試管嬰兒治療中

病人焦慮的來源及處理

蔡永杰
Sweden

Why do couples discontinue in vitro

fertilization treatment? a cohort study

Fertil Steril 2004;81:258–61

Fertility Sterility
Why do couples discontinue in vitro
fertilization treatment? a cohort study
 Setting: Center for reproductive
medicine at a large university hospital.
 Patient(s): The 450 couples of a cohort
of 974 couples who started IVF
treatment between January 1996 and
December 1997 and did not achieve
childbirth.

Fertility Sterility
Fertility Sterility
Why do couples discontinue in vitro
fertilization treatment? a cohort study
Psychological burden included
 Several earlier failed treatments for

infertility
 Late miscarriage

 Legal abortion due to fetal chromosomal

abnormalities in previous IVF

 Seeing different doctors each visit

 Feeling pressure to succeed in the

treatment.

Fertility Sterility
Why do couples discontinue in vitro
fertilization treatment? a cohort study

Conclusion(s):
 An unexpectedly high percentage of

couples who performed IVF discontinued

the treatment before the three cycles.
 A majority of these discontinuations

were due to psychological stress. Many

of the patients reported the need for
psychological counseling during
treatment.

Fertility Sterility
U. K.

Reasons for discontinuation of IVF

treatment: a questionnaire study

Human Reproduction 2006 21(2):358-363

Human Reproduction
Reasons for discontinuation of IVF
treatment: a questionnaire study
 Methods: Questionnaires were sent to
1510 couples who had undergone IVF
treatment at Scotland, between January
1995 and December 2001.
 Measurement: The number of couples
who discontinue treatment and the
reasons for discontinuation

Human Reproduction
 Reasons for discontinuing treatment (overall)

Reasons: 1 = pregnant; 2 = lack of success; 3 = lack of NHS funds;

4 = personal financial; 5 = medical/others’ advice; 6 = psychological stress
7 = discomfort/disruption; 8 = other reasons
Human Reproduction
 Table II. Drop-out (%) for each listed
reason by number of attempts

Reasons: 1 = pregnant; 2 = lack of success; 3 = lack of NHS funds;

4 = personal financial; 5 = medical/others’ advice; 6 = psychological stress
7 = discomfort/disruption; 8 = other reasons (including personal circumstances
Reasons for discontinuation of IVF
treatment: a questionnaire study
 Conclusion: Though funding is an
important issue, factors including lack of
success and psychological stress play a
greater role in influencing the decision to
discontinue treatment. Better information
and support are needed to improve the
continuation rates.

Human Reproduction
China

Psychological characteristics and marital

quality of infertile women registered for
IVF/ICSI in China

Fertil Steril 2007;87:792–8.

Fertility Sterility
Psychological characteristics and marital
quality of infertile women registered for
IVF/ICSI in China

 Design: A descriptive study of psychological

health status and marital relationships,
comparing infertile women who are registered
for IVF or IVF-ICSI with fertile controls.
 Patient(s): 100 registered for IVF, and 100
registered for ICSI and a control group of 100
women who have no known history of infertility.
 Intervention: Psychometric tests were
administered at the first visit of the treatment
cycle.

Fertility Sterility
◎
◎
◎
◎

◎
◎

Checklist-90 (SCL-90) has been utilized in a number of studies

from the industrialized world to evaluate psychological distress
among cohorts of infertile men and women

Fertility Sterility
The ENRICH marital inventory was used to describe
marital dynamics. This instrument provides scores of
wives’ and husbands’ evaluationof their relationship
Fertility Sterility
Psychological characteristics and marital
quality of infertile women registered for
IVF/ICSI in China

 The stresses associated with infertility

and IVF treatment had a negative
impact on Chinese women’s
psychological health status and marital
quality.
 These findings emphasize the need to
include psychological and sociocultural
considerations with any medical
interventions for infertility.

Fertility Sterility
Australia

Psychosocial stress and treatment

outcome following assisted reproductive
technology

Human Reproduction, Vol. 14, No. 6,

1656-1662, June 1999

Human Reproduction
Material and Method
 Ninety women
 Two psychometric tests
 Bi-polar Profile of Mood States, POMS
 State–Trait Anxiety Inventory, STAI

 A questionnaire to ascertain demographic

and lifestyle characteristics before the start

of treatment.
 12 months later an outcome measure was
determined

Human Reproduction
Psychosocial stress and treatment outcome
following assisted reproductive technology

Human Reproduction
Figure 1. Comparison of cumulative conception curves
for previously pregnant women (dashed line) and
women without a previous pregnancy (solid line)

Human Reproduction
Figure 2. Comparison of cumulative conception curves
for women who work full-time (dashed line) and women
who do not (solid line)

Human Reproduction
Figure 3. Comparison of cumulative conception curves
for women with low (dashed line) and high (solid line)
scores on the Bi-polar Profile of Mood States (POMS)

Human Reproduction
Figure 4. Comparison of cumulative conception curves
for women with high (dashed line) and low (solid line)
trait anxiety estimated with product-limit analysis.

Human Reproduction
Conclusion
 There is an important link between lifestyle
and personality characteristics and the
outcome of IVF and GIFT.
 Anxiety and depression are related to
treatment outcome.
 The role of psychosocial support
programmes in infertility treatment needs
to be more actively investigated.

Human Reproduction
Australia

Women’s experience of IVF: a follow-up

study

Human Reproduction 2001 16(2):374–383

Human Reproduction
Women’s experience of IVF: a follow-up
study
 To increase understanding of how women
feel about the experience of IVF 2–3
years after ceasing treatment.
 A questionnaire

 Satisfaction With Life Scale (SWLS),

 Golombok Rust Inventory of Marital State

(GRIMS)
 General Health Questionnaire (GHQ-12)]

Human Reproduction
Human Reproduction
Human Reproduction
●

Human Reproduction
OPINIO
N

Should fertilization treatment start

with reducing stress?

Human Reproduction 2006 21(7):1651-1658

Daniel M.Campagne
Faculty of Psychology, Spain

Human Reproduction
Schematic central response to stress and inhibition of the
hypothalamic-pituitary-gonadal (HPG) axis

Human Reproduction
Establishing stress levels before fertility treatment

Human Reproduction
Human Reproduction
Online psychoeducational support for
infertile women: a randomized controlled
trial

Human Reproduction 2008 23(3):554-566

Human Reproduction
Infertility source web images

Human Reproduction
 CONCLUSIONS
 Women exposed to the online program
significantly improved in the area of social
concerns (P = 0.038) related to infertility
distress, and felt more informed about a medical
decision with which they were contending (P =
0.037).
 A web-based patient education intervention can
have beneficial effects in several psychological
domains and may be a cost effective resource
for fertility practices.
Human Reproduction
Does psychological stress affect the
outcome of in vitro fertilization?
 個人經驗
 不孕夫妻於不孕歷程的反應與互動：台灣不孕
女性的觀點　 2004 26(1) ： 39-66 　彰化師大
輔導學報　林旖旎 蔡永杰 康介乙

 台灣女性的不孕經驗：關係的觀點 2006 19 ：
175-210 中華輔導學報 林旖
旎 蔡永杰 康介乙

 Taiwanese Women’s Psychosocial

Experiences of Postinfertility Pregnancy after
Undergoing Assisted Reproduction
Treatment.2009 (in press) 林旖 旎 蔡永杰
 不孕病人的壓力或焦慮來源
 欠缺配偶支持或同理關心
 欠缺家人支持
 欠缺社會支持
 家庭氣氛以及家族觀念 ( 例如傳統封閉 )
 家人與家族的溝通模式不良 ( 例如壓抑或威權 )
 當事者於家庭中的身分與地位 ( 家庭結構與權力配置 )
 經濟壓力
 所處的社區或社會風氣所加諸的壓力
 華人文化傳統 ( 血緣子嗣傳承 ) 的壓力
 職業與生涯發展的壓力
林旖旎等
 病人焦慮的有效處理方式
 心理諮商
 支持團體

 病友的分享與支持

 醫師的信心與關懷

 醫療團隊的關心支持

 醫療步驟與程序的詳細解釋

 對病人問題的詳細回應
林旖旎等