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P-179 Considerations regarding psychological counseling during IVF treatments in a successful center in Brazil
82% of those patients who received a PRIME-MD diagnosis were not previously diagnosed as having a mental disorder by their primary care provider. Therefore, reproductive medicine clinics should consider screening all patients with a broad based initial diagnostic/psychiatric tool.
P-179 Considerations Regarding Psychological Counseli n g D u r i n g IVF T r e a t m e n t s in a S u c c e s s f u l C e n t e r in Brazil. D. Seibel, D. Castellotti, J. R. Alegretti, E. A. Motta. Departments Psychology, OB/GYN & Centro Huntington Reproducao Humana, Fed Univ, Sao Paulo, Brasil. Objective: Infertile couples undergoing IVF treatment face high levels of anxiety, depression along with a multitude of psychological problems. Supportive counseling and psychological interventions have been essentially neglected to IVF couples in developing countries partially due to couples' financial challenges in addition to social, cultural, religious and educational background. Thus, we wished to evaluate basic perceived needs of supportive coping strategies felt by a group of patients receiving IVF treatment in our Center. Design: Prospective study consisting of volunteered responses to an anonymously distributed multiple choice and descriptive questionnaire. Material and Methods: The IVF subjects were recruited from a private, university affiliated clinic. There were no exclusion criteria. All couples replied to the questionnaire and responses of 50 couples were analyzed. Results: Cost-effective emotional support during the process of IVF was perceived as a necessity by all participants. Over 60% of the husbands felt a need to participate in a group oriented services. Interesting was the finding that 75% of couples desired to participate in therapy sessions in the premises of the clinic rather than in outside facilities. While 70% of couples would prefer group sessions, the remaining would elect privately oriented stress reducing strategies. 60% of the couples were also able to perceive a need for continuation of counseling throughout pregnancy and childbirth. Conclusions: The results of this survey clearly imply that there is an overwhelming need for psychological counseling and supportive interventions in couples undergoing IVF treatment in developing countries such as Brazil. Furthermore, the similarities of infertile couples' psycho-emotional needs transcend cultural, religious, social, educational and financial issues. Group therapy as it is largely and successfully used in the US and other developed countries appears to be the most inciting interventional modality.
P-180 T h e D e s i r e for C h i l d b e a r i n g in W o m e n o f A d v a n c e d R e p r o d u c t i v e Age: F i n d i n g s in a D o n o r O o c y t e Program. 1j. L. Rosentha], 1'2R. C. Zimmermann, 2M. V. Sauer. 1Dept of Psychiatry, ~Division of Reproductive Endocrinology, Dept of OB/GYN, Columbia Presbyterian Medical Center, New York, NY.
Objective: The desire for childbearing in women of advanced reproductive age (ARA), with its attendant psychological, social and ethical issues, presents us with possibilities and dilemmas that we previously have not had to face. With one quick embryo transfer, we have forever changed the face of our theories about women's development, the psychology of reproduction, and the meaning of menopause. The children born to these mothers face a different legacy and have different psychological issues than those which the adoption literature has taught us, and the likelihood of parental death before these children reach adulthood is high. Should we be creating these circumstances? Design: Cross-sectional analysis of 30 women over the age of 45 who have a child or children as a result of donor egg (OD) therapy. Materials and Methods: 30 women who gave birth using OD from 1989-1996 were interviewed by 2 of the authors using a semi~structured questionnaire. The response rate was 100%. Results: When asked why they pursued OD at this particular time in their lives, 20% of the women indicated that they had delayed attempts at pregnancy until they were in the late 30's for reasons including career progression and/or marriage at an older age. ~ of these women reported ambivalent relationships with their own mother, effecting their feelings about motherhood. 50% of this group had conceived earlier in life, but had opted not to carry the pregnancy. 20% married a partner with children from a previous marriage who were themselves ambivalent about having more, thus delaying attempts at conception until the possibility of a genetically-related child was precluded. 20% intended to have children in their 30's, but were struck by significant illnesses like breast or cervical cancer, delaying their attempts to conceive. 40% of the women had adult children from previous marriages; they felt that having a child with their current husband would solidify the relationship. Over half thought this was an ideal time in their lives to raise a child because they felt financially secure and were able to spend "quality time" with them. If they did not get pregnant, 27 out of 30 said they would eventually try to adopt. They were unequivocal in their desire to have and raise a child, and the group who already had adult children felt that this could provide interesting new arrangements and possibilities in extended family. Practically all of the women perceive themselves as physically more vital and emotionally more youthful than their chronological age, and while they were thoughtful about the effects of aging, they projected that in 10 years' time they would not have aged in a way that would significantly impair their functioning as a parent. Conclusion: The desire for childbearing in women of ARA is compelling. These women have a heterogeneous group of reasons for wanting to become pregnant and have a child, all of which seem individually valid, if complex. Childbearing at an advanced age, often with already grown families, presents an implicit challenge to what we consider to be the normal life cycle, and is intriguing. For these reasons, it is particularly important that these women are seen by mental health providers who can apAbstracts
S179
P-179 Considerations Regarding Psychological Counseli n g D u r i n g IVF T r e a t m e n t s in a S u c c e s s f u l C e n t e r in Brazil. D. Seibel, D. Castellotti, J. R. Alegretti, E. A. Motta. Departments Psychology, OB/GYN & Centro Huntington Reproducao Humana, Fed Univ, Sao Paulo, Brasil. Objective: Infertile couples undergoing IVF treatment face high levels of anxiety, depression along with a multitude of psychological problems. Supportive counseling and psychological interventions have been essentially neglected to IVF couples in developing countries partially due to couples' financial challenges in addition to social, cultural, religious and educational background. Thus, we wished to evaluate basic perceived needs of supportive coping strategies felt by a group of patients receiving IVF treatment in our Center. Design: Prospective study consisting of volunteered responses to an anonymously distributed multiple choice and descriptive questionnaire. Material and Methods: The IVF subjects were recruited from a private, university affiliated clinic. There were no exclusion criteria. All couples replied to the questionnaire and responses of 50 couples were analyzed. Results: Cost-effective emotional support during the process of IVF was perceived as a necessity by all participants. Over 60% of the husbands felt a need to participate in a group oriented services. Interesting was the finding that 75% of couples desired to participate in therapy sessions in the premises of the clinic rather than in outside facilities. While 70% of couples would prefer group sessions, the remaining would elect privately oriented stress reducing strategies. 60% of the couples were also able to perceive a need for continuation of counseling throughout pregnancy and childbirth. Conclusions: The results of this survey clearly imply that there is an overwhelming need for psychological counseling and supportive interventions in couples undergoing IVF treatment in developing countries such as Brazil. Furthermore, the similarities of infertile couples' psycho-emotional needs transcend cultural, religious, social, educational and financial issues. Group therapy as it is largely and successfully used in the US and other developed countries appears to be the most inciting interventional modality.
P-180 T h e D e s i r e for C h i l d b e a r i n g in W o m e n o f A d v a n c e d R e p r o d u c t i v e Age: F i n d i n g s in a D o n o r O o c y t e Program. 1j. L. Rosentha], 1'2R. C. Zimmermann, 2M. V. Sauer. 1Dept of Psychiatry, ~Division of Reproductive Endocrinology, Dept of OB/GYN, Columbia Presbyterian Medical Center, New York, NY.
Objective: The desire for childbearing in women of advanced reproductive age (ARA), with its attendant psychological, social and ethical issues, presents us with possibilities and dilemmas that we previously have not had to face. With one quick embryo transfer, we have forever changed the face of our theories about women's development, the psychology of reproduction, and the meaning of menopause. The children born to these mothers face a different legacy and have different psychological issues than those which the adoption literature has taught us, and the likelihood of parental death before these children reach adulthood is high. Should we be creating these circumstances? Design: Cross-sectional analysis of 30 women over the age of 45 who have a child or children as a result of donor egg (OD) therapy. Materials and Methods: 30 women who gave birth using OD from 1989-1996 were interviewed by 2 of the authors using a semi~structured questionnaire. The response rate was 100%. Results: When asked why they pursued OD at this particular time in their lives, 20% of the women indicated that they had delayed attempts at pregnancy until they were in the late 30's for reasons including career progression and/or marriage at an older age. ~ of these women reported ambivalent relationships with their own mother, effecting their feelings about motherhood. 50% of this group had conceived earlier in life, but had opted not to carry the pregnancy. 20% married a partner with children from a previous marriage who were themselves ambivalent about having more, thus delaying attempts at conception until the possibility of a genetically-related child was precluded. 20% intended to have children in their 30's, but were struck by significant illnesses like breast or cervical cancer, delaying their attempts to conceive. 40% of the women had adult children from previous marriages; they felt that having a child with their current husband would solidify the relationship. Over half thought this was an ideal time in their lives to raise a child because they felt financially secure and were able to spend "quality time" with them. If they did not get pregnant, 27 out of 30 said they would eventually try to adopt. They were unequivocal in their desire to have and raise a child, and the group who already had adult children felt that this could provide interesting new arrangements and possibilities in extended family. Practically all of the women perceive themselves as physically more vital and emotionally more youthful than their chronological age, and while they were thoughtful about the effects of aging, they projected that in 10 years' time they would not have aged in a way that would significantly impair their functioning as a parent. Conclusion: The desire for childbearing in women of ARA is compelling. These women have a heterogeneous group of reasons for wanting to become pregnant and have a child, all of which seem individually valid, if complex. Childbearing at an advanced age, often with already grown families, presents an implicit challenge to what we consider to be the normal life cycle, and is intriguing. For these reasons, it is particularly important that these women are seen by mental health providers who can apAbstracts
S179