Sharon N. Covington

The psychosocial transition associated with spontaneous 46,XX primary ovarian insufficiency: illness uncertainty, stigma, goal flexibility, and purpose in life as factors in emotional health

OBJECTIVE To examine factors associated with emotional well-being in women with spontaneous primary ovarian insufficiency. DESIGN Cross-sectional and case-control study. SETTING Clinical research center, national U.S. health research facility. PATIENT(S) Women diagnosed with spontaneous 46,XX primary ovarian insufficiency (n = 100) at a mean age of 32.4 years and healthy control women of similar age (n = 60). INTERVENTION(S) Administration of validated self-reporting instruments. MAIN OUTCOME MEASURE(S) Illness uncertainty, stigma, goal disengagement/re-engagement, purpose in life, Positive and Negative Affect Schedule, Center of Epidemiologic Studies Depression Scale, State-Trait Anxiety Inventory. RESULT(S) Compared with controls, women with spontaneous primary ovarian insufficiency scored adversely on all measures of affect. Illness uncertainty and purpose in life were significant independent factors associated with anxiety (R(2) = 0.47), stigma and purpose in life were the significant independent factors associated with depression (R(2) = 0.51), and goal re-engagement and purpose in life were significantly and independently associated with positive affect (R(2) = 0.43). CONCLUSION(S) This evidence supports the need for prospective studies. Our findings are consistent with the hypothesis that clinicians could improve the emotional well-being of their patients with primary ovarian insufficiency by [1] informing them better about their condition, [2] helping them to feel less stigmatized by the disorder, and [3] assisting them in developing alternative goals with regard to family planning as well as other goals.

Women with spontaneous 46,XX primary ovarian insufficiency (hypergonadotropic hypogonadism) have lower perceived social support than control women

OBJECTIVE To test the hypothesis that women with spontaneous primary ovarian insufficiency differ from control women with regard to perceived social support and to investigate the relationship between perceived social support and self-esteem. DESIGN Cross-sectional. SETTING Mark O. Hatfield Clinical Research Center, National Institutes of Health. PATIENT(S) Women diagnosed with spontaneous primary ovarian insufficiency (n = 154) at a mean age of 27 years and healthy control women (n = 63). INTERVENTION(S) Administration of validated self-reporting instruments. MAIN OUTCOME MEASURE(S) Personal Resource Questionnaire 85 and Rosenberg Self-Esteem Scale. RESULT(S) Women with primary ovarian insufficiency had significantly lower scores than controls on the perceived social support scale and the self-esteem scale. The findings remained significant after modeling with multivariate regression for differences in age, marital status, and having children. There was a significant positive correlation between self-esteem scores and perceived social support in patients. We found no significant differences in perceived social support or self-esteem related to marital status, whether or not the women had children, or time since diagnosis. CONCLUSION(S) This evidence supports the need for prospective controlled studies. Strategies to improve social support and self-esteem might provide a therapeutic approach to reduce the emotional suffering that accompanies the life-altering diagnosis of spontaneous primary ovarian insufficiency.

Minnesota Multiphasic Personality Inventory (MMPI-2) profiles in the assessment of ovum donors

OBJECTIVE To examine the relationship between MMPI-2 scores and oocyte donation outcome. DESIGN Descriptive chart review. SETTING Two oocyte donation programs. SUBJECT(S) Five hundred anonymous oocyte donor applicants. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Demographics, MMPI-2 scores and donation outcome. RESULT(S) The mean age was 26.6 years, 54% were Caucasian, 37% were high school graduates with some college, 55% were single, and 49% were nulliparous. Fifty-nine percent of donors completed at least one donation cycle, 10% were ruled out because of medical concerns, 12% dropped out, 11% were ruled-out because of psychologic concerns, and 8% had not been selected by a recipient. On the MMPI-2, the mean profile was in the normal range. Significant differences were found between groups on subscales F, F(p), L, S, S1, 2, 4, 8, and 9. The largest differences in scores between donors who completed a cycle and those who were psychologically excluded were on L (8 points) and 9 (6 points). Use of the non-K corrected scores replicated group differences. CONCLUSION(S) MMPI-2 scores differed between donors who completed a donation cycle and those who were psychologically excluded. Attention should be paid to validity scale L when considering donor selection.

The Psychology of Antecedents to Adult Reproductive Disorders in Adolescent Girls

The normal developmental tasks and roles of adolescence are altered by a diagnosis of a reproductive disorder. The crisis of impaired fertility affects both parent and child, stressing the family system. For the adolescent girl, a reproductive disorder has an impact on her developing sense of self, body‐image, and sexuality, which, in turn, can affect her self‐esteem and relationships with others. Because of the sexual nature of a reproductive disorder, feelings of embarrassment or protectiveness are often engendered that can make it difficult for families to discuss. Nonetheless, families do best with openness and honesty regarding the condition and should be discouraged from keeping the diagnosis a secret. Adolescence encompasses a broad spectrum of emotional maturity, which needs to be considered by parents and clinicians when communicating information. Understanding that the family is an emotional unit, a family systems approach to deal with health issues is most appropriate. In this context, parents need to first deal with their own feelings about the diagnosis, before they can help their child. Secondly, parents must be provided with tools to build an ongoing conversation with their child that will avoid stigmatizing her condition and handicapping her growth into healthy adulthood. The goal for parent and clinician is to help the adolescent girl formulate positive self‐esteem and body image, despite impaired fertility.

Demographic variables related to successful anonymous oocyte donor recruitment

Only 4% of initial applicants to the oocyte donor program completed the screening process and actually donated a cohort of oocytes. Medical screen-outs were more likely for women who had children, were unmarried, and were less educated, whereas psychological screen-outs were more common among younger applicants, and both younger and African-American women were more likely to withdraw without donating.

Results of the Minnesota Multiphasic Personality Inventory‐2 among gestational surrogacy candidates

To obtain normative data on the Minnesota Multiphasic Personality Inventory‐2 (MMPI‐2) personality test for gestational surrogate (GS) candidates.