Stress and experience among women with reproductive failure.

Reproductive failure is the inability to produce viable offspring, which ranges from infertility to miscarriage. Previous studies were unable to dissect out the cause and effect relationship between psychological stress and reproductive failure. It is probably because stress and reproductive failure (outcome) is not in a direct relationship, which stress level is influenced by the nature of treatments (e.g. In-vitro fertilization procedures, IVF) and the clinical outcome (e.g. miscarriage), whilst stress and the clinical outcomes are mediated by biological mechanism (e.g. hormonal change and cortisol level). In this thesis, the focus is on three areas (I) The relationship between psychological stress and IVF clinical outcomes, (II) Reduction of stressful experience during IVF treatment and (III) Patients' experience of ultrasound guided manual vacuum aspiration (USG-MVA) as an alternative conventional miscarriage managements option, via the measurement of validated psychological instruments and stress biomarkers: (I) The relationship between psychological stress and IVF clinical outcomes. A number of studies have investigated the relationship between psychological stress on IVF pregnancy outcomes. However, current literature shows inconsistent and contraindicating results regarding stress and its impact on the reproductive outcome. The controversial findings of the association between psychological stress and clinical outcomes following IVF treatment are due to a number of the methodological considerations, including different populations studied, different instruments used and different time points assessed. Therefore, a prospective observational study was conducted to revisit the impact of stress experienced during IVF treatment. A total of 200 subjects completed all questionnaires and 197 subjects completed saliva sampling. Among the pregnant group (n= 92), 28 miscarried after ET. It was concluded that stress level as measured by various validated psychological instruments and stress biomarker did not associated with miscarriage following IVF treatment. (II) Reduction of stressful experience during IVF treatment. Although the observational study could not find any relationship between psychological stress and IVF pregnancy outcomes, IVF treatment is both an emotional and physical burden. Transvaginal ultrasound guided oocyte retrieval (TUGOR) is the most painful and stressful procedure in the whole course of IVF treatment. Therefore, we conducted a randomized controlled trial (RCT) to investigate the effectiveness of music therapy on pain and stress reduction during TUGOR procedure. A total of 209 participants were successfully recruited and they were randomized into headphone and music group (n = 80), headphone only group (n = 70) and control group (n = 69). It was found that women in the music group had significantly lower pain score and higher satisfaction level than the other two groups. Therefore, this finding suggested that the routine use of music therapy during TUGOR procedure is beneficial. (III) Patients' experience in different miscarriage managements . Apart from infertility, miscarriage is another form of reproductive failure. Approximately one in four women will experience a miscarriage in her lifetime. Surgical evacuation under general anaesthesia (GA) is the traditional approach to manage first trimester pregnancy loss. However, previous studies found its higher rate of complication, such as infection, than other miscarriage managements. Manual vacuum aspiration (MVA) was reported to be a safer and an alternative treatment option in comparing with surgical evacuation. Although a number of studies have examined different types of miscarriage managements on early pregnancy loss, there is no consensus on the optimal treatment. (PsycINFO Database Record (c) 2019 APA, all rights reserved)