Fertility quality of life tool: update on research and practice considerations.

The 36-item Fertility Quality of Life (FertiQoL) tool is increasingly used in research and practice. It measures quality of life in four personal domains (emotional, social, relational, mind/body) and two treatment domains (tolerability, environment). A literature review of published empirical research using FertiQoL was undertaken to provide an overview of this research base. Five databases were searched using 'FertiQoL' and its variant. In total, 41 published articles from 35 independent samples in 23 countries involving 16,315 participants, mainly in clinical settings, were reviewed. FertiQoL was used for three main purposes: (i) to assess quality of life and FertiQoL measurement properties (especially Core FertiQoL) using cross-sectional designs; (ii) to identify correlates, predictors, and consequences of fertility quality of life (some of which included international comparisons); (iii) to assess the effect of psychological interventions on fertility quality of life. The range of median FertiQoL Core, Treatment and subscale (scaled) scores in 31 samples was between 60 and 75. Poorer fertility quality of life was consistently associated with being a woman, longer duration of infertility, poorer psychological functioning and lower patient-centred care. Some FertiQoL subscale scores improved after psychological interventions. Future research should address measurement issues and examine reported associations with fertility quality of life.

National survey on the opinions of French specialists in assisted reproductive technologies about social issues impacting the future revision of the French Bioethics laws.

INTRODUCTION: France is known for its conservative and unique position in assisted reproductive technologies (ARTs). At the eve of the future revision of French Bioethics laws, we decided to conduct a national survey to examine the opinions of French specialists in ARTs about social issues. MATERIAL AND METHODS: Descriptive study conducted in May 2017 in a university teaching hospital using an anonymous online questionnaire on current issues in ARTs. The questionnaire was sent by email to 650 French ARTs specialists, both clinicians and embryologists. RESULTS: After 3 reminders, 408 responses were collected resulting in a participation rate of 62.7% (408/650). Concerning pre-implantation genetic testing, 80% of the physicians were in favor of expanding the indications, which in France are presently limited to incurable genetic diseases. Authorizing elective Fertility Preservation was supported by 93.4% of the specialists, but without social coverage for 86.3% of them. Concerning gamete donation, 77.4% of the French ARTs specialists were in favor of giving a financial compensation to donors, 92% promoted preserving their anonymity and 80.9% were against a directed donation. ARTs for single heterosexual women were supported by 63.4% of the French specialists and by 72.5% for lesbian couples. The legalization of surrogacy was requested by 55.2%. DISCUSSION: Pending the revision of the French Bioethics laws, this survey provides an overview of the opinion of the specialists in ARTs on expanding ARTs for various social indications.Because of the evolution of social values, a more liberal and inclusive ART program is desired by the majority of ART specialists in France.

Fertility patients demonstrate an unmet need for the provision of psychological information: A cross sectional study.

OBJECTIVES: To examine the provision of information by health care providers (HCPs) to fertility patients about accessing psychological resources. METHODS: This study utilized data from a cross-sectional survey of 659 male and female patients seeking fertility treatment at clinics in Toronto and Montreal. Regression analyses were used to assess if sociodemographic and treatment variables were associated with the receipt of information, the desire for information, the helpfulness of the information, and the likelihood that participants had sought counselling. RESULTS: The majority of respondents (79.8%) said that their HCP had not given them information about accessing psychological resources. Of the patients who did not receive this information, most (60%) said that they wanted it. Regression analysis revealed that immigrants, women, and patients with higher perceived stress scores were significantly more likely to desire this information. Furthermore, having received this information was associated with increased odds of counselling seeking (odds ratio = 3.31, p = 0.013). CONCLUSION: Fertility patients demonstrated an unmet need for information about accessing psychological resources, and HCPs may play an integral role in bridging this information gap. PRACTICE IMPLICATIONS: To improve the patient-centeredness of fertility care, HCPs should be proactive in informing all patients about how to access psychological resources.

Reproductive outcomes of familial oocyte donation.

OBJECTIVE: Oocyte donation (OD) from a family member may be more available to patients. Our objective was to compare reproductive outcomes of familial OD with those of unrelated OD. DESIGN: Retrospective cohort study in a single university-affiliated center. SETTING: Not applicable. PATIENT(S): Four hundred thirty OD cycles performed from 2010 to 2014: 124 from family members and 306 from unrelated donors. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Ovarian stimulation parameters and cycle outcomes (total gonadotropin dose, number of retrieved oocytes, number of embryos, number of vitrified embryos, blastocyst transfer rate, rate of fresh transfers); endometrial preparation parameters; implantation, clinical pregnancy, miscarriage, and live birth rates; perinatal outcomes (gestational age at birth, birth weight, delivery mode, cesarean delivery rates). RESULT(S): Implantation, clinical pregnancy, miscarriage, and live birth rates were similar between familial OD cycles and unrelated OD cycles (32.9% vs. 39.7%, 41.9% vs. 44.4%, 30.7% vs. 30.9%, and 29% vs. 28.7%, respectively). Gestational age at birth and birth weight were similar (37.8 wk ± 2.2 d vs. 37.1 wk ± 3 d and 3,043 ± 722 g vs. 2,906 ± 788 g, respectively). Similar outcomes were also found in single-embryo transfer OD cycles (live birth rate 26.7% vs. 24.2%). Sister-to-sister OD cycles outcomes were similar to those of unrelated donors. CONCLUSION(S): The reproductive outcomes of familial OD are similar to those of unrelated OD. These findings are in contrast to previous presumptions regarding the efficiency of familial OD and may help in the counseling of women who need OD.

A prospective study using Hatha Yoga for stress reduction among women waiting for IVF treatment.

Yoga has been found to be effective in treating anxiety and depression, reducing stress and improving the overall quality of life in the general population. Minimal research is available on the effect of stress-management programmes with IVF patients. Owing to the diversity of conditions treated, the poor quality of most studies, and the different assessment tools used to evaluate the psychological state, it is difficult to draw definite conclusions. Previous studies have used different mind-body interventions and general measures of stress without evaluation of specific stresses known to result from infertility and its treatment using standardized measures. In this single-centre study, 49 infertile women were recruited to participate in a 6-week Yoga class during 2013 while awaiting their IVF treatment. Study participants were asked to complete standardized questionnaires assessing fertility-related quality of life (FertiQoL), marital harmony (Dyadic Adjustment Scale [DAS]), state and trait anxiety (State-Trait Anxiety Inventory [STAI]) and depression (Beck Depression Inventory [BDI]) before commencing and after completing the Yoga workshops. Anxiety, depression and fertility-specific quality of life showed improvement over time in association with participation in a 6-week Yoga programme in women awaiting their treatment with IVF.

Assessment of symptomatic women for early diagnosis of ovarian cancer: results from the prospective DOvE pilot project.

BACKGROUND: Around 90% of deaths from ovarian cancer are due to high-grade serous cancer (HGSC), which is frequently diagnosed at an advanced stage. Several cancer organisations made a joint recommendation that all women with specified symptoms of ovarian cancer should be tested with the aim of making an early diagnosis. In the Diagnosing Ovarian Cancer Early (DOvE) study we investigated whether open-access assessment would increase the rate of early-stage diagnosis. METHODS: Between May 1, 2008, and April 30, 2011, we enrolled women who were aged 50 years or older and who had symptoms of ovarian cancer. They were offered diagnostic testing with cancer antigen (CA-125) blood test and transvaginal ultrasonography (TVUS) at a central and a satellite open-access centre in Montreal, QC, Canada. We compared demographic characteristics of DOvE patients with those of women in the same age-group in the general population of the area, and compared indicators of disease burden with those in patients with ovarian cancer referred through the usual route to our gynaecological oncology clinic (clinic patients). FINDINGS: Among 1455 women assessed, 402 (27·6%) were in the highest-risk age group (≥ 65 years). 239 (16·4%) of 1455 required additional investigations. 22 gynaecological cancers were diagnosed, 11 (50%) of which were invasive ovarian cancers, including nine HGSC. The prevalence of invasive ovarian cancer, therefore, was one per 132 women (0·76%), which is ten times higher than that reported in screening studies. DOvE patients were significantly younger, more educated, and more frequently English speakers than were women in the general population. They also presented with less tumour burden than did the 75 clinic patients (median CA-125 concentration 72 U/mL, 95% CI 12-1190 vs 888 U/mL, 440-1936; p=0·010); Eight (73%) tumours were completely resectable in DOvE patients, compared with 33 (44%) in clinic patients (p=0·075). Seven (78%) of the HGSC in the DOvE group originated outside the ovaries and five were associated with only slightly raised CA-125 concentrations and minimal or no ovarian abnormalities on TVUS. INTERPRETATION: The proportion of HGSC that originated outside the ovaries in this study suggests that early diagnosis programmes should aim to identify low-volume disease rather than early-stage disease, and that diagnostic approaches should be modified accordingly. Although testing symptomatic women may result in earlier diagnosis of invasive ovarian cancer, large-scale implementation of this approach is premature. FUNDING: Canadian Institutes of Health Research, Montreal General Hospital Foundation, Royal Victoria Hospital Foundation, Cedar's Cancer Institute, and La Fondation du Cancer Monique Malenfant-Pinizzotto.

The fertility quality of life (FertiQoL) tool: development and general psychometric properties.

BACKGROUND: To develop the first international instrument to measure fertility quality of life (FertiQoL) in men and women experiencing fertility problems, to evaluate the preliminary psychometric properties of this new tool and to translate FertiQoL into multiple languages. METHOD: We conducted a survey, both online and in fertility clinics in USA, Australia/New Zealand, Canada and UK. A total of 1414 people with fertility problems participated. The main outcome measure was the FertiQoL tool. RESULTS: FertiQoL consists of 36 items that assess core (24 items) and treatment-related quality of life (QoL) (10 items) and overall life and physical health (2 items). Cronbach reliability statistics for the Core and Treatment FertiQoL (and subscales) were satisfactory and in the range of 0.72 and 0.92. Sensitivity analyses showed that FertiQoL detected expected relations between QoL and gender, parity and support-seeking. FertiQoL was translated into 20 languages by the same translation team with each translation verified by local bilingual fertility experts. CONCLUSIONS: FertiQoL is a reliable measure of the impact of fertility problems and its treatment on QoL. Future research should establish its use in cross-cultural research and clinical work.

The Fertility Quality of Life (FertiQoL) tool: development and general psychometric properties.

OBJECTIVE: To develop the first international instrument to measure fertility quality of life, FertiQoL, in men and women experiencing fertility problems, to evaluate the preliminary psychometric properties of this new tool and to translate FertiQoL into multiple languages. DESIGN: Survey. SETTING: Online and fertility clinics in USA, Australia/New Zealand, Canada, and United Kingdom. PARTICIPANTS: A total of 1,414 people with fertility problems. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): FertiQoL. RESULT(S): FertiQoL consists of 36 items that assess core (24 items) and treatment-related (10 items) quality of life as well as overall life and physical health (2 items). Cronbach reliability statistics for the Core and Treatment FertiQoL (and subscales) were satisfactory, in the range of 0.72 and 0.92. Sensitivity analyses showed that FertiQoL detected expected relations between quality of life and gender, parity, and support seeking. FertiQoL was translated into 20 languages by the same translation team, with each translation verified by local bilingual fertility experts. CONCLUSION(S): FertiQoL is a reliable measure of the impact of fertility problems and its treatment on quality of life. Future research should establish its use in cross-cultural research and clinical work.

Cryopreservation of a mother's oocytes for possible future use by her daughter with Turner syndrome: case report.

OBJECTIVE: To report a new fertility alternative for women with Turner syndrome, who are rendered infertile, by having their mothers freeze their own oocytes for the purpose of donating to their daughters when they are adults. DESIGN: Case report. SETTING: Academic teaching hospital. PATIENT(S): A 33-year-old healthy mother of three children; and her second child, a 6-year-old daughter recently diagnosed with Turner syndrome. INTERVENTION(S): Mother-to-daughter oocyte donation combined with oocyte vitrification. MAIN OUTCOME MEASURE(S): Number of cryopreserved oocytes. RESULT(S): After three cycles of ovarian stimulation, 30 oocytes were cryopreserved for the daughter's possible future use. CONCLUSION(S): The treatment option presented here opens the door for the banking of a mother's oocytes as a possible donation to a young daughter with a medical condition that leads to infertility, for her possible future use.