Janet Takefman

Stress level across stages of in vitro fertilization in subsequently pregnant and nonpregnant women

OBJECTIVE To examine the relationship between stress and IVF outcome in women and to compare prospective ratings of IVF stress to retrospective ratings. DESIGN 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. RESULTS 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. CONCLUSIONS 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 womens attempt to cope with the strain of the waiting period.

Assessment of symptomatic women for early diagnosis of ovarian cancer: results from the prospective DOvE pilot project

BACKGROUND Around 90% of deaths from ovarian cancer are due to high-grade serous cancer (HGSC), which is frequently diagnosed at an advanced stage. Several cancer organisations made a joint recommendation that all women with specified symptoms of ovarian cancer should be tested with the aim of making an early diagnosis. In the Diagnosing Ovarian Cancer Early (DOvE) study we investigated whether open-access assessment would increase the rate of early-stage diagnosis. METHODS Between May 1, 2008, and April 30, 2011, we enrolled women who were aged 50 years or older and who had symptoms of ovarian cancer. They were offered diagnostic testing with cancer antigen (CA-125) blood test and transvaginal ultrasonography (TVUS) at a central and a satellite open-access centre in Montreal, QC, Canada. We compared demographic characteristics of DOvE patients with those of women in the same age-group in the general population of the area, and compared indicators of disease burden with those in patients with ovarian cancer referred through the usual route to our gynaecological oncology clinic (clinic patients). FINDINGS Among 1455 women assessed, 402 (27·6%) were in the highest-risk age group (≥ 65 years). 239 (16·4%) of 1455 required additional investigations. 22 gynaecological cancers were diagnosed, 11 (50%) of which were invasive ovarian cancers, including nine HGSC. The prevalence of invasive ovarian cancer, therefore, was one per 132 women (0·76%), which is ten times higher than that reported in screening studies. DOvE patients were significantly younger, more educated, and more frequently English speakers than were women in the general population. They also presented with less tumour burden than did the 75 clinic patients (median CA-125 concentration 72 U/mL, 95% CI 12-1190 vs 888 U/mL, 440-1936; p=0·010); Eight (73%) tumours were completely resectable in DOvE patients, compared with 33 (44%) in clinic patients (p=0·075). Seven (78%) of the HGSC in the DOvE group originated outside the ovaries and five were associated with only slightly raised CA-125 concentrations and minimal or no ovarian abnormalities on TVUS. INTERPRETATION The proportion of HGSC that originated outside the ovaries in this study suggests that early diagnosis programmes should aim to identify low-volume disease rather than early-stage disease, and that diagnostic approaches should be modified accordingly. Although testing symptomatic women may result in earlier diagnosis of invasive ovarian cancer, large-scale implementation of this approach is premature. FUNDING Canadian Institutes of Health Research, Montreal General Hospital Foundation, Royal Victoria Hospital Foundation, Cedars Cancer Institute, and La Fondation du Cancer Monique Malenfant-Pinizzotto.

Reactions to infertility based on extent of treatment failure

OBJECTIVE To examine the relationship between amount of treatment failure and personal and marital distress. DESIGN In this cross-sectional design, three groups of women (n = 91) with varying amounts of treatment failure experience were compared on measures of general and infertility-related distress and marital and sexual distress. RESULTS The relationship between treatment failure experience and personal and marital distress was found to be curvilinear. The group that had a moderate amount of treatment failure experienced the most distress whereas the distress level of those without or with a high amount of treatment failure experience was comparable. The results also showed that the relationship between amount of treatment failure and distress was independent of age, years infertile, or years in treatment. CONCLUSION The findings of this study provide support for infertility theories that suggest that infertility is a process rather than a series of independent emotional events and suggest that the distress women experience during infertility is a necessary part of their evolution toward acceptance of their infertility.

An analysis of the effectiveness of two components in the treatment of erectile dysfunction.

This study compared the effectiveness of two components, a ban on sexual intercourse and communication of sexual preferences, in the treatment of couples in which the male was experiencing erectile dysfunction. Sixteen couples were randomly assigned to one of two treatment conditions. In one condition spouses were asked to refrain from intercourse and to make an effort to communicate sexual tastes and preferences during noncoital erotic interaction. Couples in the second condition were assigned only the communication portion of the therapeutic instructions given to the first group. The treatment consisted of written instructions concerning tasks to be carried out at home. Therapist contact was minimal. Following a 1-month baseline period of self-monitoring using a daily record-keeping form, couples underwent a 1-month treatment period and follow-up testing after another month. Male subjects also underwent an endocrinological examination to ascertain testosterone and related hormone levels prior to participating in the treatment. Both treatment groups reported significant improvement in several measures of erectile functioning, general sexual functioning, and marital adjustment. However, the ban on intercourse did not add to the effectiveness of encouraging sexual communication, indicating that the former component probably did not contribute to change. Two pretreatment measures, the Sexual Interaction Inventory and testosterone level, were found to predict treatment outcome with sufficient accuracy to permit selection of future patients who might benefit from this type of treatment format. The effectiveness of a treatment consisting of written instructions with minimal therapist contact for males with erectile dysfunction have important cost-benefit implications.

The effects of female sexual response in coitus on early reproductive processes

Research has shown that infertility and its medical investigation are stressful for couples and have adverse effects on sexual functioning. The purpose of this study was to examine how female sexual functioning could influence aspects of the reproductive process. This question was examined within the context of the postcoital test (PCT) routinely performed during the infertility investigation. The sample consisted of 85 women with a mean age of 30 years (SD=3.8 years) and a mean infertile period of 2.5 years (SD=1.1 years). Prior to the physiological examination, women completed a battery of questionnaires about their sexual functioning during the scheduled encounter engaged in for purposes of the PCT and during other nonscheduled encounters. The results indicated that the PCT contributed to deterioration in female sexual functioning, and in turn, a poor sexual response was associated with poorer physiological results. The implications of sexual behavior influencing physiohormonal reproductive factors are discussed.

A comparison of sexually dysfunctional, maritally disturbed and well-adjusted couples

Abstract Married couples seeking sex therapy, marital therapy, or no form of therapy were compared with respect to personality, sexual and marital functioning. The Sexual Dysfunction and Marital Difficulties groups (15 and 10 couples respectively) were obtained from the waiting lists of a sexual dysfunction service and marital therapy unit. Non-Problem subjects (15 couples) were from a volunteer sample. Personal adjustment, sexual and marital functioning were assessed by means of the Eysenck Personality Inventory, a Sexual Behavior Questionnaire, the Locke-Wallace Marital Adjustment Survey, and the Azrin Marital Happiness Scale. Results indicated that although all three groups were within the normal range, problem couples had higher ‘neuroticism’ scores than did Non-Problem couples. Marital Problem couples were the most debilitated. Their marital adjustment was lowest, and their sexual functioning was comparable to the Sexual Dysfunction group. Marital adjustment of the Sexual Dysfunction couples was significantly higher than that of the Marital Difficulties couples. Therapeutic and theoretical implications of the differentiating characteristics in the three couple categories are discussed.

Behavioral sex therapy: A preliminary study of its effectiveness in a clinical setting

Abstract In this study the efficacy of behavioral sex therapy provided to 21 couples by experienced clinicians in a clinical setting was examined. Pre‐treatment test‐retest reliability (3 months) on measures of sexual and marital functioning was obtained as well as immediate and 8‐month posttreatment changes. Findings at each stage were compared with results from a demographically comparable group of 17 well‐adjusted couples. Substantial improvements in the presenting complaint were reported by most of the dysfunctional couples at follow‐up. However, some of the gains found in components of sexual interaction were not durable. There was a marked similarity between the well‐adjusted and the dysfunctional subjects, both before and after therapy, on ratings of nonsexual dimensions of marital functioning. In contrast, on most sexual items, the well‐adjusted groups ratings were superior to those of the dysfunctional couples prior to treatment and remained so at post‐treatment and at follow‐up. The magnitude o...