Psihološki problemi žena koje se leče zbog infertiliteta i njihove korelacije sa ishodom vantelesne oplodnje

Abstract

Cilj: Ispitati psihološke probleme infertilnih ţena podvrgnutih vantelesnoj oplodnji (VTO) i analizirati dvosmernost psihološko-ovarijalnih odnosno psihološko-uterusnih odnosa. Metode: Prospektivna kohortna studija obuhvatila je 120 infertilnih ţena od kojih je 29 ţena imalo PCOS, 38 neobjašnjen infertilitet (UI), 38 endometriozu, 15 tubarni faktor (TFI). Psihopatološke faktore pratili smo skalom BPRS-19, anksioznost skalom HAMA-14, a distres skalom DASS-21. Merenja smo izveli na poĉetku i kraju ovarijalne stimulacije (COH), preoperativno (OPU), pre embriotransfera (ET) i prilikom serumskog testiranja beta-hCG (ST). Rezultati: VTO je udruţen sa promenama psihološkog stanja ţene. Anksiozno-depresivni simptomi BPRS-ad rastu u ST fazi: kod UI sa 2.03±1.92 na 2.42±1.70 (p=0.017) i TFI sa 2.20±1.42 na 3.50±2.71 (p=0.004). Kod endometrioze BPRS-ad pada tokom COH i OPU faze sa 3.00±1.79 na 2.70±1.51. Tokom VTO kod UI i endometrioze opadaju: agresivnost (BPRS-hs) 0.68±0.89 do 0.36±0.68 (p=0.000) odn. 0.66±1.02 do 0.23±0.50 (p=0.001), i poremećaj mišljenja (BPRS-td) 0.45±1.01 do 0.11±0.40 (p=0.011) odn. 0.47±0.77 do 0.21±0.48 (p=0.030). Medju ţenama sa PCOS dobijeno je uvećanje u Anksioznosti HAMA-14 sa 4.59±3.65 na 8.73±3.62 (p<0.0001). Porast stresa (DASS-s) karakteriše TFI sa 4.13±2.70 na 4.79±4.69, p=0.006. Stres pada u ET fazi kod PCOS (sa 4.21±3.26 na 2.86±3.19, p=0.029), UI sa 4.32±3.68 na 3.08±4.07, p=0.019 i endometrioze sa 5.08±3.32 na 3.21±3.49, p=0.011. Kod UI ţena u COH fazi, atretiĉne oocite i embrioni dobrog kvaliteta pozitivno su udruţeni sa distresom i povuĉenošću (BPRS-wr) (p=0.018, p=0.006). Kod ţena sa endometriozom u ET i ţena sa TFI u ST fazi postoji pozitivna udruţenost izmeĊu BPRS-ad, BPRS-wr, BPRS-hs i debljine endometriuma (p=0,002, p=0,027, p=0.041). U ET i ST fazi manji distres dobijen je u trudnih u poreĊenju sa netrudnima (p=0.049, p=0.010 ponaosob). Zaključci: Ţene sa PCOS u VTO proceduri pokazuju porast depresije, stresa i anksioznosti...

Objective: The aim of the study was to evaluate psychological problems in infertile women and to analyze interaction between psychological-ovarian and psychological-uterine relationships. Methods: Prospective cohort study analyzed 120 infertile women. Study population encompassed 29 women with PCOS, 38 with unexplained infertility (UI), 38 with endometriosis and 15 with tubal infertility (TFI). BPRS-19 scale was applied to evaluate psychopathological factors, HAMA-14 scale to measure anxiety and DASS-21 scale to analyze distress. The scales were applied in each woman at the beginning and at the end of ovarian stimulation (COH), 30 minutes before operation (OPU), at the day of embryo transfer (ET), and at the day of pregnancy tests (HCG-ST). Results: IVF is associated with changes in psychological status of women. Anxious-depressive symptoms evaluated by BPRS-ad increased in the ST. This increase was in UI women from 2.03±1.92 to 2.42±1.70 (p=0.017) and in TFI women from 2.20±1:42 to 3:50±2.71 (p=0.004). In women with endometriosis BPRS-ad decreased during COH and OPU from 3:00±1.79 to 2.70±1.51. During IVF treatment we have noticed among women with UI and endometriosis the decrease of Hostility (BPRS-hs), from 0.68±0.89 to 0.36±0.68 (p=0.000), and from 0.66±1.02 to 0.23±0.50 (p=0.001), and Thinking-Disorder (BPRS-td) from 0.45±1.01 to 0.11±0.40 (p=0.011) and from 0.47±0.77 to 0.21±0.48 (p=0.030). Among PCOS women the increase in Anxyeti HAMA-14 was found from 4.59±3.65 to 8.73±3.62 (p<0.0001). Among TFI women the increase in stress (DASS-s) was found from 4.13±.70 to 4.79±4.69, p=0.006. Conversely, decrease in stress was found in women with PCOS from 4.21±3.26 to 2.86±3.19, p=0.029, with UI from 4.32±3.68 to 3.08±4.07, p=0.019 and with endometriosis from 5.08±3.32 to 3.21±3.49, p=0.011 during ET. In women with UI, during COH, atretic oocytes and Embryo good quality were positively correlated with distress and withdrawal-retardation (BPRS-wr) (p=0.018, p=0.006)...