Psychosocial responses among couples undergoing first time and repeat cycles of IVF-ET treatment

15% of couples in Taiwan, or nearly 300,000 couples, are facing fertility problems of varying degrees, i.e., infertility. With the advances in science and technology, new treatments for infertility have continuously emerged, such as the in vitro fertilization and embryo transfer (IVF-ET), and there are more and more couples receiving such treatments.

Previous studies and our clinical experiences both pointed out that medical treatment related to assisted reproductive technology (ART) may result in numerous psychosocial stress on couples receiving the treatment. Hence it is more and more important to understand the stress and coping strategies of both husband and wife.

In the Chinese culture, traditional concepts such as “a son to carry on the family name” have put more psychosocial stress on childbearing females than males.The stress could also come from other origins such as individual difference, length and frequency of the treatment, andthe intimacy between a husband and wife.

Most infertile couples undergoing ART have a long history of treatment. New hopes for pregnancy develop along with thetreatment cycles, but they also suffered setbacks when the expected pregnancy failed. Nevertheless, most couples are willing to receive repeat treatment to fulfill their emotional need of parenthood.

The nursing group in the institute of medicine of CSMU conducted a study to investigate the psychosocial responses among couples undergoing first time and repeat cycles of IVF-ET treatment in 216 couples in Division of Infertility Clinic, Lee Women’s Hospital from July to October 1996. We found there was an one-and-a half delay in seeking medical treatment for local infertile couples. More than 70% couples suffered from traditional concepts such as “a son to carry on the family name”. Women reported higher levels of anxiety and depression than their partners, men reported more suppression of their anxiety or depression than women. Women reported receiving lesser care from their husbands and presented low self-esteem, impaired self-image, increased guilt, poor sexual and interpersonal relationships.

We also found differences in the psychosocial responses between first-time and repeat cycle couples.Repeat cycle women had significantly higher levels of depression and felt that the infertility problems had a much greater impact on self-esteem, self-image, guilt and interpersonal relationships. First-time men had more anxiety than repeat cycle men.

Based on above findings, we recommendfornew couples do not take any contraceptive measures for more than one year, if they would like to have children, a medical visit should be arranged as soon as possible so as not to miss the opportunity of childbearing. On the other hand, medical care professionals should encourage the either side of the couple truly face the stress and let their partners know their thoughts and emotional stresses, and then care and support each other. The husband should let understand the physical and psychological stress experienced by their wife when receiving IVF. Sex life is not just for the succession of generations, each of the partners should learn to embrace each other, physical contact also makes it easier to get each other closer, as well as to improve their marital relationship.

Here we also recommend medical personnel to provide infertile couples with individual medical care and psychological counseling at different stages of treatment, so that infertile couples can understand the procedure of IVF-ET, and be relieved from their anxiety. The medial professionals should also encourage and spiritually support the prospective mother during the long treatment process, especially when she undergoes repeated cycles. Understanding the entire procedure largely facilitates the physical and psychological preparedness for treatment, as well as eliminates unnecessary negative responses during the IVF-ET course. Medical staff should provide relevant information in each step of the process for reasonable expectations of successful pregnancy as well as acceptance of failure. At last, regular follow-up is recommended for the infertile couples for their physical and mental recovery.