INSPIRE Summer Studentship 2016 Lydia Newman

INSPIRE Summer Studentship 2016 Lydia Newman

Introduction

I was fortunate to be awarded the INSPIRE miniGrant to allow me to join the ReProFiLe study group led by Dr Yealin Chung in Summer 2016. The project I contributed to, based at Bristol Centre for Reproductive Medicine, was a pilot and feasibility study aiming to investigate the endometrial leukocyte profile in women with Recurrent Reproductive Failure. During the month I was there, the project was in early stages which allowed me to get involved with the research process from study design through to recruitment.

Background

Recurrent Implantation Failure (RIF) is estimated to affect 1 in 10 women undergoing In-Vitro Fertilisation (IVF) or Intra-Cytoplasmic Sperm Injection (ICSI) treatment.1 This occurs whenno embryos implant following multiple cycles of IVF or ICSI, despite good quality embryos being transferred.2 Leukocytes within the endometrium particularly uterine natural killer cells, are thought to have a key role in the regulation of successful embryo implantation and continuation of pregnancy.3 It is suspected that abnormal natural killer cell activity may occur in some women explaining why they experience RIF.4

The purpose of the ReProFile study is to evaluate whether it is feasible to conduct alarge scale observational study,investigating the prognostic value of uterine natural killer cell analysis in women at risk of RIF. The study is a pilot aiming to recruit one hundred women who are experiencing RIF or who are undergoing IVF for the first time. In women recruited to the study an ovulation-timed biopsy is taken using endometrial scratch procedure.Uterine natural killer cell analysis is then performed on the biopsy sample and the outcome of the woman’s fertility treatment and pregnancy is recorded.

ReProFile study

During my time working as part of the ReProFiLe research team I was mainly involved in participant recruitment to the study. This involved attending a Patient Information Meeting to inform couples undergoing IVF treatment about our study. I learnt a great deal about IVF and ICSI treatments, and gained a better understanding of how physically and emotionally demanding the treatment process could be for patients and their partners. After patients had indicated at Patient Information Meetings that they might be interested in participation in the study, I telephoned to determine if they would meet the eligibility criteria and to answer any questions they had about what the study involved. Recruitment to the project was challenging because patients had to be recruited at a specific time in their menstrual cycle and prior to beginning their treatment. Also despite endometrial scratch procedure improving chances of conception in women with RIF, it hasn’t been shown to improve chances in women undergoing IVF for the first time meaning there was little incentive for women to undergo what can be an uncomfortable procedure for no personal gain.To ensure the research was ethical, it was really important that patients understood this. This prompted me consider the ethics in research. I really enjoyed the contact with patients which improved my obstetric and reproductive history taking skills in a scenario that required great sensitivity.

I was asked to perform a literature review where I was able to utilise the skills I have learnt from my SSUs to conduct literature searches and examine the results. The experience taught me how to read and ascertain the relevant information from studies with greater speed as well as increasing my knowledge of various gynecology-related conditions and medications. I learnt for the first time about the snowball method, which allows you to locate relevant publications that have been missed during the initial literature searches. These skills that I have developed will be very useful during my research SSU this year as well as in my future career.

Another task I was asked to complete was to create posters to advertise the opportunity to participate in Patient and Public Involvement Groups. I learnt the importance of these groups in guiding the design of research studies and changing how research is carried out. I designed data collection forms to record information about patients interested in taking part in the study and patients as they complete the study. This would hopefully enable all of the necessary data to be easily recorded in the same accessible format. It will also provide information about why interested patients were not recruited to the study and why others did not complete the study. This wouldhelp identify changes to be made to the final study design facilitating greater patient recruitment and participation.

Conclusion

I really enjoyed my research placement; it was exciting to be part of a project that could lead to new knowledge which could make a real difference to patient care.I gained greater understanding of different aspects of conducting a research study, particularly project design and recruitment. The placement also made me consider ethics in research and the importance of the project being acceptable to patients. I found the time I spent working closely with Dr Chung inspiring and it has enabled me to further appreciate what Academic Clinical Fellowships can offer by incorporating both clinical training with academic work. I believe that being a clinician and a researcher makes you both a better doctor and scientist.I hope to stay in contact with the study and I am excited to learn what the findings from the project will be. Lastly I would like to thank Dr Chung for giving me this fantastic opportunity to be involved with such an interesting project and her support throughout.

References

1 Coughlan C, Ledger W, Wang Q, Liu F, Demirol A et al. Recurrent implantation failure: definition and management. Reprod Biomed Online. 2014; 28 (1): 14-38.

2 Rinehart J. Recurrent Implantation Failure: definition. J Assist Reprod Genet.2007; 24 (7): 284- 287.

3 Parham P. NK cells and trophoblasts: partners in pregnancy.J Exp Med. 2004; 200 (8): 951- 955.

4 Atsushi F, Funamizu A, Yokota M, Yamada K, Nakamua R et al. Uterine and circulating natural killer cells and their roles in women with recurrent pregnancy loss, implantation failure and preeclampsia. J Reprod Immuno. 2011; 90 (1): 105-110.