OBJECTIVE: Insured patients undergoing treatment for infertility utilize complementary and alternative medicine. Use among low-income, uninsured patients remains unknown. METHODS AND MATERIALS: Two cohorts, uninsured and insured patients, were recruited from gynecology clinics at the University of Illinois Health System. Participants completed a questionnaire to ascertain demographics data; type and duration of complementary and alternative medicine used; and perceptions of complementary and alternative medicine. Medical charts were reviewed to augment descriptive analysis. RESULTS: Seventy-eight participants were recruited: 49 uninsured and 29 insured. More than 70% of participants were underrepresented minorities. Insured participants were older (P<.05) and more likely to have a college or graduate degree (P<.05). Among uninsured participants, annual household incomes were bimodal: 32.7% reported an income of $5,000–10,000 and 22.4% of $16–20,000; only two participants reported an income greater than $100,000. By contrast, the majority of insured participants (51.7%) reported annual income $51,000–100,000; 34.5% reported income greater than $100,000 (P<.05). Despite demographic dissimilarities, use of complementary and alternative medicine did not differ (P=.773). More than half of participants use some form of complementary and alternative medicine, mostly vitamins, to achieve pregnancy. Reasons for not using complementary and alternative medicine differed between cohorts. Overall, most reported that they did not use complementary and alternative medicine because they had “never heard of it.” Among uninsured patients, the second most common reason was that it was “too expensive,” whereas insured patients were “not interested” (P<.05). CONCLUSION: Our study is the first to characterize an underrepresented minority infertility population at an academic medical center. Although other studies have assessed use and perception of complementary and alternative medicine to achieve pregnancy, ours is the first to describe these patterns among uninsured patients.

Among those facing infertility in the United States, underinsured and uninsured women are at the greatest disadvantage. Women who receive medical care under Medicaid are rarely covered for infertility testing; only 4 states will cover infertility treatment as an element of family planning and preconception care. Studies exploring the use of complementary and alternative medicine ( CAM) in infertility patients have focused on patients who have insurance. We conducted a review of the literature via MEDLINE. Articles were limited to English-language, human studies published between 1990 and 2011. Significant disparities exist in access to infertility treatment based on race and ethnicity, household income, and level of education, even in states with mandated insurance coverage. Given the steep costs of assisted reproductive technologies, many infertility patients augment traditional medical treatment with CAM. Acupuncture and herbal supplements are the most studied therapies. Although dietary supplementsmay enhance fertility, the use of othermore expensive forms of CAM such as acupuncture has had mixed results. Complementary and alternative medicine may be a viable option for infertility care for uninsured patients who cannot otherwise afford treatment.Target Audience: Obstetricians and gynecologists, family physiciansLearning Objectives: After completing this CME activity, physicians should be better able to analyze the effects that health care disparities have on fertility treatments for uninsured and underinsured women and evaluate the literature to determine which complementary and alternative treatments for infertility can improve fertility.

Insured patients undergoing treatment for infertility report utilizing CAM. Usage among low income, uninsured patients remains unknown. Prospective cohort study in an academic medical center. Subjects recruited from gynecology clinics at the University of Illinois were uninsured or Medicaid recipients who were actively trying to conceive. Subjects completed a questionnaire to ascertain demographic data, and type and duration of CAM currently used. They also rated the helpfulness of each method on a Likert scale of 1-10, as well as likelihood of using CAM over standard therapy, and reasons for not using. Medical charts were reviewed. Data were used to provide a descriptive analysis of this cohort. 32 subjects were recruited. They were mostly black females (78.1%) under age 39 (87.6%) with BMI 33.0 ± 8.3. 25% were married, 21.9% were college graduates. Household incomes were bimodal: 28.1% had an annual income of $5,000-10,000 and 28.1% of $16,000-20,000; only 2 subjects had income >$100,000. Median duration of infertility was 36 months. Among those with formal testing, 70% had tubal factor infertility. 61.3% of subjects used some form of CAM. Among users 78.9% chose vitamins, 26.3% herbs. Massage and special diets were the next most commonly used modalities (each 21.1%). Vitamins, herbs, and special diets were perceived as most helpful. Nine subjects (28.1%) would use CAM over standard therapy. The most common reasons not to use CAM were that subject had "never heard of it" and cost; 15.6% of participants stated CAM was "too expensive". Our study is the first to describe usage of and attitudes toward CAM among uninsured, low income infertility patients. A significant proportion utilize CAM. Vitamins and diets were perceived as most efficacious, though the majority of subjects stated they had "never heard of" CAM. This highlights the need for better education about CAM as well as proven infertility treatments in this under-studied population.

Aims Bone marrow (BM)-derived endothelial progenitor cells (EPCs) in the circulation replace damaged vascular endothelium. We assessed the hypothesis that a BM transplant from healthy animals would restore normal arterial endothelium and prevent hypertension in young endothelial nitric oxide synthase-deficient (eNOS(-/-)) mice.Methods and results Radiation or busulfan-induced BM ablation in eNOS(-/-) mice on day 6, day 14, or day 28 was followed by a BM transplant consisting of enhanced green fluorescent protein positive (EGFP(+)) cells from C57BL/6J mice. Peripheral blood cell chimerism was always greater than 85% at 4 months after BM transplant. Molecular assays of heart, kidney, and liver revealed low-level chimerism in all treatment groups, consistent with residual circulating EGFP+ blood cells. When aorta, coronary, renal, hepatic, and splenic arteries in BM-transplanted eNOS(-/-) mice were examined by confocal microscopy, there were no EGFP- or eNOS-positive endothelial cells detected in these vessels in any of the treatment groups. Likewise, telemetry did not detect any reduction in blood pressure. Thus, no differences were observed in our measurements using several different treatment protocols.Conclusion We found no evidence for BM-derived EPIC renewal of endothelium in this eNOS-deficient mouse model of a chronic vascular disease or in wild-type mice during postnatal growth. Hence, renewal of chronic dysfunctional endothelium and endothelial homeostasis may be dependent on resident vascular progenitor cells.