A technique for standardization and quality control of subjective sperm motility assessments in semen analysis

Objective: To establish a quality control method to monitor and eventually to standardize the subjective assessment of sperm motility in conventional semen analysis.

Design: Quality control study running over 2 years.

Setting: University infertility clinic and andrology laboratory.

Patient(s): Randomly chosen patients attending the clinic.

Main Outcome Measure(s): Conventional semen analysis with sperm motility assessed by grading according to the World Health Organization (WHO) criteria and analysis of individual sperm tracks with a computer-aided sperm analysis (CASA) system. Formulas were established to identify, from the track data, the threshold velocity values for distinguishing between motility grades a and b and motility grades b and c for each technician.

Result(s): The subjective thresholds above which technicians categorized sperm as WHO grades a and b were determined by CASA to be 61 ± 1 and 11 ± 1 μm/s (straight-line velocity), respectively. Agreement among three to five technicians over 2 years was reasonable (coefficient of variation < 20%), but threshold values were variable.

Conclusion(s): Agreement within and between laboratories in the assessment of sperm motility grades could be achieved by agreeing on designated values for threshold velocities for grade a and b sperm. On the basis of such values, CASA analysis could be used to provide the expected percentages of grades a, b, and c forms for quality control samples recorded and distributed on videotapes, against which technicians could adjust their subjective assessments.     

Self-induction of abortion among women in the United States

Recent media coverage and case reports have highlighted women's attempts to end their pregnancies by self-inducing abortions in the United States. This study explored women's motivations for attempting self-induction of abortion. We surveyed women in clinic waiting rooms in Boston, San Francisco, New York, and a city in Texas to identify women who had attempted self-induction. We conducted 30 in-depth interviews and inductively analyzed the data. Median age at time of self-induction attempt was 19 years. Between 1979 and 2008, the women used a variety of methods, including medications, malta beverage, herbs, physical manipulation and, increasingly, misoprostol. Reasons to self-induce included a desire to avoid abortion clinics, obstacles to accessing clinical services, especially due to young age and financial barriers, and a preference for self-induction. The methods used were generally readily accessible but mostly ineffective and occasionally unsafe. Of the 23 with confirmed pregnancies, three reported a successful abortion not requiring clinical care. Only one reported medical complications in the United States. Most would not self-induce again and recommended clinic-based services. Efforts should be made to inform women about and improve access to clinic-based abortion services, particularly for medical abortion, which may appeal to women who are drawn to self-induction because it is natural, non-invasive and private.     

Efficacy of swim-up versus density gradient centrifugation in improving sperm deformity rate and DNA fragmentation index in semen samples from teratozoospermic patients

Purpose

To compare the efficacy of swim-up and DGC in improving sperm deformity and DNA fragmentation and to determine which method is better in teratozoospermic patients requiring artificial reproduction.

Methods

The present study compared the effects of swim-up and density gradient centrifugation (DGC), the two most commonly used semen preparation methods, on sperm deformity rate and DNA fragmentation index (DFI) in semen samples from teratozoospermic patients.

Results

The results demonstrated that both swim-up and DGC yielded a significantly lower sperm deformity rate and DFI in comparison to unprocessed whole semen, with DGC having more favorable results. Sperm deformity rate in unprocessed whole semen samples was significantly lower in the 20–29 age group than in the 40-49 age group, but no significant difference was observed in DFI between different age groups. There was no significant correlation between sperm deformity rate and DFI.

Conclusions

Our findings suggest that enrichment of sperm with normal morphology and intact DNA in teratozoospermic patients could be achieved by both DGC and swim-up procedures, and that DGC is a better method.     

Early mortality among triplets in the United States: black-white disparity

OBJECTIVE: In this study, we sought to estimate the black-white gap in early mortality among triplets. STUDY DESIGN: This was a retrospective cohort study on triplets delivered in the United States from 1995 to 1997. We computed relative risks for early mortality among triplets born to black mothers using the generalized estimating equation framework. RESULTS: There were 1317 black and 14,364 white triplets analyzed. Black triplets were twice as likely to have neonatal and infant mortality compared with whites (Odds ratio [OR], 2.00, 95% CI, 1.38-2.77; and OR, 2.20, 95% CI, 1.59-3.00, respectively). The widest disparity was observed postneonatally, with black triplets sustaining a level of risk almost 4-fold that of whites (OR, 3.60, 95% CI, 2.10-6.10). Stillbirth and perinatal mortality were comparable for both races. CONCLUSION: Black-white disparity for early mortality among triplets was widest postneonatally. This finding bears important clinical and public health implications.     

High prevalence of postpartum anemia among low-income women in the United States

OBJECTIVE: To determine the prevalence of anemia from 4 to 26 weeks post partum and to examine prenatal predictors of postpartum anemia. STUDY DESIGN: Retrospective cohort analysis of 59,428 participants in the Special Supplemental Nutrition Program for Women, Infants, and Children in 12 US states. RESULTS: The prevalence of postpartum anemia was 27%. Anemia rates were higher among minority women, reaching 48% among non-Hispanic black women. Of 9129 women who had normal hemoglobin in the third trimester, 21% had postpartum anemia. Prenatal anemia was the strongest predictor of postpartum anemia (adjusted odds ratio, 2.7; 95% confidence interval, 2.5-2.8). Maternal obesity, multiple birth, and not breast-feeding also predicted postpartum anemia. CONCLUSION: The high prevalence of post partum anemia among low-income women highlights the importance of anemia screening at 4 to 6 weeks post partum. These data suggest that screening should not be limited, as it is at present, to women considered at high risk.     

Barriers and facilitators for breastfeeding among working women in the United States

OBJECTIVE: To review the literature and describe the barriers and facilitators to the continuation of breastfeeding for at least 6 months by working women in the United States. DATA SOURCES: A search of PubMed, CINAHL, Sociological Abstracts, ISI, PsychInfo, and ProQuest. STUDY SELECTION: Twenty studies based on the inclusion criteria and published between January 1, 1995, and January 2006. DATA EXTRACTION: An ecologic framework, which includes the individual (microsystem), social support and relationships (mesosystem), and the workplace environment (exosystem). DATA SYNTHESIS: When working mothers possess certain personal characteristics and develop a strategic plan, breastfeeding is promoted. When social support is available and when support groups are utilized, lactation is also facilitated. Part-time work, lack of long mother-infant separations, supportive work environments and facilities, and child care options facilitate breastfeeding. CONCLUSIONS: Health care providers can use the findings of this review to promote breastfeeding among working women by using tactics geared toward the mother, her social network, and the entire community.     

Premature rupture of membranes and early mortality among triplets in the United States

OBJECTIVES: We investigated the relationship between premature rupture of the membranes (PROM) and early mortality among triplets in the United States. STUDY DESIGN: Analysis was conducted on matched and linked triplet sets born to mothers in the United States between 1995 and 1997. The generalized estimating equation framework was used to generate odds ratios after capturing the effects of sibling correlations within triplet clusters. RESULTS: Triplets exposed to PROM were twice as likely to experience stillbirth (OR=2.17, 95% CI [1.26-3.41]), neonatal death (OR=2.23, 95% CI [1.70-3.0]) and infant death (OR=2.21, 95% CI [1.72-2.85]), as compared to those who did not. The population-attributable risk for early mortality due to PROM was 11-12%. CONCLUSIONS: Triplets associated with PROM had a significantly higher level of early mortality than those without. Assuming a causal relationship, 11-12% of all early deaths among triplets in the United States are accounted for by PROM.     

Correlates of postmenopausal female hormone use among black women in the United States

Objective: To assess correlates of the use of postmenopausal female hormone supplements among black women.Methods: We assessed information obtained from 64,564 U.S. black women 21–69 years of age who enrolled in the Black Women's Health Study in 1995 by completing postal questionnaires. included in the present analyses were 13,352 women 40–69 years of age who had ceased menstruating. Most resided in ten states, with 66% from California, New York, Illinois, Michigan, Georgia, and New Jersey; 41.0% had completed college.Results: Among the 13,352 women 40 years of age or older who had ceased menstruating, 49.2% reported ever use of female hormone supplements and 33.3% were using them currently. Unopposed oral estrogens accounted for 63.4% of the medications being used currently. The use of supplements was highest in the western U.S. and lowest in the Northeast. The strongest correlate of use was menopause due to bilateral oophorectomy. Use peaked at 50–54 years of age and then declined, and also was associated positively with lower body mass index, greater years of education, participation in vigorous exercise, and past oral contraceptive use. Use was associated inversely with having a positive history of diabetes, heart attack, or breast cancer. Some of the drug use reported was at variance with suggested guidelines: unopposed estrogen was taken by some women who had a uterus, and estrogen together with a progestin was taken by some women who had had a hysterectomy.Conclusion: These data indicate that patterns of use of postmenopausal female hormone supplements among black women who participated in the present study are similar to those documented in white women. Women with risk factors for coronary artery disease were not more likely to use supplements than women at lower risk, a pattern that is not in accordance with suggestions that the greatest benefit of supplements may accrue to high-risk women. Because users differ from nonusers in important characteristics that may affect the incidence of coronary heart disease, breast cancer, and other illnesses, observational studies of the health effects of these medications must control carefully for correlates of use.     

Partner Support and Impact on Birth Outcomes among Teen Pregnancies in the United States

PurposeDespite hypothesized relationships between lack of partner support during a woman’s pregnancy and adverse birth outcomes, few studies have examined partner support among teens. We examined a potential proxy measure of partner support and its impact on adverse birth outcomes (low birth weight (LBW), preterm birth (PTB) and pregnancy loss) among women who have had a teenage pregnancy in the United States.MethodsIn a secondary data analysis utilizing cross-sectional data from 5609 women who experienced a teen pregnancy from the 2006-2010 National Survey of Family Growth (NSFG), we examined an alternative measure of partner support and its impact on adverse birth outcomes. Bivariate and multivariable logistic regression were used to assess differences in women who were teens at time of conception who had partner support during their pregnancy and those who did not, and their birth outcomes.ResultsEven after controlling for potential confounding factors, women with a supportive partner were 63% less likely to experience LBW [aOR: 0.37, 95% CI: (0.26-0.54)] and nearly 2 times less likely to have pregnancy loss [aOR: 0.48, 95% CI: (0.32-0.72)] compared to those with no partner support.ConclusionsHaving partner support or involvement during a teenager’s pregnancy may reduce the likelihood of having a poor birth outcome.