Depression, anxiety, quality of life, and infertility: a global lens on the last decade of research.

We aimed to review the global literature in the past 10 years regarding the impact of infertility on depression, anxiety, stress, and quality of life while exploring the potential clinical utility of psychosocial fertility questionnaires. PubMed, Scopus, and CINAHL were searched for English-published articles since 2013 on key search terms related to infertility, assisted reproductive technologies, and psychological terms such as depression, anxiety, mood disorders, and quality of life. The search yielded 7,947 articles, of which 366 articles were independently deemed relevant by the 3 reviewers. Anxiety, depression, and diminished quality of life are prevalent in the infertility experience of both men and women. Studies from around the world show similar experiences independent of culture.

Sperm donor attitudes and experiences with direct-to-consumer genetic testing.

Objective: To identify factors influencing sperm donor willingness to participate in direct-to-consumer genetic testing, comfort with sharing genetically identifiable data in commercial genetic testing databases, and likelihood to donate sperm again. Design: Cross-sectional online anonymous survey. Setting: Multicenter, 2 large American sperm banks from July 1, 2020 to July10, 2021. Patients: Sperm donors from 1980 to 2020. Interventions: None. Main outcome measures: Associations between donor demographic characteristics, donation history, and attitudes toward direct-to-consumer genetic testing. Results: A total of 396 donors completed the survey. Most donations (61.5%) occurred from 2010 to 2020, and 34.3% were nonidentified donations. Nonidentified donors were less comfortable with their genetic data being shared than open-identity donors (25.4% vs. 43.8%) and were less likely than open-identity donors to donate sperm again (43.3% vs. 72.1%). Donors who donated after the inception of direct-to-consumer genetic testing in 2007 were less likely to participate in commercial genetic testing than those who donated before 2007 (25.8% vs. 37.1%). Most donors (87.4%) have disclosed their donation(s) to current partners, but fewer have disclosed them to their families (56.6%) or children (30.5%). Of the donors who had been contacted by donor-conceived persons, 79.5% were identified via direct-to-consumer genetic testing. Overall, 61.1% of donors would donate again regardless of direct-to-consumer genetic testing. Conclusions: Direct-to-consumer genetic testing is playing a dynamic role in sperm donor identification, but donors seem willing to donate again. Implication counseling regarding future linkage and contact from donor-conceived persons needs to be standardized for potential donors before donation.

Optimism during pregnancy and obstetrical outcomes: A systematic review.

OBJECTIVE: To ascertain the strength of association between dispositional optimism, assessed with the Revised Life Orientation Test (LOT-R), and obstetrical outcomes, and to evaluate women's social characteristics that may lead to low dispositional optimism during pregnancy. STUDY DESIGN: The research was conducted using MEDLINE, EMBASE, Scopus, Web of Sciences, Cochrane Database, and ClinicalTrial.gov as electronic databases. The articles were identified with the use of a combination of the relevant heading term, key words, and word variants for: "optimism" or "happiness" and "pregnancy" or "obstetrical outcomes", from the inception of each database to June 2019. Review of articles also included the abstracts of all references retrieved from the search. Randomized, cohort, case-control, or case series were all accepted study designs. Only studies reporting obstetrical outcomes in women undergone LOT-R to assess dispositional optimism during pregnancy were included. Obstetrical outcomes included preterm birth, pre-eclampsia and small for gestational age fetuses. All analyses were carried out using the random effects model. Dichotomous variables were analyzed using the odds ratio (OR) with a 95 % confidence interval (95 % CI). No continuous variables were compared in the analysis. Significance level was set at P < 0.05. Heterogeneity was measured using I-squared (Higgins I2). RESULTS: Two prospective cohort studies, including 3,570 pregnancies undergone LOT-R - mostly during the second trimester - were included in the systematic review. Out of the 3,570 pregnancies included, 411 were in the lowest quartile of optimism, according to LOT-R score. Dispositional optimism showed a trend towards lower incidence of preterm birth (7.6 % vs 9.7 %; OR 0.76, CI 0.53-1.09); no difference between women at higher levels and women in the lowest quartile of optimism was found in preeclampsia and small for gestational age. Women at higher levels of dispositional optimism were significantly associated with: age ≥ 30 years; marriage or "marriage-like status"; lower rates of public assistance and smoking; white ethnicity; higher rates of higher education. CONCLUSION: There are limited data on optimism and obstetric outcomes. Higher levels of optimism, evaluated by the LOT-R tool in two studies, are associated with a non-significant decrease in preterm birth.

Old, older and too old: age limits for medically assisted fatherhood?

How old is too old to be a father? Can you be a little bit older or "old-ish" to be a dad without being considered an "older dad"? At some point, does one simply become too old to be a father? Unless a man requires medical assistance in family building, that answer has historically turned solely on his opportunity to have a willing female partner of reproductive age. As with so many other aspects of family building, assisted reproductive technologies have transformed the possibilities for-and spawned heated debates about-maternal age. Much attention has been given to this contentious topic for potential mothers, with many programs putting age-related limitations in place for their female patients. This article considers whether there should also be limits-and how we should approach that question-for men who require and seek medical assistance to become fathers.

Introduction: Mental health counseling in third party reproduction.

Mental health professionals serve an important role in guiding intended parents through a myriad of considerations from donor or surrogate selection to issues of disclosure with children. This role has evolved due to many considerations including evolving practice and ethics guidelines, as well as other factors such as access to the internet. This Views and Reviews will explore how team care, inclusive of the mental health professional, serves the interests of patients and provides a strong foundation for families created with the help of donors and/or surrogates.

Mental health counseling in third-party reproduction in the United States: evaluation, psychoeducation, or ethical gatekeeping?

The role of mental health professionals (MHPs) in third-party reproduction has grown and evolved in service to patient care and the needs of medical infertility practices. The need for mental health evaluation and psychoeducation has increased as the psychosocial considerations for the stakeholders and families created through gamete donation and surrogacy are increasingly understood and considered. The conflicting definitions of these roles of evaluation and psychoeducation often leave MHPs in the role of de facto ethical gatekeepers in third-party reproduction. Both the medical team and the MHP need to clarify their role effectively, for themselves, as well as any intended parent.

Introduction: Role of mental health professionals in the care of infertile patients.

The authors of this Views and Reviews describe the evolution of the role of mental health counseling in infertility care. As the use of assisted reproductive technologies and third-party reproduction has grown, so too has the interest and demand for mental health services. A historical perspective is presented that sets the stage for subsequent discussions of key areas where mental health practitioners are able to contribute to the utility and outcomes of infertile patients as well as those involved in their care. This series of articles stresses the value of more comprehensive integration of mental health support into infertility practice and highlights practical opportunities to do so.

Do I Buy It? How AIDET™ Training Changes Residents' Values about Patient Care.

OBJECTIVES: Acquiring communication and interpersonal skills is an important part of providing patient-centered care and improving patient satisfaction. This study explores whether residents' own values about patient communication can be influenced by training. METHODS: As part of service excellence, a three-hour communication skills training in AIDET™ (Acknowledge, Introduce, Duration, Explanation, Thank You) was delivered to first and second Post-Graduate Year (PGY) residents (n = 123). A survey was designed to measure the value of patient communication and administered pre/post communication skills training. RESULTS: Residents' scores about communication values improved significantly for all areas pre- to post-training for patient communication skills (p<0.04). After training, there was little difference by medical specialty, other than surgical specialties, which showed the greatest increase in valuing requesting permission (p=0.034). Gender was also not associated with differences in values, except men showed a greater increase in valuing sitting down (p=0.021) and introductions (p=0.005) than women who already valued these specific behaviors prior to training. CONCLUSIONS: Residents value communication, and AIDET™ training is a useful tool to increase the values of good communication and interpersonal skills to enhance service excellence.

Randomized trial of harp therapy during in vitro fertilization-embryo transfer.

OBJECTIVE: This study evaluated whether harp therapy reduces levels of stress and improves clinical outcomes in patients undergoing embryo transfer. DESIGN: This prospective randomized trial enrolled 181 women undergoing embryo transfer, who were randomized to harp therapy during embryo transfer or standard treatment. Patients underwent standardized psychological testing and physiologic assessment of stress. SETTING: The study was conducted in a reproductive medicine practice. RESULTS: No statistically significant differences were found in the heart and respiratory rates, nor was there a significant difference in event-based anxiety at baseline. Harp therapy had a significantly larger decrease in state anxiety from pre- to post-embryo transfer. Clinical pregnancy was 53% versus 48% for the harp therapy and standard treatment groups, respectively. CONCLUSION: Harp therapy decreases state, or event-based, anxiety, significantly lowering state scores posttransfer and having a positive effect on acute levels of stress. There was an increased pregnancy rate, but larger sample sizes are needed to evaluate whether harp therapy has an effect on clinical outcomes.

WITHDRAWN: Initiation of the Society for Assisted Reproductive Technology Donor Egg Registry: a report from the Donor Egg Registry Task Force.

This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.

The fertility quality of life (FertiQoL) tool: development and general psychometric properties.

BACKGROUND: To develop the first international instrument to measure fertility quality of life (FertiQoL) in men and women experiencing fertility problems, to evaluate the preliminary psychometric properties of this new tool and to translate FertiQoL into multiple languages. METHOD: We conducted a survey, both online and in fertility clinics in USA, Australia/New Zealand, Canada and UK. A total of 1414 people with fertility problems participated. The main outcome measure was the FertiQoL tool. RESULTS: FertiQoL consists of 36 items that assess core (24 items) and treatment-related quality of life (QoL) (10 items) and overall life and physical health (2 items). Cronbach reliability statistics for the Core and Treatment FertiQoL (and subscales) were satisfactory and in the range of 0.72 and 0.92. Sensitivity analyses showed that FertiQoL detected expected relations between QoL and gender, parity and support-seeking. FertiQoL was translated into 20 languages by the same translation team with each translation verified by local bilingual fertility experts. CONCLUSIONS: FertiQoL is a reliable measure of the impact of fertility problems and its treatment on QoL. Future research should establish its use in cross-cultural research and clinical work.

The Fertility Quality of Life (FertiQoL) tool: development and general psychometric properties.

OBJECTIVE: To develop the first international instrument to measure fertility quality of life, FertiQoL, in men and women experiencing fertility problems, to evaluate the preliminary psychometric properties of this new tool and to translate FertiQoL into multiple languages. DESIGN: Survey. SETTING: Online and fertility clinics in USA, Australia/New Zealand, Canada, and United Kingdom. PARTICIPANTS: A total of 1,414 people with fertility problems. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): FertiQoL. RESULT(S): FertiQoL consists of 36 items that assess core (24 items) and treatment-related (10 items) quality of life as well as overall life and physical health (2 items). Cronbach reliability statistics for the Core and Treatment FertiQoL (and subscales) were satisfactory, in the range of 0.72 and 0.92. Sensitivity analyses showed that FertiQoL detected expected relations between quality of life and gender, parity, and support seeking. FertiQoL was translated into 20 languages by the same translation team, with each translation verified by local bilingual fertility experts. CONCLUSION(S): FertiQoL is a reliable measure of the impact of fertility problems and its treatment on quality of life. Future research should establish its use in cross-cultural research and clinical work.

Screening practices and beliefs of assisted reproductive technology programs.

OBJECTIVE: To explore assisted reproductive technology (ART) programs' beliefs about and practices for screening program candidates for the use of ART services. DESIGN: An anonymous, self-administered, mailed questionnaire. SETTING: U.S. ART programs. PARTICIPANT(S): Directors of U.S. ART programs. MAIN OUTCOME MEASURE(S): Screening practices and beliefs, agreement with statements about screening rights and responsibility, information collected about candidates, and likelihood of turning away hypothetical candidates. RESULT(S): The majority of programs do not have a formal policy for screening candidates. The majority of program directors agree that they have a right and responsibility to screen candidates. On average, programs turn away 4% of candidates each year. The majority of programs report being very to extremely likely to deny treatment to the couples described in various scenarios, such as physical abuse, positive HIV status, and single parenthood. Significant variation was seen across programs in their likelihood of turning away various hypothetical candidates. CONCLUSION(S): There is substantial variation in ART programs' screening practices. These results highlight the need for increased debate over what constitutes inappropriate denial of access to services, and what are prudent, social, ethical, and medical judgments.