1. PSYCHOSOCIAL EFFECTS ON REPRODUCTIVE OUTCOMES: EXAMINING THE IMPACT
OF INFERTILITY-RELATED COPING STRATEGIES AND STRESS ON FEMALE AND MALE
BIOLOGICAL RESPONSES AND ON PREGNANCY
J. Pedro1 | J. Mesquita-Guimarães2 | C. Leal2 | V. Almeida3 | M. E. Costa1 | M. V. Martins1
1University of Porto, Faculty of Psychology and Education, Psychology Center at University of Porto
2Porto Hospital Center, Reproductive Medicine Department, Porto, Portugal.
3University of Porto, Faculty of Sciences, Porto, Portugal.
juliana_bpedro@hotmail.com
INTRODUCTION
Previous evidence showed that psychosocial variables can influence the biological response to fertility treatments, but the link between psychosocial adjustment and the successful
outcome of fertility treatments remains unclear. While there is evidence that anxiety, depression, infertility stress or escapist coping strategies can be associated with poor outcomes in
ART treatments. Results are not consistent. For example, a meta-analysis found that emotional distress is unlikely to affect the outcome of fertility treatments. These divergences could
be related with the use of different self-report measures, either of general psychological adjustment or infertility-related. The majority of studies has focused on women. Since some
evidence showed that stress can have a negative impact on seminal parameters, it is urgent to include male psychosocial adjustment when investigating outcomes such as pregnancy.
The present study examines the impact of psychosocial variables on both female and male reproductive outcomes and pregnancy while controlling for lifestyle habits.
MATERIALS AND METHODS
PARTICIPANTS AND PROCEDURE
Participants were selected from a sample of couples seeking fertility
treatments at Porto Hospital Center, between February 2010 and
March 2011. Eligible criteria included couples that were submitted to
ART after responding to the study questionnaire. The final sample
had 79 married couples, with a mean age of 33.0 for women (SD =
4.7) and 34.9 for men (SD = 6.1). Couples were trying to conceive for
4.3 years (SD = 3.4). In December 2013, medical records were
analyzed to collect data on biological responses (ovarian response
and seminal parameters), treatments outcomes and diagnosis.
MEASURES
*Fertility Problem Inventory(FPI): assesses the perceived stress
relating to infertility. The scale revealed good internal consistency
(α=0.89 for women and α=0.88 for men).
*The COMPI coping strategies scales (COMPI-CSS): assesses the
use of four strategies to cope with infertility: Active-Avoidance (α=0.53
for women; α=0.51 for men), Active-Confronting (α=0.74 for women;
α=0.70 for men), Passive-Avoidance (α=0.59 for women; α=0.53 for
men), Meaning-Based coping (α=0.83 for women; α=0.65 for men).
OUTCOMES
*Number of oocytes: number of oocytes retrieved in the cycle.
*Seminal defect: includes number of defects in sperm concentration,
motility and morphology (WHO, 2010).
*Pregnancy: positive pregnancy result confirmed by ultrasound
examination at 6 weeks of gestation.
DATA ANALYSIS
Linear and logistic multiple regression analysis were used to study the
role of psychosocial variables on female number of oocytes, seminal
defect and on pregnancy.
RESULTS
CONCLUSIONS
Predictor β
Female age -0.27*
Body mass index -0.08
FPI -0.06
Active-Avoidance 0.26
Active-Confronting -0.28*
Passive-Avoidance -0.25*
Meaning-Based coping 0.11*
* p<0.05
F(66, 73) = 3.16; P = 0.01; R2 = .25
Predictor β
Male age 0.20
Body mass index 0.02
Nr cigarretes (day) 0.21
Nr units alcohol (week) -0.25
FPI -0.09
Active-Avoidance 0.14
Active-Confronting 0.11
Passive-Avoidance -0.14
Meaning-Based coping 0.04
Predictor Odds-ratio (95% CI)
Female age 0.77 (0.63-0.94)*
Duration of infertility 1.02 (1.00-1.03)
Type of infertility (Primary vs Secundary) 2.17 (0.34-13.63)
Total sperm motility 1.03 (1.00-1.07)
Referral status 2.51 (0.65-9.67)
FPI (F) 1.01 (0.97-1.05)
FPI (M) 0.98 (0.94-1.02)
Active-Avoidance (F) 1.09 (0.40-2.93)
Active-Avoidance (M) 0.64 (0.26-1.59)
Active-Confronting (F) 0.95 (0.52-1.76)
Active-Confronting (M) 3.73 (1.50-9.29)*
Passive-Avoidance (F) 1.01 (0.60-1.72)
Passive-Avoidance (M) 0.91 (0.49-1.69)
Meaning-Based coping (F) 0.81 (0.46-1.46)
Meaning-Based coping (M) 1.01 (0.57-1.80)
F(58,67) = 9.61; P = 0.48
* p<0.05
X2 = 28.46; P = 0.02; Hosmer-Lemeshow godness-of-fit = 13.70 (P=0.06);
Cox & Snell R2 =0.355; Nagelkerke R2 =0.475
P - 518
As expected, women´s age was associated with a low number of oocytes. Results also revealed that active-confronting and passive-avoidance coping strategies adopted by women can
decrease the number of retrieved oocytes. None of the variables were significant on the male model. Female age and men´s use of active-confronting coping were predictors of
pregnancy, with male use of active-confronting increases the likelihood of pregnancy by a factor of 3.73.
Our study provide support to previous studies documenting the role of psychological variables on reproductive outcomes. More specifically, this study demonstrated that coping
strategies adopted by infertile patients can affect the biological response to infertility treatments, as well its success. For example, strategies such as ‘hoping a miracle’ or focusing on
information-seeking and finding a solution can decreased female biological response. Couples with male partners using active-confronting coping have an increase in the likelihood of
pregnancy. Couples must be aware that their coping styles can influence reproductive outcomes and mental healthcare professionals can help in order to develop more adaptive coping
strategies, which could result in better success of treatments. Further studies should measure the stress in several treatments stages and examine the effects of lifestyle and
psychosocial variables in sperm quality in larger samples.
1. PREDICTING THE NUMBER OF OOCYTES
RETRIEVED
2. PREDICTING SEMINAL DEFECT
3. PREDICTING PREGNANCY
