P-488 Perceptions of gamete and embryo donation recipient parents about the online experimental and control programs in the TELL Tool feasibility clinical trial at immediate post-test

Study question

What are parents’ initial perceptions about the online experimental and control programs at immediate post-test?

Summary answer

Parents reported overall acceptability of the online instructions, technological navigation, length, and quality of videos, as well as suggestions for further improvement.

What is known already

Multiple investigations have examined the reasons why parents who used donated gametes or embryos, decide to inform their children that they were conceived through third-party reproduction. A consistent theme in this research is parental calls for strategies and tools to aid parents with disclosure to their children. Despite these calls from parents, little research has focused on developing new methods of delivering parent-focused materials that aim to assist parents in their disclosure process. To address this concern, we developed an online experimental program called the Tool to Empower Parental TeLling and TaLking (TELL Tool) and completed alpha testing.

Study design, size, duration

A 3-month feasibility clinical trial.

Participants/materials, setting, methods

Donor sperm, egg, and embryo recipient parents were randomized to either an experimental TELL Tool program or a control program focused on good parenting practices. Both the TELL Tool and the control programs are administered online. To date 13 parents have completed the experimental or control program and each participant has answered an immediate post-test survey about the acceptability of the program. Descriptive statistics and qualitative content analysis guided the analysis.

Main results and the role of chance

The sample consists of 13 U.S. parents between 35 to 53 years (M = 41.3 years). The parents used donated sperm (n = 5), eggs (n = 2), sperm and eggs (n = 2) or embryos (n = 4) and their children were between 1 to 12 years (M = 5.7 years). Most parents were female (n = 11) and White (n = 10). Parents were asked to rate the level of truthfulness about the acceptability of the online programs (ratings: 1 to 5, with 1 being “not at all true” to 5 being “very true”). Responses about the: (1) instructions provided for accessing the program were easy, were: range 3 to 5, M = 3.9; (2) technological navigation within the program was problematic, were: range 1 to 5, M = 2.7; (3) length of the program was too long, were: range 1 to 5, M = 3; and (4) videos within the program were helpful, were: range 3 to 5, M = 3.69. Responses to the open-ended questions provided insights to the ratings, such as parents’ statements about specific technological issues (e.g., ability to print resources, ease of navigating in-and-out of the program).

Limitations, reasons for caution

Preliminary data are reported for the feasibility trial at the immediate post-test timepoint as recruitment is ongoing. As the 3-month study unfolds, additional data will be obtained to allow for more in-depth understanding of parents’ perceptions about the acceptability of the experimental TELL Tool and control programs.

Wider implications of the findings

The acceptability of the online research for donor gamete and embryo recipient parents may illuminate access issues to these often hidden and dispersed parents and their families across the lifespan. Parents’ responses can provide a window of understanding for other decision aids that target health promotion among parents and children.

Trial registration number

NCT04841967

P–496 Alpha test results: Towards developing a digital prototype intervention to support parents’ disclosure about donor conception in the United States

Study question

The objective of the study was to determine the usability, comprehensibility, and acceptability of a digital, decision-support aid prototype supporting parental disclosure of donor conception. Summary answer: This mixed methods design maximized participant feedback about the digital, decision-support aid prototype yielding rich insight about the prototype while minimizing participant and investigator burden.

What is known already

Although a paradigm shift is underway to remove the secrecy that has historically shrouded the practice of gamete donation, little is known about best practices that can support parents in disclosing the conceptional origins to their children. To address this gap, we created a decision-support aid prototype to facilitate parental disclosure post-treatment. In doing so, we followed the International Patient Decision Aid Standards Collaboration for developing decision-support aids, which recommends that Alpha testing (i.e., usability, comprehensibility, and acceptability) be completed to improve the quality of newly created decision-support interventions prior to Beta (i.e., real world) testing.

Study design, size, duration

A mixed-methods, triangulation design was used.

Participants/materials, setting, methods

Sixteen participants were purposefully selected based on desired characteristics and the needs of the study. Participants were asked to: (1) follow investigator prepared instructions for accessing the digital, decision-support aid; (2) complete a quantitative rating form about each slide within the decision-support aid prototype; and (3) participate in a qualitative, cognitive interview or focus group. Descriptive statistics and qualitative content analysis guided the iterative analysis.

Main results and the role of chance

The sample was composed of 10 parents that used donated sperm (n = 3), oocytes (n = 4), or embryos (n = 2) to conceive children and 8 clinicians; 2 participants were both donor recipient parents and clinicians. The interviews (n = 14) and one focus group (2 participants) ranged in length from 25 to 70 minutes (M = 47 minutes).

Usability: Participants suggested refining the instructions for accessing the decision-support aid and upgrading the technology used to deliver the content. Common concerns were the inconsistent volume of the audio recordings and a need for higher quality images. Comprehensibility: Feedback obtained from the participants’ rating forms and in the interviews and focus group were consistently high about the ability to understand the content and the scope of the information presented. Acceptability: Participants noted the aid would resonate with parents. They recommended shortening the length of the aid, changing specific wording, modifying some of the video content, refining specific content for individual slides and the four modules. Unintended recommendations about how the aid might be used to provide clinician education or in international research were also reported.

Limitations, reasons for caution

Alpha testing is not designed to obtain all possible technological or content issues. Rather, it is a useful and recommended step in intervention development to mitigate existing technological bugs and key content issues prior to implementation of Beta testing of a decision-support aid.

Wider implications of the findings: Other investigators that develop digital decision-support aids may consider the use of both quantitative and qualitative data collection methods during Alpha testing to refine digital interventions efficiently. The use of mixed methods not only captures rich and insightful feedback but also minimizes the burden on participants and investigators.

Trial registration number

Not applicable

Parents' knowledge about the donors and their attitudes toward disclosure in oocyte donation

BACKGROUND

Oocyte donation is a popular treatment option among women with ovarian dysfunction. Little is known about the amount of information recipients have about their donors and if the amount of information the couple has relates to their plans to disclose. The purpose of this study was to assess the amount of information recipients had about their donors and their disclosure plans.

METHODS

Sixty-two sets of oocyte donation parents from five programmes completed a self-report questionnaire.

RESULTS

Ninety percent of both men and women knew their donor's age, ethnicity, hair colour, eye colour, height, weight, education and medical history. Significantly more women than men told others about using a donor to conceive, but two-thirds of women and men would not tell others if they had to do it over again. Fifty-nine percent of women and 52% of men planned to or had told their child; 34% of women and 41% of men do not plan to tell. The amount of information known about the donor was related to plans to tell the child for men only.

CONCLUSION

Approximately half of couples plan to tell their child of their oocyte donor origin and a majority have told others but many regret having done so. Knowledge about the donor is related to disclosure for men only.

Infertility patients and their partners: differences in the desire for twin gestations

OBJECTIVE

To explore how the individuals within an infertile couple differ from one another in their attitudes toward the conception of twin gestations.

METHODS

From November 1999 through February 2000, consecutive couples undergoing treatment at a university-based infertility clinic were invited to participate in a face-to-face interview that ascertained their individual desires for singleton and twin gestations and their perception of the risks associated with these pregnancies.

RESULTS

Of the 94 couples approached, 90 (96%) agreed to participate in the study. Patients estimated the incidence of prematurity, low birth weight, preeclampsia, and postpartum depression in twin gestations to be significantly greater than their partners did (27% versus 17%, 26% versus 17%, 22% versus 16%, and 21% versus 16%, respectively). Despite these higher estimates, the desire for a twin gestation was similar. In 19 couples (21%), the patient and partner did not agree whether a singleton or twin pregnancy was the most preferred outcome. No predictive factor for this discordance could be identified.

CONCLUSION

Women undergoing infertility treatment are less risk averse than their partners. Additionally, a sizeable portion of couples do not align in their preference for a twin gestation. These differences should be recognized and addressed during the preconceptional period.

Patient perceptions of multiple gestations: an assessment of knowledge and risk aversion

OBJECTIVE

To determine whether knowledge of the increased risk of certain pregnancy complications affects a woman's desire to achieve a multifetal gestation.

STUDY DESIGN

Women who attended an infertility clinic were given an interviewer-administered survey that ascertained how intensely they desired a multifetal pregnancy and how accurately they perceived the risks of multifetal complications. In addition, 5-point Likert scales were used to assess how different perceptions of risk affected the desire for gestations of different plurality.

RESULTS

Most respondents (67%) expressed the desire to conceive a twin pregnancy, although they could not accurately estimate the probability of risks associated with this type of pregnancy. Nevertheless, their desire was affected by perceptions of pregnancy-associated risk. On the basis of ordinal regression, desire for twins was more likely after in vitro fertilization (P <.01) but less likely as a woman's estimation of the risk of pregnancy complications increased (P <.05). When women were presented with scenarios of differing pregnancy-associated risk magnitudes, their desire for twin pregnancy decreased as risk magnitudes increased (median Likert score decrease from 4 to 3 to 2, P <.01). After being confronted with the actual probabilities of specified perinatal complications associated with a twin pregnancy, women were less desirous of having a twin pregnancy (median Likert score decrease from 4 to 3, P <.001) than they had originally expressed.

CONCLUSION

Women who undergo treatment for infertility are not well aware of the risks of perinatal complications associated with multiple gestations. Moreover, these women are risk sensitive and change their desires on the basis of their perception of overall risk.

Psychological status of in vitro fertilization patients during pregnancy: a longitudinal study

OBJECTIVE

To determine whether women who get pregnant as a result of IVF differ psychologically from pregnant women who conceived naturally.

DESIGN

Prospective, longitudinal study.

SETTING

Healthy volunteers from outpatient infertility and obstetrics practices.

PATIENT(S)

Seventy-four women who became pregnant via IVF and 40 women conceiving without medical intervention.

INTERVENTION(S)

Subjects completed self-report questionnaires about demographic and reproductive history, rewards and concerns of pregnancy, self-esteem, marital adjustment, depressive symptoms, and anxiety at 12 and 28 weeks' gestational age.

MAIN OUTCOME MEASURE(S)

Self-esteem, depression, and anxiety scores.

RESULT(S)

There were no significant differences between groups on any of the outcome measures assessing psychological status at the two assessment times. Differences were found on specific items assessing the rewards and concerns of pregnancy. Within-group changes over time indicated that IVF women, not controls, showed an increase in self-esteem and a decrease in anxiety during pregnancy.

CONCLUSION(S)

Pregnant IVF women are similar psychologically to women who become pregnant naturally on dimensions of self-esteem, depression, and anxiety at 12 and 28 weeks' gestational age. The IVF group, not controls, reported improved self-esteem and decreased anxiety as the pregnancy progressed.

Analysis of Minnesota Multiphasic Personality Inventory-2 profiles of prospective anonymous oocyte donors in relation to the outcome of the donor selection process

OBJECTIVE

To examine the scores of prospective anonymous oocyte donors on the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) in four outcome groups.

DESIGN

Chart review.

SETTING

Academic medical center.

PATIENT(S)

One hundred fifty prospective anonymous oocyte donors who underwent a preliminary screening and a 1-hour structured psychological interview and who completed the MMPI-2.

INTERVENTION(S)

Psychological evaluation prior to donation.

MAIN OUTCOME MEASURE(S)

Scores on the MMPI-2 and outcomes of the donor selection process.

RESULT(S)

Seventy (47%) women were accepted as donors and completed one donation cycle; 30 (20%) were accepted as donors but did not donate because of medical reasons or relocation; 18 (12%) were accepted as donors but were noncompliant; and 32 (21%) were rejected as donors because of psychological concerns. Statistically significant differences were found between outcome groups on scales F, K, 1, 2, 7, 8, and 0. Although these differences were statistically significant, all group subscale mean scores were in the average to low-average range and differences between group means were small.

CONCLUSION(S)

The MMPI-2 differentiates between prospective donor outcome groups, but psychologists need to interpret the results of the MMPI-2 carefully in the context of clinical interview information.

Lesbian couples as therapeutic donor insemination recipients: do they differ from other patients?

Reports were based on 23 lesbian couples seeking therapeutic donor insemination (TDI). Seventeen single women and 14 heterosexual couples with known infertility, due to vasectomy, were recipient controls. No group differences were found on self-esteem, psychiatric symptomatology or dyadic adjustment, except that lesbians reported greater dyadic cohesion than heterosexuals. Lesbians and single women were likely to disclose their use of TDI to others and had planned to disclose this to any child conceived; married couples were divided on this issue. Groups were alike in what they wanted to know about the donor (principally health variables and medical history), and in their concerns about the use of TDI (genetic and medical history). Groups differed in the reasons they elected to use TDI, with lesbian couples and single women choosing TDI affirmatively, and married couples accepting it as a last resort.

Long-term outcome of nonconservative surgery (hysterectomy) for endometriosis-associated pain in women <30 years old

OBJECTIVE

This study was undertaken to evaluate the effect that a patient's age at the time of hysterectomy for endometriosis-associated pain has on long-term improvement in symptoms.

STUDY DESIGN

An investigation of women who underwent hysterectomy for pelvic pain and endometriosis at <30 or >40 years of age was performed by means of medical records review and mailed questionnaires. Participants were asked to complete 2 standardized surveys, the Disruption of Functioning Index and the Beck Depression Inventory.

RESULTS

Sixteen women in the study group (<30 years old) and 27 women in the control group returned completed questionnaires. Although similar proportions reported overall alleviation of pain, the study group was significantly more likely to report residual symptoms, such as dyspareunia and dysuria. This younger group also more often reported a sense of loss after hysterectomy and reported more overall disruption in different aspects of life.

CONCLUSION

Women who undergo hysterectomy for pelvic pain and endometriosis at <30 years old are more likely than older women to have residual symptoms, to report a sense of loss, and to report more disruption from pain in different aspects of their lives.

Relationship between psychological stress and semen quality among in-vitro fertilization patients

The purpose of this study was to determine the relationship between psychological stress and semen quality among men undergoing in-vitro fertilization (IVF). We assessed psychological variables, including self-reported stress, and sperm parameters in a group of 40 men undergoing IVF for the first time at a pre-IVF sampling period (T1) and at the time of egg retrieval (T2). Thirty-one patients completed the study. Results indicated that total and motile sperm concentration, total motile spermatozoa, and lateral head displacement decreased significantly from T1 to T2 in a high percentage of participants. In addition, the perceived importance of producing a semen specimen increased significantly (P = 0.001) from T1 to T2, and this change was significantly correlated (P < 0.05) with diminished semen quality at the time of oocyte retrieval. No decline in the semen quality or increase in perceived stress at egg retrieval was observed at T2 in male factor patients (n = 7). This study provides evidence for a significant decline in semen quality of male IVF patients at egg retrieval and demonstrates an inverse relationship between semen quality and specific aspects of psychological stress.

Stress and anxiety do not result in pregnancy wastage

The association between stress and reproductive outcome is unclear. In-vitro fertilization (IVF) is psychologically stressful and has been shown to alter psychological markers such as cortisol, prolactin and progesterone. This study was designed to assess prospectively psychological and physiological markers of stress and to determine if they are related to pregnancy outcome. Forty patients were recruited from Northwestern Medical Faculty Foundation (Chicago, Illinois, USA) having obtained an initial positive beta-human chorionic gonadotrophin (HCG) concentration 13 days after IVF with uterine embryo transfer. Patients underwent psychological and hormonal testing on three separate occasions (13, 20 and 27 days after embryo transfer) early in pregnancy. All subjects were followed to delivery. An adverse outcome was defined as a miscarriage before or after cardiac activity (including vanishing twin) or a loss before 20 weeks gestation. There was no difference in age, duration of infertility, diagnosis between patients experiencing an adverse pregnancy outcome (n = 18) and those that did not (n = 22). All patients were found to have high stress levels although this did not differentiate between groups of patients. There was no difference in hormonal markers of stress between patients. In conclusion, there is little association between psychological scores and physiological stress hormone concentrations. Also, it does not appear that high levels of anxiety and stress result in an adverse pregnancy outcome.

Predicting anonymous egg donor satisfaction: a preliminary study

Our aim was to assess the psychologic characteristics and postdonation satisfaction of anonymous oocyte donors. Twenty-five consecutive anonymous oocyte donors completed psychologic tests before donation and satisfaction ratings following completion of the egg donation cycle. The average donor was 27 years old, married, and employed outside the home. All predonation scores on the psychologic measures were within the normal range. However, 24% of donors reported a history of sexual assault, and 40% described having had some type of reproductive loss. Although monetary compensation for donation was provided, altruism was reported as the most salient motivating factor. Following oocyte donation, 80% of women stated that they would be willing to donate again. Postdonation satisfaction was high. A significant negative correlation was found between predonation financial motivation and postdonation satisfaction (r = -.48, p < 0.01) and between predonation ambivalence and postdonation satisfaction (r = -.84, p < 0.0001). Donors with high levels of predonation financial motivation or ambivalence should be carefully screened and counseled before oocyte donation to ensure satisfactory psychologic outcome.

Psychological distress among women with recurrent spontaneous abortion

Fifty-seven of 100 women with recurrent abortion completed questionnaires designed to assess demographic and reproductive variables, depression, anxiety, social desirability, self-esteem, locus of control, and marital adjustment. The results indicated that 32% of the women could be classified as depressed. The subjects also reported higher than average levels of acute and chronic anxiety. Fifty-three percent of the subjects reported below average marital adjustment. Post hoc analyses indicated that the women who had a previous elective abortion had higher levels of anxiety, lower marital adjustment, and different attributions regarding their pregnancy losses than the women who had not had an elective abortion. Having a living child was not a protective buffer against psychological distress.

A comparison of single and married recipients of donor insemination

There has been some controversy surrounding the use of donor insemination (DI) for single women. The purpose of the present study was to compare psychological characteristics of married versus single women who were DI recipients. A total of 17 single women and 17 married women completed psychological questionnaires regarding psychiatric symptomatology, self-esteem, and their attitudes towards DI prior to treatment. There were no significant differences between the groups in psychiatric symptomatology or level of self-esteem. A significant difference was found in the amount of time taken to decide to use DI with single women waiting longer. There were no significant differences between groups in reported concerns about the child. There were significant differences in attitudes towards disclosure with more single than married women reporting that they would tell the child about using DI to conceive.

Efficacy of oral micronized progesterone in the treatment of luteal phase defects

OBJECTIVE

Vaginal progesterone suppositories are an accepted treatment for infertility attributed to luteal phase defects. Although oral micronized progesterone may be preferable to suppositories for many patients, there are no studies on its use for patients with luteal phase defects. This study evaluated the efficacy of oral micronized progesterone for the treatment of luteal phase defects.

STUDY DESIGN

Seven women with luteal phase defects previously corrected by vaginal suppositories were administered oral micronized progesterone (200 mg by mouth three times a day). Endometrial biopsies were performed to evaluate treatment efficacy. Questionnaires were used to assess side effects, including sedation.

RESULTS

On oral micronized progesterone, all patients had in-phase endometrial biopsies. Despite complaints of drowsiness, the majority of patients preferred the oral formulation over the vaginal route of administration.

CONCLUSION

We conclude that oral micronized progesterone is efficacious in the treatment of luteal phase defects.

Eating disorder characteristics and psychiatric symptomatology of eumenorrheic and amenorrheic runners

Many studies have investigated the relationship between obligatory runners and eating disorder characteristics. Unfortunately, many studies have failed to consider the effect of menstrual status among females in these studies. The present study examined the psychological status and eating characteristics among amenorrheic runners, eumenorrheic runners, and eumenorrheic sedentary women. The results of the study indicated that there were no significant differences between groups on any of the psychological measures but there was a subgroup of amenorrheic runners who scored in the extreme range on the depression and eating disorder measures. There may be a subgroup of amenorrheic runners who have a significant psychiatric disorder although it is unclear whether it is a major depression or anorexia nervosa. Longitudinal studies are needed to fully understand the interaction between excessive exercise, eating disorders, and depression.

A prospective study of donor insemination recipients: secrecy, privacy, and disclosure

OBJECTIVES

To study prospectively the attitudes and behaviors of heterosexual couples undergoing donor insemination.

DESIGN

Couples undergoing donor insemination completed psychological questionnaires before treatment regarding psychiatric symptoms, self-esteem, marital adjustment, and their attitudes about privacy or disclosure.

PARTICIPANTS

Forty-one of 82 heterosexual couples participated.

MEASURES

A donor insemination questionnaire, a self-esteem scale, the Brief Symptom Inventory, and the Dyadic Adjustment scale were used.

RESULTS

Psychiatric symptoms, self-esteem, and marital adjustment were all in the normal range. The amount of time taken by the couple to decide to do donor insemination was not related to reported psychiatric symptoms, self-esteem, marital adjustment, or marital satisfaction. Ninety-five percent of the couples believed a psychological consultation should be a mandatory part of the donor insemination treatment. The greatest concern the couples had about the donor child was its genetic and medical background. Thirty-eight percent of the couples did tell or planned to tell others about using donor insemination to conceive, and only 27% of the couples planned to tell the child of his or her donor origin.

CONCLUSIONS

The results of this study support those of others, which have indicated that the majority of donor recipients are psychologically well adjusted and have average marital adjustment. In addition, this prospective study replicated the findings of other retrospective studies, indicating that most donor insemination recipients do not plan to tell the child of his or her donor origin. Additional prospective studies are needed to determine if attitudes and behavior regarding disclosure change over time.

Effects of menstrual phase on intake of nicotine, caffeine, and alcohol and nonprescribed drugs in women with late luteal phase dysphoric disorder

To investigate the possibility that cigarette smoking and other drug use are affected by menstrual phase in smokers with Late Luteal Phase Dysphoric Disorder (LLPDD), we examined daily diaries rating menstrual symptomatology, smoking, alcohol and nonprescription drug use, and caffeine intake in nine female smokers meeting criteria for LLPDD. Menstrual symptomatology peaked during the premenstrual phase. Smoking, alcohol, and nonprescription drug intake were increased during menses; caffeine intake was unaffected by phase. No systematic intrasubject correlation between symptomatology and smoking was detected. It was concluded that in women with LLPDD, smoking and alcohol and nonprescription drug intake appear to vary as a function of menstrual phase. The lack of intrasubject correlations between symptomatology and intake, and the failure of peak intake to coincide with peak symptomatology, however, indicate that these effects cannot be explained simply as "self-medication" of acute episodes of dysphoric mood.

Guidelines for the provision of psychological evaluations for infertile patients at the University of Connecticut Health Center

OBJECTIVE

Because of the psychologically demanding nature of infertility treatment, it has been recommended that psychological services be made available to infertile patients. However, no specific guidelines for the scope or usage of those services has been proposed. Our objective was to formulate guidelines to be used at our institution to provide psychological evaluations to infertility patients.

DESIGN

The guidelines were formulated through discussions between the division psychologist and attendings and then presented to and modified by the University Ethics, Risk Management, Legal, and Institutional Review Board departments.

SETTING

The University of Connecticut Health Center Division of Reproductive Endocrinology and Infertility provides tertiary level care to infertility patients. Services include assisted reproductive technologies and donor gamete programs. Surrogate parenting is not a provided service.

RESULTS

Guidelines for the provision and use of psychological services for infertility patients were formulated.

CONCLUSIONS

These guidelines are preliminary in nature and intended to provide a starting point for discussion among physicians, nurses, and mental health professionals regarding the psychological needs of infertility patients.

Psychological factors related to donor insemination

OBJECTIVE

To survey a sample of couples who had completed therapeutic donor insemination (TDI) regarding several psychological variables.

DESIGN

Couples who had conceived through TDI in the past 7 years completed a retrospective survey.

PARTICIPANTS

Thirty-five of seventy couples returned completed questionnaires.

MEASURES

Demographic questionnaire, TDI, and confidentiality questionnaire (created for this study), Dyadic Adjustment Scale.

RESULTS

The majority of the subjects told at least one person about the TDI but 81% of subjects who told someone reported that, if they had to do it over again, they would tell no one. Eighty-six percent reported that they have not and will not tell the child. Time from diagnosis to beginning TDI was not correlated with marital adjustment after TDI. Overall, the couples reported average marital adjustment. For both men and women, the biggest concern was the genetic/medical history of the donor. Most couples did not have psychological counseling, but 39% thought it should be mandatory.

CONCLUSIONS

Retrospectively, most couples regretted telling others about TDI. Most couples do not plan to tell the TDI child about its genetic origin. The major concern about TDI is the genetic and medical background of the donor. Psychological counseling should be available to couples undergoing TDI.