision of accepting counselling? Summary answer Specific infertility related sources of sufferance including low levels of infertility self-efficacy and poor quality of life significantly predict the request for professional help. What is known already Available data on the access to infertility counselling services suggest that only 10–34% of patients who are offered such opportunity actually pursue it. Qualitative studies pointed out that this might be due to a lack of information about available support and to negative attitudes toward counselling. It seems also that women and men who accept counselling have worse levels of psychological distress. However, there is a lack of quantitative studies on the topic and among those available none used measures that are specific to the experience of infertility itself Study design, size, duration The data presented herein are part of a larger data collection promoted by the Italian Ministry of Health on the psychological impact of assisted reproduction. The present study is a cross-sectional research and involves a sample of 184 patients, composed by 92 women waiting for infertility treatment and their partners, enrolled between October 2019 and October 2020 at the Infertility and IVF Unit of the S. Orsola University Hospital in Bologna, Italy. Participants/materials, setting, methods Participants were voluntarily enrolled in the study at their first medical consult. They were informed about the possibility to attend free couples infertility counselling sessions and asked to fill in the following questionnaires: Infertility Self-Efficacy Scale (ISE); Fertility Quality of Life (FERTIQoL); Dyadic Adjustment Scale (DAS). To attend infertility counselling a shared agreement between partners was requested. Couples who agreed to the study but not to counselling sessions were provided only with questionnaires. Main results and the role of chance The 34.8% (n = 32 couples) of the sample accepted to receive counselling sessions. The two groups (counselling vs no-counselling) were comparable in all socio-demographic variables, aside for education, with higher education levels in the counselling group. Overall, the counselling group reported greater psychological sufferance than the no-counselling group, with lower scores at the ISE, FERTIQoL, and DAS questionnaires. Regarding which factors predicted the decision to attend counselling sessions, logistic regression analysis showed that: for the female partner’s dimensions low scores at the ISE and at the Emotional subscale of the FertiQoL were predictive of accepting counselling (when scores increased the odds of being in the counselling group would decrease by 46% and 8% respectively); for the male’s partner dimensions, predictive factors were low scores on the Social subscale and high scores on the Relational subscale of the FertiQoL (when scores increased the odds of being in the counselling group would decrease by 8% and increase by 10% respectively). In conclusion, impairments in self-efficacy, emotional well-being and social life may drive a greater need for help, but a close relationship with the partner may be also necessary to predispose men to accept couples infertility counselling. Limitations, reasons for caution Data were collected from a well enough homogeneous sample which may have helped in better enhancing the specificity of infertile couples’ needs. However, the small sample size and the fact that data were collected from a sole Italian clinic may impact the representativity of our results. Wider implications of the findings: Findings provide important information for clinical interventions with infertile couples. Patients accepting counselling might be having a worse adjustment to the experience of infertility. Besides, women and men may be affected in different ways. Men’s closeness to the partner might be a favourable factor and should be further studied. Trial registration number The study was approved by the Ethical Committee of the S. Orsola Hospital, University of Bologna (CE: 273/2018/Sper/AOUBO) and funded by the Italian Ministry of Health (J33C17000560001)

P–478 Quality of life assessment in women undergoing assisted reproduction. A study of FertiQol and HADS

Abstract Study question The present study aims to explore infertility-related psychosocial outcomes, including fertility quality of life (QoL), as well as anxiety and depression levels, in women diagnosed with infertility. Summary answer Differences on fertility-related QoL appeared when comparing treatment types (gamete donation vs own gamete). Furthermore, statistically significant associations were found between QoL and anxious-depressive symptomatology. What is known already Those who wish to have children and do not achieve their objective just like other peers can see their goals and expectations with pessimism, generating concern and a series of negative emotions. Several psychological implications of infertility have been described, such as increased levels of stress, anxiety, depression, decreased self-esteem, mood and hope, or poor relationship adjustment. The emotional impact of infertility in people’s life cycle can be so strong that reducing it only to biological aspects would lead to a dangerous situation of neglect. For this reason, QoL assessment in ART becomes an important need. Study design, size, duration FertiQol stands as the most widely used tool to assess infertility-related QoL, overcoming the limitations of other instruments that only target specific medical conditions. The present is a multi-site cross-sectional study over patients with infertility (n = 104), aiming to explore their fertility-QoL, as well as their anxiety and depression levels, which are symptoms that have been previously associated.Questionnaire administration, and sociodemographic and medical data gathering took place between January 2019 and December 2020. Participants/materials, setting, methods Participants were 104 female patients (M.age= 39.8) undergoing or expecting a fertility treatment. The FertiQol Spanish version was administered through mobile app, and its paper version distributed at medical/psychological appointments. QoL was self-reported through FertiQol, assessing the influence of infertility problems in various areas (e.g. impact on self-esteem, emotions, general health, family, partners, social relationships, work, life projects...). Additionally, HADS (Hospital Anxiety and Depression Scale) was provided as a measurement of anxiety and depression levels. Main results and the role of chance Regarding treatments, 50.6% of participants were currently undergoing gamete donation while 44.3% were undergoing treatments that involved using their own gametes. After comparing QoL between these treatment types, results showed that patients who underwent egg donation, compared to those who used their own eggs, reported statistically significantly lower scores of QoL in the Social Subscale (p = .03), but not in the other psychological outcomes. Also, statistically significant negative correlations were found between HADS and all core FertiQol subscales (p< .05). Results are consistent with previous studies showing similar associations between fertility QoL and anxiety and depression, as well as with increased psychological negative implications of gamete donation. The majority of participants reported non-pathological scores of anxiety and depression when considering the cut off value of 8 for HADS, thus suggesting the presence of a relatively healthy sample. The number of treatments that patients had previously taken and the years of infertility were not associated with any of the psychological variables. Limitations, reasons for caution Some limitations to consider are presence of co-morbid diagnosis, differences in medication, or patient’s cultural backgrounds.Also, conclusions should be interpreted cautiously since the design doesn’t allow causal inferences. Further investigations should consider a continuous assessment to explore changes in psychological well-being at different points of intervention, specially with gamete donation. Wider implications of the findings: The great advantage we’ve seen so far when using FertiQol is the possibility to identify more accurately the true impact on other aspects of patient’s well-being besides the emotional area.ART professionals, including psychologists and counselors,will have more information within a small amount of time about QoL when using this tool. Trial registration number 1503-BCN–019-DG

P-504 A randomised controlled trial comparing expectant management or intrauterine-insemination in couples with unexplained subfertility and a poor prognosis for natural conception: the impact on health-related-quality-of-life

Abstract Study question Is health-related quality of life (HRQoL) in women with unexplained subfertility and a poor prognosis influenced by expectant management or intrauterine insemination with ovarian stimulation? Summary answer HRQoL did not differ, except for the relational domain which was lower after expectant management. Anxiety and depression disorders occurred frequently in both groups. What is known already In couples with unexplained subfertility and a poor prognosis, IUI with ovarian stimulation (IUI-OS) is a first line treatment. Not much is known about quality of live or depression and anxiety in these couples. The Fertility Quality of Life (FertiQoL) is reliable for assessment within relational and social domains, the Hospital Anxiety and Depression Scale (HADS) is a reliable tool to detect anxiety and depression disorders. Study design, size, duration We performed a multicentre RCT in couples with unexplained subfertility with a poor prognosis of conceiving naturally within one year. Women were allocated 1:1 to six months expectant management or to six months IUI-OS. HRQoL was assessed with standard self-administered psychometric measures with established reliability and validity: FertiQol and HADS. We intended to include 1091 couples but after almost 4 years, the study had to stop due to slow inclusion and therefore lack of funding. Participants/materials, setting, methods Between June 2017 and September 2020, we recruited 178 women of wich 92 were assigned expectant management and 86 IUI-OS. All women who participated and could read Dutch were eligible for the HRQoL measurements because HRQoL questionnaires in foreign languages were not yet available online. Women completed the questionnaires before randomisation, 3 and 6 months after randomisation. We used mixed model analyses to assess differences between treatment groups and the effect of time. Main results and the role of chance One hundred sixty-two women could read Dutch and were invited (162/178 (91%)). Analyzable data of the FertiQol questionnaire were available for 80% (130/162). Compared to women allocated to IUI-OS, women allocated to expectant management had a lower FertiQol score in the relational domain (mean difference -4.3 (95% CI -7.3 to -1.3) but not in the social domain (mean diff van -0.8 (95% CI -4.5 to 2.9). Data of the HADS questionnaire were available of 156 women (96% (156/162)). Both groups had comparable scores in the Anxiety (mean difference -0.20; 95% CI 0.63; -0.99 to 0.6) and Depressions score (mean difference 0.002; 95% CI -0.67 to 0.67) at all three moments. At baseline, the incidence of an anxiety disorder (definition score 8 or higher) was 19% (30/156) and increased to 30% and 29% at 3 months and 6 months respectively. The incidence of a depression disorder (definition score 8 or higher) was 5% (7/156) and increased to 16% and 18% at 3 months and 6 months respectively. The incidences of anxiety or depression disorders did not differ significantly between expectant management and IUI. Limitations, reasons for caution Our randomized controlled trial did not reach the planned sample size. The results are only applicable to women with unexplained subfertility and a poor prognosis and not to all women with unexplained subfertility. Wider implications of the findings Although often assumed, IUI-OS does not improve HRQoL compared to expectant management in all domains. IUI might prevent loss of quality of the relationship, but the impact seems small. Future studies should look into the high incidence of anxiety and depression disorders in these women and how to support them. Trial registration number Trial register NL5455 (NTR5599)

P–510 Psychological distress and quality of life in infertile women attending Infertility clinic at tertiary care center: a pilot study

Abstract Study question What are the levels of psychological distress (anxiety and depression) and quality of life faced by infertile couple presenting with or undergoing treatment for infertility? Summary answer The levels of psychological distress and quality of life seems to be affected more in women than their husbands and may require psychological intervention. What is known already Infertility is a biopsychosocial crisis which can cause psychological distress in the form of depression and anxiety, and can impair quality of life .It often has a stressful impact on relationships and can affect a couple’s sex life. Most of the time these aspects are not explored and only medical and surgical treatment is offered depending on the cause. Assessing the psychological distress and quality of life contributes to decrease the stress and helps to improve the outcome of management by improving the relationship of the individual to achieve pregnancy. These women need psychological support, in the form of counselling. Study design, size, duration Cross-sectional study .100 infertile couples attending fertility clinics. Previous data indicate that the mean infertility specific QoL in infertile couples is 54.39 for females (nd 60.63 for males .Thus, a minimum sample size of 77 samples per group is needed to be able to reject the null hypothesis with probability 80% power. With a 30% dropout rate, the sample size is 100 samples per group. The study was conducted from Jan 2018 to June 2019. Participants/materials, setting, methods Infertile couples aged between 25 to 40years attending the Infertility outpatient clinic in OBG department, JIPMER, Pondicherry, India were recruited in to the study. Presence of a pre-existing major medical illness and presence of a major psychiatric illness were excluded from the study. After written consent, the severity of depression and anxiety was measured using the Hospitol Anxiety and Depression Scale (HADS Scale) and QoL was assessed with the Fertility Quality of Life (FertiQoL) questionnaire. Main results and the role of chance The average ages (SD) of men and women were 33.6 (4.29) and 31.3(4.03) years, respectively. Women reported higher levels of depression (p < 0.001) and anxiety (p < 0.001) as compared to their husbands. Depression and anxiety was noted more in women who were more than 32year age and prolonged duration of infertility. There was a significant association between depression, gender, duration of marriage and duration of infertility among the infertile couples.78% women felt that their attention and concentration were impaired and 63% responded that they cannot move towards their life goals . Around 72% and 60% felt drained out and lost, respectively. 57% women had fluctuant thoughts like hope and despair. More women felt were socially isolated and uncomfortable with social situations than men. 45% reported social pressure and 52% were felt angry because of fertility problem. Only 24% women were satisfied with support from friends and 37% of their family can understand them. Overall only 51% of the participants gave positive response to fertiqol questions. The total FertiQoL scores were significantly higher in the husbands than the wives (p < 0.001). Poor Qol were significantly associated with male cause of infertility (p = 0.004), primary infertility (p = 0.022) and previous history of receiving multiple treatments (p = 0.020). Limitations, reasons for caution The main limitation of the study is the cross-section study design which cannot detect exact cause of psychological distress and small sample size from single center which did not define entire population. Self reported questionairre was more subjective 5han objective which might be counfounding. Wider implications of the findings: Couples going through infertility have a varying degree of emotional moods swinging between anxiety and depression impairing QoL.,women being affected more than men.Counselor who can empathize with the couple should form an integral part of the infertility team providing psychological intervention along with infertility treatment. Trial registration number NA

P–504 A randomised controlled trial comparing expectant management or intrauterine-insemination in couples with unexplained subfertility and a poor prognosis for natural conception: the impact on health-related-quality-of-life

Abstract Study question Is health-related quality of life (HRQoL) in women with unexplained subfertility and a poor prognosis influenced by expectant management or intrauterine insemination with ovarian stimulation? Summary answer HRQoL did not differ, except for the relational domain which was lower after expectant management. Anxiety and depression disorders occurred frequently in both groups. What is known already In couples with unexplained subfertility and a poor prognosis, IUI with ovarian stimulation (IUI-OS) is a first line treatment. Not much is known about quality of live or depression and anxiety in these couples. The Fertility Quality of Life (FertiQoL) is reliable for assessment within relational and social domains, the Hospital Anxiety and Depression Scale (HADS) is a reliable tool to detect anxiety and depression disorders. Study design, size, duration We performed a multicentre RCT in couples with unexplained subfertility with a poor prognosis of conceiving naturally within one year. Women were allocated 1:1 to six months expectant management or to six months IUI-OS. HRQoL was assessed with standard self-administered psychometric measures with established reliability and validity: FertiQol and HADS. We intended to include 1091 couples but after almost 4 years, the study had to stop due to slow inclusion and therefore lack of funding. Participants/materials, setting, methods Between June 2017 and September 2020, we recruited 178 women of wich 92 were assigned expectant management and 86 IUI-OS. All women who participated and could read Dutch were eligible for the HRQoL measurements because HRQoL questionnaires in foreign languages were not yet available online. Women completed the questionnaires before randomisation, 3 and 6 months after randomisation. We used mixed model analyses to assess differences between treatment groups and the effect of time. Main results and the role of chance One hundred sixty-two women could read Dutch and were invited (162/178 (91%)). Analyzable data of the FertiQol questionnaire were available for 80% (130/162). Compared to women allocated to IUI-OS, women allocated to expectant management had a lower FertiQol score in the relational domain (mean difference –4.3 (95% CI –7.3 to –1.3) but not in the social domain (mean diff van –0.8 (95% CI –4.5 to 2.9). Data of the HADS questionnaire were available of 156 women (96% (156/162)). Both groups had comparable scores in the Anxiety (mean difference –0.20; 95% CI 0.63; –0.99 to 0.6) and Depressions score (mean difference 0.002; 95% CI –0.67 to 0.67) at all three moments. At baseline, the incidence of an anxiety disorder (definition score 8 or higher) was 19% (30/156) and increased to 30% and 29% at 3 months and 6 months respectively. The incidence of a depression disorder (definition score 8 or higher) was 5% (7/156) and increased to 16% and 18% at 3 months and 6 months respectively. The incidences of anxiety or depression disorders did not differ significantly between expectant management and IUI. Limitations, reasons for caution Our randomized controlled trial did not reach the planned sample size. The results are only applicable to women with unexplained subfertility and a poor prognosis and not to all women with unexplained subfertility. Wider implications of the findings: Although often assumed, IUI-OS does not improve HRQoL compared to expectant management in all domains. IUI might prevent loss of quality of the relationship, but the impact seems small. Future studies should look into the high incidence of anxiety and depression disorders in these women and how to support them. Trial registration number Trial register NL5455 (NTR5599)

P–498 Patient’s pregnancy rates after IVF fresh embryo transfer positively correlates to the number of visual connections to live blastocyst development images of own embryos

Abstract Study question Looking at time-lapse images of own embryos during the five days of culture, as a patient’s active behaviour, may help to increase pregnancy rates? Summary answer The number of visual connections to live blastocyst development images of own embryos positively correlates to patient’s pregnancy rates after fresh single blastocyst transfer. What is known already In human reproduction, despite the evidence that infertility itself and reproductive treatments can produce anxiety and stress, the impact of emotions on pregnancy outcomes is unknown and probably underestimated. The interaction between psyche, nervous, immune and endocrine systems (PNIE) is well known and has been applied to understand and treat different pathological conditions. Patient’s active behaviour during IVF treatments appears to be a positive strategy to decrease women’s anxiety and stress, thus to increase fertility quality of life and pregnancy outcomes. Study design, size, duration Retrospective comparative study of 934 patients undergoing fresh IVF cycles during three years. To avoid any bias related to oocyte and embryo factors, we only included egg donation cycles in the study, and ≥3BB (Gardner score) single embryo transfers. All embryo cultures were performed in time-lapse incubator and patients could connect on-line to their embryo’s images before single blastocyst transfer. We evaluated the impact of visual connections to live embryo images on pregnancy rates. Participants/materials, setting, methods On day one of embryo culture, consenting patients received an individualized and secure link allowing them to connect on-line to images of their own embryos any time during the five days of culture. Patients were divided in five groups depending on the number of on-line visualisations (A = 0; B = 1–10; C = 11–20; D = 21–30; E > 30). Pregnancy and clinical pregnancy rates were compared between the five groups. Chi-square test for a large contingency table was performed to compare all groups Main results and the role of chance The distribution of patients in the five groups, based on number of visualizations, resulted as follows: 287 in group A; 328 in group B; 156 in group C; 80 in group D; 83 in group E. The five groups were homogeneous and there were no statistically significant differences in recipient’s ages (A 42.8±3.9 years; B 41.9±3.9 years; C 41.8±4.5 years; D 42.8±4.1 years; E 41.9±4.4 years) and in donor’s ages (A 25.5±4.3 years; B 26.9±4.4 years; C 27.1±4.2 years; D 26.4±4.5 years; E 26.5±4.1 years) among the five groups. We observed a progressive positive trend between the number of on-line visualisations and pregnancy rates, reaching statistical significance for group E (>30 visualizations) compared to the others groups. In group E, pregnancy rates and clinical pregnancy rates per fresh single blastocyst transfer were respectively 72.3% and 65.1%, significantly higher when compared to the others groups (p < 0.01, p < 0.001): group A 61% and 50.9%, group B 63.1% and 56.1%, group C 64.1% and 55.1%, group D 65% and 53.8%. Limitations, reasons for caution Time-lapse incubator is needed as well as a strong informatics setting to ensure secure and personalised on-line connection to each patient at any time during the five days of culture. Endocrine and endometrial biomarkers should be proposed and evaluated in further clinical trials to better understand these results. Wider implications of the findings: Repeated on-line visualization of own embryos images before fresh blastocyst transfer enhances pregnancy rates in IVF cycles. We propose that repeated visual stimuli of images produces a positive emotional connection between patients and their own developing embryos, thus reducing anxiety and enhancing recipient’s endometrial receptivity. Trial registration number Not applicable

Associations of Symptoms of Depression, Social Support, and Quality of Life Among Korean Women Who Experience Infertility

ObjectiveTo describe the quality of life (QOL) of Korean women experiencing infertility based on sociodemographic and infertility characteristics and to examine the associations among symptoms of depression, social support, and QOL. DesignCross-sectional, descriptive study. SettingParticipants were recruited from July to August 2019 on one of the largest South Korean websites where individuals share pregnancy and parenthood experiences. ParticipantsAdult women (N = 186) who received infertility treatment. MethodsParticipants completed an online survey using the Korean version of the Patient Health Questionnaire 9 to measure symptoms of depression, the Multidimensional Scale of Perceived Social Support, and the Fertility Quality of Life (FertiQOL) scale. Data were analyzed using descriptive statistics, correlation, analysis of variance, and multiple regression. ResultsThere was a significant negative relationship between scores on the Patient Health Questionnaire 9 and FertiQOL (r = −.56) and a significant positive relationship between scores on the Multidimensional Scale of Perceived Social Support and FertiQOL (r = .40). The length of time from diagnosis of infertility to data collection, past and current treatments, cost burden, and degree of inhibition of daily life due to infertility also significantly affected participants’ FertiQOL scores. Symptoms of depression, the burden of treatment, and inhibition of daily life activities explained 46% of the variance in QOL. ConclusionWomen experiencing infertility and symptoms of depression had lower FertiQOL scores. Health care providers, who are most familiar with and attentive to patients, could provide a first line of defense against poor QOL in this population. By continuously assessing the levels of psychosocial stress in women with infertility, nurses could provide timely resources and design interventions to improve women’s QOL.

Mediating Effects of Emotional Self-Disclosure on the Relationship between Depression and Quality of Life for Women Undergoing In-Vitro Fertilization.

This study aimed to identify the moderating and mediating effect of emotional self-disclosure between depression and quality of life for women under infertility treatment. The subjects included 169 infertile women under in vitro fertilization (IVF) treatment. The data were collected by self-administered questionnaires from June to August in 2019. The questionnaire consisted of questions about depression, emotional self-disclosure, and fertility quality of life. Descriptive statistics, t-tests, one-way analysis of variance, correlation, and stepwise multiple regression were analyzed using the SPSS 25.0 Windows program. Depression had a negative correlation with emotional self-disclosure (r = −0.189, p = 0.014) and fertility quality of life (r = −0.532, p < 0.001). Emotional self-disclosure had a positive correlation with fertility quality of life (r = 0.259, p = 0.001). These results confirm that emotional self-disclosure has mediating effects between depression and fertility quality of life. Therefore, nursing interventions for IVF patients need to encourage expressing and sharing various emotions experienced through the diagnosis and treatment of infertility in order to alleviate negative emotions.

Fertility quality of life (FertiQoL) among Chinese women undergoing frozen embryo transfer

BackgroundWomen undergoing infertility treatment have poor quality of life. This may cause them to withdraw from or refuse treatment. Women undergoing frozen embryo transfer have a treatment interval. The aim of this study was to investigate the status quo of the fertility quality of life in women undergoing frozen embryo transfer and analyse its predictors.MethodsA cross-sectional survey was conducted from August 2019 to August 2020 among women undergoing frozen embryo transfer in a tertiary hospital reproductive centre in Beijing, China. The survey collected demographic characteristics and treatment data and included the fertility problem inventory, the fertility quality of life scale (FertiQoL) and the state-trait anxiety scale. Multiple linear stepwise regression was used to explore the predictors of fertility quality of life.ResultsIn total, 1062 women completed the survey. Participants reported that they had high levels of fertility-related stress and anxiety during treatment. They also had lower fertility-related quality of life, and the Treatment FertiQoL scored the lowest. The regression results showed that social concern, trait anxiety, duration of treatment and age were risk factors for diminished fertility quality of life.ConclusionChinese women undergoing frozen embryo transfer have relatively poor quality of life. The potential predictors of fertility quality of life include social concern, trait anxiety, duration of treatment and age.

Correlation between perceived infertility-related stress and fertility quality of life in women diagnosed with primary infertility

IntroductionA diagnosis of infertility is a stressful emotional experience for women, leading to a significant detrimental impact in many domains of life quality.ObjectivesThe aim of this study is to explore the correlation between perceived infertility-related stress and fertility quality of life in affected women.MethodsThe study sample comprised 236 women diagnosed with primary infertility, recruited from the Gynecology Obstetrics Clinic, with a mean age of 33.21 years (min 20, max 46) and with a mean duration of conception attempts of 3.24 years (min 1, max 16), assessed by the Fertility Problem Inventory (FPI) and the Fertility quality of life questionnaire (FertiQol).ResultsThe mean FPI and FertiQol were 137.23 (SD=29.066) and 65.356 (SD=11.119) respectively. There was a significant negative correlation between perceived infertility-related stress and fertility quality of life (r= -.513; p&lt;0.01). All the subscales of the applied questionnaires showed significant negative correlations, with exception of Need for parenthood and Rejection of childfree lifestyle subscales of FPI and Treatment related quality of life of FertiQol. Furthermore, the total FPI score could significantly predict the total FertiQol score (F=83.386; df=1:234; p&lt;0.01). On the basis of perceived infertility-related stress, a 26.3% variance of fertility quality of life can be explained.ConclusionsWomen diagnosed with primary infertility who experience higher levels of infertility-related stress had a lower level of fertility quality of life.

The analysis of fertility quality of life and the influencing factors of patients with repeated implantation failure

BackgroundThe objective of this study was to investigate the current status of fertility quality of life (QoL) and explore the influencing factors for infertile women with repeated implantation failure (RIF).MethodsThe sample consisted of 137 infertile women with RIF who were under treatment from January 2019 to December 2019 in the Reproductive Medical Center of Ruijin Hospital, affiliated with Shanghai Jiaotong University School of Medicine in China. A general information questionnaire, FertiQoL scale, perceived social support scale (PSSS), self-rating anxiety scale (SAS), and self-rating depression scale (SDS) were used to analyse the fertility QoL and related factors of RIF patients.ResultsThe total fertility QoL score of RIF patients was 60.44 ± 11.60. The results of multivariate regression analysis showed that residence, financial difficulties, male infertility, BMI index, depression, and family social support were the main factors that influenced the fertility QoL of RIF patients (adjusted R2 = 0.762).ConclusionBased on the results of this study, RIF patients’ psychological status must be addressed. Corresponding interventions such as building a sound family and social support system, creating a good medical environment and offering diverse health education should be provided to improve the fertility QoL of RIF patients.

Sexual function and quality of life in Chinese couples undergoing assisted reproductive treatment: a prospective cohort study

Couples undergoing assisted reproductive technologies (ART) are prone to sexual dysfunction and lower quality of life (QoL), but whether the incidence of these problems differs with the type of ART is unknown. As such, we conducted this cross-sectional survey to compare the sexual function and QoL of 75 couples undergoing intrauterine insemination (IUI), and 160 couples undergoing in vitro fertilization (IVF). They completed an anonymous questionnaire which included: (i) demographic characteristics; (ii) female sexual function index (FSFI) or (iii) international index of erectile function-5 (IIEF-5); and (iv) fertility QoL questionnaire (FertiQoL). Overall, 22.6% of wives and 39.1% of husbands were at risk for sexual dysfunction, and the risk was similar in IUI and IVF groups. Mean core/treatment/total FertiQoL scores of husbands were higher than wives: 74.98 vs. 68.24/70.02 vs. 65.87/73.52 vs. 67.54 (all p < 0.001). FertiQoL scores were similar in IUI and IVF groups except wives’ treatment FertiQoL score was significantly higher in the IUI group (68.93 vs. 64.44; p = 0.009). This study confirms that risks for sexual dysfunction were similar in IUI and IVF couples. Wives undergoing IVF had significantly lower treatment FertiQoL score. In both IUI and IVF groups, husbands’ QoL was better than wives’ QoL.

Relationships between infertility-related stress, family sense of coherence and quality of life of couples with infertility

This is a cross-sectional study with the objective to examine the relationships between infertility-related stress, family sense of coherence and quality of life of Chinese couples with infertility in Hong Kong. A convenience sample of 135 Chinese couples were recruited at the subfertility clinics of the Family Planning Association of Hong Kong. Data were collected using the Fertility Problem Inventory, Family Sense of Coherence Scale and Fertility Quality of Life. Path analysis was used for data analysis. The results showed that infertility-related stress had a negative association with the quality of life of infertile couples and family sense of coherence mediated the effect of infertility-related stress on quality of life for both partners. The infertility-related stress of women had a negative association with their husbands’ quality of life. Infertile women had more infertility-related stress and a lower quality of life than their husbands. The findings provide new insights into the importance of family sense of coherence in facilitating couples’ adjustment to infertility. Culturally competent heath care interventions should be developed to strengthen family sense of coherence among Chinese couples with infertility and help them reduce their infertility-related stress, thus improving their quality of life.

Assessment of impact of infertility &amp; its treatment on quality of life of infertile couples using fertility quality of life questionnaire

Background:With rising trends of infertility in India, it is no longer just a medical concern, but is rapidly becoming a public health issue due to its social and interpersonal ramifications. Limited data is available regarding quality of life of the infertile couples.Aim:The aim of this study was to understand the quality of life (QOL) of Indian infertile couples using the fertility QOL (FertiQoL) tool and to find the correlation between the values of the core and treatment FertiQoL and various sociodemographic and clinical factors.Study Setting and Design:This cross-sectional study was conducted at fertility clinic at an urban tertiary care center.Materials and Methods:Over a period of 12 months, 274 completed questionnaires obtained from 137 couples were selected for the analysis. Demographic and clinical characteristics of all the patients were recorded. Data analysis was performed using the Statistical Package for the Social Sciences software version 25:0. IBM Chicago, USA.Results:Women had worse QOL than their male partners. They scored lower than men on emotional and mind body subscales. Women showed positive and uniform trend in mean scores of all core FertiQoL subscales with age and education. Rural population had poorer QOL. Patients with primary infertility had poorer QOL except in the relational domain. Couples, in whom both partners had some pathology, had the worse QOL compared to female factor, male factor or unexplained infertility.Conclusion:Our study is a step in the direction to establish the baseline QOL objectively in Indian couples with infertility.

Quality of life of Sudanese patients attending a fertility clinic: a mixed methods study

ABSTRACT Background Infertility affects over 50 million people globally, the burden is disproportionately borne by women, especially in low and middle-income countries (LMIC). The impact of infertility on quality of life (QoL) has not been well documented or assessed qualitatively in LMIC like Sudan, where infertility is a pervasive problem. Therefore, the purpose of this mixed-methods study was to assess the fertility-related QoL of infertile individuals in Sudan using the fertility quality of life (FertiQoL) tool. Methods We used explanatory sequential design (surveys and interviews) in a fertility clinic in Sudan (January 2017–May 2018). We collected socio-demographic information, medical/reproductive history and used Arabic FertiQoL. We generated descriptive statistics of FertiQoL (core, domain) scores and independent variables; multiple linear regression models to assess the relationship between FertiQoL and dependent variables; and t-tests to compare mean core/domain scores. We conducted thematic analysis on qualitative data about the subjective experience of being infertile. Results The study included 102 participants (72 women), 70 educated beyond secondary school, mean age 33.89 years (SD = 7.82) and mean duration of infertility was 4.03 years (SD 3.29). Mean FertiQoL core score 76.02 (SD = 16.26), domain scores: emotional 71.61 (SD = 22.04), relational 78.06 (SD = 16.62), mind/body 74.06 (SD 22.53) and social 78.88 (SD = 18.24). Men had better fertility-related QoL. Four themes emerged A sense of something missing because of childlessness; social pressure from peoples’ questions; impact on the spousal relationship (which differed amongst participants) and coping (faith-based and non-faith-based) which was necessary when the lived experience led to internal distress. Conclusions Infertility negatively impacted the QoL of participants in this study, and women were worse off. Cognitive appraisal, social support and pressure may be key factors influencing the QoL of infertile individuals, therefore they should be encouraged to seek social and professional support. FertiQoL is a useful tool to assess fertility QoL in LMIC like Sudan.

The Relationship Between Infertility, Stress, and Quality of Life with Posttraumatic Stress Disorder in Infertile Women.

Background:The infertility experience and its treatment are accompanied by the symptoms of posttraumatic stress disorder (PTSD). The aim of this study was determining the relationship between posttraumatic stress disorder and quality of life and the infertile women’s stress.Methods:In this descriptive-analytic study, 172 infertile women were divided in four groups. Convenience sampling was done and eligible infertile women referred to Qafqaz Infertility Center in Iran were included in the study. The data was collected between January and March 2019 through posttraumatic stress disorder checklist, The Fertility Quality of Life (FertiQoL) questionnaire, and Newton's infertility stress questionnaire. Pearson correlation, linear regression analysis, and two-way analysis of variance (ANOVA) were applied for data analysis with a significance level of 0.05.Results:The results of two-way analysis of variance (ANOVA) revealed that there was no significant relationship between the type of treatment (p=0.548) and the reception of psychological intervention (p=0.450). In addition, the results of Pearson correlation showed that there was an inverse significant relationship between the total score of posttraumatic stress disorder and quality of life (r=−0.91, p<0.001) and a direct relationship between the total score of posttraumatic stress disorder and level of stress (r=0.56, p<0.001).Conclusion:The results of this study showed that 41.3% of the infertile women had the symptoms of posttraumatic stress disorder. Due to the relationships of posttraumatic stress disorder with the quality of life and infertility stress, providing regular designed psychological interventions is recommended for infertile individuals.

Resilience as the predictor of quality of life in the infertile couples as the most neglected and silent minorities

ABSTRACT Background: It has been demonstrated that infertility can affect quality of life (QoL) in infertile couples. Resilience is considered a protective factor against the distress caused by infertility and the quality of life status. There is a new definition for Fertility Quality of Life that evaluates particularly the impact of infertility on various aspects of life. Material and methods: In this couple-based study, the main objective was investigating the quality of life based on the gender and resilience of infertile couples. Measurement tools were three questionnaires including a demographic one, a quality of life of infertile couples questionnaire and the Connor–Davidson Resilience Scale. Data analysis was done through paired t-test and linear multiple regressions test. Results: Overall the difference of mean score for QoL is statistically significant (P > 0.001) between men and women (69.48% vs 58.87%), which means that QoL status was positive in men and neutral in women. In addition, the mean score of male resilience was more than female resilience (P = 0.009). The results showed there was a significant and positive correlation between the QoL status and resilience score (P = 0.008, r = 0.13) (P < 0.1), and resilience (β = 0.04 and P = 0.04) had a significant protective effect on the quality of life. Conclusion: Low resilience status in infertile couples is better to be considered as a risk factor compromising the quality of life and infertility consolers should keep in mind this issue and provide a comprehensive and holistic approach for a better outcome of infertility treatment. Abbreviations: QoLICQ: Quality of Life in Infertile Couple Questionnaire; CD-RISC: Connor–Davidson Resilience Scale; IVF: in vitro fertilisation; ART: assisted reproductive technique; PTSD: posttraumatic stress disorder; IUI: intrauterine insemination; ICSI: intracytoplasmic sperm injection.