Effectiveness of mindful self-compassion therapy on psychopathology symptoms, psychological distress and life expectancy in infertile women treated with in vitro fertilization: a two-arm double-blind parallel randomized controlled trial.

OBJECTIVES: Infertility is a prominent problem affecting millions of couples worldwide. Recently, there has been a hightened emphasis on elucidating the subtle linkages between infertility treatment leveraging assisted reproductive technology and the complex realm of psychological challenges, as well as efforts in implementation of psychological interventions.The Mindful Self-Compassion (MSC) program seeks to improve self-compassion, compassion for others, mindfulness, and life satisfaction while reducing depression, anxiety, and stress. In the current study, an MSC intervention was performed on infertile women (IW) undergoing in vitro fertilization (IVF) to assess the effectiveness of this intervention in reducing psychological distress and psychopathological symptoms and enhancing life expectancy. METHODS: Fifty-seven IW undergoing IVF were randomly allocated to two groups: MSC (n = 29) or treatment as usual (TAU; n = 28). Participants in MSC met once a week for two hours for eight weeks and attended a half-day meditation retreat. The Synder's Hope questionnaire and the Revised 90-Symptom Checklist (SCL-90-R) were used as the primary outcome measures. Data were obtained before the intervention, immediately after the intervention, and two months post-intervention. Repeated measures of ANCOVA and paired t-tests in all assessment points were used to compare the MSC and the TAU groups in outcomes. RESULTS: In the MSC group, hopelessness, anger-hostility, anxiety, interpersonal sensitivity difficulties, and depression were significantly reduced compared with the TAU group, and those improvements persisted at the two-month follow-up. Reliable change index revealed that the MSC group's gains were both clinically significant and durable. CONCLUSIONS: MSC can facilitate higher life satisfaction and mental well-being for IW undergoing IVF by reducing psychological distress, psychopathological symptoms, and hopelessness. These encouraging findings call for more research into the effectiveness of mindfulness-based therapies in addressing psychological problems among IW undergoing IVF.

Lived experiences and coping strategies of persons seeking infertility treatment in the Kumasi metropolis: a descriptive phenomenological study.

BACKGROUND: Women seeking fertility treatment face myriad challenges that they must adapt and adjust to daily. This aimed at exploring the experiences and coping strategies of such persons in the Kumasi. Metropolis. METHODS: A qualitative approach was employed and a purposive sampling technique was used to select 19 participants. A semi-structured interview was used to collect data. The data collected were analyzed using Colaizzi's method of data analysis. RESULTS: Persons living with infertility had emotional experiences of anxiety, stress, and depression. Socially, participants experienced isolation, stigma, societal pressure, and marital problems due to their inability to conceive. The key coping strategies adopted were spiritual (faith-based) and social support. Though formal child adoption can be an option, no participant preferred it as a coping strategy. Some participants also reported using herbal medicine before going to the fertility centre upon realizing that the approach was not helping in achieving their desired outcome. CONCLUSION: Infertility is a source of suffering for most women diagnosed with it, resulting in significant negative experiences in their matrimonial homes, families, friends, and the community at large. Most participants rely on spiritual and social support as their immediate and basic coping strategies. Future research could evaluate the treatment and coping strategies and also determine the outcomes of other forms of treatment for infertility.

The Effectiveness of Mindfulness-Based Intervention on Emotional States of Women Undergoing Fertility Treatment: A Meta-Analysis.

For many infertile women, their inability to fulfill their aspirations and match society's expectations of motherhood may lead to mental illness. They frequently select in vitro fertilization (IVF) to achieve their wish to have children. In vitro fertilization is actually a multi-dimensional stressor. There are numerous psychological methods to assist patients decrease stress, among which mindfulness-based intervention is a prominent one. However, the effectiveness of mindfulness intervention in this group remains debatable. Therefore, our research seeks to evaluate the efficacy of mindfulness intervention in improving the emotional state of women undergoing in vitro fertilization by systematic review and meta-analysis, so as to provide a novel treatment plan for psychological therapy of this group. A meta-analysis was undertaken by scanning English databases PubMed, Embase, Cochrane library, Web of science, etc. Among them, the retrieval period is from the foundation of the database until July 5, 2022. Two investigators examined the literature according to the inclusion and exclusion criteria, and conducted meta-analysis using stata15.0 software. Six studies involving 964 infertile women were included. According to the meta-analysis, mindfulness was more effective than the control group in reducing anxiety, depression, and correlations in infertile women [standard mean difference, SMD = -0.31, 95% confidence interval (CI): -0.56 to -0.06], [SMD = -0.94, 95% CI: -1.84 to -0.03], [r = 0.38, 95% CI: 0.25-0.52]. In terms of mindfulness and self-compassion, there was no significant difference between the intervention and control groups [SMD = 0.73, 95% CI: -0.38 to -1.85], [SMD = 0.09, 95% CI: -0.19 to -0.37]. As an intervention strategy for infertile women with anxiety and despair, mindfulness intervention might be a treatment priority.

The impact of obesity on fertility and sexual function in women of child bearing age.

Obesity and infertility are health problems that are increasing in frequency. In this study, sexual dysfunction in obese infertile women was investigated. A total of 450 women who met the inclusion criteria were recruited for the study; 150 women who had obesity without infertility, 150 women who had obesity with infertility and 150 women with normal weight but without infertility, which was the control group. The mean age of the groups were 31.3 ± 3.9, 31.2 ± 3.8 and 31.1 ± 4.5, respectively. The participants were administered a sociodemographic data form, the Female Sexual Function Index (FSFI) and the Beck Depression Inventory following the measurement of body mass index (BMI). FSFI score below 26.55 was defined as sexual dysfunction. Our data were analysed using SPSS (Statistical Package for Social Sciences) 21.0 for Windows (SPSS Inc., Chicago, IL). FSFI scores were observed to be statistically significantly lower in the group of obese women with infertility than in the other two groups. In our study, sexual dysfunction was found to be statistically significantly higher in obese women with infertility compared to the control group. Therefore, healthcare professionals should evaluate infertility in obese women in terms of sexual dysfunction as well as infertility treatment.Impact StatementWhat is already known on this subject? Psychological problems such as depression and anxiety, changes in sex hormones, and adipokines were reported to have negative impacts on sexual functions (Plaisance et al. 2009; Kendler et al. 2010; Yaylali et al. 2010). There are also various reports stating that female infertility has negative effects on sexual satisfaction and that fertility anxiety may affect sexual functions as an independent factor (Pakpour et al. 2012; Kaya et al. 2021). Even so there is a limited amount of information concerning the effects of obesity and infertility on female sexual function.What do the results of this study add? It has been found in our study that sexual dysfunction is higher in women with obesity and infertility and that this dysfunction is correlated with BMI.What are the implications of these findings for clinical practice and/or further research? It is therefore important that healthcare professionals adopt a holistic approach that incorporates sexual health consultancy to improve the treatment and quality of life of women with obesity and infertility.

A qualitative synthesis of the impact of infertility on the mental health of African women.

Infertility is a reproductive problem that affects all gender, race, or social class. In many African countries, the burden of infertility is usually associated with economic, psychological, and socio-cultural factors. This review aimed to explore the factors that impact the mental health of African women with primary infertility. A qualitative evidence synthesis was used to summarise and analyse primary qualitative studies focused on the impact of primary infertility on African women. Seventeen studies met the eligibility criteria and were included in the review. The review found that social pressure, stigma from family and community members, and financial constraints led to psychological distress. In addition, social stigma also led to marital problems which led to significant psychological distress and low self-worth, especially on the wife. Recommendations to reduce stigma among African infertile women were as follows: advocacy and community mobilisation, education by health professionals, and holistic person-centred care. An intersectional approach to inform public health and social policy was also suggested.

Effectiveness of progressive muscle relaxation and laughter therapy on mental health and treatment outcomes in women undergoing in vitro fertilization: A randomized controlled trial.

A majority of infertile women experience emotional problems, such as anxiety and depression. Nurses need nonpharmacological methods rather than drugs to address women's emotional distress during the in vitro fertilization (IVF) process. The purpose of this study was to examine the effect of progressive muscle relaxation exercises and laughter therapy on the mental health and treatment outcomes of women receiving IVF treatment. This parallel-group, randomized controlled trial was conducted in a private IVF center. Participants were randomly assigned to the intervention group (IG; n = 71) and control group (CG; n = 70). The IG received progressive muscle relaxation and laughter therapy for 40 min in each session for 3-4 sessions, whereas the CG received routine care. Data were obtained from the patient information form, State-Trait Anxiety Inventory, Beck Depression Inventory, and medical records. The questionnaire was completed at recruitment (T1) and oocyte pick-up day (T2). In the evaluation performed on the day of the oocyte pick-up, depression and trait anxiety scores of the IG were found to be lower than those in the CG, and the effect size was small. Group × time interaction was significant for depression (large effect size) and trait anxiety (small effect size). The estradiol levels, the number of oocytes, transfer status, and pregnancy rates (according to a blood test) were similar between groups. Women receiving IVF treatment who received progressive muscle relaxation and laughter therapy demonstrated psychological changes; however, the treatment did not affect medical outcomes.

Acupuncture treatment for emotional problems in infertile women: A protocol for systematic review and meta-analysis.

BACKGROUND: Infertility causes emotional and psychological problems, including anxiety, depression, low self-efficacy, and chronic mental stress in women. These emotional problems can negatively affect fertility treatment. Numerous studies have reported the clinical therapeutic effects of acupuncture on emotional problems; however, the efficacy and safety of acupuncture treatment for emotional problems in infertile women remain unclear. This protocol aims to evaluate the efficacy and safety of acupuncture for treating emotional problems in infertile women. METHODS: We will search the following databases from their inception to April 30, 2021: MEDLINE, EMBASE, Cochrane Library, Korean Medical Databases (KoreaMed, Korean studies Information Service System, Korean Traditional Knowledge Portal, Oriental Medicine Advanced Searching Integrated System, Research Information Sharing Service, and National Digital Science Library), and Chinese databases (CNKI and Wan Fang Database). We will include randomized controlled trials on acupuncture for emotional problems in infertile women. There will be no restrictions regarding language or publication date. The primary outcome will be assessed using an emotion-related assessment scale. The risk of bias of the included studies will be measured using the Cochrane risk of bias assessment tool. For meta-analysis, RevMan Version 5.4 software will be used to combine the relative risks for dichotomous outcomes, as well as the mean differences or standardized mean differences for continuous outcomes, with both having 95% confidence intervals. RESULTS: Based on current evidence, this study will assess the effectiveness and safety of acupuncture for emotional problems in infertile women. CONCLUSION: This study will provide evidence for evaluating the acupuncture efficacy for infertile women with emotional problems. REGISTRATION NUMBER: INPLASY202150082.

Neuroendocrine disruption is associated to infertility in chronically stressed female rats.

Infertility is a growing worldwide public health problem, and stress is a main factor exerting detrimental effects on female reproduction. However, knowledge regarding the neuroendocrine changes caused by chronic stress in females is limited. Therefore, this study assessed the effects of stress on hormones that control female reproduction during the proestrus and diestrus stages of the estrous cycle, as well as its effects on fertility. Adult females were assigned to either a control or a stress group. Stress consisted of exposure, for 15 min, to cold-water immersion daily for 30 days. Estrous cyclicity, female sexual behavior, as well as hypothalamic kisspeptin, gonadotropin releasing hormone (GnRH) content, serum luteinizing hormone (LH), estradiol (E2), progesterone (P4), corticosterone (CORT) and fertility were assessed after chronic stress. The results show that chronically stressed females exhibited disrupted estrous cyclicity, decreased receptivity, low pregnancy rates and lower numbers of fetuses. The content of Kisspeptin and GnRH in the Anteroventral Periventricular/medial Preoptic Area decreased during proestrus, while Kisspeptin increased in the Arcuate nucleus in proestrus and diestrus. Serum LH decreased only during proestrus, whereas E2 and P4 concentrations decreased during proestrus and diestrus, with a concomitant increase in CORT levels in both stages. As a whole, these results indicate that chronic stress decreases Kisspeptin content in AVPV nucleus and GnRH in POA in females, and might induce disruption of the LH surge, consequently disrupting estrous cyclicity and fertility, leading to lower rates of pregnancy and number of fetuses.

An internet-based mind/body intervention to mitigate distress in women experiencing infertility: A randomized pilot trial.

OBJECTIVE: To determine if an internet-based mind/body program would lead to participants experiencing infertility (1) being willing to be recruited and randomized and (2) accepting and being ready to engage in a fertility-specific intervention. Secondary exploratory goals were to examine reduced distress over the course of the intervention and increased likelihood to conceive. METHODS: This was a pilot randomized controlled feasibility trial with a between-groups, repeated measure design. Seventy-one women self-identified as nulliparous and meeting criteria for infertility. Participants were randomized to the internet-based version of the Mind/Body Program for Fertility or wait-list control group and asked to complete pre-, mid- and post-assessments. Primary outcomes include retention rates, number of modules completed, and satisfaction with intervention. Secondary exploratory outcomes sought to provide preliminary data on the impact of the program on distress (anxiety and depression) and self-reported pregnancy rates relative to a quasi-control group. RESULTS: The retention, adherence, and satisfaction rates were comparable to those reported in other internet-based RCTs. Although time between pre- and post-assessment differed between groups, using intent-to-treat analyses, women in the intervention group (relative to the wait-list group) had significant reduction in distress (anxiety, p = .003; depression, p = .007; stress, p = .041 fertility-social, p = .018; fertility-sexual, p = .006), estimated as medium-to-large effect sizes (ds = 0.45 to 0.86). The odds of becoming pregnant was 4.47 times higher for the intervention group participants as compared to the wait-list group, OR 95% CI [1.56, 12.85], p = .005 and occurred earlier. The findings suggest that the research design and program specific to this population are feasible and acceptable. Replication efforts with an active control group are needed to verify distress reduction and conception promotion findings.

Effectiveness of acupuncture on pregnancy success rates for women undergoing in vitro fertilization: A randomized controlled trial.

OBJECTIVE: To investigate the effect of acupuncture on pregnancy success rates applied before and after embryo transfer (ET) among women undergoing in vitro fertilization (IVF). MATERIALS AND METHODS: In this randomized controlled trial, 72 infertile women undergoing IVF were randomized to acupuncture (AG; n = 36) and control group (CG; n = 36). Three sessions of acupuncture were applied to AG, the first was one week before ET, the second was 30 min before ET, and the third was 30 min after ET. CG received no acupuncture. The primary outcome was pregnancy success rate (Beta-HCG level, clinical pregnancy, ongoing pregnancy, live birth). Secondary outcome was anxiety level (STAI-1 state anxiety scale). Beta-HCG levels were assessed for conception 12 days after ET. Additionally, STAI-1 state anxiety scale was administered 30 min before and after ET to measure anxiety levels in both groups. RESULTS: The mean age was 30.9 ± 3.7 years. Positive Beta HCG was detected in 63.9% (n = 23) of the AG and 33.3% (n = 12) of CG (p = 0.009). Clinical pregnancy, ongoing pregnancy, and live birth rates were higher in AG (p < 0.05). There was no difference between the groups concerning anxiety scores before ET (p > 0.05). The mean STAI-1 score was decreasing from 57.3 ± 9.8 to 28.8 ± 3.3 in AG, while it was decreasing from 57.0 ± 8.0 to 41,1 ± 6,8 in CG after ET (p < 0.000). CONCLUSIONS: It was observed that three sessions of acupuncture before and after ET significantly increased the pregnancy rates in women with unexplained infertility. It was also found that acupuncture significantly reduced anxiety levels that occurred before ET.

The effect of mind-body interventions on psychological and pregnancy outcomes in infertile women: a systematic review.

Preliminary evidence suggests that mind-body interventions, including mindfulness-based interventions and yoga, may be effective in reducing mental health difficulties and psychological distress in infertile patients undergoing fertility treatments. We systematically reviewed and synthesized current medical literature of the effectiveness of mind-body interventions in reducing the severity of psychological distress and improving marital function and pregnancy outcomes in infertile women/couple. Databases including PsychINFO, PubMed, EMBASE, and the Cochrane Library were searched for relevant studies. Manual searches were conducted in relevant articles. We included 12 studies that met the inclusion criteria. Four studies were randomized controlled trials (RCT), 4 non-randomized controlled trial (NRCT), and 4 uncontrolled studies (UCT). Participation in a mind-body intervention was associated with reduced anxiety trait and depression scores. The reduction was of low or moderate amplitude in most studies. Our review offers evidence for the effectiveness of mind-body interventions in reducing anxiety state and depression in infertile women and a possible improvement in pregnancy rate. Further RCTs with a precise timing of intervention are needed.

Quest for Conception: Exploring Treatment Patterns Associated with Infertility in Ghana.

Due to the pronatalist orientation of the Ghanaian society and the social consequences of childlessness, infertile persons adopt several health seeking strategies in their bid to have their own children. This study therefore explored the health seeking behaviour of infertile Ghanaians and the factors that influence this behavior. The study adopted a qualitative research approach. Forty-five semi-structured in-depth interviews were used to collect data. The findings suggest that treatment seeking behaviour of infertile Ghanaians was motivated largely by perceived cause and belief in the efficacy of a treatment form. Two main treatment seeking patterns emerged from the data, hierarchical and concurrent treatment seeking behaviours. Although participants combined spiritual healing with either herbal or orthodox medicine, a combination of orthodox and herbal seemed inappropriate to them. The findings of this study should have implications for healthcare workers in general as the quest for biological parenthood and the treatment seeking behaviours employed by the infertile could be detrimental to the health of these individuals. For instance, the use of unregulated herbalists and itinerant herbal medicine sellers, as well as the over reliance on spiritual healing could have dire implications for health.

Complementary and alternative medicine use among infertile women attending infertility specialty clinics in South Korea: does perceived severity matter?

BACKGROUND: Complementary and alternative medicine (CAM) use among infertile women is popular in many countries, including Korea. Previous research has repeatedly found more than half of infertile women surveyed use CAM therapies for fertility enhancement and overall well-being. However, there is currently little evidence to support this practice, and this raises the question of infertile women's experiences in the uptake of those modalities and sociodemographic and psychological factors associated with CAM use. Thus, this study aims to explore the perceptions and experiences of infertile women with regard to their use of CAM in Korea. METHODS: A cross-sectional study was conducted using data from 263 infertile women attending infertility specialty clinics in Seoul, Korea, in June 2012. The survey instrument included 47 questions on the use of CAM, demographic characteristics, health status, and infertility related factors such as duration and type of infertility, experience and satisfaction of conventional treatment, and self-perceived severity of infertility condition. Chi-square test and logistic regression were used for data analysis. RESULTS: Among 286 respondents (response rate, 95.3%), a total of 263 women were included in the final analysis. 63.5% of respondents used one or more types of CAM modalities during infertility treatment. The utilization of CAM was associated with employment status, duration of infertility treatment, and self-perceived severity of the disease. The most commonly used CAM modalities were multivitamin and herbal medicine, and differences in types of CAM modalities used were found between the group with a higher rating of self-perceived disease severity and the lower perceived severity group. CONCLUSIONS: High prevalence of CAM use among infertile women was observed in Korea. Our findings support that infertile women's own understanding of their illness and physical condition influences self-care behavior such as CAM use. This calls for an urgent need for further in-depth study of the clinical effects of popular CAM modalities among infertile women when used in conjunction with conventional treatment.

Complementary and Alternative Medicine Methods Used by Turkish Infertile Women and Their Effect on Quality of Life.

The purpose of this study is to assess the rate of women receiving treatment of infertility who use complementary and alternative medicine (CAM), CAM methods, and the effect of these methods on their quality of life. This cross-sectional and descriptive study was conducted with 797 women applying to the in vitro fertilization center of a private hospital located in Istanbul, Turkey. The data were collected using the Personal Information Form and the "Fertility Quality of Life Questionnaire." Fertility Quality of Life Questionnaire is scored between 0 and 100. High scores signify high quality of life. The data were assessed by using mean, standard deviation, number, percentage, t test, and 1-way analysis of variance test. It was found that 36.9% of the women used CAM and 17.9% used CAM along with the infertility treatment. Educational level of infertile women, educational level of their husbands, income level, regular drug use, infertility factor, the use of CAM, and the use of CAM and infertility treatment statistically significantly affected the quality of life (P < .05). The mostly preferred CAM was prayer/worship (25.1%) and phytotherapy (15.2%). The participants had a mean score of 68.79 ± 12.99 from overall Fertility Quality of Life Questionnaire questionnaire. The quality of life of the participants was at a good level. The use of acupuncture and phytotherapy significantly affected the quality of life. Since phytotherapy may interact with the drugs, it is important for nurses to routinely ask patients about their use of phytotherapy. Further evidence-based studies on these practices need to be conducted.

Effectiveness of two guided self-administered interventions for psychological distress among women with infertility: a three-armed, randomized controlled trial.

STUDY QUESTION: What is the effect of two guided self-administered interventions on psychological distress in women undergoing IVF or ICSI? SUMMARY ANSWER: A brief mindfulness intervention significantly reduced depression and improved sleep quality, while the gratitude journal intervention showed no significant effect on any outcome variables. WHAT IS KNOWN ALREADY: Mindfulness and gratitude journal interventions have been found to be beneficial in reducing negative affect and improving well-being. However, there are very few mental health professionals who implement such interventions in low- and middle-income countries. Therefore, two guided self-administered interventions for women with infertility were designed to help them cope with their psychological distress. STUDY DESIGN, SIZE, DURATION: A three-armed, randomized controlled trial was designed to evaluate the mindfulness and gratitude journal interventions for women undergoing IVF/ICSI. Between May 2016 and November 2017, at the reproductive center in a public hospital, 234 women were randomly assigned to the brief mindfulness group (BMG, n = 78), gratitude journal group (GJG, n = 78) or control group (CG, n = 78). The inclusion criteria were being a woman undergoing her first cycle of IVF, having at least junior middle school education and having no biological or adopted children. PARTICIPANTS/MATERIALS, SETTING, METHODS: Female infertility patients (n = 346) were approached, and 112 did not meet the inclusion criteria. All three randomized groups completed questionnaires on the day of down-regulation (T1), the day before embryo(s) transfer (T2), and 3 days before the pregnancy test (T3). The BMG completed four sessions and listened to a 20-minute audio daily, including guided mindfulness breathing and body scan. The GJG completed four sessions and wrote three gratitude journals daily. The CG received routine care. A generalized estimating equation was used in an intention-to-treat analysis. The primary outcome was depression. Secondary outcomes were anxiety, sleep quality, infertility-related stress, mindfulness and gratitude. MAIN RESULTS AND THE ROLE OF CHANCE: Participants of the BMG showed decreased depression (mean difference (MD) = -1.69, [-3.01, -0.37], d = 0.44) and improved sleep quality (MD = -1.24, [-1.95, -0.39], d = 0.43) compared to the CG, but the effect was not significant for anxiety, Fertility Problem Inventory totals, mindfulness, gratitude scores or pregnancy rates. The BMG showed a significant reduction in depression and improvement in sleep quality between T1 and T2, a continuous significant reduction between T1 and T3 and no reduction between T2 and T3. There were no significant effects on any of the variables for the GJG. LIMITATIONS, REASONS FOR CAUTION: The inclusion criteria may result in bias because some participants with low education were excluded and only women with infertility were included. A low compliance rate occurred in the gratitude journals group. Moreover, men were not included in this study. Further research should consider including spouses of the target population. WIDER IMPLICATIONS OF THE FINDINGS: The brief mindfulness intervention was beneficial in decreasing depression and improving sleep quality. Implementation of guided self-administered mindfulness could make the psychological counseling service more accessible for patients with infertility in resource-poor settings. The efficiency and feasibility of the gratitude journal intervention needs to be investigated further. STUDY FUNDING/COMPETING INTEREST(S): This study was funded by the National Social Science Foundation (17BSH054). The authors have no conflicts of interest. TRIAL REGISTRATION NUMBER: ChiCTR-IOR-16008452. TRIAL REGISTRATION DATE: 9 May 2016. DATE OF FIRST PATIENT'S ENROLMENT: 15 May 2016.

Consultation and treatment behaviour of infertile couples in China: a population-based study.

RESEARCH QUESTION: The prevalence of infertility in couples actively trying to conceive is 25%. What is the consultation-seeking behaviour, diagnosis and related treatment in infertile couples across China? DESIGN: Large cross-sectional population-based study in 2010-2011, in which 25,270 couples from eight provinces/municipalities in China were approached by a multistage stratified cluster sampling strategy. RESULTS: Among the 2680 couples reporting infertility, 1246 infertile couples consulted a fertility doctor. Age of the couple, man's body mass index and women's educational level were found to be associated with consultation behaviour. After the fertility work-up, diagnoses were tubal infertility (n = 353, 28.3%), unexplained infertility (n = 311, 25.0%), male infertility (n = 234, 18.8%), ovulatory disorder (n = 194, 15.6%) and endometriosis (n = 34, 2.7%), while 8.6% (n = 107) were not classified. Most couples received non-assisted reproductive technology (ART) fertility treatment (n = 906, 89.3%), with a proportion using traditional Chinese medicine (TCM) (n = 298, 29.4%). Intrauterine insemination (n = 62, 6.1%) and IVF/intracytoplasmic sperm injection (n = 57, 5.6%) were less frequent. Medical treatment and outcomes among five subtypes of infertility were also reported: about 30% of couples with unexplained infertility (n = 94, 30.3%) or male infertility (n = 67, 29.0%) used TCM to treat infertility. Apart from patients with endometriosis, of whom 20.6% (n = 7) received ART, patients with other infertility subtypes rarely received ART. For subsequent fertility outcome, 94% of them did not achieve a pregnancy. CONCLUSION: The prevalence of infertility in China is high, but the uptake of treatment is relatively low.

'We are always desperate and will try anything to conceive': The convoluted and dynamic process of health seeking among women with infertility in the West Coast Region of The Gambia.

INTRODUCTION: In many Sub-Saharan African countries, women with infertility search relentlessly for treatment. Guided by the Partners for Applied Social Sciences model for health seeking behaviour and access to care research, this study aims to understand the health seeking behaviour of women with infertility in the West Coast region of The Gambia and the influence of aetiological beliefs on health seeking paths. METHODOLOGY: A qualitative approach was used to generate both primary and secondary data for thematic analysis. The data collection methods included in-depth interviews (36), observations (18), informal conversations (42), group discussion (7) and made use of pile-sorting exercises. Sources of secondary data included government and non-governmental reports and media outputs. RESULTS: The health seeking approaches of women living in both rural and urban areas were extremely complex and dynamic, with women reporting that they looked for biomedical treatment as well as seeking indigenous treatment provided by local healers, sacred places and kanyaleng groups. While treatment choice was related to the perceived aetiology of infertility, it was also strongly influenced by the perceived effectiveness of the treatment available and the duration of the fertility problems. Other relevant factors were the affordability, accessibility and availability of treatment and respondents' family and social networks, whereby access to the biomedical health sector was strongly influenced by people's socio-economic background. CONCLUSION: On the basis of this analysis and our wider research in the area, we see a need for health authorities to further invest in providing information and counselling on issues related to infertility prevention and treatment. The availability of locally applicable guidelines for the management of infertility for both men and women at all levels of the health system would facilitate such work. In addition, the public sphere should provide more space for alternative forms of social identity for both men and women.

Mindfulness and fertility quality of life in Chinese women with infertility: assessing the mediating roles of acceptance, autonomy and self-regulation.

Objectives: To examine whether high dispositional mindfulness was associated with heightened specific aspects of fertility quality of life (FertiQoL) in infertile women, and whether acceptance, autonomy and self-regulation, mediated any association. Background: Quality of life is one of the most important issues to be addressed in infertility counselling. A large body of evidence reveals that populations with higher dispositional mindfulness fare better than their less mindful counterparts on psychological well-being. However, no research has examined the influence of mindfulness on infertile women's FertiQoL and potential mechanisms underlying these associations. Methods: This was a cross-sectional study of infertile women attending to Southwest Hospital, China. Standardized measures of FertiQoL and proposed mediators (self-regulation, acceptance and autonomy) were administered at the conclusion of the patient's medical appointment from December 2015 to March 2016. Structural equation modelling was used to test the hypothesised mediation model. Results: Mindfulness was positively related to Core and Treatment FertiQoL. Higher mindfulness was related to higher autonomous and self-regulatory abilities, as well as lower experiential avoidance, which in turn resulted in better Treatment FertiQoL. Meanwhile, mindfulness exerted its indirect effect on Core FertiQoL through self-regulation. However, acceptance and autonomy could not mediate the link between mindfulness and Core FertiQoL. Conclusion: Mindfulness appears to be a protective individual characteristic of infertile women, and self-regulation, autonomy and acceptance may be implicated in the effects of mindfulness on specific aspects of FertiQoL. The findings can provide useful suggestions to design mindfulness-based interventions aiming at improving FertiQoL in infertile women, by adding or emphasising intentional self-regulation, autonomy and acceptance components.

The effect of yoga on stress level in infertile women.

PURPOSE: The aim of the present study was to examine the effects of planned yoga practices on stress levels in infertile women. DESIGN AND METHODS: This randomized controlled study included 128 volunteer women who were registered at a private in vitro fertilization (IVF) clinic and received infertility treatment. The patients in the experimental group took part in the yoga program twice a week for 6 weeks. A personal information form and The Copenhagen Multi-center Psychosocial Infertility (COMPI) Fertility Problem Stress Scale were used to collect data. FINDINGS: The differences between the mean scores of the control and experimental groups on the COMPI Fertility Problem Stress Scale at pre- and posttests were statistically significant (P < 0.05). PRACTICE IMPLICATIONS: Because yoga practices may be effective in reducing stress in infertile women, these applications can be performed before treatment. It may reduce patients' stress and increase the success of the treatment. These findings indicate that yoga could reduce stress levels in infertile women.

Mindfulness-based program for stress reduction in infertile women: Randomized controlled trial.

Infertile women often experience chronic stress, which may have a negative impact on general well-being and may increase the burden of infertility. In this open-label, parallel, randomized controlled trial, infertile women aged 18-50 years (median 37 years) were assigned to an 8-week mindfulness-based program (MBP) or no intervention. The primary outcome was stress severity measured by the Lipp's Stress Symptoms Inventory (ISSL). Data were analyzed by modified intent-to-treat principle, which included all cases available to follow-up regardless of adherence to the intervention (62 participants from the MBP group and 37 from the control group). The median number of symptoms of chronic stress recorded in the past month decreased from six (interquartile range 2 to 9) before the MBP to two (interquartile range 1 to 4) after the intervention (p < 0.001, repeated measures analysis of variance with Time × Group interaction). Depressive symptoms also decreased after MBP, whereas general well-being improved (p < 0.01 for both outcomes). Hair cortisol and serum brain-derived neurotrophic factor (BDNF) did not change significantly between preintervention and postintervention. None of the outcomes changed significantly in the control group. MBP was effective in reducing stress and depressive symptoms while increasing general well-being in infertile women.