Document Type : Erratum
Authors
1 Fatemeh Alzahra Infertility and Reproductive Health Research Center, Babol University of Medical Sciences, Babol, Iran
2 Department of Psychiatry, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
3 Department of Psychology, Payame Noor University, Tehran Branch, Iran
4 4Library of Center, Mazandaran University of Medical Sciences, Sari, Iran
Abstract
Keywords
The experience of infertility, defined by some as
the infertility crisis, accompanies with physical, economical and social stress that affect all aspects of individual’s life. Maybe it can be said that infertility is
one of the most stressful events in infertile people’s
life (
But others, who have more supporters, know psychological stress as the result of infertility. According
to this thesis, the experience of infertility affects the
infertile couple with deep emotional tensions which
is the fixed source of psychological and social dreads
(
A randomized controlled clinical trial was conducted in Fatemeh Alzahra Infertility and Reproductive Health Research Center of the Babol University of Medical Sciences, Babol, Iran, for nine months during 2007.
After coordination and receiving confirmation
from Fatemeh Alzahra Infertility and Reproductive Health Research Center of Babol University of
Medical Sciences (Iran), infertile women who had
dossier the center, were recruited for this study. The
participated women had the following characteristics: less than 45 years of age, more than five years
of education, more than two years of infertility, having at least one
Participants in the CBT group were engaged a two-hour group cognitive behavior therapy session for 10 weeks. Progressive muscle relaxation was added to the sessions 5-10. Groups consisted of 8-12 members, and the therapist, as an expert psychologist, was trained for the CBT program. Therapy was conducted at the Psychiatry Department of the Babol University of Medical Sciences, Babol, Iran. The first three sessions provided patients with a general orientation to cognitive therapy and the causes of infertility.
In the first three sessions, a gynecologist explained the cause of infertility for each woman.
Cognitive therapies included that dysfunctional
attitudes to social concerns, sexual concerns,
marital concerns, rejection of childfree lifestyle, and need for parenthood more required
challenged (
Flow diagram of participants through each stage of randomized controlled trial.
*; Some of 40 depressed women refusing to participate in the study denied their mood disorders, while some of them believed that they could find relief from depression without medication intervention. Some of them were concerned if they began their treatment course, their family would mark them as mental patients.
**; Stressful events, like family death, heavy accidents, pregnancy, etc, affected the stress infertility or depression tests, so these women were excluded from the analysis.
The pharmacotherapy group took a capsule of fluoxetine (20 mg) daily for 90 days. After the interview, 30 capsules, prescribed by a psychiatrist, were provided by the midwives of the center, monthly. The control group didn’t take any drug or psychological intervention. They completed two questionnaires at the beginning of the study and three months after the interview. In CBT group, subjects had therapy interventions, including IVF, anti depression or psychological drug during three months; however, some individuals with stressful events such as family death were excluded from analysis.
All participants completed the Fertility Problem Inventory (FPI) and BDI at the beginning
and end of the study. FPI used was a reliable
instrument to assess the infertility stress. This
instrument contains 46 items and 5 subscales
that cover infertile couple’s stress such as social concern, sexual concern, marital relationships, rejection of child-free lifestyle, and need
for parenthood. Participants indicated their
degree of agreement with each item on a sixpoint Likert scale ranging from "strongly disagree" to "strongly agree". Newton et al. (
All analyses were performed using SPSS
software. Paired t-tests were used to compare
the mean scores of FPI and depression tests
in each study group, separately, before and
after interventions. Analysis of variance was
performed to compare the mean scores of the
tests in the three study groups at the beginning,
and also, at the end of the study. If there was
meaning difference among three groups, Posthoc (Turkey’s test) test was used to compare
the mean differences. It should be noted that
results of this articles has been a part of extend project implemented for Fatemeh Alzahra
Fertility and Infertility Health Research Center
of the Babol University of Medical Sciences
(2007). Comparison pharmacotherapy and
psychotherapy in improvement depression,
anxiety, and general health reported in previous publications (
The findings of research showed that there were no statistically significant differences among the three groups in age, education level, and the duration of infertility. The demographic characteristics of the study sample are summarized in table 1.
Characteristics of diluting media used for control and four treatment groups
Criteria | CBTa mean (SD) | Fluoxetine mean (SD) | Control mean (SD) | Fb | P value |
---|---|---|---|---|---|
28.3 (3.8) | 29.8 (5.3) | 28.4 (5.3) | 0.8 | 0.4 | |
9.2 (2.4) | 9.4 (4.2) | 9.8 (3.9) | 0.4 | 0.2 | |
5.4 (3.9) | 6.3 (3.4) | 5.7 (4.4) | 0.3 | 0.6 | |
a; Cognitive behavior therapy and b; ANOVA was performed to compare the mean scores of groups.
Evaluating the mean of FPI scores in infertile
women showed that rejection of child-free lifestyle had the highest score in all three groups
among five main fertility problems (social, sexual,
marital concerns, rejection of child-free lifestyle,
and need for parenthood). Although fluoxetine decreased the overall mean scores of FPI, it could
only decrease the mean score of sexual concerns
among five main fertility problems. Also, mean
scores of all five main fertility problems decreased
significantly in CBT group in comparison to before starting the therapy. After CBT sessions, overall mean scores of FPI decreased significantly in
comparison to before starting the therapy. There
were no significant differences in mean scours of
control group (
The mean scores of five main fertility problems in three groups of infertile women at beginning and end of the study
Groups | CBTa mean (SD) | Fluoxetine mean (SD) | Control mean (SD) | ||||||
---|---|---|---|---|---|---|---|---|---|
2.9 ± 0.72 | *2.1 ± 0.76 | 0.0001 | 2.9 ± 0.59 | 2.8 ± 0.55 | 0.709 | 2.9 ± 0.78 | 3.1 ± 0.96 | 0.066 | |
3 ± 0.71 | *2.6 ± 0.68 | 0.007 | 3.1 ± 0.67 | *2.7 ± 0.67 | 0.041 | 2.9 ± 0.75 | 2.9 ± 0.60 | 0.425 | |
4 ± 0.89 | *3.1 ± 0.97 | 0.020 | 3.8 ± 0.89 | 3.5 ± 0.70 | 0.144 | 3.7 ± 0.75 | 3.8 ± 0.59 | 0.388 | |
4.1 ± 0.91 | *3.4 ± 0.94 | 0.002 | 4.3 ± 0.77 | 4.2 ± 0.79 | 0.432 | 4.3 ± 0.78 | 4.2 ± 0.66 | 0.688 | |
3 ± 0.73 | *2.3 ± 0.76 | 0.0001 | 3.2 ± 0.99 | 3.2 ± 0.72 | 0.925 | 3.1 ± 0.74 | 3.2 ± 0.74 | 0.580 | |
3.5 ± 0.62 | *2.7 ± 0.64 | 0.0001 | 3.5 ± 0.53 | *3.2 ± 0.44 | 0.045 | 3.4 ± 0.55 | 3.5 ± 0.48 | 0.373 | |
a; Cognitive behavior therapy and Paired t test was used to compare the mean scores, before and after inventions.
The results of this study showed that the infertile women’s mean scores for all infertility stress
dimensions (social, sexual, marital concerns, rejection of child-free lifestyle, and need for parenthood) were very high. The highest scores were
related to inability to accept the life style without
a child and marital relationships, which is in concordance to the similar study (
It evaluated CBT group and supportive psychotherapy group with control group. The results
showed that the different stressful subjects relating
to psychological indexes of intervention group,
especially the CBT group, decreased in comparison to that of control group (
Our results revealed a significant decrease in all
infertility stress dimensions (social, sexual, marital
concerns, rejection of childfree lifestyle, and need
for parenthood) in CBT group, whereas in fluoxetine group, there was only a significant decrease
in sexual concern dimension. Faramarzi et al. (
Our finding confirmed the management of depression in the both fluoxetine and CBT groups
that complete description was previously reported by Faramarzi et al. (
Studies by Thorn reported that infertility counseling decreases the emotional burden of infertility
during treatment, while psychological counseling
not only supplies the vital emotional support, but
also diminishes the drop-out rate in infertility
treatment (
CBT was effective on decreasing fertility stress in dimensions of the social concerns, sexual concerns, marital concerns, rejection of child-free lifestyle, and need for parenthood. Also, CBT was superior to fluoxetine for resolving infertility stress. Of course, more studies are needed to investigate the effect of CBT on rate of reproduction fertility in infertile women. This project proposed that it is necessary to investigate the effectiveness of routine CBT to prevent infertility stress in infertile couples.