Fertility quality of life tool: update on research and practice considerations

The 36-item Fertility Quality of Life (FertiQoL) tool is increasingly used in research and practice. It measures quality of life in four personal domains (emotional, social, relational, mind/body) and two treatment domains (tolerability, environment). A literature review of published empirical research using FertiQoL was undertaken to provide an overview of this research base. Five databases were searched using ‘FertiQoL’ and its variant. In total, 41 published articles from 35 independent samples in 23 countries involving 16,315 participants, mainly in clinical settings, were reviewed. FertiQoL was used for three main purposes: (i) to assess quality of life and FertiQoL measurement properties (especially Core FertiQoL) using cross-sectional designs; (ii) to identify correlates, predictors, and consequences of fertility quality of life (some of which included international comparisons); (iii) to assess the effect of psychological interventions on fertility quality of life. The range of median FertiQoL Core, Treatment and subscale (scaled) scores in 31 samples was between 60 and 75. Poorer fertility quality of life was consistently associated with being a woman, longer duration of infertility, poorer psychological functioning and lower patient–centred care. Some FertiQoL subscale scores improved after psychological interventions. Future research should address measurement issues and examine reported associations with fertility quality of life

Perceived challenges of working in a fertility clinic: a qualitative analysis of work stressors and difficulties working with patients

STUDY QUESTION What are some of the challenges of working in a fertility clinic? SUMMARY ANSWER The most frequently mentioned challenges were workload (e.g. high time pressure) and patient-related sources (e.g. unrealistic expectations). WHAT IS KNOWN ALREADY One study showed a too high workload, worry about handling human material and low success rates were main stressors in fertility clinics. STUDY DESIGN, SIZE, DURATION An online open-ended survey inviting participants to respond to seven questions was distributed to 5902 members of the European Society for Human Reproduction and Embryology (ESHRE, October 2010). Questions asked participants to describe the top three factors that made (i) their work stressful (hereafter ‘Work stressors’) and (ii) working with patients difficult (hereafter ‘Perceived sources of difficulties’), and (iii) to choose from these factors which top three issues they would be willing to attend a workshop to resolve (hereafter ‘Workshops’). A qualitative content analysis using inductive coding for each question was used to extract meaningful themes from the text replies, at three levels of increasing abstraction (lower and higher categories, general themes). PARTICIPANTS/MATERIALS, SETTING, METHODS The final sample comprised 526 respondents (8.9% participation rate). Respondents were predominantly clinicians (41.3%, n = 216) or embryologists (35.5%, n = 186) from European countries (73.0%, n = 386). MAIN RESULTS AND THE ROLE OF CHANCE The number of text replies generated for each question was 1421, 1208 and 907 for the ‘Work Stressors’, ‘Perceived sources of difficulties’ and ‘Workshop’ questions, respectively. The most often reported higher-order categories of Work Stressors were ‘Time and Workload’ (61.6%, e.g. time pressure), ‘Organisation, Team and management issues’ (60.4%, e.g. team conflicts) and ‘Job content and work environment’ (50.3%, e.g. burdensome administration). For ‘Perceived sources of difficulties’ these were ‘Patient-related sources’ (66.7%, e.g. unrealistic expectations), ‘Communication and Counselling with patients’ (33.7%, e.g. strained information giving) and ‘Misinformation and lack of knowledge’ (27.8%, e.g. Dr Google). Finally, the topics participants would be willing to address in Workshops were ‘Communicating and Counselling with Patients’ (24.9%), ‘Dealing with Patient-related sources’ (19.6%) and ‘Clinical topics’ (19.6%). Three general themes emerged. First, a theme of ‘time and time trade-offs’ expressed the oft-mentioned need to trade-off time spent on one activity (e.g. managing patient demands) against another activity (e.g. clinical workload, administration) with stress level dependent on the efficacy of trading-off. Second, the theme of ‘multifactorial causes’ of challenging patient interactions that embodied the many sources of difficulties working with patients. What staff would be willing to address in workshops was indicated by the final general theme of ‘a little of everything’, which linked to the need for multiple workshops addressing the multifactorial nature of challenges in fertility clinics. LIMITATIONS, REASONS FOR CAUTION Only about 10% of members receiving the survey participated. The work was limited to the stressful and difficult aspects of working in fertility clinics, which may give a more negative impression than if questions about the rewards and benefits had also been included. WIDER IMPLICATIONS OF THE FINDINGS The nature of stressors and difficulties of working in a fertility clinic are consistent with models of occupational stress and patient complexity. Specialized psychologists, management consultants and other occupational experts could assist fertility teams in overcoming many of the challenges. More research is required on the effect of encountered work stressors and perceived sources of difficulties in working with patients on staff and patient outcomes

Causal explanations for lack of pregnancy applying the common sense model of illness representation to the fertility context

Objectives: The current study explored causal explanations for lack of pregnancy and association with help-seeking behaviour. Differences based on gender and country Human Development Index were examined. Design: A mixed method design was used. Main outcome measures: Data were drawn from the International Fertility Decision-Making Study, a cross-sectional study of 10,045 individuals (1690 men; 8355 women) from 79 countries. Respondents rated to what extent they believed their lack of pregnancy was due to something they or their partner had done/not done or other factors and described their reasons for making this rating. Results: Respondents were aged 18–50 (M = 31.83) years, partnered and had been trying to achieve a pregnancy/father a child for over six months (M = 2.8 years). Men and women primarily believed their lack of pregnancy was due to medical problems or chance/bad luck. Thematic analysis of textual responses from 29.7% of the sample found that respondents focused on their personal experience or a salient life event when describing the cause of their lack of pregnancy. Women expressed more regret and helplessness about causes than men. Significant country differences were observed. Conclusions: Individuals may develop inaccurate causal explanations based on their personal experiences. Access to accurate information is necessary to facilitate timely help-seeking

The importance of the ‘family clock’: women’s lived experience of fertility decision-making 6 years after attending the Fertility Assessment and Counselling clinic

This study explored women’s lived experience of making fertility decisions six years after attending the Fertility Assessment and Counselling (FAC) clinic in Copenhagen, Denmark, which is a personalised fertility awareness intervention. We conducted a qualitative interview study with 24 women who attended the FAC clinic 6 years earlier. Interviews were semi-structured and broadly examined the women’s perceptions and experience of the intervention during follow-up. Data was analysed using a phenomenological framework and themes were identified related to women’s experience of making fertility decisions after attending the FAC clinic. The overarching theme regarding the women’s lived experience of making fertility decisions after attending the FAC clinic was: Fertility decisions were guided by the ‘family clock’. There were four themes: (i) Deciding to ‘get started’ by attending the FAC clinic; (ii) Sense of making informed and empowered decisions; (iii) Influence of partner status on fertility decisions; and (iv) Decisions dictated by circumstance over preference and knowledge. At follow-up, the majority (21 women, 88%) had become parents. More than half of the women said that they had not achieved their desired family size. Consideration of women’s ‘family clock’ is necessary in personalised fertility awareness interventions to enable women to achieve their family goals

Concomitant malaria among visceral leishmaniasis in-patients from Gedarif and Sennar States, Sudan: a retrospective case-control study

In areas where visceral leishmaniasis (VL) and malaria are co-endemic, co-infections are common. Clinical implications range from potential diagnostic delay to increased disease-related morbidity, as compared to VL patients. Nevertheless, public awareness of the disease remains limited. In VL-endemic areas with unstable and seasonal malaria, vulnerability to the disease persists through all age-groups, suggesting that in these populations, malaria may easily co-occur with VL, with potentially severe clinical effects

Doing well with change : what helps and what hinders well-educated immigrant women workers?

The purpose of this study was to gain an understanding of the strategies that new immigrant women employ to do well with changes that affect their work. This study asked the questions: What helps and what hinders immigrant women workers to do well with changes that affect their work? What would have been more helpful to do well with these changes? Participants were 10 well-educated immigrant women. Data was gathered using semi-structured, open-ended individual interviews consistent with Flanagan's (1954) Critical Incident Technique (CIT). Data was primarily analyzed using the CIT methodology. A total of 182 incidents that were grouped into 9 categories were extracted from the participants' interviews. The categories were: 1) Personal Beliefs/Traits/Values, 2) Relationships with friends/Family/ Colleagues, 3) Taking Action/Building Capacity, 4) Work Environment, 5)Self Care, 6) Skills/Knowledge/Credentials/Education, 7) Personal Issues/Challenges, 8) Contexual Issues/Challenges, and 9) Government/Community Resources. The results reaffirm the findings in the existing literature on immigrant women's thriving, resilience and hardiness and adaptation and transitions after immigration while providing a more personal account of these experiences. Uniquely, while many of the participants spoke of personal sacrifice in order to ensure the well being of their families, the importance of self-care was also highlighted. The factors that immigrant women find helpful and hindering in doing well with change can inform service delivery, program development and future research studies with this population.Education, Faculty ofEducational and Counselling Psychology, and Special Education (ECPS), Department ofGraduat

When time runs out : the experience of unintentional childlessness for women who delayed childbearing

Given that an increasing number of women are waiting to have children there is growing concern that more women will end up unintentionally childless as they continue to delay childbearing past the time when a viable pregnancy is possible. However, little is known about the experience of permanent, unintentional childlessness for women who have delayed childbearing. This phenomenon was the focus of this study. A qualitative approach was used to answer the question: What is the meaning and experience of permanent unintentional childlessness for women who delayed childbearing? In-depth, tape recorded interviews were conducted with 15 women who had expected to become mothers but were now permanently and unintentionally childless after delaying childbearing. The interviews were transcribed, coded, and analyzed using van Manen’s (1990) hermeneutic phenomenological method. Thematic representations and rich descriptions of the experience of this phenomenon were developed. Six common themes were identified across the women’s experiences of unintentional childlessness after delay including: 1) Sense of Grief and Loss; 2) Sense of Being an Outsider in a World of Mothers; 3) Sense of Judgment and Assumptions; 4) Sense of Powerlessness; 5) Need to Make Sense of Childlessness; and 6) Sense of Reconciliation and Acceptance. Trustworthiness of the results was determined using criteria consistent with the hermeneutic phenomenological method. The findings are compared with the theoretical and extant literature, with emphasis being placed on how they extend our current understanding of the phenomenon of permanent unintentional childlessness after delay for women. The implications for Counselling Psychology practice and future research are also addressed.Education, Faculty ofEducational and Counselling Psychology, and Special Education (ECPS), Department ofGraduat