Depression and state anxiety scores during assisted reproductive treatment are associated with outcome: a meta-analysis.

This meta-analysis investigated whether state anxiety and depression scores during assisted reproductive technology (ART) treatment and changes in state anxiety and depression scores between baseline and during ART treatment are associated with treatment outcome. PubMed, PsycInfo, Embase, ScienceDirect, Web of Science and Scopus were searched and meta-analytic data analysed using random effects models to estimate standardized mean differences. Eleven studies (2202 patients) were included. Women who achieved pregnancy had significantly lower depression scores during treatment than women who did not become pregnant (-0.302; 95% CI: -0.551 to -0.054, z = -2.387, P = 0.017; I2 = 77.142%, P = 0.001). State anxiety scores were also lower in women who became pregnant (-0.335; 95% CI: -0.582 to -0.087, z = -2.649, P = 0.008; I2 = 81.339%, P = 0.001). However, changes in state anxiety (d = -0.056; 95% CI: -0.195 to 0.082, z = -0.794; I2 = 0.00%) and depression scores (d = -0.106; 95% CI: -0.296 to 0.085, z = -1.088; I2 = 0.00%) from baseline to treatment were not associated with ART outcome. Clinics should aim to promote better psychosocial care to help patients manage the psychological and physical demands of ART treatment, giving realistic expectations.

For your eyes only: bio-behavioural and psycho-social research priorities.

Infertility is experienced as a deeply personal and private condition, which has been investigated across disciplines, from psycho-social to bio-behavioural (van den Akker, 2012). This is undoubtedly, in part, because the interactions between the biological-behavioural axis and psychological-social axis have been linked to aetiological and treatment factors and to the consequences of infertility. Recent data from the Human Fertilization and Embryology Authority (HFEA, 2012) show that medically assisted reproduction (MAR) for infertility is continuing to increase, with 46,000 women in the UK seeking treatment in 2010 alone. Infertility is therefore considered to be a public health concern. However, prevention and ethical treatment require individual and collective responsibility. The currently identified public health concerns are compounded by evidence that genetic factors are linked to infertility, with new generations of children conceived through IVF/ICSI potentially affected by inherited damaged DNA (Bonde et al., 2008) that would otherwise not have found its way into the gene pool of new generations. Since treatment takes place at one point in time, and consideration of the moral rights and wrongs of the consequences of some treatments takes place at another, usually much later on within the social contexts in which they coexist with others, there is a discontinuity between the initial treatment and the future consequences of these treatments. In this paper I propose a simple prevention outcome consequences (POC) model for future comprehensive research priorities with substantial policy and practice implications. The time has come to face the new challenges with all eyes wide open.

eHealth as a challenge to 'expert' power: a focus group study of internet use for health information and management.

OBJECTIVE: To investigate current use of the internet and eHealth amongst adults. DESIGN: Focus groups were conducted to explore participants' attitudes to and reasons for health internet use. MAIN OUTCOME MEASURES: The focus group data were analysed and interpreted using thematic analysis. RESULTS: Three superordinate themes exploring eHealth behaviours were identified: decline in expert authority, pervasiveness of health information on the internet and empowerment. Results showed participants enjoyed the immediate benefits of eHealth information and felt empowered by increased knowledge, but they would be reluctant to lose face-to-face consultations with their GP. CONCLUSIONS: Our findings illustrate changes in patient identity and a decline in expert authority with ramifications for the practitioner-patient relationship and subsequent implications for health management more generally.

Psychological trait and state characteristics, social support and attitudes to the surrogate pregnancy and baby.

BACKGROUND: Personality differences between surrogate mothers (SMs) who gestate and relinquish and intended mothers (IMs) who commission a genetically related or unrelated baby have been unexplored in the UK. Furthermore, the psychological effects of the arrangement have not been determined in a prospective longitudinal study, making this the first quantitative report of psychological functioning in SMs and IMs. METHODS: SMs and IMs (n = 81: 61 surrogate, 20 intended) undergoing genetic or gestational surrogacy (4 groups) were assessed by postal questionnaire during the first, second and third trimesters of pregnancy. Those with a positive outcome were assessed again in the first week, at 6 weeks and 6 months post-delivery of the surrogate baby. RESULTS: There were no significant differences between or within SM and IM groups on personality characteristics. Social support, marital harmony and state anxiety differed significantly (to P < 0.01) between SMs and IMs at different stages of the arrangement. Differences in attitudes towards the pregnancy and the baby were also observed between groups during pregnancy (to P < 0.001), but there was no evidence of post-natal depression amongst the groups studied. CONCLUSIONS: These results are important because they demonstrate psychological effects of the surrogate arrangement are notable and occur over an extended period of time. It also shows that psychological screening and support prior to, during and following surrogacy is indicated.

Psychosocial aspects of surrogate motherhood.

This review addresses the psychosocial research carried out on surrogacy triads (surrogate mothers, commissioning mothers and offspring) and shows that research has focused on a number of specific issues: attachment and disclosure to surrogate offspring; experiences, characteristics and motivations of surrogate mothers; and changes in profiles of the commissioning/intended mothers. Virtually all studies have used highly selected samples making generalizations difficult. There have been a notable lack of theory, no interventions and only a handful of longitudinal studies or studies comparing different populations. Few studies have specifically questioned the meaning of and need for a family or the influence and impact that professionals, treatment availability and financial factors have on the choices made for surrogate and intended mothers. Societal attitudes have changed somewhat; however, according to public opinion, women giving up babies still fall outside the acceptable remit. Surrogate and intended mothers appear to reconcile their unusual choice through a process of cognitive restructuring, and the success or failure of this cognitive appraisal affects people's willingness to be open and honest about their choices. Normal population surveys, on the contrary, are less accepting of third party reproduction; they have no personal need to reconsider and hence maintain their original normative cognitively consonant state.

Coping, quality of life and psychological symptoms in three groups of sub-fertile women.

The process of assisted reproductive technology (ART), surrogacy and adoption pose different physical and psychological burdens on sub-fertile populations. Sub-fertile women (n = 176) were assessed retrospectively by questionnaire to determine if process (undergoing ART, surrogacy or adoption) or outcome (having a successful versus unsuccessful outcome) affected quality of life, coping style and psychological symptoms. The ART group was significantly younger, had a shorter period of sub-fertility, and was least likely to have a child than the adoptive and surrogate groups. Quality of life and psychological symptoms were not significantly different between groups, although significantly higher Mental Disengagement and Denial coping strategy scores were obtained for the ART group. Social, psychological, health and functioning quality of life, and Denial coping strategies were good predictors of outcome group. Treatment specific counselling of individuals use of coping strategies early on in their in/subfertility career to cope with the reality of prolonged childlessness is indicated.

A longitudinal pre-pregnancy to post-delivery comparison of genetic and gestational surrogate and intended mothers: confidence and genealogy.

For women opting to use surrogacy to overcome subfertility, a choice can be made to have a genetically related or unrelated baby. Similarly, women opting to become surrogate mothers also have to choose to gestate and relinquish a genetically related or unrelated baby. This study explored the cognitions behind the initial choices made and determined the strength of those cognitions six months post-delivery of the surrogate baby. Surrogate and Intended mothers (N=81) undergoing Artificial Insemination (AI, genetic) or Embryo Transfer (ET, gestational) were studied separately (four groups) at the start of their surrogate arrangement and those with a positive outcome (n=34) were re-interviewed at six months post-relinquishment. There were significant differences between surrogate and intended mothers in their confidence about the arrangement. Beliefs about the importance of a genetic link were predictors of ET arrangements. Responses were consistent over a one and a half-year study period. The ethical and clinical implications of the results are discussed in relation to appropriate self-selection and confidence with the surrogate process and the importance of genetic offspring.

Functions and responsibilities of organizations dealing with surrogate motherhood in the UK.

The separation of maternity from social motherhood and progress in reproductive technology raise many social, psychological, medical and legal issues (van den Akker, 1994). The most recent British Medical Association report (BMA, 1996) acknowledged the practice of surrogacy and issued new guidelines for good practice and support for those involved. Surrogate motherhood services have increased around the country over the last decade, even before the formal British Medical Association acknowledgement of their necessity and existence (BMA, 1996). The present survey investigated the incidence, accessibility, and functions of such organizations, specifically, the legal, medical and psychological problems encountered and how they were dealt with, to discover what advice and support is given. Ten centres were interviewed. The incidence of surrogacy conducted through these organizations is widespread, but the processes involved and therefore the implications of the types of surrogacy dealt with are very different. The two major surrogacy agencies deal primarily with partial surrogacy, whereas the clinics are concerned almost exclusively with full (IVF) surrogacy. Information about the procedures involved appears to rely on experience; screening is generally carried out 'in house', and psychological factors are dealt with by counsellors on request by the couples. In general, although the roles of the organizations are disparate and clearly defined, no holistic or long-term care is provided by any of the organizations involved with surrogacy in the UK. The reasons for this are clear cut and stem from the nature of the organizations, and the behaviour of the clients. The data indicate that the current procedures used by the organizations are adequate but could be improved and standardized.