title: Does infertility history affect the emotional adjustment of couples undergoing assisted reproduction? the mediating role of the importance of parenthood.
abstract: OBJECTIVE
  The emotional adjustment of couples undergoing assisted reproductive technology (ART) treatments has been widely studied; however, it remains unclear whether infertility history contributes to couples' adjustment. This study examined the impact of infertility history (duration of infertility and number of previous ART treatment cycles) on the emotional adjustment of couples undergoing an ART cycle and the mediating effect of importance of parenthood on that association.
  
  
  METHODS
  In this cross-sectional study, 70 infertile couples (70 women and 70 men) completed self-report questionnaires assessing emotional adjustment and infertility stress during the hormonal stimulation phase of an ART cycle. Path models accounting for the dyadic nature of the data examined the direct and indirect effects (by affecting representations about parenthood and childlessness) of infertility history on emotional adjustment.
  
  
  RESULTS
  The number of previous cycles affected men's, but not women's, emotional adjustment by affecting the representations on the importance of parenthood and of childlessness. Duration of infertility had the opposite effect, as couples with longer infertility reported heightened importance of parenthood, which negatively affected their emotional adjustment.
  
  
  CONCLUSIONS
  Infertility history was associated with emotional adjustment in men and women, although these associations were complex. The results suggest that progression through treatment is harder for those men and women who attribute higher importance to being parents, which is aggravated by longer infertility.
  What is already known about the subject? Infertility is an unexpected and stressful life event Assisted reproductive treatments (ART) are emotionally demanding What does this study add? The influence of infertility history on adjustment is mediated by the importance of parenthood Men and women are affected by their past history of infertility differently.
authors.affiliation: Faculty of Psychology and Educational Sciences, University of Coimbra, Portugal.
authors.forename: Mariana
authors.identifier: http://orcid.org/0000-0001-7542-0497
authors.initials: M
authors.lastname: Moura-Ramos
authors.affiliation: Cardiff Fertility Studies Research Group, School of Psychology, Cardiff University, UK.
authors.forename: Sofia
authors.initials: S
authors.lastname: Gameiro
authors.affiliation: Faculty of Psychology and Educational Sciences, University of Coimbra, Portugal.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Canavarro
authors.affiliation: School of Psychology, University of Minho, Braga, Portugal.
authors.forename: Isabel
authors.initials: I
authors.lastname: Soares
authors.affiliation: Faculty of Medicine, University of Coimbra, Portugal.
authors.forename: Teresa
authors.initials: T
authors.lastname: Almeida-Santos
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D000066498:Emotional Adjustment; D005191:Family Characteristics; D005260:Female; D006801:Humans; D007246:Infertility / Q000523:psychology* / Q000628:therapy*; D008297:Male; D027724:Reproductive Techniques, Assisted / Q000523:psychology*; D012737:Sex Factors; D018454:Spouses / Q000523:psychology*; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: Fertilization; adjustment; anxiety; assisted reproduction; depression; infertility; in vitro