assisted reproduction for hiv (human immunodeficiency virus) infected patients: current practices...

Conclusions: Nurse counselling prior to an EB does not appear to reduceperceived pain associated with the test in patients with a history of recurrentmiscarriage. Future research should examine other interventions that may bemore beneficial in decreasing pain associated with an EB among thesepatients.

Supported by: unfunded.

Tuesday, October 15, 20024:30 P.M.

O-193

Potential for multiple loss during IVF treatment of infertile couples: Amid-range nursing theory. Hayes T. Davol. Univ of Miami, Miami, FL.

Objective: 1. Introduce midrange nursing theory, the potential for mul-tiple loss during IVF treatment for couples, and the applied methodology forits theoretical construction by Walker and Avant (1988). 2. Describe IVFand pinpoint potential physiological losses which translate into potentiallyenormous emotional issues for the couple undergoing IVF. 3. Developmentof a mid-range theory to be implemented into nursing care of IVF patients.

Design: Statement derivation is a theory construction strategy in whichstatements are nursing theories developed specifically for clinical practice(Walker & Avant, 1988). Steps involved in statement derivation: the processof reformulating content or structures of an existing statement existingwithin one field and transferring it to another (Walker & Avant, 1988).Organization of statement derivation is to: 1) identify an analogy betweentwo existing phenomena in different fields, one and two, 2) transpose thestatement one in field one to field two, and 3) restate statement two, createdfrom statement one, within field two (Walker & Avant, 1988). I took variousstatements, in particular, NANDA nursing diagnoses and apply them to theinfertility couple. The three NANDA nursing diagnoses are: DisturbedBody Image, Compromised Family Coping, and Grieving (Ackley & Lad-wig, 2002).I transposed the statements from general nursing diagnoses andcreated new statements specific to nursing care of the infertile couple.

Materials/Methods: Literature review including subjects/keywords: peri-natal loss, infertility, emotional and psychological outcomes performed inCINAHL and MEDLINE.

Results: Development of my mid-range nursing theory is recent. I havenot yet tested it. Phases of IVF and potential losses: The first phase of IVF:ovulation induction. Potential for loss during first phase: ovaries may notrespond to the hormone injections resulting in cancelled cycle. The secondphase of IVF: egg retrieval. Potential for loss during second phase: couplelearn of the quantity of eggs and will feel a loss if the quantity is less thanenvisioned on the sonogram prior to surgery. Potential for loss duringsecond phase:inablity produce sperm specimen resulting in no fertilization.Potential for loss during second phase: the eggs fail to fertilize and noembryos develop. Third phase in IVF:implantation. Potential for loss duringthird phase: results of the negative Beta HCG Potential for loss during thirdphase: spontaneous abortion Potential for loss during third phase: selectivereduction Losses in each IVF phase include three NANDA nursing diag-noses: Disturbed Body Image, Compromised Family Coping, and Grieving(Ackley & Ladwig, 2002).

Conclusions: Recommendations: 1. Further development of the midrange nursing theory by peer review. 2. Theory communicated to infertilitynurses to highlight phases in IVF treatment where there is potential for lossresulting in emotional issues for couple.

Supported by: Ackley, B.J. & Ladwig, G.B. (2002). Nursing diagnosishandbook, a guide to planning care (5th ed.). Philadelphia: Mosby. Walker,L.O. & Avant, K.C. (1988). Strategies for theory construction in nursing(2nd ed.). Norwalk, Connecticut: Appleton & Lange.

Tuesday, October 15, 20024:45 P.M.

O-194

Assisted reproduction for HIV (human immunodeficiency virus) in-fected patients: Current practices and attitudes of paramedical staff.Janice Copeland, Margo Fluker, Albert Yuzpe. Genesis Fertility Ctr, Van-couver, BC, Canada.

Objective: As the prevalence of HIV infection continues to grow, thenumber of discordant couples in their reproductive years is increasing.Improved treatment regimes have benefited HIV infected individuals byprolonging the time to conversion to AIDS (acquired immune deficiencysyndrome). ART programs are receiving requests from discordant couplesfor assistance in conceiving by risk reducing measures. The objectives ofthis study were 1) to determine the types of treatment that are offered to HIVdiscordant couples in North America and 2) to examine the attitudes ofparamedical staff towards working with this patient group.

Design: Questionnaire.Materials/Methods: Questionnaire distributed to paramedical staff work-

ing in the field of assisted reproduction in the U.S. and Canada.Results: Ninety-eight questionnaires were returned from approximately

200 distributed. The majority of respondents were nurses (n�96). Ninety-six percent of respondents work in programs which screen patients for HIVwhereas only 26% work where treatment options are offered to HIV positivepatients. The most common reason for not providing treatment was lack ofrequests. Other reasons cited were concern of transmission to the uninfectedpartner or offspring, lack of facilities for screening/storing semen andconcern by staff of personal risk of contracting HIV. The most commontreatment offered is donor insemination of an uninfected female partner. Afew respondents (n�12) work in programs which offer IVF or spermwash/IUI to HIV discordent couples. Forty-one percent felt that treatmentoptions should be available to these couples and 9% were uncertain (50%disagreed). The majority surveyed (59%) believe there would be only aslight risk to themselves whereas 5% felt they would be at high risk ofcontracting HIV if treatment was offered in their setting.

Conclusions: Assisted reproductive options for HIV discordant couplescurrently appear to be very limited. This is likely due to the uncertainty ofrisk of viral transmission through sperm and concerns of facilitating trans-mission to uninfected partners or offspring. However, there seems to be ageneral acceptance from paramedical staff towards working with this pop-ulation.

Supported by: n/a.

REPRODUCTIVE BIOLOGIST PROFESSIONAL GROUP

Tuesday, October 15, 20022:00 P.M.

O-195

Genes differentially expressed in fibroids and myometrium by cDNAmicroarray. Beverley J. Vollenhoven, Gareth C. Weston, Ursula Man-uelpillai, Peter Rogers. Monash Univ, Melbourne, Australia.

Objective: Fibroids are a cause of significant gynaecological morbidity,the single most common indication for hysterectomy, and cause clinicalsymptoms in 25% of women (Lancet,2001;357:293–8). Medical treatmentsaimed at reducing steroid hormone action on these hormone-responsivetumors result in unacceptable side-effects when taken long-term. It is clearthat the development of further medical treatments will rely on improvingour understanding of the biology of fibroid growth. The objective of thisstudy was to use cDNA microarray analysis to identify differentially ex-pressed genes in growing pre-menopausal fibroids compared with adjacentnormal myometrium.

Design: Laboratory study.Materials/Methods: Fibroid and myometrium specimens were collected

from pre-menopausal women undergoing a hysterectomy. Of the 12 pairedspecimens used, 6 were from the proliferative phase and 6 were from thesecretory phase of the menstrual cycle. RNA from the myometria andfibroids underwent reverse transcription and subsequent coupling with Cy3and Cy5 fluorescent dyes in an indirect labeling step. Labelled cDNA washybridized overnight on a 10.5K cDNA glass slide microarray (full gene listavailable at www.CCPGM.org), and differentially expressed genes identi-fied using a Scanarray 5000 UVlaser scanner. Quantarray software was usedto establish the ratio of gene expression between control (Cy3-labelled) andexperiment (Cy5-labelled) cDNA populations. Pooled myometrium RNA,separated into either proliferative or secretory phase groups, were used as acontrol (Cy3) against individual fibroids (Cy5), and then, in a dye-swap,pooled fibroid RNA, separated into two groups by cycle phase, were used asa control (Cy3) against individual myometrial specimens (Cy5). Statisticallysignificant differentially expressed genes were identified by t-tests with

S74 Abstracts Vol. 78, No. 3, Suppl. 1, September 2002