Analysing MyOptions: experiences of Ireland's abortion information and support service

BACKGROUND

In 2018, the Irish government enacted a liberalised abortion law permitting expanded access to abortion from January 2019. A dedicated information and support service - MyOptions - was established to provide non-directive counselling and clinical advice about unplanned pregnancy. MyOptions provides contact details for abortion providers but does not make appointments for abortion-seekers. In 2020, the Abortion Rights Campaign (ARC) conducted research into Irish residents' experiences of abortion care under the new law, including their experiences with MyOptions.

METHODS

Between September 2020 and March 2021, ARC administered an online survey. Qualitative data were coded using NVIVO software and analysed through thematic analysis. Quantitative data were analysed descriptively. This article analyses a subsection of these data to answer the question: What were abortion-seekers' experiences of using MyOptions?

RESULTS

Many respondents were unaware of MyOptions before becoming pregnant. Some described MyOptions as useful and compassionate. Others noted a lack of clarity from MyOptions about the scope of its service and a lack of information on accessing abortion after 12 weeks. Respondents reported frustration that the service did not arrange appointments, explaining that having to contact general practitioners (GPs) themselves was stressful and time-consuming, as was GPs' refusal to provide care or refer to a willing provider.

CONCLUSIONS

MyOptions primarily benefits abortion-seekers whose pregnancies are under 12 weeks and who are comfortable contacting a GP themselves. The addition of an appointments booking service and guidance on how to access abortion for medical reasons and abortion after 12 weeks could improve the service.

Online patient safety education programme for junior doctors: is it worthwhile?

BACKGROUND

Increasing demand exists for blended approaches to the development of professionalism. Trainees of the Royal College of Physicians of Ireland participated in an online patient safety programme.

AIMS

Study aims were: (1) to determine whether the programme improved junior doctors' knowledge, attitudes and skills relating to error reporting, open communication and care for the second victim and (2) to establish whether the methodology facilitated participants' learning.

METHODS

208 junior doctors who completed the programme completed a pre-online questionnaire. Measures were "patient safety knowledge and attitudes", "medical safety climate" and "experience of learning". Sixty-two completed the post-questionnaire, representing a 30 % matched response rate.

RESULTS

Participating in the programme resulted in immediate (p < 0.01) improvement in skills such as knowing when and how to complete incident forms and disclosing errors to patients, in self-rated knowledge (p < 0.01) and attitudes towards error reporting (p < 0.01). Sixty-three per cent disagreed that doctors routinely report medical errors and 42 % disagreed that doctors routinely share information about medical errors and what caused them. Participants rated interactive features as the most positive elements of the programme.

CONCLUSIONS

An online training programme on medical error improved self-rated knowledge, attitudes and skills in junior doctors and was deemed an effective learning tool. Perceptions of work issues such as a poor culture of error reporting among doctors may prevent improved attitudes being realised in practice. Online patient safety education has a role in practice-based initiatives aimed at developing professionalism and improving safety.

Pre-clinical activity of the PARP inhibitor AZD2281 in human breast cancer cell lines and in combination with DNA damaging agents

Abstract #1038

Background: Deficiencies in DNA repair mechanisms have been associated with breast cancer. AZD2281, a potent, oral, PARP inhibitor has been shown to have clinical activity in patients with BRCA mutant breast cancers. Laboratory studies have suggested that non-BRCA mutant breast cancers may also be sensitive to PARP inhibition in tumors as a consequence of deficiencies in other homologous recombination (HR) repair components. Using a large panel of human breast cancer cell lines we tested the hypotheses that (1) there may be a subset of non-BRCA mutant breast cancers that are sensitive to single-agent AZD2281 and (2) AZD2281 would potentiate the cytotoxic effects of the DNA damaging agent cisplatin. Methods: 43 human cell lines representing known molecular subgroups of breast cancer (i.e. ER+, HER2 amplified, “triple-negative”), and 3 immortalized breast lines were treated in duplicate in adherent plates with AZD2281 using two-fold dilutions over 6 concentrations for 6 days. Dose response curves were generated using a cell count assay to calculate the IC50 of AZD2281. In addition, a subset of cell lines that grow under anchorage independent conditions were grown in triplicate in the presence and absence of 1 µM AZD2281 in soft agar for at least 3 weeks and growth inhibition was calculated as per cent of untreated control. Cell lines (both sensitive and resistant to single agent AZD2281) were also evaluated in combination with cisplatin in a cell count assay to assess the interaction between the two agents.&#x2028; Results: The majority of breast cancer cell lines evaluated in the short term 2-D growth assay did not show significant growth inhibition (IC50 &lt; 1 µM) following AZD2281 treatment, including a known BRCA mutant cell line, suggesting this assay may not be ideal for determining sensitivity to AZD2281. However, in the longer term anchorage independent clonogenic assay, approximately half of the cell lines evaluated demonstrated an IC50 &lt; 1 µM. Of note, the majority of the cell lines representing a “triple-negative” phenotype appeared sensitive to AZD2281 in this assay. In addition, pre-treatment with AZD2281 prior to cisplatin, potentiated the growth inhibition seen with cisplatin in both AZD2281 sensitive and resistant cell lines. Additional studies evaluating predictive markers other than BRCA status are ongoing. Conclusion: The PARP inhibitor AZD2281 has significant pre-clinical activity in human breast cancer cell lines. In a clonogenic assay, cell lines representing the “triple negative” subtype were especially sensitive to AZD2281 supporting clinical development in this population, regardless of BRCA status. In addition, these pre-clinical data support the hypothesis that PARP inhibition may potentiate the effects of chemotherapy induced DNA damage and provide further rationale for clinical development.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1038.

Circulating divalent cations in asymptomatic ovarian hyperstimulation and in vitro fertilization patients

It is known that ovarian hyperstimulation and in vitro fertilization are accompanied by a steady increase in circulating estrogen and progesterone far beyond what is normal for young women. We have recently demonstrated that the biologically active fractions of calcium and magnesium in blood are altered depending on when in the menstrual phase a blood sample is drawn in normal cycling women. The serum ionized Ca/Mg ratio is also altered in accordance with the menstrual cycles. This suggests that the sex steroid hormones may modulate serum levels of ionized Mg and the ionized Ca/Mg ratio. We therefore studied the relationships between sex steroid hormones and the concentrations of ionized magnesium and calcium in the blood of hyperstimulated patients. We were able to demonstrate that with each increment in estrogen, a decrease in ionized Mg occurred, and as the progesterone rose in the blood, the ionized Ca/Mg ratio increased. Our results support the idea that serum estrogen and progesterone levels in women modulate the blood levels of circulating ionized Mg and the serum ionized Ca/Mg ratio.

Sequence and analysis of chromosome 5 of the plant Arabidopsis thaliana

The genome of the model plant Arabidopsis thaliana has been sequenced by an international collaboration, The Arabidopsis Genome Initiative. Here we report the complete sequence of chromosome 5. This chromosome is 26 megabases long; it is the second largest Arabidopsis chromosome and represents 21% of the sequenced regions of the genome. The sequence of chromosomes 2 and 4 have been reported previously and that of chromosomes 1 and 3, together with an analysis of the complete genome sequence, are reported in this issue. Analysis of the sequence of chromosome 5 yields further insights into centromere structure and the sequence determinants of heterochromatin condensation. The 5,874 genes encoded on chromosome 5 reveal several new functions in plants, and the patterns of gene organization provide insights into the mechanisms and extent of genome evolution in plants.

Sequence and analysis of chromosome 4 of the plant Arabidopsis thaliana

The higher plant Arabidopsis thaliana (Arabidopsis) is an important model for identifying plant genes and determining their function. To assist biological investigations and to define chromosome structure, a coordinated effort to sequence the Arabidopsis genome was initiated in late 1996. Here we report one of the first milestones of this project, the sequence of chromosome 4. Analysis of 17.38 megabases of unique sequence, representing about 17% of the genome, reveals 3,744 protein coding genes, 81 transfer RNAs and numerous repeat elements. Heterochromatic regions surrounding the putative centromere, which has not yet been completely sequenced, are characterized by an increased frequency of a variety of repeats, new repeats, reduced recombination, lowered gene density and lowered gene expression. Roughly 60% of the predicted protein-coding genes have been functionally characterized on the basis of their homology to known genes. Many genes encode predicted proteins that are homologous to human and Caenorhabditis elegans proteins.

11 beta-Hydroxysteroid dehydrogenase enzyme activity in granulosa cells derived from ovarian follicles of in vitro fertilization patients

11 beta-Hydroxysteroid dehydrogenase (HSD) activity was measured in freshly frozen granulosa cells isolated from follicles of twenty-one infertility patients undergoing in vitro fertilization-embryo transfer (IVF-ET). A total of 213 follicles were analyzed for 11 beta-HSD activity. Both nicotinamide-adenine dinucleotide (NAD) and nicotinamide-adenine dinucleotide phosphate (NADP) dependent 11 beta-dehydrogenase activities were measured in granulosa cells. The activity in reductive direction (11-oxoreductase activity) was not measurable either with NADH or NADPH as cofactors. NAD- and NADP-dependent dehydrogenase activities are in comparable levels at 100 nmol/l and 1 mumol/l corticosteroid concentrations. For comparing enzyme activities of individual follicles, significant enzyme activity was considered to be a level of > 2 nmol/l/min/mg. 41.3% of the follicles demonstrated enzyme activity, 58.7% did not. The mean 11 beta-dehydrogenase (11 beta-DH) activity was calculated for each patient. Those patients with levels > 2 nmol/l/min/mg were considered enzyme positive; those with mean levels < 2 nmol/l/min/mg were considered negative. No significant association was noted between follicle size, oocyte maturity or fertilization rates and 11 beta-DH activity. This study noted the presence of 11 beta-DH activity in granulosa cells, however, no association with oocyte maturity and fertilization was found.

Progesterone induced blocking factor seen in pregnancy lymphocytes soon after implantation

PROBLEM

The immunomodulatory effect of progesterone (P) in pregnancy manifested via a protein named the P-induced blocking factor (PIBF) was previously reported. The goal of this study was to measure and compare the PIBF expression on lymphocytes between pregnant and non-pregnant women especially in early pregnancy.

METHODS

PIBF expression was determined by immunocytochemistry using a PIBF-specific polyclonal antibody. Levels were assessed during the mid-cycle, luteal phase, and first trimester of pregnancy.

RESULTS

PIBF expression was found in 24.9% of mid-cycle sera, 49% of luteal phase sera of women who failed to conceive, and 75% of luteal phase sera of women who conceived.

CONCLUSIONS

These data indicate that the percentage of PIBF expressing lymphocytes increases as a result of pregnancy and that the stimulus for PIBF induction occurs soon after implantation. These data support the concept that PIBF may play an important role in early implantation possibly by inhibiting the destructive function of natural killer lymphocytes.

The effect of assisted hatching on pregnancy rates after frozen embryo transfer

OBJECTIVE

To compare clinical pregnancy and implantation rates after transfer of frozen-thawed embryos prepared according to an assisted hatching protocol or a nonassisted hatching protocol.

DESIGN

A historical cohort study in which a cohort of patients who underwent an assisted hatching protocol was matched for clinical parameters to an external historical cohort treated before assisted hatching was available.

SETTING

In vitro fertilization-ET facility of a university-based practice.

PATIENTS

Seventy-nine matched pairs.

INTERVENTIONS

Nonassisted hatching patients: embryos were thawed, cultured in human tubal fluid + 0.5% bovine serum albumin until 48 hours and transferred. Assisted hatching patients: embryos thawed, cultured in human tubal fluid + 10% synthetic serum substitute until 72 hours, had assisted hatching and transferred.

MAIN OUTCOME MEASURES

Clinical pregnancy (gestational sac) and implantation rates.

RESULTS

Twelve (15.2%) clinical pregnancies per transfer in nonhatched group versus 24 (30.4%) in hatched group. Nonhatched group: 284 embryos transferred; 15 (5.3%) implanted. Three pregnancies (25.0%) had two sacs. Hatched embryos: 269 were transferred; 37 (13.7%) implanted. Eleven pregnancies (45.8%) were multiple gestations (9 twins, 2 triplets).

CONCLUSION

Clinical pregnancy and implantation rates were higher for group having assisted hatching protocol. It is not clear whether the improvement is due to the overall methodology change or to assisted hatching. Assisted hatching using the zona-drilling technique is not detrimental to frozen-thawed human embryos and may be beneficial.

Evaluation of the mechanism for higher pregnancy rates in donor oocyte recipients by comparison of fresh with frozen embryo transfer pregnancy rates in a shared oocyte programme

The objective of this study was to determine the mechanism for higher pregnancy rates in oocyte recipients by comparing the pregnancy rates following fresh and frozen embryo transfers in a shared oocyte programme. A prospective study was carried out of 135 matched pairs of donors and recipients who equally share the donors' pool of oocytes. Recipients were subclassified by ovarian function: 69 were in ovarian failure and 66 retained ovarian function. A total of 474 standard in-vitro fertilization cycles using the same ovarian stimulation protocol as the donors were also evaluated. The main outcome measures were the clinical pregnancy and implantation rates for donors and recipients following fresh and frozen embryo transfers. The clinical pregnancy rates per transfer for fresh embryo transfers were 17.5% for donors, 20.4% for recipients with ovarian function and 46.3% for recipients in ovarian failure (P < 0.05). The pregnancy rates for frozen embryo transfers were 15.3% for donors, 17.2% for recipients with ovarian function and 23.8% for recipients in ovarian failure (not significantly different). The implantation rates for fresh transfers were 7.5% for donors, 8.6% for recipients with ovarian function and 15.6% for recipients in ovarian failure (P < 0.05); for frozen cycles, the implantation rates were 5.1, 5.2 and 7.1% respectively (not significantly different). When classified by age and ovarian function, the clinical pregnancy rates per transfer for recipients with ovarian function were 14.0% for those aged > or = 40 and 22.2% for those aged < 40 years. For recipients in ovarian failure, the pregnancy rates were 33.3% for the older group of women and 39.4% for the younger group. A logistic regression analysis found that ovarian function was the only factor to have an independent effect on outcome. The demonstration of higher pregnancy and implantation rates in recipients versus donors following fresh embryo transfer, despite the use of a common pool of oocytes, strongly suggests that the well-known higher fecundity found in recipients is not predominantly related to the use of better quality oocytes. The demonstration of an implantation rate twice as high following fresh versus frozen embryo transfer in recipients with ovarian failure suggests that the frozen embryo is not as hardy as the fresh embryo. Thus, the fact that both the pregnancy and implantation rates in donors were the same with fresh versus frozen embryo transfer suggests that the ovarian stimulation regimen has a negative effect on outcome. However, the clear demonstration of higher pregnancy rates in recipients with ovarian failure compared with those with ovarian function suggests that, in addition, these higher rates may be linked to a superior uterine environment in patients with ovarian failure. Alternatively, the use of gonadotrophin-releasing hormone agonists may have a negative effect on implantation in patients with ovarian function.

The relationship of endometriosis to endometrial sonographic studies prior to administration of human chorionic gonadotrophin in patients undergoing in-vitro fertilization and embryo transfer

The objective of this prospective comparative study was to investigate the relationship of endometriosis to endometrial thickness and sonographic echo pattern prior to the administration of human chorionic gonadotrophin (HCG). Patients were matched by age and ovarian stimulation protocol. A total of 210 patients undergoing in-vitro fertilization (IVF) and embryo transfer at a university-related IVF centre were enlisted. Of these, 105 women with laparoscopic confirmation of endometriosis were compared to an equal number of patients with laparoscopic confirmation of no endometriosis. Mean endometrial thickness did not differ between the groups (12.7 +/- 2.9 versus 12.2 +/- 2.5 mm). The distribution of echo patterns was also the same, irrespective of diagnosis. Evaluation of clinical pregnancy rates showed no reduction in patients with endometriosis, regardless of stage, nor when comparing patients to controls. Endometriosis has no effect on the endometrial thickness or echo pattern measured by sonography prior to administration of HCG or the pregnancy rates following IVF and embryo transfer.

Pregnancy after zona drilling of cryopreserved thawed embryos: case report

OBJECTIVE

To confirm successful implantation of IVF, cryopreserved human embryos after assisted hatching with acidic Tyrode's solution.

DESIGN

Case report.

SETTING

In vitro fertilization-ET facility of a university-based practice.

PATIENT

A 28-year-old female with nonoperable bilateral tubal occlusion and > 1 1/2 years of primary infertility.

INTERVENTIONS

The patient was stimulated for egg retrieval after an hMG-controlled ovarian hyperstimulation regime. Luteal phase leuprolide acetate (1 mg) was administered SC for 10 days. The dose was then reduced to 0.5 mg, and she was given hMG and FSH IM twice daily until two lead follicles reached 20 mm average diameter. The patient was administered 10,000 IU hCG 36 hours before retrieval.

MAIN OUTCOME MEASURES

Viable pregnancy documented by ultrasound (US).

RESULTS

After the transfer of five cryopreserved-thawed human embryos that were subjected to assisted hatching using acidic Tyrode's solution, the patient established a triplet gestation as documented by US.

CONCLUSION

This case report demonstrates that zona drilling can be successfully applied to frozen-thawed pronuclear stage embryos that were cultured to 72 hours without damaging them, as evidenced by continued cleavage and resulting implantation.

Evaluation of a new embryo-grading system to predict pregnancy rates following in vitro fertilization

This study examines two descriptive parameters of embryo morphology to determine if either parameter correlates with subsequent pregnancy rates (PRs). The two parameters were the evenness (similarity in size) of the blastomeres and the degree of cellular fragmentation. A total of 242 embryo transfers in which 4 embryos were transferred were included. Sixty-nine (28.5%) clinical and 62 (25.6%) viable pregnancies resulted. In all cases 4 embryos were transferred, but the number of embryos with even round blastomeres (grade 1) varied from 0 to 4. Statistically, there was no correlation between PR and number of grade 1 embryos transferred. When 4 grade 1 embryos were transferred, the PR was 33.3 versus 28.1% when no grade 1 embryos were transferred. There was, however, a statistical difference in the implantation rate; a higher frequency of multiple gestations occurred when 3 or 4 of the embryos transferred were graded 1:12.7 as compared with 6.7% when < or = 2 embryos were grade 1. The significance of the degree of cellular fragmentation in the embryos was also assessed. There was no statistical difference in the PR according to the number (0-4) of embryos transferred that did not have fragments (grade A). When 4 grade A embryos were transferred, the PR was 18.2 versus 26.1% when there were no grade A embryos. Neither implantation nor multiple birth rates correlated with fragmentation.

Comparison of efficacy of high-dose pure follicle-stimulating hormone versus human menopausal gonadotropins for in vitro fertilization

The advent of recombinant DNA technology will soon produce for the market a product that has pure follicle-stimulating hormone (pFSH) but no luteinizing hormone. A prospective randomized study was performed to see if pFSH (Metrodin) was able to stimulate the same in vitro fertilization parameters as human menopausal gonadotropin when preceded by gonadotropin suppression by leuprolide acetate. The results showed similar parameters between the two drugs, i.e., number of oocytes, number of embryos, endometrial thickness at time of human chorionic gonadotropin, fertilization rates and pregnancy rates in a protocol purposely designed to stimulate as many follicles as safely as possible because of a shared oocyte and successful cryopreservation program.

Relationship of endometrial thickness and sonographic echo pattern to endometriosis in non-in vitro fertilization cycles

The objective of this study was to investigate the effect of endometriosis on the proliferation of the endometrium as determined by sonographic measurements of endometrial thickness and echo pattern at peak follicular maturation. A prospective study of 60 infertility patients was conducted in which the endometrium was evaluated sonographically, both before and after laparoscopy. Prior to laparoscopy, the mean endometrial thickness was 10.5 +/- 1.9 mm in the group without endometriosis (n = 20) and 11.7 +/- 2.8 mm in the group with endometriosis (n = 40) (p > 0.05). Following the laparoscopy, there was no change in the mean thickness within each group. The incidence of an unfavorable echo pattern was negligible in both groups. Endometriosis does not cause a reduction in endometrial thickness, nor does it appear to influence the development of an unfavorable echo pattern at time of peak follicular maturation.

Embryo transfer technique as a cause of ectopic pregnancy in in vitro fertilization

A randomized prospective study was performed to compare the effects of a midfundal versus a deep fundal transfer technique on subsequent intrauterine and ectopic PRs after IVF. The clinical intra-uterine PR after the deep fundal transfer was 12.4% per cycle with a 1.5% ectopic PR (which represented 12.2% of the pregnancies) versus 14.2% IUPs per cycle with a 0.4% ectopic rate (representing 3% of pregnancies) after midfundal transfers. The midfundal technique appears superior to deep fundal procedures because of a lower percentage of EPs without any sacrifice of the intrauterine PR after midfundal transfers.

Inadvertent intra-arterial injection complicating ordinary and ultrasound-guided sclerotherapy

BACKGROUND

Intra-arterial injection is the most dreaded complication of sclerotherapy of varicose veins. The medical literature does not contain enough data to enable one to formulate a definitive strategy for either the prevention or treatment of this complication.

OBJECTIVE

Seven cases of intra-arterial injection are presented. The causes of these accidents, the recognition of the signs that intra-arterial injection has occurred, and the treatment of these cases are discussed.

METHODS

Intra-arterial injection occurs in a variety of different settings. The signs that an intra-arterial injection has taken place are variable, but in some cases there are no signs until irreversible tissue damage has already set in. Treatment protocols are based mainly on anticoagulation with heparin, which is administered both intravenously and subcutaneously.

RESULTS

Heparin, whether administered continuously by the intravenous route or subcutaneously (twice daily), makes affected areas look and feel better, but there is no proof that it alters the final outcome with respect to tissue necrosis. In agreement with previous authors, we believe that there is a beneficial effect. Coumadin, on the other hand, appears to be completely ineffective.

CONCLUSION

Protocols employing heparin should be considered in cases of suspected intra-arterial injection. The length of time heparin should be continued is uncertain. The best "treatment" is prevention.

CA 125 levels measured in different phases of the menstrual cycle in screening for endometriosis

OBJECTIVE

To examine variations in CA 125 levels during the three phases of the menstrual cycle in women with and without endometriosis.

METHODS

One hundred infertile women were studied prospectively. CA 125 levels were measured during menses and during the follicular and luteal phases before diagnostic laparoscopy. Subjects were divided into four groups: no evidence of endometriosis (35 women), stage I endometriosis (30 women), stage II endometriosis (21 women), and stages III and IV endometriosis (14 women).

RESULTS

In the endometriosis groups, there was a significant difference in the mean CA 125 levels drawn at menses and those drawn in the follicular phase. In patients with severe endometriosis, there was also a difference in the mean CA 125 levels drawn at menses and in the luteal phase. This finding led to the development of a screening test based on the ratio of CA 125 levels at menses to levels in the follicular phase. The test based on this ratio (with a cutoff of 1.5) had a sensitivity of 62.5% and specificity of 75%, compared with a sensitivity of 26.8% and specificity of 100% for the test based on a single CA 125 level drawn at menses (with a cutoff of 35 U/mL).

CONCLUSIONS

CA 125 levels during menses are elevated compared with those during the follicular phase in patients with endometriosis. Screening tests based on the relationship of multiple CA 125 levels taken throughout the menstrual cycle were more sensitive for detection of endometriosis than tests based on a single CA 125 level.