| Objective: Find out the influence of patients' social demographic characteristics,relevant information about fertility and treatment on two kinds of psychological status: anxiety and depression in frozen embryo transplantation(FET)cycles.Analyze pregnancy outcomes in FET cycles under different psychological status and endometrial preparation scheme.We look forward to find psychological factors whichmay influence the pregnancy outcome and provide evidence for exploring suitableclinical psychological intervention for infertility group in our country.Give guidelines for membrane preparation methods in transplant recipients and improve the treatment outcomes in FET cycles.Methods: Select 386 infertility patients who accept FET cycles in reproductive medicine center,Northern Jiangsu Peoples Hospital from August 2016 to January 2018.Use our self-designed psychological questionnaire(refer to survey scale of Reproductive medicine,Peking University Third Hospital,psychological experts' proposal and related literature),which involves in social and demographic information,relevant information about fertility and treatment,marital quality,SAS and SDS.Assist patients to complete the questionnaire in two hours before transplantation with the method of on-site guidance.We divide patients into two groups: natural cycle group(219 cases)and hormone-replacement cycle group(167 cases).We processed data using SPSS 16.0 statistical software.The data were described by calculating the mean,standard deviation and the rate.The results were analyzed using single factor analysis of variance(ANOVA),multiple factors logistic regression analysis,correlation analysis,t-test and chi-square test.Result: 380 questionnaires were delivered to patients,and 386 were returned,with the effective returning rate of 92.8%.The evaluation time of SAS and SDS was ranged from one week to two hours before transplantation.The total anxiety score was 40.30±7.96 on average.The anxiety group with an increased score involved a total of 54 patients,accounting for 14.0%.Mildly elevated group had 51 patients.Moderately elevated group had 3 patients.There were no patients in severely elevated group.We divided patients into normal-score group and high-score group according to anxiety score because of a small number of patients in moderately and severely elevated group.The total depression score was 42.99±11.44 on average.The depression group with an increased score involved a total of 91 patients,accounting for 23.6%.Mildly elevated group had 66 patients.Moderately elevated group had 25 patients.There were no patients in severely elevated group.We divided patients into normal-score group,mildelevated group and moderate and severe-elevated group.The natural cycle involved 219 patients and hormone-replacement cycle involved 167 patients according to different membrane preparation method.1.The influence factors of psychological status in patients with FET cycles1.1 The results analyzed by single factor analysis of variance(ANOVA)?t-test and Chi-square test showed that education,occupation,menarche age,infertility reasons,marital satisfaction and sex life were the influence factors of anxiety in patients with FET cycles(P<0.05).1.2 Logistic regression analysis demonstrated that education and occupation were the main influence factors of anxiety(P<0.05).1.3 Education,occupation,menstrual regularity,menarche age and marital satisfaction were the influence factors of depression in patients with FET cycles(P<0.05).1.4 Logistic regression analysis demonstrated that education and marital satisfaction was the main influence factors of depression(P<0.05);1.5 Correlation analysis showed that anxiety and depression scores were positively correlated and the correlation coefficient was 0.697(P < 0.05).Anxiety and depression scores were negatively correlated with marital satisfaction and sex life.The correlation coefficient was-0.191 and-0.141(P < 0.05).2.The influence of psychological status on treatment outcome.The data analyzed by t-test and Chi-square test showed that patients with lower anxiety score were reduced the number of fertilized oocytes,fertilization rate(?),the number of 2PN fertilized oocytes,retrieved oocytes,high-quality embryo rate(?)and clinical pregnancy rate(?)in patients with FET cycles(P<0.05).Patients with higher depression score were reduced the number of high-quality embryo rate(%)in patients with FET cycles(P<0.05).3.The relationship between two kinds of membrane preparation method and psychological conditions(1)The comparison of clinical parameter in patients with two kinds of membrane preparation method and the influence on treatment outcomesThe data analyzed by t-test showed that clinical parameter in patients had no influence on two kinds of membrane preparation method(P>0.05).The data analyzed by Chi-square test showed that the two kinds of membrane preparation method had no influence on treatment outcomes(P>0.05).(2)The effect of membrane preparation method on pregnancy outcome in FET patients with anxiety and depressionThe data analyzed by Chi-square test showed that FET patients with anxiety and depression has a higher embryo implantation rate(?)and clinical pregnancy rate(?)in artificial cycle group(P<0.05).Conclusion:1.Patients with low qualifications,irregular employment,menarche too early or too late,unexplained infertility reasons,infertility for both female and male factors,or low scores of marital satisfaction and sex life were more susceptible to anxiety.Patients with low qualifications,irregular employment,irregular menarche,menarche too early or too late or low scores of marital satisfaction were more susceptible to depression.We should pay attention to their psychological condition before transplantation and take psychological treatment when necessary.Psychological intervention should be performed against anxiety and depression before transplantation in patients with FET cycles and allow their spouses to receive treatment at the same time to improve the quality of marriage and increase pregnancy rate.2.The higher the anxiety score was,the lower the number of fertilized oocytes,fertilization rate(%),the number of 2PN fertilized oocytes,retrieved oocytes,high-quality embryo rate(%)and clinical pregnancy rate(%)were.The higher the depression score were,the lower the high-quality embryo rate was and patients were less likely to obtain conception.We should take psychological treatment to patients with poor psychological status before transplantation and improve pregnancy outcomes.3.The clinical parameter and the treatment outcomes in patients with two kinds of membrane preparation method showed no significant diference.Patients with anxiety and depression problems have a significantly higher embryo implantation rate and clinical pregnancy rate in artificial cycle group than in natural cycle.Therefore artificial cycle can be recommended to FET patients with poor mental health status for membrane transformation to improve pregnancy rate. |
PDF Full Text Request