ASRM Today: Equity, Access, and Innovation, Episode Seven: ASRM 2024 Preview Part Two

In this episode of ASRM Today, Jeffrey Hayes previews three key sessions from ASRM 2024 in Denver. Julia Woodward discusses the importance of integrating mental health professionals into fertility care. Ryan Flannigan explores advances in male infertility research, focusing on epigenetics and the gut microbiome. Maria Rodriguez highlights policy solutions for equitable contraceptive access, emphasizing the role of social determinants in reproductive health. The episode invites listeners to learn more about the upcoming ASRM 2024 events and encourages participation in the discussions.

Last time we touched on a few of the happenings at ASRM 2024 in Denver, Colorado, and this week we continue that. I am Jeffrey Hayes and this is ASRM Today. Welcome to ASRM Today, a podcast that takes a deeper dive into the current topics in reproductive medicine.

Episode 8, preview of ASRM 2024 Part 2. Welcome back to our ASRM 2024 preview show. This week we're going to feature three of the upcoming activities you can attend by letting the participants shed a little light on the topic. First up is Julia Woodward, an associate professor in the Department of Psychiatric and Behavioral Sciences and Obstetrics and Gynecology in the Duke University Health System, who talked to me about the symposia Integrated Behavioral Health Care in Reproductive Medicine, how and why to include mental health professionals in infertility care teams, which is happening Monday, October the 21st.

Well, one of the things that we've seen in the field of reproductive medicine are sort of two different trends happening side by side. On the one hand, we've seen the loss of a number of integrated psychology or mental health roles in some clinics. But simultaneously, there is a trend where clinics are appreciating just how valuable these roles are for the operation of the clinic.

And so there's this move to create new roles and hire mental health professionals to be integrated staff. And so we wanted to really talk more about not just those trends, but what are the specific advantages of integrated mental health services in the fertility center? And most importantly, how do we fund it? I think you're hard pressed to find people who think it's a bad idea to have patients' emotional and psychological needs better met or to argue that those aren't maximized by having somebody who's right there on site. But I think the real questions get at, okay, how do we move beyond this aspirational model to how do we specifically make this work from a financial perspective? And so those are some of the aspects that we're going to be looking at more closely in the symposium.

Next up is Ryan Flannigan, assistant professor of urology at the University of British Columbia, North Vancouver, British Columbia, Canada, who talked to me about new frontiers in male reproduction, translating from bench to bedside. A symposium at ASRM 2024 happening Tuesday, October the 22nd. Yeah, it's, you know, the topics that we ended up choosing for the symposium were areas of male infertility research that I think there's a lot of potential and there's some really brilliant people doing work on these topics in the field.

And, you know, these modalities or areas within science are, you know, have had huge leaps and bounds in other conditions outside of infertility, as well as, you know, a lot of really interesting science, either from an understanding perspective, as well as potential future therapeutic targets. So that being, you know, the epigenetic landscape, we know how important and how critical epigenetics is and some of the reprogramming involved in spermatogenesis through the various stages and some of the associations with abnormalities in epigenetic programming that may be contributing to infertility. So that's one of the areas that I think has a lot of relevance to male infertility.

There's been a lot of really great science has been performed and really interested to find out what's coming down the pipeline in this area. What are some of the newest studies showing and where do we think that can go in the field? The other big topic, is in the gut microbiome. And this area, I think, has just been exploding in recent years, not only in the infertility world, but in lots of other spaces, looking at the associations between the gut microbiome and other systemic diseases.

And certainly a lot of the story is being stitched together by these really well done experiments previously. And a lot of the rationale and hypotheses underline how male infertility can come about with oxidative stress, inflammation impacting the process. There certainly seems to be some linkages with some of the potential mechanisms with alterations in the gut microbiome and how that could be linked.

The other thing that's really interesting is a lot of epidemiological research that has linked male infertility with other health conditions and how this group of the population or patients with male infertility seem to have a higher risk of medical comorbidities, earlier mortality, and there's a lot of different theories and hypotheses as to why this may occur. Perhaps there's increased rates of gene mutations, etc. But could something like the gut microbiome also be something that plays into this where we know it's associated with other systemic conditions? And there's some links that have been drawn in the infertility and sperm production phase.

So, yeah, there's just so many different ways to explore these topics and how relevant they are to both biology of regular sperm production, as well as how that interfaces with infertility. So I'm quite excited about that. Finally, there is Maria Rodriguez, who at Oregon Health and Science University is a professor of obstetrics and gynecology and the Julia Newport Stott Endowed Professor in Women's Health, the director of the Center for Women's Health and directs the newly formed Center for Reproductive Health Equity, and serves as medical director for the state of Oregon's Reproductive Health Program.

She talked to me about the upcoming contraception keynote lecture, Policy Solutions to Promote Equitable Contraceptive Access, which is happening on Tuesday, October the 22nd. Yeah, you know, I think my early exposure in college to seeing people facing unintended pregnancy really helped me understand how the ability to become pregnant if and when somebody desires is just so fundamental to the opportunities people have, as well as to the health and well-being of their community. So I saw more of that during my years I spent at the World Health Organization, where I was not just dealing with unintended pregnancies, but also people that were suffering from infertility or subfertility, that I kind of recognized that connection between the individual health and the community health and became really interested in it.

You know, in the United States, as in many other countries around the world, we have had a growing appreciation for how it's not just about the biological processes of disease, but also the social determinants of health and the structural determinants of health. So the social determinants of health that kind of shape our well-being and our opportunities are things like where we live, where we work, where we play, and then the structural determinants give rise to those things. So the health of your neighborhood depends a lot of times on the policy or governing forces that structure it.

So things like zoning laws and where we can have fresh groceries or where liquor shops are licensed can have a tremendous impact on the neighborhoods that people live in. And so I became really interested in policy during my residency when I realized, you know, this is back before the Affordable Care Act, that the care I could provide for individual patients was really determined by their insurance coverage, and that that was very restricted depending on where they live and whether they had public insurance or private insurance or if they were insured through a Catholic-coordinated care organization or not. And so thinking about kind of contraception and people's ability to access it is important now more than ever.

And so looking at those sort of structural forces that give rise to people's ability to access contraception is what we're going to talk about in October. So much to do and experience this year at ASRM 2024. If you need more information, head on over to asrmcongress.org or email us asrm at asrm.org. I look forward to seeing everyone in Denver, and until next time, I'm Jeffrey Hayes, and this is ASRM Today.

This concludes this episode of ASRM Today. For show notes, author information, and discussions, go to asrmtoday.org. This material is copyrighted by the American Society for Reproductive Medicine and may not be reproduced or used without express consent from ASRM. ASRM Today series podcasts are supported in part by the ASRM Corporate Member Council.

The information and opinions expressed in this podcast do not necessarily reflect those of ASRM and its affiliates. These are provided as a source of general information and are not a substitute for consultation with a physician.