How does stress, depression and anxiety affect patients undergoing treatment?

PURPOSE OF REVIEW: To review latest findings about the impact of fertility care on emotional distress and effect of distress on treatment outcome. RECENT FINDINGS: Treatment failure and long agonist protocols are associated with increased emotional distress during treatment. Screening tools can be used to identify men and women at risk of emotional maladjustment at the start of fertility treatment and people unlikely to need emotional support during or after treatment. There are inconclusive results about the association between emotional distress and outcome of fertility treatment. Systematic review of studies evaluating the effect of psychological and educational interventions on anxiety, depression and live birth (or ongoing pregnancy) are uninformative because of clinical heterogeneity and risk of bias. SUMMARY: ART is emotionally demanding, patients that adapt more poorly can be identified in advance. Fertility staff should follow good practice guidelines to provide patients with support during treatment

Reactions across stages of in vitro fertilization-embryo transfer (IVF-ET) in subsequently pregnant and non-pregnant women using a daily monitoring inventory

Examines emotional, physical and behavioral reactions during treatment; the psychological results of success or failure; and, factors which predict emotional distress during treatment

Patient centred care in infertility health care: Direct and indirect associations with wellbeing during treatment

Objective To investigate whether different dimensions of patient centred care (PCC) were directly associated with wellbeing or indirectly, via lower concerns about medical procedures and/or increased tolerability of treatment. Methods Cross-sectional study with 322 women and 111 men undergoing fertility diagnosis or treatment recruited online and in clinical setting. Participants completed questionnaires that assess PCC (PCQ-Infertility), individual (BSI Anxiety and Depression subscales) and relational wellbeing (FertiQoL Relational Domain), treatment concerns (CART Procedural Concerns scale) and tolerability (FertiQoL Tolerability Domain) and they filled a socio-demographic and fertility data file. Results All dimensions of PCC were positively associated with better wellbeing except for organization of care. Information provision and continuity of care were indirectly associated with better individual wellbeing, the first via lower treatment concerns and the second via higher treatment tolerability. Competence, accessibility, continuity and communication were indirectly associated with better relational wellbeing via higher treatment tolerability. Conclusions Patient centred care promotes wellbeing during treatment. PCC is directly associated to wellbeing but also indirectly. The mode of action of the different PCC dimensions on wellbeing varies. Practical implications To promote patients’ wellbeing during treatment clinics should provide treatment related information and allow patients to establish a stable clinical relationship with a trustworthy and competent physician

Self-regulation and wellbeing when facing a blocked parenthood goal: a systematic review and meta-analysis

Developmental regulation theories claim that continuing to pursue a goal when it becomes blocked contributes to poorer wellbeing. This consequence is expected to lead to the use of self-regulation strategies in the form of higher disengagement from the goal and higher reengagement in other meaningful goals. The use of these strategies is expected to lead to better wellbeing. A systematic-review and meta-analyses were conducted to test the major predictions of developmental regulation theories for blocked parenthood goal and to investigate possible moderator variables, particularly type and degree of blockage. A total of eight meta-analyses were performed using random-effects models. Moderation was tested with subgroup analysis. After searching eight databases, 4977 potential relevant manuscripts were identified but only six met inclusion criteria. From the eight meta-analyses conducted, only two were significant. In line with prediction, higher goal blockage was related to higher negative mood and reengagement in other life goals was associated to higher positive mood (p < .001). From a total of eight subgroup analyses performed, results showed that disengaging had a positive impact on wellbeing for people experiencing an unanticipated type of blockage (i.e., infertility) but not for those with an anticipated one (i.e., postponing parenthood; X2 = 4.867, p = .03). From the total of twelve sensitivity analyses performed only one suggested that results might differ. The association between disengagement and mood varied according to study quality. When only average studies were included this association was negative, although non-significant. The evidence obtained did not fully support developmental regulation theories for the pursuit of parenthood goal, but primary research had too many methodological limitations to reach firm conclusions. Future studies aimed at investigating blocked parenthood goal are required to evaluate the value of developmental regulation theories

The double-edged sword of ovarian cancer information for women at increased risk who have previously taken part in screening

Background: Women at increased risk who decide not to have, or to delay, risk-reducing salpingo-oophorectomy have to rely on early diagnosis through symptom awareness and presenting to primary care as soon as possible in the absence of screening. However, little is known about the acceptability to women of this strategy. We aimed to gain an in-depth understanding of women’s perceptions and previous experiences of ovarian cancer symptom management, and the influences on ovarian cancer awareness and anticipated symptom presentation. Method: Qualitative interviews were conducted with eight women at increased risk of ovarian cancer who had previously taken part in ovarian cancer screening and analysed using interpretative phenomenological analysis (IPA). Results: Familial experience of ovarian cancer and perceived personal risk shaped women’s perceptions and behavioural responses to disease threat. Ovarian cancer information was perceived to be a double-edged sword, regarded as either useful for increasing knowledge and confidence in discussing symptom concerns with health professionals or to be avoided due to fears about cancer. Conclusion: Women may be cautious about searching for information independently and in the absence of routine ovarian screening. Practice implications: Thought needs to be given to how best to create and disseminate credible ovarian cancer symptom information materials

Influences on anticipated time to ovarian cancer symptom presentation in women at increased risk compared to population risk of ovarian cancer

Background In the absence of routine ovarian cancer screening, promoting help-seeking in response to ovarian symptoms is a potential route to early diagnosis. The factors influencing women’s anticipated time to presentation with potential ovarian cancer symptoms were examined. Methods Cross-sectional questionnaires were completed by a sample of women at increased familial risk (n = 283) and population risk (n = 1043) for ovarian cancer. Measures included demographic characteristics, symptom knowledge, anticipated time to symptom presentation, and health beliefs (perceived susceptibility, worry, perceived threat, confidence in symptom detection, benefits and barriers to presentation). Structural equation modelling was used to identify determinants of anticipated time to symptomatic presentation in both groups. Results Associations between health beliefs and anticipated symptom presentation differed according to risk group. In increased risk women, high perceived susceptibility (r = .35***), ovarian cancer worry (r = .98**), perceived threat (r = −.18**), confidence (r = .16**) and perceiving more benefits than barriers to presentation (r = −.34**), were statistically significant in determining earlier anticipated presentation. The pattern was the same for population risk women, except ovarian cancer worry (r = .36) and perceived threat (r = −.03) were not statistically significant determinants. Conclusions Associations between underlying health beliefs and anticipated presentation differed according to risk group. Women at population risk had higher symptom knowledge and anticipated presenting in shorter time frames than the increased risk sample. The cancer worry component of perceived threat was a unique predictor in the increased risk group. In increased risk women, the worry component of perceived threat may be more influential than susceptibility aspects in influencing early presentation behaviour, highlighting the need for ovarian symptom awareness interventions with tailored content to minimise cancer-related worry in this population

A rapid scoping review of fear of infertility in Africa

Background Fear of infertility (FOI) is often reported in studies about reproductive health but this literature not yet mapped. The aim of this rapid scoping review of qualitative studies was to describe the nature of FOI in Africa. Methods Eligibility criteria were qualitative data from Africa reporting views of women and men of any age. MEDLINE and CINAHL databases were searched for English language citations to February 2019 using keywords related to fear, infertility and Africa. Two independent reviewers screened texts for inclusion. Results Of 248 citations identified, 38 qualitative and six review papers were included. FOI was reported in diverse groups (e.g., men, women, fertile, infertile, married, unmarried, teachers, religious leaders). Two types of fears were identified: (1) fear of triggering infertility due to specific reproductive choices and (2) fear of the dire future consequences of infertility. Choices were perceived to affect fertility via internal accumulation and blockage (e.g., of menstrual blood), structural damage (e.g., burnt eggs), internal movement of contraceptive material, deliberate toxicity preventing population growth and behavioral effects impeding sexual activity. Diverse feared consequences of infertility were reported (e.g., polygamy, economic hardships). Fears were reported to affect reproductive behaviour (e.g., stopping contraception), help-seeking and social behaviour. Conclusion FOI is a phenomenon that should be studied in its own right. Fears could originate from genuine threats, incorrect knowledge, distortions of truths, or dissemination of false information. Rigorous studies are needed to better understand FOI and integrate it in health education, client counselling and family planning service provision

The impact of pharaonic female genital mutilation on sexuality: two cases from Sudan highlighting the need for widespread dissemination of sexual and reproductive health education in Africa

It is well documented that female genital mutilation (FGM) can have numerous physical and psychosocial consequences. The increased awareness about FGM and its impact on female health over the past few decades has led to a ban on FGM in many countries, however, this has yet to translate into measurable changes in prevalence. Efforts to enforce legislation have been unsuccessful in part because the general public lacks information about the negative consequences of FGM. In this report we present two cases of sexual difficulties as a result of FGM from Sudan, where the most severe form of FGM is still being practiced. During an interview about infertility, these two women volunteered information about how FGM has affected their sexuality. The lack of information about the impact of FGM on sexuality reflected in these cases, highlighted the significant need for widespread dissemination of sexual and reproductive health education in Africa