Advances in fertility preservation and pregnancy care for transplant patients

Fertility preservation and pregnancymanagement are critical considerations for patients undergoing organtransplantation. Innovations in assisted reproductive technologies, hormonalmodulation, and personalized medicine have expanded options for these patients, who face unique challenges due to immunosuppressive therapy and organ functionconcerns. This mini-review explores advancements in cryopreservationtechniques, pre-conception counseling, and multidisciplinary strategies forsafe pregnancies post-transplantation. Emphasis is placed on balancing maternalhealth, graft function, and fetal outcomes. The integration of reproductive andtransplant medicine is paving the way for improved quality of life andreproductive autonomy for this patient population.

Determinants of the economic burden of ART on the Italian NHS: insights from the Lombardy region

With the rising spread of Assisted Reproductive Technology (ART), it becomes imperative to understand the determinants of resource utilization in ART versus spontaneous pregnancies to enhance policies directed to pregnancy care. The focus of our study is to examine the costs associated with ART from the perspective of the Italian NHS and to investigate in depth the contributing social and clinical factors.Using the healthcare informative system of Lombardy, a Region of Northern Italy, we gathered individual-level information for a cohort of women who experienced either spontaneous pregnancies or pregnancies following ART from 2007 until 2020. The information covered multiple healthcare services, and we used a propensity score matching technique to match couples of ART/No ART women based on a comprehensive set of confounders. We then applied statistical tests and regression models to identify the impact of ART on the reported cost differences.Our cohort was composed of 44652 women and results revealed significantly higher costs for ART pregnancies, especially in terms of hospital admissions (additional 1611€, 95% CI 1558-1666) and drug prescriptions (additional 216 €, CI 95% 204-228) occurring before delivery. In-depth analysis showed for ART pregnancies, i) a higher likelihood of incurring expenses related to complications and ii) higher costs associated with two established clinical practices that lack scientific evidence supporting their efficacy.Our study sheds light on the complex interplay of clinical and social factors influencing the ART burden, emphasizing the importance of tailored support and evidence-based practices in optimizing outcomes and resource allocation.

Men's Perceptions and Expectations of Fertility Clinics

BACKGROUND

Most of the research and care in fertility focuses on women, whereas men's perspectives and expectations are often overlooked.

OBJECTIVES

The aim of the study was to explore the experiences and expectations of men with primary infertility regarding fertility clinics and to provide implications for personalized and inclusive care.

METHODS

A qualitative study was conducted in Iran between November 2022 and October 2023. Thirteen men with primary infertility were interviewed in-depth using a semistructured approach. Data were analyzed using the inductive content analysis method.

RESULTS

The central theme, "Therapy Environment: Private and Interactive," was identified. The theme comprises four categories: Effective Interaction-A Key to Therapy Success; Infertility Treatment-A Joint Effort; Personal and Stress-Free Environment-Essential for Treatment; and Treatment Plan-Vital for Successful Outcome.

DISCUSSIONS

Study findings underscore the importance of tailored approaches to male infertility care. Healthcare providers should prioritize personalized, stress-free environments for male infertility patients and encourage effective communication and joint participation with partners to achieve successful outcomes. Tailored approaches and therapeutic settings should be created to cater to male patients' unique needs.

Burnout in Assisted Reproduction Professionals: The Influence of Stressors in the Workplace

BACKGROUND/OBJECTIVES

Most of the research in assisted reproduction has focused on the stressful situation experienced by women or couples looking for a desired pregnancy; however, the stress experienced by assisted reproduction professional teams is seldom studied. The present study aims to evaluate burnout and its relationship with workplace stressors among assisted reproduction professionals.

METHODS

A cross-sectional design was used to conduct an online self-assessment national survey, sent to all members of the Spanish Association for Fertility. The questionnaire contained sociodemographic and occupational questions about stressors in the workplace and the Maslach Burnout Inventory (MBI-HSS) to assess the three subscales of burnout: emotional exhaustion, depersonalization and personal accomplishment.

RESULTS

The percentages showing high emotional exhaustion and depersonalization in the whole sample were 41.8% and 43.2%, respectively. Additionally, low personal accomplishment was displayed in 42.6% of the respondents. Embryologists stand out for presenting the highest percentages of burnout (emotional exhaustion = 72.1%; depersonalization = 48.1%; low personal accomplishment = 48.1%), whilst psychologists showed the lowest percentages in high emotional exhaustion (32.3%) and depersonalization (24%), and gynecologists in low personal accomplishment (28.5%). Working under pressure was the stressor most experienced by the sample (76.6%) and the one that better predicted the three subscales of burnout.

CONCLUSIONS

This study highlights the close relationship between high levels of burnout and workplace stressors and shows the need to reduce workplace stressors to improve the well-being of professionals working in assisted reproduction, and, consequently, that of the patients they look after.

Business case for psychosocial interventions in clinics: potential for decrease in treatment discontinuation and costs

RESEARCH QUESTION

From a value-based healthcare (VBHC) perspective, does an assessment of clinical outcomes and intervention costs indicate that providing cognitive behavioural therapy (CBT) or mindfulness to women seeking fertility treatment add value compared with no such intervention?

DESIGN

Proof-of-concept business case based on a VBHC perspective that considers clinical outcomes and costs. Potential effects on psychological and fertility outcomes were based on existing research. Cost outcomes were estimated with a costing model for the Dutch fertility treatment setting.

RESULTS

Thirty-two studies were identified; 13 were included. Women who received CBT had 12% lower anxiety, 40% lower depression and 6% higher fertility quality of life; difference in clinical pregnancy rates was six percentage points (CBT [30.2%]; control [24.2%]); difference in fertility discontinuation rates was 10 percentage points (CBT [5.5%]; control [15.2%]). Women who received training in mindfulness had 8% lower anxiety, 45% lower depression and 21% higher fertility quality of life; difference in mean clinical pregnancy rate was 19 percentage points (mindfulness [44.8%]; control [26.0%]). Potential total cost savings was about €1.2 million per year if CBT was provided and €11 million if mindfulness was provided. Corresponding return on investment for CBT was 30.7%, and for mindfulness 288%. Potential cost benefits are influenced by the assumed clinical pregnancy rates; such data related to mindfulness were limited to one study.

CONCLUSIONS

The provision of CBT or mindfulness to women seeking fertility treatment could add value. Higher quality primary studies are needed on the effect of mindfulness on clinical pregnancy rates.

Fertility clinics have a duty of care towards patients who do not have children with treatment

In medically assisted reproduction (MAR) success has mostly been measured in terms of achieving (healthy) livebirths. We argue this focus is too narrow and that success should be measured in terms of alleviating patient suffering caused by an unfulfilled child wish. The major implication is that clinics must better tailored care to effectively support patients who do not have child(ren) with treatment. First, we argue that clinics have a duty of care towards patients for whom MAR does not result in children because this is a common treatment outcome, because treatment is burdensome and creates new losses for patients, and because the field has the necessary expertise to provide support and it is part of patient-centred care. Then, we examine concerns about the adequacy of addressing the possibility that treatment may end without children, namely, that this may hinder patients' hope and put them off doing treatment, and that it may be perceived as a sign of clinical incompetence, as well as concerns about the required skill set. We end with a set of research-informed recommendations to promote healthy adjustment to ending fertility treatment without children. These focus on the need to reconceptualize 'success' and 'failure' in MAR, to promote open discussion about the possibility of treatment not resulting in children and encourage patients to develop 'plan(s) B', to support patients who end treatment without children, and to create the organizational structures needed to support clinics and healthcare professionals in this endeavour.

Evaluation of infertility counselling in Germany

PURPOSE

This paper reports on the first evaluation of infertility counselling in Germany.

METHODS

Sixty-nine infertility counsellors provided feedback via 524 survey sheets and 182 questionnaires were filled in by clients.

RESULTS

The results show a high level of satisfaction on behalf of the clients. They valued the emotional support, information, and exploration of family-building options with and without medical assistance and the counsellors' expertise. During counselling, coping with the emotional burden of infertility was an important issue, but in more than half of all counselling sessions, future parental issues were addressed. The group of clients seeking support can be described to be very heterogeneous, and counselling issues comprise a wide range of aspects.

CONCLUSIONS

This piece of research suggests that the following issues need to be considered to improve infertility counselling. Better integration of counselling in infertility clinics, more awareness for infertility counselling for other medical and non-medical professions Better funding for counselling so that its uptake is not dependent upon the financial resources of clients Awareness for new groups of clients and counselling issues such as single and transgender individuals, co-parenting families There is a need for more research and the development of counselling concepts.

Integrated Behavioral Health Care in Reproductive Medicine: How and Why to Include Mental Health Professionals in Infertility Care Teams

Despite fertility patients' reports of significant distress, few have access to integrated mental health care services. We elucidate the benefits and challenges of mental health integration in infertility practices from the perspective of both patients and providers. We outline specific models of integration, financial viability, and the first steps fertility clinics could take to improve their patients' access to these critical supports.

Toward a Personalized Psychological Counseling Service in Assisted Reproductive Technology Centers: A Qualitative Analysis of Couples' Needs

Infertility may have a very strong emotional impact on individuals, requiring adequate support, but few studies on patients' demands toward psychological support have been conducted. This study aims to explore the emotions related to the infertility and to the Assisted Reproductive Technology (ART) procedure for which patients consider useful a psychological support. A total of 324 women completed a sociodemographic and clinical questionnaire and an open-ended questionnaire on emotional needs for psychological support. The written texts were explored by the Linguistic Inquiry and Word Count (LIWC) programme and linguistic characteristics were related to sociodemographic and anamnestic variables. Specific linguistic features were connected to several individual characteristics. More specifically, differences in linguistic processes emerged comparing women with an age over or under 40 years, women undergoing their first attempts versus more attempts, women undergoing ART with or without gamete donation, and women undergoing ART for male or unknown causes, as well as those undergoing ART for female or both partners' problems. These differences seem to confirm that older age, more attempts, gamete donation, and ART for unknown or male causes are risk factors that may worsen women's psychological well-being. This study contributes to increase the knowledge about the emotional needs of patients undergoing an ART procedure to develop specific psychological intervention programs.