Abstract for ESHRE 2001 in Lausanne (Switzerland)

Evaluation of the psychological effects of counselling and couple-therapy with infertile couples

Wischmann T.1, Stammer H.1, Scherg, H.1, Gerhard I.2, Strowitzki, T.2, Verres R.1

1 Dept. of Medical Psychology, Psychosomatic Hospital, Heidelberg University, Germany
2 Dept. of Gynaecological Endocrinology and Reproductive Medicine, Women's Hospital, Heidelberg University, Germany

 Introduction:

About 15 to 20% of infertile couples need psychological help to cope with the emotional stress induced by the assisted reproduction techniques. There are different concepts of infertility counselling but only little is known about its psychological effects. The aim of this study was to evaluate the infertility counselling in comparison with couple-therapy offered by the „Heidelberg Fertility Consultation Service”. Our framework of counselling and couple-therapy is described in Stammer et al. (2001).
 
 Materials and Methods:
Three independent samples of patients were compared: 23 couples waiting three months for counselling (waiting group), then completing the psychological measures a second time, 110 couples which were treated with two hours of counselling (counselling group), and 24 couples which subsequently underwent ten sessions of couple-therapy (therapy group). The latter two groups completed the psychosocial measures again after treatment. These included questionnaires concerning sociodemographic factors (SOZIODAT), motives for a child (FKW), dimensions of life satisfaction and partnership satisfaction (FLZ), physical and psychic complaints (SCL-90-R). The questionnaires are described in detail in Wischmann et al. (2001). Statistical analysis included t-tests, effect sizes and repeated measures analysis of variance.
 
Results:
There were no significant differences between the three groups in age, duration of partnership and the preceding infertility treatment (see table 1).
Table 1: Selected sociodemographic variables from the three samples for the women
 
Variables
Waiting group

n = 23
Counseling group

n = 110
Therapy group

n = 24
M
SD
M
SD
M
SD
Age(women)
32.9
3.3
33.2
3.8
34.1
4.6
Age(men)
36.2
5.1
35.4
4.7
36.1
6.9
Duration of partnership
9,9
5,1
9,7
4,9
9,6
4,5
Duration of wish for a child
4,7
2,6
4,5
2,9
4,7
2,9
Duration of treatment(women)
3,7
2,0
3,0
3,0
2,4
2,1
Duration of treatment(men)
1,4
1,6
1,9
2,5
1,6
1,4
M = mean (Years); SD = standard deviation

Specific characteristics of our sample were (1) The high educational level of the couples: 38% of all women and 53% of all men had university degrees or equivalent; there were no significant differences between the three groups. (2) The high amount of couples with unexplained infertility: 48% in waiting group, 34% in counselling group and 58% in therapy group, p=.04. (3) Merely the women from the couple-therapy group were more dissatisfied with sexuality.

After treatment, the couples of the two treatment groups showed a decrease in the intensity of wishing a child and in suffering from unwanted childlessness (see tables 2 and 3).

Table 2: Effect sizes of selected psychosocial variables from the three samples for the women

Scales1
Waiting group
n = 23
Counselling group
n = 110
Therapy group
n = 24
Intensity of wishing a child **
0,27
–0,68
–1.07
Suffering from unwanted childlessness **
0,00
–0,49
–1.10
Questionnaire on motives for a child (FKW)
Enhancement of self-esteem *
0,15
–0,17
–0,43
Emotional stabilization
0,06
0,01
–0,29
Career ambivalence
–0,04
0,10
0,24
Questionnaire on life satisfaction (FLZ)
Health **
–0,14
0,07
0,38
Professional/Vocational **
–0,68
–0,05
0,08
Leisure *
0,29
–0,02
0,32
Marriage and Partnership
–0,15
–0,17
–0,23
Symptom-Checklist (SCL 90-R)
Somatisation
–0,16
–0,06
–0,23
Interpersonal sensitivity
–0,08
–0,02
–0,31
Depression
0,01
–0,09
–0,36
Anxiety
0,03
–0,06
–0,42
Anger-hostility *
0,15
–0,15
0,31
Phobic anxiety
–0,17
–0,07
–0,20
Global severity index
0,00
–0,06
–0,24
Positive symptom distress index
0,08
–0,07
–0,30
Positive symptom total
-0,07
–0,10
–0,23
1Asteriks indicate that the 3 groups differ in their change between first (pre) and second (post) measurement, as given by the significance of the interaction term from Repeated measures analysis of variance: * P < .10; ** P < .05

Table 3: Effect sizes of selected psychosocial variables from the three samples for the men

Scales1
Waiting group
N = 23
Counselling group
N = 110
Therapy group
N = 24
Intensity of wishing a child **
–0,29
–0,44
–0,69
Questionnaire on motives for a child (FKW)
Enhancement of self-esteem
–0,14
–0,21
–0,18
Parenthood ambivalence *
–0,16
0,10
0,36
Career ambivalence
0,28
0,30
0,50
Questionnaire on life satisfaction (FLZ)
Professional/Vocational
0,14
0,04
0,38
Marriage and Partnership *
0,11
–0,19
0,23
Sexuality
0,04
–0,07
–0,21
Symptom-Checklist (SCL 90-R)
Interpersonal sensitivity
0,21
–0,11
0,01
Depression
–0,22
0,00
–0,03
Positive symptom distress index 
–0,27
–0,01
–0,22
1Asteriks indicate that the 3 groups differ in their change between first (pre) and second (post) measurement, as given by the significance of the interaction term from Repeated measures analysis of variance: * P < .10; ** P < .05

The decrease was stronger for the female patients than for the male patients. The decrease in the intensity of wishing a child showed effect sizes of –.68 (counselling group) and –1.07 (therapy group) for the women and –.44 (counselling group) and –.69 (therapy group) for the men. The decrease in suffering from unwanted childlessness showed effect sizes of –.49 (counselling group) and –1.10 (therapy group) for the women. The increase in satisfaction with health showed an effect size of .38 (therapy group) for the women. While there was an decrease in satisfaction in work for the women in the waiting group with an effect size of -.68, there was no change on this scale for the women of the counseling group and the therapy group. The other effect sizes for the men were neclectible small.

The Repeated measures analysis of variance included the waiting group as controls. Thus it allowed us to test whether there are any significant differences between the 3 comparison groups with respect to their “improvement” between the first and second measurement, i.e. after waiting, after counselling or after couple therapy. For the women, four scales (intensity of wishing a child, suffering from unwanted childlessness, Health, Professional/Vocational) showed significant differences between the groups while the effects were in the expected direction and increased with dose (waiting, counselling, therapy). For the men there were no significant effects. This may be due to the pretest values of the men which were almost all in normal range compared to the pretest values of the women.

 Conclusions:
The study showed the relieving effects of psychological counselling and couple-therapy for infertile couples. Couple-therapy showed stronger effects than counselling. Effects were also stronger in women than in men. The aim of counselling and couple-therapy should be to enhance the quality of life in the actual situation of the infertile couple and to offer psychological support to cope with infertility and its medical treatment.

References:
Stammer H, Wischmann T, Verres R (2001): Counseling and Couple Therapy for Infertile Couples. Family Process (in press).
Wischmann T, Stammer H, Scherg H, Gerhard I, Verres R (2001): Psychosocial Characteristics of Infertile Couples – A Study by the "Heidelberg Fertility Consultation Service", Part I. Human Reproduction 16 (8) (in press).
Copyright ©: ESHRE 2001. Published in Human Reproduction Vol. 16, Abstract Book 1, Oxford University Press 2001, ISSN 0268-1161
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