Psychological Interventions for Infertile Couples: Does Gender Matter?

Abstract

Purpose: Gender-specific differences exist between male and female infertility patients' mental health, the meaning of infertility in their lives, and the coping strategies used. This systematic review examines whether gender-specific aspects are addressed in psychological intervention studies for infertility and whether infertile women and men benefit equally from such interventions. Methods: Databases were searched to identify relevant articles published between 1978 and 2007 (384 articles). The review included both controlled and uncontrolled psychological intervention studies examining results for infertile women and men separately. Outcome measures (depressive symptoms, anxiety, and mental distress) and gender-specific baseline characteristics (mental distress at pre-assessment, cause of infertility, and medical treatment) were collected. A total of twelve studies were finally included. Results: In 10 of 12 studies, women exhibited higher levels of mental distress than men. Gender-specific aspects were not addressed in the psychological interventions. Examining the efficacy of psychological interventions revealed that women exhibited stronger positive mental health effects in 2 of the 12 studies. Conclusion: Psychological distress before psychological treatment seems more pronounced in women than in men. Therefore psychological interventions for infertile couples should take gender-specific aspects into account. More research is needed to address the gender-specific aspects regarding psychological interventions for infertility.

Zusammenfassung

Fragestellung: Geschlechtsspezifische Unterschiede zeigen sich bei infertilen Frauen und Männern in der psychischen Gesundheit, in der Bedeutung der Infertilität für deren Leben und in den verwendeten Bewältigungsstrategien. Mittels einer systematischen Übersichtsarbeit wurde untersucht, inwiefern geschlechtsspezifische Aspekte in psychologischen Interventionsstudien zur Infertilität berücksichtigt werden und ob infertile Frauen und Männer gleichermaßen von solchen Interventionen profitieren. Methoden: In verschiedenen Datenbanken wurde nach relevanten Artikeln (384 Artikel), die zwischen 1978 und 2007 publiziert wurden, gesucht. Eingeschlossen wurden kontrollierte und nicht kontrollierte psychologische Interventionsstudien, bei denen die Resultate für infertile Frauen und Männer separat ausgewertet wurden. Als Ergebnismaße wurden depressive Symptome, Angst und psychischer Stress und als geschlechtsspezifische Charakteristika die Variablen psychischer Stress zu Beginn, Grund der Infertilität und medizinische Behandlung erfasst. Insgesamt konnten abschließend 12 Studien eingeschlossen werden. Resultate: In 10 von 12 Studien wiesen Frauen ein höheres Level an psychischem Stress auf als Männer. In keiner der vorliegenden Interventionsstudien wurden geschlechtsspezifische Aspekte berücksichtigt. In Bezug auf die Wirksamkeit psychologischer Interventionen zeigten sich in 2 von 12 Studien größere Verbesserungen des psychischen Befindens bei infertilen Frauen als bei infertilen Männern. Schlussfolgerung: Psychischer Stress vor der psychologischen Behandlung ist bei Frauen ausgeprägter als bei Männern. Deshalb sollten geschlechtsspezifische Aspekte in psychologischen Interventionen für infertile Paare berücksichtigt werden. Mehr Forschung zu geschlechtsspezifischen Aspekten ist dafür notwendig.

Key words

infertility - gender - psychological intervention - review - mental health

Schlüsselwörter

Infertilität - Geschlecht - psychologische Intervention - Review - psychische Gesundheit

References

• 1 Klemetti R, Raitanen J, Sihvo S et al. Infertility, mental disorders and well-being – a nationwide survey.  Acta Obstet Gynecol Scand. 2010;  89 677-682
• 2 Leiblum S R, Greenfield D. The Course of Infertility: immediate and long-term Reactions. In: Leiblum S R, ed. Infertility, psychological Issues and Counseling Strategies. New York: John Wiley & Sons; 1997: 83-102
• 3 Abma J C, Chandra A, Mosher W D et al. Fertility, family planning, and women's health: new data from the 1995 National Survey of Family Growth.  Vital Health Stat. 1997;  23 100-114
• 4 Boivin J, Bunting L, Collins J A et al. New debate: international estimates of infertility prevalence and treatment-seeking: potential need and demand for infertility medical care.  Hum Reprod. 2007;  22 1506-1512
• 5 Eugster A, Vingerhoets A J. Psychological aspects of in vitro fertilization: a review.  Soc Sci Med. 1999;  48 575-589
• 6 Chen T H, Chang S P, Tsai C F et al. Prevalence of depressive and anxiety disorders in assisted reproductive technique clinic.  Hum Reprod. 2004;  17 2313-2318
• 7 Wischmann T. Psychosocial aspects of fertility disorders.  Urologe. 2005;  A44 185-194
• 8 Covington S, Burns L H. Infertility Counseling: A comprehensive Handbook for Clinicians. 2nd ed. New York: Cambridge University Press; 2006
• 9 Dunkel-Schetter C, Lobel M. Psychological Reactions to Infertility. In: Stanton A L, Dunkel-Schetter C, eds. Infertility: Perspectives from Stress and Coping Research. New York, London: Plenum Press; 1991: 9-57
• 10 Strauss B, Brähler E, Kentenich H. Fertilitätsstörungen – psychosomatisch orientierte Diagnostik und Therapie. Stuttgart: Schattauer; 2004
• 11 Wischmann T. Implications of psychosocial support in infertility – a critical appraisal.  J Psychosom Obstet Gynecol. 2008;  29 83-90
• 12 Boivin J. A review of psychosocial interventions in infertility.  Soc Sci Med. 2003;  57 2325-2341
• 13 De Liz T M, Strauss B. Differential efficacy of group and individual/couple psychotherapy with infertile patients.  Hum Reprod. 2005;  20 1324-1332
• 14 Haemmerli K, Znoj H, Barth J. The efficacy of psychological interventions for infertile patients: a meta-analysis examining mental health and pregnancy rate.  Hum Reprod Update. 2009;  15 279-295
• 15 Berg B J, Wilson J F, Wingarter P J. Psychological sequelae of infertility treatment: The role of gender and sex role identification.  Soc Sci Med. 1991;  33 1071-1080
• 16 Mahlstedt M M. The psychological component of infertility.  Fertil Steril. 1985;  43 335-346
• 17 Russo N F. The motherhood mandate.  J Soc Issues. 1976;  32 143-153
• 18 Edelmann R J, Connolly K J. Gender differences in response to infertility and infertility investigations: real or illusory.  Br J Health Psychol. 2000;  5 365-375
• 19 Cousineau T M, Domar A D. Psychological impact of infertility.  Best Pract Res Clin Obstet Gynaecol. 2007;  21 293-308
• 20 Glover L, Abel P D, Gannon K. Male sub fertility: is pregnancy the only issue? Psychological response matter too-and are different in men.  Br J Clin Psychol. 1998;  35 531-542
• 21 Thorsby K, Gill R. It's different for men: masculinity and IVF.  Men and Masculinities. 2004;  6 330-338
• 22 Webb R E, Daniluk J C. The end of the line: infertile men's experience of being unable to produce a child.  Men and Masculinities. 1999;  2 6-25
• 23 Greil A L. Infertility and psychological distress: a critical review of the literature.  Soc Sci Med. 1997;  45 1679-1704
• 24 Daniluk J C. Gender and Infertility. In: Leiblum S R, ed. Infertility, psychological Issues and Counseling Strategies. New York: John Wiley & Sons; 1997: 103-125
• 25 Peterson B D, Newton C R, Rosen K H et al. Coping processes of couples experiencing infertility.  Family Relations. 2006;  55 227-239
• 26 Strauss B. Ungewollte Kinderlosigkeit: Psychologische Diagnostik, Beratung und Therapie. Göttingen: Hogrefe; 2000
• 27 Nachtigall R D, Becker G, Wozny M. The effects of gender-specific diagnosis on men's and women's response to infertility.  Fertil Steril. 1992;  57 113-121
• 28 Wright J, Duchesne C, Sabourin S et al. Psychosocial distress and infertility: Men and women respond differently.  Fertil Steril. 1991;  55 100-108
• 29 Koropatnick S, Daniluk J, Pattinson H A. Infertility: a non-event transition.  Fertil Steril. 1993;  59 163-171
• 30 Stanton A L, Tennen H, Affleck G et al. Cognitive appraisal and adjustment to infertility.  Women Health. 1991;  17 1-15
• 31 Connolly K J, Edelmann R J, Bartlett H et al. An evaluation of counselling for couples undergoing treatment for in-vitro fertilization.  Hum Reprod. 1993;  8 1332-1338
• 32 Laffont I, Edelmann R J. Psychological aspects of in vitro fertilization: A gender comparison.  J Psychosom Obstet Gynaecol. 1994;  6 165-178
• 33 Carmeli Y S, Birbaum-Carmeli D. The predicament of masculinity: towards understanding the male experience of infertility treatments.  Sex Roles. 1994;  30 663-677
• 34 Kessler R C, Berglund P, Demler O et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication.  Arch Gen Psychiat. 2005;  62 593-602
• 35 Kuehner C. Gender differences in unipolar depression: an update of epidemiological findings and possible explanations.  Acta Psychiatr Scand. 2003;  108 163-174
• 36 Wittchen H U, Mueller N, Schmidtkunz B et al. Erscheinungsformen, Haeufigkeit und Versorgung von Depressionen. Ergebnisse des bundesweiten Gesundheitssurveys „Psychische Stoerungen“.  Fortschritte der Medizin. 2000;  118 4-10
• 37 Andrews F M, Abbey A, Halman L J. Stress from infertility, marriage factors, and subjective well-being of wives and husbands.  J Health Soc Behav. 1991;  32 238-253
• 38 Abbey A, Andrews F M, Halman J. Gender's role in responses to infertility.  Psychol Women Q. 1991;  15 295-316
• 39 Beaureparie J, Jones M, Thiering P et al. Psychosocial adjustment to infertility and its treatment: male and female responses at different stages of IVF treatment.  J Psychosom Res. 1994;  38 229-240
• 40 Edelmann R J, Connolly K J, Bartlett H. Coping strategies and psychological adjustment of couples presenting for IVF.  J Psychosom Res. 1994;  38 355-364
• 41 Jordan C, Revenson T A. Gender differences in coping with infertility: a meta-analysis.  J Behav Med. 1999;  22 341-358
• 42 Tamres L K, Janicki D, Helgeson V S. Sex differences in coping behavior: a meta-analytic review and an examination of relative coping.  Pers Soc Psychol Rev. 2002;  6 2-30
• 43 McEwan K L, Costello C G, Taylor P J. Adjustment to infertility.  J Abnorm Psychol. 1987;  96 108-116
• 44 Van Balen F, Trimbos-Kemper T C. Factors influencing the well-being of long-term infertile couples.  J Psychosom Obstet Gynaecol. 1994;  15 157-164
• 45 Afifi M. Gender differences in mental health.  Singapore Med J. 2007;  48 385-391
• 46 Rochlen A B. Men in (and out of) therapy: central concepts, emerging directions, and remaining challenges.  J Clin Psychol. 2005;  61 627-631
• 47 Emery M, Béran M-D, Darwiche J et al. Results from a prospective, randomized, controlled study evaluating the acceptability and effects of routine pre-IVF counselling.  Hum Reprod. 2003;  18 2647-2653
• 48 Emery M, Joris V, Béran M-D et al. Prospective study of pre-IVF counselling: One-year follow-up.  J Reprod Med End. 2006;  1 77-78
• 49 McNaughton-Cassill M E, Bostwick J M, Vanscoy S E et al. Development of brief stress management support groups for couples undergoing in vitro fertilization treatment.  Fertil Steril. 2000;  74 87-93
• 50 McNaughton-Cassill M E, Bostwick J M, Arthur N J et al. Efficacy of brief couples support groups developed to manage the stress of in vitro fertilization treatment.  Mayo Clin Proc. 2002;  77 1060-1066
• 51 Strauss B, Hepp U, Stading G et al. Focal Counseling for Women and Couples with an unfulfilled Desire for a Child: A three-step Model. In: Strauss B, ed. Involuntary Childlessness: psychological Assessment, Counseling, and Psychotherapy. Ashland: Hogrefe and Huber Publishers; 2002: 79-103
• 52 Wischmann T, Stammer H, Scherg H et al. Evaluation of the psychological effects of counselling and couple-therapy with infertile couples.  Paper presented at the 17th Annual Meeting of the European Society for Human Reproduction and Embryology. Hum Reprod. 2001;  16 198
• 53 Wischmann T, Stammer H, Scherg H et al. Psychological characteristics of infertile couples: a study of the “Heidelberg Fertility Consultation Service”.  Hum Reprod. 2001;  16 1753-1761
• 54 Wischmann T, Stammer H, Scherg H et al. Couple Counselling and Therapy for the unfulfilled Desire for a Child: The two-step Approach of the “Heidelberg Infertility Consultation”. In: Strauss B, ed. Involuntary Childlessness: psychological Assessment, Counseling, and Psychotherapy. Ashland: Hogrefe and Huber Publishers; 2002: 127-150
• 55 Liswood M P. Treating the crisis of infertility: A cognitive-behavioral approach. Dissertation abstracts international section A.  Humanities and Social Sciences. 1995;  55 (12) 4006
• 56 Tarabusi M, Volpe A, Facchinetti E. Psychological group support attenuates distress of waiting in couples scheduled for assisted reproduction.  J Psychosom Obstet Gynecol. 2004;  25 273-279
• 57 McQueeney D A, Stanton A L, Sigmon S. Efficacy of emotion-focused and problem-focused group therapies for women with fertility problems.  J Beh Med. 1997;  20 313-331
• 58 Bents H. Verhaltenstherapeutische Paartherapie bei Kinderwunschpatienten. In: Brähler E, Myer A, Hrsg. Psychologische Probleme in der Reproduktionsmedizin. Jahrbuch der Medizinischen Psychologie. Vol. 5 Berlin: Springer; 1991: 144-155
• 59 O'Moore A M, O'Moore R R, Harrison R F et al. Psychosomatic aspects in idiopathic infertility: effects of treatment with autogenic training.  J Psychosom Res. 1983;  27 145-151
• 60 Bresnick E R. A holistic approach to the treatment of the crisis of infertility.  J Marital Fam Ther. 1981;  7 181-188
• 61 Bresnick E, Taymor M L. The role of counseling in infertility.  Fertil Steril. 1979;  32 154-156
• 62 Schmidt L, Tjornhoj-Thomsen T, Boivin J et al. Evaluation of a communication and stress management training programme for infertile couples.  Patient Educ Couns. 2005;  59 252-262
• 63 Wischmann T, Scherg H, Strowitzki T et al. Psychosocial characteristics of women and men attending infertility counselling.  Hum Reprod. 2009;  24 378-385
• 64 Boivin J, Scanlan L C, Walker S M. Why are infertile patients not using psychosocial counselling?.  Hum Reprod. 1999;  14 1384-1391
• 65 Haemmerli K, Znoj H, Berger T. Internet-based support for infertile patients: a randomized controlled study.  J Beh Med. 2010;  33 135-146
• 66 Wischmann T. Implications of psychosocial support in infertility – a critical appraisal.  J Psychosom Obstet Gynecol. 2008;  29 83-90