Recent clomiphene citrate exposure does not impact subsequent clinical outcomes in single euploid frozen embryo transfer cycles.

STUDY QUESTION: Do infertile couples who recently utilized clomiphene citrate (CC) for ovulation induction or ovarian stimulation (<90 days previously) followed by a single euploid embryo transfer (SEET) have lower implantation potential compared with patients who were not exposed to CC within 90 days before embryo transfer (ET)? SUMMARY ANSWER: There does not appear to be an association between recent CC exposure and lower implantation potential in patients who undergo a frozen embryo transfer (FET) of euploid embryos. WHAT IS KNOWN ALREADY: Clomiphene has been found to be associated with lower pregnancy rates when compared against other ovarian stimulation medications. The majority of published research about the effects of CC on implantation potential suggest an anti-estrogenic effect on the endometrium. Quality evidence and information about utilization of CC and its effect on implantation potential after euploid ETs is lacking in the literature. STUDY DESIGN, SIZE, DURATION: A retrospective cohort study with propensity score matching was carried out. We included all patients that underwent an autologous SEET from September 2016 to September 2022 at a single academic-private ART center. PARTICIPANTS/MATERIALS, SETTING, METHODS: The study group included patients that had utilized CC during either ovulation induction cycles and/or controlled ovarian stimulation at least 90 days before FET. A propensity score-matched control group of patients that were unexposed to CC within 90 days prior to SEET was used for comparisons. The primary outcome was positive pregnancy test (defined as a positive serum ß-hCG measured 9 days after ET), with other outcomes including clinical pregnancy, ongoing pregnancy, biochemical pregnancy loss, and clinical pregnancy loss rates per SEET. Multivariate regression analyses fitted with generalized estimating equations were utilized to analyze if there was an association between CC utilization and IVF outcomes. Furthermore, the study evaluated the cumulative effect of CC and endometrial receptivity in vivo and subsequent IVF outcomes. MAIN RESULTS AND THE ROLE OF CHANCE: A total of 593 patients with utilization of CC in <90 days before ET were compared with 1779 matched controls. Positive pregnancy test rates were comparable among the control group and the CC exposed groups, respectively (74.3% versus 75.7%, P = 0.79), as were clinical pregnancy (64.0% versus 65.0%, P = 0.60), ongoing pregnancy (51.8% versus 53.2%, P = 0.74), biochemical pregnancy loss (15.7% versus 14.03%, P = 0.45), and clinical pregnancy loss rates were also comparable among cohorts (17.1% versus 18.1%, P = 0.71). No association was found between utilization of clomiphene and lower implantation rates (adjusted odds ratio 0.95, 95% CI 0.76-1.18). Also, no differences were observed in sub-analyses based on multiple CC utilization periods. Finally, no association was found between the number of consecutive cumulative clomiphene cycles and sub-optimal IVF outcomes. LIMITATIONS, REASONS FOR CAUTION: The study has inherent bias that originated from its retrospective design. Serum levels of CC were not measured and sample size for the sub-analyses was small. WIDER IMPLICATIONS OF THE FINDINGS: There does not appear to be an association between recent CC exposure and lower implantation potential in patients who undergo a FET of euploid embryos. This finding remains consistent, even in patients who undergo multiple, consecutive clomiphene cycles prior to ET. There were no long-term effects of CC on endometrial development and clinical characteristics examined in this study. Patients that utilized CC medication prior to a SEET cycle for either ovarian stimulation or ovulation induction, can be assured that there is no evidence of a residual effect of recent CC administration that could jeopardize their pregnancy probability. STUDY FUNDING/COMPETING INTEREST(S): No funding was received for the realization of this study. A.C. is advisor and/or board member of Sema4 (stakeholder in data) and Progyny. The other authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER: N/A.

[Assisted hatching for improving embryo implantation. A bibliographical review]. / Eclosión asistida: para mejorar la implantación del embrión. Revisión de la bibliografía.

Embryo implantation represents the most critical step of the reproductive process in many species, to be successful requires a receptive endometrium, functional embryo at a stage of embryonic development and proper dialogue between embryonic and maternal tissues. Hatching is the process in which the blastocyst gets rid of the zona pellucida to be implemented. The failure in this factor can lead to reproductive problems, even under assisted reproduction techniques. Assisted hatching is a technique used in assisted reproduction laboratories to improve performance in the process of fecundation or in vitro fertilization. This technique is based on impairment or section of the zona pellucida using different techniques. In this review, the most common indications and techniques used to perform this procedure and improve success rates in assisted reproduction techniques are synthesized.

The Development of a Digital Patient Navigation Tool to Increase Colorectal Cancer Screening Among Federally Qualified Health Center Patients: Acceptability and Usability Testing.

BACKGROUND: Federally Qualified Health Centers (FQHCs) are an essential place for historically underserved patients to access health care, including screening for colorectal cancer (CRC), one of the leading causes of cancer death in the United States. Novel interventions aimed at increasing CRC screening completion rates at FQHCs are crucial. OBJECTIVE: This study conducts user testing of a digital patient navigation tool, called eNav, designed to support FQHC patients in preparing for, requesting, and completing CRC screening tests. METHODS: We recruited English- and Spanish-speaking patients (N=20) at an FQHC in New York City to user-test the eNav website (2 user tests; n=10 participants per user test). In each user test, participants engaged in a "think aloud" exercise and a qualitative interview to summarize and review their feedback. They also completed a baseline questionnaire gathering data about demographics, technology and internet use, medical history, and health literacy, and completed surveys to assess the website's acceptability and usability. Based on participant feedback from the first user test, we modified the eNav website for a second round of testing. Then, feedback from the second user test was used to modify and finalize the eNav website. RESULTS: Survey results supported the overall usability and acceptability of the website. The average System Usability Scale score for our first user test was 75.25; for the second, it was 75.28. The average Acceptability E-scale score for our first user test was 28.3; for the second, it was 29.2. These scores meet suggested benchmarks for usability and acceptability. During qualitative think-aloud exercises, in both user tests, many participants favorably perceived the website as motivating, interesting, informative, and user-friendly. Respondents also gave suggestions on how to improve the website's content, usability, accessibility, and appeal. We found that some participants did not have the digital devices or internet access needed to interact with the eNav website at home. CONCLUSIONS: Based on participant feedback on the eNav website and reported limitations to digital access across both user tests, we made modifications to the content and design of the website. We also designed alternative methods of engagement with eNav to increase the tool's usability, accessibility, and impact for patients with diverse needs, including those with limited access to devices or the internet at home. Next, we will test the eNav intervention in a randomized controlled trial to evaluate the efficacy of the eNav website for improving CRC screening uptake among patients treated at FQHCs.

Group Acupuncture Therapy With Yoga Therapy for Chronic Neck, Low Back, and Osteoarthritis Pain in Safety Net Settings for an Underserved Population: A Feasibility Pilot Study.

Background: Acupuncture and yoga have both been shown to be effective in chronic pain. Underrepresented populations have poorer pain outcomes with less access to effective pain care. Objective: To assess the feasibility of bundling group acupuncture with yoga therapy for chronic neck, back or osteoarthritis pain in safety net settings. Methods: This was a feasibility pilot in Bronx and Harlem primary care community health centers. Participants with chronic neck, back or osteoarthritis pain received acupuncture and yoga therapy over a 10-week period. Participants received 10 weekly acupuncture treatments in group setting; with Yoga therapy sessions beginning immediately following the 3rd session. Primary outcome was pain interference and pain intensity on the Brief Pain Inventory (BPI); Outcomes were measured at baseline, 10-week close of intervention, and 24-week follow-up. Results: 93 patients were determined to be eligible and completed the baseline interview. The majority of participants were non-White and Medicaid recipients. 78 (84%) completed the intervention and 10-week survey, and 58 (62%) completed the 24-week post intervention survey. Participants received an average number of 6.5 acupuncture sessions (out of a possible 10), and 4 yoga sessions (out of a possible 8) over the 10-week intervention. Patients showed statistically significant improvements in pain at the close of the intervention and at a somewhat lesser rate, at 24-weeks post intervention. Challenges included telephone outreach and site coordination integrating acupuncture with yoga therapy. The trial also had to be stopped early due to the COVID-19 pandemic. Conclusions: Bundling acupuncture therapy and yoga therapy is feasible for an underrepresented population with chronic pain in urban community health centers with preliminary indications of acceptability and benefit to participants.

Correlación entre concentraciones de ácido úrico y mortalidad hospitalaria en pacientes con evento vascular cerebral isquémico en un centro académico de alta especialidad / Correlation between uric acid levels and mortality in patients with ischemic cerebrovascular accident in an academic center

Resumen: ANTECEDENTES: El ácido úrico es un factor de riesgo independiente de enfermedades cardiovasculares y cerebrovasculares. OBJETIVO: Analizar el papel del ácido úrico como factor pronóstico en el accidente cerebrovascular isquémico. MATERIAL Y MÉTODO: Estudio de cohortes retrospectivo, efectuado en un hospital privado y académico. Se incluyeron pacientes con diagnóstico confirmado de evento vascular cerebral en el periodo de 2012 a 2016. Se clasificaron dos grupos: pacientes con hiperuricemia y sin hiperuricemia. RESULTADOS: Se analizaron 202 pacientes, 59 (30%) con hiperuricemia y 143 (70%) sin hiperuricemia. En el análisis comparativo la mortalidad fue de 7.3% (n = 10) en pacientes sin hiperuricemia y de 5% (n = 3) en pacientes con hiperuricemia (p = 0.56). Se encontraron diferencias significativas en las concentraciones de glucosa (p = 0.02), creatinina (p = 0.004), colesterol (p = 0.028), ácido úrico (p ≤ 0.0001) y triglicéridos (p = 0.014) entre ambas poblaciones. El análisis con regresión logística con corrección para potenciales de confusión no encontró asociación significativa entre la existencia de hiperuricemia al ingreso y la probabilidad de muerte (OR 2.098, IC95%: 0.47-9.332, p = 0.3304). CONCLUSIÓN: Este estudio demuestra que en los pacientes hospitalizados con diagnóstico de evento cerebrovascular isquémico las concentraciones de ácido úrico o la hiperuricemia no se relacionan con incremento en la mortalidad intrahospitalaria.

Abstract: BACKGROUND: Elevations in serum uric acid levels are considered a risk factor for cardiovascular and cerebrovascular conditions. OBJECTIVE: To analyze the relationship between high uric acid levels and the prognosis of patients with a cerebrovascular accident. MATERIAL AND METHOD: A retrospective cohort study performed at a single academic center. All patients with a confirmed diagnosis of cerebrovascular accident during the period between 2012 and 2016 were included in the analysis. Cohorts were segregated in patients with hyperuricemia and patients with normal serum uric acid levels. RESULTS: Two hundred two patients with cerebrovascular accident were analyzed, 59 patients (30%) were diagnosed with hyperuricemia, 143 (70%) were used as a control group. On a comparative analysis, mortality rates were 7.3% (n = 10) on hyperuricemia group vs 5% (n = 3) in the control group (p = 0.056). Significant differences were found on serum cholesterol levels (p = 0.028), uric acid (p ≤ 0.0001), glucose (p = 0.02), creatinine (p = 0.004) and triglycerides levels (p = 0.01) between cohorts. After controlling for potential confusing factors, there wasn't found an association between the increase in serum uric acid levels and the odds of mortality (OR 2.098, IC95% 0.47-9.332, p = 0.3304). CONCLUSIONS: This study demonstrates that inpatients diagnosed with a cerebrovascular accident mortality rates are not associated with hyperuricemia or increasing levels of serum uric acid.