The experience of difficulties in conception, the diagnosis of infertility and its treatment are frequently associated with anxiety and overall distress. However, current understanding regarding the determinants of variability in the levels of distress among women undergoing infertility treatment is limited; and the evidence of the significance of distress as a risk factor for assisted conception following IVF/ICSI is inconsistent. The thesis addressed both these issues.
Overall the thesis is informed by the biopsychosocial model of health and illness. Four studies were conducted. The data was collected in three IVF clinics in India. A consecutive sample of 85 infertile women about to commence IVF/ICSI cycle was recruited in the project at cycle baseline and followed through one treatment cycle. The first two studies examined this sample of women at baseline to identify the biopsychosocial factors associated with infertility related distress. The first study examined the degree of cognitive–behavioural adjustment to infertility, its treatment and treatment related eventualities, while the second study focused on the factors associated with affective aspects of infertility related distress such as increase in negativity and decrease in positivity. The third study examined the pattern of change in stress operationalized in terms of changes in Affect and State Anxiety in a sample of 74 infertile women during an IVF/ICSI cycle. The final study developed a prognostic model for evaluating the unique contribution of baseline distress as well as treatment related stress in estimating the odds of pregnancy following IVF based on a consecutive sample of 73 women.
Collectively, the first two studies indicate that at the outset of the IVF/ICSI cycle, some women are more prone to distress than others, and that this variability is associated with their intrapersonal, interpersonal and sociodemographic attributes. These two studies have identified a set of protective and vulnerability factors related to cognitive-behavioural and affective aspects of distress. The last two studies clearly indicate that the level of distress tends to rise during the treatment among the majority of infertile women. The rising trend continued to be significant even after controlling for variables known to somewhat influence infertility related distress such as age, education, occupation, employment, financial burden and etiological factors. Further, a prognostic model is developed that proposes that both baseline level of stress and treatment stress make a unique contribution in defining the odds of pregnancy outcome for the patients. In short the thesis clearly brings out the case for integrating psychosocial care with the routine medical interventions for infertility. http://proxy.library.adelaide.edu.au/login?url=http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1325419 Thesis (Ph.D.) -- University of Adelaide, School of Psychology, 2008