The Psychological Impact of IVF Treatment

Abstract

IVF treatment requires the woman to undergo several invasive procedures, which are repeated in subsequent treatment cycles. In addition to the physical burden, the threat of treatment failure confronts the couple with the possibility that they have to give up hope to have a child of their own. In line with the psychological consequences of infertility model, women seem to experience moderate levels of negative emotions (e.g. distress) before, during and after IVF treatment. According to the cyclical model of infertility and stress, the chance of conceiving through IVF is negatively influenced by high levels of psychological distress. Surprisingly, we found that women who reported a low level of pretreatment distress were less likely to achieve term live birth than women who expressed a moderate level of distress. Still, as the majority of participating women did not meet the criteria for either clinical depression or anxiety, the results of this thesis do n! ot rule out that high patient distress leads to worse IVF outcomes than moderate distress. However, the relationship between patient distress and IVF success rates might not be as straightforward as commonly believed by researchers, clinicians and patients. It has been widely argued that people undergoing IVF should receive infertility counseling by a psychosocial counsellor to help them cope with negative emotions related to treatment and infertility. Hence, the first aim of this study was to evaluate the effect of a psychosocial counselling intervention during IVF treatment on distress in first-time IVF patients in a randomized controlled trial. Counselling interventions in infertility treatment focus on expression of emotions and discussion of thoughts related to infertility and its treatment. These interventions are usually characterized by the non-directiveness of the counsellor, the couple format of the sessions and a short duration. Most women who were asked to participate in this study did not think they needed additional psychosocial counselling during their first IVF treatment cycle. Furthermore, men were less likely than women to be interested in additional counselling by a social worker. Consistent with previous stu! dies, our counselling intervention hardly influenced the amount of distress women and men experienced during their first cycle of IVF treatment. At pregnancy testing however, women who had received additional psychosocial counselling expressed less negative affect than women who had received routine care and no additional psychosocial counselling. Although this difference was marginally significant, this result might still indicate that our psychosocial counseling intervention succeeded in reducing unrealistic expectations women might have about IVF success rates. Still, alternative ways to decrease distress related to IVF treatment should also be considered. New ‘mild’ IVF strategies which combine mild ovarian stimulation with single embryo transfer may represent a more patient-friendly approach than standard IVF treatment. Mild ovarian stimulation protocols with gonadotropin-releasing hormone (GnRH) antagonists are likely to be associated with less physical discomfort and psychological distress than standard ovarian stimulation with GnRH agonists. However, the use of mild IVF strategies, which include single embryo transfer, might also be stressful to patients, as patients seem to prefer double embryo tran