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Guido Ragni, Paola Mosconi, Maria Pia Baldini, Edgardo Somigliana, Walter Vegetti, Ilaria Caliari, Anna Elisa Nicolosi, Health-related quality of life and need for IVF in 1000 Italian infertile couples, Human Reproduction, Volume 20, Issue 5, 1 May 2005, Pages 1286–1291, https://doi.org/10.1093/humrep/deh788
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Abstract
BACKGROUND:A specific and still poorly investigated issue in the field of infertility is represented by the impact that the need for IVF techniques may have on health-related quality of life (HRQoL). METHODS: A total of 1000 consecutive couples (1000 women and 1000 men) were invited to complete the Health Survey Short Form (SF-36) questionnaire separately, prior to initiating their first IVF attempt in our unit. Patients were also invited to report about demographic and clinical characteristics. RESULTS: A total of 1936 (96.8%) agreed to participate. Male SF-36 scores were higher than those reported by women. Duration of infertility and previous IVF attempts significantly influenced HRQoL (P<0.01). When scores were plotted in relation to the normative source of the Italian general population stratified by gender, corresponding age and geographical area, the subjective health profile did not significantly differ from the normative sample for both women and men. CONCLUSION: The need for IVF did not seem to markedly influence subjective health status. Conversely, duration of infertility and failure to achieve a pregnancy through IVF might have a negative impact.
Introduction
Subfertility affects ∼10–15% of individuals in Western world. This figure, however, may rise in the near future as increasing numbers of women decide to delay having children till an age when natural female fertility is in decline (Evers, 2002). Most patients experiencing fertility complaints seek medical help and many of those with persistent problems receive assisted reproduction treatment (Van Balen et al., 1997). Despite this relevant epidemiological burden, data concerning the impact that infertility and associated treatments may have upon the quality of life are controversial (Greil, 1997; Oddens et al., 1999; Matsubayashi et al., 2001; Lee et al., 2001; Dyer et al., 2002; Fassino et al., 2002; Schmidt et al., 2003). Specifically, although fertility problems are regarded as an impairment of Health, available well-designed studies on this topic have not univocally supported this popular view. Reasons to explain discrepancies between studies may be related to socio-demographic variables, time when evaluation was carried out, selection criteria, choice of controls and instruments used to assess quality of life.
A specific and still poorly investigated issue in the field of infertility is represented by the impact that the need for IVF techniques may have on infertile couples (Eugster and Vingerhoets, 1999; Lukse and Vacc, 1999; Fekkes et al., 2003). We believe that this particular concern deserves great attention considering that, despite the vast worldwide diffusion of IVF, political and social reactions about these treatments are heterogeneous. In particular, some criticisms towards these technologies have been raised that might result in patients being ashamed of their condition. Moreover, performing IVF may be considered a highly stressful event per se since patients generally feel it is the last chance to conceive. To the best of our knowledge, no previous studies have assessed health-related quality of life (HRQoL) in patients selected for IVF using the validated Health Survey Short Form (SF-36) questionnaire which is the currently most widely used instrument in this regard (Wagner et al., 1998; Ware and Gandek, 1998; Ware et al., 1998). The aim of the present study was to use SF-36 to assess HRQoL in a large sample of couples who were referred for IVF (1000 consecutive couples, 1000 women and 1000 men), to test the impact of clinical and socio-demographic determinants of health perception in this cohort and, finally, to compare results with those from the Italian normative population.
Materials and methods
From October 2002 to February 2004 all consecutively infertile couples referring for their first attempt at IVF in our Infertility Unit were asked by the attending physicians or midwives to participate in this prospective, cross-sectional survey. A total of 1000 couples (2000 subjects) was enrolled. Patients eligible for the study had the following characteristics: no previous IVF attempt in our centre, willingness to participate and ability to read and understand the Italian language. In our Unit, all patients selected for IVF are systematically evaluated a few weeks prior to initiating a treatment cycle. All patients are aware that they have already been accepted onto the programme before entering the study. Couples completed the questionnaire separately in the hospital setting at the time of this preliminary visit and returned the questionnaire anonymously in a sealed anonymous envelope. Cycle and pharmacological fees were entirely supported by the public health system in our Unit.
An ad hoc standardized questionnaire was set-up for this study, exploring two different areas: (i) demographic and clinical characteristics of patients such as gender, age, parity, education, duration of infertility (<5 versus <5 years), previous gynaecological or andrological surgery, IVF technique prescribed (classical IVF versus ICSI) and previous IVF attempts in other units; (ii) HRQoL variables. After a literature review, the Italian version of SF-36 was chosen to evaluate this aspect. This version has been previously validated and is described in detail elsewhere (Ware et al., 1993; Apolone and Mosconi, 1998). Briefly, SF-36 is a generic tool that measures two major health concepts: physical and mental health with 36 items generating eight multi-item scales: physical functioning (PF), physical role limitation (RP), bodily pain (BP), general health, vitality, social functioning (SF), emotional role limitation (RE) and mental health (MH) (Table I). For each patient, scores are assembled using the Likert method for summated ratings, and then the raw scores are linearly transformed to 0 to 100 scales, with 0 and 100 assigned to lowest and highest possible value respectively. Higher transformed scores indicate better Health.
All questionnaires were checked, validated and then analysed at the Istituto di Ricerche Farmacologiche ‘Mario Negri’ at Milan, Italy. Clinical and demographic variables of the sample were described using descriptive statistics such as mean, SD and proportion. Results were evaluated according to the following variables: gender, age, education, duration of infertility, previous gynaecological or andrological surgery and previous IVF attempts. Associations between clinical and HRQoL scores were estimated using parametric analysis of variance, and χ2-test. Multiple regression analysis was adopted to test the association between independent and dependent variables controlling for the presence of confounding factors. P<0.01 was considered statistically significant. The mean differences in the SF-36 scores were expressed as mean standardized differences (effect size, ES). The ES represents the difference between two groups divided by the SD of the reference group, enabling assessment of the difference in terms of SD units. Substantial differences between samples are expressed by value >0.4 or <–0.4 (Coen, 1988).
Standardized scores (z-scores) were calculated by dividing the difference between the individual's raw score and the mean score of the corresponding Italian normative group (determined by age, gender and geographic distribution) by the SD of the Italian normative group. These standardized scores express the individual's distance from their normative group mean in terms of units of the SD of the distribution. Any score equal to the normative mean will be equivalent to a z-score of zero. Negative or positive z-scores are produced for persons falling below or above the mean respectively (Anastasi, 1988). Statistical analyses were performed by SAS® System (Cary, NC, USA).
Results
In all, 1936 subjects were enrolled in the study, as 38 (1.9%) subjects refused to participate the survey, and 26 (1.3%) did not complete the SF-36 questionnaire. Table II gives an overview of the main characteristics of the female and male samples. Females were younger, more educated, and reported a higher rate of surgical interventions as compared with males. These differences are statistically significant. No difference in terms of duration of infertility, previous IVF attempts and type of therapy were observed.
Scores distributions of SF-36 for females and males are shown in Table III. The male scores were always higher, thus supporting a better HRQoL in this group. This significant difference persists for all scales of SF-36 even after adjusting for socio-demographic and clinical variables which were found to differ significantly according to gender. The highest differences between female and male samples were observed for ‘SF’ (ES = 0.33), ‘RE’ (ES = 0.28), and ‘MH’ (ES = 0.35) scales. All differences were <0.4.
SF-36 scores were also evaluated according to duration of infertility (<5 versus >5 years), previous gynaecological or andrological surgery, IVF technique prescribed and previous other IVF attempts. Scores were adjusted for socio-demographic and clinical variables. Significant differences were observed for duration of infertility and previous IVF attempts (Figure 1). Specifically, a lower score was documented in ‘PF’ scale in patients with a longer duration of infertility (P<0.01). Moreover, previous IVF attempts were associated with a lower score in ‘MH’ scale (P<0.01). Nevertheless, when patients were stratified according to the number of previous IVF cycles (1 versus 2 versus 3 or more), we failed to observe a trend to lower scores with the increase in the number of failed attempts (data not shown).
Scores for each scale were plotted with respect to the normative source of the Italian general population stratified by gender, corresponding age and geographical area. The subjective health profile did not significantly differ from the normative sample for both women and men (Figure 2). The male sample tended to show a slightly better HR-QoL profile than the female sample. Both male and female samples showed better scores for RP and BP scales, while PF and SF were the worst scores reported.
Discussion
In this study, we have documented that the impact of the need for IVF on HRQoL of infertile patients is, if any, limited. Indeed, the subjective health profile of patients a few weeks before performing IVF did not markedly differ from the Italian normative general population. Scores of SF-36 were markedly lower in females compared with males. However, this difference was only marginally confirmed when data were normalized on the normative population. Finally, longer duration of infertility and previous failed IVF attempts were associated with lower score in the physical and psychological areas respectively. To the best of our knowledge, this study represents the largest survey currently available on this topic.
Some limits of our study design have to be considered. A possible selection bias may be related to the decision to interview subjects before performing IVF. This strategy may impact the results in two ways. First, patients who were shocked by the necessity of performing the procedure may have decided not to attempt it, thus they were not interviewed. Second, hope about success may have reduced the degree of psychological discomfort. On the other hand, submitting questionnaires prior to initiating IVF has allowed us to obtain a remarkably high adherence to the study protocol; indeed, the percentage of completed questionnaires was 96.8%. A significant impact of such a low rate of drop-out on results is unlikely. Alternative approaches such as questionnaires mailed to the cohort of patients selected for IVF presumably lead to an unsatisfactory rate of completed questionnaires. Previous studies using this strategy have reported a rate of adhesions of 38–77% (Souter et al., 2002; Anderson et al., 2003; Olivius et al., 2004). Another possibility could have been to provide the questionnaire when the necessity for IVF was communicated to the patient; however, this approach appeared inadequate considering the temporal necessity for psychological elaboration.
A further limitation is related to the instrument used to assess subjective health status. At present, no validated health outcome measure exists to evaluate the quality of life of patients experiencing infertility. While SF-36 represents the most validated questionnaire to assess subjective health status, it might be argued that this instrument does not collect information on all the areas of well-being and functioning that may be important to patients suffering from infertility. On the other hand, this questionnaire currently remains the most appropriate and accepted instrument to assess HRQoL. Indeed, among the so-called generic questionnaires available in different languages, SF-36, because of its comprehensiveness, brevity and high standards of reliability and validity, has been translated by independent Italian teams since 1990. The launch of the International Quality of Life Project in 1991 has made possible the use of data from several comparable applications across the world (Wagner et al., 1998; Ware and Gandek, 1998; Ware et al., 1998). The standardized and accredited Italian translation used in the present study has become available after an exhaustive test in a representative sample of Italian citizens of >10 000 cases (Apolone et al., 1997).
Several studies have suggested that the impact of infertility and its treatment is higher in women than in men (Collins et al., 1992; Oddens et al., 1999; Lee et al., 2001; Pasch et al., 2002; Fekkes et al., 2003). Pasch et al. (2002) clearly demonstrate that having children was more important to women than men. Results from the present study are in line with these previous conclusions, at least in the subgroup of patients requiring IVF. Indeed, scores for all SF-36 scales were lower in females compared with males. These differences persisted even after adjusting for socio-demographic and clinical variables. On the other hand, it is worthwhile noting that females are generally known to report lower HRQoL scores compared with males using the SF-36 questionnaire (Apolone et al., 1997; Apolone and Mosconi, 1998). This profile may thus be independent of infertility complaints. To further clarify this issue, data were also analysed comparing separately women and men to a normative Italian population and stratifying for gender, age and geographical area. Surprisingly, as shown in Figure 2, men and women were extremely similar to the normative population in seven out of eight scales. A slight and non-relevant lower score in the MH scale was observed in women. Thus, overall, this analysis does not support the common assumption that women are more severely distressed by infertility status, at least among patients who were about to initiate an IVF cycle. To the best of our knowledge, previous studies which have evaluated separately women and men with infertility did not take into consideration this bias. Moreover, the comparison performed with the normative population has allowed us to document that, in general, the need for IVF does not severely impact subjective health profile. Indeed, for both women and men, variations from the normative population were within 0.25 SD for all scales. Lower scores were documented for PF and SF for both men and women. Women appeared to have a lower score also for MH. As previously mentioned, however, these variations appear to be slight, thus limiting the validity of inferences on these differences. Our results are in line with those reported by Fekkes et al. (2003) who evaluated HRQoL in a similar albeit smaller population using a different questionnaire, the Sickness Impact Profile. However, these authors reported that the subgroup of young patients (aged <30 years) planning IVF experienced more social and emotional problems. Unfortunately, a similar subgroup analysis could not be performed in our study since only a few patients were aged <30 years. Reasons to explain discrepancies with previous reports that have documented an impact of infertility on HRQoL can herein only be hypothesized. First, it has to be considered that IVF programmes are entirely supported by the public health system in our Unit. As a consequence, emotions evoked by financial impact are presumably extremely reduced in our series. Second, new hopes related to the imminent IVF cycle in our cohort may have masked a certain rate of discomfort. For this reason, it is worthwhile noting that inferences from our results on all infertile patients cannot be done. Moreover, the observation that the need for IVF does not markedly impact on HRQoL does not mean that performing IVF or failure to achieve a pregnancy through IVF does not have deleterious effects. These latest two aspects were not specifically investigated in the present study. Finally, failure to observe a significant impact on our study population as a whole does not rule out that IVF may constitute a highly charged life event in specific subgroups of patients.
Recently, much attention has been paid to psychological reasons that may determine the elevated drop-out rate observed in women after their first IVF attempt. Psychological reasons have been reported to play a major role (Goverde et al., 2000; Olivius et al., 2004; Smeenk et al., 2004). Although our study was not specifically designed to address this issue, this finding is indirectly confirmed by the observation that patients who previously underwent IVF attempts in other centres had slightly lower scores in the scale of ‘MH’. In other words, failure to achieve a pregnancy through IVF but not the need for these techniques may significantly affect the HRQoL of infertile patients. It cannot also be excluded that other unsuccessful fertility treatments such as ovulation induction and/or intrauterine inseminations may influence emotions evoked by referral for IVF. This possibility was not investigated in our survey. Further studies specifically aimed to address these topics are required. Finally, our study provides evidence that duration of infertility does not significantly affect the psychological area of HRQoL. A slightly lower score was documented only in the scale of ‘PF’ among patients who were seeking for children for a longer time. This finding is difficult to explain. Overall, it might be speculated that the duration of infertility does not markedly affect subjective health status in patients requiring IVF. The lower scores in this physical scale observed in patients with infertility lasting >5 years may be due to a selection bias. Indeed, patients with pain complaints may have postponed IVF more than those without these complaints. For instance, diseases such as endometriosis, pelvic inflammatory disease and seminal tract infections are well-known conditions associated with both infertility and pain. However, this hypothesis needs to be confirmed.
In summary, this study failed to document a significant influence of the need for IVF on subjective health status, at least when patients do not have to support the financial impact of the procedure. On the other hand, data from the literature and in part from the present study suggest that failure to achieve a pregnancy through IVF may have a relevant negative impact. Further studies are warranted in this area to clarify whether other subgroups of patients such as, for example, those with a worse prognosis, may be more severely affected by the need for IVF and to define the best clinical approach both to reduce patient drop-out after the first cycle of IVF and to attenuate post-failure impairment of HRQoL.
Multi-item scale . | No. of items . | Summary of contents . |
---|---|---|
Physical functioning (PF) | 10 | Extent to which health limits physical activities such as self-care, walking, climbing stairs, bending, lifting and moderate–vigorous exercises |
Physical role limitation (RP) | 4 | Extent to which physical health interferes with work or other daily activities, including accomplishing less than wanted, limitations in the kind of activities, or difficulty in performing activities |
Bodily pain (BP) | 2 | Intensity of pain and effect of pain on normal work, both inside and outside the home |
General health (GH) | 5 | Personal evaluation of health, including current health, health outlook and resistance to illness |
Vitality (VT) | 4 | Feeling energetic and full of pep versus feeling tired and worn out |
Social functioning (SF) | 2 | Extent to which physical health or emotional problems interfere with normal social activities |
Emotional role limitation (RE) | 3 | Extent to which emotional problems interfere with work or other daily activities, including decreased time spent on activities, accomplishing less and not working as carefully as usual |
Mental health (MH) | 5 | General mental health, including depression, anxiety, behavioural–emotional control, general positive effect |
Multi-item scale . | No. of items . | Summary of contents . |
---|---|---|
Physical functioning (PF) | 10 | Extent to which health limits physical activities such as self-care, walking, climbing stairs, bending, lifting and moderate–vigorous exercises |
Physical role limitation (RP) | 4 | Extent to which physical health interferes with work or other daily activities, including accomplishing less than wanted, limitations in the kind of activities, or difficulty in performing activities |
Bodily pain (BP) | 2 | Intensity of pain and effect of pain on normal work, both inside and outside the home |
General health (GH) | 5 | Personal evaluation of health, including current health, health outlook and resistance to illness |
Vitality (VT) | 4 | Feeling energetic and full of pep versus feeling tired and worn out |
Social functioning (SF) | 2 | Extent to which physical health or emotional problems interfere with normal social activities |
Emotional role limitation (RE) | 3 | Extent to which emotional problems interfere with work or other daily activities, including decreased time spent on activities, accomplishing less and not working as carefully as usual |
Mental health (MH) | 5 | General mental health, including depression, anxiety, behavioural–emotional control, general positive effect |
Adapted from Ware et al. (1993).
Multi-item scale . | No. of items . | Summary of contents . |
---|---|---|
Physical functioning (PF) | 10 | Extent to which health limits physical activities such as self-care, walking, climbing stairs, bending, lifting and moderate–vigorous exercises |
Physical role limitation (RP) | 4 | Extent to which physical health interferes with work or other daily activities, including accomplishing less than wanted, limitations in the kind of activities, or difficulty in performing activities |
Bodily pain (BP) | 2 | Intensity of pain and effect of pain on normal work, both inside and outside the home |
General health (GH) | 5 | Personal evaluation of health, including current health, health outlook and resistance to illness |
Vitality (VT) | 4 | Feeling energetic and full of pep versus feeling tired and worn out |
Social functioning (SF) | 2 | Extent to which physical health or emotional problems interfere with normal social activities |
Emotional role limitation (RE) | 3 | Extent to which emotional problems interfere with work or other daily activities, including decreased time spent on activities, accomplishing less and not working as carefully as usual |
Mental health (MH) | 5 | General mental health, including depression, anxiety, behavioural–emotional control, general positive effect |
Multi-item scale . | No. of items . | Summary of contents . |
---|---|---|
Physical functioning (PF) | 10 | Extent to which health limits physical activities such as self-care, walking, climbing stairs, bending, lifting and moderate–vigorous exercises |
Physical role limitation (RP) | 4 | Extent to which physical health interferes with work or other daily activities, including accomplishing less than wanted, limitations in the kind of activities, or difficulty in performing activities |
Bodily pain (BP) | 2 | Intensity of pain and effect of pain on normal work, both inside and outside the home |
General health (GH) | 5 | Personal evaluation of health, including current health, health outlook and resistance to illness |
Vitality (VT) | 4 | Feeling energetic and full of pep versus feeling tired and worn out |
Social functioning (SF) | 2 | Extent to which physical health or emotional problems interfere with normal social activities |
Emotional role limitation (RE) | 3 | Extent to which emotional problems interfere with work or other daily activities, including decreased time spent on activities, accomplishing less and not working as carefully as usual |
Mental health (MH) | 5 | General mental health, including depression, anxiety, behavioural–emotional control, general positive effect |
Adapted from Ware et al. (1993).
Characteristics . | Males . | Females . | P . | |||
---|---|---|---|---|---|---|
. | (n=958) . | (n=978) . | . | |||
Age | ||||||
<30 years | 51 (5.5) | 145 (15.1) | ||||
30–40 years | 679 (73.3) | 803 (83.6) | 0.0001 | |||
>40 years | 196 (21.2) | 12 (1.3) | ||||
Education | ||||||
<9 years | 249 (27.3) | 197 (20.6) | ||||
9–13 years | 465 (50.9) | 535 (56.1) | 0.0035 | |||
>13 years | 199 (21.8) | 222 (23.3) | ||||
Duration of infertility | ||||||
≤5 years | 706 (76.8) | 715 (74.7) | NS | |||
>5 years | 213 (23.2) | 242 (25.3) | ||||
Previous IVF cycles | ||||||
None | 725 (78.1) | 736 (76.8) | NS | |||
1 attempt | 93 (10.0) | 97 (10.1) | ||||
2 or 3 attempts | 71 (7.7) | 90 (9.4) | ||||
>3 attempts | 39 (4.2) | 35 (3.7) | ||||
Previous surgerya | ||||||
No | 719 (77.0) | 620 (65.0) | 0.0001 | |||
Yes | 215 (23.0) | 334 (35.0) | ||||
IVF technique | ||||||
Classical IVF | 387 (43.3) | 421 (43.9) | NS | |||
ICSI | 506 (56.7) | 539 (56.1) |
Characteristics . | Males . | Females . | P . | |||
---|---|---|---|---|---|---|
. | (n=958) . | (n=978) . | . | |||
Age | ||||||
<30 years | 51 (5.5) | 145 (15.1) | ||||
30–40 years | 679 (73.3) | 803 (83.6) | 0.0001 | |||
>40 years | 196 (21.2) | 12 (1.3) | ||||
Education | ||||||
<9 years | 249 (27.3) | 197 (20.6) | ||||
9–13 years | 465 (50.9) | 535 (56.1) | 0.0035 | |||
>13 years | 199 (21.8) | 222 (23.3) | ||||
Duration of infertility | ||||||
≤5 years | 706 (76.8) | 715 (74.7) | NS | |||
>5 years | 213 (23.2) | 242 (25.3) | ||||
Previous IVF cycles | ||||||
None | 725 (78.1) | 736 (76.8) | NS | |||
1 attempt | 93 (10.0) | 97 (10.1) | ||||
2 or 3 attempts | 71 (7.7) | 90 (9.4) | ||||
>3 attempts | 39 (4.2) | 35 (3.7) | ||||
Previous surgerya | ||||||
No | 719 (77.0) | 620 (65.0) | 0.0001 | |||
Yes | 215 (23.0) | 334 (35.0) | ||||
IVF technique | ||||||
Classical IVF | 387 (43.3) | 421 (43.9) | NS | |||
ICSI | 506 (56.7) | 539 (56.1) |
Data are expressed as total number (percentage).
Sum of cases according to the variable considered may differ from total number of cases because of missing values.
Surgery for gynaecological (for female) or andrological (for male) indications were considered.
NS=not significant.
Characteristics . | Males . | Females . | P . | |||
---|---|---|---|---|---|---|
. | (n=958) . | (n=978) . | . | |||
Age | ||||||
<30 years | 51 (5.5) | 145 (15.1) | ||||
30–40 years | 679 (73.3) | 803 (83.6) | 0.0001 | |||
>40 years | 196 (21.2) | 12 (1.3) | ||||
Education | ||||||
<9 years | 249 (27.3) | 197 (20.6) | ||||
9–13 years | 465 (50.9) | 535 (56.1) | 0.0035 | |||
>13 years | 199 (21.8) | 222 (23.3) | ||||
Duration of infertility | ||||||
≤5 years | 706 (76.8) | 715 (74.7) | NS | |||
>5 years | 213 (23.2) | 242 (25.3) | ||||
Previous IVF cycles | ||||||
None | 725 (78.1) | 736 (76.8) | NS | |||
1 attempt | 93 (10.0) | 97 (10.1) | ||||
2 or 3 attempts | 71 (7.7) | 90 (9.4) | ||||
>3 attempts | 39 (4.2) | 35 (3.7) | ||||
Previous surgerya | ||||||
No | 719 (77.0) | 620 (65.0) | 0.0001 | |||
Yes | 215 (23.0) | 334 (35.0) | ||||
IVF technique | ||||||
Classical IVF | 387 (43.3) | 421 (43.9) | NS | |||
ICSI | 506 (56.7) | 539 (56.1) |
Characteristics . | Males . | Females . | P . | |||
---|---|---|---|---|---|---|
. | (n=958) . | (n=978) . | . | |||
Age | ||||||
<30 years | 51 (5.5) | 145 (15.1) | ||||
30–40 years | 679 (73.3) | 803 (83.6) | 0.0001 | |||
>40 years | 196 (21.2) | 12 (1.3) | ||||
Education | ||||||
<9 years | 249 (27.3) | 197 (20.6) | ||||
9–13 years | 465 (50.9) | 535 (56.1) | 0.0035 | |||
>13 years | 199 (21.8) | 222 (23.3) | ||||
Duration of infertility | ||||||
≤5 years | 706 (76.8) | 715 (74.7) | NS | |||
>5 years | 213 (23.2) | 242 (25.3) | ||||
Previous IVF cycles | ||||||
None | 725 (78.1) | 736 (76.8) | NS | |||
1 attempt | 93 (10.0) | 97 (10.1) | ||||
2 or 3 attempts | 71 (7.7) | 90 (9.4) | ||||
>3 attempts | 39 (4.2) | 35 (3.7) | ||||
Previous surgerya | ||||||
No | 719 (77.0) | 620 (65.0) | 0.0001 | |||
Yes | 215 (23.0) | 334 (35.0) | ||||
IVF technique | ||||||
Classical IVF | 387 (43.3) | 421 (43.9) | NS | |||
ICSI | 506 (56.7) | 539 (56.1) |
Data are expressed as total number (percentage).
Sum of cases according to the variable considered may differ from total number of cases because of missing values.
Surgery for gynaecological (for female) or andrological (for male) indications were considered.
NS=not significant.
Multi-item scale . | Males . | Females . | Effect size . | P . |
---|---|---|---|---|
PF | 95.0±12.0 | 92.9±15.5 | 0:18 | 0.0011 |
RP | 94.2±17.3 | 92.2±20.2 | 0:12 | 0.0210 |
BP | 89.0±17.7 | 84.3±20.2 | 0:26 | 0.0001 |
GH | 75.9±15.0 | 74.5±15.8 | 0:10 | 0.0496 |
VT | 68.3±15.7 | 64.0±15.9 | 0:27 | 0.0001 |
SF | 83.7±18.7 | 77.6±20.4 | 0:33 | 0.0001 |
FE | 87.6±25.9 | 80.3±31.5 | 0:28 | 0.0001 |
MH | 74.7±15.6 | 69.2±16.9 | 0:35 | 0.0001 |
Multi-item scale . | Males . | Females . | Effect size . | P . |
---|---|---|---|---|
PF | 95.0±12.0 | 92.9±15.5 | 0:18 | 0.0011 |
RP | 94.2±17.3 | 92.2±20.2 | 0:12 | 0.0210 |
BP | 89.0±17.7 | 84.3±20.2 | 0:26 | 0.0001 |
GH | 75.9±15.0 | 74.5±15.8 | 0:10 | 0.0496 |
VT | 68.3±15.7 | 64.0±15.9 | 0:27 | 0.0001 |
SF | 83.7±18.7 | 77.6±20.4 | 0:33 | 0.0001 |
FE | 87.6±25.9 | 80.3±31.5 | 0:28 | 0.0001 |
MH | 74.7±15.6 | 69.2±16.9 | 0:35 | 0.0001 |
Data are expressed as mean ± SD.
Differences persisted even after adjusting for socio-demographic and clinical variables. For the effect size calculation, the male population is the reference group.
Multi-item scale . | Males . | Females . | Effect size . | P . |
---|---|---|---|---|
PF | 95.0±12.0 | 92.9±15.5 | 0:18 | 0.0011 |
RP | 94.2±17.3 | 92.2±20.2 | 0:12 | 0.0210 |
BP | 89.0±17.7 | 84.3±20.2 | 0:26 | 0.0001 |
GH | 75.9±15.0 | 74.5±15.8 | 0:10 | 0.0496 |
VT | 68.3±15.7 | 64.0±15.9 | 0:27 | 0.0001 |
SF | 83.7±18.7 | 77.6±20.4 | 0:33 | 0.0001 |
FE | 87.6±25.9 | 80.3±31.5 | 0:28 | 0.0001 |
MH | 74.7±15.6 | 69.2±16.9 | 0:35 | 0.0001 |
Multi-item scale . | Males . | Females . | Effect size . | P . |
---|---|---|---|---|
PF | 95.0±12.0 | 92.9±15.5 | 0:18 | 0.0011 |
RP | 94.2±17.3 | 92.2±20.2 | 0:12 | 0.0210 |
BP | 89.0±17.7 | 84.3±20.2 | 0:26 | 0.0001 |
GH | 75.9±15.0 | 74.5±15.8 | 0:10 | 0.0496 |
VT | 68.3±15.7 | 64.0±15.9 | 0:27 | 0.0001 |
SF | 83.7±18.7 | 77.6±20.4 | 0:33 | 0.0001 |
FE | 87.6±25.9 | 80.3±31.5 | 0:28 | 0.0001 |
MH | 74.7±15.6 | 69.2±16.9 | 0:35 | 0.0001 |
Data are expressed as mean ± SD.
Differences persisted even after adjusting for socio-demographic and clinical variables. For the effect size calculation, the male population is the reference group.
We thank Ms Gianna Costa from the ‘Mario Negri’ Institute for the assistance during the study and Ms Paola Viganò for kindly revising the manuscript.
References
Anderson KM, Sharpe M, Rattray A and Irvine DS (
Apolone G and Mosconi P (
Apolone G, Mosconi P and Ware JE (
Coen J (
Collins A, Freeman EW, Boxer AS and Tureck AR (
Dyer SJ, Abrahams N, Hoffman M and Van der Spuy ZM (
Eugster A and Vingerhoets AJ (
Fassino S, Piero A, Boggio S, Piccioni V and Garzaro L (
Fekkes M, Buitendijk SE, Verrips GH, Braat DD, Brewaeys AM, Dolfing JG, Kortman M, Leerentveld RA and Macklon NS (
Goverde AJ, McDonnell J, Vermeiden JP, Schats R, Rutten FF and Schoemaker J (
Greil AL (
Lee TY, Sun GH and Chao SC (
Lukse MP and Vacc NA (
Matsubayashi H, Hosaka T, Izumi S, Suzuki T and Makino T (
Oddens BJ, Den Tonkelaar I and Nieuwenhuyse H (
Olivius C, Friden B, Borg G and Bergh C (
Pasch LA, Dunkel-Schetter C and Christensen A (
Schmidt L, Holstein BE, Boivin J, Sangren H, Tjornhoj-Thomsen T, Blaabjerg J, Hald F, Andersen AN and Rasmussen PE (
Smeenk JM, Verhaak CM, Stolwijk AM, Kremer JA and Braat DD (
Souter VL, Hopton JL, Penney GC and Templeton AA (
Van Balen F, Verdurmen J and Ketting E (
Wagner AK, Gandek B, Aaronson NK, Acquadro C, Alonso J, Apolone G, Bullinger M, Bjorner J, Fukuhara S, Kaasa S et al. (
Ware JE and Gandek B (
Ware JE, Snow GKK, Kosinski M and Gandek B (
Ware JE, Gandek B, Kosinski M, Aaronson NK, Apolone G, Brazier J, Bullinger M, Kaasa S, Leplege A, Prieto L et al. (
Author notes
1Infertility Unit, Department of Obstetrics and Gynecology, University of Milan, Milan and 2Istituto di Ricerche Farmacologiche ‘Mario Negri’, Milan, Italy