Advancements in the application of uterine ultrasound elastography.

PURPOSE OF REVIEW: This article reviews recent advances in ultrasound elastography in diagnosing and evaluating the normal nongravid uterus and the infertile uterus in the gynecologic patient. RECENT FINDINGS: Focusing on the most recent primary literature, studies have demonstrated new findings among a breadth of gynecologic clinical settings. Studies in the nongravid uterus have found that menopausal status, age, and menstrual phase have not been associated with changes in uterine tissue stiffness. Focusing on myometrial disease, there have been conflicting data regarding the ability to distinguish uterine fibroids from adenomyosis. One area of expanding research surrounding uterine elastography includes the infertile population, where ongoing studies attempt to provide a predictive model using shear wave elastography (SWE) in patients undergoing in-vitro fertilization. SUMMARY: Ultrasound elastography has become an increasingly studied and utilized tool in assessing physiologic and pathologic processes in the field of gynecology. Evaluating tissue stiffness through strain and SWE can serve to improve diagnosis of various uterine and cervical lesions, as well as prognosticate outcomes after fertility treatments. This growing area of research will continue to establish the role and application of ultrasound elastography into clinical practice.

Question evaluation for real-time surveys: Lessons from COVID-19 data collection.

The need for high-quality, real-time data has never presented itself as clearly as it did during the COVID-19 pandemic. Responding to the COVID-19 pandemic, from both a policy and a public health perspective, required timely, accurate data about the public's attitudes and behaviors from health surveillance, monitoring, and public opinion surveys. The uniqueness of the COVID-19 pandemic also created particular challenges for survey data collection, specifically, how to develop high quality survey questions on topics that had never been previously fielded. To account for this challenge, the National Center for Health Statistics adopted an iterative, two-component, mixed-method approach to question design and evaluation. The first, a cognitive interviewing study using virtual, online interviews was used to produce interpretative schemata of the response processes underlying the survey questions. The second, a two-round, mixed method survey using a statistically-sampled panel, was designed to further develop the interpretive schemata and to allow for detailed subgroup analyses. To increase the usefulness of the survey's second round, cognitive interview findings and results from the survey's first round were used to develop both open- and close-ended embedded probes. Taken together, the studies reveal the specific problems for question-design during such a novel, quickly-evolving event: 1) a lack of shared understanding of novel concepts and vocabulary, 2) the shifting reference period respondents use to think about attitudes and behaviors during a multi-year event, 3) the pervasive nature of the event that therefore frames how respondents conceptualize and process questions about unrelated topics. This iterative approach to understanding question-design problems not only allowed for the continuing improvement of COVID-19 survey items, going forward, it also provided a methodological foundation for question development for high quality, real-time data collection.

Reproductive and obstetric outcomes in women of racial minorities aged 40 years and older undergoing IVF.

RESEARCH QUESTION: Do women of racial minorities aged 40 years or older have similar reproductive and obstetric outcomes as white women undergoing IVF? DESIGN: A retrospective cohort study conducted at a single academic university-affiliated centre. The study population included women aged 40 years or older undergoing their first IVF cycle with fresh cleavage-stage embryo transfer stratified by racial minority status: minority (black or Asian) versus white. Clinical intrauterine pregnancy and live birth rate were the primary outcomes. Preterm delivery (<37 weeks) and small for gestational age were the secondary outcomes. Odds ratios with 95% confidence intervals were estimated. P < 0.05 was considered to be statistically significant. RESULTS: A total of 2050 cycles in women over the age of 40 years were analysed, 561 (27.4%) of which were undertaken by minority women and 1489 (72.6%) by white women. Minority women were 30% less likely to achieve a pregnancy compared with their white (non-Hispanic) counterparts (adjusted OR 0.68, CI 0.54 to 0.87). Once pregnant, however, the odds of live birth were similar (adjusted OR 1.23, CI 0.91 to 1.67). Minority women were significantly more likely to have lower gestational ages at time of delivery (38.5 versus 39.2 weeks, P = 0.009) and were more likely to have extreme preterm birth delivery 24-28 weeks (5.5 versus 1.0%, P = 0.021). CONCLUSION: Minority women of advanced reproductive age are less likely to achieve a pregnancy compared with white (non-Hispanic) women. Once pregnancy is achieved, however, live birth rates are similar albeit with minority women experiencing higher rates of preterm delivery.

Combined transvaginal and transabdominal oocyte retrieval in a patient with an ectopic ovary and unicornuate uterus.

OBJECTIVE: To report the utility of combined transvaginal and transabdominal oocyte retrieval in a patient with an ectopic ovary and unicornuate uterus. DESIGN: Video case report with demonstration of oocyte retrieval technique. SETTING(S): University-affiliated fertility center. PATIENT(S): A 35-year-old woman, gravida 0, with a 6-month history of infertility who presented to our center for fertility evaluation. Hysterosalpingography revealed a left unicornuate uterus and patent left fallopian tube magnetic resonance imaging and laparoscopy showed a right ectopic ovary located in the upper abdomen. Her partner was a 36-year-old male with isolated teratozoospermia. The couple did not conceive with intrauterine insemination. INTERVENTION(S): Ovarian stimulation for in vitro fertilization (IVF). Transvaginal retrieval of oocytes from the right ovary was not deemed possible due the anatomic location of the ovary, intervening blood vessels, and limited mobility of the ovary. Institutional review board approval was not required for this case report as per our institution's policy; patient consent was obtained for publication of the case. MAIN OUTCOME MEASURE(S): Transabdominal retrieval of oocytes from the right ovary and transvaginal retrieval of oocytes from the left ovary. RESULT(S): The couple underwent two IVF cycles. Nine oocytes were retrieved during the first IVF cycle: seven transabdominal (right ovary) and two transvaginal (left ovary). All oocytes were mature, and five blastocysts were cryopreserved. Eight oocytes were retrieved during the second IVF cycle, of which five oocytes were retrieved transabdominally from the right ovary, and three oocytes were retrieved transvaginally from the left ovary. All oocytes were mature, and four blastocysts were cryopreserved. A single thawed embryo was transferred in the natural menstrual cycle, which resulted in the live birth of a full-term baby boy weighing 2,410 grams. CONCLUSION(S): The current case highlights the safety and feasibility of combined transvaginal and transabdominal oocyte retrieval in patients with an ectopic ovary located in the upper abdomen.

Outcomes in, and characteristics of, patients who undergo intrauterine insemination immediately after failed oocyte retrieval.

OBJECTIVE: To describe the patient and cycle characteristics of women who undergo intrauterine insemination (IUI) immediately after an unsuccessful oocyte retrieval. DESIGN: Retrospective case series. SETTING: University-affiliated center. PATIENTS: Women who underwent an oocyte retrieval procedure in which no oocytes were retrieved followed by an IUI on the same morning. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Live birth rate, subsequent live birth rate. RESULTS: From 2011 to 2019, 63 cycles in 57 patients were identified. The mean (SD) age was 39.6 (4.6) years, and diminished ovarian reserve (94.7%) was the most common diagnosis. The median (IQR) number of previous IVF cycles in this cohort was 3 (1-7), with 56.1% having had at least one previous canceled IVF cycle. The majority of patients had undergone either controlled ovarian hyperstimulation (COH) (64.9%) or modified natural cycles (21.1%). The mean (SD) number of follicles >14 mm at the time of trigger was 1.9 (1.4), with 38.9% of patients manifesting a drop in their estradiol levels after the trigger. One pregnancy resulting in a live birth was identified (1.8%). For patients who underwent subsequent IVF cycles, 60.7% had at least one subsequent cancelled cycle. Three patients went on to achieve a live birth using autologous oocytes (6.5%). CONCLUSIONS: Same-day IUI for patients who have no oocytes retrieved is associated with a <2% chance of achieving a live birth. Of patients who attempt subsequent IVF cycles, nearly two thirds will go on to have at least one subsequent cancelled cycle. In this poor-prognosis cohort, fewer than 10% will ultimately achieve a live birth by the use of autologous oocytes.

"Age is Just a Number": How Celebrity-Driven Magazines Misrepresent Fertility at Advanced Reproductive Ages.

Background: Recognizing the pervasive impact of popular media on reproductive-aged women, we sought to characterize the depiction of age-related fertility decline in widely consumed media. Materials and Methods: We performed a quantitative and qualitative analysis of top read print magazines targeting reproductive-aged women. Primary outcome measures include celebrity age at time of pregnancy, content related to assisted reproductive technology (ART) and donor gametes, and mention of risks related to pregnancy at advanced maternal age (AMA). Results: Four hundred sixteen magazine issues published between January 2010 and January 2014 included 1,894 headlines, photos, or text passages related to fertility. Fertility was highlighted on one-third of all magazine covers. Two hundred forty celebrities received at least one fertility-related depiction. The majority (56%) were of AMA; only two mentions of AMA-related obstetrical risks were included. Three of 240 subjects (1.25%) were reported as having used ART. Forty-five celebrities (33%) were at least 40 years old at the time of mention; 7 subjects >44 years were depicted as pregnant or having delivered a healthy infant, without mention of ART. Donor gametes received no mention. All 416 magazines (100%) contained at least 1 reference to contraception; only 10 magazines (2.4%) mentioned any form of ART. Conclusions: Widely consumed popular media downplays the impact of age on fertility. Magazines promote contraception contrasted with easily reachable fertility goals at advanced reproductive ages, with rare or no mention of ART, donor gametes, or AMA-related health risks. Magazine content may be a contributing source to the public's misconceptions about age-related fertility decline.

Cognitive evaluation of the AABB Uniform Donor History Questionnaire.

BACKGROUND: This article reports key findings of an evaluation of the AABB Uniform Donor History Questionnaire (a self-administered form completed before blood donation). The purpose of the study was to examine how respondents understand the questions and assess the nature of inaccurate responses. Another goal was to determine whether men who have sex with men (MSM) interpreted questions differently from non-MSM and whether questions were interpreted differently in various regions of the country. STUDY DESIGN AND METHODS: Cognitive interviewing was used for the study. This is a qualitative method that investigates how survey questions perform. It consists of semistructured interviews that explore whether respondents understand questions as intended and whether they can provide accurate answers. A total of 166 interviews were conducted. RESULTS: Respondents had an overwhelmingly similar understanding of the purpose of the questionnaire as assessing the safety of their blood for donation. This understanding framed respondents' interpretations such that each question was understood as asking the same thing; that is, "Is my blood safe to donate?" This interpretation did not vary among MSM versus non-MSM or by region. CONCLUSION: Respondents understood the questionnaire as assessing the safety of their blood. This interpretation served as the backdrop for the question-response process for each individual question. Specifically, rationale for answers was framed as much or more by the questionnaire's general purpose as by the specific topic of individual questions. This pattern of interpretation was the key factor responsible for both false-positive and false-negative response errors and did not vary by demographic, including in MSM.

Design and Analysis of Cognitive Interviews for Comparative Multinational Testing.

This article summarizes the work of the Comparative Cognitive Testing Workgroup, an international coalition of survey methodologists interested in developing an evidence-based methodology for examining the comparability of survey questions within cross-cultural or multinational contexts. To meet this objective, it was necessary to ensure that the cognitive interviewing (CI) method itself did not introduce method bias. Therefore, the workgroup first identified specific characteristics inherent in CI methodology that could undermine the comparability of CI evidence. The group then developed and implemented a protocol addressing those issues. In total, 135 cognitive interviews were conducted by participating countries. Through the process, the group identified various interpretive patterns resulting from sociocultural and language-related differences among countries as well as other patterns of error that would impede comparability of survey data.

Role of self-concept in answering survey questions on complementary and alternative medicine: challenges to and strategies for improving data quality.

OBJECTIVES: The aim of this study was to assess the construct validity of survey questions about the use of herbal and other nonvitamin/nonmineral dietary supplements. DESIGN: We conducted one-on-one, in-depth cognitive interviews with 32 respondents to test questions from the complementary and alternative medicine (CAM) supplement for the 2007 National Health Interview Survey. Respondents were sampled purposively according to their use of CAM. Interviewers probed respondents for their understanding of the questions, and analysis was guided by grounded theory, an approach that generates explanations of response error that are closely tied to the empirical data. RESULTS: We found two sources of misinterpretation of CAM questions. First, some respondents did not have any pre-established definition of what constitutes an herbal supplement while others had interpretations that did not match the intended definitions. These problems are common to many survey questions. However, a second finding is that misinterpretation also arose when respondents incorporated notions of self-concept into the act of taking "natural herbs," and answered based on their understanding of this image rather than on actual behavior. CONCLUSIONS: There are several sources of misinterpretation of CAM questions. One of the most important sources is whether or not the respondent has created a concept of self-image that includes the use of herbal supplements. Common questionnaire design techniques such as providing definitions to respondents will not help to eliminate misinterpretation due to self-image. We found that careful question wording that does not evoke definitions of self, combined with visual aids that narrow the focus of the questions, can lead to more accurate answers.

Use of contraception and use of family planning services in the United States: 1982-2002.

OBJECTIVE: This report presents national estimates of contraceptive use and method choice based on the 1982, 1995, and 2002 National Surveys of Family Growth (NSFG). It also presents data on where women obtained family planning and medical services, and some of the services that they received. METHODS: Data were collected through in-person interviews with 12,571 men and women 15-44 years of age in the civilian noninstitutional population of the United States in 2002. This report is based on the sample of 7,643 women interviewed in 2002. The response rate for women in the study was about 80 percent. RESULTS: The leading method of contraception in the United States in 2002 was the oral contraceptive pill, used by 11.6 million women; the second leading method was female sterilization, used by 10.3 million women. The condom was the third-leading method, used by about 9 million women and their partners. The condom is the leading method at first intercourse; the pill is the leading method among women under 30; and female sterilization is the leading method among women 35 and older. More than 98 percent of women 15-44 years of age who have ever had sexual intercourse with a male (referred to as "sexually experienced women") have used at least one contraceptive method. Over the 20 years from 1982 to 2002, the percent who had ever had a partner who used the male condom increased from 52 to 90 percent. The proportion who had ever had a partner who used withdrawal increased from 25 percent in 1982 to 56 percent in 2002. Another important measure of contraceptive use is use at the first premarital intercourse: before 1980, only 43 percent of women (or their partner) used a method of birth control at their first premarital intercourse. By 1999-2002, the proportion using a method at first premarital intercourse had risen to 79 percent.