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Purpose: To examine outcomes of oocyte retrievals completed by Reproductive Endocrinology and Infertility (REI) fellows versus faculty physicians. Methods: This retrospective cohort study examined patients who underwent oocyte retrievals at Mayo Clinic from July 15, 2009, to December 15, 2016. The primary outcome was the oocyte retrieval rate (ORR) calculated per retrieval as the number of oocytes retrieved per follicles aspirated. The Wilcoxon signed-rank test was used to compare follicle and oocyte counts and ORR between fellows and faculty during the same bilateral retrieval. Results: The study cohort included the first bilateral retrieval from 845 unique patients completed by 11 fellows and seven faculty. The median ORR was not statistically different for fellows and faculty (0.79 versus 0.80, p = 0.46). To assess for a learning curve, the outcomes of seven fellows who completed at least 80 retrievals in their first year were examined as four chronologically ordered sets of 20. When these sets were compared to the faculty physician mean ORR, no significant differences were found (p-values of 0.69, 0.69, 0.81, and 0.81, respectively). Conclusion: There were no significant differences in oocyte retrieval rates between fellows versus faculty over a 7-year period, with no significant learning curve observed. These findings suggest that fellows possess the requisite skills for successful oocyte retrieval upon entering REI fellowship following their OB/GYN residency. However, this does not diminish the critical role of comprehensive fellowship training and close supervision, especially in initial and complex cases. [ABSTRACT FROM AUTHOR]

Purpose: Prior studies found that Ob-gyn trainees believe they have inadequate experience in the REI subspecialty. We evaluated the amount of time devoted to REI within the 4-year rotation schedule of ACGME-accredited Ob-gyn residency programs. Methods: A list of current Ob-gyn residency programs, both with and without REI fellowships, was created using ACOG and ACGME databases. The programs' websites were reviewed, or the program coordinator was queried to determine the length and year of REI rotation, and the career or fellowships pursued by alumni. Wilcoxon rank sum test was utilized to assess differences in total REI rotation time between REI-affiliated and non-affiliated programs. Spearman's correlation was utilized to assess the association between total REI exposure and the percentage of alumni pursuing REI fellowships. Results: Cumulative length of REI rotations throughout residency ranged from 0 to 20 weeks. Mean cumulative rotation length was greater in non-REI than in REI-affiliated programs (7.4 weeks vs. 6.1 weeks, p = 0.007). However, REI-affiliated programs had greater exposure to REI rotations during the first 2 years of residency (3.9 weeks vs 3.1 weeks, p = 0.042). Among all programs, 24% had the REI rotation in PGY-1, 61% in PGY-2, 50% in PGY-3, and 16% in PGY-4. The proportion of alumni matching in REI fellowship was significantly greater in REI-affiliated programs than non-REI affiliated programs (9.5% vs. 3.1%, p < 0.001). Conclusion: Compared to non-REI affiliated programs, Ob-gyn residencies affiliated with REI fellowships spend less time throughout residency training in REI rotations while sending a greater proportion of residents to REI fellowships. [ABSTRACT FROM AUTHOR]

Guidelines for the investigation and management of recurrent pregnancy loss (RPL) have been developed in Europe, USA and UK, but there is currently no Australasian guideline. The Australasian Certificate of Reproductive Endocrinology and Infertility Consensus Expert Panel on Trial Evidence group has prepared a two‐part guideline to provide guidance on the management of RPL. In Part I chromosomal, anatomical, and endocrine factors are outlined along with relevant recommendations for clinical management, levels of evidence and grades of consensus. In Part II thrombophilia, autoimmune factors, infective, inflammatory, and endometrial causes, environmental and lifestyle factors, male factor and unexplained causes will be outlined. [ABSTRACT FROM AUTHOR]

Objective To evaluate the efficacy of simultaneous or staged management of uterine fibroids by transcervical resection of septum (TCRS), reproductive endocrinology and clinical prognosis. Methods Clinical data of 87 patients with uterine septum complicated with uterine fibroids were collected. All patients were divided into the simultaneous (n = 43) and staged groups (n = 44) according to different surgical methods. In the simultaneous group, hysteroscopic TCRS and transcervical resection of myoma (TCRM) were performed simultaneously, whereas staged hysteroscopic TCRS and TCRM were conducted in the staged group. Surgical conditions, postoperative myometrial healing, endometrial and subendometrial blood flow parameters (flow index (FI), vascularization flow index (VFI) and vascularization index (VI) ), endometrial thickness, reproductive endocrine indexes (luteinizing hormone (LH), follicle stimulating hormone (FSH), estradiol (E2) ), reproductive outcomes and complications were compared between two groups. Results All patients in both groups completed the surgery successfully. The operation time, time to the first off-bed activity and the length of hospital stay in the simultaneous group were shorter than those in the staged group (all P < 0.05) . In the simultaneous group, the proportion of patients with myometrial healing at 1 month after surgery was higher than that in the staged group (P < 0.05) . The differences in subendometrial VFI, FI, VI, endometrial thickness and E2, LH and FSH levels before surgery, 1 month and 3 months after surgery were not statistically significant between two groups (all P > 0.05) . The percentage of patients who were pregnant at postoperative 6 months in the simultaneous group was higher than that in the staged group (P < 0.05) . The difference in the incidence of complication was not statistically significant between two groups (P > 0.05) . Conclusions Simultaneous management of uterine fibroids by TCRS does not affect endometrial hemodynamics, endometrial tolerance, ovarian reserve function and reproductive endocrine function. In addition, it can shorten the operation time, time to the first off-bed activity and length of hospital stay, which is conducive to postoperative pregnancy and has a certain degree of safety. [ABSTRACT FROM AUTHOR]

The Disparities in Assisted Reproductive Technology (DART) hypothesis, initially described in 2013 and further modified in 2022, is a conceptual framework to examine the scope and depth of underlying contributing factors to the differences in access and treatment outcomes for racial and ethnic minorities undergoing ART in the United States. In 2009, the World Health Organization defined infertility as a disease of the reproductive system, thus recognizing it as a medical problem warranting treatment. Now, infertility care is largely recognized as a human right. However, disparities in Reproductive Endocrinology and Infertility (REI) care in the US persist today. While several studies and review articles have suggested possible solutions to racial and ethnic disparities in access and outcomes in ART, few have accounted for and addressed the multiple complex factors contributing to these disparities on a systemic level. This review aims to acknowledge and address the myriad of contributing factors through the DART hypothesis which converge in racial/ethnic disparities in ART and considers possible solutions to effect large scale societal change by narrowing these gaps within the next decade. [ABSTRACT FROM AUTHOR]

Background: In functional hypothalamic amenorrhea (FHA), luteinizing hormone and follicle-stimulating hormone levels show high interindividual variability, which significantly limits their diagnostic value in differentiating FHA from polycystic ovary syndrome (PCOS). Our aim was to profile the LH:FSH ratio in a large sample of patients with well-defined FHA. Methods: This observational study included all consecutive patients with FHA presenting to the Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, between January 2017 and August 2023. The main parameters of interest were the LH level, the FSH level, and the LH:FSH ratio. In a subgroup analysis, we compared the LH:FSH ratio of patients with PCO morphology (PCOM) on ultrasound with that of patients without PCOM. Results: A total of 135 patients were included. Only a minority of patients revealed FSH and LH levels ≤ 2.0 mIU/mL (13% and 39%, respectively). Most patients (81.5%) had an LH:FSH ratio ≤ 1.0, while a minority (2.2%) had a ratio ≥ 2.1. The LH:FSH ratio was similar in patients with and without PCOM. Conclusion: In a well-defined FHA sample, the LH:FSH ratio was ≤ 1 in most patients. The LH:FSH ratio may prove useful in distinguishing FHA from PCOS but needs further investigation. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate if social media (SM) impacts a patient's provider choice in the field of reproductive endocrinology and infertility (REI). Methods: This was a survey-based study completed in July 2022. A survey link was distributed using Amazon Mechanical Turk, which directed participants to a Qualtrics-based survey. Participants were 18–50 years old. The primary outcome was to identify the preferred method for finding a REI provider based on time spent on SM (< 1 h, 1–3 h, 3 + h). Results: A total of 336 responses were analyzed. Fifty-four percent of respondents used SM < 1 h, 33.33% used 1–3 h, and 12.80% used 3 + h. The majority (69.05%) of respondents stated that they would seek out a REI provider/clinic if they had difficulty conceiving. Most respondents identified asking their primary care physician (44.64%) as the primary means for finding an REI provider/clinic and did not prefer to use SM. Although Facebook (< 1 h: 30.94%, 1–3 h: 31.25%, 3 + h: 27.91%) was the most utilized SM platform among respondents, YouTube was the preferred SM platform if respondents were to follow a REI clinic with a preference for posts focusing on education (< 1 h: 55.68%, 1–3 h: 43.12%, 3 + h: 58.14%) or stress management (< 1 h: 17.61%, 1–3 h: 29.36%, 3 + h: 20.94%). Conclusion: Most respondents utilize traditional methods when choosing their REI provider or clinic and would not utilize SM. However, SM, primarily through YouTube, may be helpful for educating infertility patients and providing support and stress relief while they undergo treatment. [ABSTRACT FROM AUTHOR]

Fertility preservation (FP) is the use of a specific medical intervention to protect the fertility of individuals whose disease or disease treatment may lead to infertility. These medical interventions include the cryopreservation of oocytes, embryos, ovarian tissue, sperm, and testicular tissue; oocyte and embryo cryopreservation are the most widely used interventions in the United States. Although guidelines recommend FP prior to undergoing gonadotoxic treatments, cost barriers are high. For example, the average cost of an oocyte cryopreservation cycle in the United States exceeds $10,000. High cost and lack of insurance coverage are two of the most cited reasons explaining the low Reproductive Endocrinology and Infertility (REI) referral rates and limited FP utilization. Broadening insurance mandates for FP prior to gonadotoxic treatments could improve utilization and provide cancer survivors with improved quality of life post treatment. [ABSTRACT FROM AUTHOR]

Effective management and conservation of threatened species biodiversity requires knowledge of reproductive biology, such as cyclicity, mode, and age at maturity. We combined reproductive endocrinology and in-situ ultrasonography to examine reproductive characteristics of female Caribbean reef sharks Carcharhinus perezi, a widely distributed, threatened marine predator which remains largely understudied throughout its range. Unique to this study was the opportunity to conduct longitudinal assessments of two individuals, recaptured across multiple seasons during sampling in The Bahamas. Within- individual, paired hormone analyses and in-situ ultrasounds of female sharks that were confirmed as either pregnant, non-pregnant, or reproductively active, suggest a biennial reproductive cycle for Carcharhinus perezi. This unique opportunity to assess the reproductive biology of the same individuals over time underscore the importance of repeated sampling for elucidating population reproductive cyclicity of highly mobile sharks in the wild. [ABSTRACT FROM AUTHOR]

To determine if gender differences exist in letters of recommendation (LORs) for reproductive endocrinology and infertility fellowship. Cohort study. Academic medical center. A cohort of applicants to a reproductive endocrinology and infertility fellowship program at a single Midwestern academic institution in a single year. None. Quantitative measures included linguistics inquiry and word count analysis, with 4 summary variables and 25 word categories, to quantify tone and themes present by gender. Performing qualitative analysis in parallel to linguistic analysis allowed for the exploration of themes not conveyed in quantitative methods alone. Qualitative measures included the frequency of code themes in LOR by applicant gender. There were 272 letters from 72 applicants, 54 (76%) of which were women and 17 (24%) were men. One applicant was excluded because gender information was not specified; 269 letters were included in the quantitative linguistics and qualitative coding analysis. One hundred 10 letters (41%) were written by women and 159 (59%) by men. LOR written for men had a higher mean word count than those written for women (537 vs. 474, P =.04). Linguistics Inquiry and Word Count analysis exhibited more risk words used to describe men applicants (P =.01). When comparing word categories by letter writer gender, women letter writers more frequently used communal, affect, and home word categories whereas men writers more frequently used affiliation-related words. Qualitative analysis revealed that letters for men applicants described leadership, altruism, rapport with patients, and strong endorsements more frequently, whereas women applicants' letters more often mentioned doubt raisers and disclosures of personal life. In addition, letters for women applicants more often described candidates as drama free, not easy to "fluster," and not complainers. Furthermore, letters for women more frequently disclosed parenthood status. Gender differences exist among both letter writers and applicants. Qualitative analysis revealed that women applicants were more likely to be described with doubt raisers and personal life disclosures, whereas men were more likely to be described by their altruism and with a strong endorsement. Increasing bias awareness and implementing mitigation strategies would improve gender equity in LOR. [ABSTRACT FROM AUTHOR]

STUDY QUESTION What is the relationship of sex steroid levels with sexual function in women with and without polycystic ovary syndrome (PCOS)? SUMMARY ANSWER Women with PCOS reported more sexual dysfunction and more sexual distress compared to those without PCOS, but only few and weak associations between androgen levels and sexual function were observed. WHAT IS KNOWN ALREADY The literature shows that women with PCOS report lower levels of sexual function and sexual satisfactionand more sexual distress. Contributing factors seem to be obesity, alopecia, hirsutism, acne, infertility, anxiety, depression, and low self-esteem. In women with PCOS clinical and/or biochemical hyperandrogenism is common; its relationship with sexualfunction is, however, inconclusive. STUDY DESIGN, SIZE, DURATION This observational prospective case control study with 135 women (68 PCOS, 67 control) was conductedfrom March 2017 until March 2020. PARTICIPANTS/MATERIALS, SETTING, METHODS Heterosexual w omen with and without PCOS, aged 18–40 years, in a steady relationshipand without any comorbidities, underwent an extensive medical and endocrine screening using liquid chromatography-tandem mass spectrometry and validated sexual function questionnaires. MAIN RESULTS AND THE ROLE OF CHANCE Women with PCOS reported significantly lower sexual function (Female Sexual Function Index (FSFI) P  <   0.001, partial η 2 = 0.104), higher levels of sexual distress (Female Sexual Distress Scale-Revised P  <   0.001, partial η 2 = 0.090), and they more often complied with the definition of sexual dysfunction (41.2% vs 11.9%, P  <   0.001, Phi V  = 0.331) and clinical sexual distress (51.5% vs 19.4%, P  <   0.001, Phi V  = 0.335). Regression analysis adjusted for confounders showed only few and weak associations between androgen levels and sexual function, with each model explaining a maximum of 15% sexual function. Following significant Group × Hormone interactions, analyses for both groups separately showed no significant associations in the PCOS group. The control group showed only weak negative associations between testosterone and FSFI pain (β = −6.022, P  =   0.044, Adj R 2 = 0.050), between FAI and FSFI orgasm (β = −3.360, P  =   0.023, Adj R 2 = 0.049) and between androstenedione and clinical sexual distress (β = −7.293, P  =   0.036, exp(β) = 0.001). LIMITATIONS, REASONS FOR CAUTION The focus of the study on sexual functioning potentially creates selection bias. Possibly women with more severe sexual disturbances did or did not choose to participate. Differences between women with PCOS and controls in relationship duration and hormonal contraceptive use might have skewed the sexual function outcomes. WIDER IMPLICATIONS OF THE FINDINGS Sexual function is impaired in women with PCOS. However, endocrine perturbations seem to have minimal direct impact on sexual function. Addressing sexuality and offering psychosexual counseling is important in the clinical care for women with PCOS. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by the departments of the participating centers: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Psychosomatic OBGYN and Sexology, Leiden University Medical Center, Leiden, the Netherlands; and Department of Sexology and Psychosomatic OBGYN, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands. J.S.E.L. received unrestricted research grants from the following companies (in alphabetical order): Ansh Labs, Ferring, Merck Serono and Roche Diagnostics. He also received consultancy fees from Ansh Labs, Ferring, Titus Healthcare and Roche Diagnostics. The other authors have no conflicts of interest. TRIAL REGISTRATION NUMBER CCMO register, registration number: NL55484.078.16, 10 March 2016. https://www.toetsingonline.nl/to/ccmo_search.nsf/Searchform?OpenForm [ABSTRACT FROM AUTHOR]

The field of reproductive endocrinology and infertility (REI) is at a crossroads; there is a mismatch between demand for reproductive endocrinology, infertility and assisted reproductive technology (ART) services, and availability of care. This document's focus is to provide data justifying the critical need for increased provision of fertility services in the United States now and into the future, offer approaches to rectify the developing physician shortage problem, and suggest a framework for the discussion on how to meet that increase in demand. The Society of REI recommend the following: 1. Our field should aggressively explore and implement courses of action to increase the number of qualified, highly trained REI physicians trained annually. We recommend efforts to increase the number of REI fellowships and the size complement of existing fellowships be prioritized where possible. These courses of action include: a. Increase the number of REI fellowship training programs. b. Increase the number of fellows trained at current REI fellowship programs. c. The pros and cons of a 2-year focused clinical fellowship track for fellows interested primarily in ART practice were extensively explored. We do not recommend shortening the REI fellowship to 2 years at this time, because efforts should be focused on increasing the number of fellowship training slots (1a and b). 2. It is recommended that the field aggressively implements courses of action to increase the number of and appropriate usage of non-REI providers to increase clinical efficiency under appropriate board-certified REI physician supervision. 3. Automating processes through technologic improvements can free providers at all levels to practice at the top of their license. [ABSTRACT FROM AUTHOR]

Tremendous advances in genetics have transformed the field of reproductive endocrinology and infertility over the last few decades. One of the most prominent advances is preimplantation genetic testing (PGT), which allows for the screening of embryos obtained during in vitro fertilization before transfer. Moreover, PGT can be performed for aneuploidy screening, detection of monogenic disorders, or exclusion of structural rearrangements. Refinement of biopsy techniques, such as obtaining samples at the blastocyst rather than the cleavage stage, has helped optimize results from PGT, and technological advances, including next-generation sequencing, have made PGT more efficient and accurate. The continued evolution of the approach to PGT has the potential to further enhance the accuracy of results, expand the application to other conditions, and increase access by reducing cost and improving efficiency. [ABSTRACT FROM AUTHOR]

For years, reproductive surgery was the mainstay of reproductive care. With the evolution and ultimate success of in vitro fertilization (IVF), reproductive surgery became an adjuvant therapy, indicated mainly for severe symptoms or to enhance success rates with assisted reproductive technologies. As success rates for IVF have plateaued, and emerging data rekindles the enormous benefits of surgically correcting reproductive pathologies, there is renewed interest among reproductive surgeons in reviving research and surgical expertise in this area. In addition, new instrumentation and surgical techniques to preserve fertility have gained traction and will solidify the need to have skilled reproductive endocrinology and infertility surgeons in our practice. [ABSTRACT FROM AUTHOR]

The kisspeptin system, which involves hypothalamic neuropeptides, plays pivotal roles in the regulation of teleost reproduction. A previous study suggested that the kiss2/kissr2 system in largemouth bass (Micropterus salmoides) was involved in regulating gonadal development through the hypothalamus-pituitary-gonad (HPG) axis. However, whether the kiss2/kiss2r system directly regulates the activity of pituitary gland were not studied. This study aimed to elucidate the detailed mechanism of kisspeptin-induced effects on gonadotropin hormoneproducing cells in vivo and in vitro. In situ hybridization analysis revealed very widespread expression of kiss2r mRNA in the optic tectum, hypothalamus and pituitary. In the pituitary, kiss2r-expressing cells were mainly located in the proximal pars distalis and pars intermedia, among which the fshβ- and lhβ-positive cells exhibited expression of kiss2r messengers. Furthermore, primary culture of pituitary cells and peptide administration experiments revealed that the Kiss2-10 peptide stimulates the expression of fshβ and lhβ and the secretion of FSH and LH in 24 h. In addition, histology analysis revealed that three injections of the Kiss2-10 peptide promoted ovary development and increased oocyte size but had little effect on testis development. These results suggested that the intrapituitary kisspeptinergic system, as a hypophysiotropic neuropeptide factor, directly modulates of gonadotroph function. This study will help uncover the reproductive endocrinology network and improve artificial breeding technology for largemouth bass. [ABSTRACT FROM AUTHOR]

Hormonal and metabolic factors may influence endometrial quality and interfere with the action of progesterone. Therefore, the aim of our study was to address this issue. Participants were recruited from an outpatient reproductive endocrinology clinic at an academic tertiary medical care centre. All subjects underwent endometrial biopsy (EB) in the follicular phase of the cycle prior to treatment. Thereafter, they were treated with micronized progesterone (400 mg/day × 10 days intravaginally) from days 14–28 of the next cycle. A second EB was performed between days 21–24 of the cycle (the second phase). The metabolic and hormonal serum levels were evaluated during the implantation window. EB samples were analysed using light microscopy for histomorphometric analysis. The endometrium of women with Polycystic Ovarian Syndrome (PCOS) in the second phase demonstrated a uniform surface epithelium with less leukocyte infiltration and an absence of apoptotic figures compared to the control group. (p < 0.021). The thickness of the surface epithelium in the second phase of the PCOS group correlated positively with free and bioavailable testosterone values. The number of stromal cells increases with increasing insulin levels. Our results suggest that histomorphometric abnormalities of the endometrium persist and are linked to androgen and insulin levels despite progesterone supplementation in PCOS. [ABSTRACT FROM AUTHOR]

Objective: Optimal breast development is an essential part of exogenous oestrogen treatment in females undergoing pubertal induction. We set out to develop a novel technique using three‐dimensional (3D) imaging to determine change in breast volume that is applicable when no pre‐existing breast contours are present. Design: A prospective observational study. Patients: The imaging methodology was developed using a single male subject to assess reproducibility and validity. The technique was then applied to 29 participants undergoing pubertal induction with exogenous oestradiol who were recruited from Paediatric Gynaecology and Reproductive Endocrinology clinics at University College London Hospital. Measurements: Breast images were taken using a 3D photographic system. Two images, taken at different times, were manually superimposed to produce a differential breast volume. The initial step of method development set out to show that volume change was not secondary to positioning artefact or image manipulation. This was established by using images of a male participant taken on different occasions. The technique was then used to assess reproducibility in participants undergoing pubertal induction treatment. Results: Good intraobserver reproducibility (intraclass correlation (ICC) 0.77) was demonstrated with static image manipulation. Validity of the imaging technique was established as there was no significant difference between the known reference volume produced by computer generated warping and that calculated by manual image manipulation. There was excellent intraobserver reproducibility for breast volume calculation in participants undergoing induced breast development (ICC 0.99). Conclusions: 3D imaging is a promising novel tool to provide quantitative breast volume assessment in individuals undergoing breast induction with exogenous oestradiol treatment. [ABSTRACT FROM AUTHOR]

Fertility preservation (FP) counseling and interventions for adolescents prior to potentially gonadotoxic therapies is not yet accessible for all patients. Current literature acknowledges multiple known barriers to FP including insurance coverage, provider knowledge of options, and need for urgent treatment initiation. However, there is limited research surrounding disparities for accessing these services for children. This study aimed to identify inequities in receiving FP services among children undergoing gonadotoxic therapy A retrospective chart review was performed at a single academic medical center for patients aged 0-21 years old referred to Reproductive Endocrinology for FP counseling prior to gonadotoxic therapy. Patients were excluded if they were referred after treatment, prior to gender affirming therapy, or for fertility discussion due to a genetic condition. Data collected included demographics, referring provider, type of treatment, urgency of treatment initiation, and if FP was ultimately performed. Minority patients were defined as non-white race and Hispanic ethnicity. Analysis to assess differences in receiving FP based on treatment status and minority identity status was performed using paired t-tests. IRB approval was obtained The cohort included 136 patients. The majority of patients were White (72%) and identified as non-Hispanic (96%)(Table 1). Forty-six (34%) patients had Medicaid insurance. Most patients (83%) had a cancer diagnosis. 54% (n=74) of patients had gonadotoxic treatment starting urgently. Of those, 82% (n=61) desired FP and 90% (n=55) received it. All fifty-five patients who received FP also received Lupron. For referred patients without urgent treatment needs, 86% (42/49) who desired FP ultimately received it, and 36% (15/49) underwent oocyte cryopreservation as opposed to Lupron. No patients underwent ovarian tissue cryopreservation. Minority patients desired FP at a higher rate than non-minority patients (89% vs 78%, P=.10), but were significantly less likely to receive FP when desired (76% vs 93%, P<.01). There was no difference in cost being cited as the largest barrier to care between minority and non-minority groups (58% vs 80%, P = 0.39) This study identified inequities in rates of FP among adolescents undergoing gonadotoxic therapy. Minority patients were less likely than non-minority patients to be able to access FP when desired. Further research is needed to determine how to make FP services more accessible among to all patients, regardless of minority status [ABSTRACT FROM AUTHOR]

Investigation of the use of fish scales as a medium for non-lethal biomonitoring has recently commenced. Fish scales have been shown to incorporate cortisol over longer periods of time than blood and thus provide a promising means of assessing long-term stress in many species of teleost fish. However, while cortisol is a major mediator of the stress response in fishes, downstream effects of chronic stress on reproduction can involve gonadal steroids such as progesterone and testosterone. The quantification of these additional hormones alongside cortisol could therefore allow for the assessment of both stress and consequential reproductive alterations. To investigate these concepts, we artificially elevated circulating cortisol, progesterone, and testosterone in rainbow trout (Oncorhynchus mykiss) using coconut oil implants for three weeks. Following this we quantified these three hormones as well as 11-ketotestosterone, a potent androgen in teleost fishes. In all cases serum samples reflected a significant increase in the injected hormone confirming the efficacy of this method; however, this did not result in significantly elevated scale concentrations of the same hormone in all cases. As the stress and reproductive axes are closely integrated, these findings are likely a result of interactions along the steroidogenic pathway indicating that a further investigation of the relationship between scale concentrations of these hormones and actual physiological processes is required. Nevertheless, the successful quantification of both stress and gonadal steroid hormones within the scale suggests that such measurements could provide a novel and informative tool in the assessment of long-term stress and the resulting effects on reproductive endocrinology in teleost fishes. [ABSTRACT FROM AUTHOR]

The role of the neuropeptide kisspeptin (Kp) in mammalian reproduction is well established. Nevertheless, species-specific differences exist. In the horse, administration of the shortest endogenous Kp isoform, Kp10, is unable to trigger ovulation even though it increases plasma gonadotropins concentrations. To check if this issue would be dependent on Kp10 short half-life, we tested two degradation-resistant Kp analogs. The first analog was based on the equine Kp10 sequence (eC6), the second on the ovine Kp10 sequence (oC6). During the non-breeding season, a dose of 150 nmol/mare of either molecule had no significant effect on LH concentration, while oC6 provided a better stimulation of FSH than eC6 (p = 0.01). Furthermore, oC6 was more effective when injected intravenously than intramuscularly. Due to its best pharmacodynamics profile, oC6 (150 nmol/mare) was probed for ovulation induction during the breeding season. The molecule was injected during the preovulatory phase when the follicle diameter ranged from 34 to 37 mm and a uterine oedema was observed. oC6 consistently increased the total amount of gonadotropins released (FSH, p = 0.01 and LH, p = 0.02). However, as shown by transrectal ultrasonography and plasma progesterone levels, oC6 did not anticipate ovulation compared to the control group. Our results provide further evidence of the peculiar reproductive endocrinology of the mare but leave open questions regarding the exact role of Kp in the control of ovulation and breeding in the mare, which we attempt to identify and discuss. [ABSTRACT FROM AUTHOR]

STUDY QUESTION Are donor-conceived people (DCP) willing to utilize donor gametes themselves if unable to conceive spontaneously? SUMMARY ANSWER The majority of DCP would consider or are undecided about utilizing donor gametes and those who would consider the utilization are more likely to have been told about their donor-conceived origins at a young age by a family member and have overall positive experiences as a DCP. WHAT IS KNOWN ALREADY DCP view their donor conception as an important part of their self-identity and many desire contact with genetically related individuals. Additionally, many believe that sperm donation should only be practiced if identifying information on the donor is provided. STUDY DESIGN, SIZE, DURATION This was a cross-sectional study using a Web-based survey that was disseminated from 6 March to 15 August 2021. A total of 528 participants completed the questionnaire. PARTICIPANTS/MATERIALS, SETTING, METHODS The researcher-created survey was sent to registered users of the Donor Sibling Registry (DSR) who were conceived via donor-assisted reproduction and were 18 years of age or older. The survey was optional and anonymous, and the main outcome measure was the willingness to use donated gametes if unable to spontaneously conceive. MAIN RESULTS AND THE ROLE OF CHANCE Of the 528 participants who completed the survey, 40.2% (212/528) have or would consider using donor gametes themselves if unable to conceive spontaneously and 24.6% (130/528) were undecided. Those who had used or were undecided about the utilization were significantly younger (26 years vs. 31 years, P  < 0.001) and less likely to be married (32.7% vs. 47.3%, P  < 0.001) than those who would not consider using donor gametes. They were also less likely to self-identify as female (78.9% vs. 86.6%, P  = 0.03) but had no difference in sexual orientation (P  = 0.13). Additionally, they were more likely to have known about their donor-conceived origins for more years (18 (0–50) vs. 11 (0–61), P  = 0.004), be informed by a family member (75.5% vs. 65.6%, P  = 0.001) and have overall positive feelings about being conceived using a donor (93.0% vs. 52.5%, P  < 0.001). LIMITATIONS, REASONS FOR CAUTION A major limitation is that DSR participants may not be representative of all DCP. Additionally, analyzing the DCP who stated that they were undecided about using donor gametes into the 'would consider' group may be overestimating the openness to utilization in this group. WIDER IMPLICATIONS OF THE FINDINGS The findings from this study give new insight for health care workers to further counsel patients who are considering using third-party reproduction by providing reassurance that the majority of their future children would consider similar means, if needed, to achieve their family-building goals. STUDY FUNDING/COMPETING INTEREST(S) Funding for this study was received from the Department of Obstetrics and Gynecology Division of Reproductive Endocrinology and Infertility, University of Colorado. All authors declare that there are no conflicts of interest to disclose. TRIAL REGISTRATION NUMBER N/A. [ABSTRACT FROM AUTHOR]

• Sirenian reproductive hormone fluctuations are related to seasonal environmental changes. • Measuring progesterone alone is not sufficient for pregnancy determination in manatees. • There is a paucity of reproductive endocrinology data for Antillean manatees and African manatees. • A full characterization of Sirenian gonadotropin cyclicity and acyclicity is needed. Reproductive hormones are essential to mating systems, behavior, fertility, gestation, parturition, and lactation in mammals and understanding the role of hormones in these processes is essential for species conservation. Sirenia is a unique order of marine mammals that include manatees, dugongs, and the extinct Steller's sea cow. Extant Sirenian species are all listed as vulnerable due to habitat loss, cold stress, boat strike trauma, harmful algal bloom toxicity, entanglements, and illegal hunting. Therefore, successful reproduction is essential to maintaining and increasing Sirenian populations. Understanding Sirenian reproductive behavior, endocrinology, and mating strategies will aid conservation and management efforts to protect and provide the proper conditions for successful reproduction. The objectives of this review were to synthesize the current knowledge regarding reproductive cycles and endocrinology of Sirenians and identify knowledge gaps for future investigation. The current literature on Sirenian reproductive physiology reports reproductive seasonality, sexual maturation, estrous cyclicity and acyclicity, pregnancy, and sex differences. However, there remain significant knowledge gaps on the cyclicity and pulsatile release of gonadotropins, maturation in females, and characterization of pregnancy hormone profiles throughout gestation. To date, there is no explanation for confirmed pattern for ovarian acyclicity, nor understanding of the function of the numerous accessory corpus luteum described in manatees. Research including a greater number of longitudinal and postmortem studies on a wider variety of wild manatee populations are important first steps. Taken together, understanding the reproductive endocrinology of these vulnerable and threatened species is critical for policy and management decisions to better inform protection initiatives. [ABSTRACT FROM AUTHOR]

Polycystic ovary syndrome, previously known as Stein–Leventhal syndrome, is associated with altered reproductive endocrinology, predisposing a young woman towards the risk of PCOS. It has a prevalence of 6–20% among the reproductive-age women. Progesterone is a key hormone in the pathophysiology of PCOS and patients show diminished response (progesterone resistance), implicating the role of progesterone receptor (PR) as a factor in the disease etiology and prognosis. In this case–control study, we have used mutation-specific PCR (confirmed by Sanger sequencing) to detect the presence of a pathologically significant PR polymorphic variant called as PROGINS. The variant has an Alu insertion in intron G and has two SNPs in exon 4 and exon 5, with all the three aberrations in complete disequilibrium. Our results demonstrated a statistically significant difference in the frequencies of PROGINS between the PCOS patients and healthy controls (p = 0.047). The frequencies of the genotypes CC (A1/A1), CT (A1/A2), and TT (A2/A2) in patients were 74.50%, 20.58%, and 4.90%, and in healthy controls they were 87.28%, 11%, and 1.69%, respectively. Our results put forward two determining factors with regard to PCOS: (i) the frequency of PROGINS allele was significantly higher among PCOS patients compared to the healthy matched controls (0.15 vs 0.07) in the studied population, (ii) the PROGIN allele was significantly associated with the lower levels of serum progesterone in PCOS patients (p < 0.003). The findings are conspicuous as these relate the PROGINS variant to the increased susceptibility of PCOS and might explain the progesterone resistance in patients. [ABSTRACT FROM AUTHOR]

Purpose: To study patient satisfaction with new patient telehealth visits in a reproductive endocrinology and infertility (REI) office. Methods: A cross-sectional study in a university-based fertility clinic was completed including all new patients seen via telehealth between March 1, 2021, and August 19, 2021. Primary outcomes were perceived patient satisfaction, access, and preferences to telehealth visits. Results: A total of 351 participants were contacted, 61.8% (n = 217) agreed to participate in the study, and 28.8% (n = 101) completed the survey. There were no significant differences in age, BMI, distance from clinic, or length of infertility with response to survey. Ninety-three percent of responders would use telehealth services again and were satisfied with the telehealth system. Telehealth improved access to healthcare for 88% and travel time for 96%. The median distance from clinic was 24 miles, and there was no significance difference in preference for telehealth visits over in person visits (p = 0.696). Conclusions: In the era of COVID-19, healthcare implementation has dramatically changed with a drastic increase in telehealth services. Based on our survey, majority of patients were satisfied with telehealth visits and believed it saved travel time while improving access to REI care. Despite no differences in patient preference for in person versus telehealth depending on their distance from clinic, this is reassuring because patients are satisfied with telehealth for reasons other than distance from clinic. [ABSTRACT FROM AUTHOR]

Purpose: To assess telehealth services offered by reproductive endocrinology and infertility specialists and to gauge provider experiences with incorporating telehealth into their practices. Methods: A 16-question web-based survey on use of telehealth was distributed to Society for Assisted Reproductive Technology (SART) clinics and to Society for Reproductive Endocrinology and Infertility (SREI) members. Clinic demographic data, telehealth descriptive data, and provider satisfaction with use of telehealth were assessed. Results were collected via Survey Monkey. Results: A total of 1160 individuals (330 SART clinic contacts and 830 SREI members) were reached via email with an 18.6% (216) survey response rate. All respondents indicated that they offer telehealth visits. Several telehealth platforms were used, with Zoom (62.7%) and telehealth through the clinic's electronic medical record platform (34.8%) being the most common. The majority of participants (87.0%) anticipate they will offer telehealth visits after the COVID-19 pandemic. Roughly two-thirds (64.4%) of respondents anticipate fewer telehealth visits after the pandemic because of logistics, cost, and patient/provider preference. Nearly all providers are either "very satisfied" (66.2%) or "somewhat satisfied" (31.0%) with telehealth overall. Conclusion: Telehealth enabled safe patient-provider interactions throughout the COVID-19 pandemic. While only one-third of survey respondents offered telehealth services before the pandemic, nearly all providers express satisfaction with telehealth and anticipate they will offer telehealth services henceforth. [ABSTRACT FROM AUTHOR]

The size of nanoparticles is about 1–100 nm. People are exposed to nanoparticles in environmental pollutants from ancient times to the present. With the maturity of nanotechnology in the past two decades, the production of manufactured nanomaterials is rapidly increasing and they are used in a wide range of aerospace, medicine, food, and industrial applications. However, both natural and manufactured nanomaterials have been proved to pose a threat to diverse organs and systems. The endocrine system is critical to maintaining homeostasis. Endocrine disorders are associated with many diseases, including cancer, reduced fertility, and metabolic diseases. Therefore, we review the literatures dealing with the endocrine toxicity of nanomaterial. This review provides an exhaustive description of toxic effects of several common nanomaterials in the endocrine system; more involved are reproductive endocrinology. Then physicochemical factors that determine the endocrine toxicity of nanomaterials are discussed. Furthermore, oxidative stress, changes in steroid production and metabolic enzymes, organelle disruption, and alterations in signal pathways are introduced as potential mechanisms that may cause changes in hormone levels. Finally, we suggest that a risk assessment of endocrine toxicity based on standard procedures and consideration of endocrine disrupting effects of nanomaterials in the field and its environmental and population effects could be future research directions for endocrine toxicity of nanomaterials. Nanomaterials have been used in a wide range of industries. However, studies have shown that nanomaterials can cause endocrine disruption and produce adverse health outcomes, especially reproductive endocrine. The composition, particle size, charge, and surface coating of nanomaterials are factors that determine the severity and pattern of endocrine disruption. Oxidative stress, disruption of steroid synthesis and metabolic pathways, organelle damage, and altered signaling pathways are potential mechanisms by which nanomaterials contribute to reproductive endocrine disruption. [ABSTRACT FROM AUTHOR]

Behavioral observations can provide clues about female reproductive status. However, the study of the endocrine dynamics that underlie processes such as puberty, ovulation, conception, and gestation, may help increase our understanding of female reproductive biology. We used noninvasive methods to study female reproductive endocrinology in wild woolly monkeys (genus Lagothrix). We extracted ovarian steroid hormones from fecal samples collected non‐invasively to examine changes in the concentrations of progesterone and estrogen metabolites (pregnanediol‐3‐glucuronide and estrone‐3‐glucuronide, respectively) during periods of female puberty, ovarian cyclicity, and pregnancy. The two subadult females in our study showed significant increases in ovarian hormone concentrations before disappearing and presumably dispersing, suggesting that they might reach the onset of puberty before emigrating from their natal groups. Ovarian cycle length in adult females was, on average, ~22 days (N = 21). Of the 10 cycling females, five conceived and four gave birth to offspring, with an average gestation period of ~214 days, but the infant born to the female with the shortest estimated gestation period (182 days) disappeared within a month after parturition. The fact that less than half of all cycling females conceived, and that only three out of five of those females gave birth to offspring that survived past the first month, suggests that reproduction is energetically costly for female woolly monkeys. Ovarian cycle length and gestation period among woolly monkeys are similar to those in their closest relatives, spider monkeys and muriquis suggesting that reproductive physiology may be highly conserved among females within the Tribe Atelini. Research Highlights: Noninvasively‐collected fecal samples can be used to monitor ovarian steroid hormones in wild woolly monkeysWoolly monkey cycle length (~22 days) and gestation period (~214 days) are similar to other atelins, suggesting that female reproductive physiology may be highly conserved among genera in the Tribe AteliniUnlike other atelins, subadult female woolly monkeys may reach the onset of puberty before emigrating from their natal groups [ABSTRACT FROM AUTHOR]

Objective: To characterize gynecology clinical trials over time, compare gynecology subspecialties, and analyze factors associated with early discontinuation, results reporting, and publication.Methods: We conducted a cross-sectional analysis of all gynecology trials registered on ClinicalTrials.gov between 2007 and 2020 and their resulting publications. Trials were analyzed with descriptive, multivariable logistic, and Cox regression analyses. Primary exposure variables were trial funding and subspecialty. The three primary outcomes included early discontinuation, results reporting to ClinicalTrials.gov, and publication in a peer-reviewed journal indexed on PubMed.Results: Of 223,690 trials registered on ClinicalTrials.gov between October 2007 and March 2020, only 3.7% focused on gynecology (n=8,174, approximately 3,759,086 participants). Subspecialties included reproductive endocrinology and infertility (n=1,428, 17.5%), gynecologic oncology (n=2,063, 25.2%), urogynecology (n=1,118, 13.7%), family planning (n=648, 7.9%), and other benign gynecology (n=2,917, 35.7%). Only 42.0% of completed trials disseminated results through results reporting and publication. Of all funding types, industry-funded trials were the most likely to be discontinued early (P<.001). Academic-funded trials were the least likely to report results (adjusted odds ratio [aOR] 0.38, 95% CI 0.30-0.50) but the most likely to publish (aOR 1.62, 95% CI 1.24-2.12). The number of reproductive endocrinology and infertility trials increased the most of any subspecialty between 2007 and 2020 (6.4% growth rate). Reproductive endocrinology and infertility and family planning trials were the most likely to be stopped early (reproductive endocrinology and infertility: adjusted hazard ratio [aHR] 2.08, 95% CI 1.59-2.71; family planning: aHR 1.55 95% CI 1.06-2.25). When completed, reproductive endocrinology and infertility trials were the least likely to report results (aOR 0.58, 95% CI 0.38-0.88). No significant differences were seen between subspecialties with respect to publication.Conclusion: Gynecology trials comprise only 3.7% of all clinical trials. The paucity of gynecology clinical trials aligns with decades of female underrepresentation in research. When completed, gynecology trials have poor dissemination. Our findings raise concern about bias in the performance, reporting, and publication of gynecology clinical trials. [ABSTRACT FROM AUTHOR]

Purpose: To assess oncofertility content on fertility clinic websites as indicated by eight relevant keywords. Additionally, we sought to describe the relationship between oncofertility content and five predetermined clinic characteristics. Methods: We examined 381 fertility clinic websites that are members of the Society for Associated Reproductive Technology (SART). Extracted data included clinic location, practice type (private vs academic), size (cycles/year), type of NCI designated center (cancer center vs comprehensive cancer center), and distance from the nearest NCI center. Additionally, we documented whether the clinic was located in a state mandating reproductive and infertility services and/or included fertility preservation for "iatrogenic infertility" as reported by the American Society for Reproductive Medicine (ASRM). Data were summarized using descriptive statistics and compared using chi-squared or t-test as appropriate. Results: Of the 381 fertility clinic websites analyzed, 322 (85%) contained at least one oncofertility-related keyword. Most frequently used terms included cancer (79%) and fertility preservation (78%), while less frequently used terms included suppression (9.4%) and shielding (5.0%). Practices that initiated ≥ 501 cycles per year were more likely to mention one of the oncofertility keywords (OR 1.2; 95% CI 1.1–1.3). The associations of oncofertility website content with practice type, state-mandated fertility insurance coverage, and distance from an NCI-designated cancer center were not statistically significant. Large clinic size was the only predictive factor for inclusion of oncofertility website content. Further studies are required to evaluate whether inclusion of oncofertility content on clinic websites impacts the use of these services by patients with cancer. Conclusion: This is the first study correlating availability of oncofertility content on SART fertility clinic websites with consideration of geographic proximity to NCI designated cancer centers. Large clinic size was the only predictive factor for inclusion of oncofertility website content. [ABSTRACT FROM AUTHOR]

Ethical considerations are central to all medicine though, likely, nowhere more essential than in the practice of reproductive endocrinology and infertility. Through in vitro fertilization (IVF), this is the only field in medicine involved in creating human life. IVF has, indeed, so far led to close to 10 million births worldwide. Yet, relating to substantial changes in clinical practice of IVF, the medical literature has remained surprisingly quiet over the last two decades. Major changes especially since 2010, however, call for an updated commentary. Three key changes deserve special notice: Starting out as a strictly medical service, IVF in recent years, in efforts to expand female reproductive lifespans in a process given the term "planned" oocyte cryopreservation, increasingly became more socially motivated. The IVF field also increasingly underwent industrialization and commoditization by outside financial interests. Finally, at least partially driven by industrialization and commoditization, so-called add-ons, the term describing mostly unvalidated tests and procedures added to IVF since 2010, have been held responsible for worldwide declines in fresh, non-donor live birthrates after IVF, to levels not seen since the mid-1990s. We here, therefore, do not offer a review of bioethical considerations regarding IVF as a fertility treatment, but attempt to point out ethical issues that arose because of major recent changes in clinical IVF practice. [ABSTRACT FROM AUTHOR]

Objective: As the associations of sperm DNA fragmentation with morphology have not been examined in detail, this study aimed to investigate the relationship between abnormalities of morphological details and DNA integrity in human sperm. Methods: In this cross-sectional study, men from infertile couples were enrolled at Hue Center for Reproductive Endocrinology and Infertility, Vietnam. Conventional semen parameters, including morphological details, were analyzed following the World Health Organization 2010 criteria. Sperm DNA fragmentation was evaluated using a sperm chromatin dispersion assay. The relationships and correlations between semen parameters, sperm morphology, and the type of halosperm and the DNA fragmentation index (DFI) were analyzed. Results: Among 130 men in infertile couples, statistically significant differences were not found in the sperm halo type between the normal and abnormal sperm morphology groups. The percentage of round-head spermatozoa was higher in the DFI >15% group (16.98%±12.50%) than in the DFI ≤15% group (13.13% ±8.82%), higher values for amorphous heads were found in the DFI >15% group, and lower values for tapered heads were observed in the DFI ≤15% group; however, these differences were not statistically significant. Small-halo sperm and the DFI were positively correlated with round-head sperm (r=0.243, p=0.005 and r=0.197, p=0.025, respectively). Conclusion: The rate of general sperm morphological abnormalities in semen analysis was not related to sperm DNA integrity. However, round sperm heads were closely associated with sperm DNA fragmentation. [ABSTRACT FROM AUTHOR]

Background: The contribution of Bangladesh to global endocrine research is not quantified. We intend to summarize the progress Bangladesh has made in endocrine research. Methods: Global and country-specific data up to December 2021 from the PubMed database were retrieved using the keywords 'diabetes mellitus', 'obesity', 'thyroid', 'adrenal' and 'pituitary'; the keywords 'gonad' OR 'hypogonadism' OR 'PCOS' OR 'sexual dysfunction' were used for retrieving data of reproductive endocrinology research; and 'bone metabolism' OR 'osteoporosis' OR 'vitamin D' were used for bone metabolism research. Bangladeshi contributions to endocrine research were compared to global and country-specific data during the periods '1972-2021' and '2012-2021'. Results: Bangladesh has 2,467 articles in the PubMed database in different fields of endocrinology during the period 1972-2021, which is 0.132% of the total global endocrine publications published in this timeframe. We observed a gradual increment in the number of Bangladeshi publications over the last five decades in all fields of endocrinology. Over the last 10 years, the contribution has risen to 0.226% with 2003 publications. Conclusions: Currently, Bangladesh contributes very little to global endocrine research. An urgent call to amplify research works by Bangladeshi endocrinologists is of utmost importance to catch up with the global publications in endocrinology. [ABSTRACT FROM AUTHOR]

Brain and muscle aryl-hydrocarbon receptor nuclear translocator like protein1 (BMAL1), a core component of circadian oscillation, is involved in many physiological activities. Increasing evidence has demonstrated the essential role of BMAL1 in reproductive physiology. For instance, BMAL1 -knockout (KO) mice were infertile, with impaired reproductive organs and gametes. Additionally, in BMAL1 -KO mice, hormone secretion and signaling of hypothalamus-pituitary-gonadal (H-P-G) hormones were also disrupted, indicating that H-P-G axis was impaired in BMAL1 -KO mice. Moreover, both BMAL1 -KO mice and BMAL1-knockdown by small interfering RNA (siRNA) in vitro cultured steroidogenic cells showed that BMAL1 was associated with gonadal steroidogenesis and expression of related genes. Importantly, BMAL1 also participates in pathogenesis of human reproductive diseases. In this review, we elaborate on the impaired reproduction of BMAL1-KO mice including the reproductive organs, reproductive endocrine hormones, and reproductive processes, highlighting the vital role of BMAL1 in fertility and reproductive endocrinology. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness of laparoscopic tubal anastomosis for tubal occlusions associated with infertility in patients with previous laparoscopic salpingostomy for ectopic pregnancy. Methods: This study is a retrospective analysis of the pregnancy outcomes of 173 infertile patients who underwent hysteroscopy and laparoscopic tubal anastomosis treatment between January 2013 and August 2018 in the Department of Reproductive Endocrinology in West China Second University Hospital of Sichuan University. All patients had a history of laparoscopic salpingostomy for tubal pregnancy. The primary outcomes were intrauterine pregnancy, ectopic pregnancy, and delivery rates. We further studied the associated factors that could influence the change in pregnancy status. Results: The 24‐month cumulative clinical pregnancy rate of all patients was 107/173 (61.8%). The distribution of outcomes for the entire group of pregnancies was as follows: intrauterine pregnancy rate, 76/173 (43.9%); ectopic pregnancy rate, 31/173 (17.9%); delivery rate, 68/173 (39.3%); and miscarriage rate, 8/173 (4.6%). Age, type of anastomosis, hydrosalpinx, and endometrial polyps were significant prognostic factors in the multivariate model. Conclusion: Laparoscopic tubal anastomosis is an effective treatment for tubal‐associated infertility due to previous laparoscopic salpingostomy for ectopic pregnancy, especially for women under 35 years of age. Laparoscopic tubal anastomosis is an effective treatment for tubal‐associated infertility after laparoscopic salpingostomy for tubal pregnancy. [ABSTRACT FROM AUTHOR]

Objective: To identify changes in current practice patterns, salaries, and satisfaction by gender and by years in practice among board-certified reproductive endocrinology and infertility (REI) subspecialists in the United States.Design: Cross-sectional web-based survey including 37 questions conducted by the Society for Reproductive Endocrinology and Infertility.Setting: Not applicable.Patient(s): None.Intervention(s): None.Main Outcome Measure(s): The primary outcome measures were total compensation and practice patterns compared by gender and the type of practice. The secondary outcomes included demographics, the number of in vitro fertilization cycles, surgeries performed, and the morale of survey respondents.Result(s): There were 370 respondents (48.4% women and 51.4% men). Compared with a similar survey conducted 6 years earlier, a 27% increase in the number of female respondents was observed in this survey. There was a marginally significant trend toward lower compensation for female than male REI subspecialists (17% lower, $472,807 vs. $571,969). The gap was seen for responders with ≥10 years' experience, which is also when there was the largest gap between private and academic practice (mean $820,997 vs, $391,600). Most (77%) felt positively about the current state of the reproductive endocrinology field, and >90% would choose the subspecialty again.Conclusion(s): There has been a substantial increase in the number of recent female REI subspecialists showing less disparity in compensation, and the gap appears to be closing. There is an increasing gap in compensation between private and academic practices with ≥5 years of experience. Reproductive endocrinology and infertility remains a high morale specialty. [ABSTRACT FROM AUTHOR]

Elective single embryo transfer (eSET) was first introduced to IVF in 1999, and its subsequent integration into mainstream reproductive endocrinology and infertility has been hugely consequential. It can be viewed as the first (among many since) 'add-ons' to IVF that has significantly and adversely affected how IVF is practised, resulting in astonishing declines in live birth rates after fresh non-donor IVF cycles worldwide. We propose that, like most 'add-ons' to IVF over recent years, the almost universal use of eSET worldwide lacks proper validation of its underlying hypothesis and is based on statistically incorrect assumptions and incorrect data interpretation. As with most recent 'add-ons' to IVF, eSET lacks evidentiary support, and, therefore, its remarkable success in the marketplace must be based on expert opinions, the lowest level of evidence in medicine and widely recognized as frequently biased. Like other 'add-ons' to IVF, eSET-practice must be reassessed because it does not offer the benefits it has widely claimed to provide, prolongs time to conception and adversely affects live birth chances for many women. Moreover, by ignoring that infertile women value quick conception over most other considerations, provider-insistence on eSET frequently deprives them of the right to self-determination. [ABSTRACT FROM AUTHOR]

Healthcare teams must be deliberately cultivated to reach their full potential. Shifting focus from individual performance to a team's collective competence allows for targeted and evidence-based interventions that support teamwork and improve patient outcomes. We reviewed essential concepts drawn from team science and explored the practical applications of teaming. Reproductive endocrinology and infertility healthcare providers play a pivotal role by teaching, modeling, and fostering teaming attitudes and behaviors. Through teaming, we can maximize our teams' ability to learn, innovate, compete with other teams, and thrive in today's healthcare environment. [ABSTRACT FROM AUTHOR]

Outpatient procedures and flexible staffing models have become prevalent within the ambulatory surgical and procedural spaces of reproductive endocrinology and infertility practice. High volumes of outpatients are treated daily by rotating nurses, surgeons, and anesthesia staff, often with the added layer of trainees present. "Teaming" can allow stable units and ad hoc groups to partner better for enhanced efficiency, effectiveness, and patient experience in routine procedural activities. These skills then can be parlayed into the rare moments of crisis to improve safety outcomes. Teaming concepts, applied in routine and acute scenarios, can optimize clinical operations, patient experience, and outcomes in our reproductive endocrinology and infertility ambulatory procedural and surgical spaces. [ABSTRACT FROM AUTHOR]

Objective: To compare the clinical pregnancy rate (CPR) and live birth rate (LBR) of embryo transfer episodes (ETEs) performed by Reproductive Endocrinology and Infertility fellows vs. those of ETEs performed by faculty physicians.Design: Retrospective cohort analysis.Setting: Academic reproductive endocrinology and infertility practice.Patient(s): In total, 3,073 ETEs for 1,488 unique patients were performed by fellows or faculty physicians between January 2009 and January 2020.Intervention(s): None.Main Outcome Measure(s): Clinical pregnancy rate and LBR.Result(s): Fifteen fellows performed 1,225 (39.9%) of 3,073 ETEs after completing 30 mock transfers. On comparing outcomes among fellowship years (FY1, FY2, and FY3), CPR (44.1% vs. 43.2% vs. 45.7%, respectively, P = .83) and LBR (39.1% vs. 38.1% vs. 38.4%, respectively, P = .97) were not significantly different. Fellowship year 1 fellows' initial 30 ETEs vs. all the remaining FY1 ETEs had a significantly higher CPR (48.1% vs. 40.5%, respectively, P = .030) and LBR (45.4% vs. 34.3%, respectively, P = .001). There were no significant differences between faculty versus fellow ETEs in terms of CPR (43.0% vs. 45.0%, respectively, P = .30) or LBR (37.3% vs. 39.8%, respectively, P = .16), even after adjusting for patient age, body mass index, primary infertility diagnosis, autologous vs. donor oocyte, fresh vs. frozen embryo, number of embryos transferred, type of transfer catheter, and year of transfer (P = .32 for CPR, P = .22 for LBR).Conclusion(s): Appropriately trained FY1 fellows had success rates maintained throughout all FYs. There were no significant differences in clinical outcomes between fellow- and faculty-performed transfers. These data demonstrated that allowing fellows to perform live embryo transfers is not detrimental to clinical outcomes. [ABSTRACT FROM AUTHOR]