Journal of Behavioral Medicine

, Volume 28, Issue 2, pp 181–190 | Cite as

Predicting Emotional Response to Unsuccessful Fertility Treatment: A Prospective Study

  • Christianne M. Verhaak
  • Jesper M. J. Smeenk
  • Andrea W. M. Evers
  • Agnes van Minnen
  • Jan A. M. Kremer
  • Floris W. Kraaimaat


The predictive value of a comprehensive model with personality characteristics, stressor related cognitions, coping and social support was tested in a sample of 187 nonpregnant women. The emotional response to the unsuccessful treatment was predicted out of vulnerability factors assessed before the start of the treatment. The results indicated the importance of neuroticism as a vulnerability factor in emotional response to a severe stressor. They also underlined the importance of helplessness and marital dissatisfaction as additional risk factors, and acceptance and perceived social support as additional protective factors, in the development of anxiety and depression after a failed fertility treatment. From clinical point of view, these results suggest fertility-related cognitions and social support should receive attention when counselling women undergoing IVF or ICSI treatment.

fertility treatment neuroticism coping stress-vulnerability models predictive study 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Abbey, A., and Holman, L. J. (1995). The role of perceived control, attributions, and meaning in members’ of infertile couples wellbeing. J. Soc. Clin. Psychol. 14: 271–296.Google Scholar
  2. Abramson, L., Seligman, M. E. P., and Teasdale, J. (1978). Learned helplessness in humans: Critique and reformulation. J. Abnorm. Psychol. 87: 49–74.Google Scholar
  3. Aldwin, C. M. (1994). Stress, coping and development; an integrative perspective, Guilford Press, New York.Google Scholar
  4. Alloy, L. B., Abramson, L. Y., Whitehouse, W. G., Hogan, M. E., Tashman, N. A., Steinberg, D. L., Rose, D. T., and Donovan, P. (1999). Depressogenic cognitive styles: Predictive validity, information processing and personality characteristics, and developmental origins. Behav. Res. Ther. 37: 503–531.Google Scholar
  5. Arrindell, W. A., Boelens, W., and Lambert, H. (1983). On the psychometric properties of the Maudsley Marital Questionnaire (MMQ): Evaluation of self-ratings in distressed and ‘normal’ volunteer couples based on the Dutch version. Pers. Indiv. Diff. 4: 293–306.Google Scholar
  6. Baram, D., Tourtelot, E., Muechler, E., and Huang, K. (1988). Psychosocial adjustment following unsuccessful in vitro fertilization. J. Psychosom. Obst. Gyn. 9: 181–190.Google Scholar
  7. Baron, R. M., and Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. J. Pers. Soc. Psychol. 51: 1173–1182.Google Scholar
  8. Beaurepaire, J., Jones, M., Thiering, P., Saunders, D., and Tennant, C. (1994). Psychosocial adjustment to infertility and its treatment: Male and female responses at different stages of IVF/ET treatment. J. Psychosom. Res. 38: 229–240.Google Scholar
  9. Beck, A. T., Rush, A. J., Shaw, B. F., and Emery, G. (1979). Cognitive therapy and depression, Guilford Press, New York.Google Scholar
  10. Berg, B. J., and Wilson, J. F. (1991). Psychological functioning across stages of treatment for infertility. J. Behav. Med. 14: 11–26.Google Scholar
  11. Boivin, J., and Takefman, J. E. (1995). Stress levels across stages of in vitro fertilization in subsequently pregnant and non pregnant women. Fertil. Steril. 64: 802–810.Google Scholar
  12. Carver, C. S., Pozo, C. P., Harris, S. D., Noriega, V., Scheier, M. F., Robinson, D. S., Ketchman, A. S., Moffat, F. L., and Kimberley, C. C. (1993). How coping mediates the effect of optimism on distress: A study of women with early stage breast cancer. J. Pers. Soc. Psychol. 65: 375–390.Google Scholar
  13. Carver, C. S., Sutton, S. K., and Scheier, M. F. (2000). Action, emotion and personality: Emerging conceptual integration. Pers. Soc. Psychol. Bull. 26: 741–751.Google Scholar
  14. Clark, L. A., Watson, D., and Mineka, S. (1994). Temperament, personality, and the mood and anxiety disorders. J. Abnorm. Psychol. 103: 103–116.Google Scholar
  15. Cohen, S., and Wills, T. A. (1985). Stress, social support van the buffering hypothesis. Psychol. Bull. 98: 310–357.Google Scholar
  16. Cook, R., Parsons, J., Mason, B., and Golombok, J. (1989). Emotional, marital and sexual functioning in patients embarking upon IVF and AID treatment for infertility. J. Reprod. Inf. Psychol. 7: 87–93.Google Scholar
  17. Costa, P. T., and McCrae, R. R. (1980). Influence of extraversion and neuroticism on subjective wellbeing: Happy and unhappy people. J. Pers. Soc. Psychol. 38: 668–678.Google Scholar
  18. Costa, P. T., Somerfield, M. R., and McCrae, R. R. (1996). Personality and coping, a reconceptualization. In Zeidner, M., and Endler, N. S. (Eds.), Handbook of Coping: Theory, Research, Applications, Wiley, New York, pp. 44–61.Google Scholar
  19. Davis, C. G., and Nolen-Hoeksema, S. (2001). Loss and meaning: How do people make sense of loss? Am. Behav. Scient. 44: 726–741.Google Scholar
  20. Domar, A. D., Zuttermeister, P. C., and Friedman, R. (1993). The psychological impact of infertility, a comparison with patients with other medical conditions. J. Psychosom. Obstet. Gynaecol. 14: 45–52.Google Scholar
  21. Edelmann, R. J. (1992). Anxiety, Theory, Research and Intervention in Clinical and Health Psychology, Wiley, Chichester.Google Scholar
  22. Epping-Jordan, J. E., Compas, B. E., Osowiecki, D. M., Oppedisano, G., Gerhardt, C., Primo, K., and Krag, D. N. (1999). Psychological adjustment in breast cancer: Processes of emotional distress. Health Psychol. 18: 315–326.Google Scholar
  23. Evers, A. W. M., Kraaimaat, F. W. Geenen, R., and Bijlsma, J. W. J. (1997). Determinants of psychological distress and its course in the first year after diagnosis in rheumatoid arthritis patients. J. Behav. Med. 20: 489–504.Google Scholar
  24. Evers, A. W. M., Kraaimaat, F. W. Geenen, R. Jacobs, J. W. G., and Bijlsma, J. W. J. (2002). Long term predictors of anxiety and depressed mood in early rheumatoid arthritis: A 3 and 5 year follow up. J. Rheumat. 29: 2327–2336.Google Scholar
  25. Evers, A. W. M., Kraaimaat, F. W., van Lankveld, W., Jongen, P. J. H., and Bijlsma, J. W. J. (2001). Beyond unfavorable thinking: The illness cognition questionnaire for chronic diseases. J. Consult. Clin. Psychol. 69: 1026–1036.Google Scholar
  26. Eysenck, H. J. (1981). A Model for Personality, Springer-Verlag, New York.Google Scholar
  27. Holahan, C. J., and Moos, R. H. (1985). Life stress and health: Personality, coping and family support in stress resistance. J. Pers. Soc. Psychol. 49: 739–747.Google Scholar
  28. Holahan, C. J., Moos, R. H., and Schaeffer, J. A. (1996). Coping, stress resistance and growth: Conceptualizing adaptive functioning. In Zeidner, M., and Endler, N. S. (Eds.), Handbook of Coping: Theory, Research, Applications, Wiley, New York, pp. 24–43.Google Scholar
  29. Hotard, S. R., McFatter, R. M., McWhirter, R. M., and Stegall, M. E. (1989). Interactive relationships on subjective well-being. J. Pers. Soc. Psychol. 57: 321–331.Google Scholar
  30. Hynes, G. J., Callan, V. J., Terry, D. J., and Gallois, C. (1992). The psychological well-being of infertile women after a failed IVF attempt: The effects of coping. Brit. J. Med. Psychol. 65: 269–278.Google Scholar
  31. Janssen, H. J. E. M., Cuisinier, M. C. J., de Grauw, C. P. H. M., and Hoogduin, C. A. L. (1997). A prospective study of risk factors predicting grief intensity following pregnancy loss. Arch. Gen. Psychiatry 54: 56–61.Google Scholar
  32. Kerlinger, F. (1975). Foundations of Behavioral Research, Holt, Rinehart and Winston, New York.Google Scholar
  33. Kremer, J. A. M., Beekhuizen, W., Bots, R. S. G. M., Braat, D. D. M., van Dop, P. A., Jansen, C. A. M., Land, J. A., Laven, J. S. E., Leerentveld, R. A., Naaktgeboren, N., Schats, R., Simons, A. H. M., van der Veen, F., and Kastrop, P. M. M. (2002). IVF resultaten in Nederland (1996–2000) [IVF results in the Netherlands (1996–2000).] Nederlands Tijdschrift voor Geneeskunde 146: 2358–2363.Google Scholar
  34. Laffont, L., and Edelmann, R. J. (1994). Perceived support and counselling needs in relation to in vitro fertilization. J. Psychosom. Obstet. Gynecol. 15: 183–188.Google Scholar
  35. Lazarus, R. S., and Folkman, S. (1984). Stress, Appraisal and Coping, Springer, New York.Google Scholar
  36. Leventhal, H., Nerenz, D. R., and Steele, D. J. (1984). Illness representations and coping with health threats. In Baum, A., Taylor, S. E., and Singer, S. E. (Eds.), Handbook of Psychology and Health, Vol. 4, Lawrence Erlbaum Associates, Hillsdale, NY, pp. 219–252.Google Scholar
  37. Litt, D. M., Tennen, H., Affleck, G., and Klock, S. (1992). Coping and cognitive factors in adatation to in vitro fertilization failure. J. Behav. Med. 15: 171–187.Google Scholar
  38. Mazure, C. M., and Greenfeld, D. A. (1989). Psychological studies of in vitro fertilization/embryo transfer paarticipants. J. in Vitro Fertil. Emb. Transf. 6: 242–256.Google Scholar
  39. Miller-Campbell, S., Dunkel-Schetter, C., and Peplau, L. A. (1991). Perceived control and adjustment to infertility among women undergoing in vitro fertilization. In Stanton, A. L., and Dunkel-Schetter, C. (Eds.), Infertility: Perspectives from stress and coping research, Plenum, New York, pp. 133–156.Google Scholar
  40. Newman, N. E., and Zouves, C. G. (1991). Emotional Experiences of in vitro fertilization participants. J. in Vitro Fertil. Emb. Transf. 8: 322–329.Google Scholar
  41. Ormel, J., and Wohlfart, T. (1991). How neuroticism, long-term difficulties, and changes in quality of life affect psychological distress: A longitudinal approach. J Pers. Soc. Psychol. 60: 744–755.Google Scholar
  42. Osowiecki, D. M., and Compas, B. E. (1999). A prospective study of coping, perceived control, and psychological adaptation to breast cancer. Cogn. Ther. Res. 23: 169–180.Google Scholar
  43. Pakenham, K. I. (1999). Adjustment to Multiple sclerosis: Application of a stress and coping model. Health Psychol. 18: 383–392.Google Scholar
  44. Penley, J. A., Tomaka, J., and Wiebe, J. S. (2002). The association of coping to physical and psychological health outcomes: A meta-analytic review. J. Behav. Med. 25: 551–603.Google Scholar
  45. Reading, A. E., Chang, L. C., and Kerin, J. F. (1989). Psychological state and coping style across an IVF treatment cycle. J. Reprod. Inf. Psychol. 7: 95–103.Google Scholar
  46. Sanderman, R., Arrindell, W. A., Ranchor, A. V., Eysenck, H. J., and Eysenck, S. B. G. (1995). Eysenck Personality Questionnaire, Noordelijk Centrum voor Gezondheidsvraagstukken, Groningen.Google Scholar
  47. Scheier, M. F., and Carver, C. S. (1985). Optimism, coping and helath: Assessment and implications of generalized outcome expectations. Health Psychol. 4: 219–247.Google Scholar
  48. Schreurs, P. J. G., Vande Willige, G., Brosschot, J. F., Tellegen, B., and Graus, G. M. H. (1993). De Utrechtse coping lijst: UCL. Handleiding [Manual of the Utrecht Coping List], Swets & Zeitlinger, Lisse.Google Scholar
  49. Smith, T. W., Christensen, A. J., Peck, J. R., and Ward, J. R. (1994). Cognitive distortion, helplessness, and depressed mood in Rheumatoid arthritis: A four year longitudinal analysis. Health Psychol. 13: 213–217.Google Scholar
  50. Spielberger, C. D. (1983). Manual for the State-Trait Anxiety Scale, Consulting Psychologists, Palo Alto.Google Scholar
  51. Stanton, A. L., Tennen, H., Affleck, G., and Mendola, R. (1992). Coping and adjustment to infertility. J. Soc. Clin. Psychol. 11: 1–13.Google Scholar
  52. Stanton, A. L., Danoff-Burg, S. Cameron, C. L., Bishop, M., Collins, C. A., Kirk, S. B., and Sworoeski, L. A. (2000). Emotionally expressive coping predicts psychological and physical adjustment to breast cancer. J. Consult. Clin. Psychol. 68: 875–882.Google Scholar
  53. Stolwijk, A. M., Hamilton, C. J. C. M., Hollanders, J. M. G., Bastiaans, L. A., and Zielhuis, G. A. (1996). A more realistic approach to the cumulative pregnancy rate after in vitro fertilization. Hum. Reprod. 11: 660–663.Google Scholar
  54. Suls, J., and Fletcher, B. (1985). The relative efficacy of avoidant and nonavoidant coping strategies: A meta analysis. Health Psychol. 4: 249–288.Google Scholar
  55. Templeton, A., Morris, J. K., and Parslow, W. (1996). Factors that effect outcome of in vitro fertilization treatment. Lancet 348: 1402–1406.Google Scholar
  56. Terry, D. J., and Hynes, G. J. (1998). Adjustment to a low-control situation: Reexamining the role of coping responses. J. Pers. Soc. Psychol. 74: 1078–1092.Google Scholar
  57. Valentiner, D. P., Holahan, C. J., and Moos, R. H. (1994). Social support, appraisals of event controllability and coping: An integrative model. J. Pers. Soc. Psychol. 66: 1094–1102.Google Scholar
  58. Van Dam-Baggen, R., and Kraaimaat, F. W. (1992). De inventarisatielijst Sociale betrokkenheid (ISB): een zelfbeoordelingslijst om sociale steun te meten [The Inventarisation inventory to measure sociale integration: A self report inventory to assess social support]. Gedragstherapie 25: 27–45.Google Scholar
  59. Vanderploeg, H. M., Defares, P. B., and Spielberger, C. D. (2000). Handleiding bij de Zelfbeoordelingsvragenlijst: een Nederlandse bewerking van de Spielberger State Trait Anxiety Inventory [Dutch manual for the Spielberger state and trait anxiety inventory], Swets & Zeitlinger, Lisse.Google Scholar
  60. Verhaak, C. M., Smeenk, J. M. J., Eugster, A., van Minnen, A., Kremer, J. A. M., and Kraaimaat, F. W. (2001). Stress and marital satisfaction among women before and after their first cycle of in vitro fertilization and intracytoplasmic sperm injection. Fertil. Steril. 76: 525–531.Google Scholar
  61. Vinck, J., Wels, G., Arickx, M., and Vinck, S. (1998). Optimisme gemeten [Assessment of Optimism]. Gedrag en Gezondheid 26: 79–90.Google Scholar
  62. Visser, A. P., Haan, G., Zalmstra, H., and Wouters, I. (1994). Psychological aspects of in vitro fertilization. J. Psychosom. Obstet. Gynecol. 15: 35–43.Google Scholar
  63. Watson, D., and Clark, L. A. (1984). Negative affectivity: The disposition to experience aversive emotional states. Psychol. Bull. 96: 465–490.Google Scholar
  64. Westbrook, M. T. (1979). A classification of coping behavior based on multidimensional scaling of similarity ratings. J. Clin. Psychol. 35: 407–410.Google Scholar

Copyright information

© Springer Science + Business Media, Inc. 2005

Authors and Affiliations

  • Christianne M. Verhaak
    • 1
    • 3
  • Jesper M. J. Smeenk
    • 2
  • Andrea W. M. Evers
    • 1
  • Agnes van Minnen
    • 1
    • 3
  • Jan A. M. Kremer
    • 2
  • Floris W. Kraaimaat
    • 1
  1. 1.Department of Medical PsychologyUniversity Medical Center St. RadboudThe Netherlands
  2. 2.Department of Obstetrics and GynecologyUniversity Medical Center St. RadboudThe Netherlands
  3. 3.UMC-St. Radboud435 Medical PsychologyNijmegenThe Netherlands

Personalised recommendations