HKU Releases Findings On Anxiety And Depression Levels Of Women Undertaking Test-Tube Baby Treatment

Left: Pilot workshop participant Ms G;  Dr Celia Chan Hoi-Yan,
Assistant Professor of the Department of Social Work and Social
Administration; Professor Ernest Ng Hung-Yu, Clinical Professor
of the Department of Obstetrics & Gynecology, HKU

Infertility is a life challenge for couples. Infertile couples experience psychosocial distress before, during and after treatment. In vitro fertilisation (IVF) (so-called test-tube baby) is the treatment of choice for long standing infertility. However, IVF is considered as a physically and demanding process, especially for women who are  highly involved during the treatment process. In our society, there is insufficient recognition of, and support for, the needs of infertile women within their social and familial networks.

In view of this, the Department of Social Work and Social Administration, Faculty of Social Sciences and the Department of Obstetrics and Gynaecology, Li Ka Shing Faculty of Medicine at the University of Hong Kong are conducting a research to examine the effectiveness of a self-help psychosocial support program called “Body-Mind Wellness Intervention Program” tailor-made for women undergoing IVF treatment.

Increasing Popularity of Assisted Reproductive Technologies in Hong Kong
IVF is getting more and more common as an assisted reproduction method in the globe. According to the Council on Human Reproductive Technology in Hong Kong, the number of patients increase from 8,668 in 2010 to 12,206 in 2014, more than half went through IVF treatments [including fresh embryo transfer (IVF-ET) or frozen-thawed embryo transfer (FET)].

However, there is no guarantee on treatment success. In 2014, the live birth  rate of the IVF treatment ranged from 14.9% to 27.2% (Table 1), which implied that many patients would experience failure in the treatment.

Table 1. Pregnancy and Birth Rate of IVF Cycles in 2014

Procedures	No. of Patients	No. of Cycles started	No of embryo transferred/cycle	Ongoing Pregnancy Rate	Live Birth Rate
IVF	1264	1399	1.69	21.9%	17.9%
IVF+ICSI	3771	4604	1.86	18.1%	14.9%
Frozen-thawed ET	3357	4495	1.84	32.3%	27.2%

 *Council on Human Reproductive Technology (2014). Reports and Statistics. Hong Kong

Women’s Psychological Well-being during IVF Cycle

 
In the years of 2013-2015, the Department of Social Work and Social Administration and the Department of Obstetrics and Gynaecology have jointly conducted the first longitudinal study in Hong Kong, examining the anxiety and depression levels among infertile women who failed their unsuccessful IVF cycles(1). 151 women have participated and completed a set of psychosocial measurements on their psychological well-being immediately after an unsuccessful treatment (T0), one month later (T1) and 3 months afterwards (T2) (Table 2).

Results found that 39.1% of patients reported symptoms of anxiety at T0 (Scored 8 or above in the Anxiety score at T0), which warranted clinical attention. Their anxiety levels remained almost the same in the subsequent months (34.4% at T1 and 34.5% at T2). On the other hand, 18.6% of patients reported symptoms of depression at T0 (Scored 8 or above in the Anxiety score at T0), and their depression levels remained steady in the subsequent months (20.5% at T1 and 17.9% at T2). It implied that some patients undertaking the treatment may not be able to adjust to treatment failure, which might potentially turn into long-term psychological distress. Supportive interventions in facilitating better post-treatment adjustment and enhance stress coping strategies during infertility treatments are deemed necessary.

Table 2. Levels of Anxiety and Depression after Successful IVF Cycle

	Anxiety Level [N (%)]			Depression Level [N (%)]
	T0	T1	T2	T0	T1	T2
Clinical Caseness(a) (>11)	32 (21.2%)	21 (13.9%)	19 (12.6%)	9 (6.0%)	10 (6.6%)	9 (6.0%)
Borderline(a) (8-10)	27 (17.9%)	31 (20.5%)	33 (21.9%)	19 (12.6%)	21 (13.9%)	18 (11.9%)
Normal(a) (<8)	92 (60.9%)	99 (65.6%)	99 (65.6%)	123 (81.5%)	120 (79.5%)	124 (82.1%)

 
^(a) Captured by the Hospital Anxiety and Depression Scale

Availability of Psychosocial Intervention Programs on Infertility and ART in Hong Kong

 
Unlikely other countries (e.g. Canada, Australia, UK) where mandatory counselling for people undergoing ARTs are required by legislation, counselling services for infertile couple undergoing infertility treatment in Hong Kong are mostly provided on needs basis. In response to the service gap, since 2001, the two HKU Departments established psychosocial support services, which support couples throughout the course of IVF treatment at the ART clinic, and developed a body-mind psychosocial intervention for the better health of infertile patients. The psychosocial intervention model has been proven effective in enhancing patients’ physical and psychological adjustment to infertility and related treatments(2)(3).

Waiting for Pregnancy Test: The Most Stressful Period in IVF 

 
Waiting for the pregnancy test during fertility treatment can be particularly stressful because distress and intrusive cognitions about the nature and implications of the result can reduce quality of life. The stress level of women undergoing IVF rises to the peak during the two-week waiting period between embryo transfer and the pregnancy test. With no treatment-related activities, women often feel helpless and loss of control. Moreover, the unpredictability of treatment outcome exacerbates the uncertainty towards the future, resulting in excessive anxiety and emotional distress.

The waiting period is often associated with negative anticipatory anxiety and rumination about the outcome of treatment. Evidence showed that self-help coping interventions are acceptable and feasible interventions to help minimise the strain of waiting for the pregnancy test result during fertility treatment. Simple low cost self-help coping intervention is welcomed by patients who prefer to stay home during the waiting period in an IVF treatment(4).

The First Self-help “Body-Mind Health Wellness Intervention Program” for Women Undertaking IVF
The self-help “Body-Mind Wellness Intervention Program” is a self-administered psychosocial program with a standardised protocol designed specifically for women undergoing IVF treatment. It’s a combination of a 3-hour workshop and a self-administerd body-mind wellness package delivered by a professional team consisting of registered social workers and infertility counsellors. Content of the package includes a series of self-help body-mind techniques including body-mind exercises, therapeutic massage, meditation and breathing exercises.  Participants will attend a workshop before IVF and be delivered a booklet of self-help body-mind techniques. Women who are about to undergo IVF treatment are eligible to enrol.

According to a pilot programme conducted since October 2015 attended by a total of forty-two female patients, the anxiety level of the participants in the treatment group significantly decreased during post-embryo-implantation period (Before intervention = 89.00+13.76, After intervention = 84.32+13.60, p<0.05), compared with those who received no psychosocial intervention (Before intervention = 86.42+22.64, After intervention = 94.32+26.78, p<0.05) (Table 3).

Table 3. Comparison of Anxiety Level before and after the Self-help “Body-Mind Health Wellness Intervention Program”

	Before Intervention	After Intervention	Difference(b)
Intervention group	89.00	84.32	-5.26%
Control	86.42	94.32	+9.14%

^(b) Captured by the State-Trait Anxiety Scale