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Distress level in men undergoing intracytoplasmic sperm injection versus in-vitro fertilization.
Human Reproduction
Distress level in men undergoing intracytoplasmic sperm injection versus in-vitro fertilization
Jacky Boivin 2
Agneta Shoog-Svanberg 1
Lena Andersson 1
Anna Hjelmstedt 0
Torbjorn Bergh 1
Aila Collins 0
0 Department of Clinical Neuroscience, Karolinska Institute , Stockholm , Sweden
1 Carl von Linne Kliniken , Uppsala Science Park, Uppsala
2 School of Psychology, University of Wales Cardiff , Cardiff CF1 3YG , UK
4To whom correspondence should be addressed The purpose of this study was to compare the psychological reactions of men undergoing intracytoplasmic sperm injection (ICSI) (n J 18) or in-vitro fertilization (IVF) (n J 22). Men monitored their psychological reactions daily for one complete treatment cycle from the first day of downregulation until the outcome of treatment was known (approximately 52 days). The results showed that ICSI patients reported marginally more distress on the days prior to retrieval than the IVF patients. Other than this difference the pattern of results indicated that the psychological reactions of men undergoing ICSI or IVF were similar and that there was no need to manage these patients differently during treatment. However, ICSI patients may benefit from some reassuring comments on the days prior to retrieval when they showed more anticipatory anxiety.
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We here present the first report on the psychological
reactions of men undergoing intracytoplasmic sperm injection
(ICSI) compared with those involved in in-vitro fertilization
(IVF). Several hypotheses can be made concerning treatment
reactions in these two groups of patients. First, one might
hypothesize that men undergoing ICSI would experience
more distress during treatment than men undergoing IVF.
This is because of the general finding that men with male
factor diagnoses report more distress about their infertility
than men in couples with unexplained or female-only
diagnoses. Nachtigall et al. (1992) found that men diagnosed
with a male factor problem were more likely to report
feeling stigmatized and to report a loss of physical potency
and self-esteem than men from couples not diagnosed with
this kind of problem. Connolly et al. (1992) also found
that the initiation of the diagnostic investigation was
associated with a decrease in negative feelings for all
patients except men who were diagnosed with a male factor
problem. These men reported more anxiety and more
psychiatric distress than did the rest of the sample 7 months
into the diagnostic investigation. Given that male factor
diagnoses are, by definition, more common among ICSI
patients while female-only and unexplained diagnoses are
more common among IVF patients (HFEA, 1996), one
might expect that ICSI patients would report greater distress
during their treatment cycle than the IVF patients.
A second hypothesis is that the difference in distress
between the ICSI and IVF patients would be most pronounced
during the active stages of retrieval, fertilization and transfer
when men produce the sperm sample and find out whether
the oocytes were fertilized with their spermatozoa. One
aspect of providing the sperm sample that men worry about
is the possibility that they will not be able to perform under
the pressure that exists at the time the sample is requested
(McGrade and Tolor, 1981). In the case of the ICSI patient
there is the additional worry that even if a sample is
produced it may not be sufficient to fertilize the oocytes
retrieved. In this sense, ICSI patients have more to worry
about during the active stages of treatment than the IVF
patients. Significant stress may, in turn, have a negative
impact on sperm parameters at the time of treatment.
Harrison et al. (1987) found a significant deterioration in
semen quality when comparing samples produced some
months before IVF compared to those produced at the time
of IVF. It was suggested that the stress of initiating IVF
contributed to the poorer sperm quality in the 10% or so
of men affected. Similarly, Cui (1996) found that sperm
parameters in non-human mammals were significantly poorer
in animals housed under stressful conditions compared with
those with normal housing conditions. The potential negative
effects of stress may have greater implications for the ICSI
patient whose sperm quality is already compromised.
In this study we test the hypotheses by comparing daily
distress in men undergoing either ICSI or IVF. In addition,
we also examined differences in daily optimism about
achieving a pregnancy because it seemed possible that this
variable would influence the level of distress reported during
treatment. Previous studies have found that patients optimism
changes as a function of new opportunities for pregnancy.
Van Keep and Schmidt-Elmendorf (1975) and Blenner (1990)
found that the initiation of treatment after discovery of
infertility was sufficient to increase couples sense of hope
for a pregnancy while Boivin and Takefman (1996) found
a surge in optimism after embryos had (...truncated)