Assisted conception: fertility preservation, surrogate motherhood, gamete / embryo donation, and in vitro fertilization

Chapter 15. , pp 237-250. In: International Handbook of Women’s Sexual and Reproductive Health. Eds Jane Ussher, Joan Chrisler and Janette Perz. Routledge. NY, USA

Reproductive health matters

You do not need to be a psychologist to know that reproductive health plays an important role in society and that individual psychological, behavioural and social factors affect reproductive health and vice versa. What you may not know is that psychological research has shown that health education, willpower, planning and the opportunity to exercise health behaviours such as moderate alcohol and caffeine consumption, not smoking or taking drugs and maintaining a balanced diet, can lead to a healthy reproductive lifestyle, much like it affects general health. Health behaviours can also free people from unnecessary and preventable damage (e.g. unsafe abortions) or disease (e.g. sexually transmitted infections); from the potential psychological consequences of these (depression, guilt, stigma); contribute to early detection and treatment (e.g. breast or testicular cancer); and reduced time off work and utilization of the health care system (van den Akker, 2012). Clearly, reproductive health matters

Psychological and ethical issues in third party assisted conception and surrogate motherhood

The continuing increase in babies born via third party assisted conception (AC) and surrogate motherhood across the world shows the success of and medical and social demand for third party interventions in family building. However, with the increasing use of such interventions world-wide, commercialisation and commodification have proliferated. This in turn has led to inequality in access to AC services, in choice of third party input, and in questionable human rights and psychosocial welfare issues. Transitioning to parenthood using third party AC and surrogate motherhood, in addition to requiring equality in access, also demand accuracy of birth and genetic information. In the absence of accurate record keeping, continuing practices of anonymity, and marginalization of the contribution of donors and surrogates, psychological, social, health and ethical questions are raised for donors, recipients and potentially for (genetic, gestational) part, half and full offspring, siblings and others in the extended family such as grandparents

The effectiveness of persuasive health communication techniques

Objective: This study tests the effectiveness of Framing and Fear conditions to change attitudes towards elective single embryo transfer (eSET) in a large, non-clinical population. Method:A repeated measures randomised control trial design was used with 632 male and female participants allocated to one of two intervention groups (Framing or Fear condition) or a control group. There were two conditions in the Framing group (gain or loss frame), three conditions in the Fear group (high, medium or low fear) and two control conditions (education and non-education). Questionnaires were completed before exposure to the message (time 1) and immediately afterwards (time 2). Results: High fear (β = .637, P<0.008) and gain frame (β = .718, P<0.005) were the only significant conditions predicting hypothetical intentions towards eSET at Time 2 for the total sample. No other conditions were predictive of hypothetical intentions. Education only improved knowledge and non-education showed no changes in scores. Conclusion: These results highlight the benefits of multidisciplinary expertise in designing health promotion to reduce multiple pregnancies. Practice Implications: Findings suggest that educational material needs to be presented along- side persuasive communication techniques incorporating high fear and gain frames to help promote eSET in clinical practice

A systematic review of changes in women’s physical activity before and during pregnancy and the postnatal period

Objectives: To determine the magnitude and type of naturally occuring physical activity changes in women around the time of pregnancy. Background: This systematic review synthesises the results of studies examining naturally occurring physical activity in women before they become pregnant and the magnitude and type of changes during pregnancy and the postnatal period. Methods: Electronic databases were searched for relevant articles and PRISMA guidelines for selection of articles were used. Only studies examining naturally occurring, non-intervention changes in regular activity levels were included. The quality assessment was based on protocols of the Cochrane Database of Systematic Reviews. Of the initial 720 titles, 24 studies met the inclusion criteria and were included in the final review. Results: Compared to pre-pregnancy, the magnitude of physical activity decreased over the course of pregnancy and postnatally and the types of activities tended to be of lesser intensity than pre-pregnancy. The quality of the research was varied; methodological limitations included using subjective methods of assessment of physical activity (9/24), failing to report reliabilities or validity of measures used (8/24), no information on parity (13/24) or level of fitness prior to pregnancy (11/24). Conclusion: The evidence suggests a marked decrease in the amount and type of moderate to strenuous physical activity during the transition to motherhood, which does not always increase again postpartum. Patient education targeting specific physical activities at regular intervals during and after pregnancy to improve long-term maternal health is necessary

Elective single-embryo transfer: persuasive communication strategies can affect choice in a young British population

This study tested the effectiveness of the framing effect and fear appeals to inform young people about the risks of multiple births and the option of selecting elective single-embryo transfer (eSET). A non-patient student sample (age (mean±SD) 23±5.5 years; n=321) were randomly allocated to one of seven groups: (1) framing effect: (1a) gain and (1b) loss frame; (2) fear appeal: (2a) high, (2b) medium and (2c) low fear; or (3) a control group: (3a) education and (3b) non-education. The primary outcome measure was the Attitudes towards Single Embryo Transfer questionnaire, before exposure to the messages (time 1) and immediately afterwards (time 2). Results revealed participants in the high fear, medium fear and gain condition demonstrated the most positive and significant differences (P<0.001 to P<0.05) in their knowledge, hypothetical intentions and modest changes in attitudes towards eSET than the low fear, loss frame and education and non-education messages. The results demonstrate that the use of complex persuasive communication techniques on a student population to promote immediate and hypothetical eSET preferences is more successful at promoting eSET than merely reporting educational content. Future research should investigate its application in a clinical population. A multiple pregnancy is a health risk to both infant and mother following IVF treatment. The aims of this study were to test the effectiveness of two persuasive communication techniques (the framing effect and fear appeals) to inform young people about the risks of multiple births and the hypothetical option of selecting elective single-embryo transfer (eSET) (i.e., only one embryo is transferred to the uterus using IVF treatment). A total of 321 non-patient student sample (mean age 23) were randomly allocated to read a message from one of seven groups: (1) framing effect: (1a) gain and (1b) loss frame; (2) fear appeal: (2a) high, (2b) medium and (2c) low fear; or (3) a control group: education (3a) and (3b) non-education. Participants completed the Attitudes towards Single Embryo Transfer questionnaire, before exposure to the messages (time 1) and immediately afterwards (time 2). Results revealed that participants in the high fear, medium fear and gain condition demonstrated the most positive and significant differences in their knowledge, hypothetical intentions and modest changes in attitudes towards eSET than the low fear, loss frame and education and non-education messages. This study recommends that health promotion based on the framing effect and fear appeals should be tested in clinical (patient) samples in the future

Mental health and coping with fertility treatment cessation during the COVID-19 pandemic in the UK

Purpose This study examined experiences during the cessation of fertility treatment due to the COVID-19 pandemic, including levels of mental health, coping strategies used to manage uncertainty about treatment due to the pandemic, sources of support, and predictors of mental health. Methods One hundred and seventy-five participants in the UK completed an online survey. Results Half of the participants experienced clinical levels of anxiety and/or depression, and 20% reported suicidal feelings as a result of the uncertainty about treatment due to the pandemic. Support from friends, family and online forums were reported by more than half of participants, but support from fertility clinics or counsellors were reported by less than one quarter. The strategy used most frequently to cope with the uncertainty about treatment due to the pandemic was self-distraction, and this predicted reduced depression. However, self-blame, behavioral disengagement and venting predicted increased depression and self-blame, behavioral disengagement, and denial predicted increased anxiety. Conclusions Fertility clinic communication and psychological support, such as counselling, which had substantially reduced during treatment cessation, could include some focus on personal coping, including what to avoid. Psychological support is likely to be more important now than ever. Despite resumption of treatment, the impacts of the period of cessation and of COVID-19 are likely to continue to reverberate

‘Together … for only a moment’ British newspaper constructions of altruistic non-commercial surrogate motherhood

Objectives: To explore how national altruistic surrogacy is framed in a representative selection of the British press. Methods: A study of 90 British national newspaper articles was carried out using the Lexis-Nexis data base to search for articles on altruistic surrogacy. Content analysis of gain, loss, neutral frames and high or low alarm and vulnerability frames in the titles and the body of the text was carried out. The type of construction used in the article content was also analysed. Data were coded and consensus reached using a coding strategy specifically developed for the purposes of this study. Results: Titles and content were predominantly loss, high alarm and high vulnerability framed. The content was also gain framed, and written with a focus on the social and legal aspects differentially between the newspaper types. Discussion: The tabloid press emphasizes social issues, and the middle market and serious press focus on legal issues of altruistic surrogacy. Selectively framed and reinforced information provided by the different newspapers, reflect the different readership, with Tabloid readers likely to be, surrogates (mostly from lower socioeconomic strata) and serious/ middle-market readers likely to be commissioning parents (mostly professionals)

Catch 22? Disclosing assisted conception treatment at work

Purpose: The purpose of this study was to explore factors influencing decision-making about disclosure of Assisted Reproductive Technology (ART) use in the workplace. Design: A qualitative study design was used. Thirty-one women and six men who were using or had recently used ART were recruited from British fertility networks and interviewed. Data were transcribed verbatim and thematically analysed. Findings: Two main strands were identified each encompassing two themes: i) ‘Concerns about disclosure’ covered the very personal nature of disclosing ART treatment and also career concerns and ii) ‘Motives for disclosure’ covered feeling it was necessary to disclose and also the influence of workplace relationships. Research limitations: The relatively small, self-selected sample of participants was recruited from fertility support networks, and lacked some diversity. Practical implications: Clarity about entitlements to workplace support and formal protection against discrimination, along with management training and awareness raising about ART treatment is needed to help normalise requests for support and to make decisions about disclosure within the workplace easier. Originality/ value: The study has highlighted an understudied area of research in ART populations. The data provide insight into the challenging experiences of individuals combining ART with employment and, in particular, the complexity of decisions about whether or not to disclose

A systematic review and meta-analysis of lifestyle and body mass index predictors of successful assisted reproductive technologies

Objective: Lifestyle (smoking, drinking alcohol) and body mass index (BMI) predictors of successful outcomes in assisted reproductive technology (ART) treatments were examined in this meta-analysis. Method: A bibliographic search was undertaken using six databases. The review was informed by PRISMA/MOOSE guidelines. Meta analytic data were analysed using random effects models. Results: We included 77 studies examining effects of BMI, smoking and drinking alcohol. Patients with a BMI25 OR 1.219 (95% CI:1.128–1.319, z 4.971, p<.001; I2 53.779%, p .001). Non-smokers were significantly more likely to achieve a LB or pregnancy than smokers OR 1.457 (95% CI:1.228–1.727, z 4.324, p<.001; I2 51.883; p .001). Meta-regression revealed the number of embryos transferred significantly moderated the effects of smoking on ART outcomes, and there was a trend indicating primary infertility and high BMI were also significant moderators. The evidence for drinking alcohol was inconclusive due to the small number of studies. Conclusions: This meta-analysis confirms that ART treatment success can be predicted with life-style factors. Further, non-smokers’ relative odds of pregnancy/live birth increase as more embryos were transferred but there was a trend that the odds of pregnancy/live birth decrease with primary infertility and high BMI