Research Publications

Mind the Gap – Isthmoceles and Infertility

Morris JM, Romanski PA, Harris BS. Mind the Gap – Isthmoceles and Infertility. Fertil Steril. 2022 Dec 7:S0015-0282(22)02093-3. doi: 10.1016/j.fertnstert.2022.12.006. Epub ahead of print. PMID: 36496081.

Prior studies have determined that a large isthmocele, an indentation of the myometrium at the site of incision from poor healing of the uterine tissue following Cesarean delivery, produces multiple unfavorable outcomes related to embryo implantation and development. This study enrolled women with unexplained infertility and prior Cesarean delivery resulting in a large isthmocele (residual overlying myometrial thickness of < 3 mm or residual myometrial thickness of <50% of adjacent myometrial tissue) and the primary outcome was endometrial thickness in the presence or absence of intrauterine fluid. Results from this study suggest that presence of an intrauterine fibroid had no significant effect on endometrial thickness (p=0.25), and that there exists a relationship between intrauterine fluid and a slightly longer duration of infertility (24 vs. 27 months; p=0.02).

FSH: The Goldilocks Hormone, Too Little, Too Much, Just Right

Santoro N. FSH: The Goldilocks Hormone, Too Little, Too Much, Just Right. Fertil Steril. 2022 Dec 5:S0015-0282(22)02058-1. doi: 10.1016/j.fertnstert.2022.12.003. Epub ahead of print. PMID: 36481419.

In this Views and Reviews, Dr. Nanette Santoro discusses the complexities related to FSH dosing during IVF. Recent research has supported the use of higher dosages of FSH during ovarian stimulation, but these high doses of FSH may affect tissues outside the desired gonadal targets. The current literature surrounding the topic suggests that there is still much to learn regarding FSH and ovarian stimulation.

Is the “E” being removed from Reproductive Endocrinology to be replaced by a “G” for Genetics?

DeCherney AH, Brolinson M, Whiteley G, Legro RS, Santoro N. Is the “E” being removed from Reproductive Endocrinology to be replaced by a “G” for Genetics? Fertil Steril. 2022 Dec;118(6):1036-1043. doi: 10.1016/j.fertnstert.2022.10.011. Epub 2022 Nov 7. PMID: 36357198.

This is a divided discussion from physician researchers either supporting or challenging the mastery of genetics within the Reproductive Endocrinology and Infertility practice. Pro-genetics contributors summarize the historical and recent contributions from genetic screening to the field of reproductive medicine and implicate reproductive medicine’s reliance on genetic screening tools to diagnose and treat many causes of infertility. Those supporting the integration of genetics in the reproductive practice suggest that the reproductive endocrinologist should also exhibit expertise in genetics due to the integration and application of genetic tools within the practice. The opposing side indicates that while genetics are integral to the field, and the contributions from genetic testing have greatly enhanced the knowledge of reproductive endocrinologists, the field of genetics is far too in-depth to be added to the already expansive expertise of endocrinologists, and vice versa, a reproductive geneticist would be too specialized to be detrimental to the development of genetic technologies.

Reproductive endocrinology and infertility: the specialty with an ever changing alphabet soup

Santoro N. Reproductive endocrinology and infertility: the specialty with an ever changing alphabet soup. Fertil Steril. 2022 Dec;118(6):1035. doi: 10.1016/j.fertnstert.2022.10.012. Epub 2022 Nov 6. PMID: 36351855.

Dr. Nanette Santoro introduces Drs. Legro and DeCherney, and their Fertile Battle discussion topic: the application of genetics in the current and future Reproductive Endocrinology and Infertility practice.

Live-Birth Outcomes Among Women With Infertility and Anti-Müllerian Hormone Levels of 0.3 ng/mL or Lower 

Romanski PA, Gelvin B, Bortoletto P, Rosenwaks Z, Kang HJ. Live-Birth Outcomes Among Women With Infertility and Anti-Müllerian Hormone Levels of 0.3 ng/mL or Lower. Obstet Gynecol. 2022 Nov 1;140(5):743-750. doi: 10.1097/AOG.0000000000004895. Epub 2022 Oct 5. PMID: 36201783. 

Menopause hormone therapy and complementary alternative medicine, quality of life, and racial/ethnic differences: the Study of Women’s Health Across the Nation (SWAN)

Christmas M, Janssen I, Joffe H, Upchurch D, Santoro N, Kravitz HM. Menopause hormone therapy and complementary alternative medicine, quality of life, and racial/ethnic differences: the Study of Women’s Health Across the Nation (SWAN). Menopause. 2022 Dec 1;29(12):1357-1364. doi: 10.1097/GME.0000000000002087. Epub 2022 Oct 16. PMID: 36256923.

A SWAN survey was completed by 2,514 midlife women with vasomotor and/or genitourinary symptoms of menopause from seven sites across the United States to investigate a relationship between hormone therapy or complementary alternative medicine and self-reported quality of life, and if race/ethnicity influences hormone therapy and complementary alternative medicine’s relationship with quality of life. The major findings from the study include: across all ethnicities/races, neither contemporary alternative medicine nor hormone therapy were associated with self-reported quality of life; white women using hormone therapy reported higher quality of life; Black and Hispanic women reported the lowest use of hormone therapy but more frequent menopausal symptoms, compared to other ethnicities and races.

Effect of Timing by Endometrial Receptivity Testing vs Standard Timing of Frozen Embryo Transfer on Live Birth in Patients Undergoing In Vitro Fertilization: A Randomized Clinical Trial

Doyle N, Jahandideh S, Hill MJ, Widra EA, Levy M, Devine K. Effect of Timing by Endometrial Receptivity Testing vs Standard Timing of Frozen Embryo Transfer on Live Birth in Patients Undergoing In Vitro Fertilization: A Randomized Clinical Trial. JAMA. 2022 Dec 6;328(21):2117-2125. doi: 10.1001/jama.2022.20438. PMID: 36472596; PMCID: PMC9856480.

Frozen embryo transfers have gained popularity in recent years, and in 2020, 75% of fertility treatment cycles involved embryo cryopreservation. This randomized clinical trial was initiated to determine if the use of endometrial receptivity assay (ERA) to time frozen euploid blastocyst transfer increases the probability of live birth. Study participants were planning to undergo IVF, PGT-A testing, and frozen embryo transfer. Participants were aged 30 to 40 years old at the time of egg retrieval and likely to produce at least 1 euploid blastocyst. 767 patients were randomized to one of two study arms: use of ERA to time frozen embryo transfer, or standard timing for embryo transfer. Results from the study indicate that live birth rate is not improved with the use of ERA testing, compared to standard timing of frozen embryo transfer (58.5% vs. 61.9%, respectively; difference, -3.4% [95% CI, -10.3% to 3.5%]; rate ratio [RR], 0.95 [95% CI, 0.79 to 1.13]; P = 0.38). Similarly, clinical pregnancy rate was not improved with the use of ERA testing, compared to the control group (68.8% vs. 72.8%, respectively; difference, −4.0% [95% CI, −10.4% to 2.4%]; RR, 0.94 [95% CI, 0.80 to 1.12]; P = .25).

Meeting the challenge of unclaimed cryopreserved embryos

Go KJ, Romanski PA, Bortoletto P, Patel JC, Srouji SS, Ginsburg ES. Meeting the challenge of unclaimed cryopreserved embryos. Fertil Steril. 2022 Dec 4:S0015-0282(22)01744-7. doi: 10.1016/j.fertnstert.2022.09.323. Epub ahead of print. PMID: 36476953.

As the number of IVF treatment cycles with supernumerary embryos and freeze-all cycles continues to increase across the United States, many practices are faced with the storage and responsibility of a growing number of unclaimed embryos. Authors examine the importance of thorough and inclusive informed consent for embryo cryopreservation, discuss patients’ attitudes and decisions while they have embryos in storage, practice obligations, and alternative dispositions options for patients rather than embryo discard in the laboratory.

Expression and T cell Regulatory Action of the PD-1 Immune Checkpoint in the Ovary and Fallopian Tube

Johnson J, Kim SY, Sam PK, Asokan R, Cari EL, Bales ES, Luu TH, Perez L, Kallen AN, Nel-Themaat L, Polotsky AJ, Post MD, Orlicky DJ, Jordan KR, Bitler BG. Expression and T cell Regulatory Action of the PD-1 Immune Checkpoint in the Ovary and Fallopian Tube. Am J Reprod Immunol. 2022 Nov 17. doi: 10.1111/aji.13649. Epub ahead of print. PMID: 36394352.

This study was initiated to better understand how native ovary and fallopian tube cells interact with resident immune cells. Ovarian and fallopian tube samples were obtained, and PD-1 and ligan protein expression were assesed. Human follicular fluid was also obtained, of which protein expression was assessed, and treated with human T-cells to measure interferon gamma. Findings from this study suggest that soluble and membrane bound PD-1 pathway proteins are expressed in non-lymphoid/non-myeloid cells of the human ovary and were found in the fluid collected from peri-ovulatory follicles in egg retrieval procedures during IVF. Specifically, PD-1, PD-L2, and PD-L1, were present in the human ovarian cortex pre- and post-menopausally in various amounts. After menopause, PD-L1 was found distributed in the cortex more extensively compared to pre-menopause. Results also suggest that these ligands are present in human follicular fluid at levels capable of activating T-cells. The findings indicate that the PD-1 pathway dually helps to protect the ovary, oocytes, and embryos in the fallopian tubes from autoimmune reactions while also functioning as a protective immune system against infection.

Antioxidant Intervention against Male Infertility: Time to Design Novel Strategies

Ávila C, Vinay JI, Arese M, Saso L, Rodrigo R. “Antioxidant Intervention against Male Infertility: Time to Design Novel Strategies”. Biomedicines. 2022 Nov. doi: 10.3390/biomedicines10123058.

Recent findings in research have indicated that reactive oxygen species pathophysiology influences male infertility, but an antioxidant therapy to treat male infertility has yet to be introduced. This review provides an in-depth analysis of the literature regarding antioxidants and oxidative stress as contributors to male infertility and identifies gaps in the current literature. Authors identify a need for therapeutics and interventions that are based on the time course of spermatogenesis and oxidative stress, as well as provide a summary of sources of reactive oxygen species that may contribute to male infertility. 

Pregnancy outcomes after oral and injectable ovulation induction in women with infertility with a low antimüllerian hormone level compared with those with a normal antimüllerian hormone level

Romanski P, Bortoletto P, Malmsten J, Tan KS, Spandorfer S. Pregnancy outcomes after oral and injectable ovulation induction in infertile women with low anti-müllerian hormone level compared to normal anti-müllerian hormone level. Fert Steril. 2022 Nov 12. doi: 10.1016/j.fertnstert.2022.09.010.

This retrospective cohort study was initiated to determine the ongoing pregnancy rate among women diagnosed with infertility with low level of antimullerian hormone level compared to those with normal antimullerian hormone levels after oral and injectable ovulation induction/intrauterine insemination (OI/IUI). A total of 7,169 OI/IUI cycles were included: 3,122 patients completed 5,539 oral antiestrogen cycles and 1,060 women completed 1,630 injectable gonadotropin cycles at a large academic center between 2015 and 2019. Significant findings from the study include: women over the age of 35 and 35-40 years old with low AMH treated with injectable gonadotropins had a significantly reduced ongoing pregnancy rate compared to women of similar age with normal AMH levels. The difference is likely due to an unexpectedly high ongoing pregnancy rate in the normal AMH group. The decline in ongoing pregnancy rate corresponds with a reduction in AMH from 1.0 ng/mL in this cohort of women.

Patience and persistence: Is duration the missing piece for treating polycystic ovarian syndrome resistance?

Katler Q, Verrilli L. Patience and persistence: Is duration the missing piece for treating polycystic ovarian syndrome resistance? Fertil Steril. 2022 Nov 13:S0015-0282(22)02035-0. doi: 10.1016/j.fertnstert.2022.11.008. Epub ahead of print. PMID: 36379262.

This editorial discusses the strengths and weaknesses of an extended letrozole protocol for ovulation induction for patients with refractory PCOS undergoing IVF. The protocol involves extending the standard 5 mg letrozole protocol from 5 to 7 or 10 days, keeping the same letrozole dose, in women who did not respond after the initial 5 days of treatment. The editorial discusses limitations to the study, such as small sample size and the inability to analyze secondary outcomes, and study strengths, such as the potential to reduce financial barriers with this method by reducing the need for ovarian drilling.

Perception of pain and the oocyte donor experience: a retrospective analysis of commercial US donors

Combs A, Kimes MJ, Jaslow CR, Hayes H, O’Leary LB, Levy MJ, Kutteh WH. Perception of pain and the oocyte donor experience: a retrospective analysis of commercial US donors. Reprod Biomed Online. 2022 Nov;45(5):906-912. doi: 10.1016/j.rbmo.2022.06.013. Epub 2022 Jun 22. PMID: 36058796.

Pain is a commonly reported side effect among oocyte donors, but literature addressing donor pain perception is lacking. To better understand pain perception among donors and bring attention to the short-term effects of donation to donors, authors of the presented study emailed a 40-question quantitative and qualitative survey to a group of Donor Egg Bank USA donors who donated between 2016 and 2019. The survey covered subjects such as demographics, donor’s motivation for donating, reproductive history, and the consent and donor experience. Of the 503 oocyte donors who opened the survey link, 48.9% (246 participants) completed at least 90% of the survey. A large portion of women reported more pain than expected (42.7%). Particularly, the largest pain disparity between expectations and experience occurred in the week after retrieval (25.8%). Donors also reported high levels of satisfaction and felt that the consent process prepared them for retrieval, with 94% recalling being counselled on the potential for pain. This study provides information that may be helpful to women who are considering oocyte donation, but further studies should address the short-term, as well as long-term, effects of pain to oocyte donors.

A SART data cost-effectiveness analysis of planned oocyte cryopreservation versus in vitro fertilization with preimplantation genetic testing for aneuploidy considering ideal family size

Bakkensen JB, Flannagan KSJ, Mumford SL, Hutchinson AP, Cheung EO, Moreno PI, Jordan N, Feinberg EC, Goldman KN. A SART data cost-effectiveness analysis of planned oocyte cryopreservation versus in vitro fertilization with preimplantation genetic testing for aneuploidy considering ideal family size. Fertil Steril. 2022 Nov;118(5):875-884. doi: 10.1016/j.fertnstert.2022.07.022. Epub 2022 Sep 26. PMID: 36175208; PMCID: PMC9613595.

Using the SART-CORS database, this study evaluated the cost-effectiveness of oocyte cryopreservation as a mean of deferred reproductive as opposed to no oocyte cryopreservation with IVF and PGT-A testing at advanced reproductive age in women desiring one or two live births. Notable findings from the study include for women desiring one child, a higher chance of live birth occurs if oocyte cryopreservation occurs before age 39, with the highest chance of live birth occurring when oocyte cryopreservation occurs before age 32. Women desiring two children saw the most success when one cycle of oocyte cryopreservation occurred before age 37 and two cycles before age 39 rather than IVF with PGT-A at an advanced age. In this group, women had highest success of live birth when two cycles of oocyte cryopreservation occurred before age 31. Analysis of the data suggests that oocyte cryopreservation is a cost-effective strategy for delayed childbearing. This study is important as more patients are choosing to delay childbearing and incorporate ART into their family building.

AKAP13 Enhances CREB1 Activation by FSH in Granulosa Cells

Cayton Vaught KC, Hazimeh D, Carter AS, Devine K, Maher JY, Maguire M, McGee EA, Driggers PH, Segars JH. AKAP13 Enhances CREB1 Activation by FSH in Granulosa Cells. Reprod Sci. 2022 Nov 18. doi: 10.1007/s43032-022-01097-5. Epub ahead of print. PMID: 36401072.

Dietary and/or physical activity interventions in women with overweight or obesity prior to fertility treatment: protocol for a systematic review and individual participant data meta-analysis

Evans-Hoeker E, Wang Z, Groen H, Cantineau AEP, Thurin-Kjellberg A, Bergh C, Laven JSE, Dietz de Loos A, Jiskoot G, Baillargeon JP, Palomba S, Sim K, Moran LJ, Espinós JJ, Moholdt T, Rothberg AE, Shoupe D, Hoek A, Legro RS, Mol BW, Wang R; Venus-IPD Collaboration. Dietary and/or physical activity interventions in women with overweight or obesity prior to fertility treatment: protocol for a systematic review and individual participant data meta-analysis. BMJ Open. 2022 Nov 7;12(11):e065206. doi: 10.1136/bmjopen-2022-065206. PMID: 36344004; PMCID: PMC9644352.

The Venus-IPD group presents a protocol to establish a meta-analysis to understand the effectiveness and safety of dietary and/or physical activity interventions in overweight or obese women prior to beginning fertility treatments. Data will be gathered from retrospective cohort studies that involved dietary and/or physical activity interventions and compared outcomes from patients who received standard advice concerning healthy lifestyle to patients without intervention. Quasi-RCTs and women who underwent bariatric surgery are to be excluded. Studies will be identified from the following databases: MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL). Leading authors from the included studies will receive a list of requested data. The main analysis will be based on the intention-to-treat principle. Results from this study have the potential to advise clinicians on the value of postposing fertility treatment for overweight or obese women to receive dietary and/or physical activity interventions to improve reproductive, maternal, and perinatal outcomes.

The impact of the COVID-19 pandemic on gestational carriers

Romanello JP, Sun B, Hill MJ, Singer T, O’Brien JE. The impact of the COVID-19 pandemic on gestational carriers. J Assist Reprod Genet. 2022 Oct;39(10):2365-2372. doi: 10.1007/s10815-022-02622-w. Epub 2022 Sep 24. PMID: 36152113; PMCID: PMC9510232.

The COVID-19 pandemic required ART practice centers to reevaluate and adapt their practice processes, having a particularly negative effect on the gestational carrier process. This article provides a comprehensive review of the changes made at the practice level to accommodate the required precautions during the COVID-19 pandemic for couples utilizing a gestational carrier, and gestational carriers themselves. Topics include the added psychological stress unto gestational carriers from the pandemic, changes to the gestational carrier process, patient safety during pregnancy and the pandemic, vaccination counseling, and the new normal in the REI practice.

Anti-Müllerian Hormone and Follicle-Stimulating Hormone Are Poor Independent Predictors of Live Birth After Assisted Reproductive Technology

Siegel DR, Grau L, Sammel M, Nel-Themaaat L, Santoro N, Polotsky AJ. Anti-Müllerian Hormone and Follicle-Stimulating Hormone Are Poor Independent Predictors of Live Birth After Assisted Reproductive Technology. Reprod Sci. 2022 Oct 4. doi: 10.1007/s43032-022-01099-3. Epub ahead of print. PMID: 36194358.

An overview and video tutorial to the new interactive website for the American Society for Reproductive Medicine Müllerian Anomalies Classification 2021 

Romanski PA, Bortoletto P, Pfeifer SM, Lindheim SR. An overview and video tutorial to the new interactive website for the American Society for Reproductive Medicine Müllerian Anomalies Classification 2021. Am J Obstet Gynecol. 2022 Oct;227(4):644-647. doi: 10.1016/j.ajog.2022.06.049. Epub 2022 Jun 28. PMID: 35777427. 

Advancing paternal age does not negatively impact fresh embryo transfer cycle outcomes 

Punjani N, Bortoletto P, Romanski PA, Kashanian J, Spandorfer S. Advancing paternal age does not negatively impact fresh embryo transfer cycle outcomes. Reprod Biomed Online. 2022 Oct;45(4):737-744. doi: 10.1016/j.rbmo.2022.04.014. Epub 2022 Apr 29. PMID: 35840498. 

Age-specific blastocyst conversion rates in embryo cryopreservation cycles 

Romanski PA, Aluko A, Bortoletto P, Elias R, Rosenwaks Z. Age-specific blastocyst conversion rates in embryo cryopreservation cycles. Reprod Biomed Online. 2022 Sep;45(3):432-439. doi: 10.1016/j.rbmo.2022.04.006. Epub 2022 Apr 21. PMID: 35610153. 

The Estrogen Receptor α Cistrome in Human Endometrium and Epithelial Organoids

Hewitt SC, Wu SP, Wang T, Ray M, Brolinson M, Young SL, Spencer TE, DeCherney A, DeMayo FJ. The Estrogen Receptor α Cistrome in Human Endometrium and Epithelial Organoids. Endocrinology. 2022 Sep 1;163(9):bqac116. doi: 10.1210/endocr/bqac116. PMID: 35895287; PMCID: PMC9368022.

Women aged 19 to 34 years old, with regular intermenstrual interval between 25 and 35 days, and no history of infertility or pelvic disease were included in the study. Endometrial biopsies were collected and processed for ESR1 ChIPseq and isolation of epithelial cells for culture of organoids. Study findings include a preferential enrichment of HOX motifs in the mid-secretory ESR1 peaks, and bHLH motifs are enriched in proliferative and mid-secretory ESR1 peaks. Data presented in this study elucidates details of estrogen-mediated response in uterine tissue.

Probability of Pregnancy With Mono vs Multiple Folliculogenesis in Women With Unexplained Infertility

Plowden TC, Mumford SL, Wild RA, Cedars MI, Steiner AZ, Franasiak JM, Diamond MP, Santoro N. Probability of Pregnancy With Mono vs Multiple Folliculogenesis in Women With Unexplained Infertility. J Endocr Soc. 2022 Sep 15;7(1):bvac142. doi: 10.1210/jendso/bvac142. PMID: 36447958; PMCID: PMC9692188.

This study was conducted as a secondary analysis of a randomized controlled trial that included 12 clinical sites across the US. The trial ‘Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation with 3 treatment arms: gonadotropins, clomiphene, or letrozole, combine with intrauterine insemination (AMIGOS trial)’ included women aged 18 to 40 years old with a normal uterine cavity, at least 1 patent fallopian tube, and male partners with ≥5 million total motile sperm. A total of 900 couples were enrolled. In the overall cohort, women with one mature follicle ≥16 mm at the time of hCG trigger were less likely to have a clinical pregnancy (RR, 0.70; 95% CI, 0.54-0.89) and live birth (RR, 0.67; 95% CI, 0.54-0.89) compared to women with ≥2 follicles larger than 16 mm. Comparable outcomes were observed when follicle size cutoff was ≥18 mm; women with one follicle were less likely to have a clinical pregnancy (RR, 0.77; 95% CI, 0.60-0.98) and live birth (RR, 0.75; 95% CI 0.58-0.97). When stratified by treatment modality, women using letrozole saw no difference in chance of live birth and follicle number, while women using clomiphene or gonadotropins were more likely to have a clinical pregnancy and live birth when having ≥2 follicles as opposed to one follicle.

Cervical agenesis: surgical preservation of reproductive potential in spite of anatomic variation

Romanski PA, Bortoletto P, Pfeifer SM. Cervical agenesis: surgical preservation of reproductive potential in spite of anatomic variation. Fertil Steril. 2022 Sep;118(3):596-597. doi: 10.1016/j.fertnstert.2022.07.004. PMID: 36116805.

Cervical agenesis is a rare anomaly that occurs in 0.001% of the general population, granting even experienced reproductive physicians limited exposure to this congenital disorder. This editorial touches on the historical management, and poor associated outcomes, of the condition. Recent developments have determined that uterovaginal/vestibular anastomosis are the recommended treatment for this condition, but each case should be treated on a case-by-case basis, leading to variable surgical techniques per surgeon. The editorial continues a discussion of a recently developed surgical technique by Fedele et al. (Fertil Steril 2021) utilizing laparoscopically assisted uterovaginal/vestibular anastomosis for patients with cervical agenesis with complete or partial vaginal agenesis.

Fibroids and Fertility: A Comparison of Myomectomy and Uterine Artery Embolization on Fertility and Reproductive Outcomes 

Zanolli NC, Bishop KC, Kuller JA, Price TM, Harris BS. Fibroids and Fertility: A Comparison of Myomectomy and Uterine Artery Embolization on Fertility and Reproductive Outcomes. Obstet Gynecol Surv. 2022 Aug;77(8):485-494. doi: 10.1097/OGX.0000000000001052. PMID: 35932289. 

Anti-Müllerian hormone levels and breast cancer risk in the study of women’s health across the nation

Grimes NP, Bertone-Johnson ER, Whitcomb BW, Sievert LL, Crawford SL, Gold EB, Avis NE, Greendale GA, Santoro N, Habel LA, Reeves KW. Anti-Müllerian hormone levels and breast cancer risk in the study of women’s health across the nation. Cancer Causes Control. 2022 Aug;33(8):1039-1046. doi: 10.1007/s10552-022-01596-5. Epub 2022 Jun 29. PMID: 35768642.

The presented study addresses the current lack of literature addressing the relationship between AMH levels with breast cancer in women who do not identify as non-Hispanic and white, and gathered information from Chinese, Japanese, Black, Hispanic, and white women. This SWAN study measured AMH level by ELISA, and breast cancer history was assessed during a series of interviews. AMH measurements were available for 1,529 SWAN participants, 84 of which reported an incident of a breast cancer diagnosis. Subgroup analysis revealed the hazard ratio for continuous AMH was 1.11 (95% CI 0.92–1.34) for White women, 1.04 (95% CI 0.86–1.27) for Black women and 1.07 (95% CI 0.85–1.33) for Asian women. This study was not able to accurately assess the hazard ratio for Hispanic women due to low incidence of breast cancer in this subgroup. A non-significant, positive association was observed between AMH level and risk of breast cancer in pre- and perimenopausal women.

Live birth outcomes are not associated with household income and insurance disparities following ART treatment 

Chung A, Romanski PA, Bortoletto P, Spandorfer SD. Live birth outcomes are not associated with household income and insurance disparities following ART treatment. Reprod Biomed Online. 2022 Aug;45(2):410-416. doi: 10.1016/j.rbmo.2022.04.004. Epub 2022 Apr 20. PMID: 35610155. 

Spotlight on the Gut Microbiome in Menopause: Current Insights

Peters BA, Santoro N, Kaplan RC, Qi Q. Spotlight on the Gut Microbiome in Menopause: Current Insights. Int J Womens Health. 2022 Aug 10;14:1059-1072. doi: 10.2147/IJWH.S340491. PMID: 35983178; PMCID: PMC9379122.

This review emphasizes the need to further study the gut microbiome, a key contributor to women’s health, in relation to a woman’s shift into a menopause. Authors include a discussion on the gut microbiome and hormonal transition through pregnancy, pre-menopause, and post-menopause. Particular attention is drawn to the influence of hormones on microbial translocation in the gut barrier, and the role of hormones, specifically estrogens and progesterone, as regulators of the immune system. Additionally, current studies of menopause and the gut microbiome are summarized, as well as the findings. This discussion prompts the need for further research on the influence of the gut microbiome’s ability to recycle sex hormones post-menopause.

Fertility knowledge and views on egg freezing and family planning among surgical specialty trainees 

Matevossian K, Rivelli A, Uhler ML. Fertility knowledge and views on egg freezing and family planning among surgical specialty trainees. AJOG Glob Rep. 2022 Sep 7;2(4):100096. doi: 10.1016/j.xagr.2022.100096. PMID: 36536848; PMCID: PMC9758326.

A survey was emailed to medical trainees across a broad range of medical specialties to gather information about US residents’ and fellows’ fertility knowledge and their views on family planning. The responses from those who completed the survey suggest that women physicians and Ob/Gyn trainees do not have greater knowledge of basic female fertility than males or those in other specialties. Female trainees were less likely to be married or have children and more likely to report postponing childbearing.  

Oocyte Retrieval in Asymptomatic Patients Positive for SARS-CoV-2. 

Akers A, New EP, Plosker S, Silva CP, Sprague R, Imudia AN. Oocyte Retrieval in Asymptomatic Patients Positive for SARS-CoV-2. Case Rep Obstet Gynecol. 2022 Aug 12;2022:3107747. doi: 10.1155/2022/3107747. PMID: 35990707; PMCID: PMC9391171. 

COVID-19 has created an additional barrier for women who wish to or are currently undergoing fertility treatment. Fertility centers should address asymptomatic, COVID-19 positive patients on a case-by-case basis in order to ensure safety to center staff and the patient, while also mitigating the dangers associated with cycle cancellation. This study is a discussion of two case studies where women underwent oocyte retrievals and were asymptomatic but tested positive for COVID-19. In both special cases, the risks of canceling the cycles were heavily considered by practice physicians and risk management, and extra precautions were taken to ensure no medical staff were also infected.  

Are donor-conceived people willing to use donors themselves? Insights from individuals conceived via donor-assisted reproduction. 

Siegel DR, Sheeder J, Kramer W, Roeca C. Are donor-conceived people willing to use donors themselves? Insights from individuals conceived via donor-assisted reproduction. Hum Reprod. 2022 Aug 25;37(9):2087-2094. doi: 10.1093/humrep/deac169. PMID: 35906918. 

Utilizing a web-based survey that was distributed to users of the Sibling Donor Registry, this study found that 40.2% of people who were conceived using donor gametes would consider using donor gametes themselves and 24.6% were undecided. Those who were undecided or had already used donor gametes tended to be younger, and less likely to be married or identify as female than those who would not consider donor gametes. 

Impact of comprehensive state insurance mandates on in vitro fertilization utilization, embryo transfer practices, and outcomes in the United States 

Peipert BJ, Chung EH, Harris BS, Jain T. Impact of comprehensive state insurance mandates on in vitro fertilization utilization, embryo transfer practices, and outcomes in the United States. Am J Obstet Gynecol. 2022 Jul;227(1):64.e1-64.e8. doi: 10.1016/j.ajog.2022.03.003. Epub 2022 Mar 11. Erratum in: Am J Obstet Gynecol. 2023 Jun 5;: PMID: 35283088. 

Modern assessment of the uterine cavity and fallopian tubes in the era of high-efficacy assisted reproductive technology.  

Devine K, Dolitsky S, Ludwin I, Ludwin A. Modern assessment of the uterine cavity and fallopian tubes in the era of high-efficacy assisted reproductive technology. Fertil Steril. 2022 Jul;118(1):19-28. doi: 10.1016/j.fertnstert.2022.05.020. PMID: 35725118; PMCID: PMC9348809. 

Prior to embryo transfer, assessment of the fallopian tubes and uterine cavity is vital to determining if a woman’s anatomy is compliant with pregnancy. This article discusses more patient-friendly alternatives to diagnostic imaging, in particular, various modalities of ultrasound, for women who are noninfertile and undergoing embryo transfer. 

Pre-IVF treatment with a GnRH antagonist in women with endometriosis (PREGNANT): study protocol for a prospective, double-blind, placebo-controlled trial. 

Taylor H, Li HJ, Carson S, Flores V, Pal L, Robbins J, Santoro NF, Segars JH, Seifer D, Huang H, Young S, Zhang H. Pre-IVF treatment with a GnRH antagonist in women with endometriosis (PREGNANT): study protocol for a prospective, double-blind, placebo-controlled trial. BMJ Open. 2022 Jun 17;12(6):e052043. doi: 10.1136/bmjopen-2021-052043. PMID: 35715184; PMCID: PMC9207753. 

Women diagnosed with endometriosis-associated infertility are often successfully treated with IVF. The PREGnant study utilizes an oral GnRH antagonist to treat endometriosis prior to IVF start; the efficacy of the treatment will be assessed using live birth rates. This publication further explains the study protocol. 

Técnicas de reproducción asistida en personas del mismo sexo y solas por opción: realidad en Chile 2021 (Assisted reproduction techniques in people of the same sex and alone by option: Reality in Chile 2021) 

Jesam J, Jeria F, Nunez D, Pardo L, Varela S, Mondion M, Pi JE. Técnicas de reproducción asistida en personas del mismo sexo y solas por opción: realidad en Chile 2021; Assisted reproduction techniques in people of the same sex and alone by option: Reality in Chile 2021. Rev Chil Obstet Ginecol. 2022 Jun 04; 87(1):62-67. doi: 10.24875/RECHOG.21000028. 

This manuscript discusses the changing makeup of households and families in Chile as sexual and gender diversity continue to grow and their access to assisted reproduction techniques. Legislation and policies have continued to evolve to allow this diversification, but further policies and legislation are still needed to ensure all people have access to assisted reproduction technologies.  

Normalising menopause. 

Hickey M, Hunter MS, Santoro N, Ussher J. Normalising menopause. BMJ. 2022 Jun 15;377:e069369. doi: 10.1136/bmj-2021-069369. PMID: 35705221. 

Topics included in this review include: lack of a universal menopause experience, poor support during menopauses exacerbates the negativity that surrounds menopause, the current medical field fuels negative expectations regarding menopause, and how to create a positive menopause experience. 

Impact of increasing antimüllerian hormone level on in vitro fertilization fresh transfer and live birth rate 

Acharya KS, Harris BS, Weber JM, Truong T, Pieper C, Eaton JL. Impact of increasing antimüllerian hormone level on in vitro fertilization fresh transfer and live birth rate. F S Rep. 2022 Jun 30;3(3):223-230. doi: 10.1016/j.xfre.2022.06.005. PMID: 36212572; PMCID: PMC9532892. 

Perception of pain and the oocyte donor experience: a retrospective analysis of commercial US donors. 

Combs A, Kimes MJ, Jaslow CR, Hayes H, O’Leary LB, Levy MJ, Kutteh WH. Perception of pain and the oocyte donor experience: a retrospective analysis of commercial US donors. Reprod Biomed Online. 2022 Jun 22:S1472-6483(22)00421-7. doi: 10.1016/j.rbmo.2022.06.013. Epub ahead of print. PMID: 36058796. 

A survey that queried pain during egg donation was emailed to women who had undergone egg donation. Results from the survey allowed the study team to conclude that this group of women had been made aware of the risk of pain they would experience beforehand, and that those who had reported being informed of the risk of pain were less likely to report higher levels of pain. They also found that unexpected levels of pain were related to low donor satisfaction.  

Knowledge of Fertility and Perspectives About Family Planning Among Female Physicians. 

Smith KS, Bakkensen JB, Hutchinson AP, Cheung EO, Thomas J, Grote V, Moreno PI, Goldman KN, Jordan N, Feinberg EC. Knowledge of Fertility and Perspectives About Family Planning Among Female Physicians. JAMA Netw Open. 2022 May 2;5(5):e2213337. doi: 10.1001/jamanetworkopen.2022.13337. PMID: 35583866; PMCID: PMC9118076 

A group of female physicians were interviewed to develop a survey to characterize the fertility needs and family planning concerns of women in medicine. The interviews revealed that this group of women felt generally that they had inadequate formal training in fertility, that their knowledge of fertility was based on informal education, and that they desired a more formal medical education in fertility. Of the female physicians who completed the pilot survey: a notable percentage of respondents reported declining opportunities for career advancement (29%), choosing a different specialty (21%), or changing their work setting from academic to private practice (17%), to accommodate having children.  

Genome-wide association study meta-analysis identifies three novel loci for circulating anti-Müllerian hormone levels in women. 

Verdiesen RMG, van der Schouw YT, van Gils CH, Verschuren WMM, Broekmans FJM, Borges MC, Gonçalves Soares AL, Lawlor DA, Eliassen AH, Kraft P, Sandler DP, Harlow SD, Smith JA, Santoro N, Schoemaker MJ, Swerdlow AJ, Murray A, Ruth KS, Onland-Moret NC. Genome-wide association study meta-analysis identifies three novel loci for circulating anti-Müllerian hormone levels in women. Hum Reprod. 2022 May 3;37(5):1069-1082. doi: 10.1093/humrep/deac028. PMID: 35274129; PMCID: PMC9071229. 

Results from a genome-wide association study suggest three new loci associated with circulating anti-Mullerian hormone levels in pre-menopausal women, as well as confirmed one previously reported loci. This information provides more detail about the genetic variation and mechanisms of AMH expression and may be used to further study diseases associated with AMH levels.  

NAMS 2021 Utian Translational Science Symposium September 2021, Washington, DC Charting the path to health in midlife and beyond: the biology and practice of wellness. 

Santoro NF, Coons HL, El Khoudary SR, Epperson CN, Holt-Lunstad J, Joffe H, Lindsey SH, Marlatt KL, Montella P, Richard-Davis G, Rockette-Wagner B, Salive ME, Stuenkel C, Thurston RC, Woods N, Wyatt H. NAMS 2021 Utian Translational Science SymposiumSeptember 2021, Washington, DCCharting the path to health in midlife and beyond: the biology and practice of wellness. Menopause. 2022 May 1;29(5):504-513. doi: 10.1097/GME.0000000000001995. PMID: 35486944; PMCID: PMC9248978. 

This symposium synopsis discusses maintaining health and wellness throughout a lifetime, particularly for women in midlife. The synopsis touches on topics such as understanding age, the mind-body connection and the impact of mental health, using food as medicine, the accessibility of wellness to all people, and implementing science during the midlife to address menopause.  

A randomized clinical trial demonstrating cell type specific effects of hyperlipidemia and hyperinsulinemia on pituitary function. 

McDonald R, Kuhn K, Nguyen TB, Tannous A, Schauer I, Santoro N, Bradford AP. A randomized clinical trial demonstrating cell type specific effects of hyperlipidemia and hyperinsulinemia on pituitary function. PLoS One. 2022 May 11;17(5):e0268323. doi: 10.1371/journal.pone.0268323. PMID: 35544473; PMCID: PMC9094557. 

This study was performed as a secondary analysis of samples and gathered data on the effect of lipid and insulin infusions on reproductive hormonal output. These data suggest that diet and metabolism play a role in modulation of pituitary trophic hormones, and these pathways may be a target for future therapeutics.  

A call to action to reproductive endocrinologists: we cannot avoid the culture wars. 

Santoro N. A call to action to reproductive endocrinologists: we cannot avoid the culture wars. Fertil Steril. 2022 Jul;118(1):54-55. doi: 10.1016/j.fertnstert.2022.04.021. Epub 2022 May 21. PMID: 35610092. 

Dr. Nanette Santoro shares her story of being raised in a religious household and discusses the damage brought unto women from the culture wars of abortion and the pro-life movement. Dr. Santoro goes on to discuss the need to disassociate a woman’s reproductive potential to her worth and remove religious ties from public policy.  

Cryopreservation Does Not Affect the Clinical Pregnancy Rate of Blastocysts Derived from Vitrified Oocytes.  

Ramadan H, Pakrashi T, Thurman AR, Pomeroy KO, Celia G Jr. Cryopreservation Does Not Affect the Clinical Pregnancy Rate of Blastocysts Derived from Vitrified Oocytes. Sci Rep. 2022 May 27;12(1):8970. doi: 10.1038/s41598-022-12992-x. PMID: 35624188; PMCID: PMC9142575. 

In recent years, multiple studies have assessed the effect of freezing and thawing of embryos on pregnancy and birth rates, but have reached mixed conclusions. This study compared pregnancy rates in freshly transferred embryos to embryos that were vitrified (frozen) twice, once as an egg and once as an embryo. There was no significant difference in clinical pregnancy rate between the fresh and twice vitrified embryos, however, there was a downward trend (38.63% to 32.46%) of clinical pregnancy rate in the twice vitrified group compared to freshly transferred embryos.  

Do not increase the burden for poor responders 

Harris BS, Muasher SJ. Do not increase the burden for poor responders. Fertil Steril. 2022 Apr;117(4):756-757. doi: 10.1016/j.fertnstert.2022.01.022. Epub 2022 Mar 4. PMID: 35256188. 

Cardiometabolic measures and cognition in early menopause – Analysis of baseline data from a randomized controlled trial. 

Pal L, Morgan K, Santoro NF, Manson JE, Taylor HS, Miller VM, Brinton EA, Lobo R, Neal-Perry G, Cedars MI, Harman SM, James TT, Gleason CE. Cardiometabolic measures and cognition in early menopause – Analysis of baseline data from a randomized controlled trial. Maturitas. 2022 Aug;162:58-65. doi: 10.1016/j.maturitas.2022.04.004. Epub 2022 Apr 29. PMID: 35617770. 

Data from the KEEPS (Kronos Early Estrogen Prevention Study) clinical trial suggests that recently menopausal women with higher waist circumferences (over 88 cm) and waist-to-hip ratios (over 0.8) were associated with lower cognitive function, assessed by lower Modified Mini Mental Status scores.  

Menopause Is Associated with an Altered Gut Microbiome and Estrobolome, with Implications for Adverse Cardiometabolic Risk in the Hispanic Community Health Study/Study of Latinos. 

Peters BA, Lin J, Qi Q, Usyk M, Isasi CR, Mossavar-Rahmani Y, Derby CA, Santoro N, Perreira KM, Daviglus ML, Kominiarek MA, Cai J, Knight R, Burk RD, Kaplan RC. Menopause Is Associated with an Altered Gut Microbiome and Estrobolome, with Implications for Adverse Cardiometabolic Risk in the Hispanic Community Health Study/Study of Latinos. mSystems. 2022 Jun 28;7(3):e0027322. doi: 10.1128/msystems.00273-22. Epub 2022 Apr 13. PMID: 35675542; PMCID: PMC9239235. 

Analysis of the gut microbiome of a large set of Hispanic/Latinos in the United States revealed that post-menopausal Hispanic/Latino women had a gut microbiome more similar to that of men, and changes in gut microbiome due to menopause were associated with adverse cardiometabolic risks. These data suggest that the gut microbiome contributes to cardiometabolic health during menopause.  

FKBP51 Contributes to Uterine Leiomyoma Pathogenesis by Inducing Cell Proliferation and Extracellular Matrix Deposition.  

New EP, Semerci N, Ozmen A, Guo X, Jonnalagadda VA, Kim JW, Anderson ML, Guzeloglu-Kayisli O, Imudia AN, Lockwood CJ, Kayisli UA. FKBP51 Contributes to Uterine Leiomyoma Pathogenesis by Inducing Cell Proliferation and Extracellular Matrix Deposition. Reprod Sci. 2022 Jun;29(6):1939-1949. doi: 10.1007/s43032-022-00921-2. Epub 2022 Apr 14. PMID: 35426036; PMCID: PMC9009985. 

This study was able to determine that uterine leiomyoma (fibroid) cells have increased expression of FKBP51 compared to normal myometrial cells. This binding protein may be used to further study fibroid pathogenesis.  

Early pregnancy anxiety during the COVID-19 pandemic: preliminary findings from the UCSF ASPIRE study 

Morris JR, Jaswa E, Kaing A, Hariton E, Andrusier M, Aliaga K, Davis M, Cedars MI, Huddleston HG. Early pregnancy anxiety during the COVID-19 pandemic: preliminary findings from the UCSF ASPIRE study. BMC Pregnancy Childbirth. 2022 Mar 31;22(1):272. doi: 10.1186/s12884-022-04595-1. PMID: 35361137; PMCID: PMC8969813. 

“It just seems like people are talking about menopause, but nobody has a solution”: A qualitative exploration of menopause experiences and preferences for weight management among Black women 

Kracht CL, Romain JS, Hardee JC, Santoro N, Redman LM, Marlatt KL. “It just seems like people are talking about menopause, but nobody has a solution”: A qualitative exploration of menopause experiences and preferences for weight management among Black women. Maturitas. 2022 Mar;157:16-26. doi: 10.1016/j.maturitas.2021.11.005. Epub 2021 Nov 7. PMID: 35120668; PMCID: PMC8969889. 

Results of this study, conducted to characterize the experiences of Black women going through menopause and identify barriers for participating in a lifestyle program, suggested that women were interested to learn more about improving their overall health during menopause and were willing to participate in a lifestyle program. The study team also found that a program that allows other women to associate with other women creates a more sustainable lifestyle program.  

Whither cryopreservation? The landscape gets colder. 

Santoro N. Whither cryopreservation? The landscape gets colder. Fertil Steril. 2022 Mar;117(3):467-468. doi: 10.1016/j.fertnstert.2022.01.017. PMID: 35219470. 

In this review, Dr. Nanette Santoro discusses the contrasting viewpoints of medical providers and patients in how they view their storaged embryos. Dr. Santoro goes on to outline the heightened responsibility that medical staff face with advancing frozen embryo storage technology and longer storage times.  

Triggered with COVID: What are my chances, Doc? 

Clain E, Johnson J, Roeca C.Fertil Steril. 2022 Apr;117(4):781-782. doi: 10.1016/j.fertnstert.2022.01.039. Epub 2022 Mar 8.PMID: 35277260 Free PMC article. No abstract available. 

This article discusses recent studies that were unable to detect SARS-CoV-2 in the reproductive tracts of women who were newly diagnosed with COVID-19 and had mild symptoms or were asymptomatic. This editorial concludes that it may be feasible for patients who have been newly diagnosed with COVID-19 with mild symptoms or are asymptomatic to proceed with egg retrievals. One study reports that acute COVID-19 infection did not influence fertilization or embryo development, and other studies suggest that COVID-19 may influence embryo generation or embryo quality.  

Psychobiological, clinical, and sociocultural factors that influence Black women seeking treatment for infertility: a mixed-methods study. 

Cebert-Gaitors M, Shannon-Baker PA, Silva SG, Hart RE, Jahandideh S, Gonzalez-Guarda R, Stevenson EL. Psychobiological, clinical, and sociocultural factors that influence Black women seeking treatment for infertility: a mixed-methods study. F S Rep. 2022 Feb 22;3(2 Suppl):29-39. doi: 10.1016/j.xfre.2022.02.004. PMID: 35937441; PMCID: PMC9349229. 

To address the largely undocumented experiences of Black women seeking fertility treatment, this study gathered data on the sociocultural, clinical, and psychobiological barriers and facilitators Black women faced when seeking fertility treatment. These women saw barriers to treatment such as inadequate knowledge of resources, poor clinical management at the primary care level, and limited social support. The study identified psychological distress, complex gynecological medical history, and culturally competent providers as facilitators to care.  

A personalized medicine approach to ovulation induction/ovarian stimulation: development of a predictive model and online calculator from level-I evidence. 

Souter I, Sun F, Zhang H, Diamond MP, Legro RS, Wild RA, Hansen KR, Santoro N; Eunice Kennedy Schriver National Institute of Child Health and Human Development Reproductive Medicine Network. A personalized medicine approach to ovulation induction/ovarian stimulation: development of a predictive model and online calculator from level-I evidence. Fertil Steril. 2022 Feb;117(2):408-418. doi: 10.1016/j.fertnstert.2021.10.024. PMID: 35125179; PMCID: PMC8985501. 

The probability of pregnancy and the risk of a multiple pregnancy was able to be predicted in this predictive model of retrospective data of patients undergoing treatment with gonadotropins, letrozole, and clomiphene citrate for ovarian induction/ovarian stimulation with intrauterine insemination. This study was able to successfully create an easy-to-use formula to predict chances of pregnancy and a multiple pregnancy based on the characteristics of the patient for commonly used fertility treatments.  

Willingness of Women with Endometriosis Planning to Undergo IVF to Participate in a Randomized Clinical Trial and the Effects of the COVID-19 Pandemic on Potential Participation. 

Pretzel S, Kuhn K, Pal L, Polotsky A, Taylor HS, Zhang H, Robins J, Young SL, Santoro N. Willingness of Women with Endometriosis Planning to Undergo IVF to Participate in a Randomized Clinical Trial and the Effects of the COVID-19 Pandemic on Potential Participation. Reprod Sci. 2022 Feb;29(2):620-626. doi: 10.1007/s43032-021-00705-0. Epub 2021 Aug 6. PMID: 34363198; PMCID: PMC8345905. 

A brief survey was sent to women who were diagnosed with endometriosis, undergoing fertility treatment, and were within the University of Colorado healthcare system: the survey gathered information on whether these women would consider being apart of a clinical trial and whether their experiences with delays in IVF treatments due to COVID-19 would influence their consideration of a 8-week treatment prior to their IVF cycle. This survey was distributed to gather information about women who may quality for the PREGnant study for women diagnosed with endometriosis who may be randomized to an experimental group that undergoes a 60-day treatment with an GnRH antagonist prior to IVF start. Results from the survey suggest that the COVID-19 pandemic would influence the decisions of some women to delay IVF treatment to participate in a trial.  

In vitro treatment of human granulosa cells with irisin and leptin: Quantitative RT-PCR array data (female infertility panel). 

Stojchevski R, Singer T, Ziskovich K, Poretsky L, Avtanski D. In vitro treatment of human granulosa cells with irisin and leptin: Quantitative RT-PCR array data (female infertility panel). Data Brief. 2022 Jan 1;40:107781. doi: 10.1016/j.dib.2021.107781. PMID: 35028351; PMCID: PMC8741429. 

To better understand the relationship between genes involved in fertility and metabolism, 84 genes related to fertility were extracted from human ovarian granulosa cells and treated with irisin or leptin, hormones related to metabolism. The study presents the changes in gene expression after treatment.  

Characterization of an artificial intelligence model for ranking static images of blastocyst stage embryos. 

Loewke K, Cho JH, Brumar CD, Maeder-York P, Barash O, Malmsten JE, Zaninovic N, Sakkas D, Miller KA, Levy M, VerMilyea MD.Fertil Steril. 2022 Mar;117(3):528-535. doi: 10.1016/j.fertnstert.2021.11.022. Epub 2022 Jan 5.PMID: 34998577 Free article. 

A retrospective study was conducted to evaluate the benefit of characterizing an artificial intelligence model to rank blastocyst-stage embryos and identify limitations that may affect the methods clinical usage. This artificial intelligence model was able to successfully categorize embryos according to the development of the trophectoderm and inner cell mass and showed improved predictions of clinical pregnancy.  

Effects of preconception lifestyle intervention in infertile women with obesity: The FIT-PLESE randomized controlled trial. 

Legro RS, Hansen KR, Diamond MP, Steiner AZ, Coutifaris C, Cedars MI, Hoeger KM, Usadi R, Johnstone EB, Haisenleder DJ, Wild RA, Barnhart KT, Mersereau J, Trussell JC, Krawetz SA, Kris-Etherton PM, Sarwer DB, Santoro N, Eisenberg E, Huang H, Zhang H; Reproductive Medicine Network. Effects of preconception lifestyle intervention in infertile women with obesity: The FIT-PLESE randomized controlled trial. PLoS Med. 2022 Jan 18;19(1):e1003883. doi: 10.1371/journal.pmed.1003883. PMID: 35041662; PMCID: PMC8765626. 

Presented here are the outcomes and discussion of the FIT-PLESE clinical trial for women with infertility and obesity. Protocol involved all participants to increase their physical activity, and half were randomized to an intensive group treated with open-label anti-obesity medication (Orlistat), nutritional counseling, and meal replacement products for 16 weeks. This study showed that an average of 7% weight loss did not improve the rate of having any live birth or a healthy live birth but did improve participants’ cardiometabolic health. 

Menopause Is Associated With Immune Activation in Women With HIV. 

Peters BA, Xue X, Sheira LA, Qi Q, Sharma A, Santoro N, Alcaide ML, Ofotokun I, Adimora AA, McKay HS, Tien PC, Michel KG, Gustafson D, Turan B, Landay AL, Kaplan RC, Weiser SD. Menopause Is Associated With Immune Activation in Women With HIV. J Infect Dis. 2022 Jan 18;225(2):295-305. doi: 10.1093/infdis/jiab341. PMID: 34174074; PMCID: PMC8763955. 

This study found that postmenopausal women had higher innate immune activation, measured using plasma sCD14 and sCD163, compared to premenopausal women, and the elevation in the immune response occurs during the transition into menopause. Interestingly, a relationship could not be made with menopause and biomarkers of systemic inflammation, even though inflammation is normally a consequence of immune activation. 

Body composition and cardiometabolic health across the menopause transition. 

Marlatt KL, Pitynski-Miller DR, Gavin KM, Moreau KL, Melanson EL, Santoro N, Kohrt WM. Body composition and cardiometabolic health across the menopause transition. Obesity (Silver Spring). 2022 Jan;30(1):14-27. doi: 10.1002/oby.23289. PMID: 34932890; PMCID: PMC8972960. 

Women in stages of menopause are at increased cardiometabolic risk due to fluctuations in circulating estrogens and increased fat mass, and thus, a woman’s transition into menopause imposes a significant health burden. This review discusses menopause’s stages, the changes in a women’s body and cardiometabolic health throughout menopause, and lifestyle interventions women may use to improve their health during menopause. 

COVID-19 vaccination patterns and attitudes among American pregnant individuals 

Huddleston HG, Jaswa EG, Lindquist KJ, Kaing A, Morris JR, Hariton E, Corley J, Hoskin E, Gaw SL, Cedars MI. COVID-19 vaccination patterns and attitudes among American pregnant individuals. Am J Obstet Gynecol MFM. 2022 Jan;4(1):100507. doi: 10.1016/j.ajogmf.2021.100507. Epub 2021 Oct 11. PMID: 34649015; PMCID: PMC8502724. 

How far should we go to avoid PIO? 

Harris BS, Jahandideh S, Devine K.Fertil Steril. 2022 Jan;117(1):104-105. doi: 10.1016/j.fertnstert.2021.11.023. Epub 2021 Dec 3.PMID: 34865849 No abstract available. 

The rationale and data surrounding differing routes of administration for progesterone supplementation, progesterone in oil (PIO) vs. vaginal, as luteal phase support during FET cycles is discussed in this editorial. Data suggests that when using vaginal progesterone, monitoring of progesterone levels may be necessary, while PIO may render monitoring unnecessary. A recent study has shown that patients have no clear preference to route of administration of progesterone when routes have similar efficacy.  

Doyle N., Combs J., Jahandideh S., Wilkinson V., Devine K., O’Brien JE.
Live birth after transfer of a single euploid vitrified-warmed blastocyst according to standard timing versus timing as recommended by endometrial receptivity analysis. Fertility and Sterility. Accepted

Understanding Patient Evaluation of Abnormal Uterine Bleeding (AUB): A Standardized Patient Case on AUB for OB/GYN Clerkship Students 

Adkins LD, Harris BS, Gesher C, Reynolds T, Branford K, Baldwin M, Dotters-Katz S. Understanding Patient Evaluation of Abnormal Uterine Bleeding (AUB): A Standardized Patient Case on AUB for OB/GYN Clerkship Students. MedEdPORTAL. 2022 Jan 28;18:11216. doi: 10.15766/mep_2374-8265.11216. PMID: 35136836; PMCID: PMC8795174. 

Reproductive genetics laboratory may impact euploid blastocyst and live birth rates: a comparison of 4 national laboratories’ PGT-A results from vitrified donor oocytes. 

Bardos J, Kwal J, Caswell W, Jahandideh S, Stratton M, Tucker M, DeCherney A, Devine K, Hill M, O’Brien JE. Reproductive genetics laboratory may impact euploid blastocyst and live birth rates: a comparison of 4 national laboratories’ PGT-A results from vitrified donor oocytes. Fertil Steril. 2023 Jan;119(1):29-35. doi: 10.1016/j.fertnstert.2022.10.010. Epub 2022 Nov 29. PMID: 36460523.