Disparities among infertility patients regarding genetic carrier screening, sex selection, and gene editing

Knowledge, attitudes, and practices toward nutritional management among patients with gastrointestinal cancer: A cross-sectional study

Objective

This study aimed to evaluate the knowledge, attitudes, and practices (KAP) regarding nutritional management among patients with gastrointestinal cancer.

Methods

A descriptive cross-sectional study was conducted from December 2023 to May 2024 across hospitals in Jiangsu, Henan, Shanghai, and Tianjin, China. Participants completed questionnaires that collected demographic data and assessed their KAP toward nutritional management.

Results

A total of 1239 valid questionnaires were analyzed. Among the participants, 769 (62.1%) were male, and 452 (36.5%) had been diagnosed with gastrointestinal cancer for less than six months. The proportion of participants demonstrating adequate knowledge, positive attitudes, and proactive practices were 1018 (82.1%), 328 (26.4%), and 403 (32.5%), respectively. Multivariate logistic regression identified several factors independently associated with proactive practices, including adequate knowledge, lack of insurance, a gastrointestinal tumor duration of 2-3 years or more, no doubts about nutritional management, absence of nutritional screening, and having others as primary caregivers. Structural equation modeling revealed direct effects of knowledge on both attitude (β ​= ​0.308, P ​< ​0.001) and practice (β ​= ​0.475, P ​< ​0.001), as well as of attitude on practice (β ​= ​0.286, P ​< ​0.001). Additionally, knowledge indirectly influenced practice through attitude (β ​= ​0.088, P ​< ​0.001).

Conclusions

While most gastrointestinal cancer patients demonstrated adequate knowledge regarding nutritional management, their attitudes were predominantly negative, and their practices were largely inactive. These findings highlight a critical need for targeted educational interventions to bridge knowledge gaps and encourage more active engagement with nutritional guidelines.

The effect of media aids in genetic carrier screening education among patients with infertility

Objective

To evaluate the effect of educational videos on the utilization of preconception genetic carrier screening in patients with infertility.

Design

Survey study.

Subjects

New patients presenting for infertility consult with one of five providers (4 physicians and 1 nurse practitioner) from November 2021 through February 2022.

Exposure

Patients were assigned to the web application EngagedMD video arm or in-person counseling arm for education on preconception genetic screening.

Main Outcome Measures

The primary study outcome was completion of genetic carrier screening. The secondary outcomes were provider rating of patient comprehension and provider-rated time demand of counseling.

Results

A total of 73 patients were enrolled: 42 in the video arm and 31 in the in-person counseling arm. The survey response rate was 100% for patients and providers. Patients assigned to the video counseling arm were significantly more likely to plan to proceed with carrier screening (78.6%) than those receiving only in-office counseling (41.9%). The odds ratio associating video arm with actual completion of screening was 5.07 (95% confidence interval, 1.84-13.96). Patients who completed EngagedMD videos were perceived by providers to have a noninferior understanding of the purpose of carrier screening compared with those who underwent standard counseling, assessed via "teach-back" method. Providers also rated that multimedia education use significantly decreased demand on appointment time.

Conclusion

The use of patient education videos increases utilization of preconception genetic carrier screening and is an acceptable alternative to in-person provider counseling.

Exploring attitudes and experiences with reproductive genetic carrier screening among couples seeking medically assisted reproduction: a longitudinal survey study

PURPOSE

This study aimed to assess the attitudes and experiences of subfertile couples applying for medically assisted reproduction (MAR) using their own gametes towards reproductive genetic carrier screening (RGCS) for monogenic conditions.

METHODS

A prospective survey study was conducted where subfertile couples were recruited from the fertility centre of a university hospital in Flanders, Belgium. Participants were offered RGCS free of charge and completed self-administered questionnaires at three different time points.

RESULTS

The study sample consisted of 26 couples. Most participants had no children, did not consider themselves as religious, and had some form of higher education. Overall, attitudes towards RGCS were mostly positive and the intention to participate in RGCS was high. Anxiety scores were only elevated and clinically relevant for a limited number of participants. A large proportion of participants would consider preventive reproductive options like prenatal diagnosis or in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) combined with pre-implantation genetic testing for monogenic conditions (PGT-M) in the event of an increased likelihood of conceiving a child with a hereditary condition. Participants were satisfied with their decision to undergo RGCS, and the majority would recommend RGCS to other couples.

CONCLUSION

Our study findings suggest that subfertile couples applying for MAR using their own gametes find RGCS acceptable and have a positive attitude towards it. This study provides valuable insights into the perspectives of these couples, highlighting the need for appropriate counseling and timely information provision.

Acceptance of genetic editing and of whole genome sequencing of human embryos by patients with infertility before and after the onset of the COVID-19 pandemic

RESEARCH QUESTION

Has acceptance of heritable genome editing (HGE) and whole genome sequencing for preimplantation genetic testing (PGT-WGS) of human embryos changed after the onset of COVID-19 among infertility patients?

DESIGN

A written survey conducted between April and June 2018 and July and December 2021 among patients at a university-affiliated infertility practice. The questionnaire ascertained the acceptance of HGE for specific therapeutic or genetic 'enhancement' indications and of PGT-WGS to prevent adult disease.

RESULTS

In 2021 and 2018, 172 patients and 469 patients (response rates: 90% and 91%, respectively) completed the questionnaire. In 2021, significantly more participants reported a positive attitude towards HGE, for therapeutic and enhancement indications. In 2021 compared with 2018, respondents were more likely to use HGE to have healthy children with their own gametes (85% versus 77%), to reduce disease risk for adult-onset polygenic disorders (78% versus 67%), to increase life expectancy (55% versus 40%), intelligence (34% versus 26%) and creativity (33% versus 24%). Fifteen per cent of the 2021 group reported a more positive attitude towards HGE because of COVID-19 and less than 1% a more negative attitude. In contrast, support for PGT-WGS was similar in 2021 and 2018.

CONCLUSIONS

A significantly increased acceptance of HGE was observed, but not of PGT-WGS, after the onset of COVID-19. Although the pandemic may have contributed to this change, the exact reasons remain unknown and warrant further investigation. Whether increased acceptability of HGE may indicate an increase in acceptability of emerging biomedical technologies in general needs further investigation.

Gamete and embryo donation for research: what might shape the willingness to donate among gamete donors and recipients?

PURPOSE

Research using gametes and embryos donated by reproductive and third-party donors contributed to substantial, albeit contentious achievements. The views of gamete donors and recipients on donation for research and the underpinning role of attitudes towards research have been seldom explored and are yet to be incorporated into ethical, legal, and regulatory landscapes. From a cultural standpoint, this study adapts and explores psychometric properties of the Portuguese version of the Research Attitudes Questionnaire (RAQ), and analyzes the willingness of gamete donors and recipients to donate gametes and embryos for research and its association with sociodemographic, reproductive characteristics, and attitudes towards research.

METHODS

Between July 2017 and June 2018, 71 donors and 165 recipients completed a self-administered questionnaire at the Portuguese Public Bank of Gametes. Willingness to donate and attitudes towards research were measured with a 5-point Likert scale. RAQ psychometric characteristics were explored.

RESULTS

Two RAQ components were identified: "trustworthiness of research" and "critical perspective". Most participants were willing to donate gametes and embryos: donors more willing to donate gametes and male recipients more willing to donate gametes and embryos. Higher RAQ scores, indicating a more positive attitude towards research, were observed on the component "trustworthiness of research" among those willing to donate gametes and embryos and on the component "critical perspective" among those willing to donate embryos.

CONCLUSION

These findings help foster inclusivity, diversity, and responsiveness of research and call for upstream engagement of male and female gamete donors and recipients, promoting a trustworthy, anticipatory, democratic, and people-centered approach to policies, regulations, and practices in human gamete and embryo research.

Perceptions towards sex selection among Jordanian population: A survey study

Sex selection is becoming a more common practice in the society and worldwide. The current study aimed to examine the perceptions about sex selection options and possible association with sociodemographic factors and relevant characteristics. The study was a cross-sectional survey of adults in Jordan in January and February 2020 using a self-administered questionnaire. Results showed that 40.1% of respondents preferred male gender when having a child, 22.4% of respondents preferred the male gender when having a child, even if they have had children of both genders, and 71.3% preferred having children from both genders. On the other hand, 58.8% of participants preferred a male gender when there is one chance to conceive via assisted reproduction technologies. Also, among participants, 66% thought that sex selection is religiously acceptable, yet 78.0% did not support of the sex selection idea. The above factors were significantly associated with several sociodemographic variables such as gender, marital status, education, career, and place of residence, but not income. In conclusion, the current study shed a light on preferences towards sex selection in a large cohort to better understand the perception and attitude of the population towards this practice.

A review of disparities in access to infertility care and treatment outcomes among Hispanic women

Hispanic women have lower rates of use of infertility services than non-Hispanic White women. There are many barriers that impede access to infertility care including economic, geographic, cultural, and societal factors and there are disparities in treatment outcomes. Hispanic women are less likely to seek infertility care than non-Hispanic White women and even after infertility evaluation, Hispanic women are less likely to receive treatment for their infertility. Lower use of infertility treatments among Hispanic women is unlikely to be driven solely by economic factors. There is disappointingly little data on in-vitro fertilization treatment outcomes including the population of Hispanic women, and existing data has yielded conflicting results. Incomplete and variable reporting of race data across clinics raises the potential for misclassification bias and invalid study conclusions. Addressing disparities in access to reproductive medicine in the Hispanic population will required a multifaceted approach including expanded insurance coverage, improved education for both patients and providers, and additional research on barriers to care.