Psychological Aspects of Infertility – Results from an Actor–Partner Interdependence Analysis

Abstract

Introduction For some patients, undergoing medical treatment for infertility is a cause of major emotional stress which the couple needs to deal with together; it can be said that infertility is a shared stressor. From the literature it is known that a subjectively perceived sense of self-efficacy supports the patient’s ability to cope adaptively with an illness. As the basis for this study, we assumed that high levels of self-efficacy are associated with low psychological risk scores (e.g., for anxiety or depressiveness), both in the patient themselves and in their partner. Accordingly, in infertility patients, targeted support to promote helpful self-efficacy expectations could represent a new counselling strategy that could enable psychologically vulnerable patients to better cope with the treatment procedure and treatment failures of medically assisted reproduction, making these patients less at risk with regard to psychosocial factors.

Methods 721 women and men attending five fertility centers in Germany (Heidelberg, Berlin), Austria (Innsbruck), and Switzerland (St. Gallen, Basel) completed the SCREENIVF-R questionnaire to identify psychological risk factors for amplified emotional problems, as well as the ISE scale to measure self-efficacy. Using paired t-tests and the actor–partner interdependence model, we analyzed the data of 320 couples.

Results Considering the study participants as couples, women had a higher risk score than men for four out of five risk factors (depressiveness, anxiety, lack of acceptance, helplessness). In all of the risk areas, it was possible to identify a protective effect from self-efficacy on the patient’s own risk factors (actor effect). There was a negative correlation between the men’s self-efficacy level and the women’s feelings of depressiveness and helplessness (partner effect, man → woman). The women’s self-efficacy levels had a positive correlation with acceptance and access to social support in the men (partner effect, woman → man).

Conclusion Because infertility is generally something that a couple has to deal with together, future studies should focus on couples as the unit of analysis instead of just analyzing the men and women separately. In addition, couples therapy should be the gold standard in psychotherapy for infertility patients.

Keywords

infertility - couples - APIM - self-efficacy - psychosocial risk factors

Publication History

Received: 28 September 2022

Accepted after revision: 09 January 2023

Article published online:
14 April 2023

• References/Literatur

• 1 Boivin J, Bunting L, Collins JA. et al. International estimates of infertility prevalence and treatment-seeking: potential need and demand for infertility medical care. Hum Reprod 2007; 22: 1506-1512 DOI: 10.1093/humrep/dem046. (PMID: 17376819)
• 2 Verhaak CM, Smeenk JM, Evers AW. et al. Women’s emotional adjustment to IVF: a systematic review of 25 years of research. Hum Reprod Update 2007; 13: 27-36 DOI: 10.1093/humupd/dml040. (PMID: 16940360)
• 3 Greil AL. Infertility and psychological distress: a critical review of the literature. Soc Sci Med 1997; 45: 1679-1704 DOI: 10.1016/s0277-9536(97)00102-0. (PMID: 9428088)
• 4 Luk BH, Loke AY. The Impact of Infertility on the Psychological Well-Being, Marital Relationships, Sexual Relationships, and Quality of Life of Couples: A Systematic Review. J Sex Marital Ther 2015; 41: 610-625 DOI: 10.1080/0092623X.2014.958789. (PMID: 25211377)
• 5 Wischmann T, Borkenhagen A, David M. et al. Psychosomatically Oriented Diagnostics and Therapy for Fertility Disorders. Guideline of the DGPFG (S2k-Level, AWMF Registry Number 016/003, December 2019). Geburtshilfe Frauenheilkd 2021; 81: 749-768 DOI: 10.1055/a-1341-9664. (PMID: 34276062)
• 6 Gameiro S, Boivin J, Dancet E. et al. ESHRE guideline: routine psychosocial care in infertility and medically assisted reproduction-a guide for fertility staff. Hum Reprod 2015; 30: 2476-2485 DOI: 10.1093/humrep/dev177. (PMID: 26345684)
• 7 Wischmann T, Scherg H, Strowitzki T. et al. Psychosocial characteristics of women and men attending infertility counselling. Hum Reprod 2009; 24: 378-385 DOI: 10.1093/humrep/den401. (PMID: 19049994)
• 8 Wyns C, De Geyter C, Calhaz-Jorge C. et al. ART in Europe, 2018: results generated from European registries by ESHRE. Hum Reprod Open 2022; 2022: hoac022 DOI: 10.1093/hropen/hoac022. (PMID: 35795850)
• 9 Toth B, Bohlmann M, Hancke K. et al. Recurrent Miscarriage: Diagnostic and Therapeutic Procedures. Guideline of the DGGG, OEGGG and SGGG (S2k-Level, AWMF Registry No. 015/050, May 2022). Geburtshilfe Frauenheilkd 2022; DOI: 10.1055/a-1895-9940.
• 10 Bandura A. Self-efficacy. In: Ramachandran VS. Encyclopedia of human Behavior (Vol. 1). New York: Academic Press; 1994: 71-81
• 11 Zhang X, Deng X, Mo Y. et al. Relationship between infertility-related stress and resilience with posttraumatic growth in infertile couples: gender differences and dyadic interaction. Hum Reprod 2021; 36: 1862-1870 DOI: 10.1093/humrep/deab096.
• 12 Zhang J, Yu NX, Zhou M. et al. Dyadic effects of resilience on well-being in Chinese older couples: Mediating role of spousal support. J Fam Psychol 2017; 31: 273-281 DOI: 10.1037/fam0000250. (PMID: 27690500)
• 13 Cousineau TM, Green TC, Corsini EA. et al. Development and validation of the Infertility Self-Efficacy scale. Fertil Steril 2006; 85: 1684-1696 DOI: 10.1016/j.fertnstert.2005.10.077. (PMID: 16677636)
• 14 Chu X, Geng Y, Zhang R. et al. Perceived Social Support and Life Satisfaction in Infertile Women Undergoing Treatment: A Moderated Mediation Model. Front Psychol 2021; 12: 651612 DOI: 10.3389/fpsyg.2021.651612. (PMID: 34122236)
• 15 Verhaak CM, Lintsen AM, Evers AW. et al. Who is at risk of emotional problems and how do you know? Screening of women going for IVF treatment. Hum Reprod 2010; 25: 1234-1240 DOI: 10.1093/humrep/deq054. (PMID: 20228392)
• 16 Verhaak CM, Smeenk JM, van Minnen A. et al. A longitudinal, prospective study on emotional adjustment before, during and after consecutive fertility treatment cycles. Hum Reprod 2005; 20: 2253-2260 DOI: 10.1093/humrep/dei015.
• 17 Spielberger C, Gorsuch R, Lushene R, Vagg PR, Jacobs G. Manual for the State-Trait Anxiety Inventory (Form Y1–Y2). Palo Alto: Consulting Psychologists Press; 1983
• 18 Beck AT, Guth D, Steer RA. et al. Screening for major depression disorders in medical inpatients with the Beck Depression Inventory for Primary Care. Behav Res Ther 1997; 35: 785-791 DOI: 10.1016/s0005-7967(97)00025-9. (PMID: 9256522)
• 19 Van Dam-Baggen R, Kraaimaat FW. De inventarisatielijst Social Betrokkenheid (ISB): een zelfbeoordelingslijst om sociale steun te meten [The Inventarisation inventory to measure social integration: a self report inventory to assess social support]. Gedragstherapie 1992; 25: 27-45
• 20 Cserepes RE, Kollár J, Sápy T. et al. Effects of gender roles, child wish motives, subjective well-being, and marital adjustment on infertility-related stress: a preliminary study with a Hungarian sample of involuntary childless men and women. Arch Gynecol Obstet 2013; 288: 925-932 DOI: 10.1007/s00404-013-2835-7.
• 21 Yaremko SK, Lawson KL. Gender, internalization of expressive traits, and expectations of parenting. Sex Roles 2007; 57: 675-687 DOI: 10.1007/s11199-007-9301-6.
• 22 Wischmann T, Thorn P. Der Mann in der Kinderwunschbehandlung (unter besonderer Berücksichtigung der donogen Insemination). J Reproduktionsmed Endokrinol 2014; 11: 134-141
• 23 Bhamani SS, Zahid N, Zahid W. et al. Association of depression and resilience with fertility quality of life among patients presenting to the infertility centre for treatment in Karachi, Pakistan. BMC Public Health 2020; 20: 1607 DOI: 10.1186/s12889-020-09706-1.
• 24 Van den Broeck U, Emery M, Wischmann T. et al. Counselling in infertility: Individual, couple and group interventions. Patient Educ Couns 2010; 81: 422-428 DOI: 10.1016/j.pec.2010.10.009. (PMID: 21075589)