Current applications of artificial intelligence in assisted reproductive technologies through the perspective of a patient's journey.

PURPOSE OF REVIEW: This review highlights the timely relevance of artificial intelligence in enhancing assisted reproductive technologies (ARTs), particularly in-vitro fertilization (IVF). It underscores artificial intelligence's potential in revolutionizing patient outcomes and operational efficiency by addressing challenges in fertility diagnoses and procedures. RECENT FINDINGS: Recent advancements in artificial intelligence, including machine learning and predictive modeling, are making significant strides in optimizing IVF processes such as medication dosing, scheduling, and embryological assessments. Innovations include artificial intelligence augmented diagnostic testing, predictive modeling for treatment outcomes, scheduling optimization, dosing and protocol selection, follicular and hormone monitoring, trigger timing, and improved embryo selection. These developments promise to refine treatment approaches, enhance patient engagement, and increase the accuracy and scalability of fertility treatments. SUMMARY: The integration of artificial intelligence into reproductive medicine offers profound implications for clinical practice and research. By facilitating personalized treatment plans, standardizing procedures, and improving the efficiency of fertility clinics, artificial intelligence technologies pave the way for value-based, accessible, and efficient fertility services. Despite the promise, the full potential of artificial intelligence in ART will require ongoing validation and ethical considerations to ensure equitable and effective implementation.

Dynamic In Situ Monitoring of the Salt Counter-ion Effect on Surfactant Effectiveness Using Reconfigurable Janus Emulsions.

A straightforward method for visualization and quantification of surfactant effectiveness within different electrolyte environments based on using reconfigurable Janus emulsions as novel optical probes is reported. More specifically, we investigated the effect of different types and concentrations of salt counter-ions on the surfactant surface excess of commercial ionic and non-ionic surfactants, namely sodium dodecyl sulfate (SDS) and Tween 80 via in situ monitoring the morphological reconfigurations of biphasic Janus emulsions comprising hydrocarbon and fluorocarbon oils. We find that significant variations in interfacial tensions of SDS-stabilized interfaces (up to 15 mN·m-1) can be evoked by titrating mono-, di-, and trivalent cationic counter-ions, which is coherent with the lyotropic (Hofmeister) series. In contrast, the salt counter-ion effect on the surfactant effectiveness was less pronounced for the non-ionic surfactant Tween 80 (∼3 mN·m-1). Our results reveal a facile in situ method for monitoring the central role of electrolyte type and concentration on surfactant effectiveness and, more broadly, illustrate that Janus emulsions serve as powerful optical probes to dynamically study the properties of surfactants at liquid interfaces. We demonstrate the utility of our findings for an electro-induced morphological reconfiguration of Janus droplet morphologies by dynamically tuning Cu2+ concentration in solution using an electrode setup. The latter provides a unique platform for liquid-phase, real-time, and continuous tuning of Janus droplet morphologies, e.g., for their application in sensing and dynamic optical device platforms.

Experimental and cross-cultural evidence that parenthood and parental care motives increase social conservatism.

Differences in attitudes on social issues such as abortion, immigration and sex are hugely divisive, and understanding their origins is among the most important tasks facing human behavioural sciences. Despite the clear psychological importance of parenthood and the motivation to provide care for children, researchers have only recently begun investigating their influence on social and political attitudes. Because socially conservative values ostensibly prioritize safety, stability and family values, we hypothesized that being more invested in parental care might make socially conservative policies more appealing. Studies 1 (preregistered; n = 376) and 2 (n = 1924) find novel evidence of conditional experimental effects of a parenthood prime, such that people who engaged strongly with a childcare manipulation showed an increase in social conservatism. Studies 3 (n = 2610, novel data from 10 countries) and 4 (n = 426 444, World Values Survey data) find evidence that both parenthood and parental care motivation are associated with increased social conservatism around the globe. Further, most of the positive association globally between age and social conservatism is accounted for by parenthood. These findings support the hypothesis that parenthood and parental care motivation increase social conservatism.

Robot-Assisted Surgery for Endometriosis Current and Future Perspectives.

Successful resection of all visible lesions may effectively treat endometriosis-related infertility and pelvic pain. Minimally invasive surgery provides significant advantages, with lower rates of surgical complications such as surgical trauma, infection, postoperative pain, and hospital stay. Robotic surgery is shown to have similar perioperative outcomes to conventional laparoscopy; however, complex stage III and IV endometriosis, especially cases requiring significant resection such as deep infiltrating endometriosis, widespread peritoneal implants, and urologic and intestinal involvement, may benefit most from a robotic approach. There are certain aspects of endometriosis surgery where utilization of robotic technology might provide an additional benefit. These include (1) heterogeneity of lesions, and thus difficulty in identification; (2) difficulty in accurately predicting surgical complexity; and (3) prolonged operative time for complex cases. The objective of this review is to describe the current and future perspectives of robotic surgery as it pertains to endometriosis.

Altered evolution: are reproductive endocrinology and infertility specialists ready for the genetically engineered future?

Science, propelled forward by noble aspirations and, at times, human hubris, has the capacity to affect lives and alter the world in unanticipated ways. Even seemingly minor discoveries have repeatedly proven to have far reaching implications that experts within their respective fields could not have predicted. Nuclear technology is both a source of energy and a potential means of annihilation. The internet has both seamlessly connected the world but has also opened society to the misuse and manipulation of information. Both exemplify how new technologies have the potential for positive and negative outcomes that often go beyond what was initially intended. This is not a fault of science and innovation but rather an inherent occupational hazard as new discoveries exist within a gray zone between ignorance and comprehension. These gaps in our knowledge can only be filled over time as our knowledge expands. Innovations that were once seen as fringe, over time, become mainstream and that which was once revolutionary becomes a part of everyday life. Occasionally, a scientific advancement comes along that challenges societal norms and causes us to question what is feasible, acceptable, and ethical. Nowhere in the twenty-first century has this been more evident than within the fields of genetics and genetic engineering. As we gain a deeper understanding of the source code of life, from individual base pairs to epigenetic influences, the implications of new discoveries will go far beyond curing genetic diseases, and the possibilities will be endless. Reproductive endocrinology and infertility (REI) specialists utilize many tools including expanded carrier screening, preimplantation genetic testing, and embryo selection and have become some of the experts at the forefront of the ongoing genetic revolution. Now more than ever, there is a need for REIs to be trained in the fundamentals of genetics, exposed to novel gene sequencing and editing techniques, and involved in the coming ethical discussions in order to be prepared for the genetically engineered future.

Advancement of metal oxide nanomaterials on agri-food fronts.

The application of metal oxide nanomaterials (MOx NMs) in the agrifood industry offers innovative solutions that can facilitate a paradigm shift in a sector that is currently facing challenges in meeting the growing requirements for food production, while safeguarding the environment from the impacts of current agriculture practices. This review comprehensively illustrates recent advancements and applications of MOx for sustainable practices in the food and agricultural industries and environmental preservation. Relevant published data point out that MOx NMs can be tailored for specific properties, enabling advanced design concepts with improved features for various applications in the agrifood industry. Applications include nano-agrochemical formulation, control of food quality through nanosensors, and smart food packaging. Furthermore, recent research suggests MOx's vital role in addressing environmental challenges by removing toxic elements from contaminated soil and water. This mitigates the environmental effects of widespread agrichemical use and creates a more favorable environment for plant growth. The review also discusses potential barriers, particularly regarding MOx toxicity and risk evaluation. Fundamental concerns about possible adverse effects on human health and the environment must be addressed to establish an appropriate regulatory framework for nano metal oxide-based food and agricultural products.

Predictive Value of Teratospermia During Initial Sperm Analysis on the Success of Intrauterine Insemination Cycles.

OBJECTIVE: To evaluate the predictive value of sperm morphology, specifically teratospermia, seen during initial semen analysis on the success of intrauterine insemination (IUI) cycles and pregnancy outcomes. METHODS: A retrospective cohort analysis on patients undergoing IUI at a large US fertility network. Baseline demographic characteristics, primary infertility diagnoses, and pregnancy outcomes were recorded. A total of 27,925 IUI cycles in 16,169 unique patients were analyzed. IUI cycles were grouped by a sperm morphology of 1% (n = 3799), 2% (n = 5506), 3% (n = 4857), or 4% or greater (n = 13,763). The outcome measures were pregnancy rate (positive pregnancy test), clinical pregnancy rate (CPR) (ultrasound confirmation of a gestational sac with a yolk sac around 5-6 weeks), live birth rate, and miscarriage rate. RESULTS: Sperm morphology is a significant predictor of pregnancy rate (P = <.001), CPR (P =.011), and live birth rate (P = .026) following IUI. In each of these outcome measures, patients with 1% normal forms had the lowest percentage of success, and patients with 4% or greater normal forms had the most success. Relative outcome percentages, however, were similar in each group. Live birth rates in the 1%, 2%, 3%, and >4% group were 12.3%, 13.1%, 12.7%, and 13.9%, respectively. Sperm morphology is not a significant predictor of miscarriage rate per clinical pregnancy post-IUI (P = .054). CONCLUSION: Sperm morphology was a statistically significant predictor of pregnancy, clinical pregnancy, and live birth but not miscarriage rate after an IUI cycle. Higher morphology percentages were associated with increasingly favorable outcomes. However, the small observed differences did not demonstrate clinical significance.

Dysregulated expression of GATA2 and GATA6 transcription factors in adenomyosis: implications for impaired endometrial receptivity.

OBJECTIVE: To study the effect of adenomyosis on the localized expression of the GATA binding proteins 2 and 6 (GATA2 and GATA6) zinc-finger transcription factors that are involved in proliferation of hematopoietic and endocrine cell lineages, cell differentiation, and organogenesis, potentially leading to impaired endometrial implantation. DESIGN: Laboratory based experimental study. SETTING: Academic hospital and laboratory. PATIENTS: Human endometrial stromal cells (HESCs) of reproductive age patients, 18-45 years of age, with adenomyosis were compared with patients with no pathology and leiomyomatous uteri as controls (n = 4 in each group, respectively). Additionally, midsecretory phase endometrial sections were obtained from patients with adenomyosis and control patients with leiomyoma (n = 8 in each group, respectively). INTERVENTIONS: GATA2 and GATA6 immunohistochemistry and H-SCORE were performed on the midsecretory phase endometrial sections from adenomyosis and leiomyoma control patients (n = 8 each, respectively). Control and adenomyosis patient HESC cultures were treated with placebo or 10-8 M estradiol (E2), or decidualization media (EMC) containing 10-8 M E2, 10-7 M medroxyprogesterone acetate, and 5 × 10-5 M cAMP for 6 and 10 days. Additionally, control HESC cultures (n = 4) were transfected with scrambled small interfering RNA (siRNA) (control) or GATA2-specific siRNAs for 6 days while adenomyosis HESC cultures (n = 4) were transfected with human GATA2 expression vectors to silence or induce GATA2 overexpression. MAIN OUTCOME MEASURES: Immunohistochemistry was performed to obtain GATA2 and GATA6 H-SCORES in adenomyosis vs. control patient endometrial tissue. Expression of GATA2, GATA6, insulin-like growth factor-binding protein 1 (IGFBP1), prolactin (PRL), progesterone receptor (PGR), estrogen receptor 1 (ESR1), leukemia inhibitory factor (LIF), and Interleukin receptor 11 (IL11R) messenger RNA (mRNA) levels were analyzed using by qPCR with normalization to ACTB. Silencing and overexpression experiments also had the corresponding mRNA levels of the above factors analyzed. Western blot analysis was performed on isolated proteins from transfection experiments. RESULTS: Immunohistochemistry revealed an overall fourfold lower GATA2 and fourfold higher GATA6 H-SCORE level in the endometrial stromal cells of patients with adenomyosis vs. controls. Decidual induction with EMC resulted in significantly lower GATA2, PGR, PRL and IGFBP1 mRNA levels in HESC cultures from patients with adenomyosis patient vs. controls. Leukemia inhibitory factor and IL11R mRNA levels were also significantly dysregulated in adenomyosis HESCs compared with controls. . Silencing of GATA2 expression in control HESCs induced an adenomyosis-like state with significant reductions in GATA2, increases in GATA6 and accompanying aberrations in PGR, PRL, ESR1 and LIF levels. Conversely, GATA2 overexpression via vector in adenomyosis HESCs caused partial restoration of the defective decidual response with significant increases in GATA2, PGR, PRL and LIF expression. CONCLUSION: In-vivo and in-vitro experiment results demonstrate that there is an overall inverse relationship between endometrial GATA2 and GATA6 levels in patients with adenomyosis who have diminished GATA2 levels and concurrently elevated GATA6 levels. Additionally, lower GATA2 and higher GATA6 levels, together with aberrant levels of important receptors and implantation factors, such as ESR1, PGR, IGFBP1, PRL, LIF, and IL11R mRNA in HESCs from patients with adenomyosis or GATA2-silenced control HESCs, support impaired decidualization. These effects were partially restored with GATA2 overexpression in adenomyosis HESCs, demonstrating a potential therapeutic target.

The Role of Artificial Intelligence and Machine Learning in Assisted Reproductive Technologies.

Artificial intelligence (AI) and machine learning, the form most commonly used in medicine, offer powerful tools utilizing the strengths of large data sets and intelligent algorithms. These systems can help to revolutionize delivery of treatments, access to medical care, and improvement of outcomes, particularly in the realm of reproductive medicine. Whether that is more robust oocyte and embryo grading or more accurate follicular measurement, AI will be able to aid clinicians, and most importantly patients, in providing the best possible and individualized care. However, despite all of the potential strengths of AI, algorithms are not immune to bias and are vulnerable to the many socioeconomic and demographic biases that current healthcare systems suffer from. Wrong diagnoses as well is furthering of healthcare discrimination are real possibilities if both the capabilities and limitations of AI are not well understood. Armed with appropriate knowledge of how AI can most appropriately operate within medicine, and specifically reproductive medicine, will enable clinicians to both create and utilize machine learning-based innovations for the furthering of reproductive medicine and ultimately achieving the goal of building of healthy families.

Applications of artificial intelligence in ovarian stimulation: a tool for improving efficiency and outcomes.

Because of the birth of the first baby after in vitro fertilization (IVF), the field of assisted reproductive technologies (ARTs) has seen significant advancements in the past 40 years. Over the last decade, the healthcare industry has increasingly adopted machine learning algorithms to improve patient care and operational efficiency. Artificial intelligence (AI) in ovarian stimulation is a burgeoning niche that is currently benefiting from increased research and investment from both the scientific and technology communities, leading to cutting-edge advancements with promise for rapid clinical integration. AI-assisted IVF is a rapidly growing area of research that can improve ovarian stimulation outcomes and efficiency by optimizing the dosage and timing of medications, streamlining the IVF process, and ultimately leading to increased standardization and better clinical outcomes. This review article aims to shed light on the latest breakthroughs in this area, discuss the role of validation and potential limitations of the technology, and examine the potential of these technologies to transform the field of assisted reproductive technologies. Integrating AI responsibly into IVF stimulation will result in higher-value clinical care with the goal of having a meaningful impact on enhancing access to more successful and efficient fertility treatments.

3D-Printed Microfluidic Chip for Real-Time Glucose Monitoring in Liquid Analytes.

The connection of macrosystems with microsystems for in-line measurements is important in different biotechnological processes as it enables precise and accurate monitoring of process parameters at a small scale, which can provide valuable insights into the process, and ultimately lead to improved process control and optimization. Additionally, it allows continuous monitoring without the need for manual sampling and analysis, leading to more efficient and cost-effective production. In this paper, a 3D printed microfluidic (MF) chip for glucose (Glc) sensing in a liquid analyte is proposed. The chip made in Poly(methyl methacrylate) (PMMA) contains integrated serpentine-based micromixers realized via stereolithography with a slot for USB-like integration of commercial DropSens electrodes. After adjusting the sample's pH in the first micromixer, small volumes of the sample and enzyme are mixed in the second micromixer and lead to a sensing chamber where the Glc concentration is measured via chronoamperometry. The sensing potential was examined for Glc concentrations in acetate buffer in the range of 0.1-100 mg/mL and afterward tested for Glc sensing in a cell culturing medium. The proposed chip showed great potential for connection with macrosystems, such as bioreactors, for direct in-line monitoring of a quality parameter in a liquid sample.

Low-cost goldleaf electrode as a platform for Escherichia coli immunodetection.

Gold electrodes are one of most prevalent substrates in electrochemical biosensors because they can be easily and highly efficiently functionalized with thiolated biomolecules. However, conventional methods to fabricate gold electrodes are costly, time-consuming and require onerous equipment. Here, an affordable method for rapid fabrication of an electrochemical immunosensor for Escherichia coli detection is presented. The gold electrode was generated using 24-karat gold leaves and lowcost polyvinyl chloride adhesive sheets covered with an insulating PTFE layer. The goldleaf electrode (GLE) was patterned using laser ablation and characterized by cyclic voltammetry, electrochemical impedance spectroscopy, scanning electronic microscopy, contact angle and 3D profiling. The GLEs were modified by a self-assembled mercaptopropionic monolayer, followed by surface activation to allow binding of the specific anti-E. coli antibody via carbodiimide linking. The biosensor showed a detection limit of 2 CFU/mL and a linear dynamic range of 10-107 CFU/mL for E. coli cells. No false positive signals were obtained from control bacteria. The obtained results demonstrated suitability of GLE for use in biosensors with high reliability and reproducibility. It is foreseeable that our work will inspire design of point-of-need biosensors broadly applicable in low-resource settings.

The psychopharmacology of aggressive behavior: a translational approach: part 2: clinical studies using atypical antipsychotics, anticonvulsants, and lithium.

Patients experiencing mental disorders are at an elevated risk for developing aggressive behavior. In the past 10 years, the psychopharmacological treatment of aggression has changed dramatically owing to the introduction of atypical antipsychotics on the market and the increased use of anticonvulsants and lithium in the treatment of aggressive patients.This review (second of 2 parts) uses a translational medicine approach to examine the neurobiology of aggression, discussing the major neurotransmitter systems implicated in its pathogenesis (serotonin, glutamate, norepinephrine, dopamine, and γ-aminobutyric acid) and the neuropharmacological rationale for using atypical antipsychotics, anticonvulsants, and lithium in the therapeutics of aggressive behavior. A critical review of all clinical trials using atypical antipsychotics (aripiprazole, clozapine, loxapine, olanzapine, quetiapine, risperidone, ziprasidone, and amisulpride), anticonvulsants (topiramate, valproate, lamotrigine, and gabapentin), and lithium are presented. Given the complex, multifaceted nature of aggression, a multifunctional combined therapy, targeting different receptors, seems to be the best strategy for treating aggressive behavior. This therapeutic strategy is supported by translational studies and a few human studies, even if additional randomized, double-blind, clinical trials are needed to confirm the clinical efficacy of this framework.

Predicting attitudinal and behavioral responses to COVID-19 pandemic using machine learning.

At the beginning of 2020, COVID-19 became a global problem. Despite all the efforts to emphasize the relevance of preventive measures, not everyone adhered to them. Thus, learning more about the characteristics determining attitudinal and behavioral responses to the pandemic is crucial to improving future interventions. In this study, we applied machine learning on the multinational data collected by the International Collaboration on the Social and Moral Psychology of COVID-19 (N = 51,404) to test the predictive efficacy of constructs from social, moral, cognitive, and personality psychology, as well as socio-demographic factors, in the attitudinal and behavioral responses to the pandemic. The results point to several valuable insights. Internalized moral identity provided the most consistent predictive contribution-individuals perceiving moral traits as central to their self-concept reported higher adherence to preventive measures. Similar results were found for morality as cooperation, symbolized moral identity, self-control, open-mindedness, and collective narcissism, while the inverse relationship was evident for the endorsement of conspiracy theories. However, we also found a non-neglible variability in the explained variance and predictive contributions with respect to macro-level factors such as the pandemic stage or cultural region. Overall, the results underscore the importance of morality-related and contextual factors in understanding adherence to public health recommendations during the pandemic.

Advances in Nanomaterials-Based Electrochemical Biosensors for Foodborne Pathogen Detection.

Electrochemical biosensors utilizing nanomaterials have received widespread attention in pathogen detection and monitoring. Here, the potential of different nanomaterials and electrochemical technologies is reviewed for the development of novel diagnostic devices for the detection of foodborne pathogens and their biomarkers. The overview covers basic electrochemical methods and means for electrode functionalization, utilization of nanomaterials that include quantum dots, gold, silver and magnetic nanoparticles, carbon nanomaterials (carbon and graphene quantum dots, carbon nanotubes, graphene and reduced graphene oxide, graphene nanoplatelets, laser-induced graphene), metal oxides (nanoparticles, 2D and 3D nanostructures) and other 2D nanomaterials. Moreover, the current and future landscape of synergic effects of nanocomposites combining different nanomaterials is provided to illustrate how the limitations of traditional technologies can be overcome to design rapid, ultrasensitive, specific and affordable biosensors.

Vitamin D Status and Its Correlation With Anthropometric and Biochemical Indicators of Cardiometabolic Risk in Serbian Underground Coal Miners in 2016.

The status of vitamin D in underground working coal miners and its association with their cardiometabolic health is rarely studied. This study aimed to examine vitamin D (VitD) status in Serbian underground coal miners and to correlate it with anthropometric and laboratory indicators of cardiometabolic risk. Nutritional data (food frequency questionnaire, FFQ, and two times repeated 24 h recall), anthropometric data (including segmental analysis by bio-impedance analyzer TANITA BC-545N), arterial tension, and biochemical and hematological data of 103 coal miners (aged 22-63 years) were correlated with their late summer (early September) serum 25 (OH)D levels (measured by HPLC). 68.9% of the studied coal miners were overweight/obese, and 48.5% had metabolic syndrome. Their mean VitD nutritional intakes were low: 5.3 ± 3.8 µg/day (FFQ) and 4.9 ± 8 µg/day (24 h recalls), but their mean serum 25 (OH)D levels were surprisingly high (143.7 ± 41.4 nmol/L). Only 2.9% of the coal miners had 25(OH)D levels lower than 75 nmol/L (indicating an insufficient/deficient status), while 63.2% had values above 125 nmol/L (upper optimal limit), and even 10.7% had values above 200 nmol/L. There were no statistical differences in 25 (OH)D levels in the coal miners with or without metabolic syndrome (or overweight/obesity). Interestingly, 25(OH)D levels had significant positive correlations with body mass index (BMI), fat mass (FM), fat mass percentage (FM%), limbs FM%, serum triglycerides, GGT, AST, ALT, and ALT/AST ratio, and had significant negative correlations with serum HDL-cholesterol and age. All these correlations were lost after corrections for age, FM, FM%, and legs FM%. In Serbian coal miners, high levels of early September VitD levels were observed, indicating sufficient non-working-hour sun exposure during the summer period. Furthermore, the unexpected positive correlations of VitD levels with anthropometric and biochemical parameters indicative of obesity, metabolic syndrome, and fatty liver disease were found. More research is needed on the VitD status of coal miners (particularly in the winter period) and its relationship with their cardiometabolic status.

Inconsistent Mandated Access to Fertility Preservation: A Review of Relevant State Legislation.

With improvement in cancer therapies, there has been an increasing emphasis on survivorship, including options for fertility preservation. Fertility preservation is the process of either protecting or saving gametes or reproductive tissues for potential future procreation. Methods and outcomes of fertility preservation have similarly been rapidly advancing. Before initiation of gonadotoxic therapy, health care providers must consider future fertility of patients and provide options for fertility preservation. Nonetheless, the cost of fertility preservation can be prohibitory. Depending on a patient's state of residence, insurance may be mandated to cover, or offer to cover, the cost of fertility preservation. State legislation continues to change; however, legislation at the federal level has been proposed to make this coverage more cohesive. This commentary reviews current state legislation regarding mandates to cover the cost of fertility preservation for patients at risk for iatrogenic infertility and outlines the importance of developing federal legislation to improve patient access to care.

How to address the caveat of avoiding direct contact: Reducing prejudice towards gay and lesbian people in five Balkan countries.

In the Balkans, contact with gays and lesbians is typically hostile or avoided. Drawing from probability samples of young people from five Balkan countries (N = 1046), we examined whether it is possible to transfer the effects of contact with other marginalized outgroups (largest ethnic minority in every country, Roma, the extremely poor and physically disabled) to acceptance of gays and lesbians (secondary outgroup), and whether this relationship could be explained by attitude generalization and increased intergroup trust. Path analyses supported the secondary transfer effect: it confirmed that, while controlling for direct contact, contact with other marginalized groups was related to more acceptance of a secondary group; this relationship was mediated by trust. This was found across all primary groups in the combined samples, while the effect varied for different groups in country samples. The results add to the value of intergroup contact as a mean of prejudice-reduction.

Robotic single-site endometriosis resection using near-infrared fluorescence imaging with indocyanine green: a prospective case series and review of literature.

We present our preliminary experience comparing robotic near-infrared fluorescence (NIRF) imaging using indocyanine green (ICG) to 2D laparoscopic white light (WL) and 3D robotic WL illumination, in their ability to visually detect endometriosis lesions during a robotic endometriosis resection procedure in a single center. A total of twenty women were screened and seven of them with symptomatic endometriosis were included in this prospective case series. The mean patient age was 33 years with the mean body mass index being 28.6 kg/m2. The NIRF-ICG imaging technique enabled visualization of a statistically significant higher number of lesions compared to that of robotic and laparoscopic WL (13.4 vs 7.4 vs 4.7, p = 0.012). In addition, we explored the extent of quality of life (QoL) measures of these women affected by endometriosis using the validated QoL RAND Short Form Health Survey questionnaire and Numeric Pain Rating Scale. The largest reduction of quality of life was measured for the domains of social functioning (3.28 SD, 95% CI 45.7-61.5, p = 0.0001), physical limitations (3.04 SD, 95% CI 15.1-44.3, p = 0.0002), and physical functioning (3.02 SD, 95% CI 48.7-64.1, p = 0.0002), respectively. There was a significant reduction in the postoperative mean pain score as indicated by the pain rating of 0.57 ± 0.78 (p = 0.0005). We also performed a literature search to review other cases that describe the potential benefits of robotic NIRF-ICG imaging in the visual detection of peritoneal and deep endometriosis. Our study results demonstrate that the ICG fluorescence system may potentially be useful for more complete intraoperative endometriosis lesion detection and excision. Large multicenter trials with larger sample sizes and across surgeons of differing experience levels are needed to investigate the clinical utility, reproducibility and long-term outcomes of the use of this technology for patients with debilitating endometriosis.

Parent Perspective on Childhood Development after Assisted Reproductive Technology: A National Survey.

CONTEXT: There is limited understanding about parent perspectives of newborn development after assisted reproductive technology (ART). The use of ART is known to increase the risk of premature delivery and low birth weight. Both of these factors are associated with developmental delay. To our knowledge, no study has investigated how parents perceive their child's development after use of ART. AIMS: To investigate how the parent perspective of childhood development after ART use compares to the parent perspective of spontaneously conceived children. SETTINGS AND DESIGN: This is a digital survey collecting data on parent perspective of newborn development after ART and spontaneous conception. SUBJECTS AND METHODS: Invitation to participate was sent via E-mail to users of a (Ovia Health's) mobile parenting application (Ovia Parenting). Surveys were collected from August 30, 2018, to September 12, 2018, and a total of 1881 surveys were collected. STATISTICAL ANALYSIS USED: Analysis was performed with Chi-square cross-tabulations and ANOVA. RESULTS: Overall, 13,600 (12%) of users who were delivered the E-mail engaged with the content. Of those users, 2739 (20%) initiated the survey and 1881 (69%) completed the survey and were included in the analyses. When comparing spontaneous conception to ART, parents reported similar developmental milestones at most ages. A significant difference existed at 12 months where those who had used ART were more likely to report their child met all milestones. This difference did not persist for subsequent ages. CONCLUSIONS: From the parent perspective, children conceived using ART methods should be expected to meet the same age-based developmental milestones as their spontaneously conceived peers.