Summary: | This thesis explores the hypothesis that stress, which is commonly experienced by patients undergoing assisted reproductive treatments, has a negative effect on. the process of conception and pregnancy. In attempting to explore possible mechanisms underpinning any such effects, several studies were conducted. A systematic review of literature exploring which psychosocial factors are associated with distress in IVF patients revealed two groups of variables, one protective against distress (which included optimism, social support, acceptance, secure attachment style, caring spouse) and the other conferring a higher risk of emotional problems (which included neuroticism, self-criticism, escapist coping strategies, controlling spouse, and insecure attachment styles). This is followed by a study exploring whether natural variance in positive and negative affect either before commencing IVF treatment or on the day of embryo transfer could predict pregnancy odds. This revealed that both male and female depression scores were associated with reduced pregnancy odds. The effects of positive emotion however were dependent on gender. Active positive emotions (in females but not males) predicted increased pregnancy odds. Relaxed positive emotion (in males but not females) predicted reduced pregnancy rates. A randomised controlled trial was also undertaken to compare the effects of two different psychological techniques for managing stress and emoti~n. Unfortunately recruitment rates were lower than expected, resulting in too small a sample size to test these intervention effects. However, the baseline data from this study were explored for relationships between implicit and explicit stress measures. This revealed two groups of interrelated variables, one that was associated with higher distress levels, and another that was associated with better emotional outcomes. These two groups of variable fit well with the findings of the systematic review. Collectively the results presented in this thesis suggest a major role of attachment style in orchestrating multiple other coping related processes, including autonomic, attentional and behavioural strategies. Several complimentary theoretical frameworks are discussed in relation to these data. Finally an intervention approach focused on reducing distress via activation of affiliative affect systems is suggested as a possible approach for IVF patients to improve psychological health.
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