Psychosocial outcomes of children born via embryo donation.

STUDY QUESTION: What are parents' perceptions of their relationships with and the psychosocial adjustments of their children who are born via embryo donation? SUMMARY ANSWER: Families created through embryo donation have well-adjusted parent-child relationships and reassuring child psychosocial outcomes. WHAT IS KNOWN ALREADY: Embryo donation is an effective and growing form of third-party reproduction, but there is limited research in this field. Prior studies suggest that families created through gamete donation function well regarding parent-child relationship quality and child behavioral and socioemotional adjustment. STUDY DESIGN, SIZE, DURATION: This is a cross-sectional survey study with 187 total participants. PARTICIPANTS/MATERIALS, SETTING, METHODS: Parents of children born via embryo donation were recruited nationally by contacting all embryo donation programs registered with the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) as well as medically directed embryo donation or 'embryo adoption' centers. Participants completed three online Qualtrics questionnaires. The first was a survey including 33 questions on demographics, the procurement process, and self-reported obstetric outcomes. Participants also completed two standardized measures assessing children's behavior and parents' adjustment to parenthood: the Strengths and Difficulties Questionnaire (SDQ) and the Parental Acceptance-Rejection Questionnaire (PARQ). Scoring of the SDQ and PARQ was totaled and compared to standardized values (SDQ) or previously published results on other forms of gamete donation (PARQ), such as oocyte donation and sperm donation. MAIN RESULTS AND THE ROLE OF CHANCE: On the SDQ (n = 46), the average total difficulties scores by age were: 8.2 ± 0.98 for ages 2-4, 7.6 ± 0.93 for ages 5-10, and 3.5 ± 0.77 for ages 11-17; this is compared to the normal reported range of 0-13, which indicates that clinically significant psychosocial problems are unlikely. Across all ages and individual categories (emotional symptoms, conduct problem, hyperactivity, peer problem, prosocial), scores on the SDQ were within the normal ranges. The average PARQ score (n = 70) for all respondents was 27.5 ± 1.18 (range: 24-96), suggesting perceived parental acceptance. LIMITATIONS, REASONS FOR CAUTION: Because this study was cross-sectional, it could not capture familial relationships over time. This survey-based study design allows for potential selection bias (parents of well-adjusted children may be more likely to participate). Additionally, the overall sample size is relatively small; however, it remains one of the largest published to date. Another significant limitation to this study is the lack of generalizability: most participants were recruited from private, faith-based, embryo donation programs who are demographically similar. WIDER IMPLICATIONS OF THE FINDINGS: Though embryo donation is an established form of third-party reproduction, it is significantly less robustly studied compared to other forms of gamete donation (oocyte or sperm donation). This study provides a larger data set with a more expanded age range of children compared to the limited number of previously published studies. Furthermore, these findings indicate a high parental disclosure rate with respect to the use of embryo donation which contrasts previous findings. STUDY FUNDING/COMPETING INTEREST(S): No external funding source was utilized for the completion of this study. No conflicts are disclosed. TRIAL REGISTRATION NUMBER: N/A.

Harm Reduction Policy Support among Students at Two U.S. Universities.

Background: The U.S. is undergoing an opioid overdose crisis. Harm reduction (HR) policies are associated with decreased overdose deaths and incidence of communicable diseases, yet legality of HR policies differs across U.S. jurisdictions. College student perceptions of HR policies are underexplored, even though their voting behavior has increased in recent years. We sought to compare their support of different HR policies and to explore relationships between demographic characteristics and support for HR policies. Methods: We collected cross-sectional, convenience sample survey data from undergraduate students at two large public universities, one in the Midwest and one in the Southeast, during Fall 2018/Spring 2019. We analyzed data using descriptive statistics and logistic regressions. Results: The final sample included 1,263 respondents. Good Samaritan laws (n = 833, 66%) and naloxone distribution (n = 476, 37.7%) were most commonly supported, while heroin maintenance treatment (n = 232, 18.4%) and heroin decriminalization (n = 208, 16.5%) were least supported. Democrat/liberal or less religious/spiritual respondents supported HR policies more than their Republican/conservative or religious/spiritual counterparts. Midwestern students were more likely to support syringe services programs. Conclusion: HR education initiatives could target religious and/or Republican/conservative students, as they have lower HR support. Among HR policies, Good Samaritan policies may be easiest to pass in college communities.

College students' perceived knowledge of and perceived helpfulness of treatments for opioid use disorder at two American universities.

Background The U.S. is experiencing an opioid overdose health crisis, largely driven by opioid use disorder (OUD). College students have relatively high rates of substance use disorders. Objectives To identify perceived knowledge of and perceived helpfulness of various OUD treatments, including medications for OUD (MOUD), among college students. Methods A convenience sample of students enrolled at two public universities during Fall 2018/Spring 2019 were recruited for an online cross-sectional survey. Questions examined reported knowledge of and perceived helpfulness of MOUD (i.e. methadone, buprenorphine, naltrexone) and non-MOUD treatments for OUD (e.g. peer support groups, individual counseling, group counseling, outpatient treatment). Logistic regression examined associations between knowledge, perceived helpfulness, and demographic variables. Results We received 1,439 responses and kept 1,280 (39% male; 61% female). Respondents were significantly more likely to report knowledge about non-MOUD treatments than MOUD treatments (48.7% of respondents reported being very knowledgeable about individual counseling, 4.4% about methadone, 3.8% about naltrexone, and 3.4% about buprenorphine). Among those reporting at least some MOUD knowledge, few perceived MOUD as helpful/very helpful (methadone 14%, naltrexone 14%, and buprenorphine 11%). Among those reporting at least some counseling knowledge, 71% felt counseling was helpful/very helpful. Perceived treatment knowledge was significantly and positively associated with perceived treatment helpfulness. Conclusions Students had more positive attitudes toward non-MOUD treatments than toward MOUD despite greater efficacy of the latter for OUD. Colleges could provide information about MOUD during orientation, in course work, through student extracurricular organizations, or through college health clinics.

Evidence-Based, Ethical Decision-Making: Using Simulation to Teach the Application of Evidence and Ethics in Practice.

BACKGROUND: Evidence-based practice and ethics should not be taught as isolated concepts. Instead, it is imperative to prepare students with the knowledge needed to practice ethical, evidence-based decision-making in health care. PURPOSE: The purpose of this project was to describe how a mock hospital ethics committee meeting impacted students' learning about the use of evidence to support ethical decision-making in health care. METHOD: A mock hospital ethics committee was convened for 121 students from schools of nursing, social work, law, and medicine. RESULTS: Thematic content analysis showed a positive impact on nursing students' learning of ethics, group dynamics, discipline-specific responsibilities, and EBP. LINKING EVIDENCE TO ACTION: This interprofessional education experience showed students how evidence and ethics can be used to guide and support practice priorities, responsibilities, and decisions on resource utilization and treatment to enable optimal outcomes for patients and organizations.

Expanded Preconception Carrier Screening in Clinical Practice: Review of Technology, Guidelines, Implementation Challenges, and Ethical Quandaries.

In the last 10 years, expanded preconception carrier screening has become widely available and helps patients/couples make more informed decisions with regard to their reproductive options and facilitates more effective preconception planning, prenatal diagnosis, condition-specific counseling, and condition-specific care. This review provides an overview of expanded preconception carrier screening's high-throughput genotyping and sequencing approaches, current guidelines, implementation challenges and evolving ethical quandaries.

College Student Preferences for Substance Use Disorder Educational Videos: A Qualitative Study.

BACKGROUND: College student preferences regarding substance use disorder (SUD) education and treatment-related education have been understudied, despite this population's relatively high risk of developing SUDs and low help-seeking rates. We sought to identify students' preferences regarding content, style, and format of educational online videos about SUDs and SUD treatment. METHOD: We held six, two-hour long focus groups with college student participants from Indiana University from 2017 to 2018 during which participants were shown drafts of scripts, mock-up images, and animation and then asked open-ended questions about their preferences and suggested changes. Focus groups were audio recorded and transcribed. Researchers then undertook thematic analysis of focus groups: independently coding transcripts for data related to the research questions, conducting consensus coding, and then analyzing coded data for themes. RESULTS: 39 students participated in focus groups, approximately half of whom were undergraduate students and the other half were graduate students. They preferred animated video characters that were relatable to college students but abstract enough to represent a range of students, such as stick figures with backpacks. They preferred conversational narration with subtle humor and references to realistic reasons for college students using drugs or alcohol. Participants encouraged inclusion of information about SUD impacts on school, work, and relationships, in addition to physical health. Participants opposed any content or style that could be interpreted as fear-mongering. They requested more information regarding medication-assisted treatment efficacy and less information about side effects. CONCLUSION: College students have unique cultural needs, necessitating tailored educational interventions about SUD and SUD treatments.

Sexual function and fertility quality of life in women using in vitro fertilization.

INTRODUCTION: Women undergoing fertility treatment are likely to report negative changes in sexual function. With the rapid increase in the number of women pursuing in vitro fertilization (IVF), there is a need to better understand how IVF impacts a woman's sexual experiences and quality of life. AIMS: This study has three purposes: (i) test the psychometric properties of the Sexual Functioning Questionnaire (SFQ) in a sample of U.S. women undergoing IVF; (ii) compare sexual function of women undergoing IVF with a nonclinical sample of U.S. women; and (iii) identify the aspects of sexual function most related to fertility quality of life (FertiQoL). METHOD: A total of 136 women who had recently undergone or who were currently undergoing IVF completed a web-based, cross-sectional survey about sexual experiences and quality of life. MAIN OUTCOME MEASURES: Data were collected on infertility diagnosis, length of infertility, number of IVF cycles, pregnancy, and birth outcomes. Six domains of sexual function as well as the medical impact of IVF were assessed using the SFQ. A validated instrument was used to measure FertiQoL. RESULTS: Reliability analyses for the SFQ indicate sufficiently strong fit (Cronbach's alpha = 0.79 to 0.89). Compared with a nonclinical sample, women undergoing IVF scored significantly lower in sexual interest, desire, orgasm, satisfaction, sexual activity, and overall sexual function (P < 0.05). A stepwise linear regression indicated that sexual problems predicted FertiQoL scores (Beta = 4.61, P < 0.01). The most common sexual problems included lack of sexual interest or desire (30%), difficulty with orgasm (15%), vaginal dryness (14%), and vaginal tightness (13%). CONCLUSIONS: Women undergoing IVF may be at particular risk for sexual problems. Sexual function issues may markedly impact overall quality of life during fertility treatment and should be addressed as an important component of comprehensive care.

The impact of an interactive multimedia educational platform on patient comprehension and anxiety during fertility treatment: a randomized controlled trial.

Objective: To assess the impact of an interactive multimedia educational platform and consent process on patient comprehension and anxiety state compared with standard fertility counseling and paper consents in patients undergoing ovulation induction-intrauterine insemination (OI-IUI) or in vitro fertilization (IVF) throughout their first infertility treatment cycle. Design: Prospective randomized controlled trial. Setting: A university-affiliated reproductive endocrinology and infertility clinic. Patients: Patients aged 18-45 years undergoing their first OI-IUI or IVF cycle. Interventions: An interactive multimedia educational and consent platform (EngagedMD-[EMD]) before and during the first infertility treatment, in addition to standard fertility counseling by the physician and nurse team. Main Outcome Measures: Three survey time points: before the start of treatment (T1), at the start of treatment (T2), and at the completion of the treatment cycle (IUI or oocyte retrieval; T3). The main outcome measure was the comprehension score on a 15-question assessment administered at 2 times points (T2 and T3). The anxiety state at all 3 time points was assessed using a modified Spielberger State-Trait Anxiety Inventory score. Results: Eighty-six patients were included: 21 in the OI-IUI conventional (i.e., standard fertility counseling group) group, 22 in the IVF conventional group, 21 in the OI-IUI EMD group, and 22 in the IVF EMD group. Overall, the average number correct on the 15-question comprehension assessment was significantly higher in the EMD groups than in the conventional groups at T2 (EMD: 13.2 ± 1.8 vs. conventional: 11.7 ± 1.8) but not at T3. For those undergoing IVF, the average number correct was significantly higher at both T2 and T3 in the EMD vs. the conventional group (T2: 14.1 ± 1.3 vs. 12.4 ± 1.8; T3: 14.1 ± 1.7 vs. 12.5 ± 1.5). The average State-Trait Anxiety Inventory scores at each time point were similar between the EMD and conventional groups for both OI-IUI and IVF groups. Age ≤35 years and IVF treatment were significant predictors of increased State-Trait Anxiety Inventory scores. Conclusions: The addition of an interactive multimedia educational platform significantly improved patient comprehension at the initiation of OI-IUI and IVF cycles for patients undergoing fertility treatment for the first time. Those undergoing IVF with access to EMD had sustained, improved comprehension at the end of their treatment. The supplementation of a multimedia platform did not alter anxiety throughout the treatment. Younger patients undergoing IVF may benefit from increased psychological resources. Clinical Trial Registration Number: NCT03962257.

A pilot study of U.S. college students' 12-step orientation and the relationship with medications for opioid use disorder.

Objective: To examine undergraduate college students' attitudes toward 12-step support group utilization for opioid use disorder (OUD) and associations with previous experience with medications for OUD (MOUD). Participants: A convenience sample of undergraduate students at two major U.S. universities during Fall 2018 and Spring 2019. Method: A cross-sectional online survey of agreement with three 12-step orientation measures, MOUD experience, and demographic variables. Results: 1,281 students responded. Among 12-step orientation measures, respondents were most likely to agree that people with OUD should reach out to others in recovery. MOUD experience was significantly and negatively associated with agreement on each 12-step orientation measure. Religiosity/spirituality was positively associated with agreement that people with OUD should accept lack of control over OUD while placing trust in a higher power. Conclusion: Students with MOUD experience may be aware of anti-MOUD stigma in peer support groups and thus less likely to agree with 12-step orientation measures.

Boutique Egg Freezing: Empowering Technology or Marketing Phenomenon? A Word of Caution.

The introduction of oocyte vitrification has propelled the field of oncofertility. However, it is becoming increasingly common to offer planned oocyte cryopreservation to healthy, fertile women due to a lack of a partner or other personal issues. The aim of this article is to discuss the pros and cons of planned oocyte cryopreservation along with potential exploitation issues by unregulated clinics and international agencies. This article further encourages obstetricians and gynecologists to discuss these issues of planned oocyte cryopreservation with their patients to empower them to make an educated decision based on research and science rather than be susceptible to entities that stand to gain monetarily by prompting women to fear a childless future.

Receipt of training about medication for opioid use disorder from pharmaceutical manufacturers: A preliminary study of Florida criminal problem-solving and dependency court staff.

INTRODUCTION AND AIMS: People with opioid use disorder are prevalent in criminal problem-solving courts and dependency courts, which have rehabilitative aims. Medication for opioid use disorder (MOUD) is the standard of care. Court staff set treatment policies for court clients. They may receive training from MOUD manufacturers, but no studies have examined court staff receipt of such training. DESIGN AND METHODS: To examine receipt of training from MOUD manufacturers, we designed a cross-sectional survey for court staff. We distributed it online to all Florida court staff in criminal problem-solving or dependency courts (n = 585). Outcome variables were receipt of training from one or more MOUD manufacturers and training source. Covariates included dichotomous measures of court type, staff role, gender and rurality. Logistic regression models estimated the relationship between receipt of training and covariates. RESULTS: Twenty-one percent of Florida criminal problem-solving and dependency court staff completed the survey. The most common receipt of training was from the manufacturer of extended-release naltrexone (36%), followed by buprenorphine (24%) and methadone (11%). Fifty-seven percent of those who received training received it from more than one MOUD manufacturer. Criminal problem-solving court staff were more likely than dependency court staff to receive training from MOUD manufacturers. Court program co-ordinators were more likely than other staff roles to receive training from MOUD manufacturers. DISCUSSION AND CONCLUSIONS: A large minority of respondents received training from a MOUD manufacturer, primarily from extended-release naltrexone's manufacturer, raising concerns regarding information accuracy and conflicts of interest. Court staff should seek MOUD training from academic institutions and non-profit organisations instead.

Court personnel attitudes towards medication-assisted treatment: A state-wide survey.

BACKGROUND: Despite its efficacy, medication-assisted treatment (MAT) is rarely available in the criminal justice system in the United States, including in problem-solving courts or diversionary settings. Previous studies have demonstrated criminal justice administrators' hostility towards MAT, especially in prisons and jails. Yet, few studies have examined attitudes among court personnel or compared beliefs among different types of personnel. Also, few studies have explored the relationship between MAT education/training and attitudes. Finally, few studies have directly compared attitudes towards methadone, oral buprenorphine, and extended-release naltrexone in the criminal justice system. METHODS: We modified a survey by Matusow et al. (2013) to explore justice professionals' MAT attitudes, including associations with demographic variables, court role, and previous MAT education/training. After piloting the survey, we distributed it to a convenience sample of justice professionals registered for an educational summit held in Indiana in 2018. Data was analyzed using descriptive and inferential statistical methods. RESULTS: 231 Indiana court employees who had registered for a state MAT educational summit completed the survey prior to the summit, including judges, probation officers, law enforcement personnel, attorneys, probation officers, program directors, counselors, and case managers. Overall, participants had significantly more positive attitudes towards extended-release naltrexone than towards other medications (p value <0.01). Court employee average attitudes towards methadone were significantly more negative than average attitudes towards oral buprenorphine; and average attitudes towards oral buprenorphine were significantly more negative than average attitudes towards extended-release naltrexone (p value <0.01). Employment as a prosecutor or law enforcement officer was associated with more negative attitudes towards oral buprenorphine and methadone (p value <0.05). Exposure to previous MAT training was associated with more positive attitudes for all medications (p value <0.05). Compared to participants with graduate degrees, participants with less education had significantly more negative attitudes towards extended-release naltrexone (p < 0.05). Gender, age, rurality, and personal/family recovery history were not associated with differences in attitudes. CONCLUSION: As expected, court employees' attitudes significantly differ by medication, with average attitudes towards agonist medications being more negative than attitudes towards extended-release naltrexone. Despite a larger evidence base for the efficacy of methadone and oral buprenorphine, justice personnel may have more positive attitudes towards extended-release naltrexone due to targeted marketing by the pharmaceutical manufacturer, fears about diversion or misuse of agonist medications, and historic criminal justice hostility towards agonist medications. Importantly, previous education/training regarding MAT is associated with more positive attitudes, suggesting that more awareness-raising or capacity building educational interventions are needed, especially for prosecutors and law enforcement personnel.

Societal pressures and procreative preferences for gay fathers successfully pursuing parenthood through IVF and gestational carriers.

This retrospective study surveyed decision-making and challenges among 78 gay cisgender male couples utilizing in-vitro fertilization (IVF) and a gestational carrier. While most couples (67.1%) found the decision to actively pursue fertility treatment 'not difficult', 32.9% felt that it was 'somewhat difficult' or 'very or extremely difficult'. Almost 30% of couples had not undertaken financial planning for treatment, which introduced delays of > 2 years for 25.3% of participants. Conceiving twins was 'important to very important' in 52.3% of couples, and 84.2% of couples chose to transfer two embryos to 'increase the odds' or reach an ideal family size in a single attempt despite increased complications with multiple pregnancies. Paternal leave was granted for one partner in 47.3% of couples, and for both partners in 43.2% of couples. One-third of couples reported experiencing discrimination, prompting a partner to seek employment, and 38% changed jobs or careers. For 80.3% of couples, the estimated cost exceeded US$100,000. Couples where one partner was aged > 50 years were significantly more likely to find the decision to actively pursue fertility treatment 'very or extremely difficult' (28.6%), and less likely to agree on becoming parents (64.3%). Gay male couples undergoing assisted reproduction face challenges regarding decision-making, lack of infertility benefits and discrimination, which appear to be influenced by age and country of residence. Policy and educational changes are needed, including broader fertility benefits, more egalitarian parental leave, and greater awareness of risks inherent to multiple gestation.

Legal principles and seminal legal cases in oocyte donation.

Oocyte donation has played an increasingly important role in assisted reproductive technologies since the early 1980s. Over the past 30 years, unique legal standards have evolved to address issues in the oocyte donation procedure itself as well as the disputes over issues, such as parentage, that inevitably arise with new technologies, particularly for individuals seeking to build nontraditional families. This essay will explore oocyte donation's legal aspects as well as seminal law concerning the procedure, including statutory law (uniform and model provisions and enacted state laws) and selected judicial opinions concerning surrogacy and parentage, testing of oocyte donors, mix-ups of donated oocytes, and donor compensation.

Using the EngagedMD multimedia platform to improve informed consent for ovulation induction, intrauterine insemination, and in vitro fertilization.

OBJECTIVE: To study patient and provider feedback on how a multimedia platform (EngagedMD) helps patients to understand the risks and consequences of in vitro fertilization (IVF), ovulation induction (OI), and intrauterine insemination (IUI) treatments and the impact of the informed consent process. DESIGN: Prospective survey study. SETTING: IVF units in the United States. PATIENT(S): Six-thousand three-hundred and thirty-three patients who viewed the multimedia platform before IVF or OI-IUI treatment at 13 U.S. IVF centers and 128 providers. INTERVENTION(S): Quantitative survey with 17 questions. MAIN OUTCOME MEASURE(S): Assessment of the impact of a multimedia platform on patient anxiety, comprehension, and satisfaction and provider/nurse feedback related to the informed consent process. RESULT(S): The survey was completed by 3,097 respondents (66% IVF treatment; 34% OI-IUI treatment) and 44 providers. Overall, 93% felt the media platform was intuitive, and 90% and 95% felt it had appropriate duration and detail, respectively. Most agreed/strongly agreed it better prepared them to consent (88%), increased their comfort in pursuing treatment (77%) and increased their satisfaction with their care (83%). Compared with the OI-IUI group, statistically significantly more participants who viewed the IVF media platform strongly agreed that the comprehension questions reinforced key concepts (47% vs. 40%), educated them about treatment risks (55% vs. 44%), helped them ask providers informed questions (45% vs. 36%), and better prepared them to sign consent forms (46% vs. 37%). Overall, 63% of providers felt that the media platform improved patient learning, made patients more accountable, and standardized information dissemination. CONCLUSION(S): The EngagedMD media platform improves patient knowledge, satisfaction, and control over medical decision making and better prepares patients to give informed consent. Furthermore, it is well-liked by providers and is easily implemented.

Paper trails, trailing behind: improving informed consent to IVF through multimedia applications.

Though intended to educate patients on the risks, benefits, side effects and alternatives within medical treatment, informed consent documents may have unanticipated consequences for patients. Patients may regard these forms as little more than a ritual to access treatment. Or patients may perceive that these forms exist to protect doctors rather than to contribute to a meaningful, patient-protective educational interaction. To rehabilitate the informed consent project, this essay considers the baggage that informed consent documents have acquired through practical use, explores patients' and providers' lived experience of informed consent, and considers whether a multimedia consent application would be a viable solution to the various difficulties that currently erode perceptions of and confidence in the informed consent process.

Conceiving of Products and the Products of Conception: Reflections on Commodification, Consumption, ART, and Abortion.

Assisted reproductive technologies and abortion prompt serious questions about how we should understand the complex relationship between money, markets, choice, and the care relationship. This essay defines "patient" and "consumer," and then describes how they are less important than their attributes. Then it describes theories of commodification and consumption in reproductive contexts and their consequences, from compliance and coercion to resistance and creativity. It also examines whether ART and abortion are "markets." Finally, this essay explores how the attributes which comprise the patient/consumer roles can be incorporated into health care reform, and the implications of health care reform models on ART and abortion.