- Email: [email protected]
Physician's perspectives and practices regarding the fertility counseling and management of obese patients
MATERIALS AND METHODS: Data analysis was performed of infertile couples who underwent IVF from 2008-2009. Inclusion criteria were: 1) that the study cycle was conducted at the University of Colorado Hospital; and 2) self-report of ethnicity on the treatment intake questionnaire. Exclusion criteria were: 1) oocyte donation; 2) cycle cancellation; 3) failed fertilization; or 4) freeze all cycle. RESULTS: 102 patients met restrictive requirements and underwent 113 treatment cycles. 31 cycles were conducted in women who self-identified as Black, Hispanic, Asian, or other and these women were included in the minority group. 82 cycles were performed in Caucasian women. Both groups were of similar age (33.5 vs. 33.3, P¼0.80), and had similar rates of diminished ovarian reserve (40% vs. 35%, P¼0.66). Minorities also had a similar number of oocytes retrieved (13.1 vs. 15.3, P¼0.22), number of oocytes fertilized (6.8 vs. 8.3, P¼0.15), peak estradiol levels (3266 vs. 3353, P¼0.84), and peak endometrial thickness (11.6 vs. 10.9, P¼0.13). Minorities had more embryos transferred per cycle (2.8 vs. 2.5, P¼0.036), and a lower implantation rate (27% vs. 38%, P¼0.1). Minorities had a significantly lower ongoing pregnancy rate (30% vs. 60%, P¼0.0094), although when minorities did achieve pregnancy, they trended towards a higher multiple pregnancy rate (33% vs. 19%, P¼0.39). CONCLUSION: Minorities have similar stimulation parameters to Caucasians, yet have significantly lower ongoing pregnancy rates. Although minorities tended to have greater endometrial thickness, implantation rate was lower than in Caucasian women. The reasons for these differences are unclear at present, but further investigation is needed to improve the reproductive outcomes of minority patients.
O-235 Wednesday, October 19, 2011 12:00 PM NATIONAL AND INTERNATIONAL REPRODUCTIVE ‘‘TOURISM’’: PATIENTS’ PERSPECTIVES ON A GROWING GLOBAL PHENOMENON. M. C. Inhorn, P. Patrizio. Anthropolgy, Yale University, New Haven, CT; Obstetrics/Gynecology/Reproductive Sciences, Yale University, New Haven, CT. OBJECTIVE: To study what motivates the global movements of infertile people searching for ART in the USA (across states) and the Middle East (international travelers). DESIGN: Person-centered, qualitative (ethnographic) interviews. MATERIALS AND METHODS: A three-year study (2007-9) of reproductive tourists to the Middle East and the US. The study was carried out in ART clinics in Dubai, United Arab Emirates (UAE), and Yale University (IRB-approved protocol). Nearly 300 reproductive tourists hailing from more than 50 nations and six continents (North America, South America, Europe, Australia, Asia, and Africa) were interviewed. Interviews lasted from onehalf to three hours and were conducted in ARTclinic settings (some were conducted over the telephone or in patients’ homes). RESULTS: Eight major factors promote reproductive tourism: 1) religious, ethical, and legal restrictions; 2) lack of expertise and equipment; 3) supply problems and waiting lists; 4) safety concerns; 5) prohibitions on categories of individuals, on the basis of age, marital status, or sexual orientation; 6); lack of medical privacy and confidentiality; 7) poor quality medical care and low ART success rates; and finally, 8) cost factors. Other less-discussed factors also play a role. These include language barriers, desire for a physician co-religionist, need for familial social support, and desire to produce an ‘‘anchor baby’’ conferring citizenship rights in another country. CONCLUSION: This study represents the first long-term, comparative, qualitative investigation of reproductive tourism from the patients’ perspectives. A major finding is that most reproductive travelers lament the lack of necessary ART services in their own residential locales, and wish that they could remain ‘‘at home’’ instead of ‘‘temporary exiling’’. Whereas the UAE represents a ‘‘global hub’’ for reproductive tourism from many countries, the coastal cities of the US are also drawing European, Latin American, and East Asian patients seeking specifically oocyte donation and surrogacy.
DESIGN: National, electronic physician survey. MATERIALS AND METHODS: We conducted a national survey of program directors of forty-one academic programs and sixty-five medical directors of private practices. RESULTS: There were 43 total respondents, 22 from University-based practices, and 21 from Private practices. The majority of respondents reported that their clinics performed fewer than 300 cycles per year and had fewer than 100 cycles with patients whom had a BMI greater than 30 (67.8% and 73.8%, respectively). Only 42.9% of clinics had a cut-off for access to insemination, while 73.2% of program/medical directors personally believed that a cut-off should exist. For IVF, 54.8% of clinics had a BMI cut-off despite 82.9% of program/medical directors stating that they believed such a cut-off should exist. The specific cut-points recommended varied from a BMI of 30 to 55, the responses came in a normal distribution with a mode and median of 40. Regarding recommendations for weight loss and preconception management, 36.6% of respondents stated that they typically recommend a 5-10% weight loss for their obese patients, while 58.5% recommend weight loss until a specific BMI cut-off is reached. Seventy-eight percent of respondents stated that they would recommend the same number of embryos regardless of BMI. The remainder of respondents said that they recommend fewer embryos be transferred to the obese patient. CONCLUSION: It is clear from this survey that there are varying opinions and practices throughout the country regarding the management of obese patients seeking ART. However, there seems to be appears to be consensus that a set of guidelines should exist, and the SREI and ASRM are the best suited organizations for making such recommendations.
O-237 Wednesday, October 19, 2011 12:30 PM LATINO PERSPECTIVES ON INFERTILITY TREATMENT: THE IMPACT OF CULTURAL, SOCIAL AND RELIGIOUS FACTORS ON THE UTILIZATION OF INFERTILITY SERVICES. A. L. Dawson, L. G. Rodriguez-Riesco, R. Alvero. Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO. OBJECTIVE: Multiple studies have shown that Latino couples access fertility services at half the rate of other groups even in low cost settings. This study evaluates the reasons for this underutilization. DESIGN: A qualitative interview research study of Latino couples selfidentifying as having compromised fertility MATERIALS AND METHODS: Fifteen women and seven men were interviewed in a single sex setting about their attitudes and understanding of infertility diagnoses and treatment. An open-ended and iterative question format was used to elicit patients’ understanding of and experience with infertility. All interviews were led by a certified native Spanish speaker, recorded, transcribed and translated for analysis. RESULTS: Persistent themes mentioned by most couples included lack of familiarity with the health care system and available services, lack of basic medical knowledge, and fear of knowing which member of the couple was responsible for infertility. Participants reported greater familiarity with and confidence in alternative treatments as their primary source of care. Couples perceived a lack of knowledge and interest from primary providers, the health care system and public policy with regard to infertility issues in Latinos. The majority of participants denied that their religion prohibited them from seeking care but a consistent fatalism about fertility was voiced by most. Interviewees suggested awareness could be increased and the stigma of infertility decreased by disseminating knowledge through radio, TVand other media outlets. While cost was mentioned by many, it is not clear that this is the primary prohibitive factor in accessing care. CONCLUSION: We identified numerous barriers to infertility care in Latino couples, many of which could be remediated through education of primary care physicians and efforts to empower patients through knowledge. Novel public health approaches include the use of media outlets to accurately inform patients. Supported by: Academic Enrichment Fund at University of Colorado Denver.
O-236 Wednesday, October 19, 2011 12:15 PM
O-238 Wednesday, October 19, 2011 12:45 PM
PHYSICIAN’S PERSPECTIVES AND PRACTICES REGARDING THE FERTILITY COUNSELING AND MANAGEMENT OF OBESE PATIENTS. I. D. Harris, J. Python, L. Roth, R. Alvero, S. Murray, W. D. Schlaff. Obstetrics and Gynecology, University of Colorado Hospital, Aurora, CO. OBJECTIVE: To determine physicians attitudes and practice patterns regarding access to care and management strategies for obese patients.
TRENDS OF SOCIODEMOGRAPHIC DISPARITIES IN REFERRAL PATTERNS FOR FERTILITY PRESERVATION CONSULTATION. L. R. Goodman, J. E. Merserseau, U. Balthazar, J. Kim. Reproductive Endocrinology and Infertility, University of North Carolina at Chapel Hill, Chapel Hill, NC. OBJECTIVE: While oncologists are aware that cancer treatments may impact fertility, referral rates for fertility preservation consultation (FPC)
S70
Abstracts
Vol. 96., No. 3, Supplement, September 2011
O-235 Wednesday, October 19, 2011 12:00 PM NATIONAL AND INTERNATIONAL REPRODUCTIVE ‘‘TOURISM’’: PATIENTS’ PERSPECTIVES ON A GROWING GLOBAL PHENOMENON. M. C. Inhorn, P. Patrizio. Anthropolgy, Yale University, New Haven, CT; Obstetrics/Gynecology/Reproductive Sciences, Yale University, New Haven, CT. OBJECTIVE: To study what motivates the global movements of infertile people searching for ART in the USA (across states) and the Middle East (international travelers). DESIGN: Person-centered, qualitative (ethnographic) interviews. MATERIALS AND METHODS: A three-year study (2007-9) of reproductive tourists to the Middle East and the US. The study was carried out in ART clinics in Dubai, United Arab Emirates (UAE), and Yale University (IRB-approved protocol). Nearly 300 reproductive tourists hailing from more than 50 nations and six continents (North America, South America, Europe, Australia, Asia, and Africa) were interviewed. Interviews lasted from onehalf to three hours and were conducted in ARTclinic settings (some were conducted over the telephone or in patients’ homes). RESULTS: Eight major factors promote reproductive tourism: 1) religious, ethical, and legal restrictions; 2) lack of expertise and equipment; 3) supply problems and waiting lists; 4) safety concerns; 5) prohibitions on categories of individuals, on the basis of age, marital status, or sexual orientation; 6); lack of medical privacy and confidentiality; 7) poor quality medical care and low ART success rates; and finally, 8) cost factors. Other less-discussed factors also play a role. These include language barriers, desire for a physician co-religionist, need for familial social support, and desire to produce an ‘‘anchor baby’’ conferring citizenship rights in another country. CONCLUSION: This study represents the first long-term, comparative, qualitative investigation of reproductive tourism from the patients’ perspectives. A major finding is that most reproductive travelers lament the lack of necessary ART services in their own residential locales, and wish that they could remain ‘‘at home’’ instead of ‘‘temporary exiling’’. Whereas the UAE represents a ‘‘global hub’’ for reproductive tourism from many countries, the coastal cities of the US are also drawing European, Latin American, and East Asian patients seeking specifically oocyte donation and surrogacy.
DESIGN: National, electronic physician survey. MATERIALS AND METHODS: We conducted a national survey of program directors of forty-one academic programs and sixty-five medical directors of private practices. RESULTS: There were 43 total respondents, 22 from University-based practices, and 21 from Private practices. The majority of respondents reported that their clinics performed fewer than 300 cycles per year and had fewer than 100 cycles with patients whom had a BMI greater than 30 (67.8% and 73.8%, respectively). Only 42.9% of clinics had a cut-off for access to insemination, while 73.2% of program/medical directors personally believed that a cut-off should exist. For IVF, 54.8% of clinics had a BMI cut-off despite 82.9% of program/medical directors stating that they believed such a cut-off should exist. The specific cut-points recommended varied from a BMI of 30 to 55, the responses came in a normal distribution with a mode and median of 40. Regarding recommendations for weight loss and preconception management, 36.6% of respondents stated that they typically recommend a 5-10% weight loss for their obese patients, while 58.5% recommend weight loss until a specific BMI cut-off is reached. Seventy-eight percent of respondents stated that they would recommend the same number of embryos regardless of BMI. The remainder of respondents said that they recommend fewer embryos be transferred to the obese patient. CONCLUSION: It is clear from this survey that there are varying opinions and practices throughout the country regarding the management of obese patients seeking ART. However, there seems to be appears to be consensus that a set of guidelines should exist, and the SREI and ASRM are the best suited organizations for making such recommendations.
O-237 Wednesday, October 19, 2011 12:30 PM LATINO PERSPECTIVES ON INFERTILITY TREATMENT: THE IMPACT OF CULTURAL, SOCIAL AND RELIGIOUS FACTORS ON THE UTILIZATION OF INFERTILITY SERVICES. A. L. Dawson, L. G. Rodriguez-Riesco, R. Alvero. Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO. OBJECTIVE: Multiple studies have shown that Latino couples access fertility services at half the rate of other groups even in low cost settings. This study evaluates the reasons for this underutilization. DESIGN: A qualitative interview research study of Latino couples selfidentifying as having compromised fertility MATERIALS AND METHODS: Fifteen women and seven men were interviewed in a single sex setting about their attitudes and understanding of infertility diagnoses and treatment. An open-ended and iterative question format was used to elicit patients’ understanding of and experience with infertility. All interviews were led by a certified native Spanish speaker, recorded, transcribed and translated for analysis. RESULTS: Persistent themes mentioned by most couples included lack of familiarity with the health care system and available services, lack of basic medical knowledge, and fear of knowing which member of the couple was responsible for infertility. Participants reported greater familiarity with and confidence in alternative treatments as their primary source of care. Couples perceived a lack of knowledge and interest from primary providers, the health care system and public policy with regard to infertility issues in Latinos. The majority of participants denied that their religion prohibited them from seeking care but a consistent fatalism about fertility was voiced by most. Interviewees suggested awareness could be increased and the stigma of infertility decreased by disseminating knowledge through radio, TVand other media outlets. While cost was mentioned by many, it is not clear that this is the primary prohibitive factor in accessing care. CONCLUSION: We identified numerous barriers to infertility care in Latino couples, many of which could be remediated through education of primary care physicians and efforts to empower patients through knowledge. Novel public health approaches include the use of media outlets to accurately inform patients. Supported by: Academic Enrichment Fund at University of Colorado Denver.
O-236 Wednesday, October 19, 2011 12:15 PM
O-238 Wednesday, October 19, 2011 12:45 PM
PHYSICIAN’S PERSPECTIVES AND PRACTICES REGARDING THE FERTILITY COUNSELING AND MANAGEMENT OF OBESE PATIENTS. I. D. Harris, J. Python, L. Roth, R. Alvero, S. Murray, W. D. Schlaff. Obstetrics and Gynecology, University of Colorado Hospital, Aurora, CO. OBJECTIVE: To determine physicians attitudes and practice patterns regarding access to care and management strategies for obese patients.
TRENDS OF SOCIODEMOGRAPHIC DISPARITIES IN REFERRAL PATTERNS FOR FERTILITY PRESERVATION CONSULTATION. L. R. Goodman, J. E. Merserseau, U. Balthazar, J. Kim. Reproductive Endocrinology and Infertility, University of North Carolina at Chapel Hill, Chapel Hill, NC. OBJECTIVE: While oncologists are aware that cancer treatments may impact fertility, referral rates for fertility preservation consultation (FPC)
S70
Abstracts
Vol. 96., No. 3, Supplement, September 2011