Distress level in men undergoing intracytoplasmic sperm injection versus in-vitro fertilization.

Human Reproduction, May 1998

The purpose of this study was to compare the psychological reactions of men undergoing intracytoplasmic sperm injection (ICSI) (n=18) or in-vitro fertilization (IVF) (n=22). Men monitored their psychological reactions daily for one complete treatment cycle from the first day of down-regulation 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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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. - 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)


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J Boivin, A Shoog-Svanberg, L Andersson, A Hjelmstedt, T Bergh, A Collins. Distress level in men undergoing intracytoplasmic sperm injection versus in-vitro fertilization., Human Reproduction, 1998, pp. 1403-1406, 13/5, DOI: 10.1093/humrep/13.5.1403