The impact of sociocultural and psychological stress on the outcome of assisted reproductive technology in remarried families

Figures & data

Figure 1. Flow diagram for participants enrolled in this study.

Figure 2. Social attributes of participants.

Table 1. Baseline characters of all participants.

	Second marriage group (n = 561)	First marriage group (n = 5600)	p-Value
Female age			<0.001
Mean ± SD	34.66 ± 4.09	30.65 ± 4.34
Min-max	24-49	20-54
Male age
Mean ± SD	31.07 ± 3.67	31.37 ± 4.69	0.071
Infertility years			<0.01
<4 years	458 (81.6%)	3259 (58.2%)
4–8 years	93 (16.6%)	1940 (34.6%)
>8 years	10 (1.8%)	401 (7.2%)
Female education			<0.01
<6 Years	51 (9.1%)	139 (2.5%)
6–9 Years	315 (56.1%)	1571 (28.1%)
9–12 Years	121(21.6%)	1075 (19.2%)
>12 Years	74(13.2%)	2815 (50.3%)
Male education			<0.01
<6 Years	30 (5.3%)	106 (1.9%)
6–9 Years	299 (53.3%)	1736 (31.0%)
9–12 Years	149 (26.6%)	1198 (21.4%)
>12 Years	83 (14.8%)	2560 (45.7%)
BMI			<0.01
Mean ± SD	24.19 ± 3.43	23.63 ± 3.63
Median(Q1–Q3)	24.00(21.67–26.30)	23.20(20.90–25.90)
Fertility history
Previous live birth	346 (61.7%)	989 (17.7%)	<0.01
Previous miscarriage	417 (74.3%)	1633 (29.2%)	<0.01
Classification of infertility
Primary	77 (13.7%)	3176 (56.7%)	<0.01
Secondary	484 (86.3%)	2424 (43.3%)
Indication for IVF
Tubal factor	385(68.6%)	3114(55.6%)	<0.01
Male factor	3 (0.5%)	27(0.5%)
Other factors	166 (29.6%)	2224(39.7%)
Combined factors	7 (1.2%)	235(4.2%)
FSH			0.192#
Mean ± SD	8.08 ± 3.60	7.83 ± 2.71
Median(Q1–Q3)	7.49 (6.25–9.12)	7.45(6.24–8.98)
LH			0.037#
Mean ± SD	4.99 ± 3.51	5.19 ± 2.95
Median(Q1–Q3)	4.26(3.19–5.81)	4.43(3.26–6.13)
E2			0.49#
Mean ± SD	51.95 ± 64.19	44.79 ± 27.04
Median(Q1–Q3)	40.00 (28.00–56.37)	40.00 (28.00–55.00)
P			0.026#
Mean ± SD	1.03 ± 2.6	0.68 ± 0.42
Median(Q1–Q3)	0.63 (0.38–0.95)	0.60 (0.38–0.88)
PRL			0.15#
Mean ± SD	11.88 ± 6.25	12.21 ± 6.86
Median(Q1–Q3)	10.53 (7.95–14.17)	12.67 (9.48–17.19)
T			0.776#
Mean ± SD	0.43 ± 0.17	0.44 ± 0.16
Median(Q1–Q3)	0.44 (0.32–0.59)	0.47 (0.34–0.61)
AMH			<0.01#
Mean ± SD	2.50 ± 1.78	3.23 ± 2.56
Median(Q1–Q3)	2.10(1.25–3.21)	2.68 (1.61–4.12)

Note: # Mann–Whitney test.

Table 2. Outcome of ART for all participants.

	Second marriage group (n = 561)	First marriage group (n = 5600)	p-Value
Protocol			<0.01
Antagonist protocol	198 (35.3%)	1525 (27.2%)
GnRH agonist protocol	266 (47.4%)	2426(43.3%)
Depot GnRHa protocol	90 (16%)	1630(29.1%)
Others	7 (1.2%)	19(0.3%)
Endometrial thickness			0.085#
Mean ± SD	10.86 ± 2.10	11.03 ± 2.04
Median(Q1–Q3)	11.00 (9.00–12.00)	11.00 (10.00–12.00)
Oocyte retrievals			<0.01#
Mean ± SD	9.19 ± 4.79	10.25 ± 5.01
Median(Q1–Q3)	9.00 (5.00–12.00)	10.00 (6.00–14.00)
No. of embryos transferred			<0.01
Mean	1.81	1.89
Single embryo transfer	108 (19.3%)	665 (11.7%)
Double embryo transfer	449 (80%)	4925 (86.9%)
Triple embryo transfer	4 (0.7%)	21.8 (0.4%)
Embryo transferred			<0.01
Day 3	524 (93.4%)	5458 (97.5%)
Day 5	37 (6.6%)	142 (2.5%)
Clinical pregnancy
No	338 (60.2%)	2737 (48.9%)	<0.01
Yes	223 (39.8%)	2863 (51.1%)
Live birth
No	389 (69.3%)	3158 (56.4%)	<0.01
Yes	172 (30.7%)	2442 (43.6%)

Note: # Mann–Whitney test.

Table 3. Univariate analysis and multivariate logistic analysis for all participants.

	Univariate analysis		Multivariate analysis
	OR (95%CI)	p Value	OR (95%CI)	p Value
Age	0.937 (0.926–0.948)	<0.01	0.951(0.937–0.964)	<0.01
Infertility years
<4 Years	1.040 (0.846–1.279)	0.71
4–8 Years	1.031 (0.832–1.278)	0.78
>8 Years	1.0
Female education
<6 Years	0.682 (0.502–0.926)	0.014	0.743 (0.541–1.021)	0.67
6–9 Years	0.900 (0.802–1.012)	0.079	0.875 (0.770–0.995)	0.42
9–12 Years	0.825 (0.719–0.946)	0.006	0.795 (0.689–0.917)	0.06
>12 years	1.0
BMI	1.007 (0.993–1.021)	0.319
Fertility history
Previous live birth	1.429 (1.261–1.621)	<0.01	1.013 (0.857–1.198)	0.879
Previous abortion	1.280 (1.149–1.426)	<0.01	0.994 (0.843–1.174)	0.948
Classification of infertility
Primary	1.0		1.001 (0.842–1.190)	0.993
Secondary	1.282 (1.158–1.418)	<0.01
Indication for IVF
Tubal factor	0.943 (0.724–1.227)	0.106
Male factor	0.900 (0.415–1.950)	0.661
Other factors	1.076 (0.823–1.405)	0.789
Combined factors	1.0	0.593
FSH	0.964 (0.964–0.982)	<0.01	0.988 (0.968–1.008)	0.231
LH	0.993 (0.977–1.010)	0.433
E2	0.997 (0.995–0.999)	0.03	0.998 (0.968–1.000)	0.018
P	0.990 (0.934–1.050)	0.74
PRL	1.005 (0.998–1.013)	0.147
T	1.166 (0.974–1.395)	0.094
AMH	1.070 (1.047–1.093)	<0.01	1.018 (0.995–1.041)	0.129
Protocol
Antagonist protocol	1.912 (0.764–4.785)	0.166
GnRH agonist protocol	2.653 (1.062–6.627)	0.037
Depot GnRHa protocol	2.812 (1.124–7.036)	0.027
Others	1.0
Endometrial thickness	1.081 (1.055–1.108)	<0.01	1.064 (1.037–1.092)	<0.01
On hCG day
Oocyte retrievals	1.046 (1.035–1.057)	<0.01	1.026 (1.014–1.038)	<0.01
NO. of embryos transferred
Single	0.474 (0.207–1.085)	0.077
Double	1.139 (0.505–2.569)	0.753
Triple	1.0
Second marriage	1.0
First marriage	1.749 (1.450–2.109)	<0.01	1.269 (1.031–1.562)	0.025

Table 4. Characters for matched participants.

	Second marriage group (n = 537)	First marriage group (n = 537)	p-Value
Age
Mean ± SD	34.64 ± 3.987	34.76 ± 4.606	0.655
Female education			<0.01
<6 Years	9.3%	3.0%
6–9 Years	56.2%	24.0%
9–12 Years	21.2%	17.7%
>12 Years	13.2%	55.3%
Fertility history
Previous live birth	63.1%	32.6%	<0.01
Previous miscarriage	75.4%	41.2%	<0.01
Classification of infertility			<0.01
Primary	12.3%	42.8%
Secondary	87.7%	57.2%
Indication for IVF			<0.01
Tubal factor	69.1%	53.8%
Male factor	0.6%	0.4%
Other factor	29.1%	41.3%
Combined factors	1.3%	4.5%
BMI
Median (Q1–Q3)	23.89 (20.00–26.30)	23.90 (29.90–26.00)	0.590#
FSH
Median (Q1–Q3)	7.46 (6.25–9.12)	7.63 (6.51–9.43)	0.204#
LH
Median (Q1–Q3)	4.24 (3.16–5.65)	4.19(3.12–5.47)	0.537#
E2
Median (Q1–Q3)	40.00 (28.00–57.00)	43.03 (30.00–77.00)	0.124#
P
Median (Q1–Q3)	0.62 (0.22–0.96)	0.60 (0.23–0.88)	0.131#
T
Median (Q1–Q3)	0.44 (0.31–0.58)	0.44 (0.30–0.57)	0.552#
AMH
Median (Q1–Q3)	2.08 (1.24–3.15)	1.99 (1.20–4.35)	0.483#

Note: # Mann–Whitney test.

Table 5. Outcome for matched participants.

	Second marriage group(n = 537)	First marriage group (n = 537)	p-Value
Protocol
Antagonist protocol	189(35.2%)	196(36.5%)	0.06
GnRH agonist protocol	262(48.8%)	222(41.3%)
Depot GnRH protocol	80(14.9%)	117(21.8%)
Others	6(1.1%)	2(0.4%)
Endometrial thickness
Median (Q1–Q3)	11.00 (9.00–12.00)	11.00 (9.50–12.00)	0.968#
Oocyte retrievals
Median (Q1–Q3)	8.00 (5.00–12.00)	8.00 (5.00–12.00)	0.387#
NO. of embryo transferred			0.090
Mean	1.83
Single embryo transfer	106(19.7%)	83(15.5%)
Double embryo transfer	428(79.7%)	447(83.2%)
Triple embryo transfer	3(0.6%)	7(1.3%)
Embryo transferred			0.070
Day 3	501(93.3%)	520(96.8%)
Day 5	36(6.7%)	17(3.2%)
Clinical pregnant
No	339(63.1%)	304(56.6%)	0.029
Yes	198(36.9%)	233(43.4%)
Live birth
No	383(71.3%)	344(64.1%)	0.011
Yes	154(28.7%)	195(35.9%)

Note: # Mann–Whitney test.

Data availability statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.