The anxious 14 days - the role of spirituality in helping women during their in vitro fertilization result awaiting period by a self-help I-BMS model (RCT)

Abstract

STUDY QUESTION: How effective is the I-BMS self-help model in alleviating the anxiety of the women during their IVF result awaiting period? SUMMARY ANSWER: The self-help model was proven effective in alleviating women’s anxiety, while the role of spirituality was also an important factor to their childbearing belief. WHAT IS KNOWN ALREADY: Many women experience complicated emotions throughout IVF treatment. Among all treatment stages, many studies have proven that their uncertainty and anxiety level peaks in the waiting period between embryo transfer and pregnancy test. The situation is especially difficult and stressful for Chinese women who bear the obligation to extend the family tree. The introduced model adopted Traditional Chinese Medicine (TCM) as the framework aims at maintaining a harmonious balance in holistic wellbeing. It has been proven effective in alleviating anxiety, improving marital satisfaction and achieving holistic well-being of the Chinese women in face of IVF treatment. STUDY DESIGN, SIZE, DURATION: The study has been launched since January, 2015. In our pilot study, 38 women who were going to undergo IVF treatment were recruited in an infertility clinic in Hong Kong, and were randomly assigned to three groups: spiritual–behavioral (SB) group (n = 19) included a 3-h I-BMS workshop and a self-help exercise book on exercises and spiritual stories for home practicing; Spiritual (S) group (n = 10) received the latter with only spiritual stories; Control group (n = 8) received educational materials on healthy diet. PARTICIPANTS/MATERIALS, SETTING, METHODS: 38 women who were going to receive IVF treatment participated in the study. They were invited to complete a set of self-administered questionnaires which comprised of Chinese State-trait Anxiety Inventory (C-STAI) and Importance of Childbearing Index on the day of embryo transfer (T1) and the day of pregnancy test (T2). The results were analyzed by ANOVA. MAIN RESULTS AND THE ROLE OF CHANCE: The mean age of the participants was 38.14 years old (SD: 2.26). They had married for 7.25 years (SD: 3.12) and had gone through 2.33 treatment cycles (SD: 1.45) on average. 11 out of 38 participants had experienced at least 1 previous pregnancy loss. The course of subfertility was mostly due to male factors (n = 14), followed by unexplained factors (n = 5) and female factors (n = 3). Some couples faced both male and female factors (n = 2), while some did not indicate. Participants in SB-group showed reduction in anxiety level (T1 = 88.50 + 14.14, T2 = 87.84 + 15.76, p < 0.001) as measured by C-STAI in pre–post test. However, the anxiety level of the participants in S group raised (T1 = 86.50 + 24.92, T2 = 88.90 + 26.42, p < 0.001), while that of control group increased the most obviously (T1 = 89.14 + 21.97, T2 = 92.43, p < 0.001). Apart from the anxiety level, participants in S group showed significant reduction in their childbearing belief (T1 = 17.29 + 3.20, T2 = 16.56 + 3.90, p < 0.001) as measure by Importance of Childbearing Index, while SB group showed slight reduction (T1 = 15.69 + 5.04, T2 = 15.47 + 4.78, p < 0.001). In contrast, the control group demonstrated increased childbearing belief (T1 = 14.63 + 4.87, T2 = 15.63 + 7.03, p < 0.001). LIMITATIONS, REASONS FOR CAUTION: The sample size was limited and might not be able to generalize. Moreover, some women who experienced earlier symptoms or signs of treatment failure, such as menstruation came before pregnancy test might bring external effect to the result. Their opinions towards to model during the period were unknown. WIDER IMPLICATIONS OF THE FINDINGS: The self-help intervention allows more autonomy, flexibility and privacy at lower cost to fulfill the women’s special needs during the result awaiting period. It could psychologically and physically prepare them to be ready for the treatment outcomes. With limited existing psychosocial services specific for this period, it could provide another choice of support.