Collective, unruly, and becoming

Online contexts offer an important source of information and emotional support for those facing involuntary childlessness. This article reports the results from an ethnographic exploration of TTC (trying-to-conceive) communication on Instagram. Through a new materialist approach that pays attention to the web of intraacting agencies in online communication, this article explores the question of what material-discursive bodies (constructs of embodiment and medical information) emerge in TTC communication as the result of shared images and narratives of bodies, symptoms, fertility treatments, and reproductive technologies. Drawing on a lengthy ethnographic immersion, observations of 394 Instagram accounts, and the close analysis of 100 posts, the study found that TTC communication produces collective, unruly, and becoming bodies. Collective bodies reflect collectively acquired, solidified, and contested medical knowledge and bodies produced in TTC communication. Unruly bodies are bodies that do not conform to standard medical narratives. Becoming bodies are marked by their shifting agency, such as pregnant or fetal bodies.

Prevention of Emotional Disorders and Symptoms Under Health Conditions: A Pilot Study using the Unified Protocol in a Fertility Unit

Emotional Disorders (EDs) are common in women who undergo fertility treatments. The Unified Protocol (UP) is a transdiagnostic intervention that has demonstrated efficacy in preventing EDs under different health conditions. The aim of this pilot study is to: 1) improve emotional dysregulation for the prevention of anxiety and depressive symptoms in women undergoing intrauterine inseminations (IUI); 2) assess their acceptability (e.g., satisfaction and adherence rates). Method: Five women undergoing IUI, with no clinical diagnoses, responded to measures of mood (anxiety and depression), affect, quality of life and emotional dysregulation in the pre- and post-assessments, and at the 1-, 3- and 6-month follow-ups. The UP was adapted to be applied during six face-to-face group sessions lasting 2 h. The COVID-19 pandemic situation implied changing to an online format to end the program. Results: The results showed that women did not develop EDs, and no statistically significant pre-post and pre-follow-up differences were found for anxiety, depression, quality of life and emotional dysregulation (all p > .050). A tendency towards improvement in the post-assessment evaluation was noted. Satisfaction with the format and UP program was high. Conclusions: It would seem that programs focusing on therapeutic common factors like the UP could have an emotional preventive effect during IUI. Los trastornos emocionales (TE) son frecuentes durante los tratamientos de fertilidad. El Protocolo Unificado (PU) es una intervención transdiagnóstica que ha demostrado su eficacia en la prevención de TE en condiciones médicas. El objetivo de este estudio piloto es: 1) mejorar la disregulación emocional para prevenir síntomas ansiosos y depresivos en mujeres en tratamiento de inseminación artificial (IA); 2) evaluar la aceptabilidad (satisfacción y adherencia). Método: 5 mujeres en tratamiento de IA, sin diagnóstico clínico, respondieron a medidas de estado de ánimo (ansiedad y depresión), afecto, calidad de vida y regulación emocional en el pre- y post-evaluación, y en los seguimientos a los 1, 3 y 6 meses. La adaptación preventiva del PU se basó en la aplicación de 6 sesiones presenciales grupales de 2 horas de duración. La situación generada por la COVID-19 provocó el cambio al formato online para finalizar el programa. Resultados: las mujeres no desarrollaron TE, no se encontraron diferencias pre-post y pre-seguimientos estadísticamente significativas en ansiedad, depresión, calidad de vida y disregulación emocional (p > .050). Se observa una tendencia a la mejoría en la evaluación post-programa. Conclusiones: Parece que programas como el PU, centrado en factores terapéuticos compartidos, ha tenido un efecto emocional preventivo durante IA.

Estrogen and Progesterone Therapy and Meningiomas

Meningiomas are common intracranial tumors with female predominance. Their etiology is still poorly documented. The role of sexual hormones has long been evoked, and data have been conflicting across studies. However, a dose-dependent relationship between the incidence and growth of meningiomas and hormonal treatment with the progestin cyproterone acetate (CPA) has recently been established. CPA- associated meningiomas seem to be mainly located in the anterior and middle skull base, are more likely to be multiple; may harbor P1K3CA mutations in up to 1/3 of cases and are favored by a longer duration of treatment. A similar but lower risk of meningiomas has been recently reported with the use of chlormadinone acetate and nomegestrol acetate as progestin treatments. Concerning hormonal replacement therapy (HRT) in menopausal patients, evidence from epidemiological studies seem to favor an increased risk of meningiomas in treated patients although a recent study failed to show an increased growth of meningiomas in HRT treated vs. non treated patients. Until larger studies are available, it seems wise to recommend avoiding HRT in patients with meningiomas. Evidence from published data does not seem to support an increased risk of meningiomas with oral contraceptive (OC) use. Data are too scarce to conclude on fertility treatments. Based on studies demonstrating the expression of hormonal receptors in meningiomas, therapies targeting these receptors have been tried but have failed to show an overall favorable clinical outcome in meningioma treatment.

Choosing Wisely Canada: Canadian Fertility and Andrology Society’s List of Top Items Physicians and Patients Should Question in Fertility Medicine

Purpose: To create a Choosing Wisely Canada list of the top 5 diagnostic and therapeutic interventions that should be questioned in Reproductive Endocrinology and Infertility in Canada.Methods: The Canadian Fertility and Andrology Society (CFAS) National Working Group developed an initial list of recommendations of diagnostic and therapeutic interventions that are commonly used, but are not supported by evidence, and could expose patients to unnecessary harm. These were chosen based on their prevalence, cost, potential for harm, and quality of supporting evidence. A modified Delphi consensus was used over 5 rounds to generate ideas, review supporting evidence, assess clinical relevance, estimate recommendation impact and narrow the recommendations list to 5 items. Results: Fifty unique ideas were first proposed by the working group, and after 5 rounds including a survey of Canadian Fertility and Andrology Society (CFAS) members, the final list of recommendations was created, including topics related to unnecessary investigations and interventions for patients with infertility and recurrent pregnancy loss, and those undergoing IVF. In this article, we describe not only the Delphi process used to determine the list, but also provide a summary of the evidence behind each of the final recommendations. Conclusions: The list of 5 recommendations highlights opportunities to initiate conversations between clinicians and patients about the risks, benefits, harms and costs of unnecessary fertility treatments and procedures in a Canadian context.

Fertility Practitioners’ Coping Strategies When Faced with Intra-Role Conflict from Screening Aspiring Single Mothers by Choice

Women without a partner can become single mothers by choice through the use of fertility treatments. In Belgium, the decision to accept a candidate single mother by choice rests with the fertility clinic’s multidisciplinary team of fertility practitioners. As a result, the fertility practitioners fulfil a gatekeeping role. However, this can cause an intra-role conflict as the responsibility to select the best fitting candidates is at odds with the responsibility to help patients. In this explorative study, we examine how fertility practitioners cope with the strain resulting from intra-role conflict in the decision-making process regarding single motherhood by choice in Belgium. The findings showed that practitioners appear to mainly resort to problem-focused coping, by constructing a grassroots criteria list and by shifting their role from screening agent to counsellor. These results are based on ten open in-depth interviews with fertility practitioners employed in the multidisciplinary teams of fertility centers, using a reflexive interview lead.

The Current Role of Induced Endometrial Trauma (Endometrial Scratch) in Women Undergoing Infertility Treatment

Induced endometrial trauma, otherwise known as endometrial scratch is a simple technique that has been rapidly adopted into clinical practice, mainly for women having IVF treatment, in an attempt to increase pregnancy rates. The introduction of endometrial scratch followed early reports of improved clinical pregnancy rates in women with repetitive implantation failure after having the procedure and follows on from evidence from animal models in the early 20th century suggesting that mechanical trauma to the endometrium can induce decidual changes. Due to the ease and low cost of the procedure, it has been rapidly adopted as an add-on to fertility treatments, in many cases where evidence is still lacking. Despite the initial publication of a large number of studies that demonstrated encouraging improvements in pregnancy rates in women who underwent this procedure, these studies were mainly limited by the small sample sizes and heterogeneity of their study populations, leading to limited validity of the evidence provided by these studies. More recently, three large randomized controlled studies have been published that paint a different picture regarding the value of this procedure. This article explores the evolution of the evidence and the current state of endometrial scratch as an adjuvant therapy for women undergoing IVF treatment.

Knowledge of Fertility and Perception of Fertility Treatment Among Adults with Sickle Cell Disease (KNOW FERTILITY)

Background Adults with sickle cell disease (SCD) face unique fertility risks due to SCD and use of disease modifying therapies (DMTs). Concerns about compromising fertility may inform patients' therapy choices, but little is known about fertility knowledge in adults with SCD. The Cardiff Fertility Knowledge Scale (CFKS) and Fertility Treatment Perception Survey have been studied in international and national cohorts 1,2. The purpose of this study was to administer these surveys to adults with SCD and compare responses to previously studied populations. Methods Our IRB approved this cross-sectional study of adults with SCD (≥18YO) cared for at our Sickle Cell Center for Adults. Due to the COVID-19 pandemic, eligible subjects were recruited during routine telemedicine clinic visits and by invitation via electronic medical record. We collected demographic information (sex, age (≥/< 31YO), educational attainment, and use of DMTs). The CFKS is a 13-question survey that measures knowledge of causes of reduced fertility, common misconceptions about fertility, and infertility facts. Questions are answered True/False/Don't know and equally weighted; the cumulative score is 0-100%. We compared the mean CFKS scores to the scores from two published cohorts 1,2. The fertility treatment perception survey consists of two positive and four negative statements about fertility treatment with responses given on a five-point Likert scale (1= strongly disagree to 5= strongly agree). Responses are calculated by number of respondents with an agreement score of 4 and/or 5 divided by total number of respondents per sub-group; higher scores indicate stronger agreement. Analysis included summary statistics with means and standard deviations and independent student's T-test to compare the mean fertility knowledge scores. Results We contacted 435 subjects; 91 respondents were enrolled (21% response rate). Respondents were 77% female [median age 33 years (IQR 23, 50)]. 51% completed high school or less and 18% used one or more DMTs, with 65% taking hydroxyurea. Table 1 shows the CFKS results. The average CFKS score was 50%, lower than the international cohort (50% vs. 57%, p<0.001) and higher than a cohort of Black women in Atlanta, GA (50% vs. 38%, p<0.001). Respondents with higher educational attainment had a higher score (55% secondary education vs. 44% primary education, p=0.04). The questions most answered correctly addressed the lack of correlation between erectile function and fertility (79%) and smoking's risk to fertility in men (69%) and women (71%). The questions least answered correctly were about classifying infertility (32%) and the impact of age effect (34%), overweight effect (25%), and sexually transmitted infections' effect on fertility (36%). There was no difference in knowledge scores by age, sex, or SCD treatment. Table 2 shows fertility treatment perception survey results. Some respondents (34%) agreed that fertility treatments are safe. Almost half (46%) agreed that fertility treatments are effective. Over 60% of respondents agreed that fertility treatments are scary and/or cause emotional problems, while 48% agreed that fertility treatments may have short-term physical effects. There was no difference in responses by sex, age, or SCD treatment. Conclusion In this study, we identify that higher educational attainment in adults with SCD is associated with better fertility knowledge. All subjects had low knowledge of sexually transmitted infections, weight gain, and older age as infertility risks. Although there is concern that hydroxyurea may compromise fertility, its use was not associated with greater fertility knowledge in this study. Given concerns about fertility in the SCD community, we identify an opportunity to support patients concerned about fertility by contextualizing real or theorized SCD-specific fertility risks within a broader set of established fertility risks. References: 1. Bunting L, Tsibulsky I, Boivin J. Fertility knowledge and beliefs about fertility treatment: findings from the International Fertility Decision-making Study. Hum Reprod. 2013 Feb;28(2):385-97. doi: 10.1093/humrep/des402. Epub 2012 Nov 25. PMID: 23184181. 2. Wiltshire A, Brayboy LM, Phillips K, et al. Infertility knowledge and treatment beliefs among African American women in an urban community. Contracept Reprod Med. 2019 Sep 24;4:16. doi: 10.1186/s40834-019-0097-x. PMCID: PMC6757383. Figure 1 Figure 1. Disclosures Lanzkron: Shire: Research Funding; GBT: Research Funding; Novo Nordisk: Consultancy; CSL Behring: Research Funding; Pfizer: Current holder of individual stocks in a privately-held company; Teva: Current holder of individual stocks in a privately-held company; Novartis: Research Funding; Bluebird Bio: Consultancy; Imara: Research Funding.

Prediction of sperm progression in three dimensions using rapid optical imaging and dynamic mechanical modeling

We present a multidisciplinary approach for predicting how sperm cells with various morphologies swim in three-dimensions (3D), over time scales of milliseconds to hours at spatial resolutions of less than half a micron. We created the sperm 3D geometry and built a numerical mechanical model using the experimentally acquired dynamic 3D refractive index profiles of sperm cells swimming freely in vitro as imaged by high-resolution optical diffraction tomography. By controlling parameters in the model, such as the size and shape of the sperm head and tail, we can then predict how different sperm cells, normal or abnormal, would swim in 3D, in the short or long term. We quantified various 3D structural factor effects on the sperm long-term motility. We found that some abnormal sperm cells swim faster than normal sperm cells, in contrast to the commonly-used sperm selection assumption during IVF, according to which sperm cells should mainly be chosen based on their progressive motion. We established a new tool for sperm analysis and male-infertility diagnosis, as well as new sperm selection criteria for fertility treatments.