The Effect of Hormonal Contraception Use on Ovarian Reserve Markers and the Uptake of Assisted Reproductive Technology in Individuals Seeking an Infertility Evaluation.

Background and objective The effects of hormonal contraception (HC) use on ovarian reserve (OR) markers in individuals seeking an infertility evaluation and the success of assisted reproductive technology (ART) warrant further investigation. Therefore, the aim of this study was to determine if women seeking an evaluation for unexplained infertility who used long-term (≥2 years) HC have lower ovarian reserve (OR) markers and higher uptake of ART compared to short-term (<2 years) or never HC users. Methods We performed a cross-sectional patient survey involving a retrospective medical chart review of patients seeking an evaluation for unexplained infertility at the University of Colorado Advanced Reproductive Medicine (CU ARM) clinic. Results Most participants (87%; 107/123) reported a history of HC use with 98 (79.7%) reporting long-term continuous use for two or more years. Median OR markers were similar between long-term and short-term/never HC users [anti-Müllerian hormone (AMH): 2.4 vs. 3.2, p=0.20; antral follicle count (AFC): 18 vs. 26, p=0.10; follicle-stimulating hormone (FSH): 7.6 vs. 6.3, p=0.26] and remained so after adjusting for age and diagnosis of polycystic ovarian syndrome (PCOS) or primary ovarian insufficiency (POI) in linear regression models. However, among HC users aged less than 30 years (n=9), those who had discontinued HC between two and three years prior to the assessment of their OR markers had a 6.20 ng/mL increase in AMH level compared to those who had discontinued HC less than two years prior to the assessment (p=0.02). Additionally, there was a marginally increased use of ART overall among long-term HC users compared to short-term/never HC users (64.3% vs. 44.0%, p=0.06), specifically in the use of in vitro fertilization (IVF) (58.7% vs. 18.2%, p=0.01). Among long-term HC users, ovulation induction was less likely to result in live birth compared to short-term/never HC users (8.9% vs. 62.5%, p<0.001); however, after adjusting for age, PCOS, POI, and type of ART used, there was no difference in the odds of live birth after ART between long-term HC users and short-term/never users. Conclusion While long-term HC users report increased use of ART, in particular IVF, the overall conception rates and live birth outcomes among ART users do not appear to be significantly affected by a history of long-term HC use.

Anti-Müllerian Hormone and Follicle-Stimulating Hormone Are Poor Independent Predictors of Live Birth After Assisted Reproductive Technology.

To query if anti-Müllerian hormone (AMH) and/or follicle-stimulating hormone (FSH) predict live birth at the University of Colorado Advanced Reproductive Medicine (CU ARM). This was a retrospective analysis using the Society for Assisted Reproductive Technology (SART) Clinic Outcome Reporting System database at CU ARM from 2017 to 2019 to identify the pregnancy outcomes of the initial fresh or frozen embryo transfer (FET) and their corresponding AMH and FSH. Fisher's exact tests were used to identify differences in pregnancy outcome by age group, and area under the receiver operator characteristic curves was used to quantify live birth prediction. A total of 1083 records from 557 patients were reviewed. After only including the first autologous transfer, 270 cycles were analyzed. Overall live birth (L/B) rate was 58.15% (157/270), which declined with increasing age group (p ≤ 0.01). Although AMH significantly decreased with increasing age (p < 0.001), it was not associated with pregnancy outcome (3.54 ng/mL vs. 3.41 ng/mL, p = 0.56); this relationship was unchanged after controlling for age in logistic regression models (p = 0.52). FSH was also not significantly related to pregnancy outcome (7.00 IU/L vs 6.00 IU/L, p = 0.15), and this relationship did not change after controlling for age (p = 0.61). Using AUC, the only variable predictive of live birth was age (p = 0.002). AMH and FSH are not associated with the probability of live birth. Only age was significantly associated with live birth in this series. AMH and FSH should therefore be used cautiously when counseling patients about ART outcomes.

Clinical and diagnostic spectrum of optic neuritis: A single-center retrospective study of disorders associated with multiple sclerosis, anti-aquaporin-4 and anti-myelin oligodendrocyte glycoprotein antibodies.

OBJECTIVE: Optic neuritis (ON) is an immune-mediated optic neuropathy associated with multiple immune-mediated neurological conditions. Our aim was to characterize the clinical and diagnostic features of first or initial episodes of ON associated with multiple sclerosis (MS)-associated (typical) and antibody-related (atypical) ON. METHODS: Retrospective, single institution, medical record review. We analyzed demographic, clinical, laboratory, and radiographic findings of 139 patients who presented with first episodes of MS-associated ON (MS-ON), aquaporin 4 antibody-associated ON (AQP4-ON), and myelin oligodendrocyte glycoprotein antibody-associated ON (MOG-ON) between January 2015 and October 2019 without preceding diagnosis. Simple hypothesis testing assessed differences between groups were performed. RESULTS: Of 139 patients (109 [79 %] women; 29 [21 %] men; mean age 47 [SD, 14] years), 106 had MS-ON, 25 had AQP4-ON, and 8 had MOG-ON. Patients with MOG-ON had the highest recurrence rate (88 %) relative to MS-ON (28 %) and AQP4-ON (56 %) patients (P < .001). Patients with AQP4-ON had the highest mean visual functional system scores (4.3 [SD, 1.8]) relative to MS-ON (2.0 [SD, 1.9]) and MOG-ON patients (2.8 [SD, 2.0]) (P < .001). CONCLUSION: Patients presenting with initial episodes of ON exhibit a range radiographic and laboratory feature depending on the underlying associated disease. Understanding the variable characteristics of typical (MS-associated) and atypical (antibody-associated) ON may help physicians accurately diagnose and effectively treat ON.

Racial and Ethnic Disparities in Fertility Awareness Among Reproductive-Aged Women.

Background: Despite the rising prevalence of infertility, studies have indicated that in the United States fertility awareness remains low. No published study to date, however, has investigated the impact of any racial or ethnic disparities in fertility awareness. Materials and Methods: We conducted a cross-sectional survey of people self-identifying as female, aged 18-45 years, via Amazon Mechanical Turk in August 2020. The study was approved by the institutional review board at the University of Colorado. The survey consisted of demographic questions and a validated questionnaire, the Fertility and Infertility Treatment Knowledge Score (FIT-KS). Participants were classified as non-Hispanic White (NHW) or "Minority" race/ethnicity. Results: A total of 476 women completed the survey, 405 of which were included in analysis. Of those, 54.6% self-identified as NHW and 45.4% were in the Minority group. The median FIT-KS was 51.7% (16 items answered correctly). The Minority group scored significantly lower than the NHW participants overall (58.6% vs. 48.3%, p < 0.001) and in all three subscales (p < 0.05). The Minority group was significantly more likely to underestimate the rate of miscarriage (47.3% vs. 32.6%, p = 0.003) and had a lower awareness of risk factors that can impact fertility including smoking (88.7% vs. 71.6%, p < 0.001), obesity (90.5% vs. 70.5%, p < 0.001), and/or a history of gonorrhea/chlamydia infection (83.7% vs. 64.7%, p < 0.001). Conclusions: Minority women appear to have a lower fertility awareness than their NHW counterparts. Addressing these disparities and improving fertility education in diverse communities may lead to a reduction in clinically significant infertility disparities.

The Utility of EMRs in Student Run Clinics.

BACKGROUND: A student-run free clinic (SRFC) is a health care delivery system in which undergraduate medical students assume the responsibility of an outpatient health clinic. This provides a unique opportunity for early exposure to patients in a student's pre-clinical years. METHODS: Pre- and post-experience electronic surveys were sent out to first-year medical students who were required to complete a minimum of three sessions as a volunteer at one of two SRFCs in the metro Detroit area. The Fisher's exact test was used to assess for a significant change after clinic experience with p < 0.05. RESULTS: Thirty-one students completed the pre-experience survey. Twenty-five students completed the post-experience survey. The Fisher's exact test demonstrated a significant increase in the proportion of positive answers for questions concerning comfort with taking a medical history (p = 0.002) and comfort with using an electronic medical record (EMR) (p = 0.048). There was no significant difference in comfort working as part of a team (p = 0.581), discussing a patient with a physician (p = 0.602) or interacting with different socio-economic backgrounds (p = 0.720). CONCLUSION: SRFCs provide a beneficial opportunity for early patient and clinical exposure for pre-clinical medical students, including practice using an EMR, which is an essential tool in our electronic era. More research, however, is needed to determine the most effective way to teach skillful EMR use.

A retrospective review of 93 cases of cellular dermatofibromas.

BACKGROUND: Cellular dermatofibromas (CDF) are an uncommon variant of benign fibrous histiocytomas with propensity to recur and rarely metastasize as well as demonstrate histologic similarities to more dangerous lesions. OBJECTIVES: The aim of this present study was to further describe the presentation and outcome of the cellular variant of benign fibrous histiocytomas so that it can be diagnosed and treated appropriately. METHODS: A retrospective chart review was performed on all patients seen in a single hospital system in Detroit, Michigan, from 2007 to 2017. CDF was confirmed by pathology. Baseline demographics, specialty service of diagnosis and treatment, treatment modality, and outcome were collected. RESULTS: Of the 93 qualifying patients, the average age at diagnosis was 42.65 years. The most common specialty service that diagnosed and treated patients was dermatology (38.71%). About 95.0% of CDF stained positive for Factor 13A (19/20), and 90.48% were CD34 negative (19/21). Of patients, 33.33% had recurrences of their CDF (9/27). Two patients had three or more recurrences. One patient's death was attributed to the CDF. CONCLUSION: CDF have a high local recurrence rate and similarities to more dangerous and malignant lesions. Patients with cellular dermatofibromas present to many subspecialty services for diagnosis and should be treated aggressively.