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Hospitals and clinics develop Internet strategies to emancipate and empower their patient population. At Radboud University Nijmegen Medical Centre, we developed an Internet-based personal health record that provides patients with general and personal information about their treatment and that provides facilities for communication with fellow patients and with physicians. Because not much is known about information and communication needs of IVF and ICSI patients in relation to their treatment, we observed the intensity of use of this personal health record during the various stages of IVF treatment. We measured the numbers of page views and the number of contributions to the chat room. Data regarding Website use and treatment schedules were available for 51 couples. These couples generated 25,420 page views and posted 11,403 utterances. Two-way analysis of variance showed that significant individual changes occurred in the intensity of use during the different stages of the treatment. During the stages in which there is no contact between the patient and the clinic, patients make use of the Website's communication functions. This reflects the patients' need for continued communication and support during the last stages of treatment, a service that IVF clinics traditionally cannot or do not provide.

Objective: To study the effect of an Internet-based personal health record on the empowerment of patients undergoing IVF., Design: Randomized clinical trial., Setting: Patients undergoing IVF and intracytoplasmic sperm injection (ICSI) in an academic research environment., Patient(s): We selected patients who were undergoing an IVF or ICSI treatment, have an Internet connection, and speak fluent Dutch., Intervention(s): An Internet-based personal health record that provides patients with general and personal information concerning their given treatment and that also provides facilities for communication with fellow patients and physicians., Main Outcome Measure(s): Patient empowerment (measured as a multidimensional concept consisting of self-efficacy, actual and perceived knowledge, and involvement in the decision process), patient satisfaction, meaning of infertility problems, social support, anxiety, and depression., Result(s): A total of 91 female and 89 male participants were suitable for analysis. No significant differences were observed in per person change in patient empowerment. We did not find any significant differences regarding per person change in patient satisfaction, the meaning of infertility problems, social support, anxiety, and depression., Conclusion(s): Usage of the personal health record did not have any effects on patient empowerment, but, at the same time, the study did not find that the personal health record had any significant adverse effects either.

Objective: To gain more insight into psychological aspects of dropping out from IVF-ICSI., Design: Prospective cohort study., Setting: University hospital-based tertiary care fertility clinic., Patient(s): Women entering their first treatment cycle of IVF or ICSI., Intervention(s): Standardized psychological questionnaires were administered before the start of the treatment and after treatment., Main Outcome Measure(s): Reasons for dropout, state and trait anxiety, depression, and marital and sexual satisfaction., Result(s): Baseline psychological factors and the probability of dropout after IVF-ICSI treatment were found to be associated in the group that stopped treatment for psychological reasons. Those who were denied further treatment by the medical team, the "actively censored" group, did not show pretreatment differences regarding psychological measures in comparison with those who continued treatment. After treatment, the group that was denied further treatment showed higher levels of anxiety and depression compared with those that continued., Conclusion(s): Dropout, being a well-known phenomenon in IVF-ICSI, is related to preexisting psychological factors in IVF-ICSI. Actively censored patients were psychologically well-adjusted before treatment, but this changed after censoring.

Because several studies indicate that psychological factors play a role in dropping out of IVF treatment, the question arises as to whether psychological interference is indicated.

Objective: To determine differences in emotional status (anxiety and depression) and marital satisfaction in pregnant and nonpregnant women before and after their first cycle of IVF and intracytoplasmic sperm injection (ICSI)., Design: Repeated measurement., Setting: Fertility department at a university and a regional hospital., Patient(s): Women entering their first treatment cycle of IVF or ICSI., Intervention(s): Questionnaires on psychological factors were administered 3 to 12 days before the start of their first treatment cycle and repeated 3 weeks after the pregnancy test., Main Outcome Measure(s): State anxiety, depression, mood, and marital satisfaction., Result(s): At pretreatment, the women who became pregnant showed lower levels of depression than those who did not. Higher levels of depression in the pregnant women after the first cycle were due to higher scores on vital aspects of depression, related to signs of early pregnancy. Higher levels of depression in the nonpregnant women were due to a higher score on cognitive aspects of depression., Conclusion(s): Differences in emotional status between pregnant and nonpregnant women were present before treatment and became more apparent after the first IVF and ICSI cycle. There were no differences in emotional status between the women who underwent IVF and those who underwent ICSI.