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The use of assisted reproduction among women in relationships with other women has increased in the United States over the past decade as a result of increased legal access and social acceptance. Despite this shift, limited studies currently exist to guide optimal fertility care for this growing patient population of women seeking assisted reproduction. In this Commentary, assisted reproduction will be meant to include ovulation induction, intrauterine insemination (IUI), and in vitro fertilization (IVF). Conflicting studies suggest that self-identified lesbian women may demonstrate an increased prevalence of polycystic ovarian syndrome. Most available studies find that a woman's sexual orientation does not affect the outcome of fertility treatment. Self-identified lesbian women undergoing donor sperm IUI and IVF have similar pregnancy and live-birth rates as heterosexual women. Better evidence regarding patient demographics and comorbidities, underlying etiologies of subfertility, and assisted reproductive outcomes among women building families with other women is needed to optimize care.

Background Isolated absent thelarche is a rare condition that is infrequently reviewed in the literature. Case A 28-year-old woman with neurofibromatosis type 1 and acromegaly presented with absent breast development despite hormone therapy. Examination noted a normally developed woman with acromegalic features and Tanner stage I breasts. Hormone studies and karyotype were normal. Magnetic resonance imaging of the patient's brain demonstrated a voluminous pituitary. Chromosome microarray analysis diagnosed the neurofibromatosis 1 microdeletion syndrome. Breast ultrasonography and surgical consultation were offered. Conclusions Neither neurofibromatosis type 1, acromegaly, nor neurofibromatosis 1 microdeletion syndrome are linked to absent thelarche. After attempting hormone therapy, patients with absent thelarche should be evaluated for congenital breast anomalies, estrogen receptor abnormalities, or gene defects. Psychological and surgical consultation should also be offered.

OBJECTIVE: To assess, from the patient’s perspective, the prevalence and impact of postoperative fatigue after hysterectomy and to increase understanding of physician–patient communications before and after surgery regarding recovery and diminished postoperative energy level. METHODS: We completed a telephone survey of 300 women aged 25–50 who had undergone a hysterectomy or myomectomy within the past 2 years. The patients were recruited randomly from two national, random samples of households: 1) women aged 25–50, and 2) women taking hormone replacement therapy in the target age range. Patients were asked a series of questions about their postoperative fatigue after surgery. RESULTS: Overall, 74% of patients experienced moderate-to-severe fatigue within the first few weeks after surgery. Fatigue occurred more frequently and persisted twice as long as pain, the next most frequent symptom, which was experienced by 63% of patients overall. Fatigue was the symptom that most interfered with daily activities (37%) and also contributed to feelings of frustration (52%), to depression (37%), and to difficulty in concentrating (42%). Patients employed at the time of surgery missed an average of 5.8 weeks of work; 69% of those surveyed required 2 or more weeks of caregiver assistance. Postoperative fatigue was discussed by 68% of patients’ physicians before surgery, and 57% of patients discussed postoperative fatigue with their physicians after surgery. Oral iron therapy and dietary supplements were the most frequently recommended treatments; 52% of patients were not offered any treatments or recommendations to alleviate their fatigue. CONCLUSIONS: Fatigue is a highly prevalent posthysterectomy and myomectomy symptom and has substantial negative physical, psychosocial, and economic effects on patients during recovery.

Thirty-three cases of Asherman syndrome from Yale-New Haven Hospital are presented. Restoration of menses occurred in 91% of patients with pregnancy resulting in 79% of all treated patients. Spontaneous abortion occurred in only one patient (4%), whereas viable pregnancies resulted 96% of the time. Severe obstetric complications excluding premature labor occurred in three cases (12%) and included placenta increta, uterine sacculation, and a paper-thin uterine fundus (ie, uterine dehiscence). These cases are discussed to reinforce considering treated patients with Asherman syndrome to be a high-risk obstetric population, and to counsel and manage these patients accordingly.

The relationship between placental and peripheral concentrations of pregnancy-associated plasma protein A (PAPP-A) was investigated, using specific radioimmunoassay techniques. At term, placental concentrations of PAPP-A were significantly lower in diabetic pregnancies; 1.9 +/- 0.2 micrograms/mg (mean +/- SE) placental protein as compared with controls (3.2 +/- 0.3). Similar findings were noted when results were analyzed per total placental weight. Patients with classes C-R (1.2 +/- 0.3) had significantly lower PAPP-A levels than in classes A, B (2.4 +/- 0.3 micrograms/mg protein, P = .02). Peripheral PAPP-A levels were measured in patients with chronic hypertension, toxemia, diabetes mellitus, and healthy controls. Overall, the distribution of PAPP-A values in patients with diabetes mellitus were different from controls. In addition, concentrations of PAPP-A in patients with classes B-D were significantly lower than in class A (P less than .001). In patients with chronic hypertension, some values of PAPP-A were lower than the tenth percentile, while patients with toxemia had a distribution which was similar to that of controls.