Getting Through the Two Week Wait – A Self-Help Intervention for Women Anxiously Waiting for Their in Vitro Fertilization Result

Abstract

Study question: How effective the I-BMS self-help intervention in reducing the anxiety among women during the two week wait? Summary answer: The anxiety level during the 2-week-wait of the women in intervention groups increased less than that of control group.Their need for parenthood decreased after intervention. What is known already: IVF treatment is always considered as a stressful experience to women. Among all the treatment stages, it has been proven that women’s anxiety level peaks at the two week wait,i.e. the waiting period between embryo transfer and pregnancy test.The situation is especially difficult for Chinese women who bear the obligation to extend the family tree. The psychosocial self-help model adopted Traditional Chinese Medicine (TCM) as the framework, which 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: 536 women who were going to undergo IVF treatment were recruited in infertility clinics in Hong Kong. 412 who agreed to study participation were randomly assigned to three groups after the two-hour briefing session: Spiritual-behavioral (SB) group (n = 143) received a self-help exercise book on bodily exercises and spiritual reflections for home practicing; Spiritual (S) group (n = 107) received only spiritual stories; Control group (n = 103) received health information on infertility and ART treatments. Participants/materials, setting, methods: All participants were invited to complete a set of self-administered questionnaires which comprised of the Chinese State-trait Anxiety Inventory (C-STAI) and Fertility Problem Inventory (FPI) on the day of embryo transfer (T1) and the day of pregnancy test (T2). The results were analyzed by repeated measures of ANOVA. Main results and the role of chance: The mean age of the participants was 36.4 years old (SD:3.2), and the mean duration of marriage was 6.7 years (SD: 3.2). They had been diagnosed of subfertility for 3.8 years (SD: 2.4) in average, and 34.2% of them had gone through more than one treatment cycle. The reasons of subfertility were mostly due to male factors (37.4%), followed by female factors (29.2%), unexplained factors (18.1%) and mixed factors (15.3%). Participants in the intervention groups (SB group: T1=42.3+10.9, T2=49.8 +10.6, p < 0.05, Difference=+17.7%; S group: T1=42.2+11.8, T2= 48.6+14.0, p < 0.05, Difference=+15.2%) showed lowered increase in state anxiety level than the control group (T1=45.1+11.3, T2=55.5+8.8, p < 0.05, Difference=+23.1%) as measured by C-STAI. Apart from the anxiety level, participants in SB group showed significant reduction in their need for parenthood (T1=36.4+7.7, T2=34.9+8.1, p < 0.05) as measured by the sub-scale of FPI, while S group showed no significant changes (T1=38.5+7.0, T2=39.3+7.6, p>0.05). In contrast, the control group demonstrated the highest increase in their need for parenthood (T1=37.4+6.7, T2=38.2+7.8, p < 0.05). Limitations, reasons for caution: The sample size was not standardized for the three groups due to the on-going recruitment of the study. Moreover, since it was a quantitative study, the women’s treatment experience and their opinions towards to self-help intervention during the period were subject to further study. 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 two week wait. It could prepare them psychologically and physically for the treatment outcomes. With limited existing psychosocial services specific for this period, it could provide another choice of support.