ORCID Profile
0000-0002-5988-5865
Current Organisations
Monash University
,
Victorian Assisted Reproductive Treatment Authority
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Sociology | Social and Cultural Anthropology | Sociology and Social Studies of Science and Technology
Expanding Knowledge through Studies of Human Society | Socio-Cultural Issues in Tourism |
Publisher: Elsevier BV
Date: 07-2019
DOI: 10.1016/J.FERTNSTERT.2019.03.001
Abstract: To determine the health outcomes for adults aged 22-35 years old who were conceived via assisted reproduction technology (ART) compared with adults of the same age conceived without use of ART. Cohort study. Not applicable. Adult men and women aged 22-35 years who were conceived with and without use of ART. Questionnaire and clinical review. Vascular structure (carotid artery intima-media thickness, pulse wave velocity), vascular function (blood pressure), metabolic markers (fasting blood glucose, insulin, and standard lipid profiles), anthropometric measurements, and respiratory function (spirometry). The mean age of the 193 ART and 86 non-ART participants was 27.0 and 26.9 years, respectively. There were no substantial intragroup differences in demographics or vascular intermediate phenotypes, metabolic parameters, or anthropometric measures, before or after adjusting for perinatal factors and a quality of life measure with four domains. Diastolic blood pressure was lower in the ART men than the non-ART men (adjusted mean difference -4.4 mm Hg, 95% CI, -8.7 to -0.1). The ART group reported a higher prevalence of ever having asthma, (40.8% vs. 28.6% odds ratio 1.7 95% CI, 1.0-3.0), but expiratory flow rates were similar. This study of the health of 193 adults conceived via ART, the largest to date globally, found no evidence of increased vascular or cardiometabolic risk, or growth or respiratory problems in the ART group compared with a non-ART group from the same source population. Follow-up observation for reproductive and later-onset adverse health effects remains important.
Publisher: Elsevier BV
Date: 02-2013
DOI: 10.1016/J.FERTNSTERT.2012.10.031
Abstract: To explore knowledge about the effects on fertility of age, obesity, smoking, and timing of intercourse among Australians of reproductive age. Telephone survey of a representative s le of Australians. Not applicable. Australians aged 18 to 45 years who wish to have a child or another child now or in the future. None. Knowledge about the effect on fertility of age, obesity, smoking, and timing of intercourse. A total of 462 interviews were conducted. The majority of respondents underestimated, by about 10 years, the age at which male and female fertility starts to decline. Only one in four correctly identified that female fertility starts to decline before age 35, and one in three identified that male fertility starts to decline before age 45. Most (59%) were aware that female obesity and smoking affect fertility, but fewer recognized that male obesity (30%) and smoking (36%) also influence fertility. Almost 40% of respondents had inadequate knowledge of when in the menstrual cycle a woman is most likely to conceive. Considerable knowledge gaps about modifiable factors that affect fertility were identified. These are targeted in a national education c aign to promote awareness of factors that influence fertility.
Publisher: Wiley
Date: 09-07-2020
DOI: 10.1111/AJO.13174
Publisher: Oxford University Press (OUP)
Date: 02-04-2023
Abstract: While education about fertility is not intrinsically controversial, finding the right language to communicate the topic can be challenging, as there are several risks of unintended negative effects such as dissonance, anxiety, culpability and stigma due to social norming. In this commentary, we share some of our learnings from promoting fertility awareness in the hope it will inspire further debate and research on this topic. Starting from the ethical principles of respect for reproductive autonomy, avoiding harm (in terms of stigma or anxiety) and inclusivity, we have formulated five recommendations: (1) frame fertility awareness messages with (reproductive) autonomy in mind and aim to be inclusive of those who do not represent the traditional nuclear family (2) be empathetic and steer clear of blame (3) avoid scaremongering and offer a positive angle (4) give due consideration to both women and men in fertility health messaging (5) tailor the messages to particular contexts and audiences and develop resources in close collaboration with the target groups.
Publisher: Springer Science and Business Media LLC
Date: 10-05-2017
Publisher: Oxford University Press (OUP)
Date: 06-08-2009
Abstract: Higher rates of admission to residential early parenting services (REPSs) after assisted conception compared with spontaneous conception have been reported. The aim of this study was to characterize early post-partum psychological functioning and the rate of, and risks factors for, admission to REPSs in women conceiving with assisted reproductive technology (ART) in Australia. A consecutive cohort of women who had conceived through ART was recruited systematically in early pregnancy. At 3 months post-partum, participants completed postal questionnaires which included a new measure of the degree of difficulty involved in conceiving, the Burden of Infertility and Treatment (BIT) scale. Of 166 women who participated, 8% had already been admitted to a REPS within 3 months, which is a higher rate compared with other women in the first 12 months (5%). Compared with community s les of new mothers, there was no difference in rate of depression. A higher proportion reported dysregulated infant behaviours (P < 0.0001) and a smaller proportion was breast feeding exclusively (P < 0.0001). Greater difficulty conceiving (higher BIT score) was associated with lower maternal confidence. Clinical care of the increasing group of women who conceive with ART should include explicit assessment of early post-partum psychological functioning and early intervention if difficulties in managing infant behaviour are reported.
Publisher: Oxford University Press (OUP)
Date: 22-05-2008
Abstract: It is known that infertility affects emotional well-being, satisfaction with life and self-esteem and that failed assisted reproductive technology (ART) treatment is associated with diminished life satisfaction, reduced self-confidence and substantial psychological distress. Investigations of whether these persist when treatment results in a pregnancy and live birth have been undertaken. A systematic search for English-language research articles on psychological and social aspects of pregnancy, childbirth and the first post-partum year after ART conception. Of 466 retrieved papers, 46 met inclusion criteria. These reported data from 28 studies. There is consistent evidence that marital satisfaction, emotional well-being and self-regard in pregnancy, attachment to the fetus and parent-infant relationship in ART groups are similar to comparison groups. Anxiety about the survival of the fetus and early parenting difficulties appear to be higher and post-natal self-confidence lower. Evidence about adjustment to pregnancy and parenthood and the experience of childbirth is inconclusive and reports of parental perceptions of infant temperament and behaviour are contradictory. Between-study methodological differences may explain the lack of consistency in findings of the influence of infertility and ART on some aspects of the transition to parenthood. Overall, this body of evidence is best described as emergent. It is possible that in pregnancy after ART, parenthood might be idealized and this might then hinder adjustment and the development of a confident parental identity.
Publisher: Wiley
Date: 18-05-2020
DOI: 10.1111/AJO.13179
Publisher: Elsevier BV
Date: 12-2019
DOI: 10.1016/J.FERTNSTERT.2019.09.028
Abstract: Add-on treatments are the new black. They are provided (most frequently, sold) to patients undergoing in vitro fertilization on the premise that they will improve the chances of having a baby. However, the regulation of add-ons is consistently minimal, meaning that they are introduced into routine practice before they have been shown to improve the live birth rate. Debate on the adequacy of this light-touch approach rages. Defenders argue that demands for a rigorous approval process are paternalistic, as this would delay access to promising treatments. Critics respond that promising treatments may turn out to have adverse effects on patients and their offspring, contradicting the clinician's responsibility to do no harm. Some add-ons, including earlier versions of preimplantation genetic testing for aneuploidy, might even reduce the live birth rate, raising the prospect of desperate patients paying more to worsen their chances. Informed consent represents a solution in principle, but in practice there is a clear tension between impartial information and direct-to-consumer advertising. Because the effects of a treatment cannot be known until it has been robustly evaluated, we argue that strong evidence should be required before add-ons are introduced to the clinic. In the meantime, there is an imperative to identify methods for communicating the associated risks and uncertainties of add-ons to prospective patients.
Publisher: Informa UK Limited
Date: 13-03-2015
Publisher: Springer Science and Business Media LLC
Date: 20-09-2017
Publisher: Informa UK Limited
Date: 28-07-2020
Publisher: Springer Science and Business Media LLC
Date: 02-09-2019
DOI: 10.1038/S41467-019-11929-9
Abstract: More than 7 million in iduals have been conceived by Assisted Reproductive Technologies (ART) and there is clear evidence that ART is associated with a range of adverse early life outcomes, including rare imprinting disorders. The periconception period and early embryogenesis are associated with widespread epigenetic remodeling, which can be influenced by ART, with effects on the developmental trajectory in utero, and potentially on health throughout life. Here we profile genome-wide DNA methylation in blood collected in the newborn period and in adulthood (age 22–35 years) from a unique longitudinal cohort of ART-conceived in iduals, previously shown to have no differences in health outcomes in early adulthood compared with non-ART-conceived in iduals. We show evidence for specific ART-associated variation in methylation around birth, most of which occurred independently of embryo culturing. Importantly, ART-associated epigenetic variation at birth largely resolves by adulthood with no direct evidence that it impacts on development and health.
Publisher: Elsevier BV
Date: 04-2011
DOI: 10.1111/J.1753-6405.2010.00653.X
Abstract: Australia has specialist psychiatric and residential early parenting services (REPS) to which women with postnatal psychiatric illness or psychological difficulties in adjusting to motherhood can be admitted with their infants. The study aim was to ascertain the proportions of Victorian mother-infant dyads admitted to these services in one year. The numbers of mother-infant dyads admitted to public and private psychiatric and REP services in any 12-month period 2002-2004 were collected from publications, annual reports and health-service administrators. When exact data was unavailable, estimates were based on occupancy rates. Birth rates were obtained from Victorian Perinatal Data Collection reports. About 5.9% of Victorian mother-infant dyads were admitted for psychiatric or psychological causes in 2002: 0.9% to psychiatric and 5.05% to REPS. Most mother-infant admissions for mental health care in Victoria are to non-psychiatric REPS. Long waiting lists and high occupancy rates suggest unmet need for these services. Lower occupancy rates suggest that Victoria has sufficient specialist psychiatric Mother Baby beds to meet community needs. Strengthening the REP sector's capacity to provide mother-infant mental health care might assist realisation of the Australian National Perinatal Depression Initiative's goal of early intervention for women with non-psychotic common postnatal psychological disorders.
Publisher: Elsevier BV
Date: 10-2019
DOI: 10.1016/J.FERTNSTERT.2019.05.012
Abstract: To study the impact of the donor's and recipient's age on the cumulative live-birth rate (CLBR) in oocyte donation cycles. A population-based retrospective cohort study. Not applicable. All women using donated oocytes (n = 1,490) in Victoria, Australia, between 2009 and 2015. None. The association between the donor's and recipient's age and CLBR modeled by multivariate Cox proportional hazard regression with the covariates of male partner's age, recipient parity, and cause of infertility adjusted for, and donor age grouped as <30, 30-34, 35-37, 38-40, and ≥41 years, and recipient age as <35, 35-37, 38-40, 41-42, 43-44, and ≥45 years. The mean age of the oocyte donors was 33.7 years (range: 21 to 45 years) with 49% aged 35 years and over. The mean age of the oocyte recipients was 41.4 years (range: 19 to 53 years) with 25.4% aged ≥45 years. There was a statistically significant relationship between the donor's age and the CLBR. The CLBR for recipients with donors aged <30 years and 30-34 years was 44.7% and 43.3%, respectively. This decreased to 33.6% in donors aged 35-37 years, 22.6% in donors aged 38-40 years, and 5.1% in donors aged ≥41 years. Compared with recipients with donors aged <30 years, the recipients with donors aged 38-40 years had 40% less chance of achieving a live birth (adjusted hazard ratio 0.60 95% CI, 0.43-0.86) and recipients with donors aged ≥41 years had 86% less chance of achieving a live birth (adjusted hazard ratio 0.14 95% CI, 0.04-0.44). The multivariate analysis showed no statistically significant effect of the recipient's age on CLBR. We have demonstrated that the age of the oocyte donor is critical to the CLBR and is independent of the recipient woman's age. Recipients using oocytes from donors aged ≥35 years had a statistically significantly lower CLBR when compared with recipients using oocytes from donors aged <35 years.
Publisher: Oxford University Press (OUP)
Date: 21-09-2010
Abstract: The aim of this study was to describe the perceptions of infertile men regarding the impact of infertility on their intimate relationships, their experience of treatment and their sources of information and support. A cross-sectional survey of a consecutive cohort of men diagnosed 5 years earlier as infertile at Melbourne IVF and the Royal Women's Hospital Reproductive Services, Melbourne was conducted. Study-specific questions assessed the impact of male factor infertility on the intimate relationships, their perceived quality of infertility-related health care and their preferred sources of infertility-related information and personal support and the effectiveness of these. The response rate was 41% (112/276). Male factor infertility was reported to have had a negative impact on the intimate partner relationship by 25% of men, and 32% reported a negative effect on their sexual satisfaction. Satisfaction with medical care and clinic information was high and not influenced by the outcome of the treatment. Clinic-provided information and discussion with clinic staff were the most strongly preferred sources of information, and the partner and clinic staff were the most valued sources of personal support. Very few men found support groups useful and less than half confided in friends. The findings suggest that for a significant subgroup of men, male factor infertility affects their intimate relationship negatively. Wider sources of social support are not used by infertile men as they rely predominantly on clinic-provided information and support. This indicates that psychologically informed supportive clinical care is particularly important for men diagnosed as infertile.
Publisher: Georg Thieme Verlag KG
Date: 16-05-2022
Abstract: Preconception care (PCC) involves a wide-ranging set of interventions to optimize health prior to pregnancy. These interventions seek to enhance conception rates, pregnancy outcomes, childhood health, and the health of future generations. To assist health care providers to exercise high-quality clinical care in this domain, clinical practice guidelines from a range of settings have been published. This systematic review sought to identify existing freely accessible international guidelines, assess these in terms of their quality using the AGREE II tool, and assess the summary recommendations and the evidence level on which they are based. We identified 11 guidelines that focused on PCC. Ten of these were classified as moderate quality (scores ranging from 3.5 to 4.5 out of 7) and only one was classified as very high quality, scoring 6.5. The levels of evidence for recommendations ranged from the lowest possible level of evidence (III) to the highest (I-a): the highest quality evidence available is for folic acid supplementation to reduce risk of neural tube defects and the role of antiviral medication to prevent HIV transmission. This systematic review identified that high-quality guidelines on PCC are lacking and that few domains of PCC recommendations are supported by high-quality evidence.
Publisher: Elsevier
Date: 2018
Publisher: Informa UK Limited
Date: 26-09-2021
DOI: 10.1080/17441692.2021.1983000
Abstract: Third-party disclosure by participants is inherent to much global health research. It presents ethical tensions with respecting the autonomy and privacy of non-consenting in iduals whose data are disclosed but is neglected in ethics guidelines. Our aim was to describe and ethically reflect on, third party disclosure in a community-participatory demographic and health survey (DHS) implemented within participatory health research (PHR) about community-based care of children affected by AIDS in Eswatini. We collected DHS data and analysed it statistically. We studied the PHR process and outcomes ethnographically and analysed the data interpretively, using theories that conceptualise secrecy as relational and power-laden. We found that third parties' data were disclosed by DHS respondents (typically women), including data about health conditions, abuse perpetration and being a caregiving burden. Ethnographic findings suggested that some third parties may not have consented to us collecting their data. However, respecting third parties' autonomy and privacy presents ethical tensions related to silencing survey respondents and impairing knowledge creation. To minimise the ethical tensions surrounding third-party disclosure researchers can analyse risks, benefits and power dynamics and extend their ethical responsibilities to protect participants to also protect non-participants, and from data collection to also include reporting.
Publisher: Wiley
Date: 10-1988
DOI: 10.1111/J.1749-6632.1988.TB22246.X
Abstract: The Prestwick and NIH chemical libraries were screened for drugs that protect baker's yeast from sugar-induced cell death (SICD). SICD is triggered when stationary-phase yeast cells are transferred from spent rich medium into water with 2% glucose and no other nutrients. The rapid, apoptotic cell death occurs because reactive oxygen species (ROS) accumulate. We found that triclabendazole, which is used to treat liver flukes in cattle and man, partially protects against SICD. Characterization of triclabendazole revealed that it also protects yeast cells from death induced by the Parkinson's disease-related protein alpha-synuclein (α-syn), which is known to induce the accumulation of ROS.
Publisher: Medknow
Date: 19-12-2011
DOI: 10.1038/AJA.2011.72
Publisher: Informa UK Limited
Date: 04-2013
Publisher: OMICS Publishing Group
Date: 2013
Publisher: Research Square Platform LLC
Date: 24-01-2020
Abstract: Background: Optimal parental preconception health benefits reproductive outcomes . However, preconception health promotion is not routinely offered in primary health care settings to people of reproductive age. The aim was to gauge the planned preconception health behaviours and attitudes towards being asked about pregnancy intention by a general practitioner (GP) among people of reproductive age in Australia. Method: The research was conducted on a single wave of Australia’s first and only probability-based online panel, Life in Australia™. Members of the Life in Australia™ panel are Australian residents aged 18 years or over. All active members between the ages of 18 and 45 years were eligible to participate. Eligible panel members were invited to complete a survey about fertility and childbearing. Data were collected from 18 February to 4 March 2019. Results: In all 965 female and male members of Life in Australia™ aged between 18 and 45 years were invited to complete the survey. Of these, 716 (74.2%) agreed. Most respondents indicated that if they were planning to have a child they would try to optimise their preconception health by adopting a healthier diet (80%), seeing a GP for a health check-up (78%), reducing alcohol consumption (78% of those consuming alcohol), getting fitter (73%), and stopping smoking (70% of smokers). Three in four (74%) stated that they would not mind if their GP asked them about their pregnancy intentions. Conclusion: Findings suggests that routinely asking people of reproductive age about their pregnancy intentions and advising those who are planning pregnancy about what they can do to ensure optimal preconception health would be acceptable to most people and may improve reproductive outcomes.
Publisher: Elsevier BV
Date: 07-2010
DOI: 10.1016/J.FERTNSTERT.2009.01.165
Abstract: To investigate attitudes toward parenthood, long-term life satisfaction, and health and well-being in men diagnosed as infertile. A cross-sectional survey of a cohort of men 5 years after diagnosis of infertility. The andrology clinic at the Royal Women's Hospital Reproductive Services, Melbourne Australia. All men diagnosed at this center as infertile in 2001 and 2002. None. Attitudes to parenthood (Meaning of Parenthood), quality of intimate relationship (Intimate Bonds Measure), personality characteristics (Vulnerable Personality Style Questionnaire), life satisfaction (Satisfaction with Life Scale), and self-rated physical health (Physical Component Summary of SF-12 [PCS-12]) and relationship with mental health (Mental Component Summary of SF12 [MCS-12]). A total of 112 (41%) of 276 men completed the survey. Of these, 96% had pursued infertility treatment and 87% had become fathers. Only 10% thought that fertility confirmed by fatherhood reflected masculinity, and 84% desired parenthood as much as their partners did. When all other factors were controlled for, men who had not become fathers had poorer mental health (MCS-12 score = 43.9 +/- 9.9) than those who were fathers (MCS-12 score = 49.25 +/- 8.7). Clinical practice should not presume that infertile men conflate fertility and masculinity, are less distressed than women about the potential loss of parenthood, or adjust more readily to childlessness, which appear to be inaccurate but widespread stereotypes.
Publisher: Springer Science and Business Media LLC
Date: 15-03-2013
Abstract: Use of assisted reproductive technologies (ART) continues to increase, yet little is known of the longer term health of ART conceived offspring. There are some adverse birth outcomes associated with ART conception but the subsequent developmental trajectory is unclear. Undertaking research in this area is challenging due the sensitive nature of the topic and the time elapsed since birth of the ART conceived young adults. The aim of this report is to describe a research protocol, including design and ethical considerations, used to compare the physical and psychosocial health outcomes of ART conceived young adults aged 18-28 years, with their spontaneously conceived peers. This is a retrospective cohort study of mothers who conceived with ART in Victoria, Australia and gave birth to a singleton child between 1982 and 1992. A current address for each mother was located and a letter of invitation to participate in the study was sent by registered mail. Participation involved completing a telephone interview about her young adult offspring’s health and development from birth to the present. Mothers were also asked for consent for the researcher to contact their son/daughter to invite them to complete a structured telephone interview about their physical and psychosocial health. A comparison group of women living in Victoria, Australia, who had given birth to a spontaneously conceived singleton child between 1982 and 1992 was recruited from the general population using random digit dialling. Data were collected from them and their young adult offspring in the same way. Regression analyses were used to evaluate relationships between ART exposure and health status, including birth defects, chronic health conditions, hospital admissions, growth and sexual development. Psychosocial wellbeing, parental relationships and educational achievement were also assessed. Factors associated with the age of disclosure of ART conception were explored with the ART group only. The conceptualization and development of this large project posed a number of methodological, logistical and ethical challenges which we were able to overcome. The lessons we learnt can assist others who are investigating the long-term health implications for ART conceived offspring.
Publisher: Research Square Platform LLC
Date: 17-12-2019
Abstract: Background: Optimal parental preconception health benefits reproductive outcomes. However, preconception health promotion is not routinely offered in primary health care settings to people of reproductive age. The aim was to gauge the planned preconception health behaviours and attitudes towards being asked about pregnancy intention by a general practitioner (GP) among people of reproductive age in Australia. Method: The research was conducted on a single wave of Australia’s first and only probability-based online panel, Life in Australia™. Members of the Life in Australia™ panel are Australian residents aged 18 years or over. All active members between the ages of 18 and 45 years were eligible to participate. Eligible panel members were invited to complete a survey about fertility and childbearing. Data were collected from 18 February to 4 March 2019. Results: In all 965 female and male members of Life in Australia™ aged between 18 and 45 years were invited to complete the survey. Of these, 716 (74.2%) agreed. Most respondents indicated that if they were planning to have a child they would try to optimise their preconception health by adopting a healthier diet (80%), seeing a GP for a health check-up (78%), reducing alcohol consumption (78% of those consuming alcohol), getting fitter (73%), and stopping smoking (70% of smokers). Three in four (74%) stated that they would not mind if their GP asked them about their pregnancy intentions. Conclusion: Findings suggests that routinely asking people of reproductive age about their pregnancy intentions and advising those who are planning pregnancy about what they can do to ensure optimal preconception health would be acceptable to most people and may improve reproductive outcomes.
Publisher: Springer Science and Business Media LLC
Date: 20-02-2020
DOI: 10.1186/S12875-020-01110-3
Abstract: Optimal parental preconception health benefits reproductive outcomes. However, preconception health promotion is not routinely offered in primary health care settings to people of reproductive age. The aim was to gauge the planned preconception health behaviours and attitudes towards being asked about pregnancy intention by a general practitioner (GP) among people of reproductive age in Australia. The research was conducted on a single wave of Australia’s first and only probability-based online panel, Life in Australia™. Members of the Life in Australia™ panel are Australian residents aged 18 years or over. All active members between the ages of 18 and 45 years were eligible to participate. Eligible panel members were invited to complete a survey about fertility and childbearing. Data were collected from 18 February to 4 March 2019. In all 965 female and male members of Life in Australia™ aged between 18 and 45 years were invited to complete the survey. Of these, 716 (74.2%) agreed. Most respondents indicated that if they were planning to have a child they would try to optimise their preconception health by adopting a healthier diet (80%), seeing a GP for a health check-up (78%), reducing alcohol consumption (78% of those consuming alcohol), getting fitter (73%), and stopping smoking (70% of smokers). Three in four (74%) stated that they would not mind if their GP asked them about their pregnancy intentions. Findings suggests that routinely asking people of reproductive age about their pregnancy intentions and advising those who are planning pregnancy about what they can do to ensure optimal preconception health would be acceptable to most people and may improve reproductive outcomes.
Publisher: Oxford University Press (OUP)
Date: 06-01-2017
Abstract: What are the reproductive experiences of women who cryopreserve oocytes for non-medical reasons? One in three women had been pregnant at some stage in their lives and while most still wanted to have a child or another child, very few had used their stored oocytes, predominantly because they did not want to be single parents. The number of healthy women who freeze oocytes to avoid age-related infertility is increasing. Evidence about reproductive outcomes after oocyte cryopreservation for non-medical reasons is needed to help women make informed decisions. A cross-sectional survey was carried out. Study packs which included a self-administered questionnaire were mailed by clinic staff to 193 eligible women. Women who had stored oocytes for non-medical reasons at Melbourne IVF, a private ART clinic, between 1999 and 2014 were identified from medical records and invited to complete an anonymous questionnaire about their reproductive histories and experience of oocyte cryopreservation. A total of 10 survey packs were returned to the clinic marked 'address unknown'. Of the 183 potential respondents, 96 (53%) returned the questionnaire. One respondent provided only free-text comments, thus data from 95 respondents were compiled. The mean age at the time of freezing oocytes was 37.1 years (SD ± 2.6, range: 27-42) and the average number of oocytes stored was 14.2 (SD ± 7.9, range: 0-42) 2% had attempted to store oocytes but had none suitable for freezing, 24% had stored 23 oocytes. About one-third of respondents (34%) had been pregnant at some point in their lives. Six women (6%) had used their stored oocytes and three of them had given birth as a result. The main reason for not using stored oocytes was not wanting to be a single parent. Of the 87 (91%) women who still had oocytes stored, 21% intended to use them while 69% indicated that their circumstances would determine usage. The mean number of children respondents would ideally have liked to have was significantly higher than the number of children they expected to have (2.11 versus 1.38, P < 0.001). The limitations are inherent to any anonymously completed questionnaire: participation bias, missing data and the possibility that some questions or response alternatives may have been ambiguous. The findings add to the very limited evidence about the reproductive outcomes experienced by women who freeze oocytes for non-medical reasons and can be used to help women make informed decisions about whether to store oocytes. The study was funded by Melbourne IVF. K.H. has received honoraria from Merck-Serono, J.M. is a clinician at Melbourne IVF, F.A. is a Melbourne IVF employee, J.F. is supported by a Monash Professorial Fellowship and the Jean Hailes Professorial Fellowship which receives funding from the L and H Hecht Trust, managed by Perpetual Trustees Pty Ltd. M.K., N.P., M.H., M.P. and C.B. have no competing interests. Not applicable.
Publisher: Wiley
Date: 07-2013
DOI: 10.1111/AJO.12112
Abstract: Australian data regarding spontaneous conceptions following a live birth conceived by assisted reproductive technologies (ART) have not yet been reported. This study aimed to determine the incidence of spontaneous conceptions within 18-24 months after women had a first infant conceived by ART (ARTC) or spontaneously conceived (SC). Factors associated with spontaneous pregnancies in women with ARTC first infants were investigated. Nulliparous women were recruited through ART clinics (n = 297) and maternity hospitals (n = 295) in Melbourne and Sydney, Australia. Participants were interviewed in pregnancy and when their first infants were aged 18-24 months. Information was collected on pregnancies since the first infant's birth. The outcome was any subsequent conception during this period. Follow-up data were available for 198 women with SC first infants and 236 women with ARTC first infants, 94 (40%) of whom had further ART following the first birth. Spontaneous conceptions had occurred in 40% of women with SC first infants and 33% of women with ARTC first infants who had not had subsequent ART. Twenty-four per cent of pregnancies after the birth of SC first infants were unexpected, compared with 61% of subsequent pregnancies (without further treatment) after the birth of ARTC first infants (P < 0.001). Subsequent, spontaneous pregnancies in women with ARTC first infants were significantly associated with unexplained infertility and shorter partner relationship duration. Discussion about contraception is recommended if women with ARTC first infants do not wish to have more children or wish to delay subsequent pregnancies.
Publisher: Wiley
Date: 03-08-2013
DOI: 10.1111/APA.12336
Abstract: To establish the relationships between age, mode of conception and breastfeeding. Consecutive cohorts of nulliparous women >25 weeks pregnant who had conceived through ART (ARTC) or spontaneously (SC) in three age groups ≤30, 31-36 and ≥37 years were recruited. Data were obtained via telephone interviews and postal questionnaires in late pregnancy and 4 months postpartum. Sociodemographic characteristics, reproductive health, birth and breastfeeding experiences were assessed by study-specific questions. Self-rated general health and symptoms of depression and anxiety were assessed with standardized psychometric instruments. Main outcomes were exclusive breastfeeding at discharge from maternity hospital and 4 months postpartum. Of 1179 eligible women, 791 (67%) participated 549 (93%) had singleton infants, provided complete data and were included in analyses. Overall, 37.2% of participants aged ≤30, 33% aged 31-36 and 55.1% aged ≥37 years experienced Caesarean births. Regardless of age, compared with the SC group, ARTC women had twice the rate of Caesareans prior to labour. Controlling for other factors, exclusive breastfeeding rates at hospital discharge and 4 months postpartum were lowest amongst ARTC women who experienced Caesarean prior to labour (p < .001). Independent of age, assisted conception increases the risk conferred by Caesarean birth to breastfeeding initiation and maintenance.
Publisher: Oxford University Press (OUP)
Date: 11-01-2016
Publisher: Wiley
Date: 14-02-2020
DOI: 10.1002/HPJA.326
Abstract: Changes in health require new learning. There are increased risks of chronic noncommunicable diseases after menopause and positive health behaviour during the peri‐menopausal years and beyond are crucial for a healthy postmenopausal life. In order to implement health promotion messages, women require adequate health literacy skills in order to achieve better health and access to appropriate health care. This qualitative study explored menopause‐related health literacy and experiences of menopause‐related health care using semi‐structured interviews with women from the Horn of Africa nations who had migrated to Melbourne, Australia. Participants viewed menopause as a normal life phase and did not see the need for accessing menopause‐related information and care. Limited education, low literacy and being unfamiliar with the internet were barriers to health literacy. Participants' preferred health care providers who could converse in their first language, but regretted their lack of proactive engagement in providing menopause‐related information. Primary health care providers need to be aware that immigrant women from the Horn of Africa nations have poor health literacy and may be unaware of the benefits of positive health behaviours during and after menopause. Offering menopause‐related health promotion opportunistically may lead to better postmenopausal health for this group of women. Health promotion and education programs codesigned with community stakeholders may be effective in engaging immigrant communities to improve menopause‐related health literacy.
Publisher: Wiley
Date: 16-02-2021
DOI: 10.1111/AJO.13321
Abstract: In vitro fertilisation (IVF) ‘add‐ons’ are extra (non‐essential) procedures, techniques or medicines, which usually claim to increase the chance of a successful IVF outcome. Use of IVF add‐ons is believed to be widespread in many settings however, information about add‐on availability in Australasia is lacking. To understand which add‐ons are advertised on Australasian IVF clinic websites, and what is the evidence for their benefit. A systematic assessment of website content was undertaken between December 2019–April 2020, capturing IVF add‐ons advertised, including costs, claims of benefit, statements of risk or limitations, and evidence of effectiveness for improving live birth and pregnancy. A literature review assessed the strength and quality of evidence for each add‐on. Of the 40 included IVF clinics websites, 31 (78%) listed one or more IVF add‐ons. A total of 21 different add‐ons or add‐on groups were identified, the most common being preimplantation genetic testing for aneuploidies (offered by 63% of clinics), time‐lapse systems (33%) and assisted hatching (28%). In most cases (77%), descriptions of the IVF add‐ons were accompanied by claims of benefit. Most claims (90%) were not quantified and very few referenced scientific publications to support the claims (9.8%). None of the add‐ons were supported by high‐quality evidence of benefit for pregnancy or live birth rates. The cost of IVF add‐ons varied from $0 to $3700 (AUD/NZD). There is widespread advertising of add‐ons on IVF clinic websites, which report benefits for add‐ons that are not supported by high‐quality evidence.
Publisher: Oxford University Press (OUP)
Date: 17-10-2017
Abstract: What are the reproductive experiences and outcomes of people who store reproductive material before cancer treatment? Of respondents who had tried to achieve pregnancy since completing cancer treatment almost all had succeeded, in most cases through natural conception. People of reproductive age who are diagnosed with cancer can cryopreserve reproductive material to guard against the adverse effects on fertility of gonadotoxic treatment. Little is known about the reproductive outcomes of people who undergo fertility preservation before cancer treatment. Cross-sectional survey. Women and men who had stored reproductive material before cancer treatment at two private and one public fertility clinics up to June 2014 and were at least 18 years old at the time were identified from medical records and invited to complete an anonymous questionnaire about their reproductive experiences. Of the 870 potential respondents 302 (171 female and 131 male) returned completed questionnaires yielding a response rate of 34.5% (39.5% and 29.7% for female and male respondents, respectively). Current age was similar for women and men (37.2 years) but men had been diagnosed with cancer significantly earlier in life than women (28.2 versus 30.3 years, P = 0.03). Almost two-thirds of respondents wished to have a child or another child in the future, some of whom knew that they were unable to. One in ten respondents was a parent before the cancer diagnosis and around one-third had had a child since diagnosis or was pregnant (or a partner in pregnancy) at the time of the survey. Of those who had tried to conceive since completing cancer treatment (N = 119) 84% (79% of women and 90% of men) had had a child or were pregnant (or a partner in pregnancy). Most of the pregnancies since the diagnosis of cancer occurred after natural conception (58/100, 58%). Of the 22 women (13% of all women) and 35 men (27% of all men) who had used their stored reproductive material four women (18%) and 28 men (80%) had had a child or were pregnant or a partner in pregnancy at the time of completing the survey. The most commonly stated reason for not using the stored material was not being ready to try for a baby. The relatively low response rate, particularly among men, means that participation bias may have influenced the findings. As type of cancer was self-reported and we did not ask questions about respondents' cancer treatments, it is not possible to link reproductive outcomes to type of cancer or cancer treatment. Also, there is no way of comparing the s le with the populations they were drawn from as data on reproductive outcomes of people who store reproductive material before cancer treatment are not collected routinely. This might have led to over- or underestimates of the reproductive experiences and outcomes reported in this paper. The findings add to the limited evidence about the reproductive outcomes of this growing group of people and can be used to inform the advice given to those contemplating fertility preservation in the context of cancer. The study was funded by the National Health and Medical Research Council (APP1042347). The authors have no conflicts of interest to declare. Not applicable.
Publisher: Oxford University Press (OUP)
Date: 06-12-2013
Publisher: Springer International Publishing
Date: 2017
Publisher: Oxford University Press (OUP)
Date: 25-08-2021
Publisher: Elsevier BV
Date: 04-2015
DOI: 10.1016/J.EVALPROGPLAN.2014.12.019
Abstract: There have been few systematic evaluations of experiences of participating in peer support groups for parents and other caregivers of children with special needs. In Australia, facilitated groups are available to caregivers in community settings, through a nationally funded program, MyTime. Mechanisms for ongoing monitoring and evaluation have not yet been instituted. To establish whether brief, online surveys can be used for monitoring and evaluating peer support groups for caregivers of children with special needs. Two brief, online surveys, with both fixed-choice and open-ended questions, were developed. All caregivers who attended any MyTime group during a 1-month period were invited to participate. Of 89 caregivers who expressed interest in participating, 54 and 31 respondents completed respectively. Respondents represented a variety of backgrounds and circumstances. Responses revealed both positive and negative aspects of group participation. Linked data on expectations and experiences provided important feedback for the program. Brief, online surveys are a suitable mechanism for ongoing monitoring and evaluation of peer support group programs for caregivers.
Publisher: Oxford University Press (OUP)
Date: 2019
Publisher: Wiley
Date: 09-2014
DOI: 10.5694/MJA14.01086
Abstract: To describe the outcomes of surrogacy among Australian intended parents who engage in compensated surrogacy overseas. Members of two Australian parenting support forums who were considering surrogacy or were currently or previously in a surrogacy arrangement were invited to complete an anonymous online survey during July 2013. Destination countries source of eggs number of surrogates and embryo transfers proportions who experienced pregnancy loss after 12 weeks' gestation, multiple pregnancy, prematurity, and live birth by destination country and intentions regarding disclosure to children about the way they were conceived. Of 1135 potential participants 259 (23%) completed the survey. Of these, 112 (43%) had undertaken at least one surrogacy attempt overseas. India and the United States were the two most common destination countries. Most respondents (95/112 85%) had used donor eggs half (57/112 51%) had used more than one surrogate and the mean number of embryo transfer procedures was 2.9. As a result of surrogacy, 85% (95/112) had at least one child 55% (62/112) reported that their surrogate had a multiple pregnancy 10% (11/112) reported that a pregnancy had ended in a late miscarriage or perinatal death and 45% of births (35/78) were premature. Most respondents (80/112 71%) were most comfortable with using an identity-release donor, and 87% (97/112) believed that this would also be in their child's best interests. Almost universally, parents were planning to disclose the use of a surrogate and/or a donor to their child. Almost half of the intended parents via surrogacy who completed this survey had undertaken compensated surrogacy overseas most of these used donor eggs, but few considered Australian donors. A high proportion of surrogates had multiple pregnancies and there was a high rate of premature birth. These adverse outcomes could be avoided if the surrogacy was undertaken in Australia. Removing some of the existing barriers to surrogacy in Australia may reduce the number of surrogacy arrangements carried out overseas.
Publisher: Wiley
Date: 02-1990
Abstract: Effectiveness of vaginal sonography combined with urinary human chorionic gonadotropin (hCG) for identification of ectopic pregnancy (EP) was studied in 107 pregnant women. Eighty-nine women had clinical symptoms suspicious of EP. It was suggested that 18 women carried an increased risk for developing EP. In 63 women endovaginal sonography showed no evidence of intrauterine pregnancy. Fifty-eight of these turned out to be pathological pregnancies. In 44 women endovaginal ultrasonography revealed intrauterine pregnancies. Thirty-two of these turned out to be viable, 10 were not viable and resulted in spontaneous abortions, and 2 turned out to be EP. The sensitivity of vaginal sonography to identify a viable intrauterine pregnancy thus was 81% and its specificity was 97%. The sensitivity and the specificity for endovaginal ultrasonography for identifying EP was 96% and 71%, respectively. Endovaginal ultrasonography demonstrated an intrauterine gestational sac in 54% of the women with urinary HCG as low as 40 IU/L to 500 IU/L. These results show that endovaginal ultrasonography is a sensitive instrument for identifying both early normal intrauterine pregnancies as well as pathological pregnancies.
Publisher: BMJ
Date: 11-2020
DOI: 10.1136/BMJOPEN-2020-042696
Abstract: To identify sex and age differences in clinically significant symptoms of depression and anxiety and the factors associated with these differences among adults in Australia during COVID-19-related restrictions. Anonymous online survey. Australia. Adults aged over 18 years living in Australia were eligible and 13 829 contributed complete data. Of these, 13 762 identified as female (10 434) or male (3328) and were included in analyses. None. Clinically significant symptoms of depression (≥10 on Patient Health Questionnaire 9) or anxiety (≥10 on Generalized Anxiety Disorder Scale 7 (GAD-7)), and experiences of irritability (GAD-7 item 6). Women were more likely than men to have clinically significant symptoms of depression (26.3% (95% CI 25.4 to 27.1) vs 20.1% (95% CI 18.7 to 21.5), p .001) and anxiety (21.8% (95% CI 21.0 to 22.6) vs 14.2% (95% CI 13.0 to 15.4), p .001) and to have experienced irritability in the previous fortnight (63.1% (95% CI 62.1 to 64.0) vs 51.4% (95% CI 49.7 to 53.2), p .001). They were also more likely than men to be doing unpaid work caring for children (22.8% (95% CI 22.0 to 23.6) vs 8.6% (95% CI 7.7 to 9.6), p .001) and dependent relatives (9.8% (95% CI 9.2 to 10.3) vs 5.7% (95% CI 4.9 to 6.5), p .001) which made significant contributions to the mental health outcomes of interest. Loss of employment, fear of contracting COVID-19 and feeling a severe impact of the restrictions were associated with poorer mental health in women and men of all ages. Rates of clinically significant symptoms of depression and anxiety were higher among women than men. Rather than being intrinsically more vulnerable to mental health problems during the COVID-19 pandemic, the higher risk of symptoms of anxiety and depression among women may in part be explained by their disproportionate burden of unpaid caregiving.
Publisher: Elsevier BV
Date: 05-2008
DOI: 10.1016/J.FERTNSTERT.2007.05.022
Abstract: Australian women conceiving with ART are at fourfold risk of admission to early parenting treatment programs compared with those conceiving spontaneously. This study aimed to identify prevalence and determinants of antenatal mood disturbance and other risks for early parenting difficulties after assisted conception. A prospective longitudinal investigation from conception to 18 months postpartum using telephone interviews and self-report questionnaires. Melbourne IVF and Royal Women's Hospital Reproductive Services, Victoria, Australia. A consecutive cohort of English-speaking women with ultrasound-confirmed ART-conceived pregnancies. Standardized psychometric measures of mood, quality of marital relationship, mother-to-fetus emotional attachment, and personality. None. Of the 288 women with confirmed pregnancies, 239 were contactable, and 183 (77%) were recruited, 95% of whom completed both early and late pregnancy assessments. Participants were socioeconomically advantaged, had very good pregnancy health, exceptional marital relationships, normal personality styles, and intense affectionate attachment to the fetus. Very few (<5%) had clinically significant mood disturbance in late pregnancy. There were low rates of antenatal mood disturbance and other risk factors for postpartum depression. Pregnancy and motherhood might be idealized after ART conception, and preparation for the realities of infant care might then be insufficient.
Publisher: Elsevier BV
Date: 06-2017
Publisher: Informa UK Limited
Date: 25-06-2018
DOI: 10.1080/13625187.2018.1483020
Abstract: Women with polycystic ovary syndrome (PCOS) are usually told that the condition is associated with fertility difficulties. However, little is known about their fertility management including contraceptive use, childbearing desires, and pregnancy outcomes. To compare the fertility management experiences and outcomes of Australian women with and without PCOS. The 2013 Australian electoral roll was used to identify a random s le of 18- to 50-year-old women who were sent the Understanding Fertility Management in Australia survey to be completed anonymously. Factors associated with fertility management and outcomes were identified in multivariable analyses. Among the 1543 women who completed and returned the survey, 113 (7.3%) reported having PCOS. Women with PCOS reported a similar rate of current contraceptive use as women without PCOS (50.4% vs. 52.6%, p = .66). However, they were significantly younger at first pregnancy (24.9 vs. 26.8 years, p = .015), more likely to have consulted a health professional about fertility management (OR: 3.86, 95% CI: 2.50-5.96, p < .001), and perceive that it would be difficult to conceive (OR: 2.31, 95% CI: 1.41-3.79, p = .001) than women without PCOS. There were no significant differences in the number of desired children, unintended pregnancies, live births, abortions or miscarriages between women with and without PCOS. These findings indicate that women with PCOS need more nuanced information about their fertility potential. While they may experience fertility difficulties because of their condition, they should also be informed that they can conceive spontaneously and need reliable contraception to avoid pregnancy when it is not wanted.
Publisher: Hindawi Limited
Date: 24-03-2018
DOI: 10.1111/ECC.12682
Abstract: Gestational breast cancer (GBC) presents many challenges for women and the clinicians who care for them. The aim of this study was to explore the health care experiences of women diagnosed with GBC to inform and improve clinical care of women in this predicament. Semi-structured interviews were conducted with 17 women who had been diagnosed with GBC in the previous 5 years. The overarching themes for perceived quality of care were "communication" and "comprehensive care." "Communication" had two sub themes: "interdisciplinary communication" (the way health professionals from different disciplines communicated with each other about the management of the woman's care) and "patient communication" (how they communicated this to the woman). The "comprehensive care" theme incorporated three sub themes: "the spirit" (psychological care) "the mind" (information provision) and "the body" (management of treatment side effects). Women's own accounts of positive and negative experiences of GBC care provide unique and specific insights which improve understanding of their concerns and needs. The findings can inform advances in quality and efficacy of clinical care offer guidance for obstetricians, oncologists and allied health professionals about the needs of women diagnosed with GBC and how care can be optimised and inform the development of resources to assist women and their families.
Publisher: Springer Science and Business Media LLC
Date: 02-1987
DOI: 10.1007/BF03347143
Publisher: Wiley
Date: 02-1989
Abstract: During the period from 1984 through 1986, 72 ultrasound-guided cyst punctures were performed in 60 young women (less than or equal to 40 years). Thirty-one punctures were performed using the transabdominal route and 41 punctures under the guidance of endovaginal scanning. General or local anesthesia were used in 97% of the transabdominal punctures while the corresponding figure for the endovaginal technique was 49%. Seventy-seven percent (46/60) of the women developed no new cysts within one year of the last puncture. Thirteen percent (8/60) had to be punctured twice and 3% (2/60) three times. No complications occurred in any of the 72 punctures. Of those women with cyst relapses and/or persistent abdominal pain, 7 were subjected to laparotomy and 5 to laparoscopy. Ultrasound-guided puncture of cystic tumors in the lower pelvis of young women seems to be an alternative to laparoscopically guided puncture or laparotomy. As compared to surgery, the ultrasound-guided technique may mean less risk for pelvic adhesions in young women with unproven fertility.
Publisher: Elsevier BV
Date: 04-2015
DOI: 10.1016/J.JAD.2015.01.025
Abstract: This study examines whether (1) older maternal age is associated with increased risk of depressive episodes between four months and two years after first birth and (2) the role of subsequent reproductive, social and child factors in vulnerability to later onset depression. 592 women were recruited in the third trimester of pregnancy in three age-groups (≤ 30 years 31-36 years,≥37 years) 434 (73%) completed all assessments at four months and two years after birth. Major Depression episodes (MDE) were assessed at four months and two years using the Mini International Neuropsychiatric Interview (MINI). Maternal (age, mode of conception, prior mood symptoms, health), child (temperament, health), reproductive (subsequent fertility treatment, pregnancy, birth, pregnancy loss) and social contextual variables (language background, paid work, practical support, life stresses) were assessed in pregnancy and postnatally using validated questionnaires and structured interview questions. Maternal age was not related to prevalence or timing of MDE. Depression symptoms, poor child health, low practical support at four months and a non-English language background predicted episodes of depression between four months and two years, ps <0.05. Life history risks for depression were not considered, nor symptom profiles over time. Findings indicate that despite a more complex reproductive context, older first time mothers are not more likely to report major depressive episodes in the first two years after birth. Prevalence for the whole s le was at the lower end of reported community ranges and was comparable early and later in the postpartum period. Screening for depression after childbirth should not be restricted to the early months.
Publisher: Oxford University Press (OUP)
Date: 28-02-2011
Abstract: The use of assisted reproductive technology (ART) is now well established in many countries and the first generations of offspring are reaching maturity. We reviewed the published literature to describe the available evidence about health outcomes in ART-conceived young people who were of an adolescent age or older. The EMBASE, Medline and PsychINFO databases were searched from January 1998 to October 2010. Key inclusion criteria were that the study s le have a mean age of ≥ 12 years or a mean follow-up period of ≥ 12 years and were conceived by ART. Seven publications reported physical health outcomes and 10 reported psychosocial health outcomes in ART offspring. Compared with control groups, some differences in physiological outcomes in relation to growth and development, chronic illness and risk of cancer have been reported. Overall, psychosocial studies of ART-conceived young people indicate that their cognitive function and psychological and social adjustment are similar to that of comparison groups. Overall, nine ART-conceived populations of this age group have been studied. Most s les included < 300 participants and methodologies varied between studies. Health information on this age group is therefore limited and the clinical significance of the findings remains unclear. Further research focusing on ART-conceived young adults is needed, particularly in relation to neurological health outcomes where no studies have been reported to date.
Publisher: Springer Science and Business Media LLC
Date: 08-04-2013
Publisher: Oxford University Press (OUP)
Date: 25-05-2017
Publisher: Public Library of Science (PLoS)
Date: 09-01-2020
Publisher: Oxford University Press (OUP)
Date: 15-11-2018
Publisher: AMPCo
Date: 26-10-2020
DOI: 10.5694/MJA2.50831
Publisher: Oxford University Press (OUP)
Date: 20-02-2013
Abstract: Is anxiety focused on the pregnancy outcome, known to be particularly salient in women conceiving through assisted reproductive technology (ART), related to difficult infant temperament? While trait anxiety predicts infant temperament, pregnancy-focused anxiety is not associated with more difficult infant temperament. A large body of research has provided convincing evidence that fetal exposure to maternal anxiety and stress in pregnancy has adverse consequences for child neurodevelopmental, behavioural and cognitive development, and that pregnancy-specific anxiety (concerns related to the pregnancy outcome and birth) may be of particular significance. Women conceiving through ART are of particular interest in this regard. Research over more than 20 years has consistently demonstrated that while they do not differ from spontaneously conceiving (SC) women with respect to general (state and trait) anxiety, they typically report higher pregnancy-specific anxiety. While research suggests normal behavioural and developmental outcomes for children conceived through ART, there is some evidence of more unsettled infant behaviour during the first post-natal year. The longitudinal cohort design followed 562 nulliparous women over a 7-month period, during the third trimester of pregnancy and at 4 months after birth. Approximately equal numbers of nulliparous women conceiving through ART (n = 250) and spontaneously (SC: n = 262) were recruited through ART clinics and nearby hospitals in Melbourne and Sydney, Australia. Participants completed three anxiety measures (state, trait, pregnancy specific) at time 1 in the third trimester of pregnancy and a measure of infant temperament at time 2, 4 months after birth. At time 1, relevant socio-demographic, pregnancy (maternal age, smoking, alcohol, medications, medical complications) information was recorded and at time 2, information regarding childbirth (gestation, infant birthweight, mode of delivery) and post-natal (concurrent mood) variables was recorded and controlled for in analyses. In the third trimester of pregnancy, women conceiving through ART reported lower state and trait anxiety, but higher pregnancy-focused anxiety than their SC counterparts (all Ps < 0.05). Hierarchical regression analyses including mode of conception, all anxiety variables and relevant covariates indicated that while trait anxiety in pregnancy predicted more difficult infant temperament (P < 0.001), pregnancy specific and state anxiety did not. Mode of conception predicted infant temperament with ART women reporting less difficult infant temperament (P < 0.001) than their SC counterparts. The major limitations in the study are the reliance on a self-report measure of infant temperament and the fact that the study did not assess quality of caregiving which may moderate the effect of pregnancy anxiety on infant temperament. This study is the first to our knowledge to prospectively examine the impact of gestational stress (pregnancy anxiety) on infant temperament in women conceiving through ART. Findings confirm existing research indicating that trait anxiety in pregnancy is associated with difficult infant temperament and suggest that pregnancy-specific anxiety (measured in the third trimester) is not implicated. These findings are reassuring for women conceiving through ART whose pregnancies may be characterized by particularly intense concerns about the wellbeing of a long sought after baby. The study was funded by a grant from the Australian Research Council (ARC) and in kind and financial contributions from IVF Australia and Melbourne. N/A.
Publisher: Informa UK Limited
Date: 25-10-2017
DOI: 10.1080/14647273.2016.1245447
Abstract: Some potentially modifiable factors adversely affect fertility and pregnancy health. To inform a fertility health promotion programme, this study investigated fertility knowledge and information-seeking behaviour among people of reproductive age. This was a qualitative study involving six focus group discussions with women and men who intended to have children in the future and eight paired interviews with couples who were actively trying to conceive. Participants (n = 74) themselves generally claimed 'low' to 'average' levels of knowledge about fertility. Most of them overestimated women's reproductive lifespan and had limited knowledge about the 'fertile window' of the menstrual cycle. The Internet was a common source of fertility-related information and social media was viewed as a potential effective avenue for dissemination of messages about fertility and how to protect it. Most participants agreed that primary health care providers, such as general practitioners (GPs), are well placed to provide information regarding fertility and pregnancy health. This study identified several gaps in knowledge among people of reproductive age about factors that influence fertility and pregnancy health negatively. Addressing these knowledge gaps in school curricula, primary care and health promotion would assist people to realize their reproductive goals and reduce the risk of infertility and adverse obstetric outcomes.
Publisher: Wiley
Date: 12-11-2018
DOI: 10.1111/AJO.12745
Abstract: Many factors influence the chance of having a baby with assisted reproductive technologies (ART). A 2016 Australian Competition and Consumer Commission (ACCC) investigation concluded that ART clinics needed to improve the quality of information they provide about chance of ART success. To evaluate changes in the quality of information about success rates provided on the websites of ART clinics in Australia and New Zealand before and after the ACCC investigation. Desktop audits of websites of ART clinics in Australia and New Zealand were conducted in 2016 and 2017 and available information about success rates was scored using a matrix with eight variables and a possible range of scores of 0-9. Of the 54 clinic websites identified in 2016, 32 had unique information and were eligible to be audited. Of these, 29 were also eligible to be audited in 2017. While there was a slight improvement in the mean score from 2016 to 2017 (4.93-5.28), this was not statistically significantly different. Of the 29 clinics, 14 had the same score on both occasions, 10 had a higher and five a lower information quality score in 2017. To allow people who consider ART to make informed decisions about treatment they need comprehensive and accurate information about what treatment entails and what the likely outcomes are. As measured by a scoring matrix, most ART clinics had not improved the quality of the information about success rates following the ACCC investigation.
Publisher: Oxford University Press (OUP)
Date: 12-06-2018
Abstract: What is the cumulative live birth rate following ICSI cycles compared with IVF cycles for couples with non-male factor infertility? ICSI resulted in a similar cumulative live birth rate compared with IVF for couples with non-male factor infertility. The ICSI procedure was developed for couples with male factor infertility. There has been an increased use of ICSI regardless of the cause of infertility. Cycle-based statistics show that there is no difference in pregnancy rates between ICSI and IVF in couples with non-male factor infertility. However, evidence indicates that ICSI is associated with an increased risk of adverse perinatal outcomes. A population-based cohort of 14 693 women, who had their first ever stimulated cycle with fertilization performed for at least one oocyte by either IVF or ICSI between July 2009 and June 2014 in Victoria, Australia was evaluated retrospectively. The pregnancy and birth outcomes following IVF or ICSI were recorded for the first oocyte retrieval (fresh stimulated cycle and associated thaw cycles) until 30 June 2016, or until a live birth was achieved, or until all embryos from the first oocyte retrieval had been used. Demographic, treatment characteristics and resulting outcome data were obtained from the Victorian Assisted Reproductive Treatment Authority. Data items in the VARTA dataset were collected from all fertility clinics in Victoria. Women were grouped by whether they had undergone IVF or ICSI. The primary outcome was the cumulative live birth rate, which was defined as live deliveries (at least one live birth) per woman after the first oocyte retrieval. A discrete-time survival model was used to evaluate the cumulative live birth rate following IVF and ICSI. The adjustment was made for year of treatment in which fertilization occurred, the woman's and male partner's age at first stimulated cycle, parity and the number of oocytes retrieved in the first stimulated cycle. A total of 4993 women undergoing IVF and 8470 women undergoing ICSI had 7980 and 13 092 embryo transfers, resulting in 1848 and 3046 live deliveries, respectively. About one-fifth of the women (19.0% of the IVF group versus 17.9% of the ICSI group) had three or more cycles during the study period. For couples who achieved a live delivery, the median time from oocyte retrieval to live delivery was 8.9 months in both IVF (range: 4.2-66.5) and ICSI group (range: 4.5-71.3) (P = 0.474). Fertilization rate per oocyte retrieval was higher in the IVF than in the ICSI group (59.8 versus 56.2%, P < 0.001). The overall cumulative live birth rate was 37.0% for IVF and 36.0% for ICSI. The overall likelihood of a live birth for women undergoing ICSI was not significantly different to that for women undergoing IVF (adjusted hazard ratio (AHR): 0.99, 95% CI: 0.92-1.06). For couples with a known cause of infertility, non-male factor infertility (female factor only or unexplained infertility) was reported for 64.0% in the IVF group and 36.8% in the ICSI group (P < 0.001). Among couples with non-male factor infertility, ICSI resulted in a similar cumulative live birth rate compared with IVF (AHR: 0.96, 95% CI: 0.85-1.10). Data were not available on clinic-specific protocols and processes for IVF and ICSI and the potential impact of these technique aspects on clinical outcomes. The reported causes of infertility were based on the treating clinician's classification which may vary between clinicians. This population-based study found ICSI resulted in a lower fertilization rate per oocyte retrieved and a similar cumulative live birth rate compared to conventional IVF. These data suggest that ICSI offers no advantage over conventional IVF in terms of live birth rate for couples with non-male factor infertility. No specific funding was received to undertake this study. There is no conflict of interest, except that M.B. is a shareholder in Genea Ltd. N/A.
Publisher: Informa UK Limited
Date: 2003
DOI: 10.1080/1464770312331368963
Abstract: In a follow-up study about women's experience of assisted reproductive technology (ART) some events were identified as particularly stressful, including making the decision to try ART, starting treatment, waiting for results after a scan, having oocyte collection, the 2 week wait after embryo transfer and finding out that the treatment was unsuccessful. On the basis of these findings, a review of the literature and extensive clinical practice as a nurse co-ordinator in an ART programme, implications for nursing practice are discussed and strategies to use that may help reduce stress and improve the well-being of ART participants are suggested.
Publisher: Wiley
Date: 10-1988
DOI: 10.1111/J.1749-6632.1988.TB22249.X
Abstract: The development of vaginal ultrasound transducers has facilitated ovum pick-up (OPU) by providing higher precision and less trauma than are found with laparoscopy and other ultrasound-assisted techniques. In order to evaluate the patients' acceptance, 65 patients were asked to answer a questionnaire about their experience with the procedure. The punctures were executed with specially designed needles introduced through a needle guide attached to a vaginal transducer with a frequency of 7 MHz (Brüel & Kjaer, Denmark). The anesthesia consisted of a light premedication and a paracervical block. If needed, a small dose of sedative was given intravenously intraoperatively. The patients classified their pain experience within the day of the puncture on a four-grade scale. Their statements were compared to the physician's opinion of the discomfort caused. Oocytes were retrieved from all patients. Fifty-one patients answered the questionnaire, of whom five found the OPU painful. In two cases the physician underestimated the patients' pain experience. The mean time required for the procedure was 16 min/OPU. We conclude that transvaginal ultrasound-guided OPU is well accepted by most patients under local anesthesia and that it is a rapid and accurate procedure.
Publisher: Elsevier BV
Date: 04-2021
Publisher: Informa UK Limited
Date: 22-06-2022
DOI: 10.1080/14647273.2020.1778803
Abstract: In high-income countries, parental age at first birth has increased and this postponement increases the risk of involuntary childlessness or having fewer children than desired. This interview study was conducted in Denmark and Sweden among childless men (
Publisher: Informa UK Limited
Date: 14-12-2023
DOI: 10.1080/14647273.2021.1995902
Abstract: Endometrial scratching is a common IVF add-on. In 2015, a survey in Australia, New Zealand and the United Kingdom (UK) reported that 83% of fertility specialists recommended endometrial scratching for IVF. Several large trials have since been published reporting no clear evidence for improved live birth rates following endometrial scratching before IVF. An online survey was undertaken to ascertain the current practices and views across Australia, New Zealand, and the UK. A total of 121 eligible responses were received between October and December 2020 (fertility specialists (
Publisher: Elsevier BV
Date: 04-2014
DOI: 10.1016/J.FERTNSTERT.2014.01.006
Abstract: To compare outcomes for young adults conceived by assisted reproductive technology (ART) with non-ART-conceived young adults. Cohort study. Not applicable. Mothers and their offspring (aged 18-28 years) conceived by ART mothers and their non-ART-conceived offspring, randomly selected from the same source population. Structured telephone interviews, one with mothers and another with their young adult offspring. Maternal report on young adult offspring hospitalizations and chronic illness accumulated over the first 18 years of their lives young adult self-report on perceived current quality of life, body mass index, pubertal development, and educational achievement. Of 1,480 eligible ART mothers, 80% were traced and contacted. Of those, 656 (55%) participated, reporting on 705 ART-conceived offspring 269 (23%) declined participation and 262 (22%) did not respond. Of the participants, 84% consented to contact with their young adult offspring, of whom 547 (92%) participated. Random-digit dialing recruited 868 non-ART mothers and 549 offspring. Compared with non-ART young adults, the ART group had significant increases in three maternally reported outcomes: 1) hospital admissions, including those in the secondary school years 2) atopic respiratory conditions and 3) combined endocrine, nutritional, and metabolic disease ICD-10 category. Young adult reported outcomes were similar for both groups. This study addresses gaps in knowledge of outcomes beyond adolescence for those conceived by ART. Results show few adverse outcomes in this large cohort of young adults, but additional assessment through clinical review is required to address issues unable to be examined in this study.
Publisher: Elsevier BV
Date: 11-2015
DOI: 10.1016/J.RBMO.2015.08.008
Abstract: Cross-border reproductive care (CBRC) is becoming increasingly common. Little is known about the motivations and information and support needs of people who cross borders to access surrogacy. This study aimed to explore: how those considering or undertaking extraterritorial surrogacy reach their decision what other avenues they have considered and tried to have children their sources of information and support and perceptions of how others view their decision. Members of two Australian parenting support forums completed an anonymous online survey. Of the 249 respondents, 51% were gay men, 43% heterosexual women and 7% heterosexual men. Most heterosexual respondents had tried to conceive spontaneously and with assisted reproductive technology before considering surrogacy. Most respondents felt supported in their decision to try extraterritorial surrogacy by close family and friends. Surrogacy-related information was mostly sourced online and from other parents through surrogacy. Few sought information from a local general practitioner or IVF clinic and those who did reported IVF clinic staff were significantly (P < 0.001) more likely than other groups to communicate negative reactions to their decision to seek surrogacy. The apparent negative attitudes to cross-border surrogacy among health professionals warrants further research into health professionals' knowledge, beliefs and attitudes relating to surrogacy.
Publisher: Wiley
Date: 12-2008
Publisher: Elsevier BV
Date: 11-2011
DOI: 10.1016/J.FERTNSTERT.2011.08.037
Abstract: To evaluate whether older first-time mothers (≥37 years) have higher rates of postpartum depression compared with younger first-time mothers, controlling for mode of conception and known risk factors for postpartum depression. Prospective cohort study. Assisted reproductive technology (ART) clinics in two large Australian cities and public and private antenatal clinics and/or classes in the vicinity of ART clinics. Nulliparous women who had conceived spontaneously (n = 295) or through ART (n = 297) in three age-groups: younger, 20 to 30 years (n = 173) middle, 31 to 36 years (n = 214) and older, ≥37 years (n = 189). Semistructured interviews and questionnaires. Major depressive disorder in the first 4 months after birth as assessed by structured diagnostic interview. The study performed 592 complete pregnancy assessments and 541 postpartum assessments. The prevalence of major depressive disorder was 7.9%, at the lower end of community rates. Neither maternal age-group nor mode of conception was statistically significantly related to depression. Older first-time mothers, whether conceiving through ART or spontaneously, do not show increased vulnerability to postnatal depression.
Publisher: Oxford University Press (OUP)
Date: 08-1987
DOI: 10.1093/OXFORDJOURNALS.HUMREP.A136575
Abstract: Follicle puncture under the guidance of ultrasound has now been used for some years. The most important advantage of the ultrasound-guided technique compared with the laparoscopic technique is that the former can be performed under local anaesthesia. However, both the trans-vesical and the perurethral ultrasound-guided puncturing routes may be quite painful for the patient. For that reason we have developed a trans-vaginal follicle puncture technique using a vaginal transducer. The aim of this study was to evaluate the patients' experience of pain with this new technique. Scanning of follicles was performed using a specially designed vaginal transducer that makes the patients having a full bladder unnecessary. Local anaesthesia was applied as a paracervical block. Follicles were then punctured through the vagina with a needle inserted through a needle guide attached to the transducer. Fifty-one patients answered a questionnaire about their experience of the puncture procedure. Only 10% of the patients found the puncture painful. Ninety-eight per cent of the patients felt no anxiety about going through the procedure again. We therefore conclude that trans-vaginal oocyte pick-up using a vaginal transducer is very well accepted by most women.
Publisher: BMJ
Date: 07-2021
DOI: 10.1136/BMJOPEN-2020-046927
Abstract: The anti-Mullerian hormone (AMH) test has been promoted as a way to inform women about their future fertility. However, data consistently show the test is a poor predictor of natural fertility potential for an in idual woman. As fertility centre websites are often a primary source of information for reproductive information, it is essential the information provided is accurate and reflects the available evidence. We aimed to systematically record and categorise information about the AMH test found on Australian and New Zealand fertility clinic websites. Content analysis of online written information about the AMH test on fertility clinic websites. Accredited Australian and New Zealand fertility clinic websites. Data were extracted between April and June 2020. Any webpage that mentioned the AMH test, including blogs specifically about the AMH test posted since 2015, was analysed and the content categorised. Of the 39 active accredited fertility clinics’ websites, 25 included information about the AMH test. The amount of information varied widely, and embodied four overarching categories (1) the utility of the AMH test, (2) who the test is suitable for, (3) possible actions in response to the test and (4) caveats and limitations of the test. Eight specific statements about the utility of the test were identified, many of which are not evidence-based. While some websites were transparent regarding the test’s limitations, others mentioned no caveats or included persuasive statements actively promoting the test as empowering for a range of women in different circumstances. Several websites had statements about the utility of the AMH test that are not supported by the evidence. This highlights the need for higher standards for information provided on fertility clinic websites to prevent women being misled to believe the test can reliably predict their fertility.
Publisher: Informa UK Limited
Date: 22-03-2022
DOI: 10.1080/14647273.2022.2042860
Abstract: Numerous studies have investigated the physical health and development of children and adolescents conceived with assisted reproductive technology (ART). Less is known about the quality of life of ART-conceived adults. This study explores the contributions of being conceived with ART and psychosocial cofactors present in young adulthood to the quality of life of adults aged 22-35 years. Young adults conceived through ART or natural conception (NC) completed questionnaires which included a standardized measure of quality of life (World Health Organization Quality of Life - Brief assessment (WHOQoL-BREF)) when aged 18-28 years (T1) and again when aged 22-35 years (T2). The WHOQoL-BREF has four domains: (i) Physical, (ii) Psychological, (iii) Social relationships and (iv) Environment. A total of 193 ART-conceived and 86 NC in iduals completed both questionnaires. When accounting for other cofactors in multivariable analyses, being ART-conceived was strongly associated with higher scores (better quality of life) on the Social relationships, and Environment WHOQoL-BREF domains at T2. In addition, less psychological distress, a better relationship with parents, a better financial situation, and perceptions of being about the right weight at T1 were associated with higher scores on one or more of the WHOQoL-BREF domains at T2. In conclusion, being ART-conceived can confer advantages in quality of life in adulthood, independent of psychosocial cofactors.
Publisher: Wiley
Date: 05-1987
Abstract: Sonography has proved to be an important diagnostic and operative instrument in an in-vitro fertilization and embryo transfer (IVF/ET) program. In some IVF/ET programs the technique has even replaced laparoscopy for oocyte retrieval. To date, transvesical follicle aspiration has been the main technique for ultrasound-guided oocyte pick-up. However, this technique has some disadvantages. Therefore, we have developed a transvaginal ultrasound-guided puncturing technique. A new high-frequency vaginal sector transducer was utilized (Brüel & Kjaer). This new transducer, equipped with a needle guide, changed the oocyte retrieval into a simple, safe, and rapid procedure that can be performed under local anesthesia without any discomfort for the patient.
Publisher: Wiley
Date: 24-08-2021
Abstract: The aim of this study was to gauge the opinions of people in Australia about policies to help them recover from the consequences of COVID‐19 pandemic and its associated restrictions. An anonymous online survey of people aged 18 years and older in Australia was available from 1 July to 31 August 2020. It included 16 proposed policies which respondents rated as ‘Not at all helpful’, ‘Somewhat helpful’, or ‘Very helpful’ in assisting them recover from the COVID‐19 restrictions. In all, 9220 people completed the survey. The most endorsed policy was ‘To have a publicly available plan about management of future pandemics’ which was rated as ‘very helpful’ by 46.1% of respondents. Four other policies were rated as ‘very helpful’ by more than 30% of respondents: two related to mental health support, one to in idual financial support for living expenses, and one to support for community organisations. Government preparedness for future pandemics and support for mental health, in idual finance, and community organisations should be policy priorities in the post‐COVID‐19 recovery phase. The findings can guide policy development to support people in Australia as they recover from COVID‐19 and the restrictions that have been imposed to control its spread.
Publisher: Elsevier BV
Date: 04-2019
DOI: 10.1016/J.MATURITAS.2019.01.011
Abstract: To describe the mental and physical self-reported health of community-based women in Australia aged 50 years and over, and ascertain factors associated with better physical and emotional health. A national, anonymous, online survey of women aged 18 years and above living in Australia. Factors associated with better physical and mental health among women aged ≥50 years. Of the 10,620 women who completed the survey, 4947 (46.6%) were aged 50 years or over. More than half (60.1%) reported being in "excellent" or "very good" overall health. While almost 40% had been diagnosed with depression or anxiety by a medical doctor or a psychologist at some time in their life, almost all (89.4%) had low levels of current anxiety. Factors significantly associated with good overall health were being in paid employment, partnered, "about the right weight", and doing at least 2.5 h of physical activity per week. Better lifelong (never been diagnosed with depression or anxiety) and current mental health were both associated with older age, being in paid employment, being partnered, being in good overall health, doing at least 2.5 h of physical activity per week, and using less health care (<5 visits to the doctor in the previous year). The findings that regular exercise and workforce participation were associated with better physical and mental health in this growing population can inform future targeted interventions to increase physical activity levels and support the retention of older women in the workforce.
Publisher: Wiley
Date: 09-01-2014
DOI: 10.1111/SCS.12110
Abstract: Social support is essential for physical and mental health and well-being. Evidence indicates that social and peer support is particularly important and beneficial for the well-being of those who care for children with chronic illness or disability in improving personal well-being and influencing parent-child play opportunities and child behaviour and development positively. MyTime is a government-funded Australia-wide facilitated peer support group program for carers of children with special needs. The aim was to investigate the barriers and promoters of participation in this peer support group program. A qualitative approach was adopted where semi-structured telephone interviews were conducted with 20 group members, four group facilitators and three play helpers. Interviews were recorded and transcribed. Inductive thematic analysis of the transcripts was conducted. Most group members described gaining significant social support from group participation. Good group facilitation, the availability of play helpers, access to disability-related information and expertise, and the mutual exchange of support between members emerged as the most important promoters of group participation. Barriers included insufficient funding to run the program throughout the year, too much ersity in group members' socio-economic position and severity of their children's disability. The facilitated peer support group program described in this paper appears to confer significant benefits to carers of children with disabilities and may be a model for other nations to consider in their strategies to improve services for carers of children with special needs.
Publisher: Oxford University Press (OUP)
Date: 25-03-2011
Abstract: It is increasingly common for women in high-income countries to delay childbearing. We aimed to describe the context of pregnancy for first-time mothers of different ages and examine relationships among maternal age at first birth, mode of conception and psychosocial wellbeing in pregnancy. Using stratified s ling, we recruited similar numbers of women conceiving through assisted reproductive technology (ART n = 297) or spontaneously (n = 295) across three age groups: younger, ≤ 20-30 years middle, 31-36 years older, ≥ 37 years. Women participated in a structured interview and completed validated questionnaires assessing socio-economic status, personality, quality of partner relationship, state and trait anxiety, pregnancy-focused (P-F) anxiety and maternal-fetal attachment. Older maternal age was associated with lower depression and anxiety symptoms, lower maternal-fetal attachment (P< 0.05), greater psychological hardiness (resilience) (P< 0.001) and lower ratings of control in the partner relationship (P< 0.05) at a univariate level. ART conception, but not older maternal age, was associated with more P-F anxiety. Although most main effects of age and mode of conception became non-significant after controlling for contextual/reproductive history variables, a significant association between ART conception and more intense fetal attachment emerged (P< 0.05). Women having their first baby when older appear to have some psychological advantages over their younger counterparts they are more resilient, report their partners as less controlling and report lower symptoms of depression and anxiety during pregnancy. However, women conceiving through ART have a more complex experience of pregnancy, simultaneously experiencing more P-F anxiety and more intense emotional attachment to the fetus.
Publisher: Wiley
Date: 15-12-2010
DOI: 10.1111/J.1651-2227.2010.02095.X
Abstract: The aims were to investigate the prevalence of breastfeeding after conception with assisted reproductive technology (ART) and identify risk factors for breastfeeding duration <6 weeks and cessation of breastfeeding before the baby is 8 months old. A consecutive cohort of women who had conceived at one of two ART centres in Melbourne, Australia, was recruited in early pregnancy. The women completed telephone interviews and postal questionnaires in pregnancy and 3, 8 and 18 months after the birth. Of 239 eligible women, 183 (77%) agreed to take part. Participants were more likely than the general population of childbearing Australian women to initiate breastfeeding (89% vs 83.3%, p=0.05) but by 3 months, a smaller proportion was breastfeeding exclusively (46% vs 57.3%, p=0.004). The proportions not providing any breast milk at 6 weeks and 8 months were 23% and 57%, respectively. More anxiety in late pregnancy and sub-optimal breastfeeding advice predicted breastfeeding duration <6 weeks and breastfeeding cessation before 8 months. The predictors of less favourable breastfeeding outcomes after ART identified may be modifiable. Antenatal strategies to reduce anxiety in pregnancy and postnatal strategies to ensure consistent breastfeeding advice may improve breastfeeding outcomes among women who give birth after ART.
Publisher: Oxford University Press (OUP)
Date: 27-01-2020
Abstract: Community participation in all aspects of health research is widely advocated. However, there is a lack of specificity in reporting what community members actually do, and reported participation is typically limited to discrete research activities. Greater specificity in reporting has potential to clarify how community participation might occur and how it might influence empowerment and research rigour. We conducted an ethnographic study of participatory health research (PHR) in a socio-economically marginalized rural Swazi community. Data about 10 community co-researchers’ participation in research workshops and field work were collected through participant observation over 14 months and analysed using directed content analysis, informed by the Comprehensive Community Participation in Research Framework (CCPRF). The analysis demonstrated that facilitating extensive community participation in PHR is feasible and identified 10 new research process activities in which community members might participate, for inclusion in an expanded CCPRF. We provide ex les of how community members might participate in 57/59 expanded CCPRF activities and show that participatory, dialogue-based activities can be effective tools for facilitating research participation in ways that empower in idual co-researchers and enhance research rigour. However, our results highlight limitations of community participation related to utilizing research results to inform actions, and empowering communities to control their environments and improve their health.
Publisher: Oxford University Press (OUP)
Date: 04-05-2021
Abstract: What is the prevalence and pattern of IVF add-on use in Australia? Among women having IVF in the last 3 years, 82% had used one or more IVF add-on, most commonly acupuncture, preimplantation genetic testing for aneuploidy and Chinese herbal medicine. IVF add-ons are procedures, techniques or medicines which may be considered nonessential to IVF, but usually used in attempts to improve the probability of conception and live birth. The use of IVF add-ons is believed to be widespread however, there is little information about the prevalence and patterns of use in different settings. An online survey was distributed via social media to women in Australia who had undergone IVF since 2017. Women were excluded if they were gestational surrogates, used a surrogate, or underwent ovarian stimulation for oocyte donation or elective oocyte cryopreservation only. The survey was open from 21 June to 14 July 2020. Survey questions included demographics, IVF and medical history, and use of IVF add-ons including details of the type of add-on, costs and information sources used. Participants were also asked about the relative importance of evidence regarding safety and effectiveness, factors considered in decision-making and decision regret. A total of 1590 eligible responses were analysed. Overall, 82% of women had used one or more add-ons and these usually incurred an additional cost (72%). Around half (54%) had learned about add-ons from their fertility specialist, and most reported that the decision to use add-ons was equally shared with the specialist. Women placed a high level of importance on scientific evidence for safety and efficacy, and half (49%) assumed that add-ons were known to be safe. Most women experienced some regret at the decision to use IVF add-ons (66%), and this was more severe among women whose IVF was unsuccessful (83%) and who believed that the specialist had a larger contribution to the decision to use add-ons (75%). This retrospective survey relied on patient recall. Some aspects were particularly prone to bias such as contributions to decision-making. This approach to capturing IVF add-on use may yield different results to data collected directly from IVF clinics or from fertility specialists. There is a very high prevalence of IVF add-on use in Australia which may be generalisable to other settings with similar models of IVF provision. Although women placed high importance on scientific evidence to support add-ons, most add-ons do not have robust evidence of safety and effectiveness. This suggests that IVF patients are not adequately informed about the risks and benefits of IVF add-ons, or are not aware of the paucity of evidence to support their use. This research was supported by a McKenzie Postdoctoral Fellowship Grant (University of Melbourne), a Department of Obstetrics and Gynaecology Innovation Grant (University of Melbourne) and an NHMRC Investigator Grant (APP1195189). A.P. declares that he provides fertility services at Melbourne IVF (part of Virtus Health). J.W. reports grants from Wellcome Trust, during the conduct of the study, and that publishing benefits his career. The remaining authors report no conflict of interest. N/A
Publisher: Oxford University Press (OUP)
Date: 18-02-2014
Publisher: Oxford University Press (OUP)
Date: 13-06-2023
Abstract: What is the anti-Mullerian hormone (AMH) test usage, awareness, and perceived reasons for testing in a representative community s le of women in Australia? : Among women aged 18–55 years, 13% had heard about AMH testing and 7% had had an AMH test, with the top three reasons for testing including due to infertility investigations (51%), considering pregnancy and wanting to understand their chances (19%) or to find out if a medical condition had affected fertility (11%). The growing availability of direct-to-consumer AMH testing has raised concerns about overuse, however as most AMH tests are paid for privately by consumers, data on test usage is not publicly available. National cross-sectional survey of 1773 women, conducted in January 2022. Females aged 18–55 years were recruited from the representative ‘Life in Australia’ probability-based population panel and completed the survey online or by telephone. Main outcome measures included if and how participants had heard about AMH testing, whether they had ever had an AMH test, main reason for testing and test access. Of the 2423 women who were invited 1773 responded (73% response rate). Of these, 229 (13%) had heard about AMH testing and 124 (7%) had had an AMH test. Testing rates were highest among those currently aged 35–39 years (14%) and associated with educational attainment. Almost all accessed the test through their general practitioner or fertility specialist. Reasons for testing were: part of an infertility investigation (51%), considering pregnancy and wanting to understand chances of conceiving (19%), finding out if a medical condition had affected fertility (11%), curiosity (9%), considering egg freezing (5%), and considering delaying pregnancy (2%). Although the s le was large and mostly representative, it was over-represented by people holding a university degree and under-represented by people aged 18–24, however, we used weighted data where possible to account for this. All data were self-reported so there is a risk of recall bias. The number of survey items was also restricted, so the type of counselling women received prior to testing, reasons for declining an AMH test or test timing were not measured. Whilst most women reported having an AMH test for appropriate reasons, about one third had it for reasons not supported by evidence. Public and clinician education about the lack of utility of AMH testing for women not undergoing infertility treatment is needed. This project was supported by a National Health and Medical Research Council (NHMRC) Centre for Research Excellence grant (1104136) and Program grant (1113532). T.C. is supported by an NHMRC Emerging Leader Research Fellowship (2009419). B.W.M. reports research funding, consultancy and travel support from Merck. D.L. is the Medical Director of City Fertility NSW and reports consultancy for Organon, Ferring, Besins and Merck. The authors have no other competing interests. N/A.
Publisher: Oxford University Press (OUP)
Date: 18-04-2008
Abstract: The proportion of women who give birth after assisted reproduction technology (ART) treatment is increasing. To date, little is known about their experience of childbirth. One of the aims of this study was to investigate the experience of childbirth and the post-natal healthcare after ART. A prospective, longitudinal study of a systematically recruited consecutive cohort of women who had conceived with ART in Melbourne, Australia, in 2001 was investigated using telephone interviews and self-report questionnaires. The experience of birth was explored 3 months post-partum. One hundred and sixty-six women who had conceived through ART participated. Compared with other Australian women, participants were more likely to have a Caesarean birth (51% versus 25%, P < 0.0001). Women who had a Caesarean birth were less likely to report having had an active say about the management of the birth (P < 0.01) and to have held their baby at birth (P < 0.0001) and more likely to report disappointment with the birth event (P < 0.0001), severe post-natal pain (P = 0.02) and needing a lot of help or advice with infant feeding (P = 0.001) than those who had a vaginal birth. After ART, there are highly elevated rates of operative birth which appear to influence early post-natal adjustment.
Publisher: Springer Science and Business Media LLC
Date: 28-10-2008
Publisher: Springer International Publishing
Date: 2017
Publisher: Oxford University Press (OUP)
Date: 10-03-2017
Abstract: The increasingly common practice in high-income countries to delay childbearing to the fourth and fifth decades of life increases the risk of involuntary childlessness or having fewer children than desired. Older age also increases the risk of age-related infertility, the need for ART to conceive, and obstetric and neonatal complications. Existing research relating to childbearing focusses almost exclusively on women, and in public discourse declining fertility rates are often assumed to be the result of women delaying childbearing to pursue other life goals such as a career and travel. However, evidence suggests that the lack of a partner or a partner willing to commit to parenthood is the main reason for later childbearing. To better understand men's contributions to childbearing decisions and outcomes, the literature pertaining to men's fertility-related knowledge, attitudes and behaviours was reviewed. The electronic databases of Medline, Embase and PsycINFO were searched to identify investigations of men's knowledge, attitudes and behaviours relating to fertility, infertility, reproductive health or childbearing using relevant fertility keyword search terms. Studies were included if they had investigated factors associated with men's fertility-related knowledge, attitudes and behaviours, had been conducted in a high-income country and were published in an English language peer-reviewed journal between January 2005 and August 2016. The search yielded 1349 citations. Of these, 47 papers representing 43 unique studies were included in the review. Where response rate was reported, it ranged between 13 and 94%. Studies varied in terms of research design inclusion and exclusion criteria recruitment strategies adequacy of s le size recruitment and retention rates and data collection tools. However, findings were consistent and indicate that men almost universally value parenthood, want and expect to become fathers, and aspire to have at least two children. Yet most men have inadequate knowledge about the limitations of female and male fertility and overestimate the chance of spontaneous and assisted conception. Perceptions of ideal circumstances in which to have children included being in a stable and loving relationship, having completed studies, secured a permanent job and a dependable income, having achieved personal maturity, and having a partner who desires children and is 'suitable' as a potential co-parent. Although all studies were conducted in high-income countries, between-country social and cultural differences may have influenced the findings relating to attitudes. Men aspire to parenthood as much as women do but have limited knowledge about the factors that influence fertility. The gap between ideal biological and ideal social age for having children appears to be widening, narrowing the time frame in which parenthood can be achieved. This may lead to unfulfilled parenthood aspirations. The findings can inform government policies and public education strategies aimed to support childbearing during the most fertile years, reduce the personal and societal cost of infertility and ART use, and allow people to fulfil their parenthood goals.
Publisher: Elsevier BV
Date: 07-2006
DOI: 10.1016/J.FERTNSTERT.2005.11.071
Abstract: To investigate the decisions that couples make regarding supernumerary frozen embryos, the factors influencing these decisions, and the degree of difficulty involved in reaching a decision and to canvass attitudes toward donating embryos to stem-cell research. Anonymous postal survey. A large, private IVF clinic in a major city in Victoria, Australia. A consecutive cohort of couples who contacted the Monash IVF clinic in relation to embryos in long-term storage. Subjects completed a survey regarding decisions about surplus frozen embryos. Couples' decision regarding supernumerary embryos and reasons for the decision, experience of deciding, and attitudes about embryo donation for stem-cell research. Forty percent (123/311) returned completed questionnaires. The most common decision was donation to research (42%). Altruistic motives and desire not to waste embryos were determinants of embryo donation. Determinants of disposal were not wanting a full sibling to existing children and opposition of embryo research. Forty-five percent found deciding distressing. The majority (69%) approved of embryo donation to stem-cell research. Most couples preferred embryos to come to some use rather than being disposed of. Almost half the s le reported finding the decision making distressing. A majority approved of embryo donation for stem-cell research.
Publisher: Elsevier BV
Date: 06-2012
DOI: 10.1016/J.FERTNSTERT.2012.02.050
Abstract: To describe rate of and risks for residential early parenting service (REPS) admissions in women with infants conceived with assisted reproductive technology (ART). A prospective study of women who conceived with ART. Self-report telephone interview and questionnaire data were collected in two pregnancy and three postpartum waves. Melbourne IVF and Royal Women's Hospital Reproductive Services, Victoria, Australia. A consecutive cohort of women with ART pregnancies. None. REPS admission up to 18 months postpartum. Of 239 eligible women. 183 (77%) were recruited, six experienced pregnancy loss, and 153/177 (86%) were retained. In total, 17% (26/153) of participants were admitted to a REPS, 3.37 times more than the population admission rate of 5.05%. Admission risk was increased by primiparity, inadequate breastfeeding advice, low caregiving confidence when discharged from maternity hospital, lower early postpartum mood, unsettled infant behavior, and insufficient help from others. Compared with spontaneous conception, women who conceived with ART are at elevated risk of early parenting difficulties. Early interventions to address breastfeeding difficulties, management of unsettled infant behavior, social isolation, and postpartum anxiety are indicated.
Publisher: Elsevier BV
Date: 02-2013
DOI: 10.1016/J.RBMO.2012.11.009
Abstract: It is often presumed that infertility is not a problem in resource-poor areas where fertility rates are high. This is challenged by consistent evidence that the consequences of childlessness are very severe in low-income countries, particularly for women. In these settings, childless women are frequently stigmatized, isolated, ostracized, disinherited and neglected by the family and local community. This may result in physical and psychological abuse, polygamy and even suicide. Attitudes among people in high-income countries towards provision of infertility care in low-income countries have mostly been either dismissive or indifferent as it is argued that scarce healthcare resources should be directed towards reducing fertility and restricting population growth. However, recognition of the plight of infertile couples in low-income settings is growing. One of the United Nation's Millennium Development Goals was for universal access to reproductive health care by 2015, and WHO has recommended that infertility be considered a global health problem and stated the need for adaptation of assisted reproductive technology in low-resource countries. This paper challenges the construct that infertility is not a serious problem in resource-constrained settings and argues that there is a need for infertility care, including affordable assisted reproduction treatment, in these settings. It is often presumed that infertility is not a problem in densely populated, resource-poor areas where fertility rates are high. This presumption is challenged by consistent evidence that the consequences of childlessness are very severe in low-income countries, particularly for women. In these settings, childless women are frequently stigmatized, isolated, ostracized, disinherited and neglected by the family and local community. This may result in physical and psychological abuse, polygamy and even suicide. Because many families in low-income countries depend on children for economic survival, childlessness and having fewer children than the number identified as appropriate are social and public health matters, not only medical problems. Attitudes among people in high-income countries towards provision of infertility care in low-income countries have mostly been either dismissive or indifferent as it is argued that scarce healthcare resources and family planning activities should be directed towards reducing fertility and restricting population growth. However, recognition of the plight of infertile couples in low-income settings is growing. One of the United Nation's Millennium Development Goals was for universal access to reproductive health care by 2015, and WHO has recommended that infertility be considered a global health problem and stated the need for adaptation of assisted reproduction technology in low-resource countries. In this paper, we challenge the construct that infertility is not a serious problem in resource-constrained settings and argue that there is a need for infertility care, including affordable assisted reproduction treatment, in these settings.
Publisher: Oxford University Press (OUP)
Date: 2018
Publisher: AMPCo
Date: 15-08-2014
DOI: 10.5694/MJA13.11311
Abstract: To investigate the characteristics of parents and intended parents and their current and planned behaviour in relation to surrogacy arrangements. Members of two Australian parenting support forums who were considering surrogacy or were currently or previously in a surrogacy arrangement were invited to complete an online survey during July 2013. Sociodemographic characteristics proportions engaging in domestic uncompensated and overseas compensated arrangements countries used costs incurred and impact on behaviour of state laws criminalising compensated surrogacy. Of 1135 potential participants, 312 (27%) commenced the survey. Of these, 24 did not fulfil inclusion criteria and 29 did not complete the survey. Eighty-nine respondents were considering surrogacy and 170 had commenced or completed surrogacy. Many respondents (53%) considered both overseas and domestic surrogacy. Among those who only considered one option, overseas surrogacy was considered significantly more often than domestic surrogacy (92% v 8% P < 0.05). Only 22 respondents (8%) commenced with a surrogate in Australia. The most common countries used for compensated surrogacy were India and the United States, and average total estimated costs were $69 212 for India and $172 347 for the US. Barriers discouraging domestic surrogacy included concern that the surrogate might keep the child (75%), belief that it was too long and complicated a process (68%) and having no one of the right age or life stage to ask (61%). Few intended parents (9%) were deterred by state laws criminalising compensated surrogacy. Most Australian intended parents via surrogacy consider or use overseas compensated arrangements. Laws banning compensated surrogacy do not appear to deter those seeking surrogacy arrangements.
Publisher: Oxford University Press (OUP)
Date: 2018
Publisher: Elsevier BV
Date: 08-2005
DOI: 10.1016/J.FERTNSTERT.2005.02.016
Abstract: To investigate whether assisted conception is associated with an increased risk of admission to a residential early parenting program for treatment of maternal mood disorder or infant feeding or sleeping disorders in the postpartum year. Systematic audit of consecutive medical records. Masada Private Hospital Mother Baby Unit (MPHMBU), Melbourne, Australia. Medical records of all mother-infant dyads admitted to MPHMBU between July 2000 and August 2002. None. Modes of conception and delivery of index infant, maternal and infant age on admission, multiplicity of birth, infant birth weight, and Edinburgh Postnatal Depression Scale scores. A total of 745 records were audited, and mode of conception was recorded in 526 (70.6%) of records. Overall 6% (45/745) of the admitted infants had been conceived through assisted reproductive technologies compared with 1.52% in the general population (relative risk 4.0 95% confidence interval, 3.0-5.4). Mothers who had conceived with assisted reproductive technologies were older and more likely to have had cesarean and multiple births than those who conceived spontaneously. Assisted conception appears to be associated with a significantly increased rate of early parenting difficulties. Women who experience assisted conception may require additional support before and after their babies are born.
Location: Australia
Start Date: 12-2020
End Date: 12-2024
Amount: $572,812.00
Funder: Australian Research Council
View Funded Activity