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Kroll-Desrosiers A, Copeland LA, Mengeling MA, Mattocks KM. Infertility Services for Veterans Enrolled in Veterans Health Administration Care. J Gen Intern Med 2023; 38:2347-2353. [PMID: 36810630 PMCID: PMC9943037 DOI: 10.1007/s11606-023-08080-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/30/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Infertility care is provided to Veterans through the Veterans Health Administration (VHA) medical benefits package and includes infertility evaluation and many infertility treatments. OBJECTIVE Our objective was to examine the incidence and prevalence of infertility diagnoses and the receipt of infertility healthcare among Veterans using Veterans Health Administration (VHA) healthcare from 2018 to 2020. METHODS Veterans using the VHA and diagnosed with infertility during October 2017-September 2020 (FY18-20) were identified in VHA administrative data and through VA-purchased care (i.e., community care) claims. Infertility was categorized among men as azoospermia, oligospermia, and other and unspecified male infertility, and among women as anovulation, infertility of tubal origin, infertility of uterine origin, and other and unspecified female infertility using diagnosis and procedure codes (ICD-10, CPT). KEY RESULTS A total of 17,216 Veterans had at least one VHA infertility diagnosis in FY18, FY19, or FY20, including 8766 male Veterans and 8450 female Veterans. Incident diagnoses of infertility were observed in 7192 male Veterans (10.8/10,000 person (p)-years) and 5563 female Veterans (93.6/10,000 p-years). A large proportion of Veterans who were diagnosed with infertility received an infertility-related procedure in the year of their incident diagnosis (males: 74.7, 75.3, 65.0%, FY18-20 respectively; females: 80.9, 80.8, 72.9%, FY18-20 respectively). CONCLUSIONS In comparison to a recent study of active duty servicemembers, we found a lower rate of infertility among Veteran men and a higher rate among Veteran women. Further work is needed to investigate military exposures and circumstances that may lead to infertility. Given the rates of infertility among Veterans and active duty servicemembers, enhancing communications between Department of Defense and VHA systems regarding sources of and treatment for infertility is essential to help more men and women benefit from infertility care during military service or as Veterans.
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Affiliation(s)
- Aimee Kroll-Desrosiers
- VA Central Western Massachusetts Healthcare System, Leeds, MA, USA.
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA.
| | - Laurel A Copeland
- VA Central Western Massachusetts Healthcare System, Leeds, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Michelle A Mengeling
- Center for Access & Delivery Research and Evaluation (CADRE) and VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City VA Health Care System, Iowa City, IA, USA
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Kristin M Mattocks
- VA Central Western Massachusetts Healthcare System, Leeds, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
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Zańko A, Siewko K, Krętowski AJ, Milewski R. Lifestyle, Insulin Resistance and Semen Quality as Co-Dependent Factors of Male Infertility. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:ijerph20010732. [PMID: 36613051 PMCID: PMC9819053 DOI: 10.3390/ijerph20010732] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 05/11/2023]
Abstract
Infertility is a problem that affects millions of couples around the world. It is known as a disease of couples, not individuals, which makes diagnosis difficult and treatment unclear. Male infertility can have many causes, from mechanical ones to abnormal spermatogenesis or spermiogenesis. Semen quality is determined by a number of factors, including those dependent on men themselves, with the number of infertile men growing every year. These include, e.g., diet, physical activity, sleep quality, stress, among many others. As these factors co-exist with insulin resistance, which is a disease closely related to lifestyle, it has been singled out in the study due to its role in affecting semen quality. In order to examine connections between lifestyle, insulin resistance, and semen quality, a review of literature published from 1989 to 2020 in the following databases PubMed/Medline, EMBASE (Elsevier), Scopus, Web of Science, and Google Scholar was performed. Hence, semen quality, environment, and insulin resistance are interrelated, thus it is difficult to indicate which aspect is the cause and which is the effect in a particular relationship and the nature of possible correlations. Since the influence of lifestyle on semen quality has been extensively studied, it is recommended that more thorough research be done on the relationship between insulin resistance and semen quality, comparing the semen quality of men with and without insulin resistance.
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Affiliation(s)
- Adrianna Zańko
- Doctoral School, Medical University of Białystok, 15-089 Białystok, Poland
| | - Katarzyna Siewko
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Białystok, 15-276 Białystok, Poland
| | - Adam Jacek Krętowski
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Białystok, 15-276 Białystok, Poland
| | - Robert Milewski
- Department of Biostatistics and Medical Informatics, Medical University of Białystok, 15-295 Białystok, Poland
- Correspondence:
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Perry MJ, Arrington S, Freisthler MS, Ibe IN, McCray NL, Neumann LM, Tajanlangit P, Trejo Rosas BM. Pervasive structural racism in environmental epidemiology. Environ Health 2021; 20:119. [PMID: 34784917 PMCID: PMC8595076 DOI: 10.1186/s12940-021-00801-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 10/22/2021] [Indexed: 05/22/2023]
Abstract
BACKGROUND Epistemological biases in environmental epidemiology prevent the full understanding of how racism's societal impacts directly influence health outcomes. With the ability to focus on "place" and the totality of environmental exposures, environmental epidemiologists have an important opportunity to advance the field by proactively investigating the structural racist forces that drive disparities in health. OBJECTIVE This commentary illustrates how environmental epidemiology has ignored racism for too long. Some examples from environmental health and male infertility are used to illustrate how failing to address racism neglects the health of entire populations. DISCUSSION While research on environmental justice has attended to the structural sources of environmental racism, this work has not been fully integrated into the mainstream of environmental epidemiology. Epidemiology's dominant paradigm that reduces race to a mere data point avoids the social dimensions of health and thus fails to improve population health for all. Failing to include populations who are Black, Indigenous, and people of color (BIPOC) in health research means researchers actually know very little about the effect of environmental contaminants on a range of population health outcomes. This commentary offers different practical solutions, such as naming racism in research, including BIPOC in leadership positions, mandating requirements for discussing "race", conducting far more holistic analyses, increasing community participation in research, and improving racism training, to address the myriad of ways in which structural racism permeates environmental epidemiology questions, methods, results and impacts.
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Affiliation(s)
- Melissa J Perry
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave NW Suite 400, Washington, DC, 20052, USA.
| | - Suzanne Arrington
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave NW Suite 400, Washington, DC, 20052, USA
| | - Marlaina S Freisthler
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave NW Suite 400, Washington, DC, 20052, USA
| | - Ifeoma N Ibe
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave NW Suite 400, Washington, DC, 20052, USA
| | - Nathan L McCray
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave NW Suite 400, Washington, DC, 20052, USA
| | - Laura M Neumann
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave NW Suite 400, Washington, DC, 20052, USA
| | - Patrick Tajanlangit
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave NW Suite 400, Washington, DC, 20052, USA
| | - Brenda M Trejo Rosas
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave NW Suite 400, Washington, DC, 20052, USA
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McCray NL, Young HA, Irwig MS, Frankfurter D, Schwartz AM, Witmyer J, Hynes M, Jayanthi VV, Marcus M, Patel M, Perry MJ. The Association Between Race, Obesity, and Sperm Quality Among Men Attending a University Physician Practice in Washington, DC. Am J Mens Health 2021; 14:1557988320925985. [PMID: 32602769 PMCID: PMC7328221 DOI: 10.1177/1557988320925985] [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] [Indexed: 01/25/2023] Open
Abstract
A decades-long decline in sperm counts in Western countries has coincided with an
increase in obesity rates, prompting study into their association. Few of these
studies have incorporated men of color, the sperm health of whom is relatively
unknown. The present exploratory study evaluated the association between body
mass index (BMI), race, ethnicity, and sperm parameters among a diverse sample
of U.S. men attending a Washington, DC physician practice. Semen samples were
collected and processed at a single laboratory and sperm concentration,
motility, morphology, and count were evaluated according to World Health
Organization (WHO) 5th edition criteria. Multivariate models accounted for
covariates related to sperm health. The study population (n =
128) was largely obese (45.3%) or overweight (34.4%), and 36.0% were black or
Hispanic. Black men had lower adjusted sperm concentration compared to white men
(75.0 million/mL to 107.4 million/mL, p = .01) and were more
likely to have oligozoospermia (p = .01), asthenozoospermia
(p = .004), and low sperm count (p <
.0001). Hispanic men had higher adjusted sperm concentration compared to
non-Hispanic men (124.5 million/mL to 62.1 million/mL, p =
.007) and were less likely to have teratozoospermia (p = .001).
Obesity and BMI were associated with lower sperm motility and count in crude
models only. Given the study’s sample size its findings should be interpreted
with caution but align with the limited epidemiological literature to date that
has evaluated racial and ethnic differences in semen quality. Heightened
clinical research attention is needed to ensure men of color are included in
representative numbers in studies of urologic and andrologic health.
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Affiliation(s)
- Nathan L McCray
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Heather A Young
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Michael S Irwig
- Division of Endocrinology, Diabetes & Metabolism, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - David Frankfurter
- Department of Obstetrics & Gynecology, The George Washington University Medical Faculty Associates, Washington, DC, USA
| | - Arnold M Schwartz
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA.,Department of Pathology, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Jeannine Witmyer
- Department of Obstetrics & Gynecology, The George Washington University Medical Faculty Associates, Washington, DC, USA
| | - Marijane Hynes
- Department of Medicine, The George Washington University Medical Faculty Associates, Washington, DC, USA
| | - Vimala V Jayanthi
- Department of Medicine, The George Washington University Medical Faculty Associates, Washington, DC, USA
| | - Mia Marcus
- Department of Medicine, The George Washington University Medical Faculty Associates, Washington, DC, USA
| | - Mihir Patel
- Department of Medicine, The George Washington University Medical Faculty Associates, Washington, DC, USA
| | - Melissa J Perry
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
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