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，极大地改变了女性和夫妇应对计划生育的方式。对于女性来说，年龄是生育能力的最佳预测指标之一：也就是说，女性是否能够怀孕。年轻女性通常更有生育能力，怀孕能力下降，直到女性进入更年期。然而，女性生育能力下降的年龄取决于个体身体的许多独特因素，包括基因构成、饮食、生活方式和环境。在过去的十年里，医疗服务提供者增加了使用一种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的卵子分泌的激素。抗微生物激素水平在一些医疗机构中被用作生育力的指标，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，在美国正变得越来越普遍。随着抗微生物药物耐药性测试变得越来越普遍，了解妇女如何将测试结果作为计划生育的工具并指导她们选择生儿育女是很重要的。除了为培训一名人类学研究生学习经验、科学数据收集和分析方法提供资金外，该项目还将通过向投资于发现更有效改善公共卫生手段的组织广泛传播其研究结果，增进科学理解。在西北大学Thomas McDade博士的指导下，Moira Kyweluk将探索抗微生物药物耐药性检测的文化和社会层面。这项研究将在AMH检测普遍的两个地方进行：首先，在一个私人诊所网络中，这些诊所直接向消费者提供低费用的生育检测；其次，在一家大型研究医院的生育诊所中，检测通常是使用卵子冷冻和体外受精等生殖技术的计划生育的一部分。该项目使用人类学方法，包括仔细观察和记录两个诊所的谈话，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小组了解妇女为何以及何时寻求抗生殖激素检测，以及浪漫伴侣、家庭和社会网络在获得生育检测和利用检测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、族裔和性取向的妇女进行低成本生育测试的经验数据，其中有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保健的大多数患者，从而构成了研究参与者的大多数，都是富裕的白人。最终，该项目的数据对于帮助妇女和提供者决定何时、是否以及如何进行这种生育测试非常重要，因为它会对计划生育决策、情感健康和社会生活产生影响。早期生育筛查和贯穿女性一生的持续筛查可能很快就会成为一种标准护理。从这些访谈中获得的信息将向公众提供，以使妇女更多地了解其他人进行选择性抗微生物药物耐药性测试的经验。该奖项反映了美国国家科学基金会的法定使命，并通过使用基金会的知识价值和更广泛的影响审查标准进行评估，被认为值得支持。

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.