Psychosocial Vulnerability, Resilience Resources, and Coping with Infertility: A Longitudinal Model of Adjustment to Primary Ovarian Insufficiency.

BACKGROUND: The infertility associated with primary ovarian insufficiency (POI) presents significant emotional challenges requiring psychosocial adjustment. Few investigations have explored the longitudinal process of adaptation to POI. PURPOSE: This longitudinal investigation tests a model of adjustment to POI that includes separate psychosocial vulnerability and resilience resource factors. METHODS: Among 102 women with POI, personal attributes reflective of vulnerability and resilience were assessed at baseline. Coping strategies were assessed 4 months later and measures of distress and well-being 12 months later. RESULTS: As hypothesized, confirmatory factor analysis yielded separate, inversely correlated vulnerability and resilience resource factors at baseline, and distress and well-being factors at 12 months. Contrary to predictions, maladaptive and adaptive coping strategies were not bi-factorial. Moreover, a single stand-alone strategy, avoidance (i.e., refusing to acknowledge stress), mediated the association between baseline vulnerability and 12-month distress. CONCLUSIONS: For women with POI, interventional studies targeted to reduce avoidance are indicated.

Results of the Minnesota Multiphasic Personality Inventory-2 among gestational surrogacy candidates.

OBJECTIVE: To obtain normative data on the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) personality test for gestational surrogate (GS) candidates. METHODS: A retrospective study was undertaken through chart review of all GS candidates assessed at Shady Grove Fertility Center, Rockville, MD, USA, between June 2007 and December 2009. Participants completed the MMPI-2 test during screening. MMPI-2 scores, demographic information, and screening outcome were retrieved. RESULTS: Among 153 included candidates, 132 (86.3%) were accepted to be a GS, 6 (3.9%) were ruled out because of medical reasons, and 15 (9.8%) were ruled out because of psychological reasons. The mean scores on each of the MMPI-2 scales were within the normal range. A score of more than 65 (the clinical cutoff) was recorded on the L scale for 46 (30.1%) candidates, on the K scale for 61 (39.9%), and on the S scale for 84 (54.9%). Women who were ruled out for psychological reasons had significantly higher mean scores on the validity scales F and L, and on clinical scale 8 than did women who were accepted (P<0.05 for all). CONCLUSION: Most GS candidates are well adjusted and free of psychopathology, but candidates tend to present themselves in an overly positive way.

A family systems approach to primary ovarian insufficiency.

Receiving the diagnosis of Primary Ovarian Insufficiency (POI) can be emotionally difficult and confusing for young girls and their families. Parents need assistance in knowing how to help their daughters understand and live with the diagnosis in a way that allows for healthy growth and development. This paper provides a starting point for parents and clinicians with "Tips and Tools for Talking: Helping Your Daughter Understand Primary Ovarian Insufficiency".

Demographic variables related to successful anonymous oocyte donor recruitment.

Only 4% of initial applicants to the oocyte donor program completed the screening process and actually donated a cohort of oocytes. Medical screen-outs were more likely for women who had children, were unmarried, and were less educated, whereas psychological screen-outs were more common among younger applicants, and both younger and African-American women were more likely to withdraw without donating.

Minnesota Multiphasic Personality Inventory (MMPI-2) profiles in the assessment of ovum donors.

OBJECTIVE: To examine the relationship between MMPI-2 scores and oocyte donation outcome. DESIGN: Descriptive chart review. SETTING: Two oocyte donation programs. SUBJECT(S): Five hundred anonymous oocyte donor applicants. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Demographics, MMPI-2 scores and donation outcome. RESULT(S): The mean age was 26.6 years, 54% were Caucasian, 37% were high school graduates with some college, 55% were single, and 49% were nulliparous. Fifty-nine percent of donors completed at least one donation cycle, 10% were ruled out because of medical concerns, 12% dropped out, 11% were ruled-out because of psychologic concerns, and 8% had not been selected by a recipient. On the MMPI-2, the mean profile was in the normal range. Significant differences were found between groups on subscales F, F(p), L, S, S1, 2, 4, 8, and 9. The largest differences in scores between donors who completed a cycle and those who were psychologically excluded were on L (8 points) and 9 (6 points). Use of the non-K corrected scores replicated group differences. CONCLUSION(S): MMPI-2 scores differed between donors who completed a donation cycle and those who were psychologically excluded. Attention should be paid to validity scale L when considering donor selection.

The psychosocial transition associated with spontaneous 46,XX primary ovarian insufficiency: illness uncertainty, stigma, goal flexibility, and purpose in life as factors in emotional health.

OBJECTIVE: To examine factors associated with emotional well-being in women with spontaneous primary ovarian insufficiency. DESIGN: Cross-sectional and case-control study. SETTING: Clinical research center, national U.S. health research facility. PATIENT(S): Women diagnosed with spontaneous 46,XX primary ovarian insufficiency (n = 100) at a mean age of 32.4 years and healthy control women of similar age (n = 60). INTERVENTION(S): Administration of validated self-reporting instruments. MAIN OUTCOME MEASURE(S): Illness uncertainty, stigma, goal disengagement/re-engagement, purpose in life, Positive and Negative Affect Schedule, Center of Epidemiologic Studies Depression Scale, State-Trait Anxiety Inventory. RESULT(S): Compared with controls, women with spontaneous primary ovarian insufficiency scored adversely on all measures of affect. Illness uncertainty and purpose in life were significant independent factors associated with anxiety (R(2) = 0.47), stigma and purpose in life were the significant independent factors associated with depression (R(2) = 0.51), and goal re-engagement and purpose in life were significantly and independently associated with positive affect (R(2) = 0.43). CONCLUSION(S): This evidence supports the need for prospective studies. Our findings are consistent with the hypothesis that clinicians could improve the emotional well-being of their patients with primary ovarian insufficiency by [1] informing them better about their condition, [2] helping them to feel less stigmatized by the disorder, and [3] assisting them in developing alternative goals with regard to family planning as well as other goals.

Women with spontaneous 46,XX primary ovarian insufficiency (hypergonadotropic hypogonadism) have lower perceived social support than control women.

OBJECTIVE: To test the hypothesis that women with spontaneous primary ovarian insufficiency differ from control women with regard to perceived social support and to investigate the relationship between perceived social support and self-esteem. DESIGN: Cross-sectional. SETTING: Mark O. Hatfield Clinical Research Center, National Institutes of Health. PATIENT(S): Women diagnosed with spontaneous primary ovarian insufficiency (n = 154) at a mean age of 27 years and healthy control women (n = 63). INTERVENTION(S): Administration of validated self-reporting instruments. MAIN OUTCOME MEASURE(S): Personal Resource Questionnaire 85 and Rosenberg Self-Esteem Scale. RESULT(S): Women with primary ovarian insufficiency had significantly lower scores than controls on the perceived social support scale and the self-esteem scale. The findings remained significant after modeling with multivariate regression for differences in age, marital status, and having children. There was a significant positive correlation between self-esteem scores and perceived social support in patients. We found no significant differences in perceived social support or self-esteem related to marital status, whether or not the women had children, or time since diagnosis. CONCLUSION(S): This evidence supports the need for prospective controlled studies. Strategies to improve social support and self-esteem might provide a therapeutic approach to reduce the emotional suffering that accompanies the life-altering diagnosis of spontaneous primary ovarian insufficiency.

The psychology of antecedents to adult reproductive disorders in adolescent girls.

The normal developmental tasks and roles of adolescence are altered by a diagnosis of a reproductive disorder. The crisis of impaired fertility affects both parent and child, stressing the family system. For the adolescent girl, a reproductive disorder has an impact on her developing sense of self, body-image, and sexuality, which, in turn, can affect her self-esteem and relationships with others. Because of the sexual nature of a reproductive disorder, feelings of embarrassment or protectiveness are often engendered that can make it difficult for families to discuss. Nonetheless, families do best with openness and honesty regarding the condition and should be discouraged from keeping the diagnosis a secret. Adolescence encompasses a broad spectrum of emotional maturity, which needs to be considered by parents and clinicians when communicating information. Understanding that the family is an emotional unit, a family systems approach to deal with health issues is most appropriate. In this context, parents need to first deal with their own feelings about the diagnosis, before they can help their child. Secondly, parents must be provided with tools to build an ongoing conversation with their child that will avoid stigmatizing her condition and handicapping her growth into healthy adulthood. The goal for parent and clinician is to help the adolescent girl formulate positive self-esteem and body image, despite impaired fertility.

What is happening to the price of eggs?

OBJECTIVE: To survey reproductive medical programs that are members of the Society for Assisted Reproductive Technology (SART) to ascertain their ovum donor compensation rates. DESIGN: Survey. SETTING: Society of Assisted Reproductive Technology member programs. PATIENT(S): None applicable. INTERVENTION(S): One-page anonymous e-mail survey returned by FAX within 1 week. MAIN OUTCOME MEASURE(S): Clinics were asked if they have a donor oocyte program, and, if yes, their standard compensation rate. In addition, clinics were asked if there are other variables that increase compensation rates, and, if yes, the maximum compensation. Data were analyzed according to U.S. geographic regions. RESULT(S): Over half SART clinics (53%, 207 out of 394) responded to the survey, with 191 (92%, 191 out of 207) having a donor oocyte program. The national average for standard donor compensation was $4,217, with a maximum payment average of $4,576. Geographic location affected compensation rates, with highest reported standard mean compensation in the East/Northeast ($5,018) and West regions ($4,890), and lowest in the Northwest ($2,900). CONCLUSION(S): The national average for compensating oocyte donors in reporting SART programs is approximately $4,200.

Functional well-being is positively correlated with spiritual well-being in women who have spontaneous premature ovarian failure.

OBJECTIVE: To examine the relationship between spiritual well-being and functional well-being in women who have spontaneous premature ovarian failure. DESIGN: Cross-sectional. SETTING: The Mark O. Hatfield Clinical Research Center at the US National Institutes of Health. PATIENT(S): Women diagnosed with spontaneous premature ovarian failure (N = 138) at a median age of 28 years. INTERVENTION(S): Administration of validated self-reporting instruments. MAIN OUTCOME MEASURE(S): Functional Well-Being, Spiritual Well-Being, Meaning/Peace, and Faith scores. RESULT(S): We found a significant positive correlation between overall spiritual well-being and functional well-being scores. The Meaning/Peace subscale strongly correlated with functional well-being, explaining approximately 62% of the variance. In contrast, the Faith subscale was less strongly correlated with functional well-being, explaining only 7% of the variance. In multiple regression analysis evaluating the relative subscale contributions to functional well-being, only Meaning/Peace remained statistically significant. We found no significant associations between either spiritual well-being or functional well-being and age; age at diagnosis; time since diagnosis; or partner, children, or racial status. CONCLUSION(S): This study provides cross-sectional data supporting the need for prospective controlled studies. Strategies to improve spiritual well-being in the domains of meaning, purpose, and inner peace may provide a therapeutic approach to reduce the emotional suffering that accompanies the life-altering diagnosis of premature ovarian failure.

Assessing the emotional needs of women with spontaneous premature ovarian failure.

OBJECTIVE: To examine women's emotional responses to learning the diagnosis of premature ovarian failure (POF) and identify the sources of support used for coping. DESIGN: Observational study. SETTING: National Institutes of Health Clinical Center. PATIENT(S): One hundred women previously diagnosed with POF of median age 28 years at diagnosis. INTERVENTION(S): Structured telephone interviews based on focus group findings. MAIN OUTCOME MEASURE(S): Manner informed of POF diagnosis, emotional response, and areas of emotional support. RESULT(S): Overall, 71% were unsatisfied with the manner in which they were informed by their clinician, and 89% reported experiencing moderate to severe emotional distress at the time. The degree of emotional distress was positively correlated with the degree of dissatisfaction with the manner in which the women had been informed of the diagnosis. Thorough and accurate medical information on POF, support of others, and spirituality were perceived as helpful in coping. CONCLUSION(S): Learning the diagnosis of POF can be emotionally traumatic and difficult for women. The findings suggest that the manner in which patients are informed of this diagnosis can significantly impact their level of distress. Patients perceive a need for clinicians to spend more time with them and provide more information about POF.

An update: spontaneous premature ovarian failure is not an early menopause.

OBJECTIVE: To update clinicians regarding the management of women with spontaneous premature ovarian failure (POF). DESIGN: Literature review and consensus building among three clinicians with experience in caring for women with spontaneous POF. CONCLUSION(S): Clearly the ovarian "failure" in this disorder is not permanent in all women. Approximately 5%-10% may conceive spontaneously and unexpectedly after the diagnosis. An integrated approach to management is best, and there is a need to first address physical and mental health issues before addressing plans for family building. Women with spontaneous POF are at increased risk of adrenal insufficiency, which should be detected and managed appropriately, especially before proceeding to ovum or embryo donation procedures. Young women with POF experience pathologically low serum E2 levels at least intermittently. Despite the absence of controlled evidence for this specific population, physiologic replacement of ovarian steroid hormones seems rational until the age of normal menopause. The disorder may be associated with other conditions that require evaluation and management, including hypothyroidism, dry eye syndrome, abnormal karyotype, or a premutation of the FMR1 gene. Finally, clinicians need to be sensitive to the emotional aspects of this disorder when delivering the diagnosis and during subsequent management.