The psychosocial impact of infertility among women seeking fertility treatment

The psychosocial impact of infertility among women seeking fertility treatment

OBJECTIVE: While the Uterine Fibroid Symptom and Quality of Life questionnaire (UFS-QOL) is a validated and helpful tool in determining response to tr...

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OBJECTIVE: While the Uterine Fibroid Symptom and Quality of Life questionnaire (UFS-QOL) is a validated and helpful tool in determining response to treatment, it does not allow for the texture and intensity of fibroid related experiences to be conveyed. The purpose of this study is to qualitatively identify and characterize challenges that impact quality of life and emotional well-being of women with symptomatic fibroids. DESIGN: Qualitative semi-structured interviews, health literacy assessments, and demographic surveys. MATERIALS AND METHODS: Women with symptomatic uterine fibroids were recruited from an urban academic medical center and community-based organizations in a large Midwest metropolitan area. Participants completed in-depth, one-on-one interviews, a health literacy assessment and a demographic survey. Interviews were transcribed verbatim and uploaded to NVivo version 10 for data management and thematic coding. Three coders identified major themes and subthemes using a grounded theory approach. RESULTS: Sixty women completed the study for a total of 35 hours of interviews yielding 1,357 transcribed pages. The k across coders was 0.94. The mean age of participants was 43.0  6.8 (mean  SD). 61.7% of participants self-identified as African-American, 25.0% as Caucasian, 8.3% as Hispanic and 5.0% as Asian. 68.3% of the participants had at least a 4-year college degree and 55.0% of the women had a total annual household income of less than $75,000. Two of the major themes identified were impact of fibroids on work and impact on social life. Work impact examples include women feeling distressed due to fear of soiling their clothes and furniture. They also felt frustration and anxiety because heavy bleeding and pain symptoms frequently led to missed days of work. Women’s social lives were also impaired by having symptomatic fibroids. Women reported feeling lonely and socially isolated due to staying at home to avoid embarrassment caused by unexpected pain or bleeding and expressed guilt about missing out on major social events and disruption of relationships. Women also expressed shame about their appearance, difficulty planning for social events, and limited behavioral coping strategies as a result of having to work around the symptoms of their fibroids. CONCLUSIONS: Symptomatic fibroids greatly impair women’s work and social lives in ways that cannot be fully captured in a survey. These challenges impact the quality of life in women largely by limiting their work productivity and social engagement with loved ones. The emotional distress reported by women in this qualitative study suggests the need for the inclusion of mental health professionals in improving clinical care and wholehealth outcomes for women suffering from these prevalent tumors. Supported by: NIH WRHR Program K12HD050121; RWJ Foundation; NMH; Evergreen Foundation (EEM). P-734 Wednesday, October 21, 2015 DONOR EGGS: ON ICE, STILL NICE? J. C. Patel,a D. L. Cunningham,a M. Y. Fung,b D. A. Sheehan,a M. K. Connerney,a K. J. Go.b aEmbryology, IVF New England, Lexington, MA; bIVF New England, Lexington, MA. OBJECTIVE: The vitrification and thawing of mature human eggs are among the newest of assisted reproductive technologies (ART), and present the opportunity for creating donor egg banks. Given some of the advantages to the recipient patient of using vitrified eggs (VE), e.g., greater selection of

donors, lower cost, and more convenience with no need for cycle synchronization with the donor, ART laboratories may encounter VE cycles more frequently, requiring development of expertise in using VE. To learn how VE compare with fresh eggs (FE) and identify the technical differences in using each egg type, we compared clinical outcomes for recipients of VE and FE from July 1, 2012 through December 31, 2014. VE were purchased from a single egg bank in this study. DESIGN: Retrospective data analysis of IVF cycles of recipients of FE or VE from a single VE bank. Statistical analyses were conducted by Student’s t-test and Mann-Whitney U test. MATERIALS AND METHODS: Recipient cycles of FE or VE were compared for average number of eggs per cycle, fertilization rate, #embryo transfers, average # embryos transferred, pregnancy rate,and chance for the recipient to have supernumerary embryos for cryopreservation. FE were inseminated conventionally or by ICSI; VE received ICSI exclusively. Assisted hatching was used electively on cleavage stage embryos (CSE)from FE but on all VE CSE. Embryologists were trained in the specific thawing protocol of VE obtained from a single egg bank. RESULTS: 80 FE and 168 VE cycles were analyzed, with 1595 and 1171 eggs, respectively, available for the recipients (averages of 19.9 FE vs 7 VE per recipient). Fertilization rates of 76.18.5% and 84.18.0%)of inseminated FE and VE, respectively, were achieved(significant, p¼0.0011) leading to averages of 1.2 (FE) and 1.3 (VE) embryos per transfer (no statistical difference)and 49/75 FE and 91/158 VE clinical pregnancies per ET (not significant, chi-squared¼1.2699, p¼0260).72.5% of FE recipients had frozen embryos after ET compared to 51.2% of VE. CONCLUSIONS: Despite the almost 3-fold higher number of eggs available per treatment cycle for FE vs. VE, comparable fertilization rates, application of elective single embryo transfer, and clinical pregnancy rates per ET were obtained. FE patients had an advantage in more frequently having supernumerary embryos for freezing from their cycles. VE can provide more cost-effective and convenient treatment to patients but require specific training in the thawing protocol prescribed by the egg bank to realize this advantage. P-735 Wednesday, October 21, 2015 THE PSYCHOSOCIAL IMPACT OF INFERTILITY AMONG WOMEN SEEKING FERTILITY TREATMENT. W. D. Winkelman,a P. P. Katz,b J. F. Smith,c T. Rowen.a aObstetrics, Gynecology and Reproductive Medicine, University of California, San Francisco, San Francisco, CA; b Department of Medicine, University of California, San Francisco, San Francisco, CA; cDepartment of Urology, University of California, San Francisco, San Francisco, CA. OBJECTIVE: To identify factors that are associated with increased psychosocial impact on women seeking infertility treatment. DESIGN: Cross sectional study of women seeking infertility treatment who presented for an initial intake exam. MATERIALS AND METHODS: Responses to written questionnaire that included items on the sexual, personal, marital, and social impact of infertility using a previously validated scale. Respondents also classified the underlying cause of infertility as female factor, male factor, concurrent male and female factor or unexplained infertility. Multivariate regression

Table 1: Impact of infertility among respondents for select demographic traits, adjusted model,

Characteristic Perceived Infertility Etiology Age (years) Duration of infertility (months)

Male factor only Combined Female factor only Unexplained <40 R40 <6 6-48 48-60 >60 Unknown

FERTILITY & STERILITYÒ

Sexual impact score, mean (p)

Personal impact score, mean (p)

Marital impact score, mean (p)

Social impact score, mean (p)

22 (ref) 15 (0.09) 33 (<0.01) 15 (0.28) 22 (ref) 15 (<0.01) 22 (ref) 31 (0.05) 23 (0.92) 33 (0.09) 30 (0.10)

58 (ref) 67 (0.1) 72 (<0.01) 74 (0.05) 58 (ref) 50 (0.01) 58 (ref) 51 (0.19) 54 (0.66) 54 (0.60) 49 (0.51)

27 (ref) 29 (0.68) 30 (0.34) 32 (0.38) 27 (ref) 30 (0.18) 27 (ref) 36 (0.03) 32 (0.42) 33 (0.29) 33 (0.17)

55 (ref) 40 (0.2) 40 (0.18) 44 (0.17) 35 (ref) 28 (<0.01) 35 (ref) 33 (0.67) 42 (0.33) 42 (0.24) 30 (0.32)

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analyses were used to identify factors independently associated with increased impact. RESULTS: A total of 809 women met the inclusion criteria, of which 396 (49%) completed the questionnaire. Most participants (75.5%) reported having no prior children. The majority (58.8%) attributed infertility to only female factors, 30.4% to a combination of male and female factors, 7.3% to only male factor, and 3.5% reported that the etiology had not been determined. The actual cause of infertility from the medical records was statistically different from the perceived cause of infertility, p<0.01. In the multivariate analysis, women with female factor only infertility reported the highest level of sexual dysfunction (p<0.01) and personal distress (p¼0.01). Women <40 years old were at higher risk for sexual dysfunction, personal distress and social distress when compared to those older than 40 (p<0.01 for all). Respondents with prior biological children reported lower levels of social and personal distress but higher levels of marital distress (p<0.05). Relative to those with <6 months of infertility, respondents with 6-48 months of infertility reported lower rates of sexual dysfunction (p¼0.05) but higher rates of marital distress (p¼0.04). These results are similar to those previously published for male respondents from the same cohort (1). CONCLUSIONS: Women seeking care for infertility are at high risk of sexual dysfunction, and social, marital, and personal distress. These data support the practice of screening female infertility patients for psychosocial distress and offering appropriate treatment or referrals to help address these concerns. Providers should consider the roles that younger age and perceived causes of infertility play in a women’s overall wellbeing. Reference: 1. Smith JF, Walsh TJ, Shindel AW, et al. Sexual, marital, and social impact of a man’s perceived infertility diagnosis. J Sex Med. 2009;6(9):2505-15.

P-736 Wednesday, October 21, 2015 A CRY FOR HELP: THE RELATIONSHIP BETWEEN PERCEIVED SOCIAL SUPPORT AND QUALITY OF LIFE IN INFERTILITY PATIENTS. J. M. Wong,a A. Lawson,b M. Lanham,c S. Fisseha,c M. B. Moravek.a aObstetrics and Gynecology, Northwestern University, Chicago, IL; bNorthwestern Medical Group, Chicago, IL; cUniversity of Michigan, Ann Arbor, MI. OBJECTIVE: To investigate the relationship between affect (Positive and Negative Affect Scale; PANAS-X) and fertility-related quality of life (Fertility Quality of Life Scale; FertiQoL), and to examine demographic and clinical predictors of psychological distress among women with infertility. DESIGN: Questionnaire administered at a tertiary outpatient fertility clinic. MATERIALS AND METHODS: 266 women undergoing infertility assessment and treatment were given a survey including demographics, fertility history, experience of social support during fertility treatment, PANAS-X, and FertiQoL scales. RESULTS: The majority of patients were married (90%), white (69%) women with at least a college degree (81%) who earned >$75,000 (59%) per year. Negative Affect (PANAS-X NA) was significantly correlated with decreased FertiQoL Core and Treatment scale scores (r¼-0.68, p<0.001; r¼-0.42, p<0.001), while Positive Affect (PANAS-X PA) was significantly correlated with increased FertiQoL Core and Treatment scale scores (r¼0.51, p<0.001; r¼0.25, p<0.01). Although PANAS-X and FertiQoL scores both demonstrated significant correlations with mental health history and a reported need for more social support, a negative correlation was found between mental health history and need for more social support (r¼-0.134, p<0.05). Regression analyses predicting PANAS-X NA, PANAS-X PA, and FertiQoL Core and Treatment scale scores demonstrated that in 3 of the 4 models, poor quality of life and affect were largely driven by perceptions of inadequate social support (p<0.05). CONCLUSIONS: Screening patients with the PANAS-X or FertiQoL scales can provide insight into patients’ emotional functioning; however, screening for perceived level of social support may allow for an earlier identification of patients at an increased risk of psychological distress. Further, the negative correlations between patient mental health history and a reported need for more social support demonstrate that simply screening patients for a history of anxiety or depression is insufficient to adequately recognize at-risk patients. Infertility and mental health providers therefore must work together

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ASRM Abstracts

to provide prompt and preventive support to infertility patients from the first patient encounter. P-737 Wednesday, October 21, 2015 ADOLESCENTS CONCEIVED THROUGH DONOR INSEMINATION: AN IN-DEPTH QUALITATIVE STUDY OF THE EXPERIENCES OF CONTACTING AND MEETING DONOR OFFSPRING. S. Persaud,a T. Freeman,b V. Jadva,b J. Slutsky,c W. Kramer,d M. Steele,c H. Steele,e S. Golombok.f aClinical Psychology, The New School for Social Research, New York, NY; bUniversity of Cambridge, Cambridge, United Kingdom; cThe New School for Social Research, New York, NY; dDonor Sibling Registry, Nederland, CO; ePsychology Dept, New School for Social Research, New York, NY; fCentre for Family Research, Cambridge, United Kingdom. OBJECTIVE: This study aims to examine the experiences of adolescents conceived through donor insemination contacting and meeting their donor relations and how they make meaning of these relationships. DESIGN: Adolescents were interviewed at their home using semi-structured interviews aimed at understanding the experiences of adolescents meeting other children conceived from the same donor’s sperm. MATERIALS AND METHODS: Twenty-three participants were recruited from the Donor Sibling Registry, a website that assists families in contacting their donor relations (both the donor and other families who share the same donor). Inclusion criteria included the following: participants must be 12-19 years old, reside in New York, New Jersey, or Connecticut, and have contacted or met at least one donor sibling. Thematic analysis was conducted on interview transcripts to identify central themes within and across interviews. RESULTS: Preliminary analysis has produced the following emergent themes: a) neutrality/normality in discussion of donor conception in which participants express a sense of normalcy about donor conception through an integration of their identity as a donor-conceived person, b) curiosity related to knowing about their donor relations and forming relationships with them, c) donor siblings in multiple relationship roles in which participants experience their donor siblings in a multi-faceted manner as both ‘‘friend’’ and ‘‘family,’’ and d) having a unique experience as part of identity where being donor conceived provides a sense of being different that is affected by the social context. CONCLUSIONS: This study highlights the importance of an in-depth, qualitative inquiry into the experiences of donor-conceived persons meeting their donor relations, particularly in the adolescent age range, when identity formation is developing. As this is an area that has not previously been studied, it provides insight into these experiences in their complexity and challenges assumptions commonly held about this population. Supported by: This study was Supported by the Wellcome Trust [097857/ Z/11/Z].

P-738 Wednesday, October 21, 2015 PSYCHOLOGICAL DISTRESS IN WOMEN PRESENTING FOR FIRST-TIME IN VITRO FERTILIZATION: RELATIONSHIPS AMONG MATERNAL IDENTITY CENTRALITY, GRIEF, AND PSYCHOPATHOLOGY. K. Levin, L. Samstag, S. Haden, J. Duncan, N. Papouchis. Department of Psychology, Long Island University, Brooklyn, NY. OBJECTIVE: The objective of the present study was to answer the following two questions: (1) to what extent do women presenting for firsttime IVF differ from ‘non-infertile’ control samples on measures of anxiety, depression, and grief; and (2) does the interaction between maternal identity centrality – a developmental construct measuring self-reported identification with the social role of motherhood (Levin et al., 2014) – and infertility-specific grief increase the likelihood of developing anxiety and depression in women presenting for first-time IVF? DESIGN: A between-subjects design was used to compare women presenting for first-time IVF to control samples on measures of anxiety (N ¼ 152), depression (N ¼ 152), and grief (n ¼ 138). A within-group design was used to examine a possible interaction between maternal identity centrality and grief on the presence of anxiety and depression in a sample of women presenting for first-time IVF (n ¼ 112).

Vol. 104, No. 3, Supplement, September 2015