Protocol - Mode of Conception - Medical Record Abstraction
- Causes and Treatments of Known Infertility - Female
- Causes and Treatments of Known Infertility - Male
- Current Contraception Use - Female
- Current Contraception Use - Male
- Difficulty Getting Pregnant - Current Duration
- Difficulty Getting Pregnant - Prospective Assessment
- Difficulty Getting Pregnant - Retrospective Assessment
- Reproductive History - Female
- Reproductive History - Male
Description
Information about the woman’s use of fertility treatments or fertility drugs or in vitro fertilization procedures is abstracted from the medical record.
Specific Instructions
The fertility clinic and obstetric medical records provide objective information about medical interventions to achieve pregnancy. Information from the medical record complements the information obtained from the Mode of Conception - Interview protocol and ideally, both modes of administration are used.
Availability
Protocol
1. Did the mother have any fertility therapy to get pregnant this time?
0[ ]No
1[ ]Yes
If she did NOT have any fertility treatment, then proceed to END.
2. If YES: Treatment with:
2a. Intrauterine insemination (IUI).
Enter 1 if the woman had intrauterine insemination, 0 otherwise.
0[ ]No
1[ ]Yes
2b. A fertility drug such as Clomiphene (Clomid) or Perganol
Enter 1 if the woman was treated with a fertility drug, 0 otherwise.
0[ ]No
1[ ]Yes
2c. A procedure such as IVF or ICSI
Enter 1 if the woman had a fertility procedure, 0 otherwise.
Note that the mother may have more than one of the fertility therapies.
0[ ]No
1[ ]Yes
3. If Q2b = YES: What drug(s)?
Please identify all fertility drug types here:
1[ ]Clomid, Serophene (Clomiphene)
2[ ]Gonal-F, Follistim
3[ ]Pergonal, Repronex, Humogon
4[ ]Fertinex
5[ ]Pregnyl, Profasi, Novarelle, Ovidrel
6[ ]Lupron
7[ ]Progesterone, Utrogestan, Prometrium, Crinone
8[ ]Other
4. If the mother did NOT have a fertility procedure, skip the remaining questions. If Q2c = YES: What fertility procedure was used?
Please identify the fertility procedure.
1[ ]IVF
2[ ]IVF + assisted hatching
3[ ]GIFT
4[ ]ZIFT
5[ ]ICSI
6[ ]ICSI + assisted hatching
5. Please enter the transfer date (date embryos transferred to the mother’s uterus or fallopian tube) as listed in the chart.
Transfer date _____________ (mm/dd/yyyy)
6. Please enter the retrieval date (date eggs were harvested from the mother) as listed in the chart.
Retrieval date ________________ (mm/dd/yyyy)
7. Number of eggs retrieved _____________
Please enter the number of eggs retrieved as listed in the chart.
Personnel and Training Required
Personnel should be trained in medical record abstraction.
Equipment Needs
None
Requirements
| Requirement Category | Required |
|---|---|
| Major equipment | No |
| Specialized training | No |
| Specialized requirements for biospecimen collection | No |
| Average time of greater than 15 minutes in an unaffected individual | No |
Mode of Administration
Medical record abstraction
Lifestage
Adolescent, Adult, Pregnancy
Participants
Pregnant women
Selection Rationale
This information was abstracted from medical records for the Extremely Low Gestational Age Newborns (ELGAN) project, a major study of low gestational age newborns.
Language
English
Standards
| Standard | Name | ID | Source |
|---|---|---|---|
| Human Phenotype Ontology | Infertility | HP:0000789 | HPO |
| caDSR Form | PhenX PX241202 - Mode Of Conception Medical Record Abstraction | 6873170 | caDSR Form |
Derived Variables
None
Process and Review
Not applicable.
Protocol Name from Source
Extremely Low Gestational Age Newborns (ELGAN) Chart Abstraction Form, 2002
Source
Extremely Low Gestational Age Newborns (ELGAN) Chart Abstraction Form, 2002 version, Items 28-34
General References
O’Shea, T. M., Allred, E. N, Dammann, O., Hirtz, D., Kuban, K. C. K., Paneth, N., Leviton, A., for the ELGAN study Investigators. (2009). The ELGAN Study of brain and related disorders in extremely low gestational age newborns. Early Human Devel, 85, 719-25.
Protocol ID
241202
Variables
Export Variables| Variable Name | Variable ID | Variable Description | dbGaP Mapping | |
|---|---|---|---|---|
| PX241202_Mode_Conception_Medical_Records_Eggs_Retrieved_Number | ||||
| PX241202070000 | Number of eggs retrieved _____________ | N/A | ||
| PX241202_Mode_Conception_Medical_Records_Embryo_Retrieval_Date | ||||
| PX241202060000 | Please enter the retrieval date (date eggs more | N/A | ||
| PX241202_Mode_Conception_Medical_Records_Embryo_Transfer_Date | ||||
| PX241202050000 | Please enter the transfer date (date embryos more | N/A | ||
| PX241202_Mode_Conception_Medical_Records_Fertility_Drug | ||||
| PX241202020200 | A fertility drug such as Clomiphene (Clomid) more | N/A | ||
| PX241202_Mode_Conception_Medical_Records_Fertility_Drug_Specific | ||||
| PX241202030000 | If Q2b = YES: What drug(s)? Please identify more | N/A | ||
| PX241202_Mode_Conception_Medical_Records_Fertility_Procedure | ||||
| PX241202020300 | A procedure such as IVF or ICSI. Enter 1 if more | N/A | ||
| PX241202_Mode_Conception_Medical_Records_Fertility_Procedure_Specific | ||||
| PX241202040000 | If Q2c = YES: What fertility procedure was more | N/A | ||
| PX241202_Mode_Conception_Medical_Records_Intrauterine_Insemination | ||||
| PX241202020100 | Enter 1 if the woman had intrauterine more | N/A | ||
| PX241202_Mode_Conception_Medical_Records_Trying_Pregnant | ||||
| PX241202010000 | Did the mother have any fertility therapy to more | N/A | ||
Measure Name
Mode of Conception
Release Date
January 31, 2017
Definition
Questions about whether medical intervention of any kind was needed to achieve pregnancy.
Purpose
Information about natural or assisted conception (i.e., infertility treatments or reproductive technologies) is essential to determine fertility status.
Keywords
pregnancy, conception, fertility, infertility treatment, Extremely Low Gestational Age Newborns, ELGAN, Pregnancy Risk Assessment Monitoring System, PRAMS, Centers for Disease Control and Prevention, CDC
Measure Protocols
| Protocol ID | Protocol Name |
|---|---|
| 241201 | Mode of Conception - Interview |
| 241202 | Mode of Conception - Medical Record Abstraction |
Publications
There are no publications listed for this protocol.