Linda D. Applegarth

A cross-sectional study of the psychosexual impact of cancer-related infertility in women: third-party reproductive assistance

IntroductionThis study empirically assessed emotional and sexual functioning, reproductive concerns, and quality of life (QOL) of cancer-related infertile women in comparison to those without a cancer history and explored awareness of third-party reproduction options in cancer survivors.MethodsOne hundred twenty-two cancer survivors (Gynecologic and Bone Marrow/Stem Cell Transplant) with cancer-related infertility and 50 non-cancer infertile women completed a self-report survey assessing: reproductive concerns (RCS), mood (CES D), distress (IES), sexual function (FSFI), menopause (SCL), QOL (SF 12), relationships (ADAS), and exploratory (reproductive options) items.ResultsCancer survivors exhibited greater sexual dysfunction and lower physical QOL than non-cancer infertile women (P < 0.001). No significant group differences were identified for mood (CES-D), mental health QOL (SF-12), reproductive concerns (RCS), and relationship satisfaction (ADAS). All groups scored in the FSFI range of sexual dysfunction, and with RCS scores above published means. Multivariate comparisons showed comparable depression and distress levels for all groups, but cancer survivors had poorer physical QOL [F(5,146)=4.22, P < 0.01]. A significant effect was also found for knowledge of third-party reproductive options on depression and distress levels [F(3,97)=4.62,P < 0.01]. Adjusted means demonstrated higher depression and distress scores for women with perceived unmet informational needs.ConclusionsOverall, loss of fertility was an emotionally challenging experience for women regardless of its cause. Cancer survivors were found to have lower scores of physical QOL and sexual function than non-cancer infertile women. Unmet informational needs about reproductive options appeared to be associated with negative mood and increased distress in cancer survivors.Implications for cancer survivorsTargeted interventions to increase knowledge about reproductive options could be of great assistance to women pursuing parenthood in cancer survivorship. Additionally, intervention studies to improve sexual functioning and QOL in women with cancer-related infertility should be a priority of future research.

A CROSS-SECTIONAL COHORT STUDY OF INFERTILE WOMEN AWAITING OOCYTE DONATION: THE EMOTIONAL, SEXUAL, AND QUALITY-OF-LIFE IMPACT

OBJECTIVE To examine the emotional, sexual, physical, and quality-of-life (QOL) impact on infertile women awaiting oocyte donation. DESIGN Cross-sectional cohort study. SETTING Cancer center and reproductive medicine center. PATIENT(S) Fifty infertile women awaiting oocyte donation, enrolled from October 2006 to February 2009. INTERVENTION(S) Woman awaiting oocyte donation completed a one-time survey of empirical measures and exploratory items. MAIN OUTCOME MEASURE(S) Reproductive concerns, depression, sexual function, distress, menopausal symptoms, physical and mental health, and relationship satisfaction. RESULT(S) Of the participants, 33% were clinically depressed (Center for Epidemiologic Studies Depression Scale), and 59% had high levels of distress (Impact of Events Scale). The cohorts mean Female Sexual Function Index score (24.09) was below the cutoff value (26.55), indicating sexual dysfunction. Relationship satisfaction (Abbreviated Dyadic Adjustment Scale) scores were comparable to the population norm. Patients had good physical QOL but below average mental QOL (Medical Outcomes SF-12 Health Survey). Sixty-four percent were concerned about long-term effects of treatment, although 94% were grateful for reproductive assistance options and described parenthood as providing enrichment, happiness, and meaning to their lives. CONCLUSION(S) Infertility can negatively impact sexual function, QOL, and emotional well-being. Quantitative empirical measures and qualitative data have shown that these women experienced and recognized the emotional toll of reproductive assistance. Despite concerns about the long-term effects of treatment, participants were grateful for this third-party parenting option.

Families created through ovum donation: A preliminary investigation of obstetrical outcome and psychosocial adjustment

PurposeThis study attempted to obtain preliminary followup information regarding obstetrical outcomes and the psychosocial well-being of families created through ovum donation. There is presently very little known about this population with respect to obstetrical care, health status of offspring, family and marital relationships of recipient couples, or how couples feel about having chosen ovum donation as a family-building option.ResultsFifty-nine couples were initially surveyed and, ultimately, extensive information was obtained for 30 husbands, 31 wives, and 51 offspring. There was a very high percentage of cesarean section deliveries (81.6%), and although a few children experienced health problems at birth, they are all now in good health and developmental milestones are within normal limits. Information was also obtained about breast-feeding experiences, choice of donor (known) [sister] or anonymous), reasons for choosing ovum donation over other parenting options, and the impact of this choice on marital and family relationships. Demographic data were also obtained.ConclusionsFor many infertile couples, the long struggle to become parents culminated in a successful birth, and the experience of pregnancy seemed to meet a need to be both biological and psychosocial parents. In general, subjects were extremely cooperative with the investigation and they indicated a desire to learn as much as possible about the psychosocial status of families created through ovum donation. As the assisted reproductive technologies move rapidly into the 21st century, it now seems imperative that health and mental health professionals gain more knowledge about the impact of third party reproduction and the psychosocial adjustment and well-being of families created by this medical technology.