Psychological and cultural determinants of women's intentions to donate oocytes.

In oocyte donation, oocytes from one woman can be transferred to another for fertility treatment or used for medical research. However, there is an acute shortage of women from the general population donating their oocytes and this has adverse consequences for infertile patients and medical researchers. The aims of this thesis were to explore the psychological determinants of oocyte donation intentions and to investigate the link between oocyte donation intentions and parenthood using components of the Theory of Planned Behaviour (TPB) among women from different ethnic backgrounds. In doing so, a triangulation approach was adopted and one systematic review and five empirical investigations consisting of quantitative, qualitative and experimental research methodologies were carried out. Results revealed that oocyte donation is best accounted for by a diverse dimension of factors, which include positive attitudes towards oocyte donation, unconventional perceptions of parenthood and demographic variables. Some theoretical components of the TPB were supported; in particular Structural Equation Modelling found positive attitudes towards oocyte donation and subjective norms demonstrated a direct influence on the decision to donate oocytes. However, the role of perceived behavioural control in intentions to donate remains uncertain. Perceptions of the importance of parenthood and genetic ties between parent and child are key in determining [un]willingness to donate oocytes for fertility treatment. In addition, findings from this thesis suggest that it may be possible to modify intentions towards oocyte donation using the Framing Effect among White women, but not Women from South East Asia. The results of this thesis have some important implications for research and clinical practice, particularly in its potential to tailor clinical service provision regarding the recruitment of oocyte donors

In situ detection of airbourne fibres by light scattering

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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

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

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

Depression and state anxiety scores during assisted reproductive treatment are associated with outcome: a meta-analysis

This meta-analysis investigated whether state anxiety and depression scores during assisted reproductive technology (ART) treatment and changes in state anxiety and depression scores between baseline and during ART treatment are associated with treatment outcomes. PubMed, PsycInfo, Embase, ScienceDirect, Web of Science and Scopus were searched for studies to include in the meta-analysis. Meta-analytic data were analysed using random effects models to estimate standardised mean differences. 11 studies (2202 patients) were included. Women who achieved a pregnancy had significantly lower depression scores during treatment than women who did not become pregnant -0.302 (95% CI: -0.551 - -0.054, z = -2.387, p = 0.017; I2= 77.142%, p = 0.001). State anxiety scores were also lower in women who became pregnant -0.335 (95% CI: -0.582 - -0.087: z=-2.649, p=0.008; I2 =81.339%, p = 0.001). However, changes in state anxiety (d=-0.056; 95% CI: -0.195 - 0.082, z = -0.794; I2= 0.00%) and depression scores (d=-0.106; 95% CI: -0.296 - 0.085, z = -1.088; I2= 0.00%) from baseline to treatment were not associated with ART outcomes. Clinics should aim to promote better psychosocial care for patients to help them manage the psychological and physical demands ART treatment, giving realistic expectations

A systematic review and meta‑analysis of psychological predictors of successful assisted reproductive technologies

Objectives: The aim of this systematic review and meta-analysis was to perform an updated investigation of the effects of depression and anxiety on pregnancy outcomes following assisted reproductive technologies. A bibliographic search was performed using PubMed, PsycINFO, Embase, Science Direct databases. Data retrieved were analysed using a random effects model to estimate standardised mean differences. Results: Of the 22 included studies, 18 investigated depression, 15 state anxiety, and seven trait anxiety. Data from 4018 patients were included in the meta-analysis. Results indicated that women who achieved pregnancy or a live birth reported lower levels of depression pre-treatment than those who did not, although the effects were small d = − 0.177 (95% CI − 0.327 to − 0.027, z = 2.309, p = 0.021). These results were consistent under different methodological conditions and the quality of these observational were graded as satisfactory. A similar pattern was seen for state (d = − 0.096, 95% CI − 0.180 to − 0.012: z = 2.241, p = 0.025) and trait anxiety (d = − 0.188, 95% CI − 0.007 to 0.356, z = 2.181, p = 0.029). More research is needed to investigate the impact of psychological variables on assisted reproductive technologies outcomes and moderator influences during assisted reproductive technologies processes

Posttraumatic stress and posttraumatic stress disorder after termination of pregnancy and reproductive loss: a systematic review

Objective: The aims of this systematic review were to integrate the research on posttraumatic stress (PTS) and posttraumatic stress disorder (PTSD) after termination of pregnancy (TOP), miscarriage, perinatal death, stillbirth, neonatal death, and failed in vitro fertilisation (IVF). Methods. Electronic databases (AMED, British Nursing Index, CINAHL, MEDLINE, SPORTDiscus, PsycINFO, PubMEd, ScienceDirect) were searched for articles using PRISMA guidelines. Results: Data from48 studies were included. Quality of the research was generally good. PTS/PTSD has been investigated in TOP and miscarriage more than perinatal loss, stillbirth, and neonatal death. In all reproductive losses and TOPs, the prevalence of PTS was greater than PTSD, both decreased over time, and longer gestational age is associated with higher levels of PTS/PTSD. Women have generally reported more PTS or PTSD than men. Sociodemographic characteristics (e.g., younger age, lower education, and history of previous traumas or mental health problems) and psychsocial factors influence PTS and PTSD after TOP and reproductive loss. Conclusions. This systematic review is the first to investigate PTS/PTSD after reproductive loss. Patients with advanced pregnancies, a history of previous traumas, mental health problems, and adverse psychosocial profiles should be considered as high risk for developing PTS or PTSD following reproductive loss

Maternal psychosocial consequences of twins and multiple births following assisted and natural conception: a meta-analysis

The aim of this meta-analysis is to provide new evidence on the effects on maternal health of multiple births due to assisted reproductive technology (ART). A bibliographic search was undertaken using PubMed, PsycINFO, CINAHL and Science Direct. Data extraction was completed using Cochrane Review recommendations, and the review was performed following PRISMA and MOOSE guidelines. Meta-analytic data were analysed using random effects models. Eight papers (2993 mothers) were included. Mothers of ART multiple births were significantly more likely to experience depression (standardized mean difference [SMD] d = 0.198, 95% CI 0.050 − 0.345, z = 2.623, P = 0.009; heterogeneity I2 = 36.47%), and stress (SMD d = 0.177, 95% CI 0.049 − 0.305, P = 0.007; heterogeneity I2 = 0.01%) than mothers of ART singletons. No difference in psychosocial distress (combined stress and depression) (SMD d = 0.371, 95% CI −0.153 − 0.895; I2 = 86.962%, P = 0.001) or depression (d = 0.152, 95% CI −0.179 − 0.483: z = 0.901; I2 = 36.918%) were found between mothers of ART and naturally conceived multiple births. In conclusion, mothers of ART multiple births were significantly more likely to have depression and stress than mothers of ART singletons, but were no different from mothers of naturally conceived multiples