NURS 6052: ESSENTIALS OF EVIDENCE-BASED PRACTICE

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Hashiloni-Dolev, Y., Kaplan, A., & Shkedi-Rafid, S. (2011). The fertility myth: Israeli students' knowledge regarding age-related fertility decline and late pregnancies in an era of assisted reproduction technology. Human reproduction, 26(11), 3045-3053. Doi: 10.1093/humrep/der304

Iliodromiti, S., Iglesias Sanchez, C., Messow, C. M., Cruz, M., Garcia Velasco, J., & Nelson, S. M. (2016). Excessive age-related decline in functional ovarian reserve in infertile women: prospective cohort of 15,500 women. The Journal of Clinical Endocrinology & Metabolism, 101(9), 3548-3554. Doi: 10.1210/jc.2015-4279

Tartagni, M., Cicinelli, M. V., Baldini, D., Tartagni, M. V., Alrasheed, H., DeSalvia, M. A., ... & Montagnani, M. (2015). Dehydroepiandrosterone decreases the age-related decline of the in vitro fertilization outcome in women younger than 40 years old. Reproductive Biology and Endocrinology, 13(1), 18. Doi: 10.1186/s12958-015-0014-3

Virtala, A., Vilska, S., Huttunen, T., & Kunttu, K. (2011). Childbearing, the desire to have children, and awareness about the impact of age on female fertility among Finnish university students. The European Journal of Contraception & Reproductive Health Care, 16(2), 108-115. Doi: 10.3109/13625187.2011.553295

Conceptual Framework

\Describe the theoretical basis for the study

Hashiloni-Dolev et al. (2011) believed that individuals who are aware of age-related fertility rates might alter their behaviors to avoid postponing childbearing, which prevents them from experiencing age-related fertility complications. The independent variables of the study were age, gender, religion, year of study, and family status. The researchers believed that age, gender, religion, year of study, and family status influenced the level of awareness of individuals on the issue of age-related fertility problem.

Age-related fertility issues have been found in women who have fully functional ovarian reserves. Aged women are all at the risk of age-related fertility problems regardless of whether their ovarian reserves are functional or not. Iliodromiti et al. (2016) sought to compare the rate of age-related fertility decline in women with fully functional ovarian reserves and those with fertility complications and are seeking medical assistance.

As infertile women advance in age, the chances of conceiving significantly decline. However, Dehydroepiandrosterone (DHEA) can be used successfully to improve the conception rate of infertile women as they advance in age as long as their ovarian reserve is normal. DHEA can potentially reverse the effects of aging. However, this is not possible were the ovarian reserve is low.

Women in most developed countries delay childbearing as they seek to establish them financially or get married. Age-related infertility makes this practice a risky one due to the increased number of infertile women who are advanced in age. Virtala et al. (2011) acknowledged that the decisions women make about childbearing depend on the their level of awareness about age-related infertility.

Design/Method Describe the design

and how the study

was carried out

The study used a mixed approach. Both quantitative and qualitative research designs were used in the study.

This looked like it was just a survey, did they get qualitative informaton?

The study using a quantitative research design to study a cross-sectional data that was derived from a cohort study.

Quantitative research design was adopted in the study.

The study employed a quantitative research design.

Sample/Setting

The number and

characteristics of

patients,

attrition rate, etc.

A sample of 518 university students was used in the study. 410 out of 518 respondents filled and submitted the questionnaires, which represented a 79.1 percent response rate. The questionnaires were submitted in the classrooms to the students who had attended the lectures at the time.

The study used a sample of 15,500 participants all of whom were women. 9,778 of sample were women seeking medical assistance due to infertility while 5,722 were fertile women. The study was conducted in 13 fertility centers in Spain.

A sample of 109 patients was used in the study. The patients had been diagnosed with infertility and were undergoing in vitro fertilization (IVF). The patients had previously attempted to get pregnant unsuccessfully in the last years through intrauterine insemination. The patients were aged 36-40 years and a normal ovarian reserve. The sample was divided into two groups of 53 and 56 patients. Group 1 used DHEA while Group 2 didn’t.

The study used a sample of 9,967 participants. A total of 3,222 women and 1,864 men filled and submitted the questionnaires representing 59% and 48% respectively. .

Major Variables Studied

List and define dependent and independent variables

The independent variables were age, gender, year of study, family status (single or married), and religion. The dependent variable was the knowledge of age-related fertility decline.

The dependent variables of the study were ovarian reserve, which was represented by antral follicle count (AFC). The independent variables are fertile women, and in infertile women.

The independent variable is Dehydroepiandrosterone (DHEA) and the dependent variable is improvement of fertility.

The independent variables are number of children; desire to bear children, and knowledge of age-related infertility in women. The dependent variable is age-related infertility in women.

Measurement

Identify primary statistics used to answer clinical questions

Descriptive statistics, and t-test methods were used to evaluate the medical estimates that were provided by the respondents. Statistical Package for the Social Sciences, Version 19.0 (SPSS) was used to analyze the responses of the participants. The responses about the knowledge of age-related fertility decline were collected using open-ended questions and the responses were qualitatively analyzed.

Regression analysis was used in the analysis of data collected. The researchers calculated the root mean square error to summarize the model that was derived from the predicted values and the actual values. A normal distribution of data was assumed in the analysis of the data.

Fisher’s exact test, student’s t-test, and stat soft statistical software were used in the statistical analysis the data. The results were also expressed in mean and standard deviation.

The study used descriptive statistics, cross tabulations, and frequency distributions.

Data Analysis

Statistical or

qualitative

findings

The results were presented in tables to show the responses of all students across all age-groups between the ages of 20 to 50 years. The students’ responses were compared with existing data on the chances of a woman becoming pregnant without premedication. Students between 20 and 25 years showed the highest chances of getting pregnant with a 77.1% chance of pregnancy while those between the age of 46 and 50 had the lowest chance of pregnancy with only 31.9% chance of pregnancy.

The root mean square errors (RMSE) of the fertile women were 0.32 and that of infertile women was 0.62. The ages of women considered was 25 years and above and the highest age was 35 years. Women aged 25 years of age represented 56.1% of the fertile women while most of the infertile women were between 34 and 35 years.

The mean age of the two groups of patients was 37.1 and 37.4 respectively, while the standard deviation (SD) was 2.2 and 2.9. Group 1 had serum levels of 3378 while Group 2 had serum levels of 2051. Endometrial thickness for Group 1 was 10.4 and Group 2 was 9.1. The number of pregnancies in Group 1 was 22 while those of Group 1 were 18.

The results of the study showed that the chances of a woman conceiving between the 25 and 30 years was 80-89%, while those between the age of 35-40 years had a 50-59% chance of conceiving. 92.2% of the male students were childless, while 94% were female. 94% of the participants want to bear children in future. Most participants believed that age-related fertility problems start between 49-50 years of age.

Findings and Recommendations

General findings and recommendations of the research

The findings of the study showed that students across all age groups were aware of age-related fertility decline in women. Both male and female students gave similar responses on the level of awareness of age-related decline in fertility. The study established that the fertility myth is common in Israeli students and most of them believe late pregnancies are as a result of people’s lifestyles and not reproductive treatments. Future studies are necessary because the study sample did not accurately represent the Israeli population and the results, therefore, need to be tested in further studies.

Infertile had low ovarian reserve from the age of 20. Infertile women of the age of 35 had the least ovarian reserve. The findings of the study showed that fertile women had experienced more terminated pregnancies than the infertile women. The study showed that there is fertility decline across the two groups. However, it could be noted that fertility decline is higher in infertile women due to the low ovarian reserve younger women.

The findings of the study show that DHEA increases the pregnancy rates for women undergoing IVF. DHEA increases pregnancy rates by lowering chances of miscarriages.

The findings of the study showed that most of the participants lack sufficient knowledge on age-related infertility especially young and male respondents. A third of the males and a fifth of the females believe that age-related fertility problems start at the age of 50. Policy makers should consider the risks of delaying child bearing in women. Students should be properly educated about age-related decline in fertility.

Appraisal

Describe the general worth of this research to practice. What are the strengths and limitations of study? What are the risks associated with implementation of the suggested practices or processes detailed in the research? What is the feasibility of

use in your practice?

The study provides critical information for the clinical issue of age-related fertility problems in women. The strengths of the study are that the participants are not forced to participate in the study and it used open-ended questions, which minimizes bias. The limitation of the study is that the study sample did not accurately represent the whole Israel population and therefore, the results cannot be generalized. The risks of implementing the findings of the study are that the results may be misleading because the sample was not representative.

The study is essential because it provides critical information on the clinical issue of age-related infertility. The strengths of the study are that it provides information from a large sample, which increases the reliability of the results and compares the results of two diverse sets of the population. The limitation of the study is that only one cause of age-related infertility was studied. The study is not feasible based on the large sample that needed to be studied which requires high financial investment.

The study is useful in helping infertile women struggling to conceive. The limitation of the study is that the women who were using DHEA and miscarried were not probed further to give more inferences. Also, the study doesn’t explain the effect of DHEA for infertile women above the age of 40 years. Further research is required to establish the effect of DHEA in infertile women above the age of 40.

The study is useful in exposing the gaps that exist in the knowledge provided to students in schools. Despite being highly educated, students showed lack of awareness on such a critical matter. The strengths of the study were that it was a national study and revealed the views of a wide population and the sample was a representative sample for the whole population. The limitation of the study is that the questionnaire was very extensive and not all questions were answered. The study is not feasible at this level due to its huge requirements of time, funds, and personnel.

General Notes/Comments

The myth surrounding late pregnancies can be cleared by proper awareness of the issue of age-related fertility issues especially among the younger population.

Ovarian reserve declines in both fertile women and infertile women and can be a potential cause of future fertility problems in fertile women.

DHEA is critical to women diagnosed with infertility since it increases the rate of pregnancy.

As a national survey, it gives the opinions of students across the country and provides reliable results.

Author and year of selected article

Article #1

Article #2

Article #3

Article #4

Hashiloni-Dolev et al. (2011)

Iliodromiti et al. (2016)

Tartagni et al. (2015)

Virtala et al. (2011)

Study Design

Theoretical basis for the study

The study sought to establish the level of awareness about age-related infertility in women among students in universities in Israel.

A cohort study aimed at establishing the ovarian reserve in women diagnosed with age-related fertility problems

A cross-sectional study aimed at establishing the effect of Dehydroepiandrosterone (DHEA) in decreasing age-related infertility in women under IVF.

A study to establish the university students’ knowledge about age-related infertility.

Sample/Setting

The number and

characteristics of

patients

518 participants were included in the study. The response rate was 79.1%.

15,500 respondents were selected to participate in the study. 9,778 of the respondents had been diagnosed with age-related decline in fertility while 5,722 were fertile.

109 women were used as the sample of the study. The sample was divided into two; 53 women were selected to use DHEA while the rest were expected to attempt conceiving without DHEA.

Questionnaires were shared with 9,967 respondents. The response rate was 51% with 59% of female students and 48% of males students responding.

Evidence Level *

(I, II, or III)

I

II

II

II

Outcomes

A majority of the students believe that women of the age of 25 years have the highest chance of conceiving represented by 77.1 percent while those between 46 and 50 years of age have the lowest chance.

Fertility starts to decline between the age of 34 and 35 years. Ovarian reserve is highest at the age of 25 years.

DHEA thickens endometrial walls, which are critical in preserving pregnancies. Hence, the high conception rate.

A significant number of students in Finnish University believe that age related decline in fertility starts at the age of 50. A majority of the students believe age related decline in fertility starts at the age of 35-40 years.

General Notes/Comments

Knowledge of age-related decline in fertility affects women childbearing decisions.

Low ovarian reserve is the major contributor of infertility in women

DHEA should also be tested in women with low ovarian reserve.

All young people seems to have the desire to bear children in future regardless of their levels of knowledge about age-related decline in fertility

Author and year of selected article

Article #1

Article #2

Article #3

Article #4

Hashiloni-Dolev et al. (2011)

Iliodromiti et al. (2016)

Tartagni et al. (2015)

Virtala et al. (2011)

Sample/Setting

The number and

characteristics of

patients

518 participants were included in the study. The response rate was 79.1%.

15,500 respondents were selected to participate in the study. 9,778 of the respondents had been diagnosed with age-related decline in fertility while 5,722 were fertile.

109 women were used as the sample of the study. The sample was divided into two; 53 women were selected to use DHEA while the rest were expected to attempt conceiving without DHEA.

Questionnaires were shared with 9,967 respondents. The response rate was 51% with 59% of female students and 48% of males students responding.

Outcomes

A majority of the students believe that women of the age of 25 years have the highest chance of conceiving represented by 77.1 percent while those between 46 and 50 years of age have the lowest chance.

Fertility starts to decline between the age of 34 and 35 years. Ovarian reserve is highest at the age of 25 years.

DHEA thickens endometrial walls, which are critical in preserving pregnancies. Hence, the high conception rate.

A significant number of students in Finnish University believe that age related decline in fertility starts at the age of 50. A majority of the students believe age related decline in fertility starts at the age of 35-40 years.

Key Findings

Students in Israeli universities are aware of age-related decline in infertility.

Ovarian reserve is low in women diagnosed with age-related fertility decline and also decreases as fertile women age.

DHEA increases the effectiveness of DHEA when used by women diagnosed with age-related fertility problems by reducing miscarriages especially in patients under IVF.

University students in Finnish University have poor knowledge of age-related decline in fertility.

Appraisal and Study Quality

The study provides reliable findings and forms a basis for further research. The findings show the perceptions of Israeli students towards the clinical issue of age-related decline in fertility and compare them with existing research data to make informed conclusions.

Iliodromiti et al. (2016) provided reliable findings due to the large sample of the population, which makes it a representative sample. Regression analysis is a reliable statistical tool in the analysis of data. Data from large samples can be easily generalized.

Unlike other studies, which just identify age-related decline in fertility, this study provides a possible solution to patients diagnosed with age-related infertility. The statistical software used in the analysis of the data such as t-tests, provide reliable inferences.

The methods used in the collection and analysis of the data is reliable. Questionnaires allow the researchers to collect useful informal at a low cost. Descriptive statistics, cross tabulations, and frequency distributions are used to analyze data by presenting it in tables and drawing inferences from the results.

General Notes/Comments

The research findings contradict other researches regarding students’ perception on the clinical issue, such as

Virtala et al. (2011)

The research provides a basis for further research in other aspects of age-related infertility or other clinical issues.

There is need for more studies to be conducted to provide more possible ways of dealing with age-related infertility

The findings reveal that health issues are not taught at depth in schools despite the danger they pose to women.