title: Are attachment dimensions associated with infertility-related stress in couples undergoing their first IVF treatment? A study on the individual and cross-partner effect.
abstract: OBJECTIVE
  Are attachment anxiety and avoidance dimensions in female and male partners in couples seeking infertility treatment associated with her and his infertility-related stress?
  
  
  CONCLUSIONS
  Attachment dimensions are significantly associated with several aspects of infertility stress in couples undergoing IVF treatment.
  
  
  BACKGROUND
  Attachment dimensions of anxiety and avoidance (where highly anxious individuals fear rejection and are preoccupied with maintaining proximity to their partner and highly avoidant individuals are uncomfortable with intimacy and prefer to maintain distance from their partner) may influence the well being of individuals undergoing IVF/ICSI treatment. This study showed that one partner's attachment dimensions had a direct effect on the infertility-related stress of the other partner.
  
  
  METHODS
  Cross-sectional study of consecutive couples before starting their first IVF/ICSI treatment in 2009-2011 at the ANDROS clinic in Palermo, Italy.
  
  
  METHODS
  Three hundred and fifty-nine couples undergoing fertility treatments were invited to participate in the research. The final sample comprised 316 females and 316 males who filled out the psychological questionnaires (Experiences in Close Relationships; Fertility Problem Inventory; State scale of State-Trait Anxiety Inventory). The participants included patients who had a primary infertility diagnosis and were about to undergo their first IVF or ICSI treatment.
  
  
  METHODS
  Paired t-tests were used to examine gender differences on the study variables (attachment anxiety, attachment avoidance, infertility stress, state anxiety, etc.). Associations between infertility-related stress and the study variables were explored using hierarchical stepwise multivariate linear regression analyses.
  
  
  RESULTS
  Attachment anxiety and attachment avoidance were significantly associated with global infertility stress in both women (β = 0.24, P < 0.01 and β = 0.27, P < 0.01) and men (β = 0.23, P < 0.01 and β = 0.37, P < 0.01). Regarding the cross-partner effects, men's infertility stress and relationship concerns were associated with their partners' attachment avoidance (β = 0.10 P < 0.05 and β = 0.12, P < 0.05); and the infertility stress of women and the scores for need of parenthood were associated with their partners' attachment anxiety (β = 0.14 P < 0.05 and β = 0.16, P < 0.05).
  
  
  CONCLUSIONS
  The study data are cross sectional, and specifically focus on associations between adult attachment style and infertility stress. Treating the data from couples as independent observations may be a limitation of the analysis. Potential moderators of such relationships (e.g. coping strategies, stress appraisal) are not included in this study.
  
  
  BACKGROUND
  This research was supported by funds provided by Centro Andros S.r.l., Palermo, Italy. The authors declare no financial or commercial conflicts of interest in this study.
authors.affiliation: ANDROS Day Surgery, Psychology Unit, Palermo, Italy. zairadn@libero.it
authors.forename: Zaira
authors.initials: Z
authors.lastname: Donarelli
authors.forename: Gianluca
authors.initials: G
authors.lastname: Lo Coco
authors.forename: Salvatore
authors.initials: S
authors.lastname: Gullo
authors.forename: Angelo
authors.initials: A
authors.lastname: Marino
authors.forename: Andrea
authors.initials: A
authors.lastname: Volpes
authors.forename: Adolfo
authors.initials: A
authors.lastname: Allegra
mesh_terms: D000328:Adult; D001007:Anxiety / Q000209:etiology; D001010:Anxiety, Separation / Q000209:etiology; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D005307:Fertilization in Vitro / Q000523:psychology*; D006801:Humans; D007247:Infertility, Female / Q000523:psychology* / Q000628:therapy*; D007248:Infertility, Male / Q000523:psychology* / Q000628:therapy*; D007558:Italy; D008137:Longitudinal Studies; D008297:Male; D009769:Object Attachment; D054315:Oocyte Retrieval / Q000523:psychology; D010062:Ovulation Induction / Q000523:psychology; D011446:Prospective Studies; D012747:Sexual Partners / Q000523:psychology*; D020554:Sperm Injections, Intracytoplasmic / Q000523:psychology; D013315:Stress, Psychological / Q000503:physiopathology*