Geneva, 5 July 2017: Despite repeated claims that the disappointments of infertility and stress of treatment can put intolerable strain on relationships, a large nationwide study involving more than 40,000 women has found that fertility treatment does not increase the risk of divorce.
"Our results will be reassuring for couples who have had or are contemplating IVF," said investigator Dr Mariana Martins from the Faculty of Psychology at the University of Porto, Portugal. "Findings on the security of relationships and parenthood can be particularly helpful in supporting patients' commitment to treatment."
Dr Martins will present results of the study today at the 33rd Annual Meeting of ESHRE in Geneva.
This was a cohort study based on registry data of all women having assisted reproduction treatment (ART) in Denmark between 1994 and 2009, a total of 42,845 patients. Marital/cohabiting status was confirmed for two years before inclusion in the cohort, which was then matched (for age) with a control group from the general population, and similarly followed throughout the study period.
During the 16 years of follow-up the majority of couples had children with their baseline partners (56% non-ART vs 65% ART), and around one-fifth ended up separated or divorced (20% ART vs 22% non-ART). Although initial findings did reveal a lower risk of break-up among the ART couples, when subsequent children were added to the model, and after adjusting for both partners' age, education and partnership status, no difference in the risk of marriage/partnership break-up was found.
"This significant interaction between ART status and common children suggests that the risk of break-up is mainly influenced by childlessness," explained Dr Martins.
She added that the results of this study were not incompatible with what is so far known about the stress and anxiety caused by infertility and its treatment. "We have previously found that subjects who divorce, repartner and come back to treatment are the ones that five years before had the most stress," she explained. "We also know that despite all the strain that this infertility can bring, going through ART can actually bring benefit to a couple's relationship, because it forces them to improve communication and coping strategies."(1,2)
Dr Martins added that most couples experience some degree of stress during fertility treatment, but the uncertainty of results makes the psychological symptomatology similar to many other chronic diseases. Infertility, she also noted, has the distinction of having both partners as patients, "even though the male partner often adopts the role of a supportive caregiver". "We believe that providing couples with appropriate knowledge and expectations about success rates and the burden that ART can bring to a marriage will make that treatment much easier for most couples."
This was the first study able to follow a large cohort of couples over a period of 16 years. "The fact that it is a national registry-based sample makes us very confident of the results," said Dr Martins.
Abstract O-257, Wednesday 5 July 2017
Does ART treatment increase the risk for divorce? A registered-based study 1994-2010
1. Martins MV, Costa P, Peterson BD, et al. Marital stability and repartnering: infertility-related stress trajectories of unsuccessful fertility treatment. Fertil Steril 2014; 102: 1716-1722.
2. Peterson BD, Pirritano M, Block JM, Schmidt L. Marital benefit and coping strategies in men and women undergoing unsuccessful fertility treatments over a 5-year period. Fertil Steril 2011; 95: 1759-1763.
The psychological effects of ART: the story so far
- The psychological impact of infertility and its treatment have been extensively studied in the era of IVF. All have identified a high level of stress and anxiety in most subjects.
- A review of studies into women's emotional adjustments to IVF (which is usually the last treatment resort to infertility) found four stressful moments: the prospect of the treatment itself; its unpredictable outcome; initial results; and giving up treatment (see Verhhak CM, et al. Human Reproduction Update 2007; 13: 27-36).
- Most counselling interventions are directed towards stress reduction and emotional adjustment. In women, stress is related mostly to treatment failure or anticipation of failure: after a positive pregnancy test all negative emotions tend to disappear. In men in treatment, stress appears higher one year after an initial evaluation, but reduces two years or more after (see Martins MV, et al, Human Reproduction Update 2016; 22: 466-478).
- Previously infertile childless couples have poorer adjustment than those who achieved parenthood, even 10 years after. The continuity of a wish for children has been found a stronger predictor of maladjustment than the absence of a child (see Gameiro S, et al, Human Reproduction 2014; 29: 2238-2246).
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