Psychological aspects of in vitro fertilization: a review

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Abstract

This paper reviews psychological research within the context of in vitro fertilization (IVF). The focus will be on psychological reactions before entering an IVF-procedure, during an IVF-treatment, and after both unsuccessful and successful IVF. The effects of psychosocial factors on the treatment outcome after IVF and interventions on conception rates will also be discussed.

Undergoing an IVF-treatment is an emotional and physical burden, for both the woman and her partner. Research results suggest that couples entering an IVF-treatment program are, in general, psychologically well adjusted. Concerning reactions during the treatment, both women and men experience waiting for the outcome of the IVF-treatment and an unsuccessful IVF, as most stressful. Common reactions during IVF are anxiety and depression, while after an unsuccessful IVF, feelings of sadness, depression and anger prevail. After a successful IVF-treatment, IVF-parents experience more stress during pregnancy than `normal fertile' parents. Mothers with children conceived by IVF express a higher quality of parent–child relationship than mothers with a naturally conceived child.

Research further suggests that psychosocial factors, like ineffective coping strategies, anxiety and/or depression are associated with a lower pregnancy rate following IVF-procedures. In addition, support has been found suggesting that stress reduction through relaxation training or behavioral treatment improves conception rates.

Introduction

Over the last few years, impressive progress has been made in the development of medical technological interventions for couples with fertility problems. Depending on the precise nature of the fertility problem, various reproductive technologies are available to help couples achieve a pregnancy. This includes in vitro fertilization (IVF), artificial insemination with the semen of a donor (AID), artificial insemination with the semen of the husband (AIH) and, recently, intracytoplasmic sperm injection (ICSI). Although the reproductive treatments are impressive from a technical point of view, they nevertheless can be a source of tension for the couples involved. The interventions contain a number of stressful aspects, such as the daily injections, blood samples, ultra-sound scan and a sperm sample from masturbation.

In this article, the literature on the role of psychological reactions to and consequences of in vitro fertilization will be summarized. This review will briefly describe the incidence of infertility and the procedure of IVF. Its main focus will be on psychological issues within the context of in vitro fertilization (IVF), including the psychological states before entering, during and after the IVF-treatment, coping strategies and the effect of psychosocial factors on the treatment outcome after IVF. In addition, the effect of psychological interventions on conception rates will be discussed.

Section snippets

Incidence of infertility

Infertility is defined as ``the inability of a couple to achieve conception or to bring a pregnancy to term after a year or more of regular, unprotected intercourse'' (WHO, 1992). Although having children is taken for granted, not achieving a pregnancy is a common occurrence. According to the WHO (1992), approximately 8–10% of couples worldwide experience some form of infertility problem, with wide differences from region to region. Approximately 10–12% of American couples of reproductive age (

Application

IVF is applied to many forms of infertility, but the criteria differ per center. Initially, the IVF-treatment was applied only to women with blocked ovaries. Nowadays, other fertility problems are also treated with IVF, such as infertility resulting from endometriosis, woman's antibodies against sperm, bad sperm quality or unexplained infertility. The latter means that the woman can not get pregnant, yet there is no medical explanation for this. (van Hall, 1988; DES-Nieuws, 1993; Gaasbeek and

Psychological reactions before and during IVF

Undergoing an IVF-treatment is an emotional and physical burden, for both the woman and her partner. Aspects like the hormone treatments, the sometimes daily returning blood tests, daily ultra sound scans, masturbating, waiting until the female germ cells are maturing well, the punction, waiting if the fertilization takes place, the transfer and waiting if one gets pregnant can interfere with other matters in a couple’s life (Gaasbeek and Leerentveld, 1993). The different stages of the

Reactions following an unsuccessful IVF

For many couples, IVF is the last possibility to get their `own' child. When the IVF-treatments are not successful, the couple has to face their infertility. Like the influence of the different stages of the IVF-procedure on psychological functioning, the failure of the treatment can also influence the psychosocial functioning of the man and the woman negatively.

After an unsuccessful IVF-treatment, couples may experience severe tension. Disappointment because of an IVF-failure is common (

The experience of pregnancy

When, after years of infertility and infertility treatments, a couple finally achieves a pregnancy, one might expect that they will experience more psychological problems during the pregnancy than couples who did not experience fertility problems. The previously infertile couple now finally gets what it fought for for such a long time. Anxiety to lose it may accompany the pregnancy period. Several studies addressed this issue.

In a study of Reading et al. (1989b), women who had conceived by IVF

Coping with in vitro fertilization

The coping strategy most frequently used by couples when entering an IVF treatment program is taking direct action (Edelmann et al., 1994) and problem focused coping (Hearn et al., 1987). This may not be surprising, if one considers that undergoing an infertility treatment may be a problem focused strategy preeminently to deal with the fertility problems (Eugster and Vingerhoets, 1996).

Men and women tend to cope rather differently with infertility and IVF-treatment. In the study of Newton et

The effect of psychosocial factors on the treatment outcome after IVF

After three IVF-attempts, about 60% of the couples have not achieved a pregnancy. Besides bio-medical factors, psychosocial factors seem to play a role in infertility. Garssen et al. (1989)reviewed the literature on the role of psychological factors in infertility of the period 1965–1986. The only consistent finding was that the anxiety level of infertile women was higher than of fertile women. Because most of the reviewed studies lacked a sound methodological basis, it was hard to conclude

The effect of psychological interventions on conception rates

Domar (1997)stated that if stress may contribute to infertility, then it may be hypothesized that stress reduction will improve conception rates. She indeed found support for the hypothesis. Relaxation training for women with unexplained infertility (Rodriguez et al., 1983) or women who were to undergo an IVF (Farrar et al., 1990) resulted in higher conception rates in the experimental groups than in the control subjects. Also, drug intervention to reduce anxiety in women with unexplained

Conclusion

Results of several studies strongly suggest that it is important to assess respondents' psychological reactions during different phases of the IVF procedure. There is consensus concerning couples' general psychological well-being when entering an IVF treatment program. Couples appear to be, in general, psychologically well adjusted. However, more specifically, some researchers have found that women, entering an IVF program, score above the norm on measures of anxiety, while others did not find

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