Publicly available information about fertility benefits for trainees at medical schools in the US.

PURPOSE: Infertility affects one in four female physicians, yet current availability of fertility benefits within Accreditation Council for Graduate Medical Education (ACGME) accredited residency programs in the United States (US) is unknown. Our objective was to examine publicly available fertility benefits information for residents and fellows. METHODS: The top 50 medical schools in the US for research were identified using US News & World Report 2022. In April 2022, we reviewed fertility benefits available to residents and fellows at these medical schools. Websites of their associated graduate medical education (GME) websites were queried for details surrounding fertility benefits. Two investigators collected data from GME and publicly available institutional websites. The primary outcome was fertility coverage and rates are reported as percentages. RESULTS: Within the top 50 medical schools, 66% of institutional websites included publicly available medical benefits, 40% included any mention of fertility benefits, and 32% had no explicit information on fertility or medical benefits. Fertility benefit coverage included infertility diagnostic workup (40%), intrauterine insemination (32%), prescription coverage (12%), and in vitro fertilization (IVF, 30%). No information on coverage for third party reproduction or LGBT family building was available on public websites. Most programs with fertility benefits were in the South (40%) or Midwest (30%). CONCLUSION: To support the reproductive autonomy of physicians in training, it is critical to ensure access to information on fertility care coverage. Given the prevalence of infertility among physicians and the impact of medical training on family planning goals, more programs should offer and publicize coverage for fertility care.

Effect of prunes on gastrointestinal function after benign gynecological surgery: a randomized control trial.

OBJECTIVE: To investigate the effect of postoperative prune consumption on time to first bowel movement after benign gynecologic surgery. MATERIALS AND METHODS: In this randomized, open label, controlled trial, 77 adult women who had benign gynecologic surgery that required at least one night in the hospital were enrolled from July 2018 to April 2019. Participants were randomized in a 1:1 ratio to one of two groups using a randomization assignment: 4 oz prunes daily plus docusate sodium 100 g twice daily versus docusate alone. The study's primary objective was time to first bowel movement (BM). Secondary outcomes were pain associated with first BM, stool consistency using Bristol stool scale, and patient satisfaction with bowel regimen and surgery experience. RESULTS: Postoperative survey data was available for 68.4% of participants (n = 52). There was no difference in time to first BM between the two groups (p = 0.29); however, consumption of > 12 prunes was associated with an increased likelihood of having a BM in the study period. Among women who consumed at least 12 prunes, hospital discharge was earlier, and there was a not statistically significant greater satisfaction with postoperative bowel regimen. CONCLUSIONS: The addition of prunes to postoperative bowel regimen of docusate sodium may be a beneficial adjunct to postoperative bowel regimen. CLINICAL TRIAL: The Institutional Review Board at the University of Southern California approved the study, and the study was registered at clinicaltrials.gov (ID: NCT03523715).

Genetic counseling decisions in gestational carrier pregnancies.

OBJECTIVE: Pregnancies conceived as contracted gestational carriers are a relatively new phenomenon for reproductive medicine. Since the intended parents control genetic screening decisions, there may be differences in genetic decisions made for gestational carrier (GC) in vitro fertilization (IVF) pregnancies as compared to traditional non-gestational carrier IVF pregnancies. Our goal was to investigate the frequency and types of these genetic testing decisions. METHODS: We performed a retrospective study of GC pregnancies counseled at a private maternal-fetal medicine practice between January 2006 and January 2021. Inclusion criteria were pregnancies that completed counseling with a certified genetic counselor and obtained high-resolution imaging. Controls were non-GC IVF pregnancies seen in the same period matched by parity, estimated delivery date (EDD), and the oocyte age utilized in conception. Statistical analysis included patient demographics, pre-implantation genetic testing (PGT-A) frequency and results, ultrasound imaging results, and the frequency with results of prenatal genetic screening (first or second-trimester serum screens), non-invasive prenatal testing (NIPT), or diagnostic testing (chorionic venous sampling (CVS) or amniocentesis). RESULTS: One hundred and ninety one gestational carrier pregnancies were identified and 167 met inclusion criteria. Gestational carrier pregnancies were significantly more likely to pursue PGT-A, PGT-A with NIPT, first-trimester screening, and second-trimester screening. There were no differences in rates of amniocentesis or CVS over controls. CONCLUSIONS: Regarding genetic counseling and screening options, our series is the first to demonstrate that gestational carrier parents seek additional genetic counseling resources, even with reassuring PGT-A and ultrasound.

Liability for embryo mix-ups in fertility practices in the USA.

PURPOSE: To study recent legal cases involving the transfer of the incorrect embryo into patients and learn how fertility clinics can better serve clients, protect themselves financially, and safeguard their physicians' personal assets. METHODS: The Nexis Uni database was used to review legal cases, news, and business publications of previous cases of embryo mix-ups. County and district courthouse dockets were also queried for filings and court documents related to lawsuits involving embryo mix-ups using Public Access to Court Electronic Records (PACER). Emphasis was placed on court decisions, awarded damages, and legal and media coverage related to embryo mix-up events. RESULTS: A case law review of US legal databases and courthouse dockets was conducted for cases between 2000 and 2020, focusing on lawsuits against reproductive endocrinologists and in vitro fertilization (IVF) facilities offering embryo transfer (ET). Improper labeling and ineffective communication led to errors in the cases reviewed. CONCLUSION: It is prudent for clinics to protect themselves from embryo mix-ups, which can subsequently lead to undesirable clinical outcomes, as well as lawsuits stemming from these errors. This article emphasizes following labeling guidelines when storing embryos, employing a two-step read back method prior to ET, and offering genetic testing when a discrepancy is found in the record. In the case an embryo mix-up does occur, it is recommended to protect personal assets through business organizing procedures and consider settlement offers for policy limits.

Has oncofertility information for male patients improved? Objective assessment of internet-based fertility preservation resources at NCI cancer centers from 2015 to 2020.

PURPOSE: Fertility preservation is a critical patient counseling component following cancer diagnosis. The aim of this study was to compare change and quality of fertility preservation information available to patients on the websites of National Cancer Institute (NCI)-designated cancer centers over 5 years (2015 to 2020) for both women and men. METHODS: All NCI-designated cancer center websites were queried for information on oncofertility in 2020 publicly available to patients using the methodology and rubric previously employed in 2015. Data was evaluated based on each center's city, county, and state by demographic data obtained from the US Census. Additionally, the yearly number of in vitro fertilization (IVF) cycles performed in the city, county, and state of each NCICC was included using websites of clinics reporting data to the Society for Assisted Reproductive Technology. RESULTS: Significantly NCICCs have a standalone pages for fertility preservation in 2020 compared with 2015 (p = 0.004). There is a statistically significant association between discussion of male fertility and the number of fertility centers in the county and state of the NCICC (p = 0.04 and p = 0.001). NCICCs in counties in the highest quartile of per capita income were significantly more likely to address male fertility (p = 0.03). CONCLUSIONS: Oncofertility information on NCICC websites has improved between 2015 and 2020. The impact of cancer treatment on male fertility, while improved, is still limited, particularly in counties with lower per capita income.

The change in endometrial thickness following progesterone exposure correlates with in vitro fertilization outcome after transfer of vitrified-warmed blastocysts.

PURPOSE: To determine if the change in endometrial thickness following exogenous progesterone (P) initiation correlates with outcome following autologous transfer of a single thawed blastocyst. METHODS: The study is a retrospective observational cohort study conducted at a private fertility center. Patients scheduled for thawed blastocyst transfer received artificial endometrial preparation (artificial cycle FET) and underwent serial ultrasonography. The main outcomes were the rate of ongoing pregnancy (fetal heart motion at 12 weeks of gestation) and early pregnancy loss. Logistic regression was used to test for correlations between these outcomes and the change in endometrial thickness while adjusting for potential confounders (patient age, embryo quality, and the use of genetic testing). RESULTS: There were 232 qualifying autologous single-blastocyst transfers in the 20-month study period ending 31 December 2019. Mean endometrial thicknesses were 3.8 mm, 10.0 mm, and 11.2 mm at baseline, P initiation, and at transfer, respectively. The change in endometrial thickness after exogenous P exposure ranged from - 5 to + 9 mm and negatively correlated with ongoing pregnancy in logistic regression analyses. Specifically, ongoing pregnancy rates per transfer were 63.2% in 19 cases where endometria compacted by 10% or more, 64.2% in 95 cases where there was unchanged endometrial thickness, and 52.5% in 118 cases where endometria expanded. CONCLUSIONS: The change in endometrial thickness after P initiation was associated with the probability of ongoing pregnancy but not with early pregnancy loss. Ongoing pregnancy rates were greater in endometria with negative growth (compaction) when compared to endometria that grew (expanded) after P exposure.

Male infertility and obesity.

PURPOSE OF REVIEW: The increasing rate of obesity is having an adverse impact on male reproduction. RECENT FINDINGS: The negative effect of reactive oxygen species on male reproductive tissues and the age of onset of obesity are new areas of research on male infertility. SUMMARY: This review highlights how obesity impairs male reproduction through complex mechanisms, including metabolic syndrome, lipotoxicity, sexual dysfunction, hormonal and adipokine alterations as well as epigenetic changes, and how new management strategies may improve the reproductive health of men throughout life.

The Subcutaneous Adipose Microenvironment as a Determinant of Body Fat Development in Polycystic Ovary Syndrome.

Context: Adipose steroid metabolism modifies body fat development in polycystic ovary syndrome (PCOS). Objective: To determine whether subcutaneous (SC) abdominal adipose aldo-keto reductase 1C3 (AKR1C3; a marker of testosterone generation) is increased in normal-weight women with PCOS vs age- and body mass index (BMI)-matched normoandrogenic ovulatory women (controls) and is related to SC abdominal adipose activator protein-1 (AP-1; a marker of adipocyte differentiation) and/or androgen receptor (AR) protein expression in predicting fat accretion. Design: Prospective cohort study. Setting: Academic center. Patients: Eighteen normal-weight PCOS women; 17 age- and BMI-matched controls. Interventions: Circulating hormone/metabolic determinations, intravenous glucose tolerance testing, total body dual-energy x-ray absorptiometry, SC abdominal fat biopsy, immunohistochemistry. Main Outcome Measures: Clinical characteristics, hormonal concentrations, body fat distribution, SC adipose AKR1C3, AR, and AP-1 protein expression. Results: Women with PCOS had significantly higher serum androgen levels and greater android/gynoid fat mass ratios than controls. SC adipose AKR1C3, AR, and AP-1 protein expressions were comparable between the study groups, but groups differed in correlations. In PCOS women vs controls, SC adipose AKR1C3 protein expression correlated positively with android and gynoid fat masses and negatively with SC adipose AP-1 protein expression. SC adipose AR protein expression correlated negatively with fasting serum free fatty acid and high-density lipoprotein levels. In both study groups, SC adipose AKR1C3 protein expression negatively correlated with serum cortisol levels. Conclusion: In normal-weight PCOS women, SC abdominal adipose AKR1C3 protein expression, in combination with intra-adipose AP-1 and AR-dependent events, predicts fat accretion in the presence of physiological cortisol levels.

Social media engagement with transgender fertility content.

Objective: To identify transgender fertility content with the highest online engagement on social media, determine its accuracy and quality, and see how this has changed over a 2-year period. Design: BuzzSumo, a content research tool, was used to identify the top 10 article links related to transgender fertility most interacted with on the social media platforms of Facebook, Twitter, Pinterest, and Reddit. We compared article links from June 2019 to June 2020 and from June 2020 to June 2021. The articles were categorized as accurate or misleading based on the references cited and current research. A qualitative analysis was performed using article references to scientific literature and journal impact factors. User engagement was compared with the accuracy of online information using descriptive and χ2 statistics. Setting: Not applicable. Patients: Not applicable. Interventions: Not applicable. Main Outcome Measures: Not applicable. Results: The top 10 article links for each time period were examined, with 7,077 total engagements. Fourteen articles referenced 14 unique scientific studies; no references were available for the remaining 6 articles. Alternative media was the primary source of popular article links, and accurate articles accounted for 74% of the total engagements. There was a significant association between the number of engagements with accurate articles and the time periods used for analysis (P < .0001). Conclusions: As the popularity of social media continues to rise, patients are more likely to turn to online platforms in search of information and advice regarding fertility. Transgender fertility is an emerging topic covered by scientific peer-reviewed journals, news organizations, and alternative media, and it is imperative for internet users to consider the accuracy of the information presented by social media platforms. Further, reproductive endocrinology and infertility physicians should use social media platforms to educate their patients on the topic of transgender fertility and prevent the spread of misinformation.

The effect of ovarian follicle size on oocyte and embryology outcomes.

OBJECTIVE: To identify relationships between the size of punctured ovarian follicles and subsequent embryology outcomes. DESIGN: Prospective observational cohort study. SETTING: Private fertility center. PATIENTS: One hundred fifty-seven oocyte retrievals performed during the study period. INTERVENTIONS: The diameter of punctured follicles was ultrasonically measured during routine oocyte collection. The resulting embryos were group-cultured to the blastocyst stage and classified into 8 groups according to follicle size (≤9.5, 10-12.5, 13-15.5, 16-18.5, 19-21.5, 22-24.5, 25-27.5, and ≥28 mm). MAIN OUTCOME MEASURE: Rate of good-quality blastocysts per follicle puncture. RESULTS: This study included 4,539 follicle punctures, 2,348 oocytes, 1,772 mature oocytes, 1,258 bipronuclear (2pn) oocytes, and 571 good-quality blastocysts derived from 157 oocyte retrievals. The per-puncture yields of oocytes, mature oocytes, 2pn oocytes, and good-quality blastocysts were associated with the size of the punctured follicle. The rates of good-quality blastocysts per punctured follicle were 2.2% (≤9.5 mm), 6.2% (10-12.5 mm), 11.9% (13-15.5 mm), 14.5% (16-18.5 mm), 18.9% (19-21.5 mm), 17.5% (22-24.5 mm), 15.9% (25-27.5 mm), and 16.0% (≥28 mm). When compared with the overall average, punctures of follicles in groups ≤12.5 mm in diameter had significantly inferior yields of good-quality blastocysts, whereas punctures of follicles in groups 19-24.5 mm in diameter were associated with significantly greater than average yields of good-quality blastocysts. Other groups did not differ significantly from average. No correlation was observed between follicle diameter and ploidy of biopsied blastocysts. CONCLUSIONS: Punctures of follicles ≤12.5 mm in diameter rarely result in good-quality blastocysts. The yield of good-quality blastocysts progressively increases with follicle size up to approximately 19 mm in diameter, with no substantial decline above that size. The ploidy of the blastocysts that form appears to be unaffected by follicle size.

Postmenopausal Pregnancy in the Era of Assisted Reproductive Technologies.

Assisted reproductive technologies allow women to achieve pregnancy at ages beyond the limits of their natural reproductive lifespans. As women seek pregnancy later in life, physicians are challenged with balancing their professional autonomy against patient autonomy. Increased parental age increases risk to mother and fetus. Legal aspects of postmenopausal women desiring fertility services will vary by location. Ethically, the principles of beneficence, nonmaleficence, and justice become important factors in a physician's evaluation process. This article aims to highlight current guidelines for postmenopausal women desiring fertility services and address medical, legal, and ethical concerns that may arise when assessing these patients.

Predicting Body Height in a Pediatric Intensive Care Unit Using Ulnar Length.

Objective: To determine if ulnar length obtained by the bedside nurse can be used to estimate patient length. To compare our findings to previous predictive equations of height and ulnar length. To evaluate the performance of predictive equations for height and ulnar length on patients with syndromes that affect height. Design: Retrospective observational study of prospectively collected data. Settings: Multidisciplinary Pediatric Intensive Care Unit in a university teaching hospital. Patients: 1,177 patients, ages 1 month to 23 years. Mean age was 79.7 months (1,3 IQR 19.5, 164.5 months) and 55.4% male. Measurements: Ulnar length was obtained using digital calipers by bedside nurses in PICU as well as height and weight. The electronic health care record was used to extract patient information. Main Results: The predictive equation for height for the entire group is: height (cm) = 0.59*ulnar length (mm) + 13.1 (r2 = 0.93). Bland Altman analysis of the derivation formula applied to the testing group did not show any systematic bias. Conclusions: Our study shows that ulnar length measurements can be used to predict height with a simple linear formula in a PICU setting. Not having specific individuals or specific training for ulnar measurement did not seem to alter the accuracy (r2 = 0.93). The robust nature of the measurement and ease of use may make this an unconventional but reasonable alternative to obtaining height when that cannot be measured directly.