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不孕女性及其伴侣的生活质量和情绪状态的差异。

Differences in quality of life and emotional status between infertile women and their partners.

机构信息

Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands.

出版信息

Hum Reprod. 2013 Aug;28(8):2168-76. doi: 10.1093/humrep/det239. Epub 2013 Jun 7.

Abstract

STUDY QUESTION

Do the quality of life (QoL) and the risk factors for emotional problems during and after treatment of infertile women differ from their partners?

SUMMARY ANSWER

Women have lower levels of fertility-related QoL, and more and differing risk factors for emotional problems during and after treatment than their partners. WHAT IS KNOWN ALREADY?: The psychological impact of infertility in patients negatively affects their QoL and is also related to increased discontinuation of treatment. Moreover, psychological factors might positively affect pregnancy rates. However, it is still unclear if differences in QoL and emotional status exist between infertile women and their partners. So far, research mainly focused on generic instruments to measure patients' QoL in the area of fertility care.

STUDY DESIGN, SIZE, DURATION: A cross-sectional study of infertile couples within 32 Dutch fertility clinics.

PARTICIPANTS/MATERIALS, SETTING, METHODS: We included infertile women and their partners (both heterosexual and lesbian couples) under any treatment and at any stage of treatment in one of the 32 participating clinics. Per clinic, 25-75 patients were randomly selected depending on clinic size. In total, 1620 women and their partners were invited separately to complete the FertiQoL and SCREENIVF questionnaires to measure their level of QoL and risk factors for emotional problems during and after treatment, respectively.

MAIN RESULTS AND THE ROLE OF CHANCE

A total of 946 women (response rate 58%) and 670 partners (response rate 41%) completed the questionnaire set. As 250 women and 150 partners were already pregnant, questionnaires from 696 women and 520 partners could be analysed. Women scored significantly lower on the FertiQoL total scores [B = -6.31; 95% confidence interval (CI) = -7.63 to 4.98] and three of the FertiQoL subscales (Emotional, Mind-Body and Social) than their partners, indicating lower QoL. Scores on the SCREENIVF questionnaire were significantly higher for women (B = 0.22; 95% CI = 0.06-0.38), indicating that women are more at risk for developing emotional problems (and these factors differed from those of their partners) during and after fertility treatment than their partners.

LIMITATIONS, REASONS FOR CAUTION: Although the number of participants is high (n = 1216), the relatively low response rate, especially for partners (41%), may have influenced the results through selection bias. An analysis of non-responders could not be performed. The FertiQoL and SCREENIVF questionnaires, which have been validated only in women starting a first IVF cycle, should also be validated for studying partners. In addition, the SCREENIVF questionnaire has been validated in Dutch women only and further research in an international setting is also required.

WIDER IMPLICATIONS OF THE FINDINGS

Our study results represent the Dutch infertile population as more than one-third of all Dutch clinics participated in the study. As the FertiQoL questionnaire is an internationally validated questionnaire already, these results can be put in a more broader and international perspective.

STUDY FUNDING/COMPETING INTEREST(S): This work was supported by Merck Sharp & Dohme (MSD), The Netherlands. There are no competing interests.

摘要

研究问题

不孕女性在治疗期间和治疗后经历的生活质量(QoL)和情绪问题风险因素是否与她们的伴侣不同?

总结答案

与伴侣相比,女性的生育相关 QoL 水平更低,且存在更多和不同的情绪问题风险因素。

已知情况

不孕患者的心理影响会对其 QoL 产生负面影响,并且与治疗中断的增加有关。此外,心理因素可能会对妊娠率产生积极影响。然而,目前尚不清楚不孕女性与其伴侣之间是否存在 QoL 和情绪状态的差异。迄今为止,研究主要集中在使用通用工具来衡量生育护理领域患者的 QoL 上。

研究设计、规模、持续时间:32 家荷兰生育诊所内的不孕夫妇的横断面研究。

参与者/材料、地点、方法:我们纳入了正在任何一家诊所接受任何阶段治疗的不孕女性及其伴侣(包括异性恋和同性恋伴侣)。根据诊所的规模,每个诊所随机选择 25-75 名患者。总共邀请了 1620 名女性及其伴侣分别完成 FertiQoL 和 SCREENIVF 问卷,以分别衡量其治疗期间和治疗后的 QoL 和情绪问题风险因素。

主要结果和机会作用

共有 946 名女性(回应率 58%)和 670 名伴侣(回应率 41%)完成了问卷。由于 250 名女性和 150 名伴侣已经怀孕,因此可以分析 696 名女性和 520 名伴侣的问卷。与伴侣相比,女性在 FertiQoL 总分[B = -6.31;95%置信区间(CI)= -7.63 至 4.98]和三个 FertiQoL 子量表(情绪、身心和社会)上的得分显著更低,表明 QoL 较低。女性在 SCREENIVF 问卷上的得分明显更高(B = 0.22;95%CI = 0.06-0.38),这表明女性在接受生育治疗期间和之后出现情绪问题的风险(并且这些因素与伴侣不同)高于伴侣。

局限性、谨慎原因:尽管参与者人数众多(n = 1216),但相对较低的回应率(尤其是伴侣为 41%)可能通过选择偏差影响了结果。无法对非应答者进行分析。FertiQoL 和 SCREENIVF 问卷仅在开始首次 IVF 周期的女性中进行了验证,也应在研究伴侣时进行验证。此外,SCREENIVF 问卷仅在荷兰女性中进行了验证,还需要在国际环境中进行进一步研究。

研究结果的更广泛影响

我们的研究结果代表了荷兰不孕人群,因为超过三分之一的荷兰诊所参与了这项研究。由于 FertiQoL 问卷是一个已经经过国际验证的问卷,因此这些结果可以放在更广泛和国际的视角下。

研究资金/竞争利益:这项工作得到了默克夏普和多姆(MSD)的支持,来自荷兰。没有竞争利益。

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