妇女在体外受精—胚胎移植过程中焦虑和抑郁症状及其相关因素

发布时间：2018-05-04 23:13

本文选题：不育 + 女(雌)性生殖技术　；参考：《安徽医科大学》2007年硕士论文

【摘要】： 目的了解安徽省某医院生殖中心不孕症妇女在接受体外受精-胚胎移植治疗期间的焦虑、抑郁症状及其在不同治疗阶段的变化趋势,比较不同治疗阶段焦虑、抑郁症状与应付方式、婚姻调适的关系,探讨与焦虑、抑郁症状相关联的因素,为开展不孕妇女心理健康促进提供依据。方法选取2006年5月28日～2006年11月28日期间在安徽省某医院生殖中心接受体外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)或卵胞浆内单精子注射(intracytoplasmic sperm injection,ICSI)治疗的225例不孕症妇女为研究对象,采用匿名方式进行问卷调查。分别在不孕症妇女接受治疗过程中不同阶段的4个治疗时点进行调查,对过去一周的焦虑和抑郁症状进行回顾性自评。其中Ⅰ期在治疗的开始;Ⅱ期为胚胎移植前的1～2小时;Ⅲ期为胚胎移植后9～10天,即移植后等待期;Ⅳ期为胚胎移植后20天,即移植后结局期。Ⅰ期有225名不孕症妇女接受调查,Ⅱ期、Ⅲ期和Ⅳ期的调查人数均为212例。问卷调查内容包括不孕症妇女的社会人口学特征、健康状况、不孕症因素、既往治疗情况、本次治疗过程中的情况、焦虑自评量表(SAS)、流调中心用抑郁量表(CES-D)、应付方式问卷、Locke-Wallace婚姻调适测定等。使用焦虑自评量表(SAS)对调查对象在治疗过程Ⅰ～Ⅳ期进行焦虑症状评定,以粗分≥40分界定为有焦虑症状;使用流调中心用抑郁量表(CES-D)对调查对象在治疗过程Ⅰ～Ⅳ期进行抑郁症状评定,粗分≥20分界定为有抑郁心理症状。分析不孕症妇女的社会人口学特征、不孕症情况;IVF-ET/ICSI治疗4个时期的焦虑和抑郁症状检出率、症状评分及其变化趋势;用χ2检验分析社会人口学因素、不孕症及既往治疗因素、本次治疗中的因素与4个治疗时期的不孕妇女的焦虑和抑郁症状关系;用t检验比较在4个治疗时期应付方式的6个因子分、婚姻调适总分与焦虑、抑郁症状的关系;多元Logistic回归分析影响4个治疗时期不孕妇女焦虑、抑郁症状的相关因素。结果225名接受调查的不孕症妇女的年龄为21~44岁,平均30.9岁;人均年收入平均为2.2万元;受教育程度为初中者占35.6%,高中及以上占64.4%;婚龄最长18年,平均6.1年;长期居住城市者为75.6%。不孕症持续时间最长为17.0年,平均5.3年;不孕症既往治疗时间最长为14.0年,平均3.2年;引起不孕症的因素中男方因素占14.6%,女方因素占54.2%,双方因素占27.8%,不明原因占3.3%;接受IVF-ET/ICSI的次数中第1次者占84.0%,第2次者占12.0%,第3次者占4.0%;既往不孕症治疗费用平均1.9万元。本研究结果显示,不孕症妇女在治疗的4个时期的焦虑症状检出率分别为15.1%,17.5%,18.4%, 25.9%;抑郁症状检出率分别为32.1%,27.4%,30.2%,47.2%;焦虑和抑郁症状共患率分别为:9.4%,12.7%,12.7%,25.0%;Ⅳ期(移植后结局期)的焦虑、抑郁症状检出率和焦虑、抑郁共患率均高于Ⅰ期(治疗开始期)、Ⅱ期(移植前期)和Ⅲ期(移植后等待期),差异有统计学意义。4个治疗时期的焦虑和抑郁症状得分均存在正相关,其中Ⅳ期的焦虑和抑郁症状评分呈高度正相关,表明各期的焦虑和抑郁症状存在伴随现象,Ⅳ期的焦虑和抑郁症状伴随现象最为明显。在Ⅰ期(治疗开始)时,人均年收入低于1.8万元妇女焦虑症状高于年收入大于1.8万元者;不孕症妇女的抑郁症状检出率在受教育程度为初中、人均年收入低于1.8万元、婚龄10年以上、居住农村者分别高于受教育程度为高中及以上、人均年收入1.8万元以上、10年以下婚龄、城市居住者;不孕症持续时间为5.5年以上、既往治疗费用2万元以上、不孕原因由女方和夫妇双方因素引起的妇女焦虑症状均较高,差异有统计学意义;多元Logistic回归分析结果显示,人均年收入低于1.8万元和不孕症既往治疗费用2万元以上妇女的焦虑症状危险性增加到3倍;婚龄在10年以上妇女抑郁症状的危险性是婚龄10年及以下者的7倍,居住城市的妇女有抑郁症状的危险性是居住农村者的1/3。在Ⅱ期(胚胎移植前期)的不孕症妇女焦虑和抑郁自评结果表明,居住农村妇女抑郁症状高于居住城市者;焦虑和抑郁症状与受教育程度、人均年收入、婚龄等因素未发现统计学关联。男方因素引起不孕症的妇女抑郁症状高于由女方和双方因素引起者,受精率低于74%和卵裂率低于80%者抑郁症状检出率较高,随着IVF-ET/ICSI妇女在治疗过程中发生卵巢过度刺激综合征(ovarian hyperstimulation syndrome, OHSS)的程度加重,焦虑和抑郁症状检出率升高。多元Logistic回归分析结果显示,发生中度OHSS者有抑郁和焦虑症状危险性是无OHSS者的2～3倍;高龄、既往治疗时间长和本次促排卵用药时间长增加焦虑症状的危险性;人均年收入高、本次促排卵用药时间长增加抑郁症状的危险性;卵裂率低于80%者发生抑郁症状的风险是卵裂率在80%及以上者约2倍。 Ⅲ期(移植后等待期)妇女的焦虑和抑郁症状与社会人口学特征未发现统计学关联;既往治疗时间低于2.5年的妇女抑郁症状较高;本次治疗中受精率低于74%、卵裂率低于80%和不知道自己移植胚胎个数者抑郁症状检出率较高,随着IVF-ET/ICSI妇女在治疗过程中发生OHSS的程度加重,焦虑和抑郁症状检出率升高。多元Logistic回归分析结果显示,发生中度OHSS者有抑郁和焦虑症状危险性是无OHSS者的2.5倍;人均年收入高、本次促排卵用药时间长增加焦虑症状的危险性;不孕症持续时间长和IVF-ET/ICSI妇女抑郁症状危险性降低有关;卵裂率高于80%和知道移植胚胎个数发生抑郁症状的危险性是卵裂率低于80%和不知道移植胚胎个数者的0.3和0.4倍。在Ⅳ期(移植后结局期),居住在农村的不孕症妇女的焦虑症状高于居住城市者,既往治疗时间低于2.5年的妇女焦虑症状较高,拥有冷冻胚胎和生化妊娠者的焦虑和抑郁症状检出率较低,差异有统计学意义。冷冻胚胎数目多的妇女抑郁症状检出率降低。多元Logistic回归分析结果显示,IVF-ET/ICSI治疗次数每增加1次,焦虑症状的危险性增加到2.6倍;既往治疗时间长的妇女焦虑和抑郁症状降低,已明确生化妊娠妇女发生焦虑和抑郁症状的危险性约是未妊娠者的1/4,冷冻胚胎数目多和抑郁症状降低与拥有冷冻胚胎和焦虑症状危险性的降低有关。本研究的单因素分析和多元Logistic回归分析的结果均显示,不孕症妇女在IVF-ET/ICSI治疗的4个时期中,随着解决问题因子分升高,不孕症妇女在Ⅲ期(移植后等待期)发生焦虑症状的危险性降低,在Ⅰ期(治疗开始前期)和Ⅳ期(移植后结局期)出现抑郁症状的危险性减少;求助因子分增加与Ⅰ期的抑郁症状降低有关;Ⅱ期(移植前期)和Ⅳ期的焦虑症状与Ⅰ期、Ⅱ期和Ⅲ期的抑郁症状危险性均随着自责因子分增加而显著升高;而幻想因子分的增加与Ⅲ期和Ⅳ期的焦虑、抑郁症状危险性升高均显著相关联。不孕症妇女的婚姻调适评分增加与Ⅱ期和Ⅲ期出现抑郁症状的危险性降低有关联。结论不孕症妇女在IVF-ET/ICSI治疗4个阶段均普遍存在焦虑和抑郁症状,尤其是Ⅳ期最为多见,焦虑与抑郁症状存在较高的共患现象。居住农村、婚龄10年以上、不孕症持续时间长、治疗费用高于2万元、本次治疗发生中度OHSS、卵裂率低于80%、冷冻胚胎情况、生化妊娠以及采取的应付方式和婚姻调适状况,分别与不同治疗阶段的焦虑和抑郁症状相关。应关注IVF-ET/ICSI治疗妇女的心理健康状况,通过多途径的方法改进应付方式、促进社会与家庭支持,降低IVF-ET/ICSI治疗妇女的心理健康问题的发生。
[Abstract]:Objective to understand the anxiety, depressive symptoms and changes in different treatment stages of infertility women during the treatment of in vitro fertilization and embryo transfer in the reproductive center of a hospital in Anhui Province, and to compare the anxiety, depressive symptoms and coping styles in different treatment stages, the relationship between the marital adjustment and the factors associated with anxiety and depression. To provide basis for promoting mental health of infertile women.
Methods from May 28, 2006 to November 28, 2006, 225 women with infertility were treated with in vitro fertilization and embryo transfer, IVF-ET, or intracytoplasmic sperm injection (intracytoplasmic sperm injection, ICSI) in a hospital reproductive center of Anhui province. A questionnaire survey was conducted on 4 points of treatment at different stages of the treatment of infertility women, and a retrospective review of the anxiety and depressive symptoms of the past week was carried out. The first stage was at the beginning of the treatment, the second stage was 1~2 hours before the embryo transfer, and the third stage was 9~10 days after the embryo transfer, that is, the waiting period after the transplantation; Stage IV was 20 days after the embryo transfer, that is, the outcome period after transplantation. In phase I, 225 women with infertility were investigated, and 212 cases were investigated in stage II, stage III and IV. The questionnaire included the social demographic characteristics of infertility women, health status, infertility factors, both treatment and anxiety. The rating scale (SAS), the Depression Scale (CES-D), the coping style questionnaire and the Locke-Wallace marriage adjustment were used in the flow center. The anxiety symptom was evaluated by the self rating Anxiety Scale (SAS), and the anxiety symptoms were defined as greater than 40, and the Depression Scale (CES-D) was used in the center of flow modulation. The depressive symptoms were evaluated in stage I to IV of the treatment process. The gross score was more than 20 points as depressive psychological symptoms. The social demography characteristics of infertility women and infertility were analyzed; the prevalence of anxiety and depression in the 4 periods of IVF-ET/ICSI treatment, the symptom score and the trend of change, and the analysis of social demography factors and infertility were analyzed by the chi chi 2 test. The factors of disease and previous treatment were related to the anxiety and depression symptoms of infertile women in the 4 period of treatment; the t test was used to compare the 6 factors of coping styles in the 4 period of treatment, the relationship between the total score of the marriage adjustment and the anxiety and the depressive symptoms, and the analysis of the multiple Logistic return to the anxiety of the infertile women during the treatment period. Related factors of depression symptoms.
Results the age of 225 women with infertility was 21~44 years, an average of 30.9 years, average annual income of 22 thousand yuan per capita, 35.6% for junior high school students, 64.4% for high school and above, 18 years for marriage, and 6.1 years on average. The longest duration of 75.6%. infertility in long lived cities was 5.3 years, with an average of 5.3 years of infertility. The longest time for treatment was 14 years, an average of 3.2 years. Among the factors causing infertility, male and female factors accounted for 14.6%, women accounted for 54.2%, both factors accounted for 27.8%, and 3.3% of unexplained reasons were 27.8%, 84% in the number of IVF-ET/ICSI, 12% and third in 12%, and third in 4%, and the average cost of infertility treatment was 19 thousand.
The results showed that the rate of anxiety symptoms in the 4 periods of the treatment of infertility was 15.1%, 17.5%, 18.4%, 25.9%, and the rate of depressive symptoms was 32.1%, 27.4%, 30.2%, 47.2%, respectively: 9.4%, 12.7%, 12.7%, 25%; the anxiety, the detection rate of depressive symptoms and the focus in stage IV (post transplant). The prevalence of depression was higher than phase I (initial stage of treatment), stage II (pre transplant) and stage III (post transplant waiting period). There was a positive correlation between the scores of anxiety and depressive symptoms during the period of.4 treatment. The scores of anxiety and depressive symptoms in stage IV were highly positive, indicating that the symptoms of anxiety and depressive symptoms at all stages were associated with each other. The incidence of anxiety and depression in stage IV is the most obvious.
At the first stage (treatment start), the annual income per capita was less than 18 thousand yuan in women's anxiety symptoms higher than that of the annual income of more than 18 thousand yuan; the prevalence rate of depressive symptoms in women with infertility was lower than 18 thousand yuan per capita, and the age of marriage was over 10 years. More than 18 thousand yuan, more than 10 years of marriage age, urban residents; infertility duration of more than 5.5 years, previous treatment costs more than 20 thousand yuan, the reasons for infertility caused by women and the couple factors caused by women's anxiety symptoms are higher, the difference is statistically significant; multivariate Logistic regression analysis results show that per capita income is less than 18 thousand yuan per capita. The risk of anxiety symptoms of women with past 20 thousand yuan of infertility increased to 3 times, and the risk of depressive symptoms for women aged more than 10 years was 7 times that of those who were married 10 years and below. The risk of depressive symptoms for women living in urban areas was the 1/3. of rural residents.
The self evaluation results of anxiety and depression in women with infertility in stage II (early embryo transfer) showed that the depression symptoms of women living in rural areas were higher than those in urban residents. There was no statistical correlation between anxiety and depression symptoms and factors such as the degree of education, annual income per capita, marriage age and so on. The positive rate of depressive symptoms was higher than that of 74% and the rate of cleavage rate below 80%. With the increase of the degree of ovarian hyperstimulation syndrome (ovarian hyperstimulation syndrome, OHSS) in the treatment of IVF-ET/ICSI women, the prevalence of anxiety and depression was increased. The results of multivariate Logistic regression analysis showed that hair was found. The risk of depression and anxiety in patients with moderate and moderate OHSS was 2~3 times as high as that of those without OHSS; older age, longer duration of treatment and longer time for oovulation increased the risk of anxiety symptoms; per capita annual income was high, the time of ovulating for this time increased the risk of depressive symptoms; the rate of cleavage was lower than the risk of depressive symptoms of 80%. The rate of cleavage is about 2 times more than that of 80% or more.
There was no statistical correlation between the anxiety and depressive symptoms of women in stage III (post transplant waiting period) and social demography characteristics; women who had a previous treatment time of less than 2.5 years had higher depressive symptoms. The rate of fertilization was lower than 74% in this treatment, the rate of cleavage was lower than 80% and the rate of depressive symptoms was higher in those who did not know the number of their own transplanting embryos, with IVF-ET/ICSI The degree of OHSS in the treatment of women was aggravated and the prevalence of anxiety and depressive symptoms increased. The multivariate Logistic regression analysis showed that the risk of depression and anxiety in those with moderate OHSS was 2.5 times as high as those without OHSS; the per capita annual income was higher, the risk of prolonged anxiety in this period of ovulation induction increased the risk of anxiety, and the duration of infertility persisted. The length of the interval was associated with a decrease in the risk of depressive symptoms in IVF-ET/ICSI women; the cleavage rate was higher than 80% and the risk of depressive symptoms of the number of transplanted embryos was 0.3 and 0.4 times the cleavage rate less than 80% and those who did not know the number of transplanted embryos.
The anxiety symptoms of infertile women living in rural areas were higher than those in urban residents, with higher anxiety symptoms for women who had been treated for less than 2.5 years, and the rates of anxiety and depression with frozen embryos and biochemical pregnancies were lower, the difference was statistically significant. Women with a large number of frozen embryos were depressed. The multiple Logistic regression analysis showed that the risk of anxiety and depression in women with a long period of treatment increased by 1 times, and the risk of anxiety and depression decreased. The risk of anxiety and depressive symptoms in women who had been treated for a long period of time was about the 1/4 of the non pregnant women and the number of frozen embryos. Deb and depression were associated with decreased risk of frozen embryos and anxiety symptoms.
The results of single factor analysis and multiple Logistic regression analysis in this study showed that in the 4 periods of IVF-ET/ICSI treatment in women with infertility, the risk of anxiety symptoms was reduced in stage III (the waiting period after transplantation) with the increase of the problem factor, and in phase I (initial stage of treatment) and stage IV (post transplant outcome period). The risk of depressive symptoms decreased; the increase in help factor scores was associated with the depression of stage I; the risk of anxiety in stage II (pre transplant) and stage IV and the risk of depressive symptoms in stage I, stage II and stage III increased significantly with the increase of self blame factors; and the increase of fantasy factor and anxiety in stage III and IV, depression There was a significant association between risk elevation and increased marital adjustment score in women with infertility.
Conclusion there are general symptoms of anxiety and depression in the 4 stages of IVF-ET/ICSI treatment for women with infertility, especially the most common in stage IV, and there is a higher codevelopment in anxiety and depressive symptoms. Living in the countryside, the age of marriage is more than 10 years, the duration of infertility is longer and the cost of treatment is higher than 20 thousand yuan. This treatment has moderate OHSS, the cleavage rate is lower than 80%, cold and cold. The conditions of frozen embryos, biochemical pregnancies, coping styles and marital adjustment are related to the symptoms of anxiety and depression at different stages of treatment. Attention should be paid to the psychological health of IVF-ET/ICSI in the treatment of women, to improve coping styles, to promote social and family support and to reduce the psychology of IVF-ET/ICSI in the treatment of women. The occurrence of health problems.

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2007
【分类号】：R714.8;R395

【参考文献】