Assisted Reproductive Technology: Gaps in young adults’ perceptions and information from clinics

Background

Around 186 million individuals are facing infertility worldwide, with a huge impact on their wellbeing. Fertility care is considered a key element to promote reproductive health. This study aims to explore young adults’ knowledge, perceptions and concerns about infertility and Assisted Reproductive Technology (ART), and to contrast it with the information provided by ART clinics.

Methods

A multi-country qualitative study was conducted in Albania, Belgium, Slovenia, Spain, Italy, Kosovo, North Macedonia and Switzerland within the H2020 B2-INF project (Grant Agreement 872706). In 2021, 10-15 semi-structured interviews were conducted in each country with participants aged 18-30, childless and non-ART users. Additionally, 3-5 clinics’ websites in each country were explored. Data was collected in native languages and translated into English. A thematic analysis was carried out.

Results

In total, 98 interviews were conducted and 38 clinics’ websites were explored. Three themes emerged from the analysis of the interviews: 1. Parenthood and (in)fertility; 2. Young people's perception on ART; 3. Information and publicity of ART. Parenthood was described as a relationship beyond biological ties and infertility as a social taboo. Most participants perceived ART positively and would use it if needed, although knowledge on ART was low. Participants considered information on ART as scarce and suggested that government-led information campaigns should be launched to raise awareness on it. Concerning clinics, the websites provided information on infertility and exhaustive technical descriptions of ART techniques, although it may be difficult for the general population to understand. Data offered on success rates were unclear and heterogeneous.

Conclusions

Gaps in citizens’ expectations and needs and the information provided by ART clinics were identified. Awareness campaigns are needed to diminish social taboo on infertility and ART and to promote reproductive health.

Key messages

• Assisted Reproductive Technology is positively perceived by young adults, though their knowledge of it and infertility is low. Information campaigns are thus needed to raise awareness among the young.

• ART clinics have room for improvement in aligning the information provided on their websites with young people's perceptions and needs, and to show it in a more accessible and understandable way.

O-201 B2-INF: Giving voice to citizens towards improving assisted reproduction technologies for society. Gaps between young people’s perceptions and the information offered by ART providers

Study question

Are the young citizens’ perceptions and expectations on Assisted Reproduction Technologies (ART) aligned with the information that ART clinics offer to citizens?

Summary answer

There is a gap between young citizen’s perceptions and expectations and the information offered by ART providers taking into account gender, sociocultural, and legal perspectives.

What is known already

Studies investigating young people’s opinions, concerns, and expectations in relation to ART are scarce. Some studies have highlighted that young adults reported low general knowledge about ART and overestimated its success rates. In addition, gaps in knowledge about fertility and the potential of ART have been described among this population. To our knowledge, there are no studies that compare young people’s perceptions with the information offered by ART providers.

Study design, size, duration

B2-Inf is funded by the European Union’s Horizon 2020 research and innovation programme (Grant Agreement No 872706), to be executed in 36 months. B2-InF contrasts ART perceptions of young population from 8 countries (Spain, Belgium, Italy, Switzerland, Kosovo, Albania, Macedonia, Slovenia) with the information provided by ART clinics to society in the same countries. To reach this objective, a descriptive multicentre qualitative study was designed through semi-structured interviews and documentary data collection from ART clinics

Participants/materials, setting, methods

From March to December 2021, 10-15 semi-structured interviews were conducted in each country. Participants were men and women aged 18 to 30 years old, childless and non-ART users. Additionally, 3-5 clinics’ websites from each country were planned to be explored and clinics’ ‘physical information’, such as consent forms, were requested. All the information was collected and transcribed verbatim in the native language and afterwards translated into English. A thematic analysis was conducted using Atlas.ti V9.

Main results and the role of chance

In total, 98 interviews were conducted: 15 in Spain, 14 in Belgium, 13 in Italy, 10 in Switzerland, 15 in Kosovo, 11 in Albania, 10 in North Macedonia and 10 in Slovenia; and 33 clinics were explored: 5 in Spain, 5 in Belgium, 5 in Italy, 5 in Switzerland, 5 in Kosovo, 5 in Albania, 5 in North Macedonia and 3 in Slovenia.

The themes that emerged in the analysis of interviews were: 1. Social perceptions of parenthood and fertility; 2. Young people’s perceptions on ART; 3. Information and publicity of ART. Participants described parenthood as a relationship beyond biological ties and identified infertility as a social taboo. Young’s perceptions on ART techniques were positive and most would use it in case of need, but the knowledge related to ART was limited. Most participants suggested that trustworthy national information campaigns led by Governments should be implemented to raise awareness of ART.

Regarding clinics, information on websites addressed risk factors and prevalence of infertility. It included description of ART techniques with unclear data about success rates, economic information and clinics human resources and facilities. Gaps were identified between citizens’ expectations and needs and the online information provided by ART clinics.

Limitations, reasons for caution

This is a first thematic analysis that provides an overview of the possible gaps between young citizen’s expectations and the information provided by ART clinics. In next steps of B2-InF project, an in-depth qualitative analysis will be conducted considering gender, sociocultural, and legal perspectives.

Wider implications of the findings

This is the first systematic multinational study that compare young people’s perceptions about ART and information provided by ART clinics. Although this is a preliminary analysis, the results will be used to develop national guidelines to inform policies on ART services with potential impact on European citizens and ART providers.

Trial registration number

European Union’s Horizon 2020 Research and Innovation Programme (Grant Agreement No 872706)

Antibody-Mediated Rejection of Renal Allografts: Diagnostic Pitfalls and Challenges

Antibody-mediated rejection (ABMR) is a major obstacle to the long-term success in kidney transplantation. Diagnosis of ABMR is determined according to the internationally recognized Banff criteria. However, a significant proportion of patients does not meet all the defined criteria, and the outcome of such cases remains poorly understood. The histology of ABMR frequently lacks sensitivity and specificity. More importantly, mixed forms of ABMR and T cell-mediated rejection as well as findings of nonspecific injury are common in clinical settings. Donor-specific anti-HLA antibodies (DSA) are detectable only in half of the ABMR cases by histology. Prognostic role of non-HLA antibodies against various endothelial proteins has been discussed. Antibody independent NK cell activation reflecting killer-cells’ inhibitory receptor incompatibility is suggested in microvascular inflammation in DSA negative patients. Molecular assessment of ABMR has been prioritized to overcome high interobserver variability and improve diagnostics in mixed forms of rejections and in DSA negative cases. Finally, donor-derived cell-free DNA detected in a recipient’s peripheral blood sample has been proposed as a noninvasive marker for diagnosis of graft rejection, and thus might serve as a liquid biopsy in the near future. Despite all achievements, diagnosing ABMR in kidney allografts remains to be a challenge in a significant number of cases.

[Torsion of the omentum - an unexpected cause of acute surgical abdomen in a pregnant woman -case report]

OBJECTIVE

Torsion of the omentum is a rare cause of acute surgical abdomen. Here we describe a case of a pregnant woman with acute abdominal pain and a perioperative diagnosis of necrosis of torted omentum was made.

DESIGN

Case report.

SETTING

Department of Obstetrics and Gynaecology, Masaryks Hospital, Jilemnice.

CASE REPORT

Thirty year old female patient, who was 38 weeks pregnant, presented to our department with acute surgical abdomen. Acute appendicitis was suspected and an urgent caesarean section followed by appendectomy was scheduled. However, perioperatively a necrotic part of torted omentum was identified and resected.

CONCLUSION

Torsion of the omentum is a rare cause of acute abdominal pain which is usually diagnosed only perioperatively. This condition usually presents with nonspecific symptoms and most commonly mimics acute appendicitis. Owing to, inexplicit symptoms and wide range of differential diagnoses it is important to think of this entity as a possible cause of acute abdominal pain. Clear indication for abdominal surgery, especially in pregnant patients is essential and requires efficient team working between gynaecologists, abdominal surgeons and radiologists.

[Laparoscopic uterus sparing treatment of uterine fibroids]

OBJECTIVE

To report up-to date knowledge on laparoscopic, uterine sparing treatment of uterine fibroids.

STUDY DESIGN

Review.

SETTING

Uterine Fibroids Center, Department of Obstetrics and Gynecology, Charles University, Prague.

METHODS

Analysis of our clinical experience and available literature resources.

RESULTS

The management of uterine fibroids depends on the symptoms, location, and size of fibroids and on the reproductive plans of the patient. The surgical treatment has changed from laparotomy to minimally invasive surgery. In general, laparoscopic myomectomy (LM) is considered the best option in symptomatic patients with pregnancy plans. The laparoscopic approach is associated with lower postoperative morbidity as well as lower incidence of massive postoperative adhesion formation compared to laparotomy. The limitation of laparoscopic myomectomy is the size and the number of fibroids but also the location and the accessibility for the laparoscopic suturing. Laparoscopic uterine artery occlusion (LUAO) represents one of the alternatives to LM in patients with multiple small myomas or in patients with fibroids in unfavorable location. LUAO may be advantageously used prior to LM in order to reduce peroperative blood loss or to prevent the persisting fibroids from growing. However there is no universal treatment of uterine fibroids in fertile patients and in each single patient the indication and surgical method should be thoroughly considered. .

Detection of fetal major structural anomalies at the 11-14 ultrasound scan in an unselected population

OBJECTIVE

The aim of the study was to determine the efficacy of the 11-14 week scan in detecting fetuses with structural anomalies.

STUDY DESIGN AND METHODS

Prospective interventional study in an unselected population of pregnant women in a 5-year period (2003-2008) in a single ultrasound unit. 8889 fetuses with median CRL 65mm (45-84mm) were examined. Continuing pregnancies were rescanned at 20-22 weeks. Actual structural anomalies among newborns from the studied group were obtained from our computerized database.

RESULTS

The median maternal age was 30 years (14-50 years). The incidence of anomalies was 16.08 per 1000 (143/8889). Of these, 99 of the 143 were detected with prenatal sonography. 46.9% (67/143) of all anomalies were detected at the 11-14 week scan. Later in pregnancy, another 22.3% (32/143) of structural anomalies were detected.

CONCLUSIONS

67.7% of all antenatally detected malformations by ultrasound were recognized in the 11 14 week scan. Obviously, the second trimester scan cannot be abandoned, as it provides effective detection of other anomalies.

Body height, body mass index, waist-hip ratio, fluctuating asymmetry and second to fourth digit ratio in subjects with latent toxoplasmosis

Between 20% and 60% of the population of most countries are infected with the protozoanToxoplasma gondii. Subjects with clinically asymptomatic life-long latent toxoplasmosis differ from those who areToxoplasmafree in several behavioural parameters. Case-control studies cannot decide whether these differences already existed before infection or whether they were induced by the presence ofToxoplasmain the brain of infected hosts. Here we searched for such morphological differences betweenToxoplasma-infected andToxoplasma-free subjects that could be induced by the parasite (body weight, body height, body mass index, waist-hip ratio), or could rather correlate with their natural resistance to parasitic infection (fluctuating asymmetry, 2D[ratio ]4D ratio). We foundToxoplasma-infected men to be taller andToxoplasma-infected men and women to have lower 2D[ratio ]4D ratios previously reported to be associated with higher pre-natal testosterone levels. The 2D[ratio ]4D ratio negatively correlated with the level of specific anti-Toxoplasmaantibodies inToxoplasma-free subjects. These results suggest that some of the observed differences between infected and non-infected subjects may have existed before infection and could be caused by the lower natural resistance toToxoplasmainfection in subjects with higher pre-natal testosterone levels.

Telomerase as a diagnostic and predictive marker in colorectal carcinoma

In a search for molecular markers providing both informative diagnostics of malignant disease, and rational stratification of a therapeutic strategy to achieve optimal response in a given patient, we examined the possibility of using telomerase for this purpose in colorectal cancer. Telomerase, a ribonucleoprotein enzyme complex catalysing synthesis of chromosome ends (telomeres), has been known as an almost universal tumor marker but its predictive value has been found in only a limited number of malignant tumor types. Telomerase activity and expression of its catalytic subunit hTERT was determined in 82 surgical specimens from 41 patients (a sample of tumor tissue and of adjacent morphologically normal tissue was obtained from each patient). Telomerase activity was present in tumor samples from 34 (83%) patients, reaching an average value of 47.6 telomerase units (T.U.), while adjacent tissue specimens were either negative (in 25 (61%) patients), or slightly positive (in 16 (39%) patients) showing 1.5 T.U. on average. In tumor samples from patients without lymphatic node metastases (pN0), an average of 37.1 T.U was found. In contrast, in tumor samples from patients with lymphatic node involvement (pN1 or pN2) the average activity was significantly higher (60.2 T.U., p<0.05). In patients with distant metastases a tendency towards higher telomerase activity, although lacking statistical significance, could be observed. Among patients that obtained chemotherapy with 5-fluoruracil, those with low telomerase activity showed a tendency to chemosensitivity. Expression of hTERT was detected not only in samples showing telomerase activity, but also in a considerable portion of telomerase-negative samples either from the tumor or the adjacent normal tissue. We demonstrate that some of these apparent discrepancies may be attributed to differential splicing of hTERT mRNA. We conclude that TRAP assay for telomerase activity is more informative than the common testing for hTERT expression. Telomerase activity is useful both as a diagnostic as well as a predictive factor in colorectal cancer.

[Long-term use of combined hormonal contraception--myths and reality]

OBJECTIVE

To assess relationship of long-term use of combined oral contraception (COC) and women health, discussion about myths connected with use of COC.

DESIGN

Review of literature.

SETTING

Department of Obstetrics and Gynaecology, Hospital of Merciful Brothers, Brno, Czech Republic.

METHODS

Identification of studies able to address the topic using Medline database search.

RESULTS

Besides reliable control of fertility COC protect women against dysmenorrhea, iron deficiency anemia, ovarian cysts and uterine fibroids. COC plays very important role in gynecologic endocrinology suppressing effectively hyperandrogenism, which has not only cosmetic effect but brings also improvement in cardiovascular health of affected perimenopausal women. Premenopausal using of COC could help preserve bone mineral density and can reduce the risk of developing Alzheimer's disease. The most important feature is protective effect against endometrial (by 70%) and ovarian (by 50%) cancer which increases with duration of COC use and is long lasting and may be observed 15 to 20 years after stopping use. Association of use COC with increased risk neither of cervical cancer nor breast cancer has not been confirmed. Controversy still persists over the association of long-term (longer than 8 years) COC use by young nulliparas and breast cancer. The risk in this group of users is probably slightly increased. But no authorities recommended any restriction of COC's prescription. Some studies have suggested an inverse relationship between use of COC and risk of colorectal cancer. The only established evidence of direct association between OC use and cancer risk is the increased risk for hepatocellular carcinoma in the absence of hepatitis B (but maximum by 4 cases per 1,000,000 users per year).

CONCLUSION

Most non-contraceptive health benefits of COC are still not widely appreciated in spite of much evidence. The final decision of contraception method is upon well and adequate informed user by well educated doctor.

[Arterial diseases in women using combined hormonal contraceptives]

OBJECTIVE

To determine the association between myocardial infarction and cerebral stroke and use of combined oral contraceptives.

DESIGN

Review of literature.

SETTING

Department of Obstetrics and Gynaecology, Hospital of Merciful Brothers, Brno, Czech Republic.

METHODS

Identification of methodologically sound studies able to address the topic. Studies were identified by Medline database search.

RESULTS

Five the most recent and important studies were the main source of information (Oxford Family Planning Association Contraception Study 1984, Royal College of General Practitioners' Study 1994, WHO Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception 1996, 1997, Transnational Study on Oral Contraceptives and the Health of Young Women 1997, Myocardial Infarction and Oral Contraceptives Study, 1997). Generally there was no evidence of a significantly increased risk of arterial wall disease in healthy non smoked users younger than 35 years. No difference between second and third generation oral contraceptives on risk of arterial wall disease were found. In the most of cases of myocardial infarction or stroke one or more risk factor were identified. Two of the most relevant risk factors are smoking and the absence of blood pressure control.

CONCLUSION

The risk of arterial cardiovascular system diseases seems not to be increased at no-risk users (healthy non-smoker younger than 35 years).

[Comparison of the risk of fetal hypoxia in active and expectant management of post-term delivery]

OBJECTIVE

Evaluation and comparison of risk of intrapartum foetal hypoxia in expectative and active approach after term of delivery.

DESIGN

Retrospective analysis.

SETTING

Gynaecological and Obstetric Clinic Medical Faculty, Masaryk University Brno.

METHODS

The authors compared retrospectively two groups. Group A comprised 1906 deliveries in 1996, group B 2008 deliveries in 1999. In group A 194 deliveries after the 41st week term was applied. In group B there were 373 deliveries with an expectative approach, with inductions after the 42nd week of pregnancy. The authors evaluated the number of surgical and induced deliveries in after-term pregnancy in both groups and analyzed in indications. The post-delivery condition of neonates was evaluated in both groups according to the Apgar score during the 1st, 5th and 10th minute, In group B the authors had for the blood from the umbilical artery. The condition of neonates delivered by a surgical approach in group B was made more accurate by the base excess (BE) blood from the umbilical artery. The statistical significance of results was evaluated by the U-test and chi 2 test.

RESULTS

The differences in the condition of neonates after delivery between the two groups are insignificant. In the expectative approach in 1999 there was a significant decline of the total number of induced deliveries and the total number of surgical deliveries. The difference in the number of surgical deliveries on account of imminent foetal hypoxia in group A and B are statistically insignificant. The number of hypoxic neonates is the same in both groups.

CONCLUSION

Based on the results of comparison of the two groups it is obvious that the expectative approach is safe and medically justified. It is not associated with a greater risk of intrauterine foetal hypoxia. It does not lead to deterioration of perinatal results and leads to a marked reduction of induced deliveries.

[An active approach in membrane rupture before the 32nd week of pregnancy and perinatal results]

During the period from Jan. 1, 1991 to Dec. 31, 1994 at the Second Department of Gynaecology and Obstetrics in Brno 125 patients were delivered of babies after premature rupture of membranes (PROM) before the 32nd week of gestation. After verification of PROM the active approach involved the following steps administration of antibiotics, corticoids, tocolysis, monitoring of markers of inflammation, of the foetoplacental unit and side-effects of treatment. Unless the patient had a spontaneous delivery within three days, the pregnancy was terminated, if the portio uteri was mature, by induction, if it was not mature, by Caesarean section. The latter was performed in cases of a pathological position of the foetus, multiple pregnancy, foetal hypoxia, metrorrhagia or associated complications. The perinatal results were evaluated in four weight categories (500-749, 750-999, 1000-1249, 1250-1499). The early neonatal mortality rate in the different groups was 750/1000, 420/1000, 217/1000, and 90/1000, RDS IV 37%, 36%, 21%, 12% and adnatal infection 25%, 11%, 34% and 21%. According to the authors results an active approach in case of PROM before the 32nd week of gestation is another factor which reduces the perinatal mortality and morbidity.

Evaluation of methods for the determination of chlorophenols in surface water

Three methods for the determination of chlorophenols in surface water have been evaluated. Two of them utilize solid phase extraction followed by derivatization either in aqueous phase or in organic solvent. The third method is based on liquid-liquid extraction with simultaneous in-situ derivatization. This method was found to be not applicable for samples of surface water. The surfactants present in the samples prevent the separation of the hexane layer at a ratio of 1 : 20 or higher. Both methods using solid phase extraction gave acceptable results; however, the derivatization in aqueous phase proved its priority.

[Induction of cervical maturation using vaginal administration of estrogens]

During the period between September 1, 1993 and September 1, 1994 the authors preinduced 38 pregnant women in term by oestrogen administered by the vaginal route. The group comprised patients with a single pregnancy, PPH, CS 5n and reactive NST. For preinduction 150 mg oestradiol in a viscous gel were used which along with a pessary was inserted 24 hours before the planned induction of delivery by the vaginal route on the portio uteri. After removal of the pessary the CS was evaluated and then delivery was induced by intracervically administered prostaglandin. The preinduction was successful in 32 patients (84.3%), in 6 patients uterine contractions started during preinduction, delivery by forceps was used twice (5.3%) and Caesarean section six time (15.8%). In the course of preinduction there were no side-effects, no irregularities in the course of parturition were observed. The described method can be recommended as the method of choice for the treatment of an immature portio uteri before planned induction of delivery.