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in category sexual and reproductive health

199 results found. For more information, click each entry to expand.

1: Effect of SARS-CoV-2 infection upon male gonadal function: A single center-based study
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Posted 24 Mar 2020

Effect of SARS-CoV-2 infection upon male gonadal function: A single center-based study
39,509 downloads medRxiv sexual and reproductive health

Ling Ma, Wen Xie, Danyang Li, Lei Shi, Yanhong Mao, Yao Xiong, Yuanzhen Zhang, Ming Zhang

Since SARS-CoV-2 infection was first identified in December 2019, it spread rapidly and a global pandemic of COVID-19 has occurred. ACE2, the receptor for entry into the target cells by SARS-CoV-2, was found to abundantly express in testes, including spermatogonia, Leydig and Sertoli cells. However, there is no clinical evidence about whether SARS-CoV-2 infection can affect male gonadal function so far. In this study, we compared the sex-related hormones between 81 reproductive-aged men with SARS-CoV-2 infection and 100 age-matched healthy men, and found that serum luteinizing hormone (LH) was significantly increased, but the ratio of testosterone (T) to LH and the ratio of follicle stimulating hormone (FSH) to LH were dramatically decreased in males with COVID-19. Besides, multivariable regression analysis indicated that c-reactive protein (CRP) level was significantly associated with serum T:LH ratio in COVID-19 patients. This study provides the first direct evidence about the influence of medical condition of COVID-19 on male sex hormones, alerting more attention to gonadal function evaluation among patients recovered from SARS-CoV-2 infection, especially the reproductive-aged men.

2: First case of placental infection with SARS-CoV-2
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Posted 05 May 2020

First case of placental infection with SARS-CoV-2
18,891 downloads medRxiv sexual and reproductive health

Hillary Hosier, Shelli Farhadian, Raffaella Morotti, Uma Deshmukh, Alice Lu-Culligan, Katherine Campbell, Yuki Yasumoto, Chantal Vogels, Arnau Cassanovas-Massana, Pavithra Vijayakumar, Bertie Geng, Camila Odio, John Fournier, Anderson Brito, Joseph Fauver, Feimei Liu, Tara Alpert, Reshef Tal, Klara Szigeti-Buck, Sudhir Perincheri, Christopher Larsen, Aileen Gariepy, Gabriela Aguilar, Kristen Fardelmann, Malini Harigopal, Hugh Taylor, Christian Pettker, Anne Wyllie, Charles Dela Cruz, Aaron M. Ring, Nathan Grubaugh, Albert Ko, Tamas Horvath, Akiko Iwasaki, Uma Reddy, Heather Lipkind

Background: The effects of Covid-19 in pregnancy remain relatively unknown. We present a case of second trimester pregnancy with symptomatic Covid-19 complicated by severe preeclampsia and placental abruption. Methods: We analyzed placenta for the presence of SARS-CoV-2 through molecular and immunohistochemical assays and by and electron microscopy, and we measured the maternal antibody response in blood to this infection. Results: SARS-CoV-2 localized predominantly to syncytiotrophoblast cells at the maternal-fetal interface of the placenta. Histological examination of the placenta revealed a dense macrophage infiltrate, but no evidence for vasculopathy typically associated with preeclampsia. Conclusion: This case demonstrates, for the first time, SARS-CoV-2 invasion of the placenta, highlighting the potential for severe morbidity among pregnant women with Covid-19.

3: Short-term outcomes of pubertal suppression in a selected cohort of 12 to 15 year old young people with persistent gender dysphoria in the UK
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Posted 02 Dec 2020

Short-term outcomes of pubertal suppression in a selected cohort of 12 to 15 year old young people with persistent gender dysphoria in the UK
12,836 downloads medRxiv sexual and reproductive health

Polly Carmichael, Gary Butler, Una Masic, Tim J. Cole, Bianca L De Stavolta, Sarah Davidson, Elin M. Skageberg, Sophie Khadr, Russell M Viner

Background In adolescents with severe and persistent gender dysphoria (GD), gonadotropin releasing hormone analogues (GnRHa) are used from early/middle puberty with the aim of delaying irreversible and unwanted pubertal body changes. Evidence of outcomes of pubertal suppression in GD is limited. Methods We undertook an uncontrolled prospective observational study of GnRHa as monotherapy in 44 12-15 year olds with persistent and severe GD. Prespecified analyses were limited to key outcomes: bone mineral content (BMC) and bone mineral density (BMD); Child Behaviour CheckList (CBCL) total t-score; Youth Self-Report (YSR) total t-score; CBCL and YSR self-harm indices; at 12, 24 and 36 months. Semistructured interviews were conducted on GnRHa. Results 44 patients had data at 12 months follow-up, 24 at 24 months and 14 at 36 months. All had normal karyotype and endocrinology consistent with birth-registered sex. All achieved suppression of gonadotropins by 6 months. At the end of the study one ceased GnRHa and 43 (98%) elected to start cross-sex hormones. There was no change from baseline in spine BMD at 12 months nor in hip BMD at 24 and 36 months, but at 24 months lumbar spine BMC and BMD were higher than at baseline (BMC +6.0 (95% CI: 4.0, 7.9); BMD +0.05 (0.03, 0.07)). There were no changes from baseline to 12 or 24 months in CBCL or YSR total t-scores or for CBCL or YSR self-harm indices, nor for CBCL total t-score or self-harm index at 36 months. Most participants reported positive or a mixture of positive and negative life changes on GnRHa. Anticipated adverse events were common. Conclusions Overall patient experience of changes on GnRHa treatment was positive. We identified no changes in psychological function. Changes in BMD were consistent with suppression of growth. Larger and longer-term prospective studies using a range of designs are needed to more fully quantify the benefits and harms of pubertal suppression in GD.

4: Changes in Solo and Partnered Sexual Behaviors during the COVID-19 Pandemic: Findings from a U.S. Probability Survey
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Posted 11 Jun 2020

Changes in Solo and Partnered Sexual Behaviors during the COVID-19 Pandemic: Findings from a U.S. Probability Survey
10,971 downloads medRxiv sexual and reproductive health

Devon J. Hensel, Molly Rosenberg, Maya Luetke, Tsung-chieh Fu, Debby Herbenick

Background: Research demonstrates that pandemics adversely impact sexual and reproductive health (SRH), but few have examined their impact on participation in sex. We examined self-reported changes in solo and sexual behaviors in U.S. adults during early stages of the public health response to COVID-19. Methods: We conducted an online, nationally representative, cross-sectional survey of U.S. adults (N=1010; aged 18-94 years; 62% response rate) from April 10-20, 2020. We used weighted multinomial logistic regression to examine past month self-reported changes (decreased, stable or increased) in ten solo and partnered sexual behaviors. Predictor variables included: having children at home, past month depressive symptoms, (ACHA 3-item scale), past month loneliness (UCLA 3-Item Loneliness scale), COVID-19 protection behaviors (adapted 12-item scale), perceived COVID-19 consequences (adapted 10-item scale) and COVID-19 knowledge (adapted 10-item scale). Findings: Nearly half of all adults reported some kind of change, most commonly, a decrease, in their sexual behavior in the past month. Having elementary aged children at home, past month depressive symptoms and loneliness and enacting more COVID-19 protective behaviors were associated with both reduced partnered bonding behaviors, such as hugging, cuddling, holding hands and kissing, as well as reduced partnered sexual behaviors, such as oral sex, partnered genital touching and vaginal sex. Greater COVID19 risk perception and greater COVID19 knowledge were associated with mixed effects in behavior outcomes. Interpretations: Our data illustrate the very personal ways in which different pandemic-associated factors may create or inhibit opportunities for solo and partnered sex. The centrality of sexuality to health and well-being, even during pandemics, means that a critical piece of public health prevention and management responses should is ensuring that services and resource that support positive sexual decision making remain open and available.

5: Effect of COVID-19 vaccination on menstrual periods in a retrospectively recruited cohort
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Posted 15 Nov 2021

Effect of COVID-19 vaccination on menstrual periods in a retrospectively recruited cohort
8,570 downloads medRxiv sexual and reproductive health

Victoria Male

Surveillance schemes are receiving increasing numbers of reports from people who have noticed a change to their period following COVID-19 vaccination. In order to investigate this, we retrospectively recruited 1273 people who have a record of their menstrual cycle and vaccination dates and used their reports to explore hypotheses about how COVID-19 vaccination and menstrual changes could be linked. In this dataset, we were unable to detect strong signals to support the idea that COVID-19 vaccination is linked to menstrual changes. However, larger, prospectively recruited studies may be able to find associations that we were not powered to detect.

6: Factors Associated with Antenatal Care Service Utilization among Mothers with Children under five years in Sunyani Municipality, Ghana
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Posted 02 Mar 2021

Factors Associated with Antenatal Care Service Utilization among Mothers with Children under five years in Sunyani Municipality, Ghana
7,822 downloads medRxiv sexual and reproductive health

Sekyere Stephen Owusu

BackgroundMaternal and neonatal mortality remains a public health burden around the globe most especially in developing countries. A well utilized antenatal care (ANC) is however among the identified interventions to reduce this burden of maternal and neonatal mortality rates. A lot of factors therefore predispose, enable and cause mothers to identify the need to utilize this service (ANC). Aims/objectivesThe aim of this study was to determine factors associated with the utilization of ANC service among postpartum mothers in the Sunyani municipality. MethodsThis study employed descriptive cross-sectional survey design. A semi-structured questionnaire consisting of demographic profile of the respondents, their knowledge about ANC services and the level of ANC utilization. Logistic regression analysis techniques and chi-square were used for the categorical variables to examine the associations between the dependent and independent variables. Data analysis was done using the Statistical Package for Social Science software (SPSS) version 22. ResultsMajority (87%) of postpartum mothers in the Sunyani municipality attended ANC at least once during their last pregnancy of which 95.6% had four or more visits and 77.1% initiated their ANC attendance within their first trimester. It was further observed that 97.3% of the mothers had good knowledge about ANC. Marital status and ANC knowledge were found to be significantly associated with ANC attendance. Husbands were found to be poorly involved in ANC services in the Sunyani municipality. ConclusionMarital status and ANC knowledge predisposes most mothers to utilize ANC services. Hence, health education activities about ANC services and its importance should be channeled more to areas where ANC utilization is low.

7: Basic emergency Obstetric and Neonatal Care Knowledge retention and Skills of Health Professionals in Burundi following an ALARM International Program Training: A pilot study
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Posted 18 May 2020

Basic emergency Obstetric and Neonatal Care Knowledge retention and Skills of Health Professionals in Burundi following an ALARM International Program Training: A pilot study
5,675 downloads medRxiv sexual and reproductive health

Anifa Luyinga Kalay, Veronique Mareschal, Juma Ndereye, Jocelyn Cook

Background : This study describes the immediate and short-term improvement in basic emergency obstetric and neonatal care (BEmONC) knowledge and skills after ALARM International Programme (AIP) training in Burundi. Subjects and Method: In 2017, sixteen health professionals participated in a 5-day AIP training. They completed pre and post course tests. At the end of the training, they did objective structured clinical examinations (OSCE) on postpartum hemorrhage (PPH), shoulder dystocia and neonatal resuscitation.In 2018, a refresher course was offered to participants who scored the highest in the 2017 post-training test. Pre and post tests were administered.Mean pre- and post-test scores and t-paired test was performed to determine the knowledge change and retention between 2017 and 2018. Mean OSCE scores were calculated to describe acquired clinical skills at the 2017 training. A one-way ANOVA test was performed to assess the differences between cadres in the tests and the OSCEs. Results: In 2017, pre and post scores were significantly different within cadres except imidwives : physicians t(5)=8.77(p<0.05), midwives t(1)=5,29 (p=0,11) and nurses t(7)=7,91(p<0.05)A gain of 25% was observed between the scores obtained in 2017 and the ones recorded in 2018. The difference was significant (t(7)=4.80, p<0.05). Scores were significantly different between cadres in PPH [F=(2,13)=6.17 , p <0.05)] and dystocia [F=(2,13)=3.92, p <0.05)] . Conclusion: An immediate gain in knowledge and acquisition of critical skills was observed in all cadres. Knowledge significantly decreased eight months following AIP training. Supervision, mentoring of trainees and continuing medical education are needed following the initial training.

8: SARS-CoV-2 infects, replicates, elevates angiotensin II and activates immune cells in human testes
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Posted 08 Feb 2022

SARS-CoV-2 infects, replicates, elevates angiotensin II and activates immune cells in human testes
5,462 downloads medRxiv sexual and reproductive health

Guilherme M J Costa, Samyra MSN Lacerda, Andre F.A. Figueiredo, Natalia T. Wnuk, Marcos R. Brener, Gabriel H. Campolina-Silva, Andrea Kauffmann-Zeh, Lucila GG Pacifico, Alice F. Versiani, Lidia M. Andrade, Maisa M. Antunes, Fernanda R. Souza, Geovanni D. Cassali, Andre L. Caldeira-Brant, Helio Chiarini-Garcia, Vivian V. Costa, Flavio G da Fonseca, Mauricio L Nogueira, Guilherme R. F. Campos, Lucas M. Kangussu, Estefania M. N. Martins, Loudiana M. Antonio, Cintia Bittar, Paula Rahal, Renato S. Aguiar, Barbara P. Mendes, Marcela S. Procopio, Thiago P. Furtado, Yuri L Guimaraes, Gustavo B Menezes, Ana Martinez-Marchal, Miguel Brieno-Enriquez, Kyle E. Orwig, Marcelo H. Furtado

Although much has been published since the first cases of COVID-19, there remain unanswered questions regarding SARS-CoV-2 impact on testes and the potential consequences for reproductive health. We investigated testicular alterations in deceased COVID-19-patients, the precise location of the virus, its replicative activity, and the molecules involved in the pathogenesis. We found that SARS-CoV-2 testicular tropism is higher than previously thought and that reliable viral detection in the testis requires sensitive nanosensoring or RT-qPCR using a specific methodology. Macrophages and spermatogonial cells are the main SARS-CoV-2 lodging sites and where new virions form inside the Endoplasmic Reticulum Golgi Intermediate Complex. Moreover, we showed infiltrative infected monocytes migrating into the testicular parenchyma. SARS-CoV-2 maintains its replicative and infective abilities long after the patient infection, suggesting that the testes may serve as a viral sanctuary. Further, infected testes show thickening of the tunica propria, germ cell apoptosis, Sertoli cell barrier loss, evident hemorrhage, angiogenesis, Leydig cell inhibition, inflammation, and fibrosis. Finally, our findings indicate that high angiotensin II levels and activation of mast cells and macrophages may be critical for testicular pathogenesis. Importantly, our data suggest that patients who become critically ill exhibit severe damages and may harbor the active virus in testes.

9: Feasibility of Continuous Distal Body Temperature for Passive, Early Pregnancy Detection
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Posted 21 Aug 2021

Feasibility of Continuous Distal Body Temperature for Passive, Early Pregnancy Detection
5,104 downloads medRxiv sexual and reproductive health

Azure Dominique Grant, Benjamin Smarr

The majority of American women become aware of pregnancy ~3-7 weeks after conception, and all must seek testing to confirm their pregnant status. The delay between conception and awareness is often a time in which contraindicated behaviors take place. However, there is long standing evidence that passive, early pregnancy detection may be possible using body temperature. To address this possibility, we analyzed 30 individuals continuous distal body temperature (DBT) in the 180 days surrounding self-reported conception in comparison to self-reported pregnancy confirmation. Features of DBT nightly maxima changed rapidly following self-reported conception, reaching uniquely elevated values after a median of 5.5 +/- 3.5 days, whereas individuals reported a positive pregnancy test result at a median of 14.5 +/- 4.2 days. Together, we were able to generate a retrospective, hypothetical alert a median of 9 +/- 3.9 days prior to the date at which individuals received a positive pregnancy test. Continuous temperature-derived features can provide early, passive indication of pregnancy onset. We propose these features for testing and refinement in clinical settings, and for exploration in large, diverse cohorts. The development of pregnancy detection using DBT may reduce the delay from conception to awareness and increase the agency of pregnant individuals.

10: Voices from the frontline: findings from a thematic analysis of a rapid online global survey of maternal and newborn health professionals facing the COVID-19 pandemic
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Posted 11 May 2020

Voices from the frontline: findings from a thematic analysis of a rapid online global survey of maternal and newborn health professionals facing the COVID-19 pandemic
3,758 downloads medRxiv sexual and reproductive health

Aline T Semaan, Constance Audet, Elise Huysmans, Bosede B Afolabi, Bouchra Assarag, Aduragbemi Banke-Thomas, Hannah Blencowe, Severine Caluwaerts, Oona M R Campbell, Francesca L Cavallaro, Leonardo Chavane, Louise Tina Day, Alexandre Delamou, Therese Delvaux, Wendy Graham, Giorgia Gon, Peter Kascak, Mitsuaki Matsui, Sarah G Moxon, Annettee Nakimuli, Andrea B. Pembe, Emma Radovich, Thomas van den Akker, Lenka Benova

Objective To prospectively document experiences of frontline maternal and newborn healthcare providers during the COVID-19 pandemic. Design Cross-sectional study via an online survey disseminated through professional networks and social media in 12 languages. We analysed responses using descriptive statistics and qualitative thematic analysis disaggregating by low- and middle-income countries (LMICs) and high-income countries (HICs). Setting 81 countries, between March 24 and April 10, 2020. Participants 714 maternal and newborn healthcare providers. Main outcome measures Preparedness for and response to COVID-19, experiences of health workers providing care to women and newborns, and adaptations to 17 outpatient and inpatient care processes during the pandemic. Results Only one third of respondents received training on COVID-19 from their health facility and nearly all searched for information themselves. Half of respondents in LMICs received updated guidelines for care provision compared with 82% in HICs. Overall, only 47% of participants in LMICs, and 69% in HICs felt mostly or completely knowledgeable in how to care for COVID-19 maternity patients. Facility-level responses to COVID-19 (signage, screening, testing, and isolation rooms) were more common in HICs than LMICs. Globally, 90% of respondents reported somewhat or substantially higher levels of stress. There was a widespread perception of reduced use of routine maternity care services, and of modification in care processes, some of which were not evidence-based. Conclusions Substantial knowledge gaps exist in guidance on management of maternity cases with or without COVID-19. Formal information sharing channels for providers must be established and mental health support provided. Surveys of maternity care providers can help track the situation, capture innovations, and support rapid development of effective responses.

11: Early indirect impact of COVID-19 pandemic on utilization and outcomes of reproductive, maternal, newborn, child and adolescent health services in Kenya
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Posted 09 Sep 2020

Early indirect impact of COVID-19 pandemic on utilization and outcomes of reproductive, maternal, newborn, child and adolescent health services in Kenya
3,278 downloads medRxiv sexual and reproductive health

DUNCAN N SHIKUKU, Irene Nyaoke, Sylvia Gichuru, Onesmus Maina, Martin Eyinda, Pamela Godia, Lucy Nyaga, Charles Ameh

Background: The COVID-19 global pandemic is expected to result in 8.3-38.6% additional maternal deaths in many low-income countries. The objective of this paper was to determine the initial impact of COVID-19 pandemic on reproductive, maternal, newborn, child and adolescent health (RMNCAH) services in Kenya. Methods: Data for the first four months (March-June) of the pandemic and the equivalent period in 2019 were extracted from Kenya Health Information System. Two-sample test of proportions for hospital attendance for select RMNCAH services between the two periods were computed. Results: There were no differences in monthly mean ({+/-}SD) attendance between March-June 2019 vs 2020 for antenatal care (400,191.2{+/-}12,700.0 vs 384,697.3{+/-}20,838.6), hospital births (98,713.0{+/-}4,117.0 vs 99,634.5{+/-}3,215.5), family planning attendance (431,930.5{+/-}19,059.9 vs 448,168.3{+/-}31,559.8), post-abortion care (3,206.5{+/-}111.7 vs 448,168.3{+/-}31,559.8) and pentavalent 1 immunisation (114,701.0{+/-}3,701.1 vs 110,915.8{+/-}7,209.4), p>0.05. However, there were increasing trends for adolescent pregnancy rate, significant increases in FP utilization among young people (25.7% to 27.0%), injectable (short-term) FP method uptake (58.2% to 62.3%), caesarean section rate (14.6% to 15.8%), adolescent maternal deaths (6.2% to 10.9%) and fresh stillbirths (0.9% to 1.0%) with a reduction in implants (long-term) uptake (16.5% to 13.0%) (p<0.05). No significant change in maternal mortality ratio between the two periods (96.6 vs 105.8/100,000 live births, p=0.1023) although the trend was increasing. Conclusion: COVID-19 may have contributed to increased adolescent pregnancy, adolescent maternal death and stillbirth rates in Kenya. If this trend persists, recent gains achieved in maternal and perinatal health in Kenya will be lost. With uncertainty around the duration of the pandemic, strategies to mitigate against catastrophic indirect maternal health outcomes are urgently needed. Key words: COVID-19, maternal, reproductive, stillbirths, family planning, adolescent, mortality, Kenya.

12: Utilization of Family Planning and Associated Factors among Reproductive Age Women with Disability in Arba Minch , Southern Ethiopia
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Posted 06 Dec 2019

Utilization of Family Planning and Associated Factors among Reproductive Age Women with Disability in Arba Minch , Southern Ethiopia
2,711 downloads medRxiv sexual and reproductive health

Yibeltal Mesfin Yesgat, Feleke G/Meskel, Wubshet Estifanous, Yordanos Gizachew, Seid Jemal, Natneal Atnafu, Keyirden Nuriye

Introductionglobally, one type of contraceptive was used by around 63 percent of women. Women with disabilities account for 10 percent of all women and make up three-quarters of the disabled people in low and middle-income countries. Objectiveto assess utilization of family planning and associated factors among reproductive-age women with disability group in Arba Minch town, southern Ethiopia from 1st March to April 15, 2019. Methodscommunity-based cross-sectional study with simple random sampling was used to select 4l8 reproductive age women with disabilities. Data were collected using a structured questionnaire and interview by eight trained females who completed grade twelve two of which communicate by speaking and sign language. Data were entered using Epi info 7 and exported to SPSS version 20 for analysis. A statically significant variable in the final model was declared by AOR, 95%CI and p-value <0.05. Resultin the current study family planning utilization among all reproductive-age women with disabilities was 33.7%. Family planning utilization was 2.2 times higher among those who have employed compared with those with not employed (AOR2.2 95% CI, 1.77-4.15). Women who had a positive attitude were 2.3 times more likely to use family planning than negative attitudes (AOR 2.3:95% CI, 1.21- 3.87). Besides these women who got married were almost four times more likely to use family planning methods than unmarried (AOR 3.9:95% CI, 2.31-6.63). ConclusionThe level of family planning utilization was low among reproductive women with disabilities and factors associated were attitude, marital status, & employed status, therefore governmental and non-governmental organization should promote for women with disabilities to change the attitude and creating job opportunities.

13: Genetic insights into the biological mechanisms governing human ovarian ageing
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Posted 15 Jan 2021

Genetic insights into the biological mechanisms governing human ovarian ageing
2,573 downloads medRxiv sexual and reproductive health

Katherine S Ruth, Felix R. Day, Jazib Hussain, Ana Martinez-Marchal, Catherine E Aiken, Ajuna Azad, Deborah J Thompson, Hironori Abe, Jane L Tarry-Adkins, Javier Martin Gonzalez, Annique Claringbould, Olivier B. Bakker, Patrick Sulem, Sandra Turon, N. Charlotte Onland-Moret, Emil Peter Trane Hertz, Pascal N Timshel, Vallari Shukla, Rehannah Borup, Kristina W Olsen, Monica Ferrer-Roda, Yan Huang, Stasa Stankovic, Paul RHJ Timmers, Thomas U. Ahearn, Behrooz Z. Alizadeh, Elnaz Naderi, Irene L. Andrulis, Alice M Arnold, Kristan J. Aronson, Annelie Augustinsson, Stefania Bandinelli, Caterina M. Barbieri, Robin N Beaumont, Heiko Becher, Matthias W. Beckmann, Stefania Benonisdottir, Sven Bergmann, Murielle Bochud, Eric Boerwinkle, Stig E Bojesen, Manjeet K. Bolla, Dorret I. Boomsma, Nicholas Bowker, Jennifer A. Brody, Linda Broer, Julie E Buring, Archie Campbell, Harry Campbell, Jose E. Castelao, Eulalia Catamo, Stephen J. Chanock, Georgia Chenevix-Trench, Marina Ciullo, Tanguy Corre, Fergus J. Couch, Angela Cox, Simon S. Cross, Francesco Cucca, Kamila Czene, George Davey-Smith, Eco JCN de Geus, Renee de Mutsert, Immaculata De Vivo, Ellen W Demerath, Joe Dennis, Alison M Dunning, Miriam Dwek, Mikael Eriksson, Tonu Esko, Peter A. Fasching, Jessica D. Faul, Luigi Ferrucci, Nora Franceschini, Timothy M. Frayling, Manuela Gago-Dominguez, Massimo Mezzavilla, Montserrat Garcia-Closas, Christian Gieger, Graham G Giles, Harald Grallert, Daniel F. Gudbjartsson, Vilmundur Gudnason, Pascal Guenel, Christopher A. Haiman, Niclas Hakansson, Per Hall, Caroline Hayward, Chunyan He, Wei He, Gerardo Heiss, Miya K Hoffding, John L Hopper, Jouke J. Hottenga, Frank Hu, David Hunter, Mohammad A Ikram, Rebecca D Jackson, Micaella DR Joaquim, Esther M. John, Peter K. Joshi, David Karasik, Sharon LR Kardia, Robert Karlsson, Cari M. Kitahara, Ivana Kolcic, Charles Kooperberg, Peter Kraft, Allison W. Kurian, Zoltan Kutalik, Martina La Bianca, Genevieve LaChance, Claudia Langenberg, Lenore J Launer, Joop S.E. Laven, Deborah A Lawlor, Loic Le Marchand, Jingmei Li, Annika Lindblom, Sara Lindstrom, Tricia Lindstrom, Martha Linet, YongMei Liu, Simin Liu, Jianan Luan, Reedik Magi, Patrik K.E. Magnusson, Massimo Mangino, Arto Mannermaa, Brumat Marco, Jonathan Marten, Nicholas G Martin, Hamdi Mbarek, Barbara McKnight, Sarah E. Medland, Christa Meisinger, Thomas Meitinger, Christina Menni, Andres Metspalu, Lili Milani, Roger L Milne, Grant W Montgomery, Dennis O Mook- Kanamori, Antonella Mulas, Anna M. Mulligan, Alison E Murray, Mike A Nalls, Anne Newman, Raymond Noordam, Teresa Nutile, Dale R Nyholt, Andrew F Olshan, Hakan Olsson, Jodie N Painter, Alpa V Patel, Nancy L. Pedersen, Natalia Perjakova, Annette Peters, Ulrike Peters, Paul DP. Pharoah, Ozren Polasek, Eleonora Porcu, Bruce M Psaty, Iffat Rahman, Gad Rennert, Hedy S. Rennert, Paul M Ridker, Susan M. Ring, Antonietta Robino, Lynda M. Rose, Frits Richard Rosendaal, Jacques Rossouw, Igor Rudan, Rico Rueedi, Daniela Ruggiero, Cinzia F Sala, Emmanouil Saloustros, Dale P Sandler, Serena Sanna, Elinor J. Sawyer, Chloe Sarnowski, David Schlessinger, Marjanka K. Schmidt, Minouk J. Schoemaker, Katharina E Schraut, Christopher Scott, Saleh Shekari, Amruta Shrikhande, Albert V Smith, Blair H. Smith, Jennifer A. Smith, Rossella Sorice, Melissa C Southey, Tim D. Spector, John J. Spinelli, Meir Stampfer, Doris Stockl, Joyce B.J. van Meurs, Konstantin Strauch, Unnur Styrkarsdottir, Anthony J. Swerdlow, Toshiko Tanaka, Lauren R Teras, Alexander Teumer, Unnur Thorsteinsdottir, Nicholas J. Timpson, Daniela Toniolo, Michela Traglia, Melissa A Troester, Therese Truong, Jessica Tyrrell, Andre G Uitterlinden, Sheila Ulivi, Celine M. Vachon, Veronique Vitart, Uwe Völker, Peter Vollenweider, Henry Volzke, Qin Wang, Nicholas J Wareham, Clarice R. Weinberg, David R. Weir, Amber N. Wilcox, Ko Willems van Dijk, Gonneke Willemsen, James F Wilson, Bruce HR Wolffenbuttel, Alicja Wolk, Andrew R Wood, Wei Zhao, Marek Zygmunt, Biobank-based Integrative Omics Study (BIOS) Consortium, eQTLGen Consortium, kConFab Investigators, The LifeLines Cohort Study, The InterAct consortium, Lude Franke, Stephen Burgess, Patrick Deelen, Tune H Pers, Marie Louise Grondahl, Claus Yding Andersen, Anna Pujol, Andres J Lopez-Contreras, Jeremy A Daniel, Kari Stefansson, Jenny Chang-Claude, Yvonne T. van der Schouw, Kathyrn L Lunetta, Daniel I Chasman, Douglas F. Easton, Jenny A Visser, Susan E Ozanne, Satoshi H Namekawa, Joanne M Murabito, Ken K Ong, Eva R. Hoffmann, Anna Murray, Ignasi Roig, John R.B. Perry

Reproductive longevity is critical for fertility and impacts healthy ageing in women, yet insights into the underlying biological mechanisms and treatments to preserve it are limited. Here, we identify 290 genetic determinants of ovarian ageing, assessed using normal variation in age at natural menopause (ANM) in ~200,000 women of European ancestry. These common alleles influence clinical extremes of ANM; women in the top 1% of genetic susceptibility have an equivalent risk of premature ovarian insufficiency to those carrying monogenic FMR1 premutations. Identified loci implicate a broad range of DNA damage response (DDR) processes and include loss-of-function variants in key DDR genes. Integration with experimental models demonstrates that these DDR processes act across the life-course to shape the ovarian reserve and its rate of depletion. Furthermore, we demonstrate that experimental manipulation of DDR pathways highlighted by human genetics increase fertility and extend reproductive life in mice. Causal inference analyses using the identified genetic variants indicates that extending reproductive life in women improves bone health and reduces risk of type 2 diabetes, but increases risks of hormone-sensitive cancers. These findings provide insight into the mechanisms governing ovarian ageing, when they act across the life-course, and how they might be targeted by therapeutic approaches to extend fertility and prevent disease.

14: Knowledge and practices related to menstruation among Lucknow college students in North India: results from cross-sectional survey
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Posted 15 Feb 2021

Knowledge and practices related to menstruation among Lucknow college students in North India: results from cross-sectional survey
2,440 downloads medRxiv sexual and reproductive health

Absar Ahmad, Surbhi G. Garg, Suman Gupta, Ruqayya Alvi

BackgroundGirls in many low and middle-income countries enter puberty with knowledge gaps and misconceptions about menstruation may lead to unsafe hygienic practices that increase health risk. Despite such importance, educated girls knowledge and hygienic practice towards menstruation are not well addressed in India. Consequently, the present study attempted to assess menstrual hygiene knowledge and practice among college students in Lucknow city in north India. MethodAn online college-based cross-sectional study design was employed in Lucknow, the capital of Uttar Pradesh in India. Data collection was carried out from September 11 to September 25, 2020, using a google form among undergraduate and Postgraduate students. All variables that were significant at bivariate level (at P-value < 0.05) were entered into multivariate analysis using a logistic regression model to control for confounding factors. In the final model, P-value of less than 0.05 was used as a base to identify factors having a statistically significant association with poor knowledge and hygiene practice at corresponding 95% confidence interval. ResultsMore than half of students ages of menarche were between 12-15 years, and duration of menses flow was between 3-5 days. The most common premenstrual symptom was abdominal pain (67%) and back pain (50.5%). Majority of the students had first time discussed menstrual problems with their mothers (69.2%). Around 94% of students were currently using a sanitary pad as an absorbent. Regarding cleanliness, about (90.9%) girls clean their genitals after urinating during mensuration. Around 18.9% used medication during menstruation. Multivariate analyses reveal that students of Science and Technology (vs Commerce and Management Students) and monthly family income 50-100 thousand (vs < 25 thousands) were associated with good knowledge about menstruation. In contrast, students fathers were graduates (vs school educated); the occupation was Other(vs Farmer); living in a nuclear family(vs Joint family) and residing in urban areas(vs Rural) were less likely to have good menstruation knowledge. Besides, good hygiene practices are less likely to have with Other Religion(vs Hindu), working mother(vs Housewife), monthly family income between 25 to 50 thousand(vs <25 thousands), and Nuclear family(vs Joint family) (p<0.05). ConclusionsMost college students had poor knowledge but followed hygienic practices correctly. It demonstrates a need to design acceptable awareness creation and advocacy programs to improve college students knowledge during menstruation. Of all the sociodemographic factors, monthly income and types of family influenced students knowledge and practices related to menstruation.

15: A prospective double-blinded non-selection trial of reproductive outcomes and chromosomal normalcy of newborns derived from putative low/moderate-degree mosaic IVF embryos
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Posted 08 Feb 2021

A prospective double-blinded non-selection trial of reproductive outcomes and chromosomal normalcy of newborns derived from putative low/moderate-degree mosaic IVF embryos
2,390 downloads medRxiv sexual and reproductive health

Antonio Capalbo, Maurizio Poli, Laura Francesca Rienzi, Laura Girardi, Danilo Cimadomo, Francesca Benini, Alessio Farcomeni, Juliana Cuzzi, Carmen Rubio, Elena Albani, Laura Sacchi, Alberto Vaiarelli, Ivan Vogel, Eva R. Hoffmann, Claudia Livi, Paolo Emanuele Levi Setti, Filippo Maria Ubaldi, Carlos Simon

Background Next generation sequencing (NGS) has increased detection sensitivity of intermediate chromosome copy number variations (CNV) consistent with chromosomal mosaicism. Recently, this methodology has found application in preimplantation genetic testing (PGT) of trophectoderm (TE) biopsies collected from IVF-generated human embryos. As a consequence, the detection rate of intermediate CNV states in IVF embryos has drastically increased, posing questions about the accuracy in identifying genuine mosaicism in highly heterogeneous biological specimens. The association between analytical values consistent with mosaicism and the reproductive potential of the embryo, as well as newborn's chromosomal normalcy, have not yet been thoroughly determined. Methods We conducted a multicentre, double-blinded, non-selection trial including 1,190 patients undergoing in a total of 1,337 IVF with preimplantation genetic testing for aneuploidies (PGT-A) treatment cycles. NGS was performed on clinical TE biopsies collected from blastocyst-stage embryos. All embryos were reported as euploid if all autosomes had a chromosomal copy number value below the threshold of 50% abnormal cells per sample. After embryo transfer, three comparative classes were analysed: uniformly euploid profiles (<20% aneuploid cells), putative low-degree mosaicism (20%-30% aneuploid cells) or putative moderate-degree mosaicism (30%-50% aneuploid cells). Primary outcome measure was live birth rate (LBR) per transfer and newborn's karyotype. Results LBR after transfer of uniformly euploid embryos, low-degree, and moderate-degree mosaic embryos were 43.4% (95% C.I. 38.9 - 47.9), 42.9% (95% C.I. 37.1 - 48.9) and 42% (95% C.I. 33.4 - 50.9), respectively. No difference was detected for this primary outcome between euploid and mosaic low/moderate categories (OR= 0.96; 95% CI 0.743 to 1.263; P=0.816). The non-inferiority endpoint was met as the confidence interval for the difference fell below the planned 7.5% margin (95% C.I. -5.7 - 7.3). Likewise, no statistically significant difference was observed comparing moderate versus low degree mosaic embryos (P=0.92). Neonatal karyotypes were also similar and no instances of mosaicism or uniparental disomies (UPDs) were detected in babies born following putative low or moderate-degree mosaic embryo transfer. Should the embryos with low or moderate-degree mosaic TE biopsies had been classified as chromosomally abnormal and thus discarded for clinical use, LBR per cycle would have decreased by 36% without any clinical benefit. Conclusions This prospective non-selection trial provides substantial evidence that reporting and/or not transferring embryos with low/moderate-degree mosaicism for whole chromosomes have no clinical utility. Moreover, dismissing these embryos from clinical use has the counterproductive effect of reducing overall embryo availability, thus reducing the chance of successful outcome derived from an IVF treatment without any clinical benefit. (Funded by Igenomix; ClinicalTrials.gov number, NCT03673592)

16: Unmasking Seasonal Cycles in Human Fertility: How holiday sex and fertility cycles shape birth seasonality
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Posted 19 Nov 2020

Unmasking Seasonal Cycles in Human Fertility: How holiday sex and fertility cycles shape birth seasonality
2,190 downloads medRxiv sexual and reproductive health

Laura Symul, Peggy Hsieh, Amanda Shea, Claudia Roberta de Castro Moreno, Debra Skene, Susan P Holmes, Micaela E Martinez

The mechanisms of human birth seasonality have been debated for over 150 years1. In particular, the question of whether sexual activity or fertility variations drive birth seasonality has remained open and challenging to test without large-scale data on sexual activity 2,3. Analyzing data from half-a-million users worldwide collected from the female health tracking app Clue combined with birth records, we inferred that birth seasonality is primarily driven by seasonal fertility, yet increased sexual activity around holidays explains minor peaks in the birth curve. Our data came from locations in the Northern Hemisphere (UK, US, and France) and the Southern Hemisphere (Brazil). We found that fertility peaks between the autumn equinox and winter solstice in the Northern Hemisphere locations and shortly following the winter solstice in the Southern Hemisphere locations.

17: Love during lockdown: findings from an online survey examining the impact of COVID-19 on the sexual practices of people living in Australia
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Posted 12 Aug 2020

Love during lockdown: findings from an online survey examining the impact of COVID-19 on the sexual practices of people living in Australia
2,083 downloads medRxiv sexual and reproductive health

Jacqueline Coombe, Fabian Kong, Helen Bittleston, Hennie Williams, Jane Tomnay, Alaina Vaisey, Sue Malta, Jane Goller, Meredith Temple-Smith, Louise Bourchier, Andrew Lau, Eric Chow, Jane S Hocking

Introduction: Australia recorded its first case of COVID-19 in late January 2020. On 22 March 2020, amid increasing daily case numbers, the Australian Government implemented lockdown restrictions to help flatten the curve. Our study aimed to understand the impact of lockdown restrictions on sexual and reproductive health. Here we focus on sexual practices. Methods: An online survey was open from the 23 April 2020 to the 11 May 2020. Participants were recruited online via social media and other networks and were asked to report on their sexual practices in 2019 and during lockdown. Logistic regression was used to calculate the difference (including 95% confidence intervals) in the proportion of sex practices between time periods. Results: Of the 1187 who commenced the survey, 965 (81.3%) completed it. Overall 70% were female and 66.3% were aged 18 to 29 years. Most (53.5%) reported less sex during lockdown than in 2019. Compared with 2019, participants were more likely to report sex with a spouse (35.3% vs 41.7%; difference=6.4%; 95%CI: 3.6, 9.2) and less likely to report sex with a girl/boyfriend (45.1% vs 41.8%; diff=-3.3%; 95%CI: -7.0, -0.4) or with casual hook-up (31.4% vs 7.8%; 95%CI:-26.9, -19.8). Solo sex activities increased, 14.6% (123/840) reported using sex toys more often and 26.0% (218/838) reported masturbating more often. Dating app use decreased during lockdown compared with 2019 (42.1% vs 27.3%; difference= -14.8%; 95%CI: -17.6, -11.9). Using dating apps for chatting/texting (89.8% vs 94.5%; diff=4.7%; 95%CI:1.0, 8.5) and for setting up virtual dates (2.6% vs 17.2%; diff=14.6%; 95%CI:10.1, 19.2) increased during lockdown. Conclusion: Although significant declines in sexual activity during lockdown were reported, people did not completely stop engaging in sexual activities during the pandemic, highlighting the importance of ensuring availability of normal sexual and reproductive health services during global emergencies.

18: Knowledge, attitudes, and perceptions of long-acting reversible contraceptive (LARC) methods among healthcare workers in sub-Saharan Africa: a systematic review and meta-analysis
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Posted 28 Oct 2020

Knowledge, attitudes, and perceptions of long-acting reversible contraceptive (LARC) methods among healthcare workers in sub-Saharan Africa: a systematic review and meta-analysis
1,981 downloads medRxiv sexual and reproductive health

Laura Rouncivell, Simbarashe Takuva, Neo Ledibane, Alfred Musekiwa, Trudy Leong

Objective: To assess the knowledge, attitudes, and perceptions (KAP) of long-acting reversible contraceptive (LARC) methods among healthcare workers (HCW's) in sub-Saharan Africa (SSA). Methods: A systematic review and meta-analysis were conducted following the PRISMA methodology. Two authors independently searched three electronic databases for studies published between 2000 and January 2020 reporting on the KAP of LARC methods among HCW's in SSA. Titles and abstracts were screened against eligibility criteria, data were extracted and the included studies were assessed for risk of bias. A meta-analysis of proportions for 11 pre-determined questions relating to LARC KAP was performed. Heterogeneity was explored using the I2-statistic and publication bias investigated using funnel plots and Egger's tests. Results: Twenty-two studies comprising of 11 272 HCW's from 11 SSA countries were included. Forty-one percent (95% CI: 20%, 61%) of HCWs had received intrauterine contraceptive device (IUCD) insertion training while 63% (95% CI: 44%, 81%) expressed a desire for training. Only 27% (95% CI: 18%, 36%) deemed IUCD appropriate for HIV-infected women. Restrictions for IUCD and injectables based on a minimum age were imposed by 56% (95% CI: 33%, 78%) and 60% (95% CI: 36%, 84%), respectively. Minimum parity restrictions were observed among 29% (95% CI: 9%, 50%) of HCW's for IUCDs and 36% (95% CI: 16%, 56%) for injectable contraceptives. Heterogeneity was high and publication bias was present in two of the 11 questions. Conclusion: The systematic review and meta-analysis indicate that unnecessary provider-imposed restrictions may hinder the uptake of LARC methods by women in SSA.

19: The impact of COVID-19 infection on maternal and reproductive health care services in governmental health institutions of Dessie town, North-East Ethiopia, 2020 G.C.
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Posted 23 Sep 2020

The impact of COVID-19 infection on maternal and reproductive health care services in governmental health institutions of Dessie town, North-East Ethiopia, 2020 G.C.
1,953 downloads medRxiv sexual and reproductive health

Kibir Temesgen Assefa, Amare Workie Gashu, Tenagnework Dilnessa Mulualem

Background: The COVID 19 pandemic is causing huge stress on the health care system of all countries in the world. The impact of the pandemic is both social and economic. Pregnancy is an exciting and sometimes stressful experience. Being pregnant during a disease outbreak may add extra anxiety and concern for pregnant women and for those who provide care for them [1, 2]. During the initial stages of the pandemic, it appeared Africa would be spared the burden of COVID-19. However, by April 7th, a total of 45 countries within the WHO African region had reported over 7000 cases (although some place it at over 10 000), with at least 292 deaths and 612 people recovered. Ethiopia, being one of the developing countries trying to address the diverse needs of its people, is currently at the verge of the epidemic [5, 7]. Objectives: The general objective of this study was to assess the impact of COVID-19 infection on maternal and reproductive health care services among mothers getting service in governmental health institutions of Dessie town, 2020 G.C. Methods: Institution based cross sectional study design using mixed (quantitative supplemented with qualitative) method was employed to identify the impact of COVID-19 infection on maternal and reproductive health care services among women who get service in governmental health institutions of Dessie town. The study was conducted from July 1-15 / 2020. Result: According to this study, Six percent (6%) of antenatal care attendees, 18% of delivery care attendees and nearly half (46.7%) of postnatal care attendees reported inappropriate service delivery due to fear of health care providers, shortage medical supplies and staff work load. The study also showed that utilization of these services was decreased due to fear of clients to go to health institutions. Conclusion and recommendation: This study concluded that COVID-19 significantly affects the quality and utilization of maternal and reproductive health care services. The study also showed that utilization of these services was decreased due to fear of clients to go to health institutions. Ministry of health should continue maternity and reproductive health care services such as family planning to be prioritized as an essential core health service. Key words: COVID-19, impact, antenatal care, Dessie

20: Intermittent Lactobacilli-containing Vaginal Probiotic or Metronidazole Use to Prevent Bacterial Vaginosis Recurrence: Safety and Preliminary Efficacy by Microscopy and Sequencing
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Posted 08 Jul 2019

Intermittent Lactobacilli-containing Vaginal Probiotic or Metronidazole Use to Prevent Bacterial Vaginosis Recurrence: Safety and Preliminary Efficacy by Microscopy and Sequencing
1,388 downloads medRxiv sexual and reproductive health

Janneke H.H.M van de Wijgert, Marijn C. Verwijs, Stephen K. Agaba, Christina Bronowski, Lambert Mwambarangwe, Mireille Uwineza, Elke Lievens, Adrien Nivoliez, Jacques Ravel, Alistair C Darby

Bacterial vaginosis (BV) is associated with HIV acquisition and adverse pregnancy outcomes. Recurrence after metronidazole treatment is high. HIV-negative, non-pregnant Rwandan BV patients were randomized to four groups (n=17/group) after seven-day oral metronidazole treatment: behavioral counseling only (control), or counseling plus intermittent use of oral metronidazole, Ecologic Femi+ vaginal capsule (containing multiple Lactobacillus and one Bifidobacterium species), or Gynophilus LP vaginal tablet (L. rhamnosus 35) for two months. Vaginal microbiota assessments at all visits included Gram stain Nugent scoring and 16S rRNA gene qPCR and HiSeq sequencing. All interventions were safe. BV (Nugent 7-10) incidence was 10.18 per person-year at risk in the control group, and lower in the metronidazole (1.41/person-year; p=0.004), Ecologic Femi+ (3.58/person-year; p=0.043), and Gynophilus LP groups (5.36/person-year; p=0.220). In mixed effects models adjusted for hormonal contraception/pregnancy, sexual risk-taking, and age, metronidazole and Ecologic Femi+ users, each compared to controls, had higher Lactobacillus and lower BV-anaerobes concentrations and/or relative abundances, and were less likely to have a dysbiotic vaginal microbiota type by sequencing. Inter-individual variability was high and effects disappeared soon after intervention cessation. Lactobacilli-based vaginal probiotics warrant further evaluation because, in contrast to antibiotics, they are not expected to negatively affect microbiota or cause antimicrobial resistance.

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