VALUE study : a protocol for a qualitative semi-structured interview study of IVF add-ons use by patients, clinicians and embryologists in the UK and Australia

Funding This research was funded by an Obstetrics and Gynaecology Innovation Grant from the University of Melbourne Australia. MP is supported by a University of Melbourne Department of Obstetrics and Gynaecology MCR Fellowship. Acknowledgements Our heartfelt thanks to our PPI panel who gave up their time to contribute to the development of VALUE. UK: Isabella Dash, Jennifer Nisbett, Hannah Reid, Ally Richardson, Victoria Thomas, Bassel Wattar. Australia: Katherine Gobbi, Hilary Smith, Natasha Devetak, Alex Polyakov, Anna Ninnis, Lisa Lee, Vadim Mirmilstein.Peer reviewedPublisher PD

Patient and professional perspectives about using in vitro fertilisation add-ons in the UK and Australia: a qualitative study

Objectives In vitro fertilisation (IVF) add-ons are additional procedures offered alongside an IVF cycle with the aim of improving live birth rates. They are controversial because of the paucity of evidence to support their efficacy and safety, alongside the additional financial cost they often pose to patients. Despite this, they are popular. However, there is limited qualitative research regarding their use. The aims of the VALUE Study were to understand the decision-making process surrounding using or recommending add-ons; report sources of information for add-ons; and explore concerns for safety and effectiveness when considering their use. Design ‘VALUE’ is a qualitative semistructured interview study using inductive thematic analysis of anonymised transcriptions. Setting Participants were recruited from a broad geographical spread across the UK and Australia from public and private clinical settings. Participants Patients (n=25) and health professionals (embryologists (n=25) and clinicians (n=24)) were interviewed. A purposive sampling strategy was undertaken. The sampling framework included people having state-subsidised and private cycles, professionals working in public and private sectors, geographical location and professionals of all grades. Results Patients often made decisions about add-ons based on hope, minimising considerations of safety, efficacy or cost, whereas professionals sought the best outcomes for their patients and wanted to avoid them wasting their money. The driving forces behind add-on use differed: for patients, a professional opinion was the most influential reason, whereas for professionals, it was seen as patient driven. For both groups, applying the available evidence to individual circumstances was very challenging, especially in the sphere of IVF medicine, where the stakes are high. Conclusions There is scope to build on the quality of the discourse between patients and professionals. Patients describe valuing their autonomy with add-ons, but for professionals, undertaking informed consent will be critical, no matter where they sit on the spectrum regarding add-ons

Modelling the effects of normal faulting on alluvial river meandering

The meandering of alluvial rivers may be forced by normal faulting due to tectonically altered topographic gradients of the river valley and channel at and near the fault zone. Normal faulting can affect river meandering by either instantaneous (e.g. surface-rupturing earthquakes) or gradual displacement. To enhance our understanding of river channel response to tectonic faulting at the fault zone scale we used the physics-based, two-dimensional morphodynamic model Nays2D to simulate the responses of a laboratory-scale alluvial river with vegetated floodplain to various faulting and offset scenarios. The results of a model with normal fault downstepping in the downstream direction show that channel sinuosity and bend radius increase up to a maximum as a result of the faulting-enhanced valley gradient. Hereafter, a chute cutoff reduces channel sinuosity to a new dynamic equilibrium value that is generally higher than the pre-faulting sinuosity. A scenario where a normal fault downsteps in the upstream direction leads to reduced morphological change upstream of the fault due to a backwater effect induced by the faulting. The position within a meander bend at which faulting occurs has a profound influence on the evolution of sinuosity; fault locations that enhance flow velocities over the point bar during floods result in a faster sinuosity increase and subsequent chute cutoff than locations that enhance flow velocity directed towards the floodplain. This upward causation from the bend scale to the reach and floodplain scale arises from the complex interactions between meandering and floodplain and the nonlinearities of the sediment transport and chute cutoff processes. Our model results provide a guideline to include process-based reasoning in the interpretation of geomorphological and sedimentological observations of fluvial response to faulting. The combination of these approaches leads to better predictions of possible effects of faulting on alluvial river meandering

Modelling the effects of normal faulting on alluvial river meandering

The meandering of alluvial rivers may be forced by normal faulting due to tectonically altered topographic gradients of the river valley and channel at and near the fault zone. Normal faulting can affect river meandering by either instantaneous (e.g. surface-rupturing earthquakes) or gradual displacement. To enhance our understanding of river channel response to tectonic faulting at the fault zone scale we used the physics-based, two-dimensional morphodynamic model Nays2D to simulate the responses of a laboratory-scale alluvial river with vegetated floodplain to various faulting and offset scenarios. The results of a model with normal fault downstepping in the downstream direction show that channel sinuosity and bend radius increase up to a maximum as a result of the faulting-enhanced valley gradient. Hereafter, a chute cutoff reduces channel sinuosity to a new dynamic equilibrium value that is generally higher than the pre-faulting sinuosity. A scenario where a normal fault downsteps in the upstream direction leads to reduced morphological change upstream of the fault due to a backwater effect induced by the faulting. The position within a meander bend at which faulting occurs has a profound influence on the evolution of sinuosity; fault locations that enhance flow velocities over the point bar during floods result in a faster sinuosity increase and subsequent chute cutoff than locations that enhance flow velocity directed towards the floodplain. This upward causation from the bend scale to the reach and floodplain scale arises from the complex interactions between meandering and floodplain and the nonlinearities of the sediment transport and chute cutoff processes. Our model results provide a guideline to include process-based reasoning in the interpretation of geomorphological and sedimentological observations of fluvial response to faulting. The combination of these approaches leads to better predictions of possible effects of faulting on alluvial river meandering

Modelling the effects of normal faulting on alluvial river meandering

The meandering of alluvial rivers may be forced by normal faulting due to tectonically altered topographic gradients of the river valley and channel at and near the fault zone. Normal faulting can affect river meandering by either instantaneous (e.g. surface-rupturing earthquakes) or gradual displacement. To enhance our understanding of river channel response to tectonic faulting at the fault zone scale we used the physics-based, two-dimensional morphodynamic model Nays2D to simulate the responses of a laboratory-scale alluvial river with vegetated floodplain to various faulting and offset scenarios. The results of a model with normal fault downstepping in the downstream direction show that channel sinuosity and bend radius increase up to a maximum as a result of the faulting-enhanced valley gradient. Hereafter, a chute cutoff reduces channel sinuosity to a new dynamic equilibrium value that is generally higher than the pre-faulting sinuosity. A scenario where a normal fault downsteps in the upstream direction leads to reduced morphological change upstream of the fault due to a backwater effect induced by the faulting. The position within a meander bend at which faulting occurs has a profound influence on the evolution of sinuosity; fault locations that enhance flow velocities over the point bar during floods result in a faster sinuosity increase and subsequent chute cutoff than locations that enhance flow velocity directed towards the floodplain. This upward causation from the bend scale to the reach and floodplain scale arises from the complex interactions between meandering and floodplain and the nonlinearities of the sediment transport and chute cutoff processes. Our model results provide a guideline to include process-based reasoning in the interpretation of geomorphological and sedimentological observations of fluvial response to faulting. The combination of these approaches leads to better predictions of possible effects of faulting on alluvial river meandering

Conventional ovarian stimulation no longer exists: welcome to the age of individualized ovarian stimulation

The prediction of extremes of ovarian response to stimulation and the irreversibility of reduced ovarian reserve remain important clinical and basic science research issues of IVF treatment. Recommending commencement of ovarian stimulation using any of the available exogenous compounds without knowledge of individual ovarian potentials is simplistic and dangerous because of the possible adverse consequences for the woman. The identification of groups of patients likely to benefit from one protocol than another is central to the workup process of IVF. Determining the agents for ovarian stimulation as well as the combination of them, the daily dose and duration according to some background information should be seen as the way to enhance safety and cost-effectiveness. This discussion paper aims to introduce the concept of individualized ovarian stimulation in routine clinical practice and to generate interest for tailored stimulation protocols