Psychological health of women who have conceived using assisted reproductive technology in Taiwan: findings from a longitudinal study

Background: Despite the increasing use of Assisted Reproductive Technology (ART) and the significant physical and emotional commitments that these treatments and procedures involve, only limited evidence exists regarding the psychological health of women who undergo ART. This study investigated the changes over time in the psychological health of women who have conceived using ART during the first, second, and third trimesters of pregnancy and during the postpartum period in Taiwan. Methods: A quantitative longitudinal study was conducted at a fertility centre in Taiwan. 158 pregnant women who had conceived using ART completed a web-based questionnaire that included the following instruments: State Anxiety Inventory, Edinburgh Postnatal Depression Scale, Modified Maternal Foetal Attachment Scale, Pregnancy Stress Rating Scale, Maternity Social Support Scale, Intimate Bond Measure, and Parenting Stress Index. The data were collected the first (9–12 weeks), second (19–22 weeks), third (28–31 weeks) trimesters of pregnancy and at 7–10 weeks postpartum. Results: Levels of anxiety and depression, which are both key indicators of psychological health, were highest during the first trimester, with scores of 42.30 ± 11.11 and 8.43 ± 4.44, respectively. After the first trimester, anxiety scores decreased and remained stable through the remainder of pregnancy, with scores of 38.03 ± 10.58 in the second and 38.39 ± 10.36 in the third trimester, but increased at two-months postpartum, attaining a score of 41.18 ± 11.68. Further, depression scores showed a similar pattern, declining to a mean of 7.21 ± 4.23 in the second and 6.99 ± 4.11 in the third trimester and then increasing to 8.39 ± 5.25 at two-months postpartum. Pregnancy stress and social support were found to be the most important predictors of change in psychological health during pregnancy and the postpartum period. Conclusion: Psychological health was found to be poorest during the first trimester and at two-months postpartum. Moreover, pregnancy stress and social support were identified as key predictors of change in psychological health. The findings indicate a need for increased sensitivity among healthcare professionals to the psychological vulnerability of women who have conceived using ART as well as a need to introduce tailored interventions to provide appropriate psychological support to these women

CFTR Mutation Analysis of a Caucasian Father with Congenital Bilateral Absence of Vas Deferens, a Taiwanese Mother, and Twins Resulting from ICSI Procedure

Cystic fibrosis (CF), caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene, is one of the most common autosomal recessive diseases in Caucasians. We screened for the CFTR gene mutation in a Caucasian father with congenital bilateral absence of the vas deferens (CBAVD), a Taiwanese mother, and twins resulting from an intracytoplasmic single sperm injection (ICSI) procedure. DNA fragments that showed abnormal banding patterns on temporal temperature gradient gel electrophoresis analysis followed by analysis of DNA sequence was used. The Caucasian father with CBAVD had ΔF508 and p.L375F mutations. The two children were heterozygous for the ΔF508 and p.L375F mutations, respectively. Mutation analysis of the CFTR gene should always be recommended for infertile couples seeking ICSI. The possibility of the children resulting from ICSI being a victim or carrier of CBAVD or CF, especially when the father is Caucasian with CBAVD, should be discussed during genetic counseling

Persistent Megalocystic Ovary Following in Vitro Fertilization in a Postpartum Patient with Polycystic Ovarian Syndrome

SummaryObjectiveOvarian hyperstimulation syndrome (OHSS) is more severe when pregnancy occurs, as the developing pregnancy produces human chorionic gonadotropin, which stimulates the ovary's persistent growth. If no pregnancy occurs, the syndrome will typically resolve within 1 week. In a maintained pregnancy, slow resolution of symptoms usually occurs over 1-2 months.Case ReportA 31-year-old woman, gravida 2, para 1, aborta 1, with polycystic ovary syndrome underwent in vitro fertilization (IVF) with clomiphene citrate and follicle-stimulating hormone/gonadotropin releasing hormone-antagonist stimulation. During transvaginal oocyte retrieval, enlarged bilateral ovaries were noted. She had an episode of OHSS after IVF/embryo transfer, for which paracentesis was performed three times. Pregnancy was achieved. Throughout antenatal examinations, bilateral ovaries were enlarged. She delivered a healthy baby by cesarean section at term. However, 1 month after delivery, the bilateral ovary had not shrunk, and levels of tumor markers CA125 and CA199 were 50.84 and 41.34 U/mL, respectively. At laparotomy for suspected malignancy, both adnexae formed “kissing ovaries”, which were multinodulated with yellow serous fluid. Specimens from wedge resection submitted for frozen section showed a benign ovarian cyst. The final pathology report showed bilateral follicle cysts.ConclusionWith the increasing use of gonadotropins in the management of infertility, ovarian enlargement secondary to hyperstimulation is common. Generally, symptoms appear between the 6th and 13th weeks of pregnancy and disappear thereafter. The hyperstimulated ovary often subsides after the first trimester. This case is unusual as the megalocystic ovary persisted after delivery. To the best of our knowledge, we report the first case of enlarged bilateral ovaries persisting 2 months after delivery

Cytogenic and molecular analyses of 46,XX male syndrome with clinical comparison to other groups with testicular azoospermia of genetic origin

XX male is a rare sex chromosomal disorder in infertile men. The purpose of this study was to distinguish the clinical and genetic features of the 46,XX male syndrome from other more frequent, testicular-origin azoospermic causes of male infertility. Methods: To study 46,XX male syndrome, we compared clinical and endocrinological parameters to other groups with testicular-origin azoospermia, and to an age-matched group of healthy males and females as normal control. Fluorescent in situ hybridization for detection and localization of the sex-determining region of the Y gene (SRY), array-based comparative genomic hybridization screening, and real-time qualitative polymerase chain reaction of FGF9, WT1, NR5A1, and SPRY2 genes were performed in this genetic investigation. Results: Our three patients with 46,XX male syndrome had a much higher follicular-stimulating hormone level, lower body height, lower testosterone level, and ambiguous external genitalia. One of the three patients with 46,XX male syndrome was SRY-negative. A further genetic study, including a comparative genomic hybridization array and real-time polymerase chain reaction, showed a gain of FGF9 copy numbers only in the SRY-negative 46,XX male. The genetic copy number of the FGF9 gene was duplicated in that case compared to the normal female control and was significantly lower than that of the normal male control. No such genomic gain was observed in the case of the two SRY-positive 46,XX males. Conclusion: Similar to clinical manifestations of 46,XX male syndrome, genetic evidence in this study suggests that FGF9 may contribute to sex reversal, but additional confirmation with more cases is still needed

The fertility quality of life (FertiQoL) questionnaire in Taiwanese infertile couples

AbstractObjectiveTo characterize the fertility quality of life (QoL) in Taiwanese infertile couples using an objective measurement tool—the FertiQoL questionnaire, and establish a reference level of QoL for clinical applications and future studies.Materials and MethodsThe FertiQoL tool, a self-report questionnaire, was distributed to seven infertility centers across Taiwan for infertile couples who were undergoing the treatment of in vitro fertilization. The online version of the FertiQoL questionnaire was issued on the website of Taiwan Society for Reproductive Medicine and was opened to the public.ResultsA total of 534 copies of eligible FertiQoL questionnaires were collected. The total scores for the Core FertiQoL and Treatment FertiQoL are 55.12 ± 13.72 and 56.40 ± 10.96, respectively. Both the Core and Treatment FertiQoL were significantly higher in the males of infertile couples than the females (60.63 ± 14.07 vs. 54.39 ± 13.52, p = 0.001, and 59.13 ± 12.44 vs. 56.03 ± 10.71, p = 0.035, respectively). Significantly better QoL was found in infertile patients in the Southern Taiwan, with a Core FertiQoL of 58.21 ± 12.70 and a Treatment FertiQoL of 58.79 ± 10.15.ConclusionThe results of this study provide a baseline QoL in infertile couples in Taiwan, and could potentially be used as a guide for clinical counseling and future works