Abortion service availability during the COVID-19 pandemic: Results from a national census of abortion facilities in the U.S.

OBJECTIVE: This study assessed the impact of COVID-19 on abortion services in all 50 United States states and the District of Columbia. STUDY DESIGN: ANSIRH's Abortion Facility Database is a systematic collection of data on all publicly-advertising abortion facilities in the United States, updated annually through online searches and mystery shopper phone calls. Research staff updated the database in May-August 2020, assessing the number of facilities that closed, limited or stopped providing abortions, and provided telehealth options in summer 2020 due to COVID-19.  We describe these changes using frequencies and highlighting themes and examples from coded qualitative data. RESULTS: Located primarily in the South and Midwest, 24 of 751 facilities that were open in 2019 temporarily closed due to the pandemic, with 9 still closed by August 2020. Other facilities described suspending abortions, referring abortion patients to other facilities, or limiting services to medication abortion. While most facilities required in-person visits for reasons like state abortion restrictions, 22% (n = 150) offered phone or telehealth consultations, no-test visits, or medication abortion by mail to reduce or eliminate patient time in the clinic. Some facilities used creative strategies to reduce COVID-19 risk like allowing patients to wait for visits in their cars or offering drive-through medication pick-up. CONCLUSIONS: The COVID-19 pandemic caused several disruptions to abortion service availability, including closures. To reduce in-person visit time, some clinics shifted to offering medication abortion (versus procedural) or telehealth. While the pandemic and abortion restrictions increased barriers to abortion provision, facilities were resilient and adapted to provide safe care for their patients. IMPLICATIONS: Barriers to abortion access were exacerbated during the COVID-19 pandemic, particularly in areas of the country with more restrictive policies toward abortion. Telehealth care protocols offered by many abortion facilities provide an option to reduce or eliminate in-person visits.

Evidence favoring sperm selection over sperm competition in the interaction between human seminal plasma and sperm motility in vitro.

The effect on sperm motility of sperm-sperm and sperm-seminal plasma interactions was studied among homologous and heterologous sperm. There were no significant interactions between sperm in vitro, but it was found that seminal plasmas of different donors have different effects on sperm motility, and different sperm react differently to the same seminal plasma. Sperm showed higher motility in a pure physiological solution than when mixed with seminal plasma, even if the plasma and sperm came from the same donor. Various plasma components are responsible for this modulation of sperm motility. It would appear that large numbers of sperm are adaptive, among other things, because they are involved in sperm selection.

Chimeric subgroup A respiratory syncytial virus with the glycoproteins substituted by those of subgroup B and RSV without the M2-2 gene are attenuated in African green monkeys.

Using the existing reverse genetics system developed for the subgroup A respiratory syncytial virus (RSV), a chimeric virus (designated rA-G(B)F(B)) that expresses subgroup B-specific antigens was constructed by replacing the G and F genes of the A2 strain with those of the 9320 strain of subgroup B RSV. rA-G(B)F(B) grew well in tissue culture, but it was attenuated in the respiratory tracts of cotton rats and African green monkeys. To further attenuate this chimeric RSV, the M2-2 open reading frame was removed from rA-G(B)F(B). rA-G(B)F(B)DeltaM2-2 was highly attenuated in replication in the respiratory tracts of the infected monkeys, but it provided complete protection against wild-type subgroup B RSV challenge following two doses of infection. In this study, rA2DeltaM2-2 (a recombinant A2 RSV that lacks the M2-2 gene) was also evaluated in African green monkeys. The replication of rA2DeltaM2-2 was highly restricted in both the upper and lower respiratory tracts of the infected monkeys and it induced titers of serum anti-RSV neutralizing antibody that were slightly lower than those induced by wild-type rA2. When rA2DeltaM2-2-infected monkeys were challenged with wild-type A2 virus, the replication of the challenge virus was reduced by approximately 100-fold in the upper respiratory tract and 45,000-fold in the lower respiratory tracts. rA2DeltaM2-2 and rA-G(B)F(B)DeltaM2-2 could represent a bivalent RSV vaccine composition for protection against multiple strains from the two RSV subgroups.

Wave parameters of the sperm flagellum as predictors of human spermatozoa motility.

We characterized the undulatory movement of the sperm's flagellum as a sigmoid wave by measuring the absolute and linear speed of the sperm, period, amplitude and length of the flagellum's wave, and the segment comprised between the head and the origin of the movement in the flagellum. These parameters were correlated with traditional ones used to determine the pattern of movement of the sperm. Our results show that wave parameters are useful predictors of sperm motility. They correlate among themselves, and thus, a few wave parameters may characterize the sperm motility. The advantage of wave parameters is that they can be easily obtained and can be eventually associated to the sperms' internal morphology.

The 60 kDa heat shock protein in human semen: relationship with antibodies to spermatozoa and Chlamydia trachomatis.

The presence of the 60 kDa heat shock protein (hsp60) in seminal fluid and its relationship to sperm autoimmunity or a localized immune response to Chlamydia trachomatis were examined. Semen from 64 male partners of infertile couples with no history of a chlamydial infection were investigated. Hsp60 was identified by an enzyme-linked immunosorbent assay (ELISA) using a monoclonal anti-hsp60 antibody bound to wells of a microtitre plate and a polyclonal anti-hsp60 antibody for detection. Antisperm antibodies on motile spermatozoa were detected by immunobead binding, while antichlamydial immuno-globulin (Ig) A and IgG in seminal fluid were identified by a commercial ELISA (SeroELISA: Savyon Diagnostics, Beer-Sheva, Israel). RNA was purified from isolated seminal round mononuclear cells and tested for hsp60-specific mRNA by a reverse transcription polymerase chain reaction ELISA. Hsp60 was present in semen from nine (14.1%) men, 12 (18.8%) men had antisperm autoantibodies. 16 (25.0%) were positive for antichlamydial IgA and 17 (26.6%) had detectable hsp60-specific mRNA. The presence of hsp60 in semen correlated with the occurrence of antichlamydial IgA (P = 0.0005), hsp60 mRNA (P = 0.04) and antisperm antibodies (P = 0.05). Thus, hsp60 was present in a soluble form in semen primarily in men with evidence of immune system activation within their genital tract. The role of hsp60 in promoting or inhibiting immune responses within the genital tract remains to be determined.

Immune regulation in the male genital tract.

Spermatozoa are not produced until puberty, long after the establishment of tolerance to self-antigens. Therefore, sperm-specific antigens are immunogenic in men. Most men, however, do not produce antibodies to their own gametes. Development of mechanisms to prevent or limit autoimmune responses to spermatozoa were essential for preservation of reproductive capacity. Tight junctions between adjacent Sertoli cells, as part of the blood-testis barrier, prevent sperm-immune cell contact. In some portions of the genital tract this barrier is thin or incomplete. Immune mechanisms have evolved to actively suppress the autoimmune response to spermatozoa within the genital tract. Unlike in the circulation where CD(4+) helper T lymphocytes predominate, CD(8+) suppressor/cytotoxic T lymphocytes are the most prominant T cells in the epididymis and vas deferens. In addition, spermatozoa suppress pro-inflammatory lymphocyte immune responses, possibly by inducing production of anti-inflammatory cytokines. Antisperm antibody production is induced in the male genital tract when a local infection or disruption in the genital tract physical barrier leads to an influx of CD(4+) T cells. In response to induction of a productive immune response, two additional mechanisms downregulate humoral immunity within the genital tract. T lymphocytes possessing the gammasigma form of the antigen receptor (gammasigma T cells) are concentrated in the male genital tract and in semen. These cells become activated and proliferate in men with evidence of sperm autoimmunity. Activated gammasigma T cells inhibit production of antibodies by activated B lymphocytes, thereby limiting antisperm antibody production. Heat shock proteins (hsps) are also present in semen in association with infection and antisperm antibody formation. Hsp gene transcription leads to inhibition of transcription of the genes coding for pro-inflammatory cytokines and, conversely, to activation of gammasigma T cells. Activated gammasigma T cells also promote hsp synthesis. The mechanisms to inhibit immunity to sperm may hinder effective immune elimination of microoganisms in the male genital tract.

Autoimmunity to spermatozoa, asymptomatic Chlamydia trachomatis genital tract infection and gamma delta T lymphocytes in seminal fluid from the male partners of couples with unexplained infertility.

The relationship between an undetected, asymptomatic Chlamydia trachomatis genital tract infection, the concentration of gamma delta and alpha b T cells in semen and sperm autoimmunity was examined in 48 male partners of couples with unexplained infertility. Immunoglobulin A (IgA) antibodies to C. trachomatis were detected in seminal fluids from 14 (29.2%) of the men. Only four of these were positive for circulating anti-chlamydial IgA, suggesting that the stimulus for antibody production was within the genital tract. In contrast, four men were positive for anti-chlamydial IgG in their semen; all were also seropositive for anti-chlamydial IgG. T lymphocytes bearing the alpha beta and gamma delta antigen receptors were present in every semen sample. Men with seminal anti-chlamydial IgA, however, had significantly (P = 0.035) elevated semen gamma delta T cell concentrations (median 3100 cells/ml) than did men lacking this antibody (median 1400 cells/ml); concentrations of alpha beta T cells were comparable in both groups. Genital tract sperm autoimmunity, as shown by antibodies bound to motile ejaculated spermatozoa, was detected in 13 (27.1%) men. The presence of these antibodies was associated with elevated concentrations of both gamma delta (median 4200 versus 700 cells/ml) and alpha beta (median 5000 versus 850 cells/ml) T cells (P = 0.0002 and 0.0001 respectively). Men with antisperm antibodies only in their serum had seminal T cell concentrations comparable with men testing negative for antisperm antibodies. Anti-chlamydial IgA was identified in semen from four of 10 men with IgA bound to their spermatozoa and in none of the men with only spermatozoa-bound IgG.(ABSTRACT TRUNCATED AT 250 WORDS)

Incidence of 1/29 translocation in Venezuelan Creole pure and crossbreed cows used in reproductive programs.

The Venezuelan Creole breed cow has shown great versatility in adapting to extreme tropical conditions, but unfortunately it has exhibited low fertility. In a previous study conducted at the Experimental Station Guárico in Calabozo, Venezuela, chromosomal analysis of 30 Creole bulls demonstrated the presence of Robertsonian translocation 1/29 (Rb 1/29) in 16.6% of the animals. Considering this finding, we sought to establish the incidence of Rb 1/29 in Creole cows. Thus, heparinized peripheral blood cells were cultured rendering metaphase spreads and were subsequently stained by Giemsa and G-banding techniques. The chromosomal diagnosis was performed in 2 groups of cows (21 pure Creole and 47 hybrids Creole x Brahman). The results confirmed the presence of Rb 1/29 in females as had already been demonstrated in bulls. In the first group of cows the incidence of Rb 1/29 was 4.8%; in the second it was 8.5%. The implication of this finding is discussed here.

Incidence of 1 29 translocation in Venezuelan Creole bulls.

The Venezuelan Creole breed cattle is a Bos taurus well adapted to tropical conditions; however, it has demonstrated a low fertility rate. Recently, improvement in animal production by selection based on chromosomal analysis has allowed for the erradication of abnormalities involved in fertility problems, especially that of the 1 29 translocation. In the present work chromosomal analyses were carried out on 60 Creole bulls. Heparinized peripheral blood cells were cultured rendering metaphase spreads and subsequently stained by G- and C-banding techniques. The 1 29 translocation was observed in 13 of the 60 bulls. The occurrence of this translocation in Creole cattle is discussed.

Activation of circulating gamma delta T-lymphocytes by autologous sperm from men sensitized to sperm.

The in vitro proliferative responses to sperm of T-lymphocytes bearing the alpha beta or gamma delta form of the antigen receptor were investigated. Peripheral blood mononuclear cells from five men without antisperm antibodies and eight men with antisperm antibodies both on sperm and in serum were incubated for 72 h in the presence of an equal concentration of autologous live sperm, freeze-thawed sperm and heat-killed sperm. Prior to incubation and after 72 h, aliquots were applied to Teflon coated microscope slides, which were subsequently incubated with monoclonal antibodies to the beta chain and delta chain of the human T-cell receptor. Urethral samples were cultured for bacteria and tested for Chlamydia trachomatis by direct staining and by ELISA. The four men with chlamydial infections had the highest concentrations of circulating gamma delta T-cells (P = 0.0008). The concentration of gamma delta T-cells from men with antisperm antibodies increased 245% over the buffer control in response to live sperm (P < 0.0001). Proliferation of gamma delta T-cells was also seen to a lesser extent in response to freeze-thawed (P = 0.002) and heat killed (P = 0.03) sperm. In contrast, gamma delta T-cells from men without antisperm antibodies proliferated only marginally (36%) in response to live sperm (P = 0.05) and were unresponsive to non-viable sperm. Only from men sensitized to sperm were alpha beta T-cells responsive, to a small extent, to live sperm (P = 0.04). Thus, in men with antisperm antibodies, peripheral gamma delta and alpha beta T-cells appeared to be sensitized to antigens on the surface of viable sperm. The immune response of gamma delta T-cells to sperm may be a useful in vitro system to examine the mechanism of gamma delta T-cell activation.