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Mikhael S, Gaidis A, Gavrilova-Jordan L. Regional disparities in access to assisted reproductive technology: assessment of patient satisfaction when employing modern technology to close the gap. J Assist Reprod Genet 2021; 38:889-894. [PMID: 33447948 PMCID: PMC7808701 DOI: 10.1007/s10815-020-02027-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/30/2020] [Indexed: 11/28/2022] Open
Abstract
Purpose Geographic disparities for assisted reproductive technology (ART) continue to exist. Travel cost and time off work may create additional barriers for patients living remotely. Implementing telehealth can alleviate these barriers by reducing office visits. The aim of this study was to evaluate patient satisfaction with telehealth during ART. Methods This was a cross-sectional survey and retrospective cohort study. Patients living remotely who underwent ART utilizing telehealth between 2015 and 2018 at a single institution were selected for the telehealth group. The non-telehealth control group included randomly selected patients who underwent IVF at the same institution between 2015 and 2018. Demographic variables and treatment outcomes were obtained for both groups. A patient satisfaction questionnaire was distributed to telehealth patients. Statistical analysis using χ2 test was performed to compare ART outcomes between both groups. Results Ninety-seven control and 97 telehealth patients were included. For telehealth patients, the mean number of office visits and distance traveled was 2.9 (± 0.8 SD) and 143.1 miles (± 49.2 SD) respectively. 58.8% of patients completed the survey. 44/57 participants had an oocyte retrieval and 42/44 underwent embryo transfer. For those who completed the survey, the clinical pregnancy rate was 31/44 and the live birth rate was 25/44. There was no difference in treatment outcomes between telehealth compared to controls. 73% of patients were highly satisfied with telehealth. Conclusions Telehealth can improve access to ART in underserved areas and results in high patient satisfaction. Reproductive health providers could consider telehealth as a safe and efficacious tool to ameliorate geographic disparities.
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Affiliation(s)
- Sasha Mikhael
- Department of Obstetrics & Gynecology, Section of Reproductive Endocrinology Infertility and Genetics, Augusta University, 1120 15th Street, BB-7518, Augusta, GA, 30912, USA.
| | - Anna Gaidis
- Department of Obstetrics & Gynecology, Section of Reproductive Endocrinology Infertility and Genetics, Augusta University, 1120 15th Street, BB-7518, Augusta, GA, 30912, USA
| | - Larisa Gavrilova-Jordan
- Department of Obstetrics & Gynecology, Section of Reproductive Endocrinology Infertility and Genetics, Augusta University, 1120 15th Street, BB-7518, Augusta, GA, 30912, USA
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Halassy S, Mikhael S, Chorich LP, Tam KB, Diamond MP, Burkholder AB, Hall JE, Korach KS, Layman LC. SUN-738 Establishing the Link Between Genetic Variations of Estrogen Receptor 2 and Unexplained Infertility. J Endocr Soc 2020. [PMCID: PMC7208208 DOI: 10.1210/jendso/bvaa046.855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background: Unexplained or idiopathic infertility comprises approximately 30% of couples who present with infertility. This has led to investigations seeking to determine the cause(s) of this important diagnosis of exclusion. Estrogen’s role in reproduction has been well- established. Estrogens bind to two hormone receptors (namely estrogen receptor-alpha and estrogen receptor-beta), which are distributed differentially throughout the body. Specifically, the estrogen receptor-beta, coded by the Estrogen Receptor 2 (ESR2) gene, is highly expressed in granulosa cells and growing follicles. The one female patient reported with an ESR2 mutation presented with hypergonadotropic hypogonadism. However, subfertility with inefficient ovulation and resistance to exogenous ovulatory stimulation is seen in an ESR2 knockout mouse model. We therefore hypothesized that less severe ESR2 variants could lead to a normal female phenotype and pubertal development but could be a cause subfertility.
Methods: DNA samples from 200 women with unexplained infertility were obtained from the Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation (AMIGOS) clinical trial, which investigated optimal ovulation induction medications for unexplained infertility. These samples were subjected to targeted next-generation sequencing (NGS) for the ESR2 gene. Likely pathogenic variants that occurred with a minor allele frequency of < 0.01 in the gnomAD database and a Combined Annotation Dependent Depletion (CADD) score of > 20 were selected for confirmation by Sanger sequencing.
Results: From the 200 patient samples, five heterozygous missense variants and one heterozygous in-frame deletion identified by targeted NGS were confirmed by Sanger sequencing. Further studies will need to be performed in vitro to confirm the likely pathogenicity of these variants.
Conclusion: These studies raise the possibility that If these variants in ESR2 that impair estrogen signaling, they could be a potential newly recognized etiology of unexplained infertility in women with unexplained infertility.
Conclusion: These studies raise the possibility that variants in ESR2 that impair estrogen signaling could be a potential newly recognized etiology of unexplained infertility in women.
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Affiliation(s)
| | - Sasha Mikhael
- Medical College of Georgia at Augusta University, Augusta, GA, USA
| | | | | | | | - Adam B Burkholder
- National Institute of Environmental Health Sciences/National Institute of Health, Research Triangle Park, NC, USA
| | - Janet Elizabeth Hall
- National Institute of Environmental Health Sciences/National Institute of Health, Research Triangle Park, NC, USA
| | - Kenneth Steven Korach
- National Institute of Environmental Health Sciences/National Institute of Health, Research Triangle Park, NC, USA
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Mikhael S, Gaidis A, Smith HN, Gavrilova-Jordan L. Regional disparities in assisted reproductive technology access to care: employing modern technology to close the gap. Fertil Steril 2019. [DOI: 10.1016/j.fertnstert.2019.07.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mikhael S, McGoldrick DM, Beamer J, Walton G. Use of ultrasound intraoperatively to locate extraoral implants. Br J Oral Maxillofac Surg 2019; 57:291-292. [PMID: 30898456 DOI: 10.1016/j.bjoms.2018.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 11/12/2018] [Indexed: 11/25/2022]
Affiliation(s)
- S Mikhael
- University Hospital Coventry and Warwickshire NHS Foundation Trust, Coventry, UK.
| | - D M McGoldrick
- University Hospital Coventry and Warwickshire NHS Foundation Trust, Coventry, UK.
| | - J Beamer
- University Hospital Coventry and Warwickshire NHS Foundation Trust, Coventry, UK
| | - G Walton
- University Hospital Coventry and Warwickshire NHS Foundation Trust, Coventry, UK
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Chatzicharalampous C, Jeelani R, Mikhael S, Aldhaheri S, Najeemudin S, Morris R, Abu-Soud H. Zinc: an essential metal for maintenance of female fertility. Fertil Steril 2018. [DOI: 10.1016/j.fertnstert.2018.02.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Aldhaheri SR, Jeelani R, Kohan-Ghadr HR, Khan SN, Mikhael S, Washington C, Morris RT, Abu-Soud HM. Dimercapto-1-propanesulfonic acid (DMPS) induces metaphase II mouse oocyte deterioration. Free Radic Biol Med 2017; 112:445-451. [PMID: 28844937 DOI: 10.1016/j.freeradbiomed.2017.08.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 08/16/2017] [Accepted: 08/18/2017] [Indexed: 12/21/2022]
Abstract
In light of the recent lead contamination of the water in Flint, Michigan and its potential adverse outcomes, much research and media attention has turned towards the safety profile of commonly used chelators. Dimercapto-1-propanesulfonic acid (DMPS) typically used in the treatment of lead, mercury and arsenic poisoning also displays a high affinity towards transition metals such as zinc and copper, essential for biological functioning. It is given in series of dosages (0.2-0.4g/day) over a long period, and has the ability to enter cells. In this work, we investigated the mechanism through which increasing concentrations of DMPS alter oocyte quality as judged by changes in microtubule morphology (MT) and chromosomal alignment (CH) of metaphase II mice oocyte. The oocytes were directly exposed to increasing concentration of DMPS (10, 25, 50, 100 and 300μM) for four hours (time of peak plasma concentration after administration) and reactive oxygen species (mainly hydroxyl radical and superoxide) and zinc content were measured. This data showed DMPS plays an important role in deterioration of oocyte quality through a mechanism involving zinc deficiency and enhancement of reactive oxygen species a major contributor to oocyte damage. Our current work, for the first time, demonstrates the possibility of DMPS to negatively impact fertility. This finding can not only help in counseling reproductive age patients undergoing such treatment but also in the development of potential therapies to alleviate oxidative damage and preserve fertility in people receiving heavy metal chelators.
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Affiliation(s)
- Sarah R Aldhaheri
- Department of Obstetrics and Gynecology, The C.S. Mott Center for Human Growth and Development, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Roohi Jeelani
- Department of Obstetrics and Gynecology, The C.S. Mott Center for Human Growth and Development, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Hamid-Reza Kohan-Ghadr
- Department of Obstetrics and Gynecology, The C.S. Mott Center for Human Growth and Development, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Sana N Khan
- Department of Obstetrics and Gynecology, The C.S. Mott Center for Human Growth and Development, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Sasha Mikhael
- Department of Obstetrics and Gynecology, The C.S. Mott Center for Human Growth and Development, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Christina Washington
- Department of Obstetrics and Gynecology, The C.S. Mott Center for Human Growth and Development, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Robert T Morris
- Department of Obstetrics and Gynecology, The C.S. Mott Center for Human Growth and Development, Wayne State University School of Medicine, Detroit, MI 48201, USA; Karmanos Cancer Institute, Detroit, MI 48201, USA
| | - Husam M Abu-Soud
- Department of Obstetrics and Gynecology, The C.S. Mott Center for Human Growth and Development, Wayne State University School of Medicine, Detroit, MI 48201, USA; Department of Biochemistry and Molecular Biology, Wayne State University School of Medicine, Detroit, MI 48201, USA.
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Jeelani R, Aldhaheri S, Mikhael S, Kohan-Ghadr H, Morris R, Abu-Soud H. Acrolein: a common toxin impacting reproductive potential. Fertil Steril 2017. [DOI: 10.1016/j.fertnstert.2017.07.943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Mikhael S, Jeelani R, Aldhaheri S, Washington C, Morris R, Abu-Soud H. Daily exposure to a household product leading to subfertility! Fertil Steril 2017. [DOI: 10.1016/j.fertnstert.2017.07.953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Beeravolu N, McKee C, Alamri A, Mikhael S, Brown C, Perez-Cruet M, Chaudhry GR. Isolation and Characterization of Mesenchymal Stromal Cells from Human Umbilical Cord and Fetal Placenta. J Vis Exp 2017. [PMID: 28447991 PMCID: PMC5564456 DOI: 10.3791/55224] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The human umbilical cord (UC) and placenta are non-invasive, primitive and abundant sources of mesenchymal stromal cells (MSCs) that have increasingly gained attention because they do not pose any ethical or moral concerns. Current methods to isolate MSCs from UC yield low amounts of cells with variable proliferation potentials. Since UC is an anatomically-complex organ, differences in MSC properties may be due to the differences in the anatomical regions of their isolation. In this study, we first dissected the cord/placenta samples into three discrete anatomical regions: UC, cord-placenta junction (CPJ), and fetal placenta (FP). Second, two distinct zones, cord lining (CL) and Wharton's jelly (WJ), were separated. The explant culture technique was then used to isolate cells from the four sources. The time required for the primary culture of cells from the explants varied depending on the source of the tissue. Outgrowth of the cells occurred within 3 - 4 days of the CPJ explants, whereas growth was observed after 7 - 10 days and 11 - 14 days from CL/WJ and FP explants, respectively. The isolated cells were adherent to plastic and displayed fibroblastoid morphology and surface markers, such as CD29, CD44, CD73, CD90, and CD105, similarly to bone marrow (BM)-derived MSCs. However, the colony-forming efficiency of the cells varied, with CPJ-MSCs and WJ-MSCs showing higher efficiency than BM-MSCs. MSCs from all four sources differentiated into adipogenic, chondrogenic, and osteogenic lineages, indicating that they were multipotent. CPJ-MSCs differentiated more efficiently in comparison to other MSC sources. These results suggest that the CPJ is the most potent anatomical region and yields a higher number of cells, with greater proliferation and self-renewal capacities in vitro. In conclusion, the comparative analysis of the MSCs from the four sources indicated that CPJ is a more promising source of MSCs for cell therapy, regenerative medicine, and tissue engineering.
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Affiliation(s)
- Naimisha Beeravolu
- Department of Biological Sciences, Oakland University; OU-WB Institute for Stem Cell and Regenerative Medicine
| | - Christina McKee
- Department of Biological Sciences, Oakland University; OU-WB Institute for Stem Cell and Regenerative Medicine
| | - Ali Alamri
- Department of Biological Sciences, Oakland University; OU-WB Institute for Stem Cell and Regenerative Medicine
| | - Sasha Mikhael
- Department of Obstetrics and Gynecology, St. John Provindence - Providence Park Hospital
| | - Christina Brown
- Department of Biological Sciences, Oakland University; OU-WB Institute for Stem Cell and Regenerative Medicine
| | - Mick Perez-Cruet
- OU-WB Institute for Stem Cell and Regenerative Medicine; Department of Neurosurgery, Beaumont Health System
| | - G Rasul Chaudhry
- Department of Biological Sciences, Oakland University; OU-WB Institute for Stem Cell and Regenerative Medicine;
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Mikhael S, Beeravolu N, Chaudhry GR. Umbilical cord derivatives for intervertebral disc regeneration: advances and challenges. ACTA ACUST UNITED AC 2016. [DOI: 10.18609/cgti.2016.076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Andraos A, Mikhael S, Elguinguihy S, Aly S, Moafy H, Mokhtar S. Crit Care 2004; 8:P74. [DOI: 10.1186/cc2541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abstract
We examined the changes in Listing's plane resulting from prismatically induced vergence. The three-dimensional angular positions of the two eyes were compared in normal subjects wearing search coils and gazing at targets 1.9 m away with and without prisms. For horizontal base-out prisms each degree of convergence in one eye yielded 0.72 deg of temporal rotation of Listing's plane in that eye. The results from vertical prisms were not what was expected from the horizontal results. A base-up prism on the right eye induced a downward and temporal rotation of Listing's plane. A base-down prism on the right eye induced an upward and nasal rotation of Listing's plane. The effects of oblique prisms were those expected from combining the effects of horizontal and vertical prisms. Thus in addition to producing a horizontal or vertical misalignment of the gaze line, prisms induce an unexpected position-dependent torsional disparity.
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Affiliation(s)
- S Mikhael
- Department of Physiology, University of Western Ontario, London, Canada
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