1
|
Siebold D, Denton J, Hurst ACE, Moss I, Korf B. A qualitative evaluation of patient and parent experiences with an undiagnosed diseases program. Am J Med Genet A 2024; 194:131-140. [PMID: 37750194 DOI: 10.1002/ajmg.a.63417] [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: 03/27/2023] [Revised: 07/03/2023] [Accepted: 09/05/2023] [Indexed: 09/27/2023]
Abstract
Previous studies have explored patient experiences before being seen or at the beginning of their evaluation by undiagnosed diseases programs. This study provides additional insight into experiences after participation through in-depth, qualitative evaluation, allowing for reflection of current practice and patient/parent needs. Semi-structured interviews were conducted with patients and parents of patients seen at the University of Alabama at Birmingham (UAB)'s unique, clinically focused Undiagnosed Diseases Program (UDP). Analysis of the interviews was guided by a thematic approach. Participants had undergone a diagnostic odyssey before being evaluated by the UDP and remained hopeful for a diagnosis. They appreciated the opportunity to be seen by the UDP. However, perception of experiences differed based on whether evaluation by the UDP led to a diagnosis. Additionally, while participants were pleased with initial communication, they indicated that there were unmet needs regarding follow-up. Patients and parents of patients believe that participation in an undiagnosed diseases program is the best option for diagnosis. The findings of this study provide a general overview of patient experiences and highlight strengths of the UAB UDP while also emphasizing areas to focus the improvement to optimize the benefit to patients and families with undiagnosed and rare diseases, which could be used helpful in the development of similar clinics.
Collapse
Affiliation(s)
- Dorothea Siebold
- University of Alabama (UAB), School of Health Professions, Birmingham, Alabama, USA
| | - Jessica Denton
- University of Alabama (UAB), School of Health Professions, Birmingham, Alabama, USA
| | | | - Irene Moss
- UAB Department of Genetics, Birmingham, Alabama, USA
| | - Bruce Korf
- UAB Department of Genetics, Birmingham, Alabama, USA
| |
Collapse
|
2
|
Sisk B, Lin S, Kerr AM. Factors affecting the ability of patients with complex vascular anomalies to navigate the healthcare system. Orphanet J Rare Dis 2024; 19:18. [PMID: 38238812 PMCID: PMC10797881 DOI: 10.1186/s13023-024-03018-y] [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: 12/16/2022] [Accepted: 01/11/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Vascular anomalies (VAs) are rare congenital disorders that can cause pain, disfigurement, coagulopathy, asymmetric growth, and disability. Patients with complex VAs experience multiple barriers to accessing expert care. It is imperative to understand which factors support these patients' ability to navigate the healthcare system. RESULTS We surveyed adult patients with VAs using previously validated measures, recruiting participants from five patient advocacy groups and multidisciplinary VA clinics. The primary outcome was self-reported ability to access needed medical care, using the "Navigating the Healthcare System" subscale of the Health Literacy Questionnaire. We evaluated factors associated with the ability to navigate the healthcare system using multivariate linear regression (n = 136). We also performed an exploratory model that included the primary care doctor's knowledge of VAs for the subset of participants with a primary care doctor (n = 114). Participants were predominantly women (n = 90, 66%), White and non-Hispanic (n = 109, 73%), and college-educated (n = 101, 73%). Most participants had PIK3CA-Related Overgrowth Spectrum (n = 107, 78%). Most participants reported that navigating the healthcare system was "sometimes" or "usually difficult" (mean score 16.4/30, standard deviation 5.6). In multivariate linear regression, ability to navigate the healthcare system was associated positively with quality of information exchange (β = 0.38, 95% Confidence Interval (CI) 0.22 to 0.55, p <.001) and whether patients had VA specialists (β = 2.31, 95% CI 0.35 to 4.28, p =.021), but not associated with patient self-advocacy, anxiety, education, age, race and ethnicity, gender, or having a primary care doctor. In exploratory analysis of participants with primary care doctors, ability to navigate the healthcare system was positively associated with quality of information exchange (β = 0.27, 95% CI 0.09 to 0.45, p =.004), having a VA specialist (β = 2.31, 95% CI 0.22 to 4.39, p =.031), and primary care doctors' VA knowledge (β = 0.27, 95% CI 0.04 to 0.50, p =.023). CONCLUSION Patients with VAs struggle to navigate the healthcare system. High-quality information from clinicians and more knowledgeable primary care doctors might help patients to access needed care. Relying on patient self-advocacy is insufficient. Future efforts should focus on patient-directed and clinician-directed educational interventions. Additionally, future work should assess the structural barriers that impede healthcare access for these patients.
Collapse
Affiliation(s)
- Bryan Sisk
- Division of Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
- Bioethics Research Center, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Sunny Lin
- Informatics Institute, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Anna M Kerr
- Department of Primary Care, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, USA.
| |
Collapse
|
3
|
Kentish-Barnes N, Souppart V, Cohen-Solal Z, Benhamou Y, Coppo P, Veyradier A, Azoulay E. The Metamorphosis, struggling to adapt to a new condition. The lived experience of patients with Thrombotic microangiopathies diagnosed in the ICU. A qualitative study. J Crit Care 2023; 78:154366. [PMID: 37453271 DOI: 10.1016/j.jcrc.2023.154366] [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: 09/09/2022] [Revised: 06/20/2023] [Accepted: 07/02/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Using qualitative interviews, our objective was to better understand the experience of patients with Thrombotic microangiopathies (TMA), from discovering their disease in the ICU to the psychological, emotional, and social specifics of living with this rare disorder. MATERIAL AND METHODS Patients were recruited at seven TMA centers belonging to the French national TMA referral network. A total of 15 patients, 15 relatives and 12 healthcare professionals participated. A majority of patients (n = 11/15) were women, median age was 41 (range 29-62) years, and median time elapsed since diagnosis was 6 (range 2-11) years. Interviews were analysed using thematic analysis. RESULTS We derived 3 major themes from qualitative analysis: 1) Discovering TMA: experiencing a life-threatening emergency with open eyes; 2) TMA: a complex and diverse disease and care plan; 3) Living with TMA: taming fear and loneliness. CONCLUSIONS Patients with TMA share common experiences with patients with other rare diseases, but also specific experiences related to their illness. Improved information at the onset and during the course of the illness, associated with enhanced care coordination plans would help TMA patients better cope with their illness and adhere to their care projects.
Collapse
Affiliation(s)
- Nancy Kentish-Barnes
- AP-HP, Saint Louis Hospital, Medical Intensive Care, Famiréa Research Group, Paris, France.
| | - Virginie Souppart
- AP-HP, Saint Louis Hospital, Medical Intensive Care, Famiréa Research Group, Paris, France
| | - Zoé Cohen-Solal
- AP-HP, Saint Louis Hospital, Medical Intensive Care, Famiréa Research Group, Paris, France
| | - Ygal Benhamou
- French Reference Center for Thrombotic Microangiopathies, France; CHU Charles Nicolle, Internal Medicine Department, Rouen, France
| | - Paul Coppo
- French Reference Center for Thrombotic Microangiopathies, France; AP-HP, Saint-Antoine Hospital, Hematology Department, Paris, France
| | - Agnès Veyradier
- French Reference Center for Thrombotic Microangiopathies, France; AP-HP, Lariboisière Hospital, Biological Hematology, Paris, France
| | - Elie Azoulay
- AP-HP, Saint Louis Hospital, Medical Intensive Care, Famiréa Research Group, Paris, France; French Reference Center for Thrombotic Microangiopathies, France
| |
Collapse
|
4
|
Laçiner K, Şenol Y. How Easy Is It to Read Websites About Schizophrenia? Cureus 2023; 15:e48790. [PMID: 38098931 PMCID: PMC10720762 DOI: 10.7759/cureus.48790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2023] [Indexed: 12/17/2023] Open
Abstract
Unlike legibility, which is determined according to the formal characteristics of a text, such as typeface and page shape, 'readability' defines whether the text is easy to follow and understand by the reader. In addition, readability refers to the level of education necessary for comprehending a given text. The readability of a text can be objectively measured using mathematical formulas based on the relationships between the number of syllables, words and sentences it contains. In order for schizophrenia patients and their relatives to understand their current situation and what kind of process awaits them and to adapt to treatment, the informative texts on websites should be easy to read. Our study aimed to examine the texts about schizophrenia on websites in terms of Turkish readability levels. For the study, 'schizophrenia' was typed into the Google search engine, and the first 50 eligible websites were included. Web pages were analysed in three groups: hospitals, websites created by physicians specializing in psychiatry and other websites. In our study, formulas developed by Ateşman and Bezirci-Yılmaz were used to evaluate readability levels. Statistical analyses used analysis of variance (ANOVA) to compare normally distributed groups of three. There was no statistically significant difference between the readability of the three groups (p>0.05). Our research discovered that the initial 50 websites inspected concerning schizophrenia contained texts that were challenging to read, requiring a minimum of 12 years of education. The readability level of schizophrenia-related websites was observed to be much higher than the average education level in Turkey. This situation may pose difficulties for individuals with schizophrenia and their relatives to get information about schizophrenia online. In addition, if the general population has more accurate information about schizophrenia and can understand it correctly, it may reduce the wrong attitudes and stigmatization towards individuals with schizophrenia.
Collapse
Affiliation(s)
- Kerem Laçiner
- Psychiatry, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, TUR
| | - Yiğit Şenol
- Public Health, Afyonkarahisar Provincial Health Directorate, Afyonkarahisar, TUR
| |
Collapse
|
5
|
Tumiene B, Peters H, Melegh B, Peterlin B, Utkus A, Fatkulina N, Pfliegler G, Graessner H, Hermanns S, Scarpa M, Blay JY, Ashton S, McKay L, Baynam G. Rare disease education in Europe and beyond: time to act. Orphanet J Rare Dis 2022; 17:441. [PMID: 36536417 PMCID: PMC9761619 DOI: 10.1186/s13023-022-02527-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 10/02/2022] [Indexed: 12/23/2022] Open
Abstract
People living with rare diseases (PLWRD) still face huge unmet needs, in part due to the fact that care systems are not sufficiently aligned with their needs and healthcare workforce (HWF) along their care pathways lacks competencies to efficiently tackle rare disease-specific challenges. Level of rare disease knowledge and awareness among the current and future HWF is insufficient. In recent years, many educational resources on rare diseases have been developed, however, awareness of these resources is still limited and rare disease education is still not sufficiently taken into account by some crucial stakeholders as academia and professional organizations. Therefore, there is a need to fundamentally rethink rare disease education and HWF development across the whole spectrum from students to generalists, specialists and experts, to engage and empower PLWRD, their families and advocates, and to work towards a common coherent and complementary strategy on rare disease education and training in Europe and beyond. Special consideration should be also given to the role of nurse coordinators in care coordination, interprofessional training for integrated multidisciplinary care, patient and family-centered education, opportunities given by digital learning and fostering of social accountability to enforce the focus on socially-vulnerable groups such as PLWRD. The strategy has to be developed and implemented by multiple rare disease education and training providers: universities, medical and nursing schools and their associations, professional organizations, European Reference Networks, patient organizations, other organizations and institutions dedicated to rare diseases and rare cancers, authorities and policy bodies.
Collapse
Affiliation(s)
- Birute Tumiene
- grid.6441.70000 0001 2243 2806Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Harm Peters
- grid.6363.00000 0001 2218 4662Dieter Scheffner Center for Medical Education and Educational Research, Dean’s Office of Study Affairs, Charité - Universitätsmedizin, Berlin, Germany ,Association of Medical Schools in Europe e.V., Berlin, Germany
| | - Bela Melegh
- grid.9679.10000 0001 0663 9479Department of Medical Genetics, and Szentagothai Research Center, University of Pecs, School of Medicine, Pecs, Hungary
| | - Borut Peterlin
- grid.29524.380000 0004 0571 7705Clinical Institute of Genomic Medicine, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Algirdas Utkus
- grid.6441.70000 0001 2243 2806Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania ,Association of Medical Schools in Europe e.V., Berlin, Germany
| | - Natalja Fatkulina
- grid.6441.70000 0001 2243 2806Institute of Health Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - György Pfliegler
- grid.7122.60000 0001 1088 8582Centre for Rare Diseases, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Holm Graessner
- grid.10392.390000 0001 2190 1447Institute for Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany ,grid.411544.10000 0001 0196 8249Centre for Rare Diseases, University Hospital Tübingen, Tübingen, Germany
| | - Sanja Hermanns
- grid.10392.390000 0001 2190 1447Institute for Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany ,grid.411544.10000 0001 0196 8249Centre for Rare Diseases, University Hospital Tübingen, Tübingen, Germany
| | - Maurizio Scarpa
- grid.411492.bRegional Center for Rare Diseases, University Hospital of Udine, Udine, Italy
| | - Jean-Yves Blay
- grid.7849.20000 0001 2150 7757Centre Léon Berard, University Claude Bernard Lyon 1& Unicancer Lyon, Lyon, France
| | - Sharon Ashton
- grid.433753.5EURORDIS - Rare Diseases Europe, Paris, France
| | - Lucy McKay
- Medics4RareDiseases, High Wycombe, England, UK
| | - Gareth Baynam
- grid.1012.20000 0004 1936 7910Telethon Kids Institute and the Faculty of Health and Medical Sciences, Division of Paediatrics, He University of Western Australia, Nedlands, WA Australia ,grid.413880.60000 0004 0453 2856Western Australian Register of Developmental Anomalies and Genetic Services of Western Australia, Perth, WA Australia ,Rare Care Centre, Child and Adolescent Health Service, Perth, WA Australia
| |
Collapse
|
6
|
How persons with systemic mastocytosis describe the time between symptom onset and receiving diagnosis. Prim Health Care Res Dev 2022; 23:e54. [PMID: 36069067 PMCID: PMC9472238 DOI: 10.1017/s146342362200024x] [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] [Indexed: 11/05/2022] Open
Abstract
AIM The aim of the study was to explore how persons with systemic mastocytosis (SM) described the time between the onset of symptoms and signs and getting the diagnosis. BACKGROUND SM is a rare disease caused by the accumulation of clonal mast cells with abnormal function. The symptoms and signs of the disease are varied, often diffuse and affect individuals differently. Due to this complexity, a multi-disciplinary diagnostic approach is required, in which general practitioners play an important part in identifying and referring patients relevant for such investigations. METHODS Sixteen persons with SM were interviewed about their experiences of the time before the diagnosis was received. Systematic text condensation was used in the analysis process. FINDINGS The time between symptom and signs onset and diagnosis was perceived as difficult. SM often had a complex and unpredictable effect on a person's daily life, long before diagnosis. In the analysis, three themes were found. Having symptoms and signs with an unknown cause included the participants' descriptions of numerous symptoms and signs, often years before diagnosis. These could be severe and result in worries for both participants and their next-of-kin. Dealing with the symptoms and signs encompassed the different ways in which the participants coped with the symptoms and signs, and sought relief. Being a patient without a diagnosis underlined the lack of information and knowledge within healthcare, often resulting in a delayed or incorrect diagnosis. The study highlighted the importance of a person-centred approach and the need to increase knowledge of the disease within primary care, to shorten this stressful and vulnerable time.
Collapse
|
7
|
Factors affecting pathways to care for children and adolescents with complex vascular malformations: parental perspectives. Orphanet J Rare Dis 2022; 17:271. [PMID: 35840977 PMCID: PMC9287854 DOI: 10.1186/s13023-022-02432-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/30/2022] [Indexed: 11/21/2022] Open
Abstract
Background Complex vascular malformations (VMs) are rare disorders that can cause pain, coagulopathy, disfigurement, asymmetric growth, and disability. Patients with complex VMs experience misdiagnosis, delayed diagnosis, delayed or inappropriate treatments, and worsened health. Given the potential consequences of delaying expert care, we must identify the factors that impede or facilitate this access to care.
Results We performed semi-structured interviews with 24 parents (21 mothers; 3 fathers; median age = 42.5 years) of children with complex VMs and overgrowth disorders living in the US, recruited through two patient advocacy groups – CLOVES Syndrome Community, and Klippel-Trenaunay Support Group. We performed thematic analysis to assess parental perspectives on barriers and facilitators to accessing expert care. We identified 11 factors, representing 6 overarching themes, affecting families’ ability to access and maintain effective care for their child: individual characteristics (clinician behaviors and characteristics, parent behaviors and characteristics), health care system (availability of specialist multidisciplinary teams, care coordination and logistics, insurance and financial issues, treatments and services), clinical characteristics (accuracy and timing of diagnosis, features of clinical presentation), social support networks, scientific progress, and luck and privilege. Additionally, access to information about VMs and VM care was a crosscutting theme affecting each of these factors. These factors influenced both the initial access to care and the ongoing maintenance of care for children with VMs. Conclusion Parents of children with VMs report multiple factors that facilitate or impede their ability to provide their child with optimal care. These factors represent possible targets for future interventions to improve care delivery for families affected by VMs. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02432-4.
Collapse
|
8
|
Mosha D, Kakolwa MA, Mahende MK, Masanja H, Abdulla S, Drakeley C, Gosling R, Wamoyi J. Safety monitoring experience of single-low dose primaquine co-administered with artemether-lumefantrine among providers and patients in routine healthcare practice: a qualitative study in Eastern Tanzania. Malar J 2021; 20:392. [PMID: 34627236 PMCID: PMC8501629 DOI: 10.1186/s12936-021-03921-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/20/2021] [Indexed: 12/01/2022] Open
Abstract
Background Primaquine is a gametocytocidal drug recommended by the World Health Organization (WHO) in a single-low dose combined with artemisinin-based combination therapy (ACT) for the treatment and prevention of Plasmodium falciparum malaria transmission. Safety monitoring concerns and the lack of a universal validated and approved primaquine pharmacovigilance tool is a challenge for a national rollout in many countries. This study aimed to explore the acceptance, reliability and perceived effectiveness of the primaquine roll out monitoring pharmacovigilance tool (PROMPT). Methods This study was conducted in three dispensaries in the Coastal region of Eastern Tanzania. The study held six in-depth interviews with healthcare providers and six participatory focus group discussions with malaria patients (3) and parents/guardians of sick children (3). Participants were purposively sampled. Thematic analysis was conducted with the aid of NVivo qualitative analysis software. Results The respondents’ general acceptance and perceived effectiveness of the single-low dose primaquine and PROMPT was good. Screening procedure for treatment eligibility and explaining to patients about the possible adverse events was considered very useful for safety reasons. Crushing and dissolving of primaquine tablet to get the appropriate dose, particularly in children, was reported by all providers to be challenging. Transport costs and poor access to the health facility were the main reasons for a patient failing to return to the clinic for a scheduled follow-up visit. Treatment was perceived to be safe by both providers and patients and reported no case of a severe adverse event. Some providers were concerned with the haemoglobin drop observed on day 7. Conclusion Single-low dose primaquine was perceived to be safe and acceptable among providers and patients. PROMPT demonstrated to be a reliable and user-friendly tool among providers. Further validation of the tool by involving the National Malaria Control Programme is pivotal to addressing key challenges and facilitating primaquine adoption in the national policy.
Collapse
Affiliation(s)
- Dominic Mosha
- Ifakara Health Institute, Plot 463, Kiko Ave, Mikocheni, P.O Box 78373, Dar es Salaam, Tanzania.
| | - Mwaka A Kakolwa
- Ifakara Health Institute, Plot 463, Kiko Ave, Mikocheni, P.O Box 78373, Dar es Salaam, Tanzania
| | - Muhidin K Mahende
- Ifakara Health Institute, Plot 463, Kiko Ave, Mikocheni, P.O Box 78373, Dar es Salaam, Tanzania
| | - Honorati Masanja
- Ifakara Health Institute, Plot 463, Kiko Ave, Mikocheni, P.O Box 78373, Dar es Salaam, Tanzania
| | - Salim Abdulla
- Ifakara Health Institute, Plot 463, Kiko Ave, Mikocheni, P.O Box 78373, Dar es Salaam, Tanzania
| | - Chris Drakeley
- Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, London, UK
| | - Roland Gosling
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.,Global Health Group, Malaria Elimination Initiative, University of California, San Francisco, CA, USA
| | - Joyce Wamoyi
- National Institute for Medical Research, Mwanza, Tanzania
| |
Collapse
|
9
|
Peláez Bejarano A, de las Aguas Robustillo Cortés M, Guzman Ramos MI. Patient experience in a rare disease: application of the IEXPAC questionnaire in hereditary transthyretin-mediated amyloidosis. Expert Opin Orphan Drugs 2021. [DOI: 10.1080/21678707.2021.1953468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Ana Peláez Bejarano
- Unidad de Gestión Clínica Farmacia, Hospital Juan Ramón Jiménez, Huelva, Spain
| | | | | |
Collapse
|
10
|
Piedade KC, Spencer H, Persani L, Nelson LM. Optimizing Fertility in Primary Ovarian Insufficiency: Case Report and Literature Review. Front Genet 2021; 12:676262. [PMID: 34249096 PMCID: PMC8261244 DOI: 10.3389/fgene.2021.676262] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/12/2021] [Indexed: 12/31/2022] Open
Abstract
Primary ovarian insufficiency (POI) is a clinical spectrum of ovarian dysfunction. Overt POI presents with oligo/amenorrhea and hypergonadotropic hypogonadism before age 40 years. Overt POI involves chronic health problems to include increased morbidity and mortality related to estradiol deficiency and the associated osteoporosis and cardiovascular disease as well as psychological and psychiatric disorders related to the loss of reproductive hormones and infertility. Presently, with standard clinical testing, a mechanism for Overt POI can only be identified in about 10% of cases. Now discovery of new mechanisms permits an etiology to be identified in a research setting in 25-30% of overt cases. The most common genetic cause of Overt POI is premutation in FMR1. The associated infertility is life altering. Oocyte donation is effective, although many women prefer to conceive with their own ova. Surprisingly, the majority who have Overt POI still have detectable ovarian follicles (70%). The major mechanism of follicle dysfunction in Overt POI has been histologically defined by a prospective NIH study: inappropriate follicle luteinization due to the tonically elevated serum LH levels. A trial of physiologic hormone replacement therapy, clinically proven to suppress the elevated LH levels in these women, may improve follicle function and increase the chance of ovulation. Here, we report the case of a woman with Overt POI diagnosed at age 35 years. To attempt pregnancy, she elected a trial of intrauterine insemination (IUI) in conjunction with follicle monitoring and physiologic hormone replacement therapy. She conceived on the eighth cycle of treatment and delivered a healthy baby. Our report calls for a concerted effort to define the best methods by which to optimize fertility for women who have POI.
Collapse
Affiliation(s)
| | - Hillary Spencer
- Vanderbilt University Medical Center, Nashville, TN, United States
| | - Luca Persani
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
- Department of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano, Milan, Italy
| | | |
Collapse
|