Human Reproduction, Vol.24, No.3 pp. 524–529, 2009
Advanced Access publication on December 9, 2008 doi:10.1093/humrep/den438
ORIGINAL ARTICLE Psychology and counselling
Personality and intrapersonal and
interpersonal functioning of women
starting their first IVF treatment
B. Lowyck 1,3, P. Luyten1, J. Corveleyn1, T. D’Hooghe1,2,
and K. Demyttenaere 1,2
1
Department of Psychology, University of Leuven, Tiensestraat 102, 3000 Leuven, Belgium 2University Hospital Gasthuisberg,
Leuven, Belgium
3
Correspondence address. Tel: þ32-16-32-59-92; Fax: þ32-16-32-59-20; E-mail: [email protected]
background: IVF treatment involves a reassessment of issues concerning autonomy and relatedness. This study aims to extend
prior studies on the psychological impact of IVF/ICSI by studying the association between the personality dimensions of Self-Criticism
and Dependency with the psychological well-being and quality of the couple relationship for women starting their first IVF treatment.
methods: This is a cross-sectional study of 68 women starting their first IVF treatment at the Leuven University Fertility Centre of the
University of Leuven, Belgium. All women were administered validated self-report measures assessing Self-Criticism and Dependency, negative life events, psychological well-being, relationship satisfaction, and relationship and sexual concerns. Pearson’s correlation coefficients
were calculated between all study variables, followed by four separate hierarchical multiple regression analyses for psychological wellbeing, relationship satisfaction, and relationship and sexual concerns.
results: High Self-Criticism was negatively associated with psychological well-being (r ¼ 20.63, P , 0.001) and relationship satisfaction
(r ¼ 20.29, P , 0.05), and positively associated with relationship (r ¼ 0.39, P , 0.01) and sexual (r ¼ 0.37, P , 0.01) concerns. High
Dependency was negatively associated with psychological well-being (r ¼ 20.30, P , 0.05), not significantly associated with relationship satisfaction and relationship concerns, and positively related to sexual concerns (r ¼ 0.31, P , 0.05).
conclusions: This cross-sectional study suggests that the personality dimensions of Self-Criticism and Dependency may enhance our
understanding of the psychological well-being and quality of the couple relationship of women starting their first IVF treatment. However,
further prospective research on this topic is needed.
Key words: fertility problems / IVF / psychological well-being / Self-Criticism / Dependency
Introduction
Many studies have demonstrated that having fertility problems as well
as planning and following a medical treatment for these problems,
such as IVF, may affect different aspects of the psychological functioning of the individuals involved (Benazon et al., 1992; Edelmann et al.,
1994; Slade et al., 1997; Demyttenaere et al., 1998; Amir et al.,
1999; Verhaak et al., 2001; Berghuis and Stanton, 2002; Lord and
Robertson, 2005; Peterson et al., 2006; Schmidt, 2006).
In this context, several authors have pointed out that dealing with fertility issues is a challenging period, especially for women, bringing issues
of identity, autonomy, competence and control on the one hand, as well
as relationships with significant others and one’s own body on the other
hand, to the fore (Greil, 1997). In other words, dealing with fertility
issues may require a reassessment of both one’s own identity and
feelings of autonomy, and one’s relationship with one’s own body and
with significant others (Besser and Priel, 2003; Raphael-Leff, 2003).
These issues of both self-definition and relatedness are central in
the theoretical framework formulated by Blatt (see Blatt and Blass,
1996; Blatt, 2004). According to Blatt (Blatt and Blass, 1996; Blatt,
2004), normal personality organization involves a complex and interactive dialectical process between two developmental lines: (i) the
self-definition line, which refers to the development of increasingly differentiated, integrated and an essentially positive sense of self, and (ii)
the relatedness line, which normally leads to the capacity to form
mature, complex and satisfying interpersonal relationships. Blatt
coined the notions of Self-Criticism and Dependency to refer to maladaptive expressions of self-definition and relatedness, respectively
(Blatt and Blass, 1996; Blatt, 2004). Self-Criticism involves excessive
self-evaluative concerns combined with a strong emphasis on high
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525
IVF, distress and couple relationship
personal standards at the expense of interpersonal relationships.
Dependency is characterized by preoccupation with interpersonal
relationships and concerns about obtaining reassurance and love, at
the expense of developing a clear and stable self-concept (Blatt and
Zuroff, 1992; Blatt, 2004). Hence, as going through IVF treatment
involves a reassessment of issues concerning both autonomy and relatedness, Blatt’s theoretical framework provides a clear theory-driven
approach to study women’s need to reassess these issues, particularly
women characterized by high levels of Self-Criticism and Dependency.
The more so because Blatt and Blass (1996) have situated the
development of self-definition and relatedness within the psychosocial
developmental model of Erikson (1963), who described development
as involving a linear series of eight hierarchical stages. Of special interest to our study are the adult stages of intimacy and generativity. Intimacy refers to the task of committing oneself to a close, intimate,
long-term relationship with another person and is usually situated in
early adulthood (Snarey, 1993). This stage of intimacy leads into and
thus is followed by the subsequent stage of generativity (Erikson,
1963; Snarey, 1993), which includes biological generativity (i.e. being
procreative) and parental generativity (i.e. care for offspring). According to Blatt and Blass (1996), in normal development, the stages of intimacy and generativity are characterized by an integration of, and
balance between, self-definition and relatedness. Maladaptive development, in contrast, would be characterized by an overemphasis on one
of these developmental lines to the neglect of the other.
A large number of studies in clinical and non-clinical populations
have consistently shown that both Self-Criticism and Dependency
are negatively related to psychological well-being (Blatt, 2004).
Further, research has shown that high Self-Criticism generally is negatively associated with couple functioning, while Dependency incorporates both positive (e.g. showing more affective behaviour) and negative
(e.g. having a claiming relational style) aspects for the couple relationship and is therefore often unrelated to relationship satisfaction
because these positive and negative consequences cancel each other
out (Mongrain et al., 1998; Vettese and Mongrain, 2000; Luyten
et al., 2005).
In addition, similarly, a growing number of studies have investigated
the role of Self-Criticism and Dependency within the domain of the
transition to parenthood, showing that Self-Criticism has a negative
impact on both intrapersonal and interpersonal functioning in the transition to parenthood, whereas Dependency seems to incorporate
both aspects of resilience and vulnerability in early parenthood
(Besser and Priel, 2003; Vliegen et al., 2006; Besser et al., 2007).
Following this line of reasoning, we therefore wanted to investigate
the role of the personality factors of Self-Criticism and Dependency
for women dealing with fertility issues and starting their first IVF/
ICSI treatment. This approach could not only substantially further
our understanding of how women deal with fertility problems and
their treatment, but also widen the psychological perspective on fertility problems and IVF treatment, by situating these in a broader model
of adult psychological development across the life span (Snarey, 1993;
Blatt and Blass, 1996; Blatt, 2004).
Therefore, the primary aim of this study was to investigate how the
personality dimensions of Self-Criticism and Dependency can further
our understanding of the psychological well-being and the quality of
the couple relationship of women starting their first IVF/ICSI treatment. In addition, we also wanted to overcome several
methodological limitations of previous studies in this domain
(Benazon et al., 1992; Peterson et al., 2006; Schmidt, 2006). First,
we measured the quality of the couple relationship in a multidimensional way, using a measure of general relationship satisfaction
as well as capturing the specific relationship and sexual concerns of
women starting their first IVF/ICSI treatment. Second, we investigated
whether personality was related to psychological well-being and
relationship functioning over and above possible covariates, such as
duration of fertility problems and number of prior treatments. In
addition, we also controlled for other negative life stressors experienced in the previous 6 months (e.g. death of a family member)
that may affect psychological well-being and the quality of the
couple relationship (Schneider and Forthofer, 2005).
The hypotheses of our study were the following.
(i) Both Self-Criticism and Dependency were expected to be negatively associated with the psychological well-being of women
starting their first IVF/ICSI treatment, even when controlling
for demographical variables, fertility-related factors and other
negative life events.
(ii) In line with previous studies in other samples, Self-Criticism was
expected to be negatively related and Dependency to be unrelated to general relationship satisfaction.
(iii) Both Self-Criticism and Dependency were expected to be positively associated with relationship and sexual concerns.
Materials and Methods
Participants
Women were eligible for the study if (i) they were married or living
together with their partner for at least 2 years, (ii) there was no oocyte
or sperm donation involved and (iii) they were about to begin their first
trial of IVF or ICSI treatment at the Leuven University Fertility Centre
(Belgium). Sixty-eight of the 123 women who met the inclusion criteria
agreed to participate (response rate ¼ 55%). All women returned their
questionnaires. Only three women were additionally contacted by
phone by the main investigator (B.L.) and subsequently returned their
questionnaires.
Women had a mean age of 32 years (SD ¼ 3.98). Most of these women
(74%) had obtained a degree of higher education or university and had a
job at the time of the study (96%). On average, women had been together
with their partners for 8 years (SD ¼ 4.1) and 71% were married.
Procedure
This study was approved by the ethical committee of the University of
Leuven (Belgium). Participation was voluntarily and anonymity was guaranteed. All participants that were eligible for the study were sent a letter with
information about the study prior to their visit to the hospital. While in the
hospital, women who were willing to participate met with the main
researcher and were provided more detailed information about the
study. After signing the informed consent, they were given a set of questionnaires and were asked to return these to the main researcher in a
closed and pre-paid envelope within 2 weeks. Data were collected in a
2-year time period (2004– 2006).
Measurements
The depressive experiences questionnaire (DEQ; Blatt et al., 1976) consists of 66 items, scored on a 7-point Likert-type scale, ranging from 1
526
(‘I don’t agree’) to 7 (‘I totally agree’) and measures the personality factors
Self-Criticism and Dependency. The Dutch version of the DEQ has good
internal consistency and validity, similar to the original DEQ (Luyten et al.,
1997; Luyten et al., 2007).
The dyadic adjustment scale (DAS; Spanier, 1976) is a 32-item scale,
which yields a total score reflecting a general sense of relationship satisfaction, as well as four subscales: cohesion, consensus, satisfaction and affectional expression. Because of the high association between the subscales
and the total scale (correlations ranging between r ¼ 0.64 and r ¼ 0.90),
only the total scale was used in this study. The internal consistency (Cronbach’s a) of the total scale was 0.91. The DAS has shown good reliability
and validity in various studies on adults in a long-term relationship (Haring
et al., 2003).
The Amsterdam scale of well-being (ASWB; van Dierendonck, 2004) is
based on the six dimensions of psychological well-being as described in
Ryff’s psychological well-being scale (Ryff and Keyes, 1995) and also
includes two additional scales referring to spiritual well-being (van Dierendonck, 2004). In this study, only the six subscales (39 items) as originally
described and validated by Ryff (e.g. Ryff, 1989; Ryff and Keyes, 1995; van
Dierendonck, 2004) were included, i.e. positive relations (e.g. ‘I feel like I
am getting a lot out of my friendships’), autonomy (e.g. ‘I don’t feel afraid
to voice my opinions, even when they are in opposition to the opinions of
most people’), self-acceptance (e.g. ‘When I look at the story of my life at
this moment, I am pleased with how things have turned out’ idem),
environmental mastery (e.g. ‘I feel I am in charge of the situation in
which I am living’), purpose in life (e.g. ‘I feel I have a sense of direction
and purpose in my life’) and personal growth (e.g. ‘I think it is important
to have new experiences that challenge how you think about yourself
and the world’ idem). All items are scored on 6-point Likert scale,
ranging from 1 (‘I don’t agree’) to 6 (‘I totally agree’). A total scale reflects
the sum of the six subscales. The internal consistency (Cronbach’s a) for
this total scale was 0.92 and studies suggest that the ASWB is a reliable
and valid instrument (van Dierendonck, 2004).
The fertility problem inventory (FPI; Newton et al., 1999) is a 46-item
questionnaire measuring levels of infertility stress. All items are scored
using a 6-point Likert scale ranging from 1 (‘I don’t agree’) to 6 (‘I
totally agree’). In this study, only the subscales referring to the quality of
the couple relationship, i.e. the subscale of sexual (8 items) and relationship stress (10 items) were used. Sexual concerns indicate diminished
sexual enjoyment or sexual self-esteem and difficulties with scheduled
sexual relations, while relationship concerns indicate difficulties talking
about infertility with one’s partner, and concerns about the impact of
infertility on the relationship. The FPI was translated to Dutch according
to guidelines of the International Test Commission (Hambleton, 1994).
The FPI demonstrates good discriminant and convergent validity
(Newton et al., 1999). The internal consistency (Cronbach’s a) for the
subscales sexual concern and relationship concern in this study were .81
and .72, respectively.
The Psychiatric Epidemiological Research Interview (PERI; Dohrenwend
et al., 1978) is a widely used instrument, covering life events in the domain
of employment, partner relationships, family, housing, crime, money,
friends and health. In this study, the PERI was used to measure 34 negative
life events, other than fertility problems, experienced during the previous 6
months. A total score of all experienced negative life events was calculated. Studies have shown that the PERI is a valid and reliable instrument
to measure negative life events and that its intracategory variability is
low (Dohrenwend, 2006).
Data analysis
First, Pearson’s correlation coefficients were calculated between all study
variables. Second, four separate hierarchical multiple regression analyses
Lowyck et al.
(HMRAs) were performed, for the following criterion variables: (i) psychological well-being, (ii) relationship satisfaction, (iii) relationship concerns
and (iv) sexual concerns. The four steps included in each HMRA were:
(i) demographical variables (age, level of education and length of the
relationship), (ii) fertility-related factors (duration of the fertility problems
and number of prior treatments), (iii) negative life events and (iv) the personality dimensions of Self-Criticism and Dependency. A P , 0.05 value
was considered significant.
Results
Descriptive data
Women had been dealing with fertility problems for 2 years on
average (SD ¼ 1.10). Prior to starting their first IVF/ICSI treatment,
19% of the women had undergone surgery for fertility-related problems (e.g. endometriosis) and 43% had unsuccessfully undergone
artificial insemination. Thirty-one per cent of the women reported
that the primary cause for the fertility problems was located in the
woman, 37% reported that the primary cause was located in the
men, 11% said that the primary cause was located both in the men
and women and 21% of the women reported that the primary
cause for the fertility problems was unknown. Univariate analysis of
variance showed no significant effects of the localization of the
cause of the fertility problems (i.e. women, men, both partners and
unknown) on any of the study variables. Therefore, we did not
control for this variable in further analyses.
Zero-order correlations
Zero-order correlations between the study variables are presented in
Table I. Self-Criticism and Dependency were not significantly correlated. Self-Criticism was negatively correlated with psychological wellbeing (r ¼ 20.63, P , 0.001) and relationship satisfaction
(r ¼ 20.29, P , 0.05), and positively with sexual (r ¼ 0.37, P ,
0.01) and relationship concerns (r ¼ 0.39, P , 0.01). Dependency
was negatively associated with psychological well-being (r ¼ 20.30,
P , 0.05), and positively with sexual concerns (r ¼ 0.31, P , 0.05).
Further, a positive relationship was found between psychological wellbeing and relationship satisfaction (r ¼ 0.47, P , 0.001), and relationship satisfaction was negatively associated with sexual concerns
(r ¼ 20.32, P , 0.01) and relationship concerns (r ¼ 20.44, P ,
0.01). Sexual concerns were negatively associated with psychological
well-being (r ¼ 20.49, P , 0.001), and positively associated with
relationship concerns (r ¼ 0.53, P , 0.001). Finally, no significant
relationships were found between any of the study variables and
negative life events experienced in the last 6 months other than fertility problems.
Hierarchical multiple regression analyses
Demographic variables, fertility characteristics and negative life events
did not significantly contribute to the variance in each of the different
criterion variables (Table II). Self-Criticism and Dependency significantly added 40% to the explained variance in psychological well-being
[F (8, 52) ¼ 7.84, P , 0.001; F-change ¼ 23.00, P , 0.001], with both
Self-Criticism (b ¼ 20.58, P , 0.001) and Dependency (b ¼ 20.23,
P , .05) negatively predicting psychological well-being.
527
IVF, distress and couple relationship
Table I Descriptive statistics and correlations between studied variables
2
3
4
5
6
7
M
SD
.............................................................................................................................................................................................
1. Dependency
0.11
0.31a
20.30a
0.02
20.39
0.37
b
0.39
20.63c
0.06
21.22
0.89
20.32b
20.44b
0.47c
0.18
122.44
12.21
0.53c
20.49c
20.11
18.66
6.45
20.43b
20.15
20.73
5.97
0.01
175.64
17.73
0.75
0.87
0.12
a
0.08
b
20.29
2. Self-Criticism
—
3. Relationship satisfaction
—
—
4. Sexual concerns
—
—
—
5. Relationship concerns
—
—
—
—
6. Psychological well-being
—
—
—
—
—
7. Negative life events
—
—
—
—
—
—
0.91
n ¼ 68.
a
P , 0.05.
b
P , 0.01.
c
P , 0.001.
Table II Hierarchical regression predicting relationship satisfaction, relationship concerns, sexual concerns and
psychological well-being
Criterion variable
Relationship
satisfaction
Relationship concerns
Sexual concerns
Well-being
................................
.................................
.................................
................................
R2
R2
R2
R2
DR 2
b
DR 2
b
DR 2
b
DR 2
b
.............................................................................................................................................................................................
Step 1: demographics
0.05
0.05
0.15
0.15a
0.09
0.09
a
0.14
0.14a
Age (year of birth)
20.15
0.35
0.23
20.20
Level of Education
20.10
0.22
0.18
0.13
20.17
Length of the relationship
Step 2: fertility Characteristics
0.06
0.01
Duration of problems
Number of prior treatments
Step 3: negative life events
0.09
0.03
Step 4: personality
0.19
0.10a
Self-Criticism
Dependency
0.04
0.16
0.01
20.19
0.07
0.14
0.05
0.14
0.01
0.02
0.09
0.09
0.11
20.10
0.02
0.23
20.02
0.19
0.17
0.01
0.30
0.13a
20.30a
0.15
20.15
0.16
0.02
0.35
0.19c
0.35b
0.08
20.16
0.15
0.00
0.55
0.40c
20.03
0.32b
20.58c
a
20.23a
0.27
a
P , 0.05.
P , 0.01.
c
P , 0.001.
b
Next, the personality dimensions of Self-Criticism and Dependency
added 10% to the explained variance [F (8, 55) ¼ 1.56, ns; F-change ¼
3.19, P , 0.05] in relationship satisfaction. More specifically, SelfCriticism was negatively associated with relationship satisfaction
(b ¼ 20.30, P , 0.05), while no significant effect was found for
Dependency. Self-Criticism and Dependency added a significant 13%
to the explained variance [F (8, 51) ¼ 2.70, P , 0.01, F-change ¼
4.50, P , 0.05) in relationship concerns. More specifically, SelfCriticism (b ¼ 0.35, P , 0.01) was a positive predictor of relationship
concerns, while no significant effect was found for Dependency.
Finally, entering Self-Criticism and Dependency in the equation
added 19% to the explained variance in sexual concerns
[F (8, 56) ¼ 3.80, F-change ¼ 8.27, P , 0.001], with both
Self-Criticism (b ¼ 0.32, P , 0.01) and Dependency (b ¼ 0.27, P ,
0.05) positively predicting sexual concerns.
Discussion
Results of this study clearly demonstrate that the personality dimensions of Self-Criticism and Dependency were significantly associated
with psychological well-being and the quality of the couple relationship
of women starting their first IVF/ICSI treatment. Importantly, these
relationships remained significant even after controlling for demographical variables, fertility characteristics and negative life events
experienced in the previous 6 months. More specifically, as expected,
Self-Criticism was negatively associated with both psychological wellbeing and the quality of the couple relationship. This negative effect
of Self-Criticism was found for general relationship satisfaction, as
well as for specific relationship concerns (e.g. ‘My partner does not
understand how the fertility problems affect me’) and sexual concerns
and distress (e.g. ‘I lost my pleasure in the sexual intercourse with my
528
partner because of the fertility problems’). Together, these findings
suggest that self-critical women, i.e. women who are typically highly
concerned with their self-concept, self-worth and self-identity and
who have a high need for control and autonomy, experience more distress and more relationship difficulties when they receive treatment
for fertility problems. Situating these findings within Blatt’s elaboration
of Erikson’s model of psychosocial development, because of their tendency to achieve, these women may experience their inability for biological generativity (Erikson, 1963; Snarey, 1993) as a personal failure,
which in turn may lead to feelings of frustration and the feeling that
important goals and wishes are being thwarted. In addition, congruent
with other studies, it can be hypothesized that these women may even
enhance distress and relationship difficulties because of their tendency
to generate stress in their relationships (Luyten et al., 2005). Further
research, however, is needed to investigate these speculations.
Findings concerning Dependency were more complex. Congruent
with theoretical expectations, Dependency was negatively related to
psychological well-being, positively associated with sexual concerns
and distress and not associated with general relationship satisfaction.
In contrast to our expectations, however, Dependency was not significantly associated with relationship concerns. In other words, these
results suggested that women who strongly emphasize their relationships with others are more vulnerable for general and sexual distress
when undergoing treatment for fertility problems. However, this preoccupation with relationships does not seem to negatively impact the
relationship with their partner.
There are two possible explanations for this latter finding. First,
dependent women undergoing IVF/ICSI treatment, because of their
fears for abandonment, may want to minimize conflict in their relationships, for instance by showing more positive behaviours towards their
partner (Mongrain et al., 1998; Vettese and Mongrain, 2000).
However, studies have shown that partners of dependent women
may not always perceive these behaviours as positive and may even
become severely frustrated and irritated by these often excessive
attempts to keep the relationship positive (Luyten et al., 2005). As
such, the positive and negative effects of Dependency on the quality
of the couple relationship may cancel each other out (Bornstein,
1998). However, it is also possible that, because of their fear of
being alone, dependent women may suppress or deny the negative
aspects and concerns they may have in their partner relationship.
Indeed, studies have shown that dependent individuals tend to show
a positive perceptual bias in relationships (Mongrain et al., 1998;
Luyten et al., 2005). Importantly, these two interpretations are not
mutually exclusive (Mongrain et al., 1998) and thus dependent
women, because of their focus on relatedness, may show more positive behaviours towards their partner in order to keep their relationship positive and may deny at the same time possible relationship
problems and conflicts. Further research is clearly needed to investigate these hypotheses.
This study may have important implications for counselling with
women starting treatment for fertility problems. More specifically,
while counselling self-critical women, more attention is needed with
respect to worries and conflicts concerning self-worth, self-identity,
achievement and failure, and how these may give rise to feelings of distress and difficulties in the partner relationship, such as low relationship satisfaction and difficulties in communication. These latter issues
are especially interesting as studies have shown that patients dealing
Lowyck et al.
with fertility problems rely primarily on their spouse when distressed
(Boivin et al., 1999) and that difficulties in partner communication
predict high fertility-related stress (Schmidt et al., 2005). For dependent women, more attention may need to be given to the value
they attach to relationships with significant others, as well as their
need to care for and to be taken care of. In both instances, the ultimate goal of the counselling sessions should be to achieve a better
balance between needs and wishes for relatedness and self-definition.
Results of this study need to be interpreted within the light of some
limitations. These include the fact that we only investigated women in
this study, as well as the fact that the design of the study was crosssectional, which does not allow drawing conclusions concerning
possible causal relationships between personality and outcomes investigated. In addition, with regard to the observed associations between
Self-Criticism and outcome, and psychological well-being in particular,
one could argue that these associations are due to content and/or
item overlap between scales. Yet, first, longitudinal studies have
clearly shown that the DEQ taps into broad and stable personality
dimensions that demonstrate remarkable stability over time, even
when persons are confronted with challenging periods (Cox and
Enns, 2003; Shahar et al., 2004), while the ASWB is more state sensitive, i.e. shows considerable change in response to significant life challenges, such as dealing with fertility issues (Ryff and Keyes, 1995; Kling
et al., 1997; Ruini et al., 2003; van Dierendonck, 2004; Luyten et al.,
2005). Second, numerous prospective studies demonstrate that the
DEQ measures trait features that predict a wide variety of variables,
other than psychological well-being, including depressive feelings
(Zuroff et al., 1995; Mongrain et al., 2004), feelings of anger (Mongrain
and Zuroff, 1994), and various aspects of interpersonal functioning
(Luyten et al., 2005). Finally, if our results were merely due to item
overlap, one would expect this overlap to be the greatest between
Self-Criticism and the Self-Acceptance and Autonomy scales of the
ASWB. However, Self-Criticism is not only negatively correlated
with Self-Acceptance (r ¼ 20.61, P , 0.001) and Autonomy
(r ¼ 20.46, P , 0.001), but also with Environmental Mastery
(r ¼ 20.58, P , 0.001), Purpose in Life (r ¼ 20.43, P , 0.001) and
Positive Relations (r ¼ 20.50, P , 0.001), scales that show no
content overlap with the DEQ Self-Criticism subscale. Hence, correlations with other dimensions are as high, or even higher, than with
scales that show potential item overlap. However, future studies
also using other validated instruments to measure psychological wellbeing are needed to further address this issue. Finally, although IVF is
considered to be one of the most demanding and stressful artificial
reproduction treatments (Boivin and Takefman, 1996; Eugster and
Vingerhoets, 1999), being able to start this procedure may have
increased the hope of these women to be able to have their own
child. Therefore, future research on this topic should use a prospective
multi-wave design, i.e. following women across different cycles of an
IVF procedure and investigating both partners simultaneously.
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Submitted on September 24, 2007; resubmitted on August 2, 2008; accepted on
September 19, 2008