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. 2016 May;21(2):302-17.
doi: 10.1111/bjhp.12169. Epub 2015 Nov 2.

Does infertility history affect the emotional adjustment of couples undergoing assisted reproduction? the mediating role of the importance of parenthood

Mariana Moura-Ramos  1 , Sofia Gameiro  2 , Maria Cristina Canavarro  1 , Isabel Soares  3 , Teresa Almeida-Santos  4
Affiliations

Does infertility history affect the emotional adjustment of couples undergoing assisted reproduction? the mediating role of the importance of parenthood

Mariana Moura-Ramos et al. Br J Health Psychol. 2016 May.

Abstract

Objectives: The emotional adjustment of couples undergoing assisted reproductive technology (ART) treatments has been widely studied; however, it remains unclear whether infertility history contributes to couples' adjustment. This study examined the impact of infertility history (duration of infertility and number of previous ART treatment cycles) on the emotional adjustment of couples undergoing an ART cycle and the mediating effect of importance of parenthood on that association.

Methods: In this cross-sectional study, 70 infertile couples (70 women and 70 men) completed self-report questionnaires assessing emotional adjustment and infertility stress during the hormonal stimulation phase of an ART cycle. Path models accounting for the dyadic nature of the data examined the direct and indirect effects (by affecting representations about parenthood and childlessness) of infertility history on emotional adjustment.

Results: The number of previous cycles affected men's, but not women's, emotional adjustment by affecting the representations on the importance of parenthood and of childlessness. Duration of infertility had the opposite effect, as couples with longer infertility reported heightened importance of parenthood, which negatively affected their emotional adjustment.

Conclusions: Infertility history was associated with emotional adjustment in men and women, although these associations were complex. The results suggest that progression through treatment is harder for those men and women who attribute higher importance to being parents, which is aggravated by longer infertility.

Statement of contribution: What is already known about the subject? Infertility is an unexpected and stressful life event Assisted reproductive treatments (ART) are emotionally demanding What does this study add? The influence of infertility history on adjustment is mediated by the importance of parenthood Men and women are affected by their past history of infertility differently.

Keywords: Fertilization; adjustment; anxiety; assisted reproduction; depression; infertility; in vitro.

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Figures

Figure 1
Figure 1
Direct and indirect effects of the number of previous ART cycles on women's and men's anxiety and depression symptoms. Path model of direct and indirect effects of number of previous ART cycles on men's and women's anxiety and depressive symptoms with linear and quadratic terms, controlling for all other paths in the model. Thick lines represent significant indirect effects. Notes. Partners' errors of mediated and dependent errors were correlated, but were not included in the figure for clarity. ART = assisted reproduction technology CFI = comparative fit index; SRMR = standardized root‐mean‐square residual; RMSEA = root‐mean‐square error of approximation. † p ≤ .1; * p ≤ .05; ** p ≤ .01; ***p ≤ .001.
Figure 2
Figure 2
Direct and indirect effects of duration of infertility on women's and men's anxiety and depression symptoms. Path model of direct and indirect effects of duration of infertility on men's and women's anxiety and depressive symptoms with linear and quadratic terms, controlling for all other paths in the model. Thick lines represent significant indirect effects. Notes. Partners' errors of mediation and dependent errors were correlated, but these correlations were not included in the figure for clarity. CFI = comparative fit index; SRMR = standardized root‐mean‐square residual; RMSEA = root‐mean‐square error of approximation. † p ≤ .1; *p ≤ .05; **p ≤ .01; ***p ≤ .001.
Figure 3
Figure 3
Quadratic (curvilinear) effects of duration of infertility on women's and men's anxiety and depressive symptoms. The figure shows the regression curves that best fit the regression model, based on the regression equation for every value of the predictor. The outcomes scores were calculated by including the linear and curvilinear (quadratic) term on the duration of infertility (Aiken & West, 1991). Note. Dotted lines refer to anxiety symptoms scores. Straight lines refer to depressive symptoms scores.
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