Understanding the preferred role in infertility treatment decision making among Chinese infertile women in Hong Kong

Session 38: Managing patient expectations: no. O-140This free journal suppl. entitled: Abstract book of the 31st ESHRE Annual Meeting, Lisbon, Portugal, 14–17 June 2015STUDY QUESTION: What are the treatment decision making preferences in Chinese women undergoing fertility treatments in Hong Kong? ...postprin

Do cultural beliefs play a role in fertility-related quality of life? A study of Chinese women after unsuccessful first IVF cycle

This free journal suppl. entitled: Abstract book of the 31st ESHRE Annual Meeting, Lisbon, Portugal, 14–17 June 2015Poster Presentation: P-553postprin

Origin and function of stomata in the moss Physcomitrella patens.

Stomata are microscopic valves on plant surfaces that originated over 400 million years (Myr) ago and facilitated the greening of Earth's continents by permitting efficient shoot-atmosphere gas exchange and plant hydration(1). However, the core genetic machinery regulating stomatal development in non-vascular land plants is poorly understood(2-4) and their function has remained a matter of debate for a century(5). Here, we show that genes encoding the two basic helix-loop-helix proteins PpSMF1 (SPEECH, MUTE and FAMA-like) and PpSCREAM1 (SCRM1) in the moss Physcomitrella patens are orthologous to transcriptional regulators of stomatal development in the flowering plant Arabidopsis thaliana and essential for stomata formation in moss. Targeted P. patens knockout mutants lacking either PpSMF1 or PpSCRM1 develop gametophytes indistinguishable from wild-type plants but mutant sporophytes lack stomata. Protein-protein interaction assays reveal heterodimerization between PpSMF1 and PpSCRM1, which, together with moss-angiosperm gene complementations(6), suggests deep functional conservation of the heterodimeric SMF1 and SCRM1 unit is required to activate transcription for moss stomatal development, as in A. thaliana(7). Moreover, stomata-less sporophytes of ΔPpSMF1 and ΔPpSCRM1 mutants exhibited delayed dehiscence, implying stomata might have promoted dehiscence in the first complex land-plant sporophytes

The Role of Boundary Ambiguity in Miscarriage: A New Understanding on Perinatal Grief and Psychological Distress among Chinese Women who Experience Reproductive Loss after IVF

Session: Paramedical - NursingPoster PresentationStudy question: The current study attempts to examine the role of boundary ambiguity in perinatal grief, psychological distress and coping, as well as to explore the phenomenological experience of boundary ambiguity and family stress among Chinese women who experience miscarriage after IVF. Summary answer: It was found that boundary ambiguity experienced by the miscarrying women after successful pregnancy through IVF, a perceptual state in which an individual is uncertain about who is in or out of the family system, could be able to predict perinatal grief and depression, difficulty in coping, as well as psychological despair. What is known already: Research focusing on boundary ambiguity has been applied to a number of different populations and can be varied among different belief systems and family structures. Little is known among the role of boundary ambiguity in case of miscarriage, which is presumably associated with the psychological wish for a baby to be present when he/she is physically absent, causing maternal stress and impair individual functioning subsequently. Study design, size, duration: A mixed method including a cross-sectional quantitative study and in-depth interviews was conducted. Structured questionnaires included Boundary Ambiguity Scale, Perinatal Grief Scale, and Hospital Anxiety and Depression Scale. Individual interviews were conducted in order to generate their subjective experience of boundary ambiguity and its association with psychological distress. Participants/materials, setting, methods: 41 women (response rate = 46%, mean age = 30, SD = 1.3) experiencing first-trimester miscarriage after successful IVF were recruited at a university-affiliated hospital in Hong Kong. Informed consent was sought during hospital-stay after miscarriage treatment. Twelve agreed to participate a follow-up interview 2 weeks after discharge from hospital. Main results and the role of chance: Quantitative analysis has shown that boundary ambiguity could significantly predict perinatal grief [F(1,39) = 63.87, p < 0.001] and depression [F(1,37) = 4.416, p < 0.05] in miscarrying women. This was consistent with the previous research on boundary ambiguity that the higher the subjective experience of boundary ambiguity, the higher the psychological distress and daily dysfunction among individuals. From the qualitative interviews, four meta-themes emerged as most representative of the phenomenological experiences of miscarriage after successful IVF cycle, namely as (i) difficulty in making sense of the sudden loss; (ii) confusion about the presence of physical body sensation and the absence of the baby; (iii) perceptual difference towards the experience among family member resulting higher ambiguity in family structure; and (iv) and the nature of disenfranchised grief in perinatal loss. Limitations, reason for caution: The lack of available information about the premorbid status of the person before their loss, which allows the researcher to infer the person’s level of functioning prior to pregnancy loss. Self-selection bias was also inevitable in questionnaire survey, and the cross-sectional nature of the study did not permit causal inferences. Wider implications of the findings: The current study adds to the understanding of boundary ambiguity of miscarriage women and their acute perinatal grief in facing pregnancy loss. The nature of ambiguity in case of miscarriage can shed light on the new perspective of counselling by acknowledging the perceptual discrepancy between the psychological presence and physical absence of the baby. The acute experience of perinatal grief and depression highlights the need of psychological support at this critical point of healthcare provision. Study funding/competing interest(s): Funding by University(ies), The University of Hong Kong

Understanding the fertility-related quality of life of women undergoing IVF treatment and how cultural beliefs shaped their treatment experience, outcome expectations and emotional reactions

Conference Theme: Steering Reproductive Medicine to the Forefront of Global Public HealthThis study aims to investigate the impact of treatment procedures on the fertility-related quality of life in women undergoing in vitro fertilization (IVF) treatment procedures, how their personal beliefs affect treatment expectations, and cultural factors influencing their reactions at times of implantation failure.link_to_OA_fulltex

Treatment decision after IVF implantation cycle failure: Chinese female patients' preferred role in decision making and its effects on decisional regret and psychological well-being

Conference Theme: Steering Reproductive Medicine to the Forefront of Global Public HealthSession - Mental Health: P-723This study aimed to understand female patients’ decision making during the in vitro fertilization (IVF) treatment process, especially at the stage when they choose between continuing or terminating treatment after implantation failure.link_to_OA_fulltex

Examining the relationship between preferred role preference in treatment decision making and decisional regret and depression among Chinese women after experiencing failure in in vitro fertilization: a longitudinal study

Session - Current Issues in Maternal and Child Health and Well-Being: paper no. 26286BACKGROUND: In recent decades, patient participation in healthcare decisions has been increasingly encouraged as it gives a sense of empowerment and autonomy. However, such responsibility may induce stress for infertile patients who experienced more than one cycle of in vitrofertilization (IVF) treatment, especially in the patrilineal field of medicine where attending doctors are male-dominated. Given the unfulfilled wish of childbearing, lack of definite cut-off point, and calculation of cost in treatment discontinuation, patients often encounter a decisional crossroad to choose whether to pursue further or discontinue IVF cycles after experiencing failure. To date, little is known about women’s preferred role in treatment decision making in the context of infertility, decisional dilemmas and complexity of factors such as physical, psychosocial, religious and cultural influence. This study examined the impact of decision role preference, prospective treatment experience and decisional regret on a longitudinal scale to inform clinicians in their facilitation of infertile patient in treatment decision making. METHODS: 130 women who experienced IVF treatment failure by indication of negative pregnancy test were recruited at a university-affiliated reproductive medicine clinic. With consent, they completed questionnaires asking their history of infertility treatment, preferred roles in treatment decision-making, perception of treatment outcome and mood at three time-points: announcement of treatment failure (T0), when they made a subsequent treatment decision (T1) and three months afterwards (T2). The study spanned 18 months. RESULTS: On average, participants were aged 37.0 (SD=3.5), married for 7.4 years (SD=3.7), and being diagnosed of subfertility for 4.1 years (SD=2.45). Majority received tertiary education and had a full-time job. Most women were classified as passive decision makers, preferred minimal shared responsibility (41.9%), or a totally passive role (40.4%). 89.4% of them regarded doctors are best to decide subsequent treatments, only 10.1% preferred shared responsibility. No respondents preferred an autonomous role. Regarding treatment discontinuation, most participants preferred minimal involvement and highly dependent on physicians for final decisions (84.3%); only a small proportion preferred shared responsibility (7.1%), or uphold autonomy (8.6%) in the process. Nonetheless, regression analysis identified a subgroup of women (N=41) who believed doctors, not patients, should make decisions in general at T0, but nonetheless wanted a bigger role in deciding their IVF treatments at T1. These women experienced significantly higher treatment regret (β=.076, p <.001) and depressed mood at T2 (β=.152, p <.05), even after controlling for depressed mood at T1 . IMPLICATIONS: Results showed when conflict arises between the belief that doctors know best and the desire to have a more active role in IVF treatment planning, women experience greater regret and become more depressed. Hence, identification with traditional beliefs of childbearing, which emphasizes the patrilineal culture, will be associated with worse psychological outcome among patients. The study underline the importance of cultural sensitivity in addressing fertility-related issues in order to better facilitate psychosocial support at the clinic, as well as to empower these women to express their patients’ concerns and decisional preferences throughout the course of medical treatment. This study was generously funded by the University Grant Council – General Research Fund HKU740613

Exploring fertility-related quality of life of infertile women experiencing in vitro fertilization treatment failure and role of childbearing beliefs in women's well-being in traditional family systems

ePoster Presentations 11: paper no. 26308BACKGROUND: The experience of infertility treatment, especially in vitro fertilization, were frequently described as an emotional roller coaster, with stress, anxiety and depression as common reactions over the course, and emotional burden and psychological distress as common side-effects of treatment discontinuation after cycle failures. Not only has the treatment experience create on marital tension, under the cultural stigma of attributing responsibility of infertility to the women, treatment failures will potentially creating emotional pain and suffering for the infertile women. Currently, few studies explored the impact of infertility treatments in women in Asian cultures, which place much importance on the continuation of patriarchal lineage, on infertile women. Little is known about their fertility-related quality of life (FertiQoL), the role of cultural beliefs in affecting their well-being, and effects on her well-being when treatment fails. This studies investigated the fertility-related quality of life in Chinese infertile women after unsuccessful treatment, and the role of cultural beliefs in childbearing in affect the women’s well-being as well as couple relationship. METHODS: A cross-sectional survey was conducted with 198 infertile women who experienced IVF treatment failure. They were recruited through individual invitation at a university-affiliated assisted reproduction clinic, and completed questionnaire about their fertility-related quality of life (FertiQoL), beliefs in childbearing, couple relationships, treatment history, and demographic characteristics. RESULTS: On average, participants were aged 37.0 (SD=3.5), married for 7.4 years (SD=3.7), and being diagnosed of subfertility for 4.1 years (SD=2.45). Majority received tertiary education and had a full-time job. The mean scores of total fertility-related quality of life (Total FertiQoL) (t = 8.10 and 8.36, p < .01) and quality of life across the emotional, mind-body, relational and social domain (Core FertiQoL) (t = 8.10 and 8.36, p < .01) were found to be better than that from a Western sample. Nonetheless, their quality of life associated with infertility treatment (Treatment FertiQoL) showed no difference from their Western counterparts (t = 1.41, n.s.). Total and Core FertiQoL were found to be negatively associated with the women’s identification with Chinese cultural beliefs about childbearing such as “It’s the Wife responsibility to childbearing’ (b= -3.384, p <.001), “No children is the biggest issue” (b= -2.97, p <.05). For Treatment FertiQoL, identification with the “It’s the daughter in-law’s responsibility continue lineage” belief significantly predicts poorer outcomes (b= -3.356, p <.01). IMPLICATIONS: This study sheds light on the quality of life of Chinese infertile women after unsuccessful IVF treatment. Identification with Chinese beliefs of childbearing, which emphasizes the patrilineal culture, was associated with worse well-being. The study underline the importance of cultural sensitivity in addressing fertility-related issues in order to better facilitate psychosocial support at the clinic, as well as to empower these women to express their personal values and cultural beliefs throughout the course of infertility treatment. This study was generously funded by the University Grant Council – General Research Fund HKU740613

Public engagement in major projects: the Hong Kong experience

Public engagement is an essential process for major municipal infrastructure and construction projects as it serves to identify the interests and concerns of citizens before the planning and design are finalised and thus ensures the schemes are beneficial to all sectors of the community. However, the success of public engagement depends on a number of factors, not least the suitability of the engagement methods used, representativeness and activeness of participants, time pressure, financial constraint and so on. In Hong Kong, the community has experienced discontent with several major projects recently, suggesting the need to examine the effectiveness of its current public engagement mechanism. This paper reports the results of a series of interviews with a variety of stakeholders – indicating the need for a carefully considered public engagement plan to be established at the beginning to drive the process and more experienced people to lead and facilitate the engagement process