Effects of Integrative Behavioral Couple Therapy on Infertility Self-efficacy, Dyadic Adjustment, and Sexual Satisfaction in Infertile Couples

Background: Given the rising rate of infertility, the prevalence of mental health disorders in infertile couples is undeniable. The present study aimed to investigate the effects of Integrative Behavioral Couple Therapy (IBCT) on infertility self-efficacy, dyadic adjustment, and sexual satisfaction in infertile couples. Methods: The present single-case experimental study used a multiple-baseline design. The statistical population of the study included all infertile couples referring to infertility centers in Ahvaz City, Iran, in 2019. The research instruments included the Infertility Self-Efficacy Scale (ISE), the Dyadic Adjustment Scale (DAS), and the Sexual Satisfaction Questionnaire (SSQ). Following a diagnostic interview, 3 couples were selected using the convenience sampling technique. Integrative behavioral couple therapy was conducted in twelve 120-minute sessions for the intervention group. The second couple entered the study in the second session of the first couple; the third couple enrolled the treatment plan in the third session of the first couple and the second session of the second couple. All questionnaires were completed in the first, third, sixth, eighth, and tenth sessions; the study participants were followed up and re-assessed two months later. The collected data were analyzed in SPSS using chart analysis, reliable change index, and significance statistics. Results: The provided IBCT increased infertility self-efficacy (39.04%), dyadic adjustment (25.91%), and sexual satisfaction (55.01%) in infertile couples. Besides, the improvement lasted throughout the follow-up which indicated the effectiveness of IBCT on infertility self-efficiency, dyadic adjustment, and sexual satisfaction in the study subjects. Conclusion: IBCT can be effective in improving personal and marital variables in infertile couples with infertility problems in addition to their marital problems.

Impact of Living in Different Altitudes on Intracytoplasmic Sperm Injection (ICSI) Outcomes for Infertile Couples in Southwestern Region of Saudi Arabia, a Retrospective Study

Objective: The aim of this study was to determine the effect of different altitudes in the Southwestern region of Saudi Arabia on ICSI outcomes, fertilization rate, embryo quality, pregnancy rate, and miscarriage rates for infertile couples. Materials and Methods: This is a retrospective study on 551 infertile couples carried out in the Assisted Reproductive Technology unit at the Maternity and Childern Hospital in Abha, Saudi Arabia between 2018 and 2019 to compare ICSI outcomes in different altitudes. Low altitude (205 patients), mild altitude (86 patients) and high altitude (260 patients). Main result measurements: fertilization rates, embryo quality, clinical pregnancy and miscarriage rates at different altitudes. Results: The data showed that there were no significant differences (P>0.67) in fertilization rates and the number of good-quality embryos between different altitudes. Importantly, clinical pregnancy rates were similar between groups and there was no significant difference in the miscarriage rates between high, mild and low altitudes. Conclusions: This study demonstrates that there is now increased risk of miscarriage or low pregnancy rates with different altitudes in Southwestern region of Saudi Arabia. This suggests that altitude changes has no obvious risk on pregnancy rate and pregnancy outcome.

Transition à la Parentalité et Fonctionnement Conjugal chez les Couples Infertiles en Tunisie

Objectif.-Evaluer l’impact de l’adoption sur le fonctionnement conjugal des couples infertiles. Méthode.-L’échantillon est composé de 146 participants hétérosexuels (73 couples) répartis en un groupe avec enfant adoptif (GAEA) composé de 30 couples infertiles vivant une parentalité adoptive et deux groupes contrôles ; le groupe avec enfant biologique (GAEB) composé de 30 couples fertiles ayant accès à la parentalité biologique et le groupe sans enfant (GSE) qui comprend 13 couples infertiles sans enfants. Résultats : Le GAEA semble éviter moins la proximité que les deux groupes contrôles et apparaît plus anxieux face à l’abandon uniquement par rapport au GAEB. Il utilise significativement plus la communication mutuelle mais uniquement par rapport au GSE et rapporte davantage des comportements de "Demande-Retrait" par rapport aux deux groupes témoins. De plus, Il est plus satisfait sur le plan conjugal que les deux groupes contrôles. Conclusion: L’étude offre une meilleure compréhension des changements au sein des couples infertiles devenant parents par voie d’adoption et ouvre plusieurs pistes d’investigation. The aim of this study is to assess the impact of adoption on the marital functioning of infertile couples. The sample is composed of 146 heterosexual participants (73 couples) divided into a group with adopted children (GWAC) made up of 30 infertile couples living in adoptive parenthood and two control groups; the group with biological child (GWBC) made up of 30 fertile couples with access to biological parenthood and the childless group (GWC) which includes 13 infertile couples without children. The GWAC seems to avoid proximity less than the two control groups and appears more anxious about abandonment only in relation to the GWBC. He used mutual communication significantly more but only in relation to the GWC and reported more "Request-Withdrawal" behaviors compared to the two control groups. In addition, he is more marital satisfaction than the two control groups. The study offers a better understanding of the changes in infertile couples becoming parents by adoption and opens several tracks of investigation.

Sexual Function, Self-Esteem, and Quality of Life in Infertile Couples Undergoing In Vitro Fertilization: A Dyadic Approach

Background: Infertility can be characterized as a situation of dyadic stress because it affects both individuals and their partners. Previous studies have shown that infertile couples have a poorer quality of life (QoL). However, the impact of sexual function on couples’ QoL and the potential mediating role of self-esteem during in vitro fertilization is unexplored. Our study aimed to investigate the relationship between sexual function and QoL in couples with infertility through mediation of self-esteem at the dyadic level. Methods: In this descriptive cross-sectional study, 428 infertile couples (856 individuals) undergoing in vitro fertilization (IVF) were recruited from the First Affiliated Hospital of Anhui Medical University in China between October 2020 and January 2021. We assessed sociodemographic and clinical characteristics, sexual function, self-esteem, and QoL of the dyads. Dyadic data were analyzed using the Actor-Partner Interdependence Mediation Model approach (APIMeM). Results: The APIMeM analysis indicated that the sexual function of infertile wives and husbands was positively correlated with their individual QoL, directly or indirectly, mediated by increasing their personal self-esteem. The wives’ sexual function was positively correlated with their husbands’ QoL, directly or indirectly, mediated by increasing the wives’ self-esteem. There were partial mediating and masking effects of the wives’ self-esteem on the relationship between their husbands’ sexual function and wives’QoL and their husbands’ sexual function and their own QoL. Conclusions: The results suggest that improving infertile husbands’ and wives’ sexual function can improve the QoL for both the individual and the partner; improving the husbands’ self-esteem can improve the husbands’ own QoL, while improving the wives’ self-esteem can improve the QoL for both themselves and their husbands. Therefore, sex therapy and psychological interventions that strengthen self-esteem should treat the couple as a unit in the context of infertility.

Using artificial intelligence to predict the intrauterine insemination success rate among infertile couples

Background To evaluate the use of artificial intelligence (AI) in predicting the success rate of intrauterine insemination (IUI) treatment among infertile couples and also to determine the importance of each of the parameters affecting IUI success. This study was a retrospective cohort study in which information from 380 infertile couples undergoing IUI treatment (190 cases resulting in positive pregnancy test and 190 cases of failed IUI) including underlying factors, female factors, sperm parameters at the beginning of the treatment cycle, and fertility results were collected from 2013 to 2019 and evaluated to determine the effectiveness of AI in predicting IUI success. Results We used the most important factors influencing the success of IUI as a neural network input. With the help of a three-layer neural network, the accuracy of the AI to predict the success rate of IUI was 71.92% and the sensitivity and specificity were 76.19% and 66.67%, respectively. The effect of each of the predictive factors was obtained by calculating the ROC curve and determining the cut-off point. Conclusions The morphology, total motility, and progressive motility of the sperm were found to be the most important predictive factors for IUI success. In this study, we concluded that by predicting IUI success rate, artificial intelligence can help clinicians choose individualized treatment for infertile couples and to shorten the time to pregnancy.

Proof of concept and development of a couple-based machine learning model to stratify infertile patients with idiopathic infertility

We aimed to develop and evaluate a machine learning model that can stratify infertile/fertile couples on the basis of their bioclinical signature helping the management of couples with unexplained infertility. Fertile and infertile couples were recruited in the ALIFERT cross-sectional case–control multicentric study between September 2009 and December 2013 (NCT01093378). The study group consisted of 97 infertile couples presenting a primary idiopathic infertility (> 12 months) from 4 French infertility centers compared with 100 fertile couples (with a spontaneously conceived child (< 2 years of age) and with time to pregnancy < 12 months) recruited from the healthy population of the areas around the infertility centers. The study group is comprised of 2 independent sets: a development set (n = 136 from 3 centers) serving to train the model and a test set (n = 61 from 1 center) used to provide an unbiased validation of the model. Our results have shown that: (i) a couple-modeling approach was more discriminant than models in which men’s and women’s parameters are considered separately; (ii) the most discriminating variables were anthropometric, or related to the metabolic and oxidative status; (iii) a refined model capable to stratify fertile vs. infertile couples with accuracy 73.8% was proposed after the variables selection (from 80 to 13). These influential factors (anthropometric, antioxidative, and metabolic signatures) are all modifiable by the couple lifestyle. The model proposed takes place in the management of couples with idiopathic infertility, for whom the decision-making tools are scarce. Prospective interventional studies are now needed to validate the model clinical use.Trial registration: NCT01093378 ALIFERT https://clinicaltrials.gov/ct2/show/NCT01093378?term=ALIFERT&rank=1. Registered: March 25, 2010.

The associations between infertility-related stress, family adaptability and family cohesion in infertile couples

To explore the association between infertility-related stress, family adaptability and family cohesion in infertile couples and the determinants of infertility-related stress in infertile couples. Fertility Problem Inventory (FPI) and Family Adaptability and Cohesion Evaluation Scales (FACESII-CV) were used to measure the infertility-related stress and family adaptability and cohesion of infertile couples. T-test, ANOVA and multiple comparisons (LSD) were conducted to compare the FPI scores of different demographic characteristics subgroups. Stepwise multivariate linear regression was used to explore the determinants of infertility-related stress. Women had greater global stress than men (P < 0.001). Women scored higher on desired family adaptability, cohesion dissatisfaction and adaptive dissatisfaction than men (P = 0.039, P = 0.036, P = 0.008). FPI scores were higher in men and women who lived in rural (P < 0.001, P < 0.001). Family cohesion and education level was negatively correlated with infertility-related stress in men. Family adaptability and education level was negatively correlated with infertility-related stress in women. Healthcare providers should pay more attention and give more support to infertile couples who lived in rural or with low education level, and provide easier medical accessing for them. Moreover, healthcare providers should value more the family function and family support in intervention of reducing infertility-related stress.

Mixed sexually transmitted infections in infertile couples: empirical treatment and influence on semen quality

Background: Trichomonas vaginalis (TV), Mycoplasma genitalium (MG) and Ureaplasma urealyticum (UU) are common sexually transmitted infections (STIs) that are diagnosed in infertile couples (cps). In cases with their simultaneous presence in a patient (mixed STI, MSTIs), treatment is complicated by the different sensitivity of microorganisms to antibacterial drugs. Moreover, in cases of complicated infections, the empirical treatment should be started before obtaining the results of drug susceptibilities. Objective: The objective of the current study is to find the effective and well-tolerated combination of drugs for the empirical antibacterial treatment of mixed STIs presented by TV, MG and UU in infertile couples. We also aimed to establish the influence of mixed STIs on semen quality. Method: Our prospective study included 154 infertile couples (308 patients) with confirmed symptomatic MSTIs in one of the couples caused by the simultaneous presence of TV, MG and UU. All couples were randomized on three groups for empirical treatment: Group 1 (n=49 cps, 98 pts) who were treated by initial prescribing of anti-trichomoniasis drug Secnidazole, 2.0 g po followed by Azythromycin 500 mg on day 1 continuing by 250 mg on days 2-7; Group 2 (n=52 cps, 104 pts: Secnidazole, 2.0 g po followed by Josamycin 1000 mg bid for 12 days); Group 3 (n=53 cps, 106 pts: Secnidazole, 2.0 g po followed by Moxifloxacin 400 mg once daily for 12 days). The endpoints were clinical and microbiological cure rates as well as the frequency of side-effects in analyzed groups. We determined the basic parameters of the spermogram and Deoxyribonucleic acid (DNA) fragmentation levels in 59 patients with MSTIs before and at the 3rd, 6th and 9th month after pathogens eradication comparing them with results in 63 healthy sperm donors. Result: After the treatment, clinical cure rates in analyzed groups were 82.6% (Group 1) vs 96.1% (Group 2) vs 92.3% (Group 3). Microbiological cure rates (UU+MG) were 73.9 % vs 97.1 % vs 84.5% correspondingly (p<0.05). TV microbiological cure rates were 97.8% vs 98.0% vs 96.1% (p>0.05). Side-effects were registered in 28.6% vs 12.5% vs 18.9% cases correspondingly (p<0.05). In MSTIs patients, we registered the increasing DNA fragmentation rates, leucocytes count and decreasing semen volume, motility, vitality, sperm concentration, total spermatozoa number and number of spermatozoa with normal morphology. At the 6th month after complete pathogens eradication, these parameters approached normal values. Conclusion: At the present time, the combination of Secnidazole+Josamycin can be considered the most effective and well-tolerated for the empirical treatment in patients with MSTIs presented by TV, MG and UU. Complete eradication of these MSTIs in males improves their semen parameters.