Infertility in the Midwest: perceptions and attitudes of current treatment.

BACKGROUND: Although infertility affects an estimated 6.1 million individuals in the United States, only half of those individuals seek fertility treatment and the majority of those patients are White and of high socioeconomic status. Research has shown that insurance mandates are not enough to ensure equal access. Many workplaces, schools, and medical education programs have made efforts in recent years to improve the cultural humility of providers in efforts to engage more racially and economically underrepresented groups in medical care. However, these efforts have not been assessed on a population of patients receiving fertility care, an experience that is uniquely shaped by individual social, cultural, and economic factors. OBJECTIVE: This study aimed to better understand the racial, cultural, economic, and religious factors that impact patient experiences obtaining fertility care. STUDY DESIGN: A cross-sectional self-administered survey was administered at an academic fertility center in Chicago, Illinois. Of 5000 consecutive fertility care patients, 1460 completed the survey and were included in the study sample. No interventions were used. Descriptive univariate frequencies and percentages were calculated to summarize sociodemographic and other relevant patient characteristics (eg, race or ethnicity, age, household income, religious affiliation, insurance coverage). Rates of endorsing perceived physician cultural competency were compared among demographic subgroups using Pearson chi-squared tests with 2-sided P<.05 indicative of statistical significance. To identify the key determinants of patient-reported worry regarding 9 different fertility treatment outcomes and related concerns, a series of multiple logistic regression models were fit to examine factors associated with patient report of being "very worried" or "extremely worried." RESULTS: Members of our sample (N=1460) were between 20 and 58 years of age (meanadjusted, 36.2; standard deviation, 4.4). Among Black participants, 42.3% reported that their physician does not understand their cultural background compared with 16.5% of White participants (P<.0001). Participants who identified as Latinx were significantly more likely than White participants to report being very/extremely worried about side effects of treatment, a miscarriage, ectopic pregnancies, and birth defects (P<.05, P=.02, P=.002, P=.001, respectively). Individuals who identify as Hindu were nearly 4 times more likely to report being very/extremely worried about experiencing an ectopic pregnancy than nonreligious participants (P<.0002). Respondents most strongly identified the biology or physiology of the couple (meanadjusted, 21.6; confidence interval, 20.4-22.7) and timing or age (meanadjusted, 27.8; confidence interval, 26.5-29.1) as being associated with fertility. Overall, respondents most strongly disagreed that the ability to bear children rests upon God's will (meanadjusted, 65.4; confidence interval, 63.7-67.1), which differed most significantly by race (P<.0001) and religion (P<.0001). CONCLUSION: Of the patient characteristics investigated, racial and ethnic subgroups showed the greatest degree of variation in regard to worries and concerns surrounding the experience of fertility treatment. Our findings emphasize a need for improved cultural humility on behalf of physicians, in addition to affordable psychological support for all patients seeking fertility care.

Single or double embryo transfer? Decision-making process in patients participating in an oocyte donation program.

In IVF/ICSI programs, after receiving the information about the success results of single embryo transfer (SET) vs double embryo transfer (DET) and the risks of multiple pregnancy, a significant number of patients opt for SET. Up to date, no comparable studies have been published in oocyte recipients. The aim of this study was to evaluate if the counseling provided to oocyte recipients influence their decision on the number of embryos to be transferred. Fifty-five recipients expressed their preference and the relevance for the decision-making process that they attribute to certain factors through an anonymous questionnaire completed pre and post-counseling. Before counseling, 32 out of 55 recipients preferred DET, 13 preferred SET and 10 were undecided. From the 32 recipients who preferred DET, 16 (50%) maintained their preference after counseling, 13 (40.6%) changed their decision to SET and 3 (9.4%) changed to undecided (McNemar's test: p < .05). After counseling, the patients attached less importance to the probability of pregnancy and more importance to maternal and perinatal risks (p < .05). We conclude that after counseling, a significant number of recipients changed their preferences from DET to SET.

Factors associated with preterm birth: from logistic regression to structural equation modeling. / Fatores associados ao nascimento pré-termo: da regressão logística à modelagem com equações estruturais.

This study proposed the application of structural equation modeling (SEM) to investigate variables associated with preterm birth based on a theoretical model analyzed previously by hierarchical logistic regression. The data came from a population-based case-control observational study of hospital births to mothers residing in Londrina, Paraná State, Brazil (June 2006 to March 2007). For the SEM, the study considered the association between socioeconomic characteristics and psychosocial aspects pertaining to reproductive history, work and physical activity, complications during the pregnancy, and fetal characteristics. It also considered the relationship between these associations and the outcome preterm birth mediated by adequacy of prenatal care. The weighted least square mean and variance adjusted estimator (WLSMV) was used for categorical data and robust maximum likelihood (MLR) for odds ratios. Three latent variables were created: socioeconomic vulnerability, family vulnerability, and unwanted pregnancy. The effect of socioeconomic and family vulnerability and unwanted pregnancy on prematurity occurred indirectly through inadequacy of prenatal care. The proposed methodology allowed using constructs, verifying the role of mediation by inadequacy of prenatal care, and identifying the variables' direct and indirect effects on the outcome preterm birth.

O estudo propôs a aplicação da modelagem com equações estruturais (MEE) para estudar variáveis associadas ao nascimento pré-termo com base em um modelo teórico analisado previamente pela regressão logística hierarquizada. Os dados foram provenientes da pesquisa observacional do tipo caso-controle populacional sobre nascidos vivos hospitalares de mães residentes em Londrina, Paraná, Brasil (junho de 2006 a março de 2007). Para a MEE foi considerada a associação de características socioeconômicas e aspectos psicossociais sobre história reprodutiva, trabalho e atividade física, intercorrências durante a gestação e características fetais. Considerou-se, ainda, a relação dessas associações sobre o desfecho nascimento pré-termo mediado pela adequação da assistência pré-natal. Foram utilizados estimadores de mínimos quadrados ajustados pela média e variância (WLSMV), para dados categóricos, e a máxima verossimilhança robusta (MLR), para obter razões de chances. Foram criadas três variáveis latentes: vulnerabilidade socioeconômica, vulnerabilidade familiar e não aceitação da gravidez. O efeito da vulnerabilidade socioeconômica, da família e da não aceitação da gravidez sobre a prematuridade ocorreu de modo indireto por meio da inadequação da assistência pré-natal. A metodologia proposta possibilitou utilizar construtos, verificar o papel de mediação da inadequação da assistência pré-natal e identificar efeitos diretos e indiretos das variáveis sobre o desfecho nascimento pré-termo.

Este estudio propuso la aplicación de modelos de ecuaciones estructurales (SEM) para investigar las variables asociadas con el parto prematuro basándose en un modelo teórico previamente analizado mediante regresión logística jerárquica. Los datos provienen de un estudio observacional de casos y controles de base poblacional de nacidos vivos en hospitales de madres que residen en Londrina, estado de Paraná, Brasil (junio de 2006 a marzo de 2007). Para el SEM, el estudio consideró la asociación entre las características socioeconómicas y los aspectos psicosociales relacionados con el historial reproductivo, el trabajo y la actividad física, las complicaciones durante el embarazo y las características fetales. También consideró la relación entre estas asociaciones y el parto prematuro mediado por la adecuación de la atención prenatal. Se utilizó el estimador de los mínimos cuadrados ponderados ajustados por la media y variancia (WLSMV) para datos categóricos y la probabilidad máxima robusta (MLR) para los odds ratios. Se crearon tres variables latentes: vulnerabilidad socioeconómica, vulnerabilidad familiar y embarazo no deseado. El efecto de la vulnerabilidad socioeconómica y familiar y el embarazo no deseado en la prematuridad ocurrió indirectamente por la insuficiencia de la atención prenatal. La metodología propuesta permitió usar constructos, verificar el papel de la mediación por la insuficiencia de la atención prenatal e identificar los efectos directos e indirectos de las variables sobre el resultado "parto prematuro".

Fatores associados ao nascimento pré-termo: da regressão logística à modelagem com equações estruturais / Factores asociados con el nacimiento prematuro: de la regresión logística al modelo de ecuaciones estructurales / Factors associated with preterm birth: from logistic regression to structural equation modeling

O estudo propôs a aplicação da modelagem com equações estruturais (MEE) para estudar variáveis associadas ao nascimento pré-termo com base em um modelo teórico analisado previamente pela regressão logística hierarquizada. Os dados foram provenientes da pesquisa observacional do tipo caso-controle populacional sobre nascidos vivos hospitalares de mães residentes em Londrina, Paraná, Brasil (junho de 2006 a março de 2007). Para a MEE foi considerada a associação de características socioeconômicas e aspectos psicossociais sobre história reprodutiva, trabalho e atividade física, intercorrências durante a gestação e características fetais. Considerou-se, ainda, a relação dessas associações sobre o desfecho nascimento pré-termo mediado pela adequação da assistência pré-natal. Foram utilizados estimadores de mínimos quadrados ajustados pela média e variância (WLSMV), para dados categóricos, e a máxima verossimilhança robusta (MLR), para obter razões de chances. Foram criadas três variáveis latentes: vulnerabilidade socioeconômica, vulnerabilidade familiar e não aceitação da gravidez. O efeito da vulnerabilidade socioeconômica, da família e da não aceitação da gravidez sobre a prematuridade ocorreu de modo indireto por meio da inadequação da assistência pré-natal. A metodologia proposta possibilitou utilizar construtos, verificar o papel de mediação da inadequação da assistência pré-natal e identificar efeitos diretos e indiretos das variáveis sobre o desfecho nascimento pré-termo.

Este estudio propuso la aplicación de modelos de ecuaciones estructurales (SEM) para investigar las variables asociadas con el parto prematuro basándose en un modelo teórico previamente analizado mediante regresión logística jerárquica. Los datos provienen de un estudio observacional de casos y controles de base poblacional de nacidos vivos en hospitales de madres que residen en Londrina, estado de Paraná, Brasil (junio de 2006 a marzo de 2007). Para el SEM, el estudio consideró la asociación entre las características socioeconómicas y los aspectos psicosociales relacionados con el historial reproductivo, el trabajo y la actividad física, las complicaciones durante el embarazo y las características fetales. También consideró la relación entre estas asociaciones y el parto prematuro mediado por la adecuación de la atención prenatal. Se utilizó el estimador de los mínimos cuadrados ponderados ajustados por la media y variancia (WLSMV) para datos categóricos y la probabilidad máxima robusta (MLR) para los odds ratios. Se crearon tres variables latentes: vulnerabilidad socioeconómica, vulnerabilidad familiar y embarazo no deseado. El efecto de la vulnerabilidad socioeconómica y familiar y el embarazo no deseado en la prematuridad ocurrió indirectamente por la insuficiencia de la atención prenatal. La metodología propuesta permitió usar constructos, verificar el papel de la mediación por la insuficiencia de la atención prenatal e identificar los efectos directos e indirectos de las variables sobre el resultado "parto prematuro".

This study proposed the application of structural equation modeling (SEM) to investigate variables associated with preterm birth based on a theoretical model analyzed previously by hierarchical logistic regression. The data came from a population-based case-control observational study of hospital births to mothers residing in Londrina, Paraná State, Brazil (June 2006 to March 2007). For the SEM, the study considered the association between socioeconomic characteristics and psychosocial aspects pertaining to reproductive history, work and physical activity, complications during the pregnancy, and fetal characteristics. It also considered the relationship between these associations and the outcome preterm birth mediated by adequacy of prenatal care. The weighted least square mean and variance adjusted estimator (WLSMV) was used for categorical data and robust maximum likelihood (MLR) for odds ratios. Three latent variables were created: socioeconomic vulnerability, family vulnerability, and unwanted pregnancy. The effect of socioeconomic and family vulnerability and unwanted pregnancy on prematurity occurred indirectly through inadequacy of prenatal care. The proposed methodology allowed using constructs, verifying the role of mediation by inadequacy of prenatal care, and identifying the variables' direct and indirect effects on the outcome preterm birth.

Evaluation of the health behaviors of women in multiple pregnancies - a preliminary study.

OBJECTIVES: The aim of the paper was to assess which health behavior indicators were characteristic for women with a multiple pregnancy. MATERIAL AND METHOD: The study involved 35 women in multiple pregnancies. The inclusion criteria were: the completion of the 22nd week of pregnancy (22 Hbd, i.e., 22 weeks and 1/7) and the consent of the women to participate in the study. We used an original questionnaire devised by us specifically for our study, as well as a standardized research tool, Juczynski's Health Behavior Inventory questionnaire, for the assessment of the pregnant women's health behaviors. RESULTS: The overall rate of health behaviors was high and was on average 93.9 ± 10.8 points (7 sten scores). Indicators of the health behaviors of women in multiple pregnancies were high across all categories. However, the highest rate was observed in preventive behaviors. CONCLUSIONS: The overall rate of health behaviors of women with a multiple pregnancy and all the individual behavior category indicators were high. However, the highest rate was for preventive behaviors. The indicator values of the health behaviors of the pregnant women in the study were not dependent on the variables adopted in this paper.

Perinatal Mental Health Treatment Needs, Preferences, and Barriers in Parents of Multiples.

PURPOSE: Many parents of multiples experience elevated mental health symptoms in the perinatal period. This population often presents with unique treatment needs and barriers to care; however, no tailored interventions have been developed for pregnant or postpartum mothers of multiples and/or their partners. This study involved an initial exploration of the perceived mental health treatment needs, preferences, and barriers to care in this population, as a first step toward developing such an intervention. METHODS: Participants were 241 parents of multiples who were recruited in-person and online. They completed self-report measures assessing treatment history/preferences, barriers to care, and symptoms during the perinatal period. RESULTS: Participants identified postpartum months 0 to 3 as the most difficult time. Few participants received any form of mental health treatment, although a significant percentage (approximately half) expressed interest in such treatment. Treatment interest was high for a range of clinical concerns. Participants were interested in both traditional treatment paradigms and eHealth approaches. Barriers to care were common, with the most common barrier being lack of time. CONCLUSIONS: There is a large, unmet need for mental health treatment in parents of multiples in the perinatal period, especially the early postpartum months. eHealth strategies seem particularly feasible and acceptable in this population and may help circumvent common barriers to care. Clinical recommendations and considerations in treatment development are discussed.

Maternal Psychological Distress and Mother-Infant Relationship: Multiple-Birth Versus Singleton Preterm Infants.

PURPOSE: Multiple preterm birth is associated with more maternal psychological distress and less positive mother-infant interactions than singleton preterm birth. This study's purpose was to compare psychological distress and the relationship with their infants in mothers of multiples and mothers of singletons. DESIGN: An exploratory secondary analysis of longitudinal data. SAMPLE: 236 mothers and their preterm infants. MAIN OUTCOME VARIABLES: Maternal psychological distress (depressive symptoms, anxiety, posttraumatic stress [PTS], parenting stress), the mother-infant relationship (worry; child vulnerability; maternal positive involvement and developmental stimulation; and child developmental maturity, irritability, and social behaviors), and the home environment. RESULTS: Mothers of multiples had greater PTS symptoms at baseline, anxiety at discharge, and depressive symptoms at six months than mothers of singletons. Mothers of multiples also had more positive home environments at six months. Multiple birth was a risk factor for psychological distress but not for less positive mother-infant interactions.

Maternal psychosocial consequences of twins and multiple births following assisted and natural conception: a meta-analysis.

The aim of this meta-analysis is to provide new evidence on the effects on maternal health of multiple births due to assisted reproductive technology (ART). A bibliographic search was undertaken using PubMed, PsycINFO, CINAHL and Science Direct. Data extraction was completed using Cochrane Review recommendations, and the review was performed following PRISMA and MOOSE guidelines. Meta-analytic data were analysed using random effects models. Eight papers (2993 mothers) were included. Mothers of ART multiple births were significantly more likely to experience depression (standardized mean difference [SMD] d = 0.198, 95% CI 0.050 - 0.345, z = 2.623, P = 0.009; heterogeneity I(2) = 36.47%), and stress (SMD d = 0.177, 95% CI 0.049 - 0.305, P = 0.007; heterogeneity I(2) = 0.01%) than mothers of ART singletons. No difference in psychosocial distress (combined stress and depression) (SMD d = 0.371, 95% CI -0.153 - 0.895; I(2) = 86.962%, P = 0.001) or depression (d = 0.152, 95% CI -0.179 - 0.483: z = 0.901; I(2) = 36.918%) were found between mothers of ART and naturally conceived multiple births. In conclusion, mothers of ART multiple births were significantly more likely to have depression and stress than mothers of ART singletons, but were no different from mothers of naturally conceived multiples.

Stress and coping in parents of newly born twins.

OBJECTIVE: Research indicates that parents of twins have poorer psychosocial outcomes than parents of singletons. Parents who have conceived using assisted reproductive technology (ART) have been found to be at higher risk of negative psychosocial outcomes compared to parents who have conceived spontaneously. The current study aimed to model the factors associated with parenting stress of newly-born twins, using the Transactional Model of Stress. METHODS: Data were collected using a cross-sectional survey design with participants identified from delivery records across Northern Ireland. Mothers and fathers (n = 104) of twins aged between 1 and 12 months old returned a questionnaire pack containing the Parenting Stress Index, Impact on the Family Scale-Financial Burden, Coping Orientation to Problems Experienced - Brief Version, Multidimensional Scale of Perceived Social Support, General Health Questionnaire and a demographic questionnaire. RESULTS: There were no differences on psychological outcomes between parents who had conceived via ART and those who conceived spontaneously. Regression analyses found that social interaction and support is an important variable in terms of the psychological outcomes experienced by parents of twins. CONCLUSION: Parents of newly-born twins regardless of the mode of conception should be considered an at risk group for parental distress. Support groups such as the Twins and Multiple Births Association could be important in providing that crucial social interaction and support that seems to be important in the emotional well-being of parents of twins.

Delineating the Association between Heavy Postpartum Haemorrhage and Postpartum Depression.

OBJECTIVES: To explore the association between postpartum haemorrhage (PPH) and postpartum depression (PPD), taking into account the role of postpartum anaemia, delivery experience and psychiatric history. METHODS: A nested cohort study (n = 446), based on two population-based cohorts in Uppsala, Sweden. Exposed individuals were defined as having a bleeding of ≥1000 ml (n = 196) at delivery, and non-exposed individuals as having bleeding of <650 ml (n = 250). Logistic regression models with PPD symptoms (Edinburgh Postnatal Depression scale (EPDS) score ≥ 12) as the outcome variable and PPH, anaemia, experience of delivery, mood during pregnancy and other confounders as exposure variables were undertaken. Path analysis using Structural Equation Modeling was also conducted. RESULTS: There was no association between PPH and PPD symptoms. A positive association was shown between anaemia at discharge from the maternity ward and the development of PPD symptoms, even after controlling for plausible confounders (OR = 2.29, 95%CI = 1.15-4.58). Path analysis revealed significant roles for anaemia at discharge, negative self-reported delivery experience, depressed mood during pregnancy and postpartum stressors in increasing the risk for PPD. CONCLUSION: This study proposes important roles for postpartum anaemia, negative experience of delivery and mood during pregnancy in explaining the development of depressive symptoms after PPH.

Surrogacy: outcomes for surrogate mothers, children and the resulting families-a systematic review.

BACKGROUND: Surrogacy is a highly debated method mainly used for treating women with infertility caused by uterine factors. This systematic review summarizes current levels of knowledge of the obstetric, medical and psychological outcomes for the surrogate mothers, the intended parents and children born as a result of surrogacy. METHODS: PubMed, Cochrane and Embase databases up to February 2015 were searched. Cohort studies and case series were included. Original studies published in English and the Scandinavian languages were included. In case of double publications, the latest study was included. Abstracts only and case reports were excluded. Studies with a control group and case series (more than three cases) were included. Cohort studies, but not case series, were assessed for methodological quality, in terms of risk of bias. We examined a variety of main outcomes for the surrogate mothers, children and intended mothers, including obstetric outcome, relationship between surrogate mother and intended couple, surrogate's experiences after relinquishing the child, preterm birth, low birthweight, birth defects, perinatal mortality, child psychological development, parent-child relationship, and disclosure to the child. RESULTS: The search returned 1795 articles of which 55 met the inclusion criteria. The medical outcome for the children was satisfactory and comparable to previous results for children conceived after fresh IVF and oocyte donation. The rate of multiple pregnancies was 2.6-75.0%. Preterm birth rate in singletons varied between 0 and 11.5% and low birthweight occurred in between 0 and 11.1% of cases. At the age of 10 years there were no major psychological differences between children born after surrogacy and children born after other types of assisted reproductive technology (ART) or after natural conception. The obstetric outcomes for the surrogate mothers were mainly reported from case series. Hypertensive disorders in pregnancy were reported in between 3.2 and 10% of cases and placenta praevia/placental abruption in 4.9%. Cases with hysterectomies have also been reported. Most surrogate mothers scored within the normal range on personality tests. Most psychosocial variables were satisfactory, although difficulties related to handing over the child did occur. The psychological well-being of children whose mother had been a surrogate mother between 5 and 15 years earlier was found to be good. No major differences in psychological state were found between intended mothers, mothers who conceived after other types of ART and mothers whose pregnancies were the result of natural conception. CONCLUSIONS: Most studies reporting on surrogacy have serious methodological limitations. According to these studies, most surrogacy arrangements are successfully implemented and most surrogate mothers are well-motivated and have little difficulty separating from the children born as a result of the arrangement. The perinatal outcome of the children is comparable to standard IVF and oocyte donation and there is no evidence of harm to the children born as a result of surrogacy. However, these conclusions should be interpreted with caution. To date, there are no studies on children born after cross-border surrogacy or growing up with gay fathers.

Reproducción Asistida: ¿Debemos solo transferir un embrión? / Assisted Reproduction: Should be transferred only one embryo?

OBJETIVO: Comparar resultados obstétricos y perinatales de embarazos únicos espontáneos con los obtenidos por reproducción asistida, tanto únicos como gemelares. MATERIAL Y MÉTODO: Estudio descriptivo observacional retrospectivo. Se analizan un total de 1 096 embarazos de pacientes que acuden a control obstétrico en una clínica privada y se clasifican en tres grupos según el modo de concepción y número de fetos: Grupo 1, embarazo único espontáneo; Grupo 2, embarazo único por técnica de reproducción asistida (TRA) y, Grupo 3, embarazo gemelar por reproducción asistida. Se analizan los resultados obstétricos y perinatales entre los tres grupos. Se considera que hay diferencia estadística con un valor menor a <0.01 utilizando la prueba de chi cuadrado. RESULTADOS: La tasa de diabetes gestacional fue mayor en el grupo de embarazo único por TRA (23,78%) comparada a la de embarazo único espontáneo (6,66%) y gemelar por TRA (0%), presentando diferencia estadísticamente significativa. Hubo mayor presencia de anemia gestacional en el grupo de embarazo único espontáneo (76,66%) que en los grupos de TRA (19,51% y 31,25% para único y gemelar respectivamente) con diferencia estadística. Se presenta diferencia significativamente estadística a favor del grupo de embarazo gemelar por TRA en cuanto a un mayor número de casos de amenaza de parto pretérmino (25 %), una mayor ganancia de peso materno a final del embarazo (12,33 ± 3,2 Kg), un mayor número de nacimientos por cesárea (81,25%), menor edad en semanas de gestación al parto (35,28 ± 3,6), menor peso del recién nacido (2 388,69 ± 378 g) y un mayor número de casos que requieren ingreso a unidad de cuidados intensivos neonatales (18,75%). CONCLUSIONES: El embarazo gemelar tiene un peor pronóstico perinatal que el embarazo único sea espontáneo o por TRA

OBJETIVE: To determine the correlation between the semen parameters (concentration, motility, morphology and vitality) and sperm DNA integrity, using the test Halosperm. Material And METHODS: Prospective study conducted at the Laboratory of Andrology of Assisted Reproduction Laboratory FERTILAB, Lima - Peru, from August 2012 to March 2013. 282 patients were analyzed. We have established the DNA fragmentation index (IFA) from patients with semen sample normozoospermic and patients with semen sample altered in some parameters. We used two types of threshold (18% and 30%) and were correlated with semen parameters. In the total population was determined the Spearman correlation between sperm parameters and the IFA. RESULTS: It was determined that the value of the median the IFA of the patients with semen sample normozoospermic was significantly lower than that patients with semen sample altered in some parameters (12.8% vs 19.0, P=0.000). Using threshold of 18% was determined the there significant difference between the median of the two groups (Group 1: ≤ 18% y Group 2: > 18%) in age (37 years vs 40 years, P = .002), sperm concentration (82.30 X 106/ml vs 58.00 X 106/ml, P = 0.046), progressive motility (45.80% vs 27.40, P = 0.000), normal morphology (12.50% vs 9.00%, P = 0.000) and sperm vitality (89.0% vs 78.0%, P = 0.000). Using the threshold of 30 % was found significant difference between the median of the two groups (Group 1: ≤ 30% y Group 2:> 30%) in age (39 years vs 44 years, P=0.000), sperm concentration ( 78.00 X 106/ml vs. 36.75  X 106/ml, P = 0.015 ), motility progressive (40.85% vs 22.38 %, P=0.000 ), normal morphology (12.0 % vs 6.0 %, P=0.004) and sperm vitality (85.0 % vs 72.5%, P=0.000). Also identified an inverse correlation between the IFA and concentration (r=- 0.219 P=0.000), progressive motility (r=-0.452 P=0.000), normal morphology (r=-0.322 P=0.000) and vitality (r = -0.452 P = 0.000) in the total population. We determined a significant positive correlation between age and the IFA (r=0.267 P = 0.000). CONCLUSIONS: The results indicate that the level of DNA damage in sperm patients with semen sample altered in some parameters is significantly higher than in patients with semen sample normozoospermic. It has been shown that the semen parameters (concentration, motility, morphology and vitality) are highly negatively correlated with sperm DNA fragmentation index. It showed a positive correlation between age and the IFA

Raising multiples: mental health of mothers and fathers in early parenthood.

The rate of twin and higher-order gestation births has risen dramatically in recent decades in the United States as well as other Western countries. Although the obstetrical and neonatal risks of multiple gestation pregnancies are well-documented, much less is known regarding the mental health impact on parents of multiples during the perinatal and early parenthood period. Given that parents of multiples face greater functional demands, as well as other pressures (financial, medical) this population may be at risk for heightened distress. We conducted a systematic review of quantitative, English language studies that assessed mental health outcomes of parents of multiples during pregnancy, in the first postpartum year, and in the period of early parenthood, including depression, anxiety, stress, and related constructs. Twenty-seven articles published between 1989 and 2014 met selection criteria and were included in the review. Studies utilized a wide range of methods and outcome constructs, often making comparisons difficult. Although some studies found no differences, most investigations that compared mental health outcomes in parents of multiples versus parents of singletons found that parents of multiples experience heightened symptoms of depression, anxiety, and parenting stress. We discuss gaps in the existing body of literature on parental mental health related to multiple gestation birth and conclude by discussing the need for novel intervention strategies to meet the needs of this growing population. Parents of multiples may experience worse mental health outcomes than parents of singletons. More research is needed, and future work should explore potential treatment and support options.

Validity and reliability of breastfeeding advice and coping with breastfeeding instruments.

PURPOSE: To pilot two instruments: Breastfeeding Advice and Coping with Breastfeeding in NICU settings. DESIGN: Psychometric testing of the Breastfeeding Advice and Coping with Breastfeeding instruments. SAMPLE: Mothers (N = 47) with singleton or twin preterm (≤36 + 6 gestation weeks) infant(s) (N = 55) at discharge collected from seven NICUs in Finland. MAIN OUTCOME VARIABLES: The validity and reliability of two instruments: Breastfeeding Advice measuring the quality of breastfeeding counseling and Coping with Breastfeeding measuring the mothers' experienced ability to cope with breastfeeding issues. RESULTS: Infants' mean gestation age was 32.5 weeks at birth. The items of the instruments were supported by previous studies, demonstrating content validity. There was a significant correlation (r = .72, p < .001) between Breastfeeding Advice and Coping with Breastfeeding, indicating constructor validity. Evidence for predictive validity was not found. Good reliability for internal consistency of the Breastfeeding Advice (Cronbach's α = .86) and Coping with Breastfeeding (Cronbach's α = .85) was found.

Women's intentions to breastfeed: a population-based cohort study.

OBJECTIVE: Given that intention to breastfeed is a strong predictor of breastfeeding initiation and duration, the objectives of this study were to estimate the population-based prevalence and the factors associated with the intention to breastfeed. DESIGN: Retrospective population-based cohort study. SETTING: All hospitals in Ontario, Canada (1 April 2009-31 March 2010). POPULATION: Women who gave birth to live, term, singletons/twins. METHODS: Patient, healthcare provider, and hospital factors that may be associated with intention to breastfeed were analysed using univariable and multivariable regression. MAIN OUTCOME MEASURES: Population-based prevalence of intention to breastfeed and its associated factors. RESULTS: The study included 92,364 women, of whom 78,806 (85.3%) intended to breastfeed. The odds of intending to breastfeed were higher amongst older women with no health problems and women who were cared for exclusively by midwives (adjusted OR 3.64, 95% CI 3.13-4.23). Being pregnant with twins (adjusted OR 0.73, 95% CI 0.57-0.94), not attending antenatal classes (adjusted OR 0.58, 95% CI 0.54-0.62), having previous term or preterm births (adjusted OR 0.79, 95% CI 0.78-0.81, and adjusted OR 0.87, 95% CI 0.82-0.93, respectively), and delivering in a level-1 hospital (adjusted OR 0.85, 95% CI 0.77-0.93) were associated with a lower intention to breastfeed. CONCLUSIONS: In this population-based study ~85% of women intended to breastfeed their babies. Key factors that are associated with the intention to breastfeed were identified, which can now be targeted for intervention programmes aimed at increasing the prevalence of breastfeeding and improving overall child and maternal health.

Effect of mood states and infertility stress on patients' attitudes toward embryo transfer and multiple pregnancy.

OBJECTIVE: To examine whether mood state or infertility stress influences perceptions of risk, preferences for embryo transfer, or views on multiple pregnancy. DESIGN: Observational cohort study. SETTING: Hospital-based fertility clinic. PATIENT(S): One hundred seventy-six women participating in IVF treatment. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Mood scores, ratings of risk, preference for multiple embryo transfer, and attitudes toward multiple pregnancy. RESULT(S): Growing feelings of tension across the cycle corresponded with increases in the perceived riskiness of double-embryo transfer, but there was no change in strength of transfer preferences. Women experiencing negative moods, such as depression, viewed twin and triplet pregnancy as less likely, whereas increasing positive feelings across the cycle were associated with increasing desire for twin pregnancy. Overall, women perceived double- and triple-embryo transfer as less risky by cycle end than at cycle beginning and felt more certain about multiple-embryo transfer. CONCLUSION(S): The dyssynchrony observed among changes in mood, perceptions of risk, and transfer preferences challenges assumptions about the way medical risk information influences transfer preferences, and the findings suggest that mood states experienced during an IVF cycle might affect transfer preferences by influencing attitudes toward multiple pregnancy. Additional considerations beyond providing risk information are needed to facilitate effective patient decision making.

[Parents of multiple births after assisted conception]. / Mehrlingselternschaft nach assistierter Reproduktion.

BACKGROUND: A major criticism is the increase in multiple pregnancies after ART in the past 30 years and the associated fetal and maternal risks. MATERIAL: Few studies examined the psychosocial risks of the parents of multiple births after ART, for example psychology adjustment, parenting stress, education problems, anxiety, depression, relationship problems or social isolation. RESULTS: The research confirms the psychosocial characteristics after multiple births. In the early postpartum period there is increased risk of depressive disorders. Mothers of twins after ART show a limitation of their psychosocial well-being compared to mothers of singles after ART. DISCUSSION: Higher expectations of parenthood during pregnancy, less sufficiency coping strategies, and consequently, greater parental stress show twin mothers after ART in comparison to twin mothers after nature conception. An interdisciplinary postpartum care services makes sense. However, clinicians should keep attention to potential psychosocial burden of a multiple birth.

[Family planning in women with schizophrenia - case report on a schizophrenic patient with multiple pregnancy resulting from in vitro fertilization]. / Familienplanung bei Frauen mit Schizophrenie - Kasuistik über eine In-vitro-Fertilisation mit resultierender Mehrlingsschwangerschaft.

Case report on a 31-year old woman with chronic schizophrenia turning to a gynaecological university outpatient clinic with her husband and asking for an in vitro fertilization. After referral to the psychiatric consultation service the patient's psychiatric and psychosocial history was taken. The issue of indication was settled by considering medicoethical aspects, general risks in respect of the course of illness in pregnancy, postpartum period, and parenthood, and the special psychological burden due to in vitro fertilization with the issues of multiple pregnancy and the dilemma of fetal reduction. The patient's course during a triple pregnancy, postpartum period and early parenthood is described.