No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Age and position moderate the effect of stress on fertility
Abstract
There is now compelling evidence that psychosocial stress is a cause of reproductive suppression in humans. However, women continue to conceive in the harshest conditions of war, poverty, or famine, suggesting that suppression can be bypassed. The reproductive suppression model (RSM) proposes that natural selection should favor factors that reliably predict conditions for reproduction. In this study, we examine two such factors, age and social position, in women undergoing fertility treatment. We hypothesized that stress-related reproductive suppression would be more likely in younger compared to older women and in women in lower compared to higher social positions. The final sample consisted of 818 women undergoing fertility treatment. Psychosocial stress and sociodemographic data were collected prior to the start of treatment (Time 1), whereas fertility, as indexed by pregnancy or live birth, was assessed 12 months later (Time 2). The results showed that younger women were four times more likely to suppress than older women, and that unskilled and manual workers were more likely to suppress than those in middle social positions (e.g., white collar workers). However, significant associations between stress and fertility were also observed for women in higher social positions (e.g., professionals and executives). The findings provide support for the RSM.
... Women cannot talk freely with men on subjects related to reproduction. The religious rules, prejudices, taboos, customs, and traditions are the reasons for this to be deemed as ul ilies (Boivin et al. 2006). Nevertheless, people connected to hierarchy in workplace cannot speak easily with administrators, especially on their private issues related to the fertility. ...
... The women whose career was affected negatively had high work stress level. Limited studies have examined the career and infertility (Ehsanpour et al. 2007, Boivin et al. 2006. Career role can influen appraisal of infertility and stress levels. ...
Background:
Infertility processis a strestfull period that effects of couple's life, especially their working life. It can be difficult for women with fertility problems to fulfill work responsibilities during infertility treatment. The current study aimed to explore effects of infertility treatment on women's stress and hence working life. There is limited literature related to effect of this treatment on women working life so this is important issue worldwide.
Subjects and methods:
This was a cross-sectional descriptive study and 200 women undergoing infertility treatment participated. Our participants were primary infertile working women who had received at least one-cycle of infertility treatment before being invited to be part of study. An Introductory Data and Fertility History Form, Infertility Treatment and Working Performance Questionnaire and Visual Analogue Stress Scale were administered over-3 month period.
Results:
More than half of women (53%) reported that they experienced problems related to ask the manager for the leave because of some procedure during the infertility treatment. Fear of administrator, not being able to focuse on work, not being understood by collegues, a negative impact on career, increase in work stress were problems reported by women. Also participants reported adversity in sharing infertility treatment with male administrators.
Conclusions:
The study found that infertility treatment process affect women's working life negatively. Therefore health professionales should improve employers awareness about impact of infertility treatment on working life for purposs of improving professional support needed during this treatment time. Women should be encouraged to share feelings/problems they experience with employers/colleagues.
... For example, seasonal breeders that have only a finite window of opportunity to breed may be more resistant to acute natural stressors (Boonstra et al. 2001). Similarly, individuals with limited opportunity for breeding due to age (Boivin et al. 2006) or social status (Sapolsky 1985) may become more resistant to the effects of stress. ...
To reverse the trend of declining wildlife populations globally, individuals must be provided with conditions that allow them to not just survive, but to thrive. It is no longer only the remit of captive breeding programs to ensure animal well-being; in situ conservation efforts also must consider how environmental and anthropogenic pressures impact wild populations, and how to mitigate them—especially with regards to reproduction and survival. Stress and welfare are complex concepts that necessitate an understanding of how stressors affect animals on both individual and population levels. There are species differences in how factors impact well-being, related in part to natural history, which also are shaped by individual perceptions and coping abilities. A multitude of stress-related responses then have the potential to disrupt fertility on many levels, and ultimately fitness. A major limitation to advancing welfare science is the lack of definitive tests to verify welfare status; i.e., is the animal happy or not? While analyses of circulating or excreted glucocorticoids have for decades been the primary method of assessing stress, today we recognize the need for more objective indicators that incorporate multiple physiological systems, including behavior, to assess both negative and positive welfare states. In this chapter, we discuss the potential for stress to disrupt, and sometimes facilitate reproduction, including the key role that glucocorticoids play. We then discuss a number of physiological biomarkers, which in addition to glucocorticoids, have the potential to assess well-being and the role of stress on reproduction. Finally, we discuss allostatic load, a method by which multiple physiological markers are used to inform on morbidity and mortality risk in humans, which if applied to wildlife, could be a powerful tool for conservation.
... [30,31] Hopelessness is found to be more prevalent in infertile women with low educational achievement, uneducated spouse, and unemployment and is not related to factors such as the age of patients, length of marital duration, and cause of infertility. [27,32,33] Theoretically speaking, "learnt helplessness" is another related psychological phenomenon that may explain why distressed patients prematurely drop out from fertility treatments. Learned helplessness [34] is "a mental state in which an organism who is forced to bear aversive or unpleasant stimuli, becomes unable or unwilling to avoid subsequent encounters with those stimuli, even if they are "escapable," presumably because he has learned that it cannot control the situation." ...
Background: Emotional response to infertility is mediated by numerous interrelated psychological variables such as personality, health perceptions, cognitive appraisals, coping, and social support. While men and women respond to infertility differently, illness cognitions are a vital component of their emotional adjustment. The aim of this study is to compare the infertile men and women undergoing fertility treatments on perceived distress, helplessness, acceptance, benefits, anxiety, and depression. Materials and Methods: Eighty-one infertile couples, undergoing intrauterine insemination participated in the study. They were assessed on the presence of infertility distress using the fertility problem inventory, for psychiatric morbidity using the Mini International Neuropsychiatric Interview, for affective disturbances using the Hamilton Anxiety and Depression scales, and for illness cognitions using the Illness Cognition Questionnaire. Statistical Analysis: Data are analyzed using SPSS version 15. The paired sample t-test is performed for assessing differences on normally distributed data. The Wilcoxon Signed-Rank test is performed for assessing differences in medians obtained on data that was skewed. Results and Discussion: Infertile women (wives) were more emotionally distressed, anxious, and depressed than men (husbands). Gender-wise differences were found for perceptions of helplessness and acceptance of infertility. Infertility was perceived to be a nonbeneficial event for both partners investigated. Conclusion: Negative cognitions and affective disturbances may contribute to higher treatment burden in couples seeking-assisted conception. The present study suggests that psychosocial intervention for couples plays a central role and should be integrated within the conventional treatments for infertility.
... food, comfort) to nurture and care for offspring, '…reproduction is suppressed until predictably better times…' (Wasser and Barash, 1983: 518). This association has also been shown in humans (Boivin et al., 2006). However, economic packages have a relatively minor impact on childbearing (McNown and Ridao-Cano, 2004). ...
This study investigated fertility decision-making in people currently trying to conceive, and examined whether factors that make people ready to conceive differ by gender and country. The study used data from the International Fertility Decision-Making Study, a cross-sectional study of 10,045 participants (1690 men and 8355 women) from 79 countries. Respondents were aged 18–50 years (mean 31.8 years), partnered and had been trying to conceive for > 6 months (mean 2.8 years). Respondents indicated their need for parenthood; their own/partner's desire for a child; and the influence of certain preconditions, motivational forces and subjective norms in relation to readiness to conceive. Factor analysis of preconditions and motivational forces revealed four decisional factors: social status of parents, economic preconditions, personal and relational readiness, and physical health and child costs. Significant gender differences were found for desire for a child, decisional factors and subjective norms. Compared with men, women had higher personal desire for a child, and rated economic and personal and relational readiness as more influential. Men were more likely to rate subjective norms and social status of parents as more influential. Country comparisons found significant differences in personal desire for a child, partner's desire for a child, need for parenthood, preconditions, motivational forces and subjective norms. The results demonstrate that some decisional factors have a universal association with starting families (e.g. desire for a child), whilst the influence of others (e.g. personal and relational readiness) is dependent on contextual factors. These findings support the need for contemporary, prospective and international research on reproductive decision-making, and emphasize the need for effective fertility policies to take contextual factors into account.
... [30,31] Hopelessness is found to be more prevalent in infertile women with low educational achievement, uneducated spouse, and unemployment and is not related to factors such as the age of patients, length of marital duration, and cause of infertility. [27,32,33] Theoretically speaking, "learnt helplessness" is another related psychological phenomenon that may explain why distressed patients prematurely drop out from fertility treatments. Learned helplessness [34] is "a mental state in which an organism who is forced to bear aversive or unpleasant stimuli, becomes unable or unwilling to avoid subsequent encounters with those stimuli, even if they are "escapable," presumably because he has learned that it cannot control the situation." ...
Background
Emotional response to infertility is mediated by numerous interrelated psychological variables such as personality, health perceptions, cognitive appraisals, coping, and social support. While men and women respond to infertility differently, illness cognitions are a vital component of their emotional adjustment. The aim of this study is to compare the infertile men and women undergoing fertility treatments on perceived distress, helplessness, acceptance, benefits, anxiety, and depression.
Materials and Methods
Eighty-one infertile couples, undergoing intrauterine insemination participated in the study. They were assessed on the presence of infertility distress using the fertility problem inventory, for psychiatric morbidity using the Mini International Neuropsychiatric Interview, for affective disturbances using the Hamilton Anxiety and Depression scales, and for illness cognitions using the Illness Cognition Questionnaire.
Statistical Analysis
Data are analyzed using SPSS version 15. The paired sample t-test is performed for assessing differences on normally distributed data. The Wilcoxon Signed-Rank test is performed for assessing differences in medians obtained on data that was skewed.
Results and Discussion
Infertile women (wives) were more emotionally distressed, anxious, and depressed than men (husbands). Gender-wise differences were found for perceptions of helplessness and acceptance of infertility. Infertility was perceived to be a nonbeneficial event for both partners investigated.
Conclusion
Negative cognitions and affective disturbances may contribute to higher treatment burden in couples seeking-assisted conception. The present study suggests that psychosocial intervention for couples plays a central role and should be integrated within the conventional treatments for infertility.
... 10 These contradictory findings are in part due to how outcomes and stress are 11 defined and assessed. Most studies focus on successful pregnancy after treatment as 12 outcome (e.g., Boivin & Schmidt, 2005;Boivin, Sanders and Schmidt, 2006), but 13 reproductive impairment is already occurring for at least one year. Additionally, 14 reported or measured stress levels might be high but not perceived as negatively 15 influencing the individual (Ebbesen et al., 2009). ...
Objective: To compare the occurrence and degree of stress attributed to life events during childhood/adolescence and adulthood between individuals diagnosed with infertility and presumably fertile individuals, and to examine the effect of life events occurrence and stress levels on an infertility diagnosis.
Background: Although stress has been very explored as a consequence of the experience of infertility, its role as a predictor of this disease still lacks research, particularly regarding the use of adequate control groups composed of non-parents.
Methods: The final sample had 151 infertile subjects (74 males and 77 females) and 225 presumably fertile participants (95 males and 130 females), who completed a questionnaire indicating occurrence (y/n) and degree of stress of life events (1-5) during childhood/adolescence and adulthood.
Results: Significant differences regarding occurrence were found in 7 stressful life events in men and in nine events in women, with infertile groups presenting higher occurrence than presumably fertile groups. Eleven stressful life events were rated differently by men and women regarding the degree of stress, with group significant differences observed in both directions. While most events were rated as more stressful by infertile men infertile women reported less stress resulting from these events than presumably fertile women. After controlling for age, the degree of stress induced by life events in childhood/adolescence and adulthood were not significant predictors of infertility diagnosis, for both men and women.
Conclusion: The amount of stress associated with earlier or concurrent life events does not seem to be related with infertility. Further prospective research is needed to validate these findings.
... with a significantly more pronounced effect (z = 3.19, p < .001) for women ; see also Boivin, Sanders, & Schmidt, 2006). Anxiety has also been found to influence pregnancy rates (Gulseren et al., 2006). ...
Psychological distress and infertility are linked in a complex pattern, such that distress may be a cause of infertility and reduce the probability of achieving a pregnancy at the same time that infertility may be a cause of psychological distress. Although infertile women are not more likely to be characterized by psychopathology, they are more likely to experience higher levels of distress than comparison groups. Infertile men also experience psychological distress, but women experience more infertility distress than men. Both infertility and its treatment are stressors putting a heavy psychological strain on couple relationships. Whereas there is general agreement about the need for psychological interventions to treat infertility distress, little is known about the efficacy and effectiveness of psychosocial intervention. Given the prevalence of infertility and the fact that the numbers of individuals and couples seeking infertility treatments are increasing, it is essential that mental health professionals understand the emotional challenges faced by this population.
... Basu (2002) and Yadava (1999) found association in women autonomy and fertility. Other factors like marital structure and stress have effects on women fertility as found by Yip and Lee (2002), and Boivin et al (2006). ...
Most of the developing countries are facing the problem of high population growth, which is causing numerous social and economic problems. The Total Fertility Rate (TFR) in most of developing countries stands higher than the developed countries (UNPD, 2000). The TFR in Pakistan was 7.0 in 1989.The continuous efforts on part of government of Pakistan bought it to 3.0 in 2008. The present study aimed at finding out the impact of education on Total Fertility Rate (TFR) in Pakistan during the period 1981-2008. Econometric techniques, Multiple Regression Model and Johansen Cointegration have been used to derive results. The results show that mean age at marriage (male), the education of both sexes and the age of women are the most important factors affecting TFR. Women education can be more useful weapon to control TFR, if it is at secondary level. Female age at marriage also negatively affects TFR. In order to achieve the desired level of population growth, the government of Pakistan should focus on Primary as well as secondary education for male as well as female.
... No 6 research has been undertaken to explore the potential impact of this on the ability of women to conceive, but experience of racist verbal abuse or physical violence is related to a greater risk of premature death, high blood pressure, respiratory illness; lower self-esteem, psychological distress, depression and anxiety, stress and anger and psychosis (Karlsen, 2007). The effects of psychological stress on human reproductive function have been shown (Cwikel et al, 2004;Boivin et al, 2006) and it is not unreasonable therefore, to suspect that stress arising from racism may be involved in fertility. ...
... The result of a study by Boivin et al in 2006 on social status and 3 variables of education, career and professional trainings showed that there was no significant relation between social status and stress during treatment. 19 Also, Alborzi in 2001 did not find any significant relation between career and mean score of infertility related stress among women under treatment. 20 Studies available to the researcher show no relation between infertility related stress and career, and since the present study measured the infertility treatment related stress (professional techniques of IVF, micro-injection, etc), this relation can be related to the interference of treatment stages with social and career situations, or women's idea of the necessity of postoperation rest, taking off days from work and their worries about the news going to colleagues. ...
Stillbirth is one of the deepest losses that can inflict a broad range of cognitive, mental, spiritual, and physical turmoil. Many researchers believe that the failure to provide the care required by health teams during the hard times is the main determinant of maternal mental health in the future. In other words, social support can significantly improve the mental health outcomes of mothers after stillbirth. This study aimed to explore social support to aid mothers in adaptation after the experience of stillbirth.
This was a qualitative content analysis in which 15 women who had experienced stillbirth participated. They were selected through purposeful sampling method. Data were gathered by individual interviews recorded on audiotapes, transcribed, and analyzed. Interview transcriptions were coded and then classified. Finally, two main categories and five subcategories emerged.
Analysis of participants' viewpoints and their statements about social support led to the emergence of the two main categories of support from relatives and support from social support systems with two and three subcategories, respectively. Analysis of findings showed that mothers experiencing stillbirth need the support of their spouse and family and friends through sympathizing, in performing everyday activities and to escape loneliness. These women require support from a peer group to exchange experiences and from trauma counseling centers to meet their needs.
It seems necessary to revise and modify the care plan in the experience of stillbirth using these results and, of course, to be considered by a panel of experts in order to provide social support to these women. Thus, midwives and healthcare provider can act, based on the development and strengthening of social protection of women experiencing stillbirth, to provide these women with effective and appropriate care.
... The use of assisted reproductive techniques (ART) is increasing steadily worldwide and in some European countries up to 4% of children are conceived through ART every year (de Mouzon et al., 2010). Couples who use ART to become parents make significant emotional, financial and time investments and have to cope with the loss of intimacy and the ups and downs of hope and disappointment during treatment (Baram, Tourtelot, Muechler, & Huang, 1988;Boivin, Sanders, & Schmidt, 2006;Read, 2004). If medical treatment is successful, the couples find themselves in the paradoxical situation of being both infertile and parents-to-be. ...
Objective: This article presents a study of the change over time in the family interactions of couples who conceived through in-vitro fertilisation (IVF).Background: Observational methods are rarely used to study family interactions in families who used assisted reproductive techniques, but these methods are crucial for taking account of the communication that occurs in interactions with infants.Methods: Thirty-one couples expecting their first child were seen during the fifth month of pregnancy and when the child was nine months old. Family interactions were recorded in pre- and postnatal versions of the Lausanne Trilogue Play situation. Measures of marital satisfaction and parent-to-foetus/baby attachment or ‘bonding’ were also used to assess family relational dynamics.Results: Results showed that family alliance, marital satisfaction and parental attachment scores in the IVF sample were all similar to or higher than those in the reference sample during pregnancy. However, at nine months postnatally, the family alliance scores were lower. While marital satisfaction decreased over the period and parent–baby attachment increased, the family alliance scores were unstable, as no association was observed between the pre- and postnatal scores. In addition, neither prenatal marital satisfaction nor parent–foetus attachment predicted the postnatal family alliance.Conclusion: The change in the family alliance over the transition to parenthood appears to be specific to our IVF sample. Given that postnatal family functioning could not be predicted by prenatal family functioning, our observational data underline the importance of offering postnatal support to these families.
... In social sciences, social class is often discussed in terms of 'social stratification'. According to Boivin et al. (2006), low social class, which may be equivalent to low resources, is likely to be associated with greater infertility-related stress. According to Waser and Isenberg (1986), reproductive suppression should vary according to the economic and social resources available to the individual because humans as a species are social and these resources are fundamental tools in the defence against stressful life events. ...
The aims of this study were to examine the association between (1) occupational social class and coping responses, (2) coping responses and infertility-related stress and (3) occupational social class and infertility-related distress.
The coping strategies that individuals use in most of the stressful situations vary according to certain factors, such as, the appraised characteristics of the stressful condition, personality dispositions and social resources.
This study was a cross-sectional survey.
The study involved 404 women undergoing infertility treatment at a public clinic in Athens, Greece. State and trait anxiety (State-Trait Anxiety Inventory), infertility-related stress (Copenhagen Multi-centre Psychosocial Infertility) and coping strategies (Copenhagen Multi-centre Psychosocial Infertility) were measured.
Women of low/very low social class reported higher levels of active-confronting coping compared with women of higher social class (p < 0·001). A positive correlation between active-avoidance coping and both state and trait anxiety (r = 0·278 and 0·233, respectively, p < 0·01) was observed. The passive-avoidance coping scale was positively correlated with marital and personal stress (r = 0·186 and 0·146, respectively, p < 0·01). All three kinds of stress (marital, personal and social) were positively correlated with both active-avoidance (r = 0·302, 0·423 and 0·211, respectively, p < 0·01) and active-confronting scale (r = 0·150, 0·211 and 0·141, respectively, p < 0·01).
Infertile women of the lowest social class used more active-confronting coping and more passive-avoidance coping than women of the highest social class. Factors such as low social class and maladaptive coping strategies might contribute to infertility-related stress and anxiety.
Nurses and midwives who work in infertility clinics should aim to identify individuals who are at high risk for infertility stress and adjustment difficulties and they should minimise the identified risk factors for infertility-related stress and strengthen the protective factors.
... [5][6][7][8][9][10][11][12][13][14][15] The following have also been suggested as influencing time to pregnancy: long working hours, parity, BMI, menstrual cycle, contraception history, and psychosocial factors. 11,[16][17][18][19][20][21][22][23] Research to date has often considered the impact of demographic, physical (BMI) and lifestyle (smoking and alcohol consumption) factors on time to pregnancy. 18,[24][25][26] Most studies to date, however, have not considered psychosocial factors in conjunction with these other factors. ...
The primary objective of this analysis was to describe demographic, physical, lifestyle, and psychosocial factors related to becoming pregnant in six months or less among women under 35 years of age who delivered a live-born infant. We also wished to determine the relative impact of these factors on time to pregnancy, regardless of use of fertility treatment.
Between July 2002 and September 2003, we conducted a survey by telephone interview of 1044 randomly selected women who had recently delivered their first live-born infant in Calgary or Edmonton, Alberta.
Among 575 women who were less than 35 years of age when they began trying to conceive and who ultimately delivered a live-born infant, the most significant predictors of taking more than six months to conceive included being overweight or obese (hazard ratio [HR] 1.34; 95% CI 1.05 to 1.72), having a history of pregnancy complications (HR 1.42; 95% CI 1.02 to 1.99), and having fair or poor self-rated emotional health six months prior to pregnancy (HR 2.02; 95% CI 1.27 to 3.22). The influence of BMI and emotional health on time to conception did not change substantially when women who had assistance with conception (16% of the sample) were excluded from the analysis.
Among those who ultimately carry a pregnancy to delivery, the relationship between high BMI or poor emotional health and delays in conception was evident among women who conceived with or without assistance. Public health strategies that help women to achieve optimal body weight and address issues of emotional health may reduce the need for assisted reproduction.
Although the association between stress and poor reproductive health is well established, this association has not been examined from a life course perspective. Using data from the National Longitudinal Survey of Youth 1997 cohort ( N = 1652), we fit logistic regression models to test the association between stressful life events (SLEs) (e.g., death of a close relative, victim of a violent crime) during childhood, adolescence, and early adulthood and later experiences of infertility (inability to achieve pregnancy after 12 months of intercourse without contraception) reported by female respondents. Because reactions to SLEs may be moderated by different family life experiences, we stratified responses by maternal responsiveness (based on the Conger and Elder Parent-Youth Relationship scale) in adolescence. After adjusting for demographic and environmental factors, in comparison to respondents with one or zero SLEs, those with 3 SLEs and ≥ 4 SLEs had 1.68 (1.16, 2.42) and 1.88 (1.38, 2.57) times higher odds of infertility, respectively. Respondents with low maternal responsiveness had higher odds of infertility that increased in a dose–response manner. Among respondents with high maternal responsiveness, only those experiencing four or more SLEs had an elevated risk of infertility (aOR = 1.53; 1.05, 2.25). In this novel investigation, we demonstrate a temporal association between the experience of SLEs and self-reported infertility. This association varies by maternal responsiveness in adolescence, highlighting the importance of maternal behavior toward children in mitigating harms associated with stress over the life course.
Infertility is defined as the lack of conception after 12 months of unprotected intercourse and is perceived as a problem in all cultures and societies. It is estimated that between 16 and 26% of European women trying to have children face infertility. From recent studies, it appears that a common reaction during fertility treatment is anxiety, while after an unsuccessful IVF, feelings of sadness, depression and anger may appear. A range of psychosocial variables (personality traits, coping strategies, social support) may influence infertile women's anxiety and stress during infertility treatment. The objective of the present chapter was to review studies describing specifically the impact of sociodemographic factors on anxiety experienced by infertile women undergoing fertility treatment. The sociodemographic background information includes variablesconcerning age, educational level, annual income and occupational social position. Sociodemographic factors are known to influence a wide range of issues, opinions, beliefs and feelings. According to Waser and Isenberg, reproductive suppression should vary according to the economic and social resources available to the individual because, humans as a species are social, and these resources are fundamental tools in the defence against stressful life events. Individuals with more resources have stronger defences and are better able to withstand the effects of stress than those with fewer resources. Therefore, it is expected and hypothesized that sociodemographic factors may influence levels of anxiety and stress during fertility treatment and that women of lower educational level, lower income and lower social class will experience a higher level of anxiety because they lack environmental 'buffers' against psychosocial stress. A systematic search of the psychological and medical electronic databases (Medline, PsycINFO, CINAHL, EMBASE and Scopus) was performed. Finally, thirteen studies that were relevant to the objective of the review chapter were included. The majority of the included studies failed to find a significant association between female age and levels of anxiety during fertility treatment. The majority of the included studies found that educational level and annual income level are statistically associated with levels of anxiety during fertility treatment. Nevertheless, the association between occupational social class and levels of anxiety is not significant. Thus, this chapter suggests that certain sociodemographic factors might make particular infertile individuals more vulnerable to anxiety. Low educational level and low income could be considered as risk factors for increased anxiety in infertile individuals undergoing infertility treatment. By assessing these factors, medical professionals who work in infertility clinics, may be able to identify individuals who are at greater risk of adjustment difficulties. Health care professionals should provide counselling which is tailored to the educational and social needs of the women.
Az asszisztált reprodukció a termékenységi problémák mesterséges, testen kívüli kezelése. Élveszülésben mért eredményessége megkezdett terápiás ciklusonként 17-18 százalék körül van, mely ciklusokba azok is beleértendők, amelyekben a páciens nem jut el a tényleges beültetésig, illetve amelyekben létrejön ugyan klinikai terhesség, de a páciens végül elvetél. Az asszisztált reprodukció reményforrás a nem-akaratlagos gyermektelenek számára, ugyanakkor betegstátuszba helyezi és minden fázisában kudarccal fenyegeti őket. Kicsi a valószínűsége, hogy a lelki tényezők önmagukban meddőséget okoznának, de elképzelhető, hogy hozzájárulnak ahhoz. A stressz negatívan befolyásolhatja a termékenységet, ám ezt számos tényező (megküzdés, reziliencia stb.) ellensúlyozhatja. A meddőséggel küzdő személyek nem eleve szorongóbbak vagy lehangoltabbak az átlagnál, hanem a diagnózissal való szembesülés jár jelentős distresszel, amit a meddőségi kezelések tovább súlyosbíthatnak. Az IVF-ciklus előtti pszichés állapot és a kezelés eredményessége között nem találtak szignifikáns összefüggést, ugyanakkor egy kisebb, pszichológiailag sérülékeny csoport esetében mégiscsak gyengébb sikeraránnyal kell számolnunk. A meddőség oki háttere nem befolyásolja jelentősen a stresszszintet, de van adat arra, hogy a férfi-okra visszavezethető illetve a megmagyarázhatatlan eredetű meddőség jobban megterheli a párt a női vagy közös hátterű infertilitásnál. A magasabb női életkor nem jár az általános lelkiállapot feltétlen romlásával, de az asszisztált reprodukció sikerét tekintve kockázati tényezőt jelent. A meddőség és annak kezelése általában negatívabb hatással van a nők lelkiállapotára, mint a férfiakéra, de férfi-hátterű infertilitás esetén a szenvedés mértéke nem különbözik jelentősen. Ugyanakkor a nők változatosabban és erőteljesebben használják megküzdési stratégiáikat is. Az asszisztált reprodukciós beavatkozás két legmegterhelőbb fázisa a petesejtleszívás és az embriótranszfer. A beavatkozás eredményének közlése ugyancsak erőteljes stresszor a kezeltek számára. A pszichés állapot a meddőségi diagnózis óta eltelt idő tengelyén erőteljes hullámzást mutat. Az IVF-beavatkozások többszörös ismétlődése ront a kezeltek lelkiállapotán. Az asszisztált reprodukciós kezelések megszakításának leggyakoribb oka a stressz kumulálódása. A negatívabb pszichés állapot gyakran hosszú távon is fennáll, de a jobb megküzdési stratégiák, a családalapítás egyéb módjai és az új életcélok ezen is enyhíthetnek. A meddőség nemcsak orvosi-pszichológiai, hanem társadalmilag konstruált valóság is, melyben az IVF társas jelentésében, hozzáférhetőségében és minőségében drasztikus különbségek adódhatnak a különböző kultúrákban.
Háttér és célkitűzések: vizsgálatunk célja magyar mintán ellenőrizni a meddőség pszichés vonatkozásait feltáró eddigi, nemzetközi eredményeket. Módszer: 75 fős (63 nő, 12 férfi), magyar, kényelmi, keresztmetszeti minta felmérése történt önkitöltős, részben sztenderdizált kérdőívekkel. Eredmények: a vizsgált nők depresszióértékei szignifikánsan magasabbak a Hungarostudy Epidemiológiai Panelvizsgálat országos reprezentatív vizsgálatban talált, nőkre vonatkozó, 2006-os pontszámoknál (BDI-S; átlag (M)=13,9; szórás(SD)=13,4; vs. M=9,7; SD=11,9; p<0,05). Az élet értelmességének mértéke szignifikánsan alacsonyabb az átlagnépesség sztenderdjeinél (BSCI-LM-7, M=8,9; SD=3,2; vs. M=9,9; SD=2,8; p<0,05). Állapot- és vonásszorongásszintjük azonban nem különbözik ezektől (rendre p=0,205 és p=0,477). A férfiak semmilyen mutató mentén nem tértek el az országos átlagoktól. Mintánkon belül sem a nem, sem az életkor, egy gyermek léte vagy a meddőség hossza, diagnózisa, a kezelések mennyisége és minősége nem látszott befolyásolni a lelkiállapotot. Szignifikánsan magasabb volt mind az állapot-, mind a vonásszorongása azoknak a nőknek, akik spontán vetélést éltek át, szemben azokkal, akiknek nem volt vetélésük, vagy terhesség-megszakításuk (is) volt (STAI-S; M=49,5; SD=13,8; vs. M=41,4; SD=11,9; p<0,05; / STAI-T; M=47,4; SD=11,6; vs. M=41,5; SD=10,4; p<0,05). Azok a med-dők, akik nem hisznek egy transzcendens hatalom létében vagy bizonytalanok, szignifikánsan magasabb depresszió-pontszámot értek el azoknál, akik hisznek (BDI-S, M=17,1; SD=15,1; vs. M=10,0; SD=10,1; p<0,05). A válaszadók 44%-a hiányolja a meddőségi centrumokban a pszicho-lógiai segítségnyújtást. Következtetések: a pilot-vizsgálat alátámasztja a nemzetközi eredményeket, miszerint a termékenységre várók lényegesen lehangoltabbak és életüket kevésbé érzik értelmesnek a ter-mékenységi nehézségekkel nem küzdőknél. Ez megfontolandóvá teszi a meddőségi kezelések során nyújtott pszichés támogatás beépítését a szakmai protokollba.
Jelen tanulmány a meddőség pszichés vonatkozásairól szóló jelentősebb kutatások eredményeit foglalja össze. Ebből a célból főleg az angol nyelvű adatbázisokban elérhető tanulmányokat tekintettük át szisztematikus kulcsszókereséses módszerrel, de támaszkodtunk a magyar szakirodalomra is. A legvilágosabban kirajzolódó következtetés az, hogy a meddőség lelki előzményei és következményei nehezen választhatók szét. Nincs megdönthetetlen bizonyíték arra nézve, hogy a stressz, a szorongás és a lehangoltság önmagában meddőséget okozna, de számos jel utal rá, hogy hozzájárul és együtt jár a terméketlenséggel. Hasonlóképpen nehéz elkülöníteni, hogy a pszichés hatások maga a meddőség vagy a megterhelő asszisztált reprodukciós beavatkozások következményei. Vegyesek a tapasztalatok arra nézve is, hogy a pszichoterápiát milyen mértékben veszik igénybe a páciensek, illetve ez mennyiben járul hozzá a beavatkozások sikeréhez, de egyetlen általunk ismert tanulmány sem kérdőjelezi meg, hogy pszichés támogatásra a meddőség kezelése során szükség van. A spirituális dimenzió és a meddőség kapcsolata kevéssé kutatott téma, de néhány tanulmány a vallásos megküzdési módok bevonását is indokoltnak tartja a meddőség kezelésébe. A magyarországi gyakorlatban mindez ma még nem magától értetődő. Összességében a tanulmány a meddőség cirkuláris oksági, rendszerszemléletű megközelítése mellett érvel.
There is a growing concern with whether nonregular professionals are concurrently committed to both the organization and their profession and whether such commitments are beneficial to that organization. This article seeks to investigate the relationship between organizational justice variables and the dual commitment of nonregular professionals via perceived organizational support (POS) and the subsequent effect of the dual commitment on organizational citizen behavior. Hypotheses are developed and then tested through structural equation modeling with data collected from a total of 1143 part-time instructors at South Korean universities. The findings of this study reveal that the perceptions held by nonregular professionals of organizational justice constructs concurrently influence organizational commitment and professional commitment via POS and that both commitments are positively associated with altruistic behavior. The findings advance our understanding of the dual commitment of nonregular professionals and provide universities with managerial implications as to how to manage effectively part-time instructors. Limitations, directions for future research, and conclusions are presented.
The aim of this study was to determine the social support and hopelessness in women undergoing infertility treatment in eastern Turkey.
For this descriptive design study, the sample was composed of 456 women.
Beck's Hopelessness Scale (BHS) and the Multidimensional Scale of Perceived Social Support (MSPSS) were used. Percentile, correlation, unpaired t test, and one-way analysis of variance test were used for statistical analysis.
The mean BHS score was 6.97 ± 3.64, with a range of 0-19 while the mean MSPSS score was 61.98 ± 16.05 with a range of 12-84. A negative correlation (r = -.336, p = .000) was noted between MSPSS scores and BHS scores.
Hopelessness levels in women negatively correlate with reported level of social support. Informing health professionals about these issues will be an important step toward improving the quality and levels of social support given to women undergoing infertility treatment.
To examine whether pretreatment emotional distress in women is associated with achievement of pregnancy after a cycle of assisted reproductive technology.
Meta-analysis of prospective psychosocial studies.
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.
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.
The findings of this meta-analysis should reassure women and doctors that emotional distress caused by fertility problems or other life events co-occurring with treatment will not compromise the chance of becoming pregnant.
To investigate race and ethnicity as risk factors for breech presentation.
Case-control study using a population-based birth certificate registry that included linkage to Medicaid/Women, Infants, & Children (WIC) eligibility data for a socioeconomic proxy variable.
Florida, USA.
912,107 mothers of singletons born in Florida 1999 to 2003.
Maternal race and ethnicity were evaluated as risk factors for breech presentation using logistic regression. The dependent variable was birth presentation. Covariates were variable measures that have been repeatedly identified as risk factors for breech presentation in the literature and are known to be highly accurate birth certificate variable measures.
White women were 69% more likely to have a breech baby (adjusted odds ratio [OR]=1.69, 95% confidence interval [CI] 1.63, 1.76) than Black women. Higher socioeconomic status was a risk factor in the bivariate analyses, but not in the adjusted analysis. Prematurity, nulliparity, female infant, and advancing maternal age were risk factors in the final model. The final model accounted for <5% of the total variance (Max Rescaled R(2)=4.18%), and thus was poorly fit (Hosmer and Lemeshow goodness of fit <0.0001).
White women were at increased risk of having a breech baby. However, important variables appear to be missing from the model.
Births to women of advanced maternal age have increased dramatically over the last decade in both the United States. The majority of women who deliver their first baby after age 35 are healthy and experience positive birth outcomes. According to current research, primigravidas over 35 tend to be educated consumers. Their physical and psychosocial needs differ from those of the mother in her 20s, due to advanced age and factors related to difficulty conceiving and life circumstances. This paper presents (a) an overview of the possible risks to outcomes of childbearing for women over the age of 35; (b) a discussion of how women of advanced maternal age may differ from younger women related to developmental stage, stress or anxiety or both, decision making, and support systems; and (c) an exploration of tailoring nursing care strategies during the peripartum period specifically for this age cohort.
Objective.
—This article defines stress and related concepts and reviews their historical development. The notion of a stress system as the effector of the stress syndrome is suggested, and its physiologic and pathophysiologic manifestations are described. A new perspective on human disease states associated with dysregulation of the stress system is provided.
This study investigated 3 broad classes of individual-differences variables (job-search motives, competencies, and constraints) as predictors of job-search intensity among 292 unemployed job seekers. Also assessed was the relationship between job-search intensity and reemployment success in a longitudinal context. Results show significant relationships between the predictors employment commitment, financial hardship, job-search self-efficacy, and motivation control and the outcome job-search intensity. Support was not found for a relationship between perceived job-search constraints and job-search intensity. Motivation control was highlighted as the only lagged predictor of job-search intensity over time for those who were continuously unemployed. Job-search intensity predicted Time 2 reemployment status for the sample as a whole, but not reemployment quality for those who found jobs over the study's duration. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This article defines stress and related concepts and reviews their historical development. The notion of a stress system as the effector of the stress syndrome is suggested, and its physiologic and pathophysiologic manifestations are described. A new perspective on human disease states associated with dysregulation of the stress system is provided.
Published original articles from human and animal studies and selected reviews. Literature was surveyed utilizing MEDLINE and the Index Medicus.
Original articles from the basic science and human literature consisted entirely of controlled studies based on verified methodologies and, with the exception of the most recent studies, replicated by more than one laboratory. Many of the basic science and clinical studies had been conducted in our own laboratories and clinical research units. Reviews cited were written by acknowledged leaders in the fields of neurobiology, endocrinology, and behavior.
Independent extraction and cross-referencing by the authors.
Stress and related concepts can be traced as far back as written science and medicine. The stress system coordinates the generalized stress response, which takes place when a stressor of any kind exceeds a threshold. The main components of the stress system are the corticotropin-releasing hormone and locus ceruleus-norepinephrine/autonomic systems and their peripheral effectors, the pituitary-adrenal axis, and the limbs of the autonomic system. Activation of the stress system leads to behavioral and peripheral changes that improve the ability of the organism to adjust homeostasis and increase its chances for survival. There has been an exponential increase in knowledge regarding the interactions among the components of the stress system and between the stress system and other brain elements involved in the regulation of emotion, cognitive function, and behavior, as well as with the axes responsible for reproduction, growth, and immunity. This new knowledge has allowed association of stress system dysfunction, characterized by sustained hyperactivity and/or hypoactivity, to various pathophysiologic states that cut across the traditional boundaries of medical disciplines. These include a range of psychiatric, endocrine, and inflammatory disorders and/or susceptibility to such disorders.
We hope that knowledge from apparently disparate fields of science and medicine integrated into a working theoretical framework will allow generation and testing of new hypotheses on the pathophysiology and diagnosis of, and therapy for, a variety of human illnesses reflecting systematic alterations in the principal effectors of the generalized stress response. We predict that pharmacologic agents capable of altering the central apparatus that governs the stress response will be useful in the treatment of many of these illnesses.
The purpose of the study was to examine the stress associated with in-vitro fertilization (IVF) concurrently with other physical
and relational variables, and to compare these reactions with those reported during a menstrual cycle without treatment. Women
(n = 20) completed a daily symptom checklist for one complete menstrual cycle without treatment and one complete IVF cycle.
The checklist included items related to stress, optimism, physical discomfort and marital and social relationships. Daily
ratings during IVF were compared with those obtained during the no-treatment menstrual cycle. IVF was associated with more
stress, optimism and physical discomfort than a menstrual cycle without treatment, and with greater changes to marital and
social relationships. The pattern of results shows that the stress associated with IVF is less salient when examined in the
context of reactions in other areas of functioning. The findings suggest that the emotional impact of IVF might be less pronounced
during the actual treatment process than is generally assumed from studies focusing on the impact of treatment failure. Variables
such as optimism and physical discomfort which have previously received less attention in the literature were significantly
affected by IVF treatment.
The objective of this study was to compare average stress levels during the month of conception to those of previous infertile
months. We postulated that stress level during the actual month of conception would be lower than that during previous non-conception
cycles. Thirteen normal women from the general community, who were attempting pregnancy, kept daily records of coital activity
and basal body temperature, and twice a month completed self-administered questionnaires and provided a 12 h overnight urine
sample. On average, women reported significantly more favourable mood states on standard psychometric tests, during the month
of conception than during the previous non-conception cycles. In addition, they felt significantly less 'hassled' during the
month of conception. However, mean urinary hormone excretion of adrenaline, noradrenaline and cortisol did not significantly
differ between conception and non-conception cycles and there was little relationship between the psychological measures of
mood state and excretion of adrenaline and cortisol. There was no evidence of increased coital frequency during the month
of conception when mood states were improved, suggesting that stress effects on libido were unlikely to account for the findings.
The results support the conclusion that psychosocial stress influences fertility in females but as yet mechanisms remain unclear.
The purpose of this study was to examine differences in daily emotional, physical and social reactions among husbands and
wives during in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). Forty couples about to undergo ICSI
or IVF at a private infertility clinic monitored their emotional, physical and social reactions daily for one complete treatment
cycle from the first day of stimulation until the outcome of treatment was known (approximately 35 days). The results showed
that men and women had a similar response pattern to oocyte retrieval, fertilization, embryo transfer and the pregnancy test.
These stages were associated with the most significant changes in reactions for both spouses. The pattern of results suggested
that the most important psychological determinant of reactions during IVF was the uncertainty of treatment procedures. Spouses
appeared to be equally sensitive to this uncertainty and both appeared to respond to it with ambivalent feelings involving
emotional distress and positive feelings of hope and intimacy.
The purpose of this study was to determine the relationship between psychological stress and semen quality among men undergoing in-vitro fertilization (IVF). We assessed psychological variables, including self-reported stress, and sperm parameters in a group of 40 men undergoing IVF for the first time at a pre-IVF sampling period (T1) and at the time of egg retrieval (T2). Thirty-one patients completed the study. Results indicated that total and motile sperm concentration, total motile spermatozoa, and lateral head displacement decreased significantly from T1 to T2 in a high percentage of participants. In addition, the perceived importance of producing a semen specimen increased significantly (P = 0.001) from T1 to T2, and this change was significantly correlated (P < 0.05) with diminished semen quality at the time of oocyte retrieval. No decline in the semen quality or increase in perceived stress at egg retrieval was observed at T2 in male factor patients (n = 7). This study provides evidence for a significant decline in semen quality of male IVF patients at egg retrieval and demonstrates an inverse relationship between semen quality and specific aspects of psychological stress.
The study aim was to clarify the role of anxiety and depression on the outcome in assisted reproductive treatment. Previous studies on this topic have shown contradicting results, which may have been caused by population characteristics, the design of the study, or small sample sizes.
In a multicentre prospective study, 291 out of 359 (81%) consecutively invited women agreed to participate. Before down-regulation by means of gonadotrophin-releasing hormone (GnRH) analogues in a long IVF protocol, patients were asked to complete the Dutch version of the State and Trait Anxiety Inventory to measure anxiety, and the Dutch version of the Beck Depression Inventory (BDI) to measure depression. Multiple logistic regression analysis was used to analyse known predictors of pregnancy and psychological factors and their relationship with treatment outcome.
A significant relationship was shown between baseline psychological factors and the probability to become pregnant after IVF/intracytoplasmic sperm injection (ICSI) treatment, controlling for other factors. State anxiety had a slightly stronger correlation (P = 0.01) with treatment outcome than depression (P = 0.03).
Pre-existing psychological factors are independently related to treatment outcome in IVF/ICSI, and should therefore be taken into account in patient counselling. Psychological factors may be improved by intervention, whereas demographic and gynaecological factors cannot. Future studies should be directed towards underlying mechanisms involved and the role of evidence-based distress reduction in order to improve treatment results.
Agriculturalists in less-developed countries (LDC) have lower progesterone levels than urban industrialized populations. However, it is unknown if urban LDC populations are also relatively lower. We tested whether urban Bolivia samples-poorer (Bol-p) and better-off (Bol-b)-have lower progesterone than a Chicago (USA) sample, and whether progesterone and rate of ovulation are lower in Bol-p than in Bol-b.
Serial salivary samples collected from Bolivians, screened according to strict exclusion criteria during two complete menstrual cycles, were radioimmunoassayed for progesterone; anthropometrics were collected at mid-follicular and mid-luteal phases.
Progesterone levels are lower in the Bolivia samples, and higher in the Bol-b than Bol-p; ovulation rate is greater in Bol-b than Bol-p. For only ovulatory cycles, mean-follicular-P (pmol/l), mean-luteal-P (pmol/l), and mean-peak-P (pmol/l) are respectively 65, 142 and 208 in Bol-p; 76, 167 and 232 in Bol-b; and 96, 240 and 330 in Chicago. Principal components representing body-size and progesterone level are positively correlated (r = 0.404, P = 0.005).
Progesterone levels appear to be influenced by chronic and acute ecological conditions, evidenced by the association with body-size and the probability of ovulation respectively. These findings have implications for understanding cancer aetiology, developing population-appropriate hormonal contraceptives, and modelling the evolution and functioning of the reproductive system.
Social isolation is a potent but little understood risk factor for morbidity and mortality, and its negative consequences are most profound among the elderly, the poor, and minorities, some of the fastest growing segments of the U.S. population. A steadily increasing number of people are living alone and are therefore more likely to experience social isolation. We discuss four mechanisms--attractiveness, health behavior, stress, and repair and maintenance--by which perceived social isolation might affect health. Our studies show that neither attractiveness nor health behaviors differ as a function of social isolation, but stress and repair and maintenance do seem to be factors. While socially isolated young adults did not report more frequent everyday stressors, they rated everyday events as more intensely stressful. They were also more likely to report passively coping with stressors, and to show greater vascular resistance, a mechanism of blood pressure control previously associated with passive coping and a risk factor for hypertension. Finally, they exhibited less efficacious repair and maintenance of physiological functioning, including slower wound healing and poorer sleep efficiency. These mechanisms have implications for designing appropriate interventions. We advocate a national health care plan that promotes preventive medicine, recognizes the significance of stress-related disorders, and supports the maintenance of social connections across the life span.
The aims were: (i). to identify gender differences in evaluation of medical and patient-centred (psychosocial) care in fertility clinics and (ii). to identify predictors of satisfaction.
An epidemiological prospective study based on questionnaire responses among all new couples attending five fertility clinics. The response rate at the 12 month follow-up was 87.7% and included a total of 1934 patients.
During the follow-up period about two-thirds had achieved a pregnancy and about a third became parents. The participants were satisfied with both the medical and patient-centred (psychosocial) services. There were no sex differences in the evaluation of treatment except that women were more satisfied than men with how the staff had performed their medical examinations. Satisfaction with medical and patient-centred services was positively associated with a treatment-related pregnancy/delivery and the report of marital benefits resulting from the infertility experience. Lower social class was a significant predictor for satisfaction.
Both men and women in fertility treatment had high ratings on medical and patient-centred care. It seemed that satisfaction with the psychosocial services was higher than in earlier studies from other countries.
The association between low socioeconomic status and poor health is well established. Empirical studies suggest that psychosocial factors are important mediators for these effects, and that the effects are mediated by psychobiological mechanisms related to stress physiology. The objective of this paper is to explore these psychobiological mechanisms. Psychobiological responses to environmental challenges depend on acquired expectancies (learning) of the relations between responses and stimuli. The stress response occurs whenever an individual is faced with a challenge. It is an essential element in the total adaptive system of the body, and necessary for adaptation, performance and survival. However, a period of recovery is necessary to rebalance and to manage new demands. Individuals with low social status report more environmental challenges and less psychosocial resources. This may lead to vicious circles of learning to expect negative outcomes, loss of coping ability, strain, hopelessness and chronic stress. This type of learning may interfere with the recovery processes, leading to sustained psychobiological activation and loss of dynamic capacity to respond to new challenges. Psychobiological responses and health effects in humans and animals depend on combinations of demands and expected outcomes (coping, control). In studies of humans with chronic psychosocial stress, and low SES, cortisol baseline levels were raised, and the cortisol response to acute stress attenuated. Low job control was associated with insufficient recovery of catecholamines and cortisol, and a range of negative health effects. Biological effects of choice of lifestyle, which also depends on the acquired outcome expectancies, reinforce these direct psychobiological effects on health. The paper concludes that sustained activation and loss of capacity to respond to a novel stressor could be a cause of the higher risk of illness and disease found among people with lower SES.
European results of assisted reproductive techniques from treatments initiated during 2001 are presented in this fifth report. Data were collected mainly from already existing national registers. From 23 countries, 579 clinics reported 289 690 cycles with: IVF 120 946, ICSI 114 378, frozen embryo transfer (FER) 47 195 and egg donation (ED) 7171. Overall this represents a 4% increase since the year 2000. For the first time, results on European data on intra-uterine inseminations (IUIs) were reported from 15 countries. A total of 67 124 cycles [IUI husband'sperm (IUI-H) 52 949 and IUI donor sperm (IUI-D) 14 185] were included. In 12 countries where all clinics reported to the register, a total of 108 910 cycles were performed in a population of 131.4 million, corresponding to 829 cycles per million inhabitants. For IVF, the clinical pregnancy rate per aspiration and per transfer was 25.1 and 29.0%, respectively. For ICSI, the corresponding rates were 26.2 and 28.3%. These figures are similar to the results from 2000. After IUI-H, the clinical pregnancy rate was 12.8% in women <40 and 9.7% in women > or =40 years of age. After IVF and ICSI, the distribution of transfer of one, two, three and > or =4 embryos was 12.0, 51.7, 30.8 and 5.5%, respectively. Compared with the year 2000, fewer embryos were transferred, but huge differences existed between countries. The distribution of singleton, twin and triplet deliveries for IVF and ICSI combined was 74.5, 24.0 and 1.5%, respectively. This gives a total multiple delivery rate of 25.5%, compared with 26.9% in the year 2000. The range of triplet deliveries after IVF and ICSI differed from 0.0 to 8.2% between countries. After IUI-H in women <40 years of age, 10.2% were twin and 1.1% were triplet gestations.
The aim of this study was to examine the unique and shared predictive power of psychological variables on reproductive physical health. Three months before fertility treatment, 97 women completed measures of dispositional optimism, trait anxiety, and coping. Information about biological response to treatment (e.g., estradiol level) was collected from medical charts after treatment. Structural equation modeling showed that measured psychological variables were all significant indicators of a single latent construct and that this construct was a better predictor of biological response to treatment than was any individual predictor. This research contributes to evidence suggesting that the health benefits of dispositional optimism are due to its shared variance with neuroticism.
The aim of the study was to investigate the effect of psychological stress before and during IVF treatment on the outcome of IVF, controlling for known physiological predictors.
This is a prospective, longitudinal study. A total of 166 women were studied during their first IVF treatment. They answered questionnaires concerning psychological and social factors on two occasions. Psychological well-being was measured by the Psychological General Well-Being (PGWB) index and psychological effects of infertility were assessed by 14 items.
In the analysis of the psychological variables, no differences were found between pregnant and non-pregnant women. The total number of good quality embryos, the number of good quality embryos transferred, and the number of embryos transferred were significantly higher in the pregnant than in the non-pregnant group. In a multivariate analysis, the number of good quality embryos transferred was the only variable that was independently associated with pregnancy.
We found no evidence that psychological stress had any influence on the outcome of IVF treatment. When counselling infertile couples, it might be possible to reduce the stress they experience during the treatment procedure by informing them of these findings.
At the sociocultural level human reproductive decisions are exceedingly complex. Individual motivations are influenced and constrained by partners, peers and family, by religious values and legal statutes, by individual psychology, national economic trends and geopolitical conflicts. Yet reproductive ‘decisions’ of a certain sort are also made at a physiological level. To an extent these physiological ‘decisions’ may be easier to comprehend than those at the sociocultural level in that the patterns they present may be more consistent and easier to describe, although they are not without subtleties of their own. This paper will concern itself with a subset of these physiological decisions, those that are made in the form of natural variations in female ovarian function which in turn, modulate female fecundity. It will not consider the role of lactation in modulating human ovarian function, as that will be the subject of a separate paper in this volume. Rather it will only consider ovarian function in non-pregnant, non-lactating women. Yet within this restricted context considerable variation exists that can be understood not as a pathological failure of homeostasis but as a functional adjustment of female fecundity to the likelihood of a successful reproductive outcome and the balance of competing reproductive and physiological investments.
The purpose of this study was to determine the relationship between psychological stress and semen quality among men undergoing
in-vitro fertilization (IVF). We assessed psychological variables, including self-reported stress, and sperm parameters in
a group of 40 men undergoing IVF for the first time at a pre-IVF sampling period (T1) and at the time of egg retrieval (T2).
Thirty-one patients completed the study. Results indicated that total and motile sperm concentration, total motile spermatozoa,
and lateral head displacement decreased significantly from T1 to T2 in a high percentage of participants. In addition, the
perceived importance of producing a semen specimen increased significantly (P = 0.001) from T1 to T2, and this change was significantly correlated (P < 0.05) with diminished semen quality at the time of oocyte retrieval. No decline in the semen quality or increase in perceived
stress at egg retrieval was observed at T2 in male factor patients (n = 7). This study provides evidence for a significant decline in semen quality of male IVF patients at egg retrieval and demonstrates
an inverse relationship between semen quality and specific aspects of psychological stress.
Infertility is a major life stressor that affects approximately 10% of U.S. married couples. Infertile women and men have reported experiencing depression, helplessness, and marital strain. Given U.S. society's emphasis on women's role as mothers, it has been suggested that women's lives are more disrupted by infertility than those of men. This hypothesis was supported in a survey of 185 infertile couples and 90 presumed fertile couples. Infertile wives, as compared to their husbands, perceived their fertility problem as more stressful, felt more responsible for and in control of their infertility, and engaged in more problem-focused coping. Infertile husbands experienced more home life stress and lower home life performance than did their wives. These differences were not found for presumed fertile couples. Both infertile and presumed fertile wives experienced more depression, more sexual dissatisfaction, and lower self-esteem than did their husbands. Theoretical and counseling implications of these findings are discussed.
A wide variety of mammals suppress their reproduction in response to cues reflecting environmental harshness, or poor physical condition of themselves or their developing conceptus. Such reproductive suppression may take the form of delayed sexual maturation, ovulatory or implantational failure, spontaneous abortion, abandonment, neglect, abuse, or infanticide. The literature we review suggests that reproductive suppression is equally prevalent among humans. However, while such phenomena among non-human mammals are commonly viewed as an adaptive response to poor reproductive conditions, similar phenomena among humans are often viewed as pathological. This paper describes a model for the evolution of reproductive ‘failure' among female mammals, termed the Reproductive Suppresion Model (RSM). It then reviews the literature on psychosocial stress and reproductive outcome among women, showing where these data are consistent with expectations from the RSM. Some biomedical studies of reproductive failure among humans that are consistent with the RSM are described as well, as are data on conscious decisions to contracept and electively terminate pregnancy. The paper then turns to approaches that address the evolution of social systems, in general, showing how questions generated from such models might also be applied to studies of psychosocial dynamics and reproductive outcomes among humans. Means we are using to acquire the appropriate data to address such questions among contemporary human populations are described, as are implications of this overall approach to biomedical practices.
A series of eight hypotheses is presented, based on the results of current research, concerning the responsiveness of the human ovary to constitutional and environmental variables. These hypotheses are motivated by a theoretical position that seeks to understand human reproductive physiology as the product of natural selection. The hypotheses are: (1) Ovarian responsiveness occurs along a graded continuum. (2) The graded continuum of response forms a final common pathway for various “stresses.” (3) Ovarian function tracks energy balance, not simply nutritional status. (4) Ovarian function tracks aerobic activity independently of energy balance. (5) Additive interactions characterize the interaction of constitutional and environmental factors modulating ovarian function. (6) Reproductive maturation is synchronized with skeletal maturation, especially of the pelvis. (7) Peak ovarian function is not ordinarily achieved until the early twenties. (8) Late reproductive maturation is associated with a slower rise in indices of ovarian function with age, and a lower level of ovarian function in adulthood. Together, these hypotheses provide for two, non-exclusive theories of facultative modulation of female reproductive effort. One theory views ovarian function as responsive to the prospects for positive reproductive outcome as these may be affected by maternal age, maturation, energy balance, and activity level. The second theory views ovarian function as responsive in a similar way to the need to maintain long-term maternal energy balance.
The effect of a coping-ineffectiveness of coping construct and of psychoendocrine stress responses upon the outcome of in vitro fertilization treatment was investigated in 40 women. Women with a high Zung depression score, high active coping, high avoidance, and a high expression of emotion have lower pregnancy rates. The mechanisms for this personality effect are not clear, although the desensitization-stimulation process (FSH, E2 concentrations) seems to be involved. The psychoendocrinological responses to the stress of oocyte retrieval and embryo transfer are important: Women with high anticipatory state anxiety levels and high anticipatory cortisol concentrations have lower pregnancy rates. The influence of prolactin stress concentrations is unclear: Women with high prolactin concentrations seem to have more oocytes but lower fertilization rates.
Evidence scattered over the literatures of zoology, psychology, agricultural science, and medicine indicates that diverse stressors will interfere with pregnancy in its early stages. It is probable that the most sensitive period is around the point of intrauterine implantation of fertilized ova. Although there is some indication that conventional "stress" hormones of the pituitary-adrenal axis can inhibit implantation, this evidence is too weak and inconsistent to suggest that these hormones are primary mediators of early pregnancy disruptions. Increasingly, evidence indicates that the balance of ovarian steroids is most important for pregnancy maintenance. It is well known that minute amounts of exogenous estrogens can completely disrupt pregnancy, and some new evidence suggests that endogenous estrogens may be released from the adrenals and/or ovaries during psychological stress.
This study was designed to investigate concurrently the psychological and hormonal changes at three critical points during in vitro fertilization (IVF) treatment. One hundred thirteen couples suffering from mechanical and unexplained infertility participated in the study and 23 of them conceived. Psychological evaluation included background questionnaires, Lubin's Depression Adjective Check List, and Spielberger's State Trait Anxiety inventory. Cortisol and prolactin levels were estimated by radioimmunoassay. The results showed that patients' anxiety and depression scores were significantly higher than the population norm. Psychological test scores and hormonal levels showed a similar pattern of change, increasing on oocyte retrieval day, decreasing on embryo transfer day, and rising again on pregnancy test day. Differences between these phases were generally significant. Differences in parameters' means between conceiving (C) and nonconceiving (NC) women were generally not significant. However, correlations between psychological measures and hormonal levels showed a clear disparity between C and NC women in the last phase. Whereas significant negative correlations were found in C patients, no relationship was found in NC patients. The findings suggest that success in IVF treatment may depend, in part, on differential modes of coping with anxiety and depression, involving hormonal or endorphin mediation.
Female mammals experience a very high and often unappreciated rate of reproductive failure. Among human pregnancies alone, over 50 per cent fail between conception and parturition, and the majority of these failures are unexplained. These findings present important problems for evolutionary theory as well as for health care practices. This paper addresses these high rates of reproductive failure among mammals, by extending the work of a number of evolutionary biologists regarding the reproductive consequences of environmental adversity. The basic model upon which we elaborate, termed the Reproductive Suppression Model, argues that females can optimize their lifetime reproductive success by suppressing reproduction when future conditions for the survival of offspring are likely to be sufficiently better than present ones as to exceed the costs of the suppression itself. These costs are a function of reproductive time lost and the direct phenotypic effects of the suppression itself. To evaluate the benefits and costs of suppression, the following types of cues should be assessed: the female's physical and mental health, her stage of reproduction, the physical and genetic status of her offspring, and the external conditions at the time of birth. We also examine various issues of social suppression, whereby the conditions for survival of offspring are a function of the reproduction and support of other group members. Under such conditions, some females may be able to improve current conditions for reproduction by suppressing the reproduction of others. Field data from our own work are presented, describing socially mediated reproductive competition among continuously breeding female yellow baboons and among female hoary marmots. Social suppression in other mammals is also evaluated, including that in human beings, and we conclude with some implications of the Reproductive Suppression Model for sexual selection theory regarding female-female reproductive competition, as well as human health care.
To examine the relationship between stress and IVF outcome in women and to compare prospective ratings of IVF stress to retrospective ratings.
Women completed daily stress ratings for one complete IVF cycle. Three days after the pregnancy test women completed a questionnaire that asked them to recall the stress of IVF. Based on the results of treatment, women were assigned to the nonpregnant (n = 23) or pregnant (n = 17) group and their daily stress ratings were compared. In addition, prospective and retrospective ratings were compared.
The nonpregnant group reported more stress during specific stages of IVF and had a poorer biologic response to treatment than the pregnant group. It also was found that women recalled the stress of the waiting period as greater than their ongoing experience of it as measured by their daily ratings.
The pattern of differences between the nonpregnant and pregnant group on stress and biologic factors indicates that stress is related to IVF outcome. Certain data suggest that negative feedback about the progress of treatment communicated to patients responding poorly to IVF (nonpregnant group) may have increased their stress level. However, the direction of causality between stress and IVF outcome remains speculative. Differences between prospective and retrospective stress ratings may reflect women's attempt to cope with the strain of the waiting period.
The impact of maternal depression and adversity on mother-infant face-to-face interactions at 2 months, and on subsequent infant cognitive development and attachment, was examined in a low-risk sample of primiparous women and their infants. The severe disturbances in mother-infant engagement characteristic of depressed groups in disadvantaged populations were not evident in the context of postpartum mood disorder in the present study. However, compared to well women, depressed mothers were less sensitively attuned to their infants, and were less affirming and more negating of infant experience. Similar difficulties in maternal interactions were also evident in the context of social and personal adversity. Disturbances in early mother-infant interactions were found to be predictive of poorer infant cognitive outcome at 18 months. Infant attachment, by contrast, was not related to the quality of 2-month interactions, but was significantly associated with the occurrence of adversity, as well as postpartum depression.
To evaluate the association between the vulnerability to stress and the treatment outcome of couples undergoing IVF-ET.
Controlled, prospective clinical study.
The Assisted Reproduction Unit of the Department of Obstetrics and Gynecology, University of Modena.
Forty-nine infertile women consecutively admitted to standard superovulation treatment. Mean age was 33.9 years, duration of infertility was 6.3 years. Reasons for assisted reproduction were mechanical factor in 22 cases, sperm problem in 9 cases, and endocrine disorder in 6 cases. In 12 cases, infertility was unexplained. More than 55% already had an IVF-ET attempt.
The day of oocyte pick-up, subjects were submitted to Stroop Color and Word test, a task measuring the ability to cope with a cognitive stressor, involving attentional and sympathoadrenal systems. Systolic (SBP) and diastolic blood pressure, as well as heart rate (HR) were measured at baseline, during the test, and 10 minutes after the end of testing.
The evidence of a biochemical pregnancy (beta-hCG value 12 days after ET) define the success and failure groups.
Sixteen women (33%) had a biochemical pregnancy, 12 also had ultrasound evidence. Eight gave birth to healthy infants. Age, education, causes, and duration of infertility were similar in the success and failure groups. The latter were more involved in a job outside home than the former. Moreover, they had a lower number of both fertilized oocytes and transferred embryos. In response to the Stroop test, every subject reported an increase of cardiovascular parameters. However, women becoming pregnant showed a lower response of both SBP and HR than women who failed.
Both a major cardiovascular vulnerability to stress and working outside home are associated to a poor outcome of IVF-ET treatment.
Both acute and chronic psychological and social stresses can impair reproductive hormone secretion in a variety of nonhuman primate species. This impairment can be subtle, consisting of a mild suppression in reproductive hormone secretion, or dramatic, underlying a complete suppression of fertility and reproductive behavior. Although group mean responses to various stresses can be measured, it is clear that there are marked differences in the response of the reproductive axis to these stresses among individual animals. Factors that contribute to the variability in the response of the reproductive axis include the type of stress, the magnitude and duration of stress, the perception of the stress by the individual, the social status of the individual, the concurrent level of aggressive behavior displayed by the individual, seasonal cues, and the prior level of activity within the reproductive axis. During some stresses, activation of the adrenal axis, endogenous opioid pathways, increased prolactin release, and changes in sensitivity to gonadal steroid hormone feedback appear to play a role in mediating the effects of behaviorally induced stresses on the reproductive axis. However, a great deal more work is needed to understand the mechanisms underlying impairment of the reproductive axis by most psychological and social stresses, as well as the mechanisms underlying differences in susceptibility to stress-induced impairment of reproductive function within individuals.
The hypothalamic-pituitary-adrenal axis exerts profound, multilevel inhibitory effects on the female reproductive system. Corticotropin-releasing hormone (CRH) and CRH-induced proopiomelanocortin peptides inhibit hypothalamic gonadotropin-releasing hormone secretion, whereas glucocorticoids suppress pituitary luteinizing hormone and ovarian estrogen and progesterone secretion and render target tissues resistant to estradiol. The hypothalamic-pituitary-adrenal axis is thus responsible for the "hypothalamic" amenorrhea of stress, which is also seen in melancholic depression, malnutrition, eating disorders, chronic active alcoholism, chronic excessive exercise, and the hypogonadism of the Cushing syndrome. Conversely, estrogen directly stimulates the CRH gene promoter and the central noradrenergic system, which may explain adult women's slight hypercortisolism; preponderance of affective, anxiety, and eating disorders; and mood cycles and vulnerability to autoimmune and inflammatory disease, both of which follow estradiol fluctuations. Several components of the hypothalamic-pituitary-adrenal axis and their receptors are present in reproductive tissues as autacoid regulators. These include ovarian and endometrial CRH, which may participate in the inflammatory processes of the ovary (ovulation and luteolysis) and endometrium (blastocyst implantation and menstruation), and placental CRH, which may participate in the physiology of pregnancy and the timing of labor and delivery. The hypercortisolism of the latter half of pregnancy can be explained by high levels of placental CRH in plasma. This hypercortisolism causes a transient postpartum adrenal suppression that, together with estrogen withdrawal, may partly explain the depression and autoimmune phenomena of the postpartum period.
This paper reviews experimental contributions published in the last two decades and exploring the effect of emotional stress on neuroendocrine function in healthy humans. Laboratory studies allow standardization of the stressor and better control for known confounding factors. Commonly used stressors are mental arithmetics, speech tasks, the Stroop test, videogame playing, films or videotapes and interviews. Little is known about the generalizability of laboratory results, with some studies suggesting great caution in extrapolating data to real-life stress conditions. Another strategy is studying the psychoendocrine reaction to real-life stressors, such as bereavement or anticipated loss, academic examinations, everyday work and parachute jumping. The effects of different stressors on neuroendocrine axes are reviewed, as well as the influence of gender, age, personality, coping style, social support, biological and nonbiological interventions. The subjective perception of the situation is probably a main determinant of the psychoendocrine response pattern. In fact, marked variability in individual responses to a variety of stressors has frequently been observed. Evidently, the 'objective' characteristics of a given event are not the only determinants of reaction to the event itself. According to a constructivistic perspective, every given stressor has a strictly personal and idiosyncratic meaning and loses its 'objective' characteristics. Of course, biological factors may also play a part. In any case, it is mandatory to overcome a rigid dichotomy between psychological and biological processes. Dualistic conceptions which imply a determination of the physical by the psychological or vice versa should give place to a systemic conception, which implies mutual, circular interactions.
This study investigated the association between psychosocial stress and outcome of in-vitro fertilization and gamete intra-Fallopian transfer treatment. Ninety women, enrolled for treatment at a private infertility clinic, completed two self-administered psychometric tests (Bi-polar Profile of Mood States, POMS; and State-Trait Anxiety Inventory, STAI) and a questionnaire to ascertain demographic and lifestyle characteristics before the start of treatment. Approximately 12 months later an outcome measure was determined for each participant in terms of whether she was pregnant or not pregnant and the number of treatment cycles undertaken to achieve clinical pregnancy. The women's scores on the psychological tests were similar to published normative scores. On univariate analysis, history of a previous pregnancy was positively related to the probability of pregnancy and full-time employment, a more 'hostile' mood state and higher trait anxiety were associated with a lower cumulative pregnancy rate. A Cox multiple regression model found previous pregnancy history, trait anxiety, and the POMS agreeable-hostile and elated-depressed scales to be the most important lifestyle and stress variables predictive of pregnancy. The results emphasize the importance of psychosocial stress in treatment outcome but indicate that the relationships are complex. Further studies are required to validate whether these findings can be generalized to other populations.
Although there is general agreement that the functional hypothalamic amenorrhea syndrome is linked to psychogenic stress and the resultant suppression of the normal activity of the GnRH pulse generator, the independent association between stress and the inhibition of the GnRH pulse generator remains to be demonstrated in the human. The challenge for the researcher remains to identify relevant and reliable stress paradigms so that prospective investigations of an HPA-HPG link can be initiated. Stress affects multiple sites; behavioral, metabolic, cardiac, and endocrine responses can be activated (Fig. 1). Stress research will be complicated by the probability that different stress challenges may activate each site to varying degrees and that each site may be variously sensitized by the presence of each ovarian steroid. In regard to the neuroendocrine response to stress, we can predict from animal studies that both HPA neuropeptides, CRH and vasopressin, and the endogenous opioid peptides will play a role in the inhibition by stress of the hypothalamic-pituitary-ovarian axis. Both the ability of CRH and vasopressin to inhibit GnRH and gonadotropin secretion and their mediation of the effects of several types of stress challenges have been demonstrated. Initial studies in the nonhuman primate of the effects of a short term stress episode on the menstrual cycle are of potential interest to the clinician because they indicate that although a stress may be insufficient to produce amenorrhea, it may interfere with the normal cycle in subtle ways and thereby potentially affect normal fertility. Primate studies have also described a paradoxical gonadotropin response to a stress challenge in the presence of estradiol, such as during the mid- to late follicular phase, resulting in an acute release of LH. The factor most likely responsible for this stimulatory effect of HPA on LH release, at least in the acute situation, may be progesterone released by the adrenals in response to HPA activation (Fig. 2). Whether this represents an additional mechanism by which an acute stress stimulus, again insufficient to interrupt the reproductive cycle, may interfere with the normal progression of folliculogenesis and with fertility remains to be determined.
To assess the effect of psychological distress on time to first pregnancy.
A follow-up study of time to pregnancy with prospective data on distress, with controlling for potential confounding variables.
Two university hospitals.
Danish couples (n = 430) who were planning their first pregnancy and had no previous reproductive experience were followed for six menstrual cycles. Psychological distress was measured in each menstrual cycle by the General Health Questionnaire.
None.
A clinically recognized pregnancy or a biochemical pregnancy detected in urine samples from each period of vaginal bleeding.
For cycles with the highest distress score (General Health Questionnaire score >80th percentile), the probability of conception per cycle was 12.8%, compared with 16.5% in other cycles (adjusted odds ratio [OR] 0.6; 95% confidence interval [CI] 0.4-1.0). The effect of distress was found almost exclusively among women with long menstrual cycles (OR 0.1; 95% CI 0.01-0.4 and OR 0.9; 95% CI 0.5-1.4 for women with cycles of > or =35 and <35 days, respectively). An increased incidence of early embryonal loss was also found among highly distressed women with long cycles, but was based on a small number of observations.
Psychological distress may be a risk factor for reduced fertility in women with long menstrual cycles.
The relationship between mood states, urinary stress hormone output (adrenaline, noradrenaline and cortisol) and adequacy of the menstrual cycle was examined in 120 recorded non-conception cycles from 34 women. It was hypothesized that women with higher stress levels would be more likely to experience abnormal cycles and that within women higher stress levels would positively relate to follicular phase length and inversely relate to luteal phase length. There was a non-significant trend for women to report higher stress levels during oligomenorrhoeic and unclear cycles compared with normal cycles. Analysis of covariance indicated that there was no consistent relationship between the measures of stress used here and follicular or luteal phase length within women. There was also no consistent pattern of relationship between reported mood states and stress hormone excretion within women. Further research is warranted to understand the role of stress and subtle menstrual cycle abnormalities in female fertility.
To evaluate the possible correlation between immunological changes and implantation rates in patients who undergo in vitro fertilization-embryo transfer (IVF-ET).
Controlled clinical study.
University hospital.
Forty infertile women undergoing IVF-ET.
Stroop Color Word (CW) test, State-Trait Anxiety Inventory (STAI) test, blood sampling.
Heart rate and systolic and diastolic blood pressure responses to Stroop CW; circulating T, B, T-helper (CD4), and T-suppressor (CD8) lymphocytes.
The total number of T lymphocytes increased significantly during superovulation, resulting in significantly higher levels in subjects achieving embryo implantation than in those showing a failure of implantation. An opposite trend was observed for the activated T cells. The number of T-helper lymphocytes and the T-helper/T-suppressor ratio showed a significant increase from baseline to the time of pick-up only in patients with implantation.
A prolonged condition of stress, which causes a decreased ability to adapt and a transitory anxious state, is associated with high amounts of activated T cells in the peripheral blood. Such a condition, in turn, is associated with a reduced implantation rate in women undergoing IVF-ET.
To evaluate whether baseline or procedural stress during in vitro fertilization (IVF) or gamete intrafallopian transfer (GIFT) affects pregnancy or live birth delivery rates.
Prospective study.
Seven clinics in Southern California between 1993 and 1998.Patient(s): One hundred and fifty-one women completed two questionnaires.
None.
The number of oocytes aspirated and fertilized, the number of embryos transferred, the achievement of a pregnancy, live birth delivery, and infant outcomes.
Positive-affect negative-affect score at baseline negatively influenced the number of oocytes retrieved and embryos transferred. A higher expectation of pregnancy was associated with greater numbers of oocytes fertilized and embryos transferred. At baseline, the risk of no live birth was 93% lower for women who had the highest positive-affect score compared to those with the lowest score. Furthermore, the score on the Infertility Reaction Scale was related to negative outcomes in live birth delivery, infant birth weight, and multiple births. During the time of the procedure, the PANAS and Bipolar Profile of Moods States results were related to the number of oocytes fertilized and embryos transferred; stress did not affect pregnancy or delivery.
Baseline (acute and chronic) stress affected biologic end points (i.e., number of oocytes retrieved and fertilized), as well as pregnancy, live birth delivery, birth weight, and multiple gestations, whereas (procedural) stress only influenced biologic end points.
Clinical review 105: Stress and the reproductive cycle Immunological changes and stress are associated with different implantation rates in patients undergoing in vitro fertilization-embryo transfer
- M J Ferin
- Boivin
Ferin, M. (1999). Clinical review 105: Stress and the reproductive cycle. Journal of Clinical Endocrinology and Metabolism, 84, 1768–17743. J. Boivin et al. / Evolution and Human Behavior 27 (2006) 345–356 355 rGallinelli, A., Roncaglia, R., Matteo, M. L., Ciaccio, I., Volpe, A., & Facchinetti, F. (2001). Immunological changes and stress are associated with different implantation rates in patients undergoing in vitro fertilization-embryo transfer. Fertility and Sterility, 76, 85–91
Reproductive filtering and the social environment New York7 Aldine de Gruyter
- S K Wasser
- N J Place
Wasser, S. K., & Place, N. J. (2001). Reproductive filtering and the social environment. In P. T. Ellison (Ed.), Reproductive ecology and human evolution (pp. 137 – 157). New York7 Aldine de Gruyter. J. Boivin et al. / Evolution and Human Behavior 27 (2006) 345 – 356
The evolution of life histories Why not so good is still good enough Reproductive ecology and human evolution (pp. 179 – 202) New York7 Aldine de Gruyter Salivary progesterone levels and rate of ovulation are significantly lower in poorer than in better-off urban-dwelling Bolivian women
- S Stearns
- V J Vitzthum
- V J Vitzthum
- G R Bentley
- H Spielvogel
- E Caceres
- J Thornburg
- L Jones
- S Shore
- K R Hodges
- R T Chatterton
Stearns, S. (1992). The evolution of life histories. New York7 Oxford University Press. Vitzthum, V. J. (2001). Why not so good is still good enough. In P. T. Ellison (Ed.), Reproductive ecology and human evolution (pp. 179 – 202). New York7 Aldine de Gruyter. Vitzthum, V. J., Bentley, G. R., Spielvogel, H., Caceres, E., Thornburg, J., Jones, L., Shore, S., Hodges, K. R., & Chatterton, R. T. (2002). Salivary progesterone levels and rate of ovulation are significantly lower in poorer than in better-off urban-dwelling Bolivian women. Human Reproduction, 17, 1906 – 1913.
This study has received support from the Danish Health Insurance Fund (Jnr. 11/097-97), the Else and Mogens Wedell–Wedellsborgs Fund, the manager E. Danielsens and Wife's Fund, the merchant L.F. Foghts Fund, and the Jacob Madsen and Wife Olga Madsens Fund Gender's role in responses to infertility
- Indeed
- Demyttenaere
- Nijs
Indeed, Demyttenaere, Nijs, Evers-Kiebooms, and Koninckx Herlev University Hospital; the Juliane Marie Centre, Rigshospitalet; and the Odense University Hospital. This study has received support from the Danish Health Insurance Fund (Jnr. 11/097-97), the Else and Mogens Wedell–Wedellsborgs Fund, the manager E. Danielsens and Wife's Fund, the merchant L.F. Foghts Fund, and the Jacob Madsen and Wife Olga Madsens Fund. References Abbey, A., Andrews, F. M., & Halman, L. J. (1991). Gender's role in responses to infertility. Psychology of Women Quarterly, 15, 295 – 316.
Multiple regression: Testing and interpreting interactions Does psychological stress affect the outcome of in vitro fertilization? Human Reproduction
- L S Aiken
- S G West
- L Anderheim
- H Holter
- C Bergh
- A Mfller
Aiken, L. S., & West, S. G. (1991). Multiple regression: Testing and interpreting interactions. Thousand Oaks7 Sage Publications. Anderheim, L., Holter, H., Bergh, C., & Mfller, A. (2005). Does psychological stress affect the outcome of in vitro fertilization? Human Reproduction, 20, 2969 – 2975.
Socialgrupper I Danmark [Social class in Denmark]. Copenhagen7 The Danish National Institute of Social Research
- E J Hansen
Hansen, E. J. (1984). Socialgrupper I Danmark [Social class in Denmark]. Copenhagen7 The Danish National Institute of Social Research.
Psykosociale konsekvenser af infertilitet og behandling [Psychosocial consequences of infertility and treatment]
- L Schmidt
Schmidt, L. (1996). Psykosociale konsekvenser af infertilitet og behandling [Psychosocial consequences of
infertility and treatment]. Copenhagen7 FADL Book Company.
Why not so good is still good enough
- Vitzthum
Vitzthum, V. J. (2001). Why not so good is still good enough. In P. T. Ellison (Ed.), Reproductive ecology and
human evolution (pp. 179 – 202). New York7 Aldine de Gruyter.
Reproductive filtering and the social environment
- Wasser