Introduction: The aim of this prospective longitudinal study is to assess how infertile couples accept their diagnosis of infertility when they become parents after In Vitro Fertilization (IVF). The main hypothesis is that the acceptance of the infertility diagnosis helps couples to make the transition to parenthood. The focus is on the relationship between the acceptance of the infertility diagnosis, the marital satisfaction and the perceived infertility-related stress.
Materials and methods: Couples are seen during three research sessions. The data are available for: T1) N ¼ 84 couples before the beginning of their first IVF, T2) N ¼ 29 couples at the 5th month of pregnancy and N ¼ 28 couples one year after T1 when there was no pregnancy; a follow up (T3) is planned for pregnant couples when the child will be 9 months-old. At each session, the couples took part in a semi-structured interview about their history of infertility. The acceptance of the infertility diagnosis is analysed on the basis of the couples' narratives (adaptation of the "Reaction to Diagnosis Interview", Pianta & Marvin, 1992) which allow to classify the individuals as Resolved or Unresolved in relation to their infertility diagnosis. The marital satisfaction is measured with the Dyadic Adjustment Scale (Spanier, 1976) and the infertility- related stress with the Fertility Problem Inventory (Newton, Sherrard & Glavac, 1999). The hypotheses are: 1) the higher the infertility-related stress, the lower the marital satisfaction and the more problematic the diagnosis resolution would be; 2) pregnant couples should have a better resolution of the infertility diagnosis than non pregnant couples.
Results: Results presented here pertain to the research sessions T1 and T2. The first hypothesis is confirmed: before IVF, infertility-related stress and marital satisfaction are negatively correlated for women (rbP ¼2.207, P , .05) and men (rbP ¼20.312, P , 0.01); Resolved women are less stressed (F(1) ¼ 4.315, P , .05) and tend to be more satisfied than Unresolved women (F(1) ¼ 3.166, P ¼ 0.082). Resolved men are also more satisfied than Unresolved men (F(1) ¼ 3.963, P , 0.05), whereas no significant difference is observed for infertility-related stress. After unsuccessful IVF, women perceive less infertility-related stress compared to before IVF (F(1) ¼ 9.112, P , 0.01). The same trend is observed for men, but it is not statistically significant. The marital satisfaction remains stable for men and women of both groups. The second hypothesis is rejected: there is no difference between pregnant and non pregnant couples for diagnosis resolution at T2. Furthermore, the acceptance of the infertility diagnosis is higher after IVF compared to before for both groups (P , 0.05 for the pregnant group and P ¼ 0.09 for the non pregnant group, McNemar's test). This outcome is the same in case of FIV or ICSI treatment.
Conclusions: This study might allow the identification of risk factors, such as lack of marital satisfaction and/or infertility-related stress, which are linked to the non acceptance of the infertility diagnosis. The longitudinal results show that positive changes are observed between the two research sessions. This leads to the following comments: 1) despite IVF failure, women are less stressed by their infertility situation than before their first IVF; 2) marital satisfaction remains stable for women and men whether they obtained a pregnancy or not; 3) IVF failure does not seem to impede non pregnant couples to better accept their infertility diagnosis. Interestingly, it seems that diagnosis resolution is more significantly linked to variables such as marital satisfaction and infertility-related stress than to a pregnancy. The next step will be to analyse the postnatal data to follow the evolution of these variables.