The Effects Of A Mindfulness-based Intervention On Fertility Quality Of Life Among IVF-ET Women And Its Psychological Mechanisms

BackgroundInfertility, the inability of a woman to become pregnant after one year of regular sexual intercourse without contraceptives, is perceived as a problem across almost all cultures and societies. Infertility and its treatment is considered to be an important medical problem influencing the quality of life(Qo L) of patients. While a large amount of health care resources, time and manpower are spent on the investigation and treatment of infertility, complete care of the patients as a whole is often overlooked by physicians, with less focus on the fertility quality of life(Ferti Qo L) of patients. Researchers suggested that Qo L is one of the most important issues to be addressed in infertility counseling, and the assessment of Qo L has become as important as the treatment. In addition, individual differences in psychological stress suggest that various psychological processes mediate or moderate the relationship between stressors and the psychological response to stressors. It is, therefore, extremely important to understand the personal coping resources of infertile women, as they try to deal with the problems associated with infertility and its treatment.Psychosocial interventions can palliate negative affect, reduce stress for infertile patients and possibly increase reproductive and infertility treatment success. Counselling has been strongly recommended by numerous governmental, medical and community associations to help infertile people. Meanwhile, the mindfulness-based interventions(MBIs) have been adopted to cope with stress, distress and some diseases for patients in western countries. MBIs, the third wave of cognitive and behavior therapy characterized with mindfulness and acceptance, have been widely and effectively applied to deal with insomnia, anxiety, depression and chronic illness as an adjuvant therapy. So, can the infertile women, particularly women subjected to in vitro fertilization and embryo transfer(IVF-ET), benefit from the MBIs? Moreover, what are the potential factors that will mediate the relationship between increased mindfulness and enhanced Ferti Qo L, if the intervention for IVF-ET women was effective? Mechanism research is probably the best strategy-- in both the short-term and the long-term-- for improving patient care.ObjectivesThe objectives of this study were as follows. Firstly, based on some theories including the study of stress in the infertility, biopsychosocial model for infertility, social support theory, coping theory and mindfulness theory, we conducted a model of fertility problem stress in infertile women. The aim was to provide theoretical guidance for the psychological interventions for infertile women clinically, and theory basis for the mindfulness-based intervention for them.Secondly, by reviewing and compiling intervention elements of MBSR, MBCT, MBCP, ACT, theoretical and clinical work with physical and psychological distress and concerns among women undergoing ART, we developed the Mindfulness-Based Intervention for IVF women(MBII). The MBII was tailored to match the population and problems being addressed,i.e., the symptoms we hoped to alleviate with the intervention, as well as the mindfulness skills we hoped to enhance. We examined the effectiveness of MBII on IVF-ET women integrating the quantitative and qualitative study methods. The qualitative investigation of the experience of MBII with first IVF-treatment women would complement the quantitative analysis, thoroughly describing the effectiveness of mindfulness meditation on them.Lastly, we identified the clinically efficacious components of MBII, and isolate important principles of adaptive behavioral and psychological change that are useful for improving the Ferti Qo L in infertile women.MethodsThe research integrated the quantitative and qualitative study methods. Firstly, we conducted a model of fertility problem stress in infertile women by adopting cross sectional design and AMOS analysis. Secondly, using a non-randomized controlled study we evaluated the effectiveness of MBII on Ferti Qo L, mindfulness, self-compassion, emotion regulation difficulties, infertility-related coping strategies and pregnancy outcome among infertile women undergoing first IVF treatment in study group when compared to women in control Group. In addition, we measured the IL-6, CRP and OT in the experimental control with pre-post MBII. Thirdly, we conducted a thematic analysis of semi-constructrual interview data and meditation diaries, and identified themes that best described or commonly suggested participants’ experience of applying mindfulness meditation to IVF-treatment as well as to their daily lives. Lastly, we explored the psychological mechanisms of the effect of MBII on the participants’ Ferti Qo L by a cross sectional design, AMOS and regression analysis.ResultsMain results for this study are as follows.Firstly, it was found that Ferti Qo L in the demographic and treatment variables was significantly different. Active- and passive-avoidance, meaning-based coping and describing partially mediated the relationship between fertility problem stress and core Ferti Qo L, in the same time, meaning-based coping, friends and significant others supports, acting with awarenss and non-judging mediated the relationship between fertility problem stress and treatment Ferti Qo L. Specifically, describing, active- and passive-avoidance coping negatively predicted core Ferti Qo L, meaning-based coping positively. Meanwhile, meaning-based coping, significant others support, acting with awareness and non-judging positively predicted treatment Ferti Qo L, and friend support negatively.Secondly, the women who attended the intervention revealed a significant increase in mindfulness, self-compassion, meaning-based coping strategies and all Ferti Qo L dimensions. Inversely, they presented a significant decrease in emotion regulation difficulties, active- and passive- avoidance coping strategies. Women in the control group did not present significant changes in any of the psychological measures. Moreover, there were statistically significant differences between participants in the pregnancy rates, the experiment group higher than the control group. However, there was no significant changes in OT for the MBII group, and significant increases in IL-6 and CRP post intervention.Thirdly, we identified five major themes that captured patients’ experiences of mindfulness in relation to infertility and IVF-treatment among participants. They were increases in Ferti Qo L(improvement in emotional, mind-body, relational, social, environment and treatment tolerability dimensions); enhanced mindfulness( increased awareness of bodies, emotions and thoughts, living in the moment more often, and enhanced concentration); increases in acceptance(destigmatization, infertility and IVF-treatment related thoughts and feelings objectified, and more kind and compassionate to themselves and others); improvement in self-regulation( improvement in cognitive, emotion and behavior regulation); enhanced autonomy( awakened both body and mind, and increase in self-efficacy to dealing with treatment).Fourthly, the changes in self-compassion, meaning-based coping, active- and passive-avoidance coping pre-post MBII partially mediated the relationship between the change in mindfulness and the change in core Ferti Qo L. The changes in self-compassion and passive-avoidance coping partially mediated the relationship between the change in mindfulness and the change in core Ferti Qo L.Lastly, the theory model in psychological mechanisms of mindfulness intervention on Ferti Qo L has been confirmed among the infertile women. Self-regulation partially mediated the relationship between mindfulness and core Ferti Qo L, meanwhile, self-regulation, autonomy and acceptance partially mediated mindfulness-treatment Ferti Qo L.ConclusionsFirstly, some demographic and treatment factors such as education, employment, infertility factors, duration of infertility and types of treatment, may influence the Ferti Qo L for infertile women. Some coping strategies such as active- and passive-avoidance, and describing, may be not useful to alleviate the negative emotions, the physical discomforts and the sense of disorder in daily life, as well as promote the marriage and social relationship, inversely, meaning-based coping useful. In addition, family support may be a double-edged sword. There are some ways to enhance the treatment tolerability and improve the satisfaction with medical staff and services, including enhanced significant others support especially the support from wardmates, reduced the communication in IVF-ET treatment with friends, meanwhile cultivating the capacity to accept and act with awareness nonjudgmentally.Secondly, the mindfulness-based intervention for IVF-ET women was effective to improve their Ferti Qo L and pregnancy rates. In addition, because of the combined effects of intervention and medical treatment, CRP and IL-6 may not reflect the clinical efficacy of MBII.Lastly, some elements such as self-compassion and adaptive coping strategies should be added to or emphasized in the mindfulness-based intervention for IVF-ET women. In the same way, some elements such as acceptance, self-regulation and autonomy should be added to or emphasized in the mindfulness-based intervention for infertile women.Innovative PiontsThere are several innovative points in this study. Firstly, from the point of Ferti Qo L, we conducted the model of fertility problem stress in infertile women to provide theoretical guidance for the psychological interventions for infertile women clinically, and theory basis for the mindfulness-based intervention for them. Secondly, we developed the mindfulness-based intervention for IVF-ET women(MBII), and demonstrated its effectiveness in improving some psychological outcomes and pregnancy rates. That explored a new effective psychological intervention for the population, and expanded the field of the clinical application of MBIs. Thirdly, we adopted a qualitative study to evaluate the experience of women attending the MBII about applying the mindfulness techniques into improving treatment, Ferti Qo L and daily life. That would complement the quantitative analysis, thoroughly describing the effectiveness of mindfulness meditation on participants. Lastly, this study identified the clinically efficacious components of mindfulness intervention, and isolated important principles of adaptive behavioral and psychological change that will be useful for designing the MBIs for infertile patients.