RESUMEN
Frequently branded the "egg timer" or "biological clock test," anti-Müllerian hormone (AMH) testing for women is becoming widely available in the United States (US) through online, direct-to-consumer (DTC) testing services. The level of AMH in the blood reflects the remaining egg supply or "ovarian reserve"-a potential fertility indicator. AMH level is primarily used as a diagnostic tool prior to ovarian stimulation for in vitro fertilization (IVF) or oocyte cryopreservation (OC; i.e., egg freezing). This article describes the first ethnographic research on DTC ovarian reserve testing in the US, with a recruited sample of 21 participants interested in pursuing testing who consented to participant observation and semi-structured interviews. Fieldwork took place from January 2018 to July 2018 in Chicago, Illinois. Ethnographic cases explore how experiences with ovarian reserve testing are shaped by relationship status, sexual orientation, socioeconomic status, racial/ethnic identity, and medical insurance coverage. Thematic analysis suggests that DTC ovarian reserve testing is a unique means of investigating fertility; participants felt empowered by receiving testing outside of traditional medical contexts. It was an alternative tool for family planning, particularly for LGBTQ + individuals and single women. However, participants experienced varying degrees of certainty about test results and the appropriate next steps to take to confirm fertility status, preserve fertility, or conceive, thus suggesting that DTC testing may confound reproductive decision-making. I argue that DTC ovarian reserve testing is a new tool in a larger medical and social project to mitigate anticipated future infertility and is an entry point into what I term the new (in)fertility pipeline encouraging entanglement with reproductive technologies across the lifespan. Due to its low cost and widespread availability, DTC ovarian reserve testing reaches a broader demographic, encourages testing across diverse identities and backgrounds, and increases awareness of more advanced assisted reproductive technology (ART), including egg freezing.
Asunto(s)
Hormona Antimülleriana , Pruebas Dirigidas al Consumidor/provisión & distribución , Fertilidad/fisiología , Reserva Ovárica/fisiología , Técnicas Reproductivas Asistidas , Adulto , Antropología Cultural , Hormona Antimülleriana/análisis , Hormona Antimülleriana/sangre , Chicago , Criopreservación , Pruebas Dirigidas al Consumidor/economía , Pruebas Dirigidas al Consumidor/tendencias , Femenino , Fertilización In Vitro , Humanos , Entrevistas como Asunto , OocitosRESUMEN
AIMS: In June 2016, Korea permitted direct-to-consumer genetic testing (DTC-GT) on 42 genes. However, both the market and industry have not yet been fully activated. Considering the aforementioned context, this study provides important insights. METHODS: The Korean DTC-GT policy assessment is based on consumer preference analysis using a discrete choice experiment. In August 2016, a web-based survey was conducted to collect data from 1,200 respondents. RESULTS: The estimation results show that consumers prefer a DTC-GT product that is cheap, tests various items or genes, offers accurate test results, and guarantees the confidentiality of all information. However, consumers are not entirely satisfied by current DTC-GT products due to the existence of insufficient and/or inadequate policies. First, the permitted testing of 42 genes is insufficient to satisfy consumers' curiosity regarding their genes. Second, the accuracy of the DTC-GT products has not been fully verified, assessed, and communicated to consumers. Finally, regulatory loopholes that allow information leaks in the DTC-GT process can occur. CONCLUSIONS: These findings imply that DTC-GT requires an improvement in government policy-making criteria and the implementation of practical measures to guarantee test accuracy and genetic information.
Asunto(s)
Comportamiento del Consumidor , Pruebas Dirigidas al Consumidor/provisión & distribución , Pruebas Genéticas/estadística & datos numéricos , Adulto , Confidencialidad , Pruebas Dirigidas al Consumidor/economía , Pruebas Dirigidas al Consumidor/normas , Femenino , Pruebas Genéticas/economía , Pruebas Genéticas/métodos , Política de Salud , Humanos , Masculino , Comercialización de los Servicios de Salud/estadística & datos numéricos , Persona de Mediana Edad , República de Corea , Encuestas y Cuestionarios , Adulto JovenRESUMEN
We conducted an in-person survey of New York City (NYC) pharmacies to assess the availability, accessibility, and price of the over-the-counter, rapid HIV self-test kit. NYC pharmacies were stratified into high, moderate and low morbidity neighborhoods by the HIV diagnosis rate of the neighborhood in which the pharmacy was located. A random sample of 500 pharmacies was taken [250 from high morbidity neighborhoods (HighMN) and 250 from low morbidity neighborhoods (LowMN)]. Pharmacies were excluded if: closed during survey, non-retail, or >10 min walk from subway. Project staff visited pharmacies to determine kit availability (in pharmacy on day of survey), accessibility (not locked/behind counter), and price (marked on shelf/product). Of 361 pharmacies (161 LowMN; 200 HighMN), kits were available in 27 % and accessible in 10 %; there was no difference by neighborhood. Kits were most often kept behind the pharmacy counter; this was more common in HighMN than in LowMN. Kits were kept solely behind the pharmacy counter in 52 %. Median price was US $42.99 without variability across neighborhoods. The rapid HIV self-test had limited availability and access in retail pharmacies. The high median price measured suggests that cost remained a barrier.