- Email: [email protected]
Infertility & family-building priorities
needed to achieve pregnancy. ASRM held a summit meeting in Washington, D.C. in September 2015 to address this unmet need. The summit resulted in several strategies to broaden access to care and a task force was created to carry out actionable strategies. One such actionable strategy was the development of private foundations to which practitioners, industry or grateful patients could donate resources and/or money. DESIGN: Observational study. MATERIALS AND METHODS: The Kevin J. Lederer Life Foundation was created to promote health and alleviate the mental and physical distress of those diagnosed with infertility through education and financial assistance. The Life Foundation is a collaborative effort among Chicagoland REI practices to broaden access to fertility care in Illinois. RESULTS: There are 19 clinics that provide ART services in Illinois. Nine of 19 (47%) participated in the Life Foundation, either by donation of medical service or volunteer service on the Foundation Board. The Foundation partnered with fertility clinics for provision of unreimbursed care and 11 IVF cycles were donated by 7 clinics. Community partners such as reproductive attorneys and third party agencies were solicited for service donations while industry partners and grateful patients were solicited for financial support. 2015 was the first fully operational year of the Life Foundation. A 5K race and a bowling fundraiser was held to raise money to cover foundation operating costs and for financial grants. All Foundation members volunteer time, there is currently no paid support staff. A medical advisory board comprised of 4 board-certified REIs selected grant recipients based on financial need and medical prognosis. Eighty-five patients applied for grants and thirteen grants (15.3%) were awarded. Grants were a combination of donated IVF cycles and financial grants to defray the costs of associated with egg donation, gestational carrier use and adoption. 3 live births and 2 pregnancies have subsequently ensued. The Foundation also held educational events covering topics such as oocyte vitrification, adoption, male factor infertility and the psychological impact of fertility care. The Foundation newsletter has 1300 subscribers. CONCLUSIONS: There remains a large unmet need within the United States for fertility care. Creation of private foundations is one mechanism to immediately increase access to care. Success of these foundations is dependent on widespread community engagement. Collaboration with organizations such as ASRM would be beneficial to streamline processes. Greater financial support is needed to help sustain growth and viability. O-9 Monday, October 17, 2016 11:45 AM INFERTILITY & FAMILY-BUILDING PRIORITIES. E. A. Duthie,a A. Cooper,b J. B. Davis,c J. Sandlow,a K. D. Schoyer,a E. Y. Strawn,a K. E. Flynn.a aMedical College of Wisconsin, Milwaukee, WI; bDuke University, Durham, NC; cMichigan State University, Grand Rapids, MI. OBJECTIVE: To describe the family-building priorities most important to patients and partners seeking care from a reproductive endocrinology and infertility specialist (REI) over time. DESIGN: Longitudinal prospective cohort study of 85 infertility patients (pregnancy candidates, PCs) and 62 supporting partners (SPs) %1 week before a first consultation with a REI and 12 months later. MATERIALS AND METHODS: At both time points, respondents separately completed a novel Family-Building Priorities Ranking Tool which tasked them with prioritizing a list of 10 factors associated with different
family-building paths (wording in Table). We describe the percentage of participants who ranked each factor among their highest (top three) priorities pre-consult and at 12 months and the agreement between partners within couples. We examined differences in priorities by role using chi-squared tests and changes in top priorities from pre-consult to 12 months using McNemar’s test (both at a¼0.05). RESULTS: We found significant differences between the top three priorities of PCs and SPs at both time points (Table). Other factors found general consensus: a majority of respondents in both roles highly prioritized maintaining their relationship with their partner, and %5% of respondents prioritized the ability to maintain privacy about their family-building methods. For PCs, more than half of those who prioritized being pregnant and giving birth pre-consult no longer included this factor among their highest priorities by 12 months post-consult (p¼0.04). There were no significant changes over time in highest priority rankings among SPs. At both time points, in >70% of couples, both members had in common 1 or 2 of their highest priorities; very few shared all 3 highest priorities (7% pre-consult; 4% at 12 months). CONCLUSIONS: While there was general agreement among PCs and SPs about the importance of maintaining their relationships with their partners throughout their family-building process, consensus was lacking when it comes to the relative importance of other family-building priorities. REIs who provide support to patients and their partners in assessing the pros and cons of available family-building paths should be aware that becoming a parent may not be the highest priority for many of their patients. Family building is frequently a partnered activity, and the clinical discussions and treatment decisions that shape it should involve both prospective parents and incorporate awareness of the potential for discrepant priorities. Supported by: Funding for this study came from R21HD071332 from the National Institute of Child Health and Human Development. Dr. Duthie received additional support from a National Research Service Award T32 HP10030. REDCap was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through 8UL1TR000055.
O-10 Monday, October 17, 2016 12:00 PM LETROZOLE + GONADOTROPIN PROTOCOL FOR SUPEROVULATION INDUCTION/INSEMINATION CYCLES: A NOVEL APPROACH TO INCREASE ACCESS OF CARE AND VALIDATED BY SUPPLY & DEMAND CURVE ANALYSIS. M. X. Ransom. OB/GYN, Quillen College of Medicine, Johnson City, TN. OBJECTIVE: To identify the benefits of offering a letrozole/FSH (folliclestimulating hormone) hybrid protocol to clomiphene citrate-alone and letrozole-alone failures for superovulation induction insemination + intrauterine (SOI/IUI) cycles prior to considering an FSH-alone protocol, and thereby increase access to care among an infertility population. DESIGN: Patients attending a University infertility practice in Eastern Appalachia were recognized who had failed to conceive by clomiphene citrate and letrozole-alone cycles and were unable to financially consider either a gonadotropin-only/IUI or IVF (in vitro fertilization) cycle. Those patients were offered a letrozole/FSH combined cycle as an affordable alternative to abandonment of treatment.
Pre-Consult
12 Months*
Percent of respondents ranking each factor among top 3 priorities
Pregnancy Supporting Pregnancy Supporting Candidates Partners Candidates Partners (n ¼ 82) (n ¼ 61) (n ¼ 39) (n ¼ 24) That I become a parent one way or another 52% 38% 59% 33% That I/my partner get(s) to be the person who is pregnant with and gives birth to my child 42% 36% 23% 38% That my child has [pregnancy candidate’s] genes 22% 30% 31% 33% That my child has [supporting partner’s] genes 20% 39% 26% 50% That I have a child in the next year or two 55% 23% 39% 25% Cost 24% 16% 13% 21% That I can build my family in a way that doesn’t make it obvious to others that we had trouble 1% 0% 5% 0% That I get to parent my child from birth 20% 16% 13% 21% That I maintain a close and satisfying relationship with my partner 62% 79% 74% 58% That I avoid side effects from medical treatments 2% 20% 10% 13%
Bold: significant difference by role; *Includes only respondents who are not pregnant/parenting
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family-building paths (wording in Table). We describe the percentage of participants who ranked each factor among their highest (top three) priorities pre-consult and at 12 months and the agreement between partners within couples. We examined differences in priorities by role using chi-squared tests and changes in top priorities from pre-consult to 12 months using McNemar’s test (both at a¼0.05). RESULTS: We found significant differences between the top three priorities of PCs and SPs at both time points (Table). Other factors found general consensus: a majority of respondents in both roles highly prioritized maintaining their relationship with their partner, and %5% of respondents prioritized the ability to maintain privacy about their family-building methods. For PCs, more than half of those who prioritized being pregnant and giving birth pre-consult no longer included this factor among their highest priorities by 12 months post-consult (p¼0.04). There were no significant changes over time in highest priority rankings among SPs. At both time points, in >70% of couples, both members had in common 1 or 2 of their highest priorities; very few shared all 3 highest priorities (7% pre-consult; 4% at 12 months). CONCLUSIONS: While there was general agreement among PCs and SPs about the importance of maintaining their relationships with their partners throughout their family-building process, consensus was lacking when it comes to the relative importance of other family-building priorities. REIs who provide support to patients and their partners in assessing the pros and cons of available family-building paths should be aware that becoming a parent may not be the highest priority for many of their patients. Family building is frequently a partnered activity, and the clinical discussions and treatment decisions that shape it should involve both prospective parents and incorporate awareness of the potential for discrepant priorities. Supported by: Funding for this study came from R21HD071332 from the National Institute of Child Health and Human Development. Dr. Duthie received additional support from a National Research Service Award T32 HP10030. REDCap was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through 8UL1TR000055.
O-10 Monday, October 17, 2016 12:00 PM LETROZOLE + GONADOTROPIN PROTOCOL FOR SUPEROVULATION INDUCTION/INSEMINATION CYCLES: A NOVEL APPROACH TO INCREASE ACCESS OF CARE AND VALIDATED BY SUPPLY & DEMAND CURVE ANALYSIS. M. X. Ransom. OB/GYN, Quillen College of Medicine, Johnson City, TN. OBJECTIVE: To identify the benefits of offering a letrozole/FSH (folliclestimulating hormone) hybrid protocol to clomiphene citrate-alone and letrozole-alone failures for superovulation induction insemination + intrauterine (SOI/IUI) cycles prior to considering an FSH-alone protocol, and thereby increase access to care among an infertility population. DESIGN: Patients attending a University infertility practice in Eastern Appalachia were recognized who had failed to conceive by clomiphene citrate and letrozole-alone cycles and were unable to financially consider either a gonadotropin-only/IUI or IVF (in vitro fertilization) cycle. Those patients were offered a letrozole/FSH combined cycle as an affordable alternative to abandonment of treatment.
Pre-Consult
12 Months*
Percent of respondents ranking each factor among top 3 priorities
Pregnancy Supporting Pregnancy Supporting Candidates Partners Candidates Partners (n ¼ 82) (n ¼ 61) (n ¼ 39) (n ¼ 24) That I become a parent one way or another 52% 38% 59% 33% That I/my partner get(s) to be the person who is pregnant with and gives birth to my child 42% 36% 23% 38% That my child has [pregnancy candidate’s] genes 22% 30% 31% 33% That my child has [supporting partner’s] genes 20% 39% 26% 50% That I have a child in the next year or two 55% 23% 39% 25% Cost 24% 16% 13% 21% That I can build my family in a way that doesn’t make it obvious to others that we had trouble 1% 0% 5% 0% That I get to parent my child from birth 20% 16% 13% 21% That I maintain a close and satisfying relationship with my partner 62% 79% 74% 58% That I avoid side effects from medical treatments 2% 20% 10% 13%
Bold: significant difference by role; *Includes only respondents who are not pregnant/parenting
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