Psychological distress, vaccine, and booster acceptance in women considering or undergoing fertility treatments during the Omicron surge of the COVID-19 pandemic.

OBJECTIVE: Follow-up study to evaluate perceptions of COVID-19 vaccination and booster with psychological distress during the COVID-19 pandemic and Omicron surge in women considering or undergoing fertility treatment. MATERIALS AND METHODS: Cross-sectional anonymous survey (N = 2558) from a single academic fertility center. Five hundred forty patients completed the survey (response rate = 21.1%). Participants were randomized 1:1 to a one-page evidence-based graphic with information and benefits regarding COVID-19 vaccination. Mental health and vaccine hesitancy were assessed via the Patient Health Questionnaire Depression (PHQ-8), the Generalized Anxiety Disorder (GAD-7) scales, and the Medical Mistrust Index (MMI). RESULTS: Majority of participants were nulliparous, fully vaccinated with a booster dose, with > 1 year of infertility and mild to moderate distress. Patients with vaccine hesitancy had higher medical mistrust scores (r = .21,  p < .001). Higher MMI scores were not associated with vaccination during pregnancy. Participants that had higher PHQ-8 and GAD-7 scores were more likely to believe the omicron variant would cause delay in fertility treatments, would have impact on fertility outcome, and were more likely exhibiting medical system distrust (p < .001). Participants who received educational material were more likely to know pregnant women with COVID-19 had increased risk of death, stillbirth, and preterm birth (p < .05). CONCLUSION: The majority of women in this study were vaccinated and had received their booster dose but also with clinically significant levels of depression. Patients with higher levels of distress and greatest medical mistrust demonstrated a concern that the Omicron variant would delay treatment, lead to suboptimal fertility outcomes, and COVID-19 vaccination would impact risk of miscarriages.

A Spontaneous Tubal Heterotopic Triplet Pregnancy Resulting in Viable Twin Deliveries.

There are limited U.S. reports of spontaneous triplet heterotopic pregnancies discussing both maternal and fetal outcomes. A 34-year-old patient at 7 weeks of gestation presented to the emergency department with abdominal pain. She was diagnosed with a spontaneous heterotopic triplet pregnancy, consisting of a twin monochorionic-diamniotic intrauterine gestation and a ruptured left ectopic pregnancy. She underwent a laparoscopic unilateral salpingectomy. Her antepartum course was complicated by gestational diabetes mellitus and fetal growth restriction. Delivery of liveborn twins was via a cesarean delivery at 32 weeks. Timely intervention and management of a ruptured spontaneous triplet heterotopic pregnancy can result in a viable twin delivery with overall favorable maternal and newborn outcomes, although long-term implications due to prematurity and other twin sequelae exist.

Vaccine hesitancy, distress, and medical mistrust in women considering or undergoing fertility treatment during the COVID-19 pandemic.

OBJECTIVE: To evaluate perceptions of COVID-19 vaccination and psychological distress during the COVID-19 pandemic in women considering or undergoing fertility treatment. MATERIALS AND METHODS: Cross-sectional anonymous survey (n= 3558) from a single academic fertility center. A total of 1103 patients completed the survey (response rate = 31% of those emailed, 97.6% of those who opened the email). Participants were randomized 1:1 to a one-page educational graphic providing facts and benefits regarding COVID-19 vaccination. Assessment of vaccine hesitancy was conducted via the Medical Mistrust Index (MMI). Mental health was assessed via the Patient Health Questionnaire Depression Scale (PHQ-8) and the Generalized Anxiety Disorder-7 (GAD-7). RESULTS: The majority of participants were married, nulliparous, white women with > 1 year of infertility and moderate to severe distress. As compared to the non-intervention group, participants in the intervention group believed that COVID-19 vaccination does not cause genetic abnormalities in a fetus (98.0% v. 94.2%) and infertility (99% v. 96.2%) and that severe infection has been associated with pregnancy (81.3% v. 74.6%) (P <0.05). Higher MMI scores were associated with vaccine hesitancy (P = 0.01), higher GAD-7 scores (P = 0.01), and greater concerns about side effects of the vaccine (P < 0.05). GAD-7 and PHQ-8 scores were not associated with vaccine hesitancy. Nearly a quarter of participants initiated psychiatric treatment after March 2020. CONCLUSION: Vaccine hesitancy was associated with mistrust of the medical system. Psychological distress was highly prevalent in this study. Efforts should be made to improve patient trust and provide psychological support for fertility patients.

Body mass index, not race, may be associated with an alteration in early embryo morphokinetics during in vitro fertilization.

OBJECTIVE: To assess the relationship between maternal body mass index (BMI) and embryo morphokinetics on time-lapse microscopy (TLM). DESIGN: Retrospective cohort study. METHODS: All IVF cycles between June 2015 and April 2017 were reviewed. Female BMI prior to egg retrieval was collected through chart review. BMI (kg/m2) classification included underweight (< 18.5), normal weight (18.5-25), overweight (25-30), and obese (≥ 30). Embryos' morphokinetic parameters were assessed with TLM and included time to syngamy, 2-cell, 3-cell, 4-cell, and 8-cell. A generalized linear mixed model was used to control for potential confounders and multiple embryos resulting from a single IVF cycle. RESULTS: A total of 2150 embryos from 589 IVF cycles were reviewed and included in the analysis. Classification based on BMI was as follows: underweight (N = 56), normal weight (N = 1252), overweight (N = 502), and obese (N = 340). After adjusting for race and use of intracytoplasmic sperm injection, the mean time to the 8-cell stage in the underweight group was 4.3 (95% CI: - 8.31, - 0.21) h less than in the normal weight group (P = 0.025) and 4.6 (95% CI: - 8.8, - 0.21) h less than in the obese group (p = 0.022). No significant difference was noted between race and TLM after controlling for possible confounders. CONCLUSIONS: Embryos from underweight women were demonstrated to have a faster time to the 8-cell stage than normal weight or obese women. No significant difference was noted for race. This study demonstrates that weight can be a factor contributing to embryo development as observed with TLM.