To explore the association between patient-centered communication, patients’ satisfaction, and retention in care in assisted reproductive technology (ART) visits. ART visits at eight Italian clinics were videotaped and coded using the Roter Interaction Analysis System, which includes a Patient-Centered Index (PCI), a summary “patient-centered communication” ratio. After the visit, patients completed a satisfaction questionnaire (SATQ). After 3 months, patients were asked about their retention in care. Spearman correlations and Mann-Whitney tests were used to test associations between the study variables; the open-ended item of SATQ was analyzed through content analysis. Eighty-five visits were videotaped (involving 28 gynecologists and 160 patients). PCI score (μ = 0.51 ± 0.28) revealed a more disease-oriented communication during the visit. Patients reported high levels of satisfaction with the visit and identified in the information provision or in the doctor’s humanity or kindness the main reasons of satisfaction. At the follow-up, the majority of the couples declared to have followed the clinicians’ recommendations and to have remained related to the ART center. No associations were found among the study variables, except for a lower male satisfaction among couples who declared to have changed ART clinic. Contrary to what was expected, the style of physician-patient communication was not found to be associated with patient satisfaction and retention in care. However, patients were highly satisfied and engaged. The actual meaning of a communication that is “patient-centered” in the ART context might be wider, including the couples’ need for information, as suggested by qualitative findings.

STUDY QUESTIONWhat are the characteristics of doctor-couple communication content during actual ART visits?SUMMARY ANSWERPhysicians were mainly focused on providing biomedical information, while communication content from couples had a 2-fold focus on providing biomedical information and on positive talk.WHAT IS KNOWN ALREADYCommunication aspects in ART seem crucial for clinical decision-making, retention in care and critical conversations with couples due to low treatment success rates. However, no studies have been carried out on the actual interaction between the doctor and the couple in this context.STUDY DESIGN, SIZE, DURATIONThis observational study involved 28 clinicians and 160 patients referred to eight Italian ART clinics during a one-year recruitment period.PARTICIPANTS/MATERIALS, SETTING, METHODSART visits at eight Italian clinics were videotaped. The visits were coded using the Roter Interaction Analysis System (RIAS), particularly focusing on RIAS composite categories, verbal dominance and patient-centeredness score.MAIN RESULTS AND THE ROLE OF CHANCEA total of 85 visits were eligible for analysis (62% acceptance rate), involving 28 clinicians and 160 patients (including 75 couples). The average visit duration was 37 ± 17.7 min. The mean verbal dominance was 1.9 ± 0.86 (range: 0.72-5.74). Physicians mainly focused on providing biomedical information. Communication content from couples had a 2-fold focus on providing biomedical information and on positive talk. The mean of patient centeredness index (PCI) was 0.51 (SD = 0.28; range 0.08-1.77); visits in which the doctor was a woman or the treatment indication was for heterologous fertilization showed higher PCI scores. Overall, females accounted for 67% of all patient talk. Taking this imbalance into account as expected frequencies for each composite category, males reported significantly more utterances in almost all of the socioemotional categories.LIMITATIONS, REASONS FOR CAUTIONThese results are preliminary and observational and only regard Italy. Communication during visits may have been biased since the professionals who agreed to participate showed an interest in communication issues. Another limitation is a possible Hawthorne effect due to the fact that participants were aware of being videotaped.WIDER IMPLICATIONS OF THE FINDINGSOur study showed that ART physicians mainly adopted an informative model of communication and a more disease-oriented approach. Findings revealed the complexity of communication content during ART consultations, given its triadic characteristic in which the third party is also a patient; clinicians should be aware of this complex aspect and of the specific male and female perspectives to be taken into account. The results could be useful for training ART professionals.STUDY FUNDING/COMPETING INTEREST(S)This study was possible thanks to an unconditional grant from Ferring Spa to the Department of Health Sciences, University of Milan. There are no competing interests to declare.TRIAL REGISTRATION NUMBERN/A.

Introduction:Acupuncture is an ancient therapeutic art, which has been given renewed attention in light of recent scientific research and current integration with modern medical practice in the treatment of a wide range of diseases, including infertility. Recently certain studies have suggested that

Luteal-phase supplementation has proved necessary in Gn-RH analog and human gonadotropin-stimulated cycles. We studied the effects of vaginally and intramuscularly delivered progesterone on the endometrium. Thirty patients enrolled in an IVF program without embryo transfer due to absence of fertilization were included in the study. Patients were randomly allocated to two treatment groups. Group A(n = 15)was administered 200 mg progesterone b.i.d. by the vaginal route (Esolut, Angelini) starting on the day of oocyte pick up and group B (n = 15) was given 100 mg intramuscular progesterone once daily (Prontogest, Amsa). Six days after HCG administration, biopsies were obtained for endometrial histological maturation and estrogen (ER) and progesterone (PR) receptor analyses. In addition, ultrasound measurements of endometrial thickness were made and uterine and myometrial artery flow was determined. Serum concentrations of estriol and progesterone were measured on the day of HCG, at oocyte pick up and at endometrial biopsy. The two treatment groups were similar in terms of follicular phase parameters during superovulation with Gn-RH analog and gonadotropin, Histologic, receptor and ultrasonographic analyses showed no significant differences between the two treatment groups. Our results indicate that both intramuscular and vaginal progesterone are equally effective on the endometrium.

Luteal-phase supplementation has proved necessary in Gn-RH analog and human gonadotropin-stimulated cycles. We studied the effects of vaginally and intramuscularly delivered progesterone on the endometrium. Thirty patients enrolled in an IVF program without embryo transfer due to absence of fertilization were included in the study. Patients were randomly allocated to two treatment groups. Group A (n = 15) was administered 200 mg progesterone b.i.d. by the vaginal route (Esolut, Angelini) starting on the day of oocyte pick up and group B (n = 15) was given 100 mg intramuscular progesterone once daily (Prontogest, Amsa). Six days after HCG administration, biopsies were obtained for endometrial histological maturation and estrogen (ER) and progesterone (PR) receptor analyses. In addition, ultrasound measurements of endometrial thickness were made and uterine and myometrial artery flow was determined. Serum concentrations of estriol and progesterone were measured on the day of HCG, at oocyte pick up and at endometrial biopsy. The two treatment groups were similar in terms of follicular phase parameters during superovulation with Gn-RH analog and gonadotropin. Histologic, receptor and ultrasonographic analyses showed no significant differences between the two treatment groups. Our results indicate that both intramuscular and vaginal progesterone are equally effective on the endometrium.

In order to compare the standard swim-up semen preparation with and without test yolk buffer (TYB) incubation in intrauterine insemination (IUI), we conducted a prospective multicentre randomized trial. A total of 121 infertile couples with male factor (n = 52) or unexplained infertility (n = 69) was randomly assigned to two groups following ovulation induction. Semen was prepared by standard swim-up in group A (n = 64) and by swim-up followed by TYB incubation in group B (n = 57). A maximum of two IUI cycles was performed. A total of 104 cycles was performed in the swim-up group and 90 in the TYB group. Overall, 15 pregnancies were achieved in group A and 23 in group B, with an overall pregnancy rate of 24.8 and 50.0% per patient respectively (chi2(1), P < 0.05). In the male factor group, pregnancy was achieved in six out of 24 couples (25%) following standard swim-up and in six out of 28 (21.4%) following swim-up and TYB incubation (chi2(1), not significant). In the unexplained infertility group, pregnancy was recorded in nine out of 40 couples (22.5%) following standard swim-up and in 17 out of 29 couples (58.6%) following swim-up and TYB incubation (chi2(1), P < 0.05).

Echoguided transvaginal oocyte retrieval gives good results even when carried out after a short training course. This study compares the results obtained by a group of physicians with long experience and a newly-trained group. No significant differences were found in the percentages of follicles punctured (87.9% vs 91.9%), of oocytes recovered (62.8 vs 70.6%), in the mean number of follicles aspirated (4.5 vs 4.1) or in duration of the procedure (33.9 min vs 34.2 min). No complications occurred in the retrieval and the patients, pain was very slight.

Multiple ovulation was induced in 122 hypogonadotrophic IVF patients with large doses of HMG. The hypogonadotrophic state, short and reversible, was obtained by nasal administration of a GnRH agonist (200 micrograms, five times per day). In the 97 induced cycles, a mean of 9.1 follicles was recorded. A comparison of the results obtained for 36 patients who had already been treated with clomiphene and HMG showed both significantly more follicles per cycle (8.5 versus 3.0) and an increase in oocytes retrieved (6.7 versus 1.3) when treated with the agonist and HMG. In addition 11 of 18 already poorly responsive patients had normal responses. The luteal phase was supported by either HCG or progesterone injection. Plasma progesterone profiles were satisfactory and, as expected, the highest progesterone concentrations were associated with HCG treatment.

We studied 32 heroin and methadone addicts, divided into 4 groups according to the type of drugs used: 5 heroin-dependent, 10 taking methadone plus heroin more or less constantly, 10 taking methadone plus heroin occasionally, and 7 taking methadone only. 93% of the heroin addicts and 65% of those taking methadone had abnormal semen. The most frequent abnormality was in motility (78%). Teratozoospermia was the second most frequent (28%) and oligozoospermia the third (16%). The 7 patients taking methadone only had neither teratozoospermia nor oligozoospermia. This semen pathology is probably secondary to decreased testosterone production, with relative hypofunction of the seminal tracts and the accessory glands.

The reproductive capacities of 35 patients with Hodgkin's disease were assessed before treatment by semen evaluation and determination of basal hypothalamic-hypophyseal function and after stimulation with gonadotropin-releasing hormone (GnRH). Sixty-five percent of the patients had asthenozoospermia, 46% had teratozoospermia, and 28% had oligozoospermia. Normal semen was more frequently seen in asymptomatic patients (7 of 18) than in symptomatic patients (2 of 15). All the patients had normal basal follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels and significantly low testosterone (T) levels (P less than 0.01). The FSH response to 100 micrograms of GnRH was normal, but the LH responses were all significantly low, both as delta % (28.4% +/- 18.7% versus 52.4% +/- 25.3%, P less than 0.005) and as peak values (36.7 +/- 20.7 mIU/ml versus 59.4 +/- 26.4 mIU/ml, P less than 0.01). It is believed that abnormal semen is a specific symptom of Hodgkin's disease, secondary to functional insufficiency of the hypothalamic-hypophyseal axis, with a relative decrease in T production.

Summary: Spermatozoa morphology at two levels in the cervical canal was compared, at the external and internal uterine orifices, in samples taken “in vivo” during 21 postcoital tests (P.C.T.s). P.C.T.s with cervical mucus, with Moghissi scores lower than 10 and exo- and endocervical pH less than 7 were excluded. At the upper level of the cervical canal, 12 of the 21 P.C.T. showed more than 5% more normal spermatozoa than at the lower level of the canal (in 5 of these P.C.T. the increase was > 10%). Selection for normal heads was seen in 2 and for normal tails in 4. The P.C.T. that selected for normal tails all had > 10% abnormal tails at the external orifice. These results confirm that there is some selection of spermatozoa during passage through the cervical canal. Above all, the selection appears to exclude those spermatozoa with defective locomotive mechanisms (abnormal tails), which indicates that the mucus acts as a “passive filter” with selection depending on the spermatozoa themselves in relation to motility. Zusammenfassung: Die Morphologie der Spermatozoen wurde in zwei Abschnitten des Cervicalkanals verglichen. Bei 21 Postcoitaltesten wurden „in vivo” Proben vom äußeren und inneren Portiobereich untersucht. Postcoitalteste des Cervicalsekrets mit einem Moghissi-Index kleiner 10 und einem exo- und endocervicalem pH-Wert kleiner 7 wurden nicht in die Untersuchung aufgenommen. Im oberen Abschnitt des Cervicalkanals zeigten 12 der 21 Postcoitaltests über 5% mehr Spermatozoen mit normaler Morphologie als im unteren Cervicalkanal (in 5 Testungen war der Anstieg über 10%). Selektion normaler Kopfformen wurde in 2 Fällen und Selektion normaler Schwanzformen in 4 Fällen beobachtet. Diese Ergebnisse bestätigen eine Spermatozoenselektion während der Cervicalkanalpassage. Vor allem scheinen Spermatozoen mit einer Störung des Motilitätsmechanimus selektiert zu werden. Dieses Ergebnis zeigt, daß das Cervicalsekret als “passiver Filter” arbeitet, der in Abhängigkeit von der Spermatozoenmotilität wirkt.

In 53 patients with regular ovulatory cycles, the pH in the lateral vaginal fornix, at the external uterine orifice and in the cervical canal was measured daily in the periovulatory period. The values of pH measured by the colorimetric and the electrometric methods did not show any statistically significant difference. The relationship between pH values of cervical mucus and the estradiol peak is discussed.