A recent prospective investigation into the reasons insured patients drop out of IVF in the United States clearly demonstrated the psychological toll infertility can take. The study found that emotional distress is the number one reason that patients discontinue treatment.
How to lower the patient’s stress level
It can be challenging to counsel the patient to set realistic expectations for success yet enable her to maintain a sense of optimism. Stress management may be a key to success.
Physicians who treat patients with fertility problems should consider offering an in-practice counseling service aimed at reducing stress and improving coping mechanisms. At the very least, physicians should refer patients to outside resources that may be able to provide these services in a way that is meaningful and accessible.
Caring for a patient’s emotional well-being takes both time and skill. Besides offering direct emotional support to your patients, you can be a bridge to mental health and support services.
Patients who participate in a stress-reduction program while undergoing fertility treatment are 1) less likely to experience harmful emotional side effects and 2) more likely to continue treatment. Physicians who make such “mind-body” programs available are likely to reduce treatment dropout, improve the pregnancy rate, and increase the number of patients who take home babies.
WHAT THIS EVIDENCE MEANS FOR PRACTICE
Pay attention to the patient’s emotional health during treatment for infertility. Offer her access to stress management and other resources.
New endometriosis fertility index predicts non-IVF success rate
Adamson GD, Pasta DJ. Endometriosis fertility index: the new, validated endometriosis staging system. Fertil Steril. 2009 Nov 18 [Epub ahead of print].
Endometriosis remains a frustrating disease for patients who have infertility, in part because no staging system has made it possible for physicians to predict the pregnancy rate with fertility treatment other than IVF. The new, validated endometriosis fertility index (EFI) changes that. This simple, robust clinical tool predicts the pregnancy rate after surgical staging of endometriosis. Using it can provide reassurance to patients who have a good prognosis and avoid cost and distress of treatment in patients who have a poor prognosis.
Among the variables the index utilizes to predict the likelihood of pregnancy are:
- age of the patient
- duration of infertility
- gravidity
- total revised American Fertility Society (R-AFS) score
- R-AFS lesion score
- the new “least function score” (capability of the tubes, fimbria, and ovaries to effect their reproductive function, as determined by the surgeon after operative treatment) (FIGURES 2 AND 3).
FIGURE 2 Estimated pregnancy rate, by EFI score
FIGURE 3 A look at the endometriosis fertility index (EFI)
The least-function (LF) score (A) is determined at the conclusion of surgery using this form. The endometriosis fertility index (EFI) (B) incorporates the LF score and other variables to determine the overall score.
WHAT THIS EVIDENCE MEANS FOR PRACTICE
If you manage endometriosis patients who have infertility, use the new endometriosis fertility index to develop a realistic treatment plan in women who have a good prognosis—or to avert the need for treatment in patients who are unlikely to conceive.