Women's experience of IVF: a follow-up study

K. Hammarberg1,4, J. Astbury2 and H.W.G. Baker3

1 Melbourne IVF, 320 Victoria Pde, East Melbourne, 3002, 2 Key Center for Women's Health in Society, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Carlton, 3053 and 3 University of Melbourne, Department of Obstetric and Gynecology, Royal Women's Hospital, Grattan Street, Carlton, 3053, Australia


    Abstract
 Top
 Abstract
 Introduction
 Materials and methods
 Results
 Discussion
 References
 
The aim of this research was to increase understanding of how women feel about the experience of IVF 2–3 years after ceasing treatment. A questionnaire covering issues relating to infertility and the value of the experience of IVF together with three self-report measures [Satisfaction With Life Scale (SWLS), Golombok Rust Inventory of Marital State (GRIMS) and General Health Questionnaire (GHQ-12)] were mailed to all women (n = 229) who had their last contact with the clinic in 1994. The response rate was 55%. Having a baby positively influenced the recall of the IVF experience. Women who did not have a baby were more critical about the clinic and more negative about the experience of treatment but did not regret having tried IVF. These women had statistically significantly lower scores on SWLS but did not differ from those with babies on GRIMS and GHQ-12 scales. The results give insight into how women look back on the IVF experience and what aspects of treatment they recall as particularly difficult. The findings can be used by providers of IVF to implement strategies that may reduce stress and improve the patients' well-being.

Key words: IVF experience/long-term well-being/patient satisfaction/psychosocial impact/stress


    Introduction
 Top
 Abstract
 Introduction
 Materials and methods
 Results
 Discussion
 References
 
It is clear that IVF treatment is emotionally and physically stressful, and often financially demanding. There are many studies where women and men give evidence of the stress involved in undergoing treatment for assisted conception (Callan and Hennessey, 1988Go; Hynes et al., 1992Go; Boivin and Tafekman, 1995Go). IVF involves a substantial emotional investment for couples, and, for many, the treatment is the last resort after years of exhausting other avenues to try to have a family. In the case of the women, there may also be considerable physical pain involved and the time required to undergo treatment may interfere with other ambitions in life. Added to treatment stress may also be external social influences. For example Woods et al. (1991) concluded that `Women who are most persistent in exploring treatment . . . become vulnerable to being labelled neurotic, dysfunctional, or maladjusted'. Some studies have tried to evaluate the stress involved in undergoing IVF treatment. In most of these studies, couples have been asked to answer questionnaires while undergoing treatment or immediately following one or more failed treatment cycles. A mixture of standardized self-report measures and questions relating to the experience of the various procedures involved in IVF treatment has been used to capture the feelings evoked, mainly after failed IVF treatment cycles (Holmes and Tymstra, 1987Go; Mahlstedt et al., 1987Go; Baram et al., 1988Go; Callan and Hennessey, 1988Go; Kentenich 1989Go; Newman and Zouves, 1991Go; Connolly et al., 1993Go). There is universal agreement among women in all these studies that the most stressful time in an IVF treatment cycle is the wait after embryo transfer to find out if the treatment has resulted in a pregnancy. In one study, women and men who were currently in IVF treatment reported the most keenly felt emotions to be sadness, anxiety, anger and disgust, and the most stressful stages of IVF were a negative pregnancy test result, waiting for pregnancy test result, waiting to hear about fertilization and the wait between IVF treatment cycle attempts (Laffont and Edelman, 1994aGo). Daily reporting of the extent of emotional, physical, marital and social reactions in an IVF cycle, and reports from the same women during a previous cycle without treatment, were compared (Boivin and Tafekman, 1996Go). They found that the difference in stress when all types of reactions were considered between the IVF and the non-treatment cycle were less pronounced than generally assumed. This might indicate that the main stressor is trying to become pregnant and not succeeding in this aspiration rather than the IVF treatment itself. Although emotional stress is inherent in having IVF, it should be remembered that IVF treatment is only one part of a long journey beginning with the first suspicion that there may be a problem conceiving, through infertility investigation and diagnosis, infertility treatment and, in some cases, pregnancy or acceptance of childlessness. To accurately quantify the stress involved in IVF is difficult because it has to be presumed that couples who have treatment have experienced considerable infertility-related stress before commencing IVF and also are affected by events which occur after they cease treatment. How women rate the effect of the various aspects of IVF may also be dependent on the length of time spent on the IVF programme, the number of treatment cycles attempted and the outcome of the treatment. Whether the emotional stress is evaluated before, during or after IVF may also have a bearing on the findings.

Follow-up studies of IVF couples have demonstrated various degrees of mainly short-term emotional consequences of treatment such as depression, increased anxiety and negative effects on self-esteem and marital relationship when treatment was unsuccessful (Leiblum et al., 1987aGo,b; Freeman et al., 1987Go; Newton et al., 1990Go; Hynes et al., 1992Go; Litt et al., 1992Go; Merari et al., 1992Go; Thierling et al., 1993Go; Visser et al., 1994Go; Boivin and Tafekman, 1995Go; Slade et al., 1997Go).

The aims of the present research were to increase the understanding of how women feel about the experience of IVF and how they view their general health, marital relationship and life satisfaction 2 to 3 years after ceasing treatment. Another important aim was to explore how the outcome of IVF treatment, i.e. whether a live birth was achieved or not, affected the recall of this experience. The reason for choosing to study women who had had their last treatment some time ago was to allow for the IVF experience to be viewed in the context of the infertility experience as a whole. It was postulated that the outcome of IVF treatment would affect how women view the IVF experience with the expectation that those who did not have a baby would feel worse about the experience and would suffer more adverse emotional consequences.

The study was carried out at a large IVF centre in Melbourne, Australia. In 1996 there were 27 units providing IVF in Australia and 1.1% of all births for 1995 were a result of IVF and associated procedures (Hurst et al., 1997Go). Assisted reproductive technology treatment is to a large extent funded by the government (~60–70% of the cost) and at the time of this study every woman was eligible for six subsidized stimulated treatment cycles.


    Materials and methods
 Top
 Abstract
 Introduction
 Materials and methods
 Results
 Discussion
 References
 
Participants
All women who had their last contact with the clinic in calendar year 1994 and at least one oocyte retrieval and embryo transfer or gamete intra-Fallopian transfer (GIFT) procedure with no embryos remaining in storage were selected for inclusion in this study (n = 303). It was not possible to contact 74 of these women as their current address was unknown, leaving 229 contactable subjects. Between 2.5 and 3.5 years had lapsed since the women had their last IVF treatment at this clinic when the study was undertaken.

Questionnaire
A 161 item questionnaire consisting of several sections was devised. The first section, `Information about you and your family', explored the socio-demographic circumstances of the subjects. This was followed by `The infertility investigation' which dealt with issues and events that pre-dated the IVF treatment and `Deciding to try IVF' which focused on how women made the decision to try IVF and their level of satisfaction with the information given by the clinic prior to commencing treatment. In the next section, `Counselling and support', the questions canvassed to what extent support from the clinic and other sources was available and helpful while on the programme. `On the programme' covered all aspects involved in having the actual treatment and the final section, `After treatment', explored the reasons for stopping treatment and how the experience of infertility and IVF treatment had affected long-term emotional well-being.

Three standardized self-report measures were also included, namely: the Satisfaction With Life Scale (SWLS) (Diener et al., 1985Go), the Golombok Rust Inventory of Marital State (GRIMS) Questionnaire (Rust et al., 1988Go) and the General Health Questionnaire (GHQ-12) (Goldberg, 1992Go).

The SWLS has been developed as a measure of life satisfaction and is a five-item, self-report scale where subjects rate their level of agreement with each item (e.g. `In most ways my life is close to ideal' and `So far I have got the things I want in life') on a seven-point Likert scale. A score is obtained by adding the rating for all items and can range from 5 (minimal life satisfaction) to 35 (best possible life satisfaction). The results of studies evaluating the measure indicate that the SWLS has good reliability and internal consistency. The 2 month test-retest reliability was 0.82 and the coefficient alpha was 0.87. Inter-item correlations are all consistently positive and factor analyses have revealed a unitary factor accounting for ~70% of the variance (Weinman et al., 1995Go).

The GRIMS is a 28 item self-report questionnaire developed to assess the overall quality of the relationship between a man and a woman who are married or live together. Evaluations of the test have shown that it is a reliable and valid instrument, providing a good estimate of problem severity in a relationship. Split-half and alpha coefficients indicated a high degree of consistency within the GRIMS items (coefficients ranged from 0.81 to 0.94) and content and face validity were regarded as high when validity of the questionnaire was assessed by means of diagnostic and empirical methods (Milne, 1992Go).

The GHQ-12 is a shortened but equally valid and reliable version of the well-validated GHQ-60 which was designed to detect non-psychotic psychiatric disorder. Each of the 12 items asks if the subject has experienced a particular symptom or item of behaviour recently using a four-point scale. The scoring method used in this study gives a range between 0 and 12 and is appropriate for detecting psychiatric cases. Based on five validation studies the threshold for psychiatric disorder is 2/3 (a score of >=8). The internal consistency of GHQ-12 using Cronbach's alpha based on a number of studies ranged from 0.82 to 0.90. The split-half reliability was 0.83 and test-retest reliability 0.73. In the original validation of GHQ-12, sensitivity was 93.5% and specificity in detecting cases was 78.5% (Johnston et al., 1995Go).

Procedure
In July 1997, 229 women were sent the questionnaire, an explanatory letter and a consent form where they were asked to indicate their intentions, and a stamped addressed return envelope. The return form gave the subjects three options: to sign the consent form and return the completed questionnaire, to return the forms declining participation or to indicate the intention to return for further treatment. The latter were asked not to participate as the study was designed for women who had stopped IVF. Eighteen women indicated they would come back for more treatment and they were therefore excluded from all analyses reducing the study population to 211.

Statistical methods
The Statistical Package for Social Sciences (SPSS; Melbourne University, Melbourne, Australia) was used to analyse the data. The {chi}2-test was used to compare responses of nominal and ordinal data between those who had a birth as a result of the treatment and those who were unsuccessful. t-Test or analysis of variance was used with interval data, and, if significant, the unequal variance t-test for equality was used.

For responses on Likert scale calculations were made using each chosen response and also aggregating responses (for example pooling `Strongly disagree' with `Disagree' and `Agree' with `Strongly agree'). The latter were analysed by 2x2 {chi}2-test. Aggregated responses are reported here, and where there were statistically significant differences between those who had a baby as a result of treatment and those who did not, this is indicated in the tables.


    Results
 Top
 Abstract
 Introduction
 Materials and methods
 Results
 Discussion
 References
 
Response rate
Of the 211 subjects, 116 (55%) returned the questionnaire completed, 14 (7%) returned the form stating that they did not wish to participate and 81 (38%) did not respond. Whether the treatment had been successful or not did not affect the likelihood of the woman responding.

Treatment information
Treatment information available from medical records is presented in Table IGo. No statistically significant differences were found between responders, non-responders and those declining participation.


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Table I. Comparison of characteristics of treatment between responders (R), non-responders (NR), those not wishing to participate (NP), means (SD) or percentage (95% confidence interval)
 
Responses
Each section will be reported as set out in the questionnaire. Where responses are tabulated, significant differences between those who were successful on the programme (`Baby' = B) and those who were unsuccessful (`No baby' = NB) were detected; the frequency of responses for B and NB are reported separately. A column labelled `No response' appears in each table and shows the percentage of women who did not provide an answer to the question. Some questions were not applicable to all responders, for example rating the stress involved in `Losing a pregnancy'. For those questions, the total number of eligible responders is shown in brackets after the question and the responses are calculated as a percentage of that number.

`Information about you and your family'
This section included demographic information and the findings are presented in Table IIGo.


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Table II. Demographic information
 
`The infertility investigation'
The median number of years trying to conceive before seeking help was 3.5 (range 1–10) and the distribution of causes was 33% female and 16% male factor, 20% both female and male causes, 29% unexplained infertility and 2% did not state a cause.

`Deciding to try IVF'
The first part of this section assessed how women felt about the decision to try IVF. They were asked to indicate on a four-point Likert scale, `Strongly disagree', `Disagree', `Agree' and `Strongly agree', the degree to which they felt 17 statements applied to them; responses are shown in Table IIIGo.


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Table III. Responses to `Deciding to try IVF'
 
The next part of this section dealt with questions relating to women's satisfaction with information provided by the doctor and the clinic before starting. Fourteen items describing areas of information were listed and women were asked to rate their satisfaction with the information they received on a four-point Likert scale, `Not satisfied', `Somewhat satisfied', `Satisfied' and `Very satisfied' (Table IVGo). On most items, women in the `No baby' group were less satisfied than those in the `Baby' group. However, the majority of all responders were either `Satisfied' or `Very satisfied' with procedural information such as `Explanation of treatment procedures', `Chance of multiple birth' and `Financial cost'. On the other hand, there was considerably less satisfaction, particularly among women in the `No baby' group, with information about emotional issues such as `What to do if unsuccessful', `Coping strategies' and `Alternatives to IVF, including child-free living'.


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Table IV. Responses to `Satisfaction with information provided'
 
When asked to recall what chance of success they expected from IVF, 83% responded with a percentage rate ranging from 0 to 100% (mean 44%). Compared with the actual eventual chance of a live birth (39%) about half of the responders underestimated the chance and the other half was too optimistic of a successful outcome. Some 25% grossly overestimated their chance of being successful. The mean estimated chance of having a baby was remarkably similar for the `Baby' group (43%) and `No baby' group (44%).

`Counselling and support'
On a four-point Likert scale, `Strongly disagree', `Disagree', `Agree' and `Strongly agree', women were asked to state the extent of their agreement with 11 statements about the counselling services and other support provided by the clinic. Counselling is mandatory in the state of Victoria before having IVF treatment, but at the clinic counselling is also available free of charge at any stage of treatment. Responses are recorded in Table VGo and in most cases they refer to the compulsory counselling as only a minority (15%) stated that they had had any other contact with the counsellor. The vast majority of women in both groups agreed that ongoing counselling should be part of having IVF treatment and that couples should be counselled about the option of stopping treatment. The women in the `No baby' group were less likely to agree with some of the positive statements about counselling and support, and more likely to feel that they would have liked to attend counselling together with other couples.


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Table V. Responses to `Counselling and support'
 
`On the programme'
The questions in the first part of this section focused on events that occur while on an IVF programme. Seventeen items relating to physical and emotional aspects of having IVF treatment were listed and the women were asked to rate the stress involved in each using a four-point Likert scale, `Extremely stressful', `Very stressful', `Somewhat stressful' or `Not stressful' and the responses are shown in Table VIGo. For the experience of stress by events that occur during IVF treatment, there was remarkable agreement between the `Baby' and the `No baby' groups. Most women rated the stress involved in the physical aspects of treatment, such as having injections and scans, as less stressful than the emotional aspects, such as waiting to find out how many eggs had fertilized. By far the most stressful event was the wait to find out if the treatment had been successful.


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Table VI. Rating of stress of events in an IVF cycle
 
Women's views on information and communication while they were undergoing treatment were also canvassed in this section. Nine areas were listed and the women asked to rate their level of satisfaction with each on a four-point Likert scale, `Not satisfied', `Somewhat satisfied', `Satisfied' and `Very satisfied' (see Table VIIGo). There was considerably less satisfaction with some areas of information and communication in the `No baby' group and they were also less likely to be satisfied with the follow-up support after treatment.


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Table VII. Rating of satisfaction with information and communication
 
The third part of this section probed what effect IVF treatment had on women's relationships and other important aspects of their lives. Nine items were listed and women were asked to state how they felt IVF had impacted on them by selecting `Extremely negative', `Somewhat negative', `No impact' or `Positive impact' (see Table VIIIGo). Although the two groups coincided in their views on most items, women in the `No baby' group were more likely to feel that IVF had negatively affected their job, lifestyle and financial situation.


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Table VIII. Responses to the impact of IVF on aspects of life
 
`After treatment'
In this last section of the questionnaire, questions were asked to clarify what the main reasons were for ceasing treatment and how women viewed the overall impact of having had IVF.

The first part listed 15 reasons for stopping treatment and the women were asked to indicate those they felt applied to them. The reasons given for ceasing treatment varied considerably between the `Baby' and the `No baby' groups as would be expected. The four most common reasons quoted by the `Baby' group were: `Being pregnant' (94%), `I had had enough' (20%), `Emotional cost' (14%) and `Concerns about health effects from IVF' (10%). For the `No baby' group the most common reasons were: `I had had enough' (66%), `Emotional cost' (64%), `Could not cope with more treatment' (42%) and `Physical cost' (39%).

Finally, 17 general statements about infertility and the IVF experience were listed. Women could chose to `Strongly disagree', `Disagree', `Agree' or `Strongly agree' with the statements. The responses are shown in Table IXGo. On most points the two groups coincided in their views and most agreed that they had had IVF to avoid future regrets. However, the `No baby' group was less likely to agree with positive statements and more likely to agree with negative statements about the experience of infertility and IVF.


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Table IX. Responses to `Overall experience of IVF'
 
Standardized self-report measures
SWLS was completed by 109 (95%) women and the mean score obtained was 25.5 (range 7–35) which is at the upper end of the scores recorded in the evaluation of the test (range 23.37–25.8) (Weinman et al., 1995Go). When the scores for `Baby' group and `No baby' group were compared, the latter had a statistically significant lower score, 24.1 versus 27.2 (P = 0.008). It should be noted that although the average score for the `No baby' group was lower than that for the `Baby' group it was still within the range obtained in the test evaluation.

Eight women had separated or divorced since IVF, leaving 108 who were eligible to fill out the GRIMS. Of these, four did not fill it out and 11 filled it out incompletely, leaving 93 cases that could be used for analysis (86% of eligible). The mean transformed score for the whole group was 3.6 (range 1–8), with the interpretation of 3 being `Good' and of 4 `Above average'. A comparison of the scores for `Baby' versus `No baby' groups revealed no significant differences between the two.

The GHQ-12 was filled out by 114 women (99%). The mean score was 1.8 with 107 (94%) having a score of <8 which is the threshold score for psychiatric disorder. Of the seven that remained, four women scored 8 and the others scored 9, 10 and 11. A comparison between the `Baby' group and the `No baby' group revealed no significant differences.


    Discussion
 Top
 Abstract
 Introduction
 Materials and methods
 Results
 Discussion
 References
 
This research provides an opportunity for a broader understanding of how women remember the experience of IVF some years after ceasing treatment. The 2.5–3.5 year time gap means that the responses reflect how the women recall how they felt, which may be different to how they actually felt at the time of having treatment. However, the purpose of this study was to explore what feelings remain in the long term.

It is well known that the main problem with mailed questionnaires as a research tool is low response rates. Adler et al. (1991) argue that particular problems are associated with questionnaires in IVF participants since attrition rates tend to be high for women who have not had a baby. Studies about the experience of IVF may therefore underestimate the negative feelings of the women who are unsuccessful as many of them would elect not to respond. With a substantial number of completed questionnaires (116), a response rate of 55% and the number of responders who had been successful and unsuccessful being proportional and not statistically significantly different from the whole study population, it would appear that the findings in this study are representative.

The hypothesis that women's recall of the experience of IVF treatment is dependent on the outcome, with those who are unsuccessful feeling worse about the experience, was partly supported by this study. The findings suggest that there were some aspects of having IVF that were particularly difficult for women and this was often more pronounced in the `No baby' group. Negative feelings and dissatisfaction with treatment may be expected when it is unsuccessful and some of the findings of the current study confirm this. However, it was noticeable that on many items the `Baby' and the `No baby' groups coincided in their views.

A very strong feeling that everything had to be tried to have a child was clearly a driving force behind the decision to try IVF. Tymstra (1989) also found that women reported that the compelling nature of IVF was a motivating factor for trying (Tymstra, 1989Go). The women felt well-informed about what was involved before starting but a large proportion expressed that it was difficult and anxiety-provoking to make the decision to try. This is important for clinic staff to be aware of, as women may be feeling particularly vulnerable at the time of starting treatment.

Although most women agreed that their family and friends and indeed society as a whole are accepting of IVF, many found infertility difficult to talk about and did not reveal that they were having IVF treatment. Secrecy and having to come up with excuses for absenteeism at work adds to the stress of having treatment and contributes to a sense of isolation. As part of counselling it may help some women to discuss these issues.

The provision of clear and unambiguous information about all aspects of treatment is essential for couples to be able to make informed decisions about treatment. The fact that the `No baby' group was less satisfied with most of the information provided probably reflects the ameliorating effect of success on recall of the quality of the information. The ability to retain information varies greatly and it has been shown that as much as 50% of information is forgotten as soon as 5 min after a consultation and that information processing can be inhibited by anxiety and how the information is presented (Reading and Kevin, 1989b). Therefore, information needs to be given repeatedly through the course of treatment and not only at the start.

Many women had concerns about the possible health risks of having IVF. As the long-term health effects of fertility drugs and assisted conception have yet to be fully determined, women need to be provided with all the information that is available in a format which enables them to make an informed decision about using fertility drugs.

It is important to ascertain what expectations couples have of the treatment being successful before starting. This would provide an opportunity to engage further with those who grossly overestimate their chance (25% in this study). Several other studies have found that the majority of women overestimate their chance of having a live birth as a result of IVF (Holmes and Tymstra, 1987Go; Leiblum et al., 1987bGo; Johnston et al., 1987Go; Reading 1989Go; Koch 1990Go; Visser et al., 1994Go).

Particularly stressful times, when counselling may have an important role to play, were identified by the women in this study. They included waiting for news about fertilization, waiting to find out if the treatment had worked, after one or more unsuccessful treatment cycles and when a pregnancy was lost. However, it is important to realize that some may not want or need counselling and this should be respected. Only a small proportion of women in this study availed themselves of the counselling services beyond the initial mandatory counselling session. Similarly, it was reported from a survey of IVF programmes in the UK that in the majority of clinics <25% of couples took up the offer of counselling (Hernon et al., 1995Go) and Laffont et al. (1994b) found that only 26% of women felt that meeting with a psychologist would `improve knowledge and passage through an IVF cycle'. Boivin (1997) makes the point that although most studies find that patients express interest in counselling, the actual take-up rate of the offer to have counselling is usually only 18–21%. She suggests that while a minority of highly distressed patients may benefit from counselling, most infertile couples cope with the distress they experience and may find more informal sources of help, such as written information, more useful. However, studies have shown that even if couples do not seek counselling they are reassured to know that it is available (Freeman et al., 1985Go; Seibel and Levin, 1987Go; Mazure et al., 1992Go; Laffont and Edelmann, 1994bGo). In another study Boivin et al., (1999) found that the most distressed patients failed to initiate contact with counsellors and this implies that clinics need to be proactive in identifying those who need their support. In comments made by the women who did use the counselling services in the present study, it is clear that the availability of the service was seen as vitally important at times of distress.

Most women agreed that ongoing counselling should be part of having IVF and that the clinic should contact couples between treatments. They also believed that couples should be counselled about the option of stopping treatment. These findings support the view expressed by Guerra et al. (1998) that a reassessment of a couple's feelings and degree of psychological distress should be made after each IVF cycle (Guerra et al., 1998Go).

This and other studies have found that unsuccessful IVF does not appear to have long-term detrimental effects on the marital relationship (Freeman et al., 1987Go; Leiblum et al., 1987bGo). In fact 37% of women in this study reported that IVF had had a positive impact on their marital relationship and feelings of improved closeness between partners having IVF have been reported by some (Baram et al., 1988Go; Litt et al., 1992Go; Laffont et al., 1994a). Van Balen and Trimbos-Kemper (1993) found that although couples reported that infertility had a negative effect on their sex life, the number who did not enjoy the sexual contact with their partner was no different to what is found among other couples.

Many women in this study, as in a study by Laffont and Edelmann (1994a), felt that having IVF interfered with their work commitments and negatively influenced their career. This would inevitably add to the stress of having IVF, particularly for women who have chosen not to disclose that they are having treatment.

Unsuccessful IVF treatment has been found to leave women feeling sad, anxious and depressed (Holmes and Tymstra, 1987Go; Baram et al., 1988Go; Newman and Zouves, 1991Go). It is important that couples are made aware that this is a normal response but that over time emotional well-being becomes similar to that of women who are successful. However, it might take 1 or 2 years to recover, as suggested by findings in one study (Slade et al., 1997Go) where 6 months after the last IVF cycle, those who had been unsuccessful showed significantly greater emotional distress and had poorer marital adjustment than the group who were pregnant. In a follow-up study of women who had their last treatment between 1982 and 1993, Leiblum et al. (1998) found that most women did not report negative effects on marital or sexual relationships after infertility treatment but that those who had been successful had greater overall life satisfaction than the unsuccessful. Similarly, the present study indicates that a few years after ending IVF treatment emotional well-being and marital satisfaction are not affected by lack of success whereas life satisfaction is lower for the women who were unsuccessful.

Most women in both groups had IVF to avoid future regrets and in spite of the difficulties involved they were glad that they had tried and did not regret having had treatment.

In conclusion, the findings from this research increase our understanding of what women who undergo IVF see as the main issues in relation to treatment. This knowledge gives providers of IVF valuable insight and may help in optimizing the information, communication, support and counselling aspects of IVF programmes. Having had a child or children as a result of treatment appears to positively influence the experience, as may have been expected. However, women who were unsuccessful seem to have dealt with the disappointment, and although more critical about the experience of treatment, their marital relationship and general health were not different from those who were successful.


    Notes
 
4 To whom correspondence should be addressed at: Melbourne IVF, 320 Victoria Pde, East Melbourne, 3002, Australia.E-mail: karinhammarberg{at}bigpond.com Back


    References
 Top
 Abstract
 Introduction
 Materials and methods
 Results
 Discussion
 References
 
Adler, N.E., Keyes, S. and Robertson, P. (1991) Psychological issues in new reproductive technologies: Pregnancy inducing and diagnostic screening. In Rodin, J. and Collins, A. (eds), Women and New Reproductive Technologies. Hillsdale, New Jersey, pp. 111–133.

Baram, D., Tourtelot, E., Muelcher, E. et al. (1988) Psychosocial adjustment following unsuccessful in vitro fertilization. J. Psychosom. Obstet. Gynecol., 9, 181–190.[ISI]

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Submitted on September 12, 2000; accepted on November 10, 2000.