by Joann Paley Galst, Ph.D., Chair, AFA Mental Health Advisory Council

• Removal of the “experimental” label for oocyte freezing led to a heated debate between Drs. Samantha Pfeifer and Nicole Noyes regarding social egg freezing, with Dr. Noyes taking the position that, if provided accurate information and appropriate counseling, the decision should rest with the woman wishing to pursue this and Dr. Pfeifer asserting that the risks, lack of data because of so few births so far, potential for exploitation, unfavorable risk/benefit ratios, cost, and potential for false hope argued against promoting egg freezing to otherwise healthy young women as a means to extend their fertility. Since IVF centers are already offering egg freezing to women for social reasons, it seems that the genie is already out of the bottle on this one. Ensuring that potential recipients of this procedure are fully aware that this does not offer a guarantee of a future pregnancy, that it is more likely to be successful if they freeze their eggs before age 36, and that most of them are unlikely to ever use these frozen eggs is critical.
• A study by L. Pasch and her colleagues at UCSF found that while 56% of women and 32% of men reported clinically significant depression either prior to or 4-18 months after treatment for infertility, most infertility patients, even those with significant depression, do not receive information from their clinics regarding mental health services nor receive such services. The researchers concluded that infertility patients experiencing clinical depression need to be offered mental health services, particularly since it is more difficult to undergo or succeed at treatment when depressed. (Pasch, Holley, Bleil, et al., Are Depressed Infertility Patients Offered and Do They Receive Mental Health Services? O-145)
• Fertility preservation counseling at the time of a cancer diagnosis, giving these patients an opportunity to make decisions regarding their fertility preservation, reduced distress and anxiety in patients throughout their cancer treatment. There was no additional reduction in distress or anxiety, however, by undergoing fertility preservation. (Niemasik, Letourneau, Katz, et al., Fertility Preservation Counseling at the Time of Cancer Diagnosis Reduces Distress and Anxiety. O-150). Nevertheless, another study did find a sub-population of patients who remained at high risk for reproductive concerns (i.e., those desiring future children at the time of diagnosis, those who are nulliparous, and those treated with both chemotherapy and radiation (vs. chemotherapy alone). This high-risk population may benefit from additional counseling post-treatment. (Shah, Letourneau, Ebbel, et al., Predictors of Reproductive Concerns for Survivors of Reproductive Age Cancers: Targeting Post-Treatment Counseling for High-Risk Populations. O-152).
• A simple take-home coping card including positive reappraisal coping statements and challenging negative thoughts methods (e.g., I will focus on what is good in my life.) was found to be useful in managing negative intrusive thoughts and feelings of anxiety/worry during the two week waiting period for results after IVF/ embryo transfer or IUI. It is unclear whether the benefit was provided by the card itself or that the patients receiving these cards from their IVF center felt sensitively cared for by their providers. Either way, over 70% of those using the cards reported that it helped them to increase their positive thinking. (Covington, Toll, Sachs, et al., Waiting for Pregnancy Test Results Following In Vitro Fertilization and Embryo Transfer (IVF/ET) or Intrauterine Insemination (IUI): Will Giving Patients a Card Help Them Cope? O-151).