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Preliminary findings of concerns & challenges among gay fathers utilizing IVF & gestational carriers
trimester miscarriage, and live birth. Poisson regression was used to determine the relative risk after adjusting for age, race, income, months trying to conceive, smoking and study. RESULTS: Data for 1,650 females and 1,608 males were included in the analysis. Antidepressant use but not SMD was associated with increased risk of 1st trimester miscarriage (Table 1). Specifically, women using non-selective serotonin reuptake inhibitors (non-SSRI) (N¼6) had an increased risk of miscarriage (RR 3.45; 95% CI: 1.99-5.98) but not women on SSRIs (N¼27) (RR 1.73; 95% CI 1.00-3.00). Male partners with SMD (N¼34) were less likely to achieve conception (RR 0.44; 95% CI 0.20-0.98) and live birth (RR 0.39; 95% CI 0.13-1.16). CONCLUSIONS: Symptoms of major depression in females does not appear to negatively impact treatment outcomes; however, in the male partner they may lower the likelihood of achieving a pregnancy. Antidepressant use in the female partner is associated with increased risk of 1st trimester miscarriage, but may be dependent upon the type of antidepressant. Supported by: National Institutes of Health (NIH)/Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) P-503 Wednesday, November 1, 2017 PRELIMINARY FINDINGS OF CONCERNS & CHALLENGES AMONG GAY FATHERS UTILIZING IVF & GESTATIONAL CARRIERS. J. Rehbein,a K. Coyne,a E. Kemner,a J. L. Madeira,b A. S. Jaeger,c G. SylvestreMargolis,d S. R. Lindheim.e aObstetrics & Gynecology, Wright State University, Boonshoft School of Medicine, Dayton, OH; bLaw, Indiana University, Bloomington, IN; cLaw Policy and Ethics, Santa Fe, NM; dObstetrics and Gynegology, Flushing Hospital Medical Center, Flushing, NY; eObstetrics & Gynecology, Wright State University Boonsoft School of Medicin, Dayton, OH. OBJECTIVE: We assessed prenatal and postpartum parenting concerns and challenges among gay fathers utilizing IVF and gestational carriers (GC). DESIGN: Questionnaire-based descriptive study. MATERIALS AND METHODS: An online questionnaire was disseminated through menhavingbabies.com to gay fathers who had previously undergone IVF-GC. RESULTS: To date, 59 surveys have been completed. Of demographics, the average age was 43.5 years (range 28-56 yrs); the average relationship length was 12.3 years; 79% were legally married (range 3-24%); 18% had a yearly income of $50K-75, 18% from $75K-100K, and 71% >$100,000. Sixty-four percent considered non-IVF options, including adoption, prior to IVF. For planning purposes, 62% reported the IVF-GC process took 1-2 yrs, 33% reported >2 yrs, and 10% reported >3 yrs. For those considering a sibling project, 97% (33/34) knew that cryopreservation would cut costs, but only 58% (19) disappointingly got to freeze. Despite known complications of multifetal pregnancies, 85% purposefully transferred two embryos to increase the ‘‘odds’’ or complete the family unit with one attempt. After birth, one partner informed his employer 95% of the time; both partners informed 85% of the time. In 53% of couples, neither partner received paid parental/family leave, and 77% used vacation time, while 15% of partners weren’t able to take time off. Birth forced 38% to change jobs or careers. For 81%, the estimated cycle cost, including birth and postpartum care, was >$100,000. CONCLUSIONS: Due to IVF’s financial challenges, gay men often transfer more than one embryo. They also face unique postnatal social challenges including limited paid leave and career changes. These concerns may be addressed by 1) extending infertility benefit coverage to gay men, and 2) more egalitarian parental leave for gay fathers. P-504 Wednesday, November 1, 2017 ETHICAL VIEWS OF THIRD-PARTY REPRODUCTION AND ATTITUDES/UTILIZATION OFADOPTION AMONG REPRODUCTIVE-AGED U.S. WOMEN. S. H. Bjorkman,a E. Chan,b S. C. Collins.a aDepartment of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT; bSociology, Yale University, New Haven, CT. OBJECTIVE: When faced with diminished ovarian reserve and/or several rounds of failed autologous IVF, clinicians and patients must often explore alternative forms of family building. However, prior research has shown
FERTILITY & STERILITYÒ
third-party reproduction to be ethically concerning to nearly half of U.S. women of reproductive age. To enable clinicians to better tailor reproductive counseling to the needs of specific patients, we sought to determine whether women with greater ethical concerns about third-party reproduction have more positive attitudes towards, and increased utilization of, adoption. DESIGN: Cross-sectional survey. MATERIALS AND METHODS: Data were obtained from the National Survey of Fertility Barriers (2004-2007), a random-digit-dialing telephone survey of 4,794 U.S. women aged 25-52. Multiple logistic regression was performed to determine the relationship between ethical views of thirdparty reproduction and attitudes towards, and utilization of, adoption. Ethical views on the use of donor sperm, donor eggs, surrogacy, and gestational carriers were integrated into a third-party reproduction ethics index. Adoption attitudes and behaviors were measured in value statements and self-report of consideration or pursuit of adoption. The regression model adjusted for covariates previously established to impact adoption attitudes and behaviors, including age, race/ethnicity, income, educational level, marital status, importance of parenthood, religion (affiliation and attendance), urban vs. rural, geographic region, and fertility history, including nulliparity, history of medical fertility evaluation, and history of infertility treatment. RESULTS: In unadjusted analysis, women who expressed greater ethical concerns with third-party reproduction were less likely to have favorable attitudes about adoption (odds ratio (OR) 0.89 [95% confidence interval (CI) 0.84 - 0.95]; P <0.001). In the adjusted analysis, this trend was maintained (adjusted OR 0.92 [95% CI 0.84 - 1.00]; P¼0.059). There was no evidence of significant association between ethical concerns with third-party reproduction and a history of either considering or pursuing adoption. CONCLUSIONS: In an attempt to tailor reproductive counseling to the specific needs of patients, clinicians can consider a patient’s ethical views of third-party reproduction, as women who have ethical concerns about third-party reproduction are also likely to have negative adoption attitudes. Given that these are the only two solutions that remain for some patients with diminished ovarian reserve, younger women with such ethical concerns should give stronger consideration to elective fertility preservation to avoid a situation with two undesired options. P-505 Wednesday, November 1, 2017 IMPROVING INFORMED CONSENT (IC) TO IVF THROUGH A MULTIMEDIA PLATFORM (MP). K. Coyne,a J. Rehbein,a J. L. Madeira,b A. S. Jaeger,c J. P. Parry,d G. Sylvestre-Margolis,e S. R. Lindheim.f aObstetrics & Gynecology, Wright State University, Boonshoft School of Medicine, Dayton, OH; bLaw, Indiana University, Bloomington, IN; cLaw Policy and Ethics, Santa Fe, NM; dOB/GYN-REI, UMMC, Flowood, MS; eObstetrics and Gynegology, Flushing Hospital Medical Center, Flushing, NY; fObstetrics & Gynecology, Wright State University, Dayton, OH. OBJECTIVE: Medical professionals have expressed concern about patient understanding of IVF and/or low-tech OI-IUI treatment’s risks and consequences. We report the impact of a multimedia platform (MP) on patient and provider feedback about the IC process. DESIGN: Quantitative survey. MATERIALS AND METHODS: A 17-question survey was given to 4336 women using MP prior to IVF or OI-IUI from 14 USA IVF centers. The EngagedMD MP IVF module consisted of 13 videos and the OI-IUI module of 9 videos, 5-7 min in length, each followed by a brief quiz with correct answer pop-ups. Survey responses were five-item Likert scales ranging from Strongly Disagree to Strongly Agree, and reported descriptively. RESULTS: The MP was completed by 3,654 patients (IVF: 76%, n¼2777 and OI-IUI: 24%, n¼877) and 92 providers. After completing the MP, patients had significantly more favorable cycle expectations for both IVF (3.3 1 vs 4.5 0.7, p<0.01) and OI-IUI modules (3.5 1 vs 4.5 0.7, p<0.01), following a scale of Strongly Disagree (1) to Strongly Agree (5). Overall, 97% felt the MP a helpful addition to medical consultation/teaching, 71% were more satisfied with their care, 54% felt it answered questions they would’ve asked providers, and 89% (IVF) and 93% (OI-IUI) thought the MP was the appropriate length and level of detail. Compared to internet-based sources (3.88 1.3), printed materials (3.66 1.2) and nurse and staff training (2.9 1.2), the MP more effectively educated about process and risks (2.5 1.2, p<0.01), following a scale of Strongly Agree (1) to Strongly Disagree (5). Overall, 73% (n¼67) of providers/nurses felt the MP improved patient learning and understanding, helped visual and auditory learners, and was more convenient for patients, with 63% (n¼58) feeling it saved up to one hour per patient.
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FERTILITY & STERILITYÒ
third-party reproduction to be ethically concerning to nearly half of U.S. women of reproductive age. To enable clinicians to better tailor reproductive counseling to the needs of specific patients, we sought to determine whether women with greater ethical concerns about third-party reproduction have more positive attitudes towards, and increased utilization of, adoption. DESIGN: Cross-sectional survey. MATERIALS AND METHODS: Data were obtained from the National Survey of Fertility Barriers (2004-2007), a random-digit-dialing telephone survey of 4,794 U.S. women aged 25-52. Multiple logistic regression was performed to determine the relationship between ethical views of thirdparty reproduction and attitudes towards, and utilization of, adoption. Ethical views on the use of donor sperm, donor eggs, surrogacy, and gestational carriers were integrated into a third-party reproduction ethics index. Adoption attitudes and behaviors were measured in value statements and self-report of consideration or pursuit of adoption. The regression model adjusted for covariates previously established to impact adoption attitudes and behaviors, including age, race/ethnicity, income, educational level, marital status, importance of parenthood, religion (affiliation and attendance), urban vs. rural, geographic region, and fertility history, including nulliparity, history of medical fertility evaluation, and history of infertility treatment. RESULTS: In unadjusted analysis, women who expressed greater ethical concerns with third-party reproduction were less likely to have favorable attitudes about adoption (odds ratio (OR) 0.89 [95% confidence interval (CI) 0.84 - 0.95]; P <0.001). In the adjusted analysis, this trend was maintained (adjusted OR 0.92 [95% CI 0.84 - 1.00]; P¼0.059). There was no evidence of significant association between ethical concerns with third-party reproduction and a history of either considering or pursuing adoption. CONCLUSIONS: In an attempt to tailor reproductive counseling to the specific needs of patients, clinicians can consider a patient’s ethical views of third-party reproduction, as women who have ethical concerns about third-party reproduction are also likely to have negative adoption attitudes. Given that these are the only two solutions that remain for some patients with diminished ovarian reserve, younger women with such ethical concerns should give stronger consideration to elective fertility preservation to avoid a situation with two undesired options. P-505 Wednesday, November 1, 2017 IMPROVING INFORMED CONSENT (IC) TO IVF THROUGH A MULTIMEDIA PLATFORM (MP). K. Coyne,a J. Rehbein,a J. L. Madeira,b A. S. Jaeger,c J. P. Parry,d G. Sylvestre-Margolis,e S. R. Lindheim.f aObstetrics & Gynecology, Wright State University, Boonshoft School of Medicine, Dayton, OH; bLaw, Indiana University, Bloomington, IN; cLaw Policy and Ethics, Santa Fe, NM; dOB/GYN-REI, UMMC, Flowood, MS; eObstetrics and Gynegology, Flushing Hospital Medical Center, Flushing, NY; fObstetrics & Gynecology, Wright State University, Dayton, OH. OBJECTIVE: Medical professionals have expressed concern about patient understanding of IVF and/or low-tech OI-IUI treatment’s risks and consequences. We report the impact of a multimedia platform (MP) on patient and provider feedback about the IC process. DESIGN: Quantitative survey. MATERIALS AND METHODS: A 17-question survey was given to 4336 women using MP prior to IVF or OI-IUI from 14 USA IVF centers. The EngagedMD MP IVF module consisted of 13 videos and the OI-IUI module of 9 videos, 5-7 min in length, each followed by a brief quiz with correct answer pop-ups. Survey responses were five-item Likert scales ranging from Strongly Disagree to Strongly Agree, and reported descriptively. RESULTS: The MP was completed by 3,654 patients (IVF: 76%, n¼2777 and OI-IUI: 24%, n¼877) and 92 providers. After completing the MP, patients had significantly more favorable cycle expectations for both IVF (3.3 1 vs 4.5 0.7, p<0.01) and OI-IUI modules (3.5 1 vs 4.5 0.7, p<0.01), following a scale of Strongly Disagree (1) to Strongly Agree (5). Overall, 97% felt the MP a helpful addition to medical consultation/teaching, 71% were more satisfied with their care, 54% felt it answered questions they would’ve asked providers, and 89% (IVF) and 93% (OI-IUI) thought the MP was the appropriate length and level of detail. Compared to internet-based sources (3.88 1.3), printed materials (3.66 1.2) and nurse and staff training (2.9 1.2), the MP more effectively educated about process and risks (2.5 1.2, p<0.01), following a scale of Strongly Agree (1) to Strongly Disagree (5). Overall, 73% (n¼67) of providers/nurses felt the MP improved patient learning and understanding, helped visual and auditory learners, and was more convenient for patients, with 63% (n¼58) feeling it saved up to one hour per patient.
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