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Infertility is a relatively common condition, greatly affecting couples medically and psychologically. Although infertility treatment is safe, it can be time-intensive, expensive, and increase the risk of multiple gestations. Thus, to reduce costs and risks, couples may initially consider lifestyle change to increase their fertility and chances of pregnancy. For many of the diet factors studied (eg, caffeine, soy, protein, iron), there are conflicting data. However, there are some items men and women consume that are detrimental to fertility, such as alcohol and tobacco. The data on exercise are varied but may have an effect on ovulation and fertility—positive or negative. Body mass index appears to affect fertility also, with obesity in both men and women negatively affecting pregnancy rates. In addition, there remains concern and a growing body of research on environmental toxin exposures and reproductive health. Finally, supporting patients through infertility diagnosis and treatment is critical, as psychological stress may affect conception. It is imperative that the relationship between lifestyle factors and fertility continue to be explored so as to lessen the morbidity associated with infertility.

Objective To determine the association between patient characteristics at diagnosis of premenopausal breast cancer, including gravidity, parity, age at menarche, age at first birth, alcohol use, smoking history, weight, height, and body mass index (BMI), with the development of persistent chemotherapy-related amenorrhea (CRA) in follow-up. Design Retrospective cohort study. Setting Dana Farber Cancer Institute and Brigham and Women’s Hospital. Patient(s) Premenopausal women with breast cancer. Intervention(s) We identified all premenopausal women who received standard adjuvant chemotherapy during 1997–2005 for whom menstrual data were available. Multivariable logistic regression models evaluating persistent amenorrhea at ≥6 month after completion of chemotherapy were conducted. Main Outcome Measure(s) Persistent chemotherapy-related amenorrhea (CRA) at ≥6 months from completion of chemotherapy. Result(s) A total of 431 women met eligibility criteria and had ≥6-months’ follow-up. Women with older (>13 years) vs. younger (12–13 years) age at menarche were more than twice as likely to remain amenorrheic. Current smokers had 2.4 greater odds of CRA vs. never smokers, although this association was not statistically significant (95% confidence interval, 0.86–6.75). Conclusion(s) Few identifiable factors contribute to the variability in CRA among premenopausal women after adjuvant chemotherapy for breast cancer. Further research to improve the prediction of CRA, premature menopause, and infertility in young breast cancer survivors is warranted.

Objective To compare markers of ovarian reserve between women exposed to cytotoxic chemotherapy for early stage breast cancer and matched controls. Design Cross-sectional evaluation of markers of ovarian reserve. Setting Dana-Farber/Brigham and Women's Cancer Center, Massachusetts General Hospital, and Faulkner Hospital in Boston, MA. Patient(s) Breast cancer survivors with continued menses after chemotherapy were compared with age-matched, gravidity-matched controls. Main Outcome Measure(s) Antral follicle count (AFC), anti-Mullerian hormone (AMH), FSH, inhibin B (InB), and E 2 on day 2, 3, or 4 of the menstrual cycle. A Bonferroni correction was performed to correct for multiple comparisons. Result(s) Twenty survivors and 20 controls were evaluated; 50% of survivors were currently on tamoxifen. Median AFC was 6 for survivors and 9.5 for controls. There were significant differences between the two groups in AFC, AMH, and nonsignificant differences in FSH and InB, all indicating better ovarian reserve in controls. The AFC and AMH levels were highly correlated ( r = 0.72). Survivors on tamoxifen had lower AFC, AMH, InB, and higher E 2 than nontamoxifen–treated survivors. Conclusion(s) Premenopausal breast cancer survivors have diminished ovarian reserve compared with controls.

BACKGROUND: Little information is available regarding the effects of new adjuvant treatment regimens on menstrual functioning in premenopausal women with early breast cancer. METHODS: The authors conducted a retrospective review of data from premenopausal women who received treatment for early breast cancer to evaluate the rates of amenorrhea in follow-up. The women who were included received treatment with either doxorubicin and cyclophosphamide (AC) or combined AC and paclitaxel (T) (AC-T) given either every 3 weeks, or as a dose-dense (DD) regimen, or as AC followed by weekly T with trastuzumab or followed by trastuzumab (AC-T+trastuzumab). A multivariate logistic regression analysis was conducted to evaluate amenorrhea during follow-up. RESULTS: Of 431 patients who were eligible for analysis, the average age at diagnosis was 13 years (range, 25-55 years), 61% of women received AC only, and 39% received AC-T. Of the 39% who received AC-T, 49% of women received DD therapy, 14% received AC-T+trastuzumab, and 71% of all patients received tamoxifen (TAM). The median follow-up was 33 months (range, 6-114 months). After adjusting for age, weight, gravidity, parity, age at menarche, smoking, alcohol use, TAM use, type and regimen of chemotherapy, and use of trastuzumab, the likelihood of remaining amenorrheic was not statistically different in patients who received AC-T versus AC (odds ratio [OR], 1.59; 95% confidence interval [CI], 0.8-3.2), DD treatment versus treatment every 3 weeks (OR, 0.56; 95% CI, 0.25-1.3), or AC-T + trastuzumab (OR, 0.6; 95% CI, 0.22-1.61). Amenorrhea was associated significantly with TAM use and age at diagnosis. CONCLUSIONS: Recent advances in the adjuvant treatment of early breast cancer do not appear to have increased the risk of amenorrhea in premenopausal women. Cancer 2010. © 2010 American Cancer Society.

Objective To evaluate SART-member fertility clinic websites for their compliance with the 2004 ASRM/SART guidelines for advertising (which is deemed mandatory for clinic membership), to survey the general characteristics of the websites, and to assess differences between academic and private clinic websites. Design Cross-sectional evaluation. Setting The Internet. Patients None. Interventions None. Main Outcome Measures Eleven objective criteria based on 2004 ASRM/SART guidelines for advertising and eight objective criteria for general characteristics of fertility clinic websites. Results All 384 SART-registered clinics were evaluated; 289 (75.3%) had functional websites (211 private, 78 academic). Success rates were published on 51% of websites (117 private, 31 academic), the majority of which were private clinics (p=.025). The percentage of fertility clinic websites adhering to ASRM/SART guidelines was low in all categories (ranging from 2.8%-54.5% in private centers and 1.3%–37.2% in academic centers). No statistically significant difference was found in the services offered at private versus academic clinics. Conclusion A significant proportion of SART-member fertility clinics, both private and academic, that have websites are not following the ASRM/SART guidelines for advertising. Increased dissemination and awareness of the guidelines is warranted.

Objective To determine if an automated time-lapse test (TL-test) combined with traditional morphology for embryo selection and day 3 transfer results in improved clinical outcomes. Design Prospective concurrent-controlled pilot study. Setting IVF clinic and laboratory. Patient(s) A total of 319 female patients Intervention(s) Automated time-lapse embryo assessment combined with morphologic assessment in the study (test) group compared with morphologic assessment only (control group). Main Outcome Measure(s) Embryo implantation, pregnancy, and multiple pregnancy rates. Subanalysis of implantation potential of embryos based on the TL-test (TL-high vs. TL-low) scores. Result(s) Implantation and clinical pregnancy rates were significantly higher in the test group compared with the control group (implantation rates 30.2% vs. 19.0%, clinical pregnancy rates 46.0% vs. 32.1%, respectively). Multiple pregnancy rates were not statistically different (26.7% vs. 18.3%). Test group patients receiving at least one TL-high embryo had significantly higher implantation rates than patients receiving only TL-low embryos (36.8% vs. 20.6%). TL-high compared with TL-low embryos had significantly higher implantation rates (44.7% vs. 20.5%). Among morphologically good embryos, TL-high embryos were more likely to implant than TL-low embryos (44.1% vs. 20.6%). Conclusion(s) This is the first report demonstrating improved implantation rates in patients receiving day 3 embryo transfers based on the combined use of a TL-test along and traditional morphology. Our findings confirm that the noninvasive TL-test adds valuable information to traditional morphologic grading. Clinical Trial Registration Number NCT01671657.

Objective: Many young breast cancer survivors experience menopausal symptoms and feel concerned about infertility due to oncologic treatment. However, there has been little research to date comparing young survivors' concerns and symptoms with those of young women of the same age and gravidity in the general population. Methods: We surveyed breast cancer survivors with regular menses after adjuvant chemotherapy and compared them with age-matched, gravidity-matched controls as part of a study to evaluate the effects of chemotherapy on ovarian reserve. All survivors were 1 year or more from diagnosis of early-stage breast cancer, without evidence of recurrence. The survey assessed menopausal symptoms and infertility concerns. Results: The study was stopped after a planned interim analysis of the first 20 matched pairs revealed significantly diminished measures of ovarian reserve in survivors compared with controls. Mean age was 37 years for both groups (range, 31-43 y). Eighty percent of survivors and 25% of controls expressed some concern regarding fertility at the time of the survey (P = 0.001). Survivors were more likely to report bothersome menopausal symptoms than were controls (P = 0.05). An exploratory analysis revealed that menopausal symptoms were greatest in the survivors taking tamoxifen. Conclusions: Young women who remained premenopausal after breast cancer chemotherapy expressed greater concern about fertility and reported more menopausal symptoms than did age- and gravidity-matched controls. This may have been due to cancer diagnosis or treatment, or it may reflect other differences between the survivors and controls in this study. Additional research is warranted to determine how to most effectively address fertility concerns and reduce symptom burden in this population.

To examine in detail the geographic distribution of reproductive endocrinology and infertility (REI) fellowships in the United States.Ecological.University-based REI fellowship program.None.None.Number and location of REI fellowship positions.A significant association was found between the number of REI fellowship positions and the number of categorical postgraduate year-1 (PGY-1) obstetrics and gynecology (OBGYN) residency positions within states. No association was observed among the land area, population, or population density within states. However, despite the fact that in the East, as in the United States overall, there was no association between population density and number of fellowships, West of the Mississippi River, as the population density increased, the number of REI fellowships increased linearly (test for heterogeneity = 0.007).First-year REI fellowship positions in the United States are correlated with the number of categorical PGY-1 OBGYN residency positions within a state. The geographically uneven distribution of fellowship positions may limit the choices for OBGYN residents wishing to pursue further training in REI.

10506 Background: The effect of the addition of paclitaxel (T) to adriamycin and cyclophosphamide (AC), or dose density (DD, q2wk) on menstrual functioning in women with early breast cancer remains uncertain. Methods: We reviewed data from premenopausal women treated at Dana-Farber Cancer Institute and Brigham and Women’s Hospital who received adjuvant chemotherapy with either AC or AC-T from 1997–2005 for whom pre- and post-treatment menstrual data were available. A multivariable logistic regression model evaluating amenorrhea at 6 months or greater follow-up was conducted. Results: Of the 403 patients eligible for analysis, average age at diagnosis was 41 years (range 25–50); average weight was 67kg; 10% were smokers, 53% had never smoked; 24% were nulliparous. 60% of women received AC, 40% AC-T; 20% of women received DD therapy (either AC or AC-T); 72% received tamoxifen. The multivariable model adjusting for age, weight, gravity, parity, smoking, alcohol use, and tamoxifen use, revealed that risk of amenorrhea was not statistically different in patients receiving AC-T versus AC (OR = 1.45, 95% CI 0.78–2.69) or in patients receiving DD therapy versus standard (OR = 1.61, 95% CI 0.74–3.49). However, a planned future analysis including data from an additional 200+ patients may yield significant differences. Age directly correlated with risk of amenorrhea, OR = 1.40, 95% CI 1.30–1.50) for every year increase in age, and women receiving tamoxifen were more likely to be amenorrheic (OR = 1.99, 95% CI 1.05–3.79). Conclusions: The addition of T to AC or use of DD therapy does not appear to increase the likelihood of amenorrhea in follow-up. These findings may assist premenopausal women with breast cancer when making decisions at diagnosis and in follow-up. No significant financial relationships to disclose.