1
|
Kahn NF, Kidd KM, Hodax JK, Goldenberg ME, Asante PG, Kyweluk MA, Christakis DA, Pratt W, Richardson LP, Sequeira GM. Telemedicine-Based Provision of Adolescent Gender-Affirming Medical Care to Promote Equitable Access. Telemed J E Health 2024. [PMID: 38597959 DOI: 10.1089/tmj.2023.0575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Abstract
Purpose: To explore transgender and nonbinary (TNB) young adults' (1) interest in receiving gender-affirming medications through telemedicine before age 18 years and (2) willingness to initiate this care with primary care providers (PCPs). Methods: Data were from a survey of TNB young adults who had not received gender-affirming medications before age 18 years. Chi-square and Wald tests identified demographic differences in telemedicine interest and willingness to initiate medications with their PCP as minors. Results: Among 280 respondents, 82.5% indicated interest in telemedicine and 42.0% were willing to initiate medications with their PCP. Black/African American respondents were more likely to indicate interest in telemedicine than White and multiracial respondents. Respondents from rural areas were more likely to indicate willingness to initiate medications with their PCP than those from urban areas. Conclusions: Telemedicine expansion and further support for PCPs may represent critical opportunities to promote equitable access to adolescent gender-affirming care.
Collapse
Affiliation(s)
- Nicole F Kahn
- Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
- University of Washington School of Medicine, Department of Pediatrics, Seattle, Washington, USA
| | - Kacie M Kidd
- West Virginia University School of Medicine, Department of Pediatrics, Morgantown, West Virginia, USA
| | - Juanita K Hodax
- Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
- University of Washington School of Medicine, Department of Pediatrics, Seattle, Washington, USA
| | | | - Peter G Asante
- Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
| | | | - Dimitri A Christakis
- Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
- University of Washington School of Medicine, Department of Pediatrics, Seattle, Washington, USA
| | - Wanda Pratt
- University of Washington School of Medicine, Department of Pediatrics, Seattle, Washington, USA
| | - Laura P Richardson
- Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
- University of Washington School of Medicine, Department of Pediatrics, Seattle, Washington, USA
| | - Gina M Sequeira
- Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
- University of Washington School of Medicine, Department of Pediatrics, Seattle, Washington, USA
| |
Collapse
|
2
|
Kyweluk MA, Kirkley J, Grimstad F, Amato P, Downing J. Desire for genetically related children among transgender and gender-diverse patients seeking gender-affirming hormones. F S Rep 2023; 4:224-230. [PMID: 37398606 PMCID: PMC10310968 DOI: 10.1016/j.xfre.2023.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 09/12/2022] [Revised: 04/10/2023] [Accepted: 04/10/2023] [Indexed: 07/04/2023] Open
Abstract
Objective To assess predictors of desire for genetically related children among a national cohort of reproductive-age transgender and gender-diverse patients aged 18 to 44 years initiating gender-affirming hormone therapy for the first time. Design Cross-sectional study. Setting National telehealth clinic. Patients A cohort of patients from 33 US states initiating gender-affirming hormone therapy. A total of 10,270 unique transgender and gender-diverse patients-aged 18 to 44 years (median age 24 years), with no prior use of gender-affirming hormone therapy-completed clinical intake forms between September 1, 2020, and January 1, 2022. Interventions Patient sex assigned at birth, insurance status, age, and geographic location. Main Outcome Measures Self-reported desire for children using own genetic material. Results Transgender and gender-diverse patients seeking gender-affirming medical treatments who are open to having genetically related children are an important population to identify and appropriately counsel. Over one quarter of the study population reported being interested in or unsure about having genetically related children, with 17.8% reporting yes and 8.4% unsure. Male-sex-assigned-at-birth patients had 1.37 (95% confidence interval: 1.25, 1.41) times higher odds of being open to having genetically related children compared with female-sex-assigned-at-birth patients. Those with private insurance had 1.13 (95% confidence interval: 1.02, 1.37) times higher odds of being open to having genetically related children compared with those without insurance. Conclusions These findings represent the largest source of self-reported data on the desire for genetically related children among reproductive-age adult transgender and gender-diverse patients seeking gender-affirming hormones. Guidelines recommend that providers offer fertility-related counseling. These results indicate that transgender and gender-diverse patients, particularly male-sex-assigned-at-birth individuals and patients with private insurance, could benefit from counseling regarding the impacts of gender-affirming hormone therapy and gender-affirming surgeries on fertility.
Collapse
Affiliation(s)
- Moira A. Kyweluk
- Plume Health, Denver, Colorado
- Third Space, LLC, Philadelphia, Pennsylvania
| | | | - Frances Grimstad
- Division of Gynecology, Department of Surgery, Boston Children’s Hospital, Cambridge, Massachusetts
- Department of Obstetrics, Gynecology, Reproductive Biology, Harvard Medical School, Cambridge, Massachusetts
| | - Paula Amato
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
| | - Jae Downing
- School of Public Health, Oregon Health & Science University, Portland, Oregon
| |
Collapse
|
3
|
Wu JK, Sadecki EN, Kyweluk MA, Flynn AN, Barnhart KT. Reply of the Authors. F S Rep 2022; 3:381. [PMID: 36568934 PMCID: PMC9783126 DOI: 10.1016/j.xfre.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Jessica K. Wu
- University of Pennsylvania, Medical Center, Philadelphia, Pennsylvania
| | - Emily N. Sadecki
- University of Pennsylvania, Medical Center, Philadelphia, Pennsylvania
| | - Moira A. Kyweluk
- University of Pennsylvania, Medical Center, Philadelphia, Pennsylvania
| | - Anne N. Flynn
- University of Pennsylvania, Medical Center, Philadelphia, Pennsylvania
| | - Kurt T. Barnhart
- University of Pennsylvania, Medical Center, Philadelphia, Pennsylvania
| |
Collapse
|
4
|
Wu JK, Sadecki EN, Kyweluk MA, Senapati S, Flynn AN, Steider E, Thomas T, Barnhart KT. Patient attitudes and preferences for the management of pregnancy of unknown location. F S Rep 2022; 3:246-252. [PMID: 36212566 PMCID: PMC9532885 DOI: 10.1016/j.xfre.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/17/2022] [Accepted: 07/05/2022] [Indexed: 11/27/2022] Open
Abstract
Objective To understand patient attitudes and preferences when faced with the uncertainty of pregnancy of unknown location (PUL). Design Qualitative, interview-based study. Setting University Hosptial. Patient(s) Patients aged >18 years sampled from the emergency department and a subspecialty fertility practice of a university hospital system. Intervention(s) Six to 8 weeks after resolution of a PUL, with an ultimate clinical outcome of either an intrauterine pregnancy, spontaneous abortion, or ectopic pregnancy. Participants underwent either surgical, medical, or expectant management. Main Outcome Measure(s) Thematic analysis of the virtual, semistructured interviews (45–60 minutes in length) conducted with participants to identify commonly expressed priorities was performed. Result(s) Interviews were completed from October 2020 to March 2021 until thematic saturation was achieved (n = 15). Resolution diagnoses included intrauterine pregnancy (26.7%, n = 4), ectopic pregnancy (40.0%, (n = 6), and spontaneous abortion (33.3%, n = 5). Moreover, 66.7% (n = 10) of the patients presented to the emergency department, whereas 33.3% (n = 5) presented to a subspecialty fertility clinic. All had desired pregnancies. Thematic analyses revealed 4 related priorities around PUL management: health of pregnancy; health of self; future fertility; and diagnostic prediction and diagnostic certainty. The relative balance of these priorities was dynamic and evolved throughout the course of management with different outcomes. A second set of themes related to logistical preferences included mental healthsupport, clarity of treatment and next steps, and continuity of care. Interrater reliability was validated with a pooled κ of >0.8. Limitations include that all participants had desired pregnancies, and the experiences of those who experienced different pregnancy outcomes may have been affected by recall bias. Conclusion(s) These data demonstrate novel themes around related priorities in patients with desired pregnancies diagnosed with a PUL previously underappreciated by clinicians. The balance of these priorities evolved throughout management with increasing information and clarity. Continually reevaluating relevant patient priorities and preferences is essential to the comprehensive management of PUL.
Collapse
|
5
|
Quain KM, Kyweluk MA, Sajwani A, Gruschow S, Finlayson C, Gordon EJ, Johnson EK, Persky R, Dowshen N, Chen D. Timing and Delivery of Fertility Preservation Information to Transgender Adolescents, Young Adults, and Their Parents. J Adolesc Health 2021; 68:619-622. [PMID: 32826153 PMCID: PMC8522212 DOI: 10.1016/j.jadohealth.2020.06.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 06/16/2020] [Accepted: 06/25/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE This study aimed to examine transgender adolescents and young adults' (AYA) and their parents' preferences regarding fertility preservation (FP) information provision and discussion timing. METHODS Data were derived from two separate studies: an online survey and semistructured qualitative interviews. Survey data were analyzed using descriptive statistics and interview data using conventional content analysis. RESULTS Survey participants (AYA: 88% and parents: 93%) preferred gender clinic physicians provide FP information, and nearly one-third endorsed mental health professionals (AYA: 28% and parents: 26%) or fertility specialists (AYA: 23% and parents: 30%). Interview participants' FP discussion timing preferences ranged from the initial clinic visit, follow-up visits, before medical intervention, to mentioning FP early but deferring in-depth discussion to follow-up visits. CONCLUSIONS Gender clinic physicians, mental health professionals, and fertility specialists should be prepared to discuss FP with transgender AYA and their parents. Opinions varied regarding when to provide FP information; therefore, discussion timing may need to be individualized.
Collapse
Affiliation(s)
- Kit M Quain
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| | - Moira A Kyweluk
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Afiya Sajwani
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Siobhan Gruschow
- Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Courtney Finlayson
- Division of Pediatric Endocrinology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Elisa J Gordon
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Emilie K Johnson
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rebecca Persky
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nadia Dowshen
- Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Diane Chen
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Psychiatric and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
6
|
Kolbuck VD, Sajwani A, Kyweluk MA, Finlayson C, Gordon EJ, Chen D. Formative development of a fertility decision aid for transgender adolescents and young adults: a multidisciplinary Delphi consensus study. J Assist Reprod Genet 2020; 37:2805-2816. [PMID: 32995972 DOI: 10.1007/s10815-020-01947-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/10/2020] [Indexed: 12/19/2022] Open
Abstract
PURPOSE No educational and decision support tools exist to aid transgender and non-binary (TNB) adolescents and young adults (AYA) in making decisions about fertility preservation in the context of initiating gender-affirming medical care that can impair fertility. This study identified critical content areas and learning objectives to include in a decision aid about fertility preservation targeted for TNB AYA. METHODS Delphi methodology was leveraged to engage 80 multidisciplinary experts in reproductive medicine and pediatric transgender health care in a two round consensus building procedure. Proposed content areas rated as "probably keep" or "definitely keep" by 75% of experts were retained. Proposed learning objectives reaching 75% agreement on ratings of importance and priority were also identified. RESULTS The Delphi procedure identified five priority content areas (Basic Reproduction; Gender-Affirming Medical Interventions: Impacts on Fertility; Established Fertility Preservation Options; Benefits and Risks of Established Fertility Preservation Procedures; Alternative Pathways to Parenting) and 25 learning objectives to prioritize in a fertility-related decision aid for TNB AYA. CONCLUSION A multidisciplinary panel of experts achieved agreement around content areas and learning objectives to incorporate into a decision aid about fertility preservation for TNB AYA.
Collapse
Affiliation(s)
- Victoria D Kolbuck
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 161B, Chicago, IL, 60611-2605, USA
| | - Afiya Sajwani
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 161B, Chicago, IL, 60611-2605, USA
| | - Moira A Kyweluk
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Courtney Finlayson
- Division of Endocrinology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Center for Health Services and Outcomes Research and Center for Bioethics and Medical Humanities, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Elisa J Gordon
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Diane Chen
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 161B, Chicago, IL, 60611-2605, USA. .,Center for Health Services and Outcomes Research and Center for Bioethics and Medical Humanities, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. .,Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA. .,Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| |
Collapse
|
7
|
Chen D, Kyweluk MA, Sajwani A, Gordon EJ, Johnson EK, Finlayson CA, Woodruff TK. Factors Affecting Fertility Decision-Making Among Transgender Adolescents and Young Adults. LGBT Health 2020; 6:107-115. [PMID: 30985275 DOI: 10.1089/lgbt.2018.0250] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE This study aimed to identify factors affecting transgender adolescents' and young adults' (AYA) decisions to pursue fertility preservation (FP). METHODS Participants completed a semistructured interview between December 2016 and June 2017 to inform improvements in fertility counseling and the development of a fertility decision aid targeted to transgender youth. Interviews included open-ended questions within the following domains: (1) gender-affirming medical care received, (2) knowledge of gender-affirming hormone effects on fertility and FP options, (3) FP decision-making, and (4) how, when, and what information AYA prefer to receive regarding FP. The interviews were analyzed thematically. RESULTS Eighteen transgender AYA (ages 15-24) participated (60% participation rate). The majority was White (61%) and assigned female at birth (67%). Half received specialized FP counseling (50%). Few of the transgender AYA pursued FP (33%). Five key themes reflecting factors affecting transgender AYA's FP decision-making were identified: (1) future parenthood desires, (2) individual experiences of gender dysphoria, (3) family values around biological parenthood, (4) financial considerations, and (5) fertility information provision. CONCLUSIONS Transgender AYA consider numerous factors in deciding whether to pursue FP. Although individual desires for and family values around biological parenthood influenced whether AYA pursued specialized FP counseling, individual experiences of gender dysphoria and costs of FP were barriers. AYA also identified shortcomings in fertility counseling with providers, highlighting the need to establish standardized counseling protocols and develop patient decision aids.
Collapse
Affiliation(s)
- Diane Chen
- 1 The Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,2 Department of Child and Adolescent Psychiatry, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,3 Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,4 Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Moira A Kyweluk
- 5 Department of Anthropology, Northwestern University, Chicago, Illinois.,6 Program in Public Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Afiya Sajwani
- 1 The Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Elisa J Gordon
- 7 Division of Transplantation, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,8 Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,9 Center for Bioethics and Medical Humanities, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Emilie K Johnson
- 8 Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,10 Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,11 Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Courtney A Finlayson
- 4 Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,12 Division of Endocrinology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Teresa K Woodruff
- 13 Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,14 Division of Reproductive Science in Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
8
|
Bernardi LA, Luck M, Kyweluk MA, Feinberg EC. Knowledge gaps in the understanding of fertility among non-medical graduate students. F S Rep 2020; 1:177-185. [PMID: 34223241 PMCID: PMC8244259 DOI: 10.1016/j.xfre.2020.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 05/11/2020] [Revised: 07/03/2020] [Accepted: 08/01/2020] [Indexed: 11/24/2022] Open
Abstract
Objective To assess knowledge of female and male fertility among students enrolled in a Master of Business Administration (MBA) program. Design Web-based cross-sectional survey. Setting Academic setting. Patient(s) Not applicable. Intervention(s) None. Main Outcome Measure(s) Knowledge of how female and male age impacts reproduction, fecundability, and success rates with in vitro fertilization (IVF). Result(s) A total of 133 female and male MBA students completed the survey. Nearly 10% of participants were not aware that women are born with a fixed number of oocytes and that oocyte quantity and quality decline with age. More than 30% of participants overestimated fecundability in women aged ≥35 years, and >50% overestimated IVF success rates in women older than 40 years. Fifteen percent of participants did not know that men have stem cells in the testes, and >25% were not aware that men experience a decrease in sperm concentration and quality with age. Nearly 30% believed that a man’s age never impacts reproductive outcomes. Less than 30% of participants correctly estimated fecundability and IVF success rates based on male age. Conclusion(s) These data highlight important knowledge gaps in a highly educated group of MBA students, most whom desire future childbearing. Specifically, there is a lack of understanding of both male and female reproductive aging and an overestimation of treatment success. As delayed childbearing continues, particularly among those with high educational attainment, attention should be focused on introducing broad fertility education at a younger age to improve future reproductive success.
Collapse
Affiliation(s)
- Lia A Bernardi
- Division of Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Marissa Luck
- Division of Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Moira A Kyweluk
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Eve C Feinberg
- Division of Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
9
|
Kalokairinou L, Zettler PJ, Nagappan A, Kyweluk MA, Wexler A. The promise of direct-to-consumer COVID-19 testing: ethical and regulatory issues. J Law Biosci 2020; 7:lsaa069. [PMID: 33569177 PMCID: PMC7543538 DOI: 10.1093/jlb/lsaa069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/07/2020] [Accepted: 08/16/2020] [Indexed: 06/12/2023]
Abstract
Widespread diagnostic and serological (antibody) testing is one key to mitigating the COVID-19 pandemic. While at first, the majority of COVID-19 diagnostic testing in the USA took place in healthcare settings, quickly a direct-to-consumer (DTC) testing market also emerged. In these DTC provision models, the test is initiated by a consumer and the sample collection occurs at home or in a commercial laboratory. Although the provision of DTC tests has potential benefits-such as expanding access to testing and reducing the risk of exposure for consumers and medical personnel-it also raises significant ethical and regulatory concerns. This article reviews these challenges and shows how they parallel and also diverge from prior concerns raised in the DTC health testing arena. The first part of this paper provides an overview of the landscape of diagnostic and serological tests for COVID-19, anticipating how provision models are likely to evolve in the future. The second part discusses five primary issues for DTC COVID-19 tests: test accuracy; potential misinterpretation of results; misleading claims and other misinformation; privacy concerns; and fair allocation of scarce resources. We conclude with recommendations for regulators and companies that aim to ensure ethically marketed DTC COVID-19 tests.
Collapse
Affiliation(s)
| | - Patricia J Zettler
- Moritz College of Law and The James Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43210, USA
| | - Ashwini Nagappan
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Moira A Kyweluk
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Anna Wexler
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| |
Collapse
|
10
|
Kyweluk MA. Quantifying fertility? Direct-to-consumer ovarian reserve testing and the new (in)fertility pipeline. Soc Sci Med 2019; 245:112697. [PMID: 31786460 DOI: 10.1016/j.socscimed.2019.112697] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 11/19/2019] [Accepted: 11/21/2019] [Indexed: 10/25/2022]
Abstract
Frequently branded the "egg timer" or "biological clock test," anti-Müllerian hormone (AMH) testing for women is becoming widely available in the United States (US) through online, direct-to-consumer (DTC) testing services. The level of AMH in the blood reflects the remaining egg supply or "ovarian reserve"-a potential fertility indicator. AMH level is primarily used as a diagnostic tool prior to ovarian stimulation for in vitro fertilization (IVF) or oocyte cryopreservation (OC; i.e., egg freezing). This article describes the first ethnographic research on DTC ovarian reserve testing in the US, with a recruited sample of 21 participants interested in pursuing testing who consented to participant observation and semi-structured interviews. Fieldwork took place from January 2018 to July 2018 in Chicago, Illinois. Ethnographic cases explore how experiences with ovarian reserve testing are shaped by relationship status, sexual orientation, socioeconomic status, racial/ethnic identity, and medical insurance coverage. Thematic analysis suggests that DTC ovarian reserve testing is a unique means of investigating fertility; participants felt empowered by receiving testing outside of traditional medical contexts. It was an alternative tool for family planning, particularly for LGBTQ + individuals and single women. However, participants experienced varying degrees of certainty about test results and the appropriate next steps to take to confirm fertility status, preserve fertility, or conceive, thus suggesting that DTC testing may confound reproductive decision-making. I argue that DTC ovarian reserve testing is a new tool in a larger medical and social project to mitigate anticipated future infertility and is an entry point into what I term the new (in)fertility pipeline encouraging entanglement with reproductive technologies across the lifespan. Due to its low cost and widespread availability, DTC ovarian reserve testing reaches a broader demographic, encourages testing across diverse identities and backgrounds, and increases awareness of more advanced assisted reproductive technology (ART), including egg freezing.
Collapse
Affiliation(s)
- Moira A Kyweluk
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Perelman School of Medicine, 423 Guardian Drive, Blockley Hall, Philadelphia, PA 19104-4884, USA.
| |
Collapse
|
11
|
Kyweluk MA, Reinecke J, Chen D. Fertility Preservation Legislation in the United States: Potential Implications for Transgender Individuals. LGBT Health 2019; 6:331-334. [PMID: 31436497 DOI: 10.1089/lgbt.2019.0017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Gender-affirming hormones may compromise gonadal function leading to subfertility or infertility. Fertility preservation (FP; i.e., egg and sperm "freezing") before starting hormones offers future options to transgender individuals. In the United States, FP is extremely expensive and rarely covered by medical insurance; state-specific laws govern required benefits. Recent changes in insurance mandates in Connecticut, Delaware, Illinois, Maryland, New Hampshire, New York, and Rhode Island have expanded FP coverage, but implications of these changes for transgender individuals are unclear. State-by-state advocacy to expand insurance coverage for FP in individuals whose medically necessary treatments compromise fertility should consider the needs of transgender individuals desiring biological parenthood.
Collapse
Affiliation(s)
- Moira A Kyweluk
- Department of Anthropology, Northwestern University, Evanston, Illinois.,Program in Public Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Joyce Reinecke
- Alliance for Fertility Preservation, Lafayette, California
| | - Diane Chen
- The Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| |
Collapse
|
12
|
Affiliation(s)
- Moira A. Kyweluk
- Department of Anthropology, Northwestern University Evanston, IL, USA
- Program in Public Health, Northwestern University Feinberg School of Medicine Chicago, IL USA
| | - Afiya Sajwani
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Diane Chen
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
- Department of Child & Adolescent Psychiatry, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
- Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
13
|
Kyweluk MA, Sievert LL, Huicochea-Gómez L, Cahuich-Campos D, McDade T, Brown DE. Variation in levels of AMH among Maya and non-Maya women in Campeche, Mexico. Am J Phys Anthropol 2018; 167:282-290. [PMID: 30159886 DOI: 10.1002/ajpa.23627] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 05/09/2018] [Accepted: 05/19/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The purpose of this study was to examine anti-Müllerian hormone (AMH) levels among women of Maya and non-Maya ancestry in the city of Campeche, Mexico. Levels of AMH can potentially predict age at menopause. Previous studies have indicated an early mean age at menopause among the Maya. MATERIALS AND METHODS Women aged 40-60 (n = 97) participated in semistructured interviews, anthropometric measures, and blood samples. Maya/non-Maya ethnicity was determined by the last names, languages spoken, and birthplace of the woman, her parents, and her grandparents. AMH values were categorized as detectable (0.05-4.19 ng/mL) and undetectable (<0.05 ng/mL). Logistic regressions calculated odds ratios (OR) for undetectable AMH. RESULTS Women were categorized as Maya (n = 44), not Maya (n = 39), or not able to be clearly defined (n = 14). In bivariate comparisons, women with detectable levels of AMH were younger, more likely to be pre-menopausal, and not Maya. Age, menopausal status, and ethnicity remained significant in a logistic regression models after controlling for age at menarche. Maya women were more than five times as likely to have nondetectable AMH levels as non-Maya women. DISCUSSION Increasing age and progression through the menopausal transition were both associated with declining levels of AMH. The association between Maya ethnicity and a lower likelihood of detecting AMH is consistent with the early ages at menopause reported in previous studies. We considered a rapid life history model as an explanatory framework, and suggest, from an ecological perspective, that future research should consider measures of developmental stress that may compromise ovarian reserves.
Collapse
Affiliation(s)
- Moira A Kyweluk
- Department of Anthropology, Northwestern University, Evanston, Illinois, 60208
| | | | | | - Diana Cahuich-Campos
- Depto de Sociedad y Cultura, El Colegio de la Frontera, ECOSUR, Campeche, México
| | - Thomas McDade
- Department of Anthropology, Northwestern University, Evanston, Illinois, 60208.,Institute for Policy Research Northwestern University, Evanston, Illinois, 60208
| | - Daniel E Brown
- Department of Anthropology, University of Hawai'i at Hilo, Hawaii, 96720
| |
Collapse
|