| 1. |
- Anderheim-Söderqvist, Lisbeth, 1952, et al.
(författare)
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Does psychological stress affect the outcome of in vitro fertilization?
- 2005
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Ingår i: Human Reproduction. - : Oxford University Press (OUP). - 0268-1161 .- 1460-2350. ; 20:10, s. 2969-75
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The aim of the study was to investigate the effect of psychological stress before and during IVF treatment on the outcome of IVF, controlling for known physiological predictors METHODS: This is a prospective, longitudinal study A total of 166 women were studied during their first IVF treatment They answered questionnaires concerning psychological and social factors on two occasions Psychological well-being was measured by the Psychological General Well-Being (PGWB) index and psychological effects of infertility were assessed by 14 items RESULTS: In the analysis of the psychological variables, no differences were found between pregnant and non-pregnant women The total number of good quality embryos, the number of good quality embryos transferred, and the number of embryos transferred were significantly higher in the pregnant than in the non-pregnant group In a multivariate analysis, the number of good quality embryos transferred was the only variable that was independently associated with pregnancy CONCLUSIONS: We found no evidence that psychological stress had any influence on the outcome of IVF treatment When counselling infertile couples, it might be possible to reduce the stress they experience during the treatment procedure by informing them of these findings
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| 2. |
- Anderheim-Söderqvist, Lisbeth, 1952, et al.
(författare)
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Extended encounters with midwives at the first IVF cycle: a controlled trial
- 2007
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Ingår i: Reproductive biomedicine online. - 1472-6483. ; 14:3, s. 279-87
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this prospective, controlled study was to investigate the impact of participation in extended encounters with midwives on the psychological well-being of women undergoing IVF treatment and on their experience of treatment procedures. A total of 166 couples were studied during their first IVF treatment at the authors' IVF unit, of which 49 underwent intervention via extended midwife encounters. Participants answered questionnaires on three occasions. Psychological effects of infertility and questions regarding the relationship with the partner were considered. On the third occasion, two open-ended questions regarding perception of the treatment and the support by the staff were assessed. Regarding the psychological effects of infertility and the relationship with the partner, no significant differences were found between the intervention group versus the control group. Analysis of the open-ended questions resulted in the finding that significantly (P = 0.01) more women in the intervention group expressed satisfaction with the care. No impact of the intervention on psychological well-being was noted. However, the intervention seemed to be an effective method to give couples a feeling of security, continuity and an opportunity to be seen as individuals and as couples, for which the women expressed their appreciation.
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| 3. |
- Holter, Herborg, 1960
(författare)
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Experiences of IVF - from a patient perspective
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to assess the quality of life and quality of care from a patient perspective, in relation to IVF treatment. This was done by: - assessing infertile couples’ short-term emotional responses to their first IVF treatment, the relationship between partners at different stages of the first treatment, and differences/similarities between the reactions of men and women as to whether or not a pregnancy was achieved - investigating whether a male infertility diagnosis had any influence on men’s experience of infertility and its treatment, view of life, relationships, self-image and psychological well-being, when compared with men in couples where the diagnosis was female, mixed or unexplained infertility - developing a validated instrument (QPP-IVF) for measuring patient-centered quality of care in an IVF-programme for both men and women - investigating patient-centered quality of care during IVF treatments as evaluated by men and women Method: Papers I and II were part of a prospective, longitudinal study carried out between 1999 and 2002 at the Reproductive Medicine Unit, Sahlgrenska University Hospital. Men and women answered questionnaires on three occasions during their first treatment. The questionnaires consisted of personal questions, including relationships with partners and social aspects of infertility and treatment. In Papers III and IV women and men undergoing IVF treatment between September 2011 and May 2012 at the Reproductive Medicine Unit at Sahlgrenska University Hospital and Fertility Centre of Scandinavia answered the QPP-IVF questionnaire used to measure quality of care from a patient perspective, developed and validated in Paper III. The measurement consisted of two kinds of evaluations, the rating of perceived quality of care and the rating of the subjective importance of various aspects of treatment. The quality of care was evaluated in separate answers to the questionnaire by men and women, within two weeks after IVF treatment (Paper IV). Results: Paper I: The women reported stronger emotional reactions to their infertility than their partners. The men, however, reacted with the same emotional pattern as their partners when pregnancy was not achieved. The majority reported that the relationship improved during treatment. Paper II: Men with a male infertility diagnosis reacted in a similar way as men in couples where the diagnosis was female, mixed or unexplained infertility at the time of the first IVF/ICSI treatment cycle. Paper III: The QPP-IVF instrument seemed to be a valid and reliable way of measuring quality of care from a patient’s perspective, for both women and men. The final questionnaire consists of 43 items for women and 42 items for men divided into ten factors; “Pain relief and physical care”, “Waiting time”, “Care room characteristics” , “Information during treatment”, “Information after treatment”, “Participation”, “Responsibility/Continuity”, “The Staff’s respect/commitment/empathy”, “Atmosphere and environment”, “Availability” and one single item measuring overall medical care. Paper IV: Women valued most aspects of care as significantly more important than men. Men and women evaluated however the importance of the different care factors in a similar pattern. General Conclusion: The results of these studies support the idea of similar response patterns in men and women concerning both quality of life in relation to IVF treatment, and the evaluation of quality of care during treatment. Despite women reporting stronger emotional reactions to their infertility and valuing the care aspects in fertility treatment more importantly than men, women and men reacted with similar emotions when pregnancy was not achieved and valued similar aspects of quality of care.
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| 4. |
- Holter, Herborg, 1960, et al.
(författare)
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First IVF treatment--short-term impact on psychological well-being and the marital relationship
- 2006
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Ingår i: Hum Reprod. ; 21:12, s. 3295-302
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The aim of this study was to assess infertile couples' short-term emotional responses to their first IVF treatment (the women's and men's emotional reactions and their experiences of the marital relationship at different stages of the first treatment) and to relate these responses to the outcome of the IVF treatment METHODS: The study was part of a prospective, longitudinal study where 117 couples participated The women and men answered questionnaires separately concerning psychological and social factors at three occasions: before, during and 1 month after treatment RESULTS: Women's and men's emotional reactions related to first IVF treatment were dependent on whether they achieved a pregnancy or not Those who failed to become pregnant rated their emotional well-being worse, whereas those who became pregnant rated their emotional well-being better than before treatment started The women reported stronger emotional reactions about their infertility than their husbands However, the men reacted in the same emotional pattern as their wives when pregnancy was not achieved A majority reported that the marital relationship improved during treatment CONCLUSION: Couples undergoing their first IVF treatment are as a group well adjusted and manage to handle the short-term emotional strain under treatment The determining factor for short-term emotional response of treatment was whether pregnancy was achieved
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| 5. |
- Holter, Herborg, 1960, et al.
(författare)
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In vitro fertilization health care professionals generally underestimate patients’ satisfaction with quality of care
- 2017
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : John Wiley & Sons. - 0001-6349 .- 1600-0412. ; 96:3, s. 302-312
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Previous studies have mainly compared professionals' and patient's ratings of the importance of different care aspects, finding poor agreement between the groups concerning patient-centered quality of care. There is still little known about the professionals' knowledge of how patients' experience the quality of care they receive during in vitro fertilization (IVF) treatments. The aim of this study was to investigate how IVF health care professionals estimate patients' experience of patient-centered quality of care and if certain factors influenced the IVF professionals' perceptions and IVF patients' experience of quality of care.MATERIAL AND METHODS: All 16 IVF public and private clinics in Sweden participated in this cross sectional study. A total of 268 IVF health care professionals and 3298 patients (women and men) undergoing IVF treatment between January and May 2015 participated by answering the validated questionnaire "Quality from the patient's perspective of in vitro fertilization treatment" (QPP-IVF).RESULTS: Healthcare professionals significantly underestimated patients' satisfaction with the patient-centered quality of care they received in all aspects measured. Both patients and professionals rated the most deficient factors to be 'responsibility/continuity', 'participation' and 'availability'. Healthcare professionals and patients belonging to private clinics evaluated patient-centered care as significantly better than professionals and patients at public clinics in almost all aspects measured.CONCLUSION: The results of this study will increase the professionals understanding of the patients' experiences during IVF treatment and provide additional knowledge when identifying areas to prioritize in order to improve quality of care.
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| 6. |
- Holter, Herborg, 1960, et al.
(författare)
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Lost and lonely: a qualitative study of women's experiences of no embryo transfer owing to non-fertilization or poor embryo quality
- 2021
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Ingår i: Human Reproduction Open. - : Oxford University Press (OUP). - 2399-3529. ; 2021:1
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Tidskriftsartikel (refereegranskat)abstract
- STUDY QUESTION: What are the experiences of women undergoing IVF who could not receive an embryo transfer because of failed fertilization or poor embryo development? SUMMARY ANSWER: No embryo transfer because of failed embryo development is associated with considerable emotional suffering and the need for an early appointment with a physician to obtain information on what went wrong and new alternatives. WHAT IS KNOWN ALREADY: The psychological and emotional impact of IVF treatments as experienced by IVF patients is well known, particularly following the failure to achieve pregnancy. STUDY DESIGN, SIZE, DURATION: A qualitative study running from January 2018 to April 2019 was carried out at one public and one private IVF clinic. The invitation to participate was sent to women within 1month after the cycle failed. PARTICIPANTS/MATERIALS, SETTING, METHODS: The women undergoing IVF were diverse in terms of cause of infertility, age, number of previous cycles, country of birth and educational level. Nineteen of the 41 invited women who had experienced no embryo transfer because of non-fertilization or poor embryo development took part in a semi-structured interview. Data were analysed by thematic content analysis. MAIN RESULTS AND THE ROLE OF CHANCE: The master theme was identified as: 'Lost and lonely' organized in two main themes 'Experience of the event' and 'Perception of needs from healthcare providers'. Considerable emotional suffering was recognized after no embryo transfer. The need for support was expressed as to be offered an early appointment with a physician for information about what went wrong, looking at new alternatives and, for many women, providing information about counselling. LIMITATIONS, REASONS FOR CAUTION: Only women participated, not partners. Of the women invited, 46% participated. Several declined to participate because of high levels of emotional stress. WIDER IMPLICATIONS OF THE FINDINGS: Patients undergoing IVF and not achieving embryo transfer due to poor embryo development are a vulnerable group. They need early feedback concerning reasons for failure and future alternatives. They also require psychological support. This ought to be offered by IVF clinics.
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| 7. |
- Holter, Herborg, 1960, et al.
(författare)
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Patient-centred quality of care in an IVF programme evaluated by men and women.
- 2014
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Ingår i: Human reproduction (Oxford, England). - : Oxford University Press (OUP). - 1460-2350 .- 0268-1161. ; 29:12, s. 2695-2703
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Tidskriftsartikel (refereegranskat)abstract
- Do men and women value the same aspects of quality of care during IVF treatment when measuring rates of importance by the validated instrument, quality from the patient's perspective of in vitro fertilization (QPP-IVF)?
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| 8. |
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| 9. |
- Holter, Herborg, 1960, et al.
(författare)
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The psychological influence of gender infertility diagnoses among men about to start IVF or ICSI treatment using their own sperm
- 2007
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Ingår i: Hum Reprod. ; 22:9, s. 2559-65
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND The aim of the present study was to investigate the psychological influence of gender infertility diagnoses among men in couples about to start their first IVF or ICSI treatment METHODS The study was a part of a prospective study of 65 men with male infertility diagnosis and 101 men in couples with female, mixed and unexplained infertility diagnoses Of the 200 men invited, 166 agreed to participate (83% response rate) The men answered questionnaires concerning psychological and social factors on three occasions, at the information meeting held 2-4 weeks prior to first treatment, 1 h before oocyte retrieval and 2 weeks after the pregnancy test RESULTS The main findings of this study gave no indication that male infertility influenced men negatively concerning their experience of infertility, view of life and relationships and psychological well-being We found that men with a male factor infertility diagnosis reacted in a similar way as compared with men in couples where the diagnosis was female, mixed or unexplained infertility CONCLUSIONS In general, men are well adjusted with regard to a first IVF/ICSI treatment cycle, independent of gender infertility diagnoses
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| 10. |
- Kluge, Linda, 1968, et al.
(författare)
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Women´s experience and long-term perspectives: a qualitative sub-study of a randomized controlled trial on weight reduction prior to in vitro fertilization.
- 2023
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Ingår i: Reproductive, Female and Child Health. ; 2:3, s. 143-151
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Obesity is associated with impaired results after in vitro fertilisation (IVF). Consequently, several fertility clinics have set limits of body mass index (BMI) and obese infertile women are thus obliged to lose weight before treatment. Randomised controlled trials (RCTs) have not been able to show an increase in live birth rate after weight reduction before fertility treatment. The purpose of this study was to investigate the patients' experiences and views of participating in a RCT on weight reduction for obese women before IVF, in a long-term perspective. Methods A qualitative follow-up interview study including 17 women was performed between September and December 2020. The interviewed women had all been included in an RCT around 6 years earlier. Semistructured interviews were conducted, the interviews were audio recorded, transcribed verbatim, and analysed using thematic content analysis. Results During the analysis two main themes emerged; ‘Pros and cons related to trial participation’ and ‘Message to health care’. Several women were excited about the prospect of possibly receiving weight reduction before IVF. The women appreciated the support during the intervention but expressed that the diet was tough, and it was hard to maintain the weight loss. Their views regarding BMI limits differed. They advocated an individual assessment regardless of the woman's BMI and expressed that it could be of value to offer weight reduction treatment before IVF. Conclusions Even though the RCT and a 2-year follow-up could not show an increase in live birth rate in the intervention group most women had a positive attitude to weight reduction treatment before IVF. The importance of this study is that the views of the women have been highlighted and their opinions can add valuable information for fertility clinics in their care of obese infertile women.
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| 11. |
- Söderbäck, Kristina, et al.
(författare)
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Barriers to using postpartum family planning among women in Zanzibar, Tanzania.
- 2023
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Ingår i: BMC women's health. - 1472-6874. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Effective family planning is associated with substantial benefits, including reductions in maternal and neonatal mortality due to the avoidance of unintended pregnancies, and contributions to spacing, timing, and limiting births. However, in Zanzibar, Tanzania, the utilization of modern contraceptive methods is low. This study therefore aimed to identify barriers to using postpartum family planning among women in Zanzibar.Five focus group discussions were conducted with 24 women who gave birth in the maternity unit at a reference hospital in Zanzibar during the first quarter of 2022. The discussions took place in Swahili, were performed with the assistance of an interview guide, and were audio recorded, transcribed in Swahili, and translated to English. Data were analysed with qualitative content analysis using an inductive approach.Barriers to using postpartum family planning in Zanzibar could be summarized in three generic categories. Inadequate knowledge about postpartum family planning is expressed in the subcategories: inadequate knowledge about contraceptive methods and their mode of action, insufficient quality of family planning services, and belief in traditional and natural medicine for family planning. Perceived risks of modern contraceptive methods are described in the subcategories: fear of being harmed, and fear of irregular bleeding. Limited power in one's own decision about contraceptive use consist of the subcategories: the need to involve the husband, and opposition and lack of interest from the husband.The participants' current knowledge of postpartum family planning was insufficient to either overcome the fear of side-effects or to understand which side-effects were real and likely to happen. The woman's power in her own decision-making around her sexual reproductive rights is of critical importance. Given the barriers identified in this study, the findings call for increased knowledge about family planning methods and their mode of action, and involvement of the husband throughout pregnancy, childbirth, and the postpartum period in postpartum family planning education and counselling, in Zanzibar and in similar settings.
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| 12. |
- Öjendal, A., et al.
(författare)
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Factors affecting the provision of high-quality postnatal care services in Zanzibar: a qualitative study
- 2023
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Ingår i: BMC Pregnancy and Childbirth. - 1471-2393. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundIn Sub-Saharan Africa, the postnatal period is associated with high mortality and accounts for a substantial proportion of maternal deaths. Although postnatal care has been identified as critical in reducing maternal mortality, the quality of care provided is often inadequate. Tanzania and Zanzibar have not made sufficient progress towards achieving the Sustainable Development Goals on maternal health, and there is limited knowledge about the utilization and quality of postnatal follow-up. The aim of this study was therefore to explore factors affecting the provision of high-quality postnatal care services in the urban area of Zanzibar.MethodsFive focus group discussions were performed in Swahili with 25 healthcare providers from primary healthcare units in urban Zanzibar. Interviews were audio-recorded, transcribed verbatim, translated into English, and analysed using qualitative content analysis with an inductive approach.ResultsFactors affecting provision of high-quality postpartum care services could be divided into three generic categories. Difficulty achieving high attendance comprised three subcategories: long waiting times, low awareness among women, and out-of-pocket payment. Lack of basic resources also comprised three subcategories: shortage of healthcare providers, lack of adequate space, and inadequate medical equipment. Insufficient care routines comprised two subcategories: lack of guidelines and deficient chain of information.ConclusionsThe present findings suggest that the women's perceptions of postnatal care do not align with the intended purpose of routine postnatal care. Instead, the postnatal period primarily leads to visits to health facilities only when urgent care is required, and there is a lack of awareness about the importance of postnatal care. Moreover, limited resources, including equipment, staff, and space, as well as long waiting times, hinder the delivery of high-quality care and contribute to a negative reputation of postnatal care services. To effectively reach all women and improve postnatal care, it is necessary to increase basic resources, modify health education approaches, and enhance the flow of information between different levels of care using context-specific strategies.
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