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New legislation was introduced in Sweden in 2016, giving single women access to medically assisted reproduction (MAR). While Swedish single women's characteristics and motivations for choosing motherhood through MAR were assessed in our previous pilot survey, their experience of considering and making the decision to undergo MAR has not been assessed through a qualitative approach. Thus, the aim of this study was to explore Swedish single women´s experience of making the decision to choose motherhood through MAR. The study design was a qualitative method with a semi-structured interview guide used for individual face-to-face interviews. Sixteen single women accepted for MAR were interviewed individually during their waiting time to start treatment. Qualitative content analysis was used to analyse the data. The data analyses resulted in three main categories: (i) longing and belonging; (ii) social exclusion and support; and (iii) evaluation and encounter. The overarching theme reflects the decision to become a single mother by choice: motherhood through MAR – an emotional and ambivalent decision to make on your own. In conclusion, to reach motherhood, by giving birth to one's child and not deviating from the norm as childless, was considered important among these women when making the decision to become a single mother by choice. [ABSTRACT FROM AUTHOR]

Several studies worldwide have shown that reproductive-aged people often have inadequate fertility awareness (FA). Since attitudes and health behaviours are influenced by the partner, there is a need for studies exploring the role of these influences on the individuals' adoption of fertility protective behaviours (FPB). This study explores the role of FA and relationship quality on couples' intention to adopt FPB. One hundred and twelve childless couples answered an online questionnaire about reproductive life plan, FA and intentions to adopt FPB. The results showed that couples were moderately congruent on their reproductive life plan. The female partners who reported higher female relationship quality and higher female willingness to undergo fertility treatments were more willing to adopt FPB. The male partners who had heightened FA also reported higher intention to adopt FPB. The influences of male and female FA, relationship quality and congruence on reproductive life plan were neither associated with couples' congruence on the intention to adopt FPB. Although the cross-sectional design restricts our ability to draw causal conclusions, these findings emphasize that future interventions should be targeted at couples and designed according to their expectations and reproductive desires. [ABSTRACT FROM AUTHOR]

The freeze all strategy has become a promising alternative to fresh embryo transfer in fertility treatment almost eliminating late ovarian hyperstimulation syndrome (OHSS) in the segmented cycle. There is a lack of in-depth knowledge regarding patients' attitudes towards the freeze all strategy. The aim of this study was to explore the attitudes towards a freeze all strategy compared with fresh embryo transfer in assisted reproductive technology (ART) treatment among couples in a public health care setting. We conducted semi-structured qualitative interviews with ten couples already participants in a randomised controlled trial (RCT) and undergoing ART treatment. The couple's responses showed five themes: (i) Starting treatment provides needed relief; (ii) Treatment must be provided with humanity; (iii) Provision of information instigates positive attitudes towards treatment; (iv) Fresh treatment – 'The normal way'; and (v) Freeze all treatment – 'The new black'. When thorough information about treatment procedures and safety aspects regarding both the freeze all and fresh embryo transfer strategy is given prior to initiation of treatment, couples feel secure and content, regardless of which treatment strategy is finally applied. This qualitative study found that starting treatment could prompt longed-for relief, as professionals would now 'take over' and assist in meeting the couple's family building goals. [ABSTRACT FROM AUTHOR]

Characteristics and motivations of single mothers by choice were assessed in this pilot study, after new legislation in 2016 allowing access to medically assisted reproduction (MAR). Single women at a university clinic in Sweden were sent a postal questionnaire to their home address (n = 86) and 54 (62.8%) women filled it out and returned it. The women had a mean age of 35.1 years and were well-educated. Most of them worked full-time, were permanently employed, and had a stable income. They had previously had long-term relationships, although these had not been right for having children. More women (61%) could consider embryo donation rather than adoption (50%) (p < 0.05). The motivations most commonly cited for choosing motherhood by MAR was that because of their age, having a child was more important than waiting for the right partner. Nevertheless, they still had hope to find a partner in the future. In conclusion, Swedish single women accepted for MAR are no different from other single mothers by choice: they are financially and socially stable, and choose motherhood by MAR due to their advanced age and not wanting to wait too long in order to meet the right partner. [ABSTRACT FROM AUTHOR]

We compared the psychometric properties of COMPI Fertility Problem Stress Scales, Fertility Problem Inventory, and Fertility Quality of Life Tool in 293 patients enrolled for assisted reproductive technology. COMPI Fertility Problem Stress Scales and Fertility Problem Inventory subscales presented higher internal consistency. COMPI Fertility Problem Stress Scales differentiated best between its domains. Fertility Problem Inventory revealed better concurrent validity. Fertility Quality of Life Tool presented better fit. While discrimination for depression was similar between measures, Fertility Quality of Life Tool was better at discriminating anxiety. Results suggest that while all compared measures are reliable and valid in assessing the psychosocial adjustment to infertility, the choice of measure should be based according to the assessment goals. [ABSTRACT FROM AUTHOR]

In previous studies, investigators have reported reduced mortality among women undergoing assisted reproductive technology (ART) treatment, possibly related to selection of healthy women into ART treatment. Our aim in this study was to explore the impact of relevant selection factors on the association between ART treatment and mortality and to explore effect modification by parity. Women treated with ART in fertility clinics in Denmark during 1994–2009 (n = 42,897) were age-matched with untreated women from the background population (n = 204,514) and followed until December 31, 2010. With adjustment for relevant confounders, the risk of death was lower among ART-treated women during the first 2 years after ART treatment (hazard ratio (HR) = 0.68, 95% confidence interval (CI): 0.63, 0.74), but there was no apparent difference after 10 years (HR = 0.92, 95% CI: 0.79, 1.07). Having children prior to ART treatment was associated with markedly reduced mortality (HR = 0.45, 95% CI: 0.38, 0.53), possibly due to better health among fertile women. While the frequencies of previous medical and psychiatric diagnoses among ART-treated and untreated women were similar, differences in disease severity could explain the reduced mortality among ART-treated women, as poor prognosis would make initiation of ART treatment unlikely. The survival advantage among ART-treated women is likely a selection phenomenon rather than a biological phenomenon. [ABSTRACT FROM AUTHOR]

Study Question: Are couples initiating ART treatment at higher risk for future union dissolution compared to other couples?Summary Answer: There is no effect of ART treatments in future marital dissolution over a period of 16 years when adjusting for all confounders.What Is Known Already: Findings regarding marital stability and infertility treatments have been sparse and controversial. While there is data showing higher divorce rates among women who go through infertility treatments, there is also some evidence of this experience bringing couples closer by forcing them to communicate more and to deal with the surrounding stigma. Using a population-based study and couple-level data, we investigated the extent to which ART treatment increases the risk for divorce/marital dissolution during up to 16 years of follow-up.Study Design Size, Duration: Register-based national cohort study including all women registered with ART treatment in Denmark between 1 January 1994 and 30 September 2009 (n = 42 845). Marital/cohabiting status was confirmed by matching these women to partners who they were married to or shared an address with. To account for having a significant relationship at baseline (2 years), marital/cohabiting status was confirmed by accessing this variable before the establishment of the cohort back to 1 January 1992.Participants/materials, Setting, Methods: A comparison group from the background population including five controls per case and matched to female age at baseline was prospectively sampled. Participants could change status during follow-up if they entered ART. The final sample had 148 972 couples, followed until marital dissolution, death of self/spouse, migration or until 31 December 2010. We used Cox regression models adjusting for female and male age, education, marriage, common child at baseline and live-born child during follow-up.Main Results and the Role Of Chance: At baseline, the majority of couples were married (69%). More non-ART couples opted for marriage (70% versus 64%; P < 0.0001) and already had common children at study entry (43% versus 9%; P < 0.0001). During the 16 years of follow-up the majority of couples had children with their baseline partners (56% non-ART versus 65% ART), and 22% ended up separated or divorced (20% ART versus 22% non-ART). Findings revealed a lower risk of break-up among ART couples (crude HR 0.84, 95% CI 0.82-0.86), even after adjusting for both partners' age, education, partnership status and having a common child at baseline (adj HR 0.83, 95% CI 0.80-0.86). However, when subsequent common children (time-dependent) was added to the model, no difference in the risk of dissolution was found (adj HR 1.00, 95% CI 0.99-1.01). A significant interaction between ART status and common children showed that the risk of break-up was attributed to childlessness regardless of having gone through ART treatment.Limitations Reason For Caution: This study did not control for involuntary childlessness, non-ART fertility care (ovulation induction, IUI) and biological parenthood. Additionally, there are important predictors of divorce that were not considered. We were unable to adjust for religion, existence of previous marital relationships, income, employment, health status of parents and child(ren), and quality of relationship.Wider Implication Of Findings: The finding that going through ART does not increase the risk of break up per se is reassuring for couples who underwent ART and have children or are contemplating to start ART.Study Funding/competing Interest(s): This work was supported by FCT (Portuguese Foundation for Science and Technology), grant ref. SFRH/BPD/85789/2012. The authors have no conflicts of interest.Trial Registration Number: N/A. [ABSTRACT FROM AUTHOR]

Introduction: This study is part of a longitudinal cohort undertaken in both women and men to describe live birth outcome after undergoing assisted reproductive technology (ART) treatment in a clinical setting. Another objective was to follow women and men living with children from other alternatives after ART, such as adoption.Material and Methods: A total of 439 (80.5%) women and 423 (77.6%) men were included in the baseline cohort (2005-2007). Live birth rate after ART was 24.8% at baseline. Up to 5 years later (2010-2011) the same participants were sent individual postal questionnaires (n = 439).Results: Overall, 278 (63.3%) women and 183 (41.7%) men filled in and returned the questionnaire at follow up. The majority of women (91.7%) and men (93.4%) were living with children. A total of 225 (80.9%) women had a live birth at follow up. Of these, almost three of four (71.6%) had a live birth after ART and more than one of four (28.0%) after spontaneous pregnancies or both. Of these, 52 (26.1%) women had a subsequent live birth after successful ART and 26 (32.9%) women after unsuccessful ART. Nineteen (6.8%) women and 13 (7.1%) men had a child after adoption. Almost one of five (19.1%) women had no live birth at follow up.Conclusion: The majority of women and men were living with children, resulting from a live birth after ART, spontaneous pregnancy and/or adoption up to 5 years later. However, almost one of five had no live birth at follow up. [ABSTRACT FROM AUTHOR]

Introduction: Until recently, limited options for preserving fertility in order to delay childbearing were available. Although egg freezing and successful thawing is now possible, it remains unclear to what extent women are aware of the availability of this technique, their attitudes towards its use, or the circumstances under which this technique may be considered.Material and Methods: An online cross-sectional survey was designed to investigate knowledge and attitudes of women in Denmark and the UK on egg freezing and their potential intentions regarding the procedure.Results: Data was collected from September 2012 to September 2013 and the responses of 973 women were analyzed. In total, 83% of women reported having heard of egg freezing, and nearly all considered it acceptable for medical indications, whilst 89% considered it acceptable for social reasons. Overall, 19% expressed active interest in the procedure, and 27% expressed possible interest. Key factors found to positively influence attitudes to accepting the procedure were reassurance that it would not affect future fertility and greater than 50% chance of achieving a live birth. Characteristics significantly associated with intention to freeze eggs were being single, age under 35 years, childlessness, and a history of infertility. In this group, risk and cost were less important considerations.Conclusions: This study indicates that there is widespread awareness and support of the availability of eggs freezing for reproductive planning. Reassurance regarding its efficacy appears more important than its potential adverse effects on their health or that of future children, or the costs of the procedure. [ABSTRACT FROM AUTHOR]

Background: Similarly to women, men suffer from engaging in fertility treatments, both physically and psychologically. Although there is a vast body of evidence on the emotional adjustment of women to infertility, there are no systematic reviews focusing on men's psychological adaptation to infertility and related treatments.Objective and Rationale: The main research questions addressed in this review were 'Does male psychological adaptation to unsuccessful medically assisted reproduction (MAR) treatment vary over time?' and 'Which psychosocial variables act as protective or risk factors for psychological maladaptation?'Search Methods: A literature search was conducted from inception to September 2015 on five databases using combinations of MeSH terms and keywords. Eligible studies had to present quantitative prospective designs and samples including men who did not achieve pregnancy or parenthood at follow-up. A narrative synthesis approach was used to conduct the review.Outcomes: Twelve studies from three continents were eligible from 2534 records identified in the search. The results revealed that psychological symptoms of maladjustment significantly increased in men 1 year after the first fertility evaluation. No significant differences were found two or more years after the initial consultation. Evidence was found for anxiety, depression, active-avoidance coping, catastrophizing, difficulties in partner communication and the use of avoidance or religious coping from the wife as risk factors for psychological maladjustment. Protective factors were related to the use of coping strategies that involve seeking information and attribution of a positive meaning to infertility, having the support of others and of one's spouse, and engaging in open communication about the infertility problem.Wider Implications: Our findings recommend an active involvement of men during the treatment process by health care professionals, and the inclusion of coping skills training and couple communication enhancement interventions in counselling. Further prospective large studies with high-quality design and power are warranted. [ABSTRACT FROM AUTHOR]

Introduction: This national retrospective cohort study investigates the prevalence of women with severe eating disorders in assisted reproductive technology (ART) treatment compared with an age-matched background population without ART treatment. It assesses the frequency distribution of the first and last eating disorder diagnosis before, during, and after ART treatment, and evaluates differences in obstetric outcomes between women with and without a severe eating disorder. Material and Methods: Hospital-diagnosed eating disorders among 42,915 women in the Danish National ART cohort (DANAC), registered during 1994-2009 in the mandatory Psychiatric Central Research Register, were compared with a non-eating disorder ART cohort of 42,644 women and an age-matched background population of 215,290 women without a history of ART treatment for the main outcome measures prevalence of eating disorders, frequency distribution of diagnoses before/during/after ART treatment, as well as ART treatment and obstetric outcomes. Results: In the ART cohort, 271 women (0.63%) had an eating disorder diagnosis compared with 0.73% in the background population (p = 0.025). The prevalence of ovulatory disorder was significantly higher in women with a severe eating disorder compared with the ART cohort without eating disorders. Obstetric outcomes were similar in ART-treated women with and without an eating disorder. Conclusion: Women with severe eating disorders were identified in the ART cohort, although significantly less often than in the age-matched background population. Women with severe eating disorders suffered more often from anovulatory infertility than the ART comparison cohort without this disease. Obstetric outcomes appeared reassuring in the ART cohort with eating disorders. [ABSTRACT FROM AUTHOR]

Introduction: Previous studies have shown conflicting results as to whether unsuccessful medically assisted reproduction is a risk factor for depression among women. This study therefore investigated if women with no live birth after assisted reproductive technology (ART) treatment had a higher risk of unipolar depression compared with women with a live birth after ART treatment.Material and Methods: The Danish National ART-Couple (DANAC) Cohort is a national register-based cohort study that consists of women who received ART treatment from 1 January 1994 to 30 September 2009, in Denmark (n = 41 050). Information on unipolar depression was obtained from the Danish Psychiatric Central Research Register. The analyses were conducted in Cox regression analysis.Results: During the 308 494 person-years of follow up, 552 women were diagnosed with unipolar depression. A Cox proportional hazards model showed that women in ART treatment, with no live birth yet, had a lower risk of unipolar depression compared with women with a live birth. Women had the highest risk of unipolar depression 0-42 days after a live birth (adjusted hazard ratio 5.08, 95% CI 3.11-8.29) compared with women with no live birth. A lower, but still increased, risk of unipolar depression, was found in women 43 days to 1 year and >1 year after a live birth compared with women with no live birth yet.Conclusions: Motherhood is an important trigger of unipolar depression in women conceiving after ART treatment. [ABSTRACT FROM AUTHOR]

Infertility and fertility treatment have the potential to impact and disrupt a couple's overall life. In order to study the associations between the impact of childlessness on one's life, and men and women's attitudes towards fertility treatment continuation and/or adoption, we analysed data from a one-year follow-up questionnaire in a prospective, longitudinal cohort study of consecutive couples initiating fertility treatment in Denmark. The study comprised 302 couples with no children at baseline and no joint children at one-year follow-up. In total, 71.9% of women and 72.5% of men reported that they wished to continue fertility treatment, while 20.2% of women and 19.2% of men reported that they wished to pursue adoption. The attitudes of nearly 8 in 10 couples were congruent towards further fertility treatments, while nearly 7 in 10 couples were congruent in their attitudes to pursuing adoption. Significantly more men who reported a lower impact of childlessness on their daily life wished to continue fertility treatment, compared with those reporting that childlessness had a greater impact on their life. Among women, significantly more were undecided about whether or not to pursue adoption when reporting a greater impact of childlessness on social life, compared with those reporting a lower impact of their childlessness. [ABSTRACT FROM AUTHOR]

Objective: To investigate the independent and combined associations between female and male body mass index (BMI) on the probability of achieving a live birth after treatments with in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) under adjustment for relevant covariates. Design: Population-based cohort study. Setting: Danish national registers. Patient(s): Patients with permanent residence in Denmark receiving IVF or ICSI treatment with use of autologous oocytes from January 1, 2006, to September 30, 2010. Intervention(s): None. Main Outcome Measure(s): Live birth. Analyses were adjusted for age and smoking at treatment initiation and results stratified by BMI groups and presented by IVF/ICSI treatment. Result(s): In total, 12,566 women and their partners went through 25,191 IVF/ICSI cycles with 23.7% ending in a live birth. Overweight and obese women with regular ovulation had reduced odds of live birth (adjusted OR 0.88, 95% CI 0.79–0.99 and adjusted OR 0.75, 95% CI 0.63–0.90, respectively) compared with normal-weight women. IVF-treated couples with both partners having BMI ≥25 kg/m2 had the lowest odds of live birth (adjusted OR 0.73, 95% CI 0.48–1.11) compared with couples with BMI <25 kg/m2. BMI showed no significant effect on chance of live birth after ICSI. Conclusion(s): Increased female and male BMI, both independently and combined, negatively influenced live birth after IVF treatments. With ICSI, the association with BMI was less clear. [Copyright &y& Elsevier]

Objectives. Infertile couples undergoing fertility treatments may experience stress and could benefit from psychological intervention. Expressive Writing Intervention (EWI) has shown promising results on various psychological outcomes, yet only one study has applied the method to infertility-related stress. Our aim was to assess feasibility and effectiveness of EWI for patients in treatment with Assisted Reproductive Technology (ART). Design and participants. Patients enrolling in their first ART treatment at the fertility clinic, Aarhus University Hospital, Denmark were offered to participate. A total of 82 participants (45 women, 37 men), mean age: 33.17, were randomized to home-based EWI or neutral writing control group and completed an infertility-related stress questionnaire at treatment enrollment, 3 weeks later (at the time of down regulation), and 6 weeks after the intervention. The intervention took place 2 weeks after treatment start. Results. Mixed between-within ANOVA showed a main effect of time (Wilks Lambda = 0.68, F(2,28) = 6.48) as well as a significant interaction effect between group (control/ EWI) and time (Wilks Lambda = 0.83, F(2,28) = 2.92). Infertility-related stress decreases were observed after the intervention in the EWI group compared to controls. Six weeks after the intervention, stress tended to increase in both groups, with the control group, follow-up stress levels exceeding baseline stress scores, whereas the follow-up scores of EWI-participants' did not exceed baseline levels. Conclusions. Our preliminary results suggest EWI to be a feasible, cost-effective, and efficient method for alleviating infertility-related stress, although results should be considered preliminary and further testing with a larger sample is warranted. [ABSTRACT FROM AUTHOR]

The author looks at the reasons for declining the fertility rates in some European countries. Some reasons cited for this trend include postponement of first birth, infertility and lack of infertility treatment. The author outlines the measures needed to be introduced to improve fertility through more baby-friendly policies. Suggestions like reimbursed fertility treatments, a user-friendly ART program and raising public awareness are presented.

A response from the author of the article "Are repeated assisted reproductive technology treatments and an unsuccessful outcome risk factors for unipolar depression in infertile women?" in the previous issue is presented.

The article focuses on the effects of infertility and unsuccessful assisted-reproduction treatment (ART) on a couple's psychosocial environment. The results of stress resulting from infertility on a couple are discussed, including depression, anxiety, communication breakdown and dissatisfaction with marital and sexual relationships. Several studies are presented regarding the psychosocial impact of ART, including in-vitro fertilization. It is suggested that practitioners offer patient-centered psychosocial support services in addition to medical care.

Study Question: Can a consensus and evidence-driven set of terms and definitions be generated to be used globally in order to ensure consistency when reporting on infertility issues and fertility care interventions, as well as to harmonize communication among the medical and scientific communities, policy-makers, and lay public including individuals and couples experiencing fertility problems?Summary Answer: A set of 283 consensus-based and evidence-driven terminologies used in infertility and fertility care has been generated through an inclusive consensus-based process with multiple stakeholders.What Is Known Already: In 2006 the International Committee for Monitoring Assisted Reproductive Technologies (ICMART) published a first glossary of 53 terms and definitions. In 2009 ICMART together with WHO published a revised version expanded to 87 terms, which defined infertility as a disease of the reproductive system, and increased standardization of fertility treatment terminology. Since 2009, limitations were identified in several areas and enhancements were suggested for the glossary, especially concerning male factor, demography, epidemiology and public health issues.Study Design, Size, Duration: Twenty-five professionals, from all parts of the world and representing their expertise in a variety of sub-specialties, were organized into five working groups: clinical definitions; outcome measurements; embryology laboratory; clinical and laboratory andrology; and epidemiology and public health. Assessment for revisions, as well as expansion on topics not covered by the previous glossary, were undertaken. A larger group of independent experts and representatives from collaborating organizations further discussed and assisted in refining all terms and definitions.Participants/materials, Setting, Methods: Members of the working groups and glossary co-ordinators interacted through electronic mail and face-to-face in international/regional conferences. Two formal meetings were held in Geneva, Switzerland, with a final consensus meeting including independent experts as well as observers and representatives of international/regional scientific and patient organizations.Main Results and the Role Of Chance: A consensus-based and evidence-driven set of 283 terminologies used in infertility and fertility care was generated to harmonize communication among health professionals and scientists as well as the lay public, patients and policy makers. Definitions such as 'fertility care' and 'fertility awareness' together with terminologies used in embryology and andrology have been introduced in the glossary for the first time. Furthermore, the definition of 'infertility' has been expanded in order to cover a wider spectrum of conditions affecting the capacity of individuals and couples to reproduce. The definition of infertility remains as a disease characterized by the failure to establish a clinical pregnancy; however, it also acknowledges that the failure to become pregnant does not always result from a disease, and therefore introduces the concept of an impairment of function which can lead to a disability. Additionally, subfertility is now redundant, being replaced by the term infertility so as to standardize the definition and avoid confusion.Limitations, Reasons For Caution: All stakeholders agreed to the vast majority of terminologies included in this glossary. In cases where disagreements were not resolved, the final decision was reached after a vote, defined before the meeting as consensus if passed with 75%. Over the following months, an external expert group, which included representatives from non-governmental organizations, reviewed and provided final feedback on the glossary.Wider Implications Of the Findings: Some terminologies have different definitions, depending on the area of medicine, for example demographic or clinical as well as geographic differences. These differences were taken into account and this glossary represents a multinational effort to harmonize terminologies that should be used worldwide.Study Funding/competing Interests: None.Trial Registration Number: N/A. [ABSTRACT FROM AUTHOR]