(see Poster Gallery) Efficacy of a Meaning-Based Implication Counseling Approach on Psychosocial Aspects and Decision-Making of Women with Failed in-Vitro Fertilization Treatment: A Quasi-Experimental Study

Background: Infertility is a stressful life-event, with the prevalence rate of 18% in China. There is an increasing number of couples seeking assisted reproductive technology (ART) such as in-vitro fertilization (IVF) to achieve goal of childbearing. However, IVF is an open-ended journey with the successful rate following one cycle of IVF can be only 60%. Previous research have proved that treatment failures elicited negative emotion such as grief and loss, making it essential to address the psychosocial issues among this population. This study aimed at evaluating the feasibility and effectiveness of a meaning-based implication counseling approach (MICA), an intervention which based on meaning-making model with various effective therapeutic techniques and patient decision aids, on women undergoing failed IVF treatment in China.

Methods: A quasi-experimental study was designed, to enroll Chinese women who have undergone at least one cycle of IVF treatment and failed to achieve clinical pregnancy into treatment. Purposive sampling method was conducted to recruit eligible participants who seeking IVF treatment in the center for reproductive medicine in China. One-session intervention was delivered by certificated social worker with individual format in online setting considering the COVID-19 pandemic. The session lasted about one hour. Effects of the intervention on meaning-making of stress (Integration of Stressful Life Experiences Scale- ISLES), locus of control (Perceived Personal Control Questionnaire-PPC), decision-making capacity (Decisional Conflict Scale-DCS), infertility stress (Fertility Problem Inventory-FPI), and emotional well-being (The Depression, Anxiety and Stress Scale-DASS-21) were examined pre and post the intervention. Analyses included descriptive statistics and paired sample t-tests.

Results: Overall, 93 IVF patients were approached and screened by the clinicians and nurses, and 63 agreed to participated the intervention and completed the questionnaires (attrition rate 32%). On average, their age was 32.8 years (SD=4.26), and received 2.6 IVF treatment cycle (SD=1.58) prior to the current failure. After the MICA intervention, significant improvement was found for adaptive meaning-made of the stressful event (p<0.001), perceived self-control in the cognitive (p<0.05) and behavioral (p<0.05) dimensions, and showed reduction in decisional conflict (p<0.05), level of stress (p<0.05) and depression (p<0.05), as well as the rejection of childfree lifestyle dimension (p<0.05).

Conclusions and Implications: The study findings indicated that the meaning-based implication counseling approach was effective in decreasing level of stress and depression, as well as fertility-related burden, and increasing the ability of meaning reconstruction and decision making. Most importantly, findings support MICA as a promising clinical tool for IVF women who experience substantial barriers to the adjustment to grief and loss symptoms and informed-based decision-making following failed IVF treatment. In addition, this intervention is a structured and non-pharmacological instrument which easy to implement for clinical professionals such as medical social worker, fertility counselor and nursing staff. The practices of this intervention will contribute to fill the services gap among those experienced the treatment failures, to foster the patient-centered care, improve holistic well-being and facilitate the shared decision-making. Future research is needed to conduct randomized controlled trial to consolidate the treatment effectiveness and explore the mechanisms of changes.