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Objective-To determine the prevalence of Complementary and Alternative Medicine (CAM) use among couples seeking fertility care and to identify the predictors of CAM use in this population. Design-Prospective cohort study Setting-Eight community and academic infertility practices Patients-428 couples presenting for an infertility evaluation Interventions-Interviews and questionnaires Main Outcome Measures-Prevalence of complementary and alternative medicine therapyResults-After 18 months of observation, 29% of the couples had utilized a CAM modality for treatment of infertility; 22% had tried acupuncture, 17% herbal therapy, 5% a form of body work, and 1% had utilized meditation. An annual household income ≥ $200,000 (OR 2.8, p=.04) relative to couples earning < $100,000, not achieving a pregnancy (OR 2.3, p=.01), and a positive attitude toward CAM use at baseline (p<.001) were independently associated with CAM use.Conclusions-A substantial minority of infertile couples utilize CAM treatments. CAM was chosen most commonly by wealthier couples, those not achieving a pregnancy, and those with a baseline belief in the effectiveness of CAM treatments.

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Objective-To describe how parents envision, plan, and enact disclosing to their children that they were conceived with donor gametes. Design-In depth ethnographic interviews.Setting-Participants were recruited from 11 medical infertility practices and 1 sperm bank in Northern California.Patients-141 married couples who had conceived a child using donor gametes (62 with donor sperm and 79 with donor oocytes).Interventions-Husbands and wives were interviewed together and separately. Main outcome measures-Thematic analysis of interview transcripts.Results-Disclosing parents predominantly subscribed to one of two disclosure strategies: the conviction that early disclosure is of paramount importance so that the child "always knows," or the belief that later disclosure is preferable after family routines have been established and the child has the maturity to understand biologic concepts and has developed a sense of discretion. No parent regretted disclosing and many expressed relief.Conclusions-Parents choosing early disclosure were more at ease with the disclosure process while parents choosing later disclosure reported greater uncertainty about how and when to disclose. Parents wished for more peer and/or professional support and guidance to assist them in with disclosure, not only initially, but continuing long after their children are born.

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Objective To examine whether psychological distress predicts IVF treatment outcome as well as whether IVF treatment outcome predicts subsequent psychological distress. Design Prospective cohort study over an 18-month period. Setting Five community and academic fertility practices. Patients Two hundred and two women who initiated their first IVF cycle. Interventions Women completed interviews and questionnaires at baseline and at 4, 10, and 18 months follow-up. Main Outcome Measures IVF cycle outcome and psychological distress. Results Using a binary logistic model including covariates (woman’s age, ethnicity, income, education, parity, duration of infertility, and time interval), pre-treatment depression and anxiety were not significant predictors of the outcome of the first IVF cycle. Using linear regression models including covariates (woman’s age, income, education, parity, duration of infertility, assessment point, time since last treatment cycle, and pre-IVF depression or anxiety), experiencing failed IVF was associated with higher post-IVF depression and anxiety. Conclusions IVF failure predicts subsequent psychological distress, but pre-IVF psychological distress does not predict IVF failure. Instead of focusing efforts on psychological interventions specifically aimed at improving the chance of pregnancy, these findings suggest that attention be paid to helping patients prepare for and cope with treatment and treatment failure.