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Boedeker D, Brolinson M, Campedelli AC, Yu R, Raiciulescu S, Devine K, Hill M, DeCherney A, Spitzer T. Initiation and outcomes of women pursuing planned fertility preservation. Fertil Steril 2024:S0015-0282(24)01935-6. [PMID: 39122086 DOI: 10.1016/j.fertnstert.2024.08.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 08/01/2024] [Accepted: 08/02/2024] [Indexed: 08/12/2024]
Abstract
OBJECTIVE To study cycle outcomes of women who choose to pursue oocyte cryopreservation, using published age-specific oocyte recommendations. DESIGN Retrospective cohort. SETTING Clinic. PATIENT(S) A total of 5,915 patients seeking planned oocyte cryopreservation, 3,504 ultimately underwent ovarian stimulation with oocyte retrieval and cryopreservation, 425 of this cohort subsequently thawed with intent to use embryo transfer. INTERVENTION(S) Planned oocyte cryopreservation. MAIN OUTCOME MEASURE(S) Planned oocyte cryopreservation consultation, fertility preservation cycle(s) and ovarian stimulation outcomes. RESULT(S) A total of 5,915 women were seen in the initial consultation for planned fertility preservation (2012-2022). Ethnicity and the highest level of education were significant in predicting who would move forward with oocyte stimulation for fertility preservation. Women who reported working within the law and public policy and in the fields of health and medicine were statistically more likely to proceed with a cycle than those who listed other occupations. Of 3,504 women in the study cohort who underwent ovarian stimulation and egg retrieval, 1,331 (38.0%) achieved the age-based recommended number of oocytes to freeze. Only 57 (4.3%) of these women who met their age-based oocyte goal did so after their initial cryopreservation cycle. There was a significant association between ethnicity and number of cryopreservation cycles, specifically showing that Black or African American women were less likely to complete two or more cycles. Patients whose education background included graduate or professional degrees were more likely to have completed more than one cycle. CONCLUSION(S) Self-identified ethnicity was significantly associated with the odds of moving forward with oocyte stimulation for fertility preservation and egg retrieval after initial consultation with ethnic minorities significantly less likely to continue treatment. Of those who undergo egg freezing, most women pursue more than one stimulation and cryopreservation cycle, yet the majority never meet their recommended number to freeze.
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Affiliation(s)
- David Boedeker
- Department of Gynecologic Surgery and Obstetrics, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Marja Brolinson
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Reproductive Endocrinology and Infertility Fellowship Program, National Institutes of Health, Bethesda, Maryland
| | - Alexandra C Campedelli
- Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of Health Sciences, Bethesda, Maryland
| | - Rona Yu
- Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of Health Sciences, Bethesda, Maryland
| | - Sorana Raiciulescu
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of Health Sciences, Bethesda, Maryland
| | - Kate Devine
- Shady Grove Fertility Center, Rockville, Maryland
| | - Micah Hill
- Department of Gynecologic Surgery and Obstetrics, Walter Reed National Military Medical Center, Bethesda, Maryland; Eunice Kennedy Shriver National Institute of Child Health and Human Development, Reproductive Endocrinology and Infertility Fellowship Program, National Institutes of Health, Bethesda, Maryland
| | - Alan DeCherney
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Reproductive Endocrinology and Infertility Fellowship Program, National Institutes of Health, Bethesda, Maryland
| | - Trimble Spitzer
- Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of Health Sciences, Bethesda, Maryland.
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Brioso X, Kuokkanen S, Akerman M, Pal L. Racial disparities in the outcomes of euploid single frozen-thawed embryo transfer cycles - analysis of the Clinical Outcome Reporting System of the Society for Assisted Reproductive Technology 2016-2018 data. Fertil Steril 2024:S0015-0282(24)00624-1. [PMID: 39069219 DOI: 10.1016/j.fertnstert.2024.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVE To evaluate if in pregnancies conceived with the transfer of single genetically tested embryos, maternal race and ethnicity relate to pregnancy outcome. DESIGN Retrospective cohort. SETTING Data available in the Clinical Outcome Reporting System of the Society for Assisted Reproductive Technology (SART-CORS) for years 2016-2018. PATIENT(S) Autologous frozen-thaw embryo transfer (FET) cycles with transfer of single genetically tested embryo in SART-CORS for years 2016-2018; cycles associated with diagnoses of recurrent pregnancy loss, gestational carrier, donor egg and donor embryo were excluded. INTERVENTION(S) Information on race and ethnicity linked with in vitro fertilization and FET cycles available in SART-CORS. MAIN OUTCOME MEASURE(S) Multivariable analyses using generalized estimating equation examined the relationship between categories of race and ethnicity with the following outcomes: Pregnancy positive β hCG (human chorionic gonadotropin), clinical pregnancy, pregnancy loss (early [at gestation <13 weeks] and late [loss between ≥13 and <20 weeks]), preterm (<37 weeks), term (≥37 weeks) and live birth. Covariates adjusted for included age, body mass index, anti-Mullerian hormone, infertility diagnosis and smoking history. RESULT(S) Seventy-nine thousand four hundred and sixteen FET cycles met the eligibility criteria. Information on race and ethnicity was specified for 50,820 (64.0%) and was not known in 28,723 (36%) of the cycles. The population was predominantly non-Hispanic White (44%); non-Hispanic Black comprised 2.7%, Asian 12.3%, Hispanic 3.4%, and American Indian, Pacific Islander, Hawaiian, and Alaskan comprised 0.2% of the population. Nearly 1.0 % self-identified with more than one race. On multivariable analyses, pregnancies in non-Hispanic Black and in Hispanic women (compared with non-Hispanic Whites') were significantly more likely to result in in preterm birth. Compared with non-Hispanic White women, the likelihood of live birth was significantly lower in non-Hispanic Blacks, Asian, Hispanic, American Indian, Pacific Islander, Hawaiian, and Alaskan women. The likelihood for delivery by Cesarean was also disproportionately higher in the non Hispanic Black and, Hispanic women and in those identifying with more than one race (0.023) compared with non-Hispanic White women. CONCLUSION(S) Racial and ethnic differentials are apparent in the outcomes of FET conceived pregnancies resulting from the transfer of single genetically tested embryos.
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Affiliation(s)
- Xiomara Brioso
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Satu Kuokkanen
- Department of Obstetrics and Gynecology, NYU Langone Health, NYU Long Island School of Medicine, New York, New York
| | - Meredith Akerman
- Biostatistics Unit, Office of Academic Affairs, Northwell Health, New York, New York
| | - Lubna Pal
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut.
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Le Goff A, Jeffries Hein R, Hart AN, Roberson I, Landecker HL. Anticipating in vitro gametogenesis: Hopes and concerns for IVG among diverse stakeholders. Stem Cell Reports 2024; 19:933-945. [PMID: 38848715 PMCID: PMC11252480 DOI: 10.1016/j.stemcr.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 06/09/2024] Open
Abstract
In vitro gametogenesis (IVG), the reconstitution of germ cell development in vitro, is an emerging stem cell-based technology with profound implications for reproductive science. Despite researchers' long-term goals for future clinical applications, little is currently known about the views of IVG held by the stakeholders potentially most affected by its introduction in humans. We conducted focus groups and interviews with 80 individuals with lived experience of infertility and/or LGBTQ+ family formation in the US, two intersecting groups of potential IVG users. Respondents expressed hope that IVG would lead to higher reproductive success than current assisted reproductive technology (ART), alleviate suffering associated with ART use, and promote greater social inclusion, while expressing concerns predominantly framed in terms of equity and safety. These findings underscore the importance of sustained engagement with stakeholders with relevant experience to anticipate the implications of IVG for research and clinical translation.
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Affiliation(s)
- Anne Le Goff
- The Institute for Society and Genetics, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Robbin Jeffries Hein
- The Institute for Society and Genetics, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Ariel N Hart
- Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA; Department of Sociology, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Isaias Roberson
- Department of Molecular, Cell and Developmental Biology, Los Angeles, CA 90095, USA; Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, Los Angeles, CA 90095, USA; Molecular Biology Institute, University of California, Los Angeles, Los Angeles, CA 90095, USA; Center for Reproductive Science, Health, and Education, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Hannah L Landecker
- The Institute for Society and Genetics, University of California, Los Angeles, Los Angeles, CA 90095, USA; Department of Sociology, University of California, Los Angeles, Los Angeles, CA 90095, USA; Center for Reproductive Science, Health, and Education, University of California, Los Angeles, Los Angeles, CA 90095, USA.
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Tierney KI, Greil AL, Bell AV. Socioeconomic and Racial/Ethnic Inequalities in Infertility Prevalence, Help-Seeking, and Help Received Since 1995. Womens Health Issues 2024; 34:401-408. [PMID: 38692970 DOI: 10.1016/j.whi.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 03/12/2024] [Accepted: 03/22/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND In the United States, infertility and treatment for infertility are marked by racial/ethnic and socioeconomic inequalities. Simultaneously, biomedical advances and increased public health attention toward preventing and addressing infertility have grown. It is not known, however, whether the racial/ethnic and socioeconomic inequalities observed in infertility prevalence, help-seeking, or help received have changed over time. METHODS Using National Survey of Family Growth data (1995 through 2017-2019 cycles), this study applied multivariable logistic regression with interaction terms to investigate whether and how racial/ethnic and socioeconomic inequalities in 1) the prevalence of infertility, 2) ever seeking help to become pregnant, and 3) use of common types of medical help (advice, testing, medication for ovulation, surgery for blocked tubes, and artificial insemination) have changed over time. RESULTS The results showed persisting, rather than narrowing or increasing, inequalities in the prevalence of infertility and help-seeking overall. The results showed persisting racial/ethnic inequalities in testing, ovulation medication use, and surgery for blocked tubes. By contrast, the results showed widening socioeconomic inequalities in testing and narrowing inequalities in the use of ovulation medications. CONCLUSIONS There is little evidence to suggest policy interventions, biomedical advances, or increased public health awareness has narrowed inequalities in infertility prevalence, treatment seeking, or use of specific treatments.
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Affiliation(s)
| | - Arthur L Greil
- Division of Social Sciences, Alfred University, Alfred, New York
| | - Ann V Bell
- Department of Sociology and Criminal Justice, University of Delaware, Newark, Delaware
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Mebane S, Harris BS, Woodward J, Brucker A, Erkanli A, Nagle C, Steele D, Neal S. A survey study evaluating donor gamete utilization rates, patient satisfaction, and fertility treatment outcomes according to desired race and ethnicity. Fertil Steril 2024:S0015-0282(24)00585-5. [PMID: 38944179 DOI: 10.1016/j.fertnstert.2024.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 06/23/2024] [Accepted: 06/24/2024] [Indexed: 07/01/2024]
Abstract
OBJECTIVE To evaluate donor gamete utilization, patient satisfaction, and fertility treatment outcomes of patients pursuing treatment with donor gametes stratified by the desired race as well as ethnicity of the gamete donor. DESIGN Survey study. SETTING Clinic. PATIENT(S) Patients planning to undergo treatment using donor sperm and/or donor oocytes at a single academic fertility clinic in the Southeastern United States between 2015 and 2020. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Utilization rates of donor gametes, satisfaction with donor gamete selection, and fertility treatment outcomes stratified by race and ethnicity of patient, as well as that of their gamete donor. RESULT(S) Four hundred fifty patients were eligible for inclusion and 170 (38%) responded to the survey. Among the respondents, 59% desired a non-Hispanic White gamete donor and 20% desired a non-Hispanic Black gamete donor. Patients seeking a non-Hispanic Black gamete donor had lower odds of using donor gametes (Odds ratio [OR], 0.13; 95% confidence interval [CI], 0.04-0.40) compared with individuals seeking a non-Hispanic White gamete donor. When evaluating satisfaction with donor gamete selection, patients seeking a non-Hispanic Black gamete donor reported lower satisfaction compared with individuals seeking a non-Hispanic White gamete donor (OR, 0.19; 95% CI, 0.09-0.43). When evaluating fertility outcomes, Non-Hispanic Black patients and those using non-Hispaninc Black gamete donors were found to have lower odds of successful conception compared with non-Hispanic White patients (OR, 0.18; 95% CI, 0.07-0.46) and individuals seeking non-Hispanic White gamete donors (OR, 0.26; 95% CI, 0.09-0.75), respectively. CONCLUSION(S) Patients seeking non-Hispanic Black donor gametes have lower utilization rates, less satisfaction with gamete donor selection, and lower odds of conception when compared with those seeking non-Hispanic White gamete donors. These findings highlight the need for more racial diversity within donor gamete banks, as well as within the donor pools available through agencies and fertility clinics.
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Affiliation(s)
- Sloane Mebane
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina.
| | - Benjamin S Harris
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina; Shady Grove Fertility - Jones Institute, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
| | - Julia Woodward
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
| | - Amanda Brucker
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Alaattin Erkanli
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Caroline Nagle
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
| | - David Steele
- Duke Office of Clinical Research, Duke University School of Medicine, Durham, North Carolina
| | - Shelby Neal
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
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Applebaum J, Kim EK, Sharp M, Dokras A, Shah DK. Racial and socioeconomic disparities in fertility treatment provision for patients with polycystic ovary syndrome. Fertil Steril 2024:S0015-0282(24)00545-4. [PMID: 38909670 DOI: 10.1016/j.fertnstert.2024.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 06/09/2024] [Accepted: 06/17/2024] [Indexed: 06/25/2024]
Abstract
OBJECTIVE To assess whether the provision of fertility treatment for patients with polycystic ovary syndrome (PCOS) varies by patient and physician-level demographic characteristics. DESIGN Retrospective cohort study. SETTING University health system. PATIENT(S) Patients seeking care for PCOS and infertility from 2007-2021. INTERVENTION(S) Patient age, body mass index, race, ethnicity, estimated household income, primary insurance payor, provider sex, and provider medical specialty. MAIN OUTCOME MEASURE(S) Prescriptions for fertility treatment, including clomiphene citrate (CC), letrozole, and injectable gonadotropins. Differences in patient and physician demographics between patients who did as well as did not receive a prescription were identified with univariable analysis. Multilevel mixed-effects logistic regression was performed to determine associations between patient and physician demographics and prescription receipt. RESULT(S) A total of 3,435 patients with PCOS and infertility were identified, with a mean age of 31.1 ± 5.7 years. Of the 68.8% of patients who received a prescription, 47.8% of prescriptions were CC, 38.6% were letrozole, and 13.7% were injectable gonadotropins. There were lower odds of prescription receipt for Black patients compared with White patients (adjusted odds ratio [aOR], 0.75; 95% confidence interval [CI], 0.61-0.93), those with estimated household income below the federal poverty level compared with those above the national median (aOR, 0.71; 95% CI, 0.46-0.97), and those with public compared with commercial insurance (aOR, 0.53; 95% CI, 0.40-0.71). These disparities persisted in a subanalysis of patients prescribed oral medications only with lower odds of prescription receipt for Black compared with White patients (aOR, 0.74; 95% CI, 0.57-0.95), those with estimated household income below the federal poverty level compared with above the national median (aOR, 0.93; 95% CI, 0.87-0.98), and those with public compared with commercial insurance (aOR, 0.57; 95% CI, 0.42-0.76). Black patients waited, on average, 153.3 days longer than White patients, from the initial visit to the prescription receipt. Patients had lower odds of receiving any prescription from family medicine physicians (aOR, 0.36; 95% CI, 0.24-0.52) and general internal medicine physicians (aOR, 0.55; 95% CI, 0.42-0.73) compared with reproductive endocrinologists. CONCLUSION(S) Racial and socioeconomic disparities exist in the provision of infertility treatments for patients with PCOS. Fewer primary care physicians engaged in first-line fertility treatment, indicating an opportunity for physician education to improve access to fertility care.
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Affiliation(s)
- Jeremy Applebaum
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Edward K Kim
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Madison Sharp
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anuja Dokras
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Divya K Shah
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Soled KRS, Hoatson T, Monseur B, Everett B, Chakraborty P, Reynolds CA, Huang AK, McKetta S, Haneuse S, Charlton BM. Differences in medically assisted reproduction use by sexual identity and partnership: a prospective cohort of cisgender women. Hum Reprod 2024; 39:1323-1335. [PMID: 38689464 DOI: 10.1093/humrep/deae077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 03/19/2024] [Indexed: 05/02/2024] Open
Abstract
STUDY QUESTION Does medically assisted reproduction (MAR) use among cisgender women differ among those with same-sex partners or lesbian/bisexual identities compared to peers with different-sex partners or heterosexual identities? SUMMARY ANSWER Women with same-sex partners or lesbian/bisexual identities are more likely to utilize any MAR but are no more likely to use ART (i.e. IVF, reciprocal IVF, embryo transfer, unspecified ART, ICSI, and gamete or zygote intrafallopian transfer) compared to non-ART MAR (i.e. IUI, ovulation induction, and intravaginal or intracervical insemination) than their different-sex partnered and completely heterosexual peers. WHAT IS KNOWN ALREADY Sexual minority women (SMW) form families in myriad ways, including through fostering, adoption, genetic, and/or biological routes. Emerging evidence suggests this population increasingly wants to form genetic and/or biological families, yet little is known about their family formation processes and conception needs. STUDY DESIGN, SIZE, DURATION The Growing Up Today Study is a US-based prospective cohort (n = 27 805). Participants were 9-17 years of age at enrollment (1996 and 2004). Biennial follow-up is ongoing, with data collected through 2021. PARTICIPANTS/MATERIALS, SETTING, METHODS Cisgender women who met the following criteria were included in this sample: endorsed ever being pregnant; attempted a pregnancy in 2019 or 2021; and endorsed either a male- or female-sex partner OR responded to questions regarding their sexual identity during their conception window. The main outcome was any MAR use including ART (i.e. procedures involving micromanipulation of gametes) and non-ART MAR (i.e. nonmanipulation of gametes). Secondary outcomes included specific MAR procedures, time to conception, and trends across time. We assessed differences in any MAR use using weighted modified Poisson generalized estimating equations. MAIN RESULTS AND THE ROLE OF CHANCE Among 3519 participants, there were 6935 pregnancies/pregnancy attempts and 19.4% involved MAR. A total of 47 pregnancies or pregnancy attempts were among the same-sex partnered participants, while 91 were among bisexual participants and 37 among lesbian participants. Participants with same-sex, compared to different-sex partners were almost five times as likely to use MAR (risk ratio [95% CI]: 4.78 [4.06, 5.61]). Compared to completely heterosexual participants, there was greater MAR use among lesbian (4.00 [3.10, 5.16]) and bisexual (2.22 [1.60, 3.07]) participants compared to no MAR use; mostly heterosexual participants were also more likely to use ART (1.42 [1.11, 1.82]) compared to non-ART MAR. Among first pregnancies conceived using MAR, conception pathways differed by partnership and sexual identity groups; differences were largest for IUI, intravaginal insemination, and timed intercourse with ovulation induction. From 2002 to 2021, MAR use increased proportionally to total pregnancies/pregnancy attempts; ART use was increasingly common in later years among same-sex partnered and lesbian participants. LIMITATIONS, REASONS FOR CAUTION Our results are limited by the small number of SMW, the homogenous sample of mostly White, educated participants, the potential misclassification of MAR use when creating conception pathways unique to SMW, and the questionnaire's skip logic, which excluded certain participants from receiving MAR questions. WIDER IMPLICATIONS OF THE FINDINGS Previous studies on SMW family formation have primarily focused on clinical outcomes from ART procedures and perinatal outcomes by conception method, and have been almost exclusively limited to European, clinical samples that relied on partnership data only. Despite the small sample of SMW within a nonrepresentative study, this is the first study to our knowledge to use a nonclinical sample of cisgender women from across the USA to elucidate family formation pathways by partnership as well as sexual identity, including pathways that may be unique to SMW. This was made possible by our innovative approach to MAR categorization within a large, prospective dataset that collected detailed sexual orientation data. Specifically, lesbian, bisexual, and same-sex partnered participants used both ART and non-ART MAR at similar frequencies compared to heterosexual and different-sex partnered participants. This may signal differential access to conception pathways owing to structural barriers, emerging conception trends as family formation among SMW has increased, and a need for conception support beyond specialized providers and fertility clinics. STUDY FUNDING/COMPETING INTEREST(S) The research reported in this publication was supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health (NIH), under award number R01MD015256. Additionally, KRSS is supported by NCI grant T32CA009001, AKH by the NCI T32CA057711, PC by the NHLBI T32HL098048, BM by the Stanford Maternal Child Health Research Institute Clinical Trainee Support Grant and the Diversity Fellowship from the American Society for Reproductive Medicine Research Institute, BGE by NICHD R01HD091405, and SM by the Thomas O. Pyle Fellowship through the Harvard Pilgrim Health Care Foundation and Harvard University, NHLBI T32HL098048, NIMH R01MH112384, and the William T. Grant Foundation grant number 187958. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The first author recently had a leadership role in the not-for-profit program, The Lesbian Health Fund, a research fund focused on improving the health and wellbeing of LGBTQ+ women and girls. The fund did not have any role in this study and the author's relationship with the fund did not bias the findings of this manuscript. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Kodiak R S Soled
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Tabor Hoatson
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Brent Monseur
- Division of Reproductive Endocrinology and Infertility, Stanford School of Medicine, Palo Alto, CA, USA
| | - Bethany Everett
- Department of Sociology, University of Utah, Salt Lake City, UT, USA
| | - Payal Chakraborty
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Colleen A Reynolds
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Aimee K Huang
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sarah McKetta
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Brittany M Charlton
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Harvard Medical School & Brigham and Women's Hospital, Boston, MA, USA
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Mahabamunuge J, Seifer DB. Moving toward Narrowing the United States Gap in Assisted Reproductive Technology (ART) Racial and Ethnic Disparities in the Next Decade. J Clin Med 2024; 13:2224. [PMID: 38673497 PMCID: PMC11050514 DOI: 10.3390/jcm13082224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/25/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
The Disparities in Assisted Reproductive Technology (DART) hypothesis, initially described in 2013 and further modified in 2022, is a conceptual framework to examine the scope and depth of underlying contributing factors to the differences in access and treatment outcomes for racial and ethnic minorities undergoing ART in the United States. In 2009, the World Health Organization defined infertility as a disease of the reproductive system, thus recognizing it as a medical problem warranting treatment. Now, infertility care is largely recognized as a human right. However, disparities in Reproductive Endocrinology and Infertility (REI) care in the US persist today. While several studies and review articles have suggested possible solutions to racial and ethnic disparities in access and outcomes in ART, few have accounted for and addressed the multiple complex factors contributing to these disparities on a systemic level. This review aims to acknowledge and address the myriad of contributing factors through the DART hypothesis which converge in racial/ethnic disparities in ART and considers possible solutions to effect large scale societal change by narrowing these gaps within the next decade.
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Affiliation(s)
- Jasmin Mahabamunuge
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA;
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9
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Fauser BCJM, Adamson GD, Boivin J, Chambers GM, de Geyter C, Dyer S, Inhorn MC, Schmidt L, Serour GI, Tarlatzis B, Zegers-Hochschild F. Declining global fertility rates and the implications for family planning and family building: an IFFS consensus document based on a narrative review of the literature. Hum Reprod Update 2024; 30:153-173. [PMID: 38197291 PMCID: PMC10905510 DOI: 10.1093/humupd/dmad028] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 09/25/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Family-planning policies have focused on contraceptive approaches to avoid unintended pregnancies, postpone, or terminate pregnancies and mitigate population growth. These policies have contributed to significantly slowing world population growth. Presently, half the countries worldwide exhibit a fertility rate below replacement level. Not including the effects of migration, many countries are predicted to have a population decline of >50% from 2017 to 2100, causing demographic changes with profound societal implications. Policies that optimize chances to have a child when desired increase fertility rates and are gaining interest as a family-building method. Increasingly, countries have implemented child-friendly policies (mainly financial incentives in addition to public funding of fertility treatment in a limited number of countries) to mitigate decreasing national populations. However, the extent of public spending on child benefits varies greatly from country to country. To our knowledge, this International Federation of Fertility Societies (IFFS) consensus document represents the first attempt to describe major disparities in access to fertility care in the context of the global trend of decreasing growth in the world population, based on a narrative review of the existing literature. OBJECTIVE AND RATIONALE The concept of family building, the process by which individuals or couples create or expand their families, has been largely ignored in family-planning paradigms. Family building encompasses various methods and options for individuals or couples who wish to have children. It can involve biological means, such as natural conception, as well as ART, surrogacy, adoption, and foster care. Family-building acknowledges the diverse ways in which individuals or couples can create their desired family and reflects the understanding that there is no one-size-fits-all approach to building a family. Developing education programs for young adults to increase family-building awareness and prevent infertility is urgently needed. Recommendations are provided and important knowledge gaps identified to provide professionals, the public, and policymakers with a comprehensive understanding of the role of child-friendly policies. SEARCH METHODS A narrative review of the existing literature was performed by invited global leaders who themselves significantly contributed to this research field. Each section of the review was prepared by two to three experts, each of whom searched the published literature (PubMed) for peer reviewed full papers and reviews. Sections were discussed monthly by all authors and quarterly by the review board. The final document was prepared following discussions among all team members during a hybrid invitational meeting where full consensus was reached. OUTCOMES Major advances in fertility care have dramatically improved family-building opportunities since the 1990s. Although up to 10% of all children are born as a result of fertility care in some wealthy countries, there is great variation in access to care. The high cost to patients of infertility treatment renders it unaffordable for most. Preliminary studies point to the increasing contribution of fertility care to the global population and the associated economic benefits for society. WIDER IMPLICATIONS Fertility care has rarely been discussed in the context of a rapid decrease in world population growth. Soon, most countries will have an average number of children per woman far below the replacement level. While this may have a beneficial impact on the environment, underpopulation is of great concern in many countries. Although governments have implemented child-friendly policies, distinct discrepancies in access to fertility care remain.
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Affiliation(s)
- Bart C J M Fauser
- University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | | | | | | | | | - Silke Dyer
- Groot Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Maitin-Shepard M, Werner EF, Feig LA, Chavarro JE, Mumford SL, Wylie B, Rando OJ, Gaskins AJ, Sakkas D, Arora M, Kudesia R, Lujan ME, Braun J, Mozaffarian D. Food, nutrition, and fertility: from soil to fork. Am J Clin Nutr 2024; 119:578-589. [PMID: 38101699 DOI: 10.1016/j.ajcnut.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 11/22/2023] [Accepted: 12/11/2023] [Indexed: 12/17/2023] Open
Abstract
Food and nutrition-related factors, including foods and nutrients consumed, dietary patterns, use of dietary supplements, adiposity, and exposure to food-related environmental contaminants, have the potential to impact semen quality and male and female fertility; obstetric, fetal, and birth outcomes; and the health of future generations, but gaps in evidence remain. On 9 November 2022, Tufts University's Friedman School of Nutrition Science and Policy and the school's Food and Nutrition Innovation Institute hosted a 1-d meeting to explore the evidence and evidence gaps regarding the relationships between food, nutrition, and fertility. Topics addressed included male fertility, female fertility and gestation, and intergenerational effects. This meeting report summarizes the presentations and deliberations from the meeting. Regarding male fertility, a positive association exists with a healthy dietary pattern, with high-quality evidence for semen quality and lower quality evidence for clinical outcomes. Folic acid and zinc supplementation have been found to not impact male fertility. In females, body weight status and other nutrition-related factors are linked to nearly half of all ovulation disorders, a leading cause of female infertility. Females with obesity have worse fertility treatment, pregnancy-related, and birth outcomes. Environmental contaminants found in food, water, or its packaging, including lead, perfluorinated alkyl substances, phthalates, and phenols, adversely impact female reproductive outcomes. Epigenetic research has found that maternal and paternal dietary-related factors can impact outcomes for future generations. Priority evidence gaps identified by meeting participants relate to the effects of nutrition and dietary patterns on fertility, gaps in communication regarding fertility optimization through changes in nutritional and environmental exposures, and interventions impacting germ cell mechanisms through dietary effects. Participants developed research proposals to address the priority evidence gaps. The workshop findings serve as a foundation for future prioritization of scientific research to address evidence gaps related to food, nutrition, and fertility.
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Affiliation(s)
| | - Erika F Werner
- Tufts University School of Medicine, Boston, MA, United States
| | - Larry A Feig
- Department of Developmental, Molecular, and Chemical Biology, Tufts University School of Medicine, Boston, MA, United States
| | - Jorge E Chavarro
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Sunni L Mumford
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, United States
| | - Blair Wylie
- Collaborative for Women's Environmental Health, Columbia University, New York, NY, United States
| | - Oliver J Rando
- Department of Biochemistry and Molecular Biotechnology, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Audrey J Gaskins
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, United States
| | | | - Manish Arora
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Marla E Lujan
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States
| | - Joseph Braun
- Department of Epidemiology, Brown University, Providence, RI, United States
| | - Dariush Mozaffarian
- Tufts University School of Medicine, Boston, MA, United States; Food is Medicine Institute, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States.
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Tordoff DM, Moseson H, Ragosta S, Hastings J, Flentje A, Capriotti MR, Lubensky ME, Lunn MR, Obedin-Maliver J. Family building and pregnancy experiences of cisgender sexual minority women. AJOG GLOBAL REPORTS 2024; 4:100298. [PMID: 38269079 PMCID: PMC10806344 DOI: 10.1016/j.xagr.2023.100298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Although 10% to 20% of cisgender women aged 18 to 40 years have a sexual minority identity (eg, bisexual, lesbian, and queer), there is limited research on the family building and pregnancy experiences of sexual minority cisgender women. Improving our understanding of the family building and pregnancy experiences of cisgender sexual minority women is critical for improving the perinatal health of this population. OBJECTIVE This study aimed to compare the mode of family building, past pregnancy experiences, and future pregnancy intentions among cisgender sexual minority women by sexual orientation. STUDY DESIGN This is an observational study which was conducted using cross-sectional data collected in 2019 from a national sample of 1369 cisgender sexual minority women aged 18 to 45 years. RESULTS Most participants (n=794, 58%) endorsed multiple sexual orientations, most commonly queer (n=641, 47%), lesbian (n=640, 47%), and/or bisexual (n=583, 43%). There were 243 (18%) cisgender sexual minority women who were parents. Pregnancy was used by 74% (181/243) of women to build their families. Among participants who used pregnancy, 60% (108/181) became pregnant through sexual activity with another parent of the child, whereas 27% (64/243) of women used donor sperm. An additional 10% (n=24) became parents through second-parent adoption, 10% (n=25) through adoption, and 14% (n=35) through step-parenting. Bisexual women more often used sexual activity to become parents (61/100, 61%) compared with queer (40/89, 45%) and lesbian women (40/130, 31%). In contrast, lesbian (50/130, 39%) and queer (25/89, 27%) women more often used donor sperm to become parents compared with bisexual women (11/100, 11%). Among the 266 (19%) cisgender sexual minority women who had ever been pregnant, there were 545 pregnancies (mean, 2.05 pregnancies per woman). Among those pregnancies, 59% (n=327) resulted in live birth, 23% (n=126) resulted in miscarriage, 15% (n=83) resulted in abortion, and 2% (n=9) resulted in ectopic pregnancy. A quarter of women had future pregnancy intentions, with no differences by sexual orientation. Overall, few participants (16%) reported that all of their healthcare providers were aware of their sexual orientation. CONCLUSION Cisgender sexual minority women primarily built their families through pregnancy and a quarter have future pregnancy desires. In addition, there were important differences in family building methods used by sexual orientation. Providers should be aware of the pregnancy and family-building patterns, plans, and needs of cisgender sexual minority women.
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Affiliation(s)
- Diana M. Tordoff
- Stanford University School of Medicine, Palo Alto, CA (Drs Tordoff, Lunn, and Obedin-Maliver)
| | - Heidi Moseson
- Ibis Reproductive Health, Oakland, CA (Dr Moseson and Mx. Ragosta)
| | - Sachiko Ragosta
- Ibis Reproductive Health, Oakland, CA (Dr Moseson and Mx. Ragosta)
| | - Jen Hastings
- University of California, San Francisco, San Francisco, CA (Drs Hastings, Flentje, and Lubensky)
| | - Annesa Flentje
- University of California, San Francisco, San Francisco, CA (Drs Hastings, Flentje, and Lubensky)
| | - Matthew R. Capriotti
- Department of Psychology, San Jose State University, San Jose, CA (Dr Capriotti)
| | - Micah E. Lubensky
- University of California, San Francisco, San Francisco, CA (Drs Hastings, Flentje, and Lubensky)
| | - Mitchell R. Lunn
- Stanford University School of Medicine, Palo Alto, CA (Drs Tordoff, Lunn, and Obedin-Maliver)
| | - Juno Obedin-Maliver
- Stanford University School of Medicine, Palo Alto, CA (Drs Tordoff, Lunn, and Obedin-Maliver)
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12
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Korkidakis A, DeSantis C, Kissin D, Hacker M, Koniares K, Yartel A, Adashi E, Penzias A. State insurance mandates and racial and ethnic inequities in assisted reproductive technology utilization. Fertil Steril 2024; 121:54-62. [PMID: 37775023 PMCID: PMC10951934 DOI: 10.1016/j.fertnstert.2023.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 09/20/2023] [Accepted: 09/20/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVE To examine whether the (1) scope of state-mandated insurance coverage for assisted reproductive technology (ART) and (2) proportion of the population eligible for this coverage are associated with reductions in racial/ethnic inequities in ART utilization. DESIGN National cross-sectional, ecologic study. SUBJECTS We employed estimates from the US Census Bureau of all women 20-44 years of age living in the US in 2018. Data on the number of women who initiated an ART cycle during that year that were reported to the US Centers for Disease Control and Prevention were obtained from the National ART Surveillance System. EXPOSURE State mandates were classified according to the scope of required coverage for fertility services: Comprehensive, Limited, and No Mandate. MAIN OUTCOME MEASURES Race and ethnic-specific ART utilization rates, defined as the number of women undergoing ≥1 ART cycles per 10,000 women, were the primary outcomes. As state mandates do not apply to all insurance plans, Comprehensive Mandate utilization rates were recalculated using denominators corrected for the estimated proportions of populations eligible for coverage. RESULTS Across all mandate categories, Non-Hispanic (NH) Asian and NH White populations had the highest ART utilization rates, whereas the lowest rates were among Hispanic, NH Black, and NH Other/Multiple Races populations. Compared with the NH Asian reference group, the NH Black population had smaller inequities in the Comprehensive Mandate group than the No Mandate group (rate ratio [RR 0.33 [0.28-0.38] vs. RR 0.23 [0.22-0.24]). Using the Comprehensive Mandate group for each race/ethnicity as the reference, the NH Black and NH Other/Multiple Races populations showed the largest relative differences in utilization between the No Mandate and Comprehensive Mandate groups (RR 0.39 [0.37-0.41] and 0.33 [0.28-0.38], respectively). Within the Comprehensive Mandate group, the disparities in the Hispanic and NH Black populations moved toward the null after correcting for state-mandated insurance eligibility. CONCLUSIONS Racial/ethnic inequities in ART utilization were reduced in states with comprehensive infertility coverage mandates. Inequities were further attenuated after correcting for mandate eligibility. Mandates alone, however, were not sufficient to eliminate disparities. These findings can inform future strategies aimed at improving ART access under a social justice framework.
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Affiliation(s)
- Ann Korkidakis
- Boston IVF-The Eugin Group, Waltham, Massachusetts; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts.
| | - Carol DeSantis
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Obstetrics and Gynecology, University of Connecticut, Farmington, Connecticut
| | - Dmitry Kissin
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michele Hacker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
| | - Katherine Koniares
- Department of Obstetrics and Gynecology, University of Connecticut, Farmington, Connecticut
| | - Anthony Yartel
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Obstetrics and Gynecology, University of Connecticut, Farmington, Connecticut
| | - Eli Adashi
- Department of Medical Sciences, Division of Biology and Medicine, Brown University, Providence, Rhode Island
| | - Alan Penzias
- Boston IVF-The Eugin Group, Waltham, Massachusetts; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
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13
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Piechota S, Marchante M, Giovannini A, Paulsen B, Potts KS, Rockwell G, Aschenberger C, Noblett AD, Figueroa AB, Sanchez M, Barrachina F, Wiemer K, Guzman L, Belchin P, Pierson Smela M, Fortuna PRJ, Chatterjee P, Tran ND, Kelk DA, Forti M, Marcinyshyn S, Smith T, McCulloh DH, Fernandez-Gonzalez MJ, Abittan B, Ortiz S, Klein JU, Klatsky P, Ordonez-Perez D, Kramme CC. Human-induced pluripotent stem cell-derived ovarian support cell co-culture improves oocyte maturation in vitro after abbreviated gonadotropin stimulation. Hum Reprod 2023; 38:2456-2469. [PMID: 37815487 PMCID: PMC10694404 DOI: 10.1093/humrep/dead205] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 09/09/2023] [Indexed: 10/11/2023] Open
Abstract
STUDY QUESTION Can in vitro maturation (IVM) and developmental competence of human oocytes be improved by co-culture with ovarian support cells (OSCs) derived from human-induced pluripotent stem cells (hiPSCs)? SUMMARY ANSWER OSC-IVM significantly improves the rates of metaphase II (MII) formation and euploid Day 5 or 6 blastocyst formation, when compared to a commercially available IVM system. WHAT IS KNOWN ALREADY IVM has historically shown highly variable performance in maturing oocytes and generating oocytes with strong developmental capacity, while limited studies have shown a positive benefit of primary granulosa cell co-culture for IVM. We recently reported the development of OSCs generated from hiPSCs that recapitulate dynamic ovarian function in vitro. STUDY DESIGN, SIZE, DURATION The study was designed as a basic science study, using randomized sibling oocyte specimen allocation. Using pilot study data, a prospective sample size of 20 donors or at least 65 oocytes per condition were used for subsequent experiments. A total of 67 oocyte donors were recruited to undergo abbreviated gonadotropin stimulation with or without hCG triggers and retrieved cumulus-oocyte complexes (COCs) were allocated between the OSC-IVM or control conditions (fetal-like OSC (FOSC)-IVM or media-only IVM) in three independent experimental design formats. The total study duration was 1 April 2022 to 1 July 2023. PARTICIPANTS/MATERIALS, SETTING, METHODS Oocyte donors between the ages of 19 and 37 years were recruited for retrieval after informed consent, with assessment of anti-Mullerian hormone, antral follicle count, age, BMI and ovarian pathology used for inclusion and exclusion criteria. In experiment 1, 27 oocyte donors were recruited, in experiment 2, 23 oocyte donors were recruited, and in experiment 3, 17 oocyte donors and 3 sperm donors were recruited. The OSC-IVM culture condition was composed of 100 000 OSCs in suspension culture with hCG, recombinant FSH, androstenedione, and doxycycline supplementation. IVM controls lacked OSCs and contained either the same supplementation, FSH and hCG only (a commercial IVM control), or FOSCs with the same supplementation (Media control). Experiment 1 compared OSC-IVM, FOSC-IVM, and a Media control, while experiments 2 and 3 compared OSC-IVM and a commercial IVM control. Primary endpoints in the first two experiments were the MII formation (i.e. maturation) rate and morphological quality assessment. In the third experiment, the fertilization and embryo formation rates were assessed with genetic testing for aneuploidy and epigenetic quality in blastocysts. MAIN RESULTS AND THE ROLE OF CHANCE We observed a statistically significant improvement (∼1.5×) in maturation outcomes for oocytes that underwent IVM with OSCs compared to control Media-IVM and FOSC-IVM in experiment 1. More specifically, the OSC-IVM group yielded a MII formation rate of 68% ± 6.83% SEM versus 46% ± 8.51% SEM in the Media control (P = 0.02592, unpaired t-test). FOSC-IVM yielded a 51% ± 9.23% SEM MII formation rate which did not significantly differ from the media control (P = 0.77 unpaired t-test). Additionally, OSC-IVM yielded a statistically significant ∼1.6× higher average MII formation rate at 68% ± 6.74% when compared to 43% ± 7.90% in the commercially available IVM control condition (P = 0.0349, paired t-test) in experiment 2. Oocyte morphological quality between OSC-IVM and the controls did not significantly differ. In experiment 3, OSC-IVM oocytes demonstrated a statistically significant improvement in Day 5 or 6 euploid blastocyst formation per COC compared to the commercial IVM control (25% ± 7.47% vs 11% ± 3.82%, P = 0.0349 logistic regression). Also in experiment 3, the OSC-treated oocytes generated blastocysts with similar global and germline differentially methylated region epigenetic profiles compared commercial IVM controls or blastocysts after either conventional ovarian stimulation. LARGE SCALE DATA N/A. LIMITATIONS, REASONS FOR CAUTION While the findings of this study are compelling, the cohort size remains limited and was powered on preliminary pilot studies, and the basic research nature of the study limits generalizability compared to randomized control trials. Additionally, use of hCG-triggered cycles results in a heterogenous oocyte cohort, and potential differences in the underlying maturation state of oocytes pre-IVM may limit or bias findings. Further research is needed to clarify and characterize the precise mechanism of action of the OSC-IVM system. Further research is also needed to establish whether these embryos are capable of implantation and further development, a key indication of their clinical utility. WIDER IMPLICATIONS OF THE FINDINGS Together, these findings demonstrate a novel approach to IVM with broad applicability to modern ART practice. The controls used in this study are in line with and have produced similar to findings to those in the literature, and the outcome of this study supports findings from previous co-culture studies that found benefits of primary granulosa cells on IVM outcomes. The OSC-IVM system shows promise as a highly flexible IVM approach that can complement a broad range of stimulation styles and patient populations. Particularly for patients who cannot or prefer not to undergo conventional gonadotropin stimulation, OSC-IVM may present a viable path for obtaining developmentally competent, mature oocytes. STUDY FUNDING/COMPETING INTEREST(S) A.D.N., A.B.F., A.G., B.P., C.A., C.C.K., F.B., G.R., K.S.P., K.W., M.M., P.C., S.P., and M.-J.F.-G. are shareholders in the for-profit biotechnology company Gameto Inc. P.R.J.F. declares paid consultancy for Gameto Inc. P.C. also declares paid consultancy for the Scientific Advisory Board for Gameto Inc. D.H.M. has received consulting services from Granata Bio, Sanford Fertility and Reproductive Medicine, Gameto, and Buffalo IVF, and travel support from the Upper Egypt Assisted Reproduction Society. C.C.K., S.P., M.M., A.G., B.P., K.S.P., G.R., and A.D.N. are listed on a patent covering the use of OSCs for IVM: U.S. Provisional Patent Application No. 63/492,210. Additionally, C.C.K. and K.W. are listed on three patents covering the use of OSCs for IVM: U.S. Patent Application No. 17/846,725, U.S Patent Application No. 17/846,845, and International Patent Application No.: PCT/US2023/026012. C.C.K., M.P.S., and P.C. additionally are listed on three patents for the transcription factor-directed production of granulosa-like cells from stem cells: International Patent Application No.: PCT/US2023/065140, U.S. Provisional Application No. 63/326,640, and U.S. Provisional Application No. 63/444,108. The remaining authors have no conflicts of interest to declare.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Marta Sanchez
- Ruber Juan Bravo University Hospital, Eugin Group, Madrid, Spain
| | | | | | | | - Pedro Belchin
- Ruber Juan Bravo University Hospital, Eugin Group, Madrid, Spain
| | - Merrick Pierson Smela
- Wyss Institute, Harvard Medical School, Boston, MA, USA
- Department of Genetics, Harvard Medical School, Boston, MA, USA
| | - Patrick R J Fortuna
- Wyss Institute, Harvard Medical School, Boston, MA, USA
- Department of Genetics, Harvard Medical School, Boston, MA, USA
| | - Pranam Chatterjee
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
- Department of Computer Science, Duke University, Durham, NC, USA
| | | | | | | | | | | | - David H McCulloh
- Gameto Inc., New York, NY, USA
- Biogenetics Corporation, Mountainside, NJ, USA
- Sperm and Embryo Bank of New York, New York, NY, USA
- Biogenetics Laboratory, Brooklyn, NY, USA
- ReproART, Georgian American Center for Reproductive Medicine, Tbilisi, GA, USA
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Peipert BJ, Mebane S, Edmonds M, Watch L, Jain T. Economics of Fertility Care. Obstet Gynecol Clin North Am 2023; 50:721-734. [PMID: 37914490 DOI: 10.1016/j.ogc.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Family building is a human right. The high cost and lack of insurance coverage associated with fertility treatments in the United States have made treatment inaccessible for many patients. The universal uptake of "add-on" services has further contributed to high out-of-pocket costs. Expansion in access to infertility care has occurred in several states through implementation of insurance mandates, and more employers are offering fertility benefits to attract and retain employees. An understanding of the economic issues shaping fertility should inform future policies aimed at promoting evidence-based practices and improving access to care in the United States.
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Affiliation(s)
- Benjamin J Peipert
- Division of Reproductive Endocrinology and Infertility, Hospital of the University of Pennsylvania, 3701 Market Street, 8th Floor, Philadelphia, PA 19104, USA
| | - Sloane Mebane
- Department of Obstetrics & Gynecology, Duke University School of Medicine, 201 Trent Drive, 203 Baker House, Durham, NC 27710, USA
| | - Maxwell Edmonds
- Department of Obstetrics & Gynecology, Duke University School of Medicine, 201 Trent Drive, 203 Baker House, Durham, NC 27710, USA
| | - Lester Watch
- Department of Obstetrics & Gynecology, Duke University School of Medicine, 201 Trent Drive, 203 Baker House, Durham, NC 27710, USA
| | - Tarun Jain
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, 676 N. Saint Clair Street, Suite 2310, Chicago, IL 60611, USA.
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15
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Portugal A, Kosturakis AK, Onyewuenyi TL, Rivera-Cruz G, Jimenez PT. Breaking Down Barriers: Advancing Toward Health Equity in Fertility Care for Black and Hispanic Patients. Obstet Gynecol Clin North Am 2023; 50:735-746. [PMID: 37914491 DOI: 10.1016/j.ogc.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Infertility can affect all people, regardless of race, ethnicity, or socioeconomic status. Barriers to quality fertility care include access, financial limitations, education, and social stigmas. Although racial disparities in outcomes of assisted reproductive technology can be largely attributed to the influences of systemic racism (not race), we can make changes to improve equity of care. We propose strategies in the areas of advocacy, clinical setting, community, and outcomes to address the racial disparities.
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Affiliation(s)
- Aileen Portugal
- Department of Obstetrics, Gynecology, University of California San Francisco, 490 Illinois Street, 10th Floor, Box 0132, San Francisco, CA 94158, USA; Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Washington University, 4444 Forest Park Avenue, Ste. 3100, St. Louis, MO 63108, USA
| | - Alyssa K Kosturakis
- Department of Obstetrics and Gynecology, University of Washington, 1959 NE Pacific Street, Box 356460, Seattle, WA 98195-6460, USA
| | - Ticara L Onyewuenyi
- Department of Obstetrics and Gynecology, Kaiser Permanente Northern California, 3600 Broadway, Oakland, CA 94611, USA
| | - Greysha Rivera-Cruz
- Herbert Wertheim College Medicine, Florida International University, 3251 North State Road 7 Suite 200, Margate, FL 33063, USA
| | - Patricia T Jimenez
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Washington University, 4444 Forest Park Avenue, Ste. 3100, St. Louis, MO 63108, USA.
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16
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Klipstein S, Collins LR. Mandated fertility coverage: the resounding choice when morality, medicine, and money align. Fertil Steril 2023; 120:821-822. [PMID: 37604399 DOI: 10.1016/j.fertnstert.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 08/14/2023] [Indexed: 08/23/2023]
Affiliation(s)
| | - Lee Rubin Collins
- RESOLVE: The National Infertility Association, Wellesley, Massachusetts
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17
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Tewari S, Coyne KD, Weinerman RS, Findley J, Kim ST, Flyckt RLR. Racial disparities in telehealth use during the coronavirus disease 2019 pandemic. Fertil Steril 2023; 120:880-889. [PMID: 37244379 PMCID: PMC10210818 DOI: 10.1016/j.fertnstert.2023.05.159] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/18/2023] [Accepted: 05/18/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To investigate the impact of coronavirus disease 2019 on initial infertility consultations. DESIGN Retrospective cohort. SETTING Fertility practice in an academic medical center. PATIENTS Patients presenting for initial infertility consultation between January 2019 and June 2021 were randomly selected for prepandemic (n = 500) and pandemic (n = 500) cohorts. EXPOSURE Coronavirus disease 2019 pandemic. MAIN OUTCOME MEASURES The primary outcome was a change in the proportion of African American patients using telehealth after pandemic onset compared with all other patients. Secondary outcomes included presentation to an appointment vs. no-show or cancellation. Exploratory outcomes included appointment length and in vitro fertilization initiation. RESULTS The prepandemic cohort vs. the pandemic cohort had fewer patients with commercial insurance (64.4% vs. 72.80%) and more African American patients (33.0% vs. 27.0%), although the racial makeup did not differ significantly between the two cohorts. Rates of missed appointments did not differ between the cohorts, but the prepandemic cohort vs. the pandemic cohort was more likely to no-show (49.4% vs. 27.8%) and less likely to cancel (50.6% vs. 72.2%). African American patients, compared with all other patients, during the pandemic were less likely to use telehealth (57.0% vs. 66.8%). African American patients, compared with all other patients, were less likely to have commercial insurance (prepandemic: 41.2% vs. 75.8%; pandemic: 57.0% vs. 78.6%), present to their scheduled appointment (prepandemic: 52.7% vs. 73.7%; pandemic: 48.1% vs. 74.8%), and cancel vs. no-show (prepandemic: 30.8% vs. 68.2%, pandemic: 64.3% vs. 78.3%). On multivariable analysis, African American patients were less likely (odds ratio 0.37, 95% confidence interval 0.28-0.50) and telehealth users were more likely (odds ratio 1.54, 95% confidence interval 1.04-2.27) to present to their appointments vs. no-show or cancel when controlling for insurance type and timing relative to the onset of the pandemic. CONCLUSION Telehealth implementation during the coronavirus disease 2019 pandemic decreased the overall no-show rate, but this shift did not apply to African American patients. This analysis highlights disparities in insurance coverage, telehealth utilization, and presentation for an initial consultation in the African American population during the pandemic.
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Affiliation(s)
- Surabhi Tewari
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Kathryn D Coyne
- Division of Reproductive Endocrinology and Infertility, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Rachel S Weinerman
- Division of Reproductive Endocrinology and Infertility, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Joseph Findley
- Division of Reproductive Endocrinology and Infertility, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Sung Tae Kim
- Division of Reproductive Endocrinology and Infertility, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Rebecca L R Flyckt
- Division of Reproductive Endocrinology and Infertility, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
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Eliason EL, Thoma ME, Steenland MW. Differences in Use of Fertility Treatment Between People With Medicaid and Private Health Insurance Coverage in the United States. Womens Health Issues 2023; 33:367-373. [PMID: 37076318 PMCID: PMC10330011 DOI: 10.1016/j.whi.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 02/28/2023] [Accepted: 03/14/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVES We aimed to compare differences in receipt of any and specific types of fertility services between people with Medicaid and private insurance. METHODS We used National Survey of Family Growth (2002-2019) data and linear probability regression models to examine the association between insurance type (Medicaid or private) and fertility service use. The primary outcome was use of fertility services in the past 12 months, and secondary outcomes were use of specific types of fertility services at any time: 1) testing, 2) common medical treatment, and 3) use of any fertility treatment type (testing, medical treatment, or surgical treatment of infertility). We additionally calculated time-to-pregnancy using a method that estimates the unobserved total amount of time the respondent spent trying to become pregnant using their current duration of pregnancy attempt at the time of the survey. We calculated time-to-pregnancy ratios across respondent characteristics to examine if insurance type was associated with differential time-to-pregnancy. RESULTS In adjusted models, Medicaid coverage was associated with an 11.2-percentage point (95% confidence interval: -22.3 to -0.0) lower use of fertility services in the past 12 months compared with private coverage. Relative to private coverage, Medicaid insurance was also associated with large and statistically significantly lower rates of ever having used infertility testing or any fertility services. Insurance type was not associated with differences in time-to-pregnancy. CONCLUSIONS People covered by Medicaid were less likely to have used fertility services compared with people with private insurance. Differences in coverage of fertility services between Medicaid and private payers may represent a barrier to fertility treatment for Medicaid recipients.
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Affiliation(s)
- Erica L Eliason
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island.
| | - Marie E Thoma
- Department of Family Science, School of Public Health, University of Maryland, College Park, Maryland
| | - Maria W Steenland
- Population Studies and Training Center, Brown University, Providence, Rhode Island
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19
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Ren Y, Xie Y, Xu Q, Long M, Zheng Y, Li L, Niu C. University students' fertility awareness and its influencing factors: a systematic review. Reprod Health 2023; 20:85. [PMID: 37280685 DOI: 10.1186/s12978-023-01628-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/25/2023] [Indexed: 06/08/2023] Open
Abstract
INTRODUCTION In recent years, a growing number of researchers have begun to study fertility awareness (FA). Evidence suggests that college students in their reproductive years have a common understanding of fertility, risk factors for infertility, and assisted reproductive technologies. Therefore, this systematic review summarizes these studies and explores the factors affecting college students' fertility awareness. METHODS A systematic literature search of databases (PUBMED/MEDLINE, Cochrane, Web of Science, Embase, and EBSCO) was conducted from inception to September 2022. Studies that assessed the levels of fertility awareness and factors influencing college students were considered for the review. The qualities of the included studies were evaluated using the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. This systematic review is reported according to the preferred reporting items for systematic review (PRISMA) guidelines. RESULTS Twenty-one articles met the eligibility criteria and were included. The preliminary results showed that participants reported low to moderate FA. Female medical students demonstrated higher levels of fertility awareness. The association between age, years of education, and FA was insufficient. CONCLUSION The results of the current study suggest that increased FA interventions are warranted, especially for the male, non-medical student population. Governments and educational institutions should strengthen education programs for young students on reproductive health to help them raise awareness about childbirth, and society should provide family support for young people.
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Affiliation(s)
- Yue Ren
- School of Nursing School of Public, Health Yangzhou University, Mid Jiangyang Road 136, Yangzhou, Jiangsu, People's Republic of China
| | - Yue Xie
- School of Nursing School of Public, Health Yangzhou University, Mid Jiangyang Road 136, Yangzhou, Jiangsu, People's Republic of China
| | - Qulian Xu
- School of Nursing School of Public, Health Yangzhou University, Mid Jiangyang Road 136, Yangzhou, Jiangsu, People's Republic of China
| | - Miaochen Long
- School of Nursing School of Public, Health Yangzhou University, Mid Jiangyang Road 136, Yangzhou, Jiangsu, People's Republic of China
| | - Ying Zheng
- School of Nursing School of Public, Health Yangzhou University, Mid Jiangyang Road 136, Yangzhou, Jiangsu, People's Republic of China
| | - Lin Li
- Department of Obstetrics and Gynecology, Yangzhou University Affiliated Hospital, Yangzhou, China
| | - Changmin Niu
- School of Nursing School of Public, Health Yangzhou University, Mid Jiangyang Road 136, Yangzhou, Jiangsu, People's Republic of China.
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20
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Violette CJ, Nguyen BT. Expectations for family building, assisted reproduction, and adoption among lesbians in the National Survey of Family Growth, 2017-2019. F S Rep 2023; 4:190-195. [PMID: 37398611 PMCID: PMC10310959 DOI: 10.1016/j.xfre.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/06/2023] [Accepted: 04/10/2023] [Indexed: 07/04/2023] Open
Abstract
Objective To characterize the family-building goals and experiences of lesbians compared with those of heterosexual females in the United States. Design Secondary analysis of nationally representative, cross-sectional survey data. Setting National Survey of Family Growth 2017-2019. Patients 159 reproductive-age lesbian respondents and 5,127 reproductive-age heterosexual respondents. Interventions We characterized family-building goals and the use of assisted reproduction and adoption among lesbians using nationally representative female respondent data from the 2017-2019 National Survey of Family Growth. We performed bivariate analyses examining variations in these outcomes between lesbian and heterosexual individuals. Main Outcome Measures Wantedness of children, use of assisted reproductive technology, and pursuit of adoption among reproductive-age lesbian and heterosexual participants. Results We identified 159 reproductive-age lesbian respondents of the National Survey of Family Growth, representing 2.3% or approximately 1.75 million US individuals of reproductive age. The lesbian respondents were younger, less religious, and less likely to have children than heterosexual respondents. These groups did not differ significantly by race/ethnicity, education, or income. More than half of the individuals reported wanting a child in the future, with proportions similar between the lesbian and heterosexual individuals (48% vs. 51%, respectively; P = .52). Accordingly, 18% of both the lesbian and heterosexual individuals reported that they would be greatly bothered if they were unable to have children. Nevertheless, health care providers reportedly asked the lesbians about their desire to get pregnant less frequently than they asked the heterosexual individuals (21% vs. 32%, respectively; P = .04). Only 26% of the lesbians had ever been pregnant compared with 64% of the heterosexual individuals (P<.01). Approximately one third (31%) of lesbians with medical insurance were seeking reproductive services compared with 10% of heterosexual individuals (P = .05). Lesbians were significantly more likely to be seeking adoption than heterosexual individuals (7.0% vs. 1.3%, respectively; P = .01), although they were more likely to report being turned down (17% vs. 10%, respectively; P = .03), not knowing why they were unable to adopt (19% vs. 1%, respectively; P = .02), and quitting because of the adoption process (100% vs. 45%, respectively; P = .04). Conclusions Approximately half of US females of reproductive age desire to have a child, a proportion that is not different between lesbian and heterosexual individuals. However, fewer lesbians are asked about their desires to get pregnant, and fewer ever become pregnant. Lesbians are significantly more likely to pursue assisted reproductive services when covered by insurance and more likely to seek adoption. Unfortunately, lesbians are more likely to face challenges with adoption.
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Affiliation(s)
- Caroline J. Violette
- Department of Obstetrics and Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Brian T. Nguyen
- Section of Family Planning, Department of Obstetrics and Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, California
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21
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Iwamoto A, Summers KM, Mancuso AC. Public opinions regarding infertility treatment insurance coverage among marginalized patient populations. J Assist Reprod Genet 2023; 40:589-598. [PMID: 36602655 PMCID: PMC10033767 DOI: 10.1007/s10815-022-02687-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 12/06/2022] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To assess public support for insurance coverage of infertility treatment among marginalized patient groups. METHODS A cross-sectional, web survey-based study using a national sample of 1226 US adults. Participants responded to questions measuring their beliefs and attitudes towards support for infertility treatment insurance coverage among specific patient populations. We then evaluated the opinions of only the participants who supported infertility treatment insurance coverage for patients meeting the standard definition of infertility. Associations between demographic data of participants and support for infertility treatment insurance coverage among these marginalized groups were queried. RESULTS Of the total responses, 61.9% of the respondents generally supported insurance coverage for infertility. Of the total responses, 54.5% did not support any insurance coverage for lesbian, gay, or transgender patients. Of those who generally supported the insurance coverage for infertility, 53.0% supported coverage for gay patients requiring infertility services, 54.6% supported coverage for lesbian patients, and 42.5% supported coverage for transgender patients. Of the total responses, 47.6% did not support insurance for green card holders, undocumented immigrants, or refugees. Of those who supported the insurance coverage for infertility in general, 63.6% supported insurance coverage for patients with green cards, 29.8% for refugees, and 20.7% for undocumented patients. For disability and genetic conditions, 39.5% did not support coverage for any groups. Of those who support the insurance coverage for infertility in general, there was most support for patients with physical disabilities (60.2%) followed by genetic disease (47.9%), then mental disabilities (31.4%). CONCLUSION Even among those who support insurance coverage for infertility in general, approximately less than half of them supported these same treatments for marginalized groups, including the diverse sexuality and gender (DSG), immigrant, and disabled populations. Increased education and awareness of infertility is needed among the general population to garner acceptance of infertility as a disease and support insurance coverage of infertility treatment for all persons.
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Affiliation(s)
- Aya Iwamoto
- Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA, 52241, USA.
| | - Karen M Summers
- Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA, 52241, USA
| | - Abigail C Mancuso
- Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA, 52241, USA
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22
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Lee JC, DeSantis CE, Yartel AK, Kissin DM, Kawwass JF. Association of state insurance coverage mandates with assisted reproductive technology care discontinuation. Am J Obstet Gynecol 2023; 228:315.e1-315.e14. [PMID: 36368429 PMCID: PMC11000072 DOI: 10.1016/j.ajog.2022.10.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/21/2022] [Accepted: 10/29/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Insurance coverage for fertility services may reduce the financial burden of high-cost fertility care such as assisted reproductive technology and improve its utilization. Patients who exit care after failing to reach their reproductive goals report higher rates of mental health problems and a lower sense of well-being. It is important to understand the relationship between state-mandated insurance coverage for fertility services and assisted reproductive technology care discontinuation. OBJECTIVE This study aimed to assess whether state-mandated insurance coverage for fertility services is associated with lower rates of care discontinuation after an initial assisted reproductive technology cycle that did not result in a live birth. STUDY DESIGN This is a retrospective, population-based cohort study using data from United States fertility clinics reporting to the National Assisted Reproductive Technology Surveillance System during 2016 and 2018. Patients who began their first autologous assisted reproductive technology cycle during 2016 and 2017 and did not have a live birth were included. We describe the rate of assisted reproductive technology care discontinuation (no additional cycle within 12 months of the previous cycle's date of failure). Multivariable analyses were conducted to evaluate factors independently associated with care discontinuation, including the scope of fertility services included in state coverage mandate at assisted reproductive technology cycle initiation that were as follows: comprehensive (≥3 assisted reproductive technology cycles), limited (1, 2, or an unspecified number of assisted reproductive technology cycles), mandate not including assisted reproductive technology, and no mandate. RESULTS Among 91,324 patients who underwent their first autologous assisted reproductive technology cycle that did not result in live birth, 24,072 (26.4%) discontinued care. Compared with patients who lived in states with mandates for comprehensive assisted reproductive technology coverage, those in states with mandates for fertility services coverage that did not include assisted reproductive technology or states with no mandate were 46% (adjusted relative risk, 1.46; 95% confidence interval, 1.31-1.63) and 26% (adjusted relative risk, 1.26; 95% confidence interval, 1.15-1.39) more likely to discontinue care, respectively, after controlling for patient and cycle characteristics. Increasing patient age, distance from clinic ≥50 miles, previous live birth, fewer oocytes retrieved, and not having embryos cryopreserved were also associated with higher rates of discontinuation. Non-Hispanic Black, non-Hispanic Asian, and Hispanic patients had higher rates of care discontinuation than non-Hispanic White patients regardless of the existence or scope of state-mandated assisted reproductive technology coverage. CONCLUSION Comprehensive state-mandated insurance coverage for assisted reproductive technology is associated with lower rates of assisted reproductive technology care discontinuation.
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Affiliation(s)
- Jacqueline C Lee
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA.
| | - Carol E DeSantis
- CDC Foundation, Atlanta, GA; Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Anthony K Yartel
- CDC Foundation, Atlanta, GA; Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Dmitry M Kissin
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA; Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA
| | - Jennifer F Kawwass
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA; Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA
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23
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Beyond awareness - National Infertility Awareness Week 2023. Fertil Steril 2023; 119:570-571. [PMID: 36813126 DOI: 10.1016/j.fertnstert.2023.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023]
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24
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Jorgensen K, Meernik C, Wu CF, Murphy CC, Baker VL, Jarmon P, Brady PC, Nitecki R, Nichols HB, Rauh-Hain JA. Disparities in Fertility-Sparing Treatment and Use of Assisted Reproductive Technology After a Diagnosis of Cervical, Ovarian, or Endometrial Cancer. Obstet Gynecol 2023; 141:341-353. [PMID: 36649345 PMCID: PMC9858239 DOI: 10.1097/aog.0000000000005044] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/07/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To assess the presence of sociodemographic and clinical disparities in fertility-sparing treatment and assisted reproductive technology (ART) use among patients with a history of cervical, endometrial, or ovarian cancer. METHODS We conducted a population-based cohort study of patients aged 18-45 years who were diagnosed with cervical cancer (stage IA, IB), endometrial cancer (grade 1, stage IA, IB), or ovarian cancer (stage IA, IC) between January 1, 2000, and December 31, 2015, using linked data from the CCR (California Cancer Registry), the California Office of Statewide Health Planning and Development, and the Society for Assisted Reproductive Technology. The primary outcome was receipt of fertility-sparing treatment , defined as surgical or medical treatment to preserve the uterus and at least one ovary. The secondary outcome was fertility preservation , defined as ART use after cancer diagnosis. Multivariable logistic regression analysis was used to estimate odds ratios and 95% CIs for the association between fertility-sparing treatment and exposures of interest: age at diagnosis, race and ethnicity, health insurance, socioeconomic status, rurality, and parity. RESULTS We identified 7,736 patients who were diagnosed with cervical, endometrial, or ovarian cancer with eligible histology. There were 850 (18.8%) fertility-sparing procedures among 4,521 cases of cervical cancer, 108 (7.2%) among 1,504 cases of endometrial cancer, and 741 (43.3%) among 1,711 cases of ovarian cancer. Analyses demonstrated nonuniform patterns of sociodemographic disparities by cancer type for fertility-sparing treatment, and ART. Fertility-sparing treatment was more likely among young patients, overall, and of those in racial and ethnic minority groups among survivors of cervical and ovarian cancer. Use of ART was low (n=52) and was associated with a non-Hispanic White race and ethnicity designation, being of younger age (18-35 years), and having private insurance. CONCLUSION This study demonstrates that clinical and sociodemographic disparities exist in the receipt of fertility-sparing treatment and ART use among patients with a history of cervical, endometrial, or ovarian cancer.
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Affiliation(s)
- Kirsten Jorgensen
- Department of Gynecologic Oncology and Reproductive Medicine and the Department of Health Services Research, University of Texas MD Anderson Cancer Center, and the Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas; the Department of Public Health Sciences, Duke University School of Medicine, Durham, North Carolina; the Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland; Tulane University School of Medicine, New Orleans, Louisiana; the Columbia University Irving Medical Center, Columbia University Fertility Center, New York, New York; and the Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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25
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Cyranoski D, Contreras JL, Carrington VT. Intellectual property and assisted reproductive technology. Nat Biotechnol 2023; 41:14-20. [PMID: 36653491 DOI: 10.1038/s41587-022-01592-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- David Cyranoski
- Institute for the Advanced Studies of Human Biology (WPI-ASHBi), Kyoto University, Kyoto, Japan.
| | - Jorge L Contreras
- S.J. Quinney College of Law, University of Utah, Salt Lake City, UT, USA
- Department of Human Genetics, University of Utah School of Medicine, Salt Lake City, UT, USA
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26
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Collins LR. Beyond mandates. F S Rep 2022; 3:296-297. [PMID: 36568930 PMCID: PMC9783127 DOI: 10.1016/j.xfre.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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27
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Tierney KI. Geographic distribution of assisted reproductive technology clinics in the USA: a multilevel sociodemographic analysis. J Assist Reprod Genet 2022; 39:2505-2519. [PMID: 36103005 PMCID: PMC9723016 DOI: 10.1007/s10815-022-02607-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/28/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To investigate whether sociodemographic characteristics of US Census tracts and counties and state-level infertility insurance policy are associated with the presence of assisted reproductive technology (ART) clinics. METHODS Multilevel logistic regression analyses using publicly available reports of ART clinic locations (2014-2018) matched with sociodemographic data from the US Census Bureau and state infertility insurance policy information. RESULTS At the tract-level, multivariate multilevel logistic regression found significant associations with the likelihood of an ART clinic in a tract and the size of the tract population (adjusted odds ratio (aOR): 1.063, SE = 0.018, p < .001), the tract median household income (aOR = 0.990, SE = 0.002, p < 0.001), and the percentages of the population who were Hispanic (aOR = 0.975, SE = 0.007, p < 0.001), women over 25 with a bachelor's degree or higher (aOR: 1.052, SE = 0.004, p < 0.001), and foreign-born (aOR: 1.037, SE = 0.009, p < .001). At the county-level, significant associations were found with the county median household income (aOR: 1.016, SE = 0.006, p < .01) and the percentage of the population that identified as Black (aOR = 1.013, SE = 0.006, p < .05) and Hispanic (aOR = 1.028, SE = 0.009, p < .05). Multivariate models showed no associations between tract clinic counts and state infertility policy. CONCLUSION There is mixed evidence that clinic concentration is associated with expected sociodemographics. In particular, physical proximity may not principally drive racial disparities in ART access. Furthermore, insurance mandates are not associated with the presence of an ART clinics in a tract, suggesting alternative policy levers may be needed to address differential access and utilization of ART services.
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Affiliation(s)
- Katherine I Tierney
- Department of Sociology, Western Michigan University, 1903 W. Michigan Ave, Kalamazoo, MI, 49008-5257, USA.
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28
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Schon SB, Kelley AS, Jiang C, Xu M, Menke M, Marsh EE. Emergency department utilization for ovarian hyperstimulation syndrome. Am J Emerg Med 2022; 60:134-139. [PMID: 35964549 DOI: 10.1016/j.ajem.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/01/2022] [Accepted: 08/05/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Ovarian hyperstimulation syndrome (OHSS) is a rare, but serious, risk of assisted reproductive technologies. In severe cases, patients may present to the emergency department (ED) for assessment, treatment of related complications, and even in-patient admission. Significant effort has been made to reduce the incidence and complications of OHSS; however, it is unknown if these strategies have decreased patient presentation for treatment in the ED. PURPOSE To assess ED utilization for OHSS over time and to examine admission rates, patient demographics, and charges. METHODS Retrospective longitudinal study utilizing data from the Nationwide Emergency Department Sample Database and the National ART Surveillance System. All ED visits between 2006 and 2016 with an ICD-9 or -10 diagnosis of OHSS were included. Demographics including age, geographic location, and income quartile and alternative diagnoses, admission rates, overall charges, and number of stimulation cycles annually were assessed. RESULTS The number of ovarian stimulation cycles steadily increased from 2006 (n = 110,183) to 2016 (n = 157,721), while the number of OHSS-related ED visits remained relatively stable (APC 2.08, p = 0.14). Admission rates for OHSS decreased from 52.7% in 2006 to 33.1% in 2016 (APC -4.43%, p < 0.01). The average charge for OHSS-related ED visits almost doubled from 2006 to 2016 (APC 8.53, p < 0.01) and was significantly higher than charges for non-OHSS-related visits for age-matched controls (p < 0.01). CONCLUSION Despite an increase in total stimulation cycles, there was no significant change in the estimated number of patients presenting to the ED; however, admission rates significantly declined. These observations suggest a possible shift in the severity and/or management of OHSS during the study period.
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Affiliation(s)
- Samantha B Schon
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA.
| | - Angela S Kelley
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA.
| | - Charley Jiang
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA.
| | - Min Xu
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA.
| | - Marie Menke
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA.
| | - Erica E Marsh
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA.
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29
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Peipert BJ, Montoya MN, Bedrick BS, Seifer DB, Jain T. Impact of in vitro fertilization state mandates for third party insurance coverage in the United States: a review and critical assessment. Reprod Biol Endocrinol 2022; 20:111. [PMID: 35927756 PMCID: PMC9351254 DOI: 10.1186/s12958-022-00984-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/21/2022] [Indexed: 11/29/2022] Open
Abstract
The American Society for Reproductive Medicine estimates that fewer than a quarter of infertile couples have sufficient access to infertility care. Insurers in the United States (US) have long considered infertility to be a socially constructed condition, and thus in-vitro fertilization (IVF) an elective intervention. As a result, IVF is cost prohibitive for many patients in the US. State infertility insurance mandates are a crucial mechanism for expanding access to fertility care in the US in the absence of federal legislation. The first state insurance mandate for third party coverage of infertility services was passed by West Virginia in 1977, and Maryland passed the country's first IVF mandate in 1985. To date, twenty states have passed legislation requiring insurers to cover or offer coverage for the diagnosis and treatment of infertility. Ten states currently have "comprehensive" IVF mandates, meaning they require third party coverage for IVF with minimal restrictions to patient eligibility, exemptions, and lifetime limits. Several studies analyzing the impact of infertility and IVF mandates have been published in the past 20 years. In this review, we characterize and contextualize the existing evidence of the impact of state insurance mandates on access to infertility treatment, IVF practice patterns, and reproductive outcomes. Furthermore, we summarize the arguments in favor of insurance coverage for infertility care and assess the limitations of state insurance mandates as a strategy for increasing access to infertility treatment. State mandates play a key role in the promotion of evidence-based practices and represent an essential and impactful strategy for the advancement of gender equality and reproductive rights.
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Affiliation(s)
- Benjamin J Peipert
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Duke University Hospital, 2301 Erwin Rd, 27705, Durham, NC, USA.
| | - Melissa N Montoya
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Duke University Hospital, 2301 Erwin Rd, 27705, Durham, NC, USA
| | - Bronwyn S Bedrick
- Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David B Seifer
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Tarun Jain
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Brodeur TY, Grow D, Esfandiari N. Access to Fertility Care in Geographically Underserved Populations, a Second Look. Reprod Sci 2022; 29:1983-1987. [PMID: 35680726 PMCID: PMC9181892 DOI: 10.1007/s43032-022-00991-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/29/2022] [Indexed: 11/30/2022]
Abstract
Infertility has a prevalence of up to 16% worldwide and is on the rise in developed nations, largely due to pursuing childbearing at advanced reproductive ages. Advances in assisted reproductive technology have benefitted socioeconomically advantaged patients disproportionately. High costs of fertility care are largely responsible for this disparity; however, patients in rural areas also face barriers in accessing both gynecology and reproductive endocrinology subspecialty care. Here, focusing on the USA, we discuss fertility care in geographically underserved areas and low-resource settings, and the impact on reproductive outcomes. Increased innovation to improve patient access to fertility care such as assisted reproductive technology is critical for ensuring equity. Remote monitoring is frequently performed by fertility centers, but partnership with local gynecologists has also been demonstrated to be an effective assisted reproductive technology monitoring method. Telehealth is now in mainstream use and the continued application to reduce geographic barriers to infertility patients is imperative. Partnership between local gynecologists and reproductive endocrinology and infertility specialists may improve patient access to fertility care and provide the unique benefits of continuity and ongoing local social support.
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Affiliation(s)
- Tia Y Brodeur
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology and Reproductive Sciences, University of Vermont, 111 Colchester Avenue, Burlington, VT, 05401, USA
| | - Daniel Grow
- The Center for Advanced Reproductive Services, Department of Obstetrics and Gynecology, University of Connecticut, Farmington, CT, USA
| | - Navid Esfandiari
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology and Reproductive Sciences, University of Vermont, 111 Colchester Avenue, Burlington, VT, 05401, USA.
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Peipert BJ, Chung EH, Harris BS, Jain T. Impact of comprehensive state insurance mandates on in vitro fertilization utilization, embryo transfer practices, and outcomes in the United States. Am J Obstet Gynecol 2022; 227:64.e1-64.e8. [PMID: 35283088 DOI: 10.1016/j.ajog.2022.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 03/01/2022] [Accepted: 03/02/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Previous studies have demonstrated that state mandated coverage of in vitro fertilization may be associated with increased utilization, fewer embryos per transfer, and lower multiple birth rates, but also lower overall live birth rates. Given new legislation and the delay between enactment and effect, a revisit of this analysis is warranted. OBJECTIVE This study aimed to characterize the current impact of comprehensive state in vitro fertilization insurance mandates on in vitro fertilization utilization, live birth rates, multiple birth rates, and embryo transfer practices. STUDY DESIGN We conducted a retrospective cohort study of in vitro fertilization cycles reported by the 2018 Centers for Disease Control and Prevention Assisted Reproductive Technology Fertility Clinic Success Rates Report in the United States. In vitro fertilization cycles were stratified according to state mandate as follows: comprehensive (providing coverage for in vitro fertilization with minimal restrictions) and noncomprehensive. The United States census estimates for 2018 were used to calculate the number of reproductive-aged women in each state. Outcomes of interest (stratified by state mandate status) included utilization rate of in vitro fertilization per 1000 women aged 25 to 44 years, live birth rate, multiple birth rate, number of embryo transfer procedures (overall and subdivided by fresh vs frozen cycles), and percentage of transfers performed with frozen embryos. Additional subanalyzes were performed with stratification of outcomes by patient age group. RESULTS In 2018, 134,997 in vitro fertilization cycles from 456 clinics were reported. Six states had comprehensive mandates; 32,029 and 102,968 cycles were performed in states with and without comprehensive in vitro fertilization mandates, respectively. In vitro fertilization utilization in states with comprehensive mandates was 132% higher than in noncomprehensive states after age adjustment; increased utilization was observed regardless of age stratification. Live birth rate per cycle was significantly higher in states with comprehensive mandates (35.4% vs 33.4%; P<.001), especially among older age groups. Multiple birth rate as a percentage of all births was significantly lower in states with comprehensive mandates (10.2% vs 13.8%; P<.001), especially among younger patients. Mean number of embryos per transfer was significantly lower in states with comprehensive mandates (1.30 vs 1.36; P<.001). Significantly fewer frozen transfers were performed as a percentage of all embryo transfers in states with comprehensive mandates (66.1% vs 76.3%; P<.001). Among fresh embryo transfers, significantly fewer embryos were transferred in comprehensive states among all patients (1.55 vs 1.67; P<.001). CONCLUSION Comprehensive state mandated insurance coverage for in vitro fertilization services is associated with greater utilization of these services, fewer embryos per transfer, fewer frozen embryo transfers, lower multiple birth rates, and higher live birth rates. These findings have important public health implications for reproductive-aged individuals in the United States and present notable opportunities for research on access to fertility care.
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Affiliation(s)
- Benjamin J Peipert
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
| | - Esther H Chung
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
| | - Benjamin S Harris
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
| | - Tarun Jain
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL.
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Wiltshire A, Ghidei L, Dawkins J, Phillips K, Licciardi F, Keefe D. Primary ovarian insufficiency: a glimpse into the racial and socioeconomic disparities found within third-party reproduction. F S Rep 2022; 3:62-65. [PMID: 35937445 PMCID: PMC9349244 DOI: 10.1016/j.xfre.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To describe a unique case of primary ovarian insufficiency and review the systemic barriers in place that hinder reproductive autonomy for Black women who require third-party reproduction. Design Case report and review of the literature. Setting Safety-net hospital in an urban community. Patient(s) A 36-year-old Black woman, gravida 0, with primary ovarian insufficiency who desires future fertility but is restricted by systemic barriers. Intervention(s) Chromosome analysis. Main Outcome Measure(s) Not applicable. Result(s) Balanced reciprocal translocation between chromosomes 1 and 13: 46,XX,t(1;13)(q25;q14.1). Conclusion(s) The field of assisted reproductive technology has evolved at an exponential rate, yet it unfortunately benefits some and not all. It is imperative that when we advocate for full spectrum infertility care, that this encompasses everyone. As we continue to further study and develop assisted reproductive technology, we must not forget to consider the factors leading to racial and socioeconomic disparities in reproductive care access, utilization, and outcomes.
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Affiliation(s)
- Ashley Wiltshire
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, New York University Langone Fertility Center, New York City, New York
- Reprint requests: Ashley Wiltshire, M.D., Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, New York University Langone Fertility Center, 660 1st Ave, New York City, New York 10016.
| | - Luwam Ghidei
- Department of Obstetrics and Gynecology, Baylor College of Medicine, One Baylor Plaza, Houston, Texas
| | - Josette Dawkins
- Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, Texas
| | - Kiwita Phillips
- Department of Obstetrics and Gynecology, Morehouse School of Medicine, Atlanta, Georgia
| | - Frederick Licciardi
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, New York University Langone Fertility Center, New York City, New York
| | - David Keefe
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, New York University Langone Fertility Center, New York City, New York
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Plowden TC, Paulson RJ. Eliminating health inequities in reproductive medicine: ensuring care for all. F S Rep 2022; 3:1. [PMID: 35937457 PMCID: PMC9349238 DOI: 10.1016/j.xfre.2022.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 04/12/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Torie Comeaux Plowden
- Department of Gynecologic Surgery and Obstetrics, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Richard J Paulson
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California
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Voigt P, Persily J, Blakemore JK, Licciardi F, Thakker S, Najari B. Sociodemographic differences in utilization of fertility services among reproductive age women diagnosed with cancer in the USA. J Assist Reprod Genet 2022; 39:963-972. [PMID: 35316438 PMCID: PMC9051007 DOI: 10.1007/s10815-022-02455-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/04/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To determine whether sociodemographic differences exist among female patients accessing fertility services post-cancer diagnosis in a representative sample of the United States population. METHODS All women ages 15-45 with a history of cancer who responded to the National Survey for Family Growth (NSFG) from 2011 to 2017 were included. The population was then stratified into 2 groups, defined as those who did and did not seek infertility services. The demographic characteristics of age, legal marital status, education, race, religion, insurance status, access to healthcare, and self-perceived health were compared between the two groups. The primary outcome measure was the utilization of fertility services. The complex sample analysis using the provided sample weights required by the NSFG survey design was used. RESULTS Five hundred forty-five women reported a history of cancer and were included in this study. Forty-three (7.89%) pursued fertility services after their cancer diagnosis. Using the NSFG sample weights, this equates to a population of 161,500.7 female cancer survivors in the USA who did utilize fertility services and 1,811,955.3 women who did not. Using multivariable analysis, household income, marital status, and race were significantly associated with women utilizing fertility services following a cancer diagnosis. CONCLUSIONS In this nationally representative cohort of reproductive age women diagnosed with cancer, there are marital, socioeconomic, and racial differences between those who utilized fertility services and those who did not. This difference did not appear to be due to insurance coverage, access to healthcare, or perceived health status.
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Affiliation(s)
- Paxton Voigt
- NYU Grossman School of Medicine, NY, New York, USA.
| | - Jesse Persily
- NYU Langone Department of Urology, New York, NY, USA
| | | | | | | | - Bobby Najari
- NYU Langone Department of Urology, New York, NY, USA
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Wiltshire A, Jackman JM, Moreta L, Ghidei L. Changing the Narrative, Starting With Us. Reprod Sci 2022; 29:2067-2070. [DOI: 10.1007/s43032-022-00915-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 03/11/2022] [Indexed: 10/18/2022]
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Patrizio P, Albertini DF, Gleicher N, Caplan A. The changing world of IVF: the pros and cons of new business models offering assisted reproductive technologies. J Assist Reprod Genet 2022; 39:305-313. [PMID: 35048274 PMCID: PMC8769942 DOI: 10.1007/s10815-022-02399-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/13/2022] [Indexed: 11/13/2022] Open
Abstract
This analysis contrasts traditional not-for-profit academic with new corporate practices of reproductive medicine and offers an assessment of risks to quality of patient care with investors entering the for-profit reproductive medicine market. Large corporate enterprises may have a global impact on access to care while at the same time is putting at risk the training of the next generation of reproductive medicine specialists.
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Affiliation(s)
- Pasquale Patrizio
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Reproductive Endocrinology and Infertility, University of Miami, Miller School of Medicine, Miami, FL, USA.
| | - David F Albertini
- Bedford Research Foundation, Bedford, MA, USA
- Stem Cell Biology and Molecular Embryology Laboratory, The Rockefeller University, New York, NY, USA
| | - Norbert Gleicher
- Stem Cell Biology and Molecular Embryology Laboratory, The Rockefeller University, New York, NY, USA
- Center for Human Reproduction, New York, NY, USA
- Foundation for Reproductive Medicine, New York, NY, USA
- Department of Obstetrics and Gynecology, Medical University of Vienna, 1090, Vienna, Austria
| | - Arthur Caplan
- Division of Medical Ethics, NYU Langone Medical Center, New York, NY, USA
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Komorowski AS, Jain T. A review of disparities in access to infertility care and treatment outcomes among Hispanic women. Reprod Biol Endocrinol 2022; 20:1. [PMID: 34980166 PMCID: PMC8722141 DOI: 10.1186/s12958-021-00875-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/07/2021] [Indexed: 01/18/2023] Open
Abstract
Hispanic women have lower rates of use of infertility services than non-Hispanic White women. There are many barriers that impede access to infertility care including economic, geographic, cultural, and societal factors and there are disparities in treatment outcomes. Hispanic women are less likely to seek infertility care than non-Hispanic White women and even after infertility evaluation, Hispanic women are less likely to receive treatment for their infertility. Lower use of infertility treatments among Hispanic women is unlikely to be driven solely by economic factors. There is disappointingly little data on in-vitro fertilization treatment outcomes including the population of Hispanic women, and existing data has yielded conflicting results. Incomplete and variable reporting of race data across clinics raises the potential for misclassification bias and invalid study conclusions. Addressing disparities in access to reproductive medicine in the Hispanic population will required a multifaceted approach including expanded insurance coverage, improved education for both patients and providers, and additional research on barriers to care.
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Affiliation(s)
- Allison S Komorowski
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, 259 E Erie St Suite 2400, Chicago, IL, 60611, USA.
| | - Tarun Jain
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, 259 E Erie St Suite 2400, Chicago, IL, 60611, USA
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Impact of access to care and race/ethnicity on IVF care discontinuation. Reprod Biomed Online 2021; 44:1159-1168. [DOI: 10.1016/j.rbmo.2021.11.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 10/27/2021] [Accepted: 11/25/2021] [Indexed: 12/17/2022]
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