The Racial and Socioeconomic Characteristics of a Cohort of Men Using at-Home Fertility Tests in the United States

INTRODUCTION AND OBJECTIVE: Infertility is a global health concern that affects couples worldwide. Economic, racial, and geographic disparities in reproductive medicine have long affected access to fertility care. These inequalities further worsened during the COVID-19 pandemic as fertility care services were systematically paused and treatments were delayed. At-home fertility tests emerged as a seemingly convenient, affordable and accessible option for all men seeking initial semen analysis testing and screening. We aim to study the racial and socioeconomic characteristics of a cohort of men utilizing at-home sperm testing kits in the United States over 3 years. METHOD(S): We retrospectively reviewed the records of 5,822 men who requested semen analysis at Give Legacy, Inc. (Legacy) facilities from 2019 to 2021. The demographic characteristics of these men were collected including their age, race/ethnicity, and place of residence. Further, the weighted median household income of Legacy customers was calculated using their personal ZIP codes and corresponding median income data from the U.S. census bureau. RESULT(S): The mean age (SD) of this cohort was 34.9+/-7.3 years. Among these 5,822 men, there were 3,936 (67.6%) normozoospermic men and 1,886 (32.3%) oligozoospermic men. The group consisted of predominantly white men (64.9%) with only 5.2% Black, 5.4% Latino, 8.9% Asian, 3.1% Arab, 2% Native Hawaiian, 2.4% Indian American, and 8.2% other groups. The geographic distribution of participants showed a majority of men from the Northeast (31.6%) and Pacific (23.4%) regions. The median household income of a Legacy customer is $108,858;significantly higher than the U.S. median household income of $70,784 (P<.01). CONCLUSION(S): Despite the fact that at-home, mail-in kits provide a better and more affordable access to initial fertility care, ethnic minorities and lower socioeconomic classes are still underrepresented in the population of men seeking fertility testing in this cohort. Further research is needed to understand the racial and socioeconomic drivers of the existing disparities in fertility care.

Validation of Sperm Chromatin Dispersion (Scd) Test Using a Mail-in, at-Home Semen Collection Kit

Objective: The covid-19 pandemic has accelerated the use of direct-to-consumer offerings of at-home, mail-in kits for sperm DNA fragmentation. However, mail-in semen collection kits involve incubation in transport media and overnight shipping. DNA fragmentation can be confounded by multiple extrinsic factors such as storage temperatures, transportation media, handling conditions, time after ejaculation, and oxidative stress. The objective of this study was to validate the sperm chromatin dispersion test using at-home, mail-in sperm collection kits. To do so, we evaluated and assessed the effect of transportation media and shipping on sperm DNA integrity using a Halosperm G2 kit in normozoospermic human sperm samples. Material(s) and Method(s): We included a control group of ten healthy normozoospermic humans whose semen samples were analyzed for sperm DNA fragmentation using a Halosperm G2 kit. Fifty healthy normozoospermic human semen samples were included in the study group.The mean age of men in the entire cohort was 34.9 +/- 8 years. These samples were divided into two equal groups. The first group was directly analyzed for sperm DNA fragmentation using a Halosperm G2 kit in the lab. The second group samples were incubated for 24 hours in transportation media (TM), then these incubated semen samples were packaged. Shipping simulation was achieved by putting the semen samples in a cargo van for 5 hours, where temperatures, pressure, and handling fluctuated. The samples were then returned to the lab, where they were subsequently analyzed for sperm DNA fragmentation using a Halosperm G2 kit. To estimate the inter-observer variability in the scoring of sperm cells with fragmented DNA, 20 aliquots from 10 different frozen semen specimens of the control group were processed at our internal lab. The other 10 aliquots were shipped to an independent, third-party CLIA-certified laboratory and processed using the same Halosperm G2 kit technique. Result(s): The Sperm DNA fragmentation index was not statistically significantly different between the non-incubated freshly analyzed sperm samples (20 %, SD +/-9%) and the 24-hour incubated samples with shipping conditions (24% SD +/- 13) (p-value: 0.0549). During the external validation study, when the internal and external lab technicians scored the same samples, the sperm DNA fragmentation percentage (SDFs) were not statistically significantly different (p-value: 0.1213) correlated (r = 0.85, p = 0.0016). Conclusion(s): This study revealed that the sperm DNA fragmentation index of normozoospermic human sperm sample is not statically significant impacted by a 24-hour transport media incubation and subsequent exposure to shipments conditions. Impact Statement: Our study showed that the accuracy and validity of DNA fragmentation detection using the Halosperm G2 kit of TM-incubated and shipped human sperm samples was comparable to those of fresh samples analyzed at the lab in normozoospermic human sperm samples. Therefore, at-home mail-in kits may provide a viable testing option for DNA fragmentation index, helping to mitigate the barriers to access of affordable fertility care. Support: None. Copyright © 2022

Suicide associated with COVID-19 infection: an immunological point of view.

OBJECTIVE: Coronavirus disease 2019 (COVID-19) is a pandemic and leading cause of death. Beyond the deaths directly caused by the virus and the suicides related to the psychological response to the dramatic changes as socioeconomic related to the pandemic, there might also be suicides related to the inflammatory responses of the infection. Infection induces inflammation as a cytokine storm, and there is an increasing number of studies that report a relationship between infection and suicide. MATERIALS AND METHODS: We searched the World Health Organization status report and the PubMed database for keywords (COVID-19, suicide, infection, inflammation, cytokines), and reviewed five cytokine pathways between suicide and inflammation using two meta-analyses and two observational studies starting from November 31, 2020, focusing on the relationship between suicide and inflammation by infection. First, we discussed existing evidence explaining the relationship between suicidal behaviors and inflammation. Second, we summarized the inflammatory features found in COVID-19 patients. Finally, we highlight the potential for these factors to affect the risk of suicide in COVID-19 patients. RESULTS: Patients infected with COVID-19 have high amounts of IL-1ß, IFN-γ, IP10, and MCP1, which may lead to Th1 cell response activation. Also, Th2 cytokines (e.g., IL-4 and IL-10) were increased in COVID-19 infection. In COVID-19 patients, neurological conditions, like headache, dizziness, ataxia, seizures, and others have been observed. CONCLUSIONS: COVID-19 pandemic can serve as a significant environmental factor contributing directly to increased suicide risk; the role of inflammation by an infection should not be overlooked.

Social environmental impact of COVID-19 and erectile dysfunction: an explorative review.

BACKGROUND: To date, no attempt has been made to collate literature on the relationship between the social environmental impact of COVID-19 and erectile dysfunction. The aim of this explorative review was to assess and compare the prevalence of erectile dysfunction (ED) in male healthcare workers and males during the COVID-19 pandemic. METHODS: A systematic review of major databases from inception to February 2021 was conducted. Prevalence data were extracted, and a random-effects meta-analysis was undertaken. OUTCOMES: The pooled prevalence of ED amongst healthcare workers working in COVID-19 specific environments, and non-healthcare during the COVID-19 pandemic. RESULTS: Of 52 initial studies, six were included for the final analysis. The pooled prevalence of ED in healthcare workers working in a COVID-19 environment was 63.6% (95% CI 20.3-92.3%), and in non-healthcare workers during the COVID-19 pandemic was 31.9% (95% CI 19.5-47.6%). CONCLUSION: The prevalence of ED in healthcare workers working in COVID-19 environments was higher than representative samples and is of concern. Sexual health (and by extension, overall health), should be a priority when considering ways to care for this population. Considering the social environmental impact of COVID-19 on sexual health and in particular on ED, it is important to provide adequate psychological support systems and to promote quality of life with particular attention to sexual health.

Clinical characteristics and mortality of patients with hematologic malignancies and COVID-19: a systematic review.

OBJECTIVE: Hematologic cancer patients with Coronavirus Disease 2019 (COVID-19) tend to have a more serious disease course than observed in the general population. Herein, we comprehensively reviewed existing literature and analyzed clinical characteristics and mortality of patients with hematologic malignancies and COVID-19. MATERIALS AND METHODS: Through searching PubMed until June 03, 2020, we identified 16 relevant case studies (33 cases) from a total of 45 studies that have reported on patients with COVID-19 and hematologic malignancies. We investigated the clinical and laboratory characteristics including type of hematologic malignancies, initial symptoms, laboratory findings, and clinical outcomes. Then, we compared those characteristics and outcomes of patients with hematologic malignancies and COVID-19 to the general population infected with COVID-19. RESULTS: The median age was 66-year-old. Chronic lymphocytic leukemia was the most common type of hematologic malignancy (39.4%). Fever was the most common symptom (75.9%). Most patients had normal leukocyte counts (55.6%), lymphocytosis (45.4%), and normal platelet counts (68.8%). In comparison to patients with COVID-19 without underlying hematologic malignancies, dyspnea was more prevalent (45.0 vs. 24.9%, p=0.025). Leukocytosis (38.9 vs. 9.8%, p=0.001), lymphocytosis (45.4 vs. 8.2%, p=0.001), and thrombocytopenia (31.3 vs. 11.4%, p=0.036) were significantly more prevalent and lymphopenia (18.2 vs. 57.4%, p=0.012) less prevalent in patients with hematologic malignancies. There were no clinical and laboratory characteristics predicting mortality in patients with hematologic malignancies. Mortality was much higher in patients with hematologic malignancies compared to those without this condition (40.0 vs. 3.6%, p<0.001). CONCLUSIONS: Co-occurrence of hematologic malignancies and COVID-19 is rare. However, due to the high mortality rate from COVID-19 in this vulnerable population, further investigation on tailored treatment and management is required.