Reproductive Issues Research Articles

Applying the new SABV (sex as a biological variable) policy to research and clinical care

Sex as a biological variable (SABV) is a key part of the new National Institutes of Health (NIH) initiative to enhance reproducibility through rigor and transparency. The SABV policy requires researchers to factor sex into the design, analysis, and reporting of vertebrate animal and human studies. The policy was implemented as it has become increasingly clear that male/female differences extend well beyond reproductive and hormonal issues. Implementation of the policy is also meant to address inattention to sex influences in biomedical research. Sex affects: cell physiology, metabolism, and many other biological functions; symptoms and manifestations of disease; and responses to treatment. For example, sex has profound influences in neuroscience, from circuitry to physiology to pain perception. Extending beyond the robust efforts of NIH to ensure that women are included in clinical trials, the SABV policy also includes rigorous preclinical experimental designs that inform clinical research. Additionally, the NIH has engaged journal editors and publishers to facilitate reproducibility by addressing rigor and promoting transparency through scientifically appropriate sex-specific study results reporting. The Sex And Gender Equity in Research (SAGER) guidelines were developed to assist researchers and journal editors in reporting sex and gender information in publications [1].

Reproductive Issues in Males with SLE

Purpose of review Sexual function and fertility are neglected topics in men with systemic lupus erythematosus (SLE) in the literature. This review examines the impact of SLE and its treatment on fertility and erectile function. Recent findings Systemic illness, such as chronic kidney disease, and drugs used in SLE are associated with male infertility and sexual dysfunction through changes at the level of the hypothalamic-pituitary axis and direct testicular damage. In SLE patients, evidence shows a dose-dependent gonadotoxicity associated with intravenous (IV) cyclophosphamide (CYC). In contrast, recent observational studies evaluating disease-modifying anti-rheumatic drugs, non-steroidal anti-inflammatory drugs, and corticosteroids have found little evidence suggesting a significant impact of paternal exposure on fertility or pregnancy outcomes. In most patients, infertility management is focused on controlling SLE disease activity, minimizing the dose of gonadotoxic medications and cryopreserving sperm prior to treatment with IV CYC. Summary Reproductive issues are not uncommon in males with SLE. Understanding the impact of disease activity and drug effects on reproductive health may avert irreversible infertility and improve patient quality of life. However, additional studies are required to further explore the impact of SLE and its treatment on male fertility.

Characterizing the reproductive biology of the female pygmy hippopotamus (Choeropsis liberiensis) through non-invasive endocrine monitoring

The pygmy hippopotamus (Choeropsis liberiensis) is endangered in the wild and very little is known about its reproductive biology. In zoological facilities, this species experiences a number of reproductive issues that complicate breeding management, including a high rate of stillbirths and failure of many pairs to reproduce. We conducted a comprehensive study to evaluate reproductive cycles and pregnancy in this species using enzyme immunoassays (EIAs) for fecal hormone metabolite analysis. Fresh fecal samples were collected twice weekly for a one to three year period from 36 female pygmy hippos housed at 24 zoological institutions. Samples were analyzed in three separate laboratories. Three progestogen metabolite EIAs (Pg-diol: 5β-pregnane-3α,20α-diol 3HS:BSA; PdG: pregnanediol-3-glucuronide R13904; mono-P4: Quidel clone 425) and three estrogen metabolite EIAs (E2a: estradiol-17β-OH 17-HS:BSA; E2b: estradiol 17β R0008; E2c: estradiol 17β R4972) accurately reflected reproductive events. Average estrous cycle length was 31.8 ± 7.4 days based on estrogen metabolite peaks and 30.9 ± 7.3 days based on nadir to nadir progestogen metabolite concentrations. Cyclical patterns in both estrogen and progestogen metabolites were detected throughout the year, indicating a lack of seasonality. Estrogen metabolite peaks were also observed during pregnancy and lactation, suggesting that follicular development occurs during both reproductive states. Pregnancy was most reliably demonstrated by elevation in progestogen metabolites (Pg-diol or PdG) in the second half of gestation. Average gestation length based on breeding to calving date was 203 ± 4 days for 15 pregnancies. This comprehensive overview of the reproductive biology of the female pygmy hippo provides valuable data for guiding long-term breeding management for this endangered species and serves as a baseline for future studies addressing the potential influence of social structure, diet, body condition, and other husbandry factors on estrous cycling and reproduction.

Morally accounting for sex selection online in Turkey

The Internet, beyond providing opportunities for advertising reproductive services, offers people an anonymous social space to exchange information, support, and personal stories regarding their reproductive goals and to enact reproductive moral reasoning regarding controversial biotechnologies in complex ways. Focusing on the online discussion forum of the Turkish web portal Women’s Club, this article examines the moral negotiations of sex selection by women seeking to legitimize or delegitimize it through rhetorical appeal to a mix of science, religion, gender, ignorance, propitiousness, and modernity. By doing so, it will reveal the ways in which women forum members work to craft not only moral selves and technologies but also a shared space for moral reflection. By examining the discursive content of Turkish women’s postings concerning sex selection, I argue that online forums offer these women an anonymous moral space to discuss their reproductive goals, although some family secrets do not escape the moral scrutiny of others even within these forums. The heterogeneity and complexity of women’s moral engagements with reproductive technologies on the Internet demonstrates that reproductive issues are moral issues directly related to the expectations for women as gendered beings, as individuals, family members, and as citizens, and also serve to reproduce social relations, including patriarchal inequalities.

Profile of Reproductive Issues Associated with Different Sickle Cell Disease Genotypes.

Purpose To describe the reproductive variables associated with different sickle cell disease (SCD) genotypes and the influence of contraceptive methods on acute painful episodes among the women with the homozygous hemoglobin S (HbSS) genotype. Methods A cross-sectional study was conducted between September of 2015 and April of 2016 on 158 women afflicted with SCD admitted to a hematology center in the Northeast of Brazil. The reproduction-associated variables of different SCD genotypes were assessed using the analysis of variance (ANOVA) test to compare means, and the Kruskal-Wallis test to compare medians. The association between the contraceptive method and the acute painful episodes was evaluated by the Chi-square test. Results The mean age of women with SCD was 28.3 years and 86.6% were mixed or of African-American ethnicity. With respect to the genotypes, 134 women (84.8%) had HbSS genotype, 12 women (7.6%) had hemoglobin SC (HbSC) disease genotype, and 12 (7.6%) were identified with hemoglobinopathy S-beta (S-β) thalassemia. The mean age of HbSS diagnosis was lower than that of HbSC disease, the less severe form of SCD (p < 0.001). The mean age of menarche was 14.8 ± 1.8 years for HbSS and 12.7 ± 1.5 years for HbSC (p < 0.001). Among women with HbSS who used progestin-only contraception, 16.6% had more than 4 acute painful episodes per year. There was no statistically significant difference when compared with other contraceptive methods. Conclusion With respect to reproduction-associated variables, only the age of the menarche showed delay in HbSS when compared with HbSC. The contraceptive method used was not associated with the frequency of acute painful episodes among the HbSS women.

Abstract 3830: Plucked anagen scalp hair: A reproducible surrogate tissue to monitor drug induced transcriptional changes and provide pharmacodynamic biomarker and target engagement information from cancer patients

Abstract Monitoring target engagement is crucial to inform on early drug development decisions, and development of a peripheral tissue-based gene expression signature indicative of pathway inhibition could facilitate the continued clinical development of compounds. Plucked anagen scalp hair is an ideal source of epithelial tissue to monitor drug induced transcriptional changes. High vascularisation of the hair follicle, frequent epithelial origin of tumors, ease of sampling and high degree of congruence of expression in hair of pathways dysregulated in cancers, make the cellular bulb of plucked human scalp hair an excellent surrogate tissue for the non-invasive monitoring of pharmacodynamic (PD) and mechanism of action (MOA) effects in clinical trials. Using our ex vivo plucked hair culture platform, hair bulbs from several healthy donors were exposed to BEZ235, a dual pan-class PI3K and mTOR inhibitor at different concentrations and durations. Total RNA was isolated from the cellular bulb of individual anagen hair post-culture and used for microarray analysis to assess global transcriptional alterations and develop a gene expression signature indicative of BEZ235 exposure. The results of the ex vivo plucked assessment generated a dose dependent appreciable and biologically relevant transcriptional signature following exposure to BEZ235. Transcriptional readouts from patients also revealed strong correlations (0.97-0.99) in the genes expressed in anagen scalp hair between donors and across samples taken from the same donor. In addition, global gene expression data indicated that assessing three plucked scalp hairs or less at each collection point was sufficient to detect significant differential expression (p&amp;lt;0.05 &amp; 1.5 fold change) underpinning the low variance in the majority of target genes in plucked hair as a biomarker platform. Gene signatures for compounds targeting the PI3K/mTOR pathway that were established using the ex vivo plucked scalp hair platform were used to support clinical trials and scalp hair taken from patients receiving treatment showed an excellent post-exposure target signature modulation. In summary, our results substantiate that plucked anagen scalp hair is an ideal non-invasive surrogate tissue to obtain drug-induced pharmacodynamic biomarker and target engagement information from oncology patients. Citation Format: Benjamin J. Reed, Timothy Mefo, Elliott Harrison, Ross Haggart, Emma Grimes, Alan Murdoch, Gino Miele. Plucked anagen scalp hair: A reproducible surrogate tissue to monitor drug induced transcriptional changes and provide pharmacodynamic biomarker and target engagement information from cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3830. doi:10.1158/1538-7445.AM2017-3830

Top or Bottom? Varsity youth talk about gay sexuality in a Stepping Stones Workshop: Implications for sexual health

This paper discusses the constructs of sexuality amongst a group of LGBTI university students during a Stepping Stones workshop aimed at exploring their engagement with sexual and reproductive health rights issues as it affects them. These constructs include notions of binary identities of being gay, such as being a ‘top’ versus being a ‘bottom’, that are then applied to sexual practices and behaviour that have serious implications for sexual health and bodily integrity. We discuss the intersections of gender identity, sexuality, sexual health and sexual rights, arguing that such constructs are not only limiting in their demarcations of sexual boundaries in relationships and for intimacy but also that attempts to engage sexual health promotion must take into account the intersecting identities of gender and sexuality that are tied to sexual behaviour.

Reproductive endocrine issues in men with sickle cell anemia.

In patients with sickle cell anemia, the sickling of red blood cells is known to cause end-organ damage by infarction. In some men who are affected by sickle cell anemia, the obstruction of venous outflow of the penis causes priapism, which could lead to erectile dysfunction. There is also evidence that the disease is linked to other reproductive issues in men-specifically delayed puberty, low testosterone, and sperm abnormalities-although the causes of these problems are less clear. Treatment of sickle cell anemia can have effects on the reproductive system as well. This review summarizes the findings from various publications pertaining to reproductive endocrinology, along with their conclusions and discrepancies.

Application of Caenorhabditis elegans (nematode) and Danio rerio embryo (zebrafish) as model systems to screen for developmental and reproductive toxicity of Piperazine compounds

To enable selection of novel chemicals for new processes, there is a recognized need for alternative toxicity screening assays to assess potential risks to man and the environment. For human health hazard assessment these screening assays need to be translational to humans, have high throughput capability, and from an animal welfare perspective be harmonized with the principles of the 3Rs (Reduction, Refinement, Replacement).In the area of toxicology a number of cell culture systems are available but while these have some predictive value, they are not ideally suited for the prediction of developmental and reproductive toxicology (DART). This is because they often lack biotransformation capacity, multicellular or multi- organ complexity, for example, the hypothalamus pituitary gonad (HPG) axis and the complete life cycle of whole organisms.To try to overcome some of these limitations in this study, we have used Caenorhabditis elegans (nematode) and Danio rerio embryos (zebrafish) as alternative assays for DART hazard assessment of some candidate chemicals being considered for a new commercial application. Nematodes exposed to Piperazine and one of the analogs tested showed a slight delay in development compared to untreated animals but only at high concentrations and with Piperazine as the most sensitive compound. Total brood size of the nematodes was also reduced primarily by Piperazine and one of the analogs. In zebrafish Piperazine and analogs showed developmental delays. Malformations and mortality in individual fish were also scored. Significant malformations were most sensitively identified with Piperazine, significant mortality was only observed in Piperazine and only at the higest dose. Thus, Piperazine seemed the most toxic compound for both nematodes and zebrafish.The results of the nematode and zebrafish studies were in alignment with data obtained from conventional mammalian toxicity studies indicating that these have potential as developmental toxicity screening systems. The results of these studies also provided reassurance that none of the Piperazines tested are likely to have any significant developmental and/or reproductive toxicity issues to humans when used in their commercial applications.

Pregnancy risk during menstrual cycle: misconceptions among urban men in India

BackgroundIn India, where men take most decisions in the family, it is useful that they have adequate knowledge about pregnancy risks during women’s menstrual cycles. Since traditional contraceptive methods are still employed by a large population in India, the knowledge regarding the pregnancy risk during the menstrual cycle is indispensable. This research paper attempts to assess the knowledge among urban men in Uttar Pradesh, India about the fertile window of the menstrual cycle; it also attempts to discover the rationales behind the misconceptions about the concept.MethodsThis study utilizes the baseline data of the Measurement, Learning, and Evaluation project for the Urban Reproductive Health Initiative in Uttar Pradesh. Descriptive Statistics has been used to assess the prevalence of knowledge among urban men regarding the concept. Using the Discriminant Analysis, we also investigate the rationales behind the misconceptions among urban men about the concept.ResultsOnly one-fifth of the men have the correct knowledge about the concept. Further, we find that education, societal perception, caste, and spousal discussion about the reproductive issues are the primary factors affecting the knowledge about the pregnancy risk during the menstrual cycle.ConclusionsThere is an urgent need for sex education in the region to make the urban men more educated about the reproductive process of women; this may reduce unwanted births and abortion due to an unwanted pregnancy as well. The study promotes the higher education and motivates couples to discuss the reproductive health issues among them. In this manner, we can provide better reproductive health to the women of urban India.

Reproductive rights as human rights: stories from advocates in Brazil, India and South Africa

ABSTRACTStories are central to building and upholding the concept of human rights across cultures. This project uses an advocacy-oriented perspective and original interviews to examine the story-building work of human rights advocates who promote a comparatively new concept in human rights – reproductive rights. These advocates use personal narratives to destigmatize reproductive issues; highlight differences in access to healthcare choices within and across national contexts; and connect reproductive rights to other substantive rights for upholding the dignity of a person, based on the principle of indivisibility of human rights. In these ways, they make transnational human rights networks more accessible to local people and vice versa.

Is healthcare providers' value-neutrality depending on how controversial a medical intervention is? Analysis of 10 more or less controversial interventions.

BackgroundSwedish healthcare providers are supposed to be value-neutral when making clinical decisions. Recent conducted studies among Swedish physicians have indicated that the proportion of those whose personal values influence decision-making (the value-influenced) vary depending on the framing and the nature of the issue.ObjectiveTo examine whether the proportions of value-influenced and value-neutral participants vary depending on the extent to which the intervention is considered controversial.MethodsTo discriminate between value-neutral and value-influenced healthcare providers, we have used the same methods in six vignette based studies including 10 more or less controversial interventions. To be controversial was understood as being an intervention where conscientious objections in healthcare have been proposed or an intervention that is against law and regulations.ResultsEnd of life decisions and female reproduction issues are associated with conscientious objection and more or less against regulations, and also resulted in the highest proportions of value-influenced participants. Following routines, which is not in conflict with official values, were associated with one of the lowest proportion of value-influenced participants. The difference between the highest and lowest proportions of value-influenced participants among the 10 examined interventions was significant (81.8% (95% confidence interval: 78.1–85.5) versus 34.7% (95% confidence interval: 29.2–40.2)).ConclusionThe study indicates that the proportions of value-neutral participants decrease the more controversial an issue is, and vice versa. In some cases, however, framing effects may potentiate or obscure this association. As a bold hypothesis, we suggest the proportion of value-neutral or value-influenced might indicate how controversial an issue is.

Self-efficacy, Marital Adjustment, and Quality of Life in Women with Polycystic Ovary Syndrome

Introduction: With a prevalence of 4-25%, polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders among women of the reproductive age. This syndrome causes different metabolic, reproductive, and psychological issues. Therefore, performing research and raising awareness in this regard seem essential. Objective: This study measured self-efficacy, quality of life, and marital adjustment in women with PCOS. Materials and Methods: This cross-sectional, descriptive study used convenience sampling to recruit 129 women with PCOS and 125 healthy women during 2013-14. The Rotterdam Diagnostic Criteria was used to confirm the diagnosis of PCOS. The participants completed the General Self-Efficacy Scale (GSE-10), the World Health Organization’s Quality of Life Questionnaire-Short Form (WHOQOL-BREF), and the Dyadic Marital Adjustment Scale (DAS-32). The data were analyzed using t-tests and multivariate analysis of variance. Results: The mean scores of marital adjustment were 139.05 ± 16.984 in healthy women and 132.78 ± 20.633 in those with PCOS. The corresponding scores of quality of life were 98.62 ± 11.370 and 93.48 ± 13.372. The mean self-efficacy scores in healthy women and women with PCOS were 28.72 ± 5.65 and 27.92 ± 4.750, respectively. Healthy women had significantly higher marital adjustment and quality of life compared to women with PCOS (t = 2.641; P = 0.009 and t = 3.234; P = 0.001, respectively). However, the two groups had no significant difference in terms of self-efficacy (t = 3.234; P = 0.001). Conclusion: Compared to healthy women, women with PCOS have lower performance in some psychological aspects. Therefore, it is essential to raise women’s awareness about the symptoms and psychological effects of PCOS. A referral system should also be designed to provide the patients with counseling services.

Competing and contested discourses of citizenship and civic praxis

In this paper, I utilize complementary features of critical discourse analysis (CDA) and Actor-Network Theory (ANT) to trace and investigate issues of power, materiality, and reproduction embedded within notions of citizenship and civic engagement. I interrogate the often narrow and conservative political and public discourses in Arizona, as well as the xenophobic-driven civics education policy. To these, I juxtapose the enactment of citizenship by youth who use, produce, and share language materials and counter authoritative citizenship and civic discourses, especially, but not exclusively, in online contexts. I explore the questions: In what ways are discourses of civic engagement and citizenship assembled, interpreted, understood, enacted, and contested in Arizona? What are the relationships between the civics education policy, discursive enactments of citizenship, and the youth of Mexican descent’s online civic practices? I draw on a mixture of textual (language materials) and discursive (events, acts, and practices) data collected in Arizona to argue that youth are doing critical, yet unrecognized and undervalued, forms of civic engagement online, which could be incorporated in the formal civics education curriculum.

The Effect Of Health Promotion About Menstruation Daughters of Adolescents on Increasing Attitude and Hygiene Knowledge Students Junior High School Bukittinggi

Adolescent knowledge is very influential on the behavior in maintaining and cleaning the reproduction, because the higher the level of knowledge, it is expected to arise a positive attitude in maintaining personal hygiene. The Initial field study conducted found that 4 out of 5 female students (80%) do not understand about menstruation and how to deal with it. The purpose of the study to determine the effect of health promotion on menstruation to increase the attitude and hygiene of grade VII students at SMPN 2 Bukittinggi. The research design was a quasi-experimental study with one group pre-post test design. This research was conducted in March-April 2017 in grade VII students at SMPN 2 Bukittinggi with a total sample of 66 people. There is the influence of health promotion about menstruation in adolescent girls to increase knowledge attitude of the student of class VII at SMPN 2 Bukittinggi year 2017 with p-value = 0,0001 (α = 0,05). There is the influence of health promotion about menstruation in adolescent girls to increase knowledge of Hygiene grade VII student at SMPN 2 Bukittinggi 2017 with p-value = 0,0001. (α = 0.05). It is expected that health services, especially Puskesmas as early health services, are expected to increase the promotion of health, especially on adolescent reproductive health issues.

MZC Gel Inhibits SHIV-RT and HSV-2 in Macaque Vaginal Mucosa and SHIV-RT in Rectal Mucosa.

The Population Council's microbicide gel MZC (also known as PC-1005) containing MIV-150 and zinc acetate dihydrate (ZA) in carrageenan (CG) has shown promise as a broad-spectrum microbicide against HIV, herpes simplex virus (HSV), and human papillomavirus. Previous data show antiviral activity against these viruses in cell-based assays, prevention of vaginal and rectal simian-human immunodeficiency virus reverse transcriptase (SHIV-RT) infection, and reduction of vaginal HSV shedding in rhesus macaques and also excellent antiviral activity against HSV and human papillomavirus in murine models. Recently, we demonstrated that MZC is safe and effective against SHIV-RT in macaque vaginal explants. Here we established models of ex vivo SHIV-RT/HSV-2 coinfection of vaginal mucosa and SHIV-RT infection of rectal mucosa in macaques (challenge of rectal mucosa with HSV-2 did not result in reproducible tissue infection), evaluated antiviral activity of MZC, and compared quantitative polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay readouts for monitoring SHIV-RT infection. MZC (at nontoxic dilutions) significantly inhibited SHIV-RT in vaginal and rectal mucosas and HSV-2 in vaginal mucosa when present during viral challenge. Analysis of SHIV-RT infection and MZC activity by 1-step simian immunodeficiency virus gag quantitative RT-PCR and p27 enzyme-linked immunosorbent assay demonstrated similar virus growth dynamics and MZC activity by both methods and higher sensitivity of quantitative RT-PCR. Our data provide more evidence that MZC is a promising dual compartment multipurpose prevention technology candidate.

In Vitro Fertilization, the Catholic Church and National Survival: The Discursive Construction of Reproductive Rights in Poland

This paper aims at analysing the public discourse on reproductive issues in Poland, focusing on In Vitro Fertilization. We wish to verify the influence of the Catholic Church on the discourse construction and unearth the rhetoric strategies employed to this end. Our corpus of analysis is composed of two sub-corpora. The first analyses the position of the Catholic Church and consists of the declaration and documents issued by the Polish Episcopal Conference throughout 2015. The second focuses on the press representation of the issue and consists of articles from five representative Polish newspapers. The analysis leads to four main results. First, it shows that the public discourse on regulation of in vitro fertilization in Poland is not neutral, but rather influenced by the narrative woven by the Catholic Church and the semantic field chosen by the institution. As it also heavily relies on previous debates on abortion, this leads to the [pre]dominance of pro-life semantics in the public discourse both in supporters and opponents arguments. Second, we witness the discursive construction of a situation of impending threat: Church hierarchies attempt to implement a securitizing action on reproductive rights. Thirdly, in the newspapers considered, the theme is treated quite asymmetrically: left-wing press does not appear to play an incisive role in taking a position on IVF. Finally, the topic appears to be of interest for the media only before the parliament's vote was pending, while it seldom appears in in the period when the law was to be implemented.

R248G cystic fibrosis transmembrane conductance regulator mutation in three siblings presenting with recurrent acute pancreatitis and reproductive issues: a case series

BackgroundMutational combinations of the cystic fibrosis transmembrane conductance regulator, CFTR, gene have different phenotypic manifestations at the molecular level with varying clinical consequences for individuals possessing such mutations. Reporting cystic fibrosis transmembrane conductance regulator mutations is important in understanding the genotype-phenotype correlations and associated clinical presentations in patients with cystic fibrosis. Understanding the effects of mutations is critical in developing appropriate treatments for individuals affected with cystic fibrosis, non-classic cystic fibrosis, or cystic fibrosis transmembrane conductance regulator-related disorders. This is the first report of related individuals possessing the R248G missense cystic fibrosis transmembrane conductance regulator mutation and we present their associated clinical histories.Case presentationAll three patients are of Spanish descent. Deoxyribonucleic acid analysis revealed that all three siblings possessed a novel c.742A>G mutation, resulting in a p.Arg248Gly (R248G) amino acid change in exon 6 in trans with the known N1303K mutant allele. Case 1 patient is a 39-year-old infertile man presenting with congenital unilateral absence of the vas deferens and recurrent episodes of epigastric pain. Case 2 patient is a 32-year-old woman presenting with periods of infertility, two previous spontaneous abortions, recurrent epigastric pain, and recurrent pancreatitis. Case 3 patient is a 29-year-old woman presenting with recurrent pancreatitis and epigastric pain.ConclusionsWe report the genotype-phenotype correlations and clinical manifestations of a novel R248G cystic fibrosis transmembrane conductance regulator mutation: congenital unilateral absence of the vas deferens in males, reduced female fertility, and recurrent acute pancreatitis. In addition, we discuss the possible functional consequences of the mutations at the molecular level.

Challenges in accessing reproductive health care in young cancer survivors.

107 Background: Infertility and early menopause are well-established late and long-term effects of many cancer treatments. Fertility preservation (FP) before (and in some cases after) treatment allows many survivors to achieve their family building goals despite gonadotoxic treatment. FP, however, is costly, and there is inconsistent, incomplete, or absent coverage across insurances. Furthermore, as many young survivors are un- or underinsured, disparities in referrals and service utilization have emerged. This presentation provides an overview of reproductive health care-related financial issues affecting young adult survivors, including cost of care, access to services, and relevant advocacy efforts, and highlights an analysis of the impact of income on FP decisions in a national sample of female survivors. Methods: We recruited female survivors aged 18-35 via social media and collected data using a web-based survey. Analyses included bivariate statistics and multiple logistic regression. Outcomes were receiving a fertility intervention (undergoing evaluation and/or fertility preservation of any sort) and freezing eggs/embryos before or after treatment. Results: 346 survivors, who were an average of 4.9 years (sd = 5.4) post-treatment, participated. 296 (86%) reported income: 35% &lt;$50K; 39% $50K-100K; and 26% over 100K. Of 259 respondents who did not undergo FP, 27% reported cost as a barrier. In logistic regression, income was significantly related with receiving an intervention and freezing eggs/embryos. Controlling for age and nulliparity, high-income survivors were more likely to receive a fertility intervention (OR = 3.0, 95% CI: 1.3, 6.9) and to freeze eggs/embryos (OR = 3.4, 95% CI: 1.2, 9.5) than low-income survivors. Conclusions: Our findings of disparity in utilization of reproductive health care among cancer survivors were similar to the published literature, with income impacting respondents’ receipt of fertility intervention and freezing of eggs/embryos. Clinical interventions and policy initiatives must address this service gap. Health care providers can help ensure that cancer survivors have access to available financial resources to assist with cost to facilitate their reproductive health care.

Same-Sex Marriage and Other Moral Taboos: Cultural Acceptances, Change in American Public Opinion and the Evidence from the Opinion Polls

This article analyzes the evolution of gay and lesbian rights and same-sex marriage in American public opinion. It describes how Obergefell v. Hodges, state-level decisions and the public opinion trends can be considered as the outcome of a grassroots coordinated campaign which began more than a decade ago and was able to conquer the majority of Americans. It also focuses on the American public opinion trends related to moral issues, examining if it is true that U.S. citizens are moving leftward. The research shows that the shift toward more liberal attitudes on a number of social values and issues has occurred across the age spectrum, not just among young people, and that when Americans are asked about moral values they are thinking of things other than just the norms surrounding sexual behavior and reproduction issues. Thus, when Americans are largely saying that the overall moral tone of their culture is in bad shape and getting worse, they are only marginally thinking of former taboos such as gay and lesbian marriage and sexual behaviors in general.