Psychological factors in IVF treatments – can improved patient experience improve pregnancy outcomes?

It has been a longer time since I haven’t posted in the blog. It was a stressfull time, but before the summer leave I would love to share a bit of the ethnographic and patient experience work in fertility I am currently involved in.

Many of you know for sure stories were an infertile couple gave up hopes of conceiving a baby therefore and dropped a fertility treatment … and a few of months later the woman became pregnant! These stories are not urban legends, but show the impact of psychological factors on fertility.

Psychology and fertility
As Eugster and Vingerhoet described as early as 1999: “Undergoing an IVF-treatment is an emotional and physical burden, for both the woman and her partner. Research results suggest that couples entering an IVF-treatment program are, in general, psychologically well adjusted. Concerning reactions during the treatment, both women and men experience waiting for the outcome of the IVF-treatment and an unsuccessful IVF as most stressful. Common reactions during IVF are anxiety and depression, while after an unsuccessful IVF, feelings of sadness, depression and anger prevail. After a successful IVF-treatment, IVF-parents experience more stress during pregnancy than ‘normal fertile’ parents.”

Although there is still much research to have conclusive results, science seems to confirm the general intuition about psychology and infertility. Several studies even suggest already that there could be a correlation between targeted psychological treatment and increase in pregnancy rate.

Psychology and treatment drop out
May be the link between psychological care pregnancy increase is not yet well studied yet, but there is a clear evidence that treating psychological factors reduces the drop out of fertility couples undergoing treatments.stress fertility

For instance, the Brazilian Clinic Androfert, reports that using psychological care for their patients has reduced the drop out rate from 55% to 22% during the first cycle and from 80% to 55% stress fertilityafter the third cycle. This is not a minor achievement, since up to 65% of couples drop out fertility treatment before completing the third cycle.

dropout rates
Source: Androfert, Brazil

What is psychological stress made of
By far, psychological stress is the most frequent reason given by patients as a cause for leaving their treatment (49% of cases) -very far away the physical burden, that is only a reason for 7% of patients. The other big reason for drop out a bad prognosis, that causes 40% of couples to leave their treatments. The other factors are money (23%) or changes in the relationship, like a divorce (15%).

If psychological burden weights so much, it is important to have closer look at it. What is psychological stress made of? In an IVF patient follow study the loss of a pregnancy is very painful for a couple and is described by 94% of patients as the most stressful event during a treatment. Unsuccessful cycles 87% are also psychologically damaging, Waiting seems also to be a cause for anxiety, since 81% of patients describe waiting after the embryo transfer and 68% waiting to see how many eggs were fertilized as stressful.

Including psychological stress reduction in the patient experience
To set up a working strategy for stress reduction, an in depth understanding of the patient’s experience is necessary. Several clinics offer psychological support, but without understanding well the patients context and experiences results can be disappointing. My own ethnographical research shows that after the first consultation patients are often overwhelmed with information and need a time to think over it. In many cases patients do so as if they agree to the physician’s proposal but in fact they do not agree. In fact, they ask nurses and assisting staff for information and for advice .. in some cases up to taking decisions more upon staff advice rather tan on medical prescription. Therefore it is necessary to train very well nurse and the non-medical staff, so that can answer all kinds of questions from patients.zen

Based on this ethnographical research the service could be redesigned thanks to patient insights: each patients gets a personal assistant assigned. Personal assistants speak the patient’s language and teach them about IVF steps and medication, they individualize the patient’s agenda, are responsible for the treatment plan. There is an Hotmail open after the clinic closes for urgency cases. Very important also is the follow up of the patient up to the live birth, but also (most important even) when the cycle has been not successful. Personal assistants have a very important role in offering comfort and courage when the couple has feelings of sadness.

Patients feel happier and report less stress in the patient satisfaction surveys. Talking about surveys, another important issue when trying to reduce patient stress is patient conversation instead of just surveys management. As we stated in the past post, if 10% of patients would value, patients care as “bad”, this does not help very much. Instead, conversation with dissatisfied patients about what went wrong, like communication, information on drugs or training on how to administer injections).

The blog will come back in September with new posts on co-creation and patient experience in healthcare and pharma. Until then I wish all readers a very happy and relaxed summer break.





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