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Pecoriello J, Quinn GP. Laying It All Out: The Challenge of Improving Fertility Care with Price Transparency. J Womens Health (Larchmt) 2024; 33:1014-1015. [PMID: 38511318 DOI: 10.1089/jwh.2024.0195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
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Boedeker D, Hunkler K, Lindner P, Phillips K, Hill M, Plowden T, Cole R. A Mixed-Methods Study to Evaluate Family Planning Desires and Barriers to Building Families Among Gay, Bisexual, and Lesbian Cisgender Military Service Members. Mil Med 2024:usae327. [PMID: 38966901 DOI: 10.1093/milmed/usae327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/21/2024] [Accepted: 06/18/2024] [Indexed: 07/06/2024] Open
Abstract
INTRODUCTION Barriers to seeking infertility care for lesbian, gay, bisexual, transgender, intersex, queer/questioning, and asexual (LGBTIQA+) individuals are well documented in the literature. However, little is known about military LGBTIQA+ service members seeking infertility care within the Military Health System. Approximately 6.1% of active duty U.S. service members across all branches identify as LGBTIQA+, which underscores the need for a deeper understanding of the needs of this community to support and retain service members. We therefore sought to describe the lived experiences of lesbian and gay cisgender service members in building their families in order to understand their family-building desires and potential barriers to seeking infertility care. MATERIALS AND METHODS We developed a survey to investigate the impact of military service on family planning. After Institutional Review Board approval, we distributed the survey throughout Walter Reed National Military Medical Center's obstetrics and gynecology clinic and posted the survey on multiple open and closed social media pages for LGBTIQA+ service members. We reported descriptive statistics of our survey and compared binary variables using the Fisher exact test. Following completion of this survey, participants could self-select to participate in semi-structured interviews. RESULTS Sixty-eight respondents completed our survey and self-identified as either cis-male (n = 28) or cis-female (n = 40). Most respondents (67.9% cis-males, 92.5% cis-females) plan to build their families during their military commitment; however, approximately half (50.0% cis-male, 42.5% cis-female) reported a lack of support in this endeavor. Many respondents were unaware of resources that would assist in the pursuit of donor egg, donor sperm, or surrogacy (78.6% cis-males, 50.0% cis-females). Thirty-six participants elected to complete a follow-up interview. After coding the interviews, 5 themes emerged: (1) barriers to initiating care; (2) institutional barriers within the military; (3) political barriers; (4) knowledge sharing; and (5) implicit and explicit bias. CONCLUSIONS Our results suggest significant barriers to LGBTIQA+ service members seeking infertility care. Overall, LGBTIQA+ service members did not feel supported by the military in building their families. Although the military has expanded access to infertility services, efforts to raise awareness and build support for LGBTIQA+ service members are warranted.
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Affiliation(s)
- David Boedeker
- Department of Gynecologic Surgery and Obstetrics, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Kiley Hunkler
- Department of Gynecologic Surgery and Obstetrics, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD 20814, USA
| | - Peter Lindner
- Department of Gynecologic Surgery and Obstetrics, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD 20814, USA
| | - Keeley Phillips
- School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
| | - Micah Hill
- Department of Gynecologic Surgery and Obstetrics, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD 20814, USA
| | - Torie Plowden
- Department of Gynecologic Surgery and Obstetrics, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD 20814, USA
| | - Rebekah Cole
- Department of Military and Emergency Medicine, Uniformed Services University, Bethesda, MD 20814, USA
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Sharifi MF, Spurlin EE, Vatan N, Quinones H, Santana E, Omurtag KR, Jimenez PT. Attitudes, concerns, and perceptions of patients undergoing fertility treatments in an abortion restrictive state in the aftermath of the Roe v. Wade reversal. J Assist Reprod Genet 2024; 41:1703-1711. [PMID: 38850329 PMCID: PMC11263275 DOI: 10.1007/s10815-024-03145-2] [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: 03/24/2024] [Accepted: 05/16/2024] [Indexed: 06/10/2024] Open
Abstract
PURPOSE To investigate the abortion views and reproductive concerns of current in vitro fertilization patients after the US Supreme Court Dobbs v. Jackson decision, which overturned the Roe v. Wade decision guaranteeing abortion access. METHODS This is a cross-sectional survey of English-speaking patients undergoing in vitro fertilization from January to November 2022 at a large academic institution in a state with restricted abortion care. Participants completed a 43-question electronic survey which measured feelings about abortion, future fertility treatments, and embryo disposition both quantitatively and qualitatively. RESULTS Of 543 eligible patients, 267 (49%) consented to participate when called and were sent the survey. Of those, 180 (67%) completed it, resulting in a total completion rate of 33%. The majority believe abortion should be legal in the case of birth defects (90.8%) or rape or incest (90.3%). A significant proportion (91.4%) expressed concerns about abortion being illegal in the state that they receive infertility care. They reported some concern about making embryos (89.6%), controlling what happens to them (95.4%), and discarding them (94.4%). Patients wrote about their concerns with pursuing fertility treatments, fear of not having access to needed medical care, and the desire to remain close to states with less restrictive abortion laws. CONCLUSIONS The evolving political landscape surrounding access to reproductive care has created significant concerns regarding legal regulation of these treatments and the disposition of embryos. By understanding patients' concerns, health care providers can more effectively advocate for the protection of fertility treatments and patients' autonomy in embryo disposition.
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Affiliation(s)
- Mitra F Sharifi
- Washington University/Barnes-Jewish Hospital/Saint Louis Children's Hospital Graduate Medical Education Consortium, 4901 Forest Park Ave Suite 710, St. Louis, MO, 63108, USA.
| | | | - Naazanene Vatan
- Washington University in St Louis School of Medicine, St. Louis, MO, USA
| | - Hayley Quinones
- Washington University in St Louis School of Medicine, St. Louis, MO, USA
| | - E'lysse Santana
- Washington University in St Louis School of Medicine, St. Louis, MO, USA
| | - Kenan R Omurtag
- Washington University in St Louis Washington University Physicians, St. Louis, MO, USA
| | - Patricia T Jimenez
- Washington University in St Louis Washington University Physicians, St. Louis, MO, USA
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Mayette E, Scalise A, Li A, McGeorge N, James K, Mahalingaiah S. Assisted reproductive technology (ART) patient information-seeking behavior: a qualitative study. BMC Womens Health 2024; 24:346. [PMID: 38877503 PMCID: PMC11179360 DOI: 10.1186/s12905-024-03183-z] [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: 04/24/2024] [Accepted: 06/05/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Approximately 13% of women in the United States of reproductive age seek infertility services. Assisted reproductive technology (ART), including in vitro fertilization, is used to help patients achieve pregnancy. Many people are not familiar with these treatments prior to becoming patients and possess knowledge gaps about care. METHODS This study employed qualitative methods to investigate how patients interact with information sources during care. Patients who underwent ART including embryo transfer between January 2017 and April 2022 at a large urban healthcare center were eligible. Semi-structured, in-depth interviews were conducted between August and October 2022. Fifteen females with an average age of 39 years participated. Reflexive thematic analysis was performed. RESULTS Two main themes emerged. Participants (1) utilized clinic-provided information and then turned to outside sources to fill knowledge gaps; (2) struggled to learn about costs, insurance, and mental health resources to support care. Participants preferred clinic-provided resources and then utilized academic sources, the internet, and social media when they had unfulfilled information needs. Knowledge gaps related to cost, insurance, and mental health support were reported. CONCLUSION ART clinics can consider providing more information about cost, insurance, and mental health support to patients. TRIAL REGISTRATION The Massachusetts General Hospital Institutional Review Board approved this study (#2022P000474) and informed consent was obtained from each participant.
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Affiliation(s)
- Emma Mayette
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Massachusetts General Hospital, 55 Fruit Street, Yawkey 10, Boston, MA, 02114, USA.
| | - Ariel Scalise
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Massachusetts General Hospital, 55 Fruit Street, Yawkey 10, Boston, MA, 02114, USA
| | - Angela Li
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA
| | - Nicolette McGeorge
- Charles River Analytics, Inc., 625 Mount Auburn St., Cambridge, MA, 02148, USA
| | - Kaitlyn James
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Massachusetts General Hospital, 55 Fruit Street, Yawkey 10, Boston, MA, 02114, USA
| | - Shruthi Mahalingaiah
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Massachusetts General Hospital, 55 Fruit Street, Yawkey 10, Boston, MA, 02114, USA
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA
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Dorfman CS, Stalls JM, Shelby RA, Arthur SS, Acharya K, Davidson B, Corbett C, Greenup RA. Impact of Financial Costs on Patients' Fertility Preservation Decisions: An Examination of Qualitative Data from Female Young Adults with Cancer and Oncology Providers. J Adolesc Young Adult Oncol 2024; 13:502-513. [PMID: 38294823 DOI: 10.1089/jayao.2023.0108] [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: 02/01/2024] Open
Abstract
Purpose: To examine the impact of financial costs on fertility preservation decisions among female young adults (YAs) with cancer. Methods: Female YAs (N = 18; aged 21-36) with a history of cancer and oncology providers (N = 12) were recruited from an National Cancer Institute-designated comprehensive cancer center in a state without insurance coverage for fertility preservation. YAs and providers completed individual interviews and a brief online assessment. Qualitative description using thematic analysis was used to identify, analyze, and report common themes. Descriptive statistics was used to characterize the sample. Results: Female YAs and oncology providers highlighted the critical role that high out-of-pocket costs play in YAs' fertility preservation decisions along with the value that enhanced insurance coverage for fertility preservation would have for increasing female YAs' access to and utilization of fertility preservation. Although providers were concerned about preservation costs for their patients, they reported that their concerns did not impact whether they referred interested female YAs to reproductive specialists. Oncology providers expressed concern about inequities in utilization of fertility preservation for female and racially/ethnically minoritized YAs that were exacerbated by the high out-of-pocket fertility preservation costs. Conclusion: Cost is a significant barrier to fertility preservation for female YA cancer patients. Female YAs of reproductive age may benefit from decision support tools to assist with balancing the cost of fertility preservation with their values and family building goals. Policy-relevant interventions may mitigate cost barriers and improve access to care.
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Affiliation(s)
- Caroline S Dorfman
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA
- Supportive Care and Survivorship Center, Duke Cancer Institute, Durham, North Carolina, USA
| | - Juliann M Stalls
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA
- Supportive Care and Survivorship Center, Duke Cancer Institute, Durham, North Carolina, USA
| | - Rebecca A Shelby
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA
- Supportive Care and Survivorship Center, Duke Cancer Institute, Durham, North Carolina, USA
| | - Sarah S Arthur
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, USA
| | - Kelly Acharya
- Division of Reproductive Endocrinology and Infertility; Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina, USA
| | - Brittany Davidson
- Division of Gynecologic Oncology; Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina, USA
| | - Cheyenne Corbett
- Supportive Care and Survivorship Center, Duke Cancer Institute, Durham, North Carolina, USA
| | - Rachel A Greenup
- Division of Surgical Oncology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
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Mofokeng T. Freedom Dreaming: On "Emerging Frameworks of Health and Human Rights". Health Hum Rights 2024; 26:27-30. [PMID: 38933225 PMCID: PMC11197874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024] Open
Affiliation(s)
- Tlaleng Mofokeng
- United Nations Special Rapporteur on the right to health and a member of the Health and Human Rights Executive Editorial Committee
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Fotovati M, Badeghiesh AM, Baghlaf HA, Dahan MH. The relationship between socioeconomic status and perinatal outcomes in in vitro fertilization conceptions. AJOG GLOBAL REPORTS 2024; 4:100329. [PMID: 38919707 PMCID: PMC11197111 DOI: 10.1016/j.xagr.2024.100329] [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] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND In vitro fertilization is the most used assisted reproductive technology in the United States that is increasing in efficiency and in demand. Certain states have mandated coverage that enable individuals with low income to undergo in vitro fertilization treatment. OBJECTIVE This study aimed to evaluate if socioeconomic status has an impact on the perinatal outcomes in in vitro fertilization pregnancies. We hypothesized that with greater coverage there may be an alleviation of the financial burden of in vitro fertilization that can facilitate the application of evidence-based practices. STUDY DESIGN This was a retrospective, population-based, observational study that was conducted in accordance with the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample database over the 6-year period from 2008 to 2014 during which period 10,000 in vitro fertilization deliveries were examined. Maternal outcomes of interest included preterm prelabor rupture of membranes, preterm birth (ie, before 37 weeks of gestation), placental abruption, cesarean delivery, operative vaginal delivery, spontaneous vaginal delivery, maternal infection, chorioamnionitis, hysterectomy, and postpartum hemorrhage. Neonatal outcomes included small for gestational age neonates, defined as birthweight <10th percentile, intrauterine fetal death, and congenital anomalies. RESULTS Our study found that the socioeconomic status did not have a statistically relevant effect on the perinatal outcomes among women who underwent in vitro fertilization to conceive after adjusting for the potential confounding effects of maternal demographic, preexisting clinical characteristics, and comorbidities. CONCLUSION The literature suggests that in states with mandated in vitro fertilization coverage, there are better perinatal outcomes because, in part, of the increased use of best in vitro fertilization practices, such as single-embryo transfers. Moreover, the quality of medical care in states with coverage is in the highest quartile in the country. Therefore, our findings of equivalent perinatal outcomes in in vitro fertilization care irrespective of socioeconomic status possibly suggests that a lack of access to quality medical care may be a factor in the health disparities usually seen among individuals with lower socioeconomic status.
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Affiliation(s)
- Misha Fotovati
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada (Ms Fotovati)
| | - Ahmad M. Badeghiesh
- King Abdulaziz University, Jeddah, Saudi Arabia (Dr Badeghiesh)
- Division of Reproductive Endocrinology and Infertility, Obstetrics and Gynaecology, Western University, London, Canada (Dr Badeghiesh)
| | - Haitham A. Baghlaf
- Division of Maternal-Fetal Medicine, Obstetrics and Gynaecology, University of Tabuk, Tabuk, Saudi Arabia (Dr Baghlaf)
| | - Michael H. Dahan
- Division of Reproductive Endocrinology and Infertility, MUHC Reproductive Center, McGill University, Montreal, Canada (Dr Dahan)
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Badreddine J, Sellke N, Rhodes S, Thirumavalavan N, Abou Ghayda R. The association of socioeconomic status with semen parameters in a cohort of men in the United States. Andrology 2024. [PMID: 38436127 DOI: 10.1111/andr.13614] [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: 05/26/2023] [Revised: 01/13/2024] [Accepted: 01/18/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Socioeconomic differences are present within the population of men who experience infertility and seek treatment. OBJECTIVE To study the association of socioeconomic status with semen parameters in a group of men using mail-in semen analyses. MATERIALS AND METHODS The records of 11,134 men that used mail-in semen analyses from a fertility company were identified. Their demographic information, semen parameters, and ZIP codes were collected. Area deprivation index (ADI) was used as a proxy for socioeconomic status and was calculated for each individual using their ZIP codes in order to measure their level of socioeconomic deprivation. A higher ADI signifies a more deprived area. The association between ADI and the semen parameters of this group was measured using linear regression analysis adjusted for age. RESULTS 11,134 men were included in the study with a median age of 35 years (interquartile range (IQR): 32-40) and a median ADI of 83 (IQR: 68-97). The cohort had a median sperm concentration of 31 million/mL (IQR: 14-59), median total sperm count of 123 million (IQR: 57-224), median total motile sperm of 35 million (IQR: 9-95), median total motility of 32% (IQR: 15-52), progressive motility of 22% (IQR: 9-38), and morphology percent normal of 4% (IQR: 2-7). Higher ADI, indicating lower socioeconomic status, was negatively associated with various semen parameters, including sperm concentration, total sperm count, total motile sperm, and total and progressive motility. DISCUSSION AND CONCLUSION Men who live in more deprived areas are more likely to have worse semen parameters. Further research is needed to thoroughly examine the impact of socioeconomic status on male fertility. A comprehensive approach that targets upstream social, economic, and healthcare factors can possibly alleviate the negative association of socioeconomic status with fertility and semen parameters.
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Affiliation(s)
- Jad Badreddine
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Nicholas Sellke
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Stephen Rhodes
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Nannan Thirumavalavan
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Ramy Abou Ghayda
- Division of Men's Health, Urology Institute, University Hospitals, Cleveland, Ohio, USA
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Cardoso BR, Fratezzi I, Kellow NJ. Nut Consumption and Fertility: a Systematic Review and Meta-Analysis. Adv Nutr 2024; 15:100153. [PMID: 37977328 PMCID: PMC10704322 DOI: 10.1016/j.advnut.2023.100153] [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: 07/14/2023] [Revised: 09/18/2023] [Accepted: 11/13/2023] [Indexed: 11/19/2023] Open
Abstract
The high concentration of omega-3 polyunsaturated fats, dietary fibers, vitamins, minerals, and polyphenols found in nuts suggest their regular consumption may be a simple strategy for improving reproductive health. This systematic review and meta-analysis aimed to present up-to-date evidence regarding the association between nut intake and fertility outcomes in males and females. Ovid MEDLINE, Embase, CINAHL, and Scopus were searched from inception to 30 June 2023. Eligible articles were interventional or observational studies in human subjects of reproductive age (18-49 y) that assessed the effects (or association) of dietary nut consumption (for a minimum of 3 mo) on fertility-related outcomes. Random-effects meta-analyses were completed to produce a pooled effect estimate of nut consumption on sperm total motility, vitality, morphology, and concentration in healthy males. Four studies involving 875 participants (646 males, 229 females) were included in this review. Meta-analysis of 2 RCTs involving 223 healthy males indicated consumption of ≥ 60g nuts/d increased sperm motility, vitality, and morphology in comparison to controls but had no effect on sperm concentration. Nonrandomized studies reported no association between dietary nut intake and conventional sperm parameters in males, embryo implantation, clinical pregnancy or live birth in males and females undergoing ART. Our meta-analysis shows that including at least 2 servings of nuts daily as part of a Western-style diet in healthy males improves sperm parameters, which are predictors of male fertility. Due to their nutritional profile, nuts were found to have potential to promote successful reproductive outcomes. This trial was registered at PROSPERO (CRD42020204586).
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Affiliation(s)
- Barbara R Cardoso
- Department of Nutrition, Dietetics and Food, Monash University, Victoria, Australia; Victorian Heart Institute, Monash University, Clayton, Victoria, Australia.
| | - Izabella Fratezzi
- Department of Nutrition, Dietetics and Food, Monash University, Victoria, Australia
| | - Nicole J Kellow
- Department of Nutrition, Dietetics and Food, Monash University, Victoria, Australia; Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Clayton, Victoria, Australia.
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Sellke N, Badreddine J, Rhodes S, Thirumavalavan N, Abou Ghayda R. The Racial and Socioeconomic Characteristics of Men Using Mail-in Semen Testing Kits in the United States. Urology 2023; 180:135-139. [PMID: 37543117 DOI: 10.1016/j.urology.2023.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/22/2023] [Accepted: 07/24/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE To describe the racial and socioeconomic characteristics of men using mail-in semen testing kits for their fertility care in the United States over 3 years. METHODS A cross-sectional analysis was conducted of men who used mail-in semen analyses from a single direct-to-consumer (DTC) fertility platform between 2020 and 2022. Age, race/ethnicity, place of residence, and education level of men using mail-in semen analysis kits was collected from user questionnaires. Zip code level socioeconomic status was estimated using the Area Deprivation Index (ADI). These characteristics were compared to the overall population of the United States. RESULTS 4342 men used mail-in semen analyses from a single DTC fertility company between 2020 and 2022 and completed the questionnaire. The median age of this cohort was 36 (IQR: 32,40) years. The group consisted of predominantly white men (72%), with 7.9% Asian and only 5.1% Black, 3.2% Hispanic, 0.4% Indian American, 0.1% pacific islander, 5.8% mixed race, and 2.8% other groups. 45.8% of the group had completed college, 22% had a master's degree, and 9% had a doctoral degree. The mean ADI was 83.47 (SD 21.44) compared to the average ADI of 100 for the general US population (P < .005). CONCLUSION DTC mail-in semen analyses have the potential to improve access to affordable fertility care. Racial and ethnic minorities and lower socioeconomic classes are underrepresented for men seeking DTC fertility testing as they are for men presenting for in-office fertility care. Additional studies are needed to determine the factors responsible for these discrepancies.
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Affiliation(s)
- Nicholas Sellke
- Case Western Reserve University School of Medicine, Cleveland, OH; Department of Urology, University Hospitals Cleveland Medical Center, Cleveland, OH.
| | - Jad Badreddine
- Department of Urology, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Stephen Rhodes
- Department of Urology, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Nannan Thirumavalavan
- Case Western Reserve University School of Medicine, Cleveland, OH; Department of Urology, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Ramy Abou Ghayda
- Case Western Reserve University School of Medicine, Cleveland, OH; Department of Urology, University Hospitals Cleveland Medical Center, Cleveland, OH
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Schlossman J, Vu M, Samborski A, Breit K, Thevenet-Morrison K, Wilbur M. Identifying barriers individuals face in accessing fertility care after a gynecologic cancer diagnosis. Gynecol Oncol Rep 2023; 49:101267. [PMID: 37719177 PMCID: PMC10502349 DOI: 10.1016/j.gore.2023.101267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/22/2023] [Accepted: 08/30/2023] [Indexed: 09/19/2023] Open
Abstract
Objective To (1) identify the major barriers premenopausal individuals face in accessing fertility care at the time of gynecologic cancer diagnosis and (2) to assess patient experiences pertaining to fertility. Methods We distributed an online survey about cancer diagnosis and fertility goals to patients ages 18-40 who had been treated for ovarian, endometrial, or cervical cancer at a single, large academic hospital. Descriptive statistics were used to analyze survey results. Patients who completed the survey were given the option to participate in a follow-up virtual interview. We conducted semi-structured interviews to discuss their fertility goals and barriers to these. Grounded theory was used to qualitatively analyze the interviews. Results Fifty-five patients completed the survey, and 20 patients participated in the interview. The median age at diagnosis was 32 years old. Seventy-three percent of patients recalled that at the time of their diagnosis they were considering future childbearing, and 32% underwent fertility preservation. Patients reported the emotional response to their diagnosis as a barrier to receiving fertility care, with patients reporting lack of control (80%), shock (55%), and confusion (45%). Patients also identified inadequate counseling (60.0%), lack of time (60.0%), economic constraints (55.0%) and prioritization of cancer treatment (55.0%) as barriers. Nearly all patients had a positive interview experience and expressed desire to help patients in similar situations. Conclusion Many premenopausal patients diagnosed with gynecologic malignancies are considering future childbearing at the time of diagnosis. Both logistical and emotional barriers prevent them from undergoing fertility preservation before initiating oncologic treatment.
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Affiliation(s)
- Julia Schlossman
- University of Rochester, School of Medicine and Dentistry, Rochester, NY, United States
| | - Michelle Vu
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, United States
| | - Alexandra Samborski
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, United States
| | - Karolina Breit
- Department of Public Health Sciences, University of Rochester Medical Center, NY, United States
| | - Kelly Thevenet-Morrison
- Department of Public Health Sciences, University of Rochester Medical Center, NY, United States
| | - MaryAnn Wilbur
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, United States
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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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Weiss MS, Marsh EE. Navigating Unequal Paths: Racial Disparities in the Infertility Journey. Obstet Gynecol 2023; 142:940-947. [PMID: 37678890 PMCID: PMC10510808 DOI: 10.1097/aog.0000000000005354] [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: 06/09/2023] [Revised: 06/30/2023] [Accepted: 07/06/2023] [Indexed: 09/09/2023]
Abstract
Infertility is one of the most emotionally devastating conditions experienced during the reproductive window. Although not life-threatening, it significantly erodes quality of life for those with the diagnosis. Disturbingly, data demonstrate the existence of profound racial disparities that persist along the entire journey of infertility. Though most of the scientific literature emphasizes disparities in clinical outcomes after infertility treatment, it is important to recognize that these inequities are the downstream effect of a series of distinct challenges encountered by historically marginalized people on their path to parenthood. In this review, we explore the current state of knowledge concerning the inequities at each "step" in the path to overcome infertility challenges and propose solutions to create a future in which reproductive medicine is truly equitable, accessible, and supportive for everyone.
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Affiliation(s)
- Marissa Steinberg Weiss
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania; and the Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
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14
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HogenEsch E, Hojjati R, Komorowski A, Maniar K, Pavone ME, Bakkensen J, Bernardi L. Chronic endometritis: screening, treatment, and pregnancy outcomes in an academic fertility center. J Assist Reprod Genet 2023; 40:2463-2471. [PMID: 37558906 PMCID: PMC10504221 DOI: 10.1007/s10815-023-02902-z] [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: 04/02/2023] [Accepted: 07/27/2023] [Indexed: 08/11/2023] Open
Abstract
PURPOSE To identify the prevalence of chronic endometritis (CE), compare the efficacy of antibiotic regimens for CE, and examine pregnancy outcomes after treatment for CE among patients in an academic fertility clinic. METHODS In this retrospective cohort study, data from patients who underwent endometrial sampling (ES) for CE evaluation at a single academic institution from 2014 to 2020 were collected and analyzed. Rates of CE were compared by indication for ES including recurrent pregnancy loss (RPL), implantation failure (IF), and recent first-trimester pregnancy loss. Treatment and pregnancy outcomes were also evaluated. RESULTS Six hundred fifty-three individuals underwent ES to evaluate for CE. The overall prevalence of CE was 28.5%; when stratified by indication, the prevalence of CE was 66.2% for recent first-trimester loss, 27.9% for RPL, and 13.1% for IF (p < .001). Of those with CE, 91.9% received antibiotics, most commonly doxycycline (76.0%). CE clearance was not significantly different when doxycycline was compared to all other regimens (71.3% vs. 58.8%, p = .17), and 68.5% of patients cleared CE after one course of antibiotics. Following two antibiotic courses, CE was cleared in 88.3% of patients. Live birth rates (LBRs) were higher for those with cleared CE compared to patients with untreated CE (34.1% vs. 5.6%, p = .014) and similar for those with cleared CE versus those without CE (34.1% vs. 29.3%, p = .297). CONCLUSION CE is common among patients with infertility, particularly those with a recent first-trimester loss. Treatment and clearance of CE were associated with higher LBRs; however, persistent CE was common despite treatment with antibiotics.
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Affiliation(s)
- Elena HogenEsch
- Obstetrics and Gynecology, Northwestern University, Chicago, IL, USA.
| | - Ronus Hojjati
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Allison Komorowski
- Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Northwestern University, Chicago, IL, USA
| | - Kruti Maniar
- Pathology, Northwestern University, Chicago, IL, USA
| | - Mary Ellen Pavone
- Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Northwestern University, Chicago, IL, USA
| | - Jennifer Bakkensen
- Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Northwestern University, Chicago, IL, USA
| | - Lia Bernardi
- Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Northwestern University, Chicago, IL, USA
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15
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Bakkensen JB, Heisler E, Bolten K, Yilmaz B, Smiley J, Hirshfeld-Cytron JE, Feinberg EC. Validation of prognosis-based in vitro fertilization grant selection criteria. F S Rep 2023; 4:286-291. [PMID: 37719099 PMCID: PMC10504529 DOI: 10.1016/j.xfre.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/12/2023] [Accepted: 06/30/2023] [Indexed: 09/19/2023] Open
Abstract
Objective To validate a prognosis-based scoring system for in vitro fertilization (IVF) grant allocation. Design Retrospective cohort study. Setting A 501(c)(3) nonprofit foundation that awards donated IVF cycles and grants to those with demonstrated financial need. In contrast to lottery-based or subjective allocation systems, applications are scored according to medical prognostic criteria in addition to personal characteristics. Patients Grant recipients from 2015 to 2019. Interventions None. Main outcome measures Live birth rate (LBR) and cumulative LBR (CLBR) among grant recipients were compared with 2019 Society for Assisted Reproductive Technology (SART) national averages. Results A total of 435 applications were reviewed, with 59 grants awarded for 51 autologous IVF cycles, 6 donor oocyte cycles, and 2 gestational carrier cycles, resulting in 39 live births after initial embryo transfer (LBR 61.9%) and 43 CLBRs (CLBR 72.9%). Among autologous cycles, the mean (±SD=3.9 years) age was 31.8 years, and LBR and CLBR were 62.8% and 68.6% vs. 28.2% and 37.1% among all autologous SART cycles, respectively. A subanalysis of grant recipients aged <35 years (n=39) revealed LBR and CLBR of 66.7% and 74.4% vs. 40.7% and 47.8% among autologous SART cycles aged <35 years, respectively. Conclusions A scoring system incorporating medical criteria identified IVF grant applicants with a high likelihood of achieving a LB. Although most IVF grant programs select recipients through a lottery or personal characteristics, a prognosis-based scoring system should be considered to maximize LBR in a limited resource setting.
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Affiliation(s)
- Jennifer B. Bakkensen
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Elise Heisler
- Department of Obstetrics and Gynecology, New York University, New York, New York
- Chicago Coalition for Family Building, Chicago, Illinois
| | - Katherine Bolten
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Bahar Yilmaz
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jill Smiley
- Chicago Coalition for Family Building, Chicago, Illinois
| | | | - Eve C. Feinberg
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Chicago Coalition for Family Building, Chicago, Illinois
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16
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Sehgal S, Dyer A, Warren C, Galic I, Jain T. Integrative medicine utilization among infertility patients. Reprod Biol Endocrinol 2023; 21:71. [PMID: 37533097 PMCID: PMC10394890 DOI: 10.1186/s12958-023-01121-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 07/24/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Previous research suggests that some women are using integrative and complementary holistic approaches to optimize their own health and treat infertility. We aimed to determine patterns of integrative medicine use among those seeking fertility optimization by 1) Characterizing patterns of integrative medicine use to increase fertility; 2) Identifying demographic predictors associated with such integrative medicine use; and 3) Exploring cultural and religious influences on use of integrative medicine. METHODS Cross-sectional self-reported survey data were collected from 1460 patients presenting to an academic fertility center in Chicago, Illinois. Variables were described with univariate frequencies and proportions, unadjusted bivariate comparisons were made between patient-level factors and reported integrative modality use, and multivariable logistic regression evaluated the strength of covariate-adjusted predictors of reported integrative medicine utilization. RESULTS 80.4% of respondents reported using at least one integrative medicine modality to treat infertility (Acupuncture: 38.5%, Yoga: 27.6%, Massage: 25.8%, Meditation: 16.7%, and Herbal supplements: 18.5%). Diet therapy was the most frequently utilized modality (74.0%) followed by body therapy (45.2%), traditional alternative medicine (42.0%), mind therapy (32.1%), and senses therapy (23.0%). Any integrative medicine modality use was 4.03 times more likely among Hindu respondents compared to participants that identified as not religious (95% CI 1.2-13.7, p < 0.026). Significant differences in specific modality use were observed by race, religious affiliation, age, income, and insurance coverage. CONCLUSION Most infertility patients in our study reported using at least one integrative medicine modality to help them conceive. Utilization was associated with age of participant, religious affiliation, annual income, and insurance coverage. Further research is needed to assess the impact of integrative medicine utilization on patient quality of life and outcomes.
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Affiliation(s)
- Shruti Sehgal
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ashley Dyer
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Christopher Warren
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Isabel Galic
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Tarun Jain
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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17
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Wang A, Anderson-Bialis J, Morris JR, Corley J, Anderson-Bialis D, Citro L, Seegulam ME, Fujimoto V. Racial and ethnic differences in self-reported satisfaction with fertility clinics and doctors. Arch Gynecol Obstet 2023; 308:239-253. [PMID: 37072582 DOI: 10.1007/s00404-023-07043-3] [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: 11/26/2022] [Accepted: 04/01/2023] [Indexed: 04/20/2023]
Abstract
OBJECTIVE To investigate if differences in self-reported satisfaction with fertility clinics and doctors differ by race/ethnicity. STUDY DESIGN We used cross-sectional survey data from FertilityIQ online questionnaires completed by patients receiving US. fertility care from July 2015 to December 2020. Univariate and multivariate logistic and linear regression analyses were performed to assess association of race/ethnicity on patient-reported clinic and physician satisfaction. RESULTS Our total sample size included 21,472 unique survey responses (15,986 Caucasian, 1856 Black, 1780 LatinX, 771 East Asian, 619 South Asian, 273 Middle Eastern, 187 Native American self-reported). When adjusting for potential confounders (demographic and patient satisfaction), we found that Black patients rated their doctors more highly (odds ratio (OR) 1.30, 95% confidence interval (CI) 1.04-1.62 p = 0.022 logistic and Coefficient 0.082, 95% CI 0.013-0.15 p = 0.02 linear), while other ethnic groups did not show significant differences compared to Caucasian patients. East Asians had borderline lower satisfaction with clinic satisfaction in logistic regression (OR 0.74 95% CI 0.55-1.00 p = 0.05), while significant differences were not found for other ethnic groups for clinic satisfaction. CONCLUSIONS In summary, some but not all minority groups differed in their self-reported perception of satisfaction with fertility clinic and doctors compared to Caucasian patients. Cultural differences towards surveys may contribute to some of these findings, and satisfaction by racial/ethnic group may also be modified by results of care.
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Affiliation(s)
- Ange Wang
- Division of Reproductive Endocrinology and Infertility, University of California, 499 Illinois Street, 6th Floor, San Francisco, CA, 94158, USA.
| | | | - Jerrine R Morris
- Division of Reproductive Endocrinology and Infertility, University of California, 499 Illinois Street, 6th Floor, San Francisco, CA, 94158, USA
| | - Jamie Corley
- Division of Reproductive Endocrinology and Infertility, University of California, 499 Illinois Street, 6th Floor, San Francisco, CA, 94158, USA
| | | | | | | | - Victor Fujimoto
- Division of Reproductive Endocrinology and Infertility, University of California, 499 Illinois Street, 6th Floor, San Francisco, CA, 94158, USA
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18
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Bedrick BS, Nickel KB, Riley JK, Jain T, Jungheim ES. Association of State Insurance Mandates for Fertility Treatment With Multiple Embryo Transfer After Preimplantation Genetic Testing for Aneuploidy. JAMA Netw Open 2023; 6:e2251739. [PMID: 36705925 DOI: 10.1001/jamanetworkopen.2022.51739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
IMPORTANCE Multiple gestation is one of the biggest risks after in vitro fertilization (IVF), largely due to multiple embryo transfer (MET). Single embryo transfer (SET) uptake has increased over time and has been attributed to various factors, such as mandated insurance coverage for IVF and preimplantation genetic testing for aneuploidy (PGT-A). OBJECTIVE To investigate whether mandates for IVF insurance coverage are associated with decreased use of MET after PGT-A. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted using data on embryo transfers reported to the Society for Assisted Reproductive Technology between 2014 and 2016. Data were analyzed from January to October 2021. EXPOSURES State-mandated coverage for fertility treatment and type of cycle transfer performed (PGT-A, untested fresh, and untested frozen). MAIN OUTCOMES AND MEASURES Use of MET compared with SET, live birth, and live birth of multiples. RESULTS There were 110 843 embryo transfers (mean [SD] patient age, 34.0 [4.5] years; 5520 individuals identified as African American [5.0%], 10 035 as Asian [9.0%], 5425 as Hispanic [4.9%], 45 561 as White [41.1%], and 44 302 as other or unknown race or ethnicity [40.0%]); 17 650 transfers used embryos that underwent PGT-A. Overall, among transferred embryos that had PGT-A, there were 9712 live births (55.0%). The odds of live birth were 70% higher with MET vs SET after frozen embryo transfer with PGT-A (OR, 1.70; 95% CI, 1.61-1.78), but the risk of multiples was 5 times higher (OR, 5.33; 95% CI, 5.22-5.44). The odds of MET in cycles with PGT-A in states with insurance mandates were 24% lower than in states without mandates (OR, 0.76; 95% CI, 0.68-0.85). CONCLUSIONS AND RELEVANCE This study found that despite the promise of using SET with PGT-A, MET after PGT-A was not uncommon. This practice was more common in states without insurance mandates and was associated with a high risk of multiples.
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Affiliation(s)
- Bronwyn S Bedrick
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Katelin B Nickel
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine in St Louis, Missouri
| | - Joan K Riley
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Tarun Jain
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Emily S Jungheim
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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19
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Fowler CI, Koo HP, Richmond AD, Creel D, Asman K. U.S. Women's Knowledge of Reproductive Biology. Womens Health Issues 2023; 33:54-66. [PMID: 35868957 DOI: 10.1016/j.whi.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 05/19/2022] [Accepted: 05/31/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Having accurate knowledge of reproductive biology can help women to improve their general, sexual, and reproductive health and assert their sexual and reproductive rights. METHODS This cross-sectional study examined knowledge of three topics (age-related fertility decline, egg supply, fertile period) among a national probability sample of 1,779 nonsterilized, English-speaking women (aged 18-29 years) in the U.S. general population. Using bivariate and multivariable regressions, we assessed associations between knowledge of these topics and individual characteristics. RESULTS Most respondents were unmarried (63%), childless (78%), and intended to have children (65%); 51% did not know whether they would have difficulty conceiving, and 44% had discussed fertility-related topics with a health care provider. More respondents knew the age of marked fertility decline (62%) than the fertile period (59%) or that ovaries do not continuously produce new eggs (45%); 22% knew all three topics, and 13% knew none. In multivariable analysis, knowledge was positively associated (p < .001) with education, income, and having regular periods. Black and Asian respondents and those for whom religion was very important were less likely (all p values < .01) than White and nonreligious respondents to know all three topics. Knowledge was unrelated to relationship status, parity, childbearing intentions, receipt of fertility-related counseling or services, self-perceived infertility risk, or health status; the relationship with Hispanic ethnicity approached but did not reach significance (p = .08). CONCLUSIONS Young U.S. women have incomplete knowledge of aspects of their reproductive biology; these knowledge gaps could increase their risk of adverse health and reproductive outcomes. Policy-, provider-, and client-level interventions are warranted to address these knowledge gaps.
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Affiliation(s)
| | - Helen P Koo
- Independent Consultant, Durham, North Carolina
| | - Alicia D Richmond
- Office of Population Affairs, U.S. Department of Health and Human Services, Washington, District of Columbia
| | - Darryl Creel
- RTI International, Washington, District of Columbia
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20
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Gietel-Basten S, Rotkirch A, Sobotka T. Changing the perspective on low birth rates: why simplistic solutions won't work. BMJ 2022; 379:e072670. [PMID: 36379520 PMCID: PMC10915774 DOI: 10.1136/bmj-2022-072670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Stuart Gietel-Basten
- Hong Kong University of Science and Technology, Kowloon, Hong Kong SAR, People's Republic of China
- Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Anna Rotkirch
- Population Research Institute, Väestöliitto, Family Federation of Finland, Helsinki, Finland
| | - Tomáš Sobotka
- Vienna Institute of Demography, Wittgenstein Centre for Demography and Global Human Capital (IIASA, OeAW, University of Vienna), Vienna, Austria
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21
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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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22
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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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Sadecki E, Weaver A, Zhao Y, Stewart EA, Ainsworth AJ. Fertility trends and comparisons in a historical cohort of US women with primary infertility. Reprod Health 2022; 19:13. [PMID: 35042514 PMCID: PMC8764822 DOI: 10.1186/s12978-021-01313-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 12/19/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There is growing interest in long-term outcomes following infertility and infertility treatment. However, there are few detailed longitudinal cohorts available for this work. This study aimed to assemble a historical cohort of women with primary infertility and age-matched controls to evaluate fertility trends, sequelae, and sociodemographic differences. Described here are cohort group characteristics and associated reproductive trends over time. METHODS A population-based historical cohort was created using the Rochester Epidemiology Project (REP) record-linkage system (Olmsted County, MN). The cohort included women aged 18-50 with a diagnosis of primary infertility between January 1, 1980, and December 31, 1999. As part of a case-control study, we identified 1:1 age-matched female controls from the same community and era. RESULTS A total of 1001 women with primary infertility and 1001 age-matched controls were identified. The women with primary infertility were significantly more likely to be married, college educated, use barrier contraception, and non-smokers compared to age-matched controls. The incidence of primary infertility increased from 14 to 20 per 10,000 person years from 1980-1985 to 1995-1999. Ovulatory dysfunction and unexplained infertility were the most common causes of primary infertility and clomiphene was the most widely used fertility medication. Rates of in vitro fertilization (IVF) increased from 1.8% during 1980-1985 to 26.0% during 1995-1999. CONCLUSION Women with primary infertility were found to have unique sociodemographic characteristics compared to age-matched control women, which is consistent with previous research. The incidence of diagnosed primary infertility increased from 1980 to 1999, as did use of IVF.
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Affiliation(s)
- Emily Sadecki
- College of Medicine and Science, Mayo Clinic, 200 1st Street NW, Rochester, MN, USA
| | - Amy Weaver
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Yulian Zhao
- College of Medicine and Science, Mayo Clinic, 200 1st Street NW, Rochester, MN, USA
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Mayo Clinic, 200 1st Street NW, Rochester, MN, USA
| | - Elizabeth A Stewart
- College of Medicine and Science, Mayo Clinic, 200 1st Street NW, Rochester, MN, USA
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Mayo Clinic, 200 1st Street NW, Rochester, MN, USA
| | - Alessandra J Ainsworth
- College of Medicine and Science, Mayo Clinic, 200 1st Street NW, Rochester, MN, USA.
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Mayo Clinic, 200 1st Street NW, Rochester, MN, USA.
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25
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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: 23] [Impact Index Per Article: 11.5] [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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26
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Pecker LH, Sharma D, Nero A, Paidas MJ, Ware RE, James AH, Smith-Whitley K. Knowledge gaps in reproductive and sexual health in girls and women with sickle cell disease. Br J Haematol 2021; 194:970-979. [PMID: 34231198 PMCID: PMC8448913 DOI: 10.1111/bjh.17658] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/17/2021] [Accepted: 06/01/2021] [Indexed: 02/02/2023]
Abstract
There is an immediate need to address long-standing questions about the reproductive health of girls and women with sickle cell disease (SCD). There are many SCD-related reproductive risks and uncertainties across girls' and women's reproductive life span, with particularly outstanding concerns about menstruation, contraception, fertility and pregnancy. Extant literature addressing women's reproductive health topics is mostly descriptive; there are few high-quality interventional studies. In 2020, the Centers for Disease Control and Prevention and the Foundation for Women and Girls with Blood Disorders convened an expert panel to assess the knowledge gaps in women's reproductive health in SCD. The panel identified significant limitations to clinical care due to the need for research. The panel also identified prominent barriers to research and care. In this report, we frame these issues, providing a roadmap for investigators, funding agencies, and policy makers to advance care for girls and women with SCD.
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Affiliation(s)
- Lydia H. Pecker
- Johns Hopkins University School of Medicine, Division of Hematology, Department of Medicine & Gynecology & Obstetrics, Baltimore MD
| | - Deva Sharma
- Vanderbilt University Medical Center, Divisions of Transfusion Medicine and Hematology
| | - Alecia Nero
- Department of Medicine, Division of Hematology/Oncology, University of Texas Southwestern
| | - Michael J. Paidas
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine
| | - Russell E. Ware
- Division of Pediatric Hematology, Department of Pediatrics, Cincinnati Children’s Hospital
| | - Andra H. James
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Department of Medicine, Division of Hematology, Duke University, Durham, NC
| | - Kim Smith-Whitley
- Division of Hematology, The Children’s Hospital of Philadelphia, Philadelphia, PA
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27
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Quaas AM, Manoj M. Infertility: still a largely uncovered and undertreated disease. J Assist Reprod Genet 2021; 38:1069-1070. [PMID: 33909177 PMCID: PMC8079517 DOI: 10.1007/s10815-021-02205-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Alexander M Quaas
- Division of Reproductive Endocrinology and Infertility, University of California, San Diego, CA, USA.
- Reproductive Partners San Diego, 9850 Genesee Avenue, Suite # 800, La Jolla, San Diego, CA, 92037, USA.
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