Racial Disparities In the Outcomes Of Euploid Single Frozen Thawed Embryo Transfer Cycles - analysis of SART-CORS 2016-2018 data.

OBJECTIVE: To evaluate if in pregnancies conceived with the transfer of single genetically tested embryos, maternal race and ethnicity relate to pregnancy outcome. DESIGN: Retrospective cohort. SUBJECTS: Autologous frozen -thaw embryo transfer (FET) cycles with transfer of single genetically tested embryo in SART-CORS for years 2016-2018; cycles associated with diagnoses of recurrent pregnancy loss, gestational carrier, donor egg and donor embryo were excluded. EXPOSURE: Information on race and ethnicity linked with in vitro fertilization and FET cycles available in the SART-CORS. MAIN OUTCOME MEASURES: Multivariable analyses utilizing generalized estimating equation examined the relationship between categories of race and ethnicity with the following outcomes: Pregnancy (+ßhCG following FET), clinical pregnancy, pregnancy loss (early [at gestation <13 weeks] and late [loss between ≥13 and <20 weeks]), preterm (<37 weeks), term (≥37 weeks) and live birth. Covariates adjusted for included age, BMI, AMH, infertility diagnosis and smoking history. RESULTS: 79,416 FET cycles met the eligibility criteria. Information on race and ethnicity was specified for 50,820 (64.0%) and was not known in 28, 723 (36%) of the cycles . The population was predominantly non-Hispanic White (NHW, 44%). Non-Hispanic Black [NHB] comprised 2.7%, Asian 12.3%, Hispanic 3.4%, American Indian, Pacific Islander, Hawaiian and Alaskan [AI_AL_PI_H] 0.2%. Nearly 1.0 % self-identified with more than one race. On multivariable analyses, pregnancies in NHB and in Hispanic women (compared to NHWs) were significantly more likely to result in in preterm birth (p<0.001). Compared to NHW women, the likelihood of live birth was significantly lower in NHBs (p<0.01), Asian (p=0.04), Hispanic (<0.01) and AI_AL_PI_H women (p<0.01). . The likelihood for delivery by Cesarean was also disproportionately higher in the NHB (p=0.047), Hispanic (p=0.007) and in women identifying with more than one race (0.023)compared to NHWs . CONCLUSION: Racial and ethnic differentials are apparent in the outcomes of FET conceived pregnancies resulting from the transfer of single genetically tested embryos.

Chronicling menstrual cycle patterns across the reproductive lifespan with real-world data.

The intricate hormonal and physiological changes of the menstrual cycle can influence health on a daily basis. Although prior studies have helped improve our understanding of the menstrual cycle, they often lack diversity in the populations included, sample size, and the span of reproductive and life stages. This paper aims to describe the dynamic differences in menstrual cycle characteristics and associated symptoms by age in a large global cohort of period-tracking application users. This work aims to contribute to our knowledge and understanding of female physiology at varying stages of reproductive aging. This cohort study included self-reported menstrual cycle and symptom information in a sample of Flo application users aged 18-55. Cycle and period length and their variability, and frequency of menstrual cycle symptom logs are described by the age of the user. Based on data logged by over 19 million global users of the Flo app, the length of the menstrual cycle and period show clear age-associated patterns. With higher age, cycles tend to get shorter (Cycle length: D ¯ = 1.85 days, Cohen's D = 0.59) and more variable (Cycle length SD: D ¯ = 0.42 days, Cohen's D = 0.09), until close to the chronological age (40-44) suggesting menopausal transition, when both cycles and periods become longer (Cycle length: D ¯ = 0.86 days, t = 48.85, Cohen's D = 0.26; Period length: D ¯ = 0.08, t = 15.6, Cohen's D = 0.07) and more variable (Cycle length SD: D ¯ = 2.80 days, t = 111.43, d = 0.51; Period length SD: D ¯ = 0.23 days, t = 67.81, Cohen's D = 0.31). The proportion of individuals with irregular cycles was highest in participants aged 51-55 (44.7%), and lowest in the 36-40 age group (28.3%). The spectrum of common menstrual cycle-related symptoms also varies with age. The frequency of logging of cramps and acne is lower in older participants, while logs of headache, backache, stress, and insomnia are higher in older users. Other symptoms show different patterns, such as breast tenderness and fatigue peaking between the ages of 20-40, or mood swings being most frequently logged in the youngest and oldest users. The menstrual cycle and related symptoms are not static throughout the lifespan. Understanding these age-related differences in cycle characteristics and symptoms is essential in understanding how best to care for and improve the daily experience for menstruators across the reproductive life span.

Aging and Adiposity-Focus on Biological Females at Midlife and Beyond.

Menopause is a physiological phase of life of aging women, and more than 1 billion women worldwide will be in menopause by 2025. The processes of global senescence parallel stages of reproductive aging and occur alongside aging-related changes in the body. Alterations in the endocrine pathways accompany and often predate the physiologic changes of aging, and interactions of these processes are increasingly being recognized as contributory to the progression of senescence. Our goal for this review is to examine, in aging women, the complex interplay between the endocrinology of menopause transition and post-menopause, and the metabolic transition, the hallmark being an increasing tendency towards central adiposity that begins in tandem with reproductive aging and is often exacerbated post menopause. For the purpose of this review, our choice of the terms 'female' and 'woman' refer to genetic females.