Support for this study was provided by both the Department of Defense, grant W81XWH1910318, and the 2017 Boston Center for Endometriosis Trainee Award. Through the J. Willard and Alice S. Marriott Foundation, financial resources were allocated for the creation of the A2A cohort and the subsequent data gathering activities. The Marriott Family Foundation has provided financial support to N.S., A.F.V., S.A.M., and K.L.T. Agricultural biomass An R35 MIRA Award from NIGMS (5R35GM142676) provides funding for C.B.S. The support of NICHD R01HD094842 is given to S.A.M. and K.L.T. Although S.A.M. holds advisory board positions with AbbVie and Roche, is the Field Chief Editor for Frontiers in Reproductive Health, and received personal fees from Abbott for roundtable participation, none of these are related to the study being discussed. No conflicts of interest are reported by other authors, as per their statements.
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Within the scope of typical clinic care, do patients readily engage in conversations regarding the potential for treatment to be unsuccessful, and which factors are associated with this willingness?
Nine tenths of patients are eager to delve into this possibility as part of their regular healthcare routine; this eagerness correlates with higher perceived gains, fewer perceived barriers, and a more positive stance.
Approximately 58% of IVF/ICSI patients within the UK who complete a maximum of three treatment cycles do not successfully conceive a live birth. Psychosocial support for patients undergoing unsuccessful fertility treatments (PCUFT), which involves guidance and assistance with the implications of treatment failure, can lessen the psychosocial distress and encourage a positive adjustment to this loss. high-dose intravenous immunoglobulin Studies indicate that 56% of patients are prepared for a cycle that doesn't yield the desired results, yet there's limited understanding of their openness and preferences regarding a discussion about definitively unsuccessful treatments.
A cross-sectional study design utilized a theoretically driven, patient-centered, mixed-methods online survey, offered in both English and Portuguese. Social media was utilized to distribute the survey, encompassing the duration between April 2021 and January 2022. Eligibility was determined by the following criteria: the applicant had to be 18 years or older, undergoing or awaiting an IVF/ICSI treatment, or having completed an IVF/ICSI treatment within the last six months without achieving pregnancy. In response to the survey, 451 people, or 693% of the 651 who accessed it, provided their consent to participate. Of the total participants, 100 did not complete 50% of the survey questions. Separately, nine failed to report on the primary outcome, willingness. However, 342 participants completed the survey, reaching a noteworthy completion rate of 758%, with 338 of them being women.
Drawing upon the Health Belief Model (HBM) and the Theory of Planned Behavior (TPB), the survey was conceived. Quantitative questions addressed sociodemographic attributes and treatment histories. To assess patient past experiences, willingness, and preferences (including who, what, how, and when) toward PCUFT, and also theoretically suggested factors possibly affecting receptiveness, a mixed methods research approach (quantitative and qualitative) was used. Statistical analysis, employing both descriptive and inferential techniques, was conducted on the quantitative data pertaining to PCUFT experiences, willingness, and preferences. The textual data was examined using thematic analysis. To explore the determinants of patient willingness, two logistic regression analyses were conducted.
A sizeable group of participants, averaging 36 years old, were concentrated in Portugal (599%) and the UK (380%). A considerable portion, specifically 971%, of the surveyed individuals had been involved in a romantic relationship for about a decade, and a significant 863% remained childless. In the average, participants endured treatment for 2 years [SD=211, range 0-12 years], with a large proportion (718%) having previously completed at least one IVF/ICSI cycle, yet nearly all (935%) without success. In a survey, about one-third (349 percent) of respondents indicated that they had received PCUFT. read more Participants' consultant was identified, through thematic analysis, as the principal source of the received information. A central point of the discussion was the dismal anticipated prognosis for patients, with achieving a positive conclusion emphasized. In the overwhelming majority of cases (933%), participants desired PCUFT. Based on the gathered data, a strong desire was indicated for psychological support from a psychologist, psychiatrist, or counselor (786%), most often sought in cases of poor prognoses (794%), emotional distress (735%), or when accepting potential treatment failure was proving challenging (712%). Optimal timing for PCUFT administration was pre-initiation of the first cycle (733%), with a preference for one-on-one (mean=637, SD=117; scored on a 1-7 scale) or dyadic (mean=634, SD=124; scored on a 1-7 scale) delivery formats. A thematic analysis underscored participants' desire for PCUFT to provide an extensive overview of treatment options and their possible consequences, customized to each patient's situation, and to encompass psychosocial support, primarily focused on strategies for coping with loss and maintaining hope for the future. Individuals who indicated a willingness to receive PCUFT showed a greater perceived benefit from strengthening psychosocial resources and coping strategies (odds ratios (ORs) 340, 95% confidence intervals (CIs) 123-938), a lower perceived barrier to experiencing negative emotions (OR 0.49, 95% CI 0.24-0.98), and a stronger positive attitude toward the usefulness and benefits of PCUFT (OR 3.32, 95% CI 2.12-5.20).
A group of female patients, self-selected, who have not yet met their objectives for parenthood, made up the majority of the sample. The study's statistical conclusions were weakened because a small contingent of participants declined to receive PCUFT. The primary outcome variable, intentions, and actual behavior were found to have a moderate association, according to research.
As part of their standard care, fertility clinics should offer patients early dialogues concerning the possibility of their treatment being unsuccessful. PCUFT's objective should be to reduce the distress associated with grief and loss by assuring patients of their strength in dealing with any treatment outcome, promoting coping mechanisms, and linking them to further support services.
M.S.-L. Kindly return the item designated M.S.-L. The fellowship, SFRH/BD/144429/2019, from the Portuguese Foundation for Science and Technology, I.P. (FCT), is held by R.C. for doctoral studies. Projects UIDB/04750/2020, LA/P/0064/2020, and UIDB/PSI/01662/2020 are used to finance, respectively, the EPIUnit, ITR, and CIPsi (PSI/01662), with the Portuguese State Budget allocated through FCT. In terms of financial disclosures, Dr. Gameiro has reported consultancy fees stemming from TMRW Life Sciences and Ferring Pharmaceuticals A/S and speaker fees from Access Fertility, SONA-Pharm LLC, Meridiano Congress International, and Gedeon Richter, and he also acknowledges grants from Merck Serono Ltd., an affiliate of Merck KGaA, Darmstadt, Germany.
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In natural cycles (NC) with standard luteal phase support, do serum progesterone (P4) levels on the embryo transfer (ET) day help forecast ongoing pregnancy (OP) after a single euploid blastocyst transfer?
Euploid embryos, frozen and transferred in North Carolina, do not demonstrate a predictive association between pre-transfer P4 levels and ovarian performance, when luteal phase support is routinely provided post-transfer.
A non-stimulated (NC) frozen embryo transfer (FET) relies on progesterone (P4) from the corpus luteum to convert the endometrium into a secretory state and sustain the pregnancy after implantation. Disputes persist regarding a P4 cutoff point on the ET day, its predictive capacity for OP, and the possible supplementary role of LPS after the ET procedure. Previous studies focused on NC FET cycles, involving the evaluation and determination of P4 cutoff values, did not definitively rule out embryo aneuploidy as a possible cause of the observed failures.
A retrospective evaluation of single, euploid embryo transfers (FETs) was conducted at a tertiary referral IVF center (NC) between September 2019 and June 2022, focusing on cases with available data on progesterone (P4) levels on the day of embryo transfer (ET) and resulting treatment outcomes. For the analysis, each patient was represented by a single data point. Outcomes were classified as ongoing pregnancy (OP), defined as a clinically recognized pregnancy with a detectable fetal heartbeat after 12 weeks, or as non-ongoing pregnancy (no-OP), encompassing no pregnancy, biochemical pregnancy, or early pregnancy loss.
Patients manifesting ovulatory cycles, accompanied by a single euploid blastocyst within an NC FET cycle, were part of the study group. The cycles were tracked using ultrasound and repeated assessments of serum LH, estradiol, and P4. A rise in LH levels by 180% above the preceding level indicated an LH surge, and simultaneously, a progesterone level of 10ng/ml served as confirmation of ovulation. The ET was programmed for the fifth day following the rise in P4, and vaginal micronized P4 was commenced on the day of the ET itself, following the measurement of P4 levels.
From a cohort of 266 patients, 159 individuals exhibited an OP, comprising a proportion of 598%. No meaningful difference was found in age, BMI, or the day of embryo biopsy/cryopreservation (Day 5 versus Day 6) when comparing the OP-group to the no-OP-group. Patient groups with or without OP showed no significant difference in their P4 levels; 148ng/ml (IQR 120-185ng/ml) for OP and 160ng/ml (IQR 116-189ng/ml) for no-OP (P=0.483). Analysis of P4 levels stratified by categories of >5 to 10, >10 to 15, >15 to 20, and >20 ng/ml also revealed no difference (P=0.341). The quality of embryos (EQ), as determined by the inner cell mass/trophectoderm ratio, differed significantly between the two groups, and this difference was even more pronounced when the groups were divided into 'good', 'fair', and 'poor' categories (P=0.0001 and P=0.0002, respectively).