Susan C. Klock

Coping and Cognitive factors in adaptation to in vitro fertilization failure

Characteristics were identified that predict adaptation following an unsuccessful attempt at in vitrofertilization (IVF). Forty-one women and their husbands were interviewed and administered questionnaires prior to IVF and 2 weeks after notice of a positive or negative pregnancy test. Of the 36 couples who failed to conceive as a result of IVF, 6 of the women studied developed clinical depressive symptoms. Those women who reported poorest adaptation to IVF failure were more likely to have reported depressive symptoms prior to IVF, were more likely to have reported feeling a general loss of control over their lives as a result of infertility, tended to use escape as a coping strategy, and reported having felt some responsibility for their IVF failure. Dispositional optimism, as well as a sense of being partially responsible for the infertility, was protective of distress following IVF failure.

Fertility preservation for female cancer patients: early clinical experience

OBJECTIVE To characterize the early experience of a clinical program designed to provide strategies for fertility preservation to female cancer patients about to undergo chemotherapy or radiation therapy. DESIGN Retrospective chart review; case-control study. SETTING Academic medical center. PATIENT(S) Sixty-five female cancer patients and 57 age-matched infertility patients. INTERVENTION Enrollment in a program for fertility preservation. MAIN OUTCOME MEASURE(S) Choice of active participation, fertility preservation option selection, clinical outcomes of patients undergoing oocyte retrieval, attitudes regarding embryo disposition. RESULT(S) Of 65 patients referred to the program, 18 declined to undergo embryo, oocyte, or tissue cryopreservation. Six were found not to be eligible for medical reasons. Of the remaining 41 patients, 35 chose to cryopreserve embryos, four chose to cryopreserve oocytes, and two chose to undergo ovarian tissue freezing. Fewer oocytes were recovered from the embryo cryopreservation group when compared with an age-matched control group, but the mean number of zygotes generated was similar. Attitudes regarding embryo disposition were different between the two groups. No serious clinical sequelae resulted from participation. CONCLUSION(S) Fertility preservation techniques employing available technology may provide safe and practical options to female cancer patients facing chemotherapy or radiation therapy. A significant number of otherwise appropriate participants decline active management. Cancer patients display different attitudes regarding embryo disposition when compared with infertility patients without cancer.

Psychological factors related to donor insemination

OBJECTIVE To survey a sample of couples who had completed therapeutic donor insemination (TDI) regarding several psychological variables. DESIGN Couples who had conceived through TDI in the past 7 years completed a retrospective survey. PARTICIPANTS Thirty-five of seventy couples returned completed questionnaires. MEASURES Demographic questionnaire, TDI, and confidentiality questionnaire (created for this study), Dyadic Adjustment Scale. RESULTS The majority of the subjects told at least one person about the TDI but 81% of subjects who told someone reported that, if they had to do it over again, they would tell no one. Eighty-six percent reported that they have not and will not tell the child. Time from diagnosis to beginning TDI was not correlated with marital adjustment after TDI. Overall, the couples reported average marital adjustment. For both men and women, the biggest concern was the genetic/medical history of the donor. Most couples did not have psychological counseling, but 39% thought it should be mandatory. CONCLUSIONS Retrospectively, most couples regretted telling others about TDI. Most couples do not plan to tell the TDI child about its genetic origin. The major concern about TDI is the genetic and medical background of the donor. Psychological counseling should be available to couples undergoing TDI.

A prospective study of donor insemination recipients: secrecy, privacy, and disclosure.

OBJECTIVES To study prospectively the attitudes and behaviors of heterosexual couples undergoing donor insemination. DESIGN Couples undergoing donor insemination completed psychological questionnaires before treatment regarding psychiatric symptoms, self-esteem, marital adjustment, and their attitudes about privacy or disclosure. PARTICIPANTS Forty-one of 82 heterosexual couples participated. MEASURES A donor insemination questionnaire, a self-esteem scale, the Brief Symptom Inventory, and the Dyadic Adjustment scale were used. RESULTS Psychiatric symptoms, self-esteem, and marital adjustment were all in the normal range. The amount of time taken by the couple to decide to do donor insemination was not related to reported psychiatric symptoms, self-esteem, marital adjustment, or marital satisfaction. Ninety-five percent of the couples believed a psychological consultation should be a mandatory part of the donor insemination treatment. The greatest concern the couples had about the donor child was its genetic and medical background. Thirty-eight percent of the couples did tell or planned to tell others about using donor insemination to conceive, and only 27% of the couples planned to tell the child of his or her donor origin. CONCLUSIONS The results of this study support those of others, which have indicated that the majority of donor recipients are psychologically well adjusted and have average marital adjustment. In addition, this prospective study replicated the findings of other retrospective studies, indicating that most donor insemination recipients do not plan to tell the child of his or her donor origin. Additional prospective studies are needed to determine if attitudes and behavior regarding disclosure change over time.

Psychological characteristics and factors related to willingness to donate again among anonymous oocyte donors

OBJECTIVE To assess post-donation psychological status of a large sample of professionally recruited, paid anonymous donors and to determine whether there were any differences between those who were willing to donate again and those who were not. DESIGN Cross-sectional survey. SETTING Healthy donors who were recruited by two private groups. SUBJECT(S) One hundred fifteen donors who had completed at least one donation cycle at one of six IVF programs in a large Midwestern city. INTERVENTION(S) None. MAIN OUTCOME MEASURES Self-report questionnaire assessing psychological symptoms, self-esteem, expectations, satisfaction, and attitudes toward donation. RESULT(S) Psychological symptomatology and self-esteem were in the normal range. Altruism and compensation were the two most frequently cited motivators for donation. Of the donors, 82% were moderately to very satisfied with the donation experience. First-time donors were significantly younger, reported more post-donation psychiatric symptoms, and had slightly lower self-esteem. Of the donors, 35% stated they would donate again; 37% would not, and 28% were undecided. Donors who were willing to donate again reported significantly less ambivalence about donation and significantly greater satisfaction with the medical aspects of donation. CONCLUSION(S) Approximately one third of donors are willing to donate more than once. These women report less ambivalence and greater satisfaction with the donation experience.

The Disposition of Unused Frozen Embryos

To the Editor: The disposition of unused embryos is a pressing problem for in vitro fertilization programs.1,2 Although cryopreservation of embryos gives couples the chance to make additional attem...

Infertility patients and their partners: Differences in the desire for twin gestations

OBJECTIVE To explore how the individuals within an infertile couple differ from one another in their attitudes toward the conception of twin gestations. METHODS From November 1999 through February 2000, consecutive couples undergoing treatment at a university-based infertility clinic were invited to participate in a face-to-face interview that ascertained their individual desires for singleton and twin gestations and their perception of the risks associated with these pregnancies. RESULTS Of the 94 couples approached, 90 (96%) agreed to participate in the study. Patients estimated the incidence of prematurity, low birth weight, preeclampsia, and postpartum depression in twin gestations to be significantly greater than their partners did (27% versus 17%, 26% versus 17%, 22% versus 16%, and 21% versus 16%, respectively). Despite these higher estimates, the desire for a twin gestation was similar. In 19 couples (21%), the patient and partner did not agree whether a singleton or twin pregnancy was the most preferred outcome. No predictive factor for this discordance could be identified. CONCLUSION Women undergoing infertility treatment are less risk averse than their partners. Additionally, a sizeable portion of couples do not align in their preference for a twin gestation. These differences should be recognized and addressed during the preconceptional period.

Psychological Distress Among Women With Recurrent Spontaneous Abortion

Fifty-seven of 100 women with recurrent abortion completed questionnaires designed to assess demographic and reproductive variables, depression, anxiety, social desirability, self-esteem, locus of control, and marital adjustment. The results indicated that 32% of the women could be classified as depressed. The subjects also reported higher than average levels of acute and chronic anxiety. Fifty-three percent of the subjects reported below average marital adjustment. Post hoc analyses indicated that the women who had a previous elective abortion had higher levels of anxiety, lower marital adjustment, and different attributions regarding their pregnancy losses than the women who had not had an elective abortion. Having a living child was not a protective buffer against psychological distress.

Long-term outcome of nonconservative surgery (hysterectomy) for endometriosis-associated pain in women <30 years old.

OBJECTIVE This study was undertaken to evaluate the effect that a patients age at the time of hysterectomy for endometriosis-associated pain has on long-term improvement in symptoms. STUDY DESIGN An investigation of women who underwent hysterectomy for pelvic pain and endometriosis at <30 or >40 years of age was performed by means of medical records review and mailed questionnaires. Participants were asked to complete 2 standardized surveys, the Disruption of Functioning Index and the Beck Depression Inventory. RESULTS Sixteen women in the study group (<30 years old) and 27 women in the control group returned completed questionnaires. Although similar proportions reported overall alleviation of pain, the study group was significantly more likely to report residual symptoms, such as dyspareunia and dysuria. This younger group also more often reported a sense of loss after hysterectomy and reported more overall disruption in different aspects of life. CONCLUSION Women who undergo hysterectomy for pelvic pain and endometriosis at <30 years old are more likely than older women to have residual symptoms, to report a sense of loss, and to report more disruption from pain in different aspects of their lives.

Lesbian couples as therapeutic donor insemination recipients: do they differ from other patients?

Reports were based on 23 lesbian couples seeking therapeutic donor insemination (TDI). Seventeen single women and 14 heterosexual couples with known infertility, due to vasectomy, were recipient controls. No group differences were found on self-esteem, psychiatric symptomatology or dyadic adjustment, except that lesbians reported greater dyadic cohesion than heterosexuals. Lesbians and single women were likely to disclose their use of TDI to others and had planned to disclose this to any child conceived; married couples were divided on this issue. Groups were alike in what they wanted to know about the donor (principally health variables and medical history), and in their concerns about the use of TDI (genetic and medical history). Groups differed in the reasons they elected to use TDI, with lesbian couples and single women choosing TDI affirmatively, and married couples accepting it as a last resort.