Browsing by Subject "Infertility"
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Item Open Access A conceptual framework for patient-centered fertility treatment.(Reproductive health, 2017-09-07) Duthie, Elizabeth A; Cooper, Alexandra; Davis, Joseph B; Schoyer, Katherine D; Sandlow, Jay; Strawn, Estil Y; Flynn, Kathryn EBACKGROUND:Patient-centered care is a pillar of quality health care and is important to patients experiencing infertility. In this study we used empirical, in-depth data on couples' experiences of infertility treatment decision making to inform and revise a conceptual framework for patient-centered fertility treatment that was developed based on health care professionals' conceptualizations of fertility treatment, covering effectiveness, burden, safety, and costs. METHODS:In this prospective, longitudinal mixed methods study, we collected data from both members (separately) of 37 couples who scheduled an initial consult with a reproductive specialist. Data collection occurred 1 week before the initial consultation, 1 week after the initial consultation, and then roughly 2, 4, 8, and 12 months later. Data collection included semi-structured qualitative interviews, self-reported questionnaires, and medical record review. Interviews were recorded, transcribed, and content analyzed in NVivo. A single coder analyzed all transcripts, with > 25% of transcripts coded by a second coder to ensure quality control and consistency. RESULTS:Content analysis of the interview transcripts revealed 6 treatment dimensions: effectiveness, physical and emotional burden, time, cost, potential risks, and genetic parentage. Thus, the revised framework for patient-centered fertility treatment retains much from the original framework, with modification to one dimension (from safety to potential risks) and the addition of two dimensions (time and genetic parentage). For patients and their partners making fertility treatment decisions, tradeoffs are explicitly considered across dimensions as opposed to each dimension being considered on its own. CONCLUSIONS:Patient-centered fertility treatment should account for the dimensions of treatment that patients and their partners weigh when making decisions about how to add a child to their family. Based on the lived experiences of couples seeking specialist medical care for infertility, this revised conceptual framework can be used to inform patient-centered treatment and research on infertility and to develop decision support tools for patients and providers.Item Open Access Cardiometabolic Risk Factors among Severely Obese Children and Adolescents in the United States, 1999-2012.(Childhood obesity (Print), 2016-02) Li, Linlin; Pérez, Adriana; Wu, Li-Tzy; Ranjit, Nalini; Brown, Henry S; Kelder, Steven HBackground
Severely obese children and adolescents are at high risk of suffering obesity-related comorbidities. This article is to examine the dose-response relationship between weight status and cardiometabolic risk factors among US adolescents.Methods
Youths aged 6-19 years participating in the National Health and Nutrition Examination Surveys (NHANES) 1999-2012 were included (N = 20,905). Severe obesity was defined as BMI ≥120% of 95th percentile of gender-specific BMI-for-age or BMI ≥35 kg/m(2). Obesity-related cardiometabolic risk factors included blood pressure (BP), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), total cholesterol (TC), triglycerides, and fasting glucose (FG). Weighted multiple logistic regression was used to assess whether severe obesity significantly changed the odds of having cardiometabolic risk factors.Results
The prevalence of high BP, high TC, low HDL, high triglycerides, high LDL, and high FG among severely obese adolescents was 9.9%, 16.5%, 40.0%, 30.0%, 13.0%, and 26.8%, respectively. Severely obese adolescents had at least twice the odds compared to normal weight adolescents of presenting high BP (OR = 5.3, 95% CI: 3.8-7.3); high TC (OR = 2.3, 95% CI: 1.8-3.0); low HDL (OR = 7.3, 95% CI: 6.1-8.8); high triglycerides (OR = 4.5, 95% CI: 3.4-5.9); high LDL (OR = 2.3, 95% CI: 1.5-3.5); and high FG (OR = 2.7, 95% CI: 1.8-4.0). Significant differences were also found between severely obese status and moderately obese status in the odds of having high BP (OR = 1.8, 95% CI: 1.7-2.2) and low HDL (OR = 1.9, 95% CI: 1.6-2.3).Conclusion
Adolescents classified as severe status exhibit higher odds of having cardiometabolic risk factors compared to those with normal weight and moderately obese weight status.Item Open Access Navigating Still Waters of Infertility: Role of Goal Features in Coping with a Thwarted Goal.(International journal of behavioral medicine, 2021-07-15) Andrade, Fernanda C; Davisson, Erin K; Kwiatek, Sarah; Hoyle, Rick HBackground
The infertility experience is often surrounded by frustration and discouragement associated with the thwarted goal to have a child. Though research has identified commonly used strategies to cope with infertility, this study is the first to examine how different goal attributes and processes associated with the experience of infertility relate to coping strategy use and psychological distress.Method
Women (N = 353) recruited from online support forums reported on the nature of their goal to have a child, their psychological distress, and their use of strategies to cope with the failure to achieve that goal.Results
Women reported high striving toward a goal high in importance and commitment, coupled with high goal-related stress and feeling that achievement is blocked. Consistent with the notion that coping strategy use is specific to the features of the experience, no single goal attribute nor combination of attributes consistently accounted for coping strategy use, suggesting that the latter may be specific to the cognitions and processes of pursuit of the goal to have a child. With one exception, perceptions of impediment were better predictors of psychological distress than any level of perceived facilitators of goal pursuit, positing potential targets for future psychological interventions.Conclusion
Understanding how women cope with infertility may require a detailed conceptualization of their goal to have a child. In the present sample, dynamic processes and coping strategies that otherwise detract from success were generally beneficial by providing alternatives to the pursuit of a thwarted goal.Item Open Access Pre-IVF treatment with a GnRH antagonist in women with endometriosis (PREGNANT): study protocol for a prospective, double-blind, placebo-controlled trial.(BMJ open, 2022-06) Taylor, Hugh; Li, Howard J; Carson, Sandra; Flores, Valerie; Pal, Lubna; Robbins, Jared; Santoro, Nanette F; Segars, James H; Seifer, David; Huang, Hao; Young, Steven; Zhang, HepingIntroduction
Infertility is a common complication of endometriosis. While in vitro fertilisation-embryo transfer (IVF) successfully treats endometriosis-associated infertility, there is some evidence that pregnancy rates may be diminished in women seeing fertility treatment for endometriosis-associated infertility compared with other etiologies of infertility. The use of gonadotropin releasing hormone (GnRH) agonist prior to IVF has been suggested to improve success, however studies have been small and rarely reported live birth rates. Recent approval of an oral GnRH antagonist for endometriosis provides a novel option for women with endometriosis who are undergoing IVF. There have been no studies on the efficacy of GnRH antagonists for the treatment of endometriosis-related infertility.Methods and analysis
This study is a multicentre, prospective, randomised, double-blind, placebo-controlled trial to study the efficacy of GnRH antagonist pretreatment for women with endometriosis who are undergoing IVF. A total of 814 patients with endometriosis undergoing fertility treatment will be enrolled and randomised 1:1 into two groups: elagolix 200 mg two times per day or placebo for 8 weeks, prior to undergoing IVF. All participants will then undergo IVF treatment per local protocols. The primary outcome is live birth. Secondary outcomes include oocyte number, fertilisation rate, embryo morphology and implantation rates, as well as rates of known endometriosis-related obstetrical outcomes (pregnancy-induced hypertension, antepartum haemorrhage, caesarean delivery and preterm birth).Ethics and dissemination
The PREGnant trial was approved by the Institutional Review Board at Johns Hopkins University. Results will be published in a peer-reviewed journal.Trial registration number
NCT04173169.Item Open Access Priorities for family building among patients and partners seeking treatment for infertility.(Reprod Health, 2017-04-05) Duthie, Elizabeth A; Cooper, Alexandra; Davis, Joseph B; Sandlow, Jay; Schoyer, Katherine D; Strawn, Estil; Flynn, Kathryn EBACKGROUND: Infertility treatment decisions require people to balance multiple priorities. Within couples, partners must also negotiate priorities with one another. In this study, we assessed the family-building priorities of couples prior to their first consultations with a reproductive specialist. METHODS: Participants were couples who had upcoming first consultations with a reproductive specialist (N = 59 couples (59 women; 59 men)). Prior to the consultation, couples separately completed the Family-Building Priorities Tool, which tasked them with ranking from least to most important 10 factors associated with family building. We describe the highest (top three) and lowest (bottom three) priorities, the alignment of priorities within couples, and test for differences in prioritization between men and women within couples (Wilcoxon signed rank test). RESULTS: Maintaining a close and satisfying relationship with one's partner was ranked as a high priority by majorities of men and women, and in 25% of couples, both partners ranked this factor as their most important priority for family building. Majorities of men and women also ranked building a family in a way that does not make infertility obvious to others as a low priority, and in 27% of couples, both partners ranked this factor as the least important priority for family building. There were also differences within couples that involved either men or women ranking a particular goal more highly than their partners. More women ranked two factors higher than did their partners: 1) that I become a parent one way or another (p = 0.015) and 2) that I have a child in the next year or two (p < 0.001), whereas more men ranked 4 factors higher than their partners: 1) that our child has [woman's] genes (p = 0.025), 2) that our child has [man's] genes (p < 0.001), 3) that I maintain a close relationship with my partner (p = 0.034), and 4) that I avoid side effects from treatment (p < 0.001). CONCLUSIONS: Clinicians who support patients in assessing available family-building paths should be aware that: (1) patients balance multiple priorities as a part of, or beside, becoming a parent; and (2) patients and their partners may not be aligned in their prioritization of achieving parenthood. For infertility patients who are in relationships, clinicians should encourage the active participation of both partners as well as frank discussions about each partner's priorities for building their family.Item Open Access Psychobiological, Clinical, and Sociocultural Factors that Influence Black Women to Seek, Initiate, and Complete Treatment for Infertility: A Mixed Methods Study(2020) Cebert, MorineBlack women in the U.S. have twice the prevalence of infertility (14%) than non-Hispanic white women (7%) yet are twice as less likely to seek initial evaluation for infertility. Disparities in infertility treatment use among Black women are crucial to address in order to promote health and wellness in this population. Childbearing is a culturally central component of Black families and Black women with infertility experience notable alterations to their self and gender identity, high levels of isolation, silence, and negative medical experiences related to their fertility status. Despite these negative experiences among Black women, the literature fails to highlight reasons for lower uptake of infertility treatment beyond highlighting the sociodemographic characteristics of those who seek, initiate, and complete treatment as mainly affluent, highly educated, and older Non-Hispanic White women. Research on the health seeking process for Black women with infertility is scarce and provide incomplete understanding of their reproductive experiences. Since little is known about what factors influence the processes of seeking, initiating, and completing treatment for infertility for Black women, the purpose of this dissertation was to generate knowledge of the multi-dimensional influences that Black women may experience during the their journey to family building.
The aim of this dissertation study was to understand the psychobiological, clinical, and sociocultural factors that influence Black women’s decisions to seek, initiate, and complete the recommended treatment plan for infertility within three different chapters. Chapter 2 reviewed the state of the science regarding the psychobiological, clinical, and sociocultural factors that influenced women in the U.S to seek treatment for their infertility symptoms and experiences. Chapter 3 analyzed and described psychobiological, clinical, and social data collected from a retrospective cohort chart review that examined 391 Black women who sought a reproductive endocrinology evaluation and determined what factors influenced initiation and completion of the recommended treatment plan for infertility. In, Chapter 4, quantitative data from Chapter 3 was merged with qualitative data from 13 semi-structured interviews in a convergent parallel mixed methods study to provide a comprehensive understanding of what psychobiological, clinical, and sociocultural experiences influenced Black women to seek and initiate treatment for infertility.
Psychobiological, clinical, and sociocultural factors are associated with seeking, initiating, and completing infertility treatment among Black women. Multi-dimensional barriers across these domains influence the entire health seeking process for women causing delays in access, reduced uptake in treatment, and ultimate completion of treatment. Black women would benefit from future research that target modifiable factors by way of intervention development and policy modifications that increase safe, affordable, and culturally sensitive access to reproductive endocrinology services to reduce these disparities affecting Black women with infertility.
Item Open Access Studying human fertility and environmental exposures.(Environ Health Perspect, 2004-08) Slama, Rémy; Ducot, Béatrice; Keiding, Niels; Bouyer, JeanItem Open Access Too much time? Time use and fertility-specific quality of life among men and women seeking specialty care for infertility.(BMC psychology, 2019-07-09) Cusatis, Rachel; Fergestrom, Nicole; Cooper, Alexandra; Schoyer, Kate D; Kruper, Abbey; Sandlow, Jay; Strawn, Estil; Flynn, Kathryn EBACKGROUND:There are known gender differences in the impacts infertility has on quality of life and well-being. Less is known about how infertile couples spend time on fertility-related tasks and associations with quality of life. The purpose of this study is to evaluate whether time spent on tasks related to family-building decision-making (including research, reflection, discussions with partner, discussions with others, and logistics) were associated with fertility-specific quality of life or anxiety among new patients. METHODS:Couples or individuals (N = 156) with upcoming initial consultations with a reproductive specialist completed the Fertility Quality of Life (FertiQoL) tool, which produces a Core (total) score and four subscales: Emotional, Relational, Social, and Mind-Body. We developed questions to measure time spent in the previous 24 h on tasks related to family-building. We tested for differences by gender in time use (McNemar's Test) and used ordinary least squares regression to analyze the relationship between time use and FertiQoL scores. RESULTS:In the week before a new consultation, a higher percentage of women reported time spent in the past 24 h in research, reflecting, discussion with others, and logistics compared to male partners (all p < 0.05). In adjusted models, more time spent reflecting was associated with worse FertiQoL scores for both men and women, as well as with higher anxiety for men. Time spent in discussion with others was associated with higher anxiety for women but better Social FertiQoL scores for men. CONCLUSIONS:Couples seeking infertility consultation with a specialist reported spending time on tasks related to family-building before the initial visit. There were gender differences in the amount of time spent on these tasks, and time was associated with fertility-specific quality of life and anxiety.