تاثیر افسردگی و اضطراب بر پیامد درمان کمک باروری

نوع مقاله: اصیل پژوهشی

نویسندگان

1 استادیار گروه زنان و ناباروری، دانشگاه علوم پزشکی مشهد

2 استادیار روانپزشکی، دانشگاه علوم پزشکی مشهد

چکیده

مقدمه: موفقیت درمان کمک باروری می تواند وابسته به عوامـل متغیـری مثـل سـطح اضـطراب زن در زمـان درمان باشد. این مطالعه برای ارزیابی تاثیر افسردگی و اضطراب زنان بارور بر پیامد درمـان کمـک بـاروری طراحی شده است. روش کار : این مطالعه موردی شاهدی بر 300 زن نابارور داوطلب روش کمـک بـاروری در مرکـز نابـاروری منتصریه دانشگاه علوم پزشکی مشهد انجام شد. بیماران با آگاهی و رضایت در مطالعه شرکت نمودند. پـیش از استفاده از آنالوگهای هورمونهای آزاد کننده گنادوتروپین، از بیماران خواسته شد که پرسشنامه بررسـی، اضطراب سرشتی و حالتی و نیز پرسشنامه بررسی افسردگی و نیز پرسشنامه مربوط به خصوصیات فـردی آزمونهای حاملگی پانزده روز بعد از انجام IUI و IVF انجالم شد. نتایج: هیچگونه ارتباط آماری قابل توجهی بین سطوح متفـاوت افـسردگی و پیامـد درمـان نابـاروری وجـود نداشت (P=0/19). این ارتباط بین سطوح متفاوت اضـطراب و درمـان نابـاروری چـشمگیر بـود (P=0/016 و P=0/19). با افزایش اضطراب سرشتی و حالتی نتایج مثبت آزمون حاملگی کمتر محتمل بود. نتیجه گیری : ارزیابی دقیق زنان بـا اسـتفاده از یـک گـروه متخصـصین شـامل یـک روانپزشـک بـالینی، یـک روانشناس و یک متخصص زنان و زایمان برای کاهش اضطراب و حصول پیامد بهتر مورد نیاز می باشد.

کلیدواژه‌ها


عنوان مقاله [English]

The Effect of Depression and Anxiety on the Outcome of Assisted Reproductive Technology (ART)

نویسندگان [English]

  • Nezhat moosavifar 1
  • Fatemeh Behdani 2
  • Atefeh Soltanifar 2
  • Paria Hebrani 2
1 Assistant Professor of Gynecology Infertility, Mashhad University of Medical Sciences
2 Assistant Professor of Psychiatry, Mashhad University of Medical Sciences
چکیده [English]

Introduction: Success of assisted reproductive treatment may be dependent a
variable factors such as the woman’s distress level at the term of the treatment. This
study was designed to evaluate the effect of anxiety and depression of infertile
women on the outcome of ART.
Material and Methods: This case-control study was performed on 300 infertile
women who volunteered to undergo ART in Montasariya Infertility Center of
Mashhad University of Medical Sciences. They consecutively invited and agreed to
participate. Before down-regulation by means of gonadotrophin-releasing hormone
(GnRH) analogues patients were asked to complete the State and Trait Anxiety
Inventory to measure anxiety, and the Beck Depression Inventory (BDI) to measure
depression and individual specifications’ questionnaires. Pregnancy tests were done
15 days after performing IUI and IVF.
Results: There were no significant statistical relation between different levels of
depression and the infertility treatment outcome (p = 0.19). This relationship was
significant between different levels of state and trait anxiety and treatment outcome
(p = 0.019 & p = 0.016). With the increase of anxiety the positive result of
pregnancy test was less probable.
Conclusion: An accurate assessment of the infertile women by a team of specialists
consisting of a clinical psychologist, a psychiatrist, and a gynecologist is needed so
that their anxiety would be reduced and better outcome achieved. 

کلیدواژه‌ها [English]

  • Assisted Reproductive Technology (ART)
  • Anxiety
  • Depression
  • Infertility
1. Berek YS, Novaks. Gynecology. 13th edition. Philadelphia: Lippincott Williams &
Wilkins; 2002. 1018- 1048.
2. Campagne DM. Should fertilization treatment start with reducing Stress . Hum Reprod.
2006; 21(7):1651-1658
3. Mahlstedt PP.The psychological component of infertility. Fertil Steril 1985; 43: 335–346/ 
 
4. Freeman EW, Boxer AS, Rickels K, et al. Psychological evaluation and support in a
program of in vitro fertilization and embryo transfer. Fertil Steril 1985; 43: 48–53.
5. Lapane K L, Zierler S, Lasater TM, et al. Is a history of depressive symptoms associated
with an increased risk of infertility in women? Psychosom Med 1995; 57: 509–513.
6. Wright J, Allard M, Lecours A, Sabourin S. Psychosocial distress and infertility: a review
of controlled research. Int J Fertil 1989; 34: 126–142.
7. Eugster A, Vingerhoets AJ. Psychological aspects of in vitro fertilization: a review. Soc
Sci Med 1999; 5: 575–589
8. Templeton A, Morris JK, Parslow W. Factors that affect outcome of in-vitro fertilisation
treatment. Lancet 1996; 348: 1402–1406.
9. Stolwijk AM, Zielhuis GA, Hamilton CJCM, et al. Prognostic models for the probability
of achieving an ongoing pregnancy after in vitro fertilization and the importance of
testing their predictive value. Hum Reprod 1996; 11: 2298–2303.
10. Smeenk J M J, Stolwijk A M, Kremer JA M, Braat DDM. External validation of the
Templeton model for predicting success after IVF. Hum Reprod 2000; 15: 1065–1068.
11. Boivin J, Takefman JE. Stress Level Across Stage of In Vitro Fertilization in
Subsequently pregnant and nonpregnant women. Fertil Steril 1995 ; 64(4): 802-10.
12. Facchinetti F, Matteo M L, Artini G P, et al. An increased vulnerability to stress is
associated with a poor outcome of in vitro fertilization-embryo transfer treatment. Fertil
Steril 1997; 67:309–314.
13. Demyttenaere K, Bonte L, Gheldof M, et al. Coping style and depression level influence
outcome in in vitro fertilization. Fertil Steril 1998; 69: 1026–1033.
14. Cwiked Y, Giron Y, Sheine E. Psychological Interactions with Infertility Among Women.
Eur J Obstet Gynecol Reprod Biol 2004; 117(2) :126-31.
15. Arefi S. Psychological Stressors As The Risk Factors of Infertility .J of Psycholog
Aspests of reprod System 2001; 6(2):5-17.
16. Matsubayashi H, Hosaka T, Izumi S, Suzuki T, Makino T. Emotional distress of
infertile women in Japan .Hum Reprod 2001; 16(5): 966-969.
17. Fassino S, Pierò1
A, Boggio1
 S, Piccioni2, V, GarzaroL .Anxiety, Depression and anger
suppression in infertile couples: a controlled study. Hum Reprod 2002; 17( 11): 2986-2994.
18. Ramazanzadeh F,Aghssa M,et al. A survey of relationship between anxiety,depression
and duration of infertility. BMC Womens health 2004; 4:9.
19. Spielberger CD, Gorsuch RL, Lushene RE. Test Manual for the Strait-Trait Anxiety
Inventory. Consulting Psychology Press: 1970.
20. Palo Alt, Beck AT, Steer R A, Garbin MG. Psychometric properties of the Beck
Depression Inventory: twenty-five years of evaluation. Clin Psychol Rev 1988; 8: 77–
100.
21. Beck AT, Beamesdeerer A. Assessment of depression: the depression inventory.
Pharmacopsychiatria 1976; 7: 51.
22. Lancastle D, Boivin J. Dispostional optimism, trait anxiety and coping: unique or shared
effects on biological response to fertility treatment? Health Psychol 2005; 24:171–178.
23. Thiering P, Beaurepaire J, Jones M, et al. Mood state as a predictor of treatment outcome
after in vitro fertilization/embryo transfer technology (IVF/ET). J Psychosom Res 1993;
37: 481–491.
24. Demyttenare K,Nijis P,Evers-Klemboos G, Koninckx PR.Coping and ineffectiveness of
coping influence the outcome of in vitro fertilization through stress
responses.Psychoneuroendocrinol 1992;17:655-665.
25. Merari D, Feldberg D, Elizur A, Goldman J. Psychological and Hormonal Changes in the
Course of In Vitro Fertilization. J Assistt Reprod Genet 1992; 9(2):161-9.
26. Boivin J, Appleton TC, Baetens P, Baron J, Bitzer J, Corrigan E,et al. Guidelines for
counselling in infertility: outline version. Hum Reprod 2001; 16: 1301–1204.
27. Boivin J, Scanlan LC, Walker SM. why are infertile patients using psychosocial
counselling? Hum Reprod 1999; 14: 1384–1391.