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It is suggested that infertility may be distressing because it results in an inability to fulfil traditional roles and thus those individuals who adhere to traditional sex roles may be more distressed by the experience of infertility. In order to examine the relationship between sex role and emotional well-being in infertility patients, 58 women attending a clinic for assisted conception procedures and 31 of their male partners completed questionnaires assessing sex-role type (i.e. masculine, feminine, androgynous or undifferentiated) and emotional, marital and sexual functioning. Women with a traditional feminine sex-role type were more anxious than those with a masculine sex-role type but there were no differences in depression or marital or sexual functioning. Men with an undifferentiated sex-role type were more anxious and depressed than those with other sex-role types. The findings are discussed in terms of the relationship between sex role and infertility, previous research into sex differences in distress amongst infertility patients, and the problems associated with measuring distress.
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PMID:The relationship between sex role and emotional functioning in patients undergoing assisted conception. 835 21

Psychosocial impacts of infertility were investigated in couples undergoing different treatment procedures in our clinic. Couples were interviewed in a semi-structured way by a psychologist or a psychiatrist and responded to three specially structured questionnaires: the Life Events Scale, the Marlowe-Crowne/Taylor Scale and the Side Effect Checklist. The data were analysed in terms of demographic characteristics as well as treatment procedure. The psychosocial, psychosexual and emotional outcomes of their infertility problem and Greek traditional culture laws are discussed. Stress has been identified in both sexes, depression mostly in women, while men showed a tendency towards repressed anxiety and thus a greater risk of psychosomatic illness, a finding supported by their response to the Side Effect Checklist. Women showed a high defensive anxiety and also reported numerous psychosomatic symptoms. These couples seem to have special needs and fears, both general and treatment specific. Very few of our couples would be considered as severely emotionally disturbed. Women seem to have more difficulties in social adjustment. Sexual dysfunction was reported by almost half of our subjects, although this was associated with a degree of deterioration in their marriage. Guilt feelings, particularly connected with previous abortions, seem to be torturing most women. Finally, both partners seem to have psychological problems irrespective of the one in whom the aetiological problem was found. Moreover, traditional rules seem to impose a special burden on people coming from rural areas. Our results strongly support the belief that infertile couples undergoing different treatments need psychological counselling and supportive psychotherapy.
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PMID:Psychosocial impacts of infertility on Greek couples. 847 55

Thirty-seven women with a mean initial weight of 98.5 +/- 18.7 kg completed a group treatment program for obese, infertile women. The program lasted for 24 weeks and included regular exercise and group discussion of topics such as coping with the psychological impact of infertility, developing healthy eating patterns, and the effects of obesity on reproductive physiology. There was significant weight loss (mean weight loss 6.2 +/- 4.5 kg, p < 0.001) and improvement on measures of self-esteem, anxiety, depression, and general health. Twenty-nine women became pregnant during the follow-up period (21-36 months). Two women were avoiding pregnancy, so only six who had completed the group program and wished to become pregnant had not conceived by the end of the follow-up period. A further five women did not complete the program as they became pregnant while attending the group. Our results suggest that active measures to improve mood and self-esteem, along with better nutrition and weight reduction through diet and exercise, can produce considerable improvement in the outcome of treatment for infertility in obese women.
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PMID:Improved pregnancy rates for obese, infertile women following a group treatment program. An open pilot study. 873 12

We report on a group program for obese infertile women. Sixty-four women completed the 24-week program, which included exercise, information about healthy eating and group discussion sessions. Their mean initial weight was 101.9 +/- 18.14 kg. The mean weight loss on completion of the program was 5.2 +/- 5.11 kg (p < 0.0001). There was significant improvement on ratings of self-esteem and depression. Changes to life-style and health which are known to improve fertility may be a useful precursor to invasive, high technology infertility treatment procedures.
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PMID:A group program for obese, infertile women: weight loss and improved psychological health. 881 23

Raised activity of the LH axis caused by activating mutations of LH receptor gene presents with precocious puberty in boys, analogous to the presentation of LH secreting pituitary adenomas (Faggiano et al., 1983; Ambrosi et al., 1990). LH "hyperactivity' in females appears to have no effect. Hyperactivity of the FSH axis caused by activating mutations of the FSH receptor gene might parallel the presentation of FSH secreting pituitary adenomas with Sertoli cell hypertrophy in men (Heseltine et al., 1989) or reversible premature ovarian failure in women (Moses et al., 1986; Okuda et al., 1989). Indeed the first such case to be described is a male who maintained testicular volume and fertility in the absence of gonadotrophins (Gromoll et al., 1996). Female precocious puberty may require hyperactivity of both gonadotrophin axes because of the "two-cell' arrangement required for ovarian oestrogen production. Mutations of the Gs alpha-subunit gene can mimic this situation in some women with the McCune-Albright syndrome (Malchoff et al., 1994). Lack of LH activity caused by defects in the LH beta molecule causes infertility in men and that resulting from inactivating mutations of the LH receptor gene causes Leydig cell agenesis in men while ovarian development in females is relatively normal. Lack of FSH activity caused by defects in the FSH beta caused infertility in a female, and that caused by inactivating mutations of the FSH receptor gene causes ovarian dysgenesis in women but only variable depression of spermatogenesis in men. Incidentally, this categorization of reproductive disorders may also be applied to the TSH axis. Pituitary adenomas and activating mutations of the TSH receptor gene (Parma et al., 1993) cause hyperthyroidism and TSH beta gene defects (Hayashizaki et al., 1989) and inactivating mutations of the TSH receptor gene (Sunthornthepvarakul et al., 1995) cause hypothyroidism. To complete the analogy with thyroid disorders, it is curious that despite structural similarities with the TSH receptor, neither LH nor FSH receptor autoantibodies have a prominent role in ovarian pathophysiology (Moncayo et al., 1989; Van Weissenbruch et al., 1991; Simoni et al., 1993). Complete gonadotrophin resistance is likely to be very rare, however, so what are we likely to find in partial gonadotrophin resistance? Might the "resistant ovary syndrome' come right in the end, with corresponding minor FSH receptor mutations? Experience with insulin and androgen resistance syndromes suggests that such a scenario is unlikely. Insulin receptor gene mutations are found in extreme Type A insulin resistance but not in moderate forms of insulin resistance (O'Rahilly et al., 1991). Androgen receptor gene mutations are found in nearly all cases of complete androgen insensitivity but rarely in partial forms (Patterson et al., 1994). Mild resistance to hormone action is rarely detectable in relatives who are heterozygous for receptor mutations which are inherited in a recessive pattern. It seems unlikely therefore, that individuals heterozygous for inactivating receptor mutations will manifest symptoms of reproductive disorders and account for common conditions. Thus, while mutation analysis provides new insights into the gender specific role of the gonadotrophins the cause of early gonadal failure in the majority of individuals remains a mystery.
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PMID:Clinical manifestations of genetic defects affecting gonadotrophins and their receptors. 903 30

The psychology of infertile women was investigated with a battery of psychological tests consisting of a semistructured interview, State Trait Anxiety Inventory (STAI), Center for Epidemiologic Studies Depression Scale (CES-D), and Cornell Medical Index (CMI). The subjects were 107 infertile women being treated for infertility. The semistructured interviews revealed that the stress factor for infertile women changes with the length of infertility. In the early states, the main stress is related to a physical inferiority complex, while later it changes into stress about what others outside the family say. According to STAI, CES-D and CMI, infertile women are considered to become more depressive the longer treatment persists. Therefore, counseling for infertile women should be adapted to long-term treatment.
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PMID:Stress of female infertility: relations to length of treatment. 912 30

Competing positions exist in the literature regarding whether problem-focused or emotion-focused coping is more useful when one confronts a chronic health-related problem. In this study, 29 infertile women, who on average had been attempting conception for almost 4 years, were assigned to six sessions of training in problem- or emotion-focused coping or to a no-treatment control condition. Problem-focused training produced improvements in general distress and infertility-specific well-being at treatment termination. However, emotion-focused training resulted in greater improvement at a 1-months, follow-up. Emotion-focused participants reported less depression and more infertility-specific well-being at 1 month than did controls. At 18 months, problem-focused group members were more likely to have a child than were other participants. Results argue for the efficacy of both emotion-directed and problem-focused interventions in women's adjustment to infertility.
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PMID:Efficacy of emotion-focused and problem-focused group therapies for women with fertility problems. 929 32

Epidemiologic studies demonstrate a twofold higher rate of depression in women than in men. The childbearing years are a time of increased risk for onset of depression in women. Pregnancy, miscarriage or pregnancy loss, infertility, and the postpartum period may challenge a woman's mental health. Virtually no life event rivals the neuroendocrine and psychosocial changes associated with pregnancy and childbirth. This paper provides a brief overview of depression during pregnancy and the postpartum period. Incidence, risk factors, and complications of depression during pregnancy and the puerperium are discussed to aid the clinician in early identification of at-risk patients. Treatment recommendations are also provided based on the available literature, clinical experience, and consideration of the possible special circumstances (i.e., breast-feeding) of this population of women.
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PMID:Depression during pregnancy and the puerperium. 942 74

Counselling in reproductive medicine has tended to focus on bereavement theory as the primary model of understanding and practice. This has meant that the experience of infertility has principally been conceptualized as a process with definable stages, leading smoothly, in time, to resolution and acceptance. This paper suggests that, whilst this is a valuable theory of the psychological and emotional components of infertility, it is also important to consider depression as a particularly significant aspect, independent of its being seen as a stage in the mourning process. The paper outlines an understanding of depression and gives case illustrations of the significance of depression for some people with infertility problems. The evidence for the prevalence of depression amongst those with impaired fertility and the various areas of personal functioning which might be affected are considered. Cognitive therapy has come to be widely accepted as an important approach to treating depression. The theoretical and research evidence for the efficacy of cognitive therapy is discussed, and how it might be applied in the context of infertility counselling.
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PMID:Beyond the bereavement model: the significance of depression for infertility counselling. 943 79

The purposes of the study were to compare treatment-related stresses of couples undergoing IVF or ICSI treatment (ejaculated, epididymal or testicular spermatozoa) and to identify sex differences and risk factors for depression. A one-year cohort of couples was retrospectively sent questionnaires on infertility and treatment-related distress and depression (Depression Scale, D-S). Two hundred and eighty-one women and 281 men (61% of those eligible) were included. As determined by analysis of the medical charts, successful couples were more likely to participate. Treatment-related distress was generally higher for women than for men. Treatment by ICSI carried additional burdens for the men: they reported a greater subjective responsibility for the infertility, impact of childlessness on daily life, treatment-related stresses (particularly for MESA/TESE) and time demands. Even when clinical differences between treatments (e.g. age, previous treatments) were controlled statistically, depression scores did not differ. Independent of the treatment, women were significantly more depressed than their age-matched female controls from the general population and their husbands. The men only reported marginally elevated depression scores compared to their controls. Meaningful characteristics were identified that could guide clinicians to give psychological support to those couples at risk for depression, e.g. an unsuccessful treatment outcome, repeated treatment cycles, a low socioeconomic status, foreign nationality, or, for women, a lack of partner support.
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PMID:Treatment-related stresses and depression in couples undergoing assisted reproductive treatment by IVF or ICSI. 994 86


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