ISAT was developed by ISW Limits, a spin-off of the University of Leuven (Belgium). It stands for Interactive Self-Assessment Tool, which is an online screening about well-being at work. ISAT provides employees with individual feedback about their mental health and well-being at work. In addition, the tool provides tailored self-management advice as well as information about how and where to get support from the employer and the Employee Assistance Program provider. To the employers, ISAT offers group results in order to help companies target interventions.
Study question How does the overall quality of life (QoL) of infertile women and men evolve during the diagnostic workup and during intrauterine insemination (IUI)? Summary answer The diagnostic workup affects the overall QoL of neither women nor men but both partner’s QoL is diminished by the time of their third IUI. What is known already Overall quality of life (QoL) is increasingly acknowledged as the ultimate measure of health care quality. The WHO defines ‘overall QoL’ as an individual’s perception of their position in life in relation to their context, goals, expectations, standards and concerns. Infertility threatens the life goal of becoming parents. Value preference studies concluded that cost analyses should consider a decrement in women’s QoL for ‘being infertile with the desire for a child’. The short-term QoL costs or benefits of the fertility clinic trajectory, before potentially achieving the long-term benefit of a live birth, have yet to be examined. Study design, size, duration Two cohorts consulting a Belgian fertility clinic were studied longitudinally. Cohort 1 (C1) included 36 women and their partners (response rate 54%), who were surveyed before their first consultation (T1) and three months later, towards the end of their diagnostic workup (T2; 2017-2019). Cohort 2 (C2) included 23 women and their partners (response rate 64%), who were surveyed during their diagnostic workup (T1) and at the time of their third IUI (T2; 2020-2021). Participants/materials, setting, methods Dutch- or English-speaking heterosexual couples first consulting a fertility clinic were eligible. Overall QoL was assessed with the valid and reliable linear analogue scale (LAS; range: 1-100; the higher, the better QoL; Moons et al., Eur J Cardiovasc Prev Rehabil, 2006). Paired samples t-tests assessed the evolution in the overall QoL of women and of men. Linear models examined whether already being parents and male factor infertility affected change scores. Main results and the role of chance Women and men of both cohorts were on average in their early thirties and couples had tried to conceive naturally for, on average, 19 (C1) and 16 (C2) months. Most individuals (65.4% in C1; 87% in C2) did not yet parent a child. A considerate proportion of couples had been diagnosed with (amongst others) male factor infertility (34.6% in C1; 26.0% in C2). The diagnostic workup did not affect the overall QoL of women (T1: 78.8±8.1 vs. T2: 75.8±9.7, p = 0.147) or men (T1: 80.8±7.9 vs. T2: 79.2±8.7, p = 0.206). The evolution in overall QoL throughout the diagnostic workup did not depend on parenthood status or male factor infertility (p > 0.05). By the time of their third IUI, women’s overall QoL had diminished (T1: 80.9±9.9 vs. T2: 74.0±15.0, p = 0.018). This evolution was not affected by parenthood status or male factor infertility (p > 0.05). Similarly, men’s overall QoL had diminished by the time of their third IUI (T1: 82.0±7.2 vs. T2: 78.1±9.6, p = 0.042). This reduction in men’s QoL was not affected by parenthood status (p = 0.759) but was especially observed (p = 0.028) among men without male factor infertility (T1: 82.9±7.9 vs. T2: 77.0±11.0, p = 0.008). Limitations, reasons for caution The rather small sample sizes were sufficient for examining the effect on QoL of time and two potential determinants (parenthood status, male factor infertility) according to the rule of thumb of including minimally five individuals per variable. Recruitment is still ongoing to increase the power of these cohort studies. Wider implications of the findings Fertility nurses/midwives should inform couples pursuing their life goal of parenthood that the fertility clinic trajectory will require short-term sacrifices. The diagnostic workup affects the overall QoL of neither women nor men, but both partner’s overall QoL is slightly diminished by the time of their third unsuccessful intrauterine insemination. Trial registration number not applicable
Study question Is the sexual desire of infertile women and men correlated with their intercourse frequency and sexual satisfaction? Summary answer Both partner’s sexual desire is moderately correlated to intercourse frequency and their own sexual satisfaction and weakly correlated to the sexual satisfaction of their partner. What is known already Reviews showed that infertile couples have worse sexual health than the general population. Qualitative studies explained that infertile patients feel less attractive and consider intercourse a ‘duty’, associated with failure. Fertility clinics offer diagnosis and treatments but have yet to start caring for sexual health. The Pleasure&Pregnancy-programme, combining psychosexual education with communication, mindfulness and sensate focus exercises, recently proved to increase the sexual desire of infertile women pursuing natural conception. Whether improving sexual desire can be expected to increase the intercourse frequency and sexual satisfaction of women and men about to start fertility treatment had yet to be explored. Study design, size, duration A cross-sectional cohort of 140 heterosexual couples (n = 280; response rate 51%) was surveyed between 2019 and 2022. Couples filled out a package questioning their sexual health over the past four weeks at a chosen moment between their first fertility clinic consultation and the end of their diagnostic workup. This package included a questionnaire to be filled out by each partner individually and a couple questionnaire. Non-responders received were reminded. Participants/materials, setting, methods Sexual desire and satisfaction of women and men was assessed with subscales of the following valid and reliable questionnaires: Female Sexual Function Index in women (FSFI; the higher, the better) or International Index of Erectile Function in men (IIEF; the higher, the better). Intercourse frequency of couples was assessed with a sexual activity event log. Spearman rho’s correlations assessed associations between sexual desire, sexual satisfaction and coital frequency. Main results and the role of chance Responding women and men were in their early thirties and had tried to conceive naturally for 18.2 months, on average. The sexual desire of women (and of men was not correlated (r = 0.116, p = 0.178). Couples had sexual intercourse seven times per month (7.12±4.03), on average. The sexual desire of both women and men was moderately correlated to couple’s intercourse frequency (♀: r = 0.402, p < 0.001; ♂: r = 0.426, p < 0.001). The sexual desire of women was also moderately correlated to their own sexual satisfaction (r = 0.481, p < 0.001) and weakly correlated to the sexual satisfaction of their male partner (r = 0.270, p = 0.001). The sexual desire of men was significantly but weakly correlated to their own sexual satisfaction (r = 0.361, p < 0.001) and the sexual satisfaction of their female partner (r = 0.239, p = 0.005). Limitations, reasons for caution The sexual health of the included couples is currently followed-up during fertility treatment. Linear mixed models, taking account of dyads and of multiple assessments, would allow analysing the impact over time of women’s sexual desire whilst taking account of the sexual desire of her male partner and vice-versa. Wider implications of the findings Sexual desire seems important for a couple’s coital frequency and both partner’s sexual satisfaction. Examining whether a six-month sexual health programme that improves women’s sexual desire, could in the longer term improve intercourse frequency and especially sexual satisfaction or prevent the deterioration thereof would be interesting. Trial registration number not applicable
Study question Can a smartphone video clip detailing the patient journey decrease the anxiety of women and men on the day of their first oocyte aspiration? Summary answer The video clip does not affect the anxiety of women but does reduce the anxiety of men on the day of couples’ first oocyte aspiration. What is known already Infertility and in vitro fertilisation (IVF) decrease the personal wellbeing of women and men. Couples shared that this contributed to their IVF discontinuation despite a good prognosis and reimbursement of IVF. Previous longitudinal studies confirmed that pre-IVF anxiety is associated with IVF discontinuation. Limiting treatment anxiety is, therefore, relevant for fertility patients and clinics. Studies from the field of reproductive medicine examining the effect of preparatory information on anxiety suggest that focussed interventions seem more effective than complex interventions. Several randomized controlled trials (RCTs) found that preparatory information movies reduce anxiety for out-patient cardiology procedures in women and men. Study design, size, duration This monocentric RCT randomized (1:1 allocation; computerized) 190 heterosexual couples about to start their first IVF cycle between care as usual (i.e. preparatory information session 1-3 months before IVF) and care as usual combined with a novel intervention during a 24 months recruitment period (2018-2020). The novel intervention is a 5-minute smartphone video clip detailing the patient journey on the day of oocyte aspiration, which was sent to both partners the day before oocyte aspiration. Participants/materials, setting, methods Upon arrival at a private fertility clinic for their first oocyte aspiration women and men independently filled out the ‘STAI-State anxiety inventory’ and the ‘infertility distress scale (IDS)’ and evaluated the novel intervention, if applicable. A minority of randomized couples didn’t comply with the standard IVF trajectory (n = 27) or didn’t fill out the questionnaires (n = 8). The data of 155 couples (76-79/group, a-priori sample size calculation requested minimally 76/group) was subjected to a modified intention-to-treat analysis. Main results and the role of chance Women and men were on average 33 and 35 years old, respectively. Couples had a mean duration of infertility of 27 months and 63 of them (41%) had tried intrauterine insemination. The background variables were equally distributed between the intervention (IG) and control group (CG). The video clip did not affect women’s anxiety on the day of oocyte aspiration (mean STAI-State score IG 42.7±8.1 vs CG 42.1±8.5, p = 0.67). However, men who watched the video clip were significantly less anxious than men who did not watch it (mean STAI-State score IG 35.8±6.4 vs CG 38.2±7.6, p = 0.04). Surprisingly, infertility-specific distress was higher among women and men who watched the video clip (mean IDS scores of 25.8±4.9 and 22.6±5.0, respectively), as compared to women (p = 0.05) and men (p = 0.02) who did not watch the video clip (mean IDS score 24.3±4.6 and 20.8±4.7, respectively). All women and men of the intervention group, except one woman, would recommend the video clip to friends and family going through IVF. The intervention and control group did not differ significantly regarding clinical pregnancy rate (31/76 vs. 29/79, p = 0.60) or miscarriage rate (2/76 vs. 3/79, p = 0.68) 12 weeks after their first oocyte aspiration. Limitations, reasons for caution Patients nor assessors were blinded and there was no attention control group. Selection bias is plausible although the participation rate was 89%. Assessing infertility-specific distress the day after watching the video clip was not optimal, as priming couples to feel infertility-specific distress short term is less problematic than longer term. Wider implications of the findings Providing additional procedural information is interesting for clinics as patients recommended the video clip and as it decreased men’s anxiety. A follow-up study should examine whether the video clip’s priming effect on infertility-specific distress lasts longer than only the day after and whether the video clip affects IVF discontinuation. Trial registration number NCT03717805
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