1
|
Salazar Mederos AM, Gutiérrez Hernández PR, Ortega González Y, Hess Medler S. Depressive ranges in infertile couples with male factor. Rev Int Androl 2023; 21:100324. [PMID: 36273995 DOI: 10.1016/j.androl.2021.02.011] [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: 09/07/2020] [Revised: 12/30/2020] [Accepted: 02/14/2021] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Depression is not uncommon among infertile couples. The objective of the study is to analyze factors that predict depression in these couples, when they are in Assisted Reproduction Techniques programs. MATERIALS AND METHOD We analyze the level of depression in couples referred from the Human Reproduction Unit to study the male factor using the Beck Depression Inventory and the clinical information contained in the SARAplus program. RESULTS Depressive ranges appear in approximately half of the participants. The degree of depression correlates in a statistically significant way between both members of the couple. Among the analyzed clinical factors, we observed relational tendency between depression and obesity and depression and smoking. CONCLUSIONS Depression in infertile couples is a fact. ART specialists should be on the lookout for symptoms of depression in order to provide patients psychological and psychiatric care and treatments, as part of the overall therapeutic framework for infertility.
Collapse
Affiliation(s)
| | - Pedro Ramón Gutiérrez Hernández
- Facultad de Ciencias de la Salud, Universidad de La Laguna, La Laguna, Santa Cruz de Tenerife, Spain; Servicio de Urología, Complejo Hospitalario Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain.
| | - Yanira Ortega González
- Facultad de Ciencias de la Salud, Universidad de La Laguna, La Laguna, Santa Cruz de Tenerife, Spain; Servicio de Urología, Complejo Hospitalario Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
| | - Stephany Hess Medler
- Facultad de Psicología y Logopedia, Universidad de La Laguna, La Laguna, Santa Cruz de Tenerife, Spain
| |
Collapse
|
2
|
Cheng L, Meiser B, Kennedy D, Kirk E, Barlow-Stewart K, Kaur R. Exploration of decision-making regarding the transfer of mosaic embryos following preimplantation genetic testing: a qualitative study. Hum Reprod Open 2022; 2022:hoac035. [PMID: 36157005 PMCID: PMC9492260 DOI: 10.1093/hropen/hoac035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 08/10/2022] [Indexed: 11/24/2022] Open
Abstract
STUDY QUESTION What are patients’ reasoning and decisional needs in relation to the transfer of mosaic embryos following preimplantation genetic testing (PGT)? SUMMARY ANSWER This study identified four themes, which were patients’ reasoning behind decision-making, their decisional needs, the influence of the mosaic embryos on the decision-making and the role of health professionals. WHAT IS KNOWN ALREADY To date, no study has investigated the reasoning of patients behind their decision-making and the influence of mosaic embryos. STUDY DESIGN, SIZE, DURATION This is a cross-sectional study using a qualitative approach. Twenty participants were interviewed, and recruitment was ceased when no new information was identified in the data analysis. It ensured a sufficient sample size for a qualitative study. PARTICIPANTS/MATERIALS, SETTING, METHODS Participants were females with mosaic embryos. Semi-structured in-depth interviews were conducted via telephone. MAIN RESULTS AND THE ROLE OF CHANCE Four themes were identified: reasoning behind decision-making, decisional needs, influence of mosaic embryos on decision-making and the role of health professionals. Potential risks of transferring mosaic embryos and prioritization of euploid embryos were the main reasons for not transferring mosaic embryos. A lack of alternatives, perceived benefits and risk tolerance were main reasons for transferring mosaic embryos. Patients reported that information on mosaic embryos, amniocentesis and termination was important to support their decision-making. Unmet needs relating to healthcare services and social support were reported. In addition, having mosaic embryos affected the patients’ emotional and behavioural responses, discussions about prenatal testing, attitudes to termination and further IVF cycles and attitudes towards PGT. Health professionals were found to influence the patients’ decision-making. LIMITATIONS, REASONS FOR CAUTION Participants were recruited through one clinic, which may limit the transferability of results. Also, patients’ experiences in relation to financial aspects of PGT may not be relevant to other jurisdictions due to different healthcare policies. WIDER IMPLICATIONS OF THE FINDINGS The results may inform how clinicians provide healthcare services based on factors influencing patients’ decision-making. Health professionals should be aware of the influence their attitudes can have on patients’ decision-making and should present information accordingly. Also, providing all relevant information may help to facilitate informed decision-making. Provision of psychological support from professionals and support groups is also critical during the process of testing and transfer. Patients have educational needs regarding mosaic embryos, and educational resources including decision aids in plain language are needed. STUDY FUNDING/COMPETING INTEREST(S) B.M. was funded through a Senior Research Fellowship Level B (ID 1078523) from the National Health and Medical Research Council of Australia. L.C. was supported by a University International Postgraduate Award under the Australian Government Research Training Program (RTP) scholarship. No other funding was received for this study. The authors report no competing interests. TRIAL REGISTRATION NUMBER N/A.
Collapse
Affiliation(s)
- Lin Cheng
- University of New South Wales Prince of Wales Clinical School, , NSW, Australia. Level 4, Lowy Cancer Research Centre, UNSW Sydney, Randwick 2052, NSW, Australia
| | - Bettina Meiser
- University of New South Wales Prince of Wales Clinical School, , NSW, Australia. Level 4, Lowy Cancer Research Centre, UNSW Sydney, Randwick 2052, NSW, Australia
| | - Debra Kennedy
- Royal Hospital for Women; IVFAustralia, NSW , Australia. MotherSafe, Royal Hospital for Women, Barker St, Randwick 2052, NSW, Australia
- Royal Hospital for Women; IVFAustralia, NSW , Australia. IVFAustralia, Level1/33 York St, Sydney, NSW 2000, Australia
| | - Edwin Kirk
- University of New South Wales Sydney Children's Hospital; School of Women's and Children's Health, , NSW, Australia. Centre for Clinical Genetics, Bright Alliance Building, High Street, Randwick 2031, NSW, Australia
| | - Kristine Barlow-Stewart
- The University of Sydney Northern Clinical School, Faculty of Medicine and Health, , NSW, Australia. Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Rajneesh Kaur
- The University of Sydney Faculty of Medicine and Health Administration, , NSW, Australia. Faculty of Medicine and Health Administration, Sydney Medical School's Education Office, The University of Sydney, NSW, Australia
| |
Collapse
|
3
|
Decision-making and experiences of preimplantation genetic diagnosis in inherited heart diseases: a qualitative study. Eur J Hum Genet 2022; 30:187-193. [PMID: 34545210 PMCID: PMC8821668 DOI: 10.1038/s41431-021-00963-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 07/15/2021] [Accepted: 09/07/2021] [Indexed: 02/03/2023] Open
Abstract
Preimplantation genetic diagnosis (PGD) ensures a disease-causing variant is not passed to the next generation, including for inherited heart diseases. PGD is known to cause significant emotional burden, but little is known about how parents experience PGD to select against inherited heart disease. We aim to understand how people with inherited heart disease, and their partners, experience and make decisions about PGD. Participants were recruited from a specialised inherited heart disease clinic. Qualitative semi-structured interviews were conducted with adult participants who had considered PGD. A semi-structured interview schedule explored overall experiences and reasons for undergoing PGD. Broad topics included experience of disease, reproductive history, psychosocial and financial considerations. Interviews were recorded, transcribed verbatim and thematically analysed using a framework method. Twenty participants were included (15 with inherited cardiomyopathy, 3 with inherited arrhythmia syndrome and 2 partners). In contemplating PGD, participants considered 3 main issues: past experience of disease e.g. sudden cardiac death, sport restrictions and clinical heterogeneity; intergenerational responsibilities; and practical considerations such as finances and maternal age. Among those who chose to undergo PGD (n = 7/18), past experience of a significant cardiac event, such as family history of sudden cardiac death, was important in the decision process. The decision to undergo PGD for inherited heart disease is complex and influenced by individual values and experience of disease. We highlight key areas where further discussion may assist in PGD decision processes.
Collapse
|
4
|
Forbes Shepherd R, Werner-Lin A, Keogh LA, Delatycki MB, Forrest LE. Reproduction and Genetic Responsibility: An Interpretive Description of Reproductive Decision-Making for Young People With Li-Fraumeni Syndrome. QUALITATIVE HEALTH RESEARCH 2022; 32:168-181. [PMID: 34781775 DOI: 10.1177/10497323211046240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The reproductive decision-making of young people (aged 15-39 years) with Li-Fraumeni syndrome (LFS), an early onset inherited cancer syndrome, has not been studied in depth. Using interpretive description methodology, we conducted semi-structured interviews with 30 young Australians (mean age 25.5 years) diagnosed with LFS or at 50% genetic risk. With reflexive thematic analysis, we show how young people's reproductive decision-making and ideals for family formation were shaped by a sense of genetic responsibility to ensure the health of future biological kin. Reproductive technology provided choices for family formation in the context of LFS and also complicated reproductive decisions, as these choices were difficult to understand, make, or carry out. We uphold that reproductive decision-making when living with LFS is a profoundly moral practice that may pose significant challenges for young people navigating their formative years. We offer genetic counseling practice recommendations to support individuals with LFS when making reproductive decisions.
Collapse
Affiliation(s)
- Rowan Forbes Shepherd
- Parkville Familial Cancer Centre, 3085Peter MacCallum Cancer Centre, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, 2281The University of Melbourne, Melbourne, VIC, Australia
- Bruce Lefroy Centre for Genetic Health Research, 34361Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Allison Werner-Lin
- School of Social Policy and Practice, 6572The University of Pennsylvania, Philadelphia, PA, USA
| | - Louise A Keogh
- Melbourne School of Population and Global Health, 2281The University of Melbourne, Melbourne, VIC, Australia
| | - Martin B Delatycki
- Bruce Lefroy Centre for Genetic Health Research, 34361Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, 2281The University of Melbourne, Melbourne, VIC, Australia
- Victorian Clinical Genetics Service, Parkville, VIC, Australia
| | - Laura E Forrest
- Parkville Familial Cancer Centre, 3085Peter MacCallum Cancer Centre, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, 2281The University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
5
|
Hughes T, Bracewell-Milnes T, Saso S, Jones BP, Almeida PA, Maclaren K, Norman-Taylor J, Johnson M, Nikolaou D. A review on the motivations, decision-making factors, attitudes and experiences of couples using pre-implantation genetic testing for inherited conditions. Hum Reprod Update 2021; 27:944-966. [PMID: 33969393 DOI: 10.1093/humupd/dmab013] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/13/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In pre-implantation genetic testing (PGT), fertile couples undergo IVF with genetic testing of embryos to avoid conceptions with a genetic condition. There is an exponentially increasing uptake with over 600 applications listed by the Human Fertilisation and Embryology Authority in the UK. The psychological aspects of the decision-making process and the experience of PGT, however, are relatively underevaluated, with the potential to leave patients unsupported in their journeys. OBJECTIVE AND RATIONALE In this review, we aim to comprehensively report on every aspect of couples' experiences of PGT. We consider what motivates users, the practical and ethical decisions involved and how couples navigate the decision-making process. Additionally, we report on the social and psychological impact on couples who are actively undergoing or have completed the PGT process. SEARCH METHODS A systematic search of English peer-reviewed journals of three computerized databases was undertaken following PRISMA guidelines. Studies that examined the motivations, attitudes, decision-making factors and experiences of patients who have been actively engaged in the PGT process were included. No restrictions were placed on study design or date of publication. Studies examining patients using PGT in a hypothetical context or solely using PGT for aneuploidy were excluded. Qualitative data were extracted using thematic analysis. OUTCOMES The main outcomes were patient motivations, deciding factors and attitudes, as well as the patient experience of coming to a decision and going through PGT.Patients were primarily motivated by the desire to have a healthy child and to avoid termination of pregnancy. Those with a sick child or previous experience of termination were more likely to use PGT. Patients also felt compelled to make use of the technology available, either from a moral responsibility to do so or to avoid feelings of guilt if not. The main factors considered when deciding to use PGT were the need for IVF and the acceptability of the technology, the financial cost of the procedure and one's ethical standpoint on the creation and manipulation of embryos. There was a general consensus that PGT should be applied to lethal or severe childhood disease but less agreement on use for adult onset or variable expression conditions. There was an agreement that it should not be used to select for aesthetic traits and a frustration with the views of PGT in society. We report that couples find it difficult to consider all of the benefits and costs of PGT, resulting in ambivalence and prolonged indecision. After deciding on PGT use, we found that patients find the process extremely impractical and psychologically demanding. WIDER IMPLICATIONS This review aimed to summarize the current knowledge on how patients decide to use and experience PGT and to make suggestions to incorporate the findings into clinical practice. We cannot stress enough the importance of holistic evaluation of patients and thorough counselling prior to and during PGT use from a multidisciplinary team that includes geneticists, IVF clinicians, psychologists and also patient support groups. Large prospective studies using a validated psychological tool at various stages of the PGT process would provide an invaluable database for professionals to better aid patients in their decision-making and to improve the patient experience.
Collapse
Affiliation(s)
- Tara Hughes
- Division of Surgery and Cancer, Institute of Developmental Reproductive & Developmental Biology, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK
| | - Timothy Bracewell-Milnes
- Division of Surgery and Cancer, Institute of Developmental Reproductive & Developmental Biology, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK
| | - Srdjan Saso
- Division of Surgery and Cancer, Institute of Reproductive & Developmental Biology, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - Benjamin P Jones
- Division of Surgery and Cancer, Institute of Reproductive & Developmental Biology, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - Paula A Almeida
- Division of Surgery and Cancer, Institute of Developmental Reproductive & Developmental Biology, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK
| | - Katherine Maclaren
- Division of Surgery and Cancer, Institute of Developmental Reproductive & Developmental Biology, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK
| | - Julian Norman-Taylor
- Division of Surgery and Cancer, Institute of Developmental Reproductive & Developmental Biology, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK
| | - Mark Johnson
- Division of Surgery and Cancer, Institute of Developmental Reproductive & Developmental Biology, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK
| | - Dimitrios Nikolaou
- Division of Surgery and Cancer, Institute of Developmental Reproductive & Developmental Biology, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK
| |
Collapse
|
6
|
Brugallé E, Antoine P, Geerts L, Bellengier L, Manouvrier-Hanu S, Fantini-Hauwel C. Growing up with a rare genetic disease: an interpretative phenomenological analysis of living with Holt-Oram syndrome. Disabil Rehabil 2019; 43:2304-2311. [PMID: 31786957 DOI: 10.1080/09638288.2019.1697763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Holt-Oram syndrome (HOS) is a rare genetic disease characterized by variable radial upper limb and cardiac defects. The aim of this research was to shed light on people's subjective perceptions of their diseases, how these perceptions provide meaning, and the consequences the syndrome can have in daily life and across all life stages. METHODS Semistructured interviews with ten participants diagnosed with HOS were conducted in France and analyzed using interpretative phenomenological analysis. RESULTS Participants' experiences fall under two main themes, namely, "stages of self-construction as different" and "when I am no longer the only one involved", each of which has three subthemes. From childhood onwards, symptoms monopolize the physical and psychological spheres. The feeling of being different is unavoidable until the patient can appropriate his or her condition, and by the end of adolescence, the patient generally feels that he or she has adapted to the syndrome. In adulthood, other concerns arise, such as the fear of rejection, the need to better understand the genetic issues of the condition and the desire for offspring to not experience the same life difficulties. CONCLUSION The findings underscore the specific psychological issues associated with the syndrome at different life stages and the need for holistic genetic treatment with dedicated reference centers to improve care and further address these issues.IMPLICATIONS FOR REHABILITATIONHolt-Oram syndrome is a genetic disease characterized by abnormalities of the upper limbs and shoulder girdle and associated with a congenital heart defect.Specific issues arise at different stages of life: the physical consequences of the syndrome arise during childhood, the self-construction of pervasive difference during adolescence, the fear of being rejected as a young adult, and concerns about future parenthood and the transmission of the syndrome and the desire that one's child not be confronted with the same difficulties in adulthood.The complexity and entanglement of medical and existential issues related to HOS requires the development of multidisciplinary consultations that promote holistic care.The rarity of the syndrome and the lack of knowledge about HOS among health professionals and the general public make it necessary both to establish reference centers and to create patient associations to support patients.
Collapse
Affiliation(s)
- Elodie Brugallé
- UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, CNRS, University of Lille, Villeneuve d'Ascq, France
| | - Pascal Antoine
- UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, CNRS, University of Lille, Villeneuve d'Ascq, France
| | - Laura Geerts
- Center of Clinical Psychology, Psychopathology and Psychosomatic Research, Université Libre de Bruxelles, Bruxelles, Belgique
| | - Laurence Bellengier
- EA 7364 - RADEME - Maladies RAres du Développement et du Métabolisme: du phénotype au génotype et à la Fonction, University of Lille, Lille, France
| | - Sylvie Manouvrier-Hanu
- EA 7364 - RADEME - Maladies RAres du Développement et du Métabolisme: du phénotype au génotype et à la Fonction, University of Lille, Lille, France.,Clinique de Génétique médicale Guy Fontaine et Centre de référence maladies rares pour les anomalies du développement Nord-Ouest, CHU de Lille, Lille, France
| | - Carole Fantini-Hauwel
- Center of Clinical Psychology, Psychopathology and Psychosomatic Research, Université Libre de Bruxelles, Bruxelles, Belgique
| |
Collapse
|
7
|
The Trauma of Birth or Parenting a Child: Effect on Parents' Negative Emotion in China. Arch Psychiatr Nurs 2017; 31:211-216. [PMID: 28359435 DOI: 10.1016/j.apnu.2016.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 10/12/2016] [Accepted: 10/15/2016] [Indexed: 11/23/2022]
Abstract
The present study assessed negative emotions associated with the traumas of infertility and child rearing (child's disability or death) and the correlates of duration of trauma. The widely used Chinese Mental Health Scale was used to assess negative emotions in 294 individuals who experienced the aforementioned traumas and 124 who did not (control group). Results showed that individuals with infertility exhibited greater anxiety, depression, and solitude than the control group; bereaved parents and had greater solitude and fear than control group; and parents of children with disabilities had greater solitude than the control group. Parents who experienced the death of a child had more fear and physiological maladjustment than parents of a child with disabilities. In addition, individuals without parenting experience had higher scores on solitude, fear, and physiological disease than those with parenting experience. After controlling for demographic variables, the duration of trauma significantly negatively predicted depression in the infertile group and for bereaved parents. The results suggest that in order to prevent psychological and physiological health problems among infertile couples, parents of a disabled child, and parents who experience the death of child, family and community-based strategies should be developed and implemented.
Collapse
|
8
|
Experiences of Pre-Implantation Genetic Diagnosis (PGD) in Sweden: a Three-Year Follow-Up of Men and Women. J Genet Couns 2017; 26:1008-1016. [PMID: 28191608 PMCID: PMC5582074 DOI: 10.1007/s10897-017-0078-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 01/30/2017] [Indexed: 11/03/2022]
Abstract
Men and women with a hereditary genetic disease are faced with different options when they wish to become parents. One is pre-implantation genetic diagnosis (PGD) which is a combination of in vitro fertilization (IVF) and genetic analysis of the embryo before implantation. The present study focused on men and women's psychological experiences of PGD three years after applying for PGD. Nineteen women and seventeen men (i.e. seventeen couples and two women) participated. The interviews were analysed by thematic method. It is better to have tried was identified as a master theme, under which came three underlying sub-themes, which had the following headings: Practical experience of PGD, Psychological experience of PGD and Goals of PGD. The results show that men and women three years after PGD are still psychologically affected by their experience. The men and women raised concerns that their relationship had been affected, both positively and negatively, and feelings of anxiety and depression still remained. Healthcare services should recognize the heterogeneous nature of the group being studied and therefore the need for counselling can arise at different times and in relation to different areas, regardless of the outcome of the PGD.
Collapse
|
9
|
Haude K, McCarthy Veach P, LeRoy B, Zierhut H. Factors Influencing the Decision-Making Process and Long-Term Interpersonal Outcomes for Parents Who Undergo Preimplantation Genetic Diagnosis for Fanconi Anemia: a Qualitative Investigation. J Genet Couns 2016; 26:640-655. [PMID: 27858211 DOI: 10.1007/s10897-016-0032-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 10/05/2016] [Indexed: 01/20/2023]
Abstract
Fanconi anemia (FA) is characterized by congenital malformations, progressive bone marrow failure, and predisposition to malignancy. Hematopoietic stem cell transplantation is used to treat FA, and best results are attained with sibling donors who are human leukocyte antigen (HLA) identical matches. Preimplantation genetic diagnosis (PGD) offers parents of an affected child the opportunity to have an unaffected child who is an HLA match. While some research has investigated parents' experiences during the PGD process, no published studies specifically address factors influencing their decision-making process and long-term interpersonal outcomes. The aims of this study are to: (1) examine parents' expectations and the influence of media, bioethics, and religion on their decision to undergo PGD; (2) examine parents' social support and emotional experiences during their PGD process; and (3) characterize long-term effects of PGD on relationship dynamics (partner, family, friends), others' attitudes, and parental regret. Nine parents participated in semi-structured interviews. Thematic analysis revealed their decision to use PGD was variously influenced by media, bioethics, and religion, in particular, affecting parents' initial confidence levels. Moreover, the PGD process was emotionally complex, with parents desiring varying amounts and types of support from different sources at different times. Parents reported others' attitudes towards them were similar or no different than before PGD. Parental regret regarding PGD was negligible. Results of this study will promote optimization of long-term care for FA families.
Collapse
Affiliation(s)
- K Haude
- GeneDx, Gaithersburg, MD, USA
| | - P McCarthy Veach
- Department of Genetics, Cell Biology, and Development, University of Minnesota - Twin Cities, 321 Church Street SE, Jackson Hall, Minneapolis, MN, 55455, USA
| | - B LeRoy
- Department of Genetics, Cell Biology, and Development, University of Minnesota - Twin Cities, 321 Church Street SE, Jackson Hall, Minneapolis, MN, 55455, USA
| | - H Zierhut
- Department of Genetics, Cell Biology, and Development, University of Minnesota - Twin Cities, 321 Church Street SE, Jackson Hall, Minneapolis, MN, 55455, USA.
| |
Collapse
|
10
|
Goldman KN, Nazem T, Berkeley A, Palter S, Grifo JA. Preimplantation Genetic Diagnosis (PGD) for Monogenic Disorders: the Value of Concurrent Aneuploidy Screening. J Genet Couns 2016; 25:1327-1337. [DOI: 10.1007/s10897-016-9975-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 05/16/2016] [Indexed: 01/16/2023]
|
11
|
Omani Samani R, Maroufizadeh S, Ezabadi Z, Alizadeh L, Vesali S. Psychometric Properties of The Persian Version of The Prenatal Attachment Inventory in Pregnant Iranian Women. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2016; 10:184-9. [PMID: 27441051 PMCID: PMC4948070 DOI: 10.22074/ijfs.2016.4908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Accepted: 08/03/2015] [Indexed: 11/06/2022]
Abstract
Background In 1993, Muller developed the Prenatal Attachment Inventory (PAI) which
has been used widely in many studies and translated into several languages. The current
study aimed to translate the PAI into Persian, assess the underlying structure of the PAI,
and the appropriateness of the one-factor solution proposed by Muller. Materials and Methods In this cross-sectional study, we recruited a total of 322 primi-
gravidae in their 27th to 34th gestational weeks that referred to private and governmental
prenatal clinics in Tehran, Iran. All participants completed the Persian versions of the PAI
and a demographic questionnaire. Participants were re-tested 2 weeks after the initial test-
ing. The following psychometric properties of the PAI were investigated: construct validity
by confirmatory factor analysis (CFA), internal consistency reliability with Cronbach’s
alpha, and test-retest reliability according to the intraclass correlation coefficient (ICC). Results The CFA results indicated that a single-factor model provided good fit to the
data, which confirmed the original model by its developer. The Cronbach’s alpha coef-
ficient for PAI was 0.856 and the test-retest reliability with ICC was 0.784. Consider-
ing the duration between marriage and pregnancy, women with low duration scored
significantly higher than women with high duration on PAI (P=0.043). Conclusion The Persian version of the PAI showed that one factor structure was ad-
equate and could be used for measuring psychological affectionate attachment between
Iranian mothers and their fetuses.
Collapse
Affiliation(s)
- Reza Omani Samani
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Saman Maroufizadeh
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Zahra Ezabadi
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Leila Alizadeh
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Samira Vesali
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| |
Collapse
|
12
|
Järvholm S, Broberg M, Thurin-Kjellberg A. Risk factors for depression and anxiety among men and women planning for pre-implantation genetic diagnosis. J Reprod Infant Psychol 2016. [DOI: 10.1080/02646838.2015.1137892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
13
|
Gameiro S, Boivin J, Dancet E, de Klerk C, Emery M, Lewis-Jones C, Thorn P, Van den Broeck U, Venetis C, Verhaak CM, Wischmann T, Vermeulen N. ESHRE guideline: routine psychosocial care in infertility and medically assisted reproduction-a guide for fertility staff. Hum Reprod 2015; 30:2476-85. [PMID: 26345684 DOI: 10.1093/humrep/dev177] [Citation(s) in RCA: 159] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 06/11/2015] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Based on the best available evidence in the literature, what is the optimal management of routine psychosocial care at infertility and medically assisted reproduction (MAR) clinics? SUMMARY ANSWER Using the structured methodology of the Manual for the European Society of Human Reproduction and Embryology (ESHRE) Guideline Development, 120 recommendations were formulated that answered the 12 key questions on optimal management of routine psychosocial care by all fertility staff. WHAT IS ALREADY KNOWN The 2002 ESHRE Guidelines for counselling in infertility has been a reference point for best psychosocial care in infertility for years, but this guideline needed updating and did not focus on routine psychosocial care that can be delivered by all fertility staff. STUDY, DESIGN, SIZE, DURATION This guideline was produced by a group of experts in the field according to the 12-step process described in the ESHRE Manual for Guideline Development. After scoping the guideline and listing a set of 12 key questions in PICO (Patient, Intervention, Comparison and Outcome) format, thorough systematic searches of the literature were conducted; evidence from papers published until April 2014 was collected, evaluated for quality and analysed. A summary of evidence was written in a reply to each of the key questions and used as the basis for recommendations, which were defined by consensus within the guideline development group (GDG). Patient and additional clinical input was collected during the scoping and the review phase of the guideline development. PARTICIPANTS/MATERIALS, SETTING, METHODS The guideline group, comprising psychologists, two medical doctors, a midwife, a patient representative and a methodological expert, met three times to discuss evidence and reach consensus on the recommendations. MAIN RESULTS AND THE ROLE OF CHANCE THE GUIDELINE PROVIDES 120 recommendations that aim at guiding fertility clinic staff in providing optimal evidence-based routine psychosocial care to patients dealing with infertility and MAR. The guideline is written in two sections. The first section describes patients' preferences regarding the psychosocial care they would like to receive at clinics and how this care is associated with their well-being. The second section of the guideline provides information about the psychosocial needs patients experience across their treatment pathway (before, during and after treatment) and how fertility clinic staff can detect and address these. Needs refer to conditions assumed necessary for patients to have a healthy experience of the fertility treatment. Needs can be behavioural (lifestyle, exercise, nutrition and compliance), relational (relationship with partner if there is one, family friends and larger network, and work), emotional (well-being, e.g. anxiety, depression and quality of life) and cognitive (treatment concerns and knowledge). LIMITATIONS, REASONS FOR CAUTION We identified many areas in care for which robust evidence was lacking. Gaps in evidence were addressed by formulating good practice points, based on the expert opinion of the GDG, but it is critical for such recommendations to be empirically validated. WIDER IMPLICATIONS OF THE FINDINGS The evidence presented in this guideline shows that providing routine psychosocial care is associated with or has potential to reduce stress and concerns about medical procedures and improve lifestyle outcomes, fertility-related knowledge, patient well-being and compliance with treatment. As only 45 (36.0%) of the 125 recommendations were based on high-quality evidence, the guideline group formulated recommendations to guide future research with the aim of increasing the body of evidence.
Collapse
Affiliation(s)
- S Gameiro
- Cardiff Fertility Studies Research Group, School of Psychology, Cardiff University, CF10 3AT Cardiff, UK
| | - J Boivin
- Cardiff Fertility Studies Research Group, School of Psychology, Cardiff University, CF10 3AT Cardiff, UK
| | - E Dancet
- Leuven University Fertility Centre, University Hospitals Leuven, 3000 Leuven, Belgium Center for Reproductive Medicine, Women's and Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam 1105 AZ, The Netherlands
| | - C de Klerk
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus MC University Medical Centre, Rotterdam 3000 CA, The Netherlands
| | - M Emery
- Centre for Medically Assisted Procreation-CPMA, CH-1003 Lausanne, Switzerland
| | | | - P Thorn
- Practice for Couple and Family Therapy, 64546 Moerfelden, Germany
| | - U Van den Broeck
- Leuven University Fertility Centre, University Hospitals Leuven, 3000 Leuven, Belgium
| | - C Venetis
- Women's and Children's Health, St George Hospital, University of New South Wales, NSW 2217 Sydney, Australia
| | - C M Verhaak
- Department of Psychology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - T Wischmann
- Institute of Medical Psychology, Centre for Psychosocial Medicine, Heidelberg University Hospital, 69115 Heidelberg, Germany
| | - N Vermeulen
- European Society for Human Reproduction and Embryology, 1852 Grimbergen, Belgium
| |
Collapse
|
14
|
Quinn GP, Knapp C, Sehovic I, Ung D, Bowman M, Gonzalez L, Vadaparampil ST. Knowledge and Educational Needs about Pre-Implantation Genetic Diagnosis (PGD) among Oncology Nurses. J Clin Med 2014; 3:632-45. [PMID: 26237394 PMCID: PMC4449683 DOI: 10.3390/jcm3020632] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 05/20/2014] [Accepted: 05/22/2014] [Indexed: 12/28/2022] Open
Abstract
Preimplantation genetic diagnosis (PGD), a form of assisted reproductive technology, is a new technology with limited awareness among health care professionals and hereditary cancer families. Nurses play a key role in the care of patients and are often in an ideal position to discuss and refer patients on sensitive quality of life issues, such as PGD. Two hundred and one nurses at Moffitt Cancer Center (MCC) responded to an online survey assessing knowledge and educational needs regarding PGD and families with hereditary cancer. The majority of respondents were female (n = 188), white (n = 175), had an RN/BSN degree (n = 83), and provided outpatient care at the cancer center (n = 102). More than half of respondents (78%) were unfamiliar with PGD prior to the survey and respondents who had heard of PGD had limited knowledge. More than half of the participants reported PGD was an acceptable option for families with hereditary cancer syndromes and thought individuals with a strong family or personal history should be provided with information about PGD. This study indicates that oncology nurses may benefit from and desire education about PGD. With advances in reproductive technology and options, further PGD education is needed among healthcare professionals. An examination of current oncology nursing curriculum and competencies regarding genetic education may identify need for future revisions and updates.
Collapse
Affiliation(s)
- Gwendolyn P Quinn
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, 12901 Bruce B Downs Blvd #11, Tampa, FL 33612, USA.
- Department of Health Outcomes & Behavior, H. Lee Moffitt Cancer Center and Research Institute, Moffitt Cancer Center, MRC CANCONT, 12902 Magnolia Drive, Tampa, FL 33612, USA.
| | - Caprice Knapp
- Department of Health Outcomes and Policy, University of Florida, 1329 SW 16th St., Gainesville, FL 32608, USA.
| | - Ivana Sehovic
- Department of Health Outcomes & Behavior, H. Lee Moffitt Cancer Center and Research Institute, Moffitt Cancer Center, MRC CANCONT, 12902 Magnolia Drive, Tampa, FL 33612, USA.
| | - Danielle Ung
- Department of Health Outcomes & Behavior, H. Lee Moffitt Cancer Center and Research Institute, Moffitt Cancer Center, MRC CANCONT, 12902 Magnolia Drive, Tampa, FL 33612, USA.
| | - Meghan Bowman
- Department of Health Outcomes & Behavior, H. Lee Moffitt Cancer Center and Research Institute, Moffitt Cancer Center, MRC CANCONT, 12902 Magnolia Drive, Tampa, FL 33612, USA.
| | - Luis Gonzalez
- Department of Health Outcomes & Behavior, H. Lee Moffitt Cancer Center and Research Institute, Moffitt Cancer Center, MRC CANCONT, 12902 Magnolia Drive, Tampa, FL 33612, USA.
| | - Susan T Vadaparampil
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, 12901 Bruce B Downs Blvd #11, Tampa, FL 33612, USA.
- Department of Health Outcomes & Behavior, H. Lee Moffitt Cancer Center and Research Institute, Moffitt Cancer Center, MRC CANCONT, 12902 Magnolia Drive, Tampa, FL 33612, USA.
| |
Collapse
|
15
|
Beukers F, Houtzager BA, Paap MCS, Middelburg KJ, Hadders-Algra M, Bos AF, Kok JH. Parental psychological distress and anxiety after a successful IVF/ICSI procedure with and without preimplantation genetic screening: follow-up of a randomised controlled trial. Early Hum Dev 2012; 88:725-30. [PMID: 22460061 DOI: 10.1016/j.earlhumdev.2012.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 03/01/2012] [Accepted: 03/04/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND Infertility treatment has an acknowledged psychological impact on women and their partners; however, information about the development of parental well-being after child birth is inconclusive. Preimplantation genetic screening (PGS) has been suggested to increase the efficacy of infertility treatments, but the effect it may have on parental well-being is unknown. AIM To evaluate parental distress and anxiety at one and two years after successful infertility treatment and to explore variables that might affect parental outcome, including PGS and child behaviour. STUDY DESIGN Follow-up of a randomised controlled trial (RCT) on the efficacy of PGS. SUBJECTS Parents (n=101) that successfully underwent IVF/ICSI with or without PGS. OUTCOME MEASURES At one and two years, parental distress and anxiety were assessed with the General Health Questionnaire 30 and State Trait Anxiety Inventory, respectively. At two years, child development and behaviour were assessed with the Dutch Bayley Scales of Infant Development-II and the Child Behaviour Checklist 1½-5, respectively. RESULTS PGS had no effect on parental distress or anxiety. Child behaviour problems were associated with parental distress and anxiety. There was a main effect of time on parental distress, with distress levels decreasing over time. CONCLUSIONS We found no objection to PGS related to parental psychological distress and anxiety. When parental psychological problems are present after infertility treatment, the results of this study could be useful to support counselling.
Collapse
Affiliation(s)
- F Beukers
- Department of Neonatology, Academic Medical Center Amsterdam, 1105 AZ Amsterdam, The Netherlands.
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Liu J, Sills ES, Yang Z, Salem SA, Rahil T, Collins GS, Liu X, Salem RD. Array comparative genomic hybridization screening in IVF significantly reduces number of embryos available for cryopreservation. Clin Exp Reprod Med 2012; 39:52-7. [PMID: 22816070 PMCID: PMC3398117 DOI: 10.5653/cerm.2012.39.2.52] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2012] [Revised: 05/09/2012] [Accepted: 05/14/2012] [Indexed: 01/12/2023] Open
Abstract
Objective During IVF, non-transferred embryos are usually selected for cryopreservation on the basis of morphological criteria. This investigation evaluated an application for array comparative genomic hybridization (aCGH) in assessment of surplus embryos prior to cryopreservation. Methods First-time IVF patients undergoing elective single embryo transfer and having at least one extra non-transferred embryo suitable for cryopreservation were offered enrollment in the study. Patients were randomized into two groups: Patients in group A (n=55) had embryos assessed first by morphology and then by aCGH, performed on cells obtained from trophectoderm biopsy on post-fertilization day 5. Only euploid embryos were designated for cryopreservation. Patients in group B (n=48) had embryos assessed by morphology alone, with only good morphology embryos considered suitable for cryopreservation. Results Among biopsied embryos in group A (n=425), euploidy was confirmed in 226 (53.1%). After fresh single embryo transfer, 64 (28.3%) surplus euploid embryos were cryopreserved for 51 patients (92.7%). In group B, 389 good morphology blastocysts were identified and a single top quality blastocyst was selected for fresh transfer. All group B patients (48/48) had at least one blastocyst remaining for cryopreservation. A total of 157 (40.4%) blastocysts were frozen in this group, a significantly larger proportion than was cryopreserved in group A (p=0.017, by chi-squared analysis). Conclusion While aCGH and subsequent frozen embryo transfer are currently used to screen embryos, this is the first investigation to quantify the impact of aCGH specifically on embryo cryopreservation. Incorporation of aCGH screening significantly reduced the total number of cryopreserved blastocysts compared to when suitability for freezing was determined by morphology only. IVF patients should be counseled that the benefits of aCGH screening will likely come at the cost of sharply limiting the number of surplus embryos available for cryopreservation.
Collapse
Affiliation(s)
- Jiaen Liu
- IVF Division, Beijing Jia En De Yun Hospital, Beijing, China
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Psychosocial aspects of preconception consultation in primary care: lessons from our experience in clinical genetics. J Community Genet 2012; 3:213-9. [PMID: 22585587 PMCID: PMC3419293 DOI: 10.1007/s12687-012-0095-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 04/04/2012] [Indexed: 11/28/2022] Open
Abstract
To date, little is known about the psychosocial aspects of preconception consultation (PCC) in primary care. PCC in primary care is appropriate for couples and individuals with a reproductive wish. In PCC, non-genetic and genetic risk factors may be identified. Focusing on non-genetic and genetic risk factors in PCC requires the use of different counselling strategies and tools in optimizing the outcome of pregnancy. Addressing lifestyle alterations requires directive counselling, whereas addressing increased genetic risk and its subsequent reproductive options requires non-directiveness. When an increased genetic risk is detected, couples should be informed about their possibilities for not passing on a disease allele. Depending upon the various modes of inheritance and reproductive options, couples may face a variety of psychosocial challenges. This paper aims to provide insights into the psychosocial impact of the genetic aspects of PCC by drawing upon literature and clinical experience in the Clinical Genetics department. Furthermore, this paper provides consideration for future developments regarding preconception genetic screening.
Collapse
|