Impact of primary care posttraumatic stress disorder (PC-PTSD) on fertility problem of Iranian women with infertility during the COVID-19 pandemic.

BACKGROUND: Infertility continued to be a major stressor among women with infertility during COVID-19pandemic. This study aimed to evaluate the impact of primary care posttraumatic stress disorder (PC-PTSD) on fertility problem of Iranian women with infertility during COVID-19 pandemic. METHOD: In this cross-sectional study, 386 women with infertility completed the questionnaires of PC-PTSD-5 and Fertility Problem Inventory (FPI) at an infertility center between 2020 and 2022. RESULTS: The mean of fertility problems was 145.20 (± 32.31). In terms of FPI subscales, the means were as follows: Sexual concern 21.80 (± 7.58), social concern 26.53 (± 8.94), relationship concern 26.02 (± 9.18), need for parenthood concern 40.88 (± 8.98), and rejection of childfree lifestyle 29.96 (± 7.69). The highest mean of FPI subscales was related to the need for parenthood concern in women with infertility. The strongest correlation was found between the subscales of sexual concern and social concern followed by sexual concern and relationship concern. The variables of PC-PTSD were a predictor of fertility problems (ß = 0.203, P < .0001). Additionally, the variables of PC-PTSDwere a predictor of sexual concern (ß = 0.248, P < .0001), social concern (ß = 0.237, P < .0001), relationship concern (ß = 0.143, P < .020), and need for parenthood concern (ß = 0.101, P < .010). After adjusting for demographic characteristics, there was a significant relationship between FPI with job (ß=-0.118, P < .031), education (ß=-0.130, P < .023), living place (ß = 0.115, P < .035), smoking (ß = 0.113, P < .036), relationship with husband (ß = 0.118, P < .027), and PC-PTSD symptom (ß = 0.158, P < .0001). In addition, the multivariate linear regression showed a significant association between sexual concern and education (ß=-0.152, P < .008), smoking (ß = 0.129, P < .018), PC-PTSD symptom (ß = 0.207, P < .0001); social concern and job (ß=-0.119, P < .033), PC-PTSD symptom (ß = 0.205, P < .0001); relationship concern and education (ß=-0.121, P < .033), living place (ß = 0.183, P < .001), relationship with husband (ß = 0.219, P < .0001); and rejection of childfree lifestyle and job (ß=-0.154, P < .007). CONCLUSION: Systematic PTSD screening during COVID-19 pandemic by healthcare providers can be uniquely used to identify, evaluate, and treat trauma-related health conditions in infertility settings, which can link women with infertility to mental health services. This can be novel and useful for future policymakers and practitioners in the infertility field.

Psychosocial wellbeing shortly after allocation to a freeze-all strategy compared with a fresh transfer strategy in women and men: a sub-study of a randomized controlled trial.

STUDY QUESTION: Is the psychosocial wellbeing affected in women and men shortly after allocation to a freeze-all strategy with postponement of embryo transfer compared to a fresh transfer strategy? SUMMARY ANSWER: In general, psychosocial wellbeing (i.e. emotional reactions to the treatment, quality-of-life, infertility-related stress, and marital benefit) was similar in women and men allocated to a freeze-all versus those allocated to a fresh-transfer strategy 6 days after disclosure of treatment strategy (i.e. 4 days after oocyte retrieval), although women in the freeze-all group reported a slightly higher degree of depressive symptoms and mood swings compared to women in the fresh transfer group. WHAT IS KNOWN ALREADY: The use of a freeze-all strategy, i.e. freezing of the entire embryo cohort followed by elective frozen embryo transfer in subsequent cycles has increased steadily over the past decade in assisted reproductive technology (ART). This strategy essentially eliminates the risk of ovarian hyperstimulation syndrome and has proven beneficial regarding some reproductive outcomes in subgroups of women. However, patients experience a longer time interval between oocyte retrieval and embryo transfer, hence a longer time to pregnancy, possibly adding additional stress to the ART treatment. So far, little focus has been on the possible psychosocial strains caused by postponement of embryo transfer. STUDY DESIGN, SIZE, DURATION: This is a self-reported questionnaire based sub-study of a multicentre randomized controlled trial (RCT) including 460 women and 396 male partners initiating their first, second, or third treatment cycle of invitro fertilisation or intracytoplasmic sperm injection (ICSI) from May 2016 to September 2018. This sub-study was included in the primary project protocol and project plan for the RCT, as psychosocial wellbeing was considered a secondary outcome. PARTICIPANTS/MATERIALS, SETTING, METHODS: Women from eight public fertility clinics in Denmark and Sweden and one private clinic in Spain were randomized in a 1:1 ratio on the day of inclusion (menstrual cycle day 2 or 3) to either a freeze-all strategy with postponement of embryo transfer to a subsequent modified natural menstrual cycle or a fresh transfer strategy with embryo transfer in the hormone stimulated cycle. Treatment allocation was blinded until the day of the ovulation trigger. Women and their male partners were asked to complete a validated self-reported questionnaire 6 days after unblinding of treatment group allocation, corresponding to 4 days after oocyte retrieval, investigating their psychosocial wellbeing related to the treatment defined as emotional reactions to the treatment, quality-of-life, infertility-related stress, and marital benefit. The questionnaire included items from the Copenhagen Multi-Centre Psychosocial Infertility (COMPI) Fertility Problem Stress Scales and the COMPI Marital Benefit Measure. MAIN RESULTS AND THE ROLE OF CHANCE: Baseline characteristics were comparable between the two groups for both women and men. In total, response rates were 90.7% for women and 90.2% for men. In the freeze-all group, 207 women and 179 men completed the questionnaire compared with 204 women and 178 men in the fresh transfer group. Men in the two treatment groups did not differ in any of the explored aspects of psychosocial wellbeing (i.e. emotional reactions to the treatment, quality-of-life, infertility-related stress, and marital benefit) 6 days after disclosure of treatment strategy. Women in the freeze-all group reported a slightly higher degree of depressive symptoms (P = 0.045) and mood swings (P = 0.001) (i.e. variables included in 'emotional reactions to treatment') compared to women in the fresh transfer group. When adjusted for multiple testing, depressive symptoms were no longer significantly different between the two groups. No additional differences in psychosocial wellbeing were found. Self-reported quality-of-life during treatment was also rated as similar between the two groups in both women and men, but was slightly lower than they would rate their quality-of-life when not in fertility treatment. LIMITATIONS, REASONS FOR CAUTION: Although response rates were high, selection bias cannot be excluded. As this study was an RCT, we assume that psychosocial characteristics of the participants were equally distributed in the two groups, thus it is unlikely that the identified psychosocial differences between the freeze-all and fresh transfer group were present already at baseline. Furthermore, the questionnaire was completed as a one-time assessment 4 days after oocyte retrieval, thus not reflecting the whole treatment process, whereas an assessment after the full completed treatment cycle is needed to draw firm conclusions about the psychosocial consequences of the whole waiting period. However, a question posted that late would be highly biased on whether or not a pregnancy had been achieved. WIDER IMPLICATIONS OF THE FINDINGS: The results indicate that individuals in the freeze-all group exhibited slightly higher levels of depressive symptoms and mood swings compared to those in the fresh transfer group. Nevertheless, it is important to note that any worries related to potential emotional strains stemming from delaying embryo transfer should not overshadow the adoption of a freeze-all approach in cases where it is clinically recommended. As long as patients are provided with comprehensive information about the treatment strategy before initiating the process, it is worth emphasising that other aspects of psychosocial wellbeing were comparable between the two groups. STUDY FUNDING/COMPETING INTEREST(S): The study is part of the Reprounion collaborative study, co-financed by the European Union, Interreg V Öresund-Kattegat-Skagerrak. L.P. reports financial support from Merck A/S. H.S.N. reports grants from Freya Biosciences ApS, Ferring Pharmaceuticals, BioInnovation Institute, Ministry of Education, Novo Nordic Foundation, Augustinus Fonden, Oda og Hans Svenningsens Fond, Demant Fonden, Ole Kirks Fond and Independent Research Fund Denmark and personal fees from Ferring Pharmaceuticals, Merck A/S, Astra Zeneca, Cook Medical, IBSA Nordic and Gedeon Richter. H.S.N is founder and chairman of the Maternity Foundation and co-developed the Safe Delivery App (non-profit). N.C.F. reports grants from Gedeon Richter, Merck A/S, Cryos International and financial support from Ferring Pharmaceuticals, Merck A/S and Gedeon Richter. N.C.F. is chairman in the steering committee for the guideline groups for The Danish Fertility Society (non-profit). P.H. reports honoraria from Merch A/S, IBSA Nordic and Gedeon Richter. A.L.M.E. reports grants and financial support from Merck A/S and Gedeon Richter. A.P. reports grants from Gedeon Richter, Ferring Pharmaceuticals, Merck A/S and personal fees from Preglem S.A., Novo Nordic Foundation, Ferring Pharmaceuticals, Gedeon Richter, Cryos International, Merch A/S, Theramex and Organon and the lend of embryoscope to the institution from Gedeon Richter. All other authors declare no conflict of interest. TRIAL REGISTRATION NUMBER: Clinicaltrials.gov NCT02746562.

Infertility-related stress and its relationship with emotional divorce among Iranian infertile people.

BACKGROUND: Infertility affects different aspects of couples' lives, so it may cause problems in couples' emotional relationships by increasing marital conflicts. This study aimed to determine Infertility-related stress and its relationship with emotional divorce among Iranian infertile people. METHODS: We conducted a cross-sectional observational study on 200 infertile people. The research environment was one of the well-equipped infertility centers in Tehran, Iran. Continuous sampling was employed. The data collection tools included a general information form, the Fertility Problem Inventory (FPI), and the Emotional Divorce Scale (EDS). RESULTS: The findings revealed a significant direct relationship between infertility-related stress and all its subscales with emotional divorce in both infertile women and men. In infertile women, the most concern was the need for parenthood, while the lowest concerns were the relationship and sexual concerns. Multiple linear regression analysis indicated that social and relationship concerns predicted 44% of emotional divorce, with social concern being the more influential factor. In infertile men, the need for parenthood was the most significant concern, while relationship and social concerns were less prominent. Multiple linear regression analysis showed that relationship concern predicted 50% of emotional divorce in infertile men. In both infertile men and women, social and relationship concerns explained 45% of the variance in emotional divorce. Among these two variables, relationship concern had a more impact in predicting emotional divorce. Also, there was no statistically significant difference between women and men regarding infertility-related stress and its subscales, except for sexual concern. CONCLUSION: The study highlights the importance of the need for parenthood as a main concern among infertile individuals. Increased infertility-related stress and its subscales contribute to higher levels of emotional divorce among this population. Additionally, relationship concern was the lowest concern in infertile people. But it significantly predicts emotional divorce among infertile individuals.

Reliability and validity of the Chinese version of the Copenhagen Multi-Centre Psychosocial Infertility-Fertility Problem Stress Scales.

AIMS: The aim of this study is to introduce the Copenhagen Multi-Centre Psychosocial Infertility (COMPI)-Fertility Problem Stress Scales (COMPI-FPSS) into China and test its applicability in Chinese infertile population. BACKGROUND: Infertility-related stress not only influences patients' psychological well-being but is also strongly associated with reduced pregnancy rates and poorer assisted conception outcomes, thus warranting focussed attention. DESIGN: The design used in this study is a cross-sectional survey. METHODS: A total of 418 participants were recruited by convenience sampling from March to July 2022. The data were randomly divided into two parts: one for item analysis and exploratory factor analysis and the other for confirmatory factor analysis and reliability test. The critical ratio and homogeneity test were used to verify the differentiation and homogeneity of the COMPI-FPSS; the construct validity was determined by explanatory and confirmatory factor analyses; Cronbach's α coefficient and Spearman-Brown coefficient were used to assess the reliability; and criterion validity was expressed using correlation coefficients for the Perceived Stress Scale and the Negative Affect Scale as the validity criteria. RESULTS: The revised Chinese version of COMPI-FPSS has 11 items and 2 dimensions (i.e., personal stress domain and social stress domain). Exploratory factor analysis showed that the cumulative variance contribution rate of the two factors was 68.6%, and confirmatory factor analysis indicated that the model fitted well. The score of the COMPI-FPSS was significantly and positively associated with perceived stress and negative affect. The Cronbach's α coefficient of the total scale was 0.905, and the Spearman-Brown coefficient was 0.836, explaining excellent reliability. CONCLUSION: The revised Chinese version of COMPI-FPSS shows good reliability and validity, and it can be used to evaluate the infertility-related stress of infertile patients in China.

Family resilience is a protective buffer in the relationship between infertility-related stress and psychological distress among females preparing for their first in vitro fertilization-embryo transfer.

The present study aimed to evaluate psychological distress and scrutinized whether family resilience plays a moderating role in the association between infertility-related stress and psychological distress among infertile females preparing for their first IVF-ET. A total of 492 infertile females completed self-reported measures including the Kessler 10 Psychological Distress Scale (K10), the fertility problem inventory (FPI), and the Family Resilience Assessment Scale (FRAS). The results showed 21 (65.2%) participants reported moderate or higher levels of psychological distress. While controlling for economic status, we found psychological distress to be positively linked to infertility-related stress (ß=0.483, P<0.001), and negatively related to family resilience (ß=-0.145, P=0.001). The simple slopes analysis showed that infertility-related stress had a weaker positive association with psychological distress for individuals at 1 SD (ß = 0.443, P < 0.001) above the mean on family resilience compared to those at 1 SD (ß = 0.537, P < 0.001) below the mean. Thus, it suggests that clinical practice should conduct family resilience-oriented interventions to facilitate family resilience among infertile females preparing for their first IVF-ET, with the goal to reduce psychological distress.

Coping styles among Vietnamese people with infertility diagnosis: does type of infertility-related stress really matter?

OBJECTIVES: The present study aims to investigate whether each coping style used by Vietnamese people living with infertility diagnosis is associated with specific types of infertility-related stress (IRS). METHODS: In this cross-sectional design study, 997 patients with primary infertility diagnosis from three hospitals and two clinics in three regions of Vietnam completed questionnaire that consisted of Fertility Problem Inventory, the Copenhagen Multi-Centre Psychosocial Infertility and other questions. Four different linear regression analyses were performed on four coping styles. The five types of IRS and covariates were included in these models. FINDINGS: The results show that participants who experience all five types of IRS reported the dominant use of active-avoidance coping, while having four types of IRS, except for social concern, was associated with higher use of meaning-based coping. Utilising active-confronting coping was reported to be the outcome of experiencing increasing need for parenthood and decreasing rejection of child-free lifestyle. Choice of passive-avoidance coping was more common among those with increasing social concern and need for parenthood. Age and educational level impacted infertile people's choice of avoidance coping strategies. CONCLUSIONS: The results provide evidence to understand the direct impact of each type of IRS on infertile people's choice of coping styles to better support them during their individual and family therapy.

Relationship between infertility-related stress and resilience with posttraumatic growth in infertile couples: gender differences and dyadic interaction.

STUDY QUESTION: Are there any gender differences and dyadic interactions in the associations between infertility-related stress and resilience and posttraumatic growth in infertile couples? SUMMARY ANSWER: Husbands' posttraumatic growth was only impacted by their own infertility-related stress and resilience, whereas wives' posttraumatic growth was influenced by their own resilience and their spouses' resilience. WHAT IS KNOWN ALREADY: Posttraumatic growth may play a significant role in protecting the infertile couples' psychological well-being and contribute to positive pregnancy outcomes. The reciprocal influence on each other within the infertile couple in terms of relationships between infertility-related stress and resilience and posttraumatic growth has been largely overlooked. STUDY DESIGN, SIZE, DURATION: This cross-sectional study included 170 couples who were recruited from the First Affiliated Hospital of Soochow University between September 2019 and January 2020. PARTICIPANTS/MATERIALS, SETTING, METHODS: The Fertility Problem Inventory, Connor-Davidson Resilience Scale-10, and Post-traumatic Growth Inventory were used to measure infertility-related stress, resilience, and posttraumatic growth. The Actor-Partner Interdependence Model was used to analyze the effects of infertility-related stress and resilience on the couple's own posttraumatic growth (actor effect) as well as on their partner's posttraumatic growth (partner effect). MAIN RESULTS AND THE ROLE OF CHANCE: Husbands had higher levels of resilience than wives, while no significant gender differences were found in the levels of infertility-related stress and posttraumatic growth. Posttraumatic growth correlated with each other among infertile couples. Husbands' infertility-related stress had actor effects on their own posttraumatic growth, while wives' infertility-related stress had no effect on their own or their spouses' posttraumatic growth. Husbands' resilience had actor and partner effects on their own and their wives' posttraumatic growth, while wives' resilience only had an actor effect on their own posttraumatic growth. LIMITATIONS, REASONS FOR CAUTION: First, our sample was limited to infertile Chinese couples seeking clinical treatment. Second, sociodemographic and psychological measures were self-reported. Third, as the current study is a cross-sectional study, the dynamic process of posttraumatic growth is unknown. WIDER IMPLICATIONS OF THE FINDINGS: Infertile couples should be considered as a whole in studies on infertility. Couple-based psychological interventions are critical and more effective in improving mental health among individuals with infertility. Elevating the level of resilience may contribute to improving posttraumatic growth for both husbands and wives. Moreover, enhancing the ability to cope with infertility-related stress might be useful for husbands and indirectly contribute to wives' posttraumatic growth. STUDY FUNDING/COMPETING INTEREST(S): This research was supported by the National Natural Science Foundation of China (Grant No. 31900783) and the College Natural Science Research Project of Jiangsu Province (Grant No.19KJD320004). The authors declare no conflict of interest. TRIAL REGISTRATION NUMBER: N/A.

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

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

Infertility-Related Stress and Psychological Health Outcomes in Infertile Couples Undergoing Medical Treatments: Testing a Multi-dimensional Model.

The study aims to propose and test a multi-dimensional infertility-related stress model including socio-demographic and fertility-related characteristics, infertility-related stress dimensions, coping strategies and couple's dyadic adjustment dimensions as predictors of anxiety and depression among partners of couples undergoing infertility treatments. Both members of 250 infertile couples filled out a questionnaire consisting of Socio-demographics (Age; Educational level; Employment status), Fertility-related characteristics (Type of diagnosis; Duration of infertility), Fertility Problem Inventory-Short Form, Coping Orientations to Problem Experienced-New Italian Version, Dyadic Adjustment Scale, State-Trait Anxiety Inventory-Y and Edinburgh Depression Scale. Hierarchical Multiple Linear Regressions indicated that the proposed predictive models for anxiety and depression were significant and had good levels of fit with the data. Gender differences emerged in predictor variables. Findings provide valid predictive models that could be adopted to assess psychological health in infertile patients and to develop evidence-based and tailored counselling interventions at centres for assisted reproduction.

Infertility-related stress and depressive symptoms - the role of experiential avoidance: a cross-sectional study.

Objective: The current study aimed to explore the mediating role of experiential avoidance in the relationship between infertility-related stress (impact of infertility in women's life and representations about the importance of parenthood) and depressive symptoms.Background: Infertility is a stress inducing condition presenting many challenges to individuals facing this diagnosis, particularly to the ones who decide to pursue medical treatment. One of its consequences may be the experience of depressive symptoms which have also been associated with increased infertility-related stress. Moreover, experiential avoidance, conceptualised as an emotion regulation process, has also been connected to psychopathological symptoms, particularly depressive symptoms.Methods: The sample consisted of 124 women presenting an infertility diagnosis who were pursuing medical treatment for fertility problems. Participants were recruited through the national patients' association website and completed the following self-report instruments: a sociodemographic and clinical questionnaire, the Acceptance and Action Questionnaire-II (AAQ-II), the Fertility Problem Inventory (FPI) and the Depression, Anxiety and Stress Scales 21 (DASS-21).Results: Results showed that representations about the importance of parenthood were associated with depressive symptoms indirectly, throughout the association with the impact of infertility in women's life and use of experiential avoidance.Conclusions: Experiential avoidance can be considered a relevant emotion regulation process to be targeted in psychological intervention programs for women facing infertility.

Infertility-related stress and the risk of antidepressants prescription in women: a 10-year register study.

STUDY QUESTION: Is the first-time redeemed prescription of antidepressants predicted by the level of infertility-related stress in women seeking ART treatment? SUMMARY ANSWER: Infertility-related stress in the personal and marital domains and general physical stress reactions were significant predictors of a first redeemed prescription of antidepressants after ART treatment in this 10-year follow-up cohort study. WHAT IS KNOWN ALREADY: The literature has found inconsistent findings regarding the association between infertility-related stress and later psychological adjustment in fertility patients. The association between infertility-related stress and later prescription of antidepressants had never been explored in long-term cohort studies. STUDY DESIGN, SIZE, DURATION: All women (n = 1169) who participated in the Copenhagen Cohort Multi-centre Psychosocial Infertility (COMPI) cohort study in the year 2000 (questionnaire data) were linked with the register-based Danish National ART-Couple (DANAC) I cohort, which includes women and their partners having received ART treatment from 1 January 1994 to 30 September 2009. The study population were among other national health and sociodemographic registers further linked with the Danish National Prescription Registry. PARTICIPANTS/MATERIALS, SETTING, METHODS: Women initiating ART treatment were followed until they had redeemed the first prescription of antidepressants or until 31 December 2009. Logistic regression analyses were conducted to test the association between general physical stress reactions and infertility-related stress in the personal, marital and social domains, respectively, and a future redeemed prescription of antidepressants. Age, education level, marital status, number of fertility treatments prior to study inclusion and female infertility diagnosis were included as covariates in the adjusted analyses. Further, the analysis was stratified according to childbirth or no childbirth during follow-up. MAIN RESULTS AND THE ROLE OF CHANCE: The final sample consisted of 1009 women with a mean age of 31.8 years. At study inclusion, women had tried to conceive for an average of 3.45 years. At 10-year follow-up, a total of 13.7% of women had a first redeemed prescription of antidepressant medication. The adjusted odds ratio (OR) showed that high general physical stress predicted the later prescription of antidepressants (adjusted (adj) OR = 2.85, 95% confidence interval (CI) 1.96-4.16). Regarding infertility-related stress domains, high personal stress (adj OR = 2.14, 95% CI 1.46-3.13) and high marital stress (adj OR = 1.80, 95% CI 1.23-2.64) were significantly associated with the later prescription of antidepressants. Social stress was not significantly associated with the future redeemed prescription of antidepressants (adj OR = 1.10, 95% CI 0.76-1.61). Among women not having achieved childbirth during follow-up, the risk of a first-time prescription of antidepressants associated with infertility-specific stress was higher compared to the risk among women having childbirth during follow-up. LIMITATIONS, REASONS FOR CAUTION: This study did not account for potential mediating factors, such as negative life events, which could be associated with the prescription of antidepressants. Second, we are not able to know if these women had sought psychological support during follow-up. Additionally, antidepressants might be prescribed for other health conditions than depressive disorders. WIDER IMPLICATIONS OF THE FINDINGS: Our results suggest that women presenting high infertility-related stress in the personal and marital domains were at higher risk of redeemed first-time prescription of antidepressants after ART, independently of having delivered a child or not after initiation of ART treatment. Women would benefit from an initial screening specifically for high infertility-related stress. The COMPI Fertility Problem Stress Scales can be used by clinical staff in order to identify women in need of psychological support before starting ART treatments. STUDY FUNDING/COMPETING INTEREST(S): This study was supported by the Portuguese Foundation for Science and Technology (FCT) under an individual doctoral grant attributed to the first author (SFRH/BD/103234/2014). The establishment of the DANAC I cohort was funded by Rosa Ebba Hansen's Fund. The COMPI Infertility Cohort project was supported by The Danish Health Insurance Fund (J.nr. 11/097-97), the Else and Mogens Wedell-Wedellsborgs Fund, the manager E. Danielsens and Wife's Fund, the merchant L.F. Foghts Fund, the Jacob Madsen and Wife Olga Madsens Fund. The authors have no conflicts of interest. TRIAL REGISTRATION NUMBER: NA.

Resilience acts as a moderator in the relationship between infertility-related stress and fertility quality of life among women with infertility: a cross-sectional study.

BACKGROUND: Infertility-related stress can seriously impact the fertility quality of life (QoL) of infertile women. Resilience, as a coping resource, can effectively combat psychological stress. This study aimed to evaluate the fertility QoL of infertile women and to examine whether resilience moderates the association of infertility-related stress with fertility QoL. METHODS: This cross-sectional study was conducted in northeast of China from December 2017 to February 2018. Out of 559 women outpatients with infertility, 498 (89.1%) completed self-reported questionnaires including the FertiQoL Scale, Fertility Problem Inventory (FPI) and Connor-Davidson Resilience Scale (CD-RISC). Hierarchical multiple regression analysis and simple slope analysis were applied to explore the influencing factors related to fertility QoL as well as to examine the moderating effect of resilience on the association of infertility-related stress with fertility QoL. RESULTS: The mean FertiQoL score was 64.54 ± 16.90 among the participants. Household monthly income and causes of infertility were significantly related to fertility QoL. In addition, infertility-related stress was negatively related to fertility QoL, and resilience was positively associated with fertility QoL, explaining 36.3% of the variance. Resilience moderated the association of infertility-related stress with fertility QoL. Specifically, the effect of infertility-related stress on fertility QoL varied by low(1 SD below the mean, B = - 0.496, ß = - 0.714, P < 0.001), mean (B = - 0.293, ß = - 0.422, P < 0.001) and high (1 SD above the mean, B = - 0.090, ß = - 0.130, P < 0.001) levels of resilience. The higher resilience was, the weaker the effect of infertility-related stress on fertility QoL was. CONCLUSIONS: Overall, women with infertility in China had relatively low FertiQoL scores. Resilience influenced the association of infertility-related stress with fertility QoL. Infertile patients' psychological status must be addressed and adequate resilience-based interventions such as mindfulness-based skills should be provided to improve fertility QoL of women with infertility.

Spirituality, infertility-related stress, and quality of life in Brazilian infertile couples: Analysis using the actor-partner interdependence mediation model.

Infertility has a stressful impact on both partners, with adverse effects on the quality of life of infertile couples. Spirituality is a meaning-based strategy that can protect couples against infertility's negative impact on quality of life, but analysis of this mediator relationship in infertile couples has not been reported. We adopted a dyadic approach and used the actor-partner interdependence mediation model to examine whether and how women's and men's spirituality was associated with their own and their partners' infertility-related stress and quality of life. In 2014, 152 infertile couples starting their first fertility treatment at a private clinic in Brazil were recruited and completed self-reports of spirituality, infertility-related stress, and quality of life. Results indicated that women's and men's level of spirituality was positively associated with their own quality of life directly and indirectly, by reducing their own infertility-related stress. Their spirituality was associated with an increase in their partners' quality of life only indirectly, by reducing their partners' infertility-related stress. Findings highlight the importance of assessing and promoting spirituality as a coping resource that infertile women and men might use to deal with the stress of infertility and reduce its adverse effects on quality of life.

Sexual satisfaction among involuntarily childless women: A cross-cultural study in Italy and Brazil.

Infertility has been negatively associated with sexual satisfaction. This study aimed to estimate the relation of infertility to sexual satisfaction from a cross-cultural perspective, comparing Italian and Brazilian women. Between June 2012 and January 2013, 528 women seeking assisted reproduction technology (ART) treatment in Italy (39%) or Brazil (61%) completed self-reports of sexual satisfaction (ISS) and infertility-related stress in the marital domain (IRS). IRS was the same across countries. ISS differed, with 34.31% of the Italians and 43.52% of the Brazilians being sexually dissatisfied at a clinical level (ISS score >30). Multiple logistic regression models showed that being sexually dissatisfied at a clinical level was associated with lower education and higher IRS among Italian women, regardless of having a diagnosed cause of infertility. It was instead associated with higher IRS only among the Brazilian women who had a diagnosed cause of infertility. These findings suggest that, regardless of nationality, sexual satisfaction and infertility-related stress need to be addressed in the treatment of infertile women turning to ART. However, as factors associated with these dimensions vary across countries, interventions to promote sexual satisfaction among infertile women should be adapted to their specific socio-cultural context.

Infertility-Related Stress, and Dyadic Coping as Predictors of Quality of Life: Gender Differences Among Couples with Infertility Issues.

Background: The purpose of this study was to explore the relationship between infertility-related stress and dyadic coping with quality of life (QoL) in couples with infertility issues, and verify gender differences and dyadic interactions in the associations between them. Methods: This cross-sectional study included 340 couples who were recruited from the First Affiliated Hospital of Lanzhou University between March 2022 and November 2022. The Fertility Problem Inventory, Dyadic Coping Inventory and FertiQoL were used to measure infertility-related stress, dyadic coping and QoL. The Actor-Partner Interdependence Model was used to analyze the effects of infertility-related stress and dyadic coping on the couple's own QoL (actor effect) as well as on their partner's QoL (partner effect). Results: Female patients perceived significantly lower levels of QoL and dyadic coping than those of husbands. There was no statistically significant difference in the infertility-related stress between wives and husbands. Husbands' infertility-related stress had actor and partner effects on their own and their wives' QoL, while wives' infertility-related stress only had an actor effect on their own QoL. Husbands' dyadic coping had both actor effect and partner effects on their own and their wives' QoL, meanwhile wives' dyadic coping had both actor effect and partner effects on their own and their husbands' QoL. Conclusion: Husbands' QoL was impacted by their own infertility-related stress, dyadic coping and their wives' dyadic coping. Whereas wives' QoL was influenced by infertility-related stress and dyadic coping from both their own and their spouses. Therefore, elevating the level of dyadic coping may contribute to improving QoL for both husbands and wives. Moreover, enhancing the ability to cope with infertility-related stress might be useful for husbands and indirectly contribute to wives' QoL.

Infertility-related stress, quality of life, and reasons for fertility treatment discontinuation among US women: A secondary analysis of a cross-sectional study.

OBJECTIVE: Fertility treatments often cause women high levels of stress and low quality of life (QoL). Women discontinue fertility treatments for a variety of reasons, yet little is known about infertility-related stress and QoL among women who discontinue treatments. The purpose of this study was to examine infertility-related stress and QoL among women who discontinued fertility treatments compared to those who continued treatments, and reasons for treatment discontinuation. METHODS: A secondary analysis was conducted to examine infertility-related stress and QoL among 70 women who discontinued from fertility treatments compared to 166 women who received fertility treatments. Statistical analysis included descriptive statistics, chi-square test for independence, independent t-tests, and binary logistic regression analysis. Conventional content analysis was conducted on responses to an open-text question about reasons for treatment discontinuation. RESULTS: No differences in infertility-related stress and QoL were found between groups. Explanatory variables of treatment discontinuation included income [odds ratios (OR) 2.50, 95% CI 1.12-5.61], QoL dissatisfaction (OR 2.49, 95% CI 1.33-4.69), and infertility duration three years or greater (OR 2.40, 95% CI 1.30-4.42). Three themes of treatment discontinuation were identified: Covering the Cost; Waiting for a Resolution; Re-envisioning Family Identity. CONCLUSION: Infertility-related stress and QoL are similar among women who discontinued and who received fertility treatments, highlighting the need for emotional support services for women regardless of their treatment status. During the period of infertility, treatment discontinuation related to cost, waiting for a resolution, or re-envisioning family identity occurred, suggesting opportunities for specific interventions to support women's mental health needs.

Relationship between stigma and infertility-related stress among couples undergoing AID: The mediating role of communication patterns.

Infertility can be stressful for infertile couples. This study aims to examine the intra-dyadic associations between stigma, communication patterns, and infertility-related stress in couples undergoing artificial insemination by donor semen (AID). This cross-sectional study was conducted from January to April 2021. Two hundred and three couples undergoing AID were recruited from a reproductive centre in China. All of the couples completed a two-item stigma questionnaire, Communication Pattern Questionnaire, and Fertility Problem Inventory. The actor-partner interdependence mediation analysis was performed using AMOS 23.0. The analysis demonstrated significant actor-actor effects for couples undergoing AID. More specifically, higher levels of stigma among wives and husbands were associated with more negative communication patterns, thereby increasing their own infertility-related stress. Simultaneously, there was a significant partner-actor effect among infertile wives, demonstrating that the husband's stigma can affect his wife's infertility-related stress by influencing her communication patterns. Couples undergoing AID experience increased infertility-related stress when they have high levels of stigma and negative communication patterns, and husbands' stigma is correlated to wives' communication patterns. Therefore, dyadic interventions aiming to improving stigma and enhancing positive communication may be conducive to reducing infertility-related stress.

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.

Illness anxiety, infertility stress, resilience and thyroid-stimulating hormone among infertile people undergoing ART treatment in China.

OBJECTIVE: Infertile people undergoing assisted reproductive technology (ART) treatment in China may experience severe infertility-related stress and illness anxiety (IA). However, little relevant research has been conducted until now. DESIGN: This study investigated the IA of 340 infertile people undergoing ART treatment, including 43 males, 292 females and 5 who preferred not to answer, in 2 tertiary general public hospitals in Wen Zhou, China. MAIN OUTCOME MEASURES: Blood samples for thyroid-stimulating hormone (TSH) levels were obtained from 107 women to explore the relationship between IA and TSH. The questionnaire contained the Mandarin version of the Fertility Problem Inventory, the Resilient Trait Scale for Chinese Adults and the Whiteley Index, measuring infertility stress, resilience and IA, respectively. RESULTS: An incidence rate of 44.1% of IA among infertile people undergoing ART treatment in China was determined, and 30.2% of men and 46.6% of women had severe IA (χ2 = 4.05, p < 0.05). The risk of severe IA in women was around twice that in men (OR = 2.01, 95% CI: 1.01-4.01). Women's IA level was significantly associated with their TSH level (ß = 0.27, p < 0.01). Resilience played a moderating role in the relationship between parenthood importance and illness anxiety. CONCLUSION: This study highlighted the importance and urgency of providing holistic care for illness anxiety of infertile people undergoing ART treatment in China, especially women. The findings of this study indicated that mind-body therapies and resilience empowerment workshops could be conducive to infertile people's holistic health.

Infertility-related stress, social support, and coping of women experiencing infertility in Vietnam.

BACKGROUND: Women with an infertility problem living in traditional and developing countries face extensive social pressure, infertility-related stress, and distress, which possibly affect their choices of coping strategies. The present study aims to investigate the impact of infertility-related stress and social support on coping of Vietnamese women who live with an infertility diagnosis. PARTICIPANTS AND PROCEDURE: A cross-sectional study was conducted with 192 women diagnosed with infertility at two hospitals in the north and central regions of Vietnam. Participants completed a questionnaire consisting of the Multidimensional Scale of Perceived Social Support, the Copenhagen Multi-centre Psychosocial Infertility coping scales and the Fertility Problem Inventory, and questions about their sociodemographic characteristics, infertility-related history, and key social relationships. Four linear regression analyses were performed on four coping strategies: active-avoidance coping (AAC), active-confronting coping (ACC), passive-avoidance coping (PAC), and meaning-based coping (MBC). RESULTS: The findings show that high infertility-related stress significantly predicted the use of avoidance coping strategies (AAC and PAC) among these women, while those with a high level of perceived social support tended to use ACC and MBC. None of the four linear regression models support the moderating role of social support in the relationship between infertility-related stress and coping styles. CONCLUSIONS: The study findings show that levels of infertility-related stress and perceived social support have a direct effect on the choice of coping strategies among Vietnamese women diagnosed with infertility. The study results have practical implications in the Vietnamese context, including: (i) the development and adaptation of evidence-based and culturally appropriate interventions and counselling strategies; and (ii) social policy advocacy to better support women diagnosed with infertility, their husbands, and both as couples.