Measuring patient-centredness in publicly funded fertility care: A New Zealand validation and international comparison of the Patient-Centred Questionnaire-Infertility.

BACKGROUND: The Patient-Centred Questionnaire-Infertility (PCQ-Infertility) has proven to be a reliable instrument to assess the extent of patient-centredness of fertility care in European countries. AIMS: To validate the PCQ-Infertility in New Zealand (NZ) and to compare results with international experience. MATERIALS AND METHODS: A cross-sectional 46-item questionnaire study among 409 women undergoing publicly funded fertility care (intrauterine insemination or in vitro fertilisation / intracytoplasmic sperm injection) in three fertility clinics in the Northern Auckland region was performed between October 2015 and September 2016. Inclusion of eligible participants was both retro- and prospective. The questionnaire was distributed by email link and women were asked to complete it with their partner. Internal consistency and construct validity were determined and correction for case mix was performed. Mean dimension scores, adjusted for 'current pregnancy', 'educational level' and 'treatment type', were calculated for each dimension of the PCQ-Infertility. NZ results were compared with PCQ-Infertility results from five countries. RESULTS: Of 409 invited women, 255 questionnaires were submitted (response rate 62%), of which 216 (53%) were analysable. The dimension 'Care organization' had poor internal consistency, but overall the questionnaire had high internal consistency (Cronbach's α = 0.93). Construct validity was also good. International comparison showed NZ to have the second highest overall score. In New Zealand, the lowest scoring domain was 'Continuity and transition'. CONCLUSIONS: The NZ version of the PCQ-infertility proved a valid instrument for the assessment of patient-centredness of publicly funded fertility care. Future research should focus on international inequities in patient-centred fertility care and use of the tool for quality improvement. Local use of the PCQ-Infertility is encouraged.

Single embryo transfer for all?

Historically to maintain live birth rates for women undergoing in vitro fertilisation (IVF), multiple embryos were transferred. Improvements in technology have meant a move to selective single embryo transfer (SET). Do we now have enough confidence in SET to make it mandatory?

High live birth rate in the subsequent IVF cycle after first-cycle poor response among women with mean age 35 and normal FSH.

Poor ovarian response in IVF cycles is associated with diminished ovarian reserve and poor pregnancy outcome. Little is known about pregnancy outcome after a poor response in women with a normal ovarian reserve. This retrospective study studied women undergoing IVF/intracytoplasmic sperm injection between January 2003 to December 2008 in the FertilityPLUS Clinic in Auckland, New Zealand. All women with a poor response in the first cycle were selected. Primary outcome was live birth after the second cycle. Secondary outcomes were poor response in the second cycle and the predictive values of female age and basal FSH at first cycle and IVF outcome at second cycle. Of the 2487 women starting IVF, 142 women (5.7%) with a poor response in the first cycle were selected, of which 66 (46.5%) women had a repeated poor response in the second cycle. There were 31 live births in the second cycle (21.8%). Female age was the only significant predictor for repeated poor response (AUC 0.69, 95% CI 0.61-0.78) and clinical pregnancy (AUC 0.66, 95% CI 0.57-0.75), but the predictive value was low. Therefore poor response in women with a normal ovarian reserve should not be a reason to discontinue further IVF treatment. Poor ovarian response in IVF cycles is associated with diminished ovarian reserve and poor pregnancy outcome. Little is known about pregnancy outcome after a poor response in women with a normal ovarian reserve. In this retrospective study, we studied women undergoing IVF/intracytoplasmic sperm injection (ICSI) between January 2003 to December 2008 in the FertilityPLUS Clinic in Auckland, New Zealand. All women with a poor response in the first cycle were selected. Primary outcome was live birth after the second cycle. Secondary outcomes were poor response in the second cycle and the predictive value of female age and basal FSH at first cycle and IVF outcome at the second cycle. Of the 2487 women starting wit IVF, a total of 142 women (5.7%) with a poor response in the first cycle were selected, of which 66 (46.5%) women had a repeated poor response in the second cycle. There were 31 live births in the second cycle (22%). Female age was the only significant predictor for repeated poor response and clinical pregnancy, but the predictive value was low. Therefore poor response in women with a normal ovarian reserve should not be a reason to discontinue further IVF treatment.

IVF and tubal pathology--not all bad news.

OBJECTIVES: In light of evidence that hydrosalpinges compromise the chance of success of in vitro fertilisation (IVF), the aim of this study was to analyse the results of IVF treatment at our clinic in relation to the cause for infertility and to make inferences concerning the impact of mild tubal disease on IVF outcome. DESIGN: Retrospective observational study. SETTING Tertiary fertility clinic in New Zealand. POPULATION: Nine hundred and six consecutive cycles among 639 couples receiving IVF treatment in the six-year period 1995-2000 inclusive. METHODS: Data extraction from the clinic database. RESULTS: The clinical pregnancy rate of 17.5% per ovarian stimulation cycle and 23.9% per embryo transfer for the cycles of couples with tubal disease as the only cause for infertility was not significantly different from the clinical pregnancy rate of 15.4% per ovarian stimulation cycle and 24.1% per embryo transfer for all other couples undergoing IVF. In the cycles of women with tubal disease, the clinical pregnancy rate of 6.6% per ovarian stimulation cycle where other causes for infertility were also present, was significantly lower than the clinical pregnancy rate of 17.5% where tubal factor alone was present. In the cycles of couples with multiple causes for infertility, where the overall pregnancy rate was 10.9% per ovarian stimulation cycle, there was no significant difference in pregnancy rate between those whose multiple causes included tubal disease (6.6% per ovarian stimulation cycle) and those whose multiple causes did not include tubal disease (17.5% per ovarian stimulation cycle). CONCLUSION: The overall population of women with tubal disease as the sole cause for infertility (including women with hydrosalpinges and those with non-hydrosalpinx tubal disease) does not have an overall reduced likelihood of success at IVF. This suggests that non-hydrosalpinx tubal disease does not compromise the chance of success from IVF. Surgical treatment prior to IVF for the milder forms of tubal disease is not warranted.