C. de Klerk

Why do couples drop-out from IVF treatment? A prospective cohort study

BACKGROUND Cumulative IVF pregnancy rates are compromised by the large number of couples who drop-out of treatment before achieving pregnancy. The aim of this study was to identify the role of the treatment strategy applied, and potential other factors that influence the decision of couples to discontinue treatment. METHODS The incidence of drop-out from IVF treatment and factors related to drop-out were studied in a cohort of IVF patients aged <38 years embarking on IVF treatment either with a mild or a standard treatment strategy for a planned maximum number of treatment cycles. RESULTS Of the 384 couples studied, 17% dropped out of IVF treatment. The physical or psychological burden of treatment was the most frequent cause of drop-out (28%). The application of a mild treatment strategy (mild ovarian stimulation along with the transfer of a single embryo) significantly reduced the chance of drop-out (hazard ratio (HR) 0.55; 95% confidence interval (CI), 0.31-0.96). When a mild IVF strategy was employed, the association between the baseline anxiety score and drop-out was reduced by >50%. The presence of severe male subfertility (HR 4.80; 95% CI, 1.63-14.13) and the failure to achieve embryo transfer (odds ratio 0.41; 95% CI, 0.24-0.72) were also related to drop-out. CONCLUSIONS Reducing drop-out rate is crucial to further improve the efficacy and cost-effectiveness of IVF treatment. An important factor determining the risk of drop-out is the burden of the treatment strategy. The application of a mild treatment strategy and managing patients expectations might reduce drop-out rates.

Psychological well-being and sexarche in women with polycystic ovary syndrome.

BACKGROUND The characteristics of polycystic ovary syndrome (PCOS) such as hyperandrogenism and anovulation can be highly stressful and might negatively affect psychological well-being and sexuality. The objective of this study was to evaluate the association between PCOS characteristics and psychological well-being as well as sexarche. METHODS Patients (n = 1148) underwent standardized clinical evaluation. Psychological well-being was investigated in 480 patients with the Rosenberg self-esteem scale (RSES), the body cathexis scale (BCS) and the fear of negative appearance evaluation scale (FNAES). Sexarche was also assessed. RESULTS Amenorrhoea was associated with lower self-esteem (P = 0.03), greater fear of negative appearance evaluation (P = 0.01) and earlier sexarche (P= 0.004). Hyperandrogenism and acne were associated with poorer body satisfaction (P = 0.03, 0.02, respectively). Hirsutism and BMI were negatively associated with all psychological variables (RSES, P = 0.01; BCS, P = 0.05; FNAES, P = 0.02 and RSES, P = 0.03; BCS, P = 0.001; FNAES, P = 0.03, respectively). CONCLUSIONS Our results suggest that menstrual irregularities might be related to sexarche. Moreover, this study stresses that the treatment of women with PCOS should notably focus on physical but also on psychological and sexual characteristics.

Bullying, abuse and family conflict as risk factors for chronic pain among Dutch adolescents

Psychosocial stress seems to serve as an important risk factor for the occurrence of pain. The present study aims to examine if early adversities, e.g. bullying, abuse and family conflict are risk factors for chronic pain in adolescents. The secondary aim of the present study was to describe the pain characteristics of chronic pain in adolescents in a community sample of Dutch adolescents.

Long-term follow-up of home-based behavioral management training provided by migraine patients

Background Behavioral migraine approaches are effective in reducing headache attacks. Availability of treatment might be increased by using migraine patients as trainers. Therefore, Mérelle and colleagues developed and evaluated a home-based behavioral management training (BMT) by lay trainers (1). The maintenance of effects at long-term follow-up is studied in the present study. Method Measurements were taken pre-BMT (T0), post-BMT (T1), at six-month follow-up (T2), and at long-term follow-up, i.e. two to four years after BMT (T3). Data of 127 participants were analyzed with longitudinal multi-level analyses. Results Short-term improvements in attack frequency and self-efficacy post-BMT were maintained at long-term follow-up (dT0–T3 = −.34 and dT0–T3 = .69, respectively). The level of internal control that increased during BMT decreased from post-BMT to long-term follow-up (dT0–T3 = .18). Quality of life and migraine-related disability improved gradually over time (dT0–T3 = .45 and dT0–T3 = −.26, respectively). Conclusions Although the results should be interpreted with caution because of the lack of a follow-up control group and the inability to gather information about additional treatments patients may have received during the follow-up period, the findings suggest that lay BMT for migraine may be beneficial over the long term. If so, this could make migraine treatments more widely available.

Signalering en doorverwijzing van adolescenten met chronische pijn door de jeugdgezondheidszorg: een pilotstudie

Chronische pijn komt veel voor bij adolescenten en kan grote invloed hebben op hun leven en dat van hun familie. Daarom is een signalerings- en doorverwijzingsinstrument (de Pijnbarometer) ontwikkeld voor gebruik tijdens het preventieve gezondheidsonderzoek. De resultaten van de pilotstudie laten zien dat 24% van de jongeren in de regio Rotterdam chronische pijn rapporteert. De komende jaren wordt de bruikbaarheid van de Pijnbarometer bij de jeugdgezondheidszorg (JGZ) verder onderzocht. In dit artikel wordt een beschrijving gegeven van het project ‘Verbetering van signalering en behandeling van chronische pijn bij adolescenten’ en in het bijzonder van het signalerings- en doorverwijzingsinstrument.