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Self-reported home and work stress and trying to conceive - using big data in the study of infertility
MENTAL HEALTH P-500 Wednesday, November 1, 2017 SELF-REPORTED HOME AND WORK STRESS AND TRYING TO CONCEIVE - USING BIG DATA IN THE STUDY OF INFERTILITY. C. Messerlian,a B. PlakuAlakbarova,a A. Lange,b J. Yeh,b T. L. Toth,b R. Hauser.a aEnvironmental Health, Harvard T.H. Chan School of Public Health, Boston, MA; bMassachusetts General Hospital Fertility Center, Boston, MA. OBJECTIVE: Few studies have examined preconception stress and infertility, despite evidence that maternal stress during pregnancy is associated with adverse outcomes including miscarriage and preterm birth. We examined the association of self-reported home and work stress with prolonged trying time (R12 months) among women using a fertility-tracking app. DESIGN: A prospective cohort of fertility app users across the United States. MATERIALS AND METHODS: We used self-reported data from a fertility-tracking app collected from female users from March 2014 to April 2016. At the time of app sign-up, women described home and work stress as low, medium, or high, and reported the number of months they had been trying to conceive. Total trying to conceive time (TTC) was estimated by adding the number of months reported at sign-up to the number of follow-up months of continued fertility tracking. We used multivariable logistic regression to examine home and work stress independently, and total stress (the combined effect of both types of stress using an additive composite score) in relation to TTC R12 months vs. TTC <12 months. We adjusted for age, categorical body mass index (BMI) for user and her partner, race, and education. RESULTS: A total of 19,965 women had complete follow-up data through April 2016. Women were on average 29 years old at sign-up and 51% had a BMI of 18-25 kg/m2. Compared with low stress, medium (OR: 1.2, 95%CI: 1.1, 1.3) and high home stress (OR: 1.5, 95% CI: 1.3, 1.8) and high work stress (OR: 1.2, 95% CI: 1.1, 1.3) were independently associated with TTC R12 months. Higher total additive stress was also associated with longer trying time. Compared with low home and work stress (score 2), women with combinations of medium- medium, low-high, high-low (score 4), medium-high, high-medium (score 5), and high-high stress (score 6) had a 1.3 (95% CI: 1.2, 1.4), 1.3 (95% CI: 1.1, 1.5), and 1.9 (95% CI: 1.5, 2.4) increased odds of total TTC R12 months, for scores 4, 5, and 6, respectively. CONCLUSIONS: In this large cohort of female fertility app users, both home and work stress were independently associated with prolonged (R12 months) time trying to conceive. Moreover, the additive effect of high home stress and high work stress (OR: 1.9) exceeded the individual effects of each, suggesting that cumulative stress from all areas of life may impact fertility. Supported by: CM was supported by a postdoctoral fellowship from the Canadian Institutes of Health Research. P-501 Wednesday, November 1, 2017 THE EXPERIENCE OF CANADIAN GESTATIONAL CARRIERS (GC) WITH THE SURROGACY PROD. Gordon,b Z. Shmorgun,a CESS. S. Yee,a S. Moskovtsev,a,b K. Zohni,b,a C. L. Librach.a,b,c aCReATe Fertility Centre, Toronto, ON, Canada; bUniversity of Toronto, Toronto, ON, Canada; cWomen’s College Hospital, Toronto, ON.
OBJECTIVE: This study aims to examine the experience of Canadian women who have been GCs. The impact of surrogacy on their family functioning and their relationships with intended parents (IP) during and after the surrogacy process was evaluated. DESIGN: Cross-sectional survey with participants recruited from the surrogacy community using convenience sampling. MATERIALS AND METHODS: A total of 144 current and 40 past Canadian GCs completed an online anonymous survey. Ninety-three of them (50.5%) had been a GC more than once. A total of 184 participants with 287 surrogacy journeys were used for analysis. RESULTS: This study received institutional REB approval. The mean age of the GCs was 32.55.3 (range: 21-48). 71.1% were married/partnered women, and 22.3% were university educated. Of the total 287 journeys, 108 (37.6%) were cross-border surrogacy involving intended parents (IPs) from 15 different countries; 124 (43.2%) cases involved single men or gay couples. The majority of GCs met their IPs through surrogacy agencies (n¼225, 78.4%) and a smaller number through the Internet (n¼40, 13.9%). The remainder were friends or family members (n¼22, 7.7%). A quarter (26.1%) found their surrogacy had a negative impact on their family functioning. A total of 157 babies were born from 131 surrogacy births. 86.5% of participants reported ‘no emotional struggle at all’ when relinquishing babies to their IPs post-birth. 6.5% and 17.9% reported thinking about the surrogacy child ‘very often’ and ‘quite often’ at the time of survey. About three quarters (74.9%) had ongoing contact with their IP post-birth at least once every 6 months. Most participants had positive attitudes towards carrying a pregnancy for gay couples (92.9%), cancer survivors (89.1%), and transgender individuals (66.9%), but less so for heterosexual couples R age 50 (30.7%). Most would ‘absolutely’ (60.3%) or ‘most likely’ (26.6%) recommend surrogacy to their friends. CONCLUSIONS: Altruistic surrogacy in Canada is available for both International IPs and local ones. Many of these services are being provided for single men and gay couples. Most GC-IP relationships did not dissolve after the birth. The majority of GCs found their experience positive, and would recommend surrogacy to their friends. Supported by: CReATe Fertility Centre P-502 Wednesday, November 1, 2017 DEPRESSIVE SYMPTOMS, ANTIDEPRESSANT USE AND FERTILITY TREATMENT OUTCOMES. E. A. EvansHoeker,a E. Eisenberg,b R. S. Legro,c M. P. Diamond,d A. Z. Steiner.e aVirginia Tech Carilion, Carilion Clinic, Roanoke, VA; bNICHD, Bethesda, MD; cPenn State University College of Medicine, Hershey, PA; dAugusta University, Augusta, GA; efor the Reproductive Medicine Network, University of North Carolina, Chapel Hill, NC. OBJECTIVE: To determine if 1) symptoms of major depression (SMD), 2) anti-depressant use, and 3) male partner SMD is associated with pregnancy and pregnancy outcome among infertile couples. DESIGN: Cohort study MATERIALS AND METHODS: We conducted a secondary analysis of data from two randomized controlled (RCT) trials: PPCOS II, a RCT comparing clomiphene citrate and letrozole for treatment of PCOS, and AMIGOS, a RCT comparing gonadotropins, clomiphene citrate, and letrozole along with intrauterine insemination in the treatment of unexplained infertility. Both partners completed the patient health questionnaire (PHQ9) at enrollment. Females were queried about medication use. A PHQ-9 score of R 10 was used to define SMD. Primary outcomes included pregnancy, 1st
TABLE 1. Outcomes by PHQ-9 status and antidepressant use
PHQ-9 < 10, No antidepressant (n¼1359) N (%)
PHQ-9 < 10, On antidepressant (n¼73) N (%)
RR (95% CI)
PHQ-9 R 10, No antidepressant (n¼72) N (%)
RR (95% CI)
PHQ-9 R 10, On antidepressant (n¼16) N (%)
RR (95% CI)
Achieved 497 (36.57%) 31 (42.47%) 1.13 (0.85-1.50) 31 (43.06%) 1.38 (1.07-1.78) 6 (37.5%) 0.94 (0.50-1.79) Pregnancy First Trimester 110 (22.13%) 14 (45.16%) 1.87 (1.18-2.99) 5 (16.12%) 0.85 (0.37-1.96) 2 (33.33%) 1.40 (0.47-4.17) Miscarriage Live Birth 345 (25.39%) 17 (23.29%) 0.88 (0.56-1.14) 20 (27.78%) 1.22 (0.84-1.78) 4 (25%) 0.91 (0.39-2.13) *Denominator for first trimester miscarriage ¼ only subjects who conceived, denominator for live birth ¼ all subjects. **Adjusted for age, race, income, months trying to conceive, smoking, and study. Reference category: PHQ-9 < 10, No antidepressant.
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Vol. 108, No. 3, Supplement, September 2017
OBJECTIVE: This study aims to examine the experience of Canadian women who have been GCs. The impact of surrogacy on their family functioning and their relationships with intended parents (IP) during and after the surrogacy process was evaluated. DESIGN: Cross-sectional survey with participants recruited from the surrogacy community using convenience sampling. MATERIALS AND METHODS: A total of 144 current and 40 past Canadian GCs completed an online anonymous survey. Ninety-three of them (50.5%) had been a GC more than once. A total of 184 participants with 287 surrogacy journeys were used for analysis. RESULTS: This study received institutional REB approval. The mean age of the GCs was 32.55.3 (range: 21-48). 71.1% were married/partnered women, and 22.3% were university educated. Of the total 287 journeys, 108 (37.6%) were cross-border surrogacy involving intended parents (IPs) from 15 different countries; 124 (43.2%) cases involved single men or gay couples. The majority of GCs met their IPs through surrogacy agencies (n¼225, 78.4%) and a smaller number through the Internet (n¼40, 13.9%). The remainder were friends or family members (n¼22, 7.7%). A quarter (26.1%) found their surrogacy had a negative impact on their family functioning. A total of 157 babies were born from 131 surrogacy births. 86.5% of participants reported ‘no emotional struggle at all’ when relinquishing babies to their IPs post-birth. 6.5% and 17.9% reported thinking about the surrogacy child ‘very often’ and ‘quite often’ at the time of survey. About three quarters (74.9%) had ongoing contact with their IP post-birth at least once every 6 months. Most participants had positive attitudes towards carrying a pregnancy for gay couples (92.9%), cancer survivors (89.1%), and transgender individuals (66.9%), but less so for heterosexual couples R age 50 (30.7%). Most would ‘absolutely’ (60.3%) or ‘most likely’ (26.6%) recommend surrogacy to their friends. CONCLUSIONS: Altruistic surrogacy in Canada is available for both International IPs and local ones. Many of these services are being provided for single men and gay couples. Most GC-IP relationships did not dissolve after the birth. The majority of GCs found their experience positive, and would recommend surrogacy to their friends. Supported by: CReATe Fertility Centre P-502 Wednesday, November 1, 2017 DEPRESSIVE SYMPTOMS, ANTIDEPRESSANT USE AND FERTILITY TREATMENT OUTCOMES. E. A. EvansHoeker,a E. Eisenberg,b R. S. Legro,c M. P. Diamond,d A. Z. Steiner.e aVirginia Tech Carilion, Carilion Clinic, Roanoke, VA; bNICHD, Bethesda, MD; cPenn State University College of Medicine, Hershey, PA; dAugusta University, Augusta, GA; efor the Reproductive Medicine Network, University of North Carolina, Chapel Hill, NC. OBJECTIVE: To determine if 1) symptoms of major depression (SMD), 2) anti-depressant use, and 3) male partner SMD is associated with pregnancy and pregnancy outcome among infertile couples. DESIGN: Cohort study MATERIALS AND METHODS: We conducted a secondary analysis of data from two randomized controlled (RCT) trials: PPCOS II, a RCT comparing clomiphene citrate and letrozole for treatment of PCOS, and AMIGOS, a RCT comparing gonadotropins, clomiphene citrate, and letrozole along with intrauterine insemination in the treatment of unexplained infertility. Both partners completed the patient health questionnaire (PHQ9) at enrollment. Females were queried about medication use. A PHQ-9 score of R 10 was used to define SMD. Primary outcomes included pregnancy, 1st
TABLE 1. Outcomes by PHQ-9 status and antidepressant use
PHQ-9 < 10, No antidepressant (n¼1359) N (%)
PHQ-9 < 10, On antidepressant (n¼73) N (%)
RR (95% CI)
PHQ-9 R 10, No antidepressant (n¼72) N (%)
RR (95% CI)
PHQ-9 R 10, On antidepressant (n¼16) N (%)
RR (95% CI)
Achieved 497 (36.57%) 31 (42.47%) 1.13 (0.85-1.50) 31 (43.06%) 1.38 (1.07-1.78) 6 (37.5%) 0.94 (0.50-1.79) Pregnancy First Trimester 110 (22.13%) 14 (45.16%) 1.87 (1.18-2.99) 5 (16.12%) 0.85 (0.37-1.96) 2 (33.33%) 1.40 (0.47-4.17) Miscarriage Live Birth 345 (25.39%) 17 (23.29%) 0.88 (0.56-1.14) 20 (27.78%) 1.22 (0.84-1.78) 4 (25%) 0.91 (0.39-2.13) *Denominator for first trimester miscarriage ¼ only subjects who conceived, denominator for live birth ¼ all subjects. **Adjusted for age, race, income, months trying to conceive, smoking, and study. Reference category: PHQ-9 < 10, No antidepressant.
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Vol. 108, No. 3, Supplement, September 2017