| Introduction: The incidence of infertility is rising year by year.It has become one of the most serious problems in modern life,and its stress intensity is similar to that of life threatening diseases.In vitro fertilization-embryo transfer(IVF-ET)is the most effective and last way to treat infertility.In general,infertile patients have psychological problems to some extent due to the complicated and expensive treatment cost of IVF-ET technology,the special conception of pregnancy and the unpredictability of pregnancy outcome.The study was conducted firstly using a quantitative method to investigate the psychosocial characteristics of pregnant couples assisted by IVF-ET,including emotion,personality,marital quality,and social support,etc.,to explore the difference between psychosocial characteristics of pregnant couples assisted by IVF-ET and normal couples of childbearing age,and to analyze related factors affecting the mood of infertile couples and the relationship between different psychological characteristics and the pregnancy outcome assisted by IVF-ET.Secondly,on the basis of a qualitative research design,the present study was further performed using a grounded theory in qualitative research according to two approaches of obtaining information from infertile patients in the hospital and from forum posts related to infertility,to further explore the psychological experience and adjustment of IVF-ET patients,extract related topics,establish theoretical models,and propose a suitable psychological intervention method for IVF-ET patients.Methods: The combination of qualitative and quantitative methods was used to establish the overall research framework.Firstly,a cross-sectional survey was utilized following the principle of convenient sampling of 260 infertile couples undergoing IVF-ET in the assisted reproduction clinic of Shengjing Hospital affiliated to Chinese Medical Sciences University.At the same time,277 normal couples were selected as the normal control group.The contents of the survey included basic information,self-rating anxiety scale and self-rating depression scale,Chinese marriage quality scale,defense style questionnaire,social support questionnaire and temperament and character inventory,etc..Simultaneously,infertility history,pregnancy clinical and embryonic laboratory indicators of IVF-ET were collected in the included infertile couples.The statistical software SPSS 21.0 was used to make a statistical analysis and compare the psychological characteristics of the infertile couples with those of the normal couples in the control group.Meanwhile,related factors of emotional state and the relationship between psychological characteristics and pregnancy outcome of IVF-ET were analyzed.Subsequently,using the grounded theory in qualitative research based on two approaches of obtaining information from infertile patients in hospitals and from forum posts related to infertility,a total of 11 infertile patients in the hospital were interviewed in this study,and 12 online forum posts were analyzed.The qualitative data analysis software Nvivo 11 was used to collate and analyze relevant data,and related topics were extracted afterwards,then establish theoretical models,and propose a suitable psychological intervention method for IVF-ET patients.Results: Quantitative research showed that both female and male in IVF-ET group had a higher level of anxiety and depression than those in normal fertility group(P<0.01),a lower total score of marital quality scale and social support scale than those in normal fertility group(P<0.05),a significantly higher score of immature defense mechanism than those in normal fertility group(P<0.05),and a significantly lower score of mature defense mechanism than those in normal fertility group(P<0.05).In the IVF-ET group,female scored significantly higher on self-directed dimension of the temperament and character inventory than those in the normal fertility group(P<0.05).However,there was no significant difference in scores for each dimension of the temperament and character inventory of males in the IVF-ET group and those in the normal fertility group.Multivariate linear regression analysis showed that female's BMI,marital quality,immature defense mechanism,mature defense mechanism,duration of infertility,other causes of infertility were the main influencing factors of anxiety in female IVF-ET patients(P<0.05);Female's BMI,family's rural residence,marital quality,immature defense mechanism and mature defense mechanism were the main influencing factors of depression in female IVF-ET patients(P<0.05);Family's rural residence,the total score of marital quality,immature defense mechanism,mature defense mechanism,concealment factors,HA and ST were the main influencing factors of anxiety in IVF-ET male patients(P<0.05);The total score of marriage quality,mature defense mechanism,immature defense mechanism,concealment factor and HA were the main influencing factors of depression in male IVF-ET patients(P<0.05).Multivariate logistic regression analysis showed that female age was an independent influencing factor for the success rate of pregnancy in IVF-ET.The younger the patients,the higher the success rate(P<0.01),and the marital quality,defense style,temperament and character had no effect on the pregnancy success rate of IVF-ET.On the basis of the grounded theory of qualitative research,in this study,the psychological experience and adaptation of infertile patients under the treatment of IVF-ET were explored and four main topics were summarized: the experience of infertility status(a wide range of stressors,a variety of emotional experience);the experience of the treatment process(physical pains,inner torture);relationship adjustment(changes in relationship with spouse and embryo,relationship with surrounding people);self-adaptation(on the behavioral,cognitive level).Through an exploration of the psychological experience and adjustment of infertility patients under the treatment of IVF-ET,it was found in this study that group and family psychotherapy therapy and network-based psychological intervention may help reduce the psychological stress of IVF-ET patients.Conclusions: In the quantitative research part of this study,it was found that the level of mental health of patients treated by IVF-ET was worse than that of fertile couples who did not have fertility problems.Defense mechanism,marital quality,temperament and character,women's body mass index(BMI),family residence,duration of infertility,causes of infertility have an influence on the mood of patients treated by IVF-ET.The younger the infertile female,the higher success rate of pregnancy assisted by IVF-ET,and the marital quality,defense style,temperament and character had no effect on the pregnancy success rate of IVF-ET.The grounded theory in qualitative research was adopted to explore the psychological experience and adaptation of patients treated by IVF-ET.After the diagnosis of infertility of patients treated by IVF-ET,multiple sources of pressure bring a lot of complex emotional experience.Diagnosis and treatment operations and the characteristics of the IVF-ET technology itself not only bring infertile patients experience of physical pains,but also inner torture.The relationship of IVF-ET patients with their spouses and their surroundings undergoes a change,and connection to their embryos and future children is established.IVF-ET patients cope with stress by adjusting their self-perception and behaviors. |
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