Psychology And Counselling

Human Reproduction, Vol.26, No.1 pp. 148–156, 2011 Advanced Access publication on October 19, 2010 doi:10.1093/humrep/deq281

ORIGINAL ARTICLE Psychology and counselling

A prospective study assessing anxiety, depression and maternal-fetal attachment in women using PGD
J.C. Karatas 1,*, K. Barlow-Stewart 2,3, B. Meiser 4, C. McMahon 5, K.A Strong 6, W. Hill 7, C. Roberts 7, and P.J. Kelly 31 2

Sydney Medical School, University of Sydney, Level 3, Building 36, Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia Centre for Genetics Education, NSW Health, Sydney, NSW 2065, Australia 3Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia 4Prince of Wales Clinical School, University of New South Wales, Psychosocial Research Group, Prince of WalesHospital, Randwick,Sydney, NSW 2031, Australia 5Department of Psychology, Macquarie University, Sydney 2019, Australia 6The Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, NSW 2006, Australia 7Sydney IVF, Sydney, NSW 2000, Australia *Correspondence address. Tel: +61-413-787-115; Fax: +61-2-9906-7529; E-mail: jkaratas@med.usyd.edu.au

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Submitted on May 23, 2010; resubmitted on September 2, 2010; accepted on September 9, 2010

background: PGD has been described in previous cross-sectional and retrospective studies as a stressful experience. No prospective studies of the psychological impact of PGD are currently available. methods: Using a prospective study design, validatedmeasures exploring anxiety and depression were used to assess women using PGD prior to treatment, following embryo transfer, following the pregnancy test result and at 24 weeks of pregnancy. Maternal-fetal attachment was also assessed during pregnancy. results: The prospective design revealed the cyclical pathway through PGD for many women, often comprising repeated cycles of
ovarian stimulations andIVF and frozen embryo transfers. As predicted, there were significant fluctuations in women’s anxiety scores, with increases observed following embryo transfer and pregnancy testing. Women’s anxiety scores returned to baseline levels during pregnancy as assessed at 24 weeks gestation. Depression scores did not significantly fluctuate during PGD. Maternal-fetal attachment scores in this sample did notdiffer from the normative Australian data.

conclusions: For some women, the PGD pathway is convoluted and requires multiple IVF cycles and embryo transfers to achieve pregnancy. A subset of women experience significant emotional burden during PGD treatment, and it is these women who require closer attention and support. In this sample, emotional adjustment in pregnancy following PGD appears to besound.
Key words: IVF / PGD / anxiety / depression / attachment

Introduction
PGD is an assisted reproductive technique (ART) used by couples at increased risk of having a child with a genetic condition. It involves the use of IVF to produce embryos that are genetically tested and selected based on the absence of particular genetic conditions. The embryo is then transferred into the uteruswith the aim of establishing a pregnancy of a healthy biologically related child. PGD was first reported as successful in humans in the early 1990s (Handyside et al., 1990); two decades later, the psychological impact of PGD has not yet been clearly defined. A recent review of literature related to the psychosocial impact of PGD by Karatas et al. (2010a) concluded that the current research focuses onattitudes of genetically at-risk couples for whom PGD may be beneficial, and the results suggest that those with traumatic reproductive and genetic histories are more likely to find

PGD an acceptable treatment option. In addition, a small number of studies have investigated samples of women who have actually used PGD, though these are all retrospective or cross-sectional in design (Katz et al.,...