The Role of Psychological Distress in the Relationship between Personality Dimensions and Pregnancy Outcome of Women Undergoing Assisted Reproductive Treatment (IVF/ICSI)
,
Abstract
Objective: The aim of this study was to determine the role played by psychological distress in the relation between personality dimensions and pregnancy outcome of women undergoing in vitro fertilization/Intra-Cytoplasmic Injections (IVF/ICSI) treatment.
Method: This prospective cohort study was conducted for 12 months on 154 infertile women who were receiving IVF/ICSI assisted reproductive treatment for the first time. Research instruments for measuring psychological distress included the Fertility Problem Inventory (FPI) and the Depression, Anxiety, and Stress Scale (DASS-21). One of these was completed prior to ovarian stimulation and the other during the embryo transfer stage. The temperament and Character Inventory-Revised (TCI-R 125) was employed once to assess personality dimensions prior to the ovarian stimulation stage. Independent t-test, Mann Whitney test, Repeated Measures and path analysis were performed for statistical analysis of data.
Results: The results of this study showed no significant difference between the pregnant and non-pregnant groups in personality traits (Harm avoidance and self-directness) and psychological distress (FPI and DASS scores). Repeated measures showed a significant difference in stress, anxiety, and depression levels between the two stages of ovarian stimulation and embryo transfer (P < 0.01). Path analysis showed no significant direct and indirect effect for harm avoidance on the pregnancy outcome when psychological distress was mediated.
Conclusion: The effect of psychological factors on IVF outcomes is more complicated than is generally assumed and more studies are mandatory to clarify the relationship between personality traits and infertility treatments.
1. Zegers-Hochschild F, Adamson GD, de Mouzon J, Ishihara O, Mansour R, Nygren K, et al. International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) revised glossary of ART terminology, 2009. Fertility and sterility. 2009;92(5):1520-4.
2. Cui Y, Yu H, Meng F, Liu J, Yang F. Prospective study of pregnancy outcome between perceived stress and stress-related hormones. J Obstet Gynaecol Res. 2020;46(8):1355-63.
3. Lakatos E, Szigeti JF, Ujma PP, Sexty R, Balog P. Anxiety and depression among infertile women: a cross-sectional survey from Hungary. BMC Womens Health. 2017;17(1):48.
4. Aimagambetova G, Issanov A, Terzic S, Bapayeva G, Ukybassova T, Baikoshkarova S, et al. The effect of psychological distress on IVF outcomes: Reality or speculations? PLoS One. 2020;15(12):e0242024.
5. Litzky JF, Marsit CJ. Epigenetically regulated imprinted gene expression associated with IVF and infertility: possible influence of prenatal stress and depression. J Assist Reprod Genet. 2019;36(7):1299-313.
6. Miller N, Herzberger EH, Pasternak Y, Klement AH, Shavit T, Yaniv RT, et al. Does stress affect IVF outcomes? A prospective study of physiological and psychological stress in women undergoing IVF. Reprod Biomed Online. 2019;39(1):93-101.
7. Rooney KL, Domar AD. The relationship between stress and infertility. Dialogues Clin Neurosci. 2018;20(1):41-7.
8. Stanhiser J, Steiner AZ. Psychosocial Aspects of Fertility and Assisted Reproductive Technology. Obstet Gynecol Clin North Am. 2018;45(3):563-74.
9. Tuncay G, Yıldız S, Karaer A, Reyhani I, Özgöcer T, Ucar C, et al. Stress in couples undergoing assisted reproductive technology. Arch Gynecol Obstet. 2020;301(6):1561-7.
10. Zhou FJ, Cai YN, Dong YZ. Stress increases the risk of pregnancy failure in couples undergoing IVF. Stress. 2019;22(4):414-20.
11. Awtani M, Kapoor GK, Kaur P, Saha J, Crasta D, Banker M. Anxiety and Stress at Different Stages of Treatment in Women Undergoing In vitro Fertilization-Intracytoplasmic Sperm Injection. J Hum Reprod Sci. 2019;12(1):47-52.
12. Purewal S, Chapman SCE, van den Akker OBA. Depression and state anxiety scores during assisted reproductive treatment are associated with outcome: a meta-analysis. Reprod Biomed Online. 2018;36(6):646-57.
13. Gabnai-Nagy E, Bugán A, Bodnár B, Papp G, Nagy BE. Association between Emotional State Changes in Infertile Couples and Outcome of Fertility Treatment. Geburtshilfe Frauenheilkd. 2020;80(2):200-10.
14. Roussos-Ross D, Rhoton-Vlasak AS, Baker KM, Arkerson BJ, Graham G. Case-based care for pre-existing or new-onset mood disorders in patients undergoing infertility therapy. J Assist Reprod Genet. 2018;35(8):1371-6.
15. Stevenson EL, Trotter KJ, Bergh C, Sloane R. Pregnancy-Related Anxiety in Women Who Conceive Via In Vitro Fertilization: A Mixed Methods Approach. J Perinat Educ. 2016;25(3):193-200.
16. Rockliff HE, Lightman SL, Rhidian E, Buchanan H, Gordon U, Vedhara K. A systematic review of psychosocial factors associated with emotional adjustment in in vitro fertilization patients. Hum Reprod Update. 2014;20(4):594-613.
17. Verhaak CM, Smeenk JM, Evers AW, van Minnen A, Kremer JA, Kraaimaat FW. Predicting emotional response to unsuccessful fertility treatment: a prospective study. J Behav Med. 2005;28(2):181-90.
18. Lazarus RS Folkman S. Stress Appraisal and Coping. New York: Springer Publishing Company; 1984
19. Zeidner M, Endler NS, Handbook of Coping, stress resistance, and growth: Conceptualizing adaptive functioning. Newyork: Wiley 1996.
20 Eysenck HJ. A model for personality. Springer Berlin Heidelberg 1981.
21 Clark LA, Watson D, Mineka S. Temperament, personality, and the mood and anxiety disorders. J Abnorm Psychol. 1994;103(1):103-16.
22 Beck AT. Cognitive therapy of depression: Guilford press; 1979.
23 Alloy LB, Abramson LY, Whitehouse WG, Hogan ME, Tashman NA, Steinberg DL, et al. Depressogenic cognitive styles: predictive validity, information processing and personality characteristics, and developmental origins. Behav Res Ther. 1999;37(6):503-31.
24 Abramson LY, Metalsky GI, Alloy LB. Hopelessness depression: A theory-based subtype of depression. Psychological review. 1989;96(2):358.
25 Cohen S, Wills TA. Stress, social support, and the buffering hypothesis. Psychol Bull. 1985;98(2):310-57.
26 Volgsten H, Ekselius L, Poromaa IS, Svanberg AS. Personality traits associated with depressive and anxiety disorders in infertile women and men undergoing in vitro fertilization treatment. Acta Obstet Gynecol Scand. 2010;89(1):27-34.
27 Verhaak CM, Smeenk JM, van Minnen A, Kremer JA, Kraaimaat FW. A longitudinal, prospective study on emotional adjustment before, during and after consecutive fertility treatment cycles. Hum Reprod. 2005;20(8):2253-60.
28 Darolia S, Ghosh D. Importance of Personality Factors in Determining the Psychological Consequences of Infertility: A Systematic Review. Health Educ Behav. 2022;49(4):708-23.
29 Gawęda Ł, Kokoszka A. Meta-cognitive beliefs as a mediator for the relationship between Cloninger's temperament and character dimensions and depressive and anxiety symptoms among healthy subjects. Compr Psychiatry. 2014;55(4):1029-37.
30 Gourounti K, Anagnostopoulos F, Vaslamatzis G. The relation of psychological stress to pregnancy outcome among women undergoing in-vitro fertilization and intracytoplasmic sperm injection. Women Health. 2011;51(4):321-39.
31 Lovibond PF, Lovibond SH. The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther. 1995;33(3):335-43.
32 Newton CR, Sherrard W, Glavac I. The Fertility Problem Inventory: measuring perceived infertility-related stress. Fertil Steril. 1999;72(1):54-62.
33 Delavarian Z, Mohtasham N, Mosannen-Mozafari P, Pakfetrat A, Shakeri MT, Ghafoorian-Maddah R. Evaluation of the diagnostic value of a Modified Liquid-Based Cytology using OralCDx Brush in early detection of oral potentially malignant lesions and oral cancer. Med Oral Patol Oral Cir Bucal. 2010;15(5):e671-6.
34 Cloninger CR, Bayon C, Svrakic DM. Measurement of temperament and character in mood disorders: a model of fundamental states as personality types. J Affect Disord. 1998;51(1):21-32.
35 Kaviani H, Haghshenas H. A Preliminary Study to Standardize The Temperament and Character Inventory(Tci-125) in Persian Speakers. Advances in Cognitive Sciences. 2000;2(3):18-24.
36 Turner K, Reynolds-May MF, Zitek EM, Tisdale RL, Carlisle AB, Westphal LM. Stress and anxiety scores in first and repeat IVF cycles: a pilot study. PLoS One. 2013;8(5):e63743.
37 Kalaitzaki AE, Mavrogiannaki S, Makrigiannakis A. A prospective, cross-sectional study of the protective and risk psychological factors of successful in vitro fertilisation outcome: preliminary results in a Greek sample. J Obstet Gynaecol. 2020;40(3):382-7.
38 Lintsen AM, Verhaak CM, Eijkemans MJ, Smeenk JM, Braat DD. Anxiety and depression have no influence on the cancellation and pregnancy rates of a first IVF or ICSI treatment. Hum Reprod. 2009;24(5):1092-8.
39 Maroufizadeh S, Navid B, Omani-Samani R, Amini P. The effects of depression, anxiety and stress symptoms on the clinical pregnancy rate in women undergoing IVF treatment. BMC Res Notes. 2019;12(1):256.
40 Nicoloro-SantaBarbara J, Busso C, Moyer A, Lobel M. Just relax and you'll get pregnant? Meta-analysis examining women's emotional distress and the outcome of assisted reproductive technology. Soc Sci Med. 2018;213:54-62.
41 Boivin J, Griffiths E, Venetis CA. Emotional distress in infertile women and failure of assisted reproductive technologies: meta-analysis of prospective psychosocial studies. Bmj. 2011;342:d223.
42 Matthiesen SM, Frederiksen Y, Ingerslev HJ, Zachariae R. Stress, distress and outcome of assisted reproductive technology (ART): a meta-analysis. Hum Reprod. 2011;26(10):2763-76.
43 Purewal S, Chapman SCE, van den Akker OBA. A systematic review and meta-analysis of psychological predictors of successful assisted reproductive technologies. BMC Res Notes. 2017;10(1):711.
44 Terzioglu F, Turk R, Yucel C, Dilbaz S, Cinar O, Karahalil B. The effect of anxiety and depression scores of couples who underwent assisted reproductive techniques on the pregnancy outcomes. Afr Health Sci. 2016;16(2):441-50.
45 Gameiro S, Boivin J, Peronace L, Verhaak CM. Why do patients discontinue fertility treatment? A systematic review of reasons and predictors of discontinuation in fertility treatment. Hum Reprod Update. 2012;18(6):652-69.
46 Frederiksen Y, Farver-Vestergaard I, Skovgård NG, Ingerslev HJ, Zachariae R. Efficacy of psychosocial interventions for psychological and pregnancy outcomes in infertile women and men: a systematic review and meta-analysis. BMJ Open. 2015;5(1):e006592.
2. Cui Y, Yu H, Meng F, Liu J, Yang F. Prospective study of pregnancy outcome between perceived stress and stress-related hormones. J Obstet Gynaecol Res. 2020;46(8):1355-63.
3. Lakatos E, Szigeti JF, Ujma PP, Sexty R, Balog P. Anxiety and depression among infertile women: a cross-sectional survey from Hungary. BMC Womens Health. 2017;17(1):48.
4. Aimagambetova G, Issanov A, Terzic S, Bapayeva G, Ukybassova T, Baikoshkarova S, et al. The effect of psychological distress on IVF outcomes: Reality or speculations? PLoS One. 2020;15(12):e0242024.
5. Litzky JF, Marsit CJ. Epigenetically regulated imprinted gene expression associated with IVF and infertility: possible influence of prenatal stress and depression. J Assist Reprod Genet. 2019;36(7):1299-313.
6. Miller N, Herzberger EH, Pasternak Y, Klement AH, Shavit T, Yaniv RT, et al. Does stress affect IVF outcomes? A prospective study of physiological and psychological stress in women undergoing IVF. Reprod Biomed Online. 2019;39(1):93-101.
7. Rooney KL, Domar AD. The relationship between stress and infertility. Dialogues Clin Neurosci. 2018;20(1):41-7.
8. Stanhiser J, Steiner AZ. Psychosocial Aspects of Fertility and Assisted Reproductive Technology. Obstet Gynecol Clin North Am. 2018;45(3):563-74.
9. Tuncay G, Yıldız S, Karaer A, Reyhani I, Özgöcer T, Ucar C, et al. Stress in couples undergoing assisted reproductive technology. Arch Gynecol Obstet. 2020;301(6):1561-7.
10. Zhou FJ, Cai YN, Dong YZ. Stress increases the risk of pregnancy failure in couples undergoing IVF. Stress. 2019;22(4):414-20.
11. Awtani M, Kapoor GK, Kaur P, Saha J, Crasta D, Banker M. Anxiety and Stress at Different Stages of Treatment in Women Undergoing In vitro Fertilization-Intracytoplasmic Sperm Injection. J Hum Reprod Sci. 2019;12(1):47-52.
12. Purewal S, Chapman SCE, van den Akker OBA. Depression and state anxiety scores during assisted reproductive treatment are associated with outcome: a meta-analysis. Reprod Biomed Online. 2018;36(6):646-57.
13. Gabnai-Nagy E, Bugán A, Bodnár B, Papp G, Nagy BE. Association between Emotional State Changes in Infertile Couples and Outcome of Fertility Treatment. Geburtshilfe Frauenheilkd. 2020;80(2):200-10.
14. Roussos-Ross D, Rhoton-Vlasak AS, Baker KM, Arkerson BJ, Graham G. Case-based care for pre-existing or new-onset mood disorders in patients undergoing infertility therapy. J Assist Reprod Genet. 2018;35(8):1371-6.
15. Stevenson EL, Trotter KJ, Bergh C, Sloane R. Pregnancy-Related Anxiety in Women Who Conceive Via In Vitro Fertilization: A Mixed Methods Approach. J Perinat Educ. 2016;25(3):193-200.
16. Rockliff HE, Lightman SL, Rhidian E, Buchanan H, Gordon U, Vedhara K. A systematic review of psychosocial factors associated with emotional adjustment in in vitro fertilization patients. Hum Reprod Update. 2014;20(4):594-613.
17. Verhaak CM, Smeenk JM, Evers AW, van Minnen A, Kremer JA, Kraaimaat FW. Predicting emotional response to unsuccessful fertility treatment: a prospective study. J Behav Med. 2005;28(2):181-90.
18. Lazarus RS Folkman S. Stress Appraisal and Coping. New York: Springer Publishing Company; 1984
19. Zeidner M, Endler NS, Handbook of Coping, stress resistance, and growth: Conceptualizing adaptive functioning. Newyork: Wiley 1996.
20 Eysenck HJ. A model for personality. Springer Berlin Heidelberg 1981.
21 Clark LA, Watson D, Mineka S. Temperament, personality, and the mood and anxiety disorders. J Abnorm Psychol. 1994;103(1):103-16.
22 Beck AT. Cognitive therapy of depression: Guilford press; 1979.
23 Alloy LB, Abramson LY, Whitehouse WG, Hogan ME, Tashman NA, Steinberg DL, et al. Depressogenic cognitive styles: predictive validity, information processing and personality characteristics, and developmental origins. Behav Res Ther. 1999;37(6):503-31.
24 Abramson LY, Metalsky GI, Alloy LB. Hopelessness depression: A theory-based subtype of depression. Psychological review. 1989;96(2):358.
25 Cohen S, Wills TA. Stress, social support, and the buffering hypothesis. Psychol Bull. 1985;98(2):310-57.
26 Volgsten H, Ekselius L, Poromaa IS, Svanberg AS. Personality traits associated with depressive and anxiety disorders in infertile women and men undergoing in vitro fertilization treatment. Acta Obstet Gynecol Scand. 2010;89(1):27-34.
27 Verhaak CM, Smeenk JM, van Minnen A, Kremer JA, Kraaimaat FW. A longitudinal, prospective study on emotional adjustment before, during and after consecutive fertility treatment cycles. Hum Reprod. 2005;20(8):2253-60.
28 Darolia S, Ghosh D. Importance of Personality Factors in Determining the Psychological Consequences of Infertility: A Systematic Review. Health Educ Behav. 2022;49(4):708-23.
29 Gawęda Ł, Kokoszka A. Meta-cognitive beliefs as a mediator for the relationship between Cloninger's temperament and character dimensions and depressive and anxiety symptoms among healthy subjects. Compr Psychiatry. 2014;55(4):1029-37.
30 Gourounti K, Anagnostopoulos F, Vaslamatzis G. The relation of psychological stress to pregnancy outcome among women undergoing in-vitro fertilization and intracytoplasmic sperm injection. Women Health. 2011;51(4):321-39.
31 Lovibond PF, Lovibond SH. The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther. 1995;33(3):335-43.
32 Newton CR, Sherrard W, Glavac I. The Fertility Problem Inventory: measuring perceived infertility-related stress. Fertil Steril. 1999;72(1):54-62.
33 Delavarian Z, Mohtasham N, Mosannen-Mozafari P, Pakfetrat A, Shakeri MT, Ghafoorian-Maddah R. Evaluation of the diagnostic value of a Modified Liquid-Based Cytology using OralCDx Brush in early detection of oral potentially malignant lesions and oral cancer. Med Oral Patol Oral Cir Bucal. 2010;15(5):e671-6.
34 Cloninger CR, Bayon C, Svrakic DM. Measurement of temperament and character in mood disorders: a model of fundamental states as personality types. J Affect Disord. 1998;51(1):21-32.
35 Kaviani H, Haghshenas H. A Preliminary Study to Standardize The Temperament and Character Inventory(Tci-125) in Persian Speakers. Advances in Cognitive Sciences. 2000;2(3):18-24.
36 Turner K, Reynolds-May MF, Zitek EM, Tisdale RL, Carlisle AB, Westphal LM. Stress and anxiety scores in first and repeat IVF cycles: a pilot study. PLoS One. 2013;8(5):e63743.
37 Kalaitzaki AE, Mavrogiannaki S, Makrigiannakis A. A prospective, cross-sectional study of the protective and risk psychological factors of successful in vitro fertilisation outcome: preliminary results in a Greek sample. J Obstet Gynaecol. 2020;40(3):382-7.
38 Lintsen AM, Verhaak CM, Eijkemans MJ, Smeenk JM, Braat DD. Anxiety and depression have no influence on the cancellation and pregnancy rates of a first IVF or ICSI treatment. Hum Reprod. 2009;24(5):1092-8.
39 Maroufizadeh S, Navid B, Omani-Samani R, Amini P. The effects of depression, anxiety and stress symptoms on the clinical pregnancy rate in women undergoing IVF treatment. BMC Res Notes. 2019;12(1):256.
40 Nicoloro-SantaBarbara J, Busso C, Moyer A, Lobel M. Just relax and you'll get pregnant? Meta-analysis examining women's emotional distress and the outcome of assisted reproductive technology. Soc Sci Med. 2018;213:54-62.
41 Boivin J, Griffiths E, Venetis CA. Emotional distress in infertile women and failure of assisted reproductive technologies: meta-analysis of prospective psychosocial studies. Bmj. 2011;342:d223.
42 Matthiesen SM, Frederiksen Y, Ingerslev HJ, Zachariae R. Stress, distress and outcome of assisted reproductive technology (ART): a meta-analysis. Hum Reprod. 2011;26(10):2763-76.
43 Purewal S, Chapman SCE, van den Akker OBA. A systematic review and meta-analysis of psychological predictors of successful assisted reproductive technologies. BMC Res Notes. 2017;10(1):711.
44 Terzioglu F, Turk R, Yucel C, Dilbaz S, Cinar O, Karahalil B. The effect of anxiety and depression scores of couples who underwent assisted reproductive techniques on the pregnancy outcomes. Afr Health Sci. 2016;16(2):441-50.
45 Gameiro S, Boivin J, Peronace L, Verhaak CM. Why do patients discontinue fertility treatment? A systematic review of reasons and predictors of discontinuation in fertility treatment. Hum Reprod Update. 2012;18(6):652-69.
46 Frederiksen Y, Farver-Vestergaard I, Skovgård NG, Ingerslev HJ, Zachariae R. Efficacy of psychosocial interventions for psychological and pregnancy outcomes in infertile women and men: a systematic review and meta-analysis. BMJ Open. 2015;5(1):e006592.
| Files | ||
| Issue | Vol 18 No 2 (2023) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijps.v18i2.12366 | |
| Keywords | ||
| Assisted Reproductive Technology Fertilization in Vitro ICSI Intracytoplasmic Sperm Injections Personality Psychological Distress | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Mirzaasgari H, Momeni F, Pourshahbaz A, Keshavarzi F, Hatami M. The Role of Psychological Distress in the Relationship between Personality Dimensions and Pregnancy Outcome of Women Undergoing Assisted Reproductive Treatment (IVF/ICSI). Iran J Psychiatry. 2023;18(2):153-164.
