LGBTQ Stories of Reproductive Loss
Christa Craven in Reproductive Losses, 2019
In addition, Elizabeth Peel and Ruth Cain emphasize that the depth of people’s feelings about miscarriage must be understood independently from gestational age at loss.31 This is especially true for LGBTQ parents, who have often gone to great lengths to achieve pregnancy. Feminist researchers have also advocated approaching the widespread use of technologies, like the home pregnancy test and ultrasound technology, with caution.32 As historian Lara Freidenfelds wrote in a recent editorial: Consider, for example, home pregnancy tests, which came on the American market in 1978. Since that time, they have become increasingly sensitive, able to detect pregnancy ever closer to the moment of implantation of the fertilized egg in a woman’s uterus. Home pregnancy test manufacturers now promise results as early as five days before the test taker’s expected menstrual period. A pregnancy identified that early in gestation has up to a 30 percent chance of miscarrying. Home pregnancy test directions should include this information so that women understand what a positive result actually means.33For LGBTQ parents, however, envisioning children in their families often began long before a positive pregnancy test. As a midwife who serves primarily LGBTQ families explained, “Queer pregnancies begin way before conception happens, so families are already deeply in a process.”
Treatment Options: II. Intrauterine Insemination
Steven R. Bayer, Michael M. Alper, Alan S. Penzias in The Boston IVF Handbook of Infertility, 2017
Depending on the state, nurses or physicians can perform the IUIs. If there is any difficulty with the insemination, a physician is called to complete the procedure. Before the insemination, the patient’s name is verified and she confirms that her name is on the tube containing the washed sperm sample. To perform the IUI treatments, a speculum examination is performed and the cervix is visualized. The cervix is wiped with a large cotton tip applicator. The washed sperm sample is loaded into a catheter, which is inserted through the cervical canal and into the uterine cavity. Immediately after the IUI, the patient is discharged and normal activity can be resumed. A pregnancy test is scheduled 14 days later. Patients should be reassured that mild cramping or discomfort can occur along with increased wetness. Luteal phase support can be considered with IUI cycles particularly in patients utilizing gonadotropins.
Pregnancy – wanted and unwanted
Suzanne Everett in Handbook of Contraception and Sexual Health, 2020
If there is any suspicion that a woman may be pregnant, a pregnancy test should be performed to confirm this. Sometimes a woman can be so adamant that she is not pregnant that when a pregnancy test disproves this, you can find it hard to believe the test results. A pregnancy test should be performed one week after a missed period or three weeks after an episode of unprotected sexual intercourse. It is useful to take a history which should include menstrual cycle length, episodes of unprotected sexual intercourse and contraception, along with any symptoms of pregnancy. Often a woman will tell you openly how she feels about a pregnancy, but if she does not discuss her feelings it is helpful to approach this subject prior to performing the test, as this will help you when you must give her the results.
Compound Heterozygosity for Hb D-Ibadan (HBB: c.263C>A) and Hb C (HBB: c.19G>A)
Published in Hemoglobin, 2018
Sirisha Kundrapu, Nafiseh Janaki, Howard J. Meyerson
A 19-year-old woman presented to the emergency department with a headache and evaluation for missed menses. Review of the systems was normal. She had no significant past medical history. Pregnancy test was performed and was positive. Subsequently additional laboratory testing was performed including a complete blood count (CBC) and Hb identification. The CBC revealed a mild microcytic anemia with Hb of 11.5 g/dL (normal: 12.0–16.0 g/dL), hematocrit or packed cell volume (PCV) of 0.33 L/L (normal: 0.36–0.46 L/L), low mean corpuscular volume (MCV) of 64.0 fL (normal: 80.0–100.0 fL), red blood cell (RBC) count of 5.48 × 1012/L (normal: 4.00–5.20 × 1012/L) and slightly increased RBC distribution width (RDW) of 15.1% (normal: 11.5–14.5%). The remaining CBC indices were normal.
Delay Discounting, Glycemic Regulation and Health Behaviors in Adults with Prediabetes
Published in Behavioral Medicine, 2021
Leonard H. Epstein, Rocco A. Paluch, Jeffrey S. Stein, Teresa Quattrin, Lucy D. Mastrandrea, Kyle A. Bree, Yan Yan Sze, Mark H. Greenawald, Mathew J. Biondolillo, Warren K. Bickel
HbA1c was measured using the A1CNow+® system (PTS Diagnostics, Sunnyvale, CA), which has been validated in comparison to the National Glycohemoglobin Standardization Program (NGSP) standards.14 Non-fasting lipid profiles (total cholesterol, high density lipoproteins (HDL), low density lipoproteins (LDL), triglycerides, and HDL/total cholesterol ratio) were measured using the Alere Cholestech LDX® system (Alere Inc., Coral Springs, FL), a validated POC lipid measurement device.15 Blood pressure was measured in triplicate on the dominant arm in a sitting posture using an automated Omron HEM 907XL (Kyoto, Japan) validated16 blood pressure device, with pressures taken at one minute intervals. The latter two readings were averaged to assess systolic, diastolic and mean arterial pressure. Participants provided a urine sample to detect recent drug use. Urine was tested using the QuickTox® Drug Screen (Branan Medical Corp., Irvine, California), a reliable and accurate measure of drug use. Females were given a pregnancy test using the SA ScientificTM Ultimate hCG test (San Antonio, TX).
Likelihood of live birth with extremely low β-hCG level 14 days after fresh embryo transfer
Published in Gynecological Endocrinology, 2021
Yixuan Wu, Haiying Liu
Sung et al. applied the β-hCG fold change between postovulatory day 12 and 14 to predict pregnancy outcomes in IVF cycles. They found that the cutoff value to predict clinical pregnancy in fresh cycle was 2.52 with the AUC of 0.784 (0.738–0.829), sensitivity of 74.4% and PPV of 89.1%. For live birth, the threshold of fold change was 2.78 with the AUC of 0.697 (0.658–0.737), sensitivity of 65.7% and PPV 70.6%. In our research with patients of poor prognosis, the threshold of fold change over 48 h to predict clinical pregnancy was 1.5, with AUC of 0.930, sensitivity of 90.2% and PPV of 64.8%. The threshold of fold change for live birth was 1.9, with AUC of 0.890, sensitivity of 92.6% and PPV of 26.7% [1]. Although the AUC and sensitivity of our research is higher than those of Sung et al.’s study, the PPV values for clinical pregnancy and live birth in our research were lower than those in their study. This can be explained by the fact that the study population in our research were patients with extremely low serum β-hCG levels. For the prediction of clinical pregnancy and live birth, the β-hCG fold change over 48 h is comparable to that of single β-hCG. However, the single β-hCG level will more helpful in scheduling the follow-up for patients on the day of first pregnancy test.
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