Psychometry of stress after the use of assisted reproduction

Abstract

The stress provoked by the use of assisted reproduction techniques (ART) may trigger important emotional reactions. The objective of the present study was to develop a program of psychological evaluation (PPE) in order to identify the occurrence of stress and to facilitate its treatment. A total de 128 women were submitted to PPE at the Center for Human Reproduction, "SinháJunqueira" Maternity Foundation, after application of ART (IVF/ICSI) at least once. The causes of infertility were male-related in 45% of cases, female-related in 48%, and both male- and female-related in 7%. Infertility was primary in 79% of cases and secondary in 21%. The mean age of the women was 34.5±5.2 years and the mean age of the men was 37.9 ± 6.8 years. Psychometry was evaluated using a questionnaire with 15 questions selected in order to detect emotional reactions caused by infertility. The responses were assigned four grades with respect to intensityy (I = mild intensity; 2 = medium intensity; 3 = high intensity, and 4 = maximum or unbearable intensity). The sum of the responses corresponded to a specific score ranging from 15 to 60 points. The reliability of the questionnaire was evaluated by the alpha coefficient of Cronbach. The specific PPE score identified five questions receiving 50% or more responses of the stressful type (sum of the percentages of responses with a score of 3 and 4). The questions were the following: I - The waiting time before being submitted to a pregnancy test (82.8% of the patients); 2 - A negative result of the pregnancy test (77.3% of the patients); 3- The degree of anxiety in a new attempt to obtain pregnancy (76.5% of the patients); 4- Finding the money necessary for the repetition of the IVF/ICSI techniques (66.4% of the patients); 5- The possibility of collecting few eggs, or of forming or not an embryo in the laboratory is an expectation that makes me anxious (57.8% of the patients). The specific mean PPE score was 33 ±6. The alpha coefficient of Cronbach was 0.757. A specific PPE score > 40 points was defined as abnormal and identified the patient as having the assisted reproduction stress syndrome (ARSS). The incidence of ARSS in this population was 15%. In conclusion the specific PPE score was an efficient tool for the identification of women with stress provoked by the application of ART and for the planning of their treatment. A psychological approach was developed for each stressful factor regardless of PPE score. In the presence of ARSS, the patients may require specialized psychotherapy.