DO & DO NOT DO DURING IVF PRACTICE.pptx

do and dont during ivf practice

1. DURING IVF PRACTICE Halim Fertility Center (HFC), Division of Reproductive, Endocrinology and Infertility, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Sumatera Utara, Adam Malik General Hospital, Medan, Indonesia. 2023

2. Individualized treatment plans Clear communication R egular monitoring Optimal medication dosages Risk assessment Educational support Emotional support Regular follow-up Addressing male factor infertility Financial transparency Team collaboration Flexibility in treatment plans

3. 1. Individualized treatment plans Each patient is given a tailored treatment plan to optimize individual success The treatment approach will be determined according to: age , diagnosis, duration of infertility, previous treatments & patient’s preferences .

4. 2. Clear communication If patients have good communication with the health professionals, they can more easily manage the infertility process ( Checton et al., 2012) infertile patients need complex & detailed information. → ↑ patients’ awareness of their condition & reduce anxiety ( Ahmadizadeh et al., 2017), ensure building trust ( Braaf et al., 2018)

5. Issues Concerning Provider-Patient Communication & Relationships Klitzman BMC Women's Health (2018)

6. 3. Regular monitoring Counting ovarian follicles & measurement by USG, hormonal assessment, particularly of serum estradiol concentration, are frequently used for monitoring COS When monitoring COS, clinicians are able to make decisions on: early cancellation of cycles without proper ovarian response the most appropriate time to trigger final follicular maturation assessment of the risk of OHSS

7. 4. Optimal medication dosages There should a be clear guidelines regarding the appropriate dose of for different clinical situations Adjust dosages based on ongoing monitoring to avoid overstimulation or under-stimulation of the ovaries

8. 5. Risk assessment Assess the risk of OHSS & take preventive measures to minimize its occurrence A combined monitoring protocol including both TVUS & serum estradiol may need to be retained as precautionary good clinical practice and as a confirmatory test in a subset of women to identify those at high risk of OHSS. Individualize the treatment to balance the need for a good ovarian response

9. Several factors have been demonstrated to independently increase the risk of developing OHSS: age < 30 years large number of small follicles (8 to 12 mm) PCOS use of hCG , as opposed to progesterone, for luteal phase support after IVF high serum estradiol at hCG trigger or rapidly rising serum estradiol large number of oocytes retrieved (> 20) previous episodes of OHSS ↑ AMH (> 3.36 ng /mL). JOGC NOVEMBRE, 2014

10. 6. Educational support Including provide comprehensive education about the medications, injections & procedures associated with IVF V aluable guidance, suggestions & counseling about drugs while monitoring patients for drug-related issues & evaluating patient adherence to prescribed treatments Depression ↓ ( 14%) with education & supportive counseling Quality of life & resilience ↑ in a psychoeducational group during their first IVF cycle. Pregnancy rates ↑ as a result of clinical pharmacist counseling (48% vs 29.3%) F1000Research 2023, 12:1592

11. 7. Emotional support Benefits for Patients Benefits for Providers More likely to receive psychological treatment, when indicated Improved understanding of patient’s needs Reduced stigma of pursuing psychotherapy Easier to navigate in-network referrals Decreased wait time for referral Reduced time burden, allows for focused fertility care appointments Improved treatment outcomes Faster time to referral appointment Continuity of care or “warm hand off” between providers on the same team Patients more likely to complete treatment Benefits to implementing mental health professionals on the fertility care team for patients and fertility providers. Megan & Angela, Women 2022, 2, 68–75

12. 8. Regular follow-up Schedule regular follow-up appointments → patient’s progress , concerns & make necessary adjustments to the treatment plan This also helps build trust & ensures between patient & provider

13. 9. Addressing male factor infertility Male factor is substantially contributory in about 50% of all cases of infertility Include both partners in discussions & assessments to ensure a comprehensive understanding of potential contributing factors Diagnostic test including: semen analysis, hormone testing, genetic testing, physical Examination

14. The results suggest that the frozen treatment approach is a better option for male factor patients. Adanacıoğlu et al., 2019

15. 10. Financial transparency From the very beginning, aim to build trust through transparency, esp financial transparency Including costs, insurance coverage & available financial assistance programs → helps manage patient expectations

16. 11. Team collaboration Delivery of IVF involves both teamwork within a discipline & teaming across multiple work areas, such as nursing, administrative, counselor laboratory & clinical. Each discipline has a different yet important role within the clinic with respect to each one’s specific work schedule & demands goes in creating a good environment Effective teamwork enhances the overall success of the IVF process

17. Improvement often requires interdisciplinary teaming & understanding performance by recording and analyzing data. When using data to track employee performance: Set clear, measurable & attainable goals that benefit the organization. Capture data on a regular basis. Engage employees in their own improvement & development. Provide regular feedback and support by checking in often. Campbell. IVF Laboratory Teaming. Fertil Steril 2021

18. 12. Flexibility in treatment plans A flexible approach allows fertility specialists to tailor treatment to specific needs, address unforeseen challenges, and increase the chances of success. Modify protocols as needed to optimize the chances of success while minimizing risks & discomfort.

19. One-Size-Fits-All Approaches Failure to Monitor Patient Progress Inadequate Patient Communication Ignoring Patient Concerns Overstimulation Risks Lack of emotional support Insufficient Education Inadequate Follow-Up Ignoring Male Factor Infertility Neglecting to Adjust Treatment Plans Failure to Address Financial Concerns

20. 1. One-Size-Fits-All Approaches There’s no one-size-fits-all approach to fertility care because everyone is unique Conslusion : A personalized, balanced approach should be taken based on individual patient characteristics & incorporating patient preference. While a freeze-all strategy might be the right choice for some patients, freeze-all is definitely not good for all.

21. 2. Failure to Monitor Patient Progress Regular ultrasound & blood tests are crucial to assess follicular development Medication dosages may change on a daily basis, as the healthcare provider is fine-tuning response based on the results.  Without such frequent monitoring, there is a greater chance that patient could become sick or have a poor response

22. 3. Inadequate Patient Communication Clinic-related communication issues (e.g., insufficient descriptions of fertility issues, lack of support with psychological issues) have been cited as key reasons why patients drop out of infertility treatment, especially after the first ART cycle failure Conceptual Model of Changing Infertility Identity & Continuity of Care A.L. Palmer- Wackerly et al. / Patient Education and Counseling 102 (2019) 804–809

23. Suggestions for Improving Infertility Continuity of Care When patients are viewing their “Infertility as Enduring”, clinicians should: Tailor each treatment recommendation to patients’ specific infertility diagnosis so that patients understand why their treatment is the best current option for them. Explain the limits of current medical knowledge when diagnosing ‘unexplained infertility’ so that patients understand that this diagnosis is valid. Give patients time to ask questions & don’t rush them to process complex information in decision-making or they may feel that you don’t care about their personal situation. Discuss all treatment options (even if not recommended) in order for patients to feel like they are an informed partner in their treatment decisions.

24. When patients are viewing their “Infertility as Integrated”, clinicians should: Acknowledge how financially, emotionally, physically & psychologically difficult IVF process can be for patients & suggest coping resources. Offer emotional support to patients before recommending next treatment steps. Emotional support needs might increase as patients continue treatment. Avoid giving ‘false hope’ when discussing live birth rates & ‘good news’ by being sensitive, honest and direct, in order for patients to be ‘cautiously optimistic’ about treatment outcomes. Provide holistic health care to infertility patients by discussing implications of infertility (and treatment) on their overall health.

25. 4. Ignoring Patient Concerns Ignoring patient concerns could lead to anxiety & depression, which could impact to overall experience and IVF outcomes Patient concerns about IVF: What kind of side effects can occur with IVF medicines ? Are there any possible side effects of injectable fertility medicines? What are the risks of the egg retrieval? What are the risks associated with the embryo transfer? If I conceive with IVF, will my pregnancy be more complicated (than if I conceived on my own )? Will IVF increase the risk of my child having a birth defect ?

26. 5. Overstimulation Risks Avoid aggressive stimulation protocols that may lead to ovarian hyperstimulation syndrome (OHSS ) The risk of overstimulation should be carefully assessed & adjustments made to medication dosages accordingly

27. 6. Lack of emotional support Acknowledge the stress & emotional challenges and provide appropriate support or referrals to professionals. Men with anxiety had lower final total motile sperm counts during IVF compared to men without anxiety (Walker et.al, 2023)

28. Regarding stress, depression and anxiety, it was found that >80% of all respondents had CES-D score >16, indicating at risk of developing clinical depression Rates of stress, anxiety and depression among IVF patients are higher than in general population. If the level of infertility-related stress is higher, IVF success rate is lower.

29. 7. Insufficient Education Avoid insufficiently educating patients about the medications, procedures, and potential side effects associated with ovarian stimulation Insights for developing appropriate printed education materials include: the use of lay language & the clear explication of medical terms a greater utilization of images better explanations of diagnosis protocols & treatment procedures more extensive coverage of infertility related knowledge

30. 8. Inadequate Follow-Up Avoid inadequate follow-up after the ovarian stimulation phase. Post-stimulation consultations are essential to discuss the outcomes, address any concerns, and plan for subsequent steps in the IVF process

31. 9. Ignoring Male Factor Infertility Male factor is as important as female factor in IVF process, ignoring it could lead to a poor outcomes IVF is the most successful way for couples experiencing male infertility to become pregnant. 

32. 10. Neglecting to Adjust Treatment Plans Avoid neglecting the need to adjust treatment plans based on patient response Be flexible in adapting the stimulation protocol, it enhance the chances of a successful IVF cycle .

33. 11. Failure to Address Financial Concerns Practitioners need to be clear & detail about costs, insurance coverage, and potential financial assistance options is crucial to managing patient expectations .

34. THANK YOU