title: Male psychological adaptation to unsuccessful medically assisted reproduction treatments: a systematic review.
abstract: Similarly to women, men suffer from engaging in fertility treatments, both physically and psychologically. Although there is a vast body of evidence on the emotional adjustment of women to infertility, there are no systematic reviews focusing on men's psychological adaptation to infertility and related treatments.
  
  
  
  The main research questions addressed in this review were 'Does male psychological adaptation to unsuccessful medically assisted reproduction (MAR) treatment vary over time?' and 'Which psychosocial variables act as protective or risk factors for psychological maladaptation?'
  
  
  
  A literature search was conducted from inception to September 2015 on five databases using combinations of MeSH terms and keywords. Eligible studies had to present quantitative prospective designs and samples including men who did not achieve pregnancy or parenthood at follow-up. A narrative synthesis approach was used to conduct the review.
  
  
  
  Twelve studies from three continents were eligible from 2534 records identified in the search. The results revealed that psychological symptoms of maladjustment significantly increased in men 1 year after the first fertility evaluation. No significant differences were found two or more years after the initial consultation. Evidence was found for anxiety, depression, active-avoidance coping, catastrophizing, difficulties in partner communication and the use of avoidance or religious coping from the wife as risk factors for psychological maladjustment. Protective factors were related to the use of coping strategies that involve seeking information and attribution of a positive meaning to infertility, having the support of others and of one's spouse, and engaging in open communication about the infertility problem.
  
  
  
  Our findings recommend an active involvement of men during the treatment process by health care professionals, and the inclusion of coping skills training and couple communication enhancement interventions in counselling. Further prospective large studies with high-quality design and power are warranted.
authors.affiliation: Faculty of Psychology and Education Sciences, University of Porto, 4200-135 Porto, Portugal Center for Psychology at University of Porto, 4200-135 Porto, Portugal mmartins@fpce.up.pt.
authors.forename: Mariana Veloso
authors.initials: MV
authors.lastname: Martins
authors.affiliation: School of Psychology, University of Minho, 4710-057 Braga, Portugal.
authors.forename: Miguel
authors.initials: M
authors.lastname: Basto-Pereira
authors.affiliation: Faculty of Psychology and Education Sciences, University of Porto, 4200-135 Porto, Portugal Center for Psychology at University of Porto, 4200-135 Porto, Portugal.
authors.forename: Juliana
authors.initials: J
authors.lastname: Pedro
authors.affiliation: School of Psychology, University of Minho, 4710-057 Braga, Portugal Crean College of Health and Behavioral Sciences, Chapman University, Orange, CA 92866, USA.
authors.forename: Brennan
authors.initials: B
authors.lastname: Peterson
authors.affiliation: Crean College of Health and Behavioral Sciences, Chapman University, Orange, CA 92866, USA Faculty of Sciences, University of Porto, 4169-007 Porto, Portugal.
authors.forename: Vasco
authors.initials: V
authors.lastname: Almeida
authors.affiliation: Section of Social Medicine, University of Copenhagen, 1014 Copenhagen K, Denmark.
authors.forename: Lone
authors.initials: L
authors.lastname: Schmidt
authors.affiliation: Faculty of Psychology and Education Sciences, University of Porto, 4200-135 Porto, Portugal Center for Psychology at University of Porto, 4200-135 Porto, Portugal.
authors.forename: Maria Emília
authors.initials: ME
authors.lastname: Costa
mesh_terms: D000223:Adaptation, Psychological; D001007:Anxiety / Q000209:etiology; D003863:Depression / Q000209:etiology; D005260:Female; D006801:Humans; D007248:Infertility, Male / Q000523:psychology* / Q000628:therapy; D008297:Male; D027724:Reproductive Techniques, Assisted / Q000523:psychology*; D012307:Risk Factors; D018454:Spouses / Q000523:psychology; D013315:Stress, Psychological / Q000209:etiology; D017211:Treatment Failure
keywords: adaptation; coping behaviour; depression; infertility; marital relationship; men; protective and risk factors; psychological; stress; systematic review