Onm-7: Safe Pregnancy after ART

Background: The transition to parenthood is a period of intra- and interpersonal changes and may bring up unexpected problems. The first child's birth has a significant effect on marital relations because the relations change from dyadic to triadic. In general, marital relationships seem to be especially vulnerable during the transition to parenthood, and several studies have revealed a decline in marital satisfaction and an increase in marital conflict among parents. However, during recent years, it has been shown that there is a great variability in the way the marital relations change during transition to parenthood. It has been suggested that babies do not create distress between couples nor bring couples closer together but rather amplify already existing difficulties, which can be seen as deterioration of the relationship. Comparisons of marital relations between couples who conceived either spontaneously or via ART have shown great variation. Couples with successful ART have been reported to show greater marital cohesion (e.g. a mutual feeling of being a couple, sharing things and ideas), less marital distress, to experience their relationships with their partners in a more positive way and to have more stable relationships than couples experiencing spontaneous pregnancy. Materials and Methods: During recent years, the development of assisted reproduction technique (ART) methods has made parenting possible for a substantial number of infertile couples. For the majority of infertile couples successful treatment outcome results in improvement in emotional wellbeing, but less is known about how a previously infertile couple, as a unit, is affected during the transition to parenthood. Social, psychological and infertility-related issues as well as gender may be of relevance in determining the impact of infertility on marital relationships. The ability to reproduce is intimately tied to sexuality, self-image and self-esteem. Some studies have revealed no difference in marital satisfaction between ART and control couples and between ART couples and those couples who had children through adoption. In contrast, there are also reports of more marital conflicts among ART parents than controls. Results: Generally, mental health problems during the transition to parenthood are also affected by various social factors; for example low economic status, stressful life events and lack of social support from spouse, friends or family are known to be risk factors for postpartum depression. In addition, child-related factors such as health of the child and worry about the child are important determinants of parental mental health Differences in the experience of pregnancy and birth after ART compared to spontaneous conception are of interest for the developmental psychologist. Individual experiences with infertility in those affected have often led to states of anxiety, low self-esteem and low confidence, but this does not seem to persist in pregnancy. Higher anxiety symptoms occur primarily. Increased symptoms of anxiety are found in pregnant women and their partners who have undergone the high stress of infertility. Pregnant women after ART are less concerned about the physical changes during pregnancy. Couples with previous ART mediated more harmony on the first impression, however, on the other hand being less communicative. A long duration of infertility (7 years or more) was associated with the expression of a large birth anxiety. Postpartum disorders such as depression are influenced by the interaction of several risk factors, particularly prematurity, multiple births and caesarean sections reinforce the emotional problems. However, where fears about the fetal survival are higher, postpartum difficulties are greater and self-esteem is lower after ART. Fears about the fetal survival and postnatal educational difficulties were greater after the application of assisted reproduction and the self-esteem lower. Pregnancy and parenthood after assisted reproduction may be idealized and is associated with a difficult transition to parenthood. Conclusion: It has been presumed that pregnancy and parenthood experienced after infertility and assisted conception will be unproblematic and gratifying. However, theorized that past infertility and ART conception might be associated with elevated anxiety about pregnancy loss; delayed mother-infant attachment; diminished maternal confidence; hyper vigilant and overprotective parenting and idealized expectations of parenting capacity and the infant.