The more we understand the emotional and psychological obstacles faced by patients who are in need of fertility treatment, the more capable we will be in helping them to handle the treatment process successfully.
It is also important that patients seek the opinion of an infertility specialist as soon as possible. This way, they may be able to decrease the time spent in treatment and identify the appropriate treatment that will most likely lead to a pregnancy which, in turn, will reduce stress. Doctors in the field of reproductive endocrinology and infertility should increase their efforts to educate junior doctors and nursing staff on how to communicate with patients to discuss the advantages of fertility care.
Patients fully benefit from successful technologies that are made available to them. It is important that they remain engaged and up-to-date throughout the process. There are many ways in which clinics can integrate programs and protocols into their every day function to help reduce the patient’s psychological burden. Looking into the various elements of infertility and the available treatment options is an overwhelming and intimidating process, so providing personalized educational and informational material, including checklists, can help ensure that all treatment-related questions are addressed. Specifically, recommendations include: 1) monitoring high-risk patients for psychological issues; 2) refer patients for emotional support/counseling; and 3) implement coping interventions for patients.
There are many tools and strategies available that healthcare providers could implement in order to improve the patient experience and increase treatment success.
ScreenIVF and FertiQoL are two available small-scale tools that can be used to screen and identify patients with infertility. ScreenIVF is an evidence-based, self-administered questionnaire with 34 items dedicated to handling 5 risk indicators for psychological distress during treatment (anxiety and depression, negative infertility, cognitive function, low acceptance of infertility, and poor social support). This information is also used for creating a risk profile for each patient and a targeted, preventive treatment plan based on identified specific vulnerabilities. FertiQoL is another reliable tool, consisting of 26 items that screens for lifestyle risk factors and helps both clinicians and patients to better understand the impact of infertility on the patient’s well-being (emotions, mind, body, relationships, and society). FertiQoL is available online and has been translated into 34 languages. Moreover, clinics can identify patients who need to be referred to a mental health professional. When psychological and emotional distress is justified, it means that doctors and patients have made an important step towards proper treatment.
Taking into account the different learning styles and coping strategies in men and women, a variety of different resources should be made available to patients and couples. Additional tools can be easily implemented and include accessible preparatory and informational leaflets, structured checklists, treatment surveys, and educational DVDs that can address common misunderstandings and fears about the treatment. Such tools are adjusted to serve different stages throughout the treatment.
Partner support and involvement throughout the treatment process is an important element for relieving patient stress and can be encouraged during couple-based interventions and counseling. Given the evidence that relationship strain is a frequent issue for patients undergoing treatment, it is important to make sure that the patient’s partner is also involved in the process. An example of beneficial couple therapy sessions is stress management and resilience training (SMART). A cognitive-behavioral intervention, SMART therapy teaches skills in self-awareness and attention, breathing-based relaxation, and incorporating gratitude, compassion, acceptance, and purpose. In a randomized clinical trial held in 2015, SMART therapy was proven to be effective in improving quality of life measures in both men and women undergoing IVF.
Another example of effective psychological intervention is the Mind/Body program for infertility. The program includes 10 sessions of cognitive–behavioral intervention. It is designed for women dealing with infertility and going through treatment (all stages). Their partners are invited to attend three of the sessions. Two randomized, controlled trials have documented the efficacy of this intervention in positively affecting pregnancy rates and decreasing psychological stress.
A recent study has shown the positive effects of a variety of psychological interventions related to patient stress as well as pregnancy rates. The results of a recent systematic review and meta-analysis of 39 eligible studies show that psychological interventions, mostly through cognitive–behavioral therapy, are effectively decreasing psychological stress and increase pregnancy rates in women who participate in some sort of intervention and who managed to became pregnant. This rate is double to that of control women.
A recent study was also carried out to test the efficacy of a brief psychological intervention (e.g., a stress management kit sent to the participants’ home). The intervention in which the participant was involved showed that not only the psychological stress was significantly low but the treatment discontinuation rate was also reduced.
Ongoing care is the key to success in this ever-expanding field of fertility treatment. It is important that this vulnerable population of patients feels supported and understood. Ongoing communication between members of the care team is also necessary. Clinics need to improve staff performance in areas that are known for having an impact on treatment discontinuation decisions. Finally, teaching stress management skills to clinic staff, using persuasive communication on lifestyle changes, simplifying treatment protocols, and handling workload issues could decrease patient stress and increase success.
To sum up, the emotional distress felt by those dealing with infertility is huge, and reducing patient emotional burden is an important step towards improving fertility treatment. Anxiety caused by infertility and the subsequent treatment will not only prevent the patient from initiating treatment, but it can also be the main reason for which many patients will end treatment. Fear of failure brings about emotional barriers which also prevent patients from taking recourse to fertility treatments.
Psychological distress is the main reason for treatment discontinuation. By addressing these barriers, clinics could witness significant improvements in patient success rates and patients will be able to endure treatments and aim at improved IVF success rates.
FERTILITY AND STERILITY (vol 105, No 5, MAY 2016)
Camilla W.Rich, B.A and Alice D. Domar
Domar Center for Mind/Body Health, Boston IVF, Beth Israel Deaconess Medical Center, Harvard Medical School, Waltham, Massachusetts