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Swift A, Thomas E, Larson K, Swanson M, Fernandez-Pineda M. Infertility-related stress, quality of life, and reasons for fertility treatment discontinuation among US women: A secondary analysis of a cross-sectional study. SEXUAL & REPRODUCTIVE HEALTHCARE 2024; 39:100955. [PMID: 38394810 DOI: 10.1016/j.srhc.2024.100955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/16/2024] [Accepted: 02/18/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVE Fertility treatments often cause women high levels of stress and low quality of life (QoL). Women discontinue fertility treatments for a variety of reasons, yet little is known about infertility-related stress and QoL among women who discontinue treatments. The purpose of this study was to examine infertility-related stress and QoL among women who discontinued fertility treatments compared to those who continued treatments, and reasons for treatment discontinuation. METHODS A secondary analysis was conducted to examine infertility-related stress and QoL among 70 women who discontinued from fertility treatments compared to 166 women who received fertility treatments. Statistical analysis included descriptive statistics, chi-square test for independence, independent t-tests, and binary logistic regression analysis. Conventional content analysis was conducted on responses to an open-text question about reasons for treatment discontinuation. RESULTS No differences in infertility-related stress and QoL were found between groups. Explanatory variables of treatment discontinuation included income [odds ratios (OR) 2.50, 95% CI 1.12-5.61], QoL dissatisfaction (OR 2.49, 95% CI 1.33-4.69), and infertility duration three years or greater (OR 2.40, 95% CI 1.30-4.42). Three themes of treatment discontinuation were identified: Covering the Cost; Waiting for a Resolution; Re-envisioning Family Identity. CONCLUSION Infertility-related stress and QoL are similar among women who discontinued and who received fertility treatments, highlighting the need for emotional support services for women regardless of their treatment status. During the period of infertility, treatment discontinuation related to cost, waiting for a resolution, or re-envisioning family identity occurred, suggesting opportunities for specific interventions to support women's mental health needs.
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Affiliation(s)
- Alison Swift
- Department of Advanced Nursing Practice and Education, East Carolina University College of Nursing, 2205 W 5(th) St., Greenville, NC, USA.
| | | | - Kim Larson
- Department of Nursing Science, East Carolina University, College of Nursing, 2205 W 5th St., Greenville, NC, USA.
| | - Melvin Swanson
- Department of Nursing Science, East Carolina University, College of Nursing, 2205 W 5th St., Greenville, NC, USA.
| | - Madeline Fernandez-Pineda
- Department of Nursing Science, East Carolina University, College of Nursing, 2205 W 5th St., Greenville, NC, USA.
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Martin-Anatias N, Davies SG. Children as Investment: Religion, Money, and Muslim Migrants' Experiences of Assisted Reproduction in Aotearoa New Zealand (NZ). J Cross Cult Gerontol 2023; 38:307-325. [PMID: 37975963 DOI: 10.1007/s10823-023-09491-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 11/19/2023]
Abstract
Children are valued in all societies although the specific framing of that value differs. Several societies frame the value of children through the lens of investment. For instance, children are worth having and financially and emotionally investing in because children may grow up to be economically productive citizens offering financial and emotional support to aging parents. Drawing on interviews with 18 Muslim participants in Aotearoa New Zealand, we show that the act of investing in children is emotional, financial and religious. However, while would-be-parents talked most strongly about children being a form of religious investment for the future, investment as money was forced upon participants as they engaged with assisted reproductive technologies (ARTs). We explore how Muslim women and couples navigate terrain around children as investment showing a tangible tension between investment as money and investment as accruing religious capital. We thus develop the concept of children as religious investment to better understand Muslims' journeys through ARTs.
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Affiliation(s)
| | - Sharyn Graham Davies
- Herb Feith Indonesia Engagement Centre, School of Languages, Literatures, Cultures and Linguistics, Monash University, Melbourne, Australia
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Lee JC, DeSantis CE, Yartel AK, Kissin DM, Kawwass JF. Association of state insurance coverage mandates with assisted reproductive technology care discontinuation. Am J Obstet Gynecol 2023; 228:315.e1-315.e14. [PMID: 36368429 PMCID: PMC11000072 DOI: 10.1016/j.ajog.2022.10.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/21/2022] [Accepted: 10/29/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Insurance coverage for fertility services may reduce the financial burden of high-cost fertility care such as assisted reproductive technology and improve its utilization. Patients who exit care after failing to reach their reproductive goals report higher rates of mental health problems and a lower sense of well-being. It is important to understand the relationship between state-mandated insurance coverage for fertility services and assisted reproductive technology care discontinuation. OBJECTIVE This study aimed to assess whether state-mandated insurance coverage for fertility services is associated with lower rates of care discontinuation after an initial assisted reproductive technology cycle that did not result in a live birth. STUDY DESIGN This is a retrospective, population-based cohort study using data from United States fertility clinics reporting to the National Assisted Reproductive Technology Surveillance System during 2016 and 2018. Patients who began their first autologous assisted reproductive technology cycle during 2016 and 2017 and did not have a live birth were included. We describe the rate of assisted reproductive technology care discontinuation (no additional cycle within 12 months of the previous cycle's date of failure). Multivariable analyses were conducted to evaluate factors independently associated with care discontinuation, including the scope of fertility services included in state coverage mandate at assisted reproductive technology cycle initiation that were as follows: comprehensive (≥3 assisted reproductive technology cycles), limited (1, 2, or an unspecified number of assisted reproductive technology cycles), mandate not including assisted reproductive technology, and no mandate. RESULTS Among 91,324 patients who underwent their first autologous assisted reproductive technology cycle that did not result in live birth, 24,072 (26.4%) discontinued care. Compared with patients who lived in states with mandates for comprehensive assisted reproductive technology coverage, those in states with mandates for fertility services coverage that did not include assisted reproductive technology or states with no mandate were 46% (adjusted relative risk, 1.46; 95% confidence interval, 1.31-1.63) and 26% (adjusted relative risk, 1.26; 95% confidence interval, 1.15-1.39) more likely to discontinue care, respectively, after controlling for patient and cycle characteristics. Increasing patient age, distance from clinic ≥50 miles, previous live birth, fewer oocytes retrieved, and not having embryos cryopreserved were also associated with higher rates of discontinuation. Non-Hispanic Black, non-Hispanic Asian, and Hispanic patients had higher rates of care discontinuation than non-Hispanic White patients regardless of the existence or scope of state-mandated assisted reproductive technology coverage. CONCLUSION Comprehensive state-mandated insurance coverage for assisted reproductive technology is associated with lower rates of assisted reproductive technology care discontinuation.
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Affiliation(s)
- Jacqueline C Lee
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA.
| | - Carol E DeSantis
- CDC Foundation, Atlanta, GA; Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Anthony K Yartel
- CDC Foundation, Atlanta, GA; Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Dmitry M Kissin
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA; Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA
| | - Jennifer F Kawwass
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA; Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA
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Sousa E, Nery SF, Casalechi M, Thimóteo LC, Paiva SP, Silva-Filho AL, Reis FM. Characteristics, prevalence and sources of stress in individuals who discontinue assisted reproductive technology treatments: a systematic review. Reprod Biomed Online 2023; 46:819-825. [PMID: 36907754 DOI: 10.1016/j.rbmo.2023.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 01/24/2023] [Indexed: 02/04/2023]
Abstract
By considering the reasons behind discontinuing assisted reproductive technology (ART) treatment, several studies have indicated that 'stress' is an important issue, but the prevalence of stressors and stress responses, either acute or chronic, remains unclear. In this systematic review, we evaluated the characteristics, prevalence and causes of what was perceived and reported as 'stress' by couples who discontinued ART treatment. Electronic databases were systematically searched, and studies were considered eligible if they evaluated stress as a possible reason for ART discontinuation. Twelve studies were included, with 15,264 participants from eight countries. In all studies, 'stress' was assessed through generic questionnaires or medical records, not by validated stress questionnaires or biomarkers. The prevalence of 'stress' ranged from 11-53%. When the results were pooled, 'stress' was cited as a reason for ART discontinuation by 775 out of 2507 participants (30.9%). Clinical factors associated with worse prognosis, physical discomfort due to treatment procedures, family demands, time pressure and economic burden were identified as sources of 'stress' that contributed to ART discontinuation. Precisely knowing the characteristics of the stress associated with infertility is essential to devise preventive or supportive interventions to help patients to cope and endure the treatments. Further studies are necessary to investigate whether the mitigation of stress factors can reduce ART discontinuation rates.
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Affiliation(s)
- Elaine Sousa
- Division of Human Reproduction, Department of Obstetrics and Gynaecology; Hospital das Clínicas, UFMG, Av. Alfredo Balena, 110, 9˚ Andar, 30130-100 Belo Horizonte, MG, Brazil
| | - Simone F Nery
- Division of Human Reproduction, Department of Obstetrics and Gynaecology; Hospital das Clínicas, UFMG, Av. Alfredo Balena, 110, 9˚ Andar, 30130-100 Belo Horizonte, MG, Brazil
| | - Maíra Casalechi
- Division of Human Reproduction, Department of Obstetrics and Gynaecology; Hospital das Clínicas, UFMG, Av. Alfredo Balena, 110, 9˚ Andar, 30130-100 Belo Horizonte, MG, Brazil
| | - Luiz C Thimóteo
- Division of Human Reproduction, Department of Obstetrics and Gynaecology; Hospital das Clínicas, UFMG, Av. Alfredo Balena, 110, 9˚ Andar, 30130-100 Belo Horizonte, MG, Brazil
| | - Sara Pc Paiva
- Division of Human Reproduction, Department of Obstetrics and Gynaecology; Hospital das Clínicas, UFMG, Av. Alfredo Balena, 110, 9˚ Andar, 30130-100 Belo Horizonte, MG, Brazil
| | - Agnaldo L Silva-Filho
- Division of Human Reproduction, Department of Obstetrics and Gynaecology; Hospital das Clínicas, UFMG, Av. Alfredo Balena, 110, 9˚ Andar, 30130-100 Belo Horizonte, MG, Brazil
| | - Fernando M Reis
- Division of Human Reproduction, Department of Obstetrics and Gynaecology; Hospital das Clínicas, UFMG, Av. Alfredo Balena, 110, 9˚ Andar, 30130-100 Belo Horizonte, MG, Brazil.
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Fragoulakis V, Mantis A, Christoforidis N, Dovas D, Deftereos S, Lainas T, Mantoudis E, Paraschos T, Sakellariou D, Makrakis E. Follitropin Alpha for assisted reproduction: an analysis based on a non-interventional study in Greece. Curr Med Res Opin 2022; 38:2227-2235. [PMID: 36193626 DOI: 10.1080/03007995.2022.2131303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To conduct an economic evaluation estimating the cost per live birth after controlled ovarian stimulation (COS) using Follitropin Alpha (Gonal-F), in the Greek National Health System setting. A secondary objective was to predict the live birth rateof the In Vitro Fertilization (IVF) procedure. METHODS A single arm, multi-center, prospective, non-interventional study was conducted on which economic, efficacy and safety data were collected by six of the largest IVF centers. The participants were 350 female patients. Three statistical methods were employed for the analysis of the study outcomes, namely (a) Generalized Linear Modeling for the estimation of the costs of IVF treatment, (b) multivariable logistic regression and (c) an Artificial Neural Network (ANN) model for live birth prediction. RESULTS The mean total cost of IVF therapy per patient was estimated at €3728 (95% CI: €3679-€3780), while the total cost per live birth was €14,872 (95% CI: €12,441-€17,951). The live birth rate after 3 complete IVF cycles was estimated at 22.9%, while the percentage of those suffering from OHSS was limited at 0.57%. In logistic regression, the Ovarian Sensitivity Index (OSI) was a factor found to be positively associated with live birth (OR 7.39, 95% CI: 1.84-29.71). For the ANN, important predictors included number of gestational sacs and the duration of infertility. CONCLUSION The present study constitutes the largest single-arm study based on real data in Greece to date. The cost of IVF treatment and the cost per live birth are not insignificant in this NHS setting. The live birth rate, cost per oocyte, and the cost per live birth are in line with literature. OSI was a main contributing factor to the accurate prediction of the live birth rate, while age and BMI were found to be negatively correlated.
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Affiliation(s)
| | - Andreas Mantis
- School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
| | | | | | | | - Tryfwnas Lainas
- Eugonia - Assisted Reproduction Unit Konstantinou Ventiri 7 (HILTON), Athens, Greece
| | - Evripidis Mantoudis
- Medically Assisted Reproduction Unit and Cryopreservation Bank, "Gennima", Athens, Greece
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Gil Juliá M, Hervás I, Navarro-Gomezlechon A, Quintana F, Amorós D, Pacheco A, González-Ravina C, Rivera-Egea R, Garrido N. Cumulative live birth rates in donor oocyte ICSI cycles are not improved by magnetic-activated cell sorting sperm selection. Reprod Biomed Online 2022; 44:677-684. [PMID: 35184950 DOI: 10.1016/j.rbmo.2021.09.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/25/2021] [Accepted: 09/20/2021] [Indexed: 10/20/2022]
Abstract
RESEARCH QUESTION Does magnetic-activated cell sorting (MACS) for sperm selection increase cumulative live birth rates (CLBR) or improve clinical parameters of reproductive success in couples undergoing intracytoplasmic sperm injection (ICSI) with donor oocytes? DESIGN Retrospective multicentre observational study including data compiled from unselected couples who underwent ICSI cycles with donated oocytes in 15 Spanish IVIRMA fertility clinics (January 2008 to February 2020). Patients were divided into reference (standard semen processing, n = 40,157) and MACS (additional sperm selection step by MACS, n = 1,240) groups. CLBR were plotted on Kaplan-Meier curves and compared using the Mantel-Cox test. Proportions were compared with a generalized estimating equation model, and results were adjusted to clinically relevant variables. RESULTS The MACS group showed a 27.1% CLBR after one embryo was transferred and 81.6% after four; the reference group had CLBR of 19.6% and 78.5%, respectively. CLBR in the MACS group was 4.2% after five oocytes were used and 75.5% after 15; for the reference group, CLBR were 7.8% and 78.3%, respectively. Kaplan-Meier curves showed statistically significant differences in CLBR per number of embryos transferred and per number of donated metaphase II oocytes between the two groups (both P < 0.0001), but not for CLBR per embryo transfer. No significant differences between groups were found for classical clinical outcomes such as pregnancy and live birth rates per embryo transfer. CONCLUSIONS Although MACS sperm selection slightly increased the CLBR per embryo transferred compared with the reference group, this change was not clinically meaningful. MACS should not be recommended indiscriminately to all infertile patients undergoing ICSI with donated oocytes as a sperm processing add-on.
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Affiliation(s)
- María Gil Juliá
- IVI Foundation - IIS La Fe Health Research Institute, Av. Fernando Abril Martorell, 106. Torre A, Planta 1ª, Valencia . 46026, Spain.
| | - Irene Hervás
- IVI Foundation - IIS La Fe Health Research Institute, Av. Fernando Abril Martorell, 106. Torre A, Planta 1ª, Valencia . 46026, Spain
| | - Ana Navarro-Gomezlechon
- IVI Foundation - IIS La Fe Health Research Institute, Av. Fernando Abril Martorell, 106. Torre A, Planta 1ª, Valencia . 46026, Spain
| | - Fernando Quintana
- IVIRMA Bilbao, Landabarri Bidea, 1-3, Planta 2ª, Leioa Bizkaia 48940, Spain
| | - David Amorós
- IVIRMA Barcelona, Ronda del General Mitre, 14, Barcelona 08017, Spain
| | | | | | | | - Nicolás Garrido
- IVI Foundation - IIS La Fe Health Research Institute, Av. Fernando Abril Martorell, 106. Torre A, Planta 1ª, Valencia . 46026, Spain
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Robertson I, Harrison C, Ng KYB, Macklon N, Cheong Y, Boivin J. OUP accepted manuscript. Hum Reprod 2022; 37:1007-1017. [PMID: 35348672 PMCID: PMC9071224 DOI: 10.1093/humrep/deac046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 01/21/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- I Robertson
- Faculty of Medicine, Human Development and Health, Princess Anne Hospital, University of Southampton, Southampton, UK
| | - C Harrison
- School of Psychology, Cardiff Fertility Studies Research Group, Cardiff University, Cardiff, UK
| | - K Y B Ng
- Faculty of Medicine, Human Development and Health, Princess Anne Hospital, University of Southampton, Southampton, UK
| | | | - Y Cheong
- Faculty of Medicine, Human Development and Health, Princess Anne Hospital, University of Southampton, Southampton, UK
- Correspondence address. School of Psychology, Cardiff Fertility Studies Research Group, Cardiff University, Tower Building, 70 Park Place, Cardiff 10 CF10 3AT, UK. E-mail: (J.B.); Complete Fertility Southampton, Princess Anne Hospital, University of Southampton, Faculty of Medicine, Human Development and health, Southampton SO16 5YA, UK. E-mail: (Y.C.)
| | - J Boivin
- School of Psychology, Cardiff Fertility Studies Research Group, Cardiff University, Cardiff, UK
- Correspondence address. School of Psychology, Cardiff Fertility Studies Research Group, Cardiff University, Tower Building, 70 Park Place, Cardiff 10 CF10 3AT, UK. E-mail: (J.B.); Complete Fertility Southampton, Princess Anne Hospital, University of Southampton, Faculty of Medicine, Human Development and health, Southampton SO16 5YA, UK. E-mail: (Y.C.)
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Gameiro S. It is beneficial to support young, good prognosis patients, who strongly desire a biological child, through multiple cycles of treatment. Fertil Steril 2021; 116:67-68. [PMID: 34148591 DOI: 10.1016/j.fertnstert.2021.05.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Sofia Gameiro
- Cardiff Fertility Studies Group, School of Psychology, Cardiff University, Cardiff, United Kingdom
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