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FIRST PSYCHOSOCIAL INTERVENTION PROGRAMME ON INFERTILITY IN HONG KONG

07 Apr 2006

 

Body-Mind-Spirit Intervention Reduces Infertility Anxiety

According to the estimation of World Health Organization, the prevalence of infertility in industrialized countries can to be as high as 15%. That is to say, almost one out of every six to seven married couples in their childbearing years are having difficulties in achieving pregnancy naturally. Assisted reproduction treatments (ARTs) such as in vitro fertilization (IVF) may be adopted by these infertile couples but are usually invasive, demanding and stressful. Women undergoing IVF treatment commonly felt that they are under high stress and experience from psychological disturbances such as anxiety.

Faculty of Social Sciences and Li Ka Shing Faculty of Medicine, The University of Hong Kong have conducted a joint research project since 2000, aiming at supporting infertile women prior to their IVF treatment through a series of psychosocial intervention groups. This first psychosocial intervention programme on infertility in Hong Kong integrated an Eastern Body-Mind-Spirit intervention approach which is culture sensitive and specifically designed for the local population.

The study wants to examine the effectiveness of this psychosocial group intervention. Promising results were found and the study was recently published in an international journal "Fertility and Sterility". The value of psychosocial group intervention on women with infertility was found to be effective in reducing anxiety.


A pioneer local study on the psychosocial group intervention for IVF women using the Eastern Body-Mind-Spirit approach

A prospective randomized-controlled study on psychosocial group intervention for IVF women was being conducted since 2000. The main objective of this study was to evaluate the effectiveness of the Eastern Body-Mind-Spirit (EBMS) group intervention approach on anxiety-reduction of Chinese women undergoing IVF. A total 227 women undergoing their first cycle of IVF treatment were recruited for the study, of which 69 women (the intervention group) received four sessions of EBMS intervention group while 117 women (the control group) did not receive any intervention. A Chinese State-Trait Anxiety Inventory was used in the study to measure the women's anxiety levels at three different time points during the course of IVF.

The Eastern Body-Mind-Spirit (EBMS) Intervention Approach

The EBMS approach was based on Traditional Chinese Medicine and Chinese philosophy of life. It recognizes the importance of the mind, body and spiritual systems in the maintenance of harmony between oneself and the environment. Different from the mind-body intervention group developed in Western countries, the EBMS intervention approach includes spiritual health as a crucial intervention component. As such, the EBMS intervention approach is a culturally-relevant intervention model.

The therapeutic goals of the EBMS intervention are to enable the patients to re-examine their meaning of childbearing, family and life. These reflections can enhance their holistic health to build up personal competence and resilience to reduce the anxiety and other psychological distress, and subsequently learn to let go of unrealistic expectation for treatment outcome to attain a peace of mind. The therapeutic components include:
i. Mini-lectures on healthy life-styles and health concepts derived from Traditional Chinese Medicine, which views health as a state of mind-body harmony;
ii. Relaxation training coupled with tai-chi exercise, massage, acupressure, meditation, and breathing techniques;
iii. Group activities, such as sharing, singing, journal writing and drawing, to encourage the discovery of positive meaning from negative experiences; and
iv. Reflections on spiritual or inspirational materials excerpted from ancient Chinese philosophical writings on suffering and the meaning of life.

Results

In comparison with the control group, the intervention group reported a significant drop (10%) in State Anxiety mean score following intervention, decreasing form 47.12 to 42.69 (Table 1). Moderate effect size of 0.42 was found.

Despite not reading 0.05 of statistical significance, the results reveal a trend of a higher pregnancy rate in the intervention group as well (27.7% of intervention group and 14.8% of control group) (Table 2).

Conclusion
The EBMS group intervention model appears to be effective in reducing anxiety among the Chinese women before IVF treatment; whole person well-being is achieved by maintaining a state of harmonious balance between the internal and integrated whole of the person in the aspects of body, mind and spirit.

Should you have any further inquiries, please feel free to contact Ms Celia Chan at 2589 0500 or chancelia@hku.hk.

Background Information

IVF as physical and psychological demands for infertile women

This is the 20th anniversary for IVF in Hong Kong. The Assisted Reproduction Unit of the Queen Mary Hospital has been offering a range of assisted reproduction services since 1986. IVF or test-tube baby is usually required by many infertile patients in their infertility treatment. It involves stimulation of ovaries by daily injection of gonadotrophin, egg collection through the transvaginal route under the guidance of ultrasound, fertilization in the laboratory and replacement of good quality embryos into the uterine cavity. Stimulation of ovaries may last for 10-12 days and the patients have to wait for about two weeks after the transfer of embryos to know about the outcome of the treatment. Therefore, it is obvious that patients undergoing IVF treatment are under great physical and psychological stress. Studies have shown that IVF treatment exerts negative psychosocial impacts on both the female patients and their male partners. This has largely to do with the intrusive nature of treatment, with the patients having no control over it. Added to the stress is the "no-guarantee" success rate of IVF (around 20-30% per cycle), women undergoing IVF treatment usually report higher levels of anxiety. Their anxiety usually increases throughout the course of the treatment and peaks at the waiting periods for the treatment outcome after oocyte retrieval and embryo transfer.

Psychosocial intervention program for infertile women

Psychosocial group intervention has been well developed in Western countries, which usually take the form of psychosocial intervention programs. In 1990s, studies performed at Harvard Medical School illustrated that fertility can be improved when couples learn to manage their emotional stress through their Mind/Body Program. Their program comprised of relaxation training, stress management and psycho-education had a higher pregnancy rate of IVF treatment. Over the past 15 years, such kind of program for infertility has become an integral part of the treatment of infertility. Massachusetts reproductive endocrinologists have also found that combining the advancement of medical techniques with psychosocial program for the emotional aspects of infertility results in patients handling the treatment better and maximizing chances for conception, especially for those women with unexplained infertility.