Levels and associations among self-esteem, fertility distress, coping, and reaction to potentially being a genetic carrier in women with diminished ovarian reserve

Among 62 women with diminished ovarian reserve, self-esteem significantly predicted fertility distress both directly and indirectly through emotional reactions to potentially being a fragile X premutation carrier.

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Ceylan Cizmeli, M.A., Marci Lobel, Ph.D., Jason Franasiak, M.D., Lisa M. Pastore, Ph.D.

Volume 99, Issue 7, Pages 2037-2044.e3, June 2013



To measure the level of distress and its relationship with other psychologic factors in women with diminished ovarian reserve (DOR) who participated in a fragile X genetics study.


Longitudinal data analyzed with structural equation modeling.


Four U.S. private and academic fertility centers.


Sixty-two infertile patients with DOR.



Main Outcome Measure(s):

Fertility Problem Inventory, Coping Scale for Infertile Couples, Rosenberg Self-Esteem, Health Orientation Scale.


Nineteen percent had low fertility distress, 56% had average fertility distress, and 24% had high fertility distress. Thirty-six percent self-reported a “favorable” or “very favorable” emotional response to potentially being a fragile X carrier (termed “emotions”), 53% were “ambivalent,” and 11% had an unfavorable reaction. Three months after learning that they were not a carrier, these percentages were 91%, 9%, and 0%, respectively. Emotions at this second time point were significantly more positive than at pretesting. At baseline, higher self-esteem was a significant predictor of reduced fertility distress both directly and indirectly through emotions. Fertility distress was not associated with coping. Self-esteem, fertility distress, pretesting emotions, and coping were unrelated to posttesting emotions.


The potential of having an explanation for one’s DOR condition may have a beneficial impact on women’s psychologic states during the process of genetic testing, and this appeared to be especially true for women with higher self-esteem. Psychologic interventions targeted to women with low self-esteem may reduce distress and improve reactions to genetic testing.

Read the full text at: http://www.fertstert.org/article/S0015-0282(13)00325-7/fulltext

Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.