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The Stress Response, Psychoeducational Interventions and Assisted University of South Florida Scholar Commons Graduate Theses and Dissertations Graduate School 11-9-2004 The trS ess Response, Psychoeducational Interventions and Assisted Reproduction Technology Treatment Outcomes: A Meta- Analytic Review Karen Rose Mumford University of South Florida Follow this and additional works at: https://scholarcommons.usf.edu/etd Part of the American Studies Commons Scholar Commons Citation Mumford, Karen Rose, "The trS ess Response, Psychoeducational Interventions and Assisted Reproduction Technology Treatment Outcomes: A Meta-Analytic Review" (2004). Graduate Theses and Dissertations. https://scholarcommons.usf.edu/etd/1173 This Dissertation is brought to you for free and open access by the Graduate School at Scholar Commons. It has been accepted for inclusion in Graduate Theses and Dissertations by an authorized administrator of Scholar Commons. For more information, please contact [email protected]. The Stress Response, Psychoeducational Interventions and Assisted Reproduction Technology Treatment Outcomes: A Meta-Analytic Review by Karen Rose Mumford A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy Department of Measurement and Research College of Education University of South Florida Co-Major Professor: John Ferron, Ph.D. Co-Major Professor: Jeff Kromrey, Ph.D. Cynthia Parshall, Ph.D. Karen M. Perrin, Ph.D. Date of Approval: November 9, 2004 Keywords: infertility, depression, research synthesis, in vitro fertilization (IVF), meta-analysis © Copyright 2004, Karen R. Mumford DEDICATION This work is dedicated to my family who has educated me in the truly worthwhile things in life. To Mark, my husband, to whom I owe so much. It is through his patience, love, and support that this achievement was possible. To my parents, Robert P. and Margaret Hutcheson, who have given guidance and encouragement throughout my life, as a token of love, gratitude, and respect. To my sisters, Sandra and Rebecca, whose friendship and companionship I cherish. In loving memory to my grandmother, Viola Rose, whose example through life and humor has inspired me daily to become a better daughter, sister, wife, and woman. ACKNOWLEDGEMENTS I am extremely grateful to a number of individuals for the support provided to me throughout the process of completing this dissertation. I thank my husband, Mark, for supporting me through my entire program of study and for giving me the most precious commodity throughout this endeavor, the time to study, conduct my research, and write. I am appreciative to my family, friends, and colleagues for their continued interest and who have assisted me in the completion of this research in one way or another. I am deeply appreciative to Dr. Alice Domar and Dr. Jackie Boivin, who provided me with not only requested information and data for this research, but also offered me assistance, supplemental information, and support. I am particularly grateful to my committee members, Dr. Kay Perrin and Dr. Cynthia Parshall, for the care with which they reviewed this study and for their guidance. I am especially indebted to my major professors, Dr. John Ferron and Dr. Jeff Kromrey, who have spent innumerable hours reviewing my work and continuously challenged me. Their knowledge about statistics and research is absolutely encyclopedic and impressive to me. The leadership and mentoring they have extended to me throughout my program of studies will serve as an example to me throughout my professional career. If I have seen farther than others, it is because I stood on the shoulders of giants. -Isaac Newton TABLE OF CONTENTS LIST OF TABLES .................................................................................................vi LIST OF FIGURES ...............................................................................................ix ABSTRACT ..........................................................................................................xi CHAPTER ONE: INTRODUCTION ..................................................................... 1 Stress......................................................................................................... 1 Infertility ..................................................................................................... 3 Social Context of Infertility............................................................... 4 The Stress of Infertility .................................................................... 6 The Role of Psychoeducational Interventions in Infertility Health Care...... 9 Stress and Infertility Research ................................................................. 10 Meta-Analysis in Medical Research......................................................... 14 Problem Statement .................................................................................. 15 Research Purpose and Questions ........................................................... 16 Limitations of the Study............................................................................ 17 Professional Significance of the Study..................................................... 18 Definitions of Terms................................................................................. 19 CHAPTER TWO: LITERATURE REVIEW......................................................... 24 Introduction .............................................................................................. 24 The Infertility Problem.............................................................................. 25 Definition, Prevalence and Trends of Infertility in the United States......................................................................................... 25 Physical Causes of Infertility ......................................................... 32 Physical Infertility Treatment Options............................................ 37 Hormonal Treatment .......................................................... 37 i Surgical Treatment ............................................................. 42 Artificial Insemination ......................................................... 44 Assisted Reproductive Technology .................................... 48 ART Success Rates................................................. 52 Associated Costs and Insurance for ART ................ 54 Legal and Ethical Considerations for Infertile Couples and ART ................................................. 59 Conceptualization and Operational Classifications of Stress................... 61 Theories of Stress......................................................................... 64 Measurements of Stress ............................................................... 77 Stress Research............................................................................ 85 Stress and Infertility ................................................................................. 88 Emotional Aspects of Infertility ...................................................... 91 Conceptualization of Stress in Infertility Research ...................... 101 The Stress and Infertility Relationship......................................... 107 The Role of Psychoeducational Interventions in Infertility ........... 108 Summary of Research Examining the Relationship Between Stress and Infertility.................................................................. 116 Methodological Issues................................................................. 126 Meta-Analysis in Research .................................................................... 129 Definition, Development and Use of Meta-Analysis in Secondary Research................................................................ 129 Meta-Analysis in Medical Research ............................................ 131 Summary ............................................................................................... 132 CHAPTER THREE: METHOD......................................................................... 134 Problem Statement ................................................................................ 134 Research Purpose, Questions and Hypotheses .................................... 134 Method................................................................................................... 136 Formulation of the Research Problem......................................... 136 Identification of Studies ............................................................... 139 ii Evaluation of Data....................................................................... 145 Coding the Quality of the Studies ..................................... 145 Coding the Studies ........................................................... 146 Analysis and Interpretation.......................................................... 149 Effect Size ........................................................................ 149 Incomplete Reporting of Results ...................................... 152 Combining Estimates of Effect Size ................................. 153 Identification of Outliers.................................................... 158 Statistical Analysis............................................................ 159 Interpreting the Results ............................................................... 162 Generalizability............................................................................ 163 CHAPTER FOUR: RESULTS.........................................................................
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