- Email: [email protected]
Sister ovum donation: Psychological outcomes
included Referring Obstetrician (ROB), Discharge Obstetrician (DOB), years of infertility, prior usage of clomiphene citrate (CC) and prior # of cycles of CC. RESULTS: 309 of the 430 patients (71.9%) had information available regarding the ROB, DOB, and complete medical records pertaining to prior treatment. The mean duration of infertility prior to referral to our infertility practice was 1.6 years (range 0.2–12). Overall, 167/309 (54.0%) returned to their referring physician (ROB) for obstetrical care. If patients were referred prior to six months of treatment by the ROB, 35/46 (76%) returned; if patients were referred after 6 months-1 year of treatment, 82/122 (67%) returned; if after 1–2 years, 33/93 (35%), and after greater than 2 years, 10/25 (40%) returned to the ROB. Overall, 77/309 (25%) patients had undergone preliminary treatment with (CC) by their ROB. If the patient was not given CC, 128/232 (55%) returned; if they were given 1– 4 treatment CC cycles 37/69 (53%) returned, and if given ⬎4 cycles, 2/8 (25%) returned. CONCLUSION: Our study identified a significant trend towards patients’ reluctance to return to their referring obstetrician for obstetrical care when the duration of infertility prior to referral to a specialist was more than one year. Though the numbers were small, there was also a trend toward seeking obstetrical care elsewhere when the patient had undergone more than 4 cycles of CC by the referring OB. Though there are many factors, including third-party payor changes, patient re-location, etc. that might also impact on patients’ return to their referring doctor, the data suggest that patients’ satisfaction with their referring physician may be related to timely referral to a specialist. Supported by: None
Wednesday, October 20, 2004 3:00 P.M. O-253 Explaining differences in how women and men cope with infertility: Effects of appraisals. L. Pasch, D. Shehab, S. Gregorich, R. Nachtigall, P. Katz, N. Adler. University of California San Francisco, San Francisco, CA. OBJECTIVE: Previous research has clearly shown sex differences in coping with infertility such that women report using most coping strategies to a greater degree than do men. No research has examined what might account for these differences. The current study tested whether women cope more than men because they 1) have a greater desire for children, 2) experience infertility as a greater threat to their self esteem, or 3) tend to appraise stress more severely in general. DESIGN: These objectives were studied in a cross-sectional sample of women and their male partners who had recently seen a fertility specialist for the first time. MATERIALS AND METHODS: Women (n⫽413) and their male partners (n⫽357) who had recently had a first consultation with a fertility specialist were recruited for a longitudinal study. Data from questionnaires completed at the first interview were used for this report. Participants completed the Brief COPE (Carver, 1997) and measures of intensity of desire for children, threat to self esteem posed by infertility, and neuroticism. RESULTS: Women reported using more of every coping strategy (except acceptance for which there was no sex difference) than did men. Women also reported a greater desire for children, more threat to self esteem from infertility, and higher neuroticism. Threat to self esteem fully mediated the sex difference in the use of denial (p ⬍ .0001), disengagement (p ⬍ .0001), substance use (p ⬍ .0001), and self-blame (p ⬍ .0001). For example, women tended to perceive greater threat to self esteem from infertility which, in turn, was associated with a greater use of denial, and the sex difference in denial became non-significant when threat to self esteem was accounted for. For distraction (p ⬍ .0001), active coping (p ⬍ .01), planful problem-solving (p ⬍ .001), religious coping (p ⬍ .01), seeking emotional support (p ⬍ .001), seeking instrumental support (p ⬍ .001), humor (p ⬍ .001), and emotional processing (p ⬍ .01), threat to self esteem partially mediated the sex difference in coping, such that women reported greater personal threat and in turn a greater use of these strategies. Intensity of desire for children was a weak mediator of the effect of sex on coping. Women tended to report a greater desire for children than their partners, and this was associated with less use of disengagement (p ⬍ .05), reframing (p ⬍ .001), seeking emotional support (p ⬍ .05) and humor (p ⬍ .01). This was true even though, overall, women use more of these strategies. Al-
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though women reported higher levels of neuroticism (a tendency to appraise stress severely), neuroticism was generally not associated with coping. CONCLUSION: These findings strongly replicate previous research showing sex differences in coping with infertility. The most accurate statement regarding the sex difference found in this and the existing literature is not that women and men cope differently, but instead that women cope more. We found strong support for threat to self esteem posed by infertility as a mediator of the effect of sex on coping. These results suggest that women may cope more with infertility because their self esteem is more threatened by it. However, because we haven’t accounted for all of the effect of sex on coping, other factors must be involved. Supported by: Support for this study was provided by PO1 HD37074 from the National Institute for Child Health and Human Development.
Wednesday, October 20, 2004 4:45 P.M. O-254 Sister ovum donation: Psychological outcomes. L. S. Josephs, E. Grill, K. Crone, L. Applegarth, I. Cholst, Z. Rosenwaks. New York Presbyterian Hospital, New York, NY; Private practice, Granby, CT. OBJECTIVE: Research on the psychosocial impact of successful sister donation has been scant. The aim of this study was to explore the psychological outcomes for both sister-recipients and sister-donors following the birth of a child through ovum donation. DESIGN: An exploratory, descriptive study investigating in depth the experiences of donor and recipient sisters. Subjects were 5 donors and 7 recipients, with children from these donations ranging in age from 19 months to 3 years. MATERIALS AND METHODS: Subjects participated in a one-hour semi-structured interview conducted by a psychologist. They responded to 4 cards of the Thematic Apperception Test (TAT) and completed the Minnesota Multiphasic Personality Inventory-2 (MMPI-2)which was compared to the MMPI-2 from their initial screening for oocyte donation. All subjects who are parents completed the Parenting Stress Index (PSI). RESULTS: Analysis of responses to the psychological interview revealed several themes: 1)unexpected levels of positive affective intensity for donors and recipients; 2)mostly, consistent clarity that the recipient sister is the (only) mother of the child; 3)role reversal in sister dyads, with (younger) donor sister assuming a more caretaking role; 4)shifts in dynamics among sisters and their partners, with donor often bonding with her sister and/or her brother-in-law, and donor’s partner experienced as outside of this circle; 5)recipients’ experiences ranging from (comfortable)gratitude to (uncomfortable) indebtedness; and 6)discordance between donor and recipient in terms of disclosure of the donation to others, with donors wanting more disclosure. TAT either elicited themes similar to those from the interview or more constricted responses. MMPI-2 results were generally within normal limits. On PSI, recipients reported very low levels of parenting stress. CONCLUSION: When patients originally present for family ovum donation assessment, prospective donors and recipients aim to present well, in order to“pass”the screening. Once a child is born, ovum donation participants may want to“move past”the experience and have little incentive for psychological followup. Thus, it is difficult to capture this population at a point where responses are less influenced by the wish to obtain the program’s approval. Exploration of sister-donors’ and sister-recipients’ responses to oocyte donation suggests that the original self-presentations of donors and recipients at screening retrospectively pale in comparison to the actuality of creating a child in this manner. Sister donations appear to be affectively intense experiences with often unanticipated emotional complications for both sisters. Further study of the psychological challenges of family donation is warranted. Supported by: None
Wednesday, October 20, 2004 5:00 P.M. O-255 A new low-dose, drospirenone-containing oral contraceptive (OC) with a new dosing regimen is effective in reducing premenstrual dysphoric
Vol. 82, Suppl. 2, September 2004
Wednesday, October 20, 2004 3:00 P.M. O-253 Explaining differences in how women and men cope with infertility: Effects of appraisals. L. Pasch, D. Shehab, S. Gregorich, R. Nachtigall, P. Katz, N. Adler. University of California San Francisco, San Francisco, CA. OBJECTIVE: Previous research has clearly shown sex differences in coping with infertility such that women report using most coping strategies to a greater degree than do men. No research has examined what might account for these differences. The current study tested whether women cope more than men because they 1) have a greater desire for children, 2) experience infertility as a greater threat to their self esteem, or 3) tend to appraise stress more severely in general. DESIGN: These objectives were studied in a cross-sectional sample of women and their male partners who had recently seen a fertility specialist for the first time. MATERIALS AND METHODS: Women (n⫽413) and their male partners (n⫽357) who had recently had a first consultation with a fertility specialist were recruited for a longitudinal study. Data from questionnaires completed at the first interview were used for this report. Participants completed the Brief COPE (Carver, 1997) and measures of intensity of desire for children, threat to self esteem posed by infertility, and neuroticism. RESULTS: Women reported using more of every coping strategy (except acceptance for which there was no sex difference) than did men. Women also reported a greater desire for children, more threat to self esteem from infertility, and higher neuroticism. Threat to self esteem fully mediated the sex difference in the use of denial (p ⬍ .0001), disengagement (p ⬍ .0001), substance use (p ⬍ .0001), and self-blame (p ⬍ .0001). For example, women tended to perceive greater threat to self esteem from infertility which, in turn, was associated with a greater use of denial, and the sex difference in denial became non-significant when threat to self esteem was accounted for. For distraction (p ⬍ .0001), active coping (p ⬍ .01), planful problem-solving (p ⬍ .001), religious coping (p ⬍ .01), seeking emotional support (p ⬍ .001), seeking instrumental support (p ⬍ .001), humor (p ⬍ .001), and emotional processing (p ⬍ .01), threat to self esteem partially mediated the sex difference in coping, such that women reported greater personal threat and in turn a greater use of these strategies. Intensity of desire for children was a weak mediator of the effect of sex on coping. Women tended to report a greater desire for children than their partners, and this was associated with less use of disengagement (p ⬍ .05), reframing (p ⬍ .001), seeking emotional support (p ⬍ .05) and humor (p ⬍ .01). This was true even though, overall, women use more of these strategies. Al-
S102
Abstracts
though women reported higher levels of neuroticism (a tendency to appraise stress severely), neuroticism was generally not associated with coping. CONCLUSION: These findings strongly replicate previous research showing sex differences in coping with infertility. The most accurate statement regarding the sex difference found in this and the existing literature is not that women and men cope differently, but instead that women cope more. We found strong support for threat to self esteem posed by infertility as a mediator of the effect of sex on coping. These results suggest that women may cope more with infertility because their self esteem is more threatened by it. However, because we haven’t accounted for all of the effect of sex on coping, other factors must be involved. Supported by: Support for this study was provided by PO1 HD37074 from the National Institute for Child Health and Human Development.
Wednesday, October 20, 2004 4:45 P.M. O-254 Sister ovum donation: Psychological outcomes. L. S. Josephs, E. Grill, K. Crone, L. Applegarth, I. Cholst, Z. Rosenwaks. New York Presbyterian Hospital, New York, NY; Private practice, Granby, CT. OBJECTIVE: Research on the psychosocial impact of successful sister donation has been scant. The aim of this study was to explore the psychological outcomes for both sister-recipients and sister-donors following the birth of a child through ovum donation. DESIGN: An exploratory, descriptive study investigating in depth the experiences of donor and recipient sisters. Subjects were 5 donors and 7 recipients, with children from these donations ranging in age from 19 months to 3 years. MATERIALS AND METHODS: Subjects participated in a one-hour semi-structured interview conducted by a psychologist. They responded to 4 cards of the Thematic Apperception Test (TAT) and completed the Minnesota Multiphasic Personality Inventory-2 (MMPI-2)which was compared to the MMPI-2 from their initial screening for oocyte donation. All subjects who are parents completed the Parenting Stress Index (PSI). RESULTS: Analysis of responses to the psychological interview revealed several themes: 1)unexpected levels of positive affective intensity for donors and recipients; 2)mostly, consistent clarity that the recipient sister is the (only) mother of the child; 3)role reversal in sister dyads, with (younger) donor sister assuming a more caretaking role; 4)shifts in dynamics among sisters and their partners, with donor often bonding with her sister and/or her brother-in-law, and donor’s partner experienced as outside of this circle; 5)recipients’ experiences ranging from (comfortable)gratitude to (uncomfortable) indebtedness; and 6)discordance between donor and recipient in terms of disclosure of the donation to others, with donors wanting more disclosure. TAT either elicited themes similar to those from the interview or more constricted responses. MMPI-2 results were generally within normal limits. On PSI, recipients reported very low levels of parenting stress. CONCLUSION: When patients originally present for family ovum donation assessment, prospective donors and recipients aim to present well, in order to“pass”the screening. Once a child is born, ovum donation participants may want to“move past”the experience and have little incentive for psychological followup. Thus, it is difficult to capture this population at a point where responses are less influenced by the wish to obtain the program’s approval. Exploration of sister-donors’ and sister-recipients’ responses to oocyte donation suggests that the original self-presentations of donors and recipients at screening retrospectively pale in comparison to the actuality of creating a child in this manner. Sister donations appear to be affectively intense experiences with often unanticipated emotional complications for both sisters. Further study of the psychological challenges of family donation is warranted. Supported by: None
Wednesday, October 20, 2004 5:00 P.M. O-255 A new low-dose, drospirenone-containing oral contraceptive (OC) with a new dosing regimen is effective in reducing premenstrual dysphoric
Vol. 82, Suppl. 2, September 2004