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PubMed2002

[Cytologic and immunologic prognosis of infertility. II Prognostic value of studies of immunoglobulins A, M, and G in peritoneal fluid and blood of infertile patients].

Immunoglobulins of A, M, and G classes were studied in the blood and peritoneal fluid of 80 women during laparoscopic operation by nefelometry. An increased concentration of these immunoglobulins A, M, G was revealed in the patients with unfavourable prognosis. The immunological changes were seen to depend on the patient's age and the stage of lesion.

Adult↗
PubMed1993

[Mechanical infertility in the female population of the Kielce province. IV. Evaluation of hypophyseal gonadotropin levels during the [Mechanical infertility in the female population of the Kielce province. IV. Evaluation of hypophyseal gonadotropin levels during the menstrual cycle].

The paper describes results of the RIA of the hypophyseal gonadotropins estimated in the menstrual cycle in the group of women with mechanical sterility in confrontation with the group of fertile women. Significantly higher mean concentration of FSH in follicular and luteal phase and higher concentration of LH after ovulation in the group of sterile women were found. There was no LH peak and mean concentration in 14th day of menstrual cycle was significantly lower in the group of women with mechanical sterility. Mean PRL concentration was higher but within the bounds of standard in sterile women.

Adult↗
PubMed2006

Infertility and assisted reproduction in Denmark. Epidemiology and psychosocial consequences.

Clinically a couple is considered to be infertile after at least one year without contraception and without pregnancy. There was scant knowledge about the prevalences of infertility, involuntary childlessness and the seeking of fertility treatment and only few longitudinal studies about the psychosocial consequences of infertility and its treatment. This thesis is about the epidemiological aspects of infertility; the conceptualization and measurement of important psychosocial aspects of infertility; and a medical sociological analysis of the associations between these psychosocial variables among Danish women and men in fertility treatment. The thesis is based on nine papers. The three main purposes were: (i) to review critically, population based studies of infertility and medical care seeking in industrialised countries. Further, to examine these prevalences and subsequent motherhood among women in former assisted reproduction in a Danish population. (ii) To develop measures of psychosocial consequences of infertility: fertility problem stress, marital benefit, communication, coping strategies, attitudes to and evaluation of fertility treatment. (iii) To examine these phenomena and to analyse their interrelations among Danish women and men in fertility treatment. The thesis is based on four empirical studies: (i) The Women and Health Survey, a cross-sectional population-based study among 15-44 year old women (n=907, 25-44 year old) in Copenhagen County, 1989. (ii) The Psychosocial Infertility Interview Study, a qualitative interview study among 16 couples (n=2 participants) infertility treatment at The Fertility Clinic, Herlev University Hospital,1992. (iii) The Infertility Cohort, a longitudinal cohort study consecutively including all couples (n=250 participants) beginning anew fertility treatment period at one of four public (Braedstrup, Herlev, Odense, Rigshospitalet) and one private fertility clinic (Trianglen),2000-2002. (iv) The Communication and Stress Management Training Programme, an intervention study among couples(n=74 participants) in fertility treatment at The Fertility Clinic, The Juliane Marie Centre, Rigshospitalet, 2001-2003. Included is also a literature review of population-based infertility studies from industrialised countries. Data from (iii) and (iv) are studies from The Copenhagen Multi-centre Psychosocial Infertility (COMPI) Research Programme (www.compipro.dk). Epidemiological and demographic studies investigating the prevalences of infertility differed in how they defined the numerator (the infertile participants) and the denominator (the population at risk). It was important to calculate reliable estimates of the infertility prevalence by including only women who had tried to have at least one child in the population at risk, as a notable proportion of women in the fertile ages had not (yet) attempted to become a mother. The lifetime prevalence of infertility in the representative population-based study was 26.4%. In the age group 35 to 44 years 5.8% were primarily involuntarily in fecund (involuntarily childless). Even in a country with access to fertility treatment in a public health-care system without self-payment lower education was a predictor of lower treatment seeking. In the cohort study (2000-2002)of couples starting a new period of assisted reproduction treatment 62.6% reported a treatment-related pregnancy at the one-year follow-up. In total 32.4% reported a treatment-related delivery. In total 24.2% reported a current continuing pregnancy and spontaneous pregnancies accounted for 2.7% of these. We developed measures of fertility problem stress, marital benefit(that infertility has brought the partners closer together and strengthened their marriage), partner communication, infertility related communication, coping strategies, attitudes to fertility treatment and evaluation of care. The medical sociological analyses showed that the variables of psychosocial consequences of infertility and treatment are interwoven with each others in a complex pattern, a pattern that both differed and was similar when comparing women and men. The infertility-related communication strategy (secrecy, formal, open-minded)identified in the qualitative interviews was later confirmed in the COMPI Infertility Cohort. Using the formal strategy and not talking about the emotional aspects of infertility and its treatment suggested high fertility problem stress. The coping strategies studied showed significant social differences and active-avoidance coping was a significant predictor of high fertility problem stress. A positive effect of infertility on the marriage, marital benefit was common. Men using the secrecy communication strategy had increased risk of low marital benefit. Difficult partner communication was a significant predictor of high fertility problem stress and among men, of low marital benefit. The intervention study showed that it was possible for the participants to change their communication with partner and other people close to them and that participants achieved an increased awareness of what, how much and when to discuss with others. High fertility problem stress and high marital benefit were associated with high importance ratings of patient-centred care and intentions to use professional psychosocial services. Among women, high fertility problem stress was a predictor of lower satisfaction ratings with fertility treatment. High marital benefit was a predictor of high satisfaction ratings of both medical and patient-centred care. In conclusion, infertility is a common experience among couples attempting to become parents. Assisted reproduction in the public health-care system in Denmark has high success rates, i.e. pregnancies,deliveries and high patient satisfaction. A large minority of people in fertility treatment experience high fertility problem stress,and some use communication and coping strategies that predicts high stress. Developing and evaluating different psychosocial interventions are necessary to offer the psychosocial support needed for this minority of fertility patients.

Adaptation, Psychological↗
PubMed1997

Infertility and psychological distress: a critical review of the literature.

This essay reviews the literature on the social psychological impact of infertility, paying special attention to the relationship between gender and the infertility experience. It is convenient to divide the literature into articles which explore the possibility that infertility may have psychological causes (Psychogenic Hypothesis) and those which examine the psychological consequences of infertility (Psychological Consequences Hypothesis). The psychogenic hypothesis is now rejected by most researchers, but a related hypothesis, which states that stress may be a causal factor in infertility, is worthy of exploration. The descriptive literature on the psychological consequences of infertility presents infertility as a devastating experience, especially for women. Attempts to test the psychological consequences hypothesis have produced more equivocal results. In general, studies which look for psychopathology have not found significant differences between the infertile and others. Studies which employ measures of stress and self-esteem have found significant differences. The psychological consequences literature is characterized by a number of flaws, including over sampling of women, small sample size, non-representative samples, failure to study those who have not sought treatment, primitive statistical techniques, and an over-reliance on self-reports. Studies on infertility and psychological distress need to take into consideration both the duration of infertility and the duration of treatment. Finding an appropriate set of "controls" is a particularly intractable problem for this area of research. In general, the psychological distress literature shows little regard for the social construction of infertility. By taking what should be understood as a characteristic of a social situation and transforming it into an individual trait, the literature presents what is essentially a medical model of the psycho-social impact of infertility. Most researchers conclude that infertility is a more stressful experience for women than it is for men. Most studies have found that the relationship between gender and infertility distress is not affected by which partner has the reproductive impairment. Future research needs to be better informed by theoretical considerations. Scholars need to pay more attention to the way the experience of infertility is conditioned by social structural realities. New ways need to be developed for better taking into account the processual nature of the infertility experience. Efforts need to be make to include under-studied portions of the infertile population. Finally, more effort needs to be made to better integrate the empirical study of the experience of infertility with important social policy questions.

Adult↗
PubMed2006

Infertility in a community and clinic-based sample of couples in Moshi, Northern Tanzania.

BACKGROUND: Previous research on the aetiology of infertility in sub-Saharan Africa was generally clinic based and it is not known whether findings from this work are representative of the general population. A better understanding of the medical causes of infertility is crucial for reducing the incidence of infertility and for improving the clinical management. OBJECTIVE: To determine the type and aetiology of infertility in a community and clinic-based sample. DESIGN: Couples identified as infertile in a representative cross-sectional survey from a community-based sample of 2019 women aged 20-44 years and couples seeking care for infertility at a tertiary health facility. SETTING: The community-based sample was drawn from Moshi Urban District and the clinic-based sample from patients seeking care at Kilimanjaro Christian Medical Centre (KCMC) in 2002 and 2003. PARTICIPANTS: Sixty six couples identified as infertile in the community-based sample and 112 couples seeking care for infertility. RESULTS: The percentage of primary infertility was 37.1% and secondary infertility was 62.9%. Female only factor infertility was identified in 65.9% of the couples, male only factor in 6.8%, male and female factors in 15.2% and unexplained infertility in 12.1%. CONCLUSION: The type and aetiology of infertility were the same in the community and clinic-based sample suggesting that the couples seeking infertility health care were representative of the general infertile population. Tubal factor infertility was the commonest cause.

Adult↗