Surveying the persistence of age- and gender-based restrictions on over-the-counter emergency contraception across pharmacies in Los Angeles County, CA.

BACKGROUND: Over-the-counter levonorgestrel emergency contraception (OTC EC) is safe and effective but underutilized for postcoital pregnancy prevention. Unnecessary restrictions imposed by pharmacies and pharmacy workers may impede EC uptake. OBJECTIVE: To assess the persistence of age- and gender-based barriers to OTC EC access among pharmacists and pharmacy staff across Los Angeles, CA. METHODS: We conducted a cross-sectional survey of registered community pharmacies randomly chosen from regions with the highest unintended pregnancy rates in Los Angeles County. Using an adaptation of the 2017 American Society for Emergency Contraception EC Access and Price Survey, we interviewed pharmacy staff about their attitudes and practices related to OTC EC, with attention to age- and gender-based barriers. RESULTS: We surveyed 139 staff members (45% pharmacists, 20% technicians, 26% retail) from 93 publicly accessible pharmacies. Thirteen pharmacies did not stock EC. Half of respondents cited age-based restrictions; only 4% noted gender-based restrictions. More than 75% reported being asked for EC by a man; 7% reported refusing to sell to a man. Nearly 40% reported that men never or rarely purchased EC. Pharmacists were more likely than technicians or retail staff to believe men rarely purchased EC (P = 0.01). The most frequently cited concern about selling to men was inability to confirm the female partner's age. CONCLUSION: Although gender-based restrictions to EC are rare, more than half of pharmacy staff continue to report age-based restrictions. Inability to verify the female partner's age may underlie cases where men are unable to purchase OTC EC.

Gender bias in the medical education of obstetrician-gynaecologists in the United States: A systematic review.

BACKGROUND: The number of men entering obstetrics and gynaecology (Ob/Gyn) residencies and general Ob/Gyn practice is decreasing. Gender biases against their participation may affect career decisions. OBJECTIVE: This systematic review examines: (i) female patients' gender preferences and perceptions of men as Ob/Gyns and/or medical students; and (ii) the influence of gender on students' education and career decisions. SEARCH STRATEGY: We identified relevant research via PubMed using variations of three concepts in combination: Ob/Gyn care, gender bias/preference, and medical education or career. We conducted the initial review in 2018 and repeated the search in March 2021, adding additional references via citation review of included research. SELECTION CRITERIA: We restricted the review to original research from the United States between 2000-2021. DATA COLLECTION: Fifteen studies met inclusion criteria, categorised into three groups: (i) patient's gender preference for Ob/Gyns; (ii) patient's gender preference for medical students during the Ob/Gyn clerkship; and (iii) influence of gender bias on Ob/Gyn career decisions. MAIN RESULTS: Patients prioritised their physician's care attributes (eg technical skill, compassion, experience) over gender when choosing Ob/Gyns; however, provider gender was prioritised for medical students. Male medical students more commonly reported exclusion from clinical opportunities, although objective clinical exposure was like that of female counterparts. Despite perceived gender bias, male medical students reported increased Ob/Gyn interest post-clerkship; interest did not translate into residency applications. These findings are limited by study quality and heterogeneity. CONCLUSIONS: Real and perceived gender bias among female patients and male medical students in Ob/Gyn may underlie declining numbers of men entering the field.

Vasectomy: An Opportunity for Obstetricians and Gynecologists.

Vasectomy is a safe, effective, and cost-effective contraceptive method, with a failure rate lower than that of female sterilization. Nevertheless, vasectomy is underutilized-only 6% of American women rely on vasectomy. Access to vasectomy may be limited by provider advocacy and availability. Obstetricians and gynecologists can increase both the acceptability of and access to this method if adequately trained to counsel about and provide the procedure. Although some concerns may persist surrounding obstetricians and gynecologists performing a vasectomy, increasing the availability and uptake of vasectomy avoids unnecessary surgical risks for female patients and promotes reproductive justice via shared contraceptive responsibility.

Advanced paternal age and the risk of spontaneous abortion: an analysis of the combined 2011-2013 and 2013-2015 National Survey of Family Growth.

BACKGROUND: Maternal and paternal age at first birth are increasing across the global population. Spontaneous abortion, one of the most common abnormal pregnancy outcomes, is known to occur more frequently with increasing maternal age. However, the relationship of advanced paternal age and spontaneous abortion is poorly understood, and previous results have yielded conflicting results. OBJECTIVE: To examine the influence of paternal age on the risk of spontaneous abortion among singleton pregnancies conceived without assisted reproductive technologies. MATERIALS AND METHODS: This was a retrospective, case-control study using combined pregnancy data from the Centers for Disease Control and Prevention's 2011-2013 and 2013-2015 National Survey of Family Growth. Spontaneous, singleton pregnancy data from women aged 15-45 years were analyzed. Ongoing pregnancies, induced abortions, ectopic pregnancies, preterm births, and intrauterine fetal deaths were excluded. Bivariate associations of pregnancy outcome (spontaneous abortion at <20 weeks and ≤12 weeks vs. live birth at ≥37 weeks) and paternal age were determined, along with those of maternal age and selected demographic and pregnancy characteristics. Significant associations were included in a multivariable logistic regression, which accounted for multiple pregnancies derived from the same respondent. RESULTS: A total of 12,710 pregnancies from 6979 women were analyzed, consisting of 2300 (18.2%) spontaneous abortions and 10,410 (81.8%) term live births. Median maternal and paternal ages were 25 and 28 years, respectively. After adjusting for maternal age, race/ethnicity, socioeconomic status, marital status, and pregnancy intention, pregnancies resulting in spontaneous abortions had 2.05 (95% confidence interval, 1.06-2.20) times the odds of being from a father aged 50 years or older, vs. 25-29 years of age. These relationships remained significant when defining SABs at ≤12 weeks (adjusted odds ratio, 2.30; 95% confidence interval, 1.17-4.52). CONCLUSION: Paternal age may increase the odds of spontaneous abortion, independent of selected factors, including demographics, pregnancy intention, and maternal age. This association was robust across several gestational age-based definitions of spontaneous abortion, even after adjustment.

Localizing Perturbations of the Racemic Equilibria Involving Dipicolinate-Derived Lanthanide(III) Complexes.

Helical D3 tris(4-amino-2,6-pyridine-dicarboxylate)terbium(III) and europium(III) complexes, which form a racemic equilibrium in aqueous solution, were prepared to study their secondary coordination sphere interactions with chiral amino acids. These interactions were probed using a combination of circularly polarized luminescence (CPL) and 13C NMR spectroscopy. The results indicate that, regardless of the interaction between the chiral molecule and the complex, without an accessible hydrogen-bond donor on the associating molecule, perturbation of the racemic equilibrium cannot occur. A generalized conclusion is established that indicates that the mechanism of chiral recognition by tris(dipicolinate)lanthanide(III) complexes is similar across a variety of analogous ligands.

The demand for male contraception: Estimating the potential market for users of novel male contraceptive methods using United States National Survey of Family Growth data.

OBJECTIVE: To estimate the potential market for novel male contraceptives (NMCs) using United States National Survey of Family Growth (NSFG) data, 2015-2017. STUDY DESIGN: We described the market for NMCs via secondary analysis of the 2015-2017 NSFG's weighted male respondent data, utilizing surrogate markers for contraceptive switching (NSFG) and contraceptive discontinuation data from the Contraceptive CHOICE project. Potential NMC users included men relying on: (1) no methods or less effective methods but who reported that they would be "very upset" if they got someone pregnant, (2) permanent methods but who reported that they might still want more children, (3) a female partner's method that she might discontinue in the next year, (4) a male method even when his partner uses her own contraceptive. RESULTS: Of 3340 respondents-representing 55,890,830 sexually active, reproductive-age men-23.2% used no contraception at last intercourse, 15.8% condoms, 5.1% withdrawal, and 5.1% vasectomy. Among respondents relying solely on condoms, withdrawal, or no method, 19.7%, 3.8%, and 4.4% would be "very upset" if they got someone pregnant. For permanent contraceptive users, 17.3%-20.5% wanted another child. For men reliant on their partner's long-acting reversible or combined hormonal contraceptive, 12-17% and 45-51% of partners might discontinue their method. These data conservatively suggest that 13% or more than 7 million men would potentially use NMCs, rising to 15.5 million with less restrictive contraceptive switching criteria. CONCLUSION: Adjusting for pregnancy attitudes and likelihood of contraceptive switching, a substantial portion (between 7-15.5 million) of reproductive age men in the US are potential NMC users. IMPLICATIONS: The population of potential novel male contraceptive users extends beyond just users of condoms, withdrawal and vasectomy and should include couples practicing dual-partner contraception and female partners using contraceptive methods that they may become dissatisfied with and discontinue.

Male contraceptive acceptability versus male acceptance of contraceptive responsibility.

Despite the projected impact of new male contraceptives, resources and investments directed at their development remain limited in part due to concerns that men would not actually use them. Now, more than 30 studies have been conducted over the last 30 years-regionally and internationally, within clinical trials, and across populations-examining men and women's attitudes towards new male contraceptive methods, all consistently demonstrating interest in and willingness to use new methods. Yet even these studies, inclusive of competitive contraceptive market projections, seem not to be convincing enough. Rather than study whether men would be willing to use male contraceptives, more resources should be devoted to developing the infrastructure and supporting the cultural changes needed to ensure that when new male contraceptives inevitably emerge, that they will be disseminated quickly and made readily accessible. Men's views on what their roles are in society, families, relationships, and pregnancy prevention are changing in ways that may impact what they consider to be acceptable contraceptive risks. As society moves toward more gender equitable beliefs, men's positive involvement in contraception might organically develop into an expected behavior. Interventions aimed at sensitizing men toward gender equitable beliefs may pay dividends in improving male contraceptive acceptability. The current lack of a reversible male contraceptive method prevents us from collecting data that might disprove presumptions that men would be unwilling to take on responsibility for pregnancy prevention. However, studies of men's involvement in (1) over-the-counter emergency contraception, (2) vasectomy, and (3) abortion offer case studies for men's increasing consciousness of opportunities for shared contraceptive responsibility, the structural and sociopolitical barriers that men face when trying to participate in family planning, and how these might translate into new male contraceptive interest and development.

Microscopic ferning in human pre-ejaculate is highly correlated with the absence of sperm.

OBJECTIVE: We characterize microscopic ferning in pre-ejaculate samples with and without sperm. STUDY DESIGN: Healthy, male, withdrawal-experienced participants provided up to three paired pre-ejaculate and ejaculate samples. We centrifuged ejaculate samples to obtain a supernatant without sperm. After sperm analysis, we dried and evaluated pre-ejaculate, ejaculate, and supernatants for microscopic ferning. RESULTS: Of 57 pre-ejaculate samples (N = 24 men), seven (12.3%) contained sperm, none of which exhibited ferning. Sixty-six percent (33/50) of pre-ejaculate samples without sperm exhibited ferning. Neither ejaculate nor supernatant samples exhibited ferning. CONCLUSION: Ferning may distinguish clinical pre-ejaculate with and without sperm. Ferning exhibited 100% specificity for pre-ejaculate without sperm.

Low to non-existent sperm content of pre-ejaculate in perfect-use contraceptive withdrawal, a pilot study.

OBJECTIVE: To assess pregnancy risk following perfect use of the withdrawal method by quantification of sperm in pre-ejaculate. STUDY DESIGN: We conducted a pilot study of sperm and factors linked to its presence in pre-ejaculate samples among healthy, reproductive-age, withdrawal-experienced men. Participants provided up to three paired pre-ejaculate and ejaculate specimens in 72-hour intervals. We analyzed samples for volume, consistency, sperm concentration, count, and motility. We set clinical pregnancy risk as our primary outcome, defined as sperm concentration >1million/mL. RESULTS: From 70 paired samples (N = 24 participants, median age: 27 years), we identified sperm in nine (12.9%) pre-ejaculate samples, from six (25.0%) participants. Only seven samples contained sperm in concentrations of significant clinical pregnancy risk. All ejaculatory specimens contained motile sperm in concentrations of significant pregnancy risk. CONCLUSION: In this study of the pre-ejaculate of perfect-use withdrawal users, motile sperm were usually absent, or found inconsistently and in insufficient quantities to confer significant clinical pregnancy risk. IMPLICATIONS: While correct and consistent withdrawal use is likely to be highly effective, given that motile sperm in concentrations >1 million/mL are usually absent or inconsistently present in pre-ejaculate, clinical trial data is lacking.

The association between gynecologic healthcare providers' sexual health and their comfort discussing their patients' sexual function.

OBJECTIVE: Stigma surrounding discussions of sexuality can prevent patients from discussing sexual health issues with their healthcare providers. Clinicians may also experience similar stigma, compounding the problem if also reticent to assess their patients' sexual health. We explored the association of healthcare providers' personal sexual experience and health with their comfort with and frequency of optimizing their patients' sexual function and satisfaction. METHODS: We conducted an anonymous online survey of gynecologic care providers and their comfort with and frequency of addressing their patients' sexual function. Covariates examined via bivariate analysis included: socio-demographics, training level, prior sexual experiences and education, history of sexual trauma, and current sexual problems and satisfaction. RESULTS: Most respondents (N = 189) identified as sexually active (82.5 %), heterosexual (90.5 %), female (85.7 %) medical trainees (63.5 %). A quarter (23.8 %) reported currently having at least 1 sexual problem and 27.0 % reported a history of sexual trauma. Notably, 91.0 % of respondents had never been asked about their own sexual health by a healthcare provider. Less than half (43.9 %) reported frequently bringing up sexual health issues with their patients, while about half (50.8 %) reported being comfortable optimizing patients' sexual function, which was significantly correlated (p < 0.05) with practicing at the attending level, being comfortable talking about their own sexuality, the absence of sexual problems, reported sexual satisfaction, and prior education in a greater number of sexual healthcare topics. CONCLUSION: Variation in how gynecologic healthcare providers manage their patients' sexual function may be linked to their own sexual experiences and well-being.

Transfection of a Molecular Clone of Naegleria gruberi rDNA into N. gruberi Trophozoites.

All ribosomal genes of Naegleria trophozoites are maintained in a closed circular extrachromosomal ribosomal DNA (rDNA) containing element (CERE). While little is known about the CERE, a complete genome sequence analysis of three Naegleria species clearly demonstrates that there are no rDNA cistrons in the nuclear genome. Furthermore, a single DNA origin of replication has been mapped in the N. gruberi CERE, supporting the hypothesis that CERE replicates independently of the nuclear genome. This CERE characteristic suggests that it may be possible to use engineered CERE to introduce foreign proteins into Naegleria trophozoites. As the first step in exploring the use of a CERE as a vector in Naegleria, we developed a protocol to transfect N. gruberi with a molecular clone of the N. gruberi CERE cloned into pGEM7zf+ (pGRUB). Following transfection, pGRUB was readily detected in N. gruberi trophozoites for at least seven passages, as well as through encystment and excystment. As a control, trophozoites were transfected with the backbone vector, pGEM7zf+, without the N. gruberi sequences (pGEM). pGEM was not detected after the first passage following transfection into N. gruberi, indicating its inability to replicate in a eukaryotic organism. These studies describe a transfection protocol for Naegleria trophozoites and demonstrate that the bacterial plasmid sequence in pGRUB does not inhibit successful transfection and replication of the transfected CERE clone. Furthermore, this transfection protocol will be critical in understanding the minimal sequence of the CERE that drives its replication in trophozoites, as well as identifying regulatory regions in the non-ribosomal sequence (NRS).

The role of the World Health Organization in male contraceptive development.

The World Health Organization has been involved in male contraceptive development for over 50 years. In line with its functions and mandate, World Health Organization works with diverse stakeholders to support research, develop norms and standards, engage member states, facilitate prequalification, introduction and scale up, measurement, and tracking of contraceptives. World Health Organization has a key role in galvanizing global efforts to ensure universal access to contraception services irrespective of income group. Regarding male contraceptive development, World Health Organization has provided technical leadership, supported early research, created and supported research centers, built research capacity in various countries, and standardized semen analysis procedures. In this paper, a detailed description is provided with examples across the various stages of male contraceptive development. Limited funding to World Health Organization is a key challenge.

Complete sequence of the closed circular extrachromosomal element of Naegleria pringsheimi De Jonckheere (strain Singh).

The DNA encoding the ribosomal RNA in Naegleria is encoded on closed circular extrachromosomal ribosomal DNA-containing elements (CERE) in the nucleolus. In this report, we describe the sequence of the CERE of Naegleria pringsheimi De Jonckheere (strain Singh).

Trends in copper versus hormonal intrauterine device breakage reporting within the United States' Food and Drug Administration Adverse Event Reporting System.

OBJECTIVE: To examine trends in national reporting of broken intrauterine devices (IUDs). STUDY DESIGN: We enumerated IUD device "breakage" reports in the Food and Drug Administration Adverse Event Reporting System from inception (1998) until February 2022. We explored associations of breakage with IUD type (copper versus hormonal), year reported, reporter (consumer versus clinician), and patient characteristics (age and weight). RESULTS: We identified 4144 breakage reports for copper versus 2140 for hormonal IUDs. Among the 170,215 adverse events reported, breaks were disproportionately reported for copper (9.6%) versus hormonal (1.7%) IUDs. CONCLUSION: National pharmacovigilance data suggests disproportionate breakage in copper versus hormonal IUDs though the true prevalence of breaks cannot be calculated from this dataset.

Men's willingness to use novel male contraception is linked to gender-equitable attitudes: Results from an exploratory online survey.

OBJECTIVES: To explore the association of men's willingness to use a novel male contraceptive with their attitudes toward gender equity. STUDY DESIGN: We conducted an anonymous online survey examining willingness to use male contraception among reproductive-age (18-50 years) cisgender men from the United States and Canada, recruited via online forums, social media ads, and male contraceptive mailing lists from April through July of 2022. We collected sociodemographics and reproductive histories and used a 20-item Gender-Equitable Men Scale to examine men's gender role attitudes. We conducted bivariate analyses to inform a multivariable logistic regression isolating the independent influence of increasingly gender-equitable attitudes on cis-men's willingness to use novel male contraceptives. RESULTS: We received 2066 surveys from primarily white (n = 1192; 58%), heterosexual (n = 1816; 88%), married cis-men (n = 1008; 49%), below age 30 (n = 1010; 49%), and who had not completed a bachelor's degree (n = 1173; 57%). The majority reported sex multiple times per week (n = 946; 46%), but had never gotten someone pregnant (n = 907; 44%); nearly half (n = 994; 48%) identified as parents. Three-quarters of respondents reported being willing to use novel male contraceptives (n = 1545; 75%); willingness was independently linked to having had an abortion (adjOR: 2.04; 95% CI: 1.37-3.02) and increasing total Gender-Equitable Men Scale scores (adjOR: 1.05; 95% CI: 1.02-1.08), even after controlling for age, race/ethnicity, and education. CONCLUSIONS: Three-quarters of cis-men surveyed reported willingness to use new male contraceptives, which was correlated with increasingly gender-equitable attitudes. IMPLICATIONS: As gender-equitable attitudes are linked to men's willingness to use novel male contraceptives, older population surveys may underestimate male contraceptive demand. Further, given the association of abortion experience with willingness to use novel male contraceptives, abortion-providing clinics may be considered for future dissemination of male contraceptives.

Expectations for family building, assisted reproduction, and adoption among lesbians in the National Survey of Family Growth, 2017-2019.

Objective: To characterize the family-building goals and experiences of lesbians compared with those of heterosexual females in the United States. Design: Secondary analysis of nationally representative, cross-sectional survey data. Setting: National Survey of Family Growth 2017-2019. Patients: 159 reproductive-age lesbian respondents and 5,127 reproductive-age heterosexual respondents. Interventions: We characterized family-building goals and the use of assisted reproduction and adoption among lesbians using nationally representative female respondent data from the 2017-2019 National Survey of Family Growth. We performed bivariate analyses examining variations in these outcomes between lesbian and heterosexual individuals. Main Outcome Measures: Wantedness of children, use of assisted reproductive technology, and pursuit of adoption among reproductive-age lesbian and heterosexual participants. Results: We identified 159 reproductive-age lesbian respondents of the National Survey of Family Growth, representing 2.3% or approximately 1.75 million US individuals of reproductive age. The lesbian respondents were younger, less religious, and less likely to have children than heterosexual respondents. These groups did not differ significantly by race/ethnicity, education, or income. More than half of the individuals reported wanting a child in the future, with proportions similar between the lesbian and heterosexual individuals (48% vs. 51%, respectively; P = .52). Accordingly, 18% of both the lesbian and heterosexual individuals reported that they would be greatly bothered if they were unable to have children. Nevertheless, health care providers reportedly asked the lesbians about their desire to get pregnant less frequently than they asked the heterosexual individuals (21% vs. 32%, respectively; P = .04). Only 26% of the lesbians had ever been pregnant compared with 64% of the heterosexual individuals (P<.01). Approximately one third (31%) of lesbians with medical insurance were seeking reproductive services compared with 10% of heterosexual individuals (P = .05). Lesbians were significantly more likely to be seeking adoption than heterosexual individuals (7.0% vs. 1.3%, respectively; P = .01), although they were more likely to report being turned down (17% vs. 10%, respectively; P = .03), not knowing why they were unable to adopt (19% vs. 1%, respectively; P = .02), and quitting because of the adoption process (100% vs. 45%, respectively; P = .04). Conclusions: Approximately half of US females of reproductive age desire to have a child, a proportion that is not different between lesbian and heterosexual individuals. However, fewer lesbians are asked about their desires to get pregnant, and fewer ever become pregnant. Lesbians are significantly more likely to pursue assisted reproductive services when covered by insurance and more likely to seek adoption. Unfortunately, lesbians are more likely to face challenges with adoption.

Cerebrospinal fluid as vaginal discharge: ventriculoperitoneal shunt migration following Cesarean section.

Congenital hydrocephalus was once a permanently disabling and even fatal disease. With the advent of ventriculoperitoneal shunts, affected women are now surviving to their reproductive years and beyond. Pregnancy outcomes in this population are generally positive. However due to possible shunt complications, including infection, migration, and organ perforation, perinatal care for pregnant individuals with a ventriculoperitoneal shunt is complex and requires input from both obstetric and neurosurgical providers. We present the case of a 28-year-old G1P1 with a history of congenital hydrocephalus and ventriculoperitoneal shunt who presented to the emergency department at two months postpartum with clear fluid leaking from her vagina. The shunt's distal end had migrated and perforated the uterus causing cerebrospinal fluid to leak into the uterine cavity. Surgical repair was required of both the uterine hysterotomy and ventriculoperitoneal shunt, and the patient's symptoms ultimately resolved. Patients with a history of shunt placement who later undergo abdominal surgery, including cesarean section, are at risk for shunt complications. Shunt-dependent patients presenting in the post-partum period with new neurological or abdominopelvic complaints should undergo evaluation by a multidisciplinary team.

Descriptive study of the real-world, long-term cost estimates and duration of use for hormonal and nonhormonal intrauterine devices using US commercial insurance claims.

BACKGROUND: Intrauterine devices (IUDs) have comparable efficacy to permanent surgical contraceptive methods; however, long-term costs are infrequently considered. Existing estimates inconsistently account for costs outside of IUD insertion or removal, actual duration of use, or differences between hormonal and nonhormonal IUDs. OBJECTIVE: To describe health care resource utilization and commercial payer costs that arise throughout hormonal and nonhormonal IUD use. METHODS: In this retrospective cohort study, paid claims data (Merative, MarketScan) from a large US commercial claims database were evaluated between 2013 and 2019. Claims were included from individuals aged 12 to 45 years who had an IUD inserted in 2014, continuous insurance coverage for 1 year prior to insertion and throughout follow-up, and no insertion, removal, or reinsertion in the previous year. Procedures and services that could be IUD-related were identified using Current Procedural Terminology and International Classification of Diseases, Ninth and Tenth Edition codes. Duration of IUD use was evaluated by Kaplan-Meier analysis of time to IUD removal. Event rates were determined for identified procedures and services; costs were calculated as the sum of payer reimbursements per enrolled individual. All IUD types available during the study period were described: 2 hormonal IUDs (52-mg and 13.5-mg levonorgestrel-releasing [LNG]) and the nonhormonal (380-mm2 copper) IUD. RESULTS: Of 195,009 individuals meeting the age requirement and receiving an IUD in 2014, 63,386 met the inclusion criteria and 53,744 had their IUD type on record-42,777 (67.5%) 52-mg LNG, 2,932 (4.6%) 13.5-mg LNG, and 8,035 (12.7%) nonhormonal IUD users. Despite differences in their indicated duration (13.5-mg LNG, 3 years; 52-mg LNG, 5 years; and nonhormonal, 10 years), most individuals had their IUD removed before its indicated full duration of use (13.5-mg LNG, 56.1%; 52-mg LNG, 61.3%; nonhormonal [at 5 years], 54.6%). The event rate per 100 individuals during the follow-up period was highest for abnormal uterine bleeding (16.2), ovarian cysts (9.3), and surgical management of uterine perforations (4.5). IUD insertion costs (mean ± SE) per enrolled individual for the 13.5-mg LNG, 52-mg LNG, and nonhormonal IUDs were $931 ± $9, $1,107 ± $4, and $897 ± $6, respectively. Cumulative mean ± SE 5-year postinsertion costs for the 13.5-mg LNG, 52-mg LNG, and nonhormonal IUDs were $2,892 ± $232, $1,514 ± $31, and $1,389 ± $97, respectively, among the remaining enrolled individuals. CONCLUSIONS: In this descriptive study of commercially insured IUD users, at least half had their IUD removed before its indicated duration. IUD improvements that reduce the frequency of abnormal uterine bleeding, ovarian cysts, and uterine perforations may help reduce long-term IUD costs.

An Ethical Argument for Health Insurance Coverage of Paternal Prenatal Genetic Testing.

Despite evidence-based recommendations from the American College of Obstetricians and Gynecologists and the American College of Medical Genetics to offer prenatal genetic carrier screening for reproductive partners, partner carrier screening or genetic testing is inconsistently covered by pregnant patients' health insurance plans. Health policies that exclude reproductive partners from insurance coverage for prenatal carrier screening or genetic testing contradict multiple ethical principles and can even contribute to adverse maternal-child health outcomes. Incomplete or missing information regarding partner carrier status can lead to costly, invasive, and potentially risky interventions for the pregnant patient that can be avoided by a simple and less expensive blood test in the reproductive partner. Lack of information regarding carrier status also harms the neonate by obviating an opportunity for early detection and treatment of potential medical complications. Insurance policies that exclude coverage for paternal genetic testing perpetuate the disproportionate burdens of pregnancy care and risk shouldered by pregnant people. To rectify these ethical dilemmas, partner carrier screening and genetic testing should be considered and covered as routine components of obstetric health care that are covered by health insurance.