Search

ObjectiveTo determine whether endometrial thickness (EMT) differs between i) clomiphene citrate (CC) and gonadotropin (Gn) utilizing patients as their own controls, and ii) patients who conceived with CC and those who did not. Furthermore, to investigate the association between late-follicular EMT and pregnancy outcomes, in CC and Gn cycles.MethodsRetrospective study. Three sets of analyses were conducted separately for the purpose of this study. In analysis 1, we included all cycles from women who initially underwent CC/IUI (CC1, n=1252), followed by Gn/IUI (Gn1, n=1307), to compare EMT differences between CC/IUI and Gn/IUI, utilizing women as their own controls. In analysis 2, we included all CC/IUI cycles (CC2, n=686) from women who eventually conceived with CC during the same study period, to evaluate EMT differences between patients who conceived with CC (CC2) and those who did not (CC1). In analysis 3, pregnancy outcomes among different EMT quartiles were evaluated in CC/IUI and Gn/IUI cycles, separately, to investigate the potential association between EMT and pregnancy outcomes.ResultsIn analysis 1, when CC1 was compared to Gn1 cycles, EMT was noted to be significantly thinner [Median (IQR): 6.8 (5.5–8.0) vs. 8.3 (7.0–10.0) mm, p

Abstract Background and Aims Healthcare provider counseling surrounding COVID‐19 vaccine in pregnancy and lactation is essential to vaccination uptake in this population; however, provider knowledge and confidence are not well characterized. We aimed to assess knowledge and confidence in COVID‐19 vaccine counseling among practitioners who provide care to pregnant persons and to describe factors associated with confidence in counseling. Methods A web‐based anonymous survey was distributed via email to a cross‐sectional convenience sample of Obstetrics and Gynecology, Primary Care, and Internal Medicine faculty at three hospitals in a single healthcare network in Massachusetts, United States. Individual demographics and institution‐specific variables were included in the survey along with questions assessing both attitudes toward COVID‐19 illness and confidence in counseling regarding the use of the vaccine in pregnancy. Results Almost all providers (151, 98.1%) reported that they received a COVID‐19 vaccine, and most (111, 72.1%) reported that they believe the benefits of the vaccine in pregnancy outweigh the risks. Forty‐one (26.6%) reported feeling very confident in counseling patients who primarily speak English about the evidence for messenger ribonucleic acid vaccination in pregnancy, and 36 (23%) reported feeling very confident in counseling patients who are not primarily English‐speaking. Forty‐three providers (28.1%) expressed strong confidence in their comfort talking to individuals with vaccine hesitancy based on historic and continued racism and systemic injustices. The sources that survey respondents most used to find information regarding COVID‐19 vaccination in pregnancy were the Centers for Disease Control (112, 74.2%), hospital‐specific resources (94, 62.3%), and the American College of Obstetricians and Gynecologists (82, 54.3%). Conclusion Ensuring that providers feel comfortable bridging the gap between their belief that the vaccine is beneficial for pregnant patients and their comfort with holding conversations with patients regarding vaccination is paramount to ensure equitable access to vaccines for pregnant patients.

IntroductionFrozen sperm utilization might negatively impact cycle outcomes in animals, implicating cryopreservation-induced sperm damage. However, in vitro fertilization and intrauterine insemination (IUI) in human studies are inconclusive.MethodsThis study is a retrospective review of 5,335 IUI [± ovarian stimulation (OS)] cycles from a large academic fertility center. Cycles were stratified based on the utilization of frozen (FROZEN, n = 1,871) instead of fresh ejaculated sperm (FRESH, n = 3,464). Main outcomes included human chorionic gonadotropin (HCG) positivity, clinical pregnancy (CP), and spontaneous abortion (SAB) rates. Secondary outcome was live birth (LB) rate. Odds ratios (OR) for all outcomes were calculated utilizing logistic regression and adjusted (adjOR) for maternal age, day-3 FSH, and OS regimen. Stratified analysis was performed based on OS subtype [gonadotropins; oral medications (OM): clomiphene citrate and letrozole; and unstimulated/natural]. Time to pregnancy and cumulative pregnancy rates were also calculated. Further subanalyses were performed limited to either the first cycle only or to the partner's sperm only, after excluding female factor infertility, and after stratification by female age (35 years old).ResultsOverall, HCG positivity and CP were lower in the FROZEN compared to the FRESH group (12.2% vs. 15.6%, p

Objective: To better understand if employer-based financial coverage of non-medical oocyte cryopreservation impacts the way women make decisions about their reproduction, including the decision to pursue oocyte cryopreservation and the time frame in which they plan to begin family building. Design: Prospective survey study. Setting: Academic medical center. Patient(s): Female graduate students at five different institutions in the Boston area. Intervention(s): A 27-question electronic survey. Main Outcome Measure(s): Likelihood of pursuing oocyte cryopreservation and time frame in which intend to build family, based on presence or absence of employer-based financial coverage. Result(s): The survey was completed by 171 female graduate students: 63% cited professional goals as their primary reason for delaying childbearing, and 54% indicated that oocyte cryopreservation would allow them to focus more on their career for the next several years. For 59% their main concern about egg freezing was the cost; 81% indicated that they would be more likely to consider egg banking if it were covered by their insurance or paid for by their employer. The majority of participants would not change when they would start building their family based on the presence or absence of employer financial coverage for egg freezing. Conclusion(s): The primary concern of female graduate students about egg freezing is the cost. More women would consider elective egg freezing if financial coverage was provided by their employer, but the vast majority would ultimately not change their plans for and timing of family building based on this coverage.