In vitro fertilization : Emotional reactions to treatment, pregnancy and parenthood

University dissertation from Stockholm : Karolinska Institutet, Department of Women's and Children's Health

Abstract: The overall aim of this thesis was to study the emotional reactions of women and men entering in vitro fertilization (IVF) treatment and to study the emotional reactions during pregnancy and postpartum in couples who have achieved a pregnancy following IVF. Ninety-one couples seeking IVF treatment were investigated regarding gender differences in stress related to infertility. The couples filled in a questionnaire covering psychosocial aspects of infertility and a scale assessing coping-style. It was found that the women reported stronger stress related to infertility than the men, and they also felt an intense desire to have a child. They received more social support than their partners, who experienced the fulfilment of the male role as well as the social obligation to become a parent as the most central aspect of infertility. Our longitudinal study included 57 women who had achieved a pregnancy via IVF (IVF women), 55 of their male partners (IVF men), 43 women who had achieved a pregnancy without assisted reproductive technology (control women) and 39 of their male partners (control men). The subjects were assessed three times during pregnancy and again at two and six months postpartum. They completed a personality inventory and a series of self-rating scales measuring emotional responses to pregnancy, anxiety, their attitudes toward parenthood, marital satisfaction and parental stress. The IVF subjects were interviewed about their experiences of pregnancy, parenthood and perception of infertility, post successful treatment. The IVF women had more muscular tension and tended to be more irritable compared to the control women. The IVF men had more somatic anxiety, indirect aggression, feelings of guilt, more detachment and they tended to have more psychic anxiety than the control men. Anxiety about loosing the pregnancy was stronger among the IVF women and the IVF men from early to late pregnancy as compared to the controls. The IVF women experienced their pregnancies in a less negative way, they were less concerned about the child's gender than the control women, and they were also less worried about possible "loss of freedom" in their future lives as parents. The IVF men were more anxious that the baby might be injured during birth as compared to the control men. Associations were found between a high degree of previous infertility distress and high levels of pregnancy related anxiety among the IVF women and the IVF men. Levels of parental stress among IVF parents were equal to those of the control parents. The pattern of marital satisfaction during transition to parenthood was comparable among IVF parents and control parents, with a decline from early pregnancy to six months postpartum. The results of the interviews with the IVF subjects showed that, negative feelings related to infertility are not easily overcome even though an IVF treatment is successful and parenthood achieved. The results showed that gender may affect how infertility is perceived and how coping strategies are chosen when dealing with infertility distress. Concerning strategies for antenatal care, it is important to pay attention to an elevated anxiety level among IVF couples that should be acknowledged while also lending support to normalize the pregnancy. In addition, it is essential to give them extra time to discuss pregnancy experiences and their future life as parents. It seems that the inability to conceive naturally continues to affect the emotions of a proportion of IVF parents even if pregnancy is achieved and a child is born. The results suggest that IVF parents may benefit from counselling with regard to the potential long-term impacts of infertility.

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