Heather Shapiro - Academia.edu (original) (raw)

Papers by Heather Shapiro

Research paper thumbnail of Serum Hormonal Testing After Ovulation Triggering in Assisted Reproductive Technology: A Survey of Practice in Canadian In Vitro Fertilization Clinics

Journal of Obstetrics and Gynaecology Canada

Research paper thumbnail of National Canadian Survey on the Management of Noneuploid Embryos

Journal of Obstetrics and Gynaecology Canada

Research paper thumbnail of Prevalence of Blood-Borne Viral Infections (HIV, HBV, HCV) Among People Seeking Fertility Services in Ontario, Canada

International Journal of Population Data Science, 2020

IntroductionThe Applied Health Research Question (AHRQ) portfolio is an initiative funded by the ... more IntroductionThe Applied Health Research Question (AHRQ) portfolio is an initiative funded by the Ontario Ministry of Health. Knowledge users submit AHRQ requests to use administrative health data to inform their planning, policy and program development. Objectives and ApproachA request to estimate prevalence and incidence of blood-borne viral infections (BBVI) among individuals seeking fertility treatment services was approved by the ICES AHRQ team. To determine whether current BBVI testing guidelines are effective for timely identification of BBVI among individuals undergoing fertility treatment, this AHRQ sought to estimate: a) the testing prevalence for BBVI (using viral hepatitis as a proxy for all BBVI including HIV), and b) BBVI incidence over a five-year follow-up period. We used infertility codes billed by gynecologists and urologists to identify individuals seeking fertility treatment between April 1, 2002 and March 31, 2013. We looked forward five years from a first BBVI t...

Research paper thumbnail of Managing and preventing blood-borne viral infection transmission in assisted reproduction: a Canadian Fertility and Andrology Society clinical practice guideline

Reproductive BioMedicine Online, 2020

People who are living with HIV or hepatitis and have a viral load that is undetectable or unquant... more People who are living with HIV or hepatitis and have a viral load that is undetectable or unquantifiable are not infectious and pose no risk of cross-contamination in the ART laboratory. ART laboratories should process these gametes in the usual fashion without any special precautions needed to prevent infection.

Research paper thumbnail of Safety and Assisted Reproductive Technology Outcomes of Hysteroscopic Tubal Microinserts Versus Laparoscopic Proximal Tubal Occlusion or Salpingectomy for Hydrosalpinges Treatment

Journal of Obstetrics and Gynaecology Canada, 2020

Objective: This study sought to answer the following question: What are the complications and ass... more Objective: This study sought to answer the following question: What are the complications and assisted reproductive technology outcomes among women with hydrosalpinges managed by hysteroscopic microinsert tubal occlusion compared with women with hydrosalpinges managed by laparoscopic proximal tubal occlusion or salpingectomy? Methods: This was a retrospective cohort study conducted from January 2009 to December 2014 at two academic, tertiary care, in vitro fertilization centres in Toronto, Ontario. All patients (n = 52) who underwent hysteroscopic tubal occlusion for hydrosalpinges were identified. Patients who proceeded with embryo transfer cycles after hysteroscopic microinsert (n = 33) were further age matched to a cohort of patients who underwent embryo transfer after laparoscopic proximal tubal occlusion or salpingectomy (n = 33). Main outcome measures were clinical pregnancy rate per patient and per embryo transfer cycle.

Research paper thumbnail of A Systematic Review of Database Validation Studies among Fertility Populations

Journal of Obstetrics and Gynaecology Canada, 2018

Of the 19 studies included, only one validated a national fertility registry and none reported th... more Of the 19 studies included, only one validated a national fertility registry and none reported their results in accordance with recommended reporting guidelines for validation studies. WHAT IS KNOWN ALREADY: Routinely collected data, including administrative databases and registries, are excellent sources of data, particularly for reporting, quality assurance, and research. However, these data are subject to misclassification bias due to misdiagnosis or errors in data entry and therefore need to be validated prior to using for clinical or research purposes. STUDY DESIGN, SIZE, DURATION: We conducted a systematic review by searching Medline, Embase, and CINAHL from inception to 6 October 2016 to identify validation studies of databases that contain routinely collected data in an ART setting. Webpages of international ART centers were also searched. PARTICIPANTS/MATERIALS, SETTING, METHODS: We included studies that compared at least two data sources to validate ART population data. Key words and MeSH terms were adapted from previous systematic reviews investigating routinely collected data (e.g. administrative databases and registries), measures of validity (including sensitivity, specificity, and predictive value), and ART (including infertility, IVF, advanced reproductive age, and diminished ovarian reserve). Only full-text studies in English were considered. Results were synthesized qualitatively. The electronic search yielded 1074 citations, of which 19 met the inclusion criteria. WIDER IMPLICATIONS OF THE FINDINGS: There is a paucity of literature on validation of routinely collected data from a fertility population. Furthermore, the prevalence of the markers that have been validated are not being presented, which can lead to biased estimates. Stakeholders rely on these data for monitoring outcomes of treatments and adverse events; therefore, it is essential to ascertain the accuracy of these databases and make the reports publicly available.

Research paper thumbnail of A Step Towards Equitable Access: Understanding the Use of Fertility Services by Immigrant Women in Toronto

Journal of Obstetrics and Gynaecology Canada, 2018

Objective: The authors sought to study whether there is differential access to fertility services... more Objective: The authors sought to study whether there is differential access to fertility services for immigrant women in a single-payer system. Methods: A cross-sectional quantitative survey was administered to 265 patients over 3 months. All participants were female patients in heterosexual relationships at a university-affiliated hospital-based fertility clinic in a large metropolitan city. Data on sociodemographic characteristics, reproductive history, and experience accessing fertility services were collected. Statistical analysis, including chisquare and ANOVA regression, was completed using JMP software. Results: The response rate of the survey was 86.6%. A total of 265 women participated, 124 (47%) immigrants and 141(53%) nonimmigrants. Immigrants more commonly left questions unanswered. Long-term immigrants had a significantly longer average duration of infertility than non-immigrant women (47 months vs. 34 months; P = 0.04). There was a trend towards a delay in seeing a health care provider among long-term immigrants. The most commonly reported reasons for delaying fertility care were "not knowing there was a problem" and "treatments being too expensive." Although participants across all groups relied on their primary care provider to supply information on fertility services, a greater percentage (17%) of recent immigrants than non-immigrant participants (7%) used the Internet to obtain information. Conclusion: Immigrant women addressed their fertility needs even when they had fewer resources and less social stability than did non-immigrant women. However, they experienced a delay in receiving specialized care for infertility. Immigrant women also appeared less comfortable disclosing personal information in a health care setting.

Research paper thumbnail of The use of vaginal ultrasound for monitoring endometrial preparation in a donor oocyte program

Fertility and Sterility, 1993

Objective: To determine whether vaginal sonographic measurements can be used to monitor the endom... more Objective: To determine whether vaginal sonographic measurements can be used to monitor the endometrial preparation of recipients in a donor egg program. Design: Prospective clinical trial. Setting: University hospital-based IVF and donor egg program. Patients: Twelve women without ovarian function. Interventions: [1) In a control cycle, patients received 4 or 8 mg of oral E 2 and vaginal ultrasound (US) daily until endometrial thickness 2: 6 mm with a triple-line pattern (favorable endometrium) was seen. Progesterone (P) in oil, 100 mg/d, was then added. [2) An endometrial biopsy was performed on day 7 of P therapy. [3) In a treatment cycle, US monitoring of endometrial development during estrogen (E) administration was used; and ET was performed on the 3rd day of P therapy. Results: In the control cycle, 8 mg/d or 4 mg/d of micronized E2 resulted in favorable endometrium development in all patients in a mean time of 5 and 7 days, respectively. After P treatment, only 1 of 12 endometrial biopsies was in phase. In the treatment cycles, the overall clinical pregnancy rate (PR) was 42%. In those patients with a favorable endometrium in theE replacement phase, before addition of P, the PR was 62.5%. All of the pregnant patients but only 42.8% of the nonpregnant patients had a favorable endometrium on US before the addition of P. Conclusion: An endometrium that is favorable for implantation can result from the use of a simple fixed dose of E 2 , with higher doses achieving favorable endometrial development in shorter time. Vaginal sonography of endometrial development before P administration is more accurate than endometrial biopsy in predicting a successful donor egg cycle. Endometrial preparation in donor oocyte programs can be simplified by the use of vaginal US monitoring.

Research paper thumbnail of End-of-Rotation Examinations in Canadian Obstetrics and Gynaecology Residency Programs: The Perspectives of Faculty Members and Residents

Journal of Obstetrics and Gynaecology Canada, 2017

The Royal College Competence by Design curriculum in obstetrics and gynaecology will launch in 20... more The Royal College Competence by Design curriculum in obstetrics and gynaecology will launch in 2019, and it will depend heavily on multiple tools for accurate resident assessment. Several Canadian obstetrics and gynaecology residency programs use rotationspecific examinations at the end of various rotations for formative feedback. The obstetrics and gynaecology residency program at the University of Toronto adopted end-of-rotation examinations (EOREs) in 2014. We conducted a national survey to assess the current use of EOREs across Canada and to examine the attitudes and beliefs of residents and program directors regarding their use. We discuss faculty and resident experiences with EOREs and their perceptions of them. We also consider the role and benefit of these examinations in the context of the educational literature, and how they may integrate with future competency-based medical education frameworks. Résumé Le programme de la compétence par conception (CPC) en obstétrique et gynécologie du Collège royal sera lancé en 2019. Il dépendra largement de plusieurs outils pour évaluer de façon adéquate les résidents. De nombreux programmes canadiens de résidence en obstétrique et gynécologie ont recours à des examens ciblés à la fin de chaque stage afin d'offrir une rétroaction formative. Le programme de résidence en obstétrique et gynécologie de l'Université de Toronto a d'ailleurs adopté cette façon de faire en 2014. Nous avons mené une étude à l'échelle du pays dans le but d'évaluer l'utilisation de ces examens au Canada et d'examiner les croyances et l'attitude des résidents et des directeurs de programmes à l'égard de ces examens et de leur emploi. Nous parlons ici de la perception qu'ont les résidents et les enseignants de ces examens ainsi que de leur expérience avec ces derniers. Nous examinons également les avantages de ces examens et la place qu'ils occupent dans la littérature universitaire, et étudions leur intégration potentielle dans d'éventuels programmes de formation fondés sur les compétences.

Research paper thumbnail of Factors Affecting Academic Promotion in Obstetrics and Gynaecology in Canada

Journal of Obstetrics and Gynaecology Canada, 2004

Objective: (I) To determine if women faculty members in departments of Obstetrics and Gynaecology... more Objective: (I) To determine if women faculty members in departments of Obstetrics and Gynaecology were less likely than men to achieve promotion; and (2) to assess gender differences in attitudes towards promotion. Methods: Department chairs at the 16 medical schools in Canada were approached to participate in this study. A questionnaire was mailed to the obstetricians/gynaecologists in faculties of medicine at the IS Canadian medical schools that agreed to participate. Likelihood of promotion for women and men was compared using survival analysis, controlling for other factors. Survival (event) time was the time in years between completion of residency and achieving promotion. Results: The response rate was 72% (376/522). Overall, 37% of respondents were women, and 63% were men. The women respondents were younger than the men, with a mean age of 43.4 ± 7.9 years compared to 52.8 ± 8.9 years. Of those in an academic stream, 39% of women (29/75) and 62% of men (90/145) had attained senior academic ranks. Completing residency more recently was associated with a higher likelihood of promotion to Assistant Professor (hazard ratio [HR], 1.05; P <0.00 I). The likelihood of promotion to Professor was lower for women than for men (HR, 0.40; P = 0.05). Having a mentor was associated with a higher likelihood of promotion to Professor (HR, 2.33; P = 0.002). Women were more likely to perceive barriers to promotion, such as family care responsibilities (P <0.00 I). Conclusion: Independent of the respondent's gender, recent completion of reSidency and having a mentor were the most significant factors increasing the likelihood of promotion in Canadian medical school departments of Obstetrics and Gynaecology. As women were found to be less likely than men to achieve promotion to Professor, mentoring and strate

Research paper thumbnail of RETIRED: Breast Cancer, Pregnancy, and Breastfeeding

Journal of Obstetrics and Gynaecology Canada, 2002

Research paper thumbnail of Delaying Thyroxine Until Positive Beta-Human Chorionic Gonadotropin is Safe for Patients Receiving Fertility Therapy: Applying New ATA Guidelines to Subclinical Hypothyroidism

Journal of Obstetrics and Gynaecology Canada, 2017

Objective: This study sought to examine the effect of changing TSH threshold recommendations from... more Objective: This study sought to examine the effect of changing TSH threshold recommendations from 2.5 to 4 mIU/L before fertility therapy on the prevalence of early gestational subclinical hypothyroidism (SCH) (TSH2 >2.5 mIU/L) and to evaluate implications on progression to clinical pregnancy (defined as detection of cardiac activity on ultrasound). Methods: A retrospective chart review was performed in an academic fertility clinic on all patients with a measured pretreatment TSH (TSH1) and positive beta-human chorionic gonadotropin following fertility treatment. The study assessed the effect of TSH2 on ongoing pregnancy, both in patients newly diagnosed with SCH and in patients previously receiving LT4, stratified by initial TSH. Results: Of 482 women included in the study, baseline TSH (TSH1) was <2.5 mIU/L in 333 women (69%) and 2.5-4 mIU/L in 64 women (13.2%). Eighty-five women were taking LT4 at baseline (17.6%). Among women with a TSH1 between 2.5 and 4 mIU/L, the corresponding TSH in early pregnancy (TSH2) was <2.5 mIU/L in 35 women (55%). Overall, there was no difference in progression to clinical pregnancy between women with a TSH2 of 2.5-4 mIU/L compared with women with a TSH2 <2.5 mIU/L (OR 0.70; 95% CI 0.44-1.09). Similarly, when excluding women taking LT4 at baseline, there was no difference in progression to clinical pregnancy (OR 0.90; 95% CI 0.28-2.86). Conclusion: Rate of progression to clinical pregnancy was equivalent between women with an early pregnancy TSH

Research paper thumbnail of Use of an oncology sperm bank: a Canadian experience

Canadian Urological Association Journal, 2013

Background: We performed a retrospective chart review in 2006to review oncology patients’ use of ... more Background: We performed a retrospective chart review in 2006to review oncology patients’ use of banked semen samples infertility treatments at a tertiary care centre.Methods: From 2002 to 2005, 367 oncology patients bankedsemen. During the same period, 31 patients used banked samplesin 48 treatment cycles. Samples were used for intrauterine insemination(IUI) in 28 cycles and for in vitro fertilization (IVF) withor without intracytoplasmic sperm injection (ICSI) in 20 cycles.Results: Pregnancy rates per cycle were 21% for IUI and 50%for IVF with or without ICSI. Overall, 16 of the 31 couples achieveda pregnancy with assisted reproductive technologies (52%).Conclusion: This data indicates high pregnancy success rates withthe use of banked semen samples from men with cancer.Contexte : Une revue rétrospective de dossiers a été effectuée afind’examiner le recours à des échantillons de sperme provenantde patients cancéreux pour le traitement de l’infertilité dans uncentre de soins tertia...

Research paper thumbnail of Randomized Trial Comparing the Effect of Endometrial Shedding With Medroxyprogesterone Acetate With Random Start of Clomiphene Citrate for Ovulation Induction in Oligo-Ovulatory and Anovulatory Women

Journal of Obstetrics and Gynaecology Canada, 2016

A recent retrospective study demonstrated that anovulatory infertile women who did not have a pro... more A recent retrospective study demonstrated that anovulatory infertile women who did not have a progestogen-induced withdrawal bleed before treatment with clomiphene citrate (CC) had higher pregnancy rates than women who had a withdrawal bleed and those who had spontaneous menstrual bleeding. We sought to assess endometrial thickness at the time of ovulation in oligo-ovulatory and anovulatory women who took CC with or without a preceding progestogen-induced withdrawal bleed. We conducted a pilot randomized trial in which women with infertility and oligomenorrhea or amenorrhea were randomly assigned to take either CC after a withdrawal bleed induced by medroxyprogesterone acetate (MPA) 10 mg daily for 10 days or to take CC without such a bleed. Study participants underwent cycle monitoring with ultrasound assessment of endometrial thickness at the time of LH surge or a human chorionic gonadotropin trigger, followed by timed intercourse or intrauterine insemination. Women who had not ovulated by cycle day 21 took an increased dose of CC, with or without an MPA-induced withdrawal bleed, to a maximum of three cycles. Participants and nurses were asked to complete a questionnaire about the study. There was no significant difference in endometrial thickness on the day of LH surge or human chorionic gonadotropin trigger between women who had a progestogen-induced withdrawal bleed and those who did not (P = 0.65). On average, the time to ovulation was 15 days longer in women who took MPA than in women who did not, but this difference was not statistically significant (P = 0.65). Satisfaction with the study was reported as high by both patients and nurses. In anovulatory or oligo-ovulatory women treated with CC, we found no significant difference in endometrial thickness whether or not the use of CC was preceded by a withdrawal bleed induced by MPA.

Research paper thumbnail of Case Report

American Journal of Geriatric Psychiatry, 2003

ABSTRACT This study explores the impact of raloxifene, a selective estrogen receptor modulator, o... more ABSTRACT This study explores the impact of raloxifene, a selective estrogen receptor modulator, on learning and memory functions in postmenopausal women with schizophrenia. Placebo improved the scores somewhat, suggesting a practice effect. Raloxifene further improved the scores to alevel similar to that of schizophrenia-free subjects The results suggest that raloxifene might prove helpful, but the samplesize is too small for useful inference from the statistical analysis.

Research paper thumbnail of A Canadian, multicentre study comparing the efficacy of a levonorgestrel-releasing intrauterine system to an oral contraceptive in women with idiopathic menorrhagia

Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2009

To evaluate the efficacy of a levonorgestrel-releasing intrauterine system (LNG-IUS) compared wit... more To evaluate the efficacy of a levonorgestrel-releasing intrauterine system (LNG-IUS) compared with a combined oral contraceptive containing 1 mg norethindrone acetate and 20 mg ethinyl estradiol (OC1/20) in reducing menstrual blood loss (MBL) in women with idiopathic menorrhagia. A prospective, randomized, open-label study was conducted in nine centres in Canada. Healthy women over 30 years of age suffering from idiopathic menorrhagia were treated either with LNG-IUS (n = 20) or with OC1/20 (n = 19) over 12 months. The primary endpoint was the change in MBL from baseline to 12 months. Secondary endpoints included treatment success (defined as a MBL score < 100 after 12 months), hemoglobin levels, and the menorrhagia severity score. In both treatment groups, MBL decreased significantly from baseline to 12 months (P < 0.001). For the primary endpoint, the MBL score decreased significantly more in the LNG-IUS group (median from 228 to 13, mean percent change-83%) compared to the ...

Research paper thumbnail of “Just what the doctor ordered”: Factors associated with oncology patients’ decision to bank sperm

Canadian Urological Association Journal, 2012

Introduction: The purpose of this cross-sectional study was to explore factors associated with on... more Introduction: The purpose of this cross-sectional study was to explore factors associated with oncology patients' decision to bank sperm prior to cancer treatment. Materials and Methods: Patients who were referred to the oncology sperm banking program between January 2009 and March 2010 were invited to complete an 18-item questionnaire during one of their sperm banking visits. Results: Of the 157 cancer patients referred to the Mount Sinai Oncology Sperm and Tissue Bank for sperm banking during the 15-month period, 79 questionnaires were returned (50% response rate). Of the respondents, 89% were informed about sperm banking by their physician. Future family planning was cited as the main reason to bank. Cost was not a barrier for the vast majority of respondents. Forty percent of respondents banked sperm within 4 days prior to initiating cancer treatment. Most respondents relied on their physician for verbal information on sperm banking. Eightyone percent were unaware of any patient organizations that have educational materials on oncology fertility preservation. Conclusion: Sperm banking prior to cancer treatment is the only proven method of preserving fertility for cancer patients. The two main determinants associated with deciding whether to bank sperm were: the physician's recommendation and the patient's desire for future fatherhood. Physicians play a key role in influencing patients' decisions. The recommendation to bank sperm is a persuasive message if patients are clearly informed about their potential risk of infertility post-cancer treatment, and that sperm banking is an effective way of preserving fertility. Providing patients with education materials might enhance compliance in sperm banking. plupart des répondants avaient reçu des informations verbales de leur médecin sur la mise en banque de sperme. Quatre-vingt-un pour cent n'étaient pas au courant s'il existait des organisations de patients offrant du matériel éducatif sur la préservation de la fertilité chez les patients cancéreux. Conclusion : La mise en banque de sperme avant un traitement contre le cancer est la seule méthode éprouvée de préservation de la fertilité chez les patients atteints de cancer. Les deux principaux facteurs déterminants dans la décision de procéder à la mise en banque de sperme étaient les suivants : recommandation du médecin et volonté du patient de devenir père plus tard. Les médecins ont une grande influence sur la décision des patients. La recommandation de mettre du sperme en banque est un message persuasif si les patients sont bien informés au sujet du risque potentiel d'infertilité après le traitement anticancéreux, et s'ils savent que la mise de sperme en banque est un moyen efficace de préserver sa fertilité. Fournir du matériel éducatif aux patients pourrait accroître leur observance quant aux programmes de mise en banque de sperme.

Research paper thumbnail of Laparoscopic myomectomy versus uterine artery embolization: long-term impact on markers of ovarian reserve

Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2014

To compare the relative long-term effects on ovarian reserve of treating fibroids in reproductive... more To compare the relative long-term effects on ovarian reserve of treating fibroids in reproductive-aged women with uterine artery embolization (UAE) versus laparoscopic myomectomy (LM), using sensitive measures including antral follicle count (AFC) and serum anti-Müllerian hormone (AMH). We undertook a retrospective cohort pilot study to evaluate the utility and feasibility of carrying out a larger prospective trial. Thirteen women were evaluated in this study, including eight in the UAE group and five in the LM group. They were identified from a larger group of 125 women who had undergone LM and 200 women who had undergone UAE at a participating institution at least 12 months previously; of these, 32 who had UAE and 27 who had LM were of reproductive age and eligible to participate. Participants had an assessment of ovarian reserve including measurements of serum AMH, estradiol, and FSH, and ultrasound assessment of AFC and ovarian volume. Median serum AMH levels were significantly ...

Research paper thumbnail of Access to conception planning information and services for people living with HIV in Ontario, Canada: A community-based research study

Vulnerable Children and Youth Studies, 2012

Decreased mortality, decreased risk of vertical HIV transmission, and many people living with HIV... more Decreased mortality, decreased risk of vertical HIV transmission, and many people living with HIV (PLWHIV) being of reproductive age have led many PLWHIV to consider pregnancy. However, scarce data exist regarding the conception planning resources required and available for PLWHIV to have safe and healthy pregnancies. This study aimed to identify gaps between the need for, knowledge of, and access

Research paper thumbnail of Psychological side-effects of clomiphene citrate and human menopausal gonadotrophin

Journal of Psychosomatic Obstetrics & Gynecology, 2005

This study evaluated the psychological side-effects of clomiphene citrate (CC) and hMG in women u... more This study evaluated the psychological side-effects of clomiphene citrate (CC) and hMG in women undergoing fertility treatment. This study was a cross-sectional, self-report survey of 454 women at various stages of treatment for infertility. At the time of study, 139 women had not taken fertility drugs and 315 women had taken one or more cycles of CC or hMG. All subjects were asked to complete the State-Trait Anxiety Inventory (STAI). Women taking CC or hMG were also asked to complete a self-administered questionnaire on the side-effects of their medications. In the CC group (n = 162) and hMG group (n = 153), 77.8% (126 of 162) and 94.8% (145 of 153) reported at least one side-effect, respectively. Irritability, mood swings, feeling down, and bloating had high frequencies in both CC and hMG groups, with a higher mean number of side effects reported in the hMG group (4.4 +/- 3.7 for the CC group and 6.8 +/- 3.7 for the hMG group, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). There was no significant difference among the CC, hMG and no medication groups for mean state and trait anxiety scores. However, there were significant differences among the three side-effect groups (those who reported 1 to 4, 5 to 7, and more than 7 side-effects) for the mean scores of state (df = 2, F = 8.7, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and trait (df = 2, F = 11.9, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) anxiety in women taking fertility drugs. Women taking CC or hMG reported high frequencies of psychological side-effects, and should be advised of these before treatment.

Research paper thumbnail of Serum Hormonal Testing After Ovulation Triggering in Assisted Reproductive Technology: A Survey of Practice in Canadian In Vitro Fertilization Clinics

Journal of Obstetrics and Gynaecology Canada

Research paper thumbnail of National Canadian Survey on the Management of Noneuploid Embryos

Journal of Obstetrics and Gynaecology Canada

Research paper thumbnail of Prevalence of Blood-Borne Viral Infections (HIV, HBV, HCV) Among People Seeking Fertility Services in Ontario, Canada

International Journal of Population Data Science, 2020

IntroductionThe Applied Health Research Question (AHRQ) portfolio is an initiative funded by the ... more IntroductionThe Applied Health Research Question (AHRQ) portfolio is an initiative funded by the Ontario Ministry of Health. Knowledge users submit AHRQ requests to use administrative health data to inform their planning, policy and program development. Objectives and ApproachA request to estimate prevalence and incidence of blood-borne viral infections (BBVI) among individuals seeking fertility treatment services was approved by the ICES AHRQ team. To determine whether current BBVI testing guidelines are effective for timely identification of BBVI among individuals undergoing fertility treatment, this AHRQ sought to estimate: a) the testing prevalence for BBVI (using viral hepatitis as a proxy for all BBVI including HIV), and b) BBVI incidence over a five-year follow-up period. We used infertility codes billed by gynecologists and urologists to identify individuals seeking fertility treatment between April 1, 2002 and March 31, 2013. We looked forward five years from a first BBVI t...

Research paper thumbnail of Managing and preventing blood-borne viral infection transmission in assisted reproduction: a Canadian Fertility and Andrology Society clinical practice guideline

Reproductive BioMedicine Online, 2020

People who are living with HIV or hepatitis and have a viral load that is undetectable or unquant... more People who are living with HIV or hepatitis and have a viral load that is undetectable or unquantifiable are not infectious and pose no risk of cross-contamination in the ART laboratory. ART laboratories should process these gametes in the usual fashion without any special precautions needed to prevent infection.

Research paper thumbnail of Safety and Assisted Reproductive Technology Outcomes of Hysteroscopic Tubal Microinserts Versus Laparoscopic Proximal Tubal Occlusion or Salpingectomy for Hydrosalpinges Treatment

Journal of Obstetrics and Gynaecology Canada, 2020

Objective: This study sought to answer the following question: What are the complications and ass... more Objective: This study sought to answer the following question: What are the complications and assisted reproductive technology outcomes among women with hydrosalpinges managed by hysteroscopic microinsert tubal occlusion compared with women with hydrosalpinges managed by laparoscopic proximal tubal occlusion or salpingectomy? Methods: This was a retrospective cohort study conducted from January 2009 to December 2014 at two academic, tertiary care, in vitro fertilization centres in Toronto, Ontario. All patients (n = 52) who underwent hysteroscopic tubal occlusion for hydrosalpinges were identified. Patients who proceeded with embryo transfer cycles after hysteroscopic microinsert (n = 33) were further age matched to a cohort of patients who underwent embryo transfer after laparoscopic proximal tubal occlusion or salpingectomy (n = 33). Main outcome measures were clinical pregnancy rate per patient and per embryo transfer cycle.

Research paper thumbnail of A Systematic Review of Database Validation Studies among Fertility Populations

Journal of Obstetrics and Gynaecology Canada, 2018

Of the 19 studies included, only one validated a national fertility registry and none reported th... more Of the 19 studies included, only one validated a national fertility registry and none reported their results in accordance with recommended reporting guidelines for validation studies. WHAT IS KNOWN ALREADY: Routinely collected data, including administrative databases and registries, are excellent sources of data, particularly for reporting, quality assurance, and research. However, these data are subject to misclassification bias due to misdiagnosis or errors in data entry and therefore need to be validated prior to using for clinical or research purposes. STUDY DESIGN, SIZE, DURATION: We conducted a systematic review by searching Medline, Embase, and CINAHL from inception to 6 October 2016 to identify validation studies of databases that contain routinely collected data in an ART setting. Webpages of international ART centers were also searched. PARTICIPANTS/MATERIALS, SETTING, METHODS: We included studies that compared at least two data sources to validate ART population data. Key words and MeSH terms were adapted from previous systematic reviews investigating routinely collected data (e.g. administrative databases and registries), measures of validity (including sensitivity, specificity, and predictive value), and ART (including infertility, IVF, advanced reproductive age, and diminished ovarian reserve). Only full-text studies in English were considered. Results were synthesized qualitatively. The electronic search yielded 1074 citations, of which 19 met the inclusion criteria. WIDER IMPLICATIONS OF THE FINDINGS: There is a paucity of literature on validation of routinely collected data from a fertility population. Furthermore, the prevalence of the markers that have been validated are not being presented, which can lead to biased estimates. Stakeholders rely on these data for monitoring outcomes of treatments and adverse events; therefore, it is essential to ascertain the accuracy of these databases and make the reports publicly available.

Research paper thumbnail of A Step Towards Equitable Access: Understanding the Use of Fertility Services by Immigrant Women in Toronto

Journal of Obstetrics and Gynaecology Canada, 2018

Objective: The authors sought to study whether there is differential access to fertility services... more Objective: The authors sought to study whether there is differential access to fertility services for immigrant women in a single-payer system. Methods: A cross-sectional quantitative survey was administered to 265 patients over 3 months. All participants were female patients in heterosexual relationships at a university-affiliated hospital-based fertility clinic in a large metropolitan city. Data on sociodemographic characteristics, reproductive history, and experience accessing fertility services were collected. Statistical analysis, including chisquare and ANOVA regression, was completed using JMP software. Results: The response rate of the survey was 86.6%. A total of 265 women participated, 124 (47%) immigrants and 141(53%) nonimmigrants. Immigrants more commonly left questions unanswered. Long-term immigrants had a significantly longer average duration of infertility than non-immigrant women (47 months vs. 34 months; P = 0.04). There was a trend towards a delay in seeing a health care provider among long-term immigrants. The most commonly reported reasons for delaying fertility care were "not knowing there was a problem" and "treatments being too expensive." Although participants across all groups relied on their primary care provider to supply information on fertility services, a greater percentage (17%) of recent immigrants than non-immigrant participants (7%) used the Internet to obtain information. Conclusion: Immigrant women addressed their fertility needs even when they had fewer resources and less social stability than did non-immigrant women. However, they experienced a delay in receiving specialized care for infertility. Immigrant women also appeared less comfortable disclosing personal information in a health care setting.

Research paper thumbnail of The use of vaginal ultrasound for monitoring endometrial preparation in a donor oocyte program

Fertility and Sterility, 1993

Objective: To determine whether vaginal sonographic measurements can be used to monitor the endom... more Objective: To determine whether vaginal sonographic measurements can be used to monitor the endometrial preparation of recipients in a donor egg program. Design: Prospective clinical trial. Setting: University hospital-based IVF and donor egg program. Patients: Twelve women without ovarian function. Interventions: [1) In a control cycle, patients received 4 or 8 mg of oral E 2 and vaginal ultrasound (US) daily until endometrial thickness 2: 6 mm with a triple-line pattern (favorable endometrium) was seen. Progesterone (P) in oil, 100 mg/d, was then added. [2) An endometrial biopsy was performed on day 7 of P therapy. [3) In a treatment cycle, US monitoring of endometrial development during estrogen (E) administration was used; and ET was performed on the 3rd day of P therapy. Results: In the control cycle, 8 mg/d or 4 mg/d of micronized E2 resulted in favorable endometrium development in all patients in a mean time of 5 and 7 days, respectively. After P treatment, only 1 of 12 endometrial biopsies was in phase. In the treatment cycles, the overall clinical pregnancy rate (PR) was 42%. In those patients with a favorable endometrium in theE replacement phase, before addition of P, the PR was 62.5%. All of the pregnant patients but only 42.8% of the nonpregnant patients had a favorable endometrium on US before the addition of P. Conclusion: An endometrium that is favorable for implantation can result from the use of a simple fixed dose of E 2 , with higher doses achieving favorable endometrial development in shorter time. Vaginal sonography of endometrial development before P administration is more accurate than endometrial biopsy in predicting a successful donor egg cycle. Endometrial preparation in donor oocyte programs can be simplified by the use of vaginal US monitoring.

Research paper thumbnail of End-of-Rotation Examinations in Canadian Obstetrics and Gynaecology Residency Programs: The Perspectives of Faculty Members and Residents

Journal of Obstetrics and Gynaecology Canada, 2017

The Royal College Competence by Design curriculum in obstetrics and gynaecology will launch in 20... more The Royal College Competence by Design curriculum in obstetrics and gynaecology will launch in 2019, and it will depend heavily on multiple tools for accurate resident assessment. Several Canadian obstetrics and gynaecology residency programs use rotationspecific examinations at the end of various rotations for formative feedback. The obstetrics and gynaecology residency program at the University of Toronto adopted end-of-rotation examinations (EOREs) in 2014. We conducted a national survey to assess the current use of EOREs across Canada and to examine the attitudes and beliefs of residents and program directors regarding their use. We discuss faculty and resident experiences with EOREs and their perceptions of them. We also consider the role and benefit of these examinations in the context of the educational literature, and how they may integrate with future competency-based medical education frameworks. Résumé Le programme de la compétence par conception (CPC) en obstétrique et gynécologie du Collège royal sera lancé en 2019. Il dépendra largement de plusieurs outils pour évaluer de façon adéquate les résidents. De nombreux programmes canadiens de résidence en obstétrique et gynécologie ont recours à des examens ciblés à la fin de chaque stage afin d'offrir une rétroaction formative. Le programme de résidence en obstétrique et gynécologie de l'Université de Toronto a d'ailleurs adopté cette façon de faire en 2014. Nous avons mené une étude à l'échelle du pays dans le but d'évaluer l'utilisation de ces examens au Canada et d'examiner les croyances et l'attitude des résidents et des directeurs de programmes à l'égard de ces examens et de leur emploi. Nous parlons ici de la perception qu'ont les résidents et les enseignants de ces examens ainsi que de leur expérience avec ces derniers. Nous examinons également les avantages de ces examens et la place qu'ils occupent dans la littérature universitaire, et étudions leur intégration potentielle dans d'éventuels programmes de formation fondés sur les compétences.

Research paper thumbnail of Factors Affecting Academic Promotion in Obstetrics and Gynaecology in Canada

Journal of Obstetrics and Gynaecology Canada, 2004

Objective: (I) To determine if women faculty members in departments of Obstetrics and Gynaecology... more Objective: (I) To determine if women faculty members in departments of Obstetrics and Gynaecology were less likely than men to achieve promotion; and (2) to assess gender differences in attitudes towards promotion. Methods: Department chairs at the 16 medical schools in Canada were approached to participate in this study. A questionnaire was mailed to the obstetricians/gynaecologists in faculties of medicine at the IS Canadian medical schools that agreed to participate. Likelihood of promotion for women and men was compared using survival analysis, controlling for other factors. Survival (event) time was the time in years between completion of residency and achieving promotion. Results: The response rate was 72% (376/522). Overall, 37% of respondents were women, and 63% were men. The women respondents were younger than the men, with a mean age of 43.4 ± 7.9 years compared to 52.8 ± 8.9 years. Of those in an academic stream, 39% of women (29/75) and 62% of men (90/145) had attained senior academic ranks. Completing residency more recently was associated with a higher likelihood of promotion to Assistant Professor (hazard ratio [HR], 1.05; P <0.00 I). The likelihood of promotion to Professor was lower for women than for men (HR, 0.40; P = 0.05). Having a mentor was associated with a higher likelihood of promotion to Professor (HR, 2.33; P = 0.002). Women were more likely to perceive barriers to promotion, such as family care responsibilities (P <0.00 I). Conclusion: Independent of the respondent's gender, recent completion of reSidency and having a mentor were the most significant factors increasing the likelihood of promotion in Canadian medical school departments of Obstetrics and Gynaecology. As women were found to be less likely than men to achieve promotion to Professor, mentoring and strate

Research paper thumbnail of RETIRED: Breast Cancer, Pregnancy, and Breastfeeding

Journal of Obstetrics and Gynaecology Canada, 2002

Research paper thumbnail of Delaying Thyroxine Until Positive Beta-Human Chorionic Gonadotropin is Safe for Patients Receiving Fertility Therapy: Applying New ATA Guidelines to Subclinical Hypothyroidism

Journal of Obstetrics and Gynaecology Canada, 2017

Objective: This study sought to examine the effect of changing TSH threshold recommendations from... more Objective: This study sought to examine the effect of changing TSH threshold recommendations from 2.5 to 4 mIU/L before fertility therapy on the prevalence of early gestational subclinical hypothyroidism (SCH) (TSH2 >2.5 mIU/L) and to evaluate implications on progression to clinical pregnancy (defined as detection of cardiac activity on ultrasound). Methods: A retrospective chart review was performed in an academic fertility clinic on all patients with a measured pretreatment TSH (TSH1) and positive beta-human chorionic gonadotropin following fertility treatment. The study assessed the effect of TSH2 on ongoing pregnancy, both in patients newly diagnosed with SCH and in patients previously receiving LT4, stratified by initial TSH. Results: Of 482 women included in the study, baseline TSH (TSH1) was <2.5 mIU/L in 333 women (69%) and 2.5-4 mIU/L in 64 women (13.2%). Eighty-five women were taking LT4 at baseline (17.6%). Among women with a TSH1 between 2.5 and 4 mIU/L, the corresponding TSH in early pregnancy (TSH2) was <2.5 mIU/L in 35 women (55%). Overall, there was no difference in progression to clinical pregnancy between women with a TSH2 of 2.5-4 mIU/L compared with women with a TSH2 <2.5 mIU/L (OR 0.70; 95% CI 0.44-1.09). Similarly, when excluding women taking LT4 at baseline, there was no difference in progression to clinical pregnancy (OR 0.90; 95% CI 0.28-2.86). Conclusion: Rate of progression to clinical pregnancy was equivalent between women with an early pregnancy TSH

Research paper thumbnail of Use of an oncology sperm bank: a Canadian experience

Canadian Urological Association Journal, 2013

Background: We performed a retrospective chart review in 2006to review oncology patients’ use of ... more Background: We performed a retrospective chart review in 2006to review oncology patients’ use of banked semen samples infertility treatments at a tertiary care centre.Methods: From 2002 to 2005, 367 oncology patients bankedsemen. During the same period, 31 patients used banked samplesin 48 treatment cycles. Samples were used for intrauterine insemination(IUI) in 28 cycles and for in vitro fertilization (IVF) withor without intracytoplasmic sperm injection (ICSI) in 20 cycles.Results: Pregnancy rates per cycle were 21% for IUI and 50%for IVF with or without ICSI. Overall, 16 of the 31 couples achieveda pregnancy with assisted reproductive technologies (52%).Conclusion: This data indicates high pregnancy success rates withthe use of banked semen samples from men with cancer.Contexte : Une revue rétrospective de dossiers a été effectuée afind’examiner le recours à des échantillons de sperme provenantde patients cancéreux pour le traitement de l’infertilité dans uncentre de soins tertia...

Research paper thumbnail of Randomized Trial Comparing the Effect of Endometrial Shedding With Medroxyprogesterone Acetate With Random Start of Clomiphene Citrate for Ovulation Induction in Oligo-Ovulatory and Anovulatory Women

Journal of Obstetrics and Gynaecology Canada, 2016

A recent retrospective study demonstrated that anovulatory infertile women who did not have a pro... more A recent retrospective study demonstrated that anovulatory infertile women who did not have a progestogen-induced withdrawal bleed before treatment with clomiphene citrate (CC) had higher pregnancy rates than women who had a withdrawal bleed and those who had spontaneous menstrual bleeding. We sought to assess endometrial thickness at the time of ovulation in oligo-ovulatory and anovulatory women who took CC with or without a preceding progestogen-induced withdrawal bleed. We conducted a pilot randomized trial in which women with infertility and oligomenorrhea or amenorrhea were randomly assigned to take either CC after a withdrawal bleed induced by medroxyprogesterone acetate (MPA) 10 mg daily for 10 days or to take CC without such a bleed. Study participants underwent cycle monitoring with ultrasound assessment of endometrial thickness at the time of LH surge or a human chorionic gonadotropin trigger, followed by timed intercourse or intrauterine insemination. Women who had not ovulated by cycle day 21 took an increased dose of CC, with or without an MPA-induced withdrawal bleed, to a maximum of three cycles. Participants and nurses were asked to complete a questionnaire about the study. There was no significant difference in endometrial thickness on the day of LH surge or human chorionic gonadotropin trigger between women who had a progestogen-induced withdrawal bleed and those who did not (P = 0.65). On average, the time to ovulation was 15 days longer in women who took MPA than in women who did not, but this difference was not statistically significant (P = 0.65). Satisfaction with the study was reported as high by both patients and nurses. In anovulatory or oligo-ovulatory women treated with CC, we found no significant difference in endometrial thickness whether or not the use of CC was preceded by a withdrawal bleed induced by MPA.

Research paper thumbnail of Case Report

American Journal of Geriatric Psychiatry, 2003

ABSTRACT This study explores the impact of raloxifene, a selective estrogen receptor modulator, o... more ABSTRACT This study explores the impact of raloxifene, a selective estrogen receptor modulator, on learning and memory functions in postmenopausal women with schizophrenia. Placebo improved the scores somewhat, suggesting a practice effect. Raloxifene further improved the scores to alevel similar to that of schizophrenia-free subjects The results suggest that raloxifene might prove helpful, but the samplesize is too small for useful inference from the statistical analysis.

Research paper thumbnail of A Canadian, multicentre study comparing the efficacy of a levonorgestrel-releasing intrauterine system to an oral contraceptive in women with idiopathic menorrhagia

Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2009

To evaluate the efficacy of a levonorgestrel-releasing intrauterine system (LNG-IUS) compared wit... more To evaluate the efficacy of a levonorgestrel-releasing intrauterine system (LNG-IUS) compared with a combined oral contraceptive containing 1 mg norethindrone acetate and 20 mg ethinyl estradiol (OC1/20) in reducing menstrual blood loss (MBL) in women with idiopathic menorrhagia. A prospective, randomized, open-label study was conducted in nine centres in Canada. Healthy women over 30 years of age suffering from idiopathic menorrhagia were treated either with LNG-IUS (n = 20) or with OC1/20 (n = 19) over 12 months. The primary endpoint was the change in MBL from baseline to 12 months. Secondary endpoints included treatment success (defined as a MBL score < 100 after 12 months), hemoglobin levels, and the menorrhagia severity score. In both treatment groups, MBL decreased significantly from baseline to 12 months (P < 0.001). For the primary endpoint, the MBL score decreased significantly more in the LNG-IUS group (median from 228 to 13, mean percent change-83%) compared to the ...

Research paper thumbnail of “Just what the doctor ordered”: Factors associated with oncology patients’ decision to bank sperm

Canadian Urological Association Journal, 2012

Introduction: The purpose of this cross-sectional study was to explore factors associated with on... more Introduction: The purpose of this cross-sectional study was to explore factors associated with oncology patients' decision to bank sperm prior to cancer treatment. Materials and Methods: Patients who were referred to the oncology sperm banking program between January 2009 and March 2010 were invited to complete an 18-item questionnaire during one of their sperm banking visits. Results: Of the 157 cancer patients referred to the Mount Sinai Oncology Sperm and Tissue Bank for sperm banking during the 15-month period, 79 questionnaires were returned (50% response rate). Of the respondents, 89% were informed about sperm banking by their physician. Future family planning was cited as the main reason to bank. Cost was not a barrier for the vast majority of respondents. Forty percent of respondents banked sperm within 4 days prior to initiating cancer treatment. Most respondents relied on their physician for verbal information on sperm banking. Eightyone percent were unaware of any patient organizations that have educational materials on oncology fertility preservation. Conclusion: Sperm banking prior to cancer treatment is the only proven method of preserving fertility for cancer patients. The two main determinants associated with deciding whether to bank sperm were: the physician's recommendation and the patient's desire for future fatherhood. Physicians play a key role in influencing patients' decisions. The recommendation to bank sperm is a persuasive message if patients are clearly informed about their potential risk of infertility post-cancer treatment, and that sperm banking is an effective way of preserving fertility. Providing patients with education materials might enhance compliance in sperm banking. plupart des répondants avaient reçu des informations verbales de leur médecin sur la mise en banque de sperme. Quatre-vingt-un pour cent n'étaient pas au courant s'il existait des organisations de patients offrant du matériel éducatif sur la préservation de la fertilité chez les patients cancéreux. Conclusion : La mise en banque de sperme avant un traitement contre le cancer est la seule méthode éprouvée de préservation de la fertilité chez les patients atteints de cancer. Les deux principaux facteurs déterminants dans la décision de procéder à la mise en banque de sperme étaient les suivants : recommandation du médecin et volonté du patient de devenir père plus tard. Les médecins ont une grande influence sur la décision des patients. La recommandation de mettre du sperme en banque est un message persuasif si les patients sont bien informés au sujet du risque potentiel d'infertilité après le traitement anticancéreux, et s'ils savent que la mise de sperme en banque est un moyen efficace de préserver sa fertilité. Fournir du matériel éducatif aux patients pourrait accroître leur observance quant aux programmes de mise en banque de sperme.

Research paper thumbnail of Laparoscopic myomectomy versus uterine artery embolization: long-term impact on markers of ovarian reserve

Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2014

To compare the relative long-term effects on ovarian reserve of treating fibroids in reproductive... more To compare the relative long-term effects on ovarian reserve of treating fibroids in reproductive-aged women with uterine artery embolization (UAE) versus laparoscopic myomectomy (LM), using sensitive measures including antral follicle count (AFC) and serum anti-Müllerian hormone (AMH). We undertook a retrospective cohort pilot study to evaluate the utility and feasibility of carrying out a larger prospective trial. Thirteen women were evaluated in this study, including eight in the UAE group and five in the LM group. They were identified from a larger group of 125 women who had undergone LM and 200 women who had undergone UAE at a participating institution at least 12 months previously; of these, 32 who had UAE and 27 who had LM were of reproductive age and eligible to participate. Participants had an assessment of ovarian reserve including measurements of serum AMH, estradiol, and FSH, and ultrasound assessment of AFC and ovarian volume. Median serum AMH levels were significantly ...

Research paper thumbnail of Access to conception planning information and services for people living with HIV in Ontario, Canada: A community-based research study

Vulnerable Children and Youth Studies, 2012

Decreased mortality, decreased risk of vertical HIV transmission, and many people living with HIV... more Decreased mortality, decreased risk of vertical HIV transmission, and many people living with HIV (PLWHIV) being of reproductive age have led many PLWHIV to consider pregnancy. However, scarce data exist regarding the conception planning resources required and available for PLWHIV to have safe and healthy pregnancies. This study aimed to identify gaps between the need for, knowledge of, and access

Research paper thumbnail of Psychological side-effects of clomiphene citrate and human menopausal gonadotrophin

Journal of Psychosomatic Obstetrics & Gynecology, 2005

This study evaluated the psychological side-effects of clomiphene citrate (CC) and hMG in women u... more This study evaluated the psychological side-effects of clomiphene citrate (CC) and hMG in women undergoing fertility treatment. This study was a cross-sectional, self-report survey of 454 women at various stages of treatment for infertility. At the time of study, 139 women had not taken fertility drugs and 315 women had taken one or more cycles of CC or hMG. All subjects were asked to complete the State-Trait Anxiety Inventory (STAI). Women taking CC or hMG were also asked to complete a self-administered questionnaire on the side-effects of their medications. In the CC group (n = 162) and hMG group (n = 153), 77.8% (126 of 162) and 94.8% (145 of 153) reported at least one side-effect, respectively. Irritability, mood swings, feeling down, and bloating had high frequencies in both CC and hMG groups, with a higher mean number of side effects reported in the hMG group (4.4 +/- 3.7 for the CC group and 6.8 +/- 3.7 for the hMG group, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). There was no significant difference among the CC, hMG and no medication groups for mean state and trait anxiety scores. However, there were significant differences among the three side-effect groups (those who reported 1 to 4, 5 to 7, and more than 7 side-effects) for the mean scores of state (df = 2, F = 8.7, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and trait (df = 2, F = 11.9, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) anxiety in women taking fertility drugs. Women taking CC or hMG reported high frequencies of psychological side-effects, and should be advised of these before treatment.