National Canadian Survey on the Management of Noneuploid Embryos.

OBJECTIVE: To comprehensively describe current preimplantation genetic testing for aneuploidy (PGT-A) practices and management of non-euploid embryos in Canada. METHODS: This was a cross-sectional study utilizing an online survey distributed by email to all medical directors of fertility clinics with independent in vitro fertilization (IVF) embryology laboratories. The survey was designed to determine practice patterns regarding PGT-A usage; PGT-A reference laboratory, platform, and thresholds for classifying embryos; and management of embryos classified as mosaic, inconclusive, or aneuploid. RESULTS: Twenty-five medical directors (69%) participated in the survey. The majority of clinics (91%) offered PGT-A screening, with 45% of clinics offering PGT-A as routine screening. The majority of clinics (90%) that offered PGT-A received mosaicism data; 61% of these clinics had transferred mosaic embryos, and 94% would transfer mosaic embryos. Clinics that performed ≥1000 IVF cycles annually were more likely to have transferred mosaic embryos (100% vs. 45.5%; P = 0.043). The mean percentage of IVF cycles using PGT-A was lower in clinics that had transferred mosaic embryos (12.3% vs. 30.4%; P = 0.033). Only 1 clinic had transferred an aneuploid embryo, but 2 other clinics would consider this option. The majority of clinics (61%) that receive mosaicism data would recommend noninvasive prenatal testing (NIPT) following mosaic embryo transfer, with 22% of clinics indicating that this would be the only genetic test offered. CONCLUSION: We report significant practice variation in PGT-A and management of non-euploid embryos across Canada and highlight areas where consensus should be encouraged.

Obstetrics and gynaecology residents' self-rated knowledge, motivation, skill, and practice patterns in counselling for contraception, STI prevention, sexual dysfunction, and intimate partner violence and sexual coercion.

OBJECTIVE: This research provides an initial exploration of obstetrics and gynaecology residents' self-rated knowledge base, motivation to practise, skills, and practice patterns with respect to patient counselling concerning contraception, prevention of sexually transmitted infection (STI), sexual dysfunction, and intimate partner violence and sexual coercion. METHODS: Obstetrics and gynaecology residents (N = 27) at all levels of training at four Ontario postgraduate programs completed self-reports of knowledge, motivation, skills, and practice patterns for counselling concerning four focal issues in women's sexual and reproductive health. RESULTS: Obstetrics and gynaecology residents generally possessed a sound knowledge base in the areas under study, but significant gaps were observed in their knowledge of condom use, abortion, sexual dysfunction, and intimate partner violence and sexual coercion. Residents were well-motivated to provide counselling in these areas, and, with the exceptions of counselling concerning sexual dysfunction and intimate partner violence and sexual coercion, felt that they were well trained to do so. Participants, however, consistently perceived only modest levels of support from their peers and from consultants with respect to counselling in the domains of contraceptive choice and adherence, STI prevention, sexual dysfunction, and intimate partner violence and sexual coercion. CONCLUSION: These findings suggest the need to review instruction and support for obstetrics and gynaecology resident training in patient counselling in important but clinically neglected areas of women's sexual and reproductive health.

The levonorgestrel intrauterine system is an effective treatment in women with abnormal uterine bleeding and anticoagulant therapy.

OBJECTIVE: To evaluate the efficacy of levonorgestrel intrauterine systems (LNG-IUS) in obese women with AUB on anticoagulant therapy. DESIGN: Prospective observational case series (Canadian Task Force Classification II-3). SETTING: University affiliated teaching hospital. PATIENTS: Premenopausal women on Warfarin therapy. INTERVENTIONS: From January 2002 through January 2007, 10 women were identified from the senior author's clinical practice (G.A.V.). After clinical assessment, including Papanicolaou smear, endometrial biopsy, and pelvic sonography, the LNG-IUS was placed to treat their AUB. MEASUREMENTS AND MAIN RESULTS: The median and range of age, parity, and body mass index were 45 years (34-49), 1 (0-4), and 38 kg/m(2) (26-52), respectively. All women were receiving warfarin therapy (4-12.5 mg/d) for previous venous thromboembolism. Some patients had additional comorbid conditions and were at high risk for traditional medical or surgical therapies. After placement of the LNG-IUS, all women reported menstrual reduction at 3 and 6 months. By 12 months, 1 woman with large fibroids expelled the LNG-IUS and was treated with transfemoral uterine artery embolization. Two women had amenorrhea, and 7 had hypomenorrhea. At 2 to 5 years, 1 woman expelled the LNG-IUS and hysterectomy indicated extensive adenomyosis in a 195-g uterus, and 1 woman had hysteroscopic endometrial ablation, 4 were menopausal, 2 had amenorrhea, and 1 had hypomenorrhea. In the 5 women with uterine fibroids measuring 4.2 to 147 cm(3), the fibroids were reduced in volume by approximately 75% in 2, were no longer detectable in 1, were subsequently shown to be adenomyoma in 1, and required uterine artery embolization in 1. CONCLUSION: In properly assessed and selected obese, premenopausal women with AUB receiving warfarin therapy and at high risk for traditional therapies, the LNG-IUS was an effective treatment in 70% of patients.