This weekend, in between earning Queen Bee three times in a row (in collaboration with some smart friends), I read a New York Times investigative piece on newer non-invasive prenatal testing that I found fascinating and disturbing. These tests—which are based on traces of the fetus’s DNA that can be detected in a pregnant person’s blood—are really good at identifying chromosomal anomalies like Down syndrome, trisomy 18, and trisomy 13. The article explains that many companies are now offering similar testing for much rarer conditions caused by microdeletions (when small pieces of DNA are missing). These results are less dependable not because they miss cases but because they return so many false positives, leaving expectant parents anxious and confused as they wait for more definitive tests and contemplate whether they want to continue the pregnancy.
I haven’t been pregnant in approximately 11 years, 4 months, 4 days, and 2 hours, but I have very clear recollections of my prenatal tests. I remember the many vials of blood I gave to determine if I had genes for any of the various and sundry conditions that we Ashkenazi Jews frequently carry from Tay-Sachs to something called Maple Syrup Urine Disease. I remember “the nuchal” at 11 weeks in part because it was the first ultrasound that did not involve a wand being stuck up my vagina. I remember the 20-week scan during the first pregnancy when we learned the sex and changed the fetus’s in utero name from Spanky to Spanky Ann (which was uttered so often, my father feared it would become her real-world nickname). And, I remember the amniocentesis we decided to have the second time around because the earlier tests did not calm my fears about what medicine insisted on calling “a geriatric pregnancy” (I was 38). Someone stuck a very large needle through my abdomen, and we watched on the sonogram as the fetus—then known as Sprocket—attempted to grab it. I spent the rest of the pregnancy reassured about chromosomal anomalies but worried about the palm of her hand.
I also remember the anxiety that came along with wanting to know in advance that the baby would be fine and the discussions about what to do if tests indicated it wasn’t. This is what makes the idea of a false positive so upsetting.
According to the article, there is an 81% chance that a positive result on the screening test for DiGeorge’s Syndrome, which affects 1 in 4,000 live births and can cause heart defects, is wrong. Similarly, if the screening for Wolf-Hirschhorn syndrome—which affects 1 in 20,000 births and can cause seizures, growth delays, and intellectual disability—comes back positive, there’s an 86% chance it’s wrong. And yet, the official advertised false positive rates are 0.5%. These rates aren’t inaccurate per se but can be misleading when you’re casting a wide net for rare conditions.
These tests are unregulated by the FDA and the Times article makes it clear that many parents-to-be are not being well briefed on what the results mean (and don’t mean) by their prenatal care teams.
I highly recommend reading the Times piece for the results of the analysis and a look at how this issue is affecting families. I also suggest checking out Emily Oster’s newsletter, Parent Data, for a better explanation of why a seemingly low false positive rate can affect so many people. And, there were a number of interesting letters to the editor after the piece ran that explored other issues, like our view of disability in general and the implications that doubting tests of any kind might have on the Covid-19 pandemic.
If you’re not up for that, I highly recommend the Times’ Spelling Bee (I know everyone is hopping on the Wordle wagon but I just started this and am not ready to add another must-do word puzzle to my day).
Post-Vaccine Period Changes Are Temporary According to New Study
A study published last week in Obstetrics & Gynecology looked at data women collected about their periods before and after they got the Covid-19 vaccine, and found that changes to period timing were small and short-lived.
As we discussed last April, there have been many anecdotal reports of women experiencing changes to their menstrual cycles after getting the vaccination. Some reported earlier periods, some later, some longer, and others heavier. Until now, we didn’t have any data on how often this happened or how severe the changes were, but that didn’t stop the anti-vax movement from hopping on these stories as proof the vaccines mess with female fertility. This new study should be reassuring to anyone who was worried about it (though I assume it will be ignored by those who used it as a reason not to get vaccinated or vaccinate their children).
Researchers at several universities teamed with Natural Cycles, a period tracking app, to analyze data on menstrual cycles of just under 4,000 app user. About 2,400 of them had gotten the vaccine (with most getting either Pfizer or Moderna) and 1,600 had not. Researchers examined six menstrual cycles for each person. In those who got the vaccine they used the three cycles before and the three cycles during or after vaccination. The study found small changes in the length of menstrual cycles (which are counted from the first day of bleeding in one cycle to the first day of bleeding in the next) and no change in the length of menses (the number of days a person bleeds during each cycle).
While there was a statistically significant change in the length of the menstrual cycle in those who were vaccinated, it was so small (less than a day) that it would not be considered clinically significant. The proportion of people who experienced what would be considered a clinically significant change in cycle length (8 days or more) did not differ between the vaccinated group (5.2%) and the unvaccinated (4.3%).
There were 358 people in the study who received both shots during the same menstrual cycle and they may have actually driven the overall findings up. Their post-vaccines cycles were closer to two days longer on average and about 10% of them had a change in length of 8 days or more. When they were removed from the analysis, the increases in cycle length dropped below one day and there were no significant differences in the proportion of individuals with a change in cycle length of 8 days or more compared with unvaccinated individuals.
It is possible that these results are not generalizable as participants are a self-selecting group. People who choose to use the app are interested in their fertility (either getting pregnant or preventing it without birth control) and are not using hormonal contraception. According to the authors, they are also more likely to be white and college educated and have lower BMIs than national distributions. Moreover, the researchers only included users whose menstrual cycle already fit in the app’s definition of “normal” length—28 to 34 days. (This definition was one of my concerns when the FDA approved the app as a contraceptive method: how would we know its efficacy results applied to women who have extra long, extra short, or widely variable cycles if they were consistently excluded from the research?)
Despite these limitations, the authors of the study say that their results are both validating (women weren’t wrong when they said their periods got wonky) and reassuring (the changes are very small and should have no impact on fertility). Alison Edelman, professor of obstetrics and gynecology at Oregon Health and Science University School of Medicine and the lead author on the paper, told Today: “In the long run we’re not seeing anything that should prevent somebody from getting vaccinated. It just gives them more information about what to expect. Now we can tell folks you might have a slight change in your menstrual cycle length.”
Wearable Climax Control
The idea of the high school kid who finally gets the chance to get laid but ends up getting off while still wearing his Levi’s is funny, but for many people with penises premature ejaculation is a real and disturbing condition. One out of three men is said to experience it at some point in their lives. Morari Medical, a start-up focusing on sexual health, is debuting a new wearable solution at this week’s Consumer Electronics Show in Las Vegas.
This far approved treatments for premature ejaculation include therapy, pelvic floor exercises (yes penis-havers can Kegel too), and medication. Some have success with anti-depressants which often cause delayed climax. Interestingly, P5-inhibitors—the class of drug that includes Viagra and Cialis—have also been successful for some men. And, of course, there are a whole host of over-the-counter analgesic lubes, sprays, and creams that promise to numb the penis just enough to keep orgasms at bay (I once found a product called Mandelay in a bodega– I thought it was pretty clever.)
This new device, however, works in a different way. It’s essentially a TENS (transdermal electric neuromodulation) unit similar to those used for physical therapy or aching lower backs that sends small electric pulses into the body. Users put a patch a little bigger than a band-aid on the area between the scrotum and the anus (known as the perineum) and control the pulses through an app on their phone.
The company says that this temporarily disrupts the signals going between the brain and the penis allowing the person to last longer during sex. While I would think you’d want to keep the lines of communication between the big head and the little one open during sex, the company promises that pleasure is an important part of its mission.
We’ll have to wait until next year, however, to find out if sex with a TENS unit is better and longer as the company doesn’t expect the product to launch until 2023.