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Emotional Support Programs for in Vitro Fertilization
observations by Chehval and Mehan2 and Dubin and Amelar,3 who showed that hCG treatment in patients with an unsuccessful SVL may be beneficial and improve sperm quality and pregnancy rates. After completion of the study and because of the disappointing results, we changed our protocol and now perform an SVL as a first step in the treatment of oligospermic men with an associated varicocele. Only one patient showed high levels of both luteinizing hormone and follicle-stimulating hormone, and we account for the large range of these gonadotropins in our papers. In their work, Drs. Futterweit and Sobrer04 have shown a 33% (9. of 27) c?nception rate in normogonadotropic ?hgospermlc males treated with hCG. However, In four of the conceptions no improvement in sperm count, motility, or morphology occurred following hCG treatment. It would therefore be difficult to conclude that these conceptions had occurred as a consequence ofhCG administration. Furthermore, in reevaluating the response of the patients presented in our paper, at least 9 months after cessation of treatment, we found that only one additional patient had succeeded in impregnating his wife. We therefore feel that our conclusion on the low efficacy of hCG treatment in oligoasthenospermia is valid in view of the poor results after a long-term follow-up period. It ~hould be noted, however, that our experience IS based only on one regimen of hCG treatment, and it is possible that different schedules or modes of administration may yield better results.
Neri Laufer, MD. Department of Obstetrics and Gynecology Yale University School of Medicine New Haven, Connecticut 06510 August 30, 1983
REFERENCES 1. Margalioth E, Laufer N, Persistz E, Gaulayev B, Shemesh
A, Schenker JG: Treatment of oligoasthenospermia with human chorionic gonadotropin: hormonal profiles and results. Fertil Steril 39:841, 1983 2. Chehval MJ, Mehan DJ: Chorionic gonadotropins in the treatment of the subfertile male. Fertil Steril 31:666 1979 ' 3. ~ubi~~, Amelar RD: Varicocelectomy as therapy in male mfertlhty: a study of 504 cases. Fertil Steril 26:217, 1975 4. Futterweit W, Sobrero AJ: Treatment ofnormogonadotropic oligospermia with large doses of chorionic gonadotropin. Fertil Steril 19:971, 1968
704
Letters to the editor
Emotional Support Programs for in Vitro Fertilization To the Editor: When we speak of an infertile couple, much of our impetus is focused on their medical status and treatment plan. We so often overlook the importance of the emotional, marital, and sexual components that infertility encompasses. As we continually progress into new avenues of diagnosis and treatment, we tend to overlook the emotional cost. Each new test and procedure carries an element of frustration for the patients. Practitioners describe the process of in vitro fertilization and embryo transfer (IVF-ET) as a long and grueling one. As the final attempt for biologic offspring, it is fraught with much anxiety. Most IVF-ET programs include the administration of some psychologic inventory to select out from the program those couples unable to withstand the pressures. A normal functioning population will remain who should not be deprived of a support system within the confines of the IVF-ET program. I suggest the following: each incoming group of patients should be seen together each day on a regularly scheduled basis. This group approach would foster a sense of camaraderie among the couples, lessening the sense of isolation for those who are far from home. These meetings would also provide a forum for discussions of feelings associated specifically with IVF-ET and, in general, with infertility. There should also be a follow-up meeting with each couple individually after the ET has been completed. I believe the benefit to the patient will far outweigh any additional costs incurred. We need to keep in mind that for the infertile couple, the chances for a pregnancy depend largelyon the medical community. We are being asked to provide assistance and medical expertise in an area where it was once assumed no help would be needed. As we fulfill our patients' emotional needs, the long days of waiting, wondering, and longing for a successful pregnancy will be more constructively . spent, regardless of the outcome.
Andrea Shrednick, M.S. Family and Infertility Counseling Mahopac, New York 10541 August 16, 1983 Fertility and Sterility
Neri Laufer, MD. Department of Obstetrics and Gynecology Yale University School of Medicine New Haven, Connecticut 06510 August 30, 1983
REFERENCES 1. Margalioth E, Laufer N, Persistz E, Gaulayev B, Shemesh
A, Schenker JG: Treatment of oligoasthenospermia with human chorionic gonadotropin: hormonal profiles and results. Fertil Steril 39:841, 1983 2. Chehval MJ, Mehan DJ: Chorionic gonadotropins in the treatment of the subfertile male. Fertil Steril 31:666 1979 ' 3. ~ubi~~, Amelar RD: Varicocelectomy as therapy in male mfertlhty: a study of 504 cases. Fertil Steril 26:217, 1975 4. Futterweit W, Sobrero AJ: Treatment ofnormogonadotropic oligospermia with large doses of chorionic gonadotropin. Fertil Steril 19:971, 1968
704
Letters to the editor
Emotional Support Programs for in Vitro Fertilization To the Editor: When we speak of an infertile couple, much of our impetus is focused on their medical status and treatment plan. We so often overlook the importance of the emotional, marital, and sexual components that infertility encompasses. As we continually progress into new avenues of diagnosis and treatment, we tend to overlook the emotional cost. Each new test and procedure carries an element of frustration for the patients. Practitioners describe the process of in vitro fertilization and embryo transfer (IVF-ET) as a long and grueling one. As the final attempt for biologic offspring, it is fraught with much anxiety. Most IVF-ET programs include the administration of some psychologic inventory to select out from the program those couples unable to withstand the pressures. A normal functioning population will remain who should not be deprived of a support system within the confines of the IVF-ET program. I suggest the following: each incoming group of patients should be seen together each day on a regularly scheduled basis. This group approach would foster a sense of camaraderie among the couples, lessening the sense of isolation for those who are far from home. These meetings would also provide a forum for discussions of feelings associated specifically with IVF-ET and, in general, with infertility. There should also be a follow-up meeting with each couple individually after the ET has been completed. I believe the benefit to the patient will far outweigh any additional costs incurred. We need to keep in mind that for the infertile couple, the chances for a pregnancy depend largelyon the medical community. We are being asked to provide assistance and medical expertise in an area where it was once assumed no help would be needed. As we fulfill our patients' emotional needs, the long days of waiting, wondering, and longing for a successful pregnancy will be more constructively . spent, regardless of the outcome.
Andrea Shrednick, M.S. Family and Infertility Counseling Mahopac, New York 10541 August 16, 1983 Fertility and Sterility