Doctoral Dissertation Research: Cultural and Social Dimensions of Anti-Mullerian Hormone Screening Technologies

美国人口结构的变化，包括第一胎平均年龄的推迟，极大地改变了妇女和夫妇的计划生育方式。对于女性来说，年龄是生育能力的最佳预测因素之一：也就是说，女性是否能够怀孕。年轻的女性通常更有生育能力，怀孕能力下降，直到女性达到更年期。然而，个体女性生育能力下降的年龄取决于她个体身体的许多独特因素，包括基因组成，饮食，生活方式和环境。在过去的十年中，医疗服务提供者增加了使用简单的血液测试来测量女性的抗苗勒管激素（AMH）水平，这是一种由女性剩余卵子分泌的激素。AMH水平已在一些医疗环境中用作生育力的指标，较低的值表明生育力降低。AMH筛查是一种低成本的生育测试，在美国越来越普及。随着抗苗勒氏管激素检测越来越普遍，重要的是要了解妇女如何使用检测结果作为计划生育的工具，并浏览他们的生物父母的选择。该项目除了提供资金，培训一名人类学研究生掌握经验科学数据收集和分析方法外，还将通过向致力于发现更有效的改善公共卫生手段的组织广泛传播其研究结果，提高科学认识。将探讨AMH测试的文化和社会层面。这项研究将在两个AMH测试常见的地方进行：首先，在一个私人诊所网络，直接向消费者提供低成本的生育测试;其次，在一家大型研究医院的生育诊所，测试通常是计划生育的一部分，使用卵子冷冻和体外受精等生殖技术。该项目使用人类学方法，包括仔细观察和记录两个诊所的对话，以及与提供测试结果的患者和提供者的访谈。定性数据将帮助研究团队了解女性为什么以及何时寻求AMH检测，以及浪漫伴侣，家庭和社交网络在访问生育测试和使用测试结果采取行动方面的作用。重要的是，该项目将收集来自不同社会经济地位、种族、民族和性取向的妇女的低成本生育测试经验数据，故意包括在生殖技术研究中经常被忽视的妇女，因为在美国获得生育医疗服务的大多数患者，因此构成了大多数研究参与者，他们是白色和富裕的人。最终，来自该项目的数据将有助于妇女和提供者决定何时，是否以及如何进行这种生育测试，因为它可能会对计划生育决策，情绪健康和社会生活产生影响。早期生育筛查和妇女一生中的持续筛查可能很快成为护理标准。从这些采访的信息将提供给公众，让妇女更多的信息与其他人的经验与选择AMH testing.This奖项反映了NSF的法定使命，并已被认为是值得通过使用基金会的智力价值和更广泛的影响审查标准进行评估的支持。

Demographic shifts in the United States, including a later average age of first birth have significantly changed how women and couples navigate family planning. For women, age is one of the best predictors of fertility: that is, whether a woman will be able to conceive. Younger women are typically more fertile, and ability to conceive declines until a woman reaches menopause. However, the age at which an individual woman becomes less fertile varies depending on many factors unique to her individual body, including genetic makeup, diet, lifestyle, and environment. Over the past decade, medical providers have increased the use of a simple blood test to measure a woman's anti-Mullerian hormone (AMH) level, a hormone secreted by a woman's remaining pool of eggs. AMH level has been used in some medical settings as an indicator of fertility, with lower values suggesting reduced fertility. AMH screening is a low-cost fertility test and is becoming more widely available in the United States. As AMH testing is becoming more widespread, it is important to understand how women are using test results as a tool in family planning and to navigate their biological parenthood options. In addition to providing funding for the training of a graduate student in anthropology in methods of empirical, scientific data collection and analysis, the project would enhance scientific understanding by broadly disseminating its findings to organizations invested in discovering more effective means of improving public health.Moira Kyweluk, under the supervision of Dr. Thomas McDade of Northwestern University, will explore the cultural and social dimensions of AMH testing. The research will take place at two locations where AMH testing is common: first, at a network of private clinics that offer fertility testing for low out-of-pocket costs directly to consumers and second, at a large research hospital fertility clinic where testing is often a part of family planning using reproductive technologies like egg freezing and in vitro fertilization. The project uses anthropology methods including careful observation and recording of conversations in both clinics, as well as interviews with patients and providers who deliver test results. Qualitative data will help the research team understand why and when women seek AMH testing, as well as the role of romantic partners, family and social networks on accessing fertility testing and taking action using test results. Importantly, this project will gather data on experiences with low-cost fertility testing from women from diverse socioeconomic statuses, races, ethnicities and sexual orientations, deliberately including women often overlooked in research on reproductive technologies, since most patients who have access to fertility medical care in the United States and thus comprise the majority of research participants are white and affluent. Ultimately, data from this project will be important in helping women and providers make decisions about when, whether, and how to take this sort of fertility test since it can have impacts on family planning decisions, emotional health, and social life. Early fertility screening and ongoing screening throughout a woman's life could soon become a standard of care. Information from these interviews will be available to the public to give women more information about others' experiences with elective AMH testing.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.