PSYCHOLOGICAL CONSEQUENCES OF ASSISTED REPRODUCTIVE TECHNOLOGY FAILURE

这项研究将是第一项关于辅助生殖技术（ART）失败（特别是反复失败）相关心理后果的大型前瞻性研究。尽管人们对ART失败如何影响个人和夫妇非常关注，但目前的研究文献包含的差距比答案更多。这项研究的具体目标是：1）确定心理和婚姻痛苦的程度以及临床诊断的精神障碍的程度（“心理结果”），2）将ART失败后仍然没有孩子的患者及其丈夫的心理结果与经历其他治疗和儿童相关结果的患者及其丈夫的心理结果进行比较，包括不寻求ART，收养孩子，和有一个孩子作为治疗的结果和3）使用能力压力模型来预测哪些患者和丈夫将经历不良的心理结果，以应对ART失败，使这些人可以有针对性的支持性干预措施。一个由620对夫妇组成的队列将接受ART医生对其第一个ART周期的初步咨询，并在随后的18个月内进行随访，无论他们的治疗轨迹如何。所有队列成员将在任何ART尝试之前参加初步访谈，在此期间将评估个人脆弱性因素。然后，所有队列成员将在第一个周期后两周参加结果后访谈（如果启动），并在6个月、12个月和18个月后进行随访访谈，在此期间将评估心理结果。那些在初次面谈后3个月内没有开始ART的人将在6个月、12个月、18个月后重新面谈。这项研究的结果将指导使用和考虑ART的夫妇的评估和干预方案的制定。

The proposed research will be the first large prospective study of the psychological consequences associated with failure (particularly repeated failure) of assisted reproductive technologies (ARTs). Although there has been much concern about how ART failures affect individuals and couples, the current research literature contains more gaps than answers. The specific aims of this research are to: 1) determine the extent of psychological and marital distress and of clinically diagnosable psychiatric disorders ("psychological outcomes") in patients and their husbands following ART failure(s), 2) compare the psychological outcomes of patients and their husbands who remain childless after ART failure(s) to those who experience other treatment and child-related outcomes, including not pursuing ART, adopting a child, and having a child as a result of treatment and 3) use a vulnerability-stress model to predict which patients and husbands will experience poor psychological outcomes in response to ART failure(s) so that those individuals can be targeted for supportive interventions. A cohort of 620 couples seeing an ART physician for an initial consultation for their first ART cycle will be interviewed and followed over the subsequent 18 month period regardless of their treatment trajectory. All cohort members will participate in an initial interview prior to any ART attempts during which individual vulnerability factors will be assessed. All cohort members will then participate in a post-results interview two weeks after their first cycle if one is initiated, and follow- up interviews 6, 12, and 18 months later, during which psychological outcomes will be assessed. Those not initiating ARTs within 3 months of the initial interview will be re-interviewed 6, 12, 18 months later. The findings of this study will guide the development of assessment and intervention protocols for couples using and considering ARTs.