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Krishnan S, Daly MP, Kipping R, Harrison C. A systematic review of interventions to improve male knowledge of fertility and fertility-related risk factors. HUM FERTIL 2024; 27:2328066. [PMID: 38497245 DOI: 10.1080/14647273.2024.2328066] [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: 10/25/2023] [Accepted: 03/02/2024] [Indexed: 03/19/2024]
Abstract
Male infertility is a global health concern. The effectiveness of interventions developed to improve males' knowledge of fertility regulation and fertility-related risk factors remains unclear. This systematic review aimed to synthesize and evaluate the evidence for these interventions. Four databases were searched from inception to June 2023. Eligible studies examined interventions to increase fertility knowledge among presumed fertile males aged ≥16 years of age. Conference abstracts, protocols and studies without sex-disaggregated results for males were excluded. A narrative synthesis without meta-analysis was performed. A total of 4884 records were identified. Five studies (reported in six publications), all conducted in high-income countries, were included. Two were randomized control trials, and three were experimental studies. Interventions were delivered in person by a health professional (n = 3), online and via a mobile app. All studies showed a significant improvement in knowledge of fertility or fertility-related risk factors from baseline to follow-up. The largest improvement was observed for secondary and vocational students. A moderate, long-term retainment of knowledge was observed at two-year follow-up in one study. Available evidence suggests interventions to improve males' fertility knowledge are effective, particularly for younger, less educated males.
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Affiliation(s)
- Srinithy Krishnan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Michael P Daly
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ruth Kipping
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - China Harrison
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, UK
- National Institute for Health and Care Research, Health Protection Research Unit (NIHR HPRU) in Behavioural Science and Evaluation, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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2
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Hamilton K, Harper JC. Young adult's views on using a poster to learn about fertility: redesigning the fertility education poster. HUM FERTIL 2024; 27:2345675. [PMID: 38804247 DOI: 10.1080/14647273.2024.2345675] [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: 11/27/2023] [Accepted: 04/10/2024] [Indexed: 05/29/2024]
Abstract
Fertility awareness should be taught to everyone. The International Reproductive Health Education Collaboration (IRHEC) designed a fertility poster in 2019 but did not have a specific target group in mind. Studies have been conducted in Denmark and Sweden to determine how the poster can be redesigned. In this study, we carried out focus groups with young adults in the UK to ask their views of the poster, with the aim of redesigning it. Six focus groups were undertaken with twenty seven, 18-25 year olds. Five questions were asked: 1. What are your thoughts, feelings, and reactions to the poster? 2. Did you learn anything from the poster? 3. How has reading the poster impacted your opinions or thoughts about having children? 4. What are your opinions about using a poster format to inform and start reflections regarding family building? 5. Reading through each point are there any changes to be made? Content analysis was performed. Themes identified revealed the information on the poster gave the participants some anxiety and apprehension, especially regarding the effect of age on fertility, perceptions of IVF, and gaps in knowledge. The fertility education poster is a good resource for education, but other resources should be developed.
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Affiliation(s)
- Katie Hamilton
- EGA Institute for Women's Health, University College London, London, UK
| | - Joyce C Harper
- EGA Institute for Women's Health, University College London, London, UK
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Sylvest R, Koert E, Balslev J, Steenberg M, Schmidt L, Ziebe S. How to talk to young adults about fertility. Reprod Biomed Online 2024; 49:103937. [PMID: 38744029 DOI: 10.1016/j.rbmo.2024.103937] [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: 10/04/2023] [Revised: 03/04/2024] [Accepted: 03/04/2024] [Indexed: 05/16/2024]
Abstract
RESEARCH QUESTION How knowledgeable are Danish young adults about fertility and what are their attitudes towards learning about their reproductive biology? DESIGN The study was conducted at different educational institutions with 11 focus-group discussions that included a total of 47 participants (aged 18-29 years). Qualitative content analysis was used. The participants' fertility knowledge score was measured using the Cardiff Fertility Knowledge Scale. RESULTS The participants had an overall fertility knowledge score of 54%. Focus-group data showed that they thought it was important to learn about fertility and how to protect their fertility potential regardless of whether or not they wanted children. Providing knowledge is like planting a seed in the young adults. They wanted to hear about fertility in multifaceted ways and formats, and believed the information should be delivered by professionals, but developed in partnership with young people. The double-edged sword of knowledge and the consequence of knowledge made them hesitant or less open to learning. CONCLUSIONS Recommendations from this study are to tailor fertility information to young people, with due cognisance of their developmental stage, and ideally from an earlier age.
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Affiliation(s)
- Randi Sylvest
- Department of Gynecology, Fertility and Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Public Health, University of Copenhagen, Denmark.
| | - Emily Koert
- Department of Public Health, University of Copenhagen, Denmark
| | - Julie Balslev
- Department of Public Health, University of Copenhagen, Denmark
| | | | - Lone Schmidt
- Department of Public Health, University of Copenhagen, Denmark
| | - Søren Ziebe
- Department of Gynecology, Fertility and Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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4
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Kimmins S, Anderson RA, Barratt CLR, Behre HM, Catford SR, De Jonge CJ, Delbes G, Eisenberg ML, Garrido N, Houston BJ, Jørgensen N, Krausz C, Lismer A, McLachlan RI, Minhas S, Moss T, Pacey A, Priskorn L, Schlatt S, Trasler J, Trasande L, Tüttelmann F, Vazquez-Levin MH, Veltman JA, Zhang F, O'Bryan MK. Frequency, morbidity and equity - the case for increased research on male fertility. Nat Rev Urol 2024; 21:102-124. [PMID: 37828407 DOI: 10.1038/s41585-023-00820-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2023] [Indexed: 10/14/2023]
Abstract
Currently, most men with infertility cannot be given an aetiology, which reflects a lack of knowledge around gamete production and how it is affected by genetics and the environment. A failure to recognize the burden of male infertility and its potential as a biomarker for systemic illness exists. The absence of such knowledge results in patients generally being treated as a uniform group, for whom the strategy is to bypass the causality using medically assisted reproduction (MAR) techniques. In doing so, opportunities to prevent co-morbidity are missed and the burden of MAR is shifted to the woman. To advance understanding of men's reproductive health, longitudinal and multi-national centres for data and sample collection are essential. Such programmes must enable an integrated view of the consequences of genetics, epigenetics and environmental factors on fertility and offspring health. Definition and possible amelioration of the consequences of MAR for conceived children are needed. Inherent in this statement is the necessity to promote fertility restoration and/or use the least invasive MAR strategy available. To achieve this aim, protocols must be rigorously tested and the move towards personalized medicine encouraged. Equally, education of the public, governments and clinicians on the frequency and consequences of infertility is needed. Health options, including male contraceptives, must be expanded, and the opportunities encompassed in such investment understood. The pressing questions related to male reproductive health, spanning the spectrum of andrology are identified in the Expert Recommendation.
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Affiliation(s)
- Sarah Kimmins
- Department of Pharmacology and Therapeutics, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- The Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
- The Département de Pathologie et Biologie Cellulaire, Université de Montréal, Montreal, Quebec, Canada
| | - Richard A Anderson
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Christopher L R Barratt
- Division of Systems Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Hermann M Behre
- Center for Reproductive Medicine and Andrology, University Hospital, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Sarah R Catford
- Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | | | - Geraldine Delbes
- Institut National de la Recherche Scientifique, Centre Armand-Frappier Sante Biotechnologie, Laval, Quebec, Canada
| | - Michael L Eisenberg
- Department of Urology and Obstetrics and Gynecology, Stanford University, Stanford, CA, USA
| | - Nicolas Garrido
- IVI Foundation, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Brendan J Houston
- School of BioSciences and Bio21 Institute, The University of Melbourne, Parkville, Melbourne, Australia
| | - Niels Jørgensen
- Department of Growth and Reproduction, International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Csilla Krausz
- Department of Experimental and Clinical Biomedical Sciences, 'Mario Serio', University of Florence, University Hospital of Careggi Florence, Florence, Italy
| | - Ariane Lismer
- Department of Pharmacology and Therapeutics, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Robert I McLachlan
- Hudson Institute of Medical Research and the Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
- Monash IVF Group, Richmond, Victoria, Australia
| | - Suks Minhas
- Department of Surgery and Cancer Imperial, London, UK
| | - Tim Moss
- Healthy Male and the Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Allan Pacey
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Lærke Priskorn
- Department of Growth and Reproduction, International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Stefan Schlatt
- Centre for Reproductive Medicine and Andrology, University of Münster, Münster, Germany
| | - Jacquetta Trasler
- Departments of Paediatrics, Human Genetics and Pharmacology & Therapeutics, McGill University and Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Leonardo Trasande
- Center for the Investigation of Environmental Hazards, Department of Paediatrics, NYU Grossman School of Medicine, New York, NY, USA
| | - Frank Tüttelmann
- Institute of Reproductive Genetics, University of Münster, Münster, Germany
| | - Mónica Hebe Vazquez-Levin
- Instituto de Biología y Medicina Experimental, Consejo Nacional de Investigaciones Científicas y Técnicas de Argentina, Fundación IBYME, Buenos Aires, Argentina
| | - Joris A Veltman
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Feng Zhang
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, China
| | - Moira K O'Bryan
- School of BioSciences and Bio21 Institute, The University of Melbourne, Parkville, Melbourne, Australia.
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Bodin M, Plantin L, Schmidt L, Ziebe S, Elmerstig E. The pros and cons of fertility awareness and information: a generational, Swedish perspective. HUM FERTIL 2023; 26:216-225. [PMID: 34423731 DOI: 10.1080/14647273.2021.1968045] [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: 02/25/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
Being aware of factors that affect fertility can help people make informed decisions about their reproductive futures. To some, however, fertility information leads to worry and self-blame. In this paper, we explore how people from different generations discuss fertility and reproductive decision-making, along with their perceptions of fertility information. The study was conducted in southern Sweden with 26 focus-group discussions that included a total of 110 participants aged 17-90 years. The material was analysed thematically. Our results show that fertility knowledge and openness to talking about fertility problems have increased over generations. Participants who were assigned female at birth were more often concerned about their fertility than those who were not, and fertility concerns were transferred from mothers to daughters. While age-related fertility concerns had been uncommon in older generations, participants aged 25-40 often expressed these concerns. Young adults appreciated being knowledgeable about fertility but simultaneously expressed how fertility information could lead to distress. Our conclusion is that fertility information was best received by high-school students, and efforts to improve fertility education in schools are therefore recommended.
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Affiliation(s)
- Maja Bodin
- Centre for Sexology and Sexuality Studies, Malmö University, Malmö, Sweden
| | - Lars Plantin
- Centre for Sexology and Sexuality Studies, Malmö University, Malmö, Sweden
| | - Lone Schmidt
- Department of Public Health, University of Copenhagen, København, Denmark
| | - Søren Ziebe
- Fertility Clinic, Copenhagen University Hospital, Copenhagen, Denmark
| | - Eva Elmerstig
- Centre for Sexology and Sexuality Studies, Malmö University, Malmö, Sweden
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Maas VYF, Poels M, Ista E, Menge LF, Vanden Auweele KLHE, de Bie RWA, de Smit DJ, van Vliet-Lachotzki EH, Franx A, Koster MPH. The effect of a locally tailored intervention on the uptake of preconception care in the Netherlands: a stepped-wedge cluster randomized trial (APROPOS-II study). BMC Public Health 2022; 22:1997. [PMID: 36319990 PMCID: PMC9623982 DOI: 10.1186/s12889-022-14343-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 10/13/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The preconception period provides a window of opportunity for interventions aiming to reduce unhealthy lifestyle behaviours and their negative effect on pregnancy outcomes. This study aimed to assess the effectiveness of a locally tailored preconception care (PCC) intervention in a hybrid-II effectiveness implementation design. METHODS A stepped-wedge cluster randomized controlled trial was performed in four Dutch municipalities. The intervention contained a social marketing strategy aiming to improve the uptake (prospective parents) and the provision (healthcare providers) of PCC. Prospective parents participated by administering a questionnaire in early pregnancy recalling their preconceptional behaviours. Experiences of healthcare providers were also evaluated through questionnaires. The composite primary outcome was adherence to at least three out of four preconceptional lifestyle recommendations (early initiation of folic acid supplements, healthy nutrition, no smoking or alcohol use). Secondary outcomes were preconceptional lifestyle behaviour change, (online) reach of the intervention and improved knowledge among healthcare providers. RESULTS A total of 850 women and 154 men participated in the control phase and 213 women and 39 men in the intervention phase. The composite primary outcome significantly improved among women participating in the municipality where the reach of the intervention was highest (Relative Risk (RR) 1.57 (95% Confidence Interval (CI) 1.11-2.22). Among women, vegetable intake had significantly improved in the intervention phase (RR 1.82 (95%CI 1.14-2.91)). The aimed online reach- and engagement rate of the intervention was achieved most of the time. Also, after the intervention, more healthcare providers were aware of PCC-risk factors (54.5% vs. 47.7%; p = 0.040) and more healthcare providers considered it easier to start a conversation about PCC (75.0% vs. 47.9%; p = 0.030). CONCLUSION The intervention showed some tentative positive effects on lifestyle behaviours among prospective parents. Primarily on vegetable intake and the knowledge and competence of healthcare providers. The results of this study contribute to the evidence regarding successfully implementing PCC-interventions to optimize the health of prospective parents and future generations. TRIAL REGISTRATION Dutch Trial Register: NL7784 (Registered 06/06/2019).
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Affiliation(s)
- V. Y. F. Maas
- grid.5645.2000000040459992XDepartment of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - M. Poels
- grid.5645.2000000040459992XDepartment of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands ,House of Women, Niasstraat 7, 1095 TS Amsterdam, The Netherlands
| | - E. Ista
- grid.5645.2000000040459992XDepartment of Internal Medicine - Nursing Science, Erasmus MC, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands ,grid.416135.40000 0004 0649 0805Department of Paediatric Surgery, Paediatric intensive care, Erasmus MC Sophia Children’s Hospital, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - L. F. Menge
- grid.5645.2000000040459992XDepartment of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | | | - R. W. A. de Bie
- grid.425719.c0000 0001 2232 838XDutch Ministry of Health, Welfare and Sports, Parnassusplein 5, 2511 VX The Hague, The Netherlands ,grid.413681.90000 0004 0631 9258Department of Obstetrics, Diakonessenhuis Hospital, Bosboomstraat 1, Utrecht, 3582 KE The Netherlands
| | - D. J. de Smit
- MediClara Projects, Prinses Beatrixstraat 7, 1396 KD Baambrugge, The Netherlands
| | - E. H. van Vliet-Lachotzki
- grid.426579.b0000 0004 9129 9166Dutch Genetic Alliance, VSOP, Koninginnelaan 23, 3762 DA Soest, The Netherlands
| | - A. Franx
- grid.5645.2000000040459992XDepartment of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - M. P. H. Koster
- grid.5645.2000000040459992XDepartment of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
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Qin X, Xu S, Ma M, Fan X, Nie X, Zhang Y, Liu B, Li L. Differences in associations between family functioning and anxious and depressive symptoms in Chinese women and their partners in early pregnancy. BJPsych Open 2022; 8:e158. [PMID: 35983767 PMCID: PMC9438476 DOI: 10.1192/bjo.2022.549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Family functioning is associated with anxiety and depression. Perinatal depression and anxiety are common and influence the well-being of women, partners and their offspring. However, little is known about differences in associations between family functioning and mood symptoms in women and their partners in early pregnancy. AIMS Investigating differences in associations between family functioning and anxious and depressive symptoms in women and their partners in early pregnancy. METHOD In total, 171 woman-partner pairs were enrolled. The Edinburgh Postnatal Depression Scale (EPDS), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder 7-Item scale (GAD-7) and Family Assessment Device (FAD) were performed. Correlation analysis and multiple linear regression analysis were applied to investigate the associations. RESULTS In pregnant women, all the subscale scores on the FAD were correlated with total scores on the EPDS and GAD-7 (all P < 0.05), whereas only the Roles subscale showed a predicting effect in regression models (P < 0.01). In partners, all the subscale scores on the FAD were related to total scores on the PHQ-9 (all P < 0.05), whereas only the Problem Solving subscale showed a predicting effect (P = 0.029). CONCLUSIONS Our findings indicate that family functioning in the domain of roles is associated with anxious and depressive symptoms in pregnant women and functioning in the domain of problem solving is associated with depressive symptoms in partners. Clinicians should pay special attention to roles and problem solving when assessing mood symptoms in pregnant women and their partners. This study also provides a basis for family health education in early pregnancy.
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Affiliation(s)
- Xuemei Qin
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China; and Mental Health Institute of Central South University, China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Hunan Medical Center for Mental Health, Changsha 410011, Hunan, China
| | - Shuyin Xu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China; and Mental Health Institute of Central South University, China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Hunan Medical Center for Mental Health, Changsha 410011, Hunan, China
| | - Mohan Ma
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China; and Mental Health Institute of Central South University, China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Hunan Medical Center for Mental Health, Changsha 410011, Hunan, China
| | - Xing Fan
- Changsha Hospital for Maternal and Child Health Care, Changsha 410011, Hunan, China
| | - Xueqing Nie
- Changsha Hospital for Maternal and Child Health Care, Changsha 410011, Hunan, China
| | - Yan Zhang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China; and Mental Health Institute of Central South University, China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Hunan Medical Center for Mental Health, Changsha 410011, Hunan, China
| | - Bangshan Liu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China; and Mental Health Institute of Central South University, China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Hunan Medical Center for Mental Health, Changsha 410011, Hunan, China
| | - Lingjiang Li
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China; and Mental Health Institute of Central South University, China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Hunan Medical Center for Mental Health, Changsha 410011, Hunan, China
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8
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Grace B, Shawe J, Johnson S, Usman NO, Stephenson J. The ABC of reproductive intentions: a mixed-methods study exploring the spectrum of attitudes towards family building. HUMAN REPRODUCTION (OXFORD, ENGLAND) 2022. [PMID: 35238351 DOI: 10.1093/humrep/deac036/6541644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
STUDY QUESTION What are the intentions of men and women of reproductive age in the UK regarding reproduction and family building? SUMMARY ANSWER We identified six main categories of people; Avoiders, Betweeners, Completers, Desirers, Expectants and Flexers, for whom reproduction education strategies should be tailored differently to suit intentions. WHAT IS KNOWN ALREADY Several studies have highlighted poor fertility awareness across men and women of reproductive age. As the average age of first-time parents continues to rise, there has been a concerted effort from educators, healthcare professionals, charities, reproductive health groups and government policymakers, to improve fertility awareness. In order to ensure that these messages are effective and to deploy the best strategies, it is important to understand people's reproductive health needs. This study therefore aimed to explore different reproductive intentions to aid tailoring of information to help individuals and couples achieve their family building desires. STUDY DESIGN, SIZE, DURATION We conducted a mixed-method study via a UK-wide cross-sectional survey with 1082 participants and semi-structured interviews of 20 women and 15 men who agreed to follow-up interviews. Interviews lasted an hour on average. Ethics approval from UCL Research Ethics Committee. PARTICIPANTS/MATERIALS, SETTING, METHODS Survey participants were recruited nationwide via online newspaper and social media adverts. Interviewees were purposely sampled to include men and women from the reproductive age range (18-45 years), varying ethnicity and education background. Survey data were analysed using the Minitab statistical software package. Interview data were transcribed and analysed using the framework method. MAIN RESULTS AND THE ROLE OF CHANCE From the survey and interviews, we identified six key categories of people, grouped alphabetically, in a user-friendly manner to highlight a spectrum of reproductive intentions: Avoiders describes respondents who have no children and do not want to have children in the future; Betweeners describes those who already have child(ren) and want more in the future but are not actively trying to conceive; Completers describes those who have child(ren) but do not want more; Desirers describes those who are actively trying to conceive or plan to have child(ren) in the future; Expectants describes those who were pregnant at the time of the study; and Flexers describes those who may or may not already have and are unsure but or open to having child(ren) in the future. Analysis of survey data identified the following proportions in our study: Avoiders, 4.7%; Betweeners, 11.3%; Completers, 13.6%; Desirers, 36.9%; Expectants, 4.1%; and Flexers 28.4% and 2.4% preferring not to answer. There was one 'other' group from qualitative analysis, who would like to have children in the future but were unsure whether they could or had changing views. We recommend classifying as 'Desirers' or 'Flexers' for the purposes of fertility education. A majority of the survey population were trying to get pregnant; were pregnant; or planning to have a child in the future-whether actively, passively or simply open to the idea, with interviews providing deep insights into their family building decision-making. LIMITATIONS, REASONS FOR CAUTION Due to the online recruitment method, there may be a bias towards more educated respondents. WIDER IMPLICATIONS OF THE FINDINGS We developed a user-friendly, alphabetical categorization of reproductive intentions, which may be used by individuals, healthcare professionals, educators, special interest groups, charities and policymakers to support and enable individuals and couples in making informed choices to achieve their desired intentions, if and when they choose to start a family. STUDY FUNDING/COMPETING INTEREST(S) There was no external funding for this study. The authors report no competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- B Grace
- Department of Sexual and Reproductive Health, UCL Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK
| | - J Shawe
- Faculty of Health, University of Plymouth, Devon, UK.,SW Clinical School, Royal Cornwall Hospital, Truro, UK
| | - S Johnson
- QIAGEN Manchester Ltd, Manchester, UK
| | - N O Usman
- Department of Community Medicine, Kaduna State University, Kaduna, Nigeria
| | - J Stephenson
- Department of Sexual and Reproductive Health, UCL Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK
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9
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Maas VYF, Poels M, Stam AL, Lieftink N, Franx A, Koster MPH. Exploring male perceptions regarding the need to engage in preconception care - a mixed-method study amongst Dutch (prospective) fathers. EUR J CONTRACEP REPR 2022; 27:322-329. [PMID: 35297717 DOI: 10.1080/13625187.2022.2045933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE While most preconception care (PCC) interventions are aimed at women, men are also in need of PCC to reduce risk factors affecting the spermatozoa quality. The objective of this study is to explore male perceptions regarding the need to engage in PCC. MATERIALS AND METHODS In a mixed-method cross-sectional study, 229 men participated with a questionnaire and 14 individual semi-structured interviews were conducted. Questionnaires data were analysed using multiple regression analyses. The interviews were analysed using thematic analyses. RESULTS Most men did not retrieve preconceptional information (n = 135; 59.0%) nor visited a preconceptional consult (n = 182; 79.5%). Men who categorised their preconceptional lifestyle as unhealthy (score ≤6 out of 10) less often retrieved information (adjusted OR 0.36 [95% CI 0.14-0.93]) than men with a healthy preconceptional lifestyle. While several men expressed their fear for infertility, this did not lead to an increased uptake of PCC as men felt they were healthy enough already. CONCLUSION Despite high awareness of the positive influence of a healthy lifestyle, the perceived need for preparing for pregnancy among men remains low. Tailoring preconceptional information towards male needs provides a window of opportunity to improve men's reproductive health and possibly the health of future generations.
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Affiliation(s)
- Veronique Y F Maas
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Marjolein Poels
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Research Agency Care2Research, Amsterdam, The Netherlands
| | - Angela L Stam
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Natalie Lieftink
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Arie Franx
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Maria P H Koster
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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Rimmer MP, Howie RA, Subramanian V, Anderson RA, Bertolla RP, Beebeejaun Y, Bortoletto P, Sunkara SK, Mitchell RT, Pacey A, van Wely M, Farquhar CM, Duffy JMN, Niederberger C. Outcome reporting across randomized controlled trials evaluating potential treatments for male infertility: a systematic review. Hum Reprod Open 2022; 2022:hoac010. [PMID: 35386119 PMCID: PMC8982407 DOI: 10.1093/hropen/hoac010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/18/2022] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION What are the primary outcomes and outcome measures used in randomized controlled trials (RCTs) evaluating potential treatments for male infertility in the last 10 years? SUMMARY ANSWER Outcome reporting across male infertility trials is heterogeneous with numerous definitions and measures used to define similar outcomes. WHAT IS KNOWN ALREADY No core outcome set for male infertility trials has been developed. Male infertility trials are unique in that they have potentially three participants, a man, a female partner and their offspring and this will likely lead to significant variation in outcome reporting in randomized trials. STUDY DESIGN SIZE DURATION A systematic review of RCTs mapping outcomes and outcome measures evaluating potential treatments for men with infertility registered in the Cochrane Register of Controlled Trials (CENTRAL) between January 2010 and July 2021. PARTICIPANTS/MATERIALS SETTING METHODS Abstract screening and study selection was undertaken in duplicate using a review protocol that was developed prior to commencing the review. No risk of bias assessment was undertaken as this review aims to report on outcome reporting only. MAIN RESULTS AND THE ROLE OF CHANCE One hundred and seventy-five RCTs were identified, and given the large number of studies we limited our review to the 100 largest trials. Seventy-nine different treatments were reported across the 100 largest RCTs including vitamin and dietary supplements (18 trials), surgical treatments (18 trials) and sperm selection techniques (22 trials). When considering the largest 100 trials (range: 80-2772 participants), 36 primary and 89 secondary outcomes were reported. Forty-seven trials reported a primary outcome and 36 trials clearly defined their primary outcome. Pregnancy outcomes were inconsistently reported and included pregnancy rate (51 trials), pregnancy loss including miscarriage, ectopic pregnancy, stillbirth (9 trials) and live birth (13 trials). Trials consistently reporting the same outcome frequently used different definitions. For example, semen quality was reported by 75 trials and was defined in 7 different ways, including; the World Health Organization (WHO) 2010 criteria (32 trials), WHO 1999 criteria (18 trials), WHO 1992 criteria (3 trials), WHO 1999 and 1992 criteria (1 trial) and the Kruger strict morphology criteria (1 trial). LIMITATIONS REASONS FOR CAUTION We only evaluated the 100 largest trials published in the last 10 years and did not report outcomes on the remaining 75. An outcome was included as a primary outcome only if clearly stated in the manuscript and we did not contact authors to clarify this. As our review mapped outcomes and outcome measures, we did not undertake an integrity assessment of the trials included in our review. WIDER IMPLICATIONS OF THE FINDINGS Most randomized trials evaluating treatments for male infertility report different outcomes. Only half of the RCTs reported pregnancy rate and even fewer reported live birth; furthermore, the definitions of these outcomes varies across trials. Developing, disseminating and implementing a minimum data set, known as a core outcome set, for male infertility research could help to improve outcome selection, collection and reporting. STUDY FUNDING/COMPETING INTERESTS A.P.-chairman of external scientific advisory committee of Cryos International Denmark ApS, member of the scientific advisory board for Cytoswim LDT and ExSeed Health. Guest lecture at the 'Insights for Fertility Conference', funded by MERK SERONO Limited. M.v.W.-holds a ZON-MW research grant. No external funding was obtained for this study.
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Affiliation(s)
| | | | - Venkatesh Subramanian
- King’s Fertility, The Fetal Medicine Research Unit, King’s College London, London, UK
| | - Richard A Anderson
- MRC Centre for Reproductive Health, Queens Medical research Institute, University of Edinburgh, Edinburgh, UK,Edinburgh Fertility Centre, Simpsons Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Ricardo Pimenta Bertolla
- Division of Urology, Department of Surgery, Universidade Federal de Sao Paulo, São Paulo, Brazil
| | - Yusuf Beebeejaun
- King’s Fertility, The Fetal Medicine Research Unit, King’s College London, London, UK
| | - Pietro Bortoletto
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Sesh K Sunkara
- Division of Women’s Health, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Rod T Mitchell
- MRC Centre for Reproductive Health, Queens Medical research Institute, University of Edinburgh, Edinburgh, UK
| | - Allan Pacey
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Madelon van Wely
- Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Cindy M Farquhar
- Cochrane Gynaecology and Fertility Group, Auckland, New Zealand,Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - James M N Duffy
- Correspondence address. King’s Fertility, The Fetal Medicine Research Unit, King’s College London, London, UK. Tel: +44-7949-066806; E-mail:
| | - Craig Niederberger
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA,Department of Bioengineering, University of Illinois at Chicago College of Engineering, Chicago, IL, USA
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11
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Effectiveness of preconception care interventions in primary care: a systematic review protocol. BJGP Open 2022; 6:BJGPO.2021.0191. [PMID: 35177414 PMCID: PMC9447311 DOI: 10.3399/bjgpo.2021.0191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/13/2021] [Accepted: 01/04/2022] [Indexed: 11/08/2022] Open
Abstract
Background Pregnancy outcomes can be adversely affected by a range of modifiable risk factors, including alcohol consumption, smoking, obesity, drug use, and poor nutrition, during the preconception period. Preconception care (PCC) involves interventions that identify and seek to change behavioural, biomedical, and social risks present in reproductive-aged women and men. Primary care is well situated to offer PCC interventions but the effectiveness of these interventions is not clear. Aim To evaluate the effectiveness of primary care-based PCC delivered to reproductive-aged women and/or men to improve health knowledge, reduce preconception risk factors, and improve pregnancy outcomes. Design & setting A systematic review of primary care-based PCC. Method Ovid MEDLINE, Cochrane Central Register of Controlled Trials, Embase, Web of Science, Scopus, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases will be searched for English language studies published between July 1999 and May 2021. For inclusion, the PCC intervention must be provided in a primary care setting and intervention recipients must be reproductive-aged women and/or men. All stages of screening and data extraction will involve a dual review. The Cochrane Risk of Bias 2 (RoB 2) for randomised controlled trials (RCTs) will be used to assess the methodological quality of studies. This protocol adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) reporting guidelines. Conclusion Findings will determine the effectiveness of primary care-based preconception interventions delivered to reproductive-aged women and men on improving health knowledge, reducing risk factors, and improving pregnancy outcomes. Findings will be published in a peer-reviewed journal.
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12
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Grace B, Shawe J, Johnson S, Usman NO, Stephenson J. OUP accepted manuscript. Hum Reprod 2022; 37:988-996. [PMID: 35238351 PMCID: PMC9071225 DOI: 10.1093/humrep/deac036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 02/02/2022] [Indexed: 11/26/2022] Open
Abstract
STUDY QUESTION What are the intentions of men and women of reproductive age in the UK regarding reproduction and family building? SUMMARY ANSWER We identified six main categories of people; Avoiders, Betweeners, Completers, Desirers, Expectants and Flexers, for whom reproduction education strategies should be tailored differently to suit intentions. WHAT IS KNOWN ALREADY Several studies have highlighted poor fertility awareness across men and women of reproductive age. As the average age of first-time parents continues to rise, there has been a concerted effort from educators, healthcare professionals, charities, reproductive health groups and government policymakers, to improve fertility awareness. In order to ensure that these messages are effective and to deploy the best strategies, it is important to understand people’s reproductive health needs. This study therefore aimed to explore different reproductive intentions to aid tailoring of information to help individuals and couples achieve their family building desires. STUDY DESIGN, SIZE, DURATION We conducted a mixed-method study via a UK-wide cross-sectional survey with 1082 participants and semi-structured interviews of 20 women and 15 men who agreed to follow-up interviews. Interviews lasted an hour on average. Ethics approval from UCL Research Ethics Committee. PARTICIPANTS/MATERIALS, SETTING, METHODS Survey participants were recruited nationwide via online newspaper and social media adverts. Interviewees were purposely sampled to include men and women from the reproductive age range (18–45 years), varying ethnicity and education background. Survey data were analysed using the Minitab statistical software package. Interview data were transcribed and analysed using the framework method. MAIN RESULTS AND THE ROLE OF CHANCE From the survey and interviews, we identified six key categories of people, grouped alphabetically, in a user-friendly manner to highlight a spectrum of reproductive intentions: Avoiders describes respondents who have no children and do not want to have children in the future; Betweeners describes those who already have child(ren) and want more in the future but are not actively trying to conceive; Completers describes those who have child(ren) but do not want more; Desirers describes those who are actively trying to conceive or plan to have child(ren) in the future; Expectants describes those who were pregnant at the time of the study; and Flexers describes those who may or may not already have and are unsure but or open to having child(ren) in the future. Analysis of survey data identified the following proportions in our study: Avoiders, 4.7%; Betweeners, 11.3%; Completers, 13.6%; Desirers, 36.9%; Expectants, 4.1%; and Flexers 28.4% and 2.4% preferring not to answer. There was one ‘other’ group from qualitative analysis, who would like to have children in the future but were unsure whether they could or had changing views. We recommend classifying as ‘Desirers’ or ‘Flexers’ for the purposes of fertility education. A majority of the survey population were trying to get pregnant; were pregnant; or planning to have a child in the future—whether actively, passively or simply open to the idea, with interviews providing deep insights into their family building decision-making. LIMITATIONS, REASONS FOR CAUTION Due to the online recruitment method, there may be a bias towards more educated respondents. WIDER IMPLICATIONS OF THE FINDINGS We developed a user-friendly, alphabetical categorization of reproductive intentions, which may be used by individuals, healthcare professionals, educators, special interest groups, charities and policymakers to support and enable individuals and couples in making informed choices to achieve their desired intentions, if and when they choose to start a family. STUDY FUNDING/COMPETING INTEREST(S) There was no external funding for this study. The authors report no competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- B Grace
- Department of Sexual and Reproductive Health, UCL Institute for Women’s Health, Faculty of Population Health Sciences, University College London, London, UK
- Correspondence address. UCL EGA Institute for Women’s Health, Faculty of Population Health Sciences, Room 236 Medical School Building, University College London, 74 Huntley Street, London WC1E 6AU, UK. E-mail:
| | - J Shawe
- Faculty of Health, University of Plymouth, Devon, UK
- SW Clinical School, Royal Cornwall Hospital, Truro, UK
| | - S Johnson
- QIAGEN Manchester Ltd, Manchester, UK
| | - N O Usman
- Department of Community Medicine, Kaduna State University, Kaduna, Nigeria
| | - J Stephenson
- Department of Sexual and Reproductive Health, UCL Institute for Women’s Health, Faculty of Population Health Sciences, University College London, London, UK
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Abstract
CONTEXT Men generally seek healthcare less often than women and, other than traditional gender norms, less is known about the explanation. The aim was to identify knowledge gaps and factors influencing men regarding sexual and reproductive healthcare (SRHC) in the Nordic countries. METHODS We searched PubMed and SveMed+ for peer-reviewed articles published between January 2010 and May 2020. The analyses identified factors influencing men's experiences of and access to SRHC. RESULTS The majority of the 68 articles included focused on pregnancy, birth, infertility and sexually transmitted infections including HIV. During pregnancy and childbirth, men were treated as accompanying partners rather than individuals with their own needs. The knowledge and attitudes of healthcare providers were crucial for their ability to provide SRHC and for the experiences of men. Organisational obstacles, such as women-centred SRHC and no assigned healthcare profession for men's sexual and reproductive health issues, hindered men's access to SRHC. Lastly, the literature rarely discussed the impact of health policies on men's access to SRHC. CONCLUSIONS The literature lacked the perspectives of specific groups of men such as migrants, men who have sex with men and transmen, as well as the experiences of men in SRHC related to sexual function, contraceptive use and gender-based violence. These knowledge gaps, taken together with the lack of a clear entry point for men into SRHC, indicate the necessity of an improved health and medical education of healthcare providers, as well as of health system interventions.
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Affiliation(s)
- Mazen Baroudi
- Department of Epidemiology and Global Health, Umeå University Faculty of Medicine, Umea, Sweden
| | - Jon Petter Stoor
- Department of Epidemiology and Global Health, Umeå University Faculty of Medicine, Umea, Sweden
- Centre for Sami Health Research, Department of Community Medicine, UiT The Arctic University of Norway, Tromso, Norway
| | - Hanna Blåhed
- Department of Epidemiology and Global Health, Umeå University Faculty of Medicine, Umea, Sweden
| | - Kerstin Edin
- Department of Epidemiology and Global Health, Umeå University Faculty of Medicine, Umea, Sweden
| | - Anna-Karin Hurtig
- Department of Epidemiology and Global Health, Umeå University Faculty of Medicine, Umea, Sweden
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14
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Bodin M, Holmström C, Plantin L, Schmidt L, Ziebe S, Elmerstig E. Preconditions to parenthood: changes over time and generations. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2021; 13:14-23. [PMID: 34136667 PMCID: PMC8178081 DOI: 10.1016/j.rbms.2021.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/16/2021] [Accepted: 03/24/2021] [Indexed: 06/12/2023]
Abstract
Reproductive decision-making and fertility patterns change with time and place, and are influenced by contemporary societal factors. In this paper, we have studied biosocial aspects of reproductive decision-making over time and generations in a Nordic setting. The aim was to explore intergenerational changes and influences on decision-making, especially regarding preconditions to first birth. Twenty-six focus group interviews were conducted in southern Sweden, including a total of 110 participants aged 17-90 years. The analysis of the interviews resulted in six themes: (i) 'Providing security - an intergenerational precondition'; (ii) 'A growing smorgasbord of choices and requirements'; (iii) 'Parenthood becoming a project'; (iv) 'Stretched out life stages'; (v) '(Im)possibilities to procreate'; and (vi) 'Intergenerational pronatalism'. Our findings reflect increasing expectations on what it means to be prepared for parenthood. Despite increasing awareness of the precariousness of romantic relationships, people still wish to build new families but try to be as prepared as possible for adverse events. The findings also show how increasing life expectancy and medical advancements have come to influence people's views on their reproductive timeline.
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Affiliation(s)
- Maja Bodin
- Centre for Sexology and Sexuality Studies, Malmö University, Sweden
| | | | - Lars Plantin
- Centre for Sexology and Sexuality Studies, Malmö University, Sweden
| | - Lone Schmidt
- Department of Public Health, University of Copenhagen, Denmark
| | - Søren Ziebe
- Fertility Clinic, Copenhagen University Hospital, Denmark
| | - Eva Elmerstig
- Centre for Sexology and Sexuality Studies, Malmö University, Sweden
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15
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Boedt T, Vanhove AC, Vercoe MA, Matthys C, Dancet E, Lie Fong S. Preconception lifestyle advice for people with infertility. Cochrane Database Syst Rev 2021; 4:CD008189. [PMID: 33914901 PMCID: PMC8092458 DOI: 10.1002/14651858.cd008189.pub3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Infertility is a prevalent problem that has significant consequences for individuals, families, and the community. Modifiable lifestyle factors may affect the chance of people with infertility having a baby. However, no guideline is available about what preconception advice should be offered. It is important to determine what preconception advice should be given to people with infertility and to evaluate whether this advice helps them make positive behavioural changes to improve their lifestyle and their chances of conceiving. OBJECTIVES To assess the safety and effectiveness of preconception lifestyle advice on fertility outcomes and lifestyle behavioural changes for people with infertility. SEARCH METHODS We searched the Cochrane Gynaecology and Fertility Group Specialised Register of controlled trials, CENTRAL, MEDLINE, Embase, PsycINFO, AMED, CINAHL, trial registers, Google Scholar, and Epistemonikos in January 2021; we checked references and contacted field experts to identify additional studies. SELECTION CRITERIA We included randomised controlled trials (RCTs), randomised cross-over studies, and cluster-randomised studies that compared at least one form of preconception lifestyle advice with routine care or attention control for people with infertility. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recommended by Cochrane. Primary effectiveness outcomes were live birth and ongoing pregnancy. Primary safety outcomes were adverse events and miscarriage. Secondary outcomes included reported behavioural changes in lifestyle, birth weight, gestational age, clinical pregnancy, time to pregnancy, quality of life, and male factor infertility outcomes. We assessed the overall quality of evidence using GRADE criteria. MAIN RESULTS We included in the review seven RCTs involving 2130 participants. Only one RCT included male partners. Three studies compared preconception lifestyle advice on a combination of topics with routine care or attention control. Four studies compared preconception lifestyle advice on one topic (weight, alcohol intake, or smoking) with routine care for women with infertility and specific lifestyle characteristics. The evidence was of low to very low-quality. The main limitations of the included studies were serious risk of bias due to lack of blinding, serious imprecision, and poor reporting of outcome measures. Preconception lifestyle advice on a combination of topics versus routine care or attention control Preconception lifestyle advice on a combination of topics may result in little to no difference in the number of live births (risk ratio (RR) 0.93, 95% confidence interval (CI) 0.79 to 1.10; 1 RCT, 626 participants), but the quality of evidence was low. No studies reported on adverse events or miscarriage. Due to very low-quality evidence, we are uncertain whether preconception lifestyle advice on a combination of topics affects lifestyle behavioural changes: body mass index (BMI) (mean difference (MD) -1.06 kg/m², 95% CI -2.33 to 0.21; 1 RCT, 180 participants), vegetable intake (MD 12.50 grams/d, 95% CI -8.43 to 33.43; 1 RCT, 264 participants), alcohol abstinence in men (RR 1.08, 95% CI 0.74 to 1.58; 1 RCT, 210 participants), or smoking cessation in men (RR 1.01, 95% CI 0.91 to 1.12; 1 RCT, 212 participants). Preconception lifestyle advice on a combination of topics may result in little to no difference in the number of women with adequate folic acid supplement use (RR 0.98, 95% CI 0.95 to 1.01; 2 RCTs, 850 participants; I² = 4%), alcohol abstinence (RR 1.07, 95% CI 0.99 to 1.17; 1 RCT, 607 participants), and smoking cessation (RR 1.01, 95% CI 0.98 to 1.04; 1 RCT, 606 participants), on low quality evidence. No studies reported on other behavioural changes. Preconception lifestyle advice on weight versus routine care Studies on preconception lifestyle advice on weight were identified only in women with infertility and obesity. Compared to routine care, we are uncertain whether preconception lifestyle advice on weight affects the number of live births (RR 0.94, 95% CI 0.62 to 1.43; 2 RCTs, 707 participants; I² = 68%; very low-quality evidence), adverse events including gestational diabetes (RR 0.78, 95% CI 0.48 to 1.26; 1 RCT, 317 participants; very low-quality evidence), hypertension (RR 1.07, 95% CI 0.66 to 1.75; 1 RCT, 317 participants; very low-quality evidence), or miscarriage (RR 1.50, 95% CI 0.95 to 2.37; 1 RCT, 577 participants; very low-quality evidence). Regarding lifestyle behavioural changes for women with infertility and obesity, preconception lifestyle advice on weight may slightly reduce BMI (MD -1.30 kg/m², 95% CI -1.58 to -1.02; 1 RCT, 574 participants; low-quality evidence). Due to very low-quality evidence, we are uncertain whether preconception lifestyle advice affects the percentage of weight loss, vegetable and fruit intake, alcohol abstinence, or physical activity. No studies reported on other behavioural changes. Preconception lifestyle advice on alcohol intake versus routine care Studies on preconception lifestyle advice on alcohol intake were identified only in at-risk drinking women with infertility. We are uncertain whether preconception lifestyle advice on alcohol intake affects the number of live births (RR 1.15, 95% CI 0.53 to 2.50; 1 RCT, 37 participants; very low-quality evidence) or miscarriages (RR 1.31, 95% CI 0.21 to 8.34; 1 RCT, 37 participants; very low-quality evidence). One study reported on behavioural changes for alcohol consumption but not as defined in the review methods. No studies reported on adverse events or other behavioural changes. Preconception lifestyle advice on smoking versus routine care Studies on preconception lifestyle advice on smoking were identified only in smoking women with infertility. No studies reported on live birth, ongoing pregnancy, adverse events, or miscarriage. One study reported on behavioural changes for smoking but not as defined in the review methods. AUTHORS' CONCLUSIONS Low-quality evidence suggests that preconception lifestyle advice on a combination of topics may result in little to no difference in the number of live births. Evidence was insufficient to allow conclusions on the effects of preconception lifestyle advice on adverse events and miscarriage and on safety, as no studies were found that looked at these outcomes, or the studies were of very low quality. This review does not provide clear guidance for clinical practice in this area. However, it does highlight the need for high-quality RCTs to investigate preconception lifestyle advice on a combination of topics and to assess relevant effectiveness and safety outcomes in men and women with infertility.
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Affiliation(s)
- Tessy Boedt
- Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Anne-Catherine Vanhove
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
- Belgian Centre for Evidence-Based Medicine - Cochrane Belgium, Leuven, Belgium
| | - Melissa A Vercoe
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Christophe Matthys
- Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Eline Dancet
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Sharon Lie Fong
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynaecology, Leuven University Fertility Center, University Hospitals Leuven, Leuven, Belgium
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16
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Niemeyer Hultstrand J, Engström E, Målqvist M, Tydén T, Maseko N, Jonsson M. Evaluating the implementation of the Reproductive Life Plan in disadvantaged communities: A mixed-methods study using the i-PARIHS framework. PLoS One 2020; 15:e0236712. [PMID: 32915798 PMCID: PMC7485818 DOI: 10.1371/journal.pone.0236712] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 07/12/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction The Reproductive Life Plan (RLP) is a clinical tool to help clients find strategies to achieve their reproductive goals. Despite much research on the RLP from high-income countries, it has never been studied in low- or middle income countries. Together with health workers called Mentor Mothers (MMs), we used a context-adapted RLP in disadvantaged areas in Eswatini. Our aim was to evaluate the implementation of the RLP in this setting. Methodology MMs participated in focus group discussions (FGDs, n = 3 MMs n = 29) in January 2018 and at follow-up in May 2018 (n = 4, MMs n = 24). FGDs covered challenges in using the RLP, how to adapt it, and later experiences from using it. We used a deductive qualitative thematic analysis with the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework, creating themes guided by its four constructs: facilitation, innovation, recipients and context. The MMs also answered a questionnaire to assess the implementation process inspired by normalization process theory. Results The RLP intervention was feasible and acceptable among MMs and fit well with existing practices. The RLP questions were perceived as advantageous since they opened up discussions with clients and enabled reflection. All except one MM (n = 23) agreed or strongly agreed that they valued the effect the RLP has had on their work. Using the RLP, the MMs observed progress in pregnancy planning among their clients and thought it improved the quality of contraceptive counselling. The clients’ ability to form and achieve their reproductive goals was hampered by contextual factors such as intimate partner violence and women’s limited reproductive health and rights. Discussion The RLP was easily implemented in these disadvantaged communities and the MMs were key persons in this intervention. The RLP should be further evaluated among clients and suitable approaches to include partners are required.
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Affiliation(s)
| | - Ellinor Engström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Mats Målqvist
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Tanja Tydén
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Maria Jonsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Bernardi LA, Luck M, Kyweluk MA, Feinberg EC. Knowledge gaps in the understanding of fertility among non-medical graduate students. F S Rep 2020; 1:177-185. [PMID: 34223241 PMCID: PMC8244259 DOI: 10.1016/j.xfre.2020.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/03/2020] [Accepted: 08/01/2020] [Indexed: 11/24/2022] Open
Abstract
Objective To assess knowledge of female and male fertility among students enrolled in a Master of Business Administration (MBA) program. Design Web-based cross-sectional survey. Setting Academic setting. Patient(s) Not applicable. Intervention(s) None. Main Outcome Measure(s) Knowledge of how female and male age impacts reproduction, fecundability, and success rates with in vitro fertilization (IVF). Result(s) A total of 133 female and male MBA students completed the survey. Nearly 10% of participants were not aware that women are born with a fixed number of oocytes and that oocyte quantity and quality decline with age. More than 30% of participants overestimated fecundability in women aged ≥35 years, and >50% overestimated IVF success rates in women older than 40 years. Fifteen percent of participants did not know that men have stem cells in the testes, and >25% were not aware that men experience a decrease in sperm concentration and quality with age. Nearly 30% believed that a man’s age never impacts reproductive outcomes. Less than 30% of participants correctly estimated fecundability and IVF success rates based on male age. Conclusion(s) These data highlight important knowledge gaps in a highly educated group of MBA students, most whom desire future childbearing. Specifically, there is a lack of understanding of both male and female reproductive aging and an overestimation of treatment success. As delayed childbearing continues, particularly among those with high educational attainment, attention should be focused on introducing broad fertility education at a younger age to improve future reproductive success.
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Affiliation(s)
- Lia A Bernardi
- Division of Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Marissa Luck
- Division of Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Moira A Kyweluk
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Eve C Feinberg
- Division of Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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18
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Abstract
Delayed childbearing is currently a major challenge in reproductive medicine as increased age has an important impact on successful conception, both in natural and in assisted reproduction. There is a lack of knowledge about the impact of age on fertility, even in highly educated populations. A number of initiatives have been taken to increase fertility awareness. Health care providers have been encouraged to talk with patients about their reproductive life plan (RLP) for almost a decade based on recommendations from the Centres for Disease Control and Prevention. This concept has been explored successfully in Swedish contraception counselling. A growing number of online interventions aim to raise fertility awareness. These websites or interactive tools provide relevant information for individuals and couples as they consider whether they want children, when they should have them, and how many they may wish to have. These interventions are important, because research depicts that knowledge helps people in their decision-making process. With new fertility preservations such as egg freezing now available, additional education is needed to be sure that women and couples are well informed about the cost and low success rates of this intervention.
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Affiliation(s)
- Ilse Delbaere
- Midwifery Education, VIVES University of Applied Sciences, Kortrijk, Belgium
- CONTACT Ilse Delbaere Midwifery Education, VIVES University of Applied Sciences, Doorniksesteenweg 145, Kortrijk, 8500, Belgium
| | - Sarah Verbiest
- Center for Maternal and Infant Health, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Tanja Tydén
- Department of Women’s and Children’s Heath, Akademiska Sjukhuset Uppsala University, Uppsala, Sweden
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Koo Andersson M, Tydén T. Implementation of reproductive life planning (RLP) in primary health care supported by an evidence-based website. EUR J CONTRACEP REPR 2019; 25:1-7. [DOI: 10.1080/13625187.2019.1695117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Melinda Koo Andersson
- Department of Women’s and Children’s Health, Uppsala University Hospital, Uppsala, Sweden
| | - Tanja Tydén
- Department of Women’s and Children’s Health, Uppsala University Hospital, Uppsala, Sweden
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Grandahl M, Bodin M, Stern J. In everybody's interest but no one's assigned responsibility: midwives' thoughts and experiences of preventive work for men's sexual and reproductive health and rights within primary care. BMC Public Health 2019; 19:1423. [PMID: 31666036 PMCID: PMC6822360 DOI: 10.1186/s12889-019-7792-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 10/16/2019] [Indexed: 11/10/2022] Open
Abstract
Background Sexual and reproductive health and rights (SRHR) have historically been regarded as a woman’s issue. It is likely that these gender norms also hinder health care providers from perceiving boys and men as health care recipients, especially within the area of SRHR. The aim of this study was to explore midwives’ thoughts and experiences regarding preventive work for men’s sexual and reproductive health and rights in the primary care setting. Methods An exploratory qualitative study. Five focus group interviews, including 4–5 participants in each group, were conducted with 22 midwives aged 31–64, who worked with reproductive, perinatal and sexual health within primary care. Data were analysed by latent content analysis. Results One overall theme emerged, in everybody’s interest, but no one’s assigned responsibility, and three sub-themes: (i) organisational aspects create obstacles, (ii) mixed views on the midwife’s role and responsibility, and (iii) beliefs about men and women: same, but different. Conclusions Midwives believed that preventive work for men’s sexual and reproductive health and rights was in everybody’s interest, but no one’s assigned responsibility. To improve men’s access to sexual and reproductive health care, actions are needed from the state, the health care system and health care providers.
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Affiliation(s)
- Maria Grandahl
- Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, SE-751 85, Uppsala, Sweden.
| | - Maja Bodin
- Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, SE-751 85, Uppsala, Sweden
| | - Jenny Stern
- Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, SE-751 85, Uppsala, Sweden.,Sophiahemmet University, Box 5605, SE-114 86, Stockholm, Sweden
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Skogsdal Y, Fadl H, Cao Y, Karlsson J, Tydén T. An intervention in contraceptive counseling increased the knowledge about fertility and awareness of preconception health-a randomized controlled trial. Ups J Med Sci 2019; 124:203-212. [PMID: 31495254 PMCID: PMC6758707 DOI: 10.1080/03009734.2019.1653407] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Background: Reproductive life plan counseling (RLPC) is a tool to encourage women and men to reflect upon their reproduction, to avoid unintended pregnancies and negative health behavior that can threaten reproduction. The aim was to evaluate the effect of RLPC among women attending contraceptive counseling. Outcomes were knowledge about fertility and awareness of preconception health, use of contraception, and women's experience of RLPC. Material and methods: Swedish-speaking women, aged 20-40 years, were randomized to intervention group (IG) or control group (CG). Participants (n = 1,946) answered a questionnaire before and two months after (n = 1,198, 62%) the consultation. All women received standard contraceptive counseling, and the IG also received the RLPC, i.e. questions on reproductive intentions, information about fertility, and preconception health. Results: Women in the IG increased their knowledge about fertility: age and fertility, chances of getting pregnant, fecundity of an ovum, and chances of having a child with help of IVF. They also increased their awareness of factors affecting preconception health, such as to stop using tobacco, to refrain from alcohol, to be of normal weight, and to start with folic acid before a pregnancy. The most commonly used contraceptive method was combined oral contraceptives, followed by long-acting reversible contraception. Three out of four women (76%) in the IG stated that the RLPC should be part of the routine in contraceptive counseling. Conclusions: Knowledge about fertility and awareness of preconception health increased after the intervention. The RLPC can be recommended as a tool in contraceptive counseling.
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Affiliation(s)
- Yvonne Skogsdal
- Maternal Health Care Unit, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- CONTACT Yvonne Skogsdal Maternal Health Care Unit, Region Örebro County, Box 1613, SE-701 16, Örebro, Sweden
| | - Helena Fadl
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Jan Karlsson
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Tanja Tydén
- Department of Women’s and Children’s Health, Akademiska Sjukhuset, Uppsala, Sweden
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Grace B, Shawe J, Johnson S, Stephenson J. You did not turn up… I did not realise I was invited…: understanding male attitudes towards engagement in fertility and reproductive health discussions. Hum Reprod Open 2019; 2019:hoz014. [PMID: 31218265 PMCID: PMC6573469 DOI: 10.1093/hropen/hoz014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/15/2019] [Indexed: 12/17/2022] Open
Abstract
STUDY QUESTION What are the underlying reasons for low male engagement in fertility and reproductive health discussions and decision-making? SUMMARY ANSWER The perception of women's primacy in fertility and reproductive health limits the extent to which men believe their engagement is important. WHAT IS KNOWN ALREADY Active participation of men in the process of informed decision-making regarding childbearing is beneficial for mother, father, and child. However, in research studies in these areas, little attention has been given to men. Additionally, there is poor engagement by men, as well as a dearth of information from, and on, the male perspective. STUDY DESIGN SIZE DURATION In total, 35 semi-structured telephone and face-to-face interviews were conducted in an office setting with three groups: 13 lay women, 13 lay men, and 9 (2 male and 7 female) healthcare professionals. Interviews took place between October 2016 and February 2017. PARTICIPANTS/MATERIALS SETTING METHODS Participants were men and women of reproductive age from the general population and healthcare professionals who had completed an online fertility awareness survey and agreed to follow-up interviews. Interviews were audio recorded and lasted ~1 hour, during which participants were asked to provide their views on childbearing decision-making, and male and female representation in fertility and reproductive health. Data was transcribed verbatim and analysed qualitatively via framework analysis. MAIN RESULTS AND THE ROLE OF CHANCE Both men and women saw fertility as a woman's issue, but from different viewpoints. Women saw it from the perspective of societal stereotypes regarding male and female roles, whereas men tended to defer to the woman's primacy in reproductive decisions. Men generally wanted to be involved in childbearing discussions and improve their fertility knowledge. However, they felt they did not have a voice on the topic because discussions have traditionally focused on women. The notion that men are not expected to be interested and engaged thus becomes a self-fulfilling prophecy. Healthcare professionals agreed that fertility was perceived as the woman's domain, but also highlighted that poor male involvement is typically observed across healthcare needs and is not necessarily unique to fertility and reproductive health. LIMITATIONS REASONS FOR CAUTION Due to the online recruitment method, there is a potential bias towards respondents of higher, rather than lower, socioeconomic status within the general population. WIDER IMPLICATIONS OF THE FINDINGS Fertility tends to be seen as a private topic. Additional concerted effort by reproductive health researchers, charity organisations, educators, healthcare service providers, and policy makers is needed to proactively encourage male involvement in reproductive decision-making. This can be achieved through normalising and breaking taboos around the topic, male-friendly research study design approaches, male-inclusive reproductive healthcare services, implementation of health policies that recognise the needs of men, encouraging male research staff representation, and age-appropriate educational programmes on sexual and reproductive health, which include boys and adolescents from a young age. STUDY FUNDING/COMPETING INTERESTS Research funding was received from SPD Development Co. Ltd. B.G. and S.J. are employed by SPD Development Co. Ltd. None of the other authors have any conflict of interest related to the discussed topic. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- B Grace
- Research Department of Reproductive Health, UCL Institute for Women’s Health, Faculty of Population Health Sciences, University College London, London, UK
- SPD Development Company Limited, Bedford, UK
| | - J Shawe
- The Institute of Health and Community, Faculty of Health & Human Sciences, the University of Plymouth, Plymouth, UK
| | - S Johnson
- SPD Development Company Limited, Bedford, UK
| | - J Stephenson
- Research Department of Reproductive Health, UCL Institute for Women’s Health, Faculty of Population Health Sciences, University College London, London, UK
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