Fear of Childbirth and Pregnancy-Related

Anxiety in Women Conceiving With Assisted

Reproduction
P. Poikkeus, MD, T. Saisto, MD, PhD, L. Unkila-Kallio, MD, PhD, R.-L. Punamaki,
L. Repokari, MD, S. Vilska, MD, A. Tiitinen, MD, PhD, and M. Tulppala, MD, PhD
OBJECTIVE: To compare the prevalence and predictors
of severe fear of childbirth and pregnancy-related anxiety in
groups of assisted reproduction treatment (ART) and spontaneously conceiving women with singleton pregnancies.
METHODS: The ART group (n 367, nulliparous 260)
represented a cohort from five Finnish infertility clinics in
1999. The control group (n 379, nulliparous 135) was
enrolled in this study by consecutive sampling the same
year. Fear of childbirth was assessed by means of the
revised version of the Fear-of-Childbirth Questionnaire
and pregnancy-related anxiety by means of the Pregnancy Anxiety Scale at gestational week 20 3.2
(meanstandard deviation).
RESULTS: The frequency of severe fear of childbirth and
anxiety (classified as total scores in the 90th percentile or
higher in the revised Fear of Childbirth Questionnaire
and Pregnancy Anxiety Scale) did not differ between the
groups. Nulliparity was associated with more frequent
severe anxiety only in the controls. In nulliparous participants, a partnership of more than 5 years decreased the
risk of severe fear of childbirth (odds ratio 0.3, 95%
confidence interval 0.2 0.7). In the nulliparous ART
group, a long duration of infertility (7 or more years)

From the Department of Obstetrics and Gynecology, Helsinki University Central

Hospital; Department of Obstetrics and Gynecology, Jorvi Hospital, Helsinki
University Central Hospital; Department of Psychology, University of Tampere;
Hospital for Children and Adolescents, Helsinki University Central Hospital;
and Infertility Clinic, the Family Federation of Finland, Helsinki, Finland.
Corresponding author: Dr. Piia Poikkeus, HYKS-instituutti huone 3009/
Terkko, Haartmaninkatu 4, 00290 Helsinki, Finland; e-mail
piia.poikkeus@hus.fi.
This study was supported by the Paivikki and Sakari Sohlberg Foundation, by
the Clinical Graduate School, Pediatrics and Obstetrics/Gynecology, University
of Helsinki, and by Research Funds from Helsinki University Central Hospital.
Organon, Finland and Serono, Finland have also given financial support to our
work. The authors thank Vilho Hiilesmaa, MD, PhD, for statistical advice.
2006 by The American College of Obstetricians and Gynecologists. Published
by Lippincott Williams & Wilkins.
ISSN: 0029-7844/06

70

VOL. 108, NO. 1, JULY 2006

PhD,

increased the risk of severe fear of childbirth (odds ratio

4.4, 95% confidence interval 1.216.9).
CONCLUSION: Women conceiving after ART do not
experience severe fear of childbirth or pregnancy-related
axiety more often than spontaneously conceiving controls. However, a long duration of infertility is an independent risk factor regarding severe fear of childbirth.
(Obstet Gynecol 2006;108:706)

LEVEL OF EVIDENCE II-2

uring pregnancy a woman prepares mentally for

permanent life changes and new responsibilities
after the birth of the infant. Ambivalent feelings are a
normal part of this process, but for some women,
these feelings intensify, leading to fear of childbirth
and pregnancy-related anxiety. One in five pregnant
women experiences moderate fear of childbirth, and
6 13% of pregnant women experience severe, disabling fear of childbirth.1 4 Fear of childbirth results in
an increased number of visits to obstetricians after
somatic symptoms and in frequent requests for cesarean delivery.5 6 Previous nonviable pregnancies and
complicated childbirth are connected to fear of childbirth, but a womans traumatic life events, depression,
general anxiety, low self-esteem, and dissatisfaction
with the partnership also contribute strongly.3,5 8
In earlier studies among unselected pregnant
women, previous infertility has not been associated
with severe fear.5,9,10 Nevertheless, these results are
based on relatively small subgroups of previously
infertile participants, and they may be insensitive to
the duration of infertility and to treatment procedures.
Infertility investigations and the process of going
through assisted reproductive technology (ART) are
stressful, and the major predisposing factors of fear of
childbirth depression and anxietyare also present
in 20 40% of infertile women.1113 For the majority of

OBSTETRICS & GYNECOLOGY

women, the symptoms of depression and anxiety

become resolved after successful treatment, but for up
to 20% of infertile women, the emotional burden of
infertility persists even after giving birth.14 Furthermore, the results of two studies show that, although
they have a similar prevalence of general anxiety as
controls, women conceiving after ART are more
prone to anxiety over loss of their pregnancy.15,16
Pregnancy-related anxiety, on the other hand, is
significantly associated with fear of childbirth in unselected low-risk pregnant women.8 Altogether, because of the psychological burden of ART and increased
pregnancy-specific
anxiety,
women
conceiving after ART might be especially vulnerable
to fear of childbirth.
The aim of this study was to compare the prevalence of severe fear of childbirth and pregnancyrelated anxiety in second trimester in groups of ART
and spontaneously conceiving women with singleton
pregnancies. We compared both the whole groups
and parity-stratified groups. Second, we evaluated
demographic and obstetric predictors of severe fear of
childbirth and pregnancy-related anxiety in nulliparous participants. Finally, we analyzed the role of the
etiology and duration of infertility and the number
and the type of ART in predicting severe fear of
childbirth and severe pregnancy-related anxiety in
the nulliparous ART group.

MATERIALS AND METHODS

The studied women took part in a larger, prospective
and longitudinal controlled study on somatic and
mental health of ART families. The ART group was a
cohort of women conceiving after ART from the
infertility clinics of Helsinki University Central Hospital, the Family Federation of Finland (Helsinki,
Oulu and Turku), and the Deaconess Institute (Helsinki) in 1999. All volunteering Finnish-speaking
women with confirmed viable singleton pregnancy
after either fresh or frozen in vitro fertilization or
intracytoplasmic sperm injection with their own gametes were recruited to this study.
The Finnish-speaking, spontaneously conceiving
control women were recruited by consecutive sampling during their appointment for a screening ultrasonographic scan at gestational weeks 16 18 at Helsinki University Central Hospital the same year.
Exclusion criteria for the control women were previous infertility, infertility treatment, and maternal age
less than 25 years. All participants received oral and
written information about the study and gave written
informed consent voluntarily. The clinics Ethics
Committees approved this study.

VOL. 108, NO. 1, JULY 2006

Collection of the data has been reported previously.17 In short, the participants completed a set of
questionnaires at a mean of 20 (standard deviation
[SD] 3.2) weeks of gestation. In addition, the
recruiting infertility doctor or the research nurse
collected information on preceding infertility treatments from clinics patient registries and on the
medical and obstetric histories of the participants by
means of structured questions.
Fear of childbirth was assessed by means of the
revised version of the Fear-of-Childbirth Questionnaire (Cronbachs alpha 0.72). The original Questionnaire18 was revised to suit a Finnish population by
Saisto.8,19 The revised Fear-of-Childbirth Questionnaire consisted of 11 dichotomous questions, and
affirmative answers indicated fear. Pregnancy-related
anxiety was assessed by means of the Pregnancy
Anxiety Scale (Cronbachs alpha 0.80) revised by
Levin.20 This has shown high reliability, including in
Finnish samples.8,19 The anxiety scale covered three
dimensions of pregnancy-related anxiety: anxiety
about being pregnant, anxiety about giving birth, and
anxiety about hospitalization. It included 10 five-scale
questions (one not at all, five a lot). Total scores
equal to or higher than the 90th percentile in the
revised Fear-of-Childbirth Questionnaire (total scores
6 or higher) and Pregnancy Anxiety Scale (total scores
30 or higher) were considered to show severe fear
and severe pregnancy-related anxiety, respectively.8 With 80% power, .05 two-sided significance, we
could detect a difference of 7% in the prevalence of
severe fear of childbirth and pregnancy-related anxiety between the ART and control groups. Total scores
in the revised Fear-of-Childbirth Questionnaire and
Pregnancy Anxiety Scale were highly correlated (r
0.73, P .001).
The participants were also asked to report the
presence or absence of somatic symptoms (none,
hyperemesis, bleeding, other not specified) in structured dichotomous questions.
The statistical software package SPSS 12.0.1
(SPSS Inc., Chicago, IL) was used for all data analyses. Continuous variables were analyzed by means of
Student t test. Categorical variables were analyzed by
means of Fisher exact test. A P value less than .05 was
regarded as statistically significant. Two separate adjusted multiple logistic regression analyses were run
regarding the nulliparous participants. First, the impact of demographic factors such as age (20 29,
30 34, 35 44 years), educational level (high professional, low professional, skilled worker, unskilled
worker), type (married or cohabiting) and duration of
partnership (less than 5, 510, more than 10 years),

Poikkeus et al

Fear of Childbirth and Assisted Reproduction

71

and obstetric factors (previous nonviable pregnancies

and somatic symptoms in the present pregnancy) in
predicting severe fear of childbirth and severe pregnancy-related anxiety was analyzed. Second, ageadjusted infertility and treatment-related predictors
(etiology and duration of infertility, and ordinal and
type of treatment) of severe fear of childbirth and
severe pregnancy-related anxiety were investigated in
the nulliparous ART group. We also analyzed
whether clinic-to-clinic variation existed in our material by including infertility clinic as a predictor to the
above-explained logistic regression model.

RESULTS
Three hundred sixty-seven (92.4%) out of 397 initially
recruited women conceiving after ART and 379
(81.7%) out of 464 control women took part in the
study (P .001). The studied pregnancies represent
367 of 412 (89.1%, ART group) and 379 of 2,187
(17%, control group) of eligible pregnancies from the
recruiting clinics in 1999.
The demographic data, obstetric history, and
somatic symptoms are presented first among all participants and then among nulliparous women in Table

1. The partnership had lasted longer (mean of two

years longer) and marriage was more frequent in the
ART group than in the control group, irrespective of
parity. Among nulliparous participants, the control
women were slightly older and of higher educational
level than the ART women. Previous pregnancies and
deliveries were more frequent in the control women
than in the ART women, with the exception of more
numerous previous ectopic pregnancies in the ART
group. The prevalence of somatic complaints differed
only in more frequent other not specified somatic
complaints in the control group than in the ART
group. Infertility and ART-related characteristics are
given in Table 2.
Severe fear of childbirth and pregnancy-related
anxiety was expressed in equal proportions in the
ART and the control groups (Table 3). Also, the
medians of revised Fear-of-Childbirth Questionnaire
(2.0) and Pregnancy Anxiety Scale (20.0) scores were
similar between the groups. Comparison of pregnancy-, delivery- and hospitalization-specific Pregnancy
Anxiety Scale questions did not reveal any differences
between the ART and the control group.
Severe fear of childbirth was more frequent in the

Table 1. Demographic and Obstetric Factors of Participating Women

All

Total (n)
Age [y, mean (SD)]
Education [n (%)]
High professional
Low professional
Skilled worker
Unskilled worker
Married [n (%)]
Cohabiting [n (%)]
Duration of partnership [y, mean (SD)]
Previous Pregnancies [n (%)]
Miscarriages
Legal abortions
Ectopic pregnancies
Previous Live births [n (%)]
Previous Delivery [n (% of previous births)]
Vaginal, spontaneous
Operative
Data Missing
Somatic symptom in present pregnancy
None
Hyperemesis
Bleeding
Other not specified

Nulliparous

ART

Control

P*

ART

Control

367
33.0 (4.2)

379
33.3 (3.0)

.18

260
32.1 (4.1)

135
32.8 (3.0)

.05

100 (27.2)
150 (40.9)
58 (15.8)
47 (12.8)
254 (69.2)
81 (22.1)
9.7 (4.4)
182 (49.9)
69 (18.8)
36 (9.8)
31 (8.4)
107 (29.2)

126 (33.2)
165 (43.5)
47 (12.4)
39 (10.3)
243 (64.1)
123 (32.5)
7.7 (4.4)
274 (72.3)
75 (19.8)
34 (9.0)
4 (1.1)
244 (64.4)

.13
.71
.14
.25
.005
.008
.001
.001
.78
.71
.001
.001

67 (25.8)
109 (41.9)
45 (17.3)
32 (12.3)
178 (68.5)
64 (24.6)
8.8 (4)
81 (31.2)
51 (19.6)
21 (8.1)
19 (7.3)
0

50 (37.0)
57 (42.2)
17 (12.6)
11 (8.1)
71 (52.6)
58 (43.0)
6.2 (3.9)
36 (26.7)
25 (18.5)
10 (7.4)
2 (1.5)
0

.04
.91
.19
.23
.001
.001
.001
.27
.89
.85
.02

51 (47.7)
15 (14.0)
41 (38.3)

88 (36.1)
37 (15.1)
119 (48.8)

286 (77.9)
29 (7.9)
35 (9.5)
17 (4.6)

293 (77.3)
22 (5.8)
29 (7.7)
35 (9.3)

.86
.31
.86
.05

202 (77.7)
18 (6.9)
27 (10.4)
13 (5.0)

110 (81.5)
4 (3.0)
7 (5.2)
13 (9.6)

.44
.16
.09
.09

ART, assisted reproductive technology.

* Comparison among all participants.

comparison among nulliparous participants.

Vacuum extraction, elective or emergency cesarean delivery.

72

Poikkeus et al

Fear of Childbirth and Assisted Reproduction

OBSTETRICS & GYNECOLOGY

Table 2. Infertility and Treatment Characteristics

of the Assisted Reproductive Technology
Group According to Parity
Parous

Nulliparous

Total
107
Etiology of infertility
Female
36 (33.6)
Male
30 (28.0)
Combined
23 (21.5)
Unexplained
18 (16.8)
Duration of infertility [y, mean (SD)] 6.3 (2.9)
Studied treatment cycle
IVF
32 (29.9)
ICSI
21 (19.6)
FET
54 (50.5)

260
86 (33.1)
65 (25.0)
48 (18.5)
61 (23.5)
4.1 (2.3)
114 (43.8)
49 (18.8)
97 (37.3)

IVF, in vitro fertilization; ICSI, intracytoplasmic sperm injection;

FET, frozen embryo transfer.
Data are presented as number (percentage) unless otherwise noted.

Table 3. Prevalence of Severe Fear of Childbirth

and Pregnancy-Related Anxiety*
According to Group and Parity
ART
Total
rFDQ
PAS
Nulliparous
rFDQ
PAS
Parous
rFDQ
PAS

367
42 (11.4)
46 (12.5)
260
34 (13.1)
37 (14.2)
107
8 (7.5)
9 (8.4)

Control
379
40 (10.6)
38 (10.0)
135
19 (14.1)
20 (14.8)
244
21 (8.6)
18 (7.4)

P
.56
.16
1.00
1.00
1.00
.51

ART, assisted reproductive technology; rFDQ, revised Fear-ofChildbirth Questionnaire; PAS, Pregnancy Anxiety Scale.
* Total scores equal to or more than the 90th percentile in revised
Fear-of-Childbirth Questionnaire or in Pregnancy Anxiety
Scale.

P .05 between the nulliparous and parous participants in the

control group.

nulliparous women (53 of 395 [13.4%]) than in the

parous women (29 of 351 [8.3%]); P .03. Nulliparous women reported also more often severe pregnancy-related anxiety (57 of 395 [14.4%]) than the
parous participants (27 of 351 [7.7%]); P .004. The
association between parity and fear of childbirth and
pregnancy-related anxiety was different in the study
groups. In the ART group, the prevalence of severe
fear of childbirth and pregnancy-related anxiety did
not differ between nulliparous and parous women.
Instead, the nulliparous control women showed more
frequent severe pregnancy-related anxiety than parous controls (Table 3).
The demographic and obstetric predictors of
severe fear of childbirth and severe pregnancy-related
anxiety were investigated in multiple logistic regres-

VOL. 108, NO. 1, JULY 2006

sion analysis in nulliparous participants (Table 4).

More than 5 years of partnership decreased the risk of
severe fear of childbirth (odds ratio [OR] 0.3, 95%
confidence interval [CI] 0.2 0.7), whereas womens
age, educational level, history of nonviable pregnancy, or presence of any somatic symptom in this
pregnancy did not affect the risks. None of the studied
factors affected the risk of pregnancy-related anxiety.
Infertility and treatment-related factors in predicting severe fear and anxiety were analyzed among
nulliparous ART women in a separate adjusted multiple logistic regression analysis (Table 5). Long duration of infertility (7 or more years) increased the risk
of severe fear of childbirth (OR 4.4, 95% CI 1.216.9).
Numerous previous IVF attempts (four or more), on
the other hand, decreased the risk of severe fear (OR
0.06, 95% CI 0.005 0.7). The etiology of infertility
and treatment type did not affect the risk of either
severe fear of childbirth or severe pregnancy-related
anxiety. The inclusion of infertility clinic to the logistic regression model did not affect the before-explained results and was not associated independently
with severe fear of childbirth and pregnancy-related
anxiety.

DISCUSSION
The number of annual ART cycles is increasing in
Europe and the United States, and understanding both
the psychological and somatic consequences of these
treatments is needed.2122 We hypothesized that cumulative stress and previous disappointments after infertility investigations and treatments could promote fear of
childbirth and pregnancy-related anxiety in women
conceiving after ART. However, according to our results, infertility and ART do not expose a woman to an
increased risk of fear of childbirth, supporting the results
of earlier case-control studies.8 10 Only women with a
long period of infertility appear to be a vulnerable group
in terms of severe fear of childbirth. Our results further
show that women conceiving after ART are not more
anxious about the pregnancy than the controls, in
contrast to previous results.15,16 Interestingly, nulliparity
was associated with more prevalent severe pregnancyrelated anxiety in the control group, but not in the ART
group. More frequent fear of childbirth among nulliparous women has been reported previously.2326
We analyzed fear of childbirth and pregnancyrelated anxiety at previously used assessment time
and by means of reliable and valid methods.8,19
Nearly 90% of eligible pregnant ART women took
part in this study, and in terms of age and parity our
ART group is representative compared with both
national and international ART registers.27,28 The

Poikkeus et al

Fear of Childbirth and Assisted Reproduction

73

Table 4. Multiple Logistic Regression Analysis: Prediction of Severe Fear of Childbirth and Severe
Pregnancy-Related Anxiety* in Nulliparous Participants
Severe Fear of Childbirth in rFDQ
(Total Scores 6 or Higher)

Age (y)
2029
3034
3544
Educational level
High professional
Low professional
Skilled worker
Unskilled worker
Married
Yes
No
Duration of partnership (y)
Less than 5
510
More than 10
Previous nonviable pregnancy
None
One or more
Somatic symptom
None
Any

Severe Pregnancy-Related
Anxiety in PAS
(Total Scores 30 or Higher)

OR

95% CI

OR

95 % CI

62
202
90

1
1.2
0.7

0.53.0
0.22.0

62
204
92

1
0.8
0.8

0.31.8
0.32.0

107
151
56
40

1
1.6
1.8
1.6

0.73.4
0.74.9
0.55.1

107
154
56
41

1
1.3
1.5
0.7

0.62.5
0.63.7
0.22.2

238
116

1
0.6

0.31.2

240
118

1
0.8

0.41.7

111
150
93

1
0.3
0.5

0.20.7
0.21.1

112
152
94

1
0.6
0.9

0.31.3
0.42.0

248
106

1
1.6

0.83.0

251
107

1
1.5

0.82.7

278
76

1
0.7

0.31.7

281
77

1
0.8

0.41.7

rFDQ, revised Fear-of-Childbirth Questionnaire; PAS, Pregnancy Anxiety Scale; OR, odds ratio; 95% CI, 95% confidence interval.
* Total scores equal to or more than the 90th percentile in revised Fear-of-Childbirth Questionnaire or in Pregnancy Anxiety Scale.

Reference group.

Indicates hyperemesis, bleeding or other somatic problem in present pregnancy.

medians of total revised Fear-of-Childbirth Questionnaire and Pregnancy Anxiety Scale scores were relatively low and comparable with those among unselected Finnish pregnant women.8 Comparison of our
scores with results from international studies is unfortunately not possible because the content of fear-ofchildbirth questionnaires, and the assessment time,
vary from one study to another. Our assessment of
fear of childbirth and pregnancy-related anxiety at the
second trimester is clinically reasonable because it
leaves enough time for therapeutic interventions before delivery. However, our results from the 20th
gestational week may be influenced by more pronounced general well-being than results from the
other trimesters.29 33
A couple of limitations of our study deserve
mention. First, our sample size was not sufficient to
detect the relatively small differences in prevalence of
severe fear of childbirth and pregnancy-related anxiety as noticed in this material with high power.
Indeed our studys power to detect the observed
differences in prevalence of severe fear of childbirth
and severe pregnancy-related anxiety was 4% and

74

Poikkeus et al

16% percent, respectively (at the .05 significance

level). Nevertheless, the observed differences between the groups hardly bear a clinical significance
when differentiating women with severe fear of childbirth or pregnancy-related anxiety and women without them. Second, we did not include depression,
general anxiety, or satisfaction with partnership (the
most important psychological contributors regarding
fear of childbirth and pregnancy-related anxiety) in
this study. Our decision to limit our analyses to the
demographic and obstetric predictors of fear of childbirth and pregnancy-related anxiety corresponds to
the clinical setting where usually only these factors are
easily accessible. A clinician should still keep in mind
the possibility of underlying and coexisting psychological problems in women showing fear of childbirth.
Third, the results of several studies have indicated that
previous operative delivery contributes strongly to
the experience of fear and anxiousness in a subsequent pregnancy.5,34 37 Unfortunately, we could not
control for previous delivery experience owing to
deficient obstetric histories of the participants. We
therefore restricted the logistic regression analyses of

Fear of Childbirth and Assisted Reproduction

OBSTETRICS & GYNECOLOGY

Table 5. Multiple Logistic Regression Analysis: Prediction of Severe Fear of Childbirth and Severe
Pregnancy-Related Anxiety in Nulliparous Assisted Reproductive Technology Participants
Severe Pregnancy-Related
Anxiety in PAS
(Total Scores 30 or Higher)

Severe Fear of Childbirth in rFDQ

(Total Scores 6 or Higher)

Etiology of infertility
Female*
Male
Combined
Unexplained
Duration of infertility (y)
03*
46
7 or more
Number of treatment
1st*
2nd
3rd
4th
More than 4th
Treatment type
IVF*
ICSI
FET

OR

95% CI

OR

95% CI

72
59
41
64

1.0
0.9
0.3
0.6

0.32.6
0.071.5
0.21.6

72
59
41
65

1.0
0.7
0.4
0.4

0.22.3
0.091.7
0.11.3

130
78
28

1.0
1.3
4.4

130
79
28

1.0
1.3
3.0

87
50
38
21
40

1.0
0.3
0.8
0.3
0.06

0.061.4
0.23.1
0.041.8
0.0050.7

86
51
38
21
41

1.0
0.6
0.6
0.4
0.1

103
45
88

1.0
0.9
0.9

0.23.3
0.23.5

102
45
90

1.0
3.0
3.6

0.53.5
1.216.9

0.43.7
0.712.4

0.13.0
0.13.1
0.052.9
0.021.3

0.613.2
0.816.0

rFDQ, revised Fear-of-Childbirth Questionnaire; PAS, Pregnancy Anxiety Scale; OR, odds ratio; 95% CI, 95% confidence interval; IVF,
in vitro fertilization; ICSI, intracytoplasmic sperm injection; FET, frozen embryo transfer.
* Reference group.

possible predictors of fear of childbirth and pregnancy-related anxiety to nulliparous participants.

The only significant demographic predictor of
fear of childbirth in this study was the duration of
partnership: a 5- to 10-year partnership decreased the
risk of severe fear of childbirth. The observed protective role of a relatively long partnership regarding fear
of childbirth has been noticed before and probably
highlights the importance of the psychosocial support
provided by a satisfactory partnership during pregnancy.8,28 Bringing this finding to the other extreme,
underlying partnership problems may exacerbate severe fear of childbirth and should be actively taken
under discussion in the maternity care with women
fearing childbirth. The observed protective role of a
relatively long partnership regarding fear of childbirth
could also explain the different impact of parity in the
groups, as the partnerships were significantly longer
in the ART than in the control group irrespective of
the parity.
The long partnership may, however, not diminish
the trauma of a long preceding infertility. Our results
indicate that women with a long history of infertility
are at an increased risk of severe fear of childbirth,
which corresponds well to our studys hypothesis.
Based on our results, a special support during preg-

VOL. 108, NO. 1, JULY 2006

nancy should be provided to women with a long

period of infertility. Interestingly, numerous preceding assisted reproductive treatments (more than four)
decreased the risk of severe fear of childbirth. The
former suggests that repeating ART does not cause an
additional psychological stress and fear of childbirth
to an infertile woman.
To conclude, the similarly reported fear of childbirth and pregnancy-related anxiety to the controls
could be a sign of well-dealt crisis of infertility and
good psychological support in the ART group. The
observed protective role of a long partnership emphasizes the need to consider fear of childbirth as a
problem involving both partners and influencing their
future relationship with the infant.
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Fear of Childbirth and Assisted Reproduction

OBSTETRICS & GYNECOLOGY