Predictors of infertility-related concerns in a Canadian survey of men and women seeking fertility treatment.

OBJECTIVE: To examine if and how factors associated with infertility-related concerns and opportunity to discuss concerns differ between male and female fertility patients. METHODS: A cross-sectional survey of 313 female and 254 male patients recruited from Canadian fertility clinics. An online survey asked about sociodemographic characteristics, psychological distress, the severity of psychosocial concerns on a scale of 0 (not concerned) to 5 (very concerned) related to fertility treatment, and their opportunity and desire to discuss concerns with healthcare providers (HCPs). RESULTS: For women, higher stress, educational attainment and being childless were associated with higher concern (F(6, 287) = 14.73, p < .001). For men, higher stress, being religious and longer treatment duration were associated with higher concern (F(8, 222) = 9.87, p < .001). No significant difference existed between men's and women's average concern scores (t(558) = -1.62, p = .11) or opportunity to discuss concerns (t(149) = 0.28, p = .78). CONCLUSION: Our results indicate an unmet need and desire for support among subgroups of patients who were concerned about psychosocial issues related to infertility, but did not have the opportunity to discuss these issues with HCPs. PRACTICE IMPLICATIONS: There is a need to tailor resources to address the concerns of male and female fertility patients from diverse sociodemographic backgrounds and with different fertility histories.

Men's expectations and experiences of fertility awareness assessment and counseling.

INTRODUCTION: Men play an important role in couples' decisions about the timing of parenthood and they tend to delay parenthood. The reasons for delaying childbearing are multifaceted and complex. Their decisions may be based on a lack of accurate information about the reproductive life span and the consequences of delaying parenthood. The aim of this study was to explore men's expectations and experiences of fertility counseling. MATERIAL AND METHODS: Data were collected through semi-structured qualitative interviews with 21 men attending either the Fertility Assessment and Counseling Clinic in Copenhagen or in Horsens, Denmark. The men had no known fertility problems before going to the fertility counseling. They were interviewed before and after fertility counseling. RESULTS: The men were not concerned about their fertility before going to counseling. They believed they would be able to conceive whenever they wanted. Three of them had low semen quality and felt "punched in the gut" when they received these results at the fertility counseling. The study participants preferred clear and concrete information, and relevant knowledge at the right time was very important. The men felt empowered after the fertility counseling because they were equipped with concrete information that could inform their parenthood plans and decisions. Even the men who received unexpected bad news felt positive about the counseling. The participants perceived their knowledge and awareness of risk factors concerning fertility had increased. CONCLUSIONS: Men may benefit from an individualized approach where their fertility is assessed and they receive tailored fertility counseling specific to their personal fertility results. This type of intervention may be effective in increasing men's fertility awareness because it is personally relevant.

Investigation of time-dependent risk of mental disorders after infertility diagnosis, through survival analysis and data mining: a nationwide cohort study.

OBJECTIVES: Infertile patients are vulnerable to mental disorders. However, a time-dependent model predicting the onset of mental disorders specific to infertile patients is lacking. This study examined the risk factors for the development of mental disorders in infertile patients and measured the duration until the occurrence of mental disorders after a diagnosis of infertility. METHODS: A total of 13,317 infertile patients in the 2002-2013 Taiwan National Health Insurance Research Database were observed. The 11 independent variables included in the hypothesised model, together with the dates of infertility and mental disorder diagnoses, were analysed using Cox proportional hazards. Data-mining methods using C5.0 and Apriori supplemented the statistical analyses. RESULTS: The total prevalence rate of mental disorders among infertile patients in Taiwan was 12.41%, including anxiety (4.66%), depression (1.81%) and other mental disorders (5.94%). The average time interval for onset of mental illness identified using survival analysis was 1.67 years. Income, occupation, treatment method, co-morbidity, region and hospital level and ownership were significant predictors of development of mental illness (all p < .05). CONCLUSIONS: The four categories of factors associated with time-dependent onset were demographics, health, health care provider and geographical characteristics. Certain patient characteristics may predict a higher likelihood of onset of a specific mental disorder. Clinical practitioners may use the findings to identify high-risk patients and make timely health interventions.

Searching for Love and Test-Tube Babies: Iraqi Refugee Men in Reproductive Exile on the Margins of Detroit.

In this article, I explore the reproductive health problems faced by Iraqi refugees, one of America's most rapidly growing immigrant populations. Based on anthropological research in "Arab Detroit," the "capital" of Arab America, I explore the experiences of Iraqi refugee men seeking medical help for their infertility. Most required intracytoplasmic sperm injection (ICSI), a variant of in vitro fertilization (IVF). However, in America's privatized medical system-where a single cycle can cost more than $12,000-few could possibly afford this assisted reproductive technology (ART). Although Iraqi refugees had diasporic dreams of making a test-tube baby, they were stuck in a situation of "reproductive exile"-forced out of their home country by war, but unable to access costly ARTs in the country that led to their displacement. I elaborate on the concept of reproductive exile, attempting to translate Iraqi refugee men's reproductive agency and desires, but also their profound disappointments.

Male factor infertility and lack of openness about infertility as risk factors for depressive symptoms in males undergoing assisted reproductive technology treatment in Italy.

OBJECTIVE: To investigate the association between male factor infertility and openness to discussing assisted reproductive technology (ART) treatment with levels of depression among men undergoing infertility treatment. DESIGN: Cross-sectional. SETTING: Not applicable. PATIENT(S): Three hundred forty participants (170 men and their partners) undergoing ART treatments. INTERVENTION(S): Administration of a set of questionnaires. MAIN OUTCOME MEASURE(S): Depressive symptoms were detected by means of the Zung Depression Self-Rating Scale. Participants' willingness to share their infertility treatment experience with other people was assessed by means of self-report questionnaires. RESULT(S): In this study, 51.8% of males chose not to discuss their ART treatments with people other than their partner. In addition, the decision to discuss or not discuss the ART treatments with others was significantly associated with men's depressive symptoms. Male factor infertility was significantly associated with depression when considered together with the decision not to discuss ART treatments with others. A general disposition characterized by a lack of openness with others seemed to be a significant predictor of depression. CONCLUSION(S): There is a need for routine fertility care to pay greater attention to men's emotional needs. Before commencing reproductive treatment, male patients may benefit from undergoing routine screening for variables (i.e., male factor infertility and openness to others about ART) that may affect their risk of depression.

Gender and Sexual Health: Infertility.

Infertility is common in the United States, with up to 15% of heterosexual couples experiencing difficulty in achieving conception. Family physicians often are the first physicians to evaluate couples attempting to conceive. Evaluation begins with assessment of ovulation, evaluation of anatomic abnormalities, and semen analysis. Many etiologies of anovulation can be managed by family physicians, and clinicians can offer counseling on timing of intercourse and assist patients with lifestyle changes to promote fertility. Ovulation induction for women with polycystic ovary syndrome and treatment of hypothyroidism also can be managed in the family physician's office. For couples who are referred to a reproductive endocrinology subspecialist, clinicians can provide emotional support, screen for depression and anxiety, and provide education about procedures and behaviors that can affect success rates.

Fertility as a priority among at-risk adolescent males newly diagnosed with cancer and their parents.

PURPOSE: Infertility is a frequent consequence of cancer therapy and is often associated with psychological distress. Although adult survivors prioritize fertility and parenthood, this issue remains unexplored among adolescent males. This study examined future fertility as a priority (relative to other life goals) at time of diagnosis for at-risk adolescents and their parents. METHODS: Newly diagnosed adolescent males (n = 96; age = 13.0-21.9 years) at increased risk for infertility secondary to cancer treatment prioritized eight life goals: to have school/work success, children, friends, wealth, health, a nice home, faith, and a romantic relationship. Patients' parents (fathers, n = 30; mothers, n = 61) rank-ordered the same priorities for their children. RESULTS: "Having children" was ranked as a "top 3" life goal among 43.8 % of adolescents, 36.7 % of fathers, and 21.3 % of mothers. Fertility ranked third among adolescents, fourth among fathers, and fifth among mothers. Future health was ranked the top priority across groups, distinct from all other goals (ps < 0.001), and fertility ranked higher than home ownership and wealth for all groups (ps < 0.001). For adolescents, low/moderate fertility risk perception was associated with higher fertility rankings than no/high risk perceptions (p = 0.01). CONCLUSIONS: Good health is the most important life goal among adolescents newly diagnosed with cancer and their parents. In this relatively small sample, adolescents prioritized fertility as a top goal, parents also rated fertility as being more important than home ownership and financial wealth. Health care providers should communicate fertility risk and preservation options at diagnosis and facilitate timely discussion among families, who may differ in prioritization of future fertility.

[Klinefelter syndrome: genetic aspects, characteristics and reproduction--present and future].

Klinefetter syndrome is one of the most common genetic causes of male infertility and the most common cause of primary testicular failure. Beside the infertility issue, the syndrome causes decreases in bone mass, muscle wasting, decline in cognitive ability and increases the risk of diseases such as diabetes mellitus, cancer and cardiovascular diseases. Most men are diagnosed late when fertility problems arise and some even remain undiagnosed. It is probably emerging because of the significant differences in clinical appearance and low "awareness" among primary doctors. Early diagnosis and hormone replacement therapy can significantly improve the quality of patients lives, reduce late health complications, and may even preserve their fertility for a longer period of time. In the past, men with this syndrome, especially those of the non-mosaic type, were considered as having no chance of becoming biological fathers. However today, with the technoLogical development of IVF and the ICSI (intracytoplasmatic sperm injectioni, together with testicular biopsies and sperm extractions (TESE), it is possible to help over 50% of the men who have this syndrome.

Are attachment dimensions associated with infertility-related stress in couples undergoing their first IVF treatment? A study on the individual and cross-partner effect.

STUDY QUESTION: Are attachment anxiety and avoidance dimensions in female and male partners in couples seeking infertility treatment associated with her and his infertility-related stress? SUMMARY ANSWER: Attachment dimensions are significantly associated with several aspects of infertility stress in couples undergoing IVF treatment. WHAT IS KNOWN AND WHAT THIS PAPER ADDS: Attachment dimensions of anxiety and avoidance (where highly anxious individuals fear rejection and are preoccupied with maintaining proximity to their partner and highly avoidant individuals are uncomfortable with intimacy and prefer to maintain distance from their partner) may influence the well being of individuals undergoing IVF/ICSI treatment. This study showed that one partner's attachment dimensions had a direct effect on the infertility-related stress of the other partner. DESIGN: Cross-sectional study of consecutive couples before starting their first IVF/ICSI treatment in 2009-2011 at the ANDROS clinic in Palermo, Italy. PARTICIPANTS AND SETTING: Three hundred and fifty-nine couples undergoing fertility treatments were invited to participate in the research. The final sample comprised 316 females and 316 males who filled out the psychological questionnaires (Experiences in Close Relationships; Fertility Problem Inventory; State scale of State-Trait Anxiety Inventory). The participants included patients who had a primary infertility diagnosis and were about to undergo their first IVF or ICSI treatment. DATA ANALYSIS METHOD: Paired t-tests were used to examine gender differences on the study variables (attachment anxiety, attachment avoidance, infertility stress, state anxiety, etc.). Associations between infertility-related stress and the study variables were explored using hierarchical stepwise multivariate linear regression analyses. MAIN RESULTS AND THE ROLE OF CHANCE: Attachment anxiety and attachment avoidance were significantly associated with global infertility stress in both women (ß = 0.24, P < 0.01 and ß = 0.27, P < 0.01) and men (ß = 0.23, P < 0.01 and ß = 0.37, P < 0.01). Regarding the cross-partner effects, men's infertility stress and relationship concerns were associated with their partners' attachment avoidance (ß = 0.10 P < 0.05 and ß = 0.12, P < 0.05); and the infertility stress of women and the scores for need of parenthood were associated with their partners' attachment anxiety (ß = 0.14 P < 0.05 and ß = 0.16, P < 0.05). BIAS, CONFOUNDING AND OTHER REASONS FOR CAUTION: The study data are cross sectional, and specifically focus on associations between adult attachment style and infertility stress. Treating the data from couples as independent observations may be a limitation of the analysis. Potential moderators of such relationships (e.g. coping strategies, stress appraisal) are not included in this study. STUDY FUNDING/COMPETING INTEREST(S): This research was supported by funds provided by Centro Andros S.r.l., Palermo, Italy. The authors declare no financial or commercial conflicts of interest in this study.

Effect of pregnancy planning and fertility treatment on cognitive outcomes in children at ages 3 and 5: longitudinal cohort study.

OBJECTIVE: To investigate how pregnancy planning, time to conception, and infertility treatment influence cognitive development at ages 3 and 5. DESIGN: Prospective population based cohort study. SETTING: Millennium Cohort Study in the United Kingdom. PARTICIPANTS: 18,818 children recruited at 9 months and followed up at 3 and 5 years. 11,790 singletons with available data on pregnancy, cognitive outcomes, and confounders were included in analyses at age 3 and 12,136 at age 5. Exposure measures Mothers reported whether the pregnancy was planned, and their feelings when first pregnant; those in whom the pregnancy was planned provided time to conception, and details of any assisted reproductive technologies. The population was divided into "unplanned" (unplanned and unhappy), "mistimed" (unplanned but happy), "planned" (planned, time to conception <12 months), "subfertile" (planned, time to conception ≥ 12 months), "induced ovulation" (received clomiphene citrate), and "assisted reproduction" (in vitro fertilisation or intracytoplasmic sperm injection). The "planned" group was the comparison group in all analyses. OUTCOME MEASURES: Three components of the British Ability Scales (BAS II). Naming vocabulary assessed verbal ability at age 3; this test was repeated at age 5 with the picture similarities and pattern construction subscales, which measure non-verbal and spatial abilities. RESULTS: In unadjusted analyses, the scores on all scales in children from unplanned pregnancies were significantly lower than in those from planned pregnancies-for example, the difference in mean verbal ability score at age 3 was -4.8 (95% confidence interval -6.0 to -3.7; P<0.05), equivalent to an average delay of four months. After adjustment for sociodemographic factors these differences were attenuated: -0.3 (-1.3 to 0.7), equivalent to no delay. Children born after assisted reproduction performed consistently better in verbal ability tests (3.8 (-0.2 to 7.9) at age 3 and 3.5 (0.2 to 6.8) at age 5), which suggests that on average these children are three to four months ahead; this difference did not completely disappear with adjustment for confounders. Children born after infertility treatment had lower mean scores in non-verbal tests (-1.2 (-4.1 to 1.6) after assisted reproduction and -1.5 (-3.5 to 0.4) after induced ovulation) and in spatial ability tests (-2.7 (-6.9 to 1.6) after assisted reproduction), though the differences were not significant. CONCLUSIONS: Pregnancy planning, subfertility, or assisted reproduction do not adversely affect children's cognitive development at age 3 or 5. The differences observed in the unadjusted analyses are almost entirely explained by marked inequalities in socioeconomic circumstances between the groups.

Fertility in men with cystic fibrosis assessment, investigations and management.

Congenital absence of the vas deferens is the primary cause of azoospermia in men with cystic fibrosis [CF]. In some there may also be an abnormality in spermatogenesis and sperm maturation. Despite these abnormalities, sperm capable of fertilizing mature oocytes in vitro can be extracted from the majority of men with cystic fibrosis. Experience at Westmead Hospital over the last 12 years has shown mature spermatozoa can be obtained by a simple percutaneous needle aspiration of the epididymis or testis after local anaesthetic has been infiltrated around the spermatic chord. This procedure has been successfully repeated up to six times in some men. Epididymal or testicular sperm can be used to fertilize mature oocytes by intracytoplasmic injection in vitro. All offspring resulting from such procedures will be CF carriers and to reduce the probability this will result in a child with CF it is important the female partner has pre-treatment screening for CF mutations.

Why treat the male in the era of assisted reproduction?

The concept of unilateral care of the female partner has gained momentum in the reproductive health community, especially with the advent of in vitro fertilization and intracytoplasmic sperm injection. Herein, the authors examine the existing evidence in support of evaluating and treating the male patient as part of the routine evaluation of the infertile couple. This evidence includes assessments of efficacy, cost-effectiveness, and safety, and-- when considered broadly--argues strongly against unilateral care.

Gender differences in infertility-related stress and the relationship between stress and social support in Thai infertile couples.

OBJECTIVE: To study infertility-related stress among men and women and to examine its relationship with the level of perceived social support. MATERIAL AND METHOD: The Fertility Problem Inventory (FPI) and the Personal Resource Questionnaire (PRQ) were translated into Thai and used to assess the level of infertility-related stress and perceived social support, respectively, in 238 infertile subjects. RESULTS: The global FPI scores for men and women were 154.2 +/- 18.3 and 154.7 +/- 22.6, respectively (p > 0.05). There was no significant difference in their perceived social support (PRQ scores = 137.8 + 14.0 and 134.0 +/- 16. 7 respectively). A significant negative correlation (r = -0.1894; p < 0.001) existed between global stress and social support in women, but not in men. CONCLUSION: Thai infertile couples experienced a high level of stress. Unlike previous studies from Western countries, there was no gender diference in infertility-related stress.

[An approach to male infertility from economic sociology].

OBJECTIVE: To study the psychology of infertility patients from the perspective of economic sociology so as to prevent the patients from medical frauds in seeking medical treatment. METHOD: We investigated 902 infertility patients of the Third Hospital of Peking University from September 2005 to January 2006 using a randomized questionnaire. RESULTS: Of the total number, 84.4% had education below college level; the majority had a low monthly family income, 36.6% below Y1,000, 19.7% from Y1,000 to Y2,000, 16.5% from Y2,000 to Y3,000, 7.8% from Y3,000 to Y4,000 and 19.4% above Y4,000; 88.7% had a strong desire for a child; 60.3% were psychologically stressed. As for the advertisements for the treatment of infertility, 50.2% of the patients disbelieved them, 6.2% wanted to have a try and about 43.6% accepted them to be true. Regarding the treatment in individual hospitals, 55.2% disbelieved in it, 5.8% wanted to try it and about 39.0% believed in it. CONCLUSION: Infertility patients of low economic status usually have a lower educational level but a higher desire for children, and therefore are more likely to be the victims of medical frauds and more psychologically stressed. It calls for our attention how to provide them with medical help.

Anxiety of infertile men who undergo genetic testing for assisted reproductive treatment.

PURPOSE: This descriptive study was conducted with the aim to determine the anxiety level of infertile men who undergo genetic testing for assisted reproductive treatment. METHOD: Sample of the study included 60 individuals. Data was collected by interview through a data collection form and Spielberger's STAI Inventory. RESULTS: It was identified that participants experienced psychological distress and anxiety before and after genetic testing. State anxiety scores of infertile men were found to be significantly higher than their trait anxiety scores (p < 0.001). About 98.3% of the participants had normal genetic test results, with only one person with Klinefelter's syndrome (XXY). CONCLUSION: Anxiety due to genetic testing in infertile men who seek assisted reproductive treatment indicated the need for informative and psychologically supportive counseling.

The value of children in African countries: insights from studies on infertility.

A number of studies have explored motives for parenthood in the Western industrialized world. These studies have documented that children are mostly desired for reasons relating to happiness and personal well-being. To date, limited data pertaining to parenthood motives in African countries exist. Insight into the value of children can, however, be derived from studies on infertility, as the negative repercussions of involuntary childlessness reflect the value of children to parents and the community. According to these studies children secure conjugal ties, offer social security, assist with labour, confer social status, secure rights of property and inheritance, provide continuity through re-incarnation and maintaining the family lineage, and satisfy emotional needs. Parenthood therefore appears to have more and, arguably, deeper roots in African communities when compared to industrialized countries.

Sperm banking: use and outcomes in patients treated for testicular cancer.

OBJECTIVE: To identify the frequency that sperm banking was used by men being treated for testicular cancer at our institution, and to characterize the differences between men choosing to bank sperm or not, and outcomes in terms of after-treatment pregnancies. PATIENTS AND METHODS: A questionnaire addressing sperm banking and fertility was administered to men treated for testicular cancer at our institution between 1994 and 2004; the results were evaluated statistically. RESULTS: Overall, 31 of 129 (24%) respondents had banked sperm. Of these, two had used their banked sperm to father a child, and 12 had had children naturally. Men who banked sperm were a mean of 10.3 years younger (P < 0.001) and less likely to have children at the time of diagnosis (P < 0.025) than men choosing not to bank sperm. The cost of banking sperm was reported to include a mean fee of US dollars 358 (median 300, range 0-1000), and a mean annual maintenance fee of US dollars 243.86 (median 300, range 0-1200). CONCLUSIONS: Only a minority of men in this study chose to bank sperm (24%). Among those who did, the use of banked sperm was low (<10%), and many men could have children without using banked sperm. Given the relatively high costs of sperm banking and the low rate of sample use, patients should be counselled on the costs and benefits of sperm banking before treatment for testicular cancer.

Nurse practice issues regarding sperm banking in adolescent male cancer patients.

The impressive increase in the survival rate of childhood cancer patients has produced increased interest in quality of life issues. This research addresses nurse practice issues in determining whether the newly diagnosed adolescent male patient is offered the option of sperm banking before undergoing chemotherapy treatment. Questionnaires were distributed to nurses and nurse practitioners on 3 inpatient and outpatient units who care for adolescent male cancer patients at the time of diagnosis, during chemotherapy, and during follow-up care. Findings indicate that 96.3% of respondents agreed that all male patients undergoing cancer treatment with infertility as a potential side effect should be offered sperm banking. Respondents viewed oncologists and nurse practitioners as appropriate professionals to discuss the option. Lack of knowledge regarding sperm banking could be limiting nurses' willingness to introduce the topic, and education regarding cryopreservation may improve their knowledge and practice.

Inconceivable? Deducting the costs of fertility treatment.

This Article considers whether infertile taxpayers can deduct their fertility treatment costs as medical expenses under Internal Revenue Code section 213 and whether they should be able to deduct them. Internal Revenue Code section 213 defines medical expenses as "amounts paid-for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body." This definition is interpreted by reference to a baseline of normal biological functioning, which includes reproductive functioning. Most people conceive and bear children without having to incur expenses for fertility treatment. Expenses incurred to approximate the baseline of normal reproductive health are deductible, even if the taxpayer winds up better off, with a child, after the fertility treatment. The medical profession recognizes that infertility is a disease or condition. Infertility is a loss, just as a broken leg is a loss. Fertility treatment costs are thus medical expenses under section 213. In addition, given the existence of the medical expense deduction, taxpayers should be able to deduct the cost of fertility treatments, including IVF, egg donor, and surrogate procedures, under either an "ability-to-pay" or consequentialist normative approach. Reproduction is extremely important to most people. In addition, allowing taxpayers to deduct the costs of fertility treatment will encourage infertile taxpayers to elect the most effective treatment option and reduce the rate of risky multifetal pregnancies. This Article concludes that fertility treatment costs are deductible as medical expenses under current law and should be deductible as medical expenses.

'You are a man because you have children': experiences, reproductive health knowledge and treatment-seeking behaviour among men suffering from couple infertility in South Africa.

BACKGROUND: In Africa, infertility traditionally has been viewed as a female problem. This study explores reproductive health knowledge, health-seeking behaviour and experiences related to involuntary childlessness in men suffering from couple infertility. METHODS: Twenty-seven men from a diverse cultural urban community in South Africa participated in in-depth interviews at the time of their first visit to an infertility clinic in a tertiary referral centre. RESULTS: Men had little knowledge about the physiology of human fertility, causes of infertility and modern treatment options. Awareness of male factor infertility was, however, high. Most men appeared involved in the health-seeking process. Men described their emotional reactions to childlessness and the impact of infertility on marital stability, and many reported that infertile men suffered from stigmatization, verbal abuse and loss of social status. CONCLUSIONS: These findings improve our understanding of the reproductive health needs of men suffering from couple infertility in Africa. This understanding is essential for the effective integration of male partners into modern infertility management. The need for appropriate counselling of men and, most particularly, for education of the community is recognized.