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Psychosocial and professional burden of Medically Assisted Reproduction (MAR): Results from a French survey.

ABSTRACT: OBJECTIVE:To evaluate the impact of infertility and Medically Assisted Reproduction (MAR) throughout all aspects of life among infertile women and men. MATERIALS AND METHODS:An online survey included 1 045 French patients (355 men, 690 women) who were living or had lived the experience of infertility and MAR. The questionnaire included 56 questions on several domains: global feelings, treatment burden, rapport with medical staff, psychosocial impact, sexual life and professional consequences. RESULTS:Respondents had experienced an average of 3.6 (95% CI: 3.3-3.9) MAR cycles: 5% (n = 46) were pregnant, 4% (n = 47) were waiting to start MAR, 50% (n = 522) succeeded in having a live birth following MAR, 19% (n = 199) were currently undergoing ART, and 21% (n = 221) dropped out of the MAR process without a live birth. Satisfaction rates regarding the received medical care were above 80%, but 42% of patients pointed out the lack of information about non-medical support. An important impact on sexual life was reported, with 21% of patients admitted having not had intercourse for several weeks or even several months. Concerning the impact on professional life, 63% of active workers currently in an MAR program (n = 185) considered that MAR had strong repercussions on the organization of their working life with 49% of them reporting a negative impact on the quality of their work, and 46% of them reporting the necessity to lie about missing work during their treatment. CONCLUSION:Despite a high overall level of satisfaction regarding medical care, the burden of infertility and MAR on quality of life is strong, especially on sexuality and professional organization. Clinical staff should be encouraged to develop non-medical support for all patients at any stage of infertility treatment. Enterprises should be warned about the professional impact of infertility and MAR to help their employees reconcile personal and professional life.

SUBMITTER: Courbiere B

PROVIDER: S-EPMC7514013 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Psychosocial and professional burden of Medically Assisted Reproduction (MAR): Results from a French survey.

Courbiere Blandine B Lacan Arnaud A Grynberg Michael M Grelat Anne A Rio Virginie V Arbo Elisangela E Solignac Céline C

PloS one 20200924 9

<h4>Objective</h4>To evaluate the impact of infertility and Medically Assisted Reproduction (MAR) throughout all aspects of life among infertile women and men.<h4>Materials and methods</h4>An online survey included 1 045 French patients (355 men, 690 women) who were living or had lived the experience of infertility and MAR. The questionnaire included 56 questions on several domains: global feelings, treatment burden, rapport with medical staff, psychosocial impact, sexual life and professional c ...[more]

PMID: 32970695

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Project description:Study questionHow did coronavirus disease 2019 (COVID-19) impact on medically assisted reproduction (MAR) services in Europe during the COVID-19 pandemic (March to May 2020)?Summary answerMAR services, and hence treatments for infertile couples, were stopped in most European countries for a mean of 7 weeks.What is known alreadyWith the outbreak of COVID-19 in Europe, non-urgent medical care was reduced by local authorities to preserve health resources and maintain social distancing. Furthermore, ESHRE and other societies recommended to postpone ART pregnancies as of 14 March 2020.Study design size durationA structured questionnaire was distributed in April among the ESHRE Committee of National Representatives, followed by further information collection through email.Participants/materials setting methodsThe information was collected through the questionnaire and afterwards summarised and aligned with data from the European Centre for Disease Control on the number of COVID-19 cases per country.Main results and the role of chanceBy aligning the data for each country with respective epidemiological data, we show a large variation in the time and the phase in the epidemic in the curve when MAR/ART treatments were suspended and restarted. Similarly, the duration of interruption varied. Fertility preservation treatments and patient supportive care for patients remained available during the pandemic.Large scale dataN/A.Limitations reasons for cautionData collection was prone to misinterpretation of the questions and replies, and required further follow-up to check the accuracy. Some representatives reported that they, themselves, were not always aware of the situation throughout the country or reported difficulties with providing single generalised replies, for instance when there were regional differences within their country.Wider implications of the findingsThe current article provides a basis for further research of the different strategies developed in response to the COVID-19 crisis. Such conclusions will be invaluable for health authorities and healthcare professionals with respect to future similar situations.Study funding/competing interestsThere was no funding for the study, apart from technical support from ESHRE. The authors had no COI to disclose.

Project description:Study questionDoes parental fertility, measured by time to pregnancy (TTP), or use of medically assisted reproduction (MAR) affect pubertal development in the offspring?Summary answerNeither TTP nor type of MAR treatment had clinically relevant implications for mean age at achieving individual pubertal milestones or overall timing of puberty in boys and girls.What is known alreadyParental TTP and MAR have been associated with impaired semen quality in adult sons. Timing of puberty reflects earlier signals of reproductive health, but it remains unclear whether parental fertility or MAR affects pubertal development, especially in the growing generation of children conceived by IVF or ICSI.Study design, size, durationIn this study, 15 819 children born by mothers in the Danish National Birth Cohort from 2000 to 2003 participated in a nationwide puberty cohort (participation rate = 70%). Parental TTP and use of MAR were reported by mothers in early pregnancy and children's pubertal development data was self-recorded in web-based questionnaires from 11 years of age and 6 monthly throughout puberty (2012-2018).Participants/materials, setting, methodsPubertal development in children (of planned pregnancies, n = 13 285) born by untreated subfecund (TTP: 6-12 months) (n =2038), untreated severely subfeund (TTP: >12 months) (n = 1242), treated subfecund (n = 230) and treated severely subfecund (n = 1234) parents were compared to children born to more fertile parents (TTP: ≤5 months). We estimated mean monthly differences in mean age at achieving individual pubertal milestones (i.e. age at menarche, voice break, first ejaculation and Tanner stages 2, 3, 4 and 5 for breast or genital development and pubic hair growth) and a combined indicator of timing of puberty. Further, we compared mean age at achieving the individual pubertal milestones in children born by use of IVF or ICSI (n = 480) with children born by controlled ovarian stimulation or ovulation induction with or without intrauterine insemination (n = 902).Main results and the role of chanceWe found tendencies towards slightly later mean age at male pubertal timing and slightly earlier mean age at female pubertal timing among children born by untreated subfecund, treated subfecund, untreated severely subfecund and treated severely subfecund parents. There were no specific patterns with increasing TTP, use of MAR nor type of MAR treatment, and the magnitude of the mean differences for individual milestones and overall timing of puberty were small, i.e. 0.9 months (95% CI: -1.0; 2.8) for first ejaculation and -0.5 months (95% CI: -2.0; 1.0) months for age at menarche in boys and girls, respectively, born by treated severely subfecund parents when compared with children born by more fertile parents.Limitations, reasons for cautionNon-differential misclassification of the self-reported information on parental TTP and pubertal development in the offspring may serve as an alternative explanation of the findings, possibly biasing the estimates towards the null. The information on pubertal development was collected from around 11 years of age and onwards.Wider implications of the findingsThis study adds to the growing body of literature suggesting only limited harmful effects of parental subfecundity and MAR on offspring's long-term growth and development.Study funding/competing interest(s)This work was supported by the Danish Council for Independent Research [DFF 4183-00152]; and the Faculty of Health at Aarhus University. The authors have no financial relationships or competing interests to disclose.

Project description:Study questionDo the parent-child relationships of adolescents born after medically assisted reproduction (MAR) using the parents' own gametes differ from those of adolescents born after natural conception (NC)?Summary answerMAR and NC families have similar parent-child relationships in terms of closeness and conflict frequency, except that MAR mothers report being closer to their children than NC mothers.What is known alreadyPrior work on parent-child relationships during childhood has reported mixed findings. While some studies have documented no differences between MAR and NC families, others have shown that MAR families have greater levels of warmth and positive feelings than NC families. Evidence on parent-child relationships during the adolescent period is generally positive but is limited because of the small number of existing studies and the reliance on small samples.Study design, size, durationThis work is based on the UK Millennium Cohort Study, whose study members were born in 2000-2002. The analyses focused on Sweep 6 which was collected when cohort members were around 14 years old. We also relied on variables collected in Sweep 1, when cohort members were aged around 9 months, to account for characteristics that could confound or mediate the relationship between MAR and our outcomes. The attrition rate between Sweeps 1 and 6 was 36.7%.Participants/materials, setting, methodsThe final sample consisted of 10 233 cohort members, 320 of whom were conceived with the help of MAR (3.1%). A total of six dependent variables were used to measure, when the cohort members were around 14 years old, levels of parent-child closeness and conflict, reported separately by the mother, the father and the cohort member. Linear models were used to analyse the association between parent-child relationships before and after adjustment for socio-demographic characteristics and mental health.Main results and the role of chanceSweep 6 achieved a response rate of 76.3% of the eligible sample. The results show that, on average, MAR and NC families had similar parent-child relationships in terms of closeness and conflict frequency. The only difference was that MAR mothers reported being closer to their children than NC mothers both before (β = 0.149, P < 0.05) and after (β = 0.102, P < 0.1) adjustment for family socio-demographic characteristics and mental health.Limitations, reasons for cautionThe outcome variables are self-reported by each of the respondents and could be subject to social desirability bias. Second, some parents may have not reported they conceived through donor insemination, which could result in the analytical sample including a small subset of children who were not genetically related to their parents. Third, the data did not include information about whether the children were aware of their conception mode, since the Millennium Cohort Study did not collect information on MAR disclosure. Moreover, they did not allow us to study other aspects of parent-child relationships. Finally, as we observed parent-child relationships at only one moment in time; we were unable to test whether they changed over time.Wider implications of the findingsThe results suggest that the difficulties and the stress parents underwent to conceive through MAR did not translate into more difficult parent-child relationships during adolescence. Given the increasing number of children conceived via MAR, the finding that MAR and NC families had similar parent-child relationships in terms of closeness and conflict frequency is reassuring.Study funding/competing interest(s)This work was supported by European Research Council agreement n. 803959 (MARTE to A.G.). The authors declare no competing interests.Trial registration numbern/a.

Project description:BackgroundMedically assisted reproduction is a vulnerable time for couples' sexual health. Believing that sexual challenges can be worked through (i.e., sexual growth beliefs) or that these challenges indicate incompatibility (i.e., sexual destiny beliefs) may be related to dyadic coping-the strategies couples use to cope-with the physical and psychological stressors of medically assisted reproduction.AimIn the current study we aimed to examine the longitudinal associations between typical (i.e., average) levels of sexual growth and destiny beliefs and positive and negative facets of dyadic coping and how greater than typical levels of these constructs predicted each other across time.MethodsCouples (n = 219) seeking medically assisted reproduction were recruited for an online longitudinal, dyadic study.OutcomesCouples completed online measures of sexual growth and destiny beliefs and positive and negative dyadic coping at baseline, 6-and 12-months.ResultsRandom intercept cross-lagged panel models demonstrated that at the within-person level, reporting higher sexual growth beliefs at baseline, relative to their average across time points, was associated with lower negative dyadic coping at 6 months. Higher negative dyadic coping at 6 months, relative to their average, was linked to lower sexual growth beliefs at 12-months. When individuals reported higher sexual destiny beliefs at 6-months, relative to their average, they and their partners reported higher negative dyadic coping at 12 -months. At the between-person level, higher overall levels of sexual destiny beliefs were related to higher overall levels of negative dyadic coping. No associations with positive dyadic coping were identified.Clinical implicationsCouples may benefit from identifying and reducing unhelpful beliefs about sex and negative dyadic coping.Strengths and limitationsStrengths of this study include our large, inclusive sample, engagement of community partners, and novel analytical approach to assess change over time. However, following couples in 6-month increments and not using questionnaires specific to medically assisted reproduction may have limited our ability to detect nuanced changes that couples experience during this time.ConclusionLower sexual growth and higher sexual destiny beliefs may promote couples' engagement in less adaptive coping behaviors as they seek medically assisted reproduction.

Dataset Information

Psychosocial and professional burden of Medically Assisted Reproduction (MAR): Results from a French survey.

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Psychosocial and professional burden of Medically Assisted Reproduction (MAR): Results from a French survey.

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