Ophra Leyser-Whalen

Tubal risk markers for failure to place transcervical sterilization coils

BACKGROUND There is a growing body of literature on placement rates of the Essure® procedure, yet prior studies have not attempted to identify tubal-associated risk factors for placement failures. The current study examines risk markers associated with the inability to deploy the Essure® coils into the tubal lumen using the new ESS305 design. STUDY DESIGN We used electronic medical record data to assess risk markers associated with the inability to place the Essure coils in the tubal lumen using the new ESS305 design. A total of 310 attempted procedures between June 14, 2007, and April 29, 2011, were analyzed. RESULTS There were 18 tubal failures (5.8%) out of the 310 attempted procedures. A history of a prior sexually transmitted infection (STI) was associated with tubal failure (odds ratio 2.64, 95% confidence interval 1.01-6.90, p=.048). CONCLUSIONS We speculate that the observed association between a prior STI and an inability to place the coil was due to a past history of pelvic inflammatory disease.

Natural and social disasters: racial inequality in access to contraceptives after Hurricane Ike.

BACKGROUND Few data are available on access to contraception following a natural disaster. The current study extends the literature by examining access to various types of birth control in a large sample of women from diverse backgrounds following Hurricane Ike, which made landfall on September 13, 2008, on the upper Texas Gulf Coast. METHODS We examined Hurricane Ikes influence on access to contraceptives through survey results from 975 white, black, and Hispanic women 16-24 years of age receiving care at one of five publicly funded reproductive health clinics in the Texas Gulf Coast region between August 2008 and July 2010. RESULTS Overall, 13% of women reported difficulties accessing contraception. Black women had more difficulty than their white (p<0.001) and Hispanic (p=0.019) counterparts. Using multivariate analysis, we found that although family planning clinics in the area were open, black women (odds ratio [OR] 2.25, 95% confidence interval [CI] 1.37-3.73; p=0.001] and hurricane evacuees (OR 2.17, 95% CI 1.27-3.72; p=0.005) reported greater difficulty in accessing birth control. Last, we found that a lack of access to birth control was related to having a higher frequency of unprotected sex for women of all races (p=0.001). CONCLUSIONS Access to resources is critical in differentiating the level of impact of disasters on various groups of people. We suggest a community-based disaster preparedness and response model that takes womens reproductive needs into account.

Adherence to hysterosalpingogram appointments following hysteroscopic sterilization among low-income women

BACKGROUND The few studies on post-Essure hysterosalpingogram (HSG) adherence rates show inconsistent results. This study examined associations between sociodemographic variables not examined in prior studies and HSG adherence among low-income women. STUDY DESIGN Medical records of 286 women who underwent sterilization between August 31, 2005, and September 30, 2011, were reviewed. chi-Square and Mann-Whitney U tests were used to determine variable associations with HSG adherence. RESULTS The adherence rate for the first HSG was 85.0% (243/286). Variables associated with adherence were lower education level (p=.01), not working outside the home (p=.04), being married (p<.0001), lower gravidity (p=.03), fewer lifetime number of sexual partners (p<.0001), no sexually transmitted infection history (p<.01), Hispanic ethnicity (p<.0001), Spanish as a primary language (p<.0001) and living farther from the clinic (p<.01). CONCLUSIONS This study demonstrates that achieving high rates of adherence with the recommended HSG following Essure placement is feasible among low income populations. Furthermore, not speaking English or having to commute a far distance to the clinic do not appear to be barriers. This is encouraging considering the importance of this test to confirm tubal occlusion.

Mexican Americans’ Lucky Few and Baby Boom Cohorts: How Is Relative Cohort Size Related to the Likelihood of Being Out-of-Poverty?

Generational cohorts influence individuals’ economic life chances. Retrospective analysis has found that the “Lucky Few” generation had better life chances than previous generations. We focus on Mexican Americans in the United States and offer a prospective analysis to explore how relative cohort size plays a role in the odds of their being out-of-poverty. Using Public Use Microdata Sample files from 1990, 2000, and 2010, we test the hypothesis by comparing Early Baby Boom (those born between 1946 and 1955) and Late Baby Boom (those born between 1956 and 1965) cohorts to the Lucky Few (born between 1936 and 1945) cohort. Models predicting the odds of being out-of-poverty during the peak wage-earning years indicate that belonging to the Lucky Few cohort affords Mexican Americans no economic advantage. Our findings demonstrate that the relative cohort size hypothesis may not always be generalized to Mexican American minority samples.

Effects of a Major U.S. Hurricane on Mental Health Disorder Symptoms Among Adolescent and Young Adult Females

OBJECTIVE This study examines the effects of Hurricane Ike-related damage, job loss, injury, and mortality of friends and family on mental health symptoms among affected young women and adolescents. METHODS Data from a cross-sectional, self-administered survey of 2,536 young women aged 16-24 years affected by Hurricane Ike was examined. Poisson regression estimated the effect of types of hurricane-related damage, job loss, injury, and mortality of family or friends on depressive and hurricane-related post-traumatic stress disorder symptoms. RESULTS Nearly half (46.3%) of the respondents suffered damage, and 13% lost jobs as a result of Ike. Hurricane-related damage, job loss, injury to self, and injury to and mortality of friends or family were associated with increased Ike-related post-traumatic stress disorder symptoms. Damage and job loss were also associated with increased depressive symptoms. CONCLUSION Accessible mental health services and plans to reduce job loss among adolescents and those they depend on for income are needed in areas affected by hurricanes to help mitigate psychological consequences among low-income young women.

Control and Constraint for Low-Income Women Choosing Outpatient Sterilization:

Little is known about Hispanics and their contraceptive choices in general, with some past studies detailing nonconsensual sterilization. This article is based on interviews with a mostly Hispanic sample of 44 women being sterilized at a public clinic in southeast Texas with the Essure device, which entails a new outpatient sterilization procedure. The women cited relationship factors, wanting to better their and their children’s lives, and past reproductive histories as reasons for deciding on sterilization. They specifically chose Essure as a result of an apprehension of surgery and potential side effects from tubal ligation. Their choices, however, were limited by larger structural factors of work, family, the political economy, and the health care system. We concluded that this new sterilization technique provided more contraceptive choices for these women, yet more contraceptive decision-making autonomy and more equitable social structures are still needed.

Ethical and Psychosocial Impact of Female Infertility.

This manuscript reviews research from the past year on the ethical and psychosocial impact of infertility on women and men. We discuss several issues surrounding ovarian stimulation, particularly high-order multiple births, egg banking (especially for research purposes), and diminished ovarian reserve. We also present recent work on distress and counseling, which includes greater attention to subgroups of infertile women. More research on issues confronting men has emerged recently, and we outline these with regard to their relationships with infertile women, or as the infertility patient. Last, we outline some ethical issues posed by newer procedures of fertility preservation and uterine transplant.