Results of a Pilot Study in the U.S. and Vietnam to Assess the Utility and Acceptability of a Multi-Level Pregnancy Test (MLPT) for Home Monitoring of hCG Trends After Assisted Reproduction.

Background To evaluate the utility and acceptability of using multi-level pregnancy tests (MLPTs) at home to monitor hCG trends following assisted reproductive technology (ART). Methods One hundred and four women presenting for ART at either Stanford Medicine Fertility and Reproductive Health Clinic (Stanford, CA) or Hung Vuong Hospital (Ho Chi Minh City, Vietnam) participated in this pilot study. Women were asked to perform the MLPT at home, primarily on days when they were also scheduled to receive standard clinic-based serum hCG testing. These tests were administered up to 6 times over the 6-week period following embryo transfer or intrauterine insemination (IUI). Concordance of serial hCG readings for each time point was assessed by comparing trends in urine MLPT results with trends in serum hCG. Stable or increasing hCG level was interpreted as an indication of a progressing pregnancy, while a declining hCG was interpreted as a lack of established or progressing pregnancy. At study end, all participants were asked about the acceptability and convenience of using the MLPT at home for monitoring hCG trends following ART. Results Data from both urine and serum testing are available for 156 of 179 clinic visits (87.2%). There was high concordance of serial trend results between the two types of tests: among the 156 sets of serum and urine hCG data points, 150 (96.2%) showed a matching trend in hCG pattern and 6 (3.8%) resulted in a discordant trend. Seventy-three percent of women reported being satisfied or very satisfied with using the MLPTs at home. Almost all (96.6%) said that the MLPT was easy or very easy to use. Conclusion The MLPT offers women and health care providers a client-friendly diagnostic tool to detect very early pregnancy and monitor its progress. Trial registration This study was registered on clinicaltrials.gov as NCT01846403 (May 1, 2013), and NCT01919502 (August 5, 2013)

Determinants of demand: Method selection and provider preference among United States women seeking abortion services.

Access to abortion services in the United States has become increasingly constrained over the past decade. Medication abortion has the potential to increase abortion availability, primarily through new provider networks, but without a better understanding of how and why women make decisions regarding both their abortion method and provider, expansion efforts may be misguided and valuable resources wasted. An exploratory study was undertaken to investigate method and provider preferences. Semi-structured one-onone interviews were conducted with 205 abortion clients at Planned Parenthood of Greater Iowa clinics. Both quantitative and qualitative analyses were carried out. Stigmatization of abortion is a driving force in how women make abortion-related decisions; this may help to explain why the majority of participants would not have wanted to obtain their abortion from their regular provider and many women were not even comfortable discussing the topic of abortion with them. Continuity with one's regular provider was not deemed important or desired by the majority of study participants. Two of the main reasons given for preferring the clinic over the private doctor were confidentiality and privacy; keeping the abortion a secret from one's parents was paramount for some of the younger participants. Study participants also discussed the lack of privacy in small town communities and related fears of confidential ities being breached as reasons for preferring the clinic setting. Travel time was not a predictor of preferring one's regular doctor over the clinic. Method selection was primarily based on process characteristics including duration of procedure or clinic visit, location (clinic vs. home), level of invasiveness, and pain. Many abortion clients feel strongly about their method of choice, and method preference was shown to trump any interest in one's regular doctor for the majority of women. Unexpectedly, participants who chose the aspiration procedure were more likely to have previous knowledge about the medication method than those choosing a medication abortion. Women at greater gestational age were more likely to choose aspiration over medication, even at 8 weeks or less. One quarter of participants claimed to have insurance that would cover abortion services, the vast majority of whom planned to use it.Ph.D.Health and Environmental SciencesObstetricsPublic healthUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/126968/2/3287632.pd