Fertility Preservation for Transgender Males: Counseling and Timing of Treatment.

Fertility-preservation counseling in the transgender patient population is recommended by multiple organizations, including the American Society for Reproductive Medicine, the World Professional Association for Transgender Health, and the Endocrine Society. The optimal time to pursue fertility preservation has not been established, and data on potential effects of testosterone therapy on future reproductive potential are limited. This Current Commentary seeks to elucidate the most appropriate time to perform oocyte cryopreservation in relation to time on and off testosterone therapy, age of the individual, and emotional effect of treatment. Although there have been multiple studies that have demonstrated successful oocyte cryopreservation regardless of testosterone exposure, the data on live-birth rates after oocyte cryopreservation are limited. Moreover, the process of oocyte cryopreservation may have a significant negative emotional effect on the transgender male given the feminizing effects of gonadotropin stimulation, as well as the invasiveness of pelvic ultrasonograms and the oocyte-retrieval procedure. With our review, we demonstrate that a comprehensive, individualized approach to fertility-preservation counseling and timing to pursue treatment are essential. Postponing fertility-preservation procedures until patients have reached early adulthood might be considered to avoid the potential effect on mental health, without compromising outcomes.

Telehealth provider experience in reproductive endocrinology and infertility clinics during the COVID-19 pandemic and beyond.

PURPOSE: To assess telehealth services offered by reproductive endocrinology and infertility specialists and to gauge provider experiences with incorporating telehealth into their practices. METHODS: A 16-question web-based survey on use of telehealth was distributed to Society for Assisted Reproductive Technology (SART) clinics and to Society for Reproductive Endocrinology and Infertility (SREI) members. Clinic demographic data, telehealth descriptive data, and provider satisfaction with use of telehealth were assessed. Results were collected via Survey Monkey. RESULTS: A total of 1160 individuals (330 SART clinic contacts and 830 SREI members) were reached via email with an 18.6% (216) survey response rate. All respondents indicated that they offer telehealth visits. Several telehealth platforms were used, with Zoom (62.7%) and telehealth through the clinic's electronic medical record platform (34.8%) being the most common. The majority of participants (87.0%) anticipate they will offer telehealth visits after the COVID-19 pandemic. Roughly two-thirds (64.4%) of respondents anticipate fewer telehealth visits after the pandemic because of logistics, cost, and patient/provider preference. Nearly all providers are either "very satisfied" (66.2%) or "somewhat satisfied" (31.0%) with telehealth overall. CONCLUSION: Telehealth enabled safe patient-provider interactions throughout the COVID-19 pandemic. While only one-third of survey respondents offered telehealth services before the pandemic, nearly all providers express satisfaction with telehealth and anticipate they will offer telehealth services henceforth.

Gender bias in the medical education of obstetrician-gynaecologists in the United States: A systematic review.

BACKGROUND: The number of men entering obstetrics and gynaecology (Ob/Gyn) residencies and general Ob/Gyn practice is decreasing. Gender biases against their participation may affect career decisions. OBJECTIVE: This systematic review examines: (i) female patients' gender preferences and perceptions of men as Ob/Gyns and/or medical students; and (ii) the influence of gender on students' education and career decisions. SEARCH STRATEGY: We identified relevant research via PubMed using variations of three concepts in combination: Ob/Gyn care, gender bias/preference, and medical education or career. We conducted the initial review in 2018 and repeated the search in March 2021, adding additional references via citation review of included research. SELECTION CRITERIA: We restricted the review to original research from the United States between 2000-2021. DATA COLLECTION: Fifteen studies met inclusion criteria, categorised into three groups: (i) patient's gender preference for Ob/Gyns; (ii) patient's gender preference for medical students during the Ob/Gyn clerkship; and (iii) influence of gender bias on Ob/Gyn career decisions. MAIN RESULTS: Patients prioritised their physician's care attributes (eg technical skill, compassion, experience) over gender when choosing Ob/Gyns; however, provider gender was prioritised for medical students. Male medical students more commonly reported exclusion from clinical opportunities, although objective clinical exposure was like that of female counterparts. Despite perceived gender bias, male medical students reported increased Ob/Gyn interest post-clerkship; interest did not translate into residency applications. These findings are limited by study quality and heterogeneity. CONCLUSIONS: Real and perceived gender bias among female patients and male medical students in Ob/Gyn may underlie declining numbers of men entering the field.

Access, barriers, and decisional regret in pursuit of fertility preservation among transgender and gender-diverse individuals.

OBJECTIVE: To query transgender and gender-diverse individuals on their desire for fertility preservation, perceived barriers to access care, and decisional regret. DESIGN: Cross-sectional. SETTING: Not applicable. PATIENT(S): A total of 397 gender-diverse individuals undergoing intake to the University of California Los Angeles Gender Health Program from January 2018 to March 2019. Seventy participated in a follow-up survey from September to October 2019 clarifying reproductive desires or intentions. INTERVENTION: Multiple-choice questionnaire. MAIN OUTCOME MEASURE(S): Perceived barriers to access fertility preservation and decisional regret surrounding choice to pursue fertility preservation as measured with the use of the validated Decision Regret Scale (scored 0 to 100). RESULT(S): Barriers to accessing care were primarily cost of treatment (36%), discontinuation/delay of hormonal therapy (19%), or worsening of gender dysphoria with treatment/pregnancy (11%). Respondents indicated that their family planning goals were addressed by primary care providers and/or medical endocrinologists (multiple responses allowed), but 37% stated that their family planning goals were not adequately addressed. Those who had made a firm decision to pursue or not pursue fertility treatment had mild decisional regret. Moderate-to-severe decisional regret was noted in those who were undecided regarding the pursuit of fertility perseveration before transition and in those who were interested in referral to reproductive endocrinology. CONCLUSION(S): Consultation with a reproductive endocrinologist may reduce decisional regret as well as clarify perceived barriers to fertility preservation in transgender and gender-diverse individuals interested in fertility preservation.

Sub-mitochondrial localization of the genetic-tagged mitochondrial intermembrane space-bridging components Mic19, Mic60 and Sam50.

Each mitochondrial compartment contains varying protein compositions that underlie a diversity of localized functions. Insights into the localization of mitochondrial intermembrane space-bridging (MIB) components will have an impact on our understanding of mitochondrial architecture, dynamics and function. By using the novel visualizable genetic tags miniSOG and APEX2 in cultured mouse cardiac and human astrocyte cell lines and performing electron tomography, we have mapped at nanoscale resolution three key MIB components, Mic19, Mic60 and Sam50 (also known as CHCHD3, IMMT and SAMM50, respectively), in the environment of structural landmarks such as cristae and crista junctions (CJs). Tagged Mic19 and Mic60 were located at CJs, distributed in a network pattern along the mitochondrial periphery and also enriched inside cristae. We discovered an association of Mic19 with cytochrome c oxidase subunit IV. It was also found that tagged Sam50 is not uniformly distributed in the outer mitochondrial membrane and appears to incompletely overlap with Mic19- or Mic60-positive domains, most notably at the CJs.

Food portion size area mediates energy effects on expected anxiety in anorexia nervosa.

A study in which adolescent patients with anorexia nervosa (n = 24) rated their expected food-anxiety in response to images of portions of food (potatoes, rice pizza, and M&Ms) showed that lower energy-dense foods elicited higher expected anxiety per kilocalorie than higher energy-dense foods. However, the area of the portion sizes could be an unmeasured variable driving the anxiety response. To test the hypothesis that area mediates the effects of energy content on expected anxiety, the same images of portions were measured in area (cm2), and standardized values of expected anxiety were regressed from standardized values of energy and area of portions. With regression of expected anxiety from portion size in area, M&Ms, which had the highest energy density of the four foods, elicited the highest expected anxiety slope (ß = 1.75), which was significantly different from the expected anxiety slopes of the other three foods (ß range = 0.67 - 0.96). Area was confirmed as a mediator of energy effects from loss of significance of the slopes when area was added to the regression of expected anxiety from energy x food. When expected anxiety was regressed from food, area, energy and area by energy interaction, area accounted for 5.7 times more variance than energy, and ß for area (0.7) was significantly larger (by 0.52, SE = 0.15, t = 3.4, p = 0.0007) than ß for energy (0.19). Area could be a learned cue for the energy content of food portions, and thus, for weight gain potential, which triggers anxiety in patients with anorexia nervosa.