The role of emotional social support in the psychological adjustment of siblings of children with cancer.

BACKGROUND: Siblings of children with cancer are at risk for reduced emotional support. The role of emotional social support in the psychological adjustment of siblings of paediatric cancer patients was examined, in the context of age and gender. METHODS: The sample consisted of two groups of siblings of children being treated for cancer: siblings referred for behaviour problems (n = 47) and a comparison group of non-referred siblings (n = 25). Forty-two were female, and 30 were male. The mean age was 10.31 years (SD = 2.71). Siblings completed measures of depression, anxiety, behaviour, and emotional social support. One parent of each sibling completed measures of sibling's behaviour and anxiety. RESULTS: Siblings who reported more social support endorsed significantly fewer symptoms of depression, anxiety, and fewer behaviour problems, and their parents reported less anxiety and fewer behaviour problems than siblings who reported lower social support. Parents of referred siblings reported significantly more behaviour problems than parents of non-referred siblings. Referred adolescent females reported significantly higher depression scores and were perceived as more anxious than referred adolescent males and non-referred adolescent females. Non-referred younger siblings with high social support were perceived by their parents as having the fewest behaviour problems. CONCLUSIONS: High level of social support appears to play a protective role in psychological adjustment of siblings of paediatric cancer patients, with age and gender as modifying factors. Although not all siblings develop behaviour or emotional problems, it is critical to identify those who do in order to intervene accordingly.

Biological versus chronological ageing of oocytes, distinguishable by raised FSH levels in relation to the success of IVF treatment.

BACKGROUND: The present study addresses the issue of biological ageing of the oocyte (as indicated by basal serum FSH levels) versus chronological ageing. METHODS: 1019 infertile but ovulating women were studied in their first cycle of IVF treatment. A series of logistic regression models were developed to assess statistical significance of effects of age and FSH on implantation rates and live babies born. RESULTS: The number of oocytes retrieved and embryos available for transfer declined with increasing age and basal serum FSH concentrations. Fertilizing ability of oocytes increased with advancing age but was not affected by FSH concentrations. Although the number of oocytes or embryos available for transfer had no independent effect on implantation rates, the implanting ability of fertilized oocytes (embryos) was inversely related to increasing age and independently to FSH. The chance of a baby being born, however, was determined more by age than by serum FSH. CONCLUSIONS: Ovarian ageing affecting oocyte quality and fecundity can occur independently of chronological age. This has important practical implications whereby serum basal FSH measurement may be a valuable prognostic index, though chronological age remains important.

The age-related decline in female fecundity: a quantitative controlled study of implanting capacity and survival of individual embryos after in vitro fertilization.

OBJECTIVE: To determine strictly comparable rates per embryo of implantation and birth of a baby related to the woman's age, which would be representative of natural fertility at least in relative terms. DESIGN: Comparative study of IVF-ET results controlling for confounding variables including cause and duration of infertility, history of previous pregnancy, hormonal treatment, rank cycle of treatment, and numbers of embryos transferred and available. SETTING: University comprehensive fertility service. PATIENTS: All couples (n = 561) in their first cycle of treatment reaching oocyte collection, women with normal uterus and ovulatory cycles, and men with normal sperm. INTERVENTIONS: Standardized methods of pituitary desensitization, ovarian stimulation, and IVF-ET, and maximum of three embryos transferred. MAIN OUTCOME MEASURES: Oocytes, pregnancies, and live births per cycle; fertilization and cleavage rates; embryo implantation and live baby rates. RESULTS: The numbers of oocytes and consequent embryos declined with age but fertilization and cleavage rates rose slightly. Embryo implantation rates were reduced when no more than three embryos were available (9.3 percent), especially in women aged 35 to 39 years (6.2 percent) or older compared with four or more embryos (17.1 percent) but were equally low in all women over 40 years even with more embryos (6.1 percent). In the age bands 25 to 29, 30 to 34, 35 to 39, and 40 to 44 years, the rates per embryo of implantation were 18.2 percent, 16.1 percent, 15.3 percent, and 6.1 percent, respectively, and of a live baby were 15.7 percent, 12.1 percent, 12.0 percent, and 3.5 percent. CONCLUSIONS: Embryo implanting ability and survival decline gradually after 30 years of age, but by more than two thirds after 40 years and in younger women with reduced ovarian capacity.

Tubal surgery versus assisted reproduction: assessing their role in infertility therapy.

The majority of women with tubal/pelvic infective damage have a poor prognosis for natural conception, and in-vitro fertilization and embryo transfer would be a better primary choice. Other determining factors are sperm disorder or the woman's age, and personal issues may be of overriding importance. The most important requirement in the first place, however, is well defined, comparable statistical information on time-specific cumulative pregnancy rates related to specific diagnostic features. The main aims of this review are to analyze the most useful comparable data available and present them in graphical form for easy reference and clear understanding (by the patients too), and to try to derive a practically simple and prognostically valuable diagnostic classification.

Outcome of inadvertent administration of a gonadotrophin-releasing hormone agonist (buserelin) in early pregnancy.

All women undergoing pituitary down-regulation before planned in-vitro fertilization (IVF) treatment in two IVF units were studied to assess the risks of and to pregnancies occurring inadvertently when gonadotropin-releasing hormone agonists (GnRHa) were used to achieve pituitary desensitization during the luteal phase prior to planned IVF treatment. In 2670 cycles, 25 women conceived (0.9% of cycles). Of these, three resulted in pre-clinical abortions (12%) but there were no clinical abortions, and 22 have ended with live births at term of apparently normal infants. Collation of these and other published data suggest that pregnancy outcome is not adversely affected by GnRHa administration in the luteal phase of the conception cycle.

Expectations of assisted conception for infertility.

OBJECTIVE: To provide reliable prognostic information for couples seeking assisted conception. DESIGN: Analysis of four years' practice (1988-91). SETTING: Private university service linked with NHS reproductive medicine services. PATIENTS: 804 couples with various causes of subfertility, median duration five years, median age of women 34 years. INTERVENTIONS: 1280 completed cycles: 950 in vitro fertilisation, 144 gamete intrafallopian transfer, and 186 intrauterine insemination and superovulation. MAIN OUTCOME MEASURES: Pregnancy and birth rates per cycle and cumulative pregnancy and take home baby rates per couple. RESULTS: In women under 40 years and men with normal sperm, whatever the cause of infertility, results with in vitro fertilisation improved steadily reaching a pregnancy rate per cycle of 30% (95% confidence interval 26% to 35%) during 1990-1 and birth rate per cycle of 29% (23% to 35%) in 1990. Pregnancy and birth rates for gamete intrafallopian transfer were 36% (28% to 44%) and 26% (17% to 37%) and for intrauterine insemination 18% (12% to 24%) and 16% (10% to 22%). After six cycles cumulative probability of pregnancy was 82% and cumulative take home baby rate 70%. Considering only in vitro fertilisation and gamete intrafallopian transfer after four cycles the pregnancy rate was 78% (66% to 91%). CONCLUSIONS: Conception is less likely in women over 40 and men with sperm dysfunction. For other couples the prognosis for a live birth is at least as good as for fertile couples if they persist with treatment.