INDIVIDUAL, FAMILY AND SOCIETAL OUTCOMES OF INFERTILITY

本方案项目提案提供了不孕不育诊断和治疗的心理、社会、经济和医疗结果的综合分析。中心主题是夫妻和提供者在提供和使用生殖技术方面都面临困难的决定。做出最佳选择需要全面了解可能的成本和收益，这在治疗过程中可能会发生变化。这样的信息将允许更好的决策和结果为患者和提供者，并将确定在诊断和治疗不孕症的轨迹干预的需求和机会。该项目的总体目标是：(1)提供有关生殖技术成本和收益的信息，从而为患者和提供者提供更好的决策和结果；(2)确定在不孕症诊断和治疗过程中的干预需求和机会；(3)将研究结果转化为对考虑使用抗逆转录病毒治疗的人员、临床医生和政策制定者有用的信息。该项目的目的是提供对不育夫妇、生育服务提供者、保险公司、医疗保健购买者和医疗保健决策者有用的信息。计划项目主任将是南希·阿德勒博士，她将领导指导委员会（SC）。常设委员会将监督和协调行政核心的活动；数据收集、管理和分析的核心；咨询委员会；以及组成部分的研究项目。研究项目将研究不孕不育夫妇的决策过程，这些选择对夫妇婚姻满意度和心理健康的影响，这些选择的经济和社会成本，以及不孕不育和技术干预导致的怀孕和分娩结果。通过跟踪一组寻求抗逆转录病毒治疗初步咨询的夫妇，将获得三个项目的数据。一个项目使用一个不同的（更大的）数据库来确定治疗可能增加的妊娠期产科和儿科不良结局风险。作为一个项目共同开展的优势包括研究者提供的综合分析和多学科视角，使用单一患者群体提供一些和所有项目共同的方法和临床支持的显著规模经济，以及使用共同的管理结构。最重要的是，所有项目都利用了与北加州不孕不育服务提供者的现有关系，没有这种关系，就不可能开展这样的项目。

This Program Project proposal provides a comprehensive analysis of the psychological, social, economic, and medical outcomes of infertility diagnosis and treatment. The central theme is that couples and providers both face difficult decisions about the provision and use of reproductive technologies. Making the best choices requires comprehensive information about the likely costs and benefits, which may change during the course of treatment. Such information will permit better decision- making and outcomes for both patients and providers, and will identify the needs and opportunities for intervention during the trajectory of the diagnosis and treatment of infertility. The overall goals of the Program Project are to: (1) provide information on the costs and benefits of reproductive technology that will allow for better decision making and outcomes for both patients and providers; (2) identify the needs and opportunities for intervention during the trajectory of diagnosis and treatment of infertility, and (3) translate the findings into information that is useful for those considering the use of ARTs, clinicians, and policy markers. The aim of the project is to provide information that will be of use to infertile couples, providers of fertility services, insurers, health care purchasers and health care policy makers. The Program Project Director will be Nancy Adler, Ph.D., who will head the Steering Committee (SC). The SC will supervise and coordinate the activities of the Administrative Core; the Core for Data Collection, Management, and Analysis; the Advisory Board; and the component research projects. The component research projects will study decision- making processes of couples who are going through infertility treatment, the impact of these choices on couples' marital satisfaction and psychological well-being, the economic and social costs of these choices, and the pregnancy and birth outcomes that result from infertility and technological intervention. Data for three projects will be obtained by following a cohort of couples who seek an initial consultation of ART. A four project uses a different (and larger) database to determine the potential increased risk of adverse obstetric and pediatric outcomes in pregnancies resulting from treatment. The advantages of conducting together as a Program Project include the comprehensive analysis and multi-disciplinary perspective provided by the investigators, significant economies of scale as a result of using a single patient population for some and common methodologic and clinical support for all projects, and use of a common administrative structure. Most importantly, all projects draw upon existing relationships with infertility service providers in Northern California, without which a project as this could not be undertaken.