People facing infertility are inevitably affected by COVID-19 pandemic, having to delay their parental projects. This study aimed to explore the emotional impact (depression and anxiety symptoms and perceived stress) of the COVID-19 pandemic in Portuguese women pursuing assisted reproductive technology (ART). Results showed 67.4% of participants were in confinement but were dealing with it in a reasonably positive way. Women who continued to work at their workplace presented significantly higher levels of depressive and anxiety symptoms than those who stayed at home. No significant differences were found regarding depression and anxiety symptoms scores when comparing the current sample with an infertility reference sample and a community sample. Depressive and anxiety symptoms remained stable, but there was a significant decrease in perceived stress over the eight-week period. Although these findings do not suggest a worsening of psychological difficulties due to the COVID-19 pandemic, health professionals should be attentive to patients' long-term psychological consequences. It may be helpful to provide additional psychological support to women when restarting their ART treatments.
Objetivo: A parentalidade constitui-se como um desejo comum a muitos indivíduos, mas em alguns casos a sua concretização implica o recurso a técnicas de reprodução medicamente assistida, como a doação de gâmetas ou a gestação de substituição. Em virtude da escassez de estudos sobre atitudes face à doação/receção de gâmetas e gestação de substituição, este estudo pretendeu explorar as atitudes de indivíduos em idade reprodutiva relativamente a estas técnicas. Métodos: Participaram 551 sujeitos com idades entre os 18 e os 40 anos, recrutados através de amostragem por bola de neve. Foi solicitado o preenchimento de um questionário desenvolvido especificamente para o estudo, disponibilizado numa plataforma online, que avaliou o posicionamento dos sujeitos face à doação/receção de gâmetas e gestação de substituição. Resultados: A maioria dos participantes revelou uma atitude positiva perante a doação/receção de gâmetas. No caso da doação a principal motivação indicada foi a de ajudar um casal que não pode ter filhos. Relativamente à receção de gâmetas, os dados sugerem tratar-se de uma circunstância bem aceite pelos participantes. Já no que se refere à gestação de substituição, ainda que exista um posicionamento favorável à sua legalização, nem todos os participantes considerariam essa possibilidade, ainda que aqueles que a equacionariam refiram que se sentiriam felizes por concretizar o sonho de se tornar mãe/pai. Conclusões: Na globalidade, a receção/doação de gâmetas é vista de um modo favorável. Aspetos como realizar o desejo de parentalidade e poder cuidar de uma criança desde o seu nascimento são relevantes, sugerindo uma menor valorização da componente genética. Por sua vez a doação de gâmetas parece relacionar-se com motivações altruístas, podendo ser potenciada com a existência de aconselhamento. A complexidade da gestação de substituição poderá contribuir para a existência de uma menor abertura, ainda que os sujeitos estejam de acordo com a sua legalização em Portugal.
IntroductionThe literature has shown that young adults reveal lack of knowledge about factors that influence fertility. Given this gap of knowledge regarding fertility, several authors indicate the need for awareness-raising and promotion of attitudes and behaviors that preserve fertility.ObjectiveThis study aimed to assess the knowledge about factors that affect fertility as well as the impact of information transmission on this topic.Materials and methodsFive hundred and fifty-one subjects aged between 18 and 40 years old without children completed an online questionnaire specifically developed for this study. Two assessment moments were considered and participants were randomly assigned to three groups:– video group;– website group;– control group.The video and website groups accessed information on fertility-related factos such as age, weight, exercise, substance abuse, irregular menstrual cycles, pollution, etc. The control group had no access to this information.ResultsMale participants revealed more knowledge about the factors that affect fertility in both moments. Participants in the groups that had access to fertility information (video group and website group) improved their level of expertise. No significant differences were found in the control group.Discussion/conclusionGroups that watched the video or visited the website where information on fertility-related lifestyle and other factors was available increased their level of knowledge, suggesting that education on this subject should be provided to general population. The means used for the information dissemination had no impact on the improvement of knowledge.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Study question Does infertility-related psychological inflexibility play a role in the relationship between infertility-related stress domains and psychopathological symptoms (depression, anxiety)? Summary answer Infertility-related psychological inflexibility mediated the relationship between infertility-related stress domains and depression. There were no effects between infertility-related stress domains and anxiety symptoms. What is known already The emotional impact of infertility may include anxiety and depressive symptoms and these seem to be related to stress. Beliefs about the importance of parenthood (need for parenthood) and rejection of a childfree lifestyle, as well as the impact of infertility in several life areas (social, sexual, and relationship) are conceptually considered two infertility-related stress domains. Although the relationship between infertility-related stress and psychopathological symptoms has been previously recognized, the mechanism underlying this relationship remains undetermined. Psychological inflexibility has been pointed as a core transdiagnostic process contributing to the development and maintenance of several psychological difficulties. Study design, size, duration Cross-sectional study. Participants were recruited through the Associação Portuguesa de Fertilidade (patients’ association). Inclusion criteria were age (18 years or older) and an infertility medical diagnosis. Data were collected online through self-report instruments between June and December 2019. Participants/materials, setting, methods: A sample comprising 287 women pursuing infertility medical treatment (at different stages) completed online a sociodemographic questionnaire, the depression and anxiety subscales of the Depression, Anxiety and Stress Scales (DASS – 21), the Psychological Inflexibility Scale - Infertility (PIS-I), and the Fertility Problem Inventory (FPI). Descriptive and correlational analyses were computed through SPSS v. 26, and path analyses were estimated in AMOS (v. 24) with bootstrap procedures (2000 samples). Main results and the role of chance Correlation analyses revealed that FPI domains (importance of parenthood and impact on life domains), depressive and anxiety symptoms were significantly and positively associated with PIS-I. A mediation analysis was conducted to examine whether PIS-I mediated the effect of FPI domains on depressive and anxiety symptoms. Paths showing not to be statistically significant were removed. This model showed a good fit to the empirical data: χ2(4) = 1.59, p = .810, CMIN/DF = .40; TLI = 1.00; CFI = 1.00; RMSEA = .00, 95% CI = .00 to .06. The effect of the importance of parenthood on depressive symptoms revealed to be both direct (b = .03; SEb = .01; Z = 2.46; p = .014; β= .15) and partially mediated by the PIS-I (b = .31, 95% CI = .24 to .37, p = .018). The effect of the impact of infertility in several life areason depressive symptoms was fully mediated by PIS-I (b = .15, 95% CI = .10 to .21, p = .008). This model explained 43% of the total variance of depressive symptoms. No significant effects were found for anxiety symptoms. Limitations, reasons for caution Participants were at different stages of their fertility treatment. Data collection was completed online and this tends to recruit participants with more access to online platforms. Results rely on cross-sectional and self-report data. Wider implications of the findings: Results suggest the relevance of targeting processes encompassing psychological inflexibility, such as cognitive fusion, experiential avoidance, conceptualized self, conceptualized past and future, lack of values clarity, and inability to commit with values-driven actions, in psychological interventions designed for women with infertility. Trial registration number N/A.
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