Transition to parenthood after assisted reproductive treatment : Follow-up study of singleton pregnancies

Infertility treatments are relatively easily available in most Western countries today, but the psychological consequences of these high-tech treatments have scarcely been addressed. The purpose of this controlled longitudinal study was to explore the early environment of the infant born by assisted reproductive treatment (ART). We focused on the parents mental well-being, marital relations and experience of parenting. In addition to this, we assessed parent child interaction and parents mental representations of their child after long-standing infertility and several unsuccessful ART attempts. The subjects were infertile couples who achieved a singleton pregnancy by in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). The control group comprised of spontaneously conceiving couples with singleton pregnancies. ART women showed fewer depressive symptoms than controls during pregnancy and after delivery, but the difference vanished by the end of the child s first year. ART men consistently had lower levels of anxiety symptoms, sleeping difficulties, and social dysfunction than control men. Control women experienced a decrease in dyadic consensus during the child s first year, which did not happen among ART women. After the child was born, ART men reported a higher level of sexual affection compared with control men. Psychic symptoms and stressful life events were differently related to marital relations in ART and control groups. The parenting experiences of ART mothers were in general at a higher level, compared with controls, and they changed in a positive direction during the child s first year. Fathering experiences were at the same level in both groups, and they changed positively in both groups by the end of the child s first year. The parenting experiences of ART mothers and fathers were more resilient to certain child-related stressors than those of control group. Both mothers and fathers with long-term infertility showed more sensitive behaviour with their child in toddler-age than in infancy. Correspondingly, children s cooperation increased. Mothers often mentioned a fear of miscarriage and difficulty in creating representations of the child during pregnancy. Descriptions of the infants were mainly rich, vivid and loaded with positive features. In conclusion, ART parents in general seem to adapt well to the transition to parenthood. Former infertility and ART do not seem to constitute a risk for parents mental health, marital relations or experience of parenting. Even longstanding infertility with several unsuccessful treatment attempts did not create a risk as regards parenting behaviour or parents mental representations of their child. In this group, however, women were found to have fear for losing the child and difficulty in creating representations of the child during pregnancy, which in some cases may indicate need for psychosocial support. Even though our results are encouraging, infertility and infertility treatments are generally considered as a stressful experience. It is a challenge for health authorities to recognize those couples who need professional help to overcome the distressing experiences of infertility and ART.Koeputkihedelmöitys sovellutuksineen on vakiintunut tahattoman lapsettomuuden tehokkaimmaksi hoidoksi viimeisen kahden vuosikymmenen aikana. Nykyään 3,4% Suomessa vuosittain syntyneistä lapsista on saanut alkunsa hedelmöityshoidolla. Hoitojen tehokkuus ja turvallisuus ovat parantuneet, mutta vähän tiedetään lapsettomuuden ja lapsettomuushoitojen psyykkisistä vaikutuksista tulevien vanhempien henkiseen hyvinvointiin. Tämän väitöskirjatutkimuksen aiheena oli selvittää miten hedelmöityshoitoja saaneen pariskunnan lapsettomuus-kokemus vaikutti yksisikiöisen, omilla sukusoluilla aikaansaadun raskauden alettua lapsen varhaiseen kasvuympäristöön eli vanhempien mielenterveyteen, parisuhteeseen ja kokemukseen omasta vanhemmuudesta. Lisäksi selvitimme muodostaako pitkäkestoinen lapsettomuus ja toistetut, epäonnistuneet hedelmöityshoidot riskin vanhemman vuorovaikutukselle lapsen kanssa. Tähän kontrolloituun, laajaan seurantatutkimukseen osallistui viiden suomalaisen lapsettomuusklinikan potilaat, joilla raskaus oli alkanut hedelmöityshoidolla vuoden 1999 aikana. Vertailuryhmään kuuluvilla pareilla ei ollut lapsettomuusongelmaa ja raskaus oli alkanut ilman hedelmöityshoitoja. Väitöstutkimuksessa todettiin, että hedelmöityshoidoilla lapsen saaneilla naisilla oli verrokkinaisia vähemmän masennusoireita raskausaikana ja synnytyksen jälkeen, mutta ero tasoittui lapsen ensimmäisen ikävuoden loppuun mennessä. Samansuuntainen muutos näkyi lapsettomilla miehillä ahdistusoireissa, univaikeuksissa ja sosiaalisissa oireissa. Lapsettomuuskokemuksella ei ollut myöskään kielteisiä vaikutuksia parisuhteen laatuun, mutta ilman hoitoa raskaaksi tulleilla pareilla tyytyväisyys parisuhteeseen väheni lapsen ensimmäisen ikävuoden aikana. Tuloksemme antavat myös viitteitä, että vanhempien keskenään jakama lapsettomuuskokemus vahvisti parisuhdetta ja lisäsi kestävyyttä elämään liittyvien stressitekijöiden vaikutuksen suhteen. Hedelmöityshoitoryhmän äitien kokemukset omasta vanhemmuudesta lapsen ensimmäisen ikävuoden aikana olivat myönteisempiä kuin verrokkiäitien. Isien kokemus lapsesta muuttui molemmissa ryhmissä positiivisemmaksi tutkimusaikana. Lapsen ominaisuudet vaikuttivat vähemmän hedelmöityshoitoryhmän vanhempien vanhemmuuskokemukseen. Pitkäkestoisen lapsettomuuden ja toistettujen epäonnistuneiden hedelmöityshoitojen jälkeen äitien oli raskausaikana vaikea luoda mielikuvia lapsesta raskauden keskeytymiseen liittyvien pelkojen vuoksi. Lapsen synnyttyä tilanne tasaantui ja äitien mielikuvat lapsesta olivat realistisia, myönteisiä ja eläviä. Molempien hedelmöityshoitoryhmän vanhempien sensitiivisyys lisääntyi lapsen kasvaessa taaperoikäiseksi. Yhteenvetona todetaan, että hedelmöityshoidolla lapsen saaneet vanhemmat sopeutuvat hyvin varhaisen vanhemmuuden haasteisiin. Lapsettomuuskokemus ja hedelmöityshoidot eivät muodosta riskiä vanhempien mielenterveydelle, parisuhteelle tai kokemukselle vanhemmuudesta lapsen ensimmäisen ikävuoden aikana. Pitkäkestoinenkaan lapsettomuus toistettuine hedelmöityshoitoineen ei vaikuttanut kielteisesti vanhempien vuorovaikutukseen lapsen kanssa. Raskausaikaan liittyi kuitenkin pelkoja raskauden keskeytymisestä ja vaikeuksia luoda mielikuvia lapsesta, mikä korostaa riittävän psykososiaalisen tuen antamisen tärkeyttä erityisesti tässä erityisryhmässä. Rohkaisevista tuloksista huolimatta on syytä pitää mielessä, että lapsettomuus ja hedelmöityshoidot koetaan yleensä hyvin kuormittaviksi, ja terveydenhuollon haasteena on havaita ne parit, jotka tarvitsevat apua päästäkseen yli raskaista kokemuksista

The experience of pregnancy resulting from ART (Assisted Reproductive Technology) treatment : a qualitative Brazilian study

Background: Pregnancies achieved through medical treatments following a period of infertility may demand extra emotional and practical investment from women. Aim: This paper aims at understanding the experience of pregnancy after Assisted Reproductive Technology (ART), and exploring whether this experience is affected by previous failed infertility treatments. Methods: This paper uses a qualitative approach. Participants were nineteen expectant first-time mothers from Brazil who conceived through ART treatment. During the third trimester of gestation, a semi-structured interview was administered to assess perceptions of and feelings about treatment and pregnancy. Interview transcripts were analyzed using thematic analysis, and the sample was divided into two groups according to whether it was the participant’s first treatment (FT) or not (NFT). Findings: Themes identified include: Tolerance of the demands of treatment and pregnancy, Consideration of the mechanics of treatment and pregnancy, and Emotionally painful aspects of treatment and pregnancy. Pregnancy itself was regarded as a reward or compensation for the difficulties undergone. Perspectives differed according to whether pregnancy followed the first ART treatment; those who had undergone previously unsuccessful treatments focused less on the mechanical aspects of the process but were more concerned about possible physical problems. Conclusion: The similarities and differences found according to number of treatments attempted should be taken into consideration when providing psychological support for expectant ART mothers

First-time mothers’ experiences of pregnancy and birth following assisted reproductive technology treatment in Taiwan

Background Assisted Reproductive Technology (ART) treatment tends to involve significant physical and emotional commitments that can impact maternal, infant and family health and well-being. An in-depth understanding of experiences is necessary to provide adequate support for women and their families during pregnancy and transition to parenthood following ART treatment. The aim of this study was to explore first-time mothers’ experiences of pregnancy and transition to parenthood following successful ART treatment in Taiwan. Method Twelve first-time mothers who conceived and gave live birth using ART treatment were purposively selected from a fertility centre in Taipei, Taiwan. Women’s experiences in pregnancy and in their transition to motherhood were explored using semi-structured in-depth interviews. All interviews were recorded, transcribed, and analysed using the Colaizzi strategy. Results The mothers’ accounts reflected three main themes: ‘being different from mothers who became pregnant naturally’; ‘ensuring health and safety of the foetus’; and ‘welcoming new lives with excitement’. The difference mothers felt about themselves was evident in four subthemes: becoming pregnant after a long wait, feeling vulnerable during pregnancy, relying on family’s assistance and support, and worrying about the impact of ART on health. The theme on ‘ensuring health and safety of the foetus’ encompassed three subthemes: activities to protect the unborn baby, monitoring foetal movement constantly to maintain peace of mind, and receiving foetal reduction for the sake of the pregnancy. Narratives around ‘welcoming new lives with excitement’ reflected four subthemes: overcoming hardship for worthwhile results, realising one’s life and dreams, proving to be fertile enough to give birth, and return to normal life track. Conclusion Findings indicate the need for educational and psychosocial interventions to support women and their families physically and psychologically during ART treatment. The stigma related to infertility and the psychosocial support from family are aspects to consider while planning intervention programmes

“Living each week as unique” : maternal fears in Assisted Reproductive Technology pregnancies

Objective: to explore women's fears during pregnancy following conception via assisted reproductive technology (ART). Methods: 19 expectant first-time mothers were interviewed during the third trimester of pregnancy using a semi-structured schedule. Perceptions of and feelings about pregnancy were assessed. Content analysis was used to identify themes and subthemes. Findings: four overarching themes emerged: the baby's survival, the health of the baby, the efficacy of the mother and childbirth. Of these, the most commonly reported fears were related to miscarriage or fetal death, and the baby being born with an abnormality. Conclusions and implications: in addition to fears that are experienced by some women who conceived spontaneously, the women in this study who conceived via ART reported other fears, such as miscarriage or fetal death, that are more specific to this context. This suggests that these concerns should be taken into consideration when providing psychological support for ART mothers

The utility of screening for perinatal depression in the second trimester among Chinese: a three-wave prospective longitudinal study

This paper aims to study the pattern of perinatal depressive symptomatology and determine the predictive power of second trimester perinatal depressive symptoms for future perinatal periods. A population-based sample of 2,178 women completed the Edinburgh Postnatal Depression Scale (EPDS) in the second and third trimesters and at 6 weeks postpartum. Repeated measures ANOVAs were used to determine the EPDS scores across three stages. The predictive power of the second trimester EPDS score in identifying women with an elevated EPDS score in the third trimester and at 6 weeks postpartum were determined. The predictive power of the second trimester EPDS score was further assessed using stepwise logistic regression and receiver operator characteristic curves. EPDS scores differed significantly across three stages. The rates were 9.9%, 7.8%, and 8.7% for an EPDS score of >14 in the second and third trimesters and at 6 weeks postpartum, respectively. Using a cut-off of 14/15, the second trimester EPDS score accurately classified 89.6% of women in the third trimester and 87.2% of those at 6 weeks postpartum with or without perinatal depressive symptomatology. Women with a second trimester EPDS score >14 were 11.78 times more likely in the third trimester and 7.15 times more likely at 6 weeks postpartum to exhibit perinatal depressive symptomatology after adjustment of sociodemographic variables. The area under the curve for perinatal depressive symptomatology was 0.85 in the third trimester and 0.77 at 6 weeks postpartum. To identify women at high risk for postpartum depression, healthcare professionals could consider screening all pregnant women in the second trimester so that secondary preventive intervention may be implemented

Lasten käytöshäiriöihin tulee puuttua ajoissa

Uhmaiät ja rajojen kokeilu kuuluvat lapsen kehitykseen, voimakas ja pitkäkestoinen väkivaltainen tai epä¬sosiaalinen käyttäytyminen eivät. Käytöshäiriön taustalla on usein neuropsykiatrisia ongelmia, trauma¬kokemuksia tai masennusta. Käytöshäiriön hoidossa voidaan lapsen toiminnan johdonmukaisen ohjaamisen lisäksi käyttää erilaisia tunteiden ja käyttäytymisen hallintaa opettavia menetelmiä sekä joskus lääkkeitä. Myös muiden häiriöiden ja sairauksien asianmukainen hoito on tärkeää. Huoltajien vanhemmuustaitojen vahvistaminen on niin ikään olennainen osa lapsen käytöshäiriön hoitoa, mutta rangaistusperusteisista kasvatusmenetelmistä ei yleensä ole hyötyä.Peer reviewe