U. Van den Broeck

Reasons for dropout in infertility treatment.

Background: The objective of this study was to explore the reasons why couples discontinue fertility treatment. Methods: A retrospective exploratory study was performed at the Leuven University Fertility Centre, a university hospital-based fertility center. Women who discontinued treatment between September 2000 and December 2001 were contacted in 2004–2005 by telephone for a standardized interview which covered 9 dropout reasons. For each reason, its importance on the decision to stop treatment was measured on an 11-point Likert scale. Results: On average, psychological burden (x = 5.96) had the highest impact on the decision to stop treatment followed by physical burden (x = 4.48) and female age (x = 3.64). Perceived lack of staff expertise (x = 1.84), negative impact on social contacts (x = 2.12) and financial burden (x = 2.16) had the lowest impact on the decision to stop treatment. Longer duration of infertility was significantly positively correlated with a higher rating of physical burden as a reason to discontinue treatment (r = 0.48; p < 0.05). Discussion: On average, psychological burden appears to be most frequently named as the number one reason to discontinue infertility treatment, whereas financial burden had the lowest impact. Longer duration of infertility is associated with more externalizing reasons to discontinue treatment.

A systematic review of sperm donors: demographic characteristics, attitudes, motives and experiences of the process of sperm donation

BACKGROUND This systematic review aimed first to integrate the current body of knowledge on the demographic, institutional and psychosocial information on sperm donors, and second to provide insight into the actual experiences of men who donate and the attitudes towards potential donation. METHODS Electronic databases (PUBMED, CINAHL, PsycINFO, Embase and Web of Science) were searched with no date restriction using a specific search strategy followed by a snowball strategy. English language peer-reviewed abstracts and full texts were screened for eligibility and the risk of bias was assessed with 15 criteria. Eligibility, quality assessments and data extraction were performed by two independent researchers, resolving disagreement by discussion. RESULTS The initial search retrieved 857 studies and after quality assessment, 29 studies were retained for data extraction. Data from nine countries were obtained. The review synthesis revealed differences and similarities between actual and potential sperm donors on demographic characteristics, financial compensation and attitudes towards anonymity, disclosure and providing information to potential offspring. A number of methodological shortcomings have been identified in the studies investigating sperm donors. CONCLUSIONS Institutional factors (such as recruitment procedures, altruism versus compensation of sperm donors, anonymity versus open-identity donation) and the impact of changing legislation have largely dominated the studies on sperm donation. Furthermore, studies from countries with a bias towards white Western ideology and interpretation were over-represented. This has resulted in a profile of potential and actual sperm donors in terms of demographics, recruitment strategies, motivation for donation and attitudes regarding anonymity, disclosure, recipients and offspring. However, the psychosocial needs and experiences of the donor, and their follow-up and counselling are largely neglected. This review has identified key issues to inform current practice and the development of pathways of care for sperm donors that reflect the multidimensional nature of sperm donation.

Consensus on Recording Deep Endometriosis Surgery: the CORDES statement

STUDY QUESTION Which essential items should be recorded before, during and after endometriosis surgery and in clinical outcome based surgical trials in patients with deep endometriosis (DE)? SUMMARY ANSWER A DE surgical sheet (DESS) was developed for standardized reporting of the surgical treatment of DE and an international expert consensus proposal on relevant items that should be recorded in surgical outcome trials in women with DE. WHAT IS KNOWN ALREADY Surgery is an important treatment for symptomatic DE. So far, data have been reported in such a way that comparison of different surgical techniques is impossible. Therefore, we present an international expert proposal for standardized reporting of surgical treatment and surgical outcome trials in women with DE. STUDY DESIGN, SIZE, DURATION International expert consensus based on a systematic review of literature. PARTICIPANTS/MATERIALS, SETTING, METHODS Taking into account recommendations from Consolidated Standards of Reporting Trials (CONSORT), the Innovation Development Exploration Assessment and Long-term Study (IDEAL), the Initiative on Methods, Measurement and Pain Assessment in Clinical trials (IMMPACT) and the World Endometriosis Research Foundation Phenome and Biobanking Harmonisation Project (WERF EPHect), a systematic literature review on surgical treatment of DE was performed and resulted in a proposal for standardized reporting, adapted by contributions from eight members of the multidisciplinary Leuven University Hospitals Endometriosis Care Program, from 18 international experts and from audience feedback during three international meetings. MAIN RESULTS AND THE ROLE OF CHANCE We have developed the DESS to record in detail the surgical procedures for DE, and an international consensus on pre-, intra- and post-operative data that should be recorded in surgical outcome trials on DE. LIMITATIONS, REASONS FOR CAUTION The recommendations in this paper represent a consensus among international experts based on a systematic review of the literature. For several items and recommendations, high-quality RCTs were not available. Further research is needed to validate and evaluate the recommendations presented here. WIDER IMPLICATIONS OF THE FINDINGS This international expert consensus for standardized reporting of surgical treatment in women with DE, based on a systematic literature review and international consensus, can be used as a guideline to record and report surgical management of patients with DE and as a guideline to design, execute, interpret and compare clinical trials in this patient population. STUDY FUNDING/COMPETING INTERESTS None of the authors received funding for the development of this paper. M.A. reports personal fees and non-financial support from Bayer Pharma outside the submitted work; H.T. reports a grant from Pfizer and personal fees for being on the advisory board of Perrigo, Abbvie, Allergan and SPD. TRIAL REGISTRATION NUMBER N/A.