Psychological Predictors, Moderators, and Mediators of Treatment Outcome Among ART Treated Women: A Prospective Study

Maria Clelia Zurlo^*Federica ValloneMaria Francesca Cattaneo Della Volta

• Universita degli Studi di Napoli Federico II, Naples, Italy

Background:The value of interfacing infertility research in the psychological and medical fields – by exploring psychological factors associated not only with the emotional adjustment to infertility experiences but also with treatment outcome – is well-recognized. Yet the branch of research crossing the respective field boundaries is still narrow, featured by mixed evidence, and often lacks adopting a valid theoretical framework to comprehensively explore/identify multiple psychological risk and protective factors associated with ART treatment outcome, so raising the need to develop further research in this promising field of reproductive health to foster a high-quality standard of care for infertile couples. Objective:Based on the Infertility-Related Stress Model (I-STRESSModel), this prospective study recruited a group of infertile women at the beginning of infertility treatment (T1) to explore and identify those psychological variables (predictors, moderating, and mediating variables) associated with Treatment Outcome (Failure/Success) collected as follow-up after four years (T2). Methods:At the beginning of infertility treatments (T1, 2019), 120 women completed self-report measures including background information (socio-demographic characteristics, type of diagnosis), Infertility-Related stressors, Coping Strategies, Couple's Dyadic Adjustment, and Psychological Health (State-Anxiety/Depression). After four years (T2, 2023), medical records were collected to gain information about Treatment Outcome (Failure/Success), duration of infertility, and number of treatment cycles. Main/Moderating/Mediating hypotheses were tested using Correlational-Analyses, Logistic-Regression-Analyses, and Hayes' Process-Tool. Results:Couple's Relationship Concern stressor, the adoption of Positive Attitude coping strategy, and perceived Couple's Dyadic Adjustment collected at T1 were significantly associated with Treatment Success at T2. Conversely, Social Concern stressor, the adoption of Avoiding coping strategy, State-Anxiety and Depression – collected at T1 – along with Duration of Infertility (>3 years) and Number of Treatment cycles (>4 cycles) – collected at T2 – were significantly associated with Treatment Failure. Duration of Infertility, Number of Treatment cycles, Couple's Dyadic Adjustment, Positive Attitude and Avoiding coping emerged as significant moderating variables. Depression played as a significant mediator in the association between Social Concern stressor and Treatment Outcome. Conclusions:Findings provided evidence on key psychological dimensions to be assessed and addressed within multidisciplinary counselling interventions to support effectively ART-treated women throughout the infertility path and reduce the risk of treatment failure.