A fetal scalp electrode as a simple aid in the search for a lost needle fragment during sacrospinous ligament fixation

A needle fragment was lost during a sacrospinous ligament fixation. This was recognized during the procedure, but could not be found at that moment. The patient complained of severe buttock pain postoperatively. The needle fragment was localized on CT scan of the pelvis. A fetal scalp electrode helped as a search device to localize the needle on X-ray during the secondary surgery. The patient was operated successfully and was free of pain after 6 weeks

Pre-Conception Interventions for Subfertile Couples Undergoing Assisted Reproductive Technology Treatment: Modeling Analysis

BACKGROUND: Approximately 1 in 7 couples experience subfertility, many of whom have lifestyles that negatively affect fertility, such as poor nutrition, low physical activity, obesity, smoking, or alcohol consumption. Reducing lifestyle risk factors prior to pregnancy or assisted reproductive technology treatment contributes to the improvement of reproductive health, but cost-implications are unknown. OBJECTIVE: The goal of this study was to evaluate reproductive, maternal pregnancy, and birth outcomes, as well as the costs of pre-conception lifestyle intervention programs in subfertile couples and obese women undergoing assisted reproductive technology. METHODS: Using a hypothetical model based on quantitative parameters from published literature and expert opinion, we evaluated the following lifestyle intervention programs: (1) Smarter Pregnancy, an online tool; (2) LIFEstyle, which provides outpatient support for obese women; (3) concurrent use of both Smarter Pregnancy and LIFEstyle for obese women; (4) smoking cessation in men; and (5) a mindfulness mental health support program using group therapy sessions. The model population was based on data from the Netherlands. RESULTS: All model-based analyses of the lifestyle interventions showed a reduction in the number of in vitro fertilization, intracytoplasmic sperm injection, or intrauterine insemination treatments required to achieve pregnancy and successful birth for couples in the Netherlands. Smarter Pregnancy was modeled to have the largest increase in spontaneous pregnancy rate (13.0%) and the largest absolute reduction in potential assisted reproductive technology treatments. Among obese subfertile women, LIFEstyle was modeled to show a reduction in the occurrence of gestational diabetes, maternal hypertensive pregnancy complications, and preterm births by 4.4%, 3.8%, and 3.0%, respectively, per couple. Modeled cost savings per couple per year were €41 (US $48.66), €360 (US$427.23), €513 (US $608.80), €586 (US$695.43), and €1163 (US $1380.18) for smoking cessation, mindfulness, Smarter Pregnancy, combined Smarter Pregnancy AND LIFEstyle, and LIFEstyle interventions, respectively. CONCLUSIONS: Although we modeled the potential impact on reproductive outcomes and costs of fertility treatment rather than collecting real-world data, our model suggests that of the lifestyle interventions for encouraging healthier behaviors, all are likely to be cost effective and appear to have positive effects on reproductive, maternal pregnancy, and birth outcomes. Further real-world data are required to determine the cost-effectiveness of pre-conception lifestyle interventions, including mobile apps and web-based tools that help improve lifestyle, and their effects on reproductive health. We believe that further implementation of the lifestyle app Smarter Pregnancy designed for subfertile couples seeking assistance to become pregnant is likely to be cost-effective and would allow reproductive health outcomes to be collected

Psychosocial counselling in donor sperm treatment: unmet needs and mental health among heterosexual, lesbian and single women

Research question: What are the unmet needs after psychosocial counselling and mental health of women who opt for donor sperm treatment (DST), and are unmet counselling needs related to their mental health? Design: This quantitative study included women in a heterosexual relationship (n = 19), women in a lesbian relationship (n = 25) and single women (n = 51) who opted for DST. Women were included if they had passed the DST intake procedure at a Dutch fertility clinic, were not pregnant and had no previous donor-child. Unmet needs were measured by a self-developed questionnaire based on specific topics identified in a previous qualitative study with added items from experts in the field of DST. The Adult Self Report was used to measure mental health. Relationships between unmet counselling needs and mental health were explored by multiple regression analyses. Results: Fifty-two women (55%) reported unmet counselling needs. Women in heterosexual relationships mostly had unmet counselling needs on the topics of the decision to opt for DST (n = 11, 58%) and non-genetic parenthood (n = 11, 58%); women in lesbian relationships (n = 10, 40%) and single women (n = 14, 27%) mostly had unmet needs on the topic of choosing a sperm donor. In general, women had good mental health, but 13 (14%) met the criteria for clinical mental health problems. Women with more unmet counselling needs also had more mental health problems. Conclusions: Evidence-based guidelines for psychosocial counselling in DST should be developed. Only then can counselling be improved and be fit for purpose

Business case for psychosocial interventions in clinics: potential for decrease in treatment discontinuation and costs

Research question From a value-based healthcare (VBHC) perspective, does an assessment of clinical outcomes and intervention costs indicate that providing cognitive behavioural therapy (CBT) or mindfulness to women seeking fertility treatment have added value compared with no such intervention? Design Proof-of-concept business case based on a VBHC perspective that considers both clinical outcomes and costs. Potential impacts in psychological and fertility outcomes were based on existing literature. Cost outcomes were estimated with a costing model for the Dutch fertility treatment setting. Results 32 studies were identified; 13 could be included. Women who received CBT had 12% lower anxiety, 40% lower depression, and 6% higher fertility quality of life; difference in clinical pregnancy rates was 6-percentage points (CBT=30.2%; Control=24.2%); difference in fertility discontinuation rates was 10-percentage points (CBT=5.5%; Control=15.2%). Women who received training in mindfulness had 8% lower anxiety, 45% lower depression, and 21% higher fertility quality of life; difference in mean clinical pregnancy rate was 19-percentage points (Mindfulness=44.8%; Control=26.0%). Potential total cost savings for the was approximately €1.2 million per year if CBT was provided and €11 million if mindfulness was. Corresponding return-on-investment for CBT was 30.7% and for mindfulness 288%. Potential cost benefits are influenced by the assumed clinical pregnancy rates; such data related to mindfulness was limited to one study. Conclusions This proof-of-concept VBHC business case suggests providing CBT or mindfulness to women seeking fertility treatment could have added value. This conclusion would be bolstered by higher quality primary studies on the effect of mindfulness on clinical pregnancy rates