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Subjective well-being of women undergoing in vitro fertilization and embryo transfer and influencing factors

  • Xi Zhang , Jinlu Li , Liye Wang , Zirui Wang , Xuemei Gou , Donghong Song EMAIL logo and Rui Yang
Published/Copyright: November 21, 2024
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Asian Journal of Medical Humanities
From the journal Asian Journal of Medical Humanities Volume 3 Issue 1

Abstract

Objectives

Infertility is a global medical problem with annually increasing prevalence. In China, since the implementation of the universal two-child policy, the demand for fertility treatments continues to rise. During treatment, women with infertility may undergo various negative emotions, which can affect the treatment outcome, or even lead to refusal or discontinuation of treatment. However, maintaining a positive psychology can help alleviate negative emotions and increase patients’ confidence during the treatment process. The aim of this study is to investigate the subjective well-being (SWB) of infertile women undergoing the treatment of in vitro fertilization and embryo transfer (IVF-ET), and to analyze the factors affecting their psychological status during IVF-ET treatment.

Methods

In this study, 1,042 subjects were selected through convenience sampling from female subjects who received IVF-ET treatment from November 2021 to April 2022 at the Reproductive Medicine Center of a Grade A tertiary hospital in Beijing. All subjects were required to complete a basic profile questionnaire, self-esteem scale, fertility problem inventory (FPI), and SWB scale. A stepwise multiple linear regression was performed to analyze the factors impacting SWB.

Results

The mean score of SWB given by subjects was 88.97±12.08 (mean±standard deviation (SD)). The main factors influencing SWB included age, occupational status, personal monthly income, duration of infertility, self-esteem, and fertility stress (p<0.05), which together explain 51.5 % of total variance.

Conclusions

Overall, female subjects receiving IVF-ET treatment have a moderate level of SWB, which is affected by various factors. Our study suggests that clinical care should identify factors influencing SWB and provide interventions to enhance SWB of infertile women during IVF-ET treatment in order to encourage them to face treatment positively.

Keywords: in vitro fertilization and embryo transfer (IVF-ET); self-esteem; fertility stress; subjective well-being (SWB); influencing factors

Introduction

There are many causes of fertility related stress for women. Traditionally, childbirth has been assigned significance on both societal and familial levels. On a societal level, having children is thought to be a social responsibility families undertake for continued social development and the survival of society [1]. An ancient Chinese saying goes, “There are three ways to be unfilial, and having no offspring is the greatest.” This expresses the importance of passing down the family line in traditional Chinese culture. Meanwhile, under the influence of traditional social roles, women who are unable to conceive may be relegated to a lower status in the family. In modern society, social roles have changed significantly, but for many families, childbirth still holds a powerful position in people’s minds as a vital continuation of family lineage.

Infertility describes a low-fertility state in couples of childbearing age having regular sexual intercourse without contraception for at least one year, but failing to achieve a clinical pregnancy. Inability to conceive after sustained attempts may affect a couple’s quality of life [2]. In China, with the relaxation of the two-child policy, the demand for fertility treatment continues to rise, especially among older women, as rates of infertility rise with age. According to the World Health Organization (WHO), infertility affects around 15 % of couples at childbearing age worldwide, and its prevalence is increasing annually [3]. In 2021, China’s National Bureau of Statistics reported that the infertility rate in China ranged from 12 to 18 %. In vitro fertilization and embryo transfer (IVF-ET) is a common method for assisted reproductive treatment of infertility [4, 5]. IVF-ET provides an effective approach for infertile women to increase their fertility rate by selecting high-quality eggs and sperm to increase the chances and quality of conception and reduce the probability of genetic disease transmission. However, previous studies have showed that IVF-ET may have adverse physiological and psychological effects on women [6]. Negative moods such as anxiety and depression, as well as fertility stress, may compromise patients’ quality of life and thus also the outcome of IVF-ET treatment 7], [8], [9. In addition, negative psychological states are a common reason for the discontinuation of IVF treatment [10]. An international multi-center survey among patients of assisted reproductive technologies (ART) found that patients are predominantly concerned not only about the side effects of treatment and success rates but also how they navigate the psychological experiences surrounding treatment [11].

Subjective well-being (SWB) is an overall evaluation of an individual’s quality of life and emotional experience, and the presence of SWB denotes a positive psychological experience. SWB increases patients’ confidence in disease treatment, reduces negative emotions, and motivates them to adopt positive and healthy behaviors, thus promoting physical and mental health and improving quality of life [12, 13]. Current psychological research on women receiving IVF-ET mainly focuses on negative emotions such as anxiety, depression, stress and pain 14], [15], [16. SWB in the field of positive psychology has not received sufficient attention. Research has shown that women with infertility have lower levels of happiness, possibly influenced by traditional Chinese cultural beliefs. Chinese traditional beliefs suggest that raising children is the main family responsibility of women, and families without descendants are considered incomplete. Women experiencing infertility may feel guilty about being unable to pass on the family line. Therefore, this study focuses on the SWB of women undergoing IVF-ET treatment, and explores the influencing factors, especially using a Fertility Problem Inventory that is suitable for patients with infertility in China. This study aims to provide a theoretical basis for the development of targeted interventions in clinical care to help patients face infertility and its treatment in a positive way.

Study purpose and significance

Study purpose

This study aims to understand the subjective well-being of infertile women, analyze the causes of psychological difficulties, and provide insights to help infertile women navigate psychological difficulties through clinical nursing work, thereby enhancing their subjective well-being under the guidance of medical staff.

Study significance

By conducting several scales for infertile women and analyzing these statistics, we have gained an understanding of infertile women’s current level of subjective well-being, and thereby promote the integration of theory and practice in the field of infertile women’s psychological distress through clinical support in medical settings.

Subjects and methods

Study subjects

Subjects were selected through convenience sampling from women who received IVF-ET cycle treatment from November 2021 to April 2022 at the Reproductive Medicine Centre of a Grade A tertiary hospital in Beijing, China.

Inclusion criteria:

  1. Eligible patients were female aged 20–45 with long-term residence in Beijing and a diagnosis of infertility meeting the WHO criteria.

  2. Patients were aware of the purpose of the study, willing to participate in this study, and able to understand the content.

Exclusion criteria:

  1. Have a history of cognitive disorders and mental illness.

  2. Have recently experienced a severely stressful event.

  3. Have other severe physical illnesses or chronic diseases.

Methods

  1. General information questionnaire: The questionnaire was developed by the research team through literature review, theoretical research and expert consultation. Thirteen elements were included, containing general patient information (i.e. ethnicity, age) and infertility-related information (i.e. years of infertility, reasons for infertility).

  2. Self-Esteem Scale (SES): The SES, developed by Rosenberg in 1965 [17], is used to measure individuals’ judgments of their self-esteem. It is currently one of the most widely used self-esteem measurement tools in Chinese psychology. The SES consists of 10 questions and is scored on a 4-point scale, with some questions reverse scored. The Cronbach’s alpha coefficient was 0.78 [18]. The score is directly proportional to the level of self-esteem. In this study, the Cronbach’s alpha coefficient was 0.79.

  3. Fertility Problem Inventory [19]: The FPI is a tool designed by Newton in 1999 to assess fertility-related stress in patients with infertility. In 2011, Peng et al. [20] adapted the FPI to the clinical investigation and assessment of patients with infertility in China, including 46 questions evaluated on 5 aspects. A 6-point scale was used to assess fertility stress with 18 reverse score questions. The minimum score of this scale is 46, and the maximum is 276, with higher scores indicating greater fertility stress. The Cronbach’s alpha coefficient in this study was 0.93.

  4. Subjective Well-being Scale for Chinese Citizens (SWBS-CC20): Proposed by Diener in 1984, the SWB is an overall assessment of the quality of life by individuals according to their own criteria, including two dimensions: emotional and cognitive. In 2003, Xing developed a short version of the SWB scale for urban Chinese (SWBS-CC20) with 20 questions [21]. The scale is scored on a 6-point scale, ranging from 1 to 6 on a scale from strongly disagree to strongly agree. Some questions are reverse scored. The Cronbach’s alpha for this scale is 0.85, in this study it was 0.89.

Data collection

The data was collected by questionnaire. The researcher and five trained professional nurses used standardized scripts to introduce the methodology, purpose and content of this research study to the participants. After obtaining informed consent, participants were instructed to fill in the questionnaire on site. A total of 1,060 questionnaires were completed, of which 1,042 were valid, with a validity rate of 98.3 %.

Statistical analysis

Excel 2016 was used to form the database. The statistical evaluation was performed using SPSS 21.0. Data was described as mean±standard deviation (x±s). Statistical analysis between groups was carried out using Student’s t-test and ANOVA test. Pearson correlation analysis was applied to explore the correlation between self-esteem, fertility stress and SWB to screen out single factors with statistical significance. Multiple Stepwise regression analysis was conducted to explore the factors influencing SWB. A statistically significant difference was defined when p<0.05.

Results

Comparison of scores between women with different basic features who received IVF-ET treatment

In this study, the investigated subjects are between 22 and 45 years old with an average age of 33.90±4.36. A comparison of SWB scores obtained by subjects with different basic features is shown in Table 1.

Table 1:

The comparison of SWB scores obtained by subjects with different basic features (n=1,042).

Categories Options Numbers Scores ( x ̄ ±s) t/F value p-Value
Age ≤35 716 88.29±12.04 7.318 0.007b
>35 326 90.47±12.03
Ethnicity Han 963 89.19±11.99 4.153 0.042a
Others 79 86.32±12.84
Are single child Both 214 91.26±11.86 4.952 0.002b
Woman 148 89.26±12.76
Man 222 89.54±12.06
Neither 458 87.54±11.80
Types of family life Couple living alone 900 88.97±12.14 1.917 0.125
Living with the man’s parents 93 90.10±11.47
Living with the woman’s parents 42 88.24±11.94
Mixed family 7 79.00±8.29
Educational level Lower secondary and below 59 86.54±8.64 2.197 0.067
High school and secondary school 90 87.66±12.27
College 228 88.15±12.07
Undergraduate 491 89.24±12.38
Postgraduate and above 174 90.80±11.93
Occupation Employed 788 89.49±11.85 5.984 0.015a
Unemployed 254 87.37±12.64
Monthly income, RMB ≤1 k 123 85.96±13.08 11.988 0.000b
1–3 k 105 85.93±11.43
3–5 k 213 87.63±11.77
5–10 k 310 88.56±11.35
>10 k 291 92.77±11.96
Years of marriage ≤3 years 356 89.87±12.52 2.952 0.053
>3–5 years 276 89.47±11.34
>5 years 410 87.86±12.10
Marriage status 1st marriage 937 88.77±12.05 2.674 0.102
Remarriage 105 90.80±12.21
Years of infertility ≤3 years 552 90.23±11.89 6.665 0.001b
>3–5 years 250 87.95±11.85
>5 years 240 87.16±12.45
Cause of infertility Female 346 87.62±12.03 3.496 0.015a
Male 196 89.80±12.43
Both 201 88.30±12.00
Unknown 299 90.46±11.80
Duration of IVF-ET ≤1 year 782 89.82±11.82 5.447 0.001b
>1–2 years 134 86.40±12.39
>2–3 years 48 85.27±12.33
>3 years 78 87.21±12.90
Number of IVF cycles performed Once 712 89.26±12.16 6.391 0.002b
Twice 209 90.08±11.63
≥3 times 121 85.41±11.79

  1. ap<0.05, bp<0.001.

Relevance analysis of SWB, self-esteem and fertility stress of women receiving IVF-ET cycle treatment

The total SWB score of women treated with IVF-ET cycle treatment was 88.97±12.08; the total SES and FPI scores were 29.62±3.24 and 128.29±27.96, respectively. Their relevance analysis is presented in Table 2.

Table 2:

Relevance analysis of SWB, SES and FPI of women with IVF-ET cycle treatment (n=1,042).

Variables r value p-Value
SES 0.656 <0.001
FPI −0.562 <0.001

Multi-factor analysis of women with IVF-ET cycle treatment

A stepwise regression analysis was performed with the total SWB score of women with IVF-ET cycle treatment as the dependent variable. Age, ethnicity, single child status, occupational status, personal monthly income, years of infertility, reasons for infertility, years of assisted reproduction, number of IVF cycles, total self-esteem score, and total fertility stress score were statistically significant univariate variables, to which the independent variables were assigned as shown in Table 3. The results of the analysis showed that age, personal monthly income, years of infertility, occupational status, self-esteem, and fertility stress were the influencing factors for SWB in women with IVF-ET cycle treatment, accounting for 51.5 % of the variance, as shown in Table 4.

Table 3:

Assignment of independent variables.

Independent variables Assignment methods
Age ≤35 years old=1, >35 years old=2
Ethnicity Han=1, others=0
Are single child Dummy variable set with both spouses as references
Occupational status Employed=1, unemployed=0,
Personal monthly income ≤1,000=1, 1,001–3,000=2, 3,001–5,000=3, 5,001–10000=4, >10,000=5
Years of infertility ≤3 years=1, >3–5 years=2, >5 years=3
Cause of infertility Dummy variable set with female causes as references
Years of assisted reproduction ≤1 year=1, >1–2 years=2, >2–3 years=3, >3 years=4
Number of IVF cycles performed Once=1, twice=2, ≥three times=3
Self-esteem Original value entry
Fertility stress Original value input
Table 4:

Multiple linear stepwise regression analysis of SWB of women with IVF-ET cycle treatment.

Non-standardized coefficients Standardized coefficients t p-Value
B SD Beta
Constant 47.648 3.832 – 12.435 0.000b
Age 1.466 0.570 0.056 2.570 0.010a
Occupational status 2.745 0.750 0.098 3.660 0.000b
Personal monthly income 0.577 0.250 0.063 2.307 0.021a
Years of infertility −0.798 0.325 −0.054 −2.453 0.014a
SES 1.865 0.094 0.500 19.855 0.000b
FPI −0.134 0.011 −0.310 −12.421 0.000b

  1. ap<0.05, bp<0.001. R2=0.517, after adjustment R2=0.515, F=184.939.299, p<0.001.

Discussion

Level of SWB of women with IVF-ET cycle treatment

In this study, the overall SWB score was 88.97±12.08. Based on previous literature [22], a score of 90 or more is considered a high level of SWB, while a score of 50 or less is considered to be low. As a result, the SWB of women with IVF-ET cycle treatment is in the upper middle range. The invasive procedures of IVF-ET treatment and lengthy treatment period also have negative mental and emotional effects on patients with infertility [23], leading to a decrease in the quality of life and SWB. In China’s socio-economic and cultural environment, the SWB of infertile women is also influenced by traditional culture’s belief in the importance of passing on the family line. Both infertility and economic pressure reduce women’s subjective well-being and increase psychological pressure. Combined with the adverse experiences brought by the disease itself, it affects the quality of reproductive life. Song demonstrated that women receiving IVF-ET treatment have a lower quality of life [24]. However, quality of life and emotional experience are important factors in SWB, which suggest that care providers should be aware of the positive role of SWB. Clinical staff should strengthen the assessment of patients’ SWB and identify the factors affecting it to develop effective care for patients.

The influencing factors of women with IVF-ET cycle treatment

Our study showed that age, monthly income, and self-esteem of patients have a positive correlation with SWB, while occupational status, years of infertility, and fertility stress have a negative correlation with SWB.

Age

This study indicated that during IVF-ET treatment, the SWB of patients aged >35 years was higher than that of the group aged ≤35 years. Patients aged over 35 years may have higher psychological resilience and post-traumatic growth capacity than those aged 35 years and below [25, 26]. They may be more resilient and resistant to stress in the face of infertility difficulties, able to change their perceptions to face the disease openly, or gradually accept if they fail to deliver a baby, and thus adapt to face difficulties positively and enhance their SWB. In addition, due to the timing of the universal two-child policy in China, women over 35 years old may have had a previous offspring, and their expectations for offspring may be lower than those of women under 35 years old. Nursing staff should therefore dedicate adequate attention to patients aged 35 years and below and use targeted interventions for patients to generate positive emotions and achieve their life values, enhance their psychological resilience, and assist them to face their illness positively.

Occupational status

This study presented that working women who underwent IVF-ET treatment had higher SWB than unemployed women. Some studies have shown that among infertile women, negative emotions such as anxiety and depression are significantly higher in unemployed patients than in working patients [27]. This may be because unemployed patients may pay more attention to their infertility or even make fertility their primary goal in life, thus leading to social isolation, whereas working women are more able to realize their self-worth in career and society. Careers may bring them confidence and satisfaction, positively impacting SWB. Additionally, working women often have a relatively lower willingness to have children overall. Therefore, care providers should be attentive toward patients who are unemployed during IVF-ET cycle treatment. Furthermore, caregivers should provide interventions that promote positive thinking and gratitude in patients [28], and encourage their families to support and motivate them to view the disease positively.

Personal monthly income

Our study found that infertile women with high personal monthly incomes had higher SWB. Infertile women often undergo frequent diagnosis, treatment, and auxiliary examinations in the early stages of their diseases in order to receive a diagnosis and enter the IVF cycle. This process may bring physical harm and psychological pressure to patients, as well as economic pressure. The cost of IVF-ET treatment is relatively high, and may pose a financial challenge for the family. Some studies have shown that patients with high incomes have higher levels of hope [29]. They have more wealth to pursue a high quality of material life, enhancing their SWB [30, 31]. On the other hand, low-income patients are more likely to feel that they are a burden to their families and may be unwilling to share their difficulties with others [32], turning negative emotions in IVF-ET treatment into a hidden emotional burden that affects patients’ psychological experiences. Therefore, sufficient attention needs to be paid to people with low personal income. Caregivers should encourage these patients to express themselves, confide in others, and make positive psychological adjustments.

Years of infertility

Our study indicated that patients with a longer diagnosis of infertility tend to have lower SWB, perhaps due to the accumulation of stresses endured from both internal and external sources eliciting negative emotions such as shame and frustration [33, 34], and the gradual wearing down of positive feelings. Moreover, Yilmaz et al. suggest that levels of distress increase with the duration of infertility [35]. Thus, peer education can be provided for patients who experience long-term infertility [36]. Health guides can also be provided to reduce patients’ negative emotions and promote positive mentalities.

Self-esteem

Total self-esteem scores were shown to have a significant positive effect on total SWB scores. Also, patients with higher levels of self-esteem had higher SWB. This is consistent with the finding in Hart’s study [37] that self-esteem is a good predictor of SWB. It is possible that patients with high self-esteem feel more confident about the future, and are more likely to face reality positively and proactively. Even in the face of infertility, they may retain a positive evaluation of themselves, making it easier to resist social rejection and feelings of worthlessness; in contrast, individuals with low self-esteem may approach problems inefficiently or with avoidance, and infertility may even reinforce their feelings of worthlessness [38]. Consequently, comprehensive psychological care interventions should be carried out for women with low self-esteem during IVF-ET cycle treatment, and a peer education system can be established to help patients improve their self-esteem.

Infertility stress

This study reveals that fertility stress has a significantly negative relationship with total SWB scores. The higher the fertility stress, the lower their SWB, which is in accordance with the results of the study conducted by Zhou et al. [39] Under the influence of China’s sociocultural environment and traditional beliefs, raising children is sometimes considered the main family responsibility of women. Women may feel guilty about not being able to pass on the family line, resulting in enormous reproductive pressure. It may be that high fertility stress results in a high negative perception of illness [40], leading to a higher likelihood of developing negative emotions such as shame and frustration, and even irrational perceptions surrounding fertility [41]. Influenced by traditional beliefs, infertile women holding childbearing as their key social role and identity may have negative psychological experiences. Healthcare professionals may pay more attention to assess patients’ fertility stress and provide personalized health education and psychological counseling to help patients view infertility more rationally, adjust negative perceptions and negative emotions, and thus improve their subjective sense of well-being.

Limitations

This study had limitations in the geographical area of the survey sample coming from the same reproductive medicine center using a cross-sectional survey and convenience sampling method. In the future, nationwide multi-center surveys and statistics should be conducted to carry out in-depth discussions and further validate the SWB of women undergoing IVF-ET treatment from different regions and with different customs and habits, so as to provide a theoretical basis for clinical work and thus be able to formulate scientific and targeted psychological interventions for patients.

Conclusions

This study found that the SWB of women undergoing IVF-ET treatment in China is at an intermediate level and still has potential for improvement. We found patients’ age, occupational status, personal monthly income, years of infertility, self-esteem and fertility stress are important factors influencing SWB. From the perspective of application, positive psychology-oriented counseling can reduce stress and improve patients’ mental health. The following suggestions are proposed for clinical nursing work to address the psychological difficulties of infertile women: Firstly, medical staff should provide psychoeducation for infertile women, attach importance to establishing professional relationships of cooperation and trust with service recipients, and improve the SWB of infertile women through psychological counseling. Secondly, medical staff should pay attention to the psychological well-being of infertile women in their work. Targeted care should be implemented for the factors influencing subjective well-being during the treatment cycle. Such psychological support should aim to stimulate positive emotions, promote their development of positive coping strategies, and increase their subjective well-being.

Relevance for clinical practice

This study provides suggestions for ameliorating the negative psychological experiences of women undergoing IVF-ET. In the clinical nursing process, more attention should be paid to patients below the age of 35 years, who are unemployed, with low monthly income, undergoing long-term infertility, with low self-esteem, or with high reproductive stress during their IVF-ET cycle. Medical staff should have the capacity to identify patients’ psychological issues and provide them with emotional guidance to enhance subjective well-being, thereby enabling patients to positively face the challenges of infertility.

Corresponding author: Donghong Song, Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, 49 Huayuan North, Haidian District, Beijing, China; National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, China; Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China; and Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China, E-mail:

Xi Zhang and Jinlu Li contributed equally to this work and share first authorship.

Acknowledgments

With the support of the hospital and patients, we express our heartfelt thanks to all the women who participated in this study and Peking University Third Hospital.

  1. Research ethics: The study was approved by the Peking University Third Hospital Medical Science Research Ethics Committee [IRB00006761-M2022468]. The research program conformed to Helsinki Declaration and guidelines of institution.

  2. Informed consent: Informed consent was obtained from all individuals included in this study.

  3. Author contributions: Xi Zhang and Jinlu Li contributed equally to this work. Xi Zhang, Jinlu Li, Liye Wang and Zirui Wang provided research ideas; Xi Zhang, Jinlu Li and Donghong Song designed the research scheme; Xi Zhang, Jinlu Li, Zirui Wang and Xuemei Gou were responsible for the implementation of the research plan and collecting data; Xi Zhang, Jinlu Li and Liye Wang were responsible for data analysis and manuscript writing; Donghong Song and Rui Yang were responsible for the final review of the manuscript. All authors read and approved the final manuscript.

  4. Use of Large Language Models, AI and Machine Learning Tools: None declared.

  5. Conflict of interest: The authors state no conflict of interest.

  6. Research funding: National key research and development program (2021YFC2700605); Beijing Science and Technology Planning Project (Z191100006619085); National Natural Science Foundation of China (82171632). The funding organization(s) played no role in the study design: in the collection, analysis, and interpretation of data: in the writing of the report; or in the decision to submit the report for publication.

  7. Data availability: The raw data can be obtained on request from the corresponding author

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Received: 2024-03-07
Accepted: 2024-07-19
Published Online: 2024-11-21

© 2024 the author(s), published by De Gruyter, Berlin/Boston

This work is licensed under the Creative Commons Attribution 4.0 International License.

Articles in the same Issue

  1. Frontmatter
  2. Editorials
  3. Expert consensus on narrative medicine in China (2023)
  4. The living will in China: progress and challenges following Shenzhen’s legislation
  5. Review Article
  6. Re-exploration of Oslerian legacy of Osler’s address “Old Humanities and New Science”
  7. Research Articles
  8. Teaching close reading: an instructor’s reflective case study of a Contemporary English Literature course for EFL medical students
  9. Subjective well-being of women undergoing in vitro fertilization and embryo transfer and influencing factors
  10. Reverse care at the end of life
  11. Impact of COVID-19 infection on medication adherence and medication taking behavior among rural-dwelling older adults with chronic diseases: a cross-sectional study
  12. A qualitative study on illness perceptions and self-mastery among Chinese elderly with hypertension
  13. Letter to the Editor
  14. Rural doctor in early 13th-century China
  15. Case Reports
  16. Denial as an ethical problem: the example of ICU triage in the context of the COVID-19 pandemic
  17. A case study of palliative care consultation: narrative practice for addressing clinical bottleneck problems
  18. Miscellaneous
  19. To solve the dilemma of modern medical ethics review with the wisdom of traditional Chinese philosophy
https://doi.org/10.1515/ajmedh-2024-0006
Keywords for this article
in vitro fertilization and embryo transfer (IVF-ET); self-esteem; fertility stress; subjective well-being (SWB); influencing factors
Creative Commons
BY 4.0

Articles in the same Issue

  1. Frontmatter
  2. Editorials
  3. Expert consensus on narrative medicine in China (2023)
  4. The living will in China: progress and challenges following Shenzhen’s legislation
  5. Review Article
  6. Re-exploration of Oslerian legacy of Osler’s address “Old Humanities and New Science”
  7. Research Articles
  8. Teaching close reading: an instructor’s reflective case study of a Contemporary English Literature course for EFL medical students
  9. Subjective well-being of women undergoing in vitro fertilization and embryo transfer and influencing factors
  10. Reverse care at the end of life
  11. Impact of COVID-19 infection on medication adherence and medication taking behavior among rural-dwelling older adults with chronic diseases: a cross-sectional study
  12. A qualitative study on illness perceptions and self-mastery among Chinese elderly with hypertension
  13. Letter to the Editor
  14. Rural doctor in early 13th-century China
  15. Case Reports
  16. Denial as an ethical problem: the example of ICU triage in the context of the COVID-19 pandemic
  17. A case study of palliative care consultation: narrative practice for addressing clinical bottleneck problems
  18. Miscellaneous
  19. To solve the dilemma of modern medical ethics review with the wisdom of traditional Chinese philosophy
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