Preventing violence and enhancing mental health among clients of an invitro fertilization clinic in Jordan: results of a pre/post pilot test of the use of cognitive behavioral therapy.

INTRODUCTION: Infertility increases women's risk of intimate partner violence (IPV). Cognitive behavioral therapy (CBT) is commonly used to treat mental health problems among fertility treatment seeking patients. CBT has not been tested for its potential to reduce IPV in this population. We pilot test the use of CBT to prevent IPV and improve patients' mental health in a fertility clinic in Jordan. METHODS: Of 38 eligible fertility-treatment seeking couples, 16 consented and underwent up to 11 CBT sessions (average = 9) over 3 months. Interviews at baseline and 16 weeks post intervention (endline) assessed IPV, quality of life, social support, coping, and fear of spouse. Wilcoxon signed-rank and McNemar's tests were used to assess change in outcomes. RESULTS: At baseline, women's rates of IPV, depression, and anxiety were 75%, 87.5%, and 75% respectively, whereas men's rates of depression and anxiety were each 80%. Average baseline post-traumatic stress disorder (PTSD) symptoms for men and women were 3.3 and 2.7 respectively out of 5. IPV decreased 25% after treatment, and women reported less spousal fear. For both men and women, depression, anxiety, and PTSD symptoms decreased and social support and fertility quality of life improved. CONCLUSION: Psychosocial support should be standard of care for the treatment of infertility given the burden of mental health problems and IPV and the utility of CBT in this patient population. Co-design with couples is needed to identify strategies to bolster participation along with population-based interventions to combat the stigma of infertility and mental health service use and enhance women's status.

Knowledge and attitudes regarding Covid-19 among syrian refugee women in Jordan.

OBJECTIVES: To explore knowledge and attitude about Covid-19, among Syrian refugee mothers in the Governorate of Irbid, where the first outbreak of Covid-19 in Jordan took place. METHODS: This is a cross-section study among Syrian refugee mothers, who were pregnant or having had children. Data was collected through an online questionnaire. The survey link was distributed in April 2020, through the social network's messaging services Facebook and WhatsApp. Contact information was obtained from local community centres and non-governmental organisations in the town of Irbid, the north of Jordan. RESULTS: In total, 389 Syrian refugee mothers participated in the study. It showed that 66% of mother's access information regarding Covid-19. The main sources of information were Facebook 87%, WhatsApp 69%, television 53%, while 21% indicated that they access professional databases or government websites. In general, Syrian refugee mothers were knowledgeable about Covid-19 transmission and prevention. However, they lacked adequate knowledge about transmission of Covid-19 between the mother and the child, and smoking risks associated with Covid-19. CONCLUSIONS: There are gaps in the knowledge and attitude of Syrian refugee mothers in the Governorate of Irbid in relation to the Covid-19 pandemic. There is a need for further health education measures.

Effect of hookah (water pipe) smoking on semen parameters.

Hookah (water pipe) smoking, an old method of tobacco smoking, is regaining widespread popularity all over the world. Although the research in this field is still deficient, it has been proven for its harmful effect on human's health by increasing the risk of cardiovascular disease, infection and lung, oral and bladder cancer (Al-Numair et al., J Food Agric Environ, 5: 17, 2007; Bou Fakhreddine et al., Respir Med, 108: 1241-1253, 2014; Chaouachi, J Negat Results Biomed, 5: 17, 2006). However, no research was found to address its effect on human fertility or reproductive outcome. In this cross-sectional study, we aim to explore the effect of smoking hookah on human semen parameters among men attending In Vitro Fertilization LABs for seminal fluid analysis testing. 104 patients aged between 25 and 45, who are noncigarette smokers and have no chronic medical illness, were enrolled in the study: 50 hookah nonsmokers and 54 hookah smokers. Their semen parameters were compared. Semen volume, normal morphology and progressive motility were slightly lower in the hookah smoker (3.21 ml; 10.2%; 29.56%) versus (3.45 ml; 11.5%; 33.20%), respectively, in nonhookah smokers; however, the difference was not statistically significant. The effect of hookah smoking on semen observed in our study was not statistically significant. Further studies are needed to explore more and confirm any unfavourable effect.

Factors Associated With Infant Pain Severity Undergoing Immunization Injections.

PURPOSE: Factors influencing infants' behavioral and vocal (cry) response to painful stimuli are explored to improve pain management plans for infants undergoing immunizations. DESIGN AND METHODS: An observational study design was used. Pain responses of 60 to 75 days-old infants (44% male vs 56% female) undergoing two-month immunization injections were videotaped and coded using the Modified Behavioral Pain Scale (MBPS), and duration of total crying time during injection was recorded. The influences of five factors (gender, caregiver attendance, previous experience of nociception (circumcision), mode of delivery), and weight (birth and current) were examined at baseline, during and post-immunization. RESULTS: Higher birth weight was the most significant factor that reduced pain responses during (p = 0.001) and post-immunization (p = 0.03). A higher birth weight reduced full lung crying (p = 0.04), which reflects crying during injection as compared to total crying time. Vaginal delivery had a significant effect on behavioral pain responses of infants only post-immunization (p = 0.006). Parent's presence in the immunization room significantly reduced total crying time (p = 0.03). Uncircumcised male infants had a significant reduction in behavioral pain responses during immunization (p = 0.01) compared to circumcised infants. CONCLUSIONS: The literature well supports the acknowledgement of early pain experience and its psychological consequences. Knowing and controlling for each of mentioned factors early in life during every painful procedure could improve coping mechanisms of infants for any painful procedures later in life. PRACTICE IMPLICATIONS: Control of certain factors during early life experiences can modify pain of immunization.

Infant Resuscitation Practices of Midwives in a Developing Country.

BACKGROUND: Effective basic newborn resuscitation is an important strategy to reduce the incidence of birth asphyxia and associated newborn outcomes. Outcomes for newborns can be markedly improved if health providers have appropriate newborn resuscitation skills. PURPOSE: To evaluate the skills of midwives in newborn resuscitation in delivery rooms in Jordan. METHODS: Data were collected from observation of 118 midwives from National Health Service hospitals in the north of Jordan who performed basic newborn resuscitation for full-term neonates. A structured checklist of 14 items of basic skills of resuscitation was used. Descriptive statistics were used to analyze the data. RESULTS: The results highlighted the lack of appropriate performance of the 8 necessary skills at birth by midwives. About 17.8% of midwives had performed the core competencies at birth (ie, assessing breathing pattern/crying, cleaning airways) appropriately and met the standard sequence. Less than half of midwives assessed skin color (40.7%) and breathing pattern or crying (41.5%) appropriately with or without minor deviations from standard sequences. Of the 6 skills that had to be performed by midwives at 30 seconds up to 5 minutes after birth, 4 skills were not performed by about one-quarter of midwives. IMPLICATIONS FOR PRACTICE AND RESEARCH: The midwives' practices at the 2 hospitals of this study were not supported by best practice international guidelines. The study showed that a high proportion of midwives had imperfect basic newborn resuscitation skills despite a mean experience of 8 years. This highlights the critical need for continuing medical education in the area of basic newborn resuscitation. The results highlight the need for formal assessment of midwives' competence in basic newborn resuscitation. National evidence-based policies and quality assurance are needed to reflect contemporary practice.

Cross-cultural comparison of fertility specific quality of life in German, Hungarian and Jordanian couples attending a fertility center.

BACKGROUND: Only a few studies have reported cross-cultural comparisons regarding psychosocial consequences of infertility. Differences between societies with different cultural backgrounds were revealed and seemed to be based on the importance of pronatalism. Our aim was to measure cross-cultural differences in fertility specific quality of life of infertile couples in Germany, Hungary and Jordan who attend a fertility center in a cross-sectional study. METHODS: A cross-sectional study was conducted in one fertility clinic in Germany, in five fertility clinics in Hungary and in one fertility clinic in Jordan. Overall 750 couples (252 couples in Jordan, 246 couples in Germany and 252 couples in Hungary) attending the first medical infertility consultation were asked to fill out our questionnaire set. Fertility specific quality of life (FertiQoL) and sociodemographic differences were measured between couples from three countries. RESULTS: Jordanian couples had the shortest relationship (5.8 ± 4.3 yrs.), though they reported the longest duration of child wish (4.2 ± 3.6 yrs.) and fertility treatments (3.0 ± 3.3 yrs.). The proportion of high education was considerably higher in Jordanian women and men (60 % and 66 %, respectively) compared to the other two samples. First, marked cross-country differences were obtained on Emotional, Mind/Body and Relational subscales of the FertiQoL, indicating that Jordanian couples reported poorer fertility-related quality of life than Germans and Hungarians (p < 0.001). After controlling for the sociodemographic and medical variables, a significant difference only in the Emotional domain was observed (p < 0.001). CONCLUSIONS: The study revealed only a few cultural based differences in fertility specific quality of life between the couples of the three countries. Thus, infertility counselors should pay attention to psychosocial problems rooted in individual sociocultural aspects of the infertile couple regardless of cultural stereotypes. Further studies should identify sociocultural factors within different subgroups of infertile patients instead of focusing different societies as a whole because intra-cultural psychosocial differences in experiencing infertility seem to be more important for the individual patient than intercultural differences.

Sudden unexpected infant death in Jordan and the home environment.

BACKGROUND: The aim of this study was to evaluate maternal common practice for infant sleep care and the home environment, in order to explore the major risk factors associated with sudden unexpected infant death in Jordan. METHODS: Data were collected via semi-structured questionnaire interview to investigate the sociodemographic features, infant sleep practices and home environments. The sample included 604 mothers with infants <1 year old. Descriptive statistics were generated. RESULTS: Sleep practices were identified as leading factors in unexpected infant death. They included infant head covering (84%), heavy bedding with multiple quilts (81%) or blankets (67%), and co-bedding (66%). Environmental risk factors included high incidence of smoking, exposure to toxic solid fuel heaters during winter and inadequate room ventilation. CONCLUSION: Factors leading to unexpected infant death were high in Jordan. Unsafe infant sleeping practices and poor environmental factors put infants at high risk of sudden death. Lack of awareness of risk factors increases the risk.

Predictive factors and adverse perinatal outcomes associated with maternal smoking status.

To identify risk factors for smoking among pregnant women, and adverse perinatal outcomes among pregnant women. A case-control study of singleton full-term pregnant women who gave birth at a university hospital in Jordan in June 2020. Pregnant women were divided into three groups according to their smoking status, active, passive, and non-smokers. They were interviewed using a semi-structured questionnaire that included demographic data, current pregnancy history, and neonatal outcomes. Low-level maternal education, unemployment, secondary antenatal care, and having a smoking husband were identified as risk factors for smoke exposure among pregnant women. The risk for cesarean section was ninefold higher in nulliparous smoking women. Women with low family income, those who did not receive information about the hazards of smoking, unemployed passive smoking women, and multiparty raised the risk of neonatal intensive care unit admission among active smoking women. This risk increased in active and passive women with lower levels of education, and inactive smoking women with low family income by 25 times compared to women with a higher level of education. Smoking is associated with adverse perinatal outcomes. Appropriate preventive strategies should address modifiable risk factors for smoking during pregnancy.

Prevalence and Related Factors of Postpartum Depression among Jordanian Mothers with a History of COVID-19 during Pregnancy or After Childbirth in a Developing Country.

Background: The magnitude of postpartum depression in Jordan during the COVID-19 pandemic is under-documented, and little is known about its potential social, demographic, and clinical correlates. This study aimed to explore the prevalence and related factors of postpartum depression among Jordanian mothers with a history of COVID-19 during pregnancy or after childbirth. Materials and Methods: This cross-sectional descriptive study was carried out in March-June 2021 among a convenient sample of 109 women with a history of COVID-19 during pregnancy or after childbirth, who were at a leading hospital equipped to care for COVID-19 cases in North Jordan. An online survey using the Edinburgh Postnatal Depression Scale (EPDS) was used to collect information from mothers with a history of COVID-19-positive tests. Results: Among the total number of women who participated in the study (n = 109), 73 women had postpartum depression. The prevalence of postpartum depression in the present study was 67%. In addition, the study found a positive statistically significant correlation between EPDS scores and being a smoker, delivery method, experiencing severe COVID-19 symptoms, and being hospitalized. Conclusions: During the COVID-19 pandemic, women had a high level of postpartum depression. It would be necessary to follow further the confirmed cases of COVID-19, and mothers should be screened for depressive symptoms during pregnancy and followed up for antenatal and postnatal care.

Effect of dual tobacco smoking of hookah and cigarettes on semen parameters of infertile men.

INTRODUCTION: The research regarding the effect of hookah smoking on health is still deficient, even though it has been proven to jeopardize human health by raising the hazard of different types of cancers, infections, and cardiovascular disease. We aimed to study the effect of dual tobacco smoking (hookah and cigarettes) on semen parameters of infertile men. METHODS: In this cross-sectional study, we studied the effect of different types of smoking patterns on human semen parameters among men who visited IVF laboratories to do a seminal fluid analysis (SFA). A total number of 761 participants were included, divided into the following: 108 dual smokers, 219 hookah smokers, 222 cigarette smokers, and 212 non-smokers. To analyze the effect of dual smoking on normal morphology, an interaction term between the cigarette index and hookah index was used. RESULTS: Multivariable regression analysis after adjustment for age, BMI, education level, children, chronic diseases, varicocele, testicular surgery history, infertility duration, and cause revealed no significant difference in the sperm concentration and the percentage of progressive motility between non-smokers, cigarette smokers, or hookah smokers. However, there was a significant difference in the log of normal morphology percentage between the three groups. Cigarette and hookah smoking were significantly associated with having lower percentages of normal morphology. There was a significant difference in the log-normal morphology %, where light and heavy dual smokers had the least exponential beta of log-normal morphology %, 0.43 (95% CI: 0.33-0.55) and 0.36 (95% CI: 0.24-0.53), respectively. CONCLUSIONS: Dual tobacco smoking can adversely affect sperm morphology.

Infertile Jordanian Women's Self-Perception About Societal Violence: An Interpretative Phenomenological Study.

Background: Infertility affects one in six couples globally and is compounded by stigma and violence, particularly for women, in Jordan's culture. While existing research has illuminated societal pressures faced by infertile women, there is, yet no comprehensive understanding of the violence they encounter in their daily lives. Objective: This Interpretative Phenomenological study seeks to unravel the experiences of infertile women regarding societal violence in Jordan. By focusing on different types of community violence - physical, psychological, and emotional - The study aims to provide nuanced insights into the challenges these women confront. It also endeavors to identify contributing factors, including societal attitudes, cultural beliefs, and individual encounters, while informing policy and practice to mitigate this issue. Methods: Employing a qualitative approach, this study conducted semi-structured interviews with purposively sampled infertile women. Thematic analysis was utilized to uncover recurring patterns and themes, facilitating a comprehensive exploration of their experiences. Results: Five main themes were identified: How the surrounding people view me as an infertile woman; I am suffocated by their questions; they interfere in the smallest details; I got burned and turned to ashes, and I have no right to complain; The problem of childbearing and the treatment plan is a matter for me and my husband only; and who supports me and what do I want from those around me? Implications: This study's implications are significant for policy and practice. By foregrounding the prevalent violence faced by infertile women, it underscores the urgency of interventions. Raising awareness, providing education, and extending support can counteract societal stigma and violence. Creating a more compassionate societal fabric can ensure a safer, more inclusive environment for these women.

The impact of an online educational program to reduce second-hand exposure to smoke among nonsmoking pregnant women; a hospital-based intervention study.

Background: Second-hand smoke is recognized as a public health concern, especially for pregnant women. Objectives: To compare pregnant women's exposure and perceptions of SHS pre-and post-intervention. Materials and methods: The study was conducted with a sample of 32 pregnant women at a tertiary university hospital in Jordan. Using a semi-structured questionnaire, researchers asked women about their knowledge, attitude and behavior regarding prenatal exposure to smoke before and after an intervention that included motivation, communication, education and counselling by using a range of media. A cotinine test was conducted to measure levels in second-hand smokers. Results: The average maternal age was 30.88 ± 1.69 years; 68% were highly educated, 43% were employed, 37% reported not having sufficient income, and 62% did not attend for antenatal care on a regular basis. There was a significant increase in knowledge and awareness regarding second-hand smoking and its effect on pregnancy outcomes after the intervention. More than 90% of pregnant women supported a comprehensive policy in relation to smoking, and 33% of used to leave the room where others smoked. This percentage increased to 70% after the intervention. Cotinine level decreased after the intervention in 81% of cases. Conclusions: There is an increase in knowledge and awareness regarding second-hand smoking and its effects on pregnancy outcomes after implementation of an educational intervention.

Screening for phthalates biomarkers and its potential role in infertility outcomes in Jordan.

BACKGROUND: Phthalates are endocrine disrupting chemicals that are used in plastic and personal care products. Phthalate exposure has been linked to reproductive and fertility outcomes. OBJECTIVES: This study aimed to assess the phthalate exposures using both urinary level of two DEHP metabolites in females and questionnaires. It also aimed to investigate the association between phthalate levels and reproductive and fertility outcomes. METHODS: 325 females with and without fertility problems at gynaecology clinics filled out a questionnaire and provided a urine sample. Urine samples were analyzed for two DEHP metabolites: MEHHP, mono (2-ethyl-5-hydroxyhexyl) phthalate; MEOHP, mono (2-ethyl-5-oxohexyl) phthalate, using an HPLC/MS/MS analytical method. RESULTS: We observed a significant difference between cases and controls in terms of heating plastic in the microwave and use of skin and eye make-up, sunscreen, and nail polish. Our findings showed that MEOHP exposure is significantly associated with infertility among Jordanian women (Adjusted OR = 1.66, 95% CI: 1.14, 2.40, p-value = 0.002). SIGNIFICANCE: To the best of our knowledge, our study is the first of its kind done in Jordan to screen for phthalate exposure and investigate its association with infertility. Our study demonstrated high exposure of the Jordanian population to DEHP. It confirms the association between DEHP exposure and infertility. IMPACT STATEMENT: We measured phthalates in infertile and fertile women, in a community unaware of phthalate sources or its impacts, and with no regulation limits set. We aimed to increase awareness to environmental exposure to phthalates, emphasize the importance of implementation of public health interventions to control and minimize the effects of phthalate exposure and provide a base for further studies and future research to aid in the formation of policies and guidelines for the manufacturing and use of phthalates.

Are STK11 polymorphisms a predictor of the response to metformin in polycystic ovarian syndrome?

The aim of this study was to determine the frequencies of different genetic Serine threonine kinase 11 (STK11) variations in women with PCOS and to evaluate possible associations between the genetic polymorphisms of the STK11 gene and the response to metformin in women with polycystic ovary syndrome (PCOS). A prospective longitudinal cohort study of 57 women with PCOS was conducted. The anthropometric measurements, menstrual history, hirsutism, hair loss, acne, and biochemical parameters, in addition to gene testing for STK11 polymorphisms, were documented. Follow-up was arranged after 6 menstrual cycles whilst on oral metformin therapy, (850 mg, twice daily). Of the 120 women who were interviewed, 88 women fulfilled the inclusion criteria and 57 women completed the study. The mean age, weight, height, and BMI were 23.8 years old, 72.1 kg, 159 cm, and 28.6 kg/m2 respectively. The frequencies of the genotypes of intron 1 of the STK11 gene were 26% CC, 44% CG, and 30% GG, and of intron 6 were 52% CC, 37% CT, and 11% TT genotype. There were statistically significant improvements following metformin therapy in menstrual frequency, blood loss, acne, ultrasound findings, and a decrease in BMI, acne, and hirsutism, but not in alopecia. Fasting insulin decreased significantly, but fasting blood sugar did not. There were no significant statistical differences in relation to the LH/FSH ratio, estradiol, FT, 17 OHP and length of menstruation. In relation to the SKT11 gene polymorphisms and metformin administration, there were variable and mostly insignificant differences in the results regarding menstrual regularity, amount of menstrual blood loss, acne, alopecia, ultrasound findings, and hirsutism score. There was a significant difference in relation to alopecia in the Intron 1 subgroups, and in relation to hirsutism score in the Intron 6 subgroups. It was concluded that polymorphisms in the STK11 gene in either Intron 1 or Intron 6 were not predictive of the response to metformin therapy at a dose of 850 mg twice daily, but may have some effect on alopecia and hirsutism.

COVID-19 infection and vaccine have no impact on in-vitro fertilization (IVF) outcome.

To investigate the effect of COVID-19 infection or vaccine on IVF outcome. This is a multicenter retrospective study. Data were collected from all patients treated in the ART units between September and November 2021 after the vaccination of the general population began. Medical records of all patients who had IVF/intracytoplasmic sperm injection (ICSI) were retrospectively reviewed. Patients were categorized into four groups: previously infected by COVID-19, vaccinated by COVID vaccine, previously infected and vaccinated, or neither infected nor vaccinated. Total number of participants 151 (vaccinated only 66, infected only 18, vaccinated and previously infected 34, and control 33. Outcomes (ET on day of trigger, number of oocytes retrieved, quality of oocytes, number of fertilized oocytes, number and quality of embryos, number of embryos transferred, number of embryos frozen, implantation rate and clinical pregnancy rate) were compared between these four groups. Moreover, we compared the outcome before and post infection, as well as before and post vaccine in a group of patients. No evidence was found to suggest that COVID-19 disease or SARS-CoV-2 Vaccine adversely affects Clinical pregnancy rates (positive fetal heartbeat) (OR 0.9, CI 0.5-1.9, OR 1.8, CI 0.9-3.6, respectively) and the following parameters: fertilization rate, implantation rate, positive bHcg) (OR 0.9, CI 0.5-1.8, OR 1.5, CI 0.7-2.9, respectively). Although a limitation of our study is the small comparison groups, and the wide confidence intervals in the Odds Ratio estimates.

Impact of COVID-19 on perinatal mental health among pregnant mothers infected with COVID-19, during the first wave of the epidemic in Jordan.

Background: Data concerning the impact of Coronavirus disease (COVID-19) infection on the mental health of pregnant women are still limited. The study explored baseline information regarding the impact of COVID-19 on mental health in the perinatal period, among mothers infected with COVID-19, during the first wave of the epidemic in Jordan. The current study aimed to examine the anxiety levels of pregnant women infected with coronavirus over the COVID-19 pandemic. Methods: A cross-sectional study was conducted during the period from March to December 2021, using an online survey that addressed key issues related to the role of COVID-19 infection in developing anxiety among pregnant women using the Edinburgh Postnatal Depression Scale (EPDS). The study population was pregnant women with laboratory-confirmed COVID-19 infection, and who agreed to participate in the study (n = 530). Results: The results indicated that one-third of the women had contracted coronavirus infection in each trimester. Most had no pregnancy complications (78.0%), 42.0% had no symptoms of coronavirus infection, 10.0% were hospitalized and 2.0% were admitted to the Intensive Care Unit (ICU). Approximately half declared that they did not receive support from the medical staff, although 71.0% had very good support from their families. Nearly a quarter of respondents stopped smiling while infected, 19% did not want to have any entertainment, and one-third had sleep problems. Moreover, more than half of the pregnant women were feeling anxiety (58.0%) and fear (59.0%). The prevalence of depression and anxiety was 67%. The EPDS scores were statistically significant and associated with being a smoker, method of delivery, getting COVID-19, experiencing COVID-19 symptoms, and being admitted to a hospital or ICU. Conclusions: This study highlights that healthcare providers and family members should pay more attention to maternal mental health during a pandemic. Fear and anxiety among pregnant women need to be taken into account more during the period of international crises, taking into account the mental health of the pregnant woman when developing health plans, developing health programs, and providing diagnostic and therapeutic management in the maternal care departments.

Conception Preferences during COVID-19 Pandemic Lockdowns.

Background: The COVID-19 lockdowns imposed new challenges to couples who were planning to conceive. In this research paper, we aimed to study the perceptions of women in Jordan during the pandemic regarding fertility behavior, the desire to use assisted reproductive technology (ART) and the awareness and beliefs of potential risks related to conception. Methods: A validated online-based questionnaire was distributed to women from April-May 2020, Statistical analysis was performed using the statistical software SPSS version 22 and R software (2020); p values ≤ 0.05 were considered statistically significant. Results: The total number of participants was 814 women, with 78.2% of the participants (58.7% fertile and 76.6% infertile) believing that pregnancy during the COVID-19 pandemic could be risky. Among them, 16% and 40%, respectively, were trying to conceive during the pandemic, and 97.4% and 89.9%, respectively, were not willing to use ART if needed during the pandemic. Young, nulliparous women who were married for less than one year were significantly associated with the desire to conceive during the COVID-19 pandemic. Conclusion: This study concluded that the fertility behavior of women in Jordan changed during the pandemic, and their desire for natural conception and for using ART declined, as they believed that there were potential risks related to conceiving during the pandemic. However, the effect was greater among the general fertile population than the infertile.

Prevalence and predictive factors for infertility-related stress among infertile couples: A cross-sectional study from Jordan and the occupied Palestinian territories.

OBJECTIVES: To assess the level of infertility-related stress, associated socio-economic, and demographic factors among infertile couples living in Jordan and those living under the chronic Israeli-Palestinian conflict in the occupied Palestinian territories. METHODS: A cross-sectional study was carried out in a number of fertility and reproductive clinics in Jordan and occupied Palestinian territories over a period of 6 months. Trained clinical pharmacists interviewed the identified couples. RESULTS: A total of 443 participants were interviewed. Three variables were significantly and independently associated with global stress scores. The need of parenthood appears higher in women than men among infertile couples in Jordan and Palestine (p=0.005). The country of origin (p<0.001) made the greatest contribution of unique variance followed by family type (p=0.035). Additionally, a significant contribution to the model was carried out by the number of clinicians who followed up on the case (p=0.013). The average total cost of treatment since the problem had been diagnosed was 2936±4529 Jordanian dinar, which may be of concern to both Jordanians and Palestinians given the limited resources available in developing nations. CONCLUSION: This study shows a significant degree of stress among infertile couples. The place of origin, family structure, and presence of medical insurance had a significant impact on the infertility global stress score. This study emphasizes the necessity for specific psychological therapies that are currently lacking in public healthcare practices in both Jordan and Palestine.

Dual trigger with gonadotropin-releasing hormone agonist and human chorionic gonadotropin significantly improves oocyte yield in normal responders on GnRH-antagonist cycles.

OBJECTIVE: During in vitro fertilization (IVF) cycles, final oocyte maturation is usually triggered by human Chorionic Gonadotropin (hCG) for its known effect in mimicking Luteinizing Hormone (LH) surge; however, with the widespread use of the 'antagonist protocol', Gonadotropin Releasing Hormone agonist (GnRHa) is being more commonly employed as a trigger in order to minimize or eliminate the risk of ovarian hyper-stimulation syndrome (OHSS). Many studies proved its efficacy in inducing oocyte maturation and its safety in preventing OHSS in high-risk groups. Moreover, some studies showed that GnRHa trigger may improve oocyte yield. This study aimed to further explore any beneficial effect of adding GnRHa to hCG (dual trigger) on oocyte yield and fertilization rate in normal responder women. METHODS: We retrospectively reviewed and analyzed the data from 127 patients on antagonist protocol (67 dual trigger and 60 HCG trigger). RESULTS: The number of total oocytes, the number of MII oocytes and the number of fertilized oocytes were all significantly higher with the dual trigger protocol compared to hCG-only trigger. However, there is no significant difference in clinical pregnancy rate. CONCLUSIONS: Using the dual trigger improved the number and quality of oocytes, and the fertilization rate in normal responders.

Depression, anxiety, and stress symptoms among Jordanian midwives: A hospital-based study.

OBJECTIVE: To investigate the prevalence of depression, anxiety, and stress symptoms in Jordanian midwives and identify associated factors. DESIGN: Setting and participants: This descriptive, cross-sectional study was conducted with a sample of 321 registered midwives from 18 public hospitals in Jordan that provide antepartum, intrapartum, postpartum care, and family planning services. The survey included the Depression, Anxiety, and Stress Scale (DASS-21) and demographic and professional data forms. FINDINGS: High rates of depression (76.2%); anxiety (85.3%) and stress (66.8%) symptoms were reported among midwives in Jordan. Midwives aged between 22 - 30 years reported more depression, anxiety, and stress symptoms than midwives in the other age groups. Married midwives had higher depression symptoms than single midwives. Midwives with < 10 years in practice had higher depression, anxiety, and stress symptoms compared to midwives with ≥ 10 years in practice. Midwives providing care for > 10 women per shift had higher anxiety and stress symptoms than midwives caring for five or less women per shift. Midwives who rotated between shifts had higher depression and stress symptoms than midwives who did not rotate. CONCLUSIONS: Rates of depression, anxiety, and stress symptoms reported by Jordanian midwives were higher than rates reported by midwives in other countries. The high rates of distress highlight the urgent need for national strategies to support the emotional wellbeing and retention of midwives within Jordanian settings.