医学卵子冷冻：以患者为中心的生育力保存方法的重要性。
Medical egg freezing: the importance of a patient-centered approach to fertility preservation.
作者信息
Inhorn Marcia C, Birenbaum-Carmeli Daphna, Westphal Lynn M, Doyle Joseph, Gleicher Norbert, Meirow Dror, Raanani Hila, Dirnfeld Martha, Patrizio Pasquale
机构信息
Department of Anthropology, Yale University, 10 Sachem Street, New Haven, CT, 06520, USA.
Department of Nursing, University of Haifa, 3498838, Haifa, Israel.
出版信息
J Assist Reprod Genet. 2018 Jan;35(1):49-59. doi: 10.1007/s10815-017-1081-5. Epub 2017 Nov 9.
PURPOSE
This binational qualitative study of medical egg freezing (MEF) examined women's motivations and experiences, including their perceived needs for patient-centered care in the midst of fertility- and life-threatening diagnoses.
METHODS
Forty-five women who had undertaken MEF were interviewed in the USA (33 women) and in Israel (12 women) between June 2014 and August 2016. Interviews lasted approximately 1 h and were conducted by two senior medical anthropologists, one in each country. Women were recruited from four American IVF clinics (two academic, two private) and two Israeli clinics (both academic) where MEF is being offered to cancer patients and women with other fertility-threatening medical conditions.
RESULTS
Women who undertake MEF view their fertility and future motherhood as important components of their identities and recovery and, thus, are grateful for the opportunity to pursue fertility preservation. However, women who undergo MEF have special needs, given that they tend to be a "vulnerable" population of young (age < 30), unmarried, resource-constrained women, who are facing not only fertility loss but also the "double jeopardy" of cancer. Through in-depth, qualitative interviews, these women's MEF stories reveal 10 dimensions of care important to fertility preservation, including five "system factors" (information, coordination and integration, accessibility, physical comfort, cost) and five "human factors" (adolescent issues, male partner involvement, family involvement, egg disposition decisions, emotional support). Together, these dimensions of care constitute an important framework that can be best described as "patient-centered MEF."
CONCLUSIONS
Women pursuing MEF have special medical needs and concerns, which require particular forms of patient-centered care. This study outlines 10 dimensions of patient-centered fertility preservation that are appropriate for MEF patients. This approach may help IVF clinics to be better prepared for delivering top-quality care to mostly young, single women facing the daunting prospect of fertility loss and life-threatening medical diagnoses.
目的
这项关于医学卵子冷冻（MEF）的双边定性研究考察了女性的动机和经历，包括她们在面临生育及危及生命的诊断时对以患者为中心的护理的感知需求。
方法
2014年6月至2016年8月期间，在美国（33名女性）和以色列（12名女性）对45名进行过MEF的女性进行了访谈。访谈持续约1小时，由两名资深医学人类学家分别在两个国家进行。这些女性是从四家美国试管婴儿诊所（两家学术型、两家私立）和两家以色列诊所（均为学术型）招募的，这些诊所为癌症患者和患有其他危及生育的疾病的女性提供MEF服务。
结果
进行MEF的女性将自己的生育能力和未来成为母亲视为其身份认同和康复的重要组成部分，因此，她们对有机会进行生育力保存心存感激。然而，接受MEF的女性有特殊需求，因为她们往往是年轻（年龄<30岁）、未婚、资源有限的“弱势群体”，她们不仅面临生育能力丧失，还面临癌症的“双重风险”。通过深入的定性访谈，这些女性的MEF故事揭示了对生育力保存至关重要的10个护理维度，包括5个“系统因素”（信息、协调与整合、可及性、身体舒适度、成本）和5个“人文因素”（青少年问题、男性伴侣参与、家庭参与、卵子处置决定、情感支持）。这些护理维度共同构成了一个重要框架，可最好地描述为“以患者为中心的MEF”。
结论
寻求MEF的女性有特殊的医疗需求和担忧，这需要特定形式的以患者为中心的护理。本研究概述了适合MEF患者的以患者为中心的生育力保存的10个维度。这种方法可能有助于试管婴儿诊所更好地为大多数面临生育能力丧失和危及生命的医学诊断这一艰巨前景的年轻单身女性提供高质量护理做好准备。
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