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Objective: To assess whether the provision of fertility treatment for patients with polycystic ovary syndrome (PCOS) varies by patient and physician-level demographic characteristics., Design: Retrospective cohort study., Setting: University health system., Patient(s): Patients seeking care for PCOS and infertility from 2007-2021., Intervention(s): Patient age, body mass index, race, ethnicity, estimated household income, primary insurance payor, provider sex, and provider medical specialty., Main Outcome Measure(s): Prescriptions for fertility treatment, including clomiphene citrate (CC), letrozole, and injectable gonadotropins. Differences in patient and physician demographics between patients who did as well as did not receive a prescription were identified with univariable analysis. Multilevel mixed-effects logistic regression was performed to determine associations between patient and physician demographics and prescription receipt., Result(s): A total of 3,435 patients with PCOS and infertility were identified, with a mean age of 31.1 ± 5.7 years. Of the 68.8% of patients who received a prescription, 47.8% of prescriptions were CC, 38.6% were letrozole, and 13.7% were injectable gonadotropins. There were lower odds of prescription receipt for Black patients compared with White patients (adjusted odds ratio [aOR], 0.75; 95% confidence interval [CI], 0.61-0.93), those with estimated household income below the federal poverty level compared with those above the national median (aOR, 0.71; 95% CI, 0.46-0.97), and those with public compared with commercial insurance (aOR, 0.53; 95% CI, 0.40-0.71). These disparities persisted in a subanalysis of patients prescribed oral medications only with lower odds of prescription receipt for Black compared with White patients (aOR, 0.74; 95% CI, 0.57-0.95), those with estimated household income below the federal poverty level compared with above the national median (aOR, 0.93; 95% CI, 0.87-0.98), and those with public compared with commercial insurance (aOR, 0.57; 95% CI, 0.42-0.76). Black patients waited, on average, 153.3 days longer than White patients, from the initial visit to the prescription receipt. Patients had lower odds of receiving any prescription from family medicine physicians (aOR, 0.36; 95% CI, 0.24-0.52) and general internal medicine physicians (aOR, 0.55; 95% CI, 0.42-0.73) compared with reproductive endocrinologists., Conclusion(s): Racial and socioeconomic disparities exist in the provision of infertility treatments for patients with PCOS. Fewer primary care physicians engaged in first-line fertility treatment, indicating an opportunity for physician education to improve access to fertility care., (Copyright © 2024 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To identify independent predictors of a successful match to reproductive endocrinology and infertility (REI) fellowships, and to develop and internally validate a prediction model for REI match results., Design: Retrospective cohort study., Setting: University-based institution., Participants: Reproductive endocrinology and infertility fellowship applications sent to the University of Pennsylvania from 2019 to 2023 (excluding 2020), which represented nearly all REI applicants nationally according to National Resident Matching Program data., Intervention(s): Demographics, education, training, and academic achievements., Main Outcome Measure(s): Match result, confirmed through online search and communication with program administrators. Univariate analyses identified variables associated with match, which were then included in multivariable models to identify independent predictors. Bootstrapping was used to assess model discrimination and calibration. The final model was integrated into a web-based tool., Result(s): Of 286 applications (99.0% of REI applications to the National Resident Matching Program), 199 (69.6%) resulted in a successful match. In univariate analyses, variables associated with match were younger age, attendance at an allopathic US medical school, United States Medical Licensing Examination (USMLE) and Council on Resident Education in Obstetrics and Gynecology scores, residency rank, residency affiliation with a fellowship, research experiences, first-author publications, abstracts/articles in progress, and poster presentations. In the adjusted model, independent predictors of match included residency affiliation with an REI fellowship (adjusted odds ratio [aOR], 5.43; 2.02-14.64), residency rank (aOR, 1.77; 1.25-2.50), USMLE score (aOR, 1.05; 1.02-1.08), at least one first-author publication (aOR, 2.32; 1.08-4.96), projects in progress (aOR, 1.26; 1.02-1.55), and poster presentations (aOR, 1.07; 1.00-1.15). Attendance at an international medical school was a negative predictor (aOR, 0.32; 0.11-0.88). The model achieved an area under the curve of 0.883, with 88.5% sensitivity and 65.8% specificity. A refined model without USMLE scores maintained strong performance (C-statistic, 0.85; 0.81-0.91; calibration slope, 0.91; 0.72-1.24)., Conclusion(s): Affiliation with an REI fellowship, residency reputation, and research output strongly predicted match success. Gender, race, and ethnicity were not major predictors, yet underrepresentation of certain racial and ethnic groups limited the power to detect potential differences. Our prediction model correctly classified >75% of candidates' match results. These findings may help candidates optimize applications and estimate chances of a successful match into REI fellowship, as well as assist programs in critically reviewing their selection criteria for fellowship match., Competing Interests: Declaration of Interests L.A.H. has nothing to disclose. J.A. has nothing to disclose. M.A.M. has nothing to disclose. C.E.M. has nothing to disclose. D.K.S has nothing to disclose., (Copyright © 2024 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To investigate whether the difference between mean gestational sac diameter and crown-rump length (mGSD - CRL) is associated with first-trimester pregnancy loss or adverse pregnancy outcomes after in vitro fertilization (IVF) and to determine if mGSD - CRL is a better predictor of pregnancy loss than either measurement alone., Design: Retrospective cohort study., Setting: University hospital., Patient(s): A total of 1,243 IVF cycles with fresh or cryopreserved autologous embryo transfers resulting in singleton gestations performed at the University of Iowa Hospitals and Clinics from January 2005 through December 2014. Cycles included ultrasound measurements of mGSD and CRL at 45-56 days' gestation., Intervention(s): Mean gestational sac diameter to crown-rump length difference., Main Outcome Measure(s): Primary outcomes were first-trimester pregnancy loss and gestational age at delivery. Secondary outcomes were infant birth weight and pregnancy complications., Result(s): First-trimester pregnancy loss rates were significantly higher in pregnancies with mGSD - CRL <5 mm (43.7%) compared with 5-9.99 mm (15.8%), 10-14.99 mm (9.9%), and ≥15 mm (7.1%). No correlations were found with infant birth weight, gestational age at delivery, or other pregnancy complications. mGSD - CRL was not a better predictor of pregnancy loss than mGSD or CRL alone., Conclusion(s): There is a strong inverse relationship between mGSD - CRL and first-trimester pregnancy loss in IVF patients, although the incidence of pregnancy loss with a mGSD - CRL <5 mm was significantly lower than previously reported. Small mGSD - CRL was not associated with an increased risk of complications in pregnancies that continued beyond 20 weeks. The association between mGSD, CRL, and miscarriage is complex., (Copyright © 2017 American Society for Reproductive Medicine. All rights reserved.)

Objective: To compare rates of clinical pregnancy (CPR) and live birth (LBR) following embryo transfer (ET) performed by reproductive endocrinology and infertility (REI) fellows before and after a prolonged lapse in clinical training due to an 18-month research rotation., Design: Retrospective cohort study., Setting: Not applicable., Patient(s): All women undergoing in vitro fertilization (IVF) and IVF-intracytoplasmic sperm injection (ICSI) cycles with ET performed by REI fellows from August 2003 to July 2012., Intervention: Eighteen-month lapse in clinical training of REI fellows., Main Outcome Measure(s): CPR and LBR before and after the lapse in clinical training were calculated and compared per fellow and as a composite group. Alternating logistic regression models were used to calculate the odds of clinical pregnancy and live birth following transfers performed before and after the lapse in training., Result(s): Unadjusted odds of clinical pregnancy and live birth were similar between the two time periods both for individual fellows and for the composite group. Alternate logistic regression analysis revealed no significant difference in CPR (odds ratio [OR] 0.94, 95% confidence interval [CI] 0.83-1.07) or LBR (OR 1.05, 95% CI 0.94-1.18) after the lapse in training compared with before., Conclusion(s): A research rotation is common in REI fellowship training programs. This prolonged departure from clinical training does not appear to negatively affect pregnancy outcome following fellow ET., (Copyright © 2015 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To assess pregnancy rates before and after a training intervention in which reproductive endocrinology and infertility fellows were required to perform 100 IUIs before performing ETs., Design: Retrospective cohort study., Setting: Large, academic training program., Patient(s): Not applicable., Intervention(s): Comparing pregnancy rates between two time periods: July 1998-June 2001 (before IUI intervention) and July 2001-June 2010 (after IUI intervention)., Main Outcome Measure(s): Clinical pregnancy rate (PR) for the first 100 ETs performed by fellows before and after the IUI training; median attending physician PR during each time period served as the referent. Multivariate generalized estimating equations were used to calculate odds of pregnancy per ET for fellows as compared with attending physicians., Result(s): Multivariate analyses revealed no significant difference in PR for the first 100 ETs performed by fellows as compared with attending physicians, before or after the IUI training requirement (odds ratio 0.99, 95% confidence interval 0.82-1.20 and odds ratio 0.91, 95% confidence interval 0.81-1.30, respectively). The median attending physician PR in the preintervention group was exceeded by fellows after the first 70 ETs; fellows in the postintervention group exceeded the median attending physician PR after 100 ETs. The PR in both groups improved as fellows progressed from the first 20 to 100 ETs., Conclusion(s): The PR for the first 100 ETs performed by fellows was unchanged after implementing an IUI training requirement. The substantial variation noted among individual fellows decreased as more ETs were completed., (Copyright © 2013 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To measure public attitudes toward posthumous reproduction., Design: Cross-sectional study., Setting: Electronic survey., Patient(s): A total of 1,049 men and women living in the United States between the ages of 18 and 75 years., Intervention(s): Multiple-choice questionnaire., Main Outcome Measure(s): Descriptive statistics regarding support for posthumous reproduction, such as regarding emergency harvesting of gametes, and attitudes toward consent; multivariable analyses of demographic and personal experiences associated with support for posthumous reproduction., Result(s): Results showed that 47.8% supported and 31.1% opposed retrieving gametes from men, and 42.7% supported and 35.9% opposed retrieving gametes from women. The remainder was undecided. Among supporters, 69.8% believed prior consent from the deceased was required. Support was positively associated with younger age, higher education, higher income, Democratic political party affiliation, history of infertility, and currently attempting conception. Gender, religion, race, and region of the country were not associated with support. Organ donors and those who support IVF were more likely to support posthumous reproduction (odds ratio [95% confidence interval] 1.68 [1.19-2.38] and 12.30 [6.56-23.04], respectively). Most respondents were initially unfamiliar with posthumous reproduction., Conclusion(s): Almost 50% of the general population support posthumous reproduction in men and women. The majority favored prior consent from the deceased. These data caution against emergency gamete harvesting without prior consent., (Copyright © 2012 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To describe an unusual case of obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome with a single uterus., Design: Case report., Setting: Major academic medical center., Patient(s): A 12-year-old girl with OHVIRA syndrome., Intervention(s): None., Main Outcome Measure(s): None., Result(s): A 12-year-old girl presented with presumed OHVIRA syndrome and had surgical correction of the obstructed hemivagina. Two years later she presented with increasing pelvic pain and underwent laparoscopy for presumed endometriosis. A single uterus with a broad flat fundus was found as well as endometriosis., Conclusion(s): OHVIRA syndrome is typically associated with a didelphys uterus with two cervices and two vaginas, one of which is obstructed. The obstruction usually occurs on the same side as the renal anomaly. We report a rare congenital anomaly of the female reproductive tract: OHVIRA syndrome with a single uterus. From a fertility standpoint, cases of a single uterus with two cervices are managed differently than two uteri with two cervices. Healthcare providers managing complex reproductive tract anomalies should be aware of this potential variant., (Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To determine the effect of thiazolidenedione derivatives (TZDs) on vascular endothelial growth factor (VEGF) production by human luteinized granulosa cells and the morphologic development of murine embryos., Design: Prospective, experimental, in vitro and in vivo study., Setting: Research laboratory., Patient(s): Follicular aspirates from 10 women undergoing oocyte retrieval., Intervention(s): Isolated human granulosa cells were treated with a dimethyl sulfoxide (DMSO) control or ciglitazone, in the presence and absence of an hCG stimulus. Embryos extracted from superovulated B6C3F1 female mice were cultured in the presence of DMSO or pioglitazone., Main Outcome Measure(s): Vascular endothelial growth factor concentrations at 24 and 48 hours. Morphologic development of murine embryos at 96 hours., Result(s): Following an hCG stimulus, treatment with 20 microM or 40 microM ciglitazone decreased VEGF production in a statistically significant manner at both time intervals. Blastocyst development at 96 hours did not significantly differ between untreated zygotes and those treated with pioglitazone., Conclusion(s): Ciglitazone significantly decreased VEGF production by human granulosa cells in an in vitro model. Pioglitazone did not adversely impact the development of cultured murine embryos. Although mechanistic evidence is not provided, the pivotal role of VEGF in ovarian hyperstimulation syndrome prompts investigation of TZDs as a novel treatment for this condition., (Copyright 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)