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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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Soled KRS, Hoatson T, Monseur B, Everett B, Chakraborty P, Reynolds CA, Huang AK, McKetta S, Haneuse S, Charlton BM. Differences in medically assisted reproduction use by sexual identity and partnership: a prospective cohort of cisgender women. Hum Reprod 2024; 39:1323-1335. [PMID: 38689464 DOI: 10.1093/humrep/deae077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 03/19/2024] [Indexed: 05/02/2024] Open
Abstract
STUDY QUESTION Does medically assisted reproduction (MAR) use among cisgender women differ among those with same-sex partners or lesbian/bisexual identities compared to peers with different-sex partners or heterosexual identities? SUMMARY ANSWER Women with same-sex partners or lesbian/bisexual identities are more likely to utilize any MAR but are no more likely to use ART (i.e. IVF, reciprocal IVF, embryo transfer, unspecified ART, ICSI, and gamete or zygote intrafallopian transfer) compared to non-ART MAR (i.e. IUI, ovulation induction, and intravaginal or intracervical insemination) than their different-sex partnered and completely heterosexual peers. WHAT IS KNOWN ALREADY Sexual minority women (SMW) form families in myriad ways, including through fostering, adoption, genetic, and/or biological routes. Emerging evidence suggests this population increasingly wants to form genetic and/or biological families, yet little is known about their family formation processes and conception needs. STUDY DESIGN, SIZE, DURATION The Growing Up Today Study is a US-based prospective cohort (n = 27 805). Participants were 9-17 years of age at enrollment (1996 and 2004). Biennial follow-up is ongoing, with data collected through 2021. PARTICIPANTS/MATERIALS, SETTING, METHODS Cisgender women who met the following criteria were included in this sample: endorsed ever being pregnant; attempted a pregnancy in 2019 or 2021; and endorsed either a male- or female-sex partner OR responded to questions regarding their sexual identity during their conception window. The main outcome was any MAR use including ART (i.e. procedures involving micromanipulation of gametes) and non-ART MAR (i.e. nonmanipulation of gametes). Secondary outcomes included specific MAR procedures, time to conception, and trends across time. We assessed differences in any MAR use using weighted modified Poisson generalized estimating equations. MAIN RESULTS AND THE ROLE OF CHANCE Among 3519 participants, there were 6935 pregnancies/pregnancy attempts and 19.4% involved MAR. A total of 47 pregnancies or pregnancy attempts were among the same-sex partnered participants, while 91 were among bisexual participants and 37 among lesbian participants. Participants with same-sex, compared to different-sex partners were almost five times as likely to use MAR (risk ratio [95% CI]: 4.78 [4.06, 5.61]). Compared to completely heterosexual participants, there was greater MAR use among lesbian (4.00 [3.10, 5.16]) and bisexual (2.22 [1.60, 3.07]) participants compared to no MAR use; mostly heterosexual participants were also more likely to use ART (1.42 [1.11, 1.82]) compared to non-ART MAR. Among first pregnancies conceived using MAR, conception pathways differed by partnership and sexual identity groups; differences were largest for IUI, intravaginal insemination, and timed intercourse with ovulation induction. From 2002 to 2021, MAR use increased proportionally to total pregnancies/pregnancy attempts; ART use was increasingly common in later years among same-sex partnered and lesbian participants. LIMITATIONS, REASONS FOR CAUTION Our results are limited by the small number of SMW, the homogenous sample of mostly White, educated participants, the potential misclassification of MAR use when creating conception pathways unique to SMW, and the questionnaire's skip logic, which excluded certain participants from receiving MAR questions. WIDER IMPLICATIONS OF THE FINDINGS Previous studies on SMW family formation have primarily focused on clinical outcomes from ART procedures and perinatal outcomes by conception method, and have been almost exclusively limited to European, clinical samples that relied on partnership data only. Despite the small sample of SMW within a nonrepresentative study, this is the first study to our knowledge to use a nonclinical sample of cisgender women from across the USA to elucidate family formation pathways by partnership as well as sexual identity, including pathways that may be unique to SMW. This was made possible by our innovative approach to MAR categorization within a large, prospective dataset that collected detailed sexual orientation data. Specifically, lesbian, bisexual, and same-sex partnered participants used both ART and non-ART MAR at similar frequencies compared to heterosexual and different-sex partnered participants. This may signal differential access to conception pathways owing to structural barriers, emerging conception trends as family formation among SMW has increased, and a need for conception support beyond specialized providers and fertility clinics. STUDY FUNDING/COMPETING INTEREST(S) The research reported in this publication was supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health (NIH), under award number R01MD015256. Additionally, KRSS is supported by NCI grant T32CA009001, AKH by the NCI T32CA057711, PC by the NHLBI T32HL098048, BM by the Stanford Maternal Child Health Research Institute Clinical Trainee Support Grant and the Diversity Fellowship from the American Society for Reproductive Medicine Research Institute, BGE by NICHD R01HD091405, and SM by the Thomas O. Pyle Fellowship through the Harvard Pilgrim Health Care Foundation and Harvard University, NHLBI T32HL098048, NIMH R01MH112384, and the William T. Grant Foundation grant number 187958. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The first author recently had a leadership role in the not-for-profit program, The Lesbian Health Fund, a research fund focused on improving the health and wellbeing of LGBTQ+ women and girls. The fund did not have any role in this study and the author's relationship with the fund did not bias the findings of this manuscript. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Kodiak R S Soled
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Tabor Hoatson
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Brent Monseur
- Division of Reproductive Endocrinology and Infertility, Stanford School of Medicine, Palo Alto, CA, USA
| | - Bethany Everett
- Department of Sociology, University of Utah, Salt Lake City, UT, USA
| | - Payal Chakraborty
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Colleen A Reynolds
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Aimee K Huang
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sarah McKetta
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Brittany M Charlton
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Harvard Medical School & Brigham and Women's Hospital, Boston, MA, USA
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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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Tierney KI, Greil AL, Bell AV. Socioeconomic and Racial/Ethnic Inequalities in Infertility Prevalence, Help-Seeking, and Help Received Since 1995. Womens Health Issues 2024:S1049-3867(24)00025-2. [PMID: 38692970 DOI: 10.1016/j.whi.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 03/12/2024] [Accepted: 03/22/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND In the United States, infertility and treatment for infertility are marked by racial/ethnic and socioeconomic inequalities. Simultaneously, biomedical advances and increased public health attention toward preventing and addressing infertility have grown. It is not known, however, whether the racial/ethnic and socioeconomic inequalities observed in infertility prevalence, help-seeking, or help received have changed over time. METHODS Using National Survey of Family Growth data (1995 through 2017-2019 cycles), this study applied multivariable logistic regression with interaction terms to investigate whether and how racial/ethnic and socioeconomic inequalities in 1) the prevalence of infertility, 2) ever seeking help to become pregnant, and 3) use of common types of medical help (advice, testing, medication for ovulation, surgery for blocked tubes, and artificial insemination) have changed over time. RESULTS The results showed persisting, rather than narrowing or increasing, inequalities in the prevalence of infertility and help-seeking overall. The results showed persisting racial/ethnic inequalities in testing, ovulation medication use, and surgery for blocked tubes. By contrast, the results showed widening socioeconomic inequalities in testing and narrowing inequalities in the use of ovulation medications. CONCLUSIONS There is little evidence to suggest policy interventions, biomedical advances, or increased public health awareness has narrowed inequalities in infertility prevalence, treatment seeking, or use of specific treatments.
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Affiliation(s)
| | - Arthur L Greil
- Division of Social Sciences, Alfred University, Alfred, New York
| | - Ann V Bell
- Department of Sociology and Criminal Justice, University of Delaware, Newark, Delaware
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Huang R, Yu JY, He WC, Liu RH. Feasibility analysis of China's medical insurance coverage of assisted reproductive technology. Sci Rep 2024; 14:7998. [PMID: 38580689 PMCID: PMC10997767 DOI: 10.1038/s41598-024-58640-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 04/01/2024] [Indexed: 04/07/2024] Open
Abstract
There are millions of patients experiencing infertility in China, but assisted reproductive technology (ART) is performed at the patient's expense and is difficult to afford. With the sharp decline in China's birth rate, there is a growing controversy over the inclusion of ART in medical insurance (MI). This study aims to explore the feasibility of ART coverage by MI for the first time. We obtained basic data such as the prevalence of infertility, the cost of ART, and the success rate in China with the method of meta-analysis and consulting the government bulletin. Then, we calculated the number of infertile couples in China and the total financial expenditure of MI covering ART. Finally, we discussed the feasibility of coverage, and analyzed the population growth and economic benefits after coverage. According to our research results, it was estimated that there were 4.102-11.792 million infertile couples in China, with an annual increase of 1.189-1.867 million. If MI covered ART, the fund would pay 72.313-207.878 billion yuan, accounting for 2-6% of the current fund balance, and the subsequent annual payment would be 20.961-32.913 billion yuan, accounting for 4-7% of the annual fund balance. This was assuming that all infertile couples would undergo ART, and the actual cost would be lower. The financial input‒output ratio would be 13.022. Benefiting from the inclusion of ART in MI coverage, there would be 3.348-9.624 million new live infants, and 8-13% newborns would be born every year thereafter, which means that by 2050, 37-65 million people would be born. Due to its affordable cost, high cost-effectiveness and favourable population growth, it may be feasible to include ART in MI.
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Affiliation(s)
- Rong Huang
- Department of Laboratory, Panyu Hexian Memorial Hospital of Guangzhou, Guangzhou, 511400, China
| | - Jing-Yun Yu
- Department of Health Care, Dongguan Maternal and Child Health Care Hospital, Dongguan, 523112, China
| | - Wei-Chao He
- Department of Health Care, Dongguan Maternal and Child Health Care Hospital, Dongguan, 523112, China
| | - Ri-Hui Liu
- Medical Insurance Office, Human Resources and Social Security Bureau of Guangzhou's Nansha District, No.15 Huanshi Avenue Middle, Nansha District, Guangzhou City, 511466, Guangdong, China.
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Imbroane MR, Kim H, Van Dorn CH, Richards EG. Impact of Mandated Insurance Coverage of Assisted Reproductive Technology on Clinic Website Transparency. J Womens Health (Larchmt) 2024. [PMID: 38502832 DOI: 10.1089/jwh.2023.0957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024] Open
Abstract
Objective: The purpose of this study was to determine whether website transparency of service costs, accepted insurance plans, and financing options differs between reproductive endocrinology and infertility clinics located in states that do and do not mandate insurance coverage of assisted reproductive technology (ART). Methods: Six hundred forty-six clinics were identified using the Society for Assisted Reproductive Technology online locator. Clinics were excluded for missing website links, duplicate entries, broken websites, or permanent closure. Mandated coverage by state was gathered on resolve.org Chi-squared testing and logistic regression were performed. Results: Of the 311 clinic websites analyzed, 28.6% were in states that mandate ART coverage and 71.4% were not. Clinics in states that have mandated coverage were more likely to list specific prices on their websites. These clinics were 2.13 times more likely to list specific costs (odds ratio [OR]; 95% confidence interval [CI]: 1.19-3.81, p = 0.01). There was also a significant difference between the percent of clinics in mandated coverage states and nonmandated states that listed accepted insurance plans. These clinics were 2.44 times more likely to report accepted insurance plans (OR; 95% CI: [1.47-4.05], p = 0.005). There was no significant difference in the mention of financial assistance between the groups. Clinics in states with mandated coverage were more likely to mention discount programs, but there was no significant difference for other types of financial assistance. Conclusion: Clinics located in states that mandate insurance coverage of ART are more likely to list specific costs, accepted insurance plans, and the availability of discount programs on their website. Patients living in states without mandated coverage are more likely to need to finance their own treatment, yet these patients are less likely to have nearby clinics that provide financial transparency on their websites.
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Affiliation(s)
- Marisa R Imbroane
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Hanna Kim
- Department of Reproductive Endocrinology and Infertility, Cleveland Clinic, Cleveland, Ohio, USA
| | - Chloe H Van Dorn
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Elliott G Richards
- Department of Reproductive Endocrinology and Infertility, Cleveland Clinic, Cleveland, Ohio, USA
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Su HI, Kaiser BN, Crable EL, Ortega RF, Yoeun SW, Economou MA, Fernandez E, Romero SAD, Aarons GA, McMenamin SB. Implementation of state health insurance benefit mandates for cancer-related fertility preservation: following policy through a complex system. Implement Sci 2024; 19:14. [PMID: 38365808 PMCID: PMC10870606 DOI: 10.1186/s13012-024-01343-1] [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: 09/12/2023] [Accepted: 01/20/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND A myriad of federal, state, and organizational policies are designed to improve access to evidence-based healthcare, but the impact of these policies likely varies due to contextual determinants of, reinterpretations of, and poor compliance with policy requirements throughout implementation. Strategies enhancing implementation and compliance with policy intent can improve population health. Critically assessing the multi-level environments where health policies and their related health services are implemented is essential to designing effective policy-level implementation strategies. California passed a 2019 health insurance benefit mandate requiring coverage of fertility preservation services for individuals at risk of infertility due to medical treatments, in order to improve access to services that are otherwise cost prohibitive. Our objective was to document and understand the multi-level environment, relationships, and activities involved in using state benefit mandates to facilitate patient access to fertility preservation services. METHODS We conducted a mixed-methods study and used the policy-optimized exploration, preparation, implementation, and sustainment (EPIS) framework to analyze the implementation of California's fertility preservation benefit mandate (SB 600) at and between the state insurance regulator, insurer, and clinic levels. RESULTS Seventeen publicly available fertility preservation benefit mandate-relevant documents were reviewed. Interviews were conducted with four insurers; 25 financial, administrative, and provider participants from 16 oncology and fertility clinics; three fertility pharmaceutical representatives; and two patient advocates. The mandate and insurance regulator guidance represented two "Big P" (system level) policies that gave rise to a host of "little p" (organizational) policies by and between the regulator, insurers, clinics, and patients. Many little p policies were bridging factors to support implementation across levels and fertility preservation service access. Characterizing the mandate's functions (i.e., policy goals) and forms (i.e., ways that policies were enacted) led to identification of (1) intended and unintended implementation, service, and patient outcomes, (2) implementation processes by level and EPIS phase, (3) actor-delineated key processes and heterogeneity among them, and (4) inner and outer context determinants that drove adaptations. CONCLUSIONS Following the midstream and downstream implementation of a state health insurance benefit mandate, data generated will enable development of policy-level implementation strategies, evaluation of determinants and important outcomes of effective implementation, and design of future mandates to improve fit and fidelity.
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Affiliation(s)
- H Irene Su
- Moores Cancer Center and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, La Jolla, San Diego, CA, 92093, USA.
| | - Bonnie N Kaiser
- Department of Anthropology and Global Health Program, University of California San Diego, La Jolla, San Diego, CA, 92093, USA
| | - Erika L Crable
- Department of Psychiatry, Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, La Jolla, Los Angeles, CA, 92093, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Ricardo Flores Ortega
- Moores Cancer Center and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, La Jolla, San Diego, CA, 92093, USA
| | - Sara W Yoeun
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, La Jolla, Loss Angeles, CA, 92093, USA
| | - Melina A Economou
- Department of Anthropology and Global Health Program, University of California San Diego, La Jolla, San Diego, CA, 92093, USA
| | - Estefania Fernandez
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, La Jolla, San Diego, CA, 92093, USA
| | - Sally A D Romero
- Department of Obstetrics, Gynecology and Reproductive Sciences and Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, San Diego, CA, 92093, USA
| | - Gregory A Aarons
- Child and Adolescent Services Research Center, San Diego, CA, USA
- Department of Psychiatry and Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, University of California San Diego, La Jolla, San Diego, CA, 92093, USA
| | - Sara B McMenamin
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, La Jolla, Loss Angeles, CA, 92093, USA.
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Maitin-Shepard M, Werner EF, Feig LA, Chavarro JE, Mumford SL, Wylie B, Rando OJ, Gaskins AJ, Sakkas D, Arora M, Kudesia R, Lujan ME, Braun J, Mozaffarian D. Food, nutrition, and fertility: from soil to fork. Am J Clin Nutr 2024; 119:578-589. [PMID: 38101699 DOI: 10.1016/j.ajcnut.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 11/22/2023] [Accepted: 12/11/2023] [Indexed: 12/17/2023] Open
Abstract
Food and nutrition-related factors, including foods and nutrients consumed, dietary patterns, use of dietary supplements, adiposity, and exposure to food-related environmental contaminants, have the potential to impact semen quality and male and female fertility; obstetric, fetal, and birth outcomes; and the health of future generations, but gaps in evidence remain. On 9 November 2022, Tufts University's Friedman School of Nutrition Science and Policy and the school's Food and Nutrition Innovation Institute hosted a 1-d meeting to explore the evidence and evidence gaps regarding the relationships between food, nutrition, and fertility. Topics addressed included male fertility, female fertility and gestation, and intergenerational effects. This meeting report summarizes the presentations and deliberations from the meeting. Regarding male fertility, a positive association exists with a healthy dietary pattern, with high-quality evidence for semen quality and lower quality evidence for clinical outcomes. Folic acid and zinc supplementation have been found to not impact male fertility. In females, body weight status and other nutrition-related factors are linked to nearly half of all ovulation disorders, a leading cause of female infertility. Females with obesity have worse fertility treatment, pregnancy-related, and birth outcomes. Environmental contaminants found in food, water, or its packaging, including lead, perfluorinated alkyl substances, phthalates, and phenols, adversely impact female reproductive outcomes. Epigenetic research has found that maternal and paternal dietary-related factors can impact outcomes for future generations. Priority evidence gaps identified by meeting participants relate to the effects of nutrition and dietary patterns on fertility, gaps in communication regarding fertility optimization through changes in nutritional and environmental exposures, and interventions impacting germ cell mechanisms through dietary effects. Participants developed research proposals to address the priority evidence gaps. The workshop findings serve as a foundation for future prioritization of scientific research to address evidence gaps related to food, nutrition, and fertility.
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Affiliation(s)
| | - Erika F Werner
- Tufts University School of Medicine, Boston, MA, United States
| | - Larry A Feig
- Department of Developmental, Molecular, and Chemical Biology, Tufts University School of Medicine, Boston, MA, United States
| | - Jorge E Chavarro
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Sunni L Mumford
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, United States
| | - Blair Wylie
- Collaborative for Women's Environmental Health, Columbia University, New York, NY, United States
| | - Oliver J Rando
- Department of Biochemistry and Molecular Biotechnology, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Audrey J Gaskins
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, United States
| | | | - Manish Arora
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Marla E Lujan
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States
| | - Joseph Braun
- Department of Epidemiology, Brown University, Providence, RI, United States
| | - Dariush Mozaffarian
- Tufts University School of Medicine, Boston, MA, United States; Food is Medicine Institute, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States.
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9
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Nadgauda AS, Butts S. Barriers to fertility preservation access in transgender and gender diverse adolescents: a narrative review. Ther Adv Reprod Health 2024; 18:26334941231222120. [PMID: 38292918 PMCID: PMC10826369 DOI: 10.1177/26334941231222120] [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: 07/01/2023] [Accepted: 11/24/2023] [Indexed: 02/01/2024] Open
Abstract
Fertility preservation (FP) involves the cryopreservation of gametes, embryos, and/or gonadal tissue oocytes, for future use in family building. FP as part of a comprehensive approach to care of transgender and gender diverse (TGD) individuals is an understudied topic. Current evidence indicates that gender affirming therapies may increase the risk for infertility. As a result, TGD individuals, including adolescents, should receive counseling regarding FP prior to beginning gender affirming treatment. Many barriers exist to TGD adolescents receiving FP counseling and undergoing FP if desired. The objective of this narrative review is to summarize the literature regarding the desire for FP in TGD adolescents, the barriers to TGD adolescents in accessing of FP, and to discuss potential interventions for alleviation of such barriers. A literature search using the following Medical Subject Headings search terms: 'transgender persons' and 'fertility preservation' and 'adolescents' was conducted via searching PubMed. Additional articles were located via reference review. Included articles consist of qualitative and quantitative research and society guidelines. Articles from inception to 1st July 2023 were included. The results of the literature search have been summarized into the format of a narrative review. Key barriers to FP for TGD adolescents include inconsistencies in form and timing of counseling, potential worsening of gender dysphoria with FP treatment, high cost of treatment, limited research on FP outcomes, and legal barriers. Intersectionality between gender identity and other forms of minority status can compound these barriers to FP and healthcare in general. Barriers to TGD adolescents accessing FP are significant. Increased research is needed upon methods to mitigate these barriers. Solutions include increasing uniformity and timing of FP counseling by varying health care providers, advocacy efforts to mitigate legal and financial barriers, increased research efforts in FP outcomes, and increased cultural competency in clinics offering FP care to TGD adolescents.
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Affiliation(s)
- Ashni S. Nadgauda
- Department of Obstetrics and Gynecology, Reading Hospital – Tower Health, 420 South 5th Avenue, Reading, PA 19611, USA
| | - Samantha Butts
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Penn State – Main Campus, Hershey, PA, USA
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Bayefsky MJ, Cascante SD, McCulloh DH, Blakemore JK. Live birth rates in in vitro fertilization cycles with five or fewer follicles. J Assist Reprod Genet 2024; 41:223-229. [PMID: 37978117 PMCID: PMC10789701 DOI: 10.1007/s10815-023-02985-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023] Open
Abstract
PURPOSE To evaluate live birth rates (LBRs) for in vitro fertilization (IVF) cycles with ≤5 follicles at trigger, with the goal of helping patients with low follicle counts decide whether to proceed to retrieval. METHODS This is a retrospective cohort study from an urban, university-affiliated fertility center. All IVF cycles that yielded <10 oocytes between 2016 and 2020 were reviewed. Cycles were included if <5 follicles measuring >14 mm were verified on trigger day. The primary outcome was LBR per retrieval after fresh or frozen transfer. Secondary outcomes were number of oocytes, mature oocytes, 2-pronuclear zygotes (2-PNs), blastocysts for transfer/biopsy, and euploid blastocysts (if preimplantation genetic testing for aneuploidy (PGT-A) was used). RESULTS 1502 cycles (900 with PGT-A) from 972 patients were included. Mean number of oocytes, mature oocytes, 2-PNs, blastocysts for transfer/biopsy, and euploid blastocysts differed by follicle number (p < 0.001). Across all age groups, there were differences in LBR associated with follicle number (p < 0.001). However, within age groups, not all results were significant. For example, for patients <35 years, LBR did not differ by follicle number and among patients 35-37 years; LBR with two or three follicles was lower than with five (p < 0.02). LBR for patients 35-40 years was <20% with 1-3 follicles and 25-40% with 4-5 follicles. LBR for patients >41 years was <5% with 1-3 follicles and <15% with 4-5 follicles. CONCLUSION As expected, LBR is higher with more follicles. Providing patients with <5 follicles with specific data can help them weigh the emotional, physical, and financial costs of retrieval.
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Affiliation(s)
- Michelle J Bayefsky
- New York University Langone Health, Grossman School of Medicine, 462 First Avenue, Ninth Floor, New York, NY, 10016, USA.
| | - Sarah D Cascante
- New York University Langone Prelude Fertility Center, 159 East 53rd Street, 3rd Floor, New York, NY, 10022, USA
| | - David H McCulloh
- New York University Langone Prelude Fertility Center, 159 East 53rd Street, 3rd Floor, New York, NY, 10022, USA
- Gameto, Inc., 286 Madison Ave, New York, NY, 10017, USA
| | - Jennifer K Blakemore
- New York University Langone Prelude Fertility Center, 159 East 53rd Street, 3rd Floor, New York, NY, 10022, USA
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Zhang L, Sun H, Chen X. Long noncoding RNAs in human reproductive processes and diseases. Mol Reprod Dev 2024; 91:e23728. [PMID: 38282314 DOI: 10.1002/mrd.23728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 11/22/2023] [Accepted: 12/19/2023] [Indexed: 01/30/2024]
Abstract
Infertility has become a global disease burden. Although assisted reproductive technologies are widely used, the assisted reproduction birth rate is no more than 30% worldwide. Therefore, understanding the mechanisms of reproduction can provide new strategies to improve live birth rates and clinical outcomes of enhanced implantation. Long noncoding RNAs (lncRNAs) have been reported to exert regulatory roles in various biological processes and diseases in many species. In this review, we especially focus on the role of lncRNAs in human reproduction. We summarize the function and mechanisms of lncRNAs in processes vital to reproduction, such as spermatogenesis and maturation, sperm motility and morphology, follicle development and maturation, embryo development and implantation. Then, we highlight the importance and diverse potential of lncRNAs as good diagnostic molecular biomarkers and therapeutic targets for infertility treatment.
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Affiliation(s)
- Le Zhang
- Center for Reproductive Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Hailong Sun
- Center for Reproductive Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Xiujuan Chen
- Center for Reproductive Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
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Peipert BJ, Mebane S, Edmonds M, Watch L, Jain T. Economics of Fertility Care. Obstet Gynecol Clin North Am 2023; 50:721-734. [PMID: 37914490 DOI: 10.1016/j.ogc.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Family building is a human right. The high cost and lack of insurance coverage associated with fertility treatments in the United States have made treatment inaccessible for many patients. The universal uptake of "add-on" services has further contributed to high out-of-pocket costs. Expansion in access to infertility care has occurred in several states through implementation of insurance mandates, and more employers are offering fertility benefits to attract and retain employees. An understanding of the economic issues shaping fertility should inform future policies aimed at promoting evidence-based practices and improving access to care in the United States.
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Affiliation(s)
- Benjamin J Peipert
- Division of Reproductive Endocrinology and Infertility, Hospital of the University of Pennsylvania, 3701 Market Street, 8th Floor, Philadelphia, PA 19104, USA
| | - Sloane Mebane
- Department of Obstetrics & Gynecology, Duke University School of Medicine, 201 Trent Drive, 203 Baker House, Durham, NC 27710, USA
| | - Maxwell Edmonds
- Department of Obstetrics & Gynecology, Duke University School of Medicine, 201 Trent Drive, 203 Baker House, Durham, NC 27710, USA
| | - Lester Watch
- Department of Obstetrics & Gynecology, Duke University School of Medicine, 201 Trent Drive, 203 Baker House, Durham, NC 27710, USA
| | - Tarun Jain
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, 676 N. Saint Clair Street, Suite 2310, Chicago, IL 60611, USA.
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13
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Swain M, Miller M, Cannella C, Daviskiba S. Disparities in fertility preservation among patients diagnosed with female breast cancer. J Assist Reprod Genet 2023; 40:2843-2849. [PMID: 37819551 PMCID: PMC10656408 DOI: 10.1007/s10815-023-02968-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/04/2023] [Indexed: 10/13/2023] Open
Abstract
PURPOSE To investigate the association of specific patient factors with disparities in fertility preservation counseling and utilization of fertility preservation among patients ≤ 40 years old diagnosed with female breast cancer. METHODS A retrospective chart review was conducted investigating patients diagnosed with breast cancer between January 2012 and December 2020 in a multi-site health system. Rates of fertility counseling and utilization of preservation services were compared based on age, race/ethnicity, parity, insurance type, and treatment site. RESULTS Of the 6,783 patients diagnosed with female breast cancer, 306 (4.5%) were ≤ 40 years old at the time of diagnosis. There was no significant difference between Black or African American and White patients in rates of fertility counseling (12.1% vs 17.4%; p = 0.285) or pursuit of fertility preservation (3.3% vs 4.2%; p = 0.508), nor was a difference observed when compared by insurance type. However, younger patients (< 30 years of age), patients with 1 or no children, and patients treated in the more affluent county were more likely to undergo counseling and pursue fertility preservation than their matched counterparts. CONCLUSION Age, parity, and location of breast cancer care may impact rates of fertility counseling and preservation among reproductive age women diagnosed with breast cancer. Thus, further attention to age discrimination, a patient's desire for future fertility, need for standardization in fertility preservation counseling, and perhaps implementation of comprehensive fertility coverage mandates across all states could help to improve gaps in fertility counseling and fertility preservation.
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Affiliation(s)
- Monique Swain
- Department of Obstetrics and Gynecology, Henry Ford Hospital, Detroit, MI, USA.
| | - Madison Miller
- Department of Obstetrics and Gynecology, Henry Ford Hospital, Detroit, MI, USA
| | | | - Sydney Daviskiba
- Department of Obstetrics and Gynecology, Henry Ford Hospital, Detroit, MI, USA
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Irene Su H, Kaiser B, Crable E, Ortega RF, Yoeun SW, Economou M, Fernandez E, Romero SA, Aarons GA, McMenamin SB. Implementation of state health insurance benefit mandates for cancer-related fertility preservation: Following policy through a complex system. RESEARCH SQUARE 2023:rs.3.rs-3340894. [PMID: 37886467 PMCID: PMC10602193 DOI: 10.21203/rs.3.rs-3340894/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Background A myriad of federal, state, and organizational policies are designed to improve access to evidence-based healthcare, but the impact of these policies likely varies due to contextual determinants, re-interpretations of and poor compliance with policy requirements throughout implementation. Strategies enhancing implementation and compliance with policy intent can improve population health. Critically assessing the multi-level environments where health policies and their related health services are implemented is essential to designing effective policy-level implementation strategies. California passed a 2019 health insurance benefit mandate requiring coverage of fertility preservation (FP) services for individuals at risk of infertility due to medical treatments to improve access to services that are otherwise cost-prohibitive. Our objective was to document and understand multi-level environment, relationships, and activities involved in using state benefit mandates to facilitate patient access to FP services. Methods We conducted a mixed-methods study and used the policy-optimized Exploration, Preparation, Implementation, Sustainment (EPIS) framework to analyze implementation of California's fertility preservation benefit mandate (SB 600) at and between the state insurance regulator, insurer and clinic levels. Results Seventeen publicly available FP benefit mandate-relevant documents were reviewed, and four insurers, 25 financial, administrative and provider participants from 16 oncology and fertility clinics, three fertility pharmaceutical representatives, and two patient advocates were interviewed. The mandate and insurance regulator guidance represented two "Big P" (system level) policies that gave rise to a host of "little p" (organizational) policies by and between the regulator, insurers, clinics, and patients. Many little p policies were bridging factors to support implementation across levels and FP service access. Characterizing the mandate's functions (i.e., policy goals) and forms (i.e., ways that policies were enacted) led to identification of (1) intended and unintended implementation, service, and patient outcomes; (2) implementation processes by level, EPIS phase; (3) actor-delineated key processes and heterogeneity among them; and (4) inner and outer context determinants that drove adaptations. Conclusions Following the mid- and down-stream implementation of a state health insurance benefit mandate, data generated will enable development of policy level implementation strategies, evaluation of determinants and important outcomes of effective implementation, and design of future mandates to improve fit and fidelity.
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Affiliation(s)
- H Irene Su
- University of California San Diego Moores Cancer Center
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Ledesma B, Campbell K, Muthigi A, Ila V, Nassau DE, Ibrahim E, Ramasamy R. Semen Cryopreservation in Men with Cancer: Identifying Patterns and Challenges. JOURNAL OF FERTILITY PRESERVATION 2023; 3:246156. [PMID: 38567027 PMCID: PMC10987015 DOI: 10.32371/jfp/246156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
OBJECTIVE The aim of this study was to determine the proportion of male cancer patients who undergo semen cryopreservation before chemotherapy after referral was placed, identify factors associated with completing the procedure, and explore reasons for not moving forward with it. METHODS The electronic medical records of men with cancer who were referred to a reproductive urologist identified with an ICD-10 code for a fertility preservation procedure (Z31.62, Z31.84) between November 2021 and February 2023 were reviewed. Cancer type, semen cryopreservation rates, and reasons for opting out of the procedure were recorded. RESULTS Of the 128 men diagnosed with cancer who were referred for cryopreservation during the study period, n:67 (52%) underwent semen cryopreservation. Those who did not undergo the procedure tended to be older, with a median age of 38 years compared to those that did it (33 years) (p: 0.10). The most common reasons for non-compliance included financial burden, and lack of interest. CONCLUSION While it is recommended that patients consider fertility preservation prior to chemotherapy, our findings suggest that only half of male cancer patients completed the procedure despite referral. Further work is needed to determine barriers to access and increase awareness of fertility preservation prior to chemotherapy.
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Affiliation(s)
- Braian Ledesma
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Katherine Campbell
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Akhil Muthigi
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Vishal Ila
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL
| | | | - Emad Ibrahim
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Ranjith Ramasamy
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL
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16
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Peipert BJ, Adashi EY, Penzias A, Jain T. Global in vitro fertilization utilization: How does the United States compare? F S Rep 2023; 4:326-327. [PMID: 37719106 PMCID: PMC10504530 DOI: 10.1016/j.xfre.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 06/27/2023] [Accepted: 06/27/2023] [Indexed: 09/19/2023] Open
Affiliation(s)
- Benjamin J. Peipert
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
| | - Eli Y. Adashi
- Department of Medical Science, the Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Alan Penzias
- Boston IVF - The Eugin Group, Waltham, Massachusetts
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Tarun Jain
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Sun Y, Hao L, Han W, Luo J, Zheng J, Yuan D, Ye H, Li Q, Huang G, Han T, Yang Z. Intrafollicular fluid metabolic abnormalities in relation to ovarian hyperstimulation syndrome: Follicular fluid metabolomics via gas chromatography-mass spectrometry. Clin Chim Acta 2023; 538:189-202. [PMID: 36566958 DOI: 10.1016/j.cca.2022.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/23/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Ovarian hyperstimulation syndrome (OHSS) is the most serious iatrogenic complication of ovulation stimulation during assisted reproductive technology. The main objective of this study was to investigate intrafollicular fluid metabolic change profiles of OHSS in non-ovarian etiologic infertility women (CON) and polycystic ovarian syndrome patients (PCOS). METHODS 87 infertile women were divided into four subgroups: CON-Norm (CON with normal ovarian response), CON-OHSS (CON with OHSS), PCOS-Norm (PCOS with normal ovarian response), and PCOS-OHSS (PCOS with OHSS). The intrafollicular fluid metabolic profiles were analyzed with gas chromatography-mass spectrometry. The multivariable-adjusted conditional logistic regression was applied to assess the association of metabolites with OHSS risk. RESULTS We identified 17 and 3 metabolites that related to OHSS risk in CON and PCOS, respectively. 13 OHSS risk-related metabolites in CON were unsaturated fatty acids, 8 of which were also the significantly altered metabolites between all PCOS and CON-Norm. CONCLUSION Our study may shed light on the role of intrafollicular fluid metabolic abnormalities in the pathophysiology of OHSS. The findings suggested that there might be some metabolic heterogeneities underlying the development of OHSS in CON and PCOS women and indicated possible shared etiological factors in the development of PCOS and OHSS.
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Affiliation(s)
- Yixuan Sun
- Department of Gynecology and Obstetrics, the Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P.R.China; Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, Chongqing 401147, P.R.China
| | - Lijuan Hao
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, Chongqing 401147, P.R.China
| | - Wei Han
- Center for Reproductive Medicine, Reproductive and Genetic Institute, Women and Children's Hospital of Chongqing Medical University, Chongqing 401147, P.R.China
| | - Jing Luo
- Department of Pathology, Basic Medical College of Chongqing Medical University, 400016, P.R.China
| | - Jing Zheng
- Department of Gynecology and Obstetrics, the Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P.R.China
| | - Dong Yuan
- Department of Gynecology and Obstetrics, the Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P.R.China
| | - Hong Ye
- Center for Reproductive Medicine, Reproductive and Genetic Institute, Women and Children's Hospital of Chongqing Medical University, Chongqing 401147, P.R.China
| | - Qinke Li
- Department of Gynecology and Obstetrics, the Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P.R.China
| | - Guoning Huang
- Center for Reproductive Medicine, Reproductive and Genetic Institute, Women and Children's Hospital of Chongqing Medical University, Chongqing 401147, P.R.China.
| | - Tingli Han
- Department of Gynecology and Obstetrics, the Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P.R.China.
| | - Zhu Yang
- Department of Gynecology and Obstetrics, the Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P.R.China.
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