Memphis Center For Reproductive Health

This study aimed to characterize associations between male childhood cancer survivors' perception of infertility risk and objective fertility status and to identify factors contributing to risk perception. Participants were from SJLIFE, exposed to alkylating agents but not radiation, and completed a Men's Health Questionnaire (MHQ) and semen analysis. Samples were obtained following the 2010 World Health Organization Guidelines, and classified as azoospermic (0 sperm), oligospermic (> 0 and < 15 million sperm/ml), or normospermic (≥ 15 million sperm/ml). Participants were classified as at minimally or high/significantly increased risk for infertility according to the Pediatric Initiative Network (PIN) criteria. Perception of infertility risk was assessed via self-report where survivors indicated the following: (1) more risk than peers without cancer history, (2) less risk, or (3) equal risk, as well as factors contextualizing perceived risk. Chi-squared tests or Fishers' exact tests assessed differences in variables of interest. Among 238 participants (age 27 ± 6years, 85% NH White, 47% survivors of leukemia), 58% perceived increased infertility risk than peers without cancer history, 29% equal risk, and 13% less risk. A larger proportion of survivors with azoospermia perceived higher risk than other groups (74%) (p = 0.01). No differences were observed in risk perception by PIN criteria. No differences were observed by sperm concentration category or PIN criteria in factors contextualizing perceived risk. Male survivors not exposed to radiation in the SJLIFE cohort are generally aware of their infertility risk. Male survivors should seek continued follow-up care regarding fertility and information on risk from reputable sources.

Racial concordance has been identified as a potential strategy to improve the perinatal health of Black women and birthing people by mitigating implicit bias and improving mutual trust, healthy communication, and satisfaction. In a recent article published in BIRTH: Issues in Perinatal Care, Bogdan-Lovis et al. surveyed 200 Black women to determine whether they possessed a race and gender practitioner preference for their birth practitioner and examined whether race and gender concordance was associated with greater birth satisfaction and perceived respect, trust, practitioner competence, empathy, and use of inclusive communication. In this commentary, written by a group of Black midwives, we respond to the study and offer a vision for race-concordant care that encompasses cultural safety provided in a community-based setting.

Celiac disease (CD) is an autoimmune intestinal inflammatory disease triggered by gluten in the diet. Untreated CD has been associated with pregnancy loss and infertility. The purpose of this study was to screen unselected women with recurrent pregnancy loss (RPL) for markers of CD to determine whether a correlation exists between RPL and CD serum markers. Frequencies of three serum markers of CD [tissue transglutaminase (TTG) IgA, endomysial (EMA) IgA, and deaminated gliadin peptide (DGP) IgA] were determined by enzyme-linked immunoassay (ELISA). Seven hundred and eight women who had two or more failed clinical pregnancies (cases) and one hundred women with at least one live birth and no miscarriages (controls) were included in this study. All cases had a full workup for RPL based on the American Society for Reproductive Medicine 2013 guidelines. Antiphospholipid antibodies (aPL) were correlated with CD markers based on their potential prothrombotic role. Results The results show no significant difference in the prevalence of CD autoantibodies when comparing the RPL patients with the controls. Over half of the patients who tested positive for serum markers for CD also had positive aPL. Conclusion Screening unselected women with RPL who are asymptomatic for CD is not supported based on these data. Women who test positive for CD may be candidates for aPL testing based on the association of adverse pregnancy outcomes.

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