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Huang H, Kuang H, Thomas TR, Wei D, Zhang H. How to minimize the dropout and crossover in an infertility trial? Fertil Steril 2024; 121:905-908. [PMID: 38316206 DOI: 10.1016/j.fertnstert.2024.01.035] [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: 01/29/2024] [Accepted: 01/29/2024] [Indexed: 02/07/2024]
Abstract
Randomized controlled trials and intent-to-treat analyses are important for infertility clinical studies. Dropouts or crossovers during the study process will disrupt the randomization design and affect the intent-to-treat analysis. In this review, we have briefly introduced the occurrence of dropout and crossover from our previous Reproductive Medicine Network and other related studies and provided some experience obtained from these studies on how to minimize and reduce the occurrence of dropout and crossover for infertility randomized clinical studies.
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Affiliation(s)
- Hao Huang
- Department of Biostatistics, Yale University, New Haven, Connecticut
| | - Hongying Kuang
- The Second Department of Gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, People's Republic of China
| | - Tracey R Thomas
- Women's Health Clinical Research Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daimin Wei
- Center for Reproductive Medicine, Shandong University, Jinan, Shandong, People's Republic of China
| | - Heping Zhang
- Department of Biostatistics, Yale University, New Haven, Connecticut.
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Collura B, Hayward B, Modrzejewski KA, Mottla GL, Richter KS, Catherino AB. Identifying Factors Associated with Discontinuation of Infertility Treatment Prior to Achieving Pregnancy: Results of a Nationwide Survey. J Patient Exp 2024; 11:23743735241229380. [PMID: 38414755 PMCID: PMC10898306 DOI: 10.1177/23743735241229380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Abstract
The purpose of this mixed methods, cross-sectional patient survey was to characterize patient experience, to explore the frequency of and reasons for infertility treatment discontinuation and return to infertility treatments. Participants were recruited from United States patient support groups. Participants had received or were receiving ovulation induction (OI) with or without intrauterine insemination (IUI), with or without subsequent in vitro fertilization (IVF), or IVF with no other previous infertility treatment. Live birth was achieved by 62% of participants. Compared with participants treated with OI/IUI only, participants who underwent OI/IUI followed by ≥1 IVF cycle were less likely to consider discontinuing care (64% vs 77%; P = .014) or to discontinue treatment without achieving a pregnancy (40% vs 58%; P = .004). The most commonly cited reasons for treatment discontinuation were financial (62%) and psychological burden/treatment fatigue (58%). Expected versus actual time to pregnancy differed greatly. Continued desire for a child (60%) was the most frequently cited reason for continuing or resuming treatment. Expanded access to treatment, counseling and fostering realistic expectations regarding cumulative time to pregnancy may reduce treatment discontinuation.
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Affiliation(s)
- Barbara Collura
- RESOLVE: The National Infertility Association, McLean, VA, USA
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Khairy M, Harb H, Eapen A, Melo P, Kazem R, Rajkhowa M, Ndukuwe G, Coomarasamy A. The use of immunomodulation therapy in women with recurrent implantation failure undergoing assisted conception: A multicentre cohort study. Am J Reprod Immunol 2024; 91:e13819. [PMID: 38348954 DOI: 10.1111/aji.13819] [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: 06/17/2023] [Revised: 01/11/2024] [Accepted: 01/26/2024] [Indexed: 02/15/2024] Open
Abstract
PROBLEM Recurrent implantation failure (RIF) after multiple embryo transfers remains a vexing problem and immunomodulators have been used with conflicting results. This study aims to assess the effect of immunomodulation therapy on live birth rate (LBR) in women with RIF undergoing assisted reproduction treatment (ART). METHOD OF STUDY DESIGN This is a retrospective cohort study in multicentre network of private assisted conception units in the UK. The study included women who had at least two failed attempts of embryo transfers at CARE fertility network in the period from 1997 to 2018. Women in the treatment group had immunomodulator drugs in the form of corticosteroids, low molecular weight heparin (LMWH), and intravenous intralipid (IVIL) infusions, either separately or in combination, after immunological testing, in addition to standard ART whilst women in the control group had only ART without immunomodulators. The primary outcome was LBR per cycle. Secondary outcomes included the rates of clinical pregnancy (CPR), cumulative live birth (CLBR), and miscarriage. RESULTS A total of 27 163 ART cycles fulfilled the inclusion criteria, of which 5083 had immunomodulation treatment in addition to standard ART treatment, and 22 080 had standard ART treatment alone. Women in the treatment group were significantly older (mean age 38.5 vs. 37.1 years, p < .001), and had a higher number of previous failed ART cycles (mean 4.3 vs. 3.8, p < .01). There was a higher LBR in women who received immunomodulation therapy when compared with the control group (20.9% vs. 15.8%, odds ratio [OR] 1.4, 95% confidence interval [CI] 1.29-1.53, p < .001). Multivariate regression analysis showed that immunomodulation treatment was a significant independent predictor of live birth after adjusting for other confounders (adjusted OR [aOR] 1.33, 95% CI 1.15-1.54, p < .001). Survival analysis showed a higher CLBR in the treatment group (adjusted hazard ratio [aHR] 1.78, 95% CI 1.62-1.94, p < .001). CONCLUSION(S) This study provides evidence of a potential beneficial effect of immunomodulation therapy in women with RIF after immunological testing. There remains a need for high quality, adequately powered multicentre RCTs to robustly address the role of immunomodulation in women with RIF. There is also an urgent need for standardised screening tests for immune disorders that could preclude implantation.
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Affiliation(s)
| | - Hoda Harb
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, Edgbaston, UK
| | - Abey Eapen
- Department of Obstetrics and Gynaecology, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Pedro Melo
- CARE Fertility Birmingham, Birmingham, Edgbaston, UK
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, Edgbaston, UK
| | | | | | | | - Arri Coomarasamy
- CARE Fertility Birmingham, Birmingham, Edgbaston, UK
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, Edgbaston, UK
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Cusatis R, Johnson C, Schoyer KD, Tsaih SW, Balza J, Sandlow J, Flynn KE. Decision regret among couples experiencing infertility: a mixed methods longitudinal cohort study. Reprod Health 2023; 20:165. [PMID: 37940984 PMCID: PMC10633954 DOI: 10.1186/s12978-023-01699-5] [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] [Received: 06/01/2023] [Accepted: 10/11/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Decisions for how to resolve infertility are complex and may lead to regret. We examined whether couples and individuals who sought a consultation from a reproductive specialist for infertility later expressed decisional regret about their family-building choices and whether regret was associated with parental role, family-building paths, or outcomes. METHODS This longitudinal mixed methods study included women and their partners who completed a questionnaire prior to their initial consultation with a reproductive specialist and 6 years later. The six-year questionnaire included the Ottawa Decision Regret Scale referencing "the decisions you made about how to add a child to your family." A score of 25+ indicates moderate-to-severe regret. Additional items invited reflections on family-building decisions, treatments, and costs. A systematic content analysis assessed qualitative themes. RESULTS Forty-five couples and 34 individuals participated in the six-year questionnaire (76% retention rate), Half (n = 61) of participants expressed no regret, which was similar by role (median 0 for women and supporting partners, F = .08; p = .77). One in 5 women and 1 in 7 partners expressed moderate-to-severe regret. Women who did not pursue any treatment had significantly higher regret (median 15; F = 5.6, p < 0.01) compared to those who pursued IVF (median 0) or other treatments (median 0). Women who did not add a child to their family had significantly higher regret (median 35; F = 10.1, p < 0.001) than those who added a child through treatment (median 0), through fostering/adoption (median 0), or naturally (median 5). Among partners, regret scores were not associated with family-building paths or outcomes. More than one-quarter of participants wished they had spent less money trying to add a child to their family. Qualitative themes included gratitude for parenthood despite the burdensome process of family-building as well as dissatisfaction or regret about the process. Results should be confirmed in other settings to increase generalizability. CONCLUSION This longitudinal study provides new insight into the burden of infertility. For women seeking parenthood, any of the multiple paths to parenthood may prevent future decision regret. Greater psychosocial, financial, and decision support is needed to help patients and their partners navigate family-building with minimal regret.
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Affiliation(s)
- Rachel Cusatis
- Department of Medicine, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, USA.
| | - Colin Johnson
- Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA
| | - Katherine D Schoyer
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, USA
| | - Shirng-Wern Tsaih
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, USA
| | - Joanna Balza
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, USA
| | - Jay Sandlow
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, USA
- Department of Urology, Medical College of Wisconsin, Milwaukee, USA
| | - Kathryn E Flynn
- Department of Medicine, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, USA
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Deshpande S, Patel KD, Parulkar T, Mahabalesh K, Madhusudhan P, Madhusudhan DK, Thimmapuram J. Effect of Heartfulness meditation based integrative therapy on infertility outcomes: A retrospective case series evaluation. J Ayurveda Integr Med 2023; 14:100793. [PMID: 37797350 PMCID: PMC10562913 DOI: 10.1016/j.jaim.2023.100793] [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: 11/02/2021] [Revised: 07/12/2023] [Accepted: 08/02/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND In Indian context, infertility is often a silent struggle. Despite the high prevalence of infertility in the country, the majority of couples do not share their struggles with family or friends due to social stigma, thus increasing their psychological vulnerability. Heartfulness meditation has shown to decrease stress, anxiety, loneliness and improve sleep along with quality of life. OBJECTIVES The current retrospective series evaluated the effectiveness of Heartfulness-based integrative therapy on infertility outcomes. METHODS The program consisted of a 5- day onsite lifestyle modification workshop and online follow up meditation sessions. RESULTS 54 couples with infertility participated in the program with a mean age of 30.74 years (SD 5.04) for females and 34.03 years (SD 4.54) for males. 15 couples presented with male infertility, 16 couples presented with female infertility and in 5 couples both partners had infertility problems. Further, 18 couples had unexplained infertility. 24 couples conceived with 18 natural conceptions, five via assisted reproductive technology and one spontaneous abortion. CONCLUSION The program was beneficial in the cohort who utilized it as prescribed resulting in conception of 24 out of 54 couples. Future research investigating the causal relationship of Heartfulness meditation on fertility outcomes in a randomized control study could solidify this treatment method to be used independently or as an adjuvant therapy with assisted reproductive technologies.
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Affiliation(s)
| | | | | | | | | | - Divya K Madhusudhan
- GCSRT, Department of Postgraduate Medical Education, Harvard Medical School, USA
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Donato R, Bessow C, Genro V, Chapon R, Oliveira de Souza T, Cunha-Filho JSLD. Corifollitropin alpha was not detrimental to follicular ovarian responsiveness measured by follicular output rate (FORT). HUM FERTIL 2023; 26:557-563. [PMID: 34412562 DOI: 10.1080/14647273.2021.1968044] [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: 12/08/2020] [Accepted: 07/15/2021] [Indexed: 10/20/2022]
Abstract
Corifollitropin alpha has been demonstrated to be non-inferior to other gonadotropins in reproductive outcomes. However, its impact on follicular ovarian responsiveness has never been evaluated. Follicular Output Rate (FORT) is an option for objective assessment of the follicular responsiveness. A prospective study was conducted with 306 infertile patients undergoing in vitro fertilisation. Ovarian stimulation protocol was performed with a single dose of 100 μg (<60kg) or 150 μg (≥60kg) corifollitropin alpha in group 1 (n = 147), and 150-300 IU/day human menopausal gonadotropin in group 2 (n = 150). Comparing ovarian stimulation between corifollitropin alpha and human menopausal gonadotropin, no differences regarding FORT were found (40.0% for group 1 versus 40.83% for group 2; p = 0.930). Patients treated with corifollitropin alpha had a higher number of embryos when compared with human menopausal gonadotropin group (3.0 for group 1 versus 2.0 for group 2; p = 0.04). Other secondary outcomes preset were similar between groups. Therefore, corifollitropin alpha can be an excellent option to simplify in vitro fertilisation treatment due to the "patient-friendly" protocol.
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Affiliation(s)
- Rafaela Donato
- Postgradute Program in Heath Sciences: Gynecology and Obstetrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Centro de Reprodução Humana Insemine, Porto Alegre, Brazil
| | - Camila Bessow
- Postgradute Program in Heath Sciences: Gynecology and Obstetrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Centro de Reprodução Humana Insemine, Porto Alegre, Brazil
| | - Vanessa Genro
- Centro de Reprodução Humana Insemine, Porto Alegre, Brazil
| | - Rita Chapon
- Centro de Reprodução Humana Insemine, Porto Alegre, Brazil
| | | | - João Sabino Lahorgue da Cunha-Filho
- Postgradute Program in Heath Sciences: Gynecology and Obstetrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Centro de Reprodução Humana Insemine, Porto Alegre, Brazil
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Vanden Meerschaut F, Blockeel C, Blaiberg S, Delbaere A, Delvigne A, Henry L, Imbert R, Lie Fong S, Van De Vijver A, Wyns C, De Neubourg D. Multicentre study on rates and reasons for treatment discontinuation in patients with remaining cryopreserved embryos. Reprod Biomed Online 2023; 46:631-641. [PMID: 36646537 DOI: 10.1016/j.rbmo.2022.10.005] [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: 05/25/2022] [Revised: 09/18/2022] [Accepted: 10/12/2022] [Indexed: 01/11/2023]
Abstract
RESEARCH QUESTION What is the discontinuation rate among patients with remaining cryopreserved embryos in Belgium and what are the reasons for discontinuation? DESIGN Multicentre, cross-sectional study across 11 Belgian fertility clinics. Patients were eligible (n = 1917) if they had previously undergone an unsuccessful fresh embryo transfer (fresh group) or frozen embryo transfer (FET) (in-between group) and did not start a subsequent FET cycle within 1 year despite having remaining cryopreserved embryos. The denominator was all patients with embryos cryopreserved during the same period (2012-2017) (n = 21,329). Data were collected through an online anonymous questionnaire. RESULTS The discontinuation rate for patients with remaining cryopreserved embryos was 9% (1917/21329). For the final analysis, 304 completed questionnaires were included. The most important reasons for discontinuing FET cycles were psychological (50%) and physical (43%) burden, effect on work (29%), woman's age (25%) and effect on the relationship (25%). In 69% of cases, the patient themselves made the decision to delay FET treatment. In 16% of respondents, the decision to delay FET was determined by external factors: treating physician (9%), social environment (4%), close family (3%) and society (3%). Suggested improvements were psychological support before (41%), during (51%) and after (51%) treatment, as well as lifestyle counselling (44%) and receiving digital information (43%). CONCLUSIONS The discontinuation rate is remarkably high in patients with remaining cryopreserved embryos who have a good prognosis. Respondents stressed the need to improve the integration of psychological and patient-tailored care into daily assisted reproductive technology practice.
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Affiliation(s)
| | - Christophe Blockeel
- Center for Reproductive Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | | | - Anne Delbaere
- Fertility Clinic, Hôpital Erasme- Université Libre de Bruxelles, Brussels, Belgium
| | - Annick Delvigne
- Centre de Procréation Médicalement Assistée, Clinique CHC Mont Légia, Liège, Belgium
| | - Laurie Henry
- Centre de Procréation Médicalement Assistée de l'Université de Liège, CHR Citadelle Hospital, Liège, Belgium
| | - Romain Imbert
- Centre de Procréation Médicalement Assistée, Chirec-hôpital, Braine l'alleud-Waterloo, Belgium
| | - Sharon Lie Fong
- Leuven university fertility center, Leuven University Hospital, Leuven, Belgium
| | | | - Christine Wyns
- Gynécologie-andrologie et fécondation in vitro, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Diane De Neubourg
- Center for Reproductive Medicine, Antwerp University Hospital, Antwerp, Belgium
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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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ŞAHİN M, KARAASLAN MF, ŞAHİN H. İnfertil kadınlarda kişilik özelliklerinin anksiyete ve depresyon gelişimi üzerine olan etkileri. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2023. [DOI: 10.17517/ksutfd.1186968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Amaç: Bu çalışmada infertil kadınların kişilik özelliklerinin anksiyete ve depresyon gelişimi üzerine olan etkilerinin araştırılması amaçlandı.
Gereç ve yöntemler: Çalışmaya, Ocak 2015-Agustos 2016 tarihleri arasında tüp bebek merkezine ve kadın doğum polikliniğine başvurmuş olan sırası ile 67 infertil ve 61 fertil kadın olmak üzere toplam 128 kişi dahil edildi. İnfertil grubu primer veya sekonder infertilitesi olup infertilite tedavisi planlanan veya başlanan kadınlar oluşturdu. Kontrol grubunu ise birden fazla sayıda çocuğu olan fertil kadınlar oluşturdu. Her iki gruba Beck Anksiyete Ölçeği (BAÖ), Beck Depresyon Ölçeği (BDÖ), Eysenck Kişilik Anketi (EKA) ve Çift Uyum Ölçeği (ÇUÖ) uygulandı.
Bulgular: İnfertil ve fertil gruplar arasında yaş gruplarının dağılımı açısından anlamlı bir fark tespit edilmedi. Bununla birlikte BAÖ, BDÖ ve ÇUÖ toplam ortalama puanları infertil grupta anlamlı olarak daha yüksek tespit edildi. Kişilik ve çift uyum ölçeklerinde nörotizm, yalan, çift doyumu, çift uyumu ve sevgi alt ölçekleri ortalama puanları infertil grupta anlamlı olarak daha yüksek bulunurken; dışa-dönüklük, psikotizm ve çiftlerin bağlılığı alt ölçekleri ortalama puanları açısından iki grup arasında anlamlı bir fark izlenmedi. Korelasyon analizinde nörotizm ile anksiyete ve depresyon arasında pozitif yönde; dışa-dönüklük ile anksiyete ve depresyon arasında negatif yönde zayıf bir ilişki bulundu.
Sonuç: Bu çalışmaya göre infertil kadınlarda nörotizm kişilik özelliğine sahip olanların anksiyete ve depresyon gelişimine daha yatkın olabileceği düşünülebilir.
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Affiliation(s)
- Merve ŞAHİN
- Kahramanmaraş Necip Fazıl Şehir Hastanesi, Ruh Sağlığı ve Hastalıkları Kliniği, Kahramanmaraş, Türkiye
| | - Mehmet Fatih KARAASLAN
- Prof.Dr. M. Fatih Karaaslan Özel Kliniği, Ruh Sağlığı ve Hastalıkları Kliniği, Kahramanmaraş, Türkiye
| | - Hamza ŞAHİN
- Kahramanmaraş Sütçü İmam Üniversitesi Tıp Fakültesi, Nöroloji Anabilim Dalı, Kahramanmaraş, Türkiye
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Pharmacotherapy of infertility in Ghana: Why do infertile patients discontinue their fertility treatment? PLoS One 2022; 17:e0274635. [PMID: 36251650 PMCID: PMC9576038 DOI: 10.1371/journal.pone.0274635] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/31/2022] [Indexed: 11/05/2022] Open
Abstract
Background Globally, millions of people of reproductive age experience infertility. With that notwithstanding, most infertile patients undergoing pharmacotherapy withdraw from treatment before achieving the desired outcome. The reasons for their withdrawal, particularly in sub-Saharan Africa, have not been well examined, hence the need for this study. Objectives The aim of the study was to examine why infertile patients discontinue pharmacotherapy prior to achieving conception. Methods The study employed an exploratory qualitative design. Purposive sampling technique was used to recruit subjects into the study. Twenty infertile patients (fourteen females and six males) who discontinued their treatment, and eight attending health professionals who provided direct care to these patients were interviewed. Telephone and face-to-face interviews were conducted using a semi-structured interview guide. The data collected were transcribed, coded, and generated into themes using thematic content analysis. Results The major reasons for discontinuation of infertility treatment included lack of support from male partners, seeking alternative treatment, unmet outcome, poor medical services, distance, stigmatization, and relocation. Conclusions Patients and healthcare personnel shared both similar and diverse views on reasons for discontinuation of infertility treatment that reflect situations in a typical African setting, most of which are not reported in existing studies. The outcome of this study will provide insight for fertility therapists and policy makers in designing appropriate measures to facilitate maximum compliance and improvement in treatment outcome.
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12
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The Lack of Ireland’s Assisted Human Reproduction (AHR) Regulation Viewed under the Lens of the Patient’s Experience. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159534. [PMID: 35954891 PMCID: PMC9368527 DOI: 10.3390/ijerph19159534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 07/30/2022] [Accepted: 07/31/2022] [Indexed: 11/17/2022]
Abstract
Assisted Human Reproduction (AHR) treatment is unregulated in Ireland, although it is practised there. Within Europe, Ireland is one of the only European countries without any form of AHR-specific regulation. This study aims to investigate the experiences and viewpoints of Irish women undergoing AHR treatments and establish if the lack of legislation is affecting these experiences. A quantitative survey was carried out on women undergoing AHR treatment in Irish clinics. Patients highlighted a lack of information in terms of end-to-end care and poor information around treatments and success rates. Key issues highlighted included unanticipated high treatment costs and add-on treatment costs, lack of financial support from the government, no redress process in the event of dissatisfaction, and generally an overall feeling of a lack of support both from the AHR clinics and the Irish government. This study offers a real-time view of the Irish AHR system from the patient’s experience of AHR and under the lens of the lack of a legislative system. In early 2022, the Irish government announced that it would adopt its bill around AHR treatment and that subsidies for AHR treatment are to come into effect, which will alleviate some financial pressures on patients. Further studies of the legislation carried out post implementation will provide more information about the impact of having a legislated AHR process on the patients.
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13
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Obrzut B, Obrzut M. Is There Still a Place for Reconstructive Surgery in Distal Tubal Disease? J Clin Med 2022; 11:jcm11123278. [PMID: 35743348 PMCID: PMC9225341 DOI: 10.3390/jcm11123278] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/01/2022] [Accepted: 06/06/2022] [Indexed: 11/16/2022] Open
Abstract
Tubal diseases account for 25–40% of female factor infertility. Mainly, they involve the distal part of the fallopian tube, and hydrosalpinx is the most severe manifestation. Usually, the management decision is made between reconstructive surgery and ART, depending on the severity of the tubal damage, patient age, ovarian reserve, and seminogram, as well as financial, religious, ethical, and psychological factors. Estimated live-birth rates after corrective surgery range from 9% to 69%. The success rate of IVF is about 30% live-birth rate per cycle initiated in women across all ages with tubal factor infertility. Surgery offers a long-term cure and patients may attempt conception many times but are burdened with perioperative adverse events. IVF bypasses potential complications of operative treatment; however, this has its own unique risks. The effectiveness of reconstructive surgery versus ART has not been adequately evaluated. The success of fertility management depends on a thorough interpretation of existing data and careful patient selection. The presented review provides updates on the most recent progress in this area.
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Affiliation(s)
- Bogdan Obrzut
- Department of Obstetrics and Gynecology, Institute of Medical Sciences, Medical College, University of Rzeszów, Rejtana 16 C, 35-959 Rzeszow, Poland
- Correspondence:
| | - Marzanna Obrzut
- Center for Diagnostic Medical Sonography, Litewska 4/4, 35-302 Rzeszow, Poland;
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14
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Ghorbani M, Hoseini FS, Yunesian M, Salehin S, Keramat A, Nasiri S. A systematic review and meta-analysis on dropout of infertility treatments and related reasons/factors. J OBSTET GYNAECOL 2022; 42:1642-1652. [DOI: 10.1080/01443615.2022.2071604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Maryam Ghorbani
- Student Research Committee, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Fatemeh Sadat Hoseini
- Faculty Member of School of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Masud Yunesian
- School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahrbanoo Salehin
- Sexual Health and Fertility Research Center, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Afsaneh Keramat
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Saeideh Nasiri
- Department of Midwifery, School of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran
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15
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Casale M. Improving the health and treatment success rates of in vitro fertilization patients with traditional Chinese medicine: Need for more robust evidence and innovative approaches. JOURNAL OF INTEGRATIVE MEDICINE 2022; 20:187-192. [PMID: 35216931 DOI: 10.1016/j.joim.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 01/26/2022] [Indexed: 06/14/2023]
Abstract
Maximising access to and the success of fertility treatments should be a priority for global reproductive health, as should overall patient well-being. The demand for in vitro fertilization (IVF) and other assisted fertility treatments has increased over the past decade and is likely to further increase in years to come. Nevertheless, there is still considerable unmet demand for infertility support worldwide. Moreover, the high emotional, physical and financial burden experienced by individuals undergoing IVF cycles can be a risk for their mental and physical health, which in turn can influence treatment continuation and the likelihood of IVF success. Studies from various parts of the world show that most individuals undergoing IVF also use adjunct alternative medicines and procedures, the most common being traditional Chinese medicine (TCM). The complementary and synergistic role of TCM for individuals undergoing IVF is an area that merits further attention and research, both for its potential positive effects on IVF success rates and for its broader physical and mental health benefits. However, much of the existing evidence is not sufficiently robust or consistent for findings to be adopted with confidence. This commentary argues that much work must be done to understand the efficacy and clinical best practices for these integrated approaches. This can be achieved in part by developing more robust and clinically relevant randomized controlled trial protocols, collecting and triangulating evidence through a variety of study designs and methods, and strengthening the collection and pooling of clinic-level data.
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Affiliation(s)
- Marisa Casale
- School of Public Health, University of the Western Cape, Bellville 7535, South Africa.
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16
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Huang TC, Huang MZ, Seow KM, Yang IJ, Pan SP, Chen MJ, Hwang JL, Chen SU. Progestin primed ovarian stimulation using corifollitropin alfa in PCOS women effectively prevents LH surge and reduces injection burden compared to GnRH antagonist protocol. Sci Rep 2021; 11:22732. [PMID: 34815477 PMCID: PMC8611037 DOI: 10.1038/s41598-021-02227-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/09/2021] [Indexed: 12/28/2022] Open
Abstract
Utilizing corifollitropin alfa in GnRH antagonist (GnRHant) protocol in conjunction with GnRH agonist trigger/freeze-all strategy (corifollitropin alfa/GnRHant protocol) was reported to have satisfactory outcomes in women with polycystic ovary syndrome (PCOS). Although lessening in gonadotropin injections, GnRHant were still needed. In addition to using corifollitropin alfa, GnRHant was replaced with an oral progestin as in progestin primed ovarian stimulation (PPOS) to further reduce the injection burden in this study. We try to investigate whether this regimen (corifollitropin alfa/PPOS protocol) could effectively reduce GnRHant injections and prevent premature LH surge in PCOS patients undergoing IVF/ICSI cycles. This is a retrospective cohort study recruiting 333 women with PCOS, with body weight between 50 and 70 kg, undergoing first IVF/ICSI cycle between August 2015 and July 2018. We used corifollitropin alfa/GnRHant protocol prior to Jan 2017 (n = 160), then changed to corifollitropin alfa/PPOS protocol (n = 173). All patients received corifollitropin alfa 100 μg on menstruation day 2/3 (S1). Additional rFSH was administered daily from S8. In corifollitropin alfa/GnRHant group, cetrorelix 0.25 mg/day was administered from S5 till the trigger day. In corifollitropin alfa/PPOS group, dydrogesterone 20 mg/day was given from S1 till the trigger day. GnRH agonist was used to trigger maturation of oocyte. All good quality day 5/6 embryos were frozen, and frozen-thawed embryo transfer (FET) was performed on subsequent cycle. A comparison of clinical outcomes was made between the two protocols. The primary endpoint was the incidence of premature LH surge and none of the patients occurred. Dydrogesterone successfully replace GnRHant to block LH surge while an average of 6.8 days of GnRHant injections were needed in the corifollitropin alfa/GnRHant group. No patients suffered from ovarian hyperstimulation syndrome (OHSS). The other clinical outcomes including additional duration/dose of daily gonadotropin administration, number of oocytes retrieved, and fertilization rate were similar between the two groups. The implantation rate, clinical pregnancy rate, and live birth rate in the first FET cycle were also similar between the two groups. In women with PCOS undergoing IVF/ICSI treatment, corifollitropin alfa/PPOS protocol could minimize the injections burden with comparable outcomes to corifollitropin alfa/GnRHant protocol.
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Affiliation(s)
- Ting-Chi Huang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, No. 7 Chung-Shan South Road, Taipei, Taiwan
| | - Mei-Zen Huang
- Department of Nursing, National Tainan Junior College of Nursing, Tainan, Taiwan
| | - Kok-Min Seow
- Department of Obstetrics and Gynecology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Ih-Jane Yang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, No. 7 Chung-Shan South Road, Taipei, Taiwan
| | - Song-Po Pan
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, No. 7 Chung-Shan South Road, Taipei, Taiwan
| | - Mei-Jou Chen
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, No. 7 Chung-Shan South Road, Taipei, Taiwan
| | - Jiann-Loung Hwang
- Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.,Taipei IVF, Center for Reproduction and Genetics, Taipei, Taiwan.,Department of Obstetrics and Gynecology, Taipei Medical University, Taipei, Taiwan
| | - Shee-Uan Chen
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, No. 7 Chung-Shan South Road, Taipei, Taiwan.
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17
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Impact of access to care and race/ethnicity on IVF care discontinuation. Reprod Biomed Online 2021; 44:1159-1168. [DOI: 10.1016/j.rbmo.2021.11.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 10/27/2021] [Accepted: 11/25/2021] [Indexed: 12/17/2022]
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18
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Pham C, Torre A, Mol B. Cost-effectiveness modelling of three different hysterosalpingography diagnostic strategies in addition to standard fertility management for couples with unexplained infertility in the United Kingdom. HUM FERTIL 2021:1-10. [PMID: 34348064 DOI: 10.1080/14647273.2021.1960435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Previous studies have demonstrated hysterosalpingography (HSG) in general, and specifically with an oil-soluble contrast medium, directly increases pregnancy rates. Decision modelling was performed to compare fertility management using three HSG diagnostic strategies: (i) water-soluble contrast medium (WSCM)-HSG; (ii) Lipiodol® Ultra Fluid (LUF)-HSG; and (iii) No HSG, for women aged ≤39 years with unexplained infertility. Four reimbursement scenarios were modelled to reflect the various funding arrangements across the regions of the United Kingdom. Compared with WSCM-HSG, the live birth rates after 24 months increased by 3.4% with LUF-HSG and decreased by 2.7% with no HSG. From a patient perspective, fertility management with LUF-HSG is the most cost-effective strategy with cost-savings ranging from £299 to £857 per patient depending on the funding arrangement for IVF. From an NHS perspective, fertility management with LUF-HSG is cost-effective when 2 or more IVF cycles are NHS-funded. If none of the IVF cycles are NHS-funded, fertility management with LUF-HSG can be considered cost-effective if society is willing to pay £8,353 for an additional live birth. The findings from this analysis suggest that fertility management with WSCM-HSG is cost-effective compared to no HSG and LUF-HSG is the most cost-effective with increased live birth rates after 24 months.
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Affiliation(s)
- Clarabelle Pham
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia
| | - Antoine Torre
- Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham, United Kingdom
| | - Ben Mol
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash Health and Monash University, Melbourne, Australia.,Aberdeen Centre for Women's Health Research, University of Aberdeen, Aberdeen, United Kingdom
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19
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Stanford JB, Carpentier PA, Meier BL, Rollo M, Tingey B. Restorative reproductive medicine for infertility in two family medicine clinics in New England, an observational study. BMC Pregnancy Childbirth 2021; 21:495. [PMID: 34233646 PMCID: PMC8265110 DOI: 10.1186/s12884-021-03946-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 06/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Restorative reproductive medicine (RRM) seeks to identify and correct underlying causes and factors contributing to infertility and reproductive dysfunction. Many components of RRM are highly suitable for primary care practice. We studied the outcomes amongst couples who received restorative reproductive medicine treatment for infertility in a primary care setting. METHODS Two family physicians in Massachusetts trained in a systematic approach to RRM (natural procreative technology, or NaProTechnology) treated couples with infertility. We retrospectively reviewed the characteristics, diagnoses, treatments, and outcomes for all couples treated during the years 1989 to 2014. We compared pregnancy and live birth by clinical characteristics using Kaplan-Meier analysis. We employed the Fleming-Harrington weighted Renyi test or the logrank test to compare the cumulative proportion with pregnancy or with live birth. RESULTS Among 370 couples beginning treatment for infertility, the mean age was 34.8 years, the mean prior time trying to conceive was 2.7 years, and 27% had a prior live birth. The mean number of diagnoses per couple was 4.9. Treatment components included fertility tracking with the Creighton Model FertilityCare System (80%); medications to enhance cervical mucus production (81%), to stimulate ovulation (62%), or to support the luteal phase (75%); and referral to female laparoscopy by a surgeon specializing in endometriosis (46%). The cumulative live birth rate at 2 years was 29% overall; this was significantly higher for women under age 35 (34%), and for women with body mass index < 25 (40%). There were 2 sets of twins and no higher-order multiple gestations. Of the 63 births with data available, 58 (92%) occurred at term. CONCLUSIONS Family physicians can provide a RRM approach for infertility to identify underlying causes and promote healthy term live births. Younger women and women with body mass index < 25 are more likely to have a live birth.
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Affiliation(s)
- Joseph B Stanford
- Office of Cooperative Reproductive Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT, 84108, USA. .,International Institute for Restorative Reproductive Medicine, London, UK.
| | - Paul A Carpentier
- International Institute for Restorative Reproductive Medicine, London, UK.,Gianna of Long Island Center for Women's Health and Fertility, New York, USA.,In His Image Family Medicine, Gardner, MA, USA
| | - Barbara L Meier
- International Institute for Restorative Reproductive Medicine, London, UK.,Gianna of Long Island Center for Women's Health and Fertility, New York, USA.,In His Image Family Medicine, Gardner, MA, USA.,Reliant Medical Group, Fitchburg, MA, USA
| | - Mark Rollo
- International Institute for Restorative Reproductive Medicine, London, UK.,Reliant Medical Group, Fitchburg, MA, USA
| | - Benjamin Tingey
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
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20
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Casale M, Carlqvist A. Is social support related to better mental health, treatment continuation and success rates among individuals undergoing in-vitro fertilization? Systematic review and meta-analysis protocol. PLoS One 2021; 16:e0252492. [PMID: 34061903 PMCID: PMC8168841 DOI: 10.1371/journal.pone.0252492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 05/15/2021] [Indexed: 11/19/2022] Open
Abstract
Infertility and its treatment via in-vitro fertilization (IVF) represent a global health area of increasing importance. However, the physical and psychological burden of IVF can negatively impact psychological wellbeing, as well as treatment retention and success. Social support has been found to have positive health effects among populations facing health-related stressors worldwide, and its potential protective role for IVF patients merits further attention. We present a protocol for a systematic review of peer-reviewed published studies quantitatively investigating associations between social support and i) mental health; ii) the decision to (dis)continue with IVF treatment cycles and; iii) IVF success (pregnancy and birth rates); among individuals who are undertaking or have undertaken IVF cycles. Studies will be included if they work with human subjects, provide correlation coefficients between measures of social support and at least one of the outcomes of interest, and are in the English language. Social support may derive from both naturally occurring networks and more formalized sources or interventions. The protocol for this systematic review was developed according to the PRISMA-P guidelines. Ten health-, psychology- and sociology-related databases will be searched using composite search terms that include keywords for ‘IVF’ and ‘social support’. To assess methodological quality, the authors will use a modified version of the Newcastle-Ottawa Scale. Should three or more moderate or good quality studies be identified for any one outcome of interest, correlation meta-analyses, using the Hedges-Olkin method, will be conducted to pool effect sizes and heterogeneity will be assessed. Should the number, quality and characteristics of eligible studies not allow for reliable quantitative synthesis, the authors will limit the analysis to qualitative synthesis, with a focus on implications of findings for future research and programming.
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Affiliation(s)
- Marisa Casale
- Department of Social Policy and Intervention, University of Oxford, Barnett House, Oxford, United Kingdom
- School of Public Health, University of the Western Cape, Bellville, South Africa
- * E-mail: ,
| | - Anna Carlqvist
- Department of Social Policy and Intervention, University of Oxford, Barnett House, Oxford, United Kingdom
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21
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Anguzu R, Cusatis R, Fergestrom N, Cooper A, Schoyer KD, Davis JB, Sandlow J, Flynn KE. Decisional conflict among couples seeking specialty treatment for infertility in the USA: a longitudinal exploratory study. Hum Reprod 2021; 35:573-582. [PMID: 32154565 DOI: 10.1093/humrep/dez292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 11/28/2019] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION What are couples' decisional conflicts around family-building approaches before and after seeking a specialty consultation for infertility? SUMMARY ANSWER Decisional conflict is high among couples before an initial specialty consultation for infertility; on average, women resolved decisional conflict more quickly than men. WHAT IS KNOWN ALREADY Couples have multiple options for addressing infertility, and decisional conflict may arise due to lack of information, uncertainty about options and potential risks or challenges to personal values. STUDY DESIGN, SIZE, DURATION We conducted a total of 385 interviews and 405 surveys for this longitudinal, mixed-methods cohort study of 34 opposite-sex couples who sought a new reproductive specialty consultation (n = 68), who enrolled before the initial consultation and were followed over 12 months. PARTICIPANTS/MATERIALS, SETTING, METHODS The in-depth, semi-structured interviews included questions about information gathering, deliberation and decision-making, and self-administered surveys included the Decisional Conflict Scale (DCS), at six time points over 12 months. A DCS total score of 25 is associated with implementing a decision, and higher scores indicate more decisional conflict. A systematic content analysis of interview transcripts identified major themes. Paired t tests identified differences in DCS between women and men within couples. Linear mixed models predicted changes in DCS over time, adjusting for sociodemographic and fertility-related factors. MAIN RESULTS AND THE ROLE OF CHANCE The major qualitative themes were communication with partners, feeling supported and/or pressured in decision (s), changing decisions over time and ability to execute a desired decision. Average DCS scores were highest before the initial consultation. Within couples, men had significantly higher decisional conflict than women pre-consultation (48.9 versus 40.2, P = 0.037) and at 2 months (28.9 versus 22.1, P = 0.015), but differences at other time points were not significant. In adjusted models, predicted DCS scores declined over time, with women, on average, reaching the DCS threshold for implementing a decision at 2 months while for men it was not until 4 months. LIMITATIONS, REASONS FOR CAUTION This is a convenience sample from a single center, and generalizability may be limited. WIDER IMPLICATIONS OF THE FINDINGS Understanding how couples discuss and make decisions regarding family-building could improve the delivery of patient-centered infertility care. Our findings are the first to prospectively explore decisional conflict at multiple time points in both men and women; the observed gender differences underlie the importance of supporting both partners in clinical decision-making for infertility. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by the National Institute of Child Health and Human Development under Grant [R21HD071332], the Research and Education Program Fund, of the Advancing a Healthier Wisconsin endowment at Medical College of Wisconsin, the National Research Service Award under Grant [T32 HP10030] and the use of REDCap for data collection from the National Center for Advancing Translational Sciences, National Institutes of Health under Grant through [8UL1TR000055]. The authors have no competing interests.
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Affiliation(s)
- R Anguzu
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - R Cusatis
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - N Fergestrom
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - A Cooper
- Social Science Research Institute, Duke University, Durham, NC 27708, USA
| | - K D Schoyer
- Department of Obstetrics & Gynecology, Division of Reproductive Endocrinology and Infertility, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - J B Davis
- Cayman Fertility Centre, Barbados Fertility Centre Group, Grand Cayman, KY1, 1005, Cayman Islands
| | - J Sandlow
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - K E Flynn
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA
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22
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Leijdekkers JA, Torrance HL, Schouten NE, van Tilborg TC, Oudshoorn SC, Mol BWJ, Eijkemans MJC, Broekmans FJM. Individualized ovarian stimulation in IVF/ICSI treatment: it is time to stop using high FSH doses in predicted low responders. Hum Reprod 2021; 35:1954-1963. [PMID: 31838515 PMCID: PMC7485616 DOI: 10.1093/humrep/dez184] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 05/06/2019] [Indexed: 11/25/2022] Open
Abstract
In IVF/ICSI treatment, the FSH starting dose is often increased in predicted low responders from the belief that it improves the chance of having a baby by maximizing the number of retrieved oocytes. This intervention has been evaluated in several randomized controlled trials, and despite a slight increase in the number of oocytes—on average one to two more oocytes in the high versus standard dose group—no beneficial impact on the probability of a live birth has been demonstrated (risk difference, −0.02; 95% CI, −0.11 to 0.06). Still, many clinicians and researchers maintain a highly ingrained belief in ‘the more oocytes, the better’. This is mainly based on cross-sectional studies, where the positive correlation between the number of retrieved oocytes and the probability of a live birth is interpreted as a direct causal relation. If the latter would be present, indeed, maximizing the oocyte number would benefit our patients. The current paper argues that the use of high FSH doses may not actually improve the probability of a live birth for predicted low responders undergoing IVF/ICSI treatment and exemplifies the flaws of directly using cross-sectional data to guide FSH dosing in clinical practice. Also, difficulties in the de-implementation of the increased FSH dosing strategy are discussed, which include the prioritization of intermediate outcomes (such as cycle cancellations) and the potential biases in the interpretation of study findings (such as confirmation or rescue bias).
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Affiliation(s)
- Jori A Leijdekkers
- Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Helen L Torrance
- Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Nienke E Schouten
- Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Theodora C van Tilborg
- Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Simone C Oudshoorn
- Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ben Willem J Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - Marinus J C Eijkemans
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Frank J M Broekmans
- Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
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23
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Patient burden and healthcare resource utilization of regimens for ovarian stimulation. Reprod Biomed Online 2021; 44:573-581. [DOI: 10.1016/j.rbmo.2021.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/09/2021] [Accepted: 03/26/2021] [Indexed: 11/21/2022]
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Orvieto R, Venetis CA, Fatemi HM, D’Hooghe T, Fischer R, Koloda Y, Horton M, Grynberg M, Longobardi S, Esteves SC, Sunkara SK, Li Y, Alviggi C. Optimising Follicular Development, Pituitary Suppression, Triggering and Luteal Phase Support During Assisted Reproductive Technology: A Delphi Consensus. Front Endocrinol (Lausanne) 2021; 12:675670. [PMID: 34040586 PMCID: PMC8142593 DOI: 10.3389/fendo.2021.675670] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/08/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND A Delphi consensus was conducted to evaluate global expert opinions on key aspects of assisted reproductive technology (ART) treatment. METHODS Ten experts plus the Scientific Coordinator discussed and amended statements plus supporting references proposed by the Scientific Coordinator. The statements were distributed via an online survey to 35 experts, who voted on their level of agreement or disagreement with each statement. Consensus was reached if the proportion of participants agreeing or disagreeing with a statement was >66%. RESULTS Eighteen statements were developed. All statements reached consensus and the most relevant are summarised here. (1) Follicular development and stimulation with gonadotropins (n = 9 statements): Recombinant human follicle stimulating hormone (r-hFSH) alone is sufficient for follicular development in normogonadotropic patients aged <35 years. Oocyte number and live birth rate are strongly correlated; there is a positive linear correlation with cumulative live birth rate. Different r-hFSH preparations have identical polypeptide chains but different glycosylation patterns, affecting the biospecific activity of r-hFSH. r-hFSH plus recombinant human LH (r-hFSH:r-hLH) demonstrates improved pregnancy rates and cost efficacy versus human menopausal gonadotropin (hMG) in patients with severe FSH and LH deficiency. (2) Pituitary suppression (n = 2 statements): Gonadotropin releasing hormone (GnRH) antagonists are associated with lower rates of any grade ovarian hyperstimulation syndrome (OHSS) and cycle cancellation versus GnRH agonists. (3) Final oocyte maturation triggering (n=4 statements): Human chorionic gonadotropin (hCG) represents the gold standard in fresh cycles. The efficacy of hCG triggering for frozen transfers in modified natural cycles is controversial compared with LH peak monitoring. Current evidence supports significantly higher pregnancy rates with hCG + GnRH agonist versus hCG alone, but further evidence is needed. GnRH agonist trigger, in GnRH antagonist protocol, is recommended for final oocyte maturation in women at risk of OHSS. (4) Luteal-phase support (n = 3 statements): Vaginal progesterone therapy represents the gold standard for luteal-phase support. CONCLUSIONS This Delphi consensus provides a real-world clinical perspective on the specific approaches during the key steps of ART treatment from a diverse group of international experts. Additional guidance from clinicians on ART strategies could complement guidelines and policies, and may help to further improve treatment outcomes.
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Affiliation(s)
- Raoul Orvieto
- Infertility and IVF Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Tarnesby-Tarnowski Chair for Family Planning and Fertility Regulation, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- *Correspondence: Raoul Orvieto,
| | - Christos A. Venetis
- Centre for Big Data Research in Health & School of Women’s and Children’s Health, UNSW Medicine, University of New South Wales, Sydney, NSW, Australia
- IVF Australia, Sydney, NSW, Australia
| | - Human M. Fatemi
- Assisted Reproductive Technology (ART), Fertility Clinics, Abu Dhabi, United Arab Emirates
| | - Thomas D’Hooghe
- Global Medical Affairs, Research and Development, Merck Healthcare KGaA, Darmstadt, Germany
- Research Group Reproductive Medicine, Department of Development and Regeneration, Organ Systems, Group Biomedical Sciences, KU Leuven (University of Leuven), Leuven, Belgium
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, United States
| | | | - Yulia Koloda
- Center of Reproduction “Life Line”, Moscow, Russia
- Department of Obstetrics and Gynecology, Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - Marcos Horton
- Pregna Medicina Reproductiva, Buenos Aires, Argentina
| | - Michael Grynberg
- Service de Médecine de la Reproduction et Préservation de la Fertilité, Hôpital Antoine Béclère, Clamart, France
| | - Salvatore Longobardi
- Global Clinical Development, Merck Serono, Italy, an Affiliate of Merck KGaA, Darmstadt, Germany
| | - Sandro C. Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Center for Male Reproduction, Campinas, Brazil
- Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Sesh K. Sunkara
- Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Yuan Li
- Medical Center for Human Reproduction, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Carlo Alviggi
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy
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Ghorbani M, Hosseini FS, Yunesian M, Keramat A. Dropout of infertility treatments and related factors among infertile couples. Reprod Health 2020; 17:192. [PMID: 33267894 PMCID: PMC7709385 DOI: 10.1186/s12978-020-01048-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 11/22/2020] [Indexed: 11/23/2022] Open
Abstract
Background Dropout of infertility treatments is a global issue and many factors play role in this phenomenon. It is one of the most challenges in life of infertile couples. The purpose of this study was to determine dropout rate and related factors/reasons in the world and in Iran. Methods We will conduct a mixed method study with sequential exploratory design (systematic review, qualitative and quantitative phase). In the first stage a systematic review on dropout rate of infertility treatments and related factors will be done. In second stage (quantitative–qualitative study), a retrospective cohort study will be conducted on infertile couples to determine dropout rate of infertility treatments. The follow-up period to assess the discontinuation of treatment in patients, who have discontinued the treatment, will be considered 6 months after the treatment cessation. Data would be analyzed by descriptive statistics. We want to determine proportion and percentage of discontinuation rate among different groups with different causes of infertility. Then, we also will use Chi-square test to compare discontinuation rates among these groups. In qualitative section of second stage, semi-structured interviews would be performed with infertile female who had the history of infertility treatments failure. In this stage, participants will be selected using purposeful sampling method with maximum variation in terms of age, education, occupation, type of infertility, type of treatments, number of unsuccessful treatment and infertility duration. Data would be analyzed using conventional content analysis. Discussion Determining dropout rate and its related factors/reasons would be helpful for future studies to plan suitable interventions for supporting infertile couples. It also helps politicians to have a better understanding of infertility and its consequences on infertile couple’s life. Plain English Summary In today’s world, infertility is a common phenomenon due to postponement of childbearing following the older age of marriage, tendency to reach higher educational level, economical problems and etc. Infertility brings many challenges and stresses to the individuals by itself and it is very hard to cope with. The problem gets worse, when it is associated with failure in treatments. Many of infertile couples cannot tolerate this failure and may decide to discontinue treatments before achieving pregnancy for ending many stressors which are associated with treatments. As we know, childbearing and having at least one child has important position in some societies such as Iranian culture; so ending the treatment before achieving optimal result may have some adverse consequences in the families such as divorce, remarriage, family conflicts, et. Absolutely many factors play role in dropout of infertility treatments, and many studies around the world have suggested many factors/reasons in dropout of infertility treatments, but there are still many gaps about this subject, especially among Iranian society. This study would be conducted in three consecutive stages, in the first stage; we will do a complete review of existing studies of the world to find out related factors/reasons of dropout in detail. In second stage, dropout rate of infertile couples (380 couples) after at least one unsuccessful cycle of treatment would be achieved by assessing medical records and telephone interview. Data of the first and second stage will help us to have better vision about the issue of dropout and would be used to construct a semi structured interview for the last stage. And finally in the third stage, reasons of dropout would be asked by an in depth interview from infertile couples. We hope the information from this study will help politicians better understand and plan for dropout of treatment.
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Affiliation(s)
- Maryam Ghorbani
- Student Research Committee, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | | | - Masud Yunesian
- School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Afsaneh Keramat
- Reproductive Studies and Women's Health Research Center, Shahroud University of Medical Sciences, Shahroud, Iran.
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Bernd M, Schick M, Rösner S, Germeyer A, Strowitzki T, Moessner M, Bauer S, Ditzen B, Wischmann T. Predictors for the Early Termination of a Psychological Intervention During Treatment with Assisted Reproductive Technologies. Geburtshilfe Frauenheilkd 2020; 80:190-199. [PMID: 32109971 PMCID: PMC7035134 DOI: 10.1055/a-0918-6118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 04/25/2019] [Accepted: 05/11/2019] [Indexed: 11/14/2022] Open
Abstract
Introduction Assisted reproductive technologies are typically perceived by couples as being an emotional burden. The objective of the study "Positive Ausrichtung bei unerfülltem Kinderwunsch" [Positive adjustment in infertility] (PACI) is to examine the efficacy and acceptance of a smartphone-supported psychosocial intervention during infertility treatment. In this investigation, the early drop-out of study subjects from the study is of primary interest. The objective of the investigation was to find predictors for ending a psychological intervention prematurely. Materials and Methods There are data available from an eight-month randomised, controlled study in which 141 patients and their partners participated. Sociodemographic and fertility-related data were collected at the start of the study. The couples received the ScreenIVF questionnaire at two points in time. As part of a post-evaluation, a survey was conducted on the efficacy of the psychological online intervention. To analyse the data, a dyadic data structure was used in order to determine connections within the study subject couples between the selected stress indicators and the drop-out. In addition, a "risk score" as a possible predictor for the drop-out was tested. Results The descriptive observation of the sample indicates in this interim assessment that the study subjects recruited are less stressed patient couples. Actor-partner interdependence models indicate statistically significant connections between the stress indicators of anxiety, little social support and helplessness and an early drop-out. Conclusions The statistically significant effects found in this study with regard to the stress indicators in connection with drop-outs from psychosocial intervention studies indicate that it is advisable to continue to seek measures for people undergoing stressful medical treatments in order to motivate and support them and thus optimally utilise the opportunities of a medical treatment. The number of patients who endure their ART treatment may also increase as a result, which could lead in turn to increased patient satisfaction over the long term (and thus possibly to higher pregnancy rates).
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Affiliation(s)
- Marie Bernd
- Institute of Medical Psychology, Centre for Psychosocial Medicine, University Hospital, Heidelberg, Germany
| | - Maren Schick
- Institute of Medical Psychology, Centre for Psychosocial Medicine, University Hospital, Heidelberg, Germany
| | - Sabine Rösner
- Department of Gynecological Endocrinology and Fertility Disorders, University Womenʼs Hospital Heidelberg, Heidelberg, Germany
| | - Ariane Germeyer
- Department of Gynecological Endocrinology and Fertility Disorders, University Womenʼs Hospital Heidelberg, Heidelberg, Germany
| | - Thomas Strowitzki
- Department of Gynecological Endocrinology and Fertility Disorders, University Womenʼs Hospital Heidelberg, Heidelberg, Germany
| | - Markus Moessner
- Center for Psychotherapy Research, Center for Psychosocial Medicine, University Hospital, Heidelberg, Germany
| | - Stephanie Bauer
- Center for Psychotherapy Research, Center for Psychosocial Medicine, University Hospital, Heidelberg, Germany
| | - Beate Ditzen
- Institute of Medical Psychology, Centre for Psychosocial Medicine, University Hospital, Heidelberg, Germany
| | - Tewes Wischmann
- Institute of Medical Psychology, Centre for Psychosocial Medicine, University Hospital, Heidelberg, Germany
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Roberts RE, Farahani L, Webber L, Jayasena C. Current understanding of hypothalamic amenorrhoea. Ther Adv Endocrinol Metab 2020; 11:2042018820945854. [PMID: 32843957 PMCID: PMC7418467 DOI: 10.1177/2042018820945854] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 07/08/2020] [Indexed: 11/19/2022] Open
Abstract
Hypothalamic amenorrhoea (HA) accounts for approximately 30% of cases of secondary amenorrhoea in women of reproductive age. It is caused by deficient secretion of hypothalamic gonadotrophin-releasing hormone, which in turn leads to failure of pituitary gonadotrophin and gonadal steroid release. Functional HA (FHA) is defined as HA occurring in the absence of a structural lesion and is predominantly caused by significant weight loss, intense exercise or stress. Treatment of FHA is crucial in avoiding the long-term health consequences on fertility and bone health, in addition to reducing psychological morbidity. This article summarises our understanding of the mechanisms underlying FHA, the evidence base for its clinical management and emerging therapies.
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Affiliation(s)
- Rachel E. Roberts
- Department of Obstetrics and Gynaecology, Queen Charlotte’s and Chelsea Hospital, London, UK
| | - Linda Farahani
- Section of Investigative Medicine, Imperial College London, London, UK, and Department of Gynaecology, St Mary’s Hospital, London, UK
| | - Lisa Webber
- Department of Gynaecology, St Mary’s Hospital, London, UK
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Whittier Olerich K, Summers K, Lewis AM, Stewart K, Ryan GL. Patient identified factors influencing decisions to seek fertility care: adaptation of a wellness model. J Reprod Infant Psychol 2019; 39:263-275. [PMID: 31856599 DOI: 10.1080/02646838.2019.1705263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: To adapt a fertility care wellness model.Background: Despite availability of a range of diagnostic and therapeutic services for infertility, many do not seek care or discontinue care prior to achieving a live birth. Wellness models can inform research on patient decisions to seek and continue fertility care, as many barriers and drivers are represented within the dimensions of wellness.Methods: A mixed-methods online survey was completed by 135 people of reproductive age who experienced infertility in the USA. Outcomes included drivers and barriers to seeking or continuing fertility care. Identified factors were compared by treatment history using chi-square and Fisher's exact tests. Themes and patterns were identified within 174 responses to 6 open-response items through conventional content analysis.Results: Thematic analysis revealed practical (environmental, financial, and physical) and affective (emotional, social and spiritual) dimensions of wellness in decisions to seek care (67%), with affective rationales more prominent in decisions to return for care (78%).Conclusion: Decisions to seek fertility care and return after failed treatment integrate practical and affective rationales from financial, physical, environmental, emotional, social and spiritual wellness dimensions. Drivers and barriers within these dimensions should be considered to encourage care seeking and improve patient retention.
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Affiliation(s)
- Kelsey Whittier Olerich
- Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Karen Summers
- Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Adam M Lewis
- Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Kathleen Stewart
- Department of Geographical and Sustainability Sciences, University of Iowa, Iowa City, IA, USA
| | - Ginny L Ryan
- Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
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Barrière P, Avril C, Benmahmoud-Zoubir A, Bénard N, Dejager S. Patient perceptions and understanding of treatment instructions for ovarian stimulation during infertility treatment. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2019; 9:37-47. [PMID: 31993512 PMCID: PMC6976931 DOI: 10.1016/j.rbms.2019.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/25/2019] [Accepted: 08/19/2019] [Indexed: 06/10/2023]
Abstract
The impact of patient-physician communication and levels of understanding of treatment on patient knowledge and compliance has been studied in patients undergoing their first cycle of infertility treatment. This observational, real-life, longitudinal study involved 488 patients from 28 infertility centres in France. Data on communication quality, understanding of treatment instructions, patient knowledge and compliance to treatment protocol were collected through questionnaires administered before treatment initiation (V1) and at oocyte retrieval (V2). At V1, patients were very satisfied with their levels of understanding of the injection and monitoring schedules, the information given by the medical team, and the way of receiving instructions, with average ratings on a scale of 0-100% of > 75%. They rated their understanding of possible treatment side-effects as satisfactory (average score 71.1%). Gaps in patient knowledge about their treatment, revealed by discrepancies between physician and patient reports, were observed in 20.5% of patients (n = 79/386), and most commonly resulted from confusion about the units and dose of gonadotropin. Anxiety about performing self-injections and a lack of confidence in their ability to self-inject correctly were each observed in approximately one-third of patients. Patient self-assessment of compliance at V2 revealed that 27% of patients (n = 83/305) did not comply with or had doubts about the injection schedule or dose injected. Meanwhile physicians reported high levels of patient compliance (94.3%; n = 350/371). In conclusion, even when patient-physician relationships appear to be satisfactory, patient miscomprehension and non-compliance during infertility treatment may be underestimated. Further interventions are required to improve these outcomes.
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Affiliation(s)
- Paul Barrière
- CRTI, U 1064, Service de biologie et médecine de la reproduction, Centre Hospitalier Universitaire, Nantes, France
| | - Catherine Avril
- Clinique Mathilde – Service de médecine de la reproduction, Rouen, France
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PGT for aneuploidy does not affect three-cycle cumulative IVF discontinuation rate in women of advanced maternal age. Reprod Biomed Online 2019; 39:75-83. [DOI: 10.1016/j.rbmo.2019.03.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/16/2019] [Accepted: 03/01/2019] [Indexed: 11/24/2022]
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Leijdekkers JA, Eijkemans MJC, van Tilborg TC, Oudshoorn SC, McLernon DJ, Bhattacharya S, Mol BWJ, Broekmans FJM, Torrance HL. Predicting the cumulative chance of live birth over multiple complete cycles of in vitro fertilization: an external validation study. Hum Reprod 2019; 33:1684-1695. [PMID: 30085143 DOI: 10.1093/humrep/dey263] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 07/11/2018] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION Are the published pre-treatment and post-treatment McLernon models, predicting cumulative live birth rates (LBR) over multiple complete IVF cycles, valid in a different context? SUMMARY ANSWER With minor recalibration of the pre-treatment model, both McLernon models accurately predict cumulative LBR in a different geographical context and a more recent time period. WHAT IS KNOWN ALREADY Previous IVF prediction models have estimated the chance of a live birth after a single fresh embryo transfer, thereby excluding the important contribution of embryo cryopreservation and subsequent IVF cycles to cumulative LBR. In contrast, the recently developed McLernon models predict the cumulative chance of a live birth over multiple complete IVF cycles at two certain time points: (i) before initiating treatment using baseline characteristics (pre-treatment model) and (ii) after the first IVF cycle adding treatment related information to update predictions (post-treatment model). Before implementation of these models in clinical practice, their predictive performance needs to be validated in an independent cohort. STUDY DESIGN, SIZE, DURATION External validation study in an independent prospective cohort of 1515 Dutch women who participated in the OPTIMIST study (NTR2657) and underwent their first IVF treatment between 2011 and 2014. Participants underwent a total of 2881 complete treatment cycles, with a complete cycle defined as all fresh and frozen thawed embryo transfers resulting from one episode of ovarian stimulation. The follow up duration was 18 months after inclusion, and the primary outcome was ongoing pregnancy leading to live birth. PARTICIPANTS/MATERIALS, SETTING, METHODS Model performance was externally validated up to three complete treatment cycles, using the linear predictor as described by McLernon et al. to calculate the probability of a live birth. Discrimination was expressed by the c-statistic and calibration was depicted graphically in a calibration plot. In contrast to the original model development cohort, anti-Müllerian hormone (AMH), antral follicle count (AFC) and body weight were available in the OPTIMIST cohort, and evaluated as potential additional predictors for model improvement. MAIN RESULTS AND THE ROLE OF CHANCE Applying the McLernon models to the OPTIMIST cohort, the c-statistic of the pre-treatment model was 0.62 (95% CI: 0.59-0.64) and of the post-treatment model 0.71 (95% CI: 0.69-0.74). The calibration plot of the pre-treatment model indicated a slight overestimation of the cumulative LBR. To improve calibration, the pre-treatment model was recalibrated by subtracting 0.35 from the intercept. The post-treatment model calibration plot revealed accurate cumulative LBR predictions. After addition of AMH, AFC and body weight to the McLernon models, the c-statistic of the updated pre-treatment model improved slightly to 0.66 (95% CI: 0.64-0.68), and of the updated post-treatment model remained at the previous level of 0.71 (95% CI: 0.69-0.73). Using the recalibrated pre-treatment model, a woman aged 30 years with 2 years of primary infertility who starts ICSI treatment for male factor infertility has a chance of 40% of a live birth from the first complete cycle, increasing to 72% over three complete cycles. If this woman weighs 70 kg, has an AMH of 1.5 ng/mL and an AFC of 10 measured at the beginning of her treatment, the updated pre-treatment model revises the estimated chance of a live birth to 30% in the first complete cycle and 59% over three complete cycles. If this woman then has five retrieved oocytes, no embryos cryopreserved and a single fresh cleavage stage embryo transfer in her first ICSI cycle, the post-treatment model estimates the chances of a live birth at 28 and 58%, respectively. LIMITATIONS, REASONS FOR CAUTION Two randomized controlled trials (RCT) evaluating the effectiveness of gonadotropin dose individualization on basis of the AFC were nested within the OPTIMIST study. The strict dosing regimens, the RCT in- and exclusion criteria and the limited follow up time of 18 months might have influenced model performance in this independent cohort. Also, consistent with the original model development study, external validation was performed using the optimistic assumption that the cumulative LBR in couples who discontinue treatment without a live birth would have been equal to that of those who continue treatment. WIDER IMPLICATIONS OF THE FINDINGS After national recalibration to account for geographical differences in IVF treatment, the McLernon prediction models can be introduced as new counselling tools in clinical practice to inform patients and to complement clinical reasoning. These models are the first to offer an objective and personalized estimate of the cumulative probability of a live birth over multiple complete IVF cycles. STUDY FUNDING/COMPETING INTEREST(S) No external funds were obtained for this study. M.J.C.E., D.J.M. and S.B. have nothing to disclose. J.A.L, S.C.O, T.C.v.T. and H.LT. received an unrestricted personal grant from Merck BV. B.W.M. is supported by a NHMRC Practitioner Fellowship (GNT1082548) and reports consultancy for ObsEva, Merck and Guerbet. F.J.M.B. receives monetary compensation as a member of the external advisory board for Merck BV (the Netherlands) and Ferring pharmaceutics BV (the Netherlands), for consultancy work for Gedeon Richter (Belgium) and Roche Diagnostics on automated AMH assay development, and for a research cooperation with Ansh Labs (USA). TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- J A Leijdekkers
- Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - M J C Eijkemans
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - T C van Tilborg
- Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - S C Oudshoorn
- Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - D J McLernon
- Institute of Applied Health Sciences, Medical Statistics Team, University of Aberdeen, Foresterhill, Aberdeen, UK
| | - S Bhattacharya
- School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Heath Park, Cardiff, UK
| | - B W J Mol
- Department of Obstetrics and Gynaecology, Monash University, Scenic Blvd & Wellington Road, Clayton VIC, Australia
| | - F J M Broekmans
- Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - H L Torrance
- Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, CX Utrecht, The Netherlands
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Bedrick BS, Anderson K, Broughton DE, Hamilton B, Jungheim ES. Factors associated with early in vitro fertilization treatment discontinuation. Fertil Steril 2019; 112:105-111. [PMID: 31043233 DOI: 10.1016/j.fertnstert.2019.03.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/02/2019] [Accepted: 03/04/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To investigate factors associated with early IVF treatment discontinuation. DESIGN Retrospective cohort study. SETTING Academic medical center. PATIENT(S) Six hundred sixty-nine first-attempt IVF patients who did not have a live birth. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Treatment discontinuation and time to return for a second IVF cycle. RESULT(S) Women without IVF insurance coverage were more likely to discontinue treatment than women with insurance coverage (adjusted odds ratio [aOR] = 3.12; 95% confidence interval [CI], 2.22-4.40). African-American women were more likely to discontinue treatment (aOR = 2.95; 95% CI, 1.54-5.66) and returned for treatment more slowly (adjusted hazard ratio [aHR] = 0.44; 95% CI, 0.28-0.71) than non-Hispanic white women, regardless of IVF insurance coverage or income. Women with a poor prognosis were more likely to discontinue treatment than women with a good prognosis. Older women with IVF insurance coverage or a good prognosis had a shorter time to return for a second IVF cycle than older women without IVF insurance coverage or with a poor prognosis. Estimated income, distance to clinic, fertility diagnosis, number of oocytes retrieved, and history of previous live birth were not associated with treatment discontinuation or time to return for a second IVF cycle after adjustment for covariates. CONCLUSION(S) IVF insurance coverage, race, age, and future treatment prognosis are associated with IVF treatment discontinuation and time to return.
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Affiliation(s)
- Bronwyn S Bedrick
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Washington University School of Medicine, St. Louis, Missouri
| | - Kelsey Anderson
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Washington University School of Medicine, St. Louis, Missouri
| | - Darcy E Broughton
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Washington University School of Medicine, St. Louis, Missouri; Pacific NW Fertility, Seattle, Washington
| | - Barton Hamilton
- Olin School of Business, Washington University in St. Louis, St. Louis, Missouri
| | - Emily S Jungheim
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Washington University School of Medicine, St. Louis, Missouri.
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Zahiri Sorouri Z, Pourmarzi D, Safar Khah N. Corifollitropin- α compared to daily r-FSH in for patients undergoing intracytoplasmic sperm injection: Clinical trial study. Int J Reprod Biomed 2019; 17. [PMID: 31435581 PMCID: PMC6652158 DOI: 10.18502/ijrm.v17i1.3817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 07/22/2018] [Accepted: 09/12/2018] [Indexed: 11/24/2022] Open
Abstract
Background The current treatment regimen for ovarian stimulation in Intracytoplasmic sperm injection (ICSI) patients is daily injections of Gonadotropins. Recombinant DNA technologies have produced a new recombinant molecule that is a long-acting Follicle Stimulating Hormone (FSH), named corifollitropin alfa. A single injection of long-acting FSH can replace seven daily FSH injections during the first week of controlled ovarian stimulation (COS) and can make assisted reproduction more patients-friendly. There is limited data with different results in this area. Objective To compare the effectiveness of long-acting FSH vs. daily r-FSH in terms of pregnancy and safety outcomes in women undergoing ICSI cycles. Materials and Methods In this clinical trial study, 109 women who were the candidates for ICSI at azzahra hospital were divided in two groups. The first group received 150 units of daily Gonal-f from second or third day of menstruation. The second group received a 150IU corifollitropin alfa on the second or third day of mensuration, and the treatment continued from day eighth of stimulation with Gonal-f based on the ultrasound finding. Both the groups received GnRH antagonist from fifth day of stimulation. Two groups were compared in terms of number of dominant follicles, number of oocytes, stimulation duration, total number of embryos, number of transferred embryos, and success rate of pregnancy. Results No significant difference was found between the two groups in terms of stimulation duration, number of follicles, number of oocytes, total number of embryos, and number of transferred embryos. Moreover, pregnancy outcomes including chemical pregnancy rate (positive pregnancy test), clinical pregnancy rate (detection of fetal heart), the rate of ovarian hyper-stimulation syndrome, multiple-pregnancy, ectopic pregnancy, and miscarriage didn't have a significant difference between the two groups. Conclusion As corifollitropin alfa was as effective as r-FSH, it could be used as an alternative to ovulation stimulation method in patients undergoing ICSI.
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Affiliation(s)
- Ziba Zahiri Sorouri
- Reproductive Health Research Center, Department of Obstetrics & Gynecology, Al-zahra Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Davoud Pourmarzi
- Epidemiology, Reproductive Health Research Center, Gilan University of Medical Sciences, Rasht, Iran
| | - Niloufar Safar Khah
- Reproductive Health Research Center, Department of Obstetrics & Gynecology, Al-zahra Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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Leone D, Borghi L, Del Negro S, Becattini C, Chelo E, Costa M, De Lauretis L, Ferraretti AP, Giuffrida G, Livi C, Luehwink A, Palermo R, Revelli A, Tomasi G, Tomei F, Filippini C, Vegni E. Doctor-couple communication during assisted reproductive technology visits. Hum Reprod 2019; 33:877-886. [PMID: 29635461 DOI: 10.1093/humrep/dey069] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 03/12/2018] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION What are the characteristics of doctor-couple communication content during actual ART visits? SUMMARY ANSWER Physicians were mainly focused on providing biomedical information, while communication content from couples had a 2-fold focus on providing biomedical information and on positive talk. WHAT IS KNOWN ALREADY Communication aspects in ART seem crucial for clinical decision-making, retention in care and critical conversations with couples due to low treatment success rates. However, no studies have been carried out on the actual interaction between the doctor and the couple in this context. STUDY DESIGN, SIZE, DURATION This observational study involved 28 clinicians and 160 patients referred to eight Italian ART clinics during a one-year recruitment period. PARTICIPANTS/MATERIALS, SETTING, METHODS ART visits at eight Italian clinics were videotaped. The visits were coded using the Roter Interaction Analysis System (RIAS), particularly focusing on RIAS composite categories, verbal dominance and patient-centeredness score. MAIN RESULTS AND THE ROLE OF CHANCE A total of 85 visits were eligible for analysis (62% acceptance rate), involving 28 clinicians and 160 patients (including 75 couples). The average visit duration was 37 ± 17.7 min. The mean verbal dominance was 1.9 ± 0.86 (range: 0.72-5.74). Physicians mainly focused on providing biomedical information. Communication content from couples had a 2-fold focus on providing biomedical information and on positive talk. The mean of patient centeredness index (PCI) was 0.51 (SD = 0.28; range 0.08-1.77); visits in which the doctor was a woman or the treatment indication was for heterologous fertilization showed higher PCI scores. Overall, females accounted for 67% of all patient talk. Taking this imbalance into account as expected frequencies for each composite category, males reported significantly more utterances in almost all of the socioemotional categories. LIMITATIONS, REASONS FOR CAUTION These results are preliminary and observational and only regard Italy. Communication during visits may have been biased since the professionals who agreed to participate showed an interest in communication issues. Another limitation is a possible Hawthorne effect due to the fact that participants were aware of being videotaped. WIDER IMPLICATIONS OF THE FINDINGS Our study showed that ART physicians mainly adopted an informative model of communication and a more disease-oriented approach. Findings revealed the complexity of communication content during ART consultations, given its triadic characteristic in which the third party is also a patient; clinicians should be aware of this complex aspect and of the specific male and female perspectives to be taken into account. The results could be useful for training ART professionals. STUDY FUNDING/COMPETING INTEREST(S) This study was possible thanks to an unconditional grant from Ferring Spa to the Department of Health Sciences, University of Milan. There are no competing interests to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- D Leone
- Department of Health Science, University of Milan, Milan 20142, Italy
| | - L Borghi
- Department of Health Science, University of Milan, Milan 20142, Italy
| | - S Del Negro
- Unit of Clinical Psychology, ASST Santi Paolo e Carlo, Milan 20142, Italy
| | - C Becattini
- Assisted Reproductive Center, Futura Diagnostica Medica, Florence 50129, Italy
| | - E Chelo
- Demetra Assisted Reproductive Center, Florence 50141, Italy
| | - M Costa
- Assisted Reproductive Unit, Ospedale Evangelico Internazionale, Genoa 16122, Italy
| | - L De Lauretis
- Assisted Reproductive Center, Istituto Clinico Città Studi, Milan 20131, Italy
| | - A P Ferraretti
- Reproductive Medicine Unit, S.I.S.Me.R., Bologna 40138, Italy
| | - G Giuffrida
- CRA, Assisted Reproductive Center, Catania 95128, Italy
| | - C Livi
- Demetra Assisted Reproductive Center, Florence 50141, Italy
| | - A Luehwink
- Assisted Reproductive Unit, Azienda Provinciale per i Servizi Sanitari-Provincia Autonoma di Trento, Arco 38123, Italy
| | - R Palermo
- Ambra Assisted Reproductive Center, Palermo 90138, Italy
| | - A Revelli
- Gynecology and Obstetrics I, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, S. Anna Hospital, University of Torino, Torino 10126, Italy
| | - G Tomasi
- CRA, Assisted Reproductive Center, Catania 95128, Italy
| | - F Tomei
- Assisted Reproductive Unit, Azienda Ospedaliera Santa Maria degli Angeli, Pordenone 33170, Italy
| | - C Filippini
- Department of Surgical Sciences, University of Turin, Turin 10126, Italy
| | - E Vegni
- Department of Health Science, University of Milan, Milan 20142, Italy.,Unit of Clinical Psychology, ASST Santi Paolo e Carlo, Milan 20142, Italy
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Kreuzer VK, Kimmel M, Schiffner J, Czeromin U, Tandler-Schneider A, Krüssel JS. Possible Reasons for Discontinuation of Therapy: an Analysis of 571 071 Treatment Cycles From the German IVF Registry. Geburtshilfe Frauenheilkd 2018; 78:984-990. [PMID: 30364331 PMCID: PMC6195432 DOI: 10.1055/a-0715-2654] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 08/23/2018] [Accepted: 08/23/2018] [Indexed: 11/30/2022] Open
Abstract
Introduction
Numerous couples discontinue fertility treatment before achieving the objective, the birth of a child. The aim of this retrospective data analysis is to identify the reasons for early discontinuation of therapy (drop-out).
Materials and Methods
Retrospective data analysis. With the aid of the German IVF Registry (D·I·R
®
), a total of 122 560 “last cycles” in Germany in the period 2012 – 2015 were identified and the courses were analysed.
Results
From the named cohort of “last cycles”, 37.3% of the female patients (45 699) gave birth to a child and ended the therapy. The remaining 76 861 discontinued the treatment before having a child. The fertility treatment was conducted due to a purely male indication in 46.27% of cases and in 17.96% the cause lay exclusively with the woman. 4.53% of the drop-outs suffered a miscarriage in the last cycle. 73.56% of the drop-out patients ended the therapy after the lack of a positive pregnancy test. After the third therapy cycle, 67% of the couples ended their treatment.
Conclusion
The results make it possible to provide couples with individual counselling. They offer an option for preparing for the emotional and physical hurdles.
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Affiliation(s)
- Vera K Kreuzer
- Universitätsklinikum Düsseldorf, Klinik für Frauenheilkunde und Geburtshilfe, UniKiD - Universitäres Interdisziplinäres Kinderwunschzentrum Düsseldorf, Düsseldorf, Germany
| | - Markus Kimmel
- Deutsches IVF-Register e. V. (D·I·R)®, Geschäftsstelle und Datenkoordination, Düsseldorf, Germany
| | | | - Ute Czeromin
- Deutsches IVF-Register e. V. (D·I·R)®, Düsseldorf, Germany.,Kinderwunschpraxis Gelsenkirchen, Gelsenkirchen, Germany
| | - Andreas Tandler-Schneider
- Deutsches IVF-Register e. V. (D·I·R)®, Mitglied des Vorstands, Düsseldorf, Germany.,Fertility Center Berlin, Berlin, Germany
| | - Jan-Steffen Krüssel
- Universitätsklinikum Düsseldorf, Klinik für Frauenheilkunde und Geburtshilfe, UniKiD - Universitäres Interdisziplinäres Kinderwunschzentrum Düsseldorf, Düsseldorf, Germany.,Deutsches IVF-Register e. V. (D·I·R)®, Mitglied des Vorstands, Düsseldorf, Germany
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36
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Freeman MP, Lee H, Savella GM, Sosinsky AZ, Marfurt SP, Murphy SK, Cohen LS. Predictors of Depressive Relapse in Women Undergoing Infertility Treatment. J Womens Health (Larchmt) 2018; 27:1408-1414. [PMID: 30067141 DOI: 10.1089/jwh.2017.6878] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite high prevalence rates among women of mood disorders and of infertility, there is a paucity of systematic data to inform the treatment of women at risk for psychiatric morbidity in the context of assisted reproductive technologies (ART). The objective was to delineate predictors of depressive relapse in women with histories of mood disorders during ART, including the role of psychotropic medication continuation. METHODS This was a prospective observational study of women undergoing ART with past diagnoses of major depressive disorder (MDD) or bipolar depression. For 6-months, follow-up included assessments of mood, perceived stress, and partner support. A subsample participated in biomarker collection. Depressive relapse was confirmed using Mini-International Neuropsychiatric Interview. RESULTS N = 38 were evaluable. Participants with MDD (N = 25) experienced a depressive relapse rate of 44.0%. Relapse rates among antidepressant maintainers (N = 15; relapse rate = 40.0%) and antidepressant discontinuers (N = 10; relapse rate = 50.0%) were not significantly different. Among participants with bipolar disorder (N = 13), the overall relapse rate was 30.8%. Among psychotropic medication maintainers (N = 10), 40.0% relapsed, and among discontinuers (N = 3), none relapsed. Scores on the Perceived Stress Scale correlated with relapse risk (odds ratio [OR] = 1.17, 95% confidence interval [CI]: 1.08-1.26, p = 0.0065). C-reactive protein was associated with relapse (OR = 1.92, 95% CI: 1.43-2.55, p < 0.0001); blood cortisol and interleukin-6 were not. CONCLUSIONS Risk of depressive relapse among women undergoing ART is considerable. Medication continuation does not adequately confer relapse prevention. Stress and inflammation appear to contribute to risk of relapse. Additional strategies to mitigate depressive relapse in at-risk women undergoing ART are needed.
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Affiliation(s)
- Marlene P Freeman
- 1 Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital , Boston, Massachusetts
| | - Hang Lee
- 2 Biostatistics Center, Massachusetts General Hospital , Boston, Massachusetts
| | - Gina M Savella
- 1 Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital , Boston, Massachusetts
| | - Alexandra Z Sosinsky
- 1 Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital , Boston, Massachusetts
| | - Samantha P Marfurt
- 1 Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital , Boston, Massachusetts
| | - Shannon K Murphy
- 1 Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital , Boston, Massachusetts
| | - Lee S Cohen
- 1 Ammon-Pinizzotto Center for Women's Mental Health, Massachusetts General Hospital , Boston, Massachusetts
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Boyle PC, de Groot T, Andralojc KM, Parnell TA. Healthy Singleton Pregnancies From Restorative Reproductive Medicine (RRM) After Failed IVF. Front Med (Lausanne) 2018; 5:210. [PMID: 30109231 PMCID: PMC6079215 DOI: 10.3389/fmed.2018.00210] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 07/03/2018] [Indexed: 11/13/2022] Open
Abstract
Objectives: To determine the live birth rate for patients who chose to undergo treatment with Restorative Reproductive Medicine (RRM) after previous IVF (includes ICSI). To look at birth outcomes with RRM after IVF, particularly rates of twin and higher order pregnancies, premature birth, low birth weight, and potential cost savings achieved with RRM. Setting: Two outpatient clinics in Ireland providing advanced RRM treatment of infertility. Materials and methods: All patients presenting between January 2004 and January 2010, with a history of infertility and previous IVF treatment were included if they proceeded beyond the initial consultation and began treatment. Main outcome is live birth per couple calculated using life table analysis. Results: 403 patients met the study criteria, among which 74 had a subsequent live birth. These women had significant negative predictive characteristics for healthy live birth including: advanced reproductive age (average 37.2 years), an average of 5.8 years of infertility with 2.1 (range 1–9) previous IVF attempts, with only 5% having previously had a live birth from IVF. Despite these undesirable prognostic indicators, the overall RRM live birth rate was 32.1% (crude 18.4%). Women aged 35–38 had a live birth rate of 37.5% (crude 23.6%) and older women over 40 had a live birth rate of 27.4% (crude 16.0%). The average birth weight was 3374g (7lb 7oz) with 92% being born at 37+ weeks and no very low birth weight babies. There was only one twin pregnancy in the study population; the potential health care savings for avoidable multiple pregnancies in these patients was estimated at £205 672 (USD$284 915). Conclusions: Patients who have already tried IVF can achieve comparable live birth outcomes with RRM compared to another cycle of IVF. RRM has a low risk of twin or multiple births, and very good neonatal outcomes with a potential cost savings to the health care system.
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Affiliation(s)
- Phil C Boyle
- International Institute for Restorative Reproductive Medicine, London, United Kingdom.,NeoFertility Clinic, Dublin, Ireland
| | - Theun de Groot
- International Institute for Restorative Reproductive Medicine, London, United Kingdom
| | - Karolina M Andralojc
- Department of Molecular Biology, Faculty of Science, Radboud Institute for Molecular Life Sciences, Radboud University, Nijmegen, Netherlands
| | - Tracey A Parnell
- International Institute for Restorative Reproductive Medicine, London, United Kingdom.,Department of Family Medicine, University of British Columbia, Vancouver, BC, Canada
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38
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Hwang JL, Chen SU, Chen HJ, Chen HF, Yang YS, Chang CH, Seow KM, Tzeng CR, Lin YH. Feasibility of corifollitropin alfa/GnRH antagonist protocol combined with GnRH agonist triggering and freeze-all strategy in polycystic ovary syndrome patients. J Formos Med Assoc 2018; 117:535-540. [DOI: 10.1016/j.jfma.2017.05.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 04/26/2017] [Accepted: 05/15/2017] [Indexed: 02/02/2023] Open
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39
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Mol BW, Bossuyt PM, Sunkara SK, Garcia Velasco JA, Venetis C, Sakkas D, Lundin K, Simón C, Taylor HS, Wan R, Longobardi S, Cottell E, D'Hooghe T. Personalized ovarian stimulation for assisted reproductive technology: study design considerations to move from hype to added value for patients. Fertil Steril 2018; 109:968-979. [DOI: 10.1016/j.fertnstert.2018.04.037] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/23/2018] [Accepted: 04/25/2018] [Indexed: 12/20/2022]
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40
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Sominsky L, Hodgson DM, McLaughlin EA, Smith R, Wall HM, Spencer SJ. Linking Stress and Infertility: A Novel Role for Ghrelin. Endocr Rev 2017; 38:432-467. [PMID: 28938425 DOI: 10.1210/er.2016-1133] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 07/24/2017] [Indexed: 12/23/2022]
Abstract
Infertility affects a remarkable one in four couples in developing countries. Psychological stress is a ubiquitous facet of life, and although stress affects us all at some point, prolonged or unmanageable stress may become harmful for some individuals, negatively impacting on their health, including fertility. For instance, women who struggle to conceive are twice as likely to suffer from emotional distress than fertile women. Assisted reproductive technology treatments place an additional physical, emotional, and financial burden of stress, particularly on women, who are often exposed to invasive techniques associated with treatment. Stress-reduction interventions can reduce negative affect and in some cases to improve in vitro fertilization outcomes. Although it has been well-established that stress negatively affects fertility in animal models, human research remains inconsistent due to individual differences and methodological flaws. Attempts to isolate single causal links between stress and infertility have not yet been successful due to their multifaceted etiologies. In this review, we will discuss the current literature in the field of stress-induced reproductive dysfunction based on animal and human models, and introduce a recently unexplored link between stress and infertility, the gut-derived hormone, ghrelin. We also present evidence from recent seminal studies demonstrating that ghrelin has a principal role in the stress response and reward processing, as well as in regulating reproductive function, and that these roles are tightly interlinked. Collectively, these data support the hypothesis that stress may negatively impact upon fertility at least in part by stimulating a dysregulation in ghrelin signaling.
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Affiliation(s)
- Luba Sominsky
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria 3083, Australia
| | - Deborah M Hodgson
- School of Psychology, Faculty of Science and IT, The University of Newcastle, New South Wales 2308, Australia
| | - Eileen A McLaughlin
- School of Biological Sciences, Faculty of Science, The University of Auckland, Auckland 1010, New Zealand.,School of Environmental & Life Sciences, Faculty of Science and IT, The University of Newcastle, New South Wales 2308, Australia
| | - Roger Smith
- Mothers and Babies Research Centre, Hunter Medical Research Institute, Lookout Road, New Lambton Heights, New South Wales 2305, Australia.,Priority Research Centre in Reproductive Science, The University of Newcastle, New South Wales 2308, Australia
| | - Hannah M Wall
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria 3083, Australia
| | - Sarah J Spencer
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria 3083, Australia
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41
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Leone D, Menichetti J, Barusi L, Chelo E, Costa M, De Lauretis L, Ferraretti AP, Livi C, Luehwink A, Tomasi G, Vegni E. Breaking bad news in assisted reproductive technology: a proposal for guidelines. Reprod Health 2017; 14:87. [PMID: 28728610 PMCID: PMC5520370 DOI: 10.1186/s12978-017-0350-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 07/11/2017] [Indexed: 11/10/2022] Open
Affiliation(s)
- Daniela Leone
- Department of Health Sciences, Università degli Studi di Milano, San Paolo University Hospital, Via di Rudinì 8, 20142 Milan, Italy
| | - Julia Menichetti
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Lorenzo Barusi
- Assisted Reproductive Unit, Parma University Hospital, Parma, Italy
| | | | - Mauro Costa
- Ospedale Evangelico Internazionale, Assisted Reproductive Unit, Genoa, Italy
| | | | | | - Claudia Livi
- Demetra Assisted Reproductive Center, Florence, Italy
| | - Arne Luehwink
- Azienda Provinciale per i Servizi Sanitari- Provincia Autonoma di Trento, Assisted Reproductive Unit, Arco, Italy
| | | | - Elena Vegni
- Department of Health Sciences, Università degli Studi di Milano, San Paolo University Hospital, Via di Rudinì 8, 20142 Milan, Italy
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Ockhuijsen HD, van Smeden M, van den Hoogen A, Boivin J. Validation study of the SCREENIVF: an instrument to screen women or men on risk for emotional maladjustment before the start of a fertility treatment. Fertil Steril 2017; 107:1370-1379.e5. [DOI: 10.1016/j.fertnstert.2017.04.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/13/2017] [Accepted: 04/13/2017] [Indexed: 11/28/2022]
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Souza PMG, Carvalho BRD, Nakagawa HM, Rassi TRE, Barbosa ACP, Silva AA. Corifollitropin alfa compared to daily rFSH or HP-HMG in GnRH antagonist controlled ovarian stimulation protocol for patients undergoing assisted reproduction. JBRA Assist Reprod 2017; 21:67-69. [PMID: 28609269 PMCID: PMC5473695 DOI: 10.5935/1518-0557.20170017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective This study aimed to compare the outcomes of controlled ovarian stimulation
(COS) with corifollitropin alfa versus daily recombinant
follicle-stimulating hormone (rRFSH) or highly purified human menopausal
gonadotropin (HP-HMG) in patients undergoing in vitro
fertilization (IVF) cycles based on gonadotropin-releasing hormone (GnRH)
antagonist protocols. The primary endpoints were total number of oocytes and
mature oocytes. Methods This retrospective study looked into 132 controlled ovarian stimulation
cycles from IVF or oocyte cryopreservation performed in a private human
reproduction center between January 1 and December 31, 2014. Enrollment
criteria: women aged < 40 years submitted to COS with corifollitropin
alfa 100µg or 150µg (n = 26) and rFSH or HP-HMG in the first
seven days of treatment with daily doses of 150-225 IU (n = 106); all
subjects were on GnRH antagonist protocols. Results The groups had similar mean ages and duration of stimulation. The mean number
± standard deviation of total aspirated oocytes and MII oocytes was
11.9±10 and 10.3±7.9 in the corifollitropin alfa group, and
10.9±7.2 and 8.6±5.7 in the group on rFSH or HMG
(p>0.05). There were no significant differences in
fertilization (76.9% vs. 76.8%, p=1.0), biochemical
pregnancy (66.7% vs. 47.2%, p=0.1561) or embryo
implantation rates (68.7% vs. 50%, p=0.2588) between the
groups using corifollitropin alfa and rFSH or HMG, respectively. Conclusions Corifollitropin alfa seems to be as effective as rFSH or HP-HMG when used in
the first seven days of ovulation induction for patients undergoing assisted
reproduction in GnRH antagonist protocols.
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Couples' discontinuation of fertility treatments: a longitudinal study on demographic, biomedical, and psychosocial risk factors. J Assist Reprod Genet 2016; 34:217-224. [PMID: 27900611 DOI: 10.1007/s10815-016-0844-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 11/14/2016] [Indexed: 10/20/2022] Open
Abstract
PURPOSE This study aims to explore the role of infertility-psychosocial variables on treatment discontinuation after controlling for demographic and biomedical variables in couples seeking reimbursed fertility treatment. METHODS A prospective study was conducted in 139 couples seeking fertility treatment. Between February 2010 and March 2011, participants completed measures of anxiety (STAI-State), depression (BDI-II), infertility-stress (FPI), and infertility coping strategies (COMPI-CSS). Medical data related to diagnosis, treatment, and discontinuation were collected in December 2013. A multiple logistic regression was performed to identify the predictors of discontinuation. RESULTS The discontinuation rate was 29.5%. Female education level, engagement in ART procedures, and female causation decreased the likelihood of treatment discontinuation, whereas female age and depression increased the likelihood of discontinuation. Female depression was the strongest predictor in this model. The model correctly identified 75.5% of cases. CONCLUSIONS Female age and female depression are associated with a higher likelihood of treatment discontinuation in couples seeking treatment. Reproductive health professionals should therefore inform couples about the link between the fertility treatment discontinuation and both female age and female depression. Couples in which female partners present clinically relevant depression should be referred to a mental health professional to prevent premature abandonment of fertility treatments and thus increase success rates.
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45
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Dodge LE, Sakkas D, Hacker MR, Feuerstein R, Domar AD. The impact of younger age on treatment discontinuation in insured IVF patients. J Assist Reprod Genet 2016; 34:209-215. [PMID: 27889867 DOI: 10.1007/s10815-016-0839-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 11/02/2016] [Indexed: 11/28/2022] Open
Abstract
PURPOSE This retrospective cohort study aimed to determine whether age influences treatment discontinuation among insured patients undergoing in vitro fertilization (IVF). We hypothesized that the youngest patients would be the least likely to discontinue treatment. METHODS All women age 18-42 who underwent their first fresh, non-donor IVF cycle from 2002 to 2013 were followed until a live birth was achieved, until they discontinued treatment at our center (not presenting for treatment for a one-year period), or until they completed six fresh or frozen embryo transfer cycles, whichever occurred first. RESULTS Of 11,361 women included, 4336 (38.2 %) discontinued treatment at our center before achieving a live birth or undergoing six IVF cycles. Discontinuation differed by age for cycles 2-4 (all P ≤ 0.004), with the proportion among women age 40-42 averaging 6-7 % higher than the other groups; discontinuation per cycle was similar among women <30 compared to women age 30-<35 and 35-<40. This continued in cycles 5 and 6, and in the sixth, 35.2, 32.0, 32.3, and 40.2 % of women among the four age groups discontinued treatment, respectively (P = 0.17). In cycles 2-5, women in the oldest two age groups with secondary infertility consistently discontinued treatment more frequently than those with primary infertility. CONCLUSIONS We found that women in the oldest age group were more likely to discontinue IVF treatment than younger women. Surprisingly, we found that the youngest women discontinued treatment in a similar fashion to women age 30-<40.
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Affiliation(s)
- Laura E Dodge
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Ave. KS 3, Boston, MA, 02215, USA.,Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA
| | - Denny Sakkas
- Boston IVF, 130 2nd Ave., Waltham, MA, 02451, USA
| | - Michele R Hacker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Ave. KS 3, Boston, MA, 02215, USA.,Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave., Boston, MA, 02115, USA
| | | | - Alice D Domar
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Ave. KS 3, Boston, MA, 02215, USA. .,Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA. .,Boston IVF, 130 2nd Ave., Waltham, MA, 02451, USA.
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Vo H, Cheng D, Cheng TL, Mistry KB. Health Behaviors Among Women Using Fertility Treatment. Matern Child Health J 2016; 20:2328-2335. [PMID: 27473090 DOI: 10.1007/s10995-016-2056-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective To describe associated perinatal behaviors among women using fertility treatment. Methods Data were obtained for 12,197 Maryland women who delivered live neonates from 2004 to 2011 and completed the Pregnancy Risk Assessment Monitoring System survey postpartum. We conducted weighted descriptive and multivariable analyses. Results Among 1368 women using fertility treatments, 28.4 % did not take folic acid daily 1 month before pregnancy, 58.1 % consumed alcohol, 16.0 % were binge drinking, and 7.5 % smoked 3 months before pregnancy, and 12.9 % consumed alcohol and 3.7 % smoked during pregnancy. Additionally, among those who consumed alcohol and smoked before pregnancy, 36.0 % and 25.7 %, respectively, reported not receiving prenatal counseling about alcohol use and smoking. Lack of counseling for these women was higher than for women with unintended pregnancies who consumed alcohol (36.0 % vs. 26.3 %, P < .001) or smoked (25.7 % vs. 15.0 %, P < .001). Women using fertility treatments were less likely to have inadequate folic acid intake [adjusted odds ratio (aOR) 0.14, 95 % confidence interval (CI) 0.10-0.18), consume alcohol (aOR 0.52, 95 % CI 0.40-0.69), and smoke (aOR 0.35, 95 % CI 0.21-0.59) before pregnancy, and no statistically significant differences were found during pregnancy for alcohol consumption (aOR 0.89, 95 % CI 0.59-1.33) or smoking (aOR 0.64, 95 % CI 0.28-1.45) compared to women with unintended pregnancies. Conclusion A significant proportion of women using fertility treatments were not practicing recommended perinatal behaviors or receiving prenatal counseling on preventable risk factors. Ongoing counseling before and during pregnancy may be especially effective for optimizing healthy behaviors among these motivated women undergoing often stressful treatments for fertility.
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Affiliation(s)
- Holly Vo
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. .,University of California, San Diego School of Medicine, 9500 Gilman Drive MC 0606, La Jolla, CA, 92093, USA.
| | - Diana Cheng
- Maternal and Child Health Bureau, Maryland Department of Health and Mental Hygiene, 201 W. Preston Street, Room 313, Baltimore, MD, 21201, USA
| | - Tina L Cheng
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Pediatrics, Johns Hopkins University School of Medicine, 1800 Orleans Street #8941, Baltimore, MD, 21287, USA
| | - Kamila B Mistry
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Agency for Healthcare Research and Quality, Office of Extramural Research, Education and Priority Populations, 5600 Fishers Lane, Room 06N03, Rockville, MD, 20857, USA
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Schaller MA, Griesinger G, Banz-Jansen C. Women show a higher level of anxiety during IVF treatment than men and hold different concerns: a cohort study. Arch Gynecol Obstet 2016; 293:1137-45. [PMID: 26884350 DOI: 10.1007/s00404-016-4033-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 01/29/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of the present study was to determine levels of anxiety during the course of IVF treatment and gender differences in treatment anxiety. METHODS This was a prospective cohort study set in a university affiliated, tertiary care IVF program. 119 women and 82 men entering the clinic to undergo IVF treatment filled out questionnaires containing the Spielberger state-trait-anxiety-inventory (STAI) as well as further items on specific stress triggers. RESULTS Women and men undergoing IVF have higher levels of anxiety than the average population in Germany. Overall, female patients show significantly higher values (mean ± SD) for state and trait anxiety (47.4 ± 11.0 and 40.1 ± 9.85) than their male partners (41.4 ± 9.66 and 35.3 ± 8.57, p < 0.01). Over the course of several IVF cycles, average STAI scores increased for both genders. When asked about specific stress factors on a 4-point scale from 'not at all' to 'very much so', women report as their main anxiety the failure to achieve a successful pregnancy, scoring significantly higher on questions like 'obtaining a negative pregnancy test' (3.24 ± 0.82, p < 0.01) and 'disclosure of infertility' (3.02 ± 1.10, p < 0.001). Their male partners are more concerned about the health risks the women have to take such as 'side effects of ovarian stimulation' (2.55 ± 0.77, p = 0.002) and 'bleeding or infection after the oocyte aspiration' (2.58 ± 0.84, p = 0.007). Both genders indicated to be very little worried about multiple pregnancies after IVF. CONCLUSIONS Women show a higher level of anxiety during IVF treatment and hold different concerns. Neither of the sexes appears to be familiar with the risks associated with multiple pregnancies, a matter that should better be addressed.
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Affiliation(s)
- Martin Alexander Schaller
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany.
| | - Georg Griesinger
- Department of Reproductive Medicine and Gynecological Endocrinology, University Hospital of Schleswig-Holstein, 23538, Luebeck, Germany
| | - Constanze Banz-Jansen
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany
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Estimating cumulative live-birth rates after IVF treatment with Kaplan–Meier and competing risk methods. Eur J Obstet Gynecol Reprod Biol 2015; 192:41-6. [DOI: 10.1016/j.ejogrb.2015.06.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 06/06/2015] [Accepted: 06/12/2015] [Indexed: 11/17/2022]
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Mamata D, Ray SK, Pratap K, Firuza P, Birla AR, Manish B. Impact of different controlled ovarian stimulation protocols on the physical and psychological burdens in women undergoing in vitro fertilization/intra cytoplasmic sperm injection. J Hum Reprod Sci 2015; 8:86-92. [PMID: 26157299 PMCID: PMC4477455 DOI: 10.4103/0974-1208.158615] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 03/18/2015] [Accepted: 04/16/2015] [Indexed: 11/04/2022] Open
Abstract
CONTEXT: Infertility treatment involves a considerable amount of physical and psychological burden which may impact the outcome. AIM: The objective was to understand the amount of physical and psychological burden in women undergoing their first in vitro fertilization (IVF)/intra cytoplasmic sperm injection (ICSI) cycles. SETTING AND DESIGN: Multi-center, prospective, parallel, observational study. MATERIALS AND METHODS: The study was conducted across 12 IVF centers in India. A total of 692 women undergoing controlled ovarian stimulation as a part of the first cycle IVF/ICSI completed the trial. Women were recruited in 2 groups based on type of treatment (Group A - gonadotropin-releasing hormone [GnRH] antagonist; Group B - GnRH agonist) and were asked to fill questionnaires during the 2 treatment visits. RESULTS: The mean changes between Visit 1 (baseline) and Visit 2 in anxiety and depression (Hospital Anxiety and Depression Scale) scores in Group A for anxiety and depression were −0.5 (3.67), −0.1 (3.57) respectively and for Group B were −0.4 (3.68), 0.1 (3.67) respectively, which was not statistically significant. In Group A, the mean (±standard deviation [SD]) Hopkins Symptom Check List (HSCL) score was 17.9 (±5.17) in visit 1 and 19.1 (±5.45) Visit 2. The change between visits was 1.1 (P < 0.0001) with higher score reflecting higher somatic distress symptoms. In Group B, the mean (±SD) HSCL score was 18.2 (±5.19) in Visit 1 and 18.8 (±5.23) in visit 2. The change between visits was 0.6 (P < 0.0014). The difference of the mean change in physical burden between Group A and Group B was not statistically significant. CONCLUSION: A significant impact in both treatment protocols with respect to the physical burden was found between Visit 1 and Visit 2 but no difference in physical or psychological burden between the two treatment groups was observed.
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Affiliation(s)
- Deenadayal Mamata
- Medical Director, Infertility Institute and Research Center, Hyderabad, Telangana, India
| | - Subrat K Ray
- Associate Director, Organon India Pvt. Ltd., Mumbai, Maharashtra, India
| | - Kumar Pratap
- Department of Obstetrics and Gynaecology, Kasturba Medical College, Manipal, Karnataka, India
| | - Parikh Firuza
- Director, Reproduction and Genetics at Jaslok Hospital, Mumbai, Maharashtra, India
| | | | - Banker Manish
- Executive Director, Nova IVI Fertility Specialty, Ahmedabad, Gujarat, India
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Role of the mental health professional in education and support of the medical staff. Fertil Steril 2015; 104:271-6. [PMID: 26056926 DOI: 10.1016/j.fertnstert.2015.05.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 05/18/2015] [Accepted: 05/19/2015] [Indexed: 11/23/2022]
Abstract
This review argues that mental health professionals are underutilized in the reproductive health care system. Counselors in the field of reproductive medicine could broaden their care from a strictly one-on-one patient care perspective to a more integrated and collaborative approach that also involves education, training, and support of the fertility clinic staff. The literature has shed light on reasons for patient discontinuation, but little is known about staff burnout in reproductive health care, and even less has been done to address work-related stress, job dissatisfaction, and poor emotional and physical health among fertility clinic staff. Specific educational strategies and training techniques are addressed to help reduce staff stress, prevent burnout, and improve overall patient care.
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