title: Top 10 priorities for future infertility research: an international consensus development study.

authors: Duffy, J.M.N.

subjects: Consensus science methods

abstract: STUDY QUESTION: Can the priorities for future research in infertility be identified?
SUMMARY ANSWER: The top 10 research priorities for the four areas of male infertility, female and unexplained infertility, medically assisted reproduction, and ethics, access, and organization of care for people with fertility problems were identified. 
WHAT IS KNOWN ALREADY: Many fundamental questions regarding the prevention, management, and consequences of infertility remain unanswered. This is a barrier to improving the care received by those people with fertility problems. 
STUDY DESIGN, SIZE, DURATION: Potential research questions were collated from an initial international survey, a systematic review of clinical practice guidelines, and Cochrane systematic reviews. A rationalized list of confirmed research uncertainties was prioritized in an interim international survey. Prioritized research uncertainties were discussed during a consensus development meeting. Using a formal consensus development method, the modified nominal group technique, diverse stakeholders identified the top 10 research priorities for each of the categories male infertility, female and unexplained infertility, medically assisted reproduction, and ethics, access, and organization of care. 
PARTICIPANTS/MATERIALS, SETTING, METHODS: Healthcare professionals, people with fertility problems, and others (healthcare funders, healthcare providers, healthcare regulators, research funding bodies and researchers) were brought together in an open and transparent process using formal consensus methods advocated by the James Lind Alliance. 
MAIN RESULTS AND THE ROLE OF CHANCE: The initial survey was completed by 388 participants from 40 countries, and 423 potential research questions were submitted. Fourteen clinical practice guidelines and 162 Cochrane systematic reviews identified a further 236 potential research questions. A rationalized list of 231 confirmed research uncertainties were entered into an interim prioritization survey completed by 317 respondents from 43 countries. The top 10 research priorities for each of the four categories male infertility, female and unexplained infertility (including age-related infertility, ovarian cysts, uterine cavity abnormalities, and tubal factor infertility), medically assisted reproduction (including ovarian stimulation, IUI, and IVF), and ethics, access, and organization of care, were identified during a consensus development meeting involving 41 participants from 11 countries. These research priorities were diverse and seek answers to questions regarding prevention, treatment, and the longer-term impact of infertility. They highlight the importance of pursuing research which has often been overlooked, including addressing the emotional and psychological impact of infertility, improving access to fertility treatment, particularly in lower resource settings, and securing appropriate regulation. Addressing these priorities will require diverse research methodologies, including laboratory-based science, qualitative and quantitative research, and population science. 
LIMITATIONS, REASONS FOR CAUTION: We used consensus development methods, which have inherent limitations, including the representativeness of the participant sample, methodological decisions informed by professional judgement, and arbitrary consensus definitions. 
WIDER IMPLICATIONS OF THE FINDINGS: We anticipate that identified research priorities, developed to specifically highlight the most pressing clinical needs as perceived by healthcare professionals, people with fertility problems, and others, will help research funding organizations and researchers to develop their future research agenda. 
STUDY FUNDING/ COMPETING INTEREST(S): The study was funded by the Auckland Medical Research Foundation, Catalyst Fund, Royal Society of New Zealand, and Maurice and Phyllis Paykel Trust. Geoffrey Adamson reports research sponsorship from Abbott, personal fees from Abbott and LabCorp, a financial interest in Advanced Reproductive Care, committee membership of the FIGO Committee on Reproductive Medicine, International Committee for Monitoring Assisted Reproductive Technologies, International Federation of Fertility Societies, and World Endometriosis Research Foundation, and research sponsorship of the International Committee for Monitoring Assisted Reproductive Technologies from Abbott and Ferring. Siladitya Bhattacharya reports being the Editor-in-Chief of Human Reproduction Open and editor for the Cochrane Gynaecology and Fertility Group. Hans Evers reports being the Editor Emeritus of Human Reproduction. Andrew Horne reports research sponsorship from the Chief Scientist's Office, Ferring, Medical Research Council, National Institute for Health Research, and Wellbeing of Women and consultancy fees from Abbvie, Ferring, Nordic Pharma, and Roche Diagnostics. M. Louise Hull reports grants from Merck, grants from Myovant, grants from Bayer, outside the submitted work and ownership in Embrace Fertility, a private fertility company. Neil Johnson reports research sponsorship from Abb-Vie and Myovant Sciences and consultancy fees from Guerbet, Myovant Sciences, Roche Diagnostics, and Vifor Pharma. José Knijnenburg reports research sponsorship from Ferring and Theramex. Richard Legro reports consultancy fees from Abbvie, Bayer, Ferring, Fractyl, Insud Pharma and Kindex and research sponsorship from Guerbet and Hass Avocado Board. Ben Mol reports consultancy fees from Guerbet, iGenomix, Merck, Merck KGaA and ObsEva. Ernest Ng reports research sponsorship from Merck. Craig Niederberger reports being the Co Editor-in-Chief of Fertility and Sterility and Section Editor of the Journal of Urology, research sponsorship from Ferring, and retains a financial interest in NexHand. Jane Stewart reports being employed by a National Health Service fertility clinic, consultancy fees from Merck for educational events, sponsorship to attend a fertility conference from Ferring, and being a clinical subeditor of Human Fertility. Annika Strandell reports consultancy fees from Guerbet. Jack Wilkinson reports being a statistical editor for the Cochrane Gynaecology and Fertility Group. Andy Vail reports that he is a Statistical Editor of the Cochrane Gynaecology & Fertility Review Group and of the journal Reproduction. His employing institution has received payment from HFEA for his advice on review of research evidence to inform their 'traffic light' system for infertility treatment 'add-ons'. Lan Vuong reports consultancy and conference fees from Ferring, Merck and Merck Sharp and Dohme. The remaining authors declare no competing interests in relation to the present work. All authors have completed the disclosure form. 
TRIAL REGISTRATION NUMBER: Not applicable.

text: Top 10 priorities for future infertility research: an international consensus development study. STUDY QUESTION: Can the priorities for future research in infertility be identified?
SUMMARY ANSWER: The top 10 research priorities for the four areas of male infertility, female and unexplained infertility, medically assisted reproduction, and ethics, access, and organization of care for people with fertility problems were identified. 
WHAT IS KNOWN ALREADY: Many fundamental questions regarding the prevention, management, and consequences of infertility remain unanswered. This is a barrier to improving the care received by those people with fertility problems. 
STUDY DESIGN, SIZE, DURATION: Potential research questions were collated from an initial international survey, a systematic review of clinical practice guidelines, and Cochrane systematic reviews. A rationalized list of confirmed research uncertainties was prioritized in an interim international survey. Prioritized research uncertainties were discussed during a consensus development meeting. Using a formal consensus development method, the modified nominal group technique, diverse stakeholders identified the top 10 research priorities for each of the categories male infertility, female and unexplained infertility, medically assisted reproduction, and ethics, access, and organization of care. 
PARTICIPANTS/MATERIALS, SETTING, METHODS: Healthcare professionals, people with fertility problems, and others (healthcare funders, healthcare providers, healthcare regulators, research funding bodies and researchers) were brought together in an open and transparent process using formal consensus methods advocated by the James Lind Alliance. 
MAIN RESULTS AND THE ROLE OF CHANCE: The initial survey was completed by 388 participants from 40 countries, and 423 potential research questions were submitted. Fourteen clinical practice guidelines and 162 Cochrane systematic reviews identified a further 236 potential research questions. A rationalized list of 231 confirmed research uncertainties were entered into an interim prioritization survey completed by 317 respondents from 43 countries. The top 10 research priorities for each of the four categories male infertility, female and unexplained infertility (including age-related infertility, ovarian cysts, uterine cavity abnormalities, and tubal factor infertility), medically assisted reproduction (including ovarian stimulation, IUI, and IVF), and ethics, access, and organization of care, were identified during a consensus development meeting involving 41 participants from 11 countries. These research priorities were diverse and seek answers to questions regarding prevention, treatment, and the longer-term impact of infertility. They highlight the importance of pursuing research which has often been overlooked, including addressing the emotional and psychological impact of infertility, improving access to fertility treatment, particularly in lower resource settings, and securing appropriate regulation. Addressing these priorities will require diverse research methodologies, including laboratory-based science, qualitative and quantitative research, and population science. 
LIMITATIONS, REASONS FOR CAUTION: We used consensus development methods, which have inherent limitations, including the representativeness of the participant sample, methodological decisions informed by professional judgement, and arbitrary consensus definitions. 
WIDER IMPLICATIONS OF THE FINDINGS: We anticipate that identified research priorities, developed to specifically highlight the most pressing clinical needs as perceived by healthcare professionals, people with fertility problems, and others, will help research funding organizations and researchers to develop their future research agenda. 
STUDY FUNDING/ COMPETING INTEREST(S): The study was funded by the Auckland Medical Research Foundation, Catalyst Fund, Royal Society of New Zealand, and Maurice and Phyllis Paykel Trust. Geoffrey Adamson reports research sponsorship from Abbott, personal fees from Abbott and LabCorp, a financial interest in Advanced Reproductive Care, committee membership of the FIGO Committee on Reproductive Medicine, International Committee for Monitoring Assisted Reproductive Technologies, International Federation of Fertility Societies, and World Endometriosis Research Foundation, and research sponsorship of the International Committee for Monitoring Assisted Reproductive Technologies from Abbott and Ferring. Siladitya Bhattacharya reports being the Editor-in-Chief of Human Reproduction Open and editor for the Cochrane Gynaecology and Fertility Group. Hans Evers reports being the Editor Emeritus of Human Reproduction. Andrew Horne reports research sponsorship from the Chief Scientist's Office, Ferring, Medical Research Council, National Institute for Health Research, and Wellbeing of Women and consultancy fees from Abbvie, Ferring, Nordic Pharma, and Roche Diagnostics. M. Louise Hull reports grants from Merck, grants from Myovant, grants from Bayer, outside the submitted work and ownership in Embrace Fertility, a private fertility company. Neil Johnson reports research sponsorship from Abb-Vie and Myovant Sciences and consultancy fees from Guerbet, Myovant Sciences, Roche Diagnostics, and Vifor Pharma. José Knijnenburg reports research sponsorship from Ferring and Theramex. Richard Legro reports consultancy fees from Abbvie, Bayer, Ferring, Fractyl, Insud Pharma and Kindex and research sponsorship from Guerbet and Hass Avocado Board. Ben Mol reports consultancy fees from Guerbet, iGenomix, Merck, Merck KGaA and ObsEva. Ernest Ng reports research sponsorship from Merck. Craig Niederberger reports being the Co Editor-in-Chief of Fertility and Sterility and Section Editor of the Journal of Urology, research sponsorship from Ferring, and retains a financial interest in NexHand. Jane Stewart reports being employed by a National Health Service fertility clinic, consultancy fees from Merck for educational events, sponsorship to attend a fertility conference from Ferring, and being a clinical subeditor of Human Fertility. Annika Strandell reports consultancy fees from Guerbet. Jack Wilkinson reports being a statistical editor for the Cochrane Gynaecology and Fertility Group. Andy Vail reports that he is a Statistical Editor of the Cochrane Gynaecology & Fertility Review Group and of the journal Reproduction. His employing institution has received payment from HFEA for his advice on review of research evidence to inform their 'traffic light' system for infertility treatment 'add-ons'. Lan Vuong reports consultancy and conference fees from Ferring, Merck and Merck Sharp and Dohme. The remaining authors declare no competing interests in relation to the present work. All authors have completed the disclosure form. 
TRIAL REGISTRATION NUMBER: Not applicable.

year: 2021

title: American Mass Media and Sustainable Development

authors: Gunn, Alastair S.

subjects: media

abstract: The American mass media overwhelmingly promote a consumer culture, while paying scant attention to the effects this culture has on the environment. American film and television, especially, is reaching more and more people worldwide, thus promoting wasteful overconsumption on a global scale by encouraging people to abandon traditional, sustainable lifestyles and to aspire to an unsustainable consumerist lifestyle. Hollywood has produced many highly successful movies addressing major social issues, including environmental issues such as chemical pollution, nuclear radiation, and global warming, yet it fails to tie these concerns to the consumerist behaviour that is at the root of these problems. Although it may be too much to expect the American mass media to actively promote sustainable development, it is surely irresponsible to promote consumerism as if it had no adverse environmental consequences. Of course, ultimate power rests with the consumer, without whom there would be no audience to make moves for: but the decision about which movies to make, and where to release them, is in the hands of production companies. They have responsibilities not only to present generations but also to future ones.

text: American Mass Media and Sustainable Development The American mass media overwhelmingly promote a consumer culture, while paying scant attention to the effects this culture has on the environment. American film and television, especially, is reaching more and more people worldwide, thus promoting wasteful overconsumption on a global scale by encouraging people to abandon traditional, sustainable lifestyles and to aspire to an unsustainable consumerist lifestyle. Hollywood has produced many highly successful movies addressing major social issues, including environmental issues such as chemical pollution, nuclear radiation, and global warming, yet it fails to tie these concerns to the consumerist behaviour that is at the root of these problems. Although it may be too much to expect the American mass media to actively promote sustainable development, it is surely irresponsible to promote consumerism as if it had no adverse environmental consequences. Of course, ultimate power rests with the consumer, without whom there would be no audience to make moves for: but the decision about which movies to make, and where to release them, is in the hands of production companies. They have responsibilities not only to present generations but also to future ones.

year: 2005

title: A critical analysis of the place of culture in evaluation

authors: Masters-Awatere, Bridgette

abstract: For the past 100 or so years formal evaluation has taken its lead from frameworks that originate from a culturally blind standpoint. Worldwide the major influence on evaluation practice comes from the United States of America. The absence of non-dominant (or indigenous) culturally constructed frameworks has been replicated around the world. Before the formation of the Aotearoa New Zealand Evaluation Association (ANZEA), as a New Zealand specific evaluation group, practitioners generally belonged to the Australasian Evaluation Society (AES) and joined in the sharing, adoption and adaptation of USAs Program Evaluation Standards. However, the context of evaluation in New Zealand has been somewhat different from the rest of the world, becoming more culturally centered than other countries. The role and place of the Treaty of Waitangi has been acknowledged as an attributing factor (ANZEA, 2011). Four indigenous “By Maori for Maori” health & wellbeing programmes externally evaluated were case studies within my research. I draw upon examples from the cases studies to highlight the vulnerable and contentious position indigenous service providers and indigenous evaluators were in. Adapting Sandra Grande’s (2004) analysis, I critiqued the context of the case study evaluations that commissioners considered as Kaupapa Maori. In this presentation I argue that while stakeholders perceived the work to be an indigenous evaluation, the case studies demonstrate that whitestream evaluation was prevalent.

text: A critical analysis of the place of culture in evaluation For the past 100 or so years formal evaluation has taken its lead from frameworks that originate from a culturally blind standpoint. Worldwide the major influence on evaluation practice comes from the United States of America. The absence of non-dominant (or indigenous) culturally constructed frameworks has been replicated around the world. Before the formation of the Aotearoa New Zealand Evaluation Association (ANZEA), as a New Zealand specific evaluation group, practitioners generally belonged to the Australasian Evaluation Society (AES) and joined in the sharing, adoption and adaptation of USAs Program Evaluation Standards. However, the context of evaluation in New Zealand has been somewhat different from the rest of the world, becoming more culturally centered than other countries. The role and place of the Treaty of Waitangi has been acknowledged as an attributing factor (ANZEA, 2011). Four indigenous “By Maori for Maori” health & wellbeing programmes externally evaluated were case studies within my research. I draw upon examples from the cases studies to highlight the vulnerable and contentious position indigenous service providers and indigenous evaluators were in. Adapting Sandra Grande’s (2004) analysis, I critiqued the context of the case study evaluations that commissioners considered as Kaupapa Maori. In this presentation I argue that while stakeholders perceived the work to be an indigenous evaluation, the case studies demonstrate that whitestream evaluation was prevalent.

year: 2015