Design and psychometric evaluation of the collaborative coping with infertility questionnaire in candidate of assisted reproductive techniques.

Evaluating couples' coping with infertility and its impact on their mental health is valuable in designing supportive programs. Since infertility is a shared problem in married life, coping with it requires collaborative coping strategies. Therefore, the aim of the present study was to design and psychometrically evaluate the collaborative coping with infertility questionnaire (CCIQ) in candidates of assisted reproductive techniques (ART). The exploratory factor analysis of a 27-item questionnaire designed based on the Likert scale in the Persian language was evaluated through the principal component analysis method in a cross-sectional study conducted on 200 couples who volunteered for ART. The cut-off point of factor loadings was considered 0.4. Furthermore, the criterion validity of the questionnaire was evaluated using a 12-item revised Fertility Adjustment Scale (R-FAS) and its relationship with the score of the CCIQ. Moreover, the internal consistency of the questionnaire was evaluated using Cronbach's alpha correlation coefficient. In the exploratory factor analysis, 20 items with a factor loading above 0.4 were extracted under three factors. The three extracted factors with a value above one explained 43.78% of the variance of CCIQ. The factor loading of the accepted items ranged between 0.402 and 0.691. External reliability was confirmed with Cronbach's alpha coefficient of 0.98. The relationship between CCIQ and R-FAS score was significant (p < 0.0001). The results of the study showed that the 20-item CCIQ enjoyed acceptable validity and reliability in the three dimensions of 'dynamic interaction,' 'reorganizing married life goals,' and 'perception about infertility,' which can be used to evaluate collaborative coping with infertility questionnaire in ART candidates.

Psychological distress, vaccine, and booster acceptance in women considering or undergoing fertility treatments during the Omicron surge of the COVID-19 pandemic.

OBJECTIVE: Follow-up study to evaluate perceptions of COVID-19 vaccination and booster with psychological distress during the COVID-19 pandemic and Omicron surge in women considering or undergoing fertility treatment. MATERIALS AND METHODS: Cross-sectional anonymous survey (N = 2558) from a single academic fertility center. Five hundred forty patients completed the survey (response rate = 21.1%). Participants were randomized 1:1 to a one-page evidence-based graphic with information and benefits regarding COVID-19 vaccination. Mental health and vaccine hesitancy were assessed via the Patient Health Questionnaire Depression (PHQ-8), the Generalized Anxiety Disorder (GAD-7) scales, and the Medical Mistrust Index (MMI). RESULTS: Majority of participants were nulliparous, fully vaccinated with a booster dose, with > 1 year of infertility and mild to moderate distress. Patients with vaccine hesitancy had higher medical mistrust scores (r = .21,  p < .001). Higher MMI scores were not associated with vaccination during pregnancy. Participants that had higher PHQ-8 and GAD-7 scores were more likely to believe the omicron variant would cause delay in fertility treatments, would have impact on fertility outcome, and were more likely exhibiting medical system distrust (p < .001). Participants who received educational material were more likely to know pregnant women with COVID-19 had increased risk of death, stillbirth, and preterm birth (p < .05). CONCLUSION: The majority of women in this study were vaccinated and had received their booster dose but also with clinically significant levels of depression. Patients with higher levels of distress and greatest medical mistrust demonstrated a concern that the Omicron variant would delay treatment, lead to suboptimal fertility outcomes, and COVID-19 vaccination would impact risk of miscarriages.

Psychosocial outcomes of children born via embryo donation.

STUDY QUESTION: What are parents' perceptions of their relationships with and the psychosocial adjustments of their children who are born via embryo donation? SUMMARY ANSWER: Families created through embryo donation have well-adjusted parent-child relationships and reassuring child psychosocial outcomes. WHAT IS KNOWN ALREADY: Embryo donation is an effective and growing form of third-party reproduction, but there is limited research in this field. Prior studies suggest that families created through gamete donation function well regarding parent-child relationship quality and child behavioral and socioemotional adjustment. STUDY DESIGN, SIZE, DURATION: This is a cross-sectional survey study with 187 total participants. PARTICIPANTS/MATERIALS, SETTING, METHODS: Parents of children born via embryo donation were recruited nationally by contacting all embryo donation programs registered with the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) as well as medically directed embryo donation or 'embryo adoption' centers. Participants completed three online Qualtrics questionnaires. The first was a survey including 33 questions on demographics, the procurement process, and self-reported obstetric outcomes. Participants also completed two standardized measures assessing children's behavior and parents' adjustment to parenthood: the Strengths and Difficulties Questionnaire (SDQ) and the Parental Acceptance-Rejection Questionnaire (PARQ). Scoring of the SDQ and PARQ was totaled and compared to standardized values (SDQ) or previously published results on other forms of gamete donation (PARQ), such as oocyte donation and sperm donation. MAIN RESULTS AND THE ROLE OF CHANCE: On the SDQ (n = 46), the average total difficulties scores by age were: 8.2 ± 0.98 for ages 2-4, 7.6 ± 0.93 for ages 5-10, and 3.5 ± 0.77 for ages 11-17; this is compared to the normal reported range of 0-13, which indicates that clinically significant psychosocial problems are unlikely. Across all ages and individual categories (emotional symptoms, conduct problem, hyperactivity, peer problem, prosocial), scores on the SDQ were within the normal ranges. The average PARQ score (n = 70) for all respondents was 27.5 ± 1.18 (range: 24-96), suggesting perceived parental acceptance. LIMITATIONS, REASONS FOR CAUTION: Because this study was cross-sectional, it could not capture familial relationships over time. This survey-based study design allows for potential selection bias (parents of well-adjusted children may be more likely to participate). Additionally, the overall sample size is relatively small; however, it remains one of the largest published to date. Another significant limitation to this study is the lack of generalizability: most participants were recruited from private, faith-based, embryo donation programs who are demographically similar. WIDER IMPLICATIONS OF THE FINDINGS: Though embryo donation is an established form of third-party reproduction, it is significantly less robustly studied compared to other forms of gamete donation (oocyte or sperm donation). This study provides a larger data set with a more expanded age range of children compared to the limited number of previously published studies. Furthermore, these findings indicate a high parental disclosure rate with respect to the use of embryo donation which contrasts previous findings. STUDY FUNDING/COMPETING INTEREST(S): No external funding source was utilized for the completion of this study. No conflicts are disclosed. TRIAL REGISTRATION NUMBER: N/A.

A critical view on using "life not worth living" in the bioethics of assisted reproduction.

This paper critically engages with how life not worth living (LNWL) and cognate concepts are used in the field of beginning-of-life bioethics as the basis of arguments for morally requiring the application of preimplantation genetic diagnosis (PGD) and/or germline genome editing (GGE). It is argued that an objective conceptualization of LNWL is largely too unreliable in beginning-of-life cases for deriving decisive normative reasons that would constitute a moral duty on the part of intending parents. Subjective frameworks are found to be more suitable to determine LNWL, but they are not accessible in beginning-of-life cases because there is no subject yet. Conceptual and sociopolitical problems are additionally pointed out regarding the common usage of clear case exemplars. The paper concludes that a moral requirement for the usage of PGD and GGE cannot be derived from the conceptual base of LNWL, as strong reasons that can be reliably determined are required to limit reproductive freedom on moral grounds. Educated predictions on prospective well-being might still be useful regarding the determination of moral permissibility of PGD and/or GGE. It is suggested that due to the high significance of subjective experience in the normativity of beginning-of-life bioethics, the discipline is called to more actively realize the inclusion of people with disabilities. This regards for instance research design, citation practices, and language choices to increase the accessibility of societal debates on the reproductive ethics of genetic technologies.

Depression, anxiety, quality of life, and infertility: a global lens on the last decade of research.

We aimed to review the global literature in the past 10 years regarding the impact of infertility on depression, anxiety, stress, and quality of life while exploring the potential clinical utility of psychosocial fertility questionnaires. PubMed, Scopus, and CINAHL were searched for English-published articles since 2013 on key search terms related to infertility, assisted reproductive technologies, and psychological terms such as depression, anxiety, mood disorders, and quality of life. The search yielded 7,947 articles, of which 366 articles were independently deemed relevant by the 3 reviewers. Anxiety, depression, and diminished quality of life are prevalent in the infertility experience of both men and women. Studies from around the world show similar experiences independent of culture.

Going through treatment: experiences of women who sought assisted reproductive technology treatment in five selected hospitals in Ghana.

Using a qualitative approach, this paper explores the accounts of 30 women who accessed assisted reproductive technology treatment in five fertility hospitals in Ghana. A semi-structured interview guide was used to collect data on women's experiences of the procedure. Findings indicated that most of the women sought ART treatment to save their relationships from collapsing, with pressure and demands from friends and in-laws as key motivating factors. Women complained of emotional imbalance and the high cost of ART treatment. They felt compelled to borrow money from friends, family and banks and, sometimes sold assets to pay for treatment costs. Health consequences such as depression, changes in menstrual flow, weight loss, body pain, breast tenderness, bleeding and disruption to daily activities and sexual life were reported as problems encountered by the women. While study findings are supportive of the inclusion of infertility treatment in the national health insurance scheme, more adequate counselling and education for women undergoing ART treatment is required.

Factors associated with discontinuation in fertility treatment: a systematic scoping review.

PURPOSE: The discontinuation of fertility treatment could decrease the chances of achieving parenthood for infertile patients and often leads to economic loss and medical resource waste. However, the evidence on the factors associated with discontinuation is unclear and inconsistent in the context of fertility treatment. This scoping review aimed to summarize the evidence on factors associated with discontinuation in fertility treatment, identify the current knowledge gap, and generate recommendations for future research. METHODS: We searched PubMed, Embase, The Cochrane Library, Web of Science, CINAHL, American Psychological Association, and http://clinicaltrials.gov from inception to June 2023 without language or time restrictions. We also searched the grey literature in Open Grey and Google Scholar and hand-searched the reference lists of relevant studies to identify potentially eligible studies. Publications that studied factors associated with discontinuation in fertility treatment were included. The identified factors were mapped to the World Health Organization's treatment adherence model. RESULTS: Thirty-seven articles involving 41,973 infertile patients from 13 countries were included in this scoping review. All studies identified the factors from the perspective of patients, except for one that described the factors from the healthcare providers' perspective. A total of 42 factors were identified, with most of them belonging to the patient-related dimension, followed by socio-economic-related, treatment-related, condition-related, and healthcare system-related dimensions. Female education level, social support, and insurance coverage decreased the likelihood of treatment discontinuation, whereas multiparous women, male infertility, depression, higher infertility duration, and treatment duration increased the likelihood of treatment discontinuation. Age, education level, and ethnicity are the commonly nonmodifiable factors for treatment discontinuation, while insurance coverage, depression, and anxiety symptoms are among some of the more commonly reported modifiable factors. CONCLUSION: This is the first scoping review examining and synthesizing evidence on the factors influencing of discontinuation in fertility treatment. This review could inform researchers, clinicians, and policymakers to address modifiable barriers and facilitators to develop personalized and multicomponent interventions that could improve the discontinuation in fertility treatment.

Precursors of Prenatal Attachment and Anxiety during Pregnancy in Women Who Procreate Naturally and Pregnant Women following Assisted Reproduction Technology.

The process of adaptation of the woman to pregnancy seems to be influenced by many factors, such as the type of conception, the mother's age, the possible presence of other children, and socio-cultural factors. Women who conceived with an assisted reproductive technique are emotionally vulnerable; compared with pregnant women who procreated naturally, they manifest elevated anxiety, which seems to be correlated to the fright of being separated from their child. Objectives of the present research are as follows: (1) to analyze the relationship between age, gestational age, time expectancy, previous failed attempts, perception of a high-risk pregnancy, and presence of other children, with the level of maternal-fetal attachment (MFA); (2) explore the level of maternal-infant attachment and anxiety by comparing the control and experimental group; (3) to measure a possible relationship between anxiety levels and MFA in ART pregnant women; (4) to identify variables predictive of prenatal attachment. The study group is formed by ninety-five women aged between 18-42 years (M = 30.57; S.D. = 5.47), pregnant from the 23rd to the 37th week (M = 28.95; S.D. = 3.99); on which 50 women who procreate naturally and 45 pregnant women following assisted reproductive technology. They completed: Maternal-Fetal Attachment Scale (MFAS), State-Trait Anxiety Inventory (STAI), and ad hoc questionnaire to collect anamnestic data. The results show the presence of a correlation between gestational age and waiting period, between the number of assisted fertilization attempts with the worry about their ability to become pregnant, but a negative correlation between pregnancy weeks and the level of maternal-fetal attachment. The study shows the predictive role of anxiety on the MFA. The applications and indications for future research are analyzed.

Optimism, Resilience, and Infertility-Specific Stress during Assisted Reproductive Technology / El optimismo, la resiliencia y el estrés especifico por infertilidad en la aplicación de las técnicas de reproducción asistida

Background: Infertility generates high levels of stress to women. The aim was to explore optimism and resilience among women undergoing assisted reproductive technology (ART). Method: Participants were recruited in a private fertility clinic. The sample consisted of 229 women under medical treatment for fertility who completed the following self-report instruments: a sociodemographic and clinical questionnaire, Resilience Scale (RS), Life Orientation Test (LOT-R), Perceived Stress Scale (PSS), and STAI State and STAI Trait. Results: Our data revealed that high resilience levels were associated with a reduced psychological stress (β = .02, p < .001, 95% CI [.34, .13]). A significant negative correlation between perceived stress and resilience (r = -.320, p = .001) was found. Conclusion: The findings highlight the protective mediating role of resilience when women are confronted with the negative effects of infertility diagnosis and assisted reproductive technology (ART), and therefore the potential utility of resilience to reduce infertility-specific stress. (AU)

Antecedentes: La infertilidad genera un nivel de estrés elevado en la mujer. El objetivo era explorar el optimismo y la resiliencia en las mujeres que se someten a técnicas de reproducción asistida (TRA). Método: Los participantes fueron reclutados en una clínica de fertilidad privada. La muestra estuvo conformada por 229 mujeres en tratamiento médico para de fertilidad que cumplimentaron los siguientes instrumentos de autoinforme: cuestionario sociodemográfico y clínico, Escala de Resiliencia (RS), Test de Orientación a la Vida (LOT-R), Escala de Estrés Percibido (PSS) y STAI Estado y Rasgo. Resultados: Los datos revelaron que un nivel elevado de resiliencia se asociaba con menos estrés psicológico (β = .02, p < .001, IC del 95 % [.34, .13]). Se obtuvo una correlación negativa significativa entre estrés percibido y resiliencia (r = -.320, p = .001). Conclusión: Los hallazgos resaltan el papel mediador protector de la resiliencia cuando las mujeres se enfrentan a los efectos negativos del diagnóstico de infertilidad y las técnicas de reproducción asistida (TRA) y, por lo tanto, la utilidad potencial de la resiliencia para reducir el estrés específico de la infertilidad. (AU)

Progress of psychological status and targeted nursing intervention in assisted reproductive technology assisted pregnancy population in female athlete patients

Objective: To investigate the current psychological status and the impact of a focused nursing intervention in the population of women who have undergone an assisted reproductive technology pregnancy. Methods: As the targeted group, 100 infertile female athlete patients who underwent assisted reproductive technology (ART) in our hospital between March 2018 and June 2021 were chosen. Using a random number system, they were divided into two groups of 50 cases each: the routine group received routine nursing care, while the targeted group received targeted nursing care depending on the female athlete patients' psychological conditions; The conventional group was chosen from 50 additional cases of naturally conceived pregnant women who had standard prenatal testing at our institution during the same time frame. The results of the self-rating symptom scale (SCL-91) for the targeted group and the conventional group were compared; Pregnancy rate, SCL-90 ratings before and after the intervention, and satisfaction with the intervention were compared between the typical group and the targeted group. Results: Comparing the targeted group to the conventional group, the SCL-90 score of the targeted group significantly rose (P <0.05); Following the intervention, both the routine group's and the targeted group's SCL-90 scores were significantly lower than they had been (P<0.05), with the targeted group's scores being significantly lower than the routine group's; The pregnancy rate of the targeted group (50.00%) was substantially higher (P<0.05) compared to the conventional group (32.00%) ; The pregnancy rate in the targeted group (92.00%) was considerably higher (P<0.05) than in the conventional group (76.00%). (AU)

Depressive ranges in infertile couples with male factor

Introduction: Depression is not uncommon among infertile couples. The objective of the study is to analyze factors that predict depression in these couples, when they are in Assisted Reproduction Techniques programs. Materials and method: We analyze the level of depression in couples referred from the Human Reproduction Unit to study the male factor using the Beck Depression Inventory and the clinical information contained in the SARAplus program. Results: Depressive ranges appear in approximately half of the participants. The degree of depression correlates in a statistically significant way between both members of the couple. Among the analyzed clinical factors, we observed relational tendency between depression and obesity and depression and smoking. Conclusions: Depression in infertile couples is a fact. ART specialists should be on the lookout for symptoms of depression in order to provide patients psychological and psychiatric care and treatments, as part of the overall therapeutic framework for infertility. (AU)

Multicentre study on rates and reasons for treatment discontinuation in patients with remaining cryopreserved embryos.

RESEARCH QUESTION: What is the discontinuation rate among patients with remaining cryopreserved embryos in Belgium and what are the reasons for discontinuation? DESIGN: Multicentre, cross-sectional study across 11 Belgian fertility clinics. Patients were eligible (n = 1917) if they had previously undergone an unsuccessful fresh embryo transfer (fresh group) or frozen embryo transfer (FET) (in-between group) and did not start a subsequent FET cycle within 1 year despite having remaining cryopreserved embryos. The denominator was all patients with embryos cryopreserved during the same period (2012-2017) (n = 21,329). Data were collected through an online anonymous questionnaire. RESULTS: The discontinuation rate for patients with remaining cryopreserved embryos was 9% (1917/21329). For the final analysis, 304 completed questionnaires were included. The most important reasons for discontinuing FET cycles were psychological (50%) and physical (43%) burden, effect on work (29%), woman's age (25%) and effect on the relationship (25%). In 69% of cases, the patient themselves made the decision to delay FET treatment. In 16% of respondents, the decision to delay FET was determined by external factors: treating physician (9%), social environment (4%), close family (3%) and society (3%). Suggested improvements were psychological support before (41%), during (51%) and after (51%) treatment, as well as lifestyle counselling (44%) and receiving digital information (43%). CONCLUSIONS: The discontinuation rate is remarkably high in patients with remaining cryopreserved embryos who have a good prognosis. Respondents stressed the need to improve the integration of psychological and patient-tailored care into daily assisted reproductive technology practice.

Comparing infertility-related stress, coping, and quality of life among assisted reproductive technology and non-assisted reproductive technology treatments.

Women who undergo assisted reproductive technology (ART) treatments experience infertility-related stress and have low quality of life (QOL). However, there is limited understanding of infertility-related stress, coping, or QOL among women who undergo non-ART treatments. The purpose of this study was to examine infertility-related stress, coping, and QOL among women who undergo ART and non-ART infertility treatments. Using a descriptive correlational cross-sectional design, we recruited 200 women who underwent infertility treatments. Participants completed the Copenhagen Multi-centre Psychosocial Infertility (COMPI) Fertility Problem Stress Scale, COMPI Coping Styles Scale, Fertility Quality of Life tool, and a demographic infertility survey. Data analysis included descriptive statistics, independent t-test, chi-square, and hierarchical multiple regression. Women who underwent non-ART had more personal stress, used more active-avoidance coping, and had lower emotional, social, and treatment environment QOL compared to those in ART treatment. Women who underwent ART treatments used more meaning-based coping but had lower treatment tolerability QOL. Stress and coping contribute to core QOL differently among infertility treatment groups. Both treatment groups report low satisfaction with emotional services. Regardless of the treatment type, women who undergo infertility treatments may need care to address their psychological health.

Embryo donation: Counselling practice issues and dilemmas within the context of identity-release donor programmes.

Embryo donation (ED) involves the donation of surplus embryos post family formation to others in need. Commensurate with Australian and New Zealand legislation and policy, ED is practiced as an identity-release programme shaped by four paramount principles. These include: the need to consider the longitudinal health and well-being of donor-conceived children born from assisted reproductive technologies (ART); recognition that offspring should be made aware of and be able to access information about their genetic origins; awareness that the short and long-term health and psychological welfare of other stakeholders (i.e., recipients and donors) should be ensured; and finally, that all donations are altruistic. Whilst embedded in ART legislation or professional guidelines, how these principles are operationalized through counselling in both countries remains variable. In this paper, we draw upon Australian and New Zealand research, legislation and policy shaping the counselling milieu. We highlight some of the key clinical issues that counsellors need to explore with participants of an ED arrangement and the implications of these as they apply to dilemmas within counselling practice such as counsellor roles and responsibilities.

Evaluating group psychological interventions for mental health in women with infertility undertaking fertility treatment: A systematic review and meta-Analysis.

ABSTRACTWe conducted a systematic review and meta-analysis of the published literature concerning the effectiveness of group psychological interventions in improving anxiety, depression, marital dissatisfaction, fertility quality of life and stress, and pregnancy outcomes of women with infertility, participating in fertility treatment. A search of five databases yielded 1603 studies; 30 articles met inclusion criteria, and computations of effect sizes ensued (Hedges' g and Odds Ratios (OR)). The total sample comprised 2752 participants, with 1279 participants receiving group intervention and 1473 participants in the comparison group. Group psychological interventions reduced depression (Hgw = -1.277; 95% CI = [-1.739- -0.815]; p = 0.000), anxiety (Hgw = -1.136, 95% CI [-1.527- -0.744]; p = 0.000), fertility stress (Hgw = -0.250, 95% CI [-0.388- -0.122]; p = 0.000), and marital dissatisfaction (Hgw = -0.938; 95% [CI -1.455- -0.421]; p = 0.000), and pregnancy rates improved (OR = 2.422 95% CI [2.037-2.879]; p = 0.000). No improvement was observed regarding fertility quality of life (Hgw = 0. 144; 95% CI [-0.176- 0.463]; p = 0.379). Our findings highlight that participation in group psychological intervention improved the mental health, fertility stress and pregnancy rates of women with infertility.

Protective Relational Factors of Lesbian Couples Navigating the Fertility Process.

Little research about lesbian couples' experiences with fertility treatment exists in the counseling literature. While there is an increase in lesbian couples exploring fertility options to expand their families, it is important to understand their experiences during this stressful process. This research seeks to understand these experiences using Moustakas' Imaginative Variation method with seven lesbian couples. Results include feelings of isolation, psychological and physical stress. Despite myriad difficulties associated with assisted reproductive technology, participants' experiences show the presence of strong relationship factors, divided into three categories: connectedness, mutuality, and resilience. The use of Relational Cultural Theory may be helpful to lesbian couples looking to expand their families through reproductive methods.

Depressive ranges in infertile couples with male factor.

INTRODUCTION: Depression is not uncommon among infertile couples. The objective of the study is to analyze factors that predict depression in these couples, when they are in Assisted Reproduction Techniques programs. MATERIALS AND METHOD: We analyze the level of depression in couples referred from the Human Reproduction Unit to study the male factor using the Beck Depression Inventory and the clinical information contained in the SARAplus program. RESULTS: Depressive ranges appear in approximately half of the participants. The degree of depression correlates in a statistically significant way between both members of the couple. Among the analyzed clinical factors, we observed relational tendency between depression and obesity and depression and smoking. CONCLUSIONS: Depression in infertile couples is a fact. ART specialists should be on the lookout for symptoms of depression in order to provide patients psychological and psychiatric care and treatments, as part of the overall therapeutic framework for infertility.

Living with the Threat of Covid-19: Exploring the Psychological Impact of Covid-19 in Those who Conceived Through ART Versus Spontaneously.

OBJECTIVES: To explore and compare anxiety relating to the threat of Covid-19 in pregnancy by women who conceived through assisted reproductive technology (ART) and spontaneously. We also examined the psychological coping strategies used and lived experience for both groups. METHODS: A total of 21 women who conceived through ART at a private university based IVF and a matched sample of women who conceived spontaneously were enrolled from July 2020 to February 2021. This was a mixed methods study. Covid-19-specific anxiety was measured using the coronavirus anxiety scale (CAS) as well as a validating qualitative data model with the use of open-ended questions to expand on quantitative findings. RESULTS: In both groups of women the level of anxiety detected by the CAS was low and mixed coping strategies (emotion-focused and problem-solving) were utilized. The ART group expressed more positive feelings towards pregnancy during the Covid-19 pandemic. CONCLUSION: The vulnerable ART group is no more at risk for negative emotional well-being during the Covid-19 pandemic. Additionally, healthcare providers ought to be knowledgeable of various Covid-19 coping strategies that may provide emotionally protective measures for all women of reproductive age. This is of particular importance as effective coping may ultimately prevent disruptions that could compromise prenatal care during the covid-19 pandemic.

Anxiety and depression among couples undergoing treatment for infertility with assisted reproductive techniques at an Indian centre.

Background Infertility and its treatment are frequently associated with psychological distress. We assessed the prevalence of anxiety and depression in couples undergoing treatment for infertility with assisted reproductive techniques (ARTs). Methods We included 160 married couples undergoing treatment for infertility at an ART centre. The prevalence of anxiety and depression was assessed using the hospital anxiety and depression scale. Results The prevalence of anxiety and depression was 46.2% and 40.9%, respectively. Women had higher mean (SD) anxiety (10.76 [2.69]) and depression (9.86 [2.06]) scores; however, this gender difference was statistically significant only with respect to anxiety (p=0.02). The mean anxiety scores were highest among both genders when the cause of infertility was attributed to both partners and during the first year and 10 years after treatment. Men in the age groups of 20-24 years and 40-44 years and those with no prior treatment had a statistically significant association with the highest anxiety scores. The mean depression scores showed a statistically significant decline in both genders with increasing age. Among men, the mean depression scoreswere significantly higher in those with no prior treatment, male cause of infertility and during the first year and after 10 years of treatment. Conclusion The prevalence of anxiety and depression among infertile couples undergoing treatment with ART was almost twice as high as that in the general population. The mean anxiety scores were significantly associated with duration of treatment and gender-based attribution in both genders; however, age and prior treatment were associated with only men. The mean scores of depression were significantly associated with age in both genders, while duration of treatment, gender-based attribution and prior treatment were significantly associated only with men.

Experiences of female clients in the assisted reproductive technology process in Nigeria.

Background: Though assisted reproductive technology (ART) has been a source of hope for many infertile couples, it is known to be associated with physical, social, psychological, and ethical challenges in different settings. Objective: The study objective was to explore the experiences of female clients who accessed services in ART clinics in Nigeria. Methods: An exploratory qualitative design, using snowballing technique was employed. It involved in-depth interviews of eight women who had gone through the assisted conception process, using an interview guide. Data collection was from November 2019 to January 2020. Results: The age range of the participants was 30 - 52 years with a mean of 41.88 years. Majority of the clients presented at advanced age to their ART providers because of lack of funds and ignorance. Other challenges were suboptimal risk disclosure, high cost of services, feelings of shame and stigmatization during and after the process. Conclusion: Cost of ART remain unaffordable to most Nigerians hence the need for government subsidization and in-corporation of ART services into the National Health Insurance Scheme. Additionally, lack of adequate information disclosure, shared decision-making and gendered suffering are areas of great concern among the study participants. A national regulatory guideline will ensure uniform international standard of care.