Experimental emotional disclosure in women undergoing infertility treatment: Are drop outs better off? Efharis Panagopoulou a, * , Anthony Montgomery b , Basil Tarlatzis a a Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece b Department of Educational and Social Policy, University of Macedonia, Thessaloniki, Greece article info Article history: Available online 15 July 2009 Keywords: Expressive writing Distress Infertility Drop outs Emotional disclosure Greece Women abstract So far, the beneficial effects of personal written emotional disclosure have been mainly examined in relation to past or current stressful/traumatic experiences. The anticipation of a medical event has rarely been studied within this paradigm. This randomized-controlled study examined whether written emotional disclosure would reduce emotional distress and increase pregnancy rates in women under- going in-vitro fertilization treatment. Participants recruited from women who were undergoing IVF in the north of Greece (n ¼ 148) were randomized to an emotional-writing condition, a fact-writing condition and a control condition. Outcomes included fertility-related distress, general distress and a positive indication of pregnancy. Psychological and medical information about women who refused to participate were also collected, and this represented a fourth group for analysis (n ¼ 66). Results indi- cated no significant difference between groups in terms of emotional distress. However, a significant difference was observed with regard to pregnancy results, with the non-participants group reporting the highest percentage of pregnancies. The present study did not support the hypotheses that emotional disclosure will reduce infertility-related or general psychological distress and improve pregnancy outcomes in women undergoing in-vitro fertilization treatment. However, women who refused to participate in the study were more likely to get pregnant. Differences in the beneficial effects of emotional disclosure are discussed. Ó 2009 Elsevier Ltd. All rights reserved. Introduction So far, the beneficial effects of written emotional disclosure have been mainly examined in relation to past or current stressful/ traumatic experiences. The anticipation of a medical event has rarely been studied within this paradigm. A recent meta-analysis indicated that out of 150 studies on emotional disclosure, only two included participants anticipating a stressful medical event (Frat- taroli, 2006). In the first study, participants anticipating a bladder papilloma resection who were assigned to the writing condition, showed improved postoperative course (Solano, Donati, Pecci, Persichetti, & Colaci, 2003). However results of a later study con- ducted by the same authors in patients waiting to undergo an endoscopic operation, found that beneficial effects were present only for patients with low preoperative risk, while patients with high-preoperative risk who were assigned in the writing condition showed a non-significant worse postoperative course (Solano et al., 2007). Given the potential impact of anticipatory psychological distress on medical outcomes it is necessary to further examine the effects of written emotional disclosure on individuals anticipating a medical stressor. In-vitro fertilization treatment (IVF) is the most frequently used procedure to treat infertility, with an average success rate per cycle of 23.8% (European Society of Human Reproduction and Embry- ology, 1996). A recent report by Nyboe Andersen et al. (2005) of European fertility clinics showed that the percentage of infants born in Europe after IVF ranges from 0.2 to 3.9%. To date, there is little doubt that in-vitro fertilization treatment is physically and psychologically stressful for both partners. The efforts associated with trying to conceive, uncertainty regarding the likely effective- ness of the treatment, and the physical pain and discomfort of the various invasive procedures all contribute to increased psycholog- ical distress (Stanton, Lobel, Sears, & de Luca, 2002). One of the most stressful times of the experience is the waiting for pregnancy test results after the embryo transfer (Demytteranaere et al., 1991). It has further been suggested that such distress may further affect treatment outcomes following IVF (Klonoff-Cohen, Chu, Natarajan, & Sieber, 2001; Verhaak, Smeenk, Van Minnen, Kremer, & Kraai- maat, 2005). The first goal of this randomized-controlled study was to test the hypothesis that written emotional disclosure in the waiting * Corresponding author. Tel.: þ30 231 0999154 E-mail address: efharis@the.forthnet.gr (E. Panagopoulou). Contents lists available at ScienceDirect Social Science & Medicine journal homepage: www.elsevier.com/locate/socscimed 0277-9536/$ – see front matter Ó 2009 Elsevier Ltd. All rights reserved. doi:10.1016/j.socscimed.2009.06.031 Social Science & Medicine 69 (2009) 678–681