Study On Symptoms Of Anxiety, Depression And Its Related Factors In Women With In Vitro Fertilization And Embryo Transfer

Objectives To determine the symptoms and its changing tendency of anxiety and depression among infertile women with in vitro fertilization and embryo transfer (IVF-ET) at a hospital reproductive center in Anhui province and to explore the relationships between anxiety, depression and coping ways, marriage adjustment during different treatment stage in IVF-ET and the factors related to anxiety and depression.Methods A total of 225 infertile women receiving the treatment of in vitro fertilization and embryo transfer (IVF-ET) or intracytoplasmic sperm injection (ICSI) were interviewed by using questionnaires at a hospital reproductive center in Anhui province from May 28, 2006 to November 28, 2006. The survey was carried out four times in four different stages of IVF-ET/ICSI. We assess the symptoms of anxiety and depression of the participants at the four different stages. The four interviewing time are defined as: the start of treatment(â… ), one hour or two hours before embryo transfer( ET)(â…¡), 9 to 10 days after ET (the wait time after ET,â…¢), 20 days after ET (the outcome time after ET,â…£) respectively. 225 women participated in the survey ofâ… , and 212 women participated in the survey ofâ…¡,â…¢andâ…£. The items of questionnaires included social demographic characteristics, health status, infertile medical factors, previous therapies, current treated situation, Self-Rating Anxiety Scale (SAS), Center for Epidemiologic Studies Depression Scale (CES-D), Coping style Scale, Locke-Wallace Marital Adjustment Test. We evaluate anxiety status among infertile women with IVF-ET/ICSI in four stages by using SAS. The cut-off point was more than 40 score in SAS. We evaluate depression status among infertile women with IVF-ET/ICSI in four stages by using CES-D. The cut-off point was more than 20 score in CES-D.Results Age of 225 participants ranged from 21 to 44 years and the mean is 30.9 years old; the average earnings each year are 22 thousand yuan. 35.6% of participants with junior middle school education and 64.4% participants'education at least middle school; the longest year of marriage is 18 years, the mean is 6.1years. 75.6% of participants live in urban. The years of infertility is 17.0 years, the mean is 5.3 years; the longest treatment times was lasting 14.0 years and mean is 3.2 years. Infertility due to man and women and both is 14.6%, 54.2%, 27.8% respectively, cause unknown account for 3.3%. The participants with the first treatment of IVF-ET/ICSI are 84.0%, the second is 12.0% and the third is 4.0%. The mean of previous treatment costs is 19 thousand yuan. The prevalence of anxiety and depression and both coexisting is 15.1 ~ 25.9% and 27.4 ~ 47.2 % and 9.4 ~ 25.0% respectively. The prevalence of anxiety and depression and both coexisting during theâ…£were significant higher than those during any other stages. The anxiety and depression at the four stages were positive correlation, this shows that anxiety and depression were coexisting, especially duringâ…£.At the first stage (â… ) , the prevalence of anxiety in women with the yearly earning less than 18 thousand yuan was higher than those with more than 18 thousand yuan. the prevalence of depression in women with junior middle school education, yearly earning less than 18 thousand, marital years more than 10 years and living in the rural were higher than those with education level more than middle school, yearly earning more than 18 thousand yuan, marital years less than 10 years and living in the urban respectively; Infertility for more than 5.5 years, previous treated costs over 20 thousand yuan , the cause of infertile due to women or couple were associated with anxiety significantly. The results from multinomial logistic regression show that previous treated costs over 20 thousand yuan (OR=2.912) is the risk factor of anxiety and yearly earning more than 18 thousand yuan (OR=0.361) is the protective factor of anxiety and marital years more than 10 years (OR=7.007) is the risk factors of depression and living in the urban (OR=0.384) is the protective factor of depression.At the second stage (â…¡), the prevalence of depression with the women living in the rural was higher than those with living in the urban. Cause of infertility due to men and rate of fertilization less than 74% and rate of cleavage less than 80% were associated with depression. With increasing of ovarian hyperstimulation syndrome (OHSS) during the treatment, the prevalence of anxiety and depression increased. The results from multinomial logistic regression show that the risk of anxiety (OR=3.190) and depression (OR=1.950) increased with the degree of OHSS increased; the age(OR=1.132), treatment lasting time(OR=1.307) and days of ovulation stimulants (OR= 1.284) are the risk factors of anxiety; yearly earning more than 18 thousand yuan (OR=2.736) and days of ovulation stimulants (OR=1.220) are the risk factors of depression and rate of cleavage more than 80% (OR=0.400) is the protective factor of depression.At the third stage (â…¢), the prevalence of depression with the previous receiving treatment time less than 2.5 years is higher than those with time at least 2.5 years; Rate of fertilization less than 74% and rate of cleavage less than 80% and unknown the number of ET herself were associated with depression ; With the degree with OHSS of this treatment increasing, the prevalence of anxiety and depression increased; The results from multinomial logistic regression demonstrate that with the degree of OHSS increased, the risk of anxiety and depression increased (anxiety OR= 2.519, depression OR=2.416); The results show that yearly earning (OR=2.428) and the days of ovulation stimulants (OR=1.229) are the risk factors of anxiety; the infertility time (OR=0.868) and rate of cleavage more than 80% (OR=0.448) and known the number of ET herself (OR=0.321) are the protective factors of depression.At the fourth stage (â…£), the prevalence of anxiety in the women living in the rural is higher than those living in the urban. The prevalence of anxiety with the receiving treatment time less than 2.5 years is higher than those with time at least 2.5 years significantly. Having freezing embryo and biochemistry pregnancies were associated with anxiety and depression. The prevalence of depression decreased with the number of freezing embryo increasing. The results from multinomial logistic regression show that with the frequency of IVF-ET/ICSI (OR=2.630) increasing, the risk of anxiety increase and longer with previous receiving treatment time (anxiety OR=0.755, depression OR=0.848), biochemistry pregnancy (anxiety OR=0.319, depression OR=0.237) are the protective factors of anxiety and depression; having freezing embryo (OR=0.412) is the protective factor of anxiety; the number of freezing embryo (OR=0.929) is associated with depression.With the factor scores of problem-solving increasing, the risk of anxiety decreased in the stage ofâ…¢, the risk of depression decrease during the stages ofâ… andâ…£; Help-seeking is negative associated with depression in the stage ofâ… ; The risk of anxiety during the stagesâ…¡andâ…£and depression during the stages fromâ… toâ…¢increased with the factor scores of self-accusation increasing; However, The risk of anxiety and depression is positive correlation with the factor scores of fantasy during the stagesâ…¢a ndâ…£. With the scores of marital adjustment increasing, the risk of depression decreased during the stagesâ…¡a ndâ…¢.Conclusions The status of anxiety and depression were common for women during the treatment with IVF-ET/ICSI, especially the fourth stages (â…£). The results demonstrate that anxiety and depression are coexisting. Living in the rural, marital years less than 10 years, infertility time, previous treatment costs over 20 thousand yuan, the degree with OHSS, rate of cleavage less than 80%, freezing embryo, biochemistry pregnancy and coping styles, marital adjustment were associated with anxiety and depression on the different stages of IVF-ET/ICSI respectively. We should pay close attention to the women with IVF-ET/ICSI, especially duringâ…£. and carry out comprehensive intervention to improve coping styles and promote social and family support to reduce the anxiety and depression of women with IVF-ET/ICSI.