Emotional distress in infertile women and failure of assisted reproductive technologies: meta-analysis of prospective psychosocial studies

Abstract

Objective To examine whether pretreatment emotional distress in women is associated with achievement of pregnancy after a cycle of assisted reproductive technology. Design Meta-analysis of prospective psychosocial studies. Data sources PubMed, Medline, Embase, PsycINFO, PsychNET, ISI Web of Knowledge, and ISI Web of Science were searched for articles published from 1985 to March 2010 (inclusive). We also undertook a hand search of reference lists and contacted 29 authors. Eligible studies were prospective studies reporting a test of the association between pretreatment emotional distress (anxiety or depression) and pregnancy in women undergoing a single cycle of assisted reproductive technology. Review methods Two authors independently assessed the studies for eligibility and quality (using criteria adapted from the Newcastle-Ottawa quality scale) and extracted data. Authors contributed additional data not included in original publication. Results Fourteen studies with 3583 infertile women undergoing a cycle of fertility treatment were included in the meta-analysis. The effect size used was the standardised mean difference (adjusted for small sample size) in pretreatment anxiety or depression (priority on anxiety where both measured) between women who achieved a pregnancy (defined as a positive pregnancy test, positive fetal heart scan, or live birth) and those who did not. Pretreatment emotional distress was not associated with treatment outcome after a cycle of assisted reproductive technology (standardised mean difference −0.04, 95% confidence interval −0.11 to 0.03 (fixed effects model); heterogeneity I²=14%, P=0.30). Subgroup analyses according to previous experience of assisted reproductive technology, composition of the not pregnant group, and timing of the emotional assessment were not significant. The effect size did not vary according to study quality, but a significant subgroup analysis on timing of the pregnancy test, a contour enhanced funnel plot, and Egger's test indicated the presence of moderate publication bias. ConclusionsThe findings of this meta-analysis should reassure women and doctors that emotional distress caused by fertility problems or other life events cooccurring with treatment will not compromise the chance of becoming pregnant.

Perception of the Psychosocial Aspects of Subfertility by Parents Following Successful Medically Assisted Conception: A Qualitative Study

“…Fertility treatment for our participants was associated with a range of negative emotions, which is consistent with earlier literature [6] [23] [30] [31] [32]. In addition our participants described positive emotions that could occur, especially hope.…”

“…One woman from our study consulted a medical psychologist and found this very helpful. Boivin, et al [30] and Péloquin [8] confirmed that talks with a psychologist help to reduce stress. The role of peer-support through internet forums is fairly new to the literature and can reflect the emerging role of internet in health-related behaviours.…”

Gender differences in emotional reactions to in vitro fertilization treatment: a systematic review

“…From the beginning, clinicians should clarify to couples the fact that elevated negative emotions in women are natural under the circumstances and will not affect the pregnancy rate [42]. The couples should also be provided with information and support, which will give them a better understanding of the process, more realistic expectations about the outcome of the treatment, and the strength to go through the treatment.…”

Relationship between hair and salivary cortisol and pregnancy in women undergoing IVF

“…The role that stress may exert on reproductive functioning has remained a topic of debate for decades (Boivin and Venetis., 2011;Mathiesen et al, 2011). This debate has been fuelled not least by the complexities of delineating plausible psychobiological pathways by which stress might influence reproductive outcomes (Whirledge and Cidlowski, 2010;Toufexis et al, 2014).…”