Risk factors for anxiety during lesbian fertility treatment

well as pain and suffering. All of them were invited to complete a self-administered questionnaire before (T0) and after (T1) the course, which contained Professional Quality of Life (ProQol) measuring CS, compassion fatigue (CF), and other validated measures related to psychological wellbeing. RESULTS: Participants showed significant improvement in CS after attending the course (Pre-course: 33.94 + 4.4; Post-course: 36.35 + 3.82, t¼-3.29, p<0.001). There was no significant change in the subscales of Burnout and Secondary Trauma. Moreover, healthcare practitioners who were younger in age, worked longer in medical field (t¼-5.196, p<0.035) but shorter in ART setting (t¼-3.042,p<0.014) showed greater difference. In addition, those who were with lower educational level (t¼3.45,p<0.014) and had religious belief (t¼-7.071,p<0.002) also showed significant improvement in CS. CONCLUSIONS: The professional quality of life among healthcare practitioners comprises of both CS and CF. Although no significant change was found in CF, the program could still enhance CS among healthcare practitioners in ART setting. Regarding CF being the emphasis of many researches, enhancing CS involved in caring thus provides a positive aspect in cultivating job satisfaction and positive feelings in healthcare profession. Apart from preventing burnout, it can shed light on how to enhance the quality of human services in the field of ART. Therefore, CS should be taken into consideration in professional training on infertility counseling. P-723 Wednesday, October 21, 2015 TREATMENT DECISION AFTER IVF IMPLANTATION CYCLE FAILURE: CHINESE FEMALE PATIENTS’ PREFERRED ROLE IN DECISION MAKING AND ITS EFFECTS ON DECISIONAL REGRET AND PSYCHOLOGICAL WELL-BEING. C. H. Chan,a M. Tam,b H. Chan,b S. Wong.a aThe University of Hong Kong, Hong Kong, Hong Kong; bDepartment of Social Work and Social Administration, Hong Kong, Hong Kong. OBJECTIVE: This study aimed to understand female patients’ decision making during the in vitro fertilization (IVF) treatment process, especially at the stage when they choose between continuing or terminating treatment after implantation failure. DESIGN: This is a longitudinal study tracking the decision-making process of female patients over 3 time-points: After notification of implantation failure (T0), when they made a subsequent treatment decision (T1), and three months after their decision (T2). The whole study spanned for 18 months. MATERIALS AND METHODS: One hundred and thirty women notified of IVF implantation failure by a university-affiliated fertility clinic was recruited. With informed consent, they completed questionnaires including items about reproductive history, preferred role in treatment decision making for general health and infertility specific procedures, decisional factors, outcome anticipation and decisional regret. Scales included Problem Solving Decision Making (PSDM) Scale, Fertility Problem Inventory (FPI), Perceived Treatment Decision-making Difficulties Scale (PTDD) and the Decision Conflict Scale (DCS). RESULTS: On average, participated were aged 37.0 (SD¼3.5), married for 7.4 years (SD¼3.7), and being diagnosed of subfertility for 4.1 years (SD¼2.45). Majority of women received tertiary education and had a fulltime job.Using the PSDM scale, most women were classified as passive decision maker, preferred minimal shared responsibility (41.9%), or a totally passive role (40.4%). 89.4% of them regarded physicians are best to decide subsequent treatments, only 10.1% preferred shared responsibility. No respondents preferred an autonomous role.Regarding infertility specific treatment decisions, most participants preferred minimal involvement and highly dependent on physicians for making final decisions between treatment continuation and discontinuation (84.3%); only a small proportion preferred shared responsibility (7.1%), or uphold autonomy (8.6%) in the process.In terms of long term effects, regression analysis identified a subgroup of women (N¼41) who believed physicians, not patients, should make decisions in general at T0, but nonetheless wanted a bigger role in deciding their IVF treatments at T1. These women experienced significantly higher treatment regret (b¼ .076, p < .001) and depressed mood at T2 (b¼ .152, p < .05), even after controlling for depressed mood at T1. CONCLUSIONS: Results showed women tend to experience poorer psychological outcomes and higher decision regret when their belief of ‘‘Doctor knows best’’ conflict with their personal desire to play a more active role in their IVF treatment planning. It is therefore important for physicians and nurses to empower these women to express their concerns as patients, and to explore their decisional preference through the course of medical treatment in order to maximize treatment satisfaction and long-term psychological outcomes.

FERTILITY & STERILITYÒ

Supported by: This study was generously funded by the University Grant Council - General Research Fund (No: HKU740613). P-724 Wednesday, October 21, 2015 THE IMPACT OF YOGA ON ANXIETY IN INFERTILITY PATIENTS. S. Jasani,a B. Heller,b L. Juarez,c M. Davidson,d S. Jasulaitis,d J. Hirshfeld-Cytron.e aObstetrics and Gynecology PGY3, Rush University Medical Center, Chicago, IL; bPulling Down the Moon, Chicago, IL; cObstetrics and Gynecology, St Joseph Hospital, Chicago, IL; dFertility Centers of Illinois, Glenview, IL; eFertility Centers of Illinois, Tinley Park, IL. OBJECTIVE: Anxiety has been shown to worsen over time during treatment in infertility patients (Lawson et al). The aim of this study is to assess the impact of a structured yoga intervention on anxiety levels in patients with infertility. DESIGN: Non-randomized controlled trial. MATERIALS AND METHODS: One hundred three participants who reported current use of infertility treatment at a large clinical infertility practice were recruited and enrolled in this study. Forty-nine participants were recruited as controls and fifty-four received our structured six-week yoga intervention. All subjects completed a validated anxiety measure, the Spielberger State-Trait Anxiety Inventory (STAI), at baseline and at a six-week follow up. ‘‘State’’ and ‘‘trait’’ anxiety scores were compared between the control group and intervention. RESULTS: There was no difference in baseline demographics between yoga participants and controls. Mean age and BMI between the control group and yoga group was as follows respectively: 33 years (SD 5) and 27kg/m2 (SD 7.7) vs. 36 years (SD 4) and 24kg/m2 (SD 5.5). The average time attempted at conceiving was 24 months in both groups and the average time in infertility treatment was 4 months in the control group vs. 7 months in the yoga group. Mean state anxiety scores in the yoga group were significantly lower after the six weeks as compared to the control group (p¼0.014). Mean trait scores were not significantly different over the 6 weeks in either group. CONCLUSIONS: Changes in state anxiety are expected to occur prior to changes in trait anxiety and our results are consistent with this finding. Mean state anxiety levels but not trait anxiety levels were significantly lower after a structured six-week yoga intervention in patients with infertility. These results suggest that yoga may have a beneficial role in reducing anxiety in patients with infertility. Reference: 1. Lawson, A.K., Klock, S.C., Pavone, M.E, et al. Prospective study of depression and anxiety in female fertility preservation and infertility patients. Fertil Steril. 2014;102(5):1377-1384.

P-725 Wednesday, October 21, 2015 RISK FACTORS FOR ANXIETY DURING LESBIAN FERTILITY TREATMENT. S. R. Holley,a L. Pasch,b K. Rogers.c aPsychology, SFSU/UCSF, San Francicsco, CA; bPsychology, UCSF, San Francicsco, CA; cPsychology, SFSU, San Francicsco, CA. OBJECTIVE: Lesbian women represent an increasing proportion of fertility treatment patients. Little is known, however, about the degree to which they experience psychological distress during treatment, or the factors associated with such distress. The present study examined the extent to which general stressors commonly experienced by fertility treatment patients (e.g., cost, duration of treatment, perceived lack of control) and sexual minorityspecific stressors (e.g., perceived heterosexist bias within healthcare) were associated with anxiety symptoms. DESIGN: A cross-sectional survey study of 60 lesbian women pursuing pregnancy using donor sperm. MATERIALS AND METHODS: Participants completed a set of online questionnaires. General treatment-related stressors were captured with single items questions (e.g., length of time trying to conceive; out-of-pocket cost of efforts). Anxiety was assessed with the Generalized Anxiety Disorder-7 scale; lack of control was assessed with the Perceived Stress Scale; perceived heterosexist bias in healthcare was assessed via a survey adapted from the Perceptions of Racism Scale. We hypothesized that 1) both general and minority-specific stressors would be associated with higher levels of anxiety symptoms; 2) minority-specific stressors would be associated with anxiety after controlling for the effect of general stressors.

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RESULTS: Correlational analyses showed positive associations between anxiety and all of the predicted risk variables. To assess the unique effect of the minority-specific stressor, a multiple regression model was used. Results showed that, after controlling for the effects of general stressors, perceptions of heterosexist bias were associated with higher levels of anxiety. Table 1: Effect of General and Minority-Specific Stressors on Anxiety.

Anxiety b Step 1: General stressors Length of time trying to conceive Cost of treatment Perceived lack of control Step 2: Minority-specific stressors Perceived heterosexist bias Note: *p< .05

.21* -0.06 0.18 0.39* .13* 0.33*

P-726 Wednesday, October 21, 2015 MOTHERHOOD AFTER AGE 50: LONG-TERM FOLLOW UP OF PHYSICAL AND MENTAL WELL-BEING OF WOMEN WHO BECAME MOTHERS THROUGH OOCYTE DONATION. E. Davenport, H. Burks, R. Paulson. Obstetrics and Gynecology, University of Southern California, Los Angeles, CA. OBJECTIVE: To compare long-term mental and physical health outcomes of women who became mothers in their 50s to outcomes of younger women who also became mothers through oocyte donation. DESIGN: A descriptive study using validated surveys. MATERIALS AND METHODS: Participants were former infertility patients at an academic IVF center who became pregnant at any age through oocyte donation, and who had a live birth of one or more children who are now adolescents age 11 to 18. Participants completed a demographic survey and the SF-36-v2 Health Survey, a multi-purpose survey to assess mental and physical well-being. The SF-36v2 scores for physical and mental well-being were calculated for each participant, and median scores were calculated for each age group: <40 years, 40-44 years, 45-49 years, and R50 years of age at the time of live birth. SF-36v2 scores were compared between age groups using a Kruskal-Wallace test. RESULTS: Of 201 eligible patients, 33 were reached by telephone and 27 agreed to participate. At the time of abstract submission, 19 have responded, and 16 have completed both surveys. All participants completed a college education and 63% completed additional graduate school. 74% were White, 21% were Asian, and the remainder were Latina. All were married at the time of oocyte donation, but 2 are now divorced (11%). All participants who delivered at age 42 or older reported that they are older than their peer group of parents. 18 of 19 (95%) were satisfied or extremely satisfied with their decision to become a parent at the age they did. All 4 participants who became parents in their 50s were satisfied or extremely satisfied with their decision. 4 of 19 participants (17%) have disclosed to their children the use of an oocyte donor. The disclosure took place anywhere from age 2 years to 12 years. 6 of the 13 remaining participants (46%) plan to disclose. Most are unsure at what age they will disclose; those who answered stated either ages 12-14 or 16-18 years. There were no significant differences among age groups in physical (p¼0.11) or mental (p¼0.22) health scores (see table). CONCLUSIONS: Women who became mothers in their 50s have similar health-related quality of life to their younger counterparts who became mothers through oocyte donation. Mothers of very advanced age are generally satisfied with their decision to become a parent.

ASRM Abstracts

Physical Age group Health Score (n¼19) n n (SF-36) (median) <40 40-44 45-49 R50

1 9 5 4

1 7 4 4

51.0 57.0 53.5 60.5

p

0.11

Mental Health Score (median) 56.0 53.0 56.5 57.5

p

0.22

R2 Change

CONCLUSIONS: In the context of fertility treatment, sexual minorityspecific stressors appear to uniquely contribute to anxiety for lesbian women above and beyond the effect of general stressors. Changes in practice that reduce perceptions of heterosexist discrimination, or interventions to help women cope with such experiences, may help optimize the experiences that lesbian women have in treatment settings and reduce psychological distress.

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Median Physical & Mental Health Scores Among Age Groups

P-727 Wednesday, October 21, 2015 FEAR-BASED DISCLOSURE: DIFFERENT CHALLENGES AND MOTIVATIONS ACROSS SINGLE MOTHERS AND SAME-SEX FEMALE -AND HETEROSEXUAL-COUPLE PARENTS WITH SPERM DONOR-CONCEIVED CHILDREN. K. N. Anderson,a J. E. Scheib,b M. Chen,a J. J. Connor,c M. A. Rueter.a aDepartment of Family Social Science, University of Minnesota, St. Paul, MN; bDepartment of Psychology, University of California, Davis & The Sperm Bank of California, Davis, CA; cDepartment of Community Psychology, Counseling, and Family Therapy, St. Cloud State University, St. Cloud, MN. OBJECTIVE: To compare disclosure content and motivations for or against telling children about their sperm donor origins across three family types: single mothers (SM), same-sex female couples (SSC), and heterosexual couples (HC). DESIGN: Cross-sectional study of 193 parents (n ¼ 85 SM, n ¼ 72 SSC, n ¼ 36 HC) of 4-17 year-old sperm donor-conceived children (M child age ¼ 7.51). MATERIALS AND METHODS: Parents recruited from fertility clinics, donor programs, and parent groups completed an online survey about disclosure content and motivations for or against telling their child about their sperm donor conception. General linear modeling was used to test differences in disclosure content and motivations across the three family types after adjusting for covariates (child age, U.S. region or country of origin, parent education, number of children in family). RESULTS: The majority (70-80%) of parents disclosed donor sperm use, with no differences across family type. Among parents not disclosing donor sperm use, heterosexual couples were most likely to agree that they were unsure about the best way (F(2, 37) ¼ 4.46, p < .05; SM: 29%, SSC: 59%, HC: 93%) and time (F(2, 37) ¼ 3.37, p < .05; SM: 40%, SSC: 74%, HC: 87%) to tell the child, and to believe that telling the child may cause him/her to believe that s/he did not belong in the family (F(2, 38) ¼ 5.34, p < .01; SM: 9%, SSC: 0%, HC: 25%). Motivations also differed across family type among parents that had disclosed donor sperm use. Heterosexual couples were most likely to agree that they disclosed to prevent relatives or friends from doing so (F(2, 125) ¼ 4.57, p ¼ .01; SM: 5%, SSC: 5%, HC: 23%), because a clinic or counselor told them to disclose (F(2, 123) ¼ 4.95, p < .01; SM: 27%, SSC: 20%, HC: 54%), and/or to prevent their child from finding out later and being upset (F(2, 124) ¼ 5.23, p < .01; SM: 80%, SSC: 68%, HC: 100%). Heterosexual couples were more likely than SSC couples to agree that they disclosed donor sperm use because the genetically-unrelated parent wanted to tell the child (F(1, 62) ¼ 6.80, p ¼ .01; SSC: 64%, HC: 92%). CONCLUSIONS: Results suggest that a notable proportion of parents across family types are unsure about how and when to disclose donor sperm use to children. Heterosexual couples tend to have the highest rates of fearbased rationales for non-disclosure, and even disclosure of, donor sperm use. Mental health professionals working with donor-conceived families should work towards minimizing fear-based responses towards disclosure, particularly among heterosexual couples. Supported by: University of Minnesota (UMN) Agriculture Experiment Station, UMN Grant-in-Aid, UMN College of Education & Human Development Research Development Investment Grant. P-728 Wednesday, October 21, 2015 PARENT AND DONOR-CONCEIVED CHILD CHARACTERISTICS IN SINGLE MOTHER FAMILIES: A FEMINIST K. N. Anderson,a J. J. Connor,b PERSPECTIVE. M. Chen,a J. E. Scheib,c M. A. Rueter.a aUniversity of Minnesota, St. Paul, MN; b MFT, St. Cloud, MN; cUniversity of California & The Sperm Bank of Calif, Davis, CA.

Vol. 104, No. 3, Supplement, September 2015