Empowerment and Sense of Adequacy in Infertile Couples: A Fundamental Need in Treatment Process of Infertility - A Qualitative Study

Many Iranian couples are suffering from infertility, and their needs have remained unexplored thus far; therefore, the purpose of this study was to explore the infertile couples’ needs and experiences during diagnosis and different stages of infertility treatment. Specific research question included: What are infertile couples’ viewpoints and perceptions about their needs in treatment process of infertility? Researchers used a qualitative design, based on a content analysis approach to analyze in-depth unstructured interviews conducted with seventeen infertile couples. The participants’ needs were categorized into five categories. All five categories had one theme in common which was identified as “empowerment and sense of adequacy” as a fundamental need during diagnosis and treatment processes of infertility. The study findings showed that the under-studied fertility care centers were not patient-centered; and patients’ needs were not recognised appropriately. Perhaps, addressing patients’ needs and expectations is the first step toward more paying attention to infertile couples and empowering them

Patient-centered Fertility Care: From Theory to Practice

Background & aim: Healthcare areas, especially fertility care (commonly accompanied with high emotions, as well as long-term and recurring treatment periods) could exclusively benefit from patient-centered care (PCC). Despite evident advantages of PCC, this approach has not been practiced as a routine procedure in current clinical environments yet, even in western developed countries. Therefore, this review aimed to evaluate the significance and different aspects of PCC, while emphasizing on patient-centered fertility care, its challenges, and applicable recommendations in this regard. Methods: This narrative review was conducted on 29 relevant medical and clinical papers (published during 1990-2015) collected using various national and international databases (e.g., SID, Magiran, Medlib, Google scholar, Proquest, Pubmed, Wiley, Science direct, and Scopus). Key words and phrases used in this review were “infertility”, “fertility care”, “childlessness”, “patient-centered care”, “patient-centered fertility care” “shared decision-making”, “infertile patient preferences”, and “patient involvement in fertility care”. Results: According to the literature, implementation challenges of patient-centered fertility care were reported as different individual and organizational factors. These factors include lack of professional motivation to change, underestimating the significance of patient-centeredness by healthcare professionals, difficulty in translation of feedback into concrete measures, lack of time and financial resources, insufficient experience of healthcare professionals with regard to identification of needs and preferences of patients, traditional organizational culture, and common misconceptions. Conclusion: Promotion of patient-centered fertility services requires the identification of infertile needs and priorities of individuals, designation of interventional and supportive programs based on sociocultural characteristics of the community to fulfill such preferences, and considering patients as the most significant stakeholders of each healthcare center. This review might provide important data for healthcare professionals and policymakers aiming to improve patient-centered fertility care

Long term management of preterm labor with MgSO4 in myomatous uterus

Background: According to the text book of obstetrics and Gynecology, prematurity is the first cause of perinatal mortality. Therefore postponing delivery will become mandatory to prevent complications of prematurity. Parental MgSO4 is one of the most common and the safest medications for this purpose. Case report: We present a primigravida patient with multiple uterine myoma who had premature labor and received intravenous MgSO4 for 58 days in order to postpone her delivery while having a cervical dilation of 4-5 cm. The patient underwent C/S at the gestational age of 34 weeks because of reducing fetal movements and Breech presentation. Conclusion: Because of many side effects of long term management with MgSO4 and bed rest, this protocol isn't recommended for all patients

Comparing the Frequency of Endometritis in Unexplained Infertility and Anovulatory Infertility

Background: Acute pelvic inflammatory disease (PID) is a common reason for infertility. This study aimed to evaluate the frequency distribution of endometritis in women with unexplained infertility and comparison with frequency distribution of endometritis in anovulatory infertility to identify the importance of endometritis due to subacute PID evaluation in the case of infertility. Materials and Methods: This case–control study was done on 100 women with unexplained infertility and ovulatory infertility who referred to Shahid Beheshti clinic in 2013 in Isfahan, Iran. They were divided into two groups of unexplained infertility and anovulatory infertility. Endometrial samples were given from all the patients by Pipelle biopsy under sterile conditions, and then prepared samples were sent to the pathology laboratory to evaluate the existence of plasma cells by a pathologist to diagnose endometritis. Results: Frequency distribution of acute PID history among the patients in both groups showed a significant difference (P < 0.05). Prevalence of endometritis in unexplained infertility group was 34% and in anovulatory group was 21% (P < 0.05). Prevalence of vaginitis was 46% in unexplained group and 40% in anovulatory group (P < 0.05), and prevalence of PID was 4% in unexplained infertility group and 0% in anovulatory infertility group. Conclusion: The prevalence of endometritis and vaginitis was more in the unexplained infertility group rather than the anovulatory infertility group that may reveal the importance of endometritis evaluation in the cases of unexplained infertility

Exploration of the counseling needs of infertile couples: A qualitative study

Background: Identification of the main needs of infertile patients is essential to provision of appropriate supportive services and care based on their needs. Thus, the present study aims to explore infertile couples' counseling needs. Materials and Methods: This study was carried out with an inductive qualitative content analysis approach during 2012–2013. The participants of this study included 26 Iranian infertile couples and 7 medical personnel (3 gynecologists and 4 midwives). The infertile couples were selected through purposive sampling and considering maximal variation from patients attending state-run and private infertility treatment centers as well as infertility specialists, offices in Isfahan and Rasht, Iran. Unstructured in-depth interviews and field notes were utilized for data gathering and replying to this research main question, "What are the counseling needs of infertile couples?" The data from medical personnel was collected through semi-structured interviews. Data analysis was carried out through conventional content analysis. Results: Data analysis revealed two main themes. The first theme was "a need for psychological counseling," which included four subthemes: Emotional distress management, sexual counseling, marital counseling, and family counseling. The second theme was "a need for guidance and information throughout treatment process," which included three subthemes: Treatment counseling, financial counseling, and legal counseling. Conclusions: The counseling needs of infertile couples are varied, and they require various psychosocial support and counseling interventions. The participants of this study identified clearly the significance of psychological counseling and information throughout the long and onerous journey of infertility and its treatment

Altered Th17/Treg Ratio in Recurrent Miscarriage after Treatment with Paternal Lymphocytes and Vitamin D3: a Double- Blind Placebo-Controlled Study

ABSTRACT Background: Recurrent miscarriage (RM) affects 2-5% of pregnant women. Paternal lymphocyte immunotherapy is a common treatment for RM patients but the outcome has not been consistent. Therefore, combined therapy with other immunosuppressive drugs such as 1a, 25-dihydroxy-vitamin-D3 (vitamin D3) may improve the outcome. Objectives: To investigate the effect of vitamin D3 on the balance of two essential T cells subsets, T helper (Th) 17 and T regulatory (Treg) cells, which contribute to the immune tolerance during pregnancy. Methods: The expression levels of CD4 and forkhead box protein 3 (FOXP3) in Treg cells, and the expression levels of CD4 and IL-17 in Th17 cells, were evaluated pre-and 3 months post-immunotherapy in RM patients treated with a combination of paternal lymphocytes and vitamin D3 compared with RM patients receiving lymphocyte immunotherapy alone. Results: Vitamin D3 therapy decreased the frequency of Th17 cells in addition to reducing the Th17/Treg ratio in peripheral blood of RM patients compared with the control group (p&lt;0.05). Conclusion: Considering that RM patients have a higher Th17/Treg ratio in peripheral blood, vitamin D3 may be a candidate therapeutic approach in this disease. Rafiee M, et al. Iran J Immunol. 2015; 12(4):252-262