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Across sub-Saharan Africa, there remains disagreement among local expert providers over the best ways to improve access to assisted reproduction in low-income contexts. Semi-structured qualitative interviews were conducted between 2021 and 2023 with 19 fertility specialists and 11 embryologists and one clinic manager from South Africa, Zimbabwe, Namibia, Kenya, Ethiopia and Uganda to explore issues surrounding access and potential low-cost IVF options. Lack of access to ART was variously conceptualised as a problem of high cost of treatment; lack of public funding for medical services and medication; poor policy awareness and prioritisation of fertility problems; a shortage of ART clinics and well-trained expert staff; the need for patients to travel long distances; and over-servicing within the largely privatised sector. All fertility specialists agreed that government funding for public sector assisted reproduction services was necessary to address access in the region. Other suggestions included: reduced medication costs by using mild stimulation protocols and oocyte retrievals under sedation instead of general anaesthetics. Insufficient data on low-cost interventions was cited as a barrier to their implementation. The lack of skilled embryologists on the continent was considered a major limitation to expanding ART services and the success of low-cost IVF systems. Very few specialists suggested that profits of pharmaceutical companies or ART clinics might be reduced to lessen the costs of treatments.

Introduction Older adults can face challenges when seeking care from emergency departments (EDs) due to presenting with multiple comorbidities and non-specific symptoms. Psychosocial care is a possible target to help improve ED care for this population. It is possible that digital health technologies can be implemented within emergency settings to improve the provision of psychosocial care. However, it is unclear what the barriers and facilitators are to implementing digital psychosocial interventions for older adults presenting to the ED. Therefore, the scoping review aims to determine what are these barriers and facilitators.Methods and analysis The scoping review will be conducted in line with the Joanna Briggs Institute guidelines and will use the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. The databases Medline, Embase, PsycINFO and Scopus will be searched. The search strategy will be developed in consultation with a specialist research librarian and will cover three key concepts: EDs, digital health technologies and older adults. Additionally, the first 100 hits of a Google Scholar search will be screened for inclusion. We will include both qualitative and quantitative studies that investigate ED digital interventions for psychosocial care where the primary focus is the views, attitudes, experiences and perceptions of patients, families and staff. After extracting all data, analysis and synthesis will follow the ‘best-fit framework synthesis’ approach and the Theoretical Domains Framework will be used to identify barriers and facilitators.Ethics and dissemination Ethics approval is not required for this scoping review since only publicly available data will be analysed and appraised. The findings of the scoping review will be disseminated through peer-reviewed publications and conference presentations.

Abstract Background Older people experiencing depression and anxiety have higher rates of health service utilisation than others, but little is known about whether these influence their seeking of emergency care. The aim was to examine the associations between symptoms of depression and the use of emergency health care, in an Australian context, among a population of people aged 70 years and over initially free of cardiovascular disease, dementia or major physical disability. Methods We undertook secondary analyses of data from a large cohort of community-dwelling Australians aged $$ \ge $$ 70 years. Multivariable logistic regression was used to compare the association of symptoms of depression (measured using the Center for Epidemiological Studies Depression Scale 10 question version, CESD at baseline) with subsequent episodes of emergency care, adjusting for physical and social factors of clinical interest. Marginal adjusted odds ratios were calculated from the logistic regression. Results Data were available for 10,837 Australian participants aged at least 70 years. In a follow-up assessment three years after the baseline assessment, 17.6% of people self-reported an episode of emergency care (attended an ED of called an emergency ambulance) in the last 12 months. Use of emergency healthcare was similar for men and women (17.8% vs. 17.4% p = 0.61). A score above the cut-off on the CESD at baseline was associated with greater use of emergency health care (OR = 1.35, 95% CI 1.11,1.64). When modelled separately, there was a greater association between a score above the cut-off on the CESD and emergency healthcare for women compared with men. Conclusions This study is unique in demonstrating how depressive symptoms among healthy older persons are associated with subsequent increased use of emergency healthcare. Improved understanding and monitoring of mental health in primary care is essential to undertake effective healthcare planning including prevention of needing emergency care.

Almost half of infertility cases involve male infertility. Understanding the consequence of a diagnosis of male infertility, as a sole or partial contributor to the couples' infertility, to the mental health of men is required to ensure clinical care meets their psychological needs. The aim of this systematic analysis was to synthesize the evidence regarding whether men diagnosed with male factor infertility experience greater psychological distress than (1) men described as fertile and (2) men in couples with other infertility diagnoses. Online databases were searched using a combination of Medical Subject Headings (MeSH) headings and keywords relating to male infertility and psychological distress. The search yielded 1016 unique publications, of which 23 were included: 8 case–control, 14 prospective cohort, and 1 data linkage studies. Seven aspects of psychological distress were identified depression, anxiety, self-esteem, quality of life, fertility-related stress, general psychological stress or well-being, and psychiatric conditions. Case–control studies reported that men with male factor infertility have more symptoms of depression, anxiety and general psychological distress, worse quality of some aspects of life, and lower self-esteem than controls. When men with male factor infertility were compared to men in couples with other causes of infertility, there were few differences in the assessed aspects of psychological distress. Despite methodological limitations within the studies, this systematic analysis suggests that the experience of infertility, irrespective of its cause, negatively affects men's mental health and demonstrates the need for assisted reproduction technology (ART) providers to consider men undergoing assisted reproduction as individuals with their own unique support needs.

Abstract Background Elective egg freezing decisions are complex. We developed a Decision Aid for elective egg freezing and conducted a phase 1 study to evaluate its acceptability and utility for decision-making. Methods The online Decision Aid was developed according to International Patient Decision Aid Standards and evaluated using a pre/post survey design. Twenty-six Australian women aged 18–45 years, interested in receiving elective egg freezing information, proficient in English, and with access to the internet were recruited using social media and university newsletters. Main outcomes were: acceptability of the Decision Aid; feedback on the Decision Aid design and content; concern raised by the Decision Aid, and; utility of the Decision Aid as measured by scores on the Decisional Conflict Scale and on a study-specific scale assessing knowledge about egg freezing and age-related infertility. Results Most participants found the Decision Aid acceptable (23/25), balanced (21/26), useful for explaining their options (23/26), and for reaching a decision (18/26). Almost all reported satisfaction with the Decision Aid (25/26) and the level of guidance it provided (25/26). No participant reported serious concerns about the Decision Aid, and most would recommend it to other women considering elective egg freezing (22/26). Median Decisional Conflict Scale score decreased from 65/100 (Interquartile range: 45–80) pre-Decision Aid to 7.5/100 (Interquartile range: 0–37.5) post-Decision Aid review (p

Abstract Objective: To measure the accessibility of Australian web‐based health information for midlife women including those from culturally and linguistically diverse (CALD) backgrounds or with low health literacy. Methods: Search terms relating to midlife health were entered into Google Australia to identify health information websites. The content of the first two results pages was assessed using the European Commission's quality criteria for health websites. Readability was assessed using the Flesch Readability Ease Score with Grade 8 accepted as the average Australian reading level. Results: Sixteen websites were evaluated. Accessibility scores ranged between 0 and 8. The Victorian Government's health website Better Health Channel and the Jean Hailes for Women's Health website contained the most accessible information, each scoring 8, but were both ‘difficult to read’ on the readability test. Four websites included written resources in languages other than English and two had information in audio‐visual format in languages other than English. Conclusions: There is a gap in accessible online health information for Australian women from CALD backgrounds or those with low health literacy. Implications for public health: Healthy behaviour changes in midlife may lead to better health in older age. More accessible health information resources are needed for women in midlife from CALD backgrounds and those with low health literacy.

Abstract Background Preparing for pregnancy and being in the best possible health before conception improves reproductive outcomes. For women living with a chronic non-communicable disease (NCD), pregnancy planning is essential to allow optimal disease control in preparation for pregnancy. Aim The aim was to review the literature relating to the pregnancy planning health information and service needs of women with NCDs. Method The MEDLINE (Ovid), Embase (Ovid), Emcare (Ovid), PsycINFO (Ovid), CINAHL and Scopus databases were searched. Studies were included if they were published in peer-reviewed English language journals between January 2010 and June 2020 and reported on the pregnancy planning health information and service needs of women with rheumatic diseases, asthma, cystic fibrosis, depression and/or anxiety, type 1 diabetes mellitus, epilepsy, or multiple sclerosis. Risk of bias was assessed using QualSyst. The characteristics of the studies were tabulated and summarised. Key findings of the included studies were analysed thematically using an inductive approach, where the study findings determined the themes. Findings are reported in a narrative synthesis. Results The database searches yielded 8291 results, of which 4304 remained after duplicates were removed. After abstract screening 104 full-text papers were reviewed. Of these 15 met inclusion criteria and were included in analysis. The narrative synthesis of the included studies revealed six themes: ‘Women with chronic conditions have unmet preconception health information needs’, ‘Women with chronic conditions want personalised preconception health information’, ‘Preferred sources of preconception health information’, ‘Learning from the experiences of other women’, ‘Improving preconception health discussions with health care professionals’, and ‘Women want holistic care’. These themes were consistent across all studies, highlighting the similarity of experiences and needs of women with different chronic conditions. Conclusion To improve pregnancy outcomes for women living with NCDs, health care providers need to ask women of reproductive age proactively and routinely about their pregnancy intentions and provide them with personalised advice on how to avoid unplanned pregnancy and be in optimal health when they wish to conceive. PROSPERO registration number CRD42020176308.

Abstract Background Globally, the number of forcibly displaced women is growing. Refugee and displaced women have poorer health outcomes compared to migrant and host country populations. Conflict, persecution, violence or natural disasters and under-resourced health systems in their country of origin contribute to displacement experiences of refugee and displaced women. Poor health outcomes are further exacerbated by the migration journey and challenging resettlement in host countries. Preventive sexual and reproductive health (SRH) needs of refugee and displaced women are poorly understood. The aim was to synthesise the evidence about access to preventive SRH care of refugee and displaced women. Methods A systematic review of qualitative, quantitative and mixed methods studies of women aged 18 to 64 years and health care providers' (HCPs’) perspectives on barriers to and enablers of SRH care was undertaken. The search strategy was registered with PROSPERO in advance of the search (ID CRD42020173039). The MEDLINE, PsycINFO, Embase, CINAHL, and Global health databases were searched for peer-reviewed publications published any date up to 30th April 2020. Three authors performed full text screening independently. Publications were reviewed and assessed for quality. Study findings were thematically extracted and reported in a narrative synthesis. Reporting of the review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. Results The search yielded 4083 results, of which 28 papers reporting 28 studies met inclusion criteria. Most related to contraception and cervical or breast cancer screening. Three main themes and ten subthemes relating to SRH care access were identified: interpersonal and patient encounter factors (including knowledge, awareness, perceived need for and use of preventive SRH care; language and communication barriers), health system factors (including HCPs discrimination and lack of quality health resources; financial barriers and unmet need; HCP characteristics; health system navigation) and sociocultural factors and the refugee experience (including family influence; religious and cultural factors). Conclusions Implications for clinical practice and policy include giving women the option of seeing women HCPs, increasing the scope of practice for HCPs, ensuring adequate time is available during consultations to listen and develop refugee and displaced women’s trust and confidence, strengthening education for refugee and displaced women unfamiliar with preventive care and refining HCPs’ and interpreters’ cultural competency. More research is needed on HCPs’ views regarding care for refugee and displaced women.

Purpose Endometriosis is a chronic condition where endometrial-like cells proliferate outside the uterus causing pain and disability. Limited treatments are available but symptom management is essential for social and economic participation. The aim was to compare women’s and health professionals’ perceptions of quality of endometriosis health care and opportunities for improvements. Methods Women participated in closed moderated online discussion groups and health professionals in semi-structured telephone interviews. Discussion group text and interview transcripts were thematically analyzed using the Framework Analysis approach. Results Forty-six women, 12 general practitioners (GPs), and 1 gynecologist participated. Endometriosis can have debilitating consequences. However, women reported that healthcare providers may dismiss symptoms, lack essential knowledge and provide inconsistent advice; treatments are seldom successful or without adverse side-effects. Health professionals acknowledged limitations in expertise, persistent myths, and challenges in achieving best practice. Enhancing collaborative care skills, individualized treatment plans, and local referral pathways to multi-disciplinary care may improve satisfaction with endometriosis care-giving and receiving. Conclusions This is the first comparison of patient and practitioner perceptions of endometriosis in primary healthcare. Models of multi-disciplinary, collaborative care need to be developed and evaluated against consumer-informed measures of women’s wellbeing, quality of life and satisfaction with symptom management and health care.

Introduction Existing randomised controlled trials (RCTs) comparing a freeze-all embryo transfer strategy and a fresh embryo transfer strategy have shown conflicting results. A freeze-all or a fresh transfer policy may be preferable for some couples undergoing in-vitro fertilisation (IVF), but it is unclear which couples would benefit most from each policy, how and under which protocols. Therefore, we plan a systematic review and individual participant data meta-analysis of RCTs comparing a freeze-all and a fresh transfer policy.Methods and analysis We will search electronic databases (Medline, Embase, PsycINFO and CENTRAL) and trial registries (ClinicalTrials.gov and the International Clinical Trials Registry Platform) from their inception to present to identify eligible RCTs. We will also check reference lists of relevant papers. The search was performed on 23 September 2020 and will be updated. We will include RCTs comparing a freeze-all embryo transfer strategy and a fresh embryo transfer strategy in couples undergoing IVF. The primary outcome will be live birth resulting from the first embryo transfer. All outcomes listed in the core outcome set for infertility research will be reported. We will invite the lead investigators of eligible trials to join the Individual participant data meta-analysis of trials comparing frozen versus fresh embryo transfer strategy (INFORM) collaboration and share the deidentified individual participant data (IPD) of their trials. We will harmonise the IPD and perform a two-stage meta-analysis and examine treatment–covariate interactions for important baseline characteristics.Ethics and dissemination The study ethics have been granted by the Monash University Human Research Ethics Committee (Project ID: 30391). The findings will be disseminated via presentations at international conferences and publication in peer-reviewed journals.PROSPERO registration number CRD42021296566.

Abstract Background Optimal parental preconception health benefits reproductive outcomes. However, preconception health promotion is not routinely offered in primary health care settings to people of reproductive age. The aim was to gauge the planned preconception health behaviours and attitudes towards being asked about pregnancy intention by a general practitioner (GP) among people of reproductive age in Australia. Method The research was conducted on a single wave of Australia’s first and only probability-based online panel, Life in Australia™. Members of the Life in Australia™ panel are Australian residents aged 18 years or over. All active members between the ages of 18 and 45 years were eligible to participate. Eligible panel members were invited to complete a survey about fertility and childbearing. Data were collected from 18 February to 4 March 2019. Results In all 965 female and male members of Life in Australia™ aged between 18 and 45 years were invited to complete the survey. Of these, 716 (74.2%) agreed. Most respondents indicated that if they were planning to have a child they would try to optimise their preconception health by adopting a healthier diet (80%), seeing a GP for a health check-up (78%), reducing alcohol consumption (78% of those consuming alcohol), getting fitter (73%), and stopping smoking (70% of smokers). Three in four (74%) stated that they would not mind if their GP asked them about their pregnancy intentions. Conclusion Findings suggests that routinely asking people of reproductive age about their pregnancy intentions and advising those who are planning pregnancy about what they can do to ensure optimal preconception health would be acceptable to most people and may improve reproductive outcomes.

Background: Surrogacy arrangements can be conducted domestically, where the surrogate and intended parents live in the same country, or internationally, where the intended parents engage a surrogate in a foreign destination. Understanding the experiences of people participating in surrogacy arrangements can inform policy to protect the best interests of all parties. Aim: To review the evidence relating to surrogates’ and intended parents’ experiences of surrogacy arrangements. Method: Studies of surrogates’ and intended parents’ experiences of a surrogacy arrangement, published since 2005 in English language peer reviewed journals were identified by searching Embase, Medline, PsycInfo and Scopus. Data relating to each participant group were synthesised separately using thematic analysis. Methodological quality of the studies was assessed using the QualSyst scoring system. Results: 67 articles were included in the synthesis. The mean QualSyst score was 0.78/1. Four themes relating to surrogates’ (exercising agency, making sense of their maternal identity, forming a relationship with the intended parents’, and accessing information and support) and intended parents’ experiences (navigating the law, rationalising the financial transaction, forming a relationship with the surrogate, and accessing information and support) were identified. Intended parents faced legal barriers when seeking domestic arrangements and difficulties when obtaining legal parenthood and citizenship for their child after an international arrangement. Having a close relationship between participants contributed to a positive experience for both parties. Conversely, a distant relationship, whether emotionally or geographically, negatively impacted participants’ experiences. Conclusion: Legal barriers in the home country lead some to seek international surrogacy which limits opportunities for intended parents and surrogates to form a close relationship and poses legal challenges when they return home. Removing the legal barriers to domestic surrogacy would allow more arrangements to be conducted where participants have a better prospect of forming close relationships and can avoid the challenges inherent in international arrangements.

Background: We have an established cohort of singleton adults conceived by IVF and GIFT born from January 1982 to December 1992, and matched controls conceived without assisted reproduction (non-ART). They have participated in two previous studies: 1) a telephone interview study when aged 21 years on average and 2) a clinical review 6 years later. As these adults are reaching the average age of first-time parents, it is important to determine their reproductive health. Aim: To examine the reproductive health of IVF/GIFT-conceived adults compared to non-ART controls. Method: Contact details were confirmed via email or the Australian Electoral Roll. Participants were asked to complete a 15-minute online questionnaire hosted in REDCap with questions about fertility and reproductive health, well-being, self-reported health status, demographics and important potential outcome modifiers. Data were analysed using chi-squared and [Formula: see text]-tests. Results: 231 IVF (60%), 74 GIFT (65%) and 153 non-ART (41%) control participants completed the questionnaire. As there were no outcome differences between IVF and GIFT, their results are combined. The overall median age of the IVF/GIFT group and controls was 31.3 years, and 63% were female in both groups. In both groups just over a third had already given birth, with 15% and 18% respectively reporting having had medical advice for fertility concerns. Endometriosis was the only condition more common in IVF/GIFT-conceived females compared to female controls (16% versus 8%, p=0.07). There were no differences between IVF/GIFT and non-ART conceived women on other female reproductive conditions such as PCOS (18% and 16% respectively) and painful periods (26% and 30% respectively). All male conditions such as undescended testes, sperm parameters or erectile disorders were rare in both groups. Conclusion: As IVF/GIFT-conceived individuals reach the average childbearing age of 31 years, they appear to have no substantial adverse outcomes related to their reproductive health or fertility.

Background: Endometrial scratching is a common IVF add-on. In 2015, a survey in Australia, New Zealand and the UK reported that 83% of fertility specialists recommended endometrial scratching for IVF (1). Several large trials have since been published reporting no clear evidence for improved live birth rates following endometrial scratching before IVF. Aim: To ascertain the current practices and views on endometrial scratching across Australia, New Zealand and the UK. Method: An anonymous online survey was distributed via professional fertility societies and through emails sent directly to Medical Directors of IVF clinics in Australia, New Zealand and the UK. Responses were received between October and December 2020. Results: 121 eligible responses were received (fertility specialists (n=61), embryologists (n=26) and fertility nurses (n=24)); at least one response was received from 40% of IVF clinics. Among fertility specialists, 34% currently offer endometrial scratching, primarily in the case of recurrent implantation failure. Most respondents (>90%) were neutral or did not believe endometrial scratching improved pregnancy and live birth rates. However, for women with recurrent implantation failure, 29% believed it was beneficial. More than half (55%) of respondents viewed reducing psychological distress as a benefit of endometrial scratching. Among fertility specialists who were not offering endometrial scratching, 51% previously did. Conclusion: This study indicates the use of endometrial scratching has declined over the last five years, which may reflect a response to recent evidence reporting no benefit from the procedure. The major limitations of this study are the low response rate, and the potential for bias; professionals with strong views about endometrial scratching (for or against) may have been more likely to complete the survey.

Background: The Anti-Mullerian hormone (AMH) test is promoted to women as a way to find out how long they have left to have children. However, data consistently show the test is a poor predictor of natural fertility potential for an individual woman. As fertility clinic websites are often a primary source of information for reproductive information, it is essential the information provided is accurate and reflects the available evidence. Aim: To systematically record and categorise information about the AMH test found on Australian and New Zealand fertility clinic websites. Method: Data were extracted from accredited Australian and New Zealand fertility clinic websites between April and June 2020. Any webpage that mentioned the AMH test, including blogs specifically about the AMH test posted since 2015, were analysed and the content categorised. Results: 25 clinic websites included information about the AMH test. The available information embodied four overarching categories; 1) the utility of the AMH test, 2) who the test is suitable for, 3) possible actions in response to the test, and 4) caveats and limitations of the test. Eight specific statements about the utility of the test were identified, many of which are not supported by evidence (e.g. “a good snapshot of current fertility”). Whilst some websites were transparent regarding the test’s limitations, others mentioned no caveats or included persuasive statements actively promoting the test as empowering for a range of women in different circumstances (e.g. “women who would like to conceive in the future”). Conclusion: The quality of information about the AMH test varied considerably. Several websites had statements about the AMH test that are not supported by evidence. This highlights the need for higher standards for information provided on fertility clinic websites to prevent women being misled to believe the test can reliably predict their current or future fertility.

Life circumstances, including not having a partner, may prevent women from having children during their most fertile years. To avoid age-related infertility women who plan to have children at an age when their fertility is likely to have declined can freeze their eggs when they are younger and use them in an assisted reproductive technology (ART) procedure when the time for childbearing is right for them. Research shows that a significant proportion of young women would consider safeguarding their reproductive potential or are at least open to the idea of oocyte freezing. To make informed decisions about fertility preservation women need accurate and realistic information about the likelihood of a live birth considering their circumstances; the cost of retrieval, storage, and later use of the eggs; the known and potential risks of the procedure for the woman herself and any future children; and the potential emotional risks of elective oocyte cryopreservation. In this presentation I will suggest how clinics can ensure women have all the information they need to make the best possible decision they can about if and when to freeze their eggs.

Objectives The anti-Mullerian hormone (AMH) test has been promoted as a way to inform women about their future fertility. However, data consistently show the test is a poor predictor of natural fertility potential for an individual woman. As fertility centre websites are often a primary source of information for reproductive information, it is essential the information provided is accurate and reflects the available evidence. We aimed to systematically record and categorise information about the AMH test found on Australian and New Zealand fertility clinic websites.Design Content analysis of online written information about the AMH test on fertility clinic websites.Setting Accredited Australian and New Zealand fertility clinic websites.Methods Data were extracted between April and June 2020. Any webpage that mentioned the AMH test, including blogs specifically about the AMH test posted since 2015, was analysed and the content categorised.Results Of the 39 active accredited fertility clinics’ websites, 25 included information about the AMH test. The amount of information varied widely, and embodied four overarching categories; (1) the utility of the AMH test, (2) who the test is suitable for, (3) possible actions in response to the test and (4) caveats and limitations of the test. Eight specific statements about the utility of the test were identified, many of which are not evidence-based. While some websites were transparent regarding the test’s limitations, others mentioned no caveats or included persuasive statements actively promoting the test as empowering for a range of women in different circumstances.Conclusions Several websites had statements about the utility of the AMH test that are not supported by the evidence. This highlights the need for higher standards for information provided on fertility clinic websites to prevent women being misled to believe the test can reliably predict their fertility.

Use of Assisted Reproductive Technologies (ART) is increasing globally but their impact on long term health remains unclear. Here the authors show that ART-conceived individuals show variation in epigenetic profile at birth that largely resolves by adulthood, with no evidence of an impact on long term outcomes.

Objectives To identify sex and age differences in clinically significant symptoms of depression and anxiety and the factors associated with these differences among adults in Australia during COVID-19-related restrictions.Design Anonymous online survey.Setting Australia.Participants Adults aged over 18 years living in Australia were eligible and 13 829 contributed complete data. Of these, 13 762 identified as female (10 434) or male (3328) and were included in analyses.Interventions None.Outcome measures Clinically significant symptoms of depression (≥10 on Patient Health Questionnaire 9) or anxiety (≥10 on Generalized Anxiety Disorder Scale 7 (GAD-7)), and experiences of irritability (GAD-7 item 6).Results Women were more likely than men to have clinically significant symptoms of depression (26.3% (95% CI 25.4 to 27.1) vs 20.1% (95% CI 18.7 to 21.5), p

Because the global shortage of blood and organ donors across all medical markets is a serious concern for health care provision, we aim in this study to better understand decisions (not) to participate in these two forms of medical donation, which can save or prolong another's life. Using unique responses from over 1,000 online survey respondents, we compare the reasons given for the donation decision given by blood and/or registered organ donors versus non-donors. To do so, we categorize responses based on five dimensions of language choice: egocentric (referring to self), social, moral, positively emotional, and negatively emotional. Our results reveal statistically significant differences between blood donors and non-donors in the use of all five categories. With respect to organ donation, we find statistically significant differences between donors and non-donors in the use of social, moral and positive emotional terms but not in the use of egocentric or negatively emotional justifications. Such results suggest that the 'gift of life' terminology used universally to market to potential blood and organ donors may only be relevant in the blood donation market and unlikely to incentivize or change organ donation behaviour.

Abstract Background Children conceived by assisted reproductive technologies (ART) currently comprise 4% of Australian births. The manipulation of biological parameters related to fertilization and implantation are integral to successful ART but potentially pose a risk to the longer-term health of the offspring. There is consensus that many common adult health problems (particularly cardiovascular, metabolic and respiratory conditions) have their origins in early life, possibly before birth, and that risk trajectories track through childhood until clinical disease manifests in adulthood. Early life epigenetic variation may play a role in this process. However little is known about the long-term health of individuals conceived by ART. In a previous study, based on telephone-interviews, we found that young adults conceived by in vitro fertilization (IVF) had significantly more maternal reported atopic respiratory, endocrine, nutritional, and metabolic conditions than non-IVF conceived matched controls. Here we outline the protocol for a follow-up biomedical assessment of this cohort and a questionnaire to obtain information on potential confounders. Methods We are conducting a clinical review of an existing, well characterised cohort comprising 547 IVF-conceived adults and 549 matched controls. We are measuring cardiovascular intermediate phenotypes, metabolic parameters and respiratory function, complemented by epigenome-wide DNA methylation analysis. A pilot study demonstrated the feasibility of our proposed protocol and its acceptability to participants. Participants attend a 2–3 h clinical assessment and complete a study-specific online questionnaire. Measurements include: 1) cardiovascular phenotypes: carotid artery intima-media thickness and distensibility, retinal vascular calibre, resting blood pressure, pulse wave velocity and pulse wave analysis; 2) respiratory function: spirometry, plethysmography, multiple breath washout; 3) auxology: height, weight, waist circumference, bio-impedance. Blood is collected for 4) biomarkers of cardiometabolic profile including inflammatory markers and 5) epigenetic analysis. Discussion Recruitment for this clinical review is challenging as many of the participants have moved to regional, interstate or international locations. Additionally, many female participants are pregnant or breastfeeding, and are therefore ineligible. Nevertheless, comprehensive strategies have been developed to optimize recruitment. Given the increasing use of IVF and related technologies, the potential long-term consequences for risk of common adult diseases is an important clinical and public health issue.

Abstract Background Cancer treatment can diminish fertility in women and men. The need for fertility preservation is growing as increasing numbers of people survive cancer. Cryostorage of reproductive material to preserve potential for conception for cancer survivors has moved from being experimental to being a part of clinical management of women and men who are diagnosed with cancer in their reproductive years. There is little existing evidence about how fertility preservation services can be enhanced to meet the complex needs of patients who are diagnosed with cancer in their reproductive years. The aim of this research was to inform clinical practice development by drawing on the collective experience and knowledge of staff at well-established clinics that offer fertility preservation before cancer treatment. Methods A qualitative research model was adopted using semi-structured interviews with professionals involved in the care of people who freeze reproductive material before cancer treatment. In the state of Victoria, Australia, two large assisted reproductive technology (ART) centres have been providing fertility preservation services for more than two decades. An invitation to participate in a semi-structured interview about clinical care in the context of fertility preservation was emailed to past and current staff members. To capture diverse perspectives, informants were sought from all relevant professions: fertility specialists, andrologists, nurses, embryologists/scientists, counsellors, and administrative staff. Transcripts were analysed thematically. Results Thirteen key informants were interviewed from August 2013 to February 2014. The identified themes relating to enhancing clinical care in a fertility preservation service were communication between oncology and ART specialists; managing urgency; managing patients’ expectations; establishing and implementing protocols, systems, and data bases; and maintaining contact with patients. Conclusion The collective knowledge of this study’s informants, who represent multidisciplinary teams with more than two decades’ experience in fertility preservation, yields important insights into strategies that fertility preservation services can employ to promote the integration of oncology and fertility care, the psychosocial care of patients, data recording and monitoring, and reporting of outcomes.

The social and legal acceptability of third-party reproduction varies around the world. In Australia, gamete and embryo donation and surrogacy are permitted within the regulatory framework set out by federal and state governments. The aim of this paper is to describe the social context and regulatory framework for third-party reproduction in Australia. This is a review of current laws and regulations related to third-party reproduction in Australia. Although subtle between-state differences exist, third-party reproduction is by and large a socially acceptable and legally permissible way to form a family throughout Australia. The overarching principles that govern the practice of third-party reproduction are altruism; the right of donorconceived people to be informed of their biological origins; and the provision of comprehensive counselling about the social, psychological, physical, ethical, financial and legal implications of third-party reproduction to those considering donating or receiving gametes or embryos and entering surrogacy arrangements. These principles ensure that donors are not motivated by financial gain, donor offspring can identify and meet with the person or persons who donated gametes or embryos, and prospective donors and recipients are aware of and have carefully considered the potential consequences of third-party reproduction. Australian state laws and federal guidelines prohibit commercial and anonymous third-party reproduction; mandate counselling of all parties involved in gamete and embryo donation and surrogacy arrangements; and require clinics to keep records with identifying and non- identifying information about the donor/s to allow donor-conceived offspring to trace their biological origins.