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Truong LQ, Luong TB, Khanh HTT. Examining the association between coping strategies and perceived social support among Vietnamese infertile women undergoing IVF treatment. PSYCHOL HEALTH MED 2024:1-14. [PMID: 38697127 DOI: 10.1080/13548506.2024.2345273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 04/15/2024] [Indexed: 05/04/2024]
Abstract
The purpose of the study was to examine the association between coping strategies and perceived social support among women diagnosed with infertility and undergoing IVF treatment. A total of 383 Vietnamese women were invited to participate in this study. Participants completed a questionnaire consisting of The Multidimensional Scale of Perceived Social Support, the Copenhagen Multi-centre Psychosocial Infertility coping scales and the Fertility Problem Inventory, and other relevant questions. The results reveal that coping strategies significantly predict some specific types of perceived social supports among women undergoing IVF treatment. Specifically, passive-avoidance coping (PAC) and active-avoidance coping (AAC) predicts a decrease in receiving support from family and friends, whereas active-confronting coping (ACC) predicts an increase in receiving support from these two sources of support. Women who demonstrate increased meaning-based coping (MBC) received all three sources of support including family, friends, and significant others support. Despite some limitations, this study is useful in understanding how coping strategies among women undergoing IVF treatment affects the social support received in the Vietnamese social context. It also emphasizes the importance of psychological support for women facing IVF treatment distress.
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Affiliation(s)
- Lam Quang Truong
- Faculty of Psychology, Vietnam National University, University of Social Sciences and Humanities, Hanoi, Vietnam
| | - Thuy Bich Luong
- Faculty of Sociology, Vietnam National University, University of Social Sciences and Humanities, Hanoi, Vietnam
| | - Ha Truong Thi Khanh
- Faculty of Psychology, Vietnam National University, University of Social Sciences and Humanities, Hanoi, Vietnam
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Braun E. Mitochondrial replacement techniques for treating infertility. JOURNAL OF MEDICAL ETHICS 2024:jme-2023-109660. [PMID: 38383152 DOI: 10.1136/jme-2023-109660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/09/2024] [Indexed: 02/23/2024]
Abstract
Mitochondrial replacement techniques (MRTs) usually aim to prevent the genetic transmission of maternally inherited mitochondrial diseases. Until now, only the UK and Australia have implemented specific legal regulations of MRTs. In both countries, clinical trials on these techniques are only permissible for cases with a high risk of severe mitochondrial disease in the offspring. However, these techniques can also be applied to treat infertility, especially for older women with impaired oocyte quality. In some countries without legal regulation of these techniques, MRTs are already offered for this purpose. Yet, this application of MRTs has received insufficient attention in the bioethical literature so far.In this paper, I examine whether there are ethical reasons to prohibit trials on MRTs in the context of infertility when they are permitted for preventing mitochondrial disease. Allowing MRTs in one context but not the other might be justified either because their application in the context of mitochondrial disease (1) is supported by a more convincing evidence base, (2) has a higher potential benefit or (3) has a lower risk. I compare both applications of MRTs with respect to these three factors. I conclude that there is no convincing reason to prohibit clinical trials on MRTs for infertility when they are permitted in the context of mitochondrial disease.
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Affiliation(s)
- Esther Braun
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, Germany
- Department of Philosophy, University of Oxford, Oxford, UK
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de Vries CEJ, Veerman-Verweij EM, van den Hoogen A, de Man-van Ginkel JM, Ockhuijsen HDL. The psychosocial impact of male infertility on men undergoing ICSI treatment: a qualitative study. Reprod Health 2024; 21:26. [PMID: 38374039 PMCID: PMC10877778 DOI: 10.1186/s12978-024-01749-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/27/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Male infertility is in 20-70% of cases the cause of a couple's infertility. Severe forms of male infertility are best treated with Intracytoplasmic Sperm Injection (ICSI). The psychosocial impact of infertility and ICSI on men is unclear because the focus is socially, clinically, and scientifically on women. However, there is evidence that it can affect the psychological well-being of men, but these studies are mainly quantitative. Qualitative research needed to explore the experiences of infertile men in-depth is limited. Therefore, the objective of this study was to clarify the psychosocial consequences of male infertility on men undergoing ICSI to understand their experiences with reproduction problems more comprehensively. METHODS In this generic qualitative study, men who were undergoing or had undergone ICSI after a male factor infertility diagnosis were included. A purposive sample with maximum variation was sought in a fertility clinic of one university medical centre in the Netherlands. Data were collected through individual face-to-face semi-structured interviews. Thematic analysis was used to identify themes from the data. RESULTS Nineteen Dutch men were interviewed. The mean duration of the interviews was 90 min. An everyday contributing backpack was identified as the main theme, as men indicated that they always carried the psychosocial consequences of infertility and ICSI with them. Different world perspective, Turbulence of emotions, Changing relation, and Selective sharing were the psychosocial consequences that men were most affected by. Moreover, men indicated that they were Searching for contribution during ICSI because the focus was entirely on the woman. CONCLUSION Men with male infertility experience psychosocial problems due to infertility and ICSI treatment. Healthcare professionals need to recognize the impact of infertility on men and create room for a role for them during ICSI.
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Affiliation(s)
- Carmen E J de Vries
- Department of Reproductive Health, University Medical Center Utrecht, 100 Heidelberglaan, 3584 CX, Utrecht, The Netherlands
- Department of Cardiology and Cardiothoracic Surgery, Erasmus University Medical Center, 40 Dr. Molenwaterplein, 3015 GD, Rotterdam, The Netherlands
| | - Esther M Veerman-Verweij
- Department of Reproductive Health, University Medical Center Utrecht, 100 Heidelberglaan, 3584 CX, Utrecht, The Netherlands
| | - Agnes van den Hoogen
- Department of Reproductive Health, University Medical Center Utrecht, 100 Heidelberglaan, 3584 CX, Utrecht, The Netherlands
| | - Janneke M de Man-van Ginkel
- Department of Nursing Science, University Medical Center Leiden, 2 Albinusdreef, 2333 ZA, Leiden, The Netherlands
| | - Henriëtta D L Ockhuijsen
- Department of Reproductive Health, University Medical Center Utrecht, 100 Heidelberglaan, 3584 CX, Utrecht, The Netherlands.
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Assaysh-Öberg S, Borneskog C, Ternström E. Women's experience of infertility & treatment - A silent grief and failed care and support. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 37:100879. [PMID: 37356208 DOI: 10.1016/j.srhc.2023.100879] [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: 01/25/2023] [Revised: 06/05/2023] [Accepted: 06/19/2023] [Indexed: 06/27/2023]
Abstract
Infertility is one of the components of sexual and reproductive health and rights, but is not as widely addressed as pregnancy, birth, and contraception. Infertility is a global problem, and it is estimated that around 186 million individuals are affected worldwide. Infertility and infertility treatment impact on women's overall wellbeing including their mental, emotional, sexual and spiritual health. Anxiety and depression is prevalent in these women. This study sought to explore the experiences of women going through infertility and IVF in a global context. This study is a metasynthesis with a meta-ethnographic analysis design based on 19 qualitative research studies, including 503 women, focusing on women's experiences of infertility and IVF treatments. Three main themes were identified; the personal reproductive trauma, the impact of and on relationships, and being failed by the healthcare system and society. The personal trauma and experiences included stress, grief, inability to focus, chock, insomnia, anxiety, withdrawing from others, sense of hopelessness and guilt and shame. The infertility and IVF journey also either caused conflicts in relationships or helped the couples to grow stronger. At the same time, relationships with friends and family were strained due to isolation and feeling stigmatized, and not understood. Finally, the healthcare system and providers lacked adequate support, holistic and caring care, and the women felt dehumanized and failed by the healthcare system. It is therefore critical that the healthcare system provide the time, information and support needed to deal with infertility and IVF to maintain quality of life and wellbeing.
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Affiliation(s)
| | - Catrin Borneskog
- School of Health and Welfare, Dalarna University, 791 88 Falun, Sweden
| | - Elin Ternström
- School of Health and Welfare, Dalarna University, 791 88 Falun, Sweden; Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, 751 85 Uppsala, Sweden
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Nakhuda GS, Li N, Yang Z, Kang S. At-home urine estrone-3-glucuronide quantification predicts oocyte retrieval outcomes comparably with serum estradiol. F S Rep 2023; 4:43-48. [PMID: 36959966 PMCID: PMC10028475 DOI: 10.1016/j.xfre.2023.01.006] [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: 11/07/2022] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 01/30/2023] Open
Abstract
Objective To investigate the feasibility of monitoring urine estrone-3-glucuronide (E3G) with an at-home device during gonadotropin stimulation for in vitro fertilization and oocyte cryopreservation. Design Prospective, observational cohort study. Setting Private fertility clinic. Patients Thirty patients undergoing stimulation with a gonadotropin-releasing hormone antagonist protocol for in vitro fertilization or oocyte cryopreservation. Interventions Daily collection of the first urine in the morning during stimulation and analysis performed at home by each patient with the Mira Fertility Tracker. Main Outcome Measures Primary outcomes were correlation of urine E3G and serum estradiol (E2) concentrations on the day of trigger to the number of total and metaphase 2 oocytes (MII). Secondary outcomes of interest were the correlation of matched E3G and E2 measurements and the daily trends of E3G and E2 during stimulation. Results Both urine E3G and serum E2 concentrations on the day of trigger significantly correlated with retrieval outcomes to a similar extent, with E3G demonstrating slightly higher correlation to the number of MII oocytes than that demonstrated by E2 (r = 0.485 vs. 0.391, respectively). The Pearson correlation coefficient for matched E3G and E2 levels was 0.761. The correlation coefficients of determination for daily trends of E3G and E2 during stimulation were 0.7066 and 0.6102, respectively. Conclusions Measured on the day of trigger, urine E3G monitoring during gonadotropin stimulation was comparable with serum E2 for predicting oocyte retrieval outcomes. Matched daily samples confirmed good correlation of urine E3G and serum E2. The option of at-home estrogen monitoring with devices such as Mira offers an alternative to traditional serum monitoring that may improve patient experience. Clinical Trial Registration Number NCT05493202.
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Affiliation(s)
- Gary S. Nakhuda
- Olive Fertility Centre, Vancouver, British Columbia, Canada
- Reprint requests: Gary S. Nakhuda, MD, Olive Fertility Centre, 555 West 12 Avenue, East tower suite 300 BC, Vancouver, British Columbia V5Z3X7, Canada.
| | - Ning Li
- Quanovate Tech, Inc., San Ramon, California
| | - Zheng Yang
- Quanovate Tech, Inc., San Ramon, California
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Keller E, Botha W, Chambers GM. Does in vitro fertilization (IVF) treatment provide good value for money? A cost-benefit analysis. Front Glob Womens Health 2023; 4:971553. [PMID: 36937042 PMCID: PMC10014591 DOI: 10.3389/fgwh.2023.971553] [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: 06/17/2022] [Accepted: 01/30/2023] [Indexed: 03/05/2023] Open
Abstract
Background Using traditional health technology assessment (HTA) outcome metrics, such as quality-adjusted life-years, to assess fertility treatments raises considerable methodological challenges because the objective of fertility treatments is to create new life rather than extend, save, or improve health-related quality of life. Objective The aim of this study was to develop a novel cost-benefit framework to assess value for money of publicly funded IVF treatment; to determine the number of cost-beneficial treatment cycles for women of different ages; and to perform an incremental cost-benefit analysis from a taxpayer perspective. Methods We developed a Markov model to determine the net monetary benefit (NMB) of IVF treatment by female age and number of cycles performed. IVF treatment outcomes were monetized using taxpayers' willingness-to-pay values derived from a discrete choice experiment (DCE). Using the current funding environment as the comparator, we performed an incremental analysis of only funding cost-beneficial cycles. Similar outputs to cost-effectiveness analyses were generated, including net-benefit acceptability curves and cost-benefit planes. We created an interactive online app to provide a detailed and transparent presentation of the results. Results The results suggest that at least five publicly funded IVF cycles are cost-beneficial in women aged <42 years. Cost-benefit planes suggest a strong taxpayer preference for restricting funding to cost-beneficial cycles over current funding arrangements in Australia from an economic perspective. Conclusions The provision of fertility treatment is valued highly by taxpayers. This novel cost-benefit method overcomes several challenges of conventional cost-effectiveness methods and provides an exemplar for incorporating DCE results into HTA. The results offer new evidence to inform discussions about treatment funding arrangements.
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René C, Landry I, de Montigny F. Couples' experiences of pregnancy resulting from assisted reproductive technologies: A qualitative meta-synthesis. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2022; 4:100059. [PMID: 38745619 PMCID: PMC11080439 DOI: 10.1016/j.ijnsa.2021.100059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 12/09/2021] [Accepted: 12/15/2021] [Indexed: 12/01/2022] Open
Abstract
Background Across the world, a growing number of couples are directly or indirectly affected by infertility. Advances in assisted reproductive technologies are now enabling many of them to plan to have a child. As pregnancies resulting from assisted reproductive technologies are being experienced by a growing number of couples, it is important to better understand their experiences and the difficulties they encounter during the prenatal period. Objective This literature review aims to synthesize the qualitative results of primary studies in order to better understand couples' experiences of pregnancy resulting from assisted reproductive technologies, after having experienced infertility. Design A meta-synthesis was conducted in accordance with the guidelines put forth by Sandelowski and Barroso in order to carry out an integrative analysis of the knowledge resulting from qualitative studies on this phenomenon. Data sources The literature search was carried out between October and November 2020. Seven electronic databases were searched (CINAHL, Medline, PsycNet, SCOPUS, ScienceDirect, CAIRN, ERUDIT) and 14 eligible articles were selected. Review methods The data from the "results" and "findings" sections of each of the articles were synthesized through thematic analysis to examine and summarize the topics found in the articles selected and develop the main themes. Results The thematic analysis is structured around four themes to describe and interpret different aspects of the experience of pregnancy resulting from ART, namely: 1) travelling a long and complex journey; 2) moving on with paradoxical emotions; 3) struggling with an emerging identity; and 4) reorganizing relationships. These results shed light on the complex issues faced by couples previously affected by infertility during a pregnancy resulting from assisted reproductive technologies. Conclusion The journey of a pregnancy resulting from assisted reproductive technologies must be recognized in order to offer support in line with the challenges faced by couples. This research will allow for a deeper understanding of women's experience, as well as that of their partner's, in a more specific way, and to better understand the impact on family and loved ones.
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Affiliation(s)
- Caroline René
- Department of Nursing, Université du Québec en Outaouais, 283, boulevard Alexandre-Taché, Gatineau, Québec J9A 1L8, Canada
| | - Isabelle Landry
- Department of Nursing, Université du Québec en Outaouais, 283, boulevard Alexandre-Taché, Gatineau, Québec J9A 1L8, Canada
| | - Francine de Montigny
- Department of Nursing, Université du Québec en Outaouais, 283, boulevard Alexandre-Taché, Gatineau, Québec J9A 1L8, Canada
- Director Paternity, Family and Society Research Team, Full Professor, Department of Nursing, Université du Québec en Outaouais, 283, boulevard Alexandre-Taché, Gatineau, Québec J9A 1L8, Canada
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Jadva V, Lysons J, Imrie S, Golombok S. An exploration of parental age in relation to parents' psychological health, child adjustment and experiences of being an older parent in families formed through egg donation. Reprod Biomed Online 2022; 45:401-409. [PMID: 35644879 PMCID: PMC10444692 DOI: 10.1016/j.rbmo.2022.03.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 03/24/2022] [Accepted: 03/30/2022] [Indexed: 11/18/2022]
Abstract
RESEARCH QUESTION Is parental age associated with parents' psychological health, couple relationship satisfaction and child adjustment in egg donation families, and how do parents think and feel about their age in relation to parenting? DESIGN Seventy-two families with a child born after IVF egg donation were included. Mothers were aged between 32 and 51 years and fathers between 31 and 61 years when the target child was born. When the child was aged 5 years, parents were interviewed and asked to complete questionnaire assessments of parenting stress, anxiety, depression, marital quality and child adjustment. RESULTS Older parents experienced more parenting stress and poorer couple relationship quality than younger parents. No differences were found for child adjustment. Qualitative content analysis of the interviews revealed themes related to 'health and mortality', 'giving and receiving support', 'treatment and age', 'positive aspects of older parenting' and 'other'. CONCLUSIONS This exploratory study found that older parents experienced greater parental stress and poorer relationship quality. Some parents had concerns about their older age, specifically in relation to their health and mortality. It would be important to follow up these families as the child grows older to understand the child's thoughts and feelings about having older parents. Furthermore, findings should be replicated in a larger sample of families formed through egg donation, which includes more younger mothers who have used egg donation.
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Affiliation(s)
- Vasanti Jadva
- Centre for Family Research, University of Cambridge, Free School Lane, Cambridge CB2 3RQ, UK; Institute for Women's Health, Faculty of Population Health Sciences, University College London, 86-96 Chenies Mews, London WC1E 6HX, UK.
| | - Joanna Lysons
- Centre for Family Research, University of Cambridge, Free School Lane, Cambridge CB2 3RQ, UK
| | - Susan Imrie
- Centre for Family Research, University of Cambridge, Free School Lane, Cambridge CB2 3RQ, UK
| | - Susan Golombok
- Centre for Family Research, University of Cambridge, Free School Lane, Cambridge CB2 3RQ, UK
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Leyser-Whalen O, Bombach B, Mahmoud S, Greil AL. From generalist to specialist: A qualitative study of the perceptions of infertility patients. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2022; 14:204-215. [PMID: 35036590 PMCID: PMC8753058 DOI: 10.1016/j.rbms.2021.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 08/02/2021] [Accepted: 10/26/2021] [Indexed: 06/14/2023]
Abstract
Few studies explore in-depth accounts of women's and men's experiences with, and transitions between, obstetrician/gynaecologists (OB/GYNs) and reproductive endocrinologists during infertility diagnostic and treatment processes. This study examined this subject matter with data from qualitative, in-depth, semi-structured interviews. Between April 2007 and March 2008, the first author interviewed 20 women and eight men from a large midwestern metropolitan area in the USA who had used, or were in the process of using, any fertility treatment in the 5 years preceding the interview. Six couples and 16 individuals were interviewed, resulting in narratives of 22 distinct infertility journeys. The main complaints made by respondents about OB/GYNs were that they were insufficiently concerned with providing timely treatment and that they paid insufficient attention to male partners. Women felt that their concerns were taken more seriously by reproductive endocrinologists, but complained of insensitivity, depersonalization and misinformation, and were suspicious of a profit orientation.
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Affiliation(s)
- Ophra Leyser-Whalen
- Department of Sociology and Anthropology, University of Texas El Paso, El Paso, TX, USA
| | - Brianne Bombach
- Department of Sociology and Anthropology, University of Texas El Paso, El Paso, TX, USA
| | - Sara Mahmoud
- Department of Sociology and Anthropology, University of Texas El Paso, El Paso, TX, USA
| | - Arthur L. Greil
- Division of Social Sciences, Alfred University, Alfred, NY, USA
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It’s all about kids, kids, kids! Negotiating reproductive citizenship and patient-centred care in ‘factory IVF’. BIOSOCIETIES 2022. [DOI: 10.1057/s41292-021-00268-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Hart RJ, D'Hooghe T, Dancet EAF, Aurell R, Lunenfeld B, Orvieto R, Pellicer A, Polyzos NP, Zheng W. Self-Monitoring of Urinary Hormones in Combination with Telemedicine - a Timely Review and Opinion Piece in Medically Assisted Reproduction. Reprod Sci 2021; 29:3147-3160. [PMID: 34780023 PMCID: PMC8592080 DOI: 10.1007/s43032-021-00754-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 09/24/2021] [Indexed: 01/18/2023]
Abstract
Cycle monitoring via ultrasound and serum-based hormonal assays during medically assisted reproduction (MAR) can provide information on ovarian response and assist in optimizing treatment strategies in addition to reducing complications such as ovarian hyperstimulation syndrome (OHSS). Two surveys conducted in 2019 and 2020, including overall 24 fertility specialists from Europe, Asia and Latin America, confirmed that the majority of fertility practitioners routinely conduct hormone monitoring during MAR. However, blood tests may cause inconvenience to patients. The reported drawbacks of blood tests identified by the survey included the validity of results from different service providers, long waiting times and discomfort to patients due to travelling to clinics for tests and repeated venepunctures. Historically, urine-based assays were used by fertility specialists in clinics but were subsequently replaced by more practical and automated serum-based assays. A remote urine-based hormonal assay could be an alternative to current serum-based testing at clinics, reducing the inconvenience of blood tests and the frequency of appointments, waiting times and patient burden. Here we provide an overview of the current standard of care for cycle monitoring and review the literature to assess the correlation between urine-based hormonal assays and serum-based hormonal assays during MAR. In addition, in this review, we discuss the evidence supporting the introduction of remote urine-based hormonal monitoring as part of a novel digital health solution that includes remote ultrasound and tele-counselling to link clinics and patients at home.
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Affiliation(s)
- Roger J Hart
- Division of Obstetrics and Gynaecology, The University of Western Australia & Fertility Specialists of Western Australia, Perth, WA, Australia
| | - Thomas D'Hooghe
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Global Medical Affairs Fertility, R&D Healthcare, the healthcare business of Merck KGaA, Frankfurter Str. 250, 64293, Darmstadt, Germany
- Department of Obstetrics and Gynecology, Yale University, New Haven, CT, USA
| | - Eline A F Dancet
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Leuven University Fertility Centre, University Hospitals Leuven, Leuven, Belgium
| | - Ramón Aurell
- IVF Unit, Fertility Campus Hospital Quirónsalud Barcelona, Barcelona, Spain
| | - Bruno Lunenfeld
- Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel
| | - Raoul Orvieto
- Infertility and IVF Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel
- Sackler School 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
| | | | - Nikolaos P Polyzos
- Department of Obstetrics, Gynecology and Reproductive Medicine, Dexeus Mujer, Dexeus University Hospital, Barcelona, Spain
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Wenjing Zheng
- Global Medical Affairs Fertility, R&D Healthcare, the healthcare business of Merck KGaA, Frankfurter Str. 250, 64293, Darmstadt, Germany.
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12
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Chatters R, White D, Pye C, Petrovic A, Sizer A, Kumar P, Metwally M. Experiences of trial participants and site staff of participating in and running a large randomised trial within fertility (the endometrial scratch trial): a qualitative interview study. BMJ Open 2021; 11:e051698. [PMID: 34531221 PMCID: PMC8449983 DOI: 10.1136/bmjopen-2021-051698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To explore the experiences of endometrial scratch (ES) trial participants and site staff of trial recruitment and participation, in order to improve the experience of participants in future trials. DESIGN Qualitative study of a subset of participants in the ES randomised controlled trial and a subset of trial site staff. SETTING A purposeful sample of 9 of the 16 UK Fertility Units that participated in the trial. PARTICIPANTS A purposeful sample of 27 trial participants and 7 site staff. RESULTS Participants were largely happy with the recruitment practices, however, some were overwhelmed with the amount of information received. Interviewees had positive preconceptions regarding the possible effect of the ES on the outcome of their in vitro fertilisation (IVF) cycle, which often originated from their own internet research and seemed to be exacerbated by how site staff described the intervention. Some participants appeared to not understand that receiving the ES could potentially reduce their chances of a successful IVF outcome. Those randomised to the control arm discussed feeling discontent; site staff developed mechanisms of dealing with this. CONCLUSIONS A lack of equipoise in both study participants and the recruiting site staff led to trial participants having positive preconceptions of the potential impact of the ES on their upcoming IVF cycle. Trial participants may not have understood the potential harms of participating in a randomised trial. The trial information sheet did not clearly state this; further research should assess how such information should be presented to potential participants, to proportionately present the level of risk, but to not unduly discourage participation. The amount of information fertility patients require about a research study should also be investigated, in order to avoid participants feeling overwhelmed by the amount of information they receive prior to starting IVF. TRIAL REGISTRATION NUMBER ISRCTN23800982.
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Affiliation(s)
- Robin Chatters
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - David White
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Clare Pye
- Obstetrics, Gynaecology & Neonatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Ana Petrovic
- Rotherham Doncaster and South Humber Mental Health NHS Foundation Trust, Doncaster, UK
| | | | - Pavithra Kumar
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Mostafa Metwally
- Obstetrics, Gynaecology & Neonatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Timmers T, Keijsers M, Kremer JAM, Janssen L, Smeenk J. Supporting Women Undergoing IVF Treatment With Timely Patient Information Through an App: Randomized Controlled Trial. JMIR Mhealth Uhealth 2021; 9:e28104. [PMID: 34448725 PMCID: PMC8433853 DOI: 10.2196/28104] [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: 02/21/2021] [Revised: 06/02/2021] [Accepted: 07/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background Since the introduction of assisted reproductive technologies in 1978, over 2 million in vitro fertilization (IVF) babies have been born worldwide. Patients play a vital role in the success of this treatment. They are required to take fertility medication (hormone injections) to activate the ovaries to produce a sufficient number of oocytes. Later, they need to take medication to increase the chance of the embryo surviving inside the uterus. Patients are educated during an intake consultation at the start of the treatment to minimize the emotional burden and reduce noncompliance. The consultation lasts about 30 to 45 minutes and covers all essential subjects. Even though ample time and energy is spent on patient education, patients still feel anxious, unknowledgeable, and unsupported. As such, electronic health utilizing a smartphone or tablet app can offer additional support, as it allows health care professionals to provide their patients with the correct information at the right time by using push notifications. Objective This randomized controlled trial aimed to evaluate the capacity of an app to support IVF patients throughout the different phases of their treatment and assess its effectiveness. The study's primary outcome was to determine the patients’ level of satisfaction with the information provided. The secondary outcomes included their level of knowledge, ability to administer the medication, overall experienced quality of the treatment, health care consumption, and app usage. Methods This study was performed at a specialized fertility clinic of the nonacademic teaching hospital Elisabeth-TweeSteden Ziekenhuis in Tilburg, the Netherlands. Patients who were scheduled for IVF or intracytoplasmic sperm injection treatments between April 2018 and August 2019 were invited to participate in a physician-blinded, randomized controlled trial. Results In total, 54 patients participated (intervention group: n=29). Patients in the intervention group demonstrated a higher level of satisfaction on a 0 to 10 scale (mean 8.43, SD 1.03 vs mean 7.70, SD 0.66; P=.004). In addition, they were more knowledgeable about the different elements of the treatment on a 7 to 35 scale (mean 27.29, SD 2.94 vs mean 23.05, SD 2.76; P<.001). However, the difference disappeared over time. There were no differences between the two patient groups on the other outcomes. In total, 25 patients in the intervention group used the app 1425 times, an average of 57 times per patient. Conclusions Our study demonstrates that, in comparison with standard patient education, using an app to provide patients with timely information increases their level of satisfaction. Furthermore, using the app leads to a higher level of knowledge about the steps and procedures of IVF treatment. Finally, the app’s usage statistics demonstrate patients’ informational needs and their willingness to use an electronic health application as part of their treatment. Trial Registration Netherlands Trial Register (NTR) 6959; https://www.trialregister.nl/trial/6959
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Affiliation(s)
- Thomas Timmers
- IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands.,Interactive Studios, Rosmalen, Netherlands
| | - Manouk Keijsers
- Department of Obstetrics and Gynaecology, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands
| | - Jan A M Kremer
- IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Jesper Smeenk
- Department of Obstetrics and Gynaecology, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands
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Sormunen T, Westerbotn M, Aanesen A, Fossum B, Karlgren K. Social media in the infertile community-using a text analysis tool to identify the topics of discussion on the multitude of infertility blogs. WOMEN'S HEALTH (LONDON, ENGLAND) 2021; 17:17455065211063280. [PMID: 34856827 PMCID: PMC8646758 DOI: 10.1177/17455065211063280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 10/14/2021] [Accepted: 11/11/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Infertility affects one in six couples. New digital resources exist which enable the study of lived experience of persons with infertility. Blogging represents a forum for sharing narratives and experiences. To provide high quality care for persons with a history of infertility, it is crucial to ascertain what they value as significant in their situation. Blogs with a focus on infertility may provide this information. OBJECTIVES The aim of this study was to gain insight into which infertility-related issues are discussed on Swedish infertility blogs. METHODS In total, 70 infertility blogs were identified on the Internet and 25 met the inclusion criteria. A quantitative-qualitative content analysis was performed with the support of the Gavagai Explorer text analysis software. RESULTS A total of 4508 postings were retrieved from the blogs, all of which were written by women. The outcome of the analysis resulted into the following topics: Emotions (16.8%), Relations (12.5%), Time and waiting (7.1%), Body (6.6%), Care and treatment (4.2%), Food and diet (1.4%) and Exercise (0.5%). For most topics, there was a balance between positive and negative statements, but the body topic stood out by having more negative than positive sentiment. CONCLUSION By considering the topics expressed in blogs, health care personnel are provided with an opportunity to better understand the situation of individuals affected by infertility.
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Affiliation(s)
- Taina Sormunen
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
| | - Margareta Westerbotn
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
- Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden
| | - Arthur Aanesen
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
- Sophiahemmet Hospital, Stockholm, Sweden
| | - Bjöörn Fossum
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
- Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden
| | - Klas Karlgren
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Department of Research, Education, Development, and Innovation, Södersjukhuset, Stockholm, Sweden
- Department of Health and Functioning, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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15
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Fedele F, Caputo A, Cordella B, Muzii L, Pietrangeli D, Aragona C, Langher V. What About Fertility Staff Emotions? An Explorative Analysis of Healthcare Professionals' Subjective Perspective. EUROPES JOURNAL OF PSYCHOLOGY 2020; 16:619-638. [PMID: 33680202 PMCID: PMC7909494 DOI: 10.5964/ejop.v16i4.2245] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 02/24/2020] [Indexed: 11/29/2022]
Abstract
Infertility-related psychological research is traditionally oriented to analyze the wellbeing of couples undergoing Assisted Reproductive Technologies (ART), than to study the job-related effects on the healthcare fertility staff. This piece of research aims at understanding the subjective perspective of the fertility professionals and contribute to identify their emotional dynamics in their work environment. An in-depth explorative research study was conducted on 12 healthcare professionals of an Italian ART hospital clinic. Structured interviews with open-ended questions were administered to explore their deep feelings about their professional experience. Emotional text analysis was then conducted to analyze the textual corpus of their narratives to grasp their affective symbolizations. Statistical multidimensional techniques were used to detect some thematic domains (cluster analysis) and latent factors organizing the contraposition between them (multiple correspondence analysis). Five thematic domains were detected which refer to different emotional dimensions, as follows: performance anxiety (Cluster 1), ambivalence between omnipotence and powerlessness (Cluster 2), care burden (Cluster 3), feeling of duty (Cluster 4), and sense of interdependence (Cluster 5). Then, four latent factors were identified dealing with the laborious attempt to remedy, the realistic sense of limitation, the incumbent feeling of pressure and the restorative sense of justice, respectively. The results are discussed based on the existing literature and some useful recommendations for staff education, training and clinical supervision are provided accordingly.
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Affiliation(s)
- Fabiola Fedele
- Department of Dynamic and Clinical Psychology, "Sapienza" University of Rome, Rome, Italy
| | - Andrea Caputo
- Department of Dynamic and Clinical Psychology, "Sapienza" University of Rome, Rome, Italy
| | - Barbara Cordella
- Department of Dynamic and Clinical Psychology, "Sapienza" University of Rome, Rome, Italy
| | - Ludovico Muzii
- Department of Gynecologic-Obstetrical and Urologic Sciences, "Sapienza" University of Rome, Umberto I Hospital, Rome, Italy
| | - Daniela Pietrangeli
- Department of Gynecologic-Obstetrical and Urologic Sciences, "Sapienza" University of Rome, Umberto I Hospital, Rome, Italy
| | - Cesare Aragona
- Department of Gynecologic-Obstetrical and Urologic Sciences, "Sapienza" University of Rome, Umberto I Hospital, Rome, Italy
| | - Viviana Langher
- Department of Dynamic and Clinical Psychology, "Sapienza" University of Rome, Rome, Italy
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Shandley LM, Hipp HS, Anderson-Bialis J, Anderson-Bialis D, Boulet SL, McKenzie LJ, Kawwass JF. Patient-centered care: factors associated with reporting a positive experience at United States fertility clinics. Fertil Steril 2020; 113:797-810. [DOI: 10.1016/j.fertnstert.2019.12.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 12/05/2019] [Accepted: 12/09/2019] [Indexed: 12/13/2022]
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17
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Hanna E, Gough B. The impact of infertility on men's work and finances: Findings from a qualitative questionnaire study. GENDER WORK AND ORGANIZATION 2019. [DOI: 10.1111/gwao.12414] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Esmée Hanna
- Centre for Reproduction ResearchDe Montfort University UK
| | - Brendan Gough
- School of Social SciencesLeeds Beckett University UK
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18
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Imrie S, Jadva V, Golombok S. Psychological well-being of identity-release egg donation parents with infants. Hum Reprod 2019; 34:2219-2227. [PMID: 31681962 PMCID: PMC7034334 DOI: 10.1093/humrep/dez201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 08/03/2019] [Indexed: 01/13/2023] Open
Abstract
STUDY QUESTION What are the psychological health, relationship quality and perceived social support outcomes of heterosexual couples who have conceived an infant through identity-release egg donation? SUMMARY ANSWER Parents' scores on all measures were within the normal range. Egg donation mothers had poorer perceived social support, and egg donation fathers had less optimal psychological health than a comparison group of IVF parents, although these differences were associated with the older age of egg donation parents, rather than being an effect of family type. WHAT IS KNOWN ALREADY There is limited understanding of the psychological health and couple relationship quality of egg donation parents, and no empirical data on parents' social support, during the first year of parenthood. No studies have included families who have used an identity-release egg donor. The study offers the first examination of the psychological well-being of identity-release egg donation parents. STUDY DESIGN, SIZE, DURATION This study included 57 families created through identity-release egg donation, and a comparison group of 56 families who had used IVF with their own gametes, recruited through UK fertility clinics. Families were visited at home between October 2013 and June 2015. The sample forms part of a larger study examining family functioning in families created following fertility treatment. PARTICIPANTS/MATERIALS, SETTING, METHOD All families were heterosexual two-parent families with an infant aged 6-18 months. Mothers and fathers were administered standardised questionnaires assessing psychological health (Edinburgh Postnatal Depression Scale, Trait Anxiety Inventory and Parenting Stress Index-short form), couple relationship quality (Golombok Rust Inventory of Marital State) and perceived social support (Multidimensional Scale of Perceived Social Support). MAIN RESULTS AND THE ROLE OF CHANCE Scores from the egg donation and IVF parents were within the normal range on all measures. Significant differences were found between the groups indicating less optimal social support in egg donation mothers compared to IVF mothers, and poorer psychological health in egg donation fathers compared to IVF fathers. These differences appeared to be related to the older age of egg donation parents or to twin parenthood, rather than to egg donation per se. No differences were found between the groups in the parents' relationship quality. LIMITATIONS, REASONS FOR CAUTION It is possible that families who were managing the transition to parenthood less well may have been less likely to participate in research. Fewer IVF than egg donation fathers participated in the study, so the statistical power was lower for comparisons between fathers. WIDER IMPLICATIONS OF THE FINDINGS The findings are of relevance to UK clinics offering identity-release egg donation. That scores of egg donation parents on measures of psychological well-being were more similar than different to those of IVF parents should prove reassuring to individuals considering this treatment type. As less optimal outcomes were found for egg donation parents on several measures, and these were associated with parental age rather than conception type, it is recommended that clinics discuss with older patients how they may establish a social support network and signpost patients to appropriate post-natal support. STUDY FUNDING, COMPETING INTERESTS This research was supported by a Wellcome Trust Senior Investigator Award [097857/Z/11/Z] and a CHESS-ESRC studentship. The authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- S Imrie
- Centre for Family Research, University of Cambridge, UK
| | - V Jadva
- Centre for Family Research, University of Cambridge, UK
| | - S Golombok
- Centre for Family Research, University of Cambridge, UK
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19
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Jadva V, Gamble N, Prosser H, Imrie S. Parents' relationship with their surrogate in cross-border and domestic surrogacy arrangements: comparisons by sexual orientation and location. Fertil Steril 2019; 111:562-570. [PMID: 30827525 PMCID: PMC6408321 DOI: 10.1016/j.fertnstert.2018.11.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/13/2018] [Accepted: 11/19/2018] [Indexed: 11/16/2022]
Abstract
Objective To study heterosexual and gay couples' relationship with their surrogate and their disclosure decisions when the surrogacy arrangement was completed domestically compared with internationally. Design Cross-sectional study. Setting Not applicable. Patient(s) Participants were 40 gay couples and 76 heterosexual couples who had domestic surrogacy in the United Kingdom (UK) (n = 38) or international surrogacy in the United States (n = 58) or Asia (20). Most (75%) of the children were aged <4 years. Intervention(s) Online surveys containing open-ended and multiple-choice questions. Main Outcome Measure(s) Experiences of finding a surrogate, relationship with the surrogate, and disclosure to the child were examined among UK parents who had undergone surrogacy in the UK, United States, or India/Thailand. Result(s) Parents who had surrogacy in the UK and United States felt very involved in the pregnancy compared with those who had surrogacy in Asia. Couples whose surrogacy was completed in Asia were less likely to want contact with their surrogate after the birth and were also less likely to have any current contact with the surrogate. Parents who had surrogacy in the UK and United States described positive relationships with their surrogate. Gay couples intended to tell their child about surrogacy more than heterosexual couples. Conclusion(s) The specific country where couples conducted their surrogacy arrangement (i.e. United States, UK, or Thailand/India) was associated with how involved they were in the pregnancy and their contact with the surrogate over time. Limitations of the study include use of survey methodology and that the representativeness of the sample is not known.
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Affiliation(s)
- Vasanti Jadva
- Centre for Family Research, University of Cambridge, Cambridge, United Kingdom.
| | - Natalie Gamble
- NGA Law and Brilliant Beginnings, London, United Kingdom
| | - Helen Prosser
- NGA Law and Brilliant Beginnings, London, United Kingdom
| | - Susan Imrie
- Centre for Family Research, University of Cambridge, Cambridge, United Kingdom
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20
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Langher V, Fedele F, Caputo A, Marchini F, Aragona C. Extreme Desire for Motherhood: Analysis of Narratives From Women Undergoing Assisted Reproductive Technology (ART). EUROPES JOURNAL OF PSYCHOLOGY 2019; 15:292-311. [PMID: 33574956 PMCID: PMC7871747 DOI: 10.5964/ejop.v15i2.1736] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 11/07/2018] [Indexed: 01/04/2023]
Abstract
The problem of infertility and its consequent treatment (denoted as Assisted Reproductive Technology or ART) represent an increasing phenomenon, especially in industrialized countries. Confronting with one’s own procreative limitations can generate strong negative emotional reactions. This study aims at understanding how the desire for motherhood manifests itself in infertile women undergoing ART, studying their emotional and subjective perspective. An in-depth explorative research study was conducted on 17 infertile women attending an Italian hospital clinic for fertility treatment. Emotional text analysis was conducted to analyze the corpus of their interviews, allowing the identification of four thematic domains (clusters) which refer, respectively, to the following emotional dimensions: an inclination to self-sacrifice, seen as the price to be paid for the desired success of the treatment (Cluster 1), pursuit of inclusion in the world of procreative mothers (Cluster 2), precarious equilibrium between the deep desire for a baby and the withdrawal from the treatment (Cluster 3), surrender to any possible consequence in order to obtain the desired mother-child relationship (Cluster 4). The witness of the couples’ suffering for their condition of infertility and their strong desire for parenting can represent a source of high pressure for the fertility care staff, as they are the only ones responsible for the fulfillment of the great dream of biological parenthood. For these reasons, a multidisciplinary approach, which involves psychological as well as medical experts all working together, could benefit both the patients and the healthcare professionals and improve the quality of the reproductive healthcare services.
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Affiliation(s)
- Viviana Langher
- Department of Dynamic and Clinical Psychology, "Sapienza" University, Rome, Italy
| | - Fabiola Fedele
- Department of Dynamic and Clinical Psychology, "Sapienza" University, Rome, Italy
| | - Andrea Caputo
- Department of Dynamic and Clinical Psychology, "Sapienza" University, Rome, Italy
| | - Francesco Marchini
- Department of Dynamic and Clinical Psychology, "Sapienza" University, Rome, Italy
| | - Cesare Aragona
- Department of Gynecologic-Obstetrical and Urologic Sciences, "Sapienza" University Hospital Umberto I, Rome, Italy.,Sterility and Assisted Reproduction Unit, "Sapienza" University Hospital Umberto I, Rome, Italy
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21
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Greil AL, Slauson-Blevins KS, Lowry MH, McQuillan J. Concerns about treatment for infertility in a probability-based sample of US women. J Reprod Infant Psychol 2019; 38:16-24. [PMID: 30892066 DOI: 10.1080/02646838.2019.1587395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: Many women experience infertility as distressing, but only about half of US women seek medical services. It is unknown whether concerns about fertility treatment are related to receiving fertility treatment or to distress levels.Methods: Using the nationally representative National Survey of Fertility Barriers, we constructed a nine-item scale measuring fertility treatment concerns. The analytical sample for this study included 1218 women who said that they were trying to become pregnant and who were asked questions regarding treatment concerns. We conducted multiple regression analysis to discover factors associated with treatment concerns and whether treatment concerns were associated with depressive symptoms and fertility-specific distress. We used logistic regression to determine whether treatment concerns were associated with receiving fertility tests.Results: Desiring a(nother) child, infertility stigma, higher family income, higher economic hardship and claiming a Hispanic identity were associated with higher levels of treatment concerns than those in the comparison groups. Having friends and family with children and having private health insurance were associated with lower levels of concern. Treatment concerns were not associated with receiving fertility tests. Higher levels of treatment concern were associated with higher levels of fertility-specific distress and depressive symptoms. Higher infertility stigma was related both directly and indirectly to higher levels of fertility-specific distress and depressive symptoms.Conclusion: For US women, fertility treatment concerns are not associated with whether women pursue fertility testing, but they are associated with higher levels of fertility-specific and general distress.
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Affiliation(s)
- Arthur L Greil
- Division of Social Sciences, Alfred University, Alfred, NY, USA
| | | | - Michele H Lowry
- Division of Social Sciences, Alfred University, Alfred, NY, USA
| | - Julia McQuillan
- Division of Social Sciences, University of Nebraska-Lincoln, Alfred, NY, USA
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22
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Boz İ, Özçetin E, Teskereci G. İnfertilitede Anne Olma: Kuramsal Bir Analiz. PSIKIYATRIDE GUNCEL YAKLASIMLAR 2018. [DOI: 10.18863/pgy.382342] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Imrie S, Jadva V, Fishel S, Golombok S. Families Created by Egg Donation: Parent-Child Relationship Quality in Infancy. Child Dev 2018; 90:1333-1349. [PMID: 30015989 PMCID: PMC6640047 DOI: 10.1111/cdev.13124] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Increasing numbers of children are being born through egg donation and thus do not share a genetic relationship with their mother. Parent–infant relationship quality was examined in 85 egg donation families and a comparison group of 65 in vitro fertilization families (infant M = 11 months). Standardized interview and observational measures were used to assess mother–infant and father–infant relationship quality at the representational and behavioral levels. Few differences were found between family types in parents’ representations of the parent–infant relationship. Differences were found between family types in the observational assessment of mother–infant relationship quality, indicating less optimal interactions in egg donation families. Findings suggest that egg donation families function well in infancy overall, but there may be subtle yet meaningful differences in mother–infant interaction quality.
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Shreffler KM, Greil AL, McQuillan J. Responding to Infertility: Lessons From a Growing Body of Research and Suggested Guidelines for Practice. FAMILY RELATIONS 2017; 66:644-658. [PMID: 29422703 PMCID: PMC5798475 DOI: 10.1111/fare.12281] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Infertility is a common, yet often misunderstood, experience. Infertility is an important topic for family scientists because of its effects on families; its relevance to research in related areas, such as fertility trends and reproductive health; and its implications for practitioners who work with individuals and couples experiencing infertility. In this review, we focus on common misperceptions in knowledge and treatment of infertility and highlight insights from recent research that includes men, couples, and people with infertility who are not in treatment. The meaning of parenthood, childlessness, awareness of a fertility problem, and access to resources are particularly relevant for treatment seeking and psychosocial outcomes. On the basis of insights from family science research, we provide specific guidelines for infertility practice within broader social contexts such as trends in health care, education, employment, and relationships. Guidelines are presented across three areas of application: infertility education for individuals, families, and practitioners; steps to support the emotional well-being of those affected by infertility; and understanding of treatment approaches and their implications for individuals and couples.
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Johnson B, Quinlan MM, Myers J. Commerce, Industry, and Security: Biomedicalization Theory and the Use of Metaphor to Describe Practitioner–Patient Communication Within Fertility, Inc. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/23293691.2017.1326250] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Bethany Johnson
- Department of Communication Studies, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Margaret M. Quinlan
- Department of Communication Studies, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
- Department of History, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Jade Myers
- Department of Communication and Journalism, University of New Mexico, Albuquerque, New Mexico, USA
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26
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Hudson N, Culley L, Blyth E, Norton W, Pacey A, Rapport F. Cross-border-assisted reproduction: a qualitative account of UK travellers' experiences. HUM FERTIL 2016; 19:102-10. [PMID: 27144511 DOI: 10.3109/14647273.2016.1168530] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Surveys on patients' experiences of cross-border fertility treatment have reported a range of positive and challenging features. However, the number of such studies is limited, and there is no detailed qualitative account of the experiences of UK patients who travel overseas for fertility treatment. The present study used a cross-sectional, qualitative design and in-depth interviews. Fifty-one participants (41 women and 10 men, representing 41 treatment 'cases') participated in semi-structured interviews. The experiences reported were broadly positive with a large proportion of participants (39 cases, 95%) citing a favourable overall experience with only two cases (5%) reporting a more negative experience. Thematic analysis revealed 6 major categories and 20 sub-categories, which described the positive and challenging aspects of cross-border fertility travel. The positive aspects were represented by the categories: 'access', 'control' and 'care and respect'. The more challenging aspects were categorized as 'logistics and coordination of care', 'uncertainty' and 'cultural dissonance'. The study confirms findings from others that despite some challenges, there is a relatively high level of patient satisfaction with cross-border treatment with participants able to extend the boundaries of their fertility-seeking trajectories and in some cases, regain a sense of control over their treatment.
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Affiliation(s)
- Nicky Hudson
- a Applied Social Sciences , De Montfort University , Leicester , UK
| | - Lorraine Culley
- a Applied Social Sciences , De Montfort University , Leicester , UK
| | - Eric Blyth
- b School of Human and Health Sciences, University of Huddersfield , Huddersfield , UK
| | - Wendy Norton
- c School of Nursing & Midwifery, De Montfort University , Leicester , UK
| | - Allan Pacey
- d Reproductive & Developmental Medicine , University of Sheffield , Sheffield , UK
| | - Frances Rapport
- e Centre for Healthcare Resilience and Implementation Science (CHRIS) , Australian Institute of Healthcare Innovation, Macquarie University , Sydney , NSW , Australia
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Dornelles L, MacCallum F, Lopes R, Piccinini C, Passos E. The experience of pregnancy resulting from Assisted Reproductive Technology (ART) treatment: A qualitative Brazilian study. Women Birth 2016; 29:123-7. [DOI: 10.1016/j.wombi.2015.08.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 08/22/2015] [Accepted: 08/23/2015] [Indexed: 11/25/2022]
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Papadatou D, Papaligoura ZG, Bellali T. From Infertility to Successful Third-Party Reproduction: The Trajectory of Greek Women. QUALITATIVE HEALTH RESEARCH 2016; 26:399-410. [PMID: 25568093 DOI: 10.1177/1049732314566322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The purpose of our phenomenological hermeneutic study was to explore the lived experiences of Greek infertile women who achieve a pregnancy through the use of sperm, oocyte, or embryo donation or surrogate motherhood. Semistructured interviews were conducted with 15 infertile women. Findings suggest that conceiving a child through assisted reproductive technologies (ART) is lived as a highly distressing experience, comprising long waiting periods for medical results, several failed attempts, and treatment options with uncertain outcomes. The analysis of women's accounts revealed a constitutive pattern, journeying between hope and despair, and three associated themes: (a) coping with uncertainty and treatment failures, (b) exploring options and decision making, and (c) being supported by spouse and professionals. Findings illuminate the specific meaning-based coping processes, decision-making patterns, and sources of support that help women who pursue treatment until they give birth to a child, to manage highly stressful situations and critical decisions.
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Affiliation(s)
- Danai Papadatou
- National and Kapodistrian University of Athens, Athens, Greece
| | | | - Thalia Bellali
- Alexandreio Technological Educational Institute, Thessaloniki, Greece
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Warmelink JC, Adema W, Pranger A, de Cock TP. Client perspectives of midwifery care in the transition from subfertility to parenthood: a qualitative study in the Netherlands. J Psychosom Obstet Gynaecol 2016; 37:12-20. [PMID: 26595088 PMCID: PMC4743598 DOI: 10.3109/0167482x.2015.1106474] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Pregnancy, childbirth and the postpartum period after fertility treatment are considered "normal" in the Netherlands, with no indication of an increased obstetric risk, and can therefore be monitored by a primary care midwife. However, there is little evidence on the experiences of couples and women who finally get pregnant after fertility treatment and a lack of training for midwives exists on this subject. The aim of this study was to map the midwifery care needs of the subfertile client with past fertility problems. METHODS In 2011, we interviewed two couples and seven women who conceived through fertility treatment and received primary midwifery care at some point during their pregnancies. This explorative, qualitative study was based on the interpretivist/constructivist paradigm. RESULTS Although the participants are not representative of all subfertile clients, the findings of our qualitative study highlight the needs of women and their partners who have become pregnant through fertility treatment including help from the primary care midwife in understanding the likely course of their pregnancy, more psychosocial support and acknowledgement of the fertility treatment history, and more consultations and frequent ultrasound scans than usual to confirm pregnancy. CONCLUSIONS Our study points out that the women who have become pregnant through fertility treatment and their partners communicate seemingly paradoxical prenatal care needs. It can help maternity care providers to optimally meet the care needs of subfertile clients and empower them during their transition from subfertility to parenthood.
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Affiliation(s)
- J. Catja Warmelink
- Midwifery Academy Amsterdam-Groningen, Dirk Huizingastraat,
Groningen,
The Netherlands,
,Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center,
Amsterdam,
The Netherlands,
,Address for correspondence: J. C. Warmelink,
Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center,
Amsterdam,
The Netherlands. Tel: +31 0 50 3618886. E-mail:
| | - Wietske Adema
- Midwifery Academy Amsterdam-Groningen, Dirk Huizingastraat,
Groningen,
The Netherlands,
,Midwifery practice Leeuwarden,
The Netherlands
| | - Annelies Pranger
- Midwifery Academy Amsterdam-Groningen, Dirk Huizingastraat,
Groningen,
The Netherlands,
,Midwifery practice Dokkum and Drachten,
The Netherlands
| | - T. Paul de Cock
- Midwifery Academy Amsterdam-Groningen, Dirk Huizingastraat,
Groningen,
The Netherlands,
,Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center,
Amsterdam,
The Netherlands
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Paradox of Modern Pregnancy: A Phenomenological Study of Women's Lived Experiences from Assisted Pregnancy. J Pregnancy 2015; 2015:543210. [PMID: 26064687 PMCID: PMC4433712 DOI: 10.1155/2015/543210] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 04/20/2015] [Indexed: 11/18/2022] Open
Abstract
The purpose of our study was describing the meaning of pregnancy through Assisted Reproductive Technologies (ARTs). A qualitative design with hermeneutic phenomenology approach was selected to carry out the research. Semistructured in-depth interviews were conducted with 12 women who experienced assisted pregnancy. Three themes emerged from women's experience including finding peace in life, paradoxical feelings, and struggling to realize a dream. We concluded that pregnancy is the beginning of a new and hard struggle for women with fertility problems. The findings of our study resulted in helpful implications for the health care professionals managing assisted pregnancies.
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Expectations towards medical personnel – a study with infertility clinic patients. HEALTH PSYCHOLOGY REPORT 2014. [DOI: 10.5114/hpr.2014.45197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
<b>Background</b><br />
Contacts with medical personnel are important for patients’ experiences. The role of physicians’ psychosocial competence was noted in Polish studies, but systematic analyses of infertile patients’ expectations have not been conducted. This study was designed to learn about patients’ views on relationships with medical personnel. It was assumed that: 1) staff involvement in infertility treatment would be reflected in expectations towards persons in different roles, 2) expectations might be related to patients’ gender, duration of infertility, and type of treatment, 3) expectations of couples would be related.<br />
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<b>Participants and procedure</b><br />
Fifty-one married couples filled in a purposely designed questionnaire. Items related to information, attitudes and support were divided into three sections – expectations towards physicians, other medical personnel, psychologists – and were scored on a scale of 1 to 5 points.<br />
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<b>Results</b><br />
No gender effect of duration of treatment, type of infertility or treatment method on expectations was found. Partners expected the same level of information from physicians and the same level of emotional support from psychologists. Other expectations were consistently higher in women. There was a clear division of expectations towards different groups of personnel – the expectation to make the best medical choices was assigned to physicians, while the expectation to provide a supportive relationship and coping skills was assigned to psychologists, but all were expected to respect patients’ privacy, choices and decisions.<br />
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<b>Conclusions</b><br />
The findings indicate the division of expectations towards different groups of personnel, with the tendency of women to articulate their expectations more clearly and strongly, but towards the same aspects of staff functioning as men do.
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Zeiler K, Malmquist A. Lesbian shared biological motherhood: the ethics of IVF with reception of oocytes from partner. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2014; 17:347-355. [PMID: 24395218 DOI: 10.1007/s11019-013-9538-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
In vitro fertilization (IVF) with reception of oocytes from partners (ROPA) allows lesbian mothers to share biological motherhood. The gestational mother receives an egg from her partner who becomes the genetic mother. This article examines the ethics of IVF with ROPA with a focus on the welfare of the woman and the resulting child, on whether ROPA qualifies as a "legitimate" medical therapy that falls within the goals of medicine, and on the meaning and value attributed to a biologically shared bond between parents and child. We also contrast IVF with ROPA with egg donor IVF for heterosexual couples and intrafamilial live uterus transplantation with IVF, and show how Swedish legislation makes certain ways of sharing biological bonds out of place. In Sweden, IVF with ROPA is illegal, egg donor IVF for heterosexual couples is allowed and practiced as is sperm donor IVF for lesbians, and live uterus transplantation is performed within a research project (though not allowed in regular health care). But is ROPA really ethically more problematic than these other cases? The article argues that IVF with ROPA gives rise to fewer ethical questions than does live uterus transplantation with IVF and, in some cases, egg donor IVF.
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Affiliation(s)
- Kristin Zeiler
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden,
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McLindon LA, Beckmann M, Flenady V, McIntyre HD, Chapman M. Women's views of a fertility awareness and hormonal support approach to subfertility. HUM FERTIL 2013; 16:252-7. [PMID: 24171651 DOI: 10.3109/14647273.2013.843791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of this study was to determine the satisfaction among subfertile women of a fertility awareness-based approach, including hormonal therapy to achieve a pregnancy by natural conception. Eighty four women attending a natural fertility service completed a postal questionnaire exploring (1) the acceptability of the sympto-thermal method and (2) the acceptability of using hormone support. Acceptability rates for the fertility charting, clinical service and clinical care were 64.9-91.6%. Acceptability rates were higher in women who did conceive or had experienced past recurrent miscarriages. Taking hormonal luteal support, by any method, was more acceptable for women over 35 years compared to those under 35 years (100% vs. 69.4%, p = 0.014). Vaginal pessaries were the preferred route of administration. The use of a fertility awareness-based method appears to be acceptable amongst subfertile women intending to conceive naturally. Most women using such a method for conception would be open to the use of hormonal support during the fertility cycle or early pregnancy.
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Aarts JWM, Faber MJ, den Boogert AG, Cohlen BJ, van der Linden PJQ, Kremer JAM, Nelen WLDM. Barriers and facilitators for the implementation of an online clinical health community in addition to usual fertility care: a cross-sectional study. J Med Internet Res 2013; 15:e163. [PMID: 23996964 PMCID: PMC3815434 DOI: 10.2196/jmir.2098] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 10/21/2012] [Accepted: 04/07/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Online health communities are becoming more popular in health care. Patients and professionals can communicate with one another online, patients can find peer support, and professionals can use it as an additional information channel to their patients. However, the implementation of online health communities into daily practice is challenging. These challenges relate to the fact that patients need to be activated to (1) become a member (ie, subscription) and (2) participate actively within the community before any effect can be expected. Therefore, we aimed at answering 2 research questions: (1) what factors are associated with subscription to an online health community, and (2) which are associated with becoming an active participant within an online health community. OBJECTIVE To identify barriers and facilitators as perceived by patients for the implementation of an online health community. METHODS We performed a cross-sectional study. Three Dutch fertility clinics (2 IVF-licensed) offered their patients a secure online clinical health community through which clinicians can provide online information and patients can ask questions to the medical team or share experiences and find support from peers. We randomly selected and invited 278 men and women suffering from infertility and attending 1 of the participating clinics. Participants filled out a questionnaire about their background characteristics and current use of the online community. Possible barriers and facilitators were divided into 2 parts: (1) those for subscription to the community, and (2) those for active participation in the community. We performed 2 multivariate logistic regression analyses to calculate determinants for both subscription and active participation. RESULTS Subscription appeared to be associated with patients' background characteristics (eg, gender, treatment phase), intervention-related facilitators (odds ratio [OR] 2.45, 95% CI 1.14-5.27), and patient-related barriers (OR 0.20, 95% CI 0.08-0.54), such as not feeling the need for such an online health community. After subscription, determinants for participation consisted of aspects related to participant's age (OR 0.86, 95% CI 0.76-0.97), length of infertility (OR 1.48, 05% CI 1.09-2.02), and to intervention-related facilitators (OR 5.79, 95% CI 2.40-13.98), such as its reliable character and possibility to interact with the medical team and peers. CONCLUSIONS Implementing an online health community in addition to usual fertility care should be performed stepwise. At least 2 strategies are needed to increase the proportion of patient subscribers and consequently make them active participants. First, the marketing strategy should contain information tailored to different subgroups of the patient population. Second, for a living online health community, incorporation of interactive elements, as well as frequent news and updates are needed. These results imply that involving patients and their needs into the promotion strategy, community's design, and implementation are crucial.
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Affiliation(s)
- Johanna W M Aarts
- Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Center, Radboud University, Nijmegen, Netherlands.
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Cipolletta S, Faccio E. Time experience during the assisted reproductive journey: a phenomenological analysis of Italian couples’ narratives. J Reprod Infant Psychol 2013. [DOI: 10.1080/02646838.2013.813627] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Wilson C, Leese B. Do nurses and midwives have a role in promoting the well-being of patients during their fertility journey? a review of the literature. HUM FERTIL 2013; 16:2-7. [PMID: 23548090 DOI: 10.3109/14647273.2013.781687] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Carol Wilson
- University of the West of Scotland, Dumfries Campus, Dumfries, UK
| | - Brenda Leese
- Faculty of Health and Social Care, University of Hull, Hull, UK
- Multiple Births Foundation, Queen Charlotte's and Chelsea Hospital, London, UK
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Mac Dougall K, Beyene Y, Nachtigall RD. Age shock: misperceptions of the impact of age on fertility before and after IVF in women who conceived after age 40. Hum Reprod 2012. [PMID: 23203214 DOI: 10.1093/humrep/des409] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION What do older women understand of the relationship between age and fertility prior and subsequent to delivering their first child? SUMMARY ANSWER Women who were first-time parents over the age of 40 did not accurately perceive the relationship between age and fertility prior to conceiving with IVF. WHAT IS KNOWN ALREADY While increases in women's age at their first birth have been most pronounced in relatively older women, the rapidity of fertility decline is not appreciated by most non-infertility specialist physicians, the general public or men and women who are delaying childbearing. STUDY DESIGN, SIZE AND DURATION Qualitative retrospective interviews were conducted from 2009 to 2011 with 61 self-selected women who were patients in one of two fertility clinics in the USA. PARTICIPANTS/MATERIALS, SETTING, METHODS All participants had delivered their first child following IVF when the woman was 40 years or older. The data include women's responses to the semi-structured and open-ended interview questions 'What information did you have about fertility and age before you started trying to get pregnant?' and 'What did you learn once you proceeded with fertility treatment?' MAIN RESULTS AND THE ROLE OF CHANCE Of the women, 30% expected their fertility to decline gradually until menopause at around 50 years and 31% reported that they expected to get pregnant without difficulty at the age of 40. Reasons for a mistaken belief in robust fertility included recollections of persistent and ongoing messaging about pregnancy prevention starting in adolescence (23%), healthy lifestyle and family history of fertility (26%), and incorrect information from friends, physicians or misleading media reports of pregnancies in older celebrity women (28%). Participants had not anticipated the possibility that they would need IVF to conceive with 44% reporting being 'shocked' and 'alarmed' to discover that their understanding of the rapidity of age-related reproductive decline was inaccurate'. In retrospect, their belated recognition of the effect of age on fertility led 72% of the women to state that they felt 'lucky' or had 'beaten the odds' in successfully conceiving after IVF. Of the women, 28% advocated better fertility education earlier in life and 23% indicated that with more information about declining fertility, they might have attempted conception at an earlier age. Yet 46% of women acknowledged that even if they had possessed better information, their life circumstances would not have permitted them to begin childbearing earlier. LIMITATIONS AND REASONS FOR CAUTION Both the self-selected nature of recruitment and the retrospective design can result in biases due to memory limitations or participant assimilation and/or contrast of past events with current moods. The cohort did not reflect broad homogeneity in that the participants were much more likely to be highly educated, Caucasian and better able to pay for treatment than national population norms. As attitudes of older women who were unsuccessful after attempting IVF in their late 30s or early 40s are not represented, it is possible (if not likely) that the recollections of women who did not conceive after IVF would have been more strongly influenced by feelings of regret or efforts to deflect blame for their inability to conceive. WIDER IMPLICATIONS OF THE FINDINGS While the failure to appreciate the true biological relationship between aging and fertility may be common and may reflect inaccessibility or misinterpretation of information, it is not sufficient to explain the decades-long socio-demographic phenomenon of delayed childbearing.
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Affiliation(s)
- K Mac Dougall
- Institute for Health & Aging, University of California, San Francisco, 3333 California Street, Suite 340, San Francisco, CA 94118, USA
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38
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Smorti M, Smorti A. Medical successes and couples' psychological problems in assisted reproduction treatment: a narrative based medicine approach. J Matern Fetal Neonatal Med 2012; 26:169-72. [PMID: 22928539 DOI: 10.3109/14767058.2012.722728] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE 1) To explore the psychological processes that develop in women and men during their first pregnancy obtained with assisted reproduction treatment; 2) to individuate the main plot that women and men use to recount their transition to parenthood. METHODS A face-to-face semi-structured autobiographical interview was administered. The interview was aimed to investigate the story of pregnancy. Interviews were transcribed verbatim and analyzed in order to merge principal themes. PARTICIPANTS 15 Italian couples waiting for the first child after a conception with assisted reproductive technologies. RESULTS Medically assisted pregnancy constitutes an extremely stressful, highly medicalised experience, that the couple, however, narrated according to a basic plot consisting in four phases: doubt, final sentence, victory, monitoring. CONCLUSIONS Results suggest that physicians can benefit from knowing the phases that infertile couples experience during pregnancy because these can serve as a framework to use in monitoring their transition to parenthood and in planning psychological support and health interventions for them.
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Affiliation(s)
- Martina Smorti
- Free University of Bolzano, Faculty of Education, Bolzano, Italy.
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Reassured or fobbed off? Perspectives on infertility consultations in primary care: a qualitative study. Br J Gen Pract 2012; 62:e438-45. [PMID: 22687237 DOI: 10.3399/bjgp12x649133] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Infertility affects 9% of couples in the UK. Most couples who visit their GP because they are worried about their fertility will ultimately conceive, but a few will not. Treatment usually happens in secondary care, but GPs can have an invaluable role in starting investigations, referring, and giving support throughout treatment and beyond. AIM To inform clinical practice by exploring primary care experiences of infertility treatment among females and males, and discussing findings with a reference group of GPs to explore practice experience. DESIGN AND SETTING A qualitative patient interview and GP focus group study. Interviews were conducted in patients homes in England and Scotland; the focus group was held at a national conference. METHOD An in-depth interview study was conducted with 27 females and 11 males. A maximum variation sample was sought and interviews were transcribed for thematic analysis. Results were discussed with a focus group of GPs to elicit their views. RESULTS Feeling that they were being taken seriously was very important to patients. Some felt that their concerns were not taken seriously, or that their GP did not appear to be well informed about infertility. The focus group of GPs highlighted the role of protocols in their management of patients who are infertile, as well as the difficulty GPs faced in communicating both reassurance and engagement. CONCLUSION Simple things that GPs say and do, such as describing the 'action plan' at the first consultation, could make a real difference to demonstrating that they are taking the fertility problem seriously.
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Ekelin M, Åkesson C, Ångerud M, Kvist LJ. Swedish high school students' knowledge and attitudes regarding fertility and family building. Reprod Health 2012; 9:6. [PMID: 22436468 PMCID: PMC3350449 DOI: 10.1186/1742-4755-9-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 03/21/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infertility is a serious problem for those who suffer. Some of the risks for infertility are preventable and the individual should therefore have knowledge of them. The purposes of this study were to investigate high-school students' knowledge about fertility, plans for family building and to compare views and knowledge between female and male students. METHODS A questionnaire containing 34 items was answered by 274 students. Answers from male and female students were compared using student's t-test for normally distributed variables and Mann-Whitney U-test for non-normal distributions. The chi-square test was used to compare proportions of male and female students who answered questions on nominal and ordinal scales. Differences were considered as statistically significant at a p-value of 0.05. RESULTS Analyses showed that 234 (85%) intended to have children. Female students felt parenthood to be significantly more important than male students: p = <0.01. The mean age at which the respondents thought they would like to start to build their family was 26 (± 2.9) years. Men believed that women's fertility declined significantly later than women did: p = <0.01. Women answered that 30.7% couples were involuntarily infertile and men answered 22.5%: p = <0.01. Females thought it significantly more likely that they would consider IVF or adoption than men, p = 0.01. Men felt they were more likely to abstain from having children than women: p = <0.01. Women believed that body weight influenced fertility significantly more often than men: p = <0.01 and men believed significantly more often that smoking influenced fertility: p = 0.03. Both female and male students answered that they would like to have more knowledge about the area of fertility. CONCLUSIONS Young people plan to start their families when the woman's fertility is already in decline. Improving young people's knowledge about these issues would give them more opportunity to take responsibility for their sexual health and to take an active role in shaping political change to improve conditions for earlier parenthood.
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Affiliation(s)
- Maria Ekelin
- Department of Health Sciences, Division of Nursing, Lund University, P.O Box 157 SE-221 00 LUND, Sweden
| | - Cecilia Åkesson
- Department of Obstetrics and Gynaecology, Kristianstad Hospital, Kristianstad, Sweden
| | - Malin Ångerud
- Department of Obstetrics and Gynaecology, Kristianstad Hospital, Kristianstad, Sweden
| | - Linda J Kvist
- Department of Health Sciences, Division of Nursing, Lund University, P.O Box 157 SE-221 00 LUND, Sweden
- Department of Obstetrics and Gynaecology, Helsingborg Hospital, Helsingborg, Sweden
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Efficacy of Traditional Chinese Herbal Medicine in the management of female infertility: A systematic review. Complement Ther Med 2011; 19:319-31. [DOI: 10.1016/j.ctim.2011.09.003] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Revised: 08/11/2011] [Accepted: 09/13/2011] [Indexed: 11/19/2022] Open
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Nachtigall RD, MacDougall K, Davis AC, Beyene Y. Expensive but worth it: older parents' attitudes and opinions about the costs and insurance coverage for in vitro fertilization. Fertil Steril 2011; 97:82-7. [PMID: 22118993 DOI: 10.1016/j.fertnstert.2011.10.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 10/11/2011] [Accepted: 10/14/2011] [Indexed: 10/15/2022]
Abstract
OBJECTIVE To describe older parents' attitudes and opinions about the costs and insurance coverage for IVF. DESIGN Qualitative interview study. SETTING Two Northern California IVF practices. PATIENT(S) Sixty women and 35 male partners in which the woman had delivered her first child after the age of 40 years using IVF. INTERVENTION(S) Two in-depth interviews over 3 months. MAIN OUTCOME MEASURE(S) Thematic analysis of interview transcripts. RESULT(S) We found that although the costs of IVF were perceived as high, even by those with insurance or who could afford them, the cost of IVF relative to other expenses in life was dwarfed by the value attributed to having a child. Women were twice as likely as men to support insurance coverage for IVF. Both men and women with complete or partial IVF insurance coverage were more likely to support insurance than those without coverage. There was a broad range of attitudes and opinions about the appropriateness of IVF insurance coverage, which addressed questions of age, gender equality, reproductive choice, whether infertility is a medical illness, and the role of personal and societal economic equity and responsibility. CONCLUSION(S) Despite a generally favorable opinion about the appropriateness of insurance coverage by those who have successfully undergone IVF treatment, the affordability of IVF remains an unresolved dilemma in the United States.
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Affiliation(s)
- Robert D Nachtigall
- Institute for Health and Aging, University of California, San Francisco, San Francisco, California 94118, USA.
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43
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Payne D, Goedeke S, Balfour S, Gudex G. Perspectives of mild cycle IVF: a qualitative study. Hum Reprod 2011; 27:167-72. [DOI: 10.1093/humrep/der361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gourounti K, Anagnostopoulos F, Alexias G, Vaslamatzis G. Appraisal of life events scale in a sample of Greek infertile women undergoing fertility treatment: a confirmatory factor analysis. Midwifery 2011; 28:385-90. [PMID: 21820777 DOI: 10.1016/j.midw.2011.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 05/13/2011] [Accepted: 06/21/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVE to examine the construct validity of the Greek version of the Appraisal of Life Events (ALE) scale, originally developed by Ferguson et al. (1999), in a sample of infertile women. As there are no data concerning the validity of the ALE scale in infertile populations, a special focus was placed on construct validity through confirmatory factor analysis (CFA). SETTING public hospital in Athens, Greece. DESIGN cross-sectional study. PARTICIPANTS 160 women undergoing fertility treatment with in-vitro fertilisation. METHODS the ALE scale was 'forward-backward' translated from English to Greek. The translated instrument was then administered to a set of infertile women for pilot testing. CFA was used to test the construct validity of the ALE scale. FINDINGS CFA supported the superiority of a model with three correlated first-order factors (challenge, threat and loss) and one second-order factor (stress appraisal) that underlay the first-order factors of threat and loss. CONCLUSION the ALE scale was found to have a multidimensional structure. IMPLICATIONS FOR PRACTICE the assessment of infertility appraisal during in-vitro fertilisation through a valid instrument may lead to the identification of women who are at greater risk of experiencing high stress, not only during fertility treatment but also during pregnancy and postnatal period in case of a successful IVF treatment.
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Affiliation(s)
- Kleanthi Gourounti
- Elena Benizelou Hospital, Department of Midwifery, Technological Educational Institution of Athens, 18756 Athens, Greece.
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45
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Greil AL, McQuillan J, Lowry M, Shreffler KM. Infertility treatment and fertility-specific distress: A longitudinal analysis of a population-based sample of U.S. women. Soc Sci Med 2011; 73:87-94. [PMID: 21645954 DOI: 10.1016/j.socscimed.2011.04.023] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Revised: 02/18/2011] [Accepted: 04/28/2011] [Indexed: 11/19/2022]
Abstract
Because research on infertile women usually uses clinic-based samples of treatment seekers, it is difficult to sort out to what extent distress is the result of the condition of infertility itself and to what extent it is a consequence of the experience of infertility treatment. We use the National Survey of Fertility Barriers, a two-wave national probability sample of U.S. women, to disentangle the effects of infertility and infertility treatment on fertility-specific distress. Using a series of ANOVAs, we examine 266 infertile women who experienced infertility both at Wave 1 and at Wave 2, three years later. We compare eight groups of infertile women based on whether or not they have received treatment and on whether or not they have had a live birth. At Wave 1, infertile women who did not receive treatment and who had no live birth reported lower distress levels than women who received treatment at Wave 1 only, regardless of whether their infertility episode was followed by a live birth. At Wave 2, women who received no treatment have significantly lower fertility-specific distress than women who were treated at Wave 1 or at Waves 1 and 2, regardless of whether there was a subsequent live birth. Furthermore, fertility-specific distress did not increase over time among infertile women who did not receive treatment. The increase infertility-specific distress was significantly higher for women who received treatment at Wave 2 that was not followed by a live birth than for women who received no treatment or for women who received treatment at Wave 1 only. These patterns suggest that infertility treatment is associated with levels of distress over and above those associated with the state of being infertile in and of itself.
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Affiliation(s)
- Arthur L Greil
- Division of Social Sciences, Alfred University, 1 Saxon Drive, Alfred, NY 14802, USA.
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Palumbo A, De La Fuente P, Rodríguez M, Sánchez F, Martínez-Salazar J, Muñoz M, Marqueta J, Hernández J, Espallardo O, Polanco C, Paz S, Lizán L. Willingness to pay and conjoint analysis to determine women's preferences for ovarian stimulating hormones in the treatment of infertility in Spain. Hum Reprod 2011; 26:1790-8. [PMID: 21558333 PMCID: PMC3113505 DOI: 10.1093/humrep/der139] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Despite many advances in assisted reproductive techniques (ART), little is known about preferences for technological developments of women undergoing fertility treatments. The aims of this study were to investigate the preferences of infertile women undergoing ART for controlled ovarian stimulation (COS) treatments; to determine the utility values ascribed to different attributes of COS treatments; and to estimate women's willingness to pay (WTP) for COS. METHODS A representative sample of ambulatory patients ready to receive, or receiving, COS therapies for infertility were recruited from seven specialized private centres in six autonomous communities in Spain. Descriptive, inferential and conjoint analyses (CA) were used to elicit preferences and WTP. Attributes and levels of COS treatments were identified by literature review and two focus groups with experts and patients. WTP valuations were derived by a combination of double-bounded (closed-ended) and open questions and contingent ranking methods. RESULTS In total, 160 patients [mean (standard deviation; SD) age: 35.8 (4.2) years] were interviewed. Over half of the participants (55.0%) had a high level of education (university degree), most (78.8%) were married and half (50.0%) had an estimated net income of >€1502 per month and had paid a mean (SD) €1194.17 (€778.29) for their most recent hormonal treatment. The most frequent causes of infertility were related to sperm abnormalities (50.3%). In 30.6% of cases, there were two causes of infertility. The maximum WTP for COS treatment was €800 (median) per cycle; 35.5% were willing to pay an additional €101-€300 for a 1-2% effectiveness gain in the treatment. Utility values (CA) showed that effectiveness was the most valued attribute (39.82), followed by costs (18.74), safety (17.75) and information sharing with physicians (14.93). CONCLUSIONS WTP for COS therapies exceeds current cost. Additional WTP exists for 1-2% effectiveness improvement. Effectiveness and costs were the most important determinants of preferences, followed by safety and information sharing with physicians.
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Affiliation(s)
- A Palumbo
- FIVAP, Santa Cruz de Tenerife 38204, Spain
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Dancet EAF, Van Empel IWH, Rober P, Nelen WLDM, Kremer JAM, D'Hooghe TM. Patient-centred infertility care: a qualitative study to listen to the patient's voice. Hum Reprod 2011; 26:827-33. [PMID: 21317152 DOI: 10.1093/humrep/der022] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND High-quality care for patients faced with infertility should be patient-centred. Few studies have provided in-depth insights into the patient's perspective on care and, to the best of our knowledge, no study has provided a model of the complex concept 'patient-centred infertility care'. Therefore, a qualitative study aimed at understanding 'patient-centred infertility care' from the patient's perspective was conducted. METHODS Fourteen focus group discussions were organized with patients (n = 103) from two European countries to find out about patients' positive and negative experiences with infertility care. Content analysis of the transcripts and analysis of patients' priority lists were conducted. RESULTS The patient-centredness of infertility care depends on 10 detailed dimensions, which can be divided into system and human factors, and there is a two-way interaction between both kinds of factors. System factors, in order of patient's priority, are: provision of information, competence of clinic and staff, coordination and integration, accessibility, continuity and transition and physical comfort. Human factors, in order of patient's priority, are: attitude of and relationship with staff, communication, patient involvement and privacy and emotional support. CONCLUSIONS This study provides a detailed patient's description of the concept 'patient-centred infertility care' and an interaction model that aids understanding of the concept. Fertility clinics are encouraged to improve the patient-centredness of their care by taking into account the detailed description of the dimensions of patient-centred infertility care, and by paying attention to both system and human factors and their interaction when setting up 'patient-centred improvement projects'.
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Affiliation(s)
- E A F Dancet
- Leuven University Fertility Centre, Leuven University Hospital, Herestraat 49, Leuven, Belgium.
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Takabayashi C, Shimada K. Do Infertile Women and Government Staff Differ in the Evaluation of Infertility-related Web Sites? Public Health Nurs 2011; 28:411-20. [DOI: 10.1111/j.1525-1446.2010.00917.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hinton L, Kurinczuk JJ, Ziebland S. Infertility; isolation and the Internet: a qualitative interview study. PATIENT EDUCATION AND COUNSELING 2010; 81:436-441. [PMID: 21036506 DOI: 10.1016/j.pec.2010.09.023] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Revised: 09/20/2010] [Accepted: 09/23/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVES This study explores the roles and meanings of the Internet, which is commonly used in this age group, as a source of support for people with fertility problems. METHODS A qualitative interview study with 27 women and 11 men who had been, or were going, through treatment for infertility. A maximum variation sample was sought. Narrative interviews were conducted and transcribed for thematic analysis. RESULTS Women and men with fertility problems often feel isolated. The Internet offers anonymity, emotional support, normalisation and reassurance. It also offers the prospect of niche support from others going through treatments at the same time and in similar circumstances. Online infertility networks can play a valuable role in helping people deal with the emotional stresses and isolation they feel during and after treatment, but has the potential to reinforce isolation. CONCLUSIONS The Internet is changing people's experience of infertility, giving people access to other's experiences. Internet communication is highly valued by couples, especially those isolated in their real world relationships. PRACTICE IMPLICATIONS Clinicians can help by referring couples to websites while being aware that increasingly 'niche' support could compound isolation.
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Affiliation(s)
- Lisa Hinton
- Health Experiences Research Group, Department of Primary Care, University of Oxford, Oxford, United Kingdom.
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Dancet EAF, Spiessens C, Blocquiaux L, Sermeus W, Vanderschueren D, D'Hooghe TM. Testicular biopsy before ART: the patients' perspective on the quality of care. Hum Reprod 2010; 25:3072-82. [PMID: 20876087 DOI: 10.1093/humrep/deq262] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND So far, research on the patients' perspective on fertility care has mainly focused on women. Our primary aim was to explore what is important to men with respect to care related to testicular sperm extraction (TESE) and to identify strengths and weaknesses of that care. METHODS This was a mixed-method study including phenomenology on interviews with 17 'interview participants' (a purposive sample with diversification for the TESE result) who received a TESE treatment at a tertiary university clinic. Strengths and weaknesses of our TESE-related quality of care were identified. Additionally, a telephone questionnaire was answered by 15 'rating participants' not willing to be interviewed and the questionnaire was analyzed quantitatively. RESULTS Interview participants wanted more than effective treatment and attached importance to the attitude of fertility clinic staff, information, time flow, personalized care, 'all that is necessary', coaching, a homely atmosphere, continuity, privacy and separate accommodation. The satisfaction of rating participants (independent of the TESE result) was problematic for 'overall experience', 'physician at the day clinic' and 'gynecologist at discussion of the result'. The attitude of fertility clinic staff and information were the most obvious strengths of our TESE-related care. Weaknesses were lack of practical information on post-surgical recovery and waiting times in the waiting room. CONCLUSIONS TESE patients focus not only on clinical effectiveness but also on patient-centeredness of care, and this has led to organizational changes and a new patient information brochure in our center. Qualitative research is useful to examine, understand and improve the patient-centeredness of care.
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Affiliation(s)
- E A F Dancet
- Leuven University Fertility Centre, Leuven University Hospital, Leuven, Belgium.
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