Protecting life in a time of war.

Despite centuries of lessons from history, war endures. Across Earth, during nearly every year from the beginning of the twentieth century to present day, over 30 wars have been fought resulting in 187 million casualties, excluding the most recent conflict, which is the impetus for this essay (Timeline of 20th and 21st century wars). We are, sadly, a war-mongering people. The word "war" word infiltrates our vernacular, e.g., the war on poverty, on drugs, on cancer, on COVID, and, apropos, on terror. How did rational approaches to disagreement and conflict evade the world's progress? Reproductive physicians and scientists are dedicated to safeguard lives and build families. Violence is antithetical to our mission as professionals, and moral integrity as humans. We are deeply concerned for, and stand in unity with, our Ukrainian colleagues-the embryologists, scientists, OBGYN and REI physicians, infertility patients, and all people under siege. Reproductive health services for Ukrainians (as with many other war-torn regions) have collapsed. Deeply disturbing reports have emerged that cite civilian hospitals (including maternity centers) being targeted. Liquid nitrogen supplies are scarce. Pregnant mothers and gestational carriers are at emergent risk of delivering in extremely harsh conditions, cold underground bunkers and refugee queues.

Boutique Egg Freezing: Empowering Technology or Marketing Phenomenon? A Word of Caution.

The introduction of oocyte vitrification has propelled the field of oncofertility. However, it is becoming increasingly common to offer planned oocyte cryopreservation to healthy, fertile women due to a lack of a partner or other personal issues. The aim of this article is to discuss the pros and cons of planned oocyte cryopreservation along with potential exploitation issues by unregulated clinics and international agencies. This article further encourages obstetricians and gynecologists to discuss these issues of planned oocyte cryopreservation with their patients to empower them to make an educated decision based on research and science rather than be susceptible to entities that stand to gain monetarily by prompting women to fear a childless future.

Artificial intelligence-the future is now.

The pros and cons of artificial intelligence in assisted reproductive technology are presented.

A cohort study of men infected with COVID-19 for presence of SARS-CoV-2 virus in their semen.

INTRODUCTION: Whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can be detected in semen and transmitted sexually is a vital question that has, thus far, been inconclusive. Prior studies, with limited numbers, have included men in various stages of infection with most in the recovery phase of the illness. The timing of test results and severity of illness has made recruiting study participants a significant challenge. Our pilot study will examine semen from men with a recent diagnosis of COVID-19 as well as those in the convalescent phase to determine if SARS-CoV-2 can be detected and its relationship, if any, with the severity of the disease. METHODS: Eighteen men with a median age of 32 (range, 24-57) who tested positive for COVID-19 by rt-PCR analysis were enrolled and provided a semen sample. The study group demonstrated symptoms of COVID-19 ranging from asymptomatic to moderate and none required hospitalization. Samples were subjected to viral RNA extraction and then processed by real-time RT-PCR using the US Centers for Disease Control and Prevention (CDC, USA) panel of 2019-Novel Coronavirus (2019-nCoV) primers and probes to detect the presence of SARS-CoV-2 RNA. RESULTS: Length of time from diagnosis to providing a specimen ranged from 1 to 28 days (median, 6 days). Fifteen participants were symptomatic and three were asymptomatic, including recovering men, at the time of semen collection. No SARS-CoV-2 was detected in any of the semen samples. CONCLUSION: Based on these preliminary results and consistent with prior findings, we suggest SARS-CoV-2 is not present in semen during the acute or convalescent phase of COVID-19.

Cross-sectional analysis of online patient reviews of infertility care providers.

OBJECTIVE: To observe the effects of practice type, location, and mandated insurance coverage on infertility physician online reviews by patients. DESIGN: Retrospective cohort study. SETTING: Not applicable. PATIENTS: Patient online reviews of fertility specialists from 2016 to 2019. INTERVENTIONSS: None. MAIN OUTCOME MEASURES: The analysis consisted of the average rating out of 5 for each physician published on Vitals, RateMD, and Healthgrades. RESULTS: Data were collected on 1,097 specialists. Physicians practicing in states with versus without mandated insurance coverage received an average rating of 4.093 versus 4.076, respectively. The average rating was 3.964 for physicians affiliated with a university or hospital versus 4.128 for those working in a private practice. Significant differences were found in physician ratings from the four regions. It was revealed that physicians who practiced in the South (n = 354) received significantly higher mean average ratings than those in the Northeast (n = 327) and Midwest (n = 175). Physicians practicing in the West (n = 241) received significantly higher ratings than those in the Midwest (n = 175). CONCLUSIONS: The average online patient rating of infertility specialists was found to be significantly higher for physicians working in a private practice compared with those affiliated with a university or hospital system. No significant difference was found between the average rating in states with versus without mandated insurance coverage for infertility treatment. We propose that qualities other than patient financial responsibility are implicated in the factors used to rate physicians.

Live birth of twins derived from zona-free oocytes.

OBJECTIVE: To report a live birth of twins from autologous zona-free oocytes. DESIGN: Case report. SETTING: Reproductive endocrinology and infertility private practice and ambulatory in vitro fertilization (IVF) center. PATIENT(S): A 34-year-old woman, gravida 0, with 100% zona-free oocytes. INTERVENTION(S): IVF with intracytoplasmic sperm injection (ICSI), blastocyst culture, and fresh embryo transfer. MAIN OUTCOME MEASURE(S): Fertilization, blastocyst development, and live birth. RESULT(S): A 34-year-old woman, gravida 0, conceived through IVF using autologous zona-free oocytes. The 11 retrieved oocytes were zona-free, from which eight were inseminated with ICSI; two embryos were transferred at morula and blastocyst stage, resulting in a twin pregnancy delivered at an estimated the gestational age of 37 weeks and 1 day. CONCLUSION(S): Patients with the rare condition of 100% zona-free oocytes maintain the potential for pregnancy after careful micromanipulation of the oocytes. Caution is recommended on the number of embryos selected for transfer to reduce the risk of multiple gestation.

Live birth from a 46-year-old using fresh autologous oocytes through in vitro fertilization.

OBJECTIVE: To report a live birth with IVF from a 46-year-old woman using autologous oocytes. DESIGN: Case report. SETTING: Reproductive endocrinology and infertility private practice and ambulatory IVF center. PATIENT(S): One 46-year-old nulligravid woman. INTERVENTION(S): IVF with fresh ET. MAIN OUTCOME MEASURE(S): Live birth after IVF. RESULT(S): A 46-year-old with antimullerian hormone (AMH) level less than 0.16 conceived through IVF using autologous oocytes. A total of seven oocytes were retrieved, from which four embryos were transferred at the cleavage stage, resulting in a pregnancy and delivery of a healthy male infant weighing 1,580 g at 31 and 3/7 weeks' estimated gestational age. CONCLUSION(S): The prognosis for a live birth from IVF in a patient with very advanced reproductive age, particularly with an undetectable AMH level using autologous oocytes, remains extremely poor. This case should be interpreted with caution so as to not provide false hope to women aged 45 and above.

Ovarian pregnancy after in vitro fertilization.

We report a rare ovarian pregnancy after in vitro fertilization and transcervical embryo transfer. Ultrasound guidance of embryo transfer does not eliminate the risk of this potentially lethal complication.