Patient Stress During Ovarian Stimulation Is Greater Than Appreciated - New Findings At European Congress Put The Reality In Perspective

Main Category: Fertility
Also Included In: Women's Health / Gynecology
Article Date: 07 Jul 2007 - 1:00 PDT

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While female patients having IVF or ICSI consistently describe high levels of stress associated with the procedure, study results reported this week indicate how stressful the ovarian stimulation can be and what a negative impact it may have on day-to-day activities. Indeed, the psychological burden associated with the whole IVF treatment program - especially the long course of daily hormone injections - has its own impact on everyday life quite distinct from concern about fertility or the outcome of treatment.

The findings come from a study (in France, UK and USA) of how the ovarian stimulation part of IVF and ICSI affects patients. This pre-egg collection phase may last from two to six weeks and currently requires at least one hormone injection each day, usually self-administered at home. Patients interviewed in the study described the timing of injections as a "major convenience issue", requiring considerable coordination with work, social life, spouse and children. Problems with the storing and transporting medications, mixing medications, and the disposal of needles were frequent.

While the doctors interviewed in the study understood that patients do worry about being able to self-inject correctly, they underestimated how many of the women believed they had made mistakes with dosages, taken the wrong medications and/or used incorrect self-injection techniques.

Commenting on the study, investigator Dr Meryl Brod said: "We found the most significant impact of ovarian stimulation was its interference with daily life, psychological impact and treatment convenience. It is also clear that clinicians and patients interviewed have different perceptions of the impact of ovarian stimulation, with clinicians underestimating the burden it places on patients and the high levels of stress associated with daily injections."

Several of the developments in IVF and ICSI over the past few years have reflected a greater recognition of what treatment means to the patient in her own everyday life. For example:

-- The definition of "success" in treatment is beginning to shift from what has mattered to the clinic (pregnancy rate per treatment cycle) to what matters to the couple (a healthy singleton live birth).

-- Treatment times are being reduced with wider use of GnRH antagonist hormones, which can cut the drug treatment phase of IVF to just two weeks.

-- A milder approach to treatment, with lower drug doses, fewer embryos transferred, less expensive interventions, and greater comfort for the patient.

Commenting on these developments at an ESHRE symposium sponsored by Organon in Lyon, Professor Bart Fauser said: "Newer treatment protocols can help reduce the overall treatment burden (shorten treatment time, reduce side effects, reduce the interval between cycles) without adversely affecting live birth rates. In addition, the trend towards replacing fewer embryos reduces multiple pregnancy rates, and thus high miscarriage rates, premature labor, and increased perinatal morbidity and mortality rates associated with multiple pregnancies."

These new approaches to IVF will not just address the concerns of the patient herself during treatment, but are already taking more account of lifestyle and social trends - and thus the demands of an ever aging reproductive population. Emerging techniques such as egg freezing or a milder approach to treatment may help to address these demands, but will put the patient - and not just science - as the object of their focus.

About Organon

Organon creates, manufactures and markets innovative prescription medicines that improve the health and quality of human life. Through a combination of innovation and business partnerships, Organon seeks to leverage its position as a leading biopharmaceutical company in each of its core therapeutic fields: fertility, gynecology and selected areas of anesthesia. It has extensive expertise in neuroscience and a rich and focused R&D program. Research areas also include immunology and specific areas of oncology. Organon products are distributed in over 100 countries worldwide, of which more than 50 have an Organon subsidiary. Organon is the human healthcare business unit of Akzo Nobel.

http://www.organon.com

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