M. Al-Memar

Investigating psychosocial attitudes, motivations and experiences of oocyte donors, recipients and egg sharers: a systematic review

INTRODUCTION The donation of oocytes has been made feasible as a result of in vitro fertilization (IVF). This treatment offers an answer for infertile women with ovarian conditions, such as primary ovarian insufficiency. Demand for oocyte donors has been on the rise globally, with infertile couples, as well as gay men, increasingly using it as a means to found their families. With an acute shortage of oocyte donors globally, the psychosocial aspects behind oocyte donation are important for fertility clinics to understand. This paper aims primarily to provide an up-to-date systematic review of the psychosocial aspects of oocyte donation from the point of view of oocyte donors and recipients and egg sharers. Its secondary aims are to explore the motives and experiences of donors as well as attitudes towards donor anonymity and disclosure. An emphasis has been placed on the analysis of donors in the UK. No review has analysed together the aforementioned donor groups along with recipient group. METHODS A systematic search of English peer-reviewed journals of four computerized databases was undertaken, with no time restriction set for publications. RESULTS There were 62 studies which met the inclusion criteria and were included in the systematic review. Attitudes towards donation were positive from both a donor oocyte and recipient point of view, with medical procedures being well tolerated and excellent post-donation satisfaction among all donor groups. There were distinct differences between the different donor groups and recipients in motivation for oocyte donation and decisions for disclosure. Attitudes towards anonymity issues were reassuring with a significant proportion of donors of all types willing to donate as identifiable donors. However, there were methodological limitations identified in the studies reviewed. CONCLUSION This review successfully explored the important psychosocial aspects of oocyte donation. In general terms the attitudes and feeling of patients involved from all sides of the donation process were extremely positive. A number of key and consistent issues emerged which demonstrated differences and similarities between the different donor groups, as well as a greater understanding of the recipient. With regard to psychosocial well-being, the results were reassuring throughout all donor groups, especially the egg share donors. Although it seems the 2005 legislative changes in the UK have not caused the anticipated dramatic decrease in gamete donation, oocyte donation still falls far short of demand. The UK has an increasing population of patients from different ethnic backgrounds and same sex relationships seeking oocyte donation, with very few studies including these groups of patients. An increased number of well-designed studies looking into the psychological issues surrounding gamete donation of different patient groups, could allow more directed assessment and counselling of oocyte donors and recipients, with a resulting increase in donor recruitment.

Evaluating the risk of ovarian cancer before surgery using the ADNEX model: a multicentre external validation study.

Background:The International Ovarian Tumour Analysis (IOTA) group have developed the ADNEX (The Assessment of Different NEoplasias in the adneXa) model to predict the risk that an ovarian mass is benign, borderline, stage I, stages II–IV or metastatic. We aimed to externally validate the ADNEX model in the hands of examiners with varied training and experience.Methods:This was a multicentre cross-sectional cohort study for diagnostic accuracy. Patients were recruited from three cancer centres in Europe. Patients who underwent transvaginal ultrasonography and had a histological diagnosis of surgically removed tissue were included. The diagnostic performance of the ADNEX model with and without the use of CA125 as a predictor was calculated.Results:Data from 610 women were analysed. The overall prevalence of malignancy was 30%. The area under the receiver operator curve (AUC) for the ADNEX diagnostic performance to differentiate between benign and malignant masses was 0.937 (95% CI: 0.915–0.954) when CA125 was included, and 0.925 (95% CI: 0.902–0.943) when CA125 was excluded. The calibration plots suggest good correspondence between the total predicted risk of malignancy and the observed proportion of malignancies. The model showed good discrimination between the different subtypes.Conclusions:The performance of the ADNEX model retains its performance on external validation in the hands of ultrasound examiners with varied training and experience.

Managing pregnancy of unknown location based on initial serum progesterone and serial serum hCG levels: development and validation of a two‐step triage protocol

A uniform rationalized management protocol for pregnancies of unknown location (PUL) is lacking. We developed a two‐step triage protocol to select PUL at high risk of ectopic pregnancy (EP), based on serum progesterone level at presentation (step 1) and the serum human chorionic gonadotropin (hCG) ratio, defined as the ratio of hCG at 48 h to hCG at presentation (step 2).

Psychological Issues Associated With Absolute Uterine Factor Infertility and Attitudes of Patients Toward Uterine Transplantation

Context: Uterine transplantation (UTx). Objective: To explore patients’ knowledge of and attitudes toward UTx before and after a short educational intervention via a video and question and answer (Q&A) session. Design: Large, in-depth survey investigating patients’ motivations, aims, and beliefs on UTx. Setting: Imperial College London. Participants: Women diagnosed with absolute uterine factor infertility (AUFI) who were seeking information on UTx and had already volunteered to participate in the study. Intervention: A semistructured interview involving a brief baseline questionnaire before a Q&A session and a 20-minute video exploring the main risks and benefits for UTx. Main outcome measures: Attitudes of self-referred patients with AUFI toward UTx before and after education focusing on UTx. Rank order of importance of key UTx-related issues. Results: Forty women were interviewed. Following the video presentation and Q&A session, 97.5% (n = 39) would undergo UTx ahead of surrogacy and adoption in full knowledge that the latter 2 options would be ultimately safer for their own well-being and the fact that the graft could fail even prior to conception. All felt that UTx should take place, and 92.5% saw UTx as achievable. Conclusion: The study demonstrates a keen interest in UTx, partly because other options seem difficult to access. It is worth noting that people appear to be distancing themselves from the risk. This requires careful assessment in any clinical program. This study is the first to demonstrate a qualitative relationship between patients with AUFI and their curiosity and desire for UTx. It paves the way for forming the introduction into the psychological assessment of a potential patient.

Can risk factors, clinical history and symptoms be used to predict risk of ectopic pregnancy in women attending an early pregnancy assessment unit?

To examine whether risk factors and symptoms may be used to predict the likelihood of ectopic pregnancy (EP) in women attending early pregnancy assessment units in the UK.

Factors to consider in pregnancy of unknown location

The management of women with a pregnancy of unknown location (PUL) can vary significantly and often lacks a clear evidence base. Intensive follow-up is usually required for women with a final outcome of an ectopic pregnancy. This, however, only accounts for a small proportion of women with a pregnancy of unknown PUL location. There remains a clear clinical need to rationalize the follow-up of PUL so women at high risk of having a final outcome of an ectopic pregnancy are followed up more intensively and those PUL at low risk of having an ectopic pregnancy have their follow-up streamlined. This review covers the main management strategies published in the current literature and aims to give clinicians an overview of the most up-to-date evidence that they can take away into their everyday clinical practice when caring for women with a PUL.

OP11.02: Endometrial thickness and its value in triaging women with a pregnancy of unknown location

Objectives: In normal fetuses the CPR falls after 34 weeks’ gestation. However, the cerebroplacental ratio (CPR) is lower in fetuses suffering from fetal growth restriction, and therefore at risk of stillbirth. It is possible that the magnitude or rate of fall could be useful in identifying those fetuses at risk. The aim of this study was to investigate the longitudinal change in small for gestational age (SGA) fetuses that had stillbirth or perinatal death. Methods: A longitudinal study of singleton pregnancies undergoing ultrasound monitoring of fetal biometry and Dopplers. Major structural abnormalities, aneuploidy, genetic syndromes or missing outcomes were excluded. Analysis of repeated measures with multilevel mixed-effects linear model (fixed effects and random effects) was performed. Regression analysis was used to investigate and adjust for potential confounding variables. ROC curve analysis was used to investigate the predictive accuracy. Results: 6906 observations were recorded in 2481 pregnancies: 1546 AGA fetuses, 31 SGA fetuses that had perinatal death, and 903 SGA fetuses that survived. There was a quadratic increase of CPR with GA in the AGA fetuses (p<0.01). CPR values were significantly lower in the SGA compared to the AGA fetuses (p<0.01). Women whose pregnancies were complicated by perinatal death were more likely to be smokers, non-Caucasian, nulliparous and delivered at an earlier GA (p<0.001 for all), compared to those who survived. CPR was significantly associated with the risk of stillbirth and perinatal death (p<0.001 for both). CPR recorded at the initial assessment had AUC 0.77 (95%CI 0.74-0.79; sensitivity 80.7%, specificity 76.6%, PPV 10.5%, NPV 99.1%), while CPR at the last assessment had AUC 0.82 (95%CI 0.79-0.84; sensitivity 80.7%, specificity 81.8%, PPV 13.2%, NPV 99.2%). Conclusions: CPR is a predictor of stillbirth and perinatal death in SGA fetuses, both at the initial and last assessments.

OC19.02: Is the presence or absence of intracavity fluid associated with a final diagnosis of ectopic pregnancy in women with a pregnancy of unknown location?

evaluated with QF-PCR or SNP array. However, in these cases, cfDNA testing was able to give the result. Conclusions: Considering nonviable pregnancies, fetal cfDNA is present in the maternal plasma with fetal fraction more than 4% in 72 % of cases between 5 an 12 weeks and thus can be used in aneuploidy detection, especially in cases, where decidual samples cannot be assessed using QF-PCR or SNP array because of maternal contamination which occurs in 26% of cases.

OP16.06: The subjective assessment of viability of early intrauterine pregnancies on ultrasound: Short oral presentation abstracts

compared between the non-surgical group (n=78) and the surgical group (n=61). Thereafter, the non-surgical group was subdivided into the local injection group (n=16) and the systemic injection group (n=62) in order to compare with respect to the procedure-related and subsequent pregnancy outcomes. Results: Compared to the non-surgical group, the surgical group had a significantly higher mean extent of hemoglobin decrease after the procedure (1.29±0.09dL vs. 2.10±0.14dL; p=<0.01). The observed subsequent pregnancy was 20.5% (16/78) in the non-surgical group and 14.8% (9/61) in the surgical group. In the latter group, there were also 2 cases (3.2%) of uterine rupture during subsequent pregnancy. In comparison of non-surgical group, success rate was higher in local injection group (93.7% vs. 69.4%, p=0.046) and with less side effect compare to systemic injection group (0% vs. 25%, p=0.036), respectively. The observed subsequent pregnancy was 25.0% (4/16) in the local injection group and 19.4% (12/62) in the systemic injection group. Conclusions: The non-surgical management of interstitial pregnancy with local and systemic injection appears to be as effective as and even safer than the surgical management. Furthermore, our results suggest that local injection is superior to systemic injection in terms of success rate and side effects. Therefore, ultrasound-guided local injection may have advantages over systemic injection and surgical management as the first-line treatment in the population of young and nulliparous women who desire future fertility.

OC19.05: Evaluating cut-off values for progesterone, single hCG and hCG ratio to define pregnancy viability and location in women with a pregnancy of unknown location (PUL)

S. Bobdiwala1, E. Christodoulou2, C. Kyriacou1, J. Farren3, N. Mitchell-Jones4, F. Ayim5, B. Chohan6, O. Abughazza7, B. Guruwadahyarhalli8, M. Al-Memar1, S. Guha8, V. Vathanan6, C. Bottomley4, D. Gould3, C. Stalder1, D. Timmerman2,9, B. Van Calster2,10, T. Bourne1,2 1Tommy’s National Centre for Miscarriage Research, Queen Charlotte’s and Chelsea Hospital, Imperial College, London, United Kingdom; 2Department of Development and Regeneration, KU Leuven, Leuven, Belgium; 3St Mary’s Hospital, London, United Kingdom; 4Chelsea and Westminster NHS Trust, London, United Kingdom; 5Hillingdon Hospital, London, United Kingdom; 6Wexham Park Hospital, London, United Kingdom; 7Royal Surrey County Hospital, Guildford, United Kingdom; 8West Middlesex University Hospital, London, United Kingdom; 9University Hospital Leuven, Leuven, Belgium; 10Leiden University Medical Centre, Leiden, Netherlands