O-196 The impact of providing couples with their IVF-prognosis on the expectations and anxiety of women and men

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
J Devroe ◽  
K Peeraer ◽  
T D’Hooghe ◽  
J Boivin ◽  
J Vriens ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
Mixed Models ◽  
Controlled Trial ◽  
Qualitative Interviews ◽  
Linear Mixed Models ◽  
Gender Effect ◽  
Prognostic Models ◽  
Fresh Embryo Transfer ◽  
Random Factor ◽  
The Impact

Abstract Study question What is the impact of providing couples with their IVF-prognosis on expectations and anxiety in women and men on the day of embryo transfer? Summary answer Only couples with a less than average IVF-prognosis updated their high expectations and IVF-prognosis was negatively associated with anxiety, especially in women. What is known already Female IVF-patients are known to expect a pregnancy rate per IVF-cycle of no less than 49-55%. Qualitative interviews and a survey showed that well informed women expect unrealistically high pregnancy rates as they think that their (family’s) fertility and their clinic is better than average. Several prognostic models have recently been published. The adapted van Loendersloot model including clinical and laboratory characteristics proved performant for our clinic (AUC=0.74) and was validated internally (Devroe et al, BMJ Open, 2020). The impact of providing couples with their IVF-prognosis on expectations and wellbeing of female and male patients has yet to be studied. Study design, size, duration A prospective survey, questioning a final sample of 148 partnered individuals, completing their 2nd-6th IVF-cycle (2019-2020) in a University clinic, on the days of oocyte aspiration (OA) and fresh embryo transfer (ET). Thirty other partnered individuals declined participation (participation rate=85%) and 26 were excluded due to ET-cancellation. The IVF-prognosis (live birth rate, LBR, per completed IVF-cycle including fresh and frozen ETs from the same ovarian stimulation) was calculated with the adapted van Loendersloot model. Participants/materials, setting, methods Each partner reported their perception of their expected IVF-LBR on a visual analogue scale on the day OA. After being informed on their IVF-prognosis by gynaecologists, they re-rated their expected IVF-LBR and filled out the reliable ‘STAI-State-Anxiety Inventory’ on the day of fresh ET. Linear mixed models, taking account of partnering and assessing the association with gender, explored whether individuals updated their expected IVF-LBR after receiving their IVF-prognosis and whether IVF-prognosis and anxiety were associated. Main results and the role of chance The mean IVF-prognosis was 30.9% (±16.8). The 148 partnered individuals had a mean expected IVF-LBR of 59.1% (±20.0) on the day of OA (no gender effect; p = 0.079). After being informed on their IVF-prognosis (day of ET), women’s and men’s mean expected IVF-LBR was 50.9% (±24.5) and 58.1% (±22.1), respectively (gender effect; p = 0.002). Linear mixed models, including couple and time as random factors, did not show an effect of time on expected IVF-LBRs (p = 0.15). Although women were more likely than men to update their expected IVF-LBR (p = 0.002), the updates were not significantly different from the IVF-LBR expected on the day of OA (p = 0.10). Women were more anxious than men (41.5±10.6 and 21.9±7.2, respectively, p < 0.001) after being given their IVF-prognosis. Linear mixed models, including couple as a random factor, showed an association between IVF-prognosis and anxiety (p = 0.016), especially in women (gender effect; p = 0.004). Subgroup analysis showed that partnered individuals with lower than average prognoses (n = 78) did update their expected IVF-LBR (p = 0.036) while others (n = 70) did not update their expected IVF-LBR (p = 0.761). Among the subgroup with lower prognoses women were more likely to update their expected IVF-LBR than men (p = 0.013), while no gender effect was observed among the subgroup with higher IVF-prognoses (p = 0.078). Limitations, reasons for caution This is an explorative study in preparation of an adequately powered randomized controlled trial, testing whether couples who are informed on their IVF-prognosis update their expected IVF-LBR and whether this causes anxiety, as compared to care as usual in which couples are not informed on their IVF-prognosis. Wider implications of the findings Men and especially women with a less than average prognosis update their IVF-expectations after having received this prognosis which may trigger anxious reactions. These findings should be re-examined in an RCT. Following up the effect of sharing IVF-prognoses on longer-term distress and IVF-discontinuation would be interesting. Trial registration number not applicable

scholarly journals Users’ perceptions about receiving personalized depression risk information: findings from a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Heidi Eccles ◽  
Doaa Nadouri ◽  
Molly Nannarone ◽  
Bonnie Lashewicz ◽  
Norbert Schmitz ◽  
...  
Keyword(s):  
Mental Health ◽  
Qualitative Study ◽  
Risk Communication ◽  
Risk Score ◽  
Controlled Trial ◽  
Qualitative Interviews ◽  
Risk Information ◽  
Depression Risk ◽  
Communication Program ◽  
The Impact

Abstract Objectives To understand users’ perceptions about receiving their personalized depression risk score and to gain an understanding about how to improve the efficiency of risk communication from the user perspective. Methods A qualitative study embedded in a randomized controlled trial (RCT) on evaluating the impact of providing personalized depression risk information on psychological harms and benefits. The participants (20 males and 20 females) were randomly selected from the intervention arm of the RCT after the 12-month assessment. The qualitative interviews were conducted through telephone, audio recorded and transcribed verbatim. We conducted a content analysis to describe the content and contextual meaning of data collected from participants. Results The first theme explained the motivation for receiving a risk score. Most participants chose to receive their personalised depression risk score with the goal of improving their self-awareness. The results revealed three sub-themes surrounding perceptions and implication of receiving their risk score: positive, negative, and neutral. Most participants found that receiving their score was positive because it improved their awareness of their mental health, but some participants could see that some people would have negative feelings when getting the score causing them to be more likely to get depression. The final theme focussed on improvements including: the best delivery methods, having resources and strategies, and targeting younger people. Conclusion The most significant motivation for, and benefit of receiving one’s personalized depression risk score was improved awareness of one’s mental health. A comprehensive risk communication program may improve the uptake and maximize the impact on behavior changes and risk reduction.

scholarly journals Mathematical modelling of waste activated sludge thermal disintegration

2018 ◽  
Vol 23 ◽  
pp. 00027
Author(s):  
Sylwia Myszograj ◽  
Magdalena Wojciech
Keyword(s):  
Activated Sludge ◽  
Mixed Models ◽  
Treatment Time ◽  
Oxygen Demand ◽  
Repeated Measurements ◽  
Waste Activated Sludge ◽  
Disintegration Time ◽  
Random Factor ◽  
Factor Measurement ◽  
The Impact

Chemical Oxygen Demand (COD) solubilisation was used to evaluate the impact of thermal pretreatment on the transfer of sewage sludge from particulate to soluble phase. It was gathering the experimental data needed for building of empirical mathematical model describing the relation between applied temperature and time and rate of COD solubilisation and degradation. In view of repeated measurements, in order to describe the relationship between changes in the fraction of dissolved COD and the time and temperature, mixed models have been adopted where by fixed factor measurement conditions have been adopted: time and temperature, while the random factor changes the characteristics of waste activated sludge. Linear and logistic nonlinear mixed models were analyzed. The tests demonstrated that all variables are statistically significant in assessing their impact on the efficiency of liquefaction of sludge. On the basis of the estimated model, the temperature rise of 10°C increases degree of disintegration 1.7% above the average treatment time for 0.5h, by 2.6% for 1 hour, and by 3.9% for 2h. COD values decrease between 3 to 23% at temperatures in the range of 55 to 115°C. At higher temperatures COD was reduced in the range of 32 to 44%. Disintegration time did not have the significant impact on the degradation effect.

The impact of unmeasured within- and between-cluster confounding on the bias of effect estimatorsof a continuous exposure

2019 ◽  
Vol 29 (8) ◽  
pp. 2119-2139
Author(s):  
Yun Li ◽  
Yoonseok Lee ◽  
Friedrich K Port ◽  
Bruce M Robinson
Keyword(s):  
Mixed Models ◽  
Instrumental Variable ◽  
Linear Mixed Models ◽  
Fixed Effect ◽  
Alternative Methods ◽  
Continuous Exposure ◽  
Unmeasured Confounding ◽  
Instrumental Variable Analysis ◽  
The Impact ◽  
Variable Analysis

Unmeasured confounding almost always exists in observational studies and can bias estimates of exposure effects. Instrumental variable methods are popular choices in combating unmeasured confounding to obtain less biased effect estimates. However, we demonstrate that alternative methods may give less biased estimates depending on the nature of unmeasured confounding. Treatment preferences of clusters (e.g. physician practices) are the most frequently used instruments in instrumental variable analyses. These preference-based instrumental variable analyses are usually conducted on data clustered by region, hospital/facility, or physician, where unmeasured confounding often occurs within or between clusters. We aim to quantify the impact of unmeasured confounding on the bias of effect estimators in instrumental variable analysis, as well as several common alternative methods including ordinary least squares regression, linear mixed models, and fixed-effect models to study the effect of a continuous exposure (e.g. treatment dose) on a continuous outcome. We derive closed-form expressions of asymptotic bias of estimators from these four methods in the presence of unmeasured within- and/or between-cluster confounders. Simulations demonstrate that the asymptotic bias formulae well approximate bias in finite samples for all methods. The bias formulae show that instrumental variable analyses can provide consistent estimates when unmeasured within-cluster confounding exists, but not when between-cluster confounding exists. On the other hand, fixed-effect models and linear mixed models can provide consistent estimates when unmeasured between-cluster confounding exits, but not for within-cluster confounding. Whether instrumental variable analyses are advantageous in reducing bias over fixed-effect models and linear mixed models depends on the extent of unmeasured within-cluster confounding relative to between-cluster confounding. Furthermore, the impact of unmeasured between-cluster confounding on instrumental variable analysis estimates is larger than the impact of unmeasured within-cluster confounding on fixed-effect model and linear mixed model estimates. We illustrate the use of these methods in estimating the effect of erythropoiesis stimulating agents on hemoglobin levels. Our findings provide guidance for choosing appropriate methods to combat the dominant types of unmeasured confounders and help interpret statistical results in the context of unmeasured confounding.

Does Sample Attrition Affect the Assessment of Frailty Trajectories Among Older Adults? A Joint Model Approach

Gerontology ◽  
2018 ◽  
Vol 64 (5) ◽  
pp. 430-439 ◽  
Author(s):  
Erwin Stolz ◽  
Hannes Mayerl ◽  
Éva Rásky ◽  
Wolfgang Freidl
Keyword(s):  
Older Adults ◽  
Mixed Models ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Linear Mixed Models ◽  
Joint Model ◽  
Joint Models ◽  
Sample Attrition ◽  
Standard Linear ◽  
The Impact

Background: Frailty constitutes an important risk factor for adverse outcomes among older adults. In longitudinal studies on frailty, selective sample attrition may threaten the validity of results. Objective: To assess the impact of sample attrition on frailty index trajectories and gaps related to socio-economic status (education) therein among older adults in Europe. Methods: A total of 64,143 observations from 21,044 respondents (50+) from the Survey of Health, Ageing and Retirement in Europe across 12 years of follow-up (2004–2015) and subject to substantial sample attrition (59%) were analysed. We compared results of a standard linear mixed model assuming missing at random (MAR) sample attrition with a joint model assuming missing not at random sample attrition. Results: Estimated frailty trajectories of both the mixed and joint models were identical up to an age of 80 years, above which modest underestimation occurred when a standard linear mixed model was used rather than a joint model. The latter effect was larger for men than women. Substantial education-based inequality in frailty continued throughout old age in both the mixed and joint models. Conclusion: Linear mixed models assuming MAR sample attrition provided good estimates of frailty trajectories up until high age. Thus, the validity of existing studies estimating frailty trajectories based on standard linear mixed models seems not threatened by substantial sample attrition.

scholarly journals Associations of hysteroscopic features of chronic endometritis with pregnancy outcomes of in vitro fertilization: A retrospective study

2021 ◽  
Author(s):  
Hui Wang ◽  
Chang-hong Liu ◽  
Cui-fang Hao
Keyword(s):  
Retrospective Study ◽  
Embryo Transfer ◽  
Pregnancy Outcomes ◽  
Birth Rate ◽  
Standardized Patients ◽  
Miscarriage Rate ◽  
Fresh Embryo Transfer ◽  
Chronic Endometritis ◽  
The Impact

Abstract The impact of the hysteroscopic features of chronic endometritis (CE) on pregnancy outcomes is unclear. This study explored whether the morphological features of CE on hysteroscopy were associated with in vitro fertilization (IVF) pregnancy outcomes. This retrospective study was conducted at Yantai Yuhuangding Hospital from 01/2017 to 09/2018. Infertile women who underwent hysteroscopy before IVF were grouped according to CE. To decrease confounding, a group of standardized patients was selected from the women enrolled in this study to compare pregnancy outcomes between the CE and non-CE groups. The outcomes were clinical pregnancy rate (CPR), live birth rate (LBR), miscarriage rate, and premature birth rate. In this study, 3280 women underwent IVF, and 3179 of these patients underwent hysteroscopy. In standardized patients, significant differences were found between the CE and non-CE groups in CPR (54.3% vs. 65.6%, P=0.02) and LBR (45.7% vs. 58.3%, P=0.012). In patients who underwent fresh embryo transfer, CPR differed among groups (P=0.002) and was highest in the hemorrhagic spots group (61.7%). In patients who underwent frozen embryo transfer (FET), CPR was higher in the CE group than in the non-CE group (54.7% vs. 43.0%, P<0.001), highest in the hemorrhagic spots group (70.6%, P=0.002) and lowest in the hyperemia combined with micropolyps group (39.4%, P=0.022). The only factor independently associated with CPR was hysteroscopic features of CE (odds ratio: 1.47, 95% confidence interval: 1.21–1.80, P<0.001). Hysteroscopic features of CE are associated with adverse pregnancy outcomes after IVF.

scholarly journals A qualitative study of parents’ and their child’s experience of a medial epicondyle fracture

2021 ◽  
Vol 2 (6) ◽  
pp. 359-364
Author(s):  
Kinga Papiez ◽  
Elizabeth Tutton ◽  
Emma E. Phelps ◽  
Janis Baird ◽  
Matthew L. Costa ◽  
...  
Keyword(s):  
Young People ◽  
Controlled Trial ◽  
Qualitative Interviews ◽  
Medial Epicondyle ◽  
Competitive Sports ◽  
Randomized Controlled ◽  
The Family ◽  
And Function ◽  
The Impact ◽  
Medial Epicondyle Fracture

Aims The aim of this study was to explore parents and young people’s experience of having a medial epicondyle fracture, and their thoughts about the uncertainty regarding the optimal treatment. Methods Families were identified after being invited to participate in a randomized controlled trial of surgery or no surgery for displaced medial epicondyle fractures of the humerus in children. A purposeful sample of 25 parents (22 females) and five young people (three females, mean age 11 years (7 to 14)) from 15 UK hospitals were interviewed a mean of 39 days (14 to 78) from injury. Qualitative interviews were informed by phenomenology and themes identified to convey participants’ experience. Results The results identify parents’ desire to do the best for their child expressed through two themes: 1) ‘uncertainty’ (being uncertain about the best treatment option); and 2) ‘facilitating recovery’ (sharing the experience). Parents and young people were shocked when confronted with uncertainty about treatment and they felt responsible for the decision. They searched for further information, drew on their own experience, and struggled to weigh up risks of the treatments. Discussion with surgeons provided crucial support for decision-making, and young people were involved to a varying degree. In facilitating recovery, parents balanced increasing activity with protecting their child, but lacked knowledge about pain management, and how to improve strength and function of the arm. They hoped for a return to normal, including competitive sports. Conclusion Surgeons are aware of the impact of injury on children and their parents; however, they may be less aware of the turmoil created by treatment uncertainty. Confident surgeons who appreciate and contextualize the importance of pre-existing experience and beliefs are best placed to help the family develop confidence to embrace uncertainty, particularly regarding participation in clinical trials. Cite this article: Bone Jt Open 2021;2(6):359–364.

P–325 The impact of letrozole on endometrial thickness in IVF cycles

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
J Ruiter-Ligeti ◽  
S Arab ◽  
W Buckett
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Fertility Preservation ◽  
Embryo Transfer ◽  
Endometrial Thickness ◽  
Oocyte Retrieval ◽  
Estradiol Level ◽  
Poor Responders ◽  
Fresh Embryo Transfer ◽  
The Impact

Abstract Study question Does daily administration of letrozole during IVF stimulation affect endometrial thickness ? Summary answer Patients treated with letrozole during fresh IVF cycles had a thinner endometrium on the day of trigger compared to patients who did not receive letrozole. What is known already Letrozole supplementation is commonly used during fertility preservation for breast cancer patients to reduce peak estrogen levels with no adverse effects on embryo outcomes. Studies in poor responders have found that letrozole use resulted in a shorter duration of stimulation and a lower total dose of gonadotropin, with no detrimental effect on IVF outcomes. In normal responders, studies have shown an increase in blastocysts obtained, but have not yet shown an increase in clinical pregnancy rates. There is concern that when a fresh embryo transfer is planned letrozole use may negatively affect endometrial thickness and subsequently diminish pregnancy rates. Study design, size, duration In a retrospective cohort study between January 2009 and June 2019 at a single academic fertility center, we compared the endometrial thickness in 97 cancer patients who underwent IVF-fertility preservation with daily letrozole use to 158 cancer patients who underwent IVF-fertility preservation without letrozole. Participants/materials, setting, methods All women diagnosed with cancer were referred for fertility preservation prior to gonadotoxic treatment exposure and were less than 40 years old at the time of oocyte retrieval. All patients who received letrozole started on day one of stimulation and continued until the day of oocyte retrieval. The primary outcome was endometrial thickness on the day of trigger. The secondary outcomes were number of oocytes retrieved, number of MII retrieved, and maximal estradiol level. Main results and the role of chance During the study period, 336 cancer patients underwent fertility preservation. Eighty-one patients were excluded; 50 because they had an intrauterine device or were on long term oral contraceptives and 31 because endometrial thickness was not documented. Of the remaining 255 patients, 86 had breast cancer, 95 had a hematological cancer and 74 had various other cancers. Ninety-seven cancer patients treated with letrozole were compared to 158 cancer patients who did not receive letrozole. Patients who received letrozole were significantly older (34 vs 28yrs, P &lt; 0.0001). There were no significant differences in baseline characteristics such as BMI, AFC nor in the total duration for stimulation. Endometrial thickness on the day of trigger was significantly less in letrozole treated patients (8 vs 9mm, P &lt; 0.003). There were no significant differences in total number of oocytes retrieved (12.5 vs 11, P = 0.126) nor in the number of mature oocytes (8 vs 8, P = 0.312). Patients in the letrozole group received a higher total gonadotropin dose (2680IU vs 1980IU, P = 0.016). The maximum estradiol level was significantly lower in patients treated with letrozole (1068 vs 3838ml/dl, P = &lt;0.0001). A regression analysis showed that using letrozole during stimulation decreased the endometrial thickness by 0.81mm (CI –1.37 to –0.253, P = 0.005). Limitations, reasons for caution The retrospective nature of this study could have introduced selection and misinformation bias. We report on cancer patients where all oocytes or embryos were vitrified. Without fresh embryo transfer data, it is unclear if a thinner endometrium due to letrozole will effect the implantation or pregnancy rate. Wider implications of the findings: As the use of letrozole expands beyond cancer patients and poor responders, it is important to understand the impact on the endometrium. This study shows that letrozole reduces endometrial thickness. However, the effect on endometrial function remains unknown. Further study is needed before letrozole can be used with fresh transfers. Trial registration number 2020–6370

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