Impact of childlessness on life and attitudes towards continuation of medically assisted reproduction and/or adoption.

Infertility and fertility treatment have the potential to impact and disrupt a couple's overall life. In order to study the associations between the impact of childlessness on one's life, and men and women's attitudes towards fertility treatment continuation and/or adoption, we analysed data from a one-year follow-up questionnaire in a prospective, longitudinal cohort study of consecutive couples initiating fertility treatment in Denmark. The study comprised 302 couples with no children at baseline and no joint children at one-year follow-up. In total, 71.9% of women and 72.5% of men reported that they wished to continue fertility treatment, while 20.2% of women and 19.2% of men reported that they wished to pursue adoption. The attitudes of nearly 8 in 10 couples were congruent towards further fertility treatments, while nearly 7 in 10 couples were congruent in their attitudes to pursuing adoption. Significantly more men who reported a lower impact of childlessness on their daily life wished to continue fertility treatment, compared with those reporting that childlessness had a greater impact on their life. Among women, significantly more were undecided about whether or not to pursue adoption when reporting a greater impact of childlessness on social life, compared with those reporting a lower impact of their childlessness.

Marital stability and repartnering: infertility-related stress trajectories of unsuccessful fertility treatment.

OBJECTIVE: To compare the trajectories of infertility-related stress between patients who remain in the same relationship and patients who repartner. DESIGN: Longitudinal cohort study using latent growth modeling. SETTING: Fertility centers. PATIENT(S): Childless men and women evaluated before starting a new cycle of fertility treatment and observed for a 5-year period of unsuccessful treatments. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Marital stability and infertility-related stress. RESULT(S): The majority of patients (86%) remained with their initial partner, but 14% of participants separated and repartnered while pursuing fertility treatments. Marital stability significantly predicted the initial status of infertility stress and infertility stress growth levels. Specifically, patients who repartnered had higher infertility stress levels at all time points compared with those who remained in the same relationship, regardless of the partner they were with at assessment. Furthermore, results showed an increasing stress trajectory over time for those who repartnered, compared with those who remained in a stable relationship. CONCLUSION(S): Men and women in fertility treatment who form a second union have higher initial levels of stress in their original relationship and higher changes in stress levels over the course of treatments. These findings suggest that high infertility-related stress levels before entering fertility treatment can negatively affect the stability of marital relationships and lead to repartnering.

Are severe depressive symptoms associated with infertility-related distress in individuals and their partners?

STUDY QUESTION: Are severe depressive symptoms in women and men associated with individual and dyadic infertility-related stress in couples undergoing infertility treatment? SUMMARY ANSWER: Severe depressive symptoms were significantly associated with increased infertility-related distress at both the individual and partner level. WHAT IS KNOWN ALREADY?: An infertility diagnosis, the stress of medical treatments and a prior history of depression are risk factors for future depression in those undergoing fertility treatments. Studies examining the impact of severe depressive symptoms on infertility-related distress in couples are lacking. STUDY DESIGN, SIZE, DURATION: This cross-sectional study included 1406 couples who were consecutively referred patients undergoing fertility treatments in Denmark in the year 2000. A total of 1049 men and 1131 women were included in the study. PARTICIPANTS/MATERIALS, SETTING, METHODS: Participants were consecutively referred patients undergoing a cycle of medically assisted reproduction treatment at five Danish public and private clinics specializing in treating fertility patients. Severe depressive symptoms were measured by the Mental Health Inventory 5 from the Short Form Health Survey 36. Infertility distress was measured by the COMPI Fertility Problem Stress Scales. Multilevel modelling using the actor-partner interdependence model was used to study the couple as the unit of analysis. MAIN RESULTS AND THE ROLE OF CHANCE: Severe depressive symptoms were reported in 11.6% of women and 4.3% of men, and were significantly associated with increased infertility-related distress at the individual and partner level. There was no significant interaction for gender indicating that men and women did not differ in how severe depressive symptoms were associated with infertility distress. LIMITATIONS, REASON FOR CAUTION: Because of the cross-sectional study design, the study findings only show an association between severe depressive symptoms to individual and partner distress at a single point in time; however, nothing is known about causality. WIDER IMPLICATIONS OF THE FINDINGS: This study adds to the growing body of literature using the couple as the unit of analysis to study the relationship between depression and infertility distress. Recommendations for medical and mental health professionals that underscore the potential risk factors for depressed men and women who are pursuing infertility treatments are provided. Additional studies using a longitudinal study design to track the impact of depression on distress over the course of the infertility treatment cycle would be valuable for increasing our understanding of the complex relationship that exists between these psychosocial factors. STUDY FUNDING/COMPETING INTERESTS: Authors Brennan Peterson and Matthew Pirritano have no financial disclosures for this study. Camilla Sandal Sejbaek and Lone Schmidt have received research grants from the Danish Health Insurance Foundation (J. nr. 2008B105) and Merck Sharp & Dohme. The funders had no influence on the data collection, analyses or conclusions of the study.

Fertility awareness and parenting attitudes among American male and female undergraduate university students.

BACKGROUND: In the USA, the postponement of childbearing reflects contemporary social norms of delaying marriage, pursing educational goals and securing economic stability prior to attempting conception. Although university students are more likely to delay childbearing, it is unclear to what extent they are aware of age-related fertility decline. The current study is the first of its kind to assess fertility awareness and parenting attitudes of American undergraduate university students. METHODS: Two-hundred forty-six randomly selected undergraduate university students (138 females and 108 males) completed an online self-report survey adapted from the Swedish Fertility Awareness Questionnaire. Students were evenly distributed between the freshman, sophomore, junior and senior classes with a mean age of 20.4 years. RESULTS: Participants wanted to have their first and last child within the window of a woman's fertility. However, participants demonstrated a lack of fertility awareness by vastly overestimating the age at which women experience declines in fertility, the likelihood of pregnancy following unprotected intercourse and the chances that IVF treatments would be successful in the case of infertility. Nearly 9 in 10 participants want to have children in the future and viewed parenthood as a highly important aspect of their future lives. CONCLUSIONS: Delaying childbearing based on incorrect perceptions of female fertility could lead to involuntary childlessness. Education regarding fertility issues is necessary to help men and women make informed reproductive decisions that are based on accurate information rather than incorrect perceptions.

Direct and indirect effects of perceived social support on women's infertility-related stress.

BACKGROUND: Social support can be a critical component of how a woman adjusts to infertility, yet few studies have investigated its impact on infertility-related coping and stress. We examined relationships between social support contexts and infertility stress domains, and tested if they were mediated by infertility-related coping strategies in a sample of infertile women. METHODS: The Multidimensional Scale of Perceived Social Support, the Copenhagen Multi-centre Psychosocial Infertility coping scales and the Fertility Problem Inventory were completed by 252 women seeking treatment. Structural equation modeling analysis was used to test the hypothesized multiple mediation model. RESULTS: The final model revealed negative effects from perceived partner support to relationship concern (ß = -0.47), sexual concern (ß = -0.20) and rejection of childfree lifestyle through meaning-based coping (ß = -0.04). Perceived friend support had a negative effect on social concern through active-confronting coping (ß = -0.04). Finally, besides a direct negative association with social concern (ß = -0.30), perceived family support was indirectly and negatively related with all infertility stress domains (ß from -0.04 to -0.13) through a positive effect of active-avoidance coping. The model explained between 12 and 66% of the variance of outcomes. CONCLUSIONS: Despite being limited by a convenience sampling and cross-sectional design, results highlight the importance of social support contexts in helping women deal with infertility treatment. Health professionals should explore the quality of social networks and encourage seeking positive support from family and partners. Findings suggest it might prove useful for counselors to use coping skills training interventions, by retraining active-avoidance coping into meaning-based and active-confronting strategies.

Marital benefit and coping strategies in men and women undergoing unsuccessful fertility treatments over a 5-year period.

OBJECTIVE: To assess the relationship between infertility, marital benefit, and coping in a sample of men and women undergoing unsuccessful fertility treatments. DESIGN: Prospective longitudinal cohort design using multilevel modeling. SETTING: Danish public and private hospitals (n = 5) specializing in treating fertility patients. PATIENT(S): Participants were Danish men and women about to start a cycle of medically assisted reproduction treatment who were followed for a 5-year period of unsuccessful treatments. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): The Copenhagen Multicenter Psychosocial Infertility research program Coping Strategy Scales and Marital Benefit Measure. RESULT(S): Compared with men, a greater percentage of women reported high levels of marital benefit. For active-avoidance coping, there was a significant partner effect by gender interaction. Meaning-based strategies increased between 1 and 5 years for men and women. The use of meaning-based coping had a significant positive actor effect with marital benefit for both men and women. CONCLUSION(S): Approximately one-third of participants undergoing unsuccessful fertility treatments reported high marital benefit as a positive consequence of the infertility experience. Partner effects for men and women related to active-avoidance coping may be related to the degree of emotional support that each spouse can offer the other, whereas differences in meaning-based coping indicate a possible timing effect related to gender.

The experiences of parents of adolescents in family therapy: a qualitative investigation.

While understanding clients' experiences in family therapy is becoming increasingly important, we know very little about how the parents of adolescents in family therapy perceive and experience this process. The current study uses a multicase qualitative design and constructivist theoretical framework to describe the experiences of 15 parents of adolescents attending family therapy in private practices. Constant comparative analysis revealed four core categories that described parents' therapeutic experiences: (a) pretherapy presentation, (b) supportive therapeutic climate, (c) family therapy process, and (d) reflections on the therapy experience. The implications of study findings for clinicians and researchers are presented and discussed.

Cybersex: the impact of a contemporary problem on the practices of marriage and family therapists.

The number of people accessing the Internet for sexual purposes (cybersex) has increased dramatically over the last 10 years. However, little research has been conducted to determine how frequently clients present for treatment with cybersex-related issues. One hundred sixty-four clinical members of the American Association for Marriage and Family Therapy participated in the current study, which was conducted to identify the impacts of cybersex on MFTs' practices. Most respondents report seeing clients with cybersex-related issues, with client numbers increasing over the past 2 years. Although most respondents felt prepared to diagnose and treat adults with cybersex problems, half felt unprepared to diagnose and treat children. Lastly, most respondents reported that their required college courses were not helpful in preparing them to diagnose and treat cybersex-related problems. The implications of study findings are discussed.

Anxiety and sexual stress in men and women undergoing infertility treatment.

OBJECTIVE: To better understand the specific nature of the relationship between anxiety and sexual infertility-related stress in men and women. DESIGN: Prospective study. SETTING: University-affiliated teaching hospital. PATIENT(S): Consecutively referred patients referred for in vitro fertilization and intrauterine insemination (306 women, 295 men). INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Fertility Problem Inventory (FPI), Beck Anxiety Inventory (BAI). RESULT(S): Women reported greater anxiety and sexual infertility stress than men. However, men and women showed a similar pattern in the way anxiety symptoms were related to sexual infertility stress, with subjective anxiety and autonomic anxiety having the strongest relationship. Anxiety symptoms accounted for a significant proportion of the variance in sexual infertility stress for both sexes and predicted sexual stress to a considerable degree in men. CONCLUSION(S): Although this study found that there is more similarity than difference in how men and women experience anxiety and sexual infertility stress, the strong linkage between anxiety and sexual stress in men was surprising, because men tend to report less sexual stress and also less anxiety. Sexual stress among infertile men may be more closely tied to performance anxiety rather than to a more general deterioration in sexual satisfaction associated with infertility.

The relationship between coping and depression in men and women referred for in vitro fertilization.

This study examined coping with infertility and how coping is related to depression for men and women. Results showed that both men and women who engage in a disproportionate degree of escape/avoidance behavior and acceptance of responsibility for infertility were more vulnerable to symptoms of depression.

Examining congruence between partners' perceived infertility-related stress and its relationship to marital adjustment and depression in infertile couples.

Because studies examining the emotional impact of infertility-related stress generally focus on individuals, there has been little research examining how relationship and individual variables are linked. The purpose of this study was to explore the impact of congruence (e.g., agreement) between partner's perceived infertility-related stress and its effects on depression and marital adjustment in infertile men and women. Couples referred for infertility treatments at a University-affiliated teaching hospital completed the Fertility Problem Inventory (FPI), the Beck Depression Inventory (BDI), and the Dyadic Adjustment Scale (DAS) 3 months prior to their first treatment cycle. Study findings show that men and women in couples who perceived equal levels of social infertility stress reported higher levels of marital adjustment when compared to men and women in couples who perceived the stress differently. In addition, women in couples who felt a similar need for parenthood reported significantly higher levels of marital satisfaction when compared to women in couples where the males reported a greater need for parenthood. While couple incongruence was unrelated to depression in males, incongruence over relationship concerns and the need for parenthood was related to female depression. These findings provide initial support for the theory that high levels of agreement between partners related to the stresses they experience help them successfully manage the impact of these stressful life events. Possibilities for future research examining the construct of couple congruence are discussed.