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Baker KM, Leung AQ, Shah JS, Korkidakis A, Sakkas D, Penzias A, Toth TL. Simulation-based training for embryo transfer for clinicians with differing levels of expertise: an application of the American Society for Reproductive Medicine Embryo Transfer Simulator. F S Rep 2023; 4:29-35. [PMID: 36959969 PMCID: PMC10028427 DOI: 10.1016/j.xfre.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 08/06/2022] [Accepted: 08/09/2022] [Indexed: 11/29/2022] Open
Abstract
Objective To compare the learning curve of clinicians with different levels of embryo transfer (ET) experience using the American Society for Reproductive Medicine (ASRM) Embryo Transfer Simulator. Design Prospective cohort study. Setting Single large university-affiliated in vitro fertilization center. Patients Participants with 3 levels of expertise with ET were recruited: "group 1" (Reproductive Endocrinology and Infertility attendings), "group 2" (Reproductive Endocrinology and Infertility nurses, advance practice providers, or medical assistants), and "group 3" (Obstetrics and Gynecology resident physicians). Interventions All participants completed ET simulation training using uterine cases A, B, and C (easiest to most difficult) of the ASRM ET Simulator. Participants completed each case 5 times for a total of 15 repetitions. Main Outcome Measures The primary outcome was ET simulation scores analyzed at each attempt for each uterine case, with a maximum score of 155. Secondary outcomes included self-assessed comfort levels before and after the completion of the simulation and total duration of ET. Comfort was assessed using a 5-point Likert scale. Results Twenty-seven participants with 3 different levels of expertise with ET were recruited from December 2020 to February 2021. For cases A and B, median total scores were not significantly different between groups 1 and 3 at first or last attempts. Group 2 did not perform as well as group 3 at the beginning of case A or group 1 at the end of case B. All groups demonstrated a decrease in total time from the first attempt to the last attempt for both cases. For case C, the "difficult" uterus, groups 2 and 3 exhibited the greatest improvement in total median score: from 0 to 75 from the first to last attempt. Group 1 scored equally well from first through last attempts. Although no one from group 2 or 3 achieved a passing score with the first attempt (80% of the max score), approximately 30% had passing scores at the last attempt. Groups 1 and 3 showed a significant decrease in total time across attempts for case C. Following simulation, 100% of groups 2 and 3 reported perceived improvement in their skills. Group 3 showed significant improvement in comfort scores with Likert scores of 1.71 ± 0.76 and 1.0 ± 0.0 for the "Easy" and "Difficult" cases, respectively, before simulation and 4.57 ± 0.53 and 2.4 ± 1.1 after simulation. Conclusions The ASRM ET Simulator was effective in improving both technical skill and comfort level, particularly for those with little to no ET experience and was most marked when training on a difficult clinical case.
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Affiliation(s)
- Katherine M. Baker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
- Reprint requests: Katherine M. Baker, M.D., Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Kirstein 3, Boston, Massachusetts 02215.
| | - Angela Q. Leung
- Division of Reproductive Endocrinology and Infertility, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Boston IVF, Waltham, Massachusetts
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
| | - Jaimin S. Shah
- Division of Reproductive Endocrinology and Infertility, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Boston IVF, Waltham, Massachusetts
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
| | - Ann Korkidakis
- Division of Reproductive Endocrinology and Infertility, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Boston IVF, Waltham, Massachusetts
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
| | | | - Alan Penzias
- Division of Reproductive Endocrinology and Infertility, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Boston IVF, Waltham, Massachusetts
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
| | - Thomas L. Toth
- Division of Reproductive Endocrinology and Infertility, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Boston IVF, Waltham, Massachusetts
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
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Training for the future. Curr Opin Obstet Gynecol 2022; 34:172-178. [PMID: 35895957 DOI: 10.1097/gco.0000000000000800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The aim of this study was to review the evolving field of Reproductive Endocrinology and Infertility (REI) and describe the current and future challenges REI fellowship programmes in the United States are facing. RECENT FINDINGS The field of REI continues to rapidly evolve largely due to the tremendous advances within the assisted reproductive technologies (ARTs). Alongside this evolution, there is a lessening emphasis on graduates being proficient in all aspects of REI. Ongoing revisions to the REI fellowship structure reflect these changes in technology and contemporary practice patterns. SUMMARY REI is a rapidly evolving field and fellowship training is continually adapting to meet the changing landscape of our field.
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Agarwal A, Finelli R, Durairajanayagam D, Leisegang K, Sharma R, Gupta S, Singh N, Belo A, Darbandi M, Madani S, Covarrubias S, Darbandi S, Sadeghi R, Pompeu C, Boitrelle F, Kandil H, Saleh R, Arafa M, Vogiatzi P, Maldonado Rosas I, Anagnostopoulou C, Chockalingam A, Wirka KA, Sallam HN, Shah R, Henkel R. A Web-Based Global Educational Model for Training in Semen Analysis during the COVID-19 Pandemic. World J Mens Health 2021; 39:804-817. [PMID: 34169688 PMCID: PMC8443981 DOI: 10.5534/wjmh.210075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 05/20/2021] [Indexed: 12/03/2022] Open
Abstract
PURPOSE In response to the COVID-19 pandemic, the American Center for Reproductive Medicine (ACRM) transitioned its annual training in assisted reproductive technology (ART) from a hands-on, laboratory-based training course to a fully online training endorsed by the American College of Embryology. Here we describe our experience and assess the quality of an online training format based on participant outcomes for the first three modules of a planned series of online ART training. MATERIALS AND METHODS These modules included manual semen analysis, sperm morphology and ancillary semen tests (testing for leukocytospermia, sperm vitality, and anti-sperm antibody screening). The virtual format consisted of lecture presentations featuring laboratory protocols with corresponding video demonstrations of routine techniques and best practices. Practical scenarios, troubleshooting, and clinical interpretation of laboratory results were also discussed. At the end of each module, an optional multiple choice question test was held as a prerequisite to obtain certification on the topics presented. Course quality was assessed using participant responses collected via online surveys. RESULTS The digital delivery methods used were found to have largely or completely met the participants' expectations for all questions (>85%). The majority (>87%) of the participants either strongly agreed or agreed that the course content was well-structured with appropriate depth, and that their overall expectations of the course had been met. CONCLUSIONS This training format appears to be a realistic teaching option to freely share highly specialized expertise and technical knowledge with participants from anywhere in the world with varying levels of competency or experience.
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Affiliation(s)
- Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.
| | - Renata Finelli
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | | | - Kristian Leisegang
- Department of Physiology, School of Natural Medicine, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, South Africa
| | - Rakesh Sharma
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Sajal Gupta
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | | | - Andrea Belo
- Huntington Centro de Medicina Reproditiva S/A, Sao Paulo, São Paulo, Brazil
| | - Mahsa Darbandi
- Fetal Health Research Center, Hope Generation Foundation, Tehran, Iran
| | - Sarah Madani
- Department of Biology and Physiology of Organisms, Faculty of Biological Sciences, University of Science and Technnology, Houari Boumedien, Algiers, Algeria
| | | | - Sara Darbandi
- Fetal Health Research Center, Hope Generation Foundation, Tehran, Iran
| | - Raha Sadeghi
- University of San Francisco, San Francisco, CA, USA
| | | | - Florence Boitrelle
- Reproductive Biology, Fertility Preservation, Andrology, CECOS, Poissy Hospital, Poissy, France
- Paris Saclay University, UVSQ, INRAE, BREED, Jouy-en-Josas, France
| | | | - Ramadan Saleh
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Mohamed Arafa
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
| | - Paraskevi Vogiatzi
- Andromed Health & Reproduction, Fertility Diagnostics Laboratory, Maroussi, Athens, Greece
| | | | | | | | | | - Hassan N Sallam
- Department of Obstetrics and Gynaecology, Alexandria University Faculty of Medicine, Alexandria, Egypt
| | - Rupin Shah
- Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
| | - Ralf Henkel
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa
- LogixX Pharma, Theale, Reading, Berkshire, UK
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Ceccaldi PF, Pirtea P, Lemarteleur V, Poulain M, Ziegler DD, Ayoubi JM. Simulation and professional development: added value of 3D modelization in reproductive endocrinology and infertility and assisted reproductive technologies teamwork. Gynecol Endocrinol 2019; 35:559-563. [PMID: 30935263 DOI: 10.1080/09513590.2019.1588874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
As in other specialties of medicine, there is more to clinical performance in reproductive endocrinology, infertility, and assisted reproductive technologies (REI-ART) than simply the individual knowledge and technical skills. Simulation is commonly used during fellowship training in REI-ART, aiming to produce a virtual cycle of professional development in order to improve patient outcome. With scientific certification and the joint development of evaluation tools, the contribution of digitalization, such as 3 D printing and digital simulators, will facilitate teamwork in REI-ART and enable a better transmission of knowledge in the specialty.
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Affiliation(s)
- Pierre-François Ceccaldi
- a Simulation Department of Paris Diderot University , ILumens Paris Diderot, Paris , France
- b Obstetrics and Gynecology Department , Beaujon Teaching Hospital, Assistance Publique Hôpitaux de Paris , Paris , France
| | - Paul Pirtea
- c Department of Obstetrics, Gynecology, and Reproductive Medicine , Hôpital Foch, Faculté de Médecine Paris Ouest, (UVSQ) , Suresnes , France
| | - Vincent Lemarteleur
- a Simulation Department of Paris Diderot University , ILumens Paris Diderot, Paris , France
| | - Marine Poulain
- c Department of Obstetrics, Gynecology, and Reproductive Medicine , Hôpital Foch, Faculté de Médecine Paris Ouest, (UVSQ) , Suresnes , France
| | - Dominique De Ziegler
- c Department of Obstetrics, Gynecology, and Reproductive Medicine , Hôpital Foch, Faculté de Médecine Paris Ouest, (UVSQ) , Suresnes , France
| | - Jean-Marc Ayoubi
- c Department of Obstetrics, Gynecology, and Reproductive Medicine , Hôpital Foch, Faculté de Médecine Paris Ouest, (UVSQ) , Suresnes , France
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Morin SJ, Scott RT. Knowledge gaps in male infertility: a reproductive endocrinology and infertility perspective. Transl Androl Urol 2018; 7:S283-S291. [PMID: 30159234 PMCID: PMC6087846 DOI: 10.21037/tau.2018.05.02] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Reproductive research has moved forward at a remarkable pace. Some of these advances are the result of a separation between male and female specialties, allowing focused study in specific areas of the field. However, the different training programs between male and female fertility specialists has created an environment in which some discoveries are not put in the greater context of clinical care. At times, interventions have been measured against surrogate markers of outcome that may not impact the most meaningful outcome for patients—the delivery of a healthy neonate. For example, medical and surgical interventions that use changes in semen parameters may have a limited impact on the likelihood of achieving a live birth due to the limitations inherent in the semen analysis for predicting outcomes. Other commonly used tests, such as sperm DNA fragmentation assays provide promising biological plausibility to account for subfertility of some male partners. However, until well defined thresholds for predicting outcomes in different treatment scenarios are available, changes in sperm DNA fragmentation testing is not an adequate outcome for measuring the utility of interventions. The biggest limitation for these tests remains their analysis of bulk semen. Tests allowing interrogation of the reproductive competence of a given sperm, while allowing that sperm to be used in assisted reproductive technology procedures remain elusive. Progress toward reaching this end (whether by hyaluronic acid binding, IMSI, or Ramen spectroscopy) is underway, but much remains to be learned. Achieving testing and capture of individual sperm would better facilitate studies that measure the most meaningful outcome for patients and providers—the delivery of a healthy baby.
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Affiliation(s)
- Scott J Morin
- IVI RMA New Jersey, Basking Ridge, NJ, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Richard T Scott
- IVI RMA New Jersey, Basking Ridge, NJ, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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Levi-Setti PE, Cirillo F, Scolaro V, Morenghi E, Heilbron F, Girardello D, Zannoni E, Patrizio P. Appraisal of clinical complications after 23,827 oocyte retrievals in a large assisted reproductive technology program. Fertil Steril 2018; 109:1038-1043.e1. [DOI: 10.1016/j.fertnstert.2018.02.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 01/22/2018] [Accepted: 02/01/2018] [Indexed: 10/14/2022]
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Behbehani S, Hasson J, Polesello S, Son WY, Tulandi T, Buckett W. Do trained reproductive endocrinologists perform better than their trainees? Comparing clinical pregnancy rates and live birth rates after transfer of single fresh blastocysts. J Assist Reprod Genet 2018; 35:885-890. [PMID: 29423789 PMCID: PMC5984878 DOI: 10.1007/s10815-018-1127-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 01/23/2018] [Indexed: 01/13/2023] Open
Abstract
PURPOSE To compare clinical pregnancy rates and live birth rates of single blastocyst transfers performed by attending physicians or fellows in reproductive endocrinology and infertility program. METHODS Retrospective study in an academic reproductive center. We evaluated 932 fresh single blastocyst transfer cycles performed by fellows in training (389 embryo transfers) and by attending physicians (543 embryo transfers). RESULTS There were no differences in the baseline characteristics and IVF cycle parameters between patients who had transfers performed by fellows or attending physicians. Transfers performed by attending physicians or fellows resulted in similar CPR (46.5 vs. 42.9%, p = 0.28) and LBR (38.3 vs. 34.2%, p = 0.11). Multivariate logistic regression analysis showed that even after adjusting for possible confounders (age, gravity, parity, baseline FSH, antral follicle count, dose of gonadotropins, stimulation protocol, and quality of embryo transferred), CPR (OR 0.81, CI 0.62-1.07) and LBR (OR 0.79, CI 0.6-1.05) in the two groups were comparable. CONCLUSION Clinical pregnancy rate and live birth rate after embryo transfer performed by attending staffs or fellows are comparable. This finding reassures fellowship programs that allowing fellows to perform embryo transfers does not compromise the outcome.
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Affiliation(s)
- Sadikah Behbehani
- Department of Obstetrics and Gynecology, McGill University Reproductive Center, Montreal, QC, Canada.
- , Montréal, Canada.
| | - Joseph Hasson
- Department of Obstetrics and Gynecology, McGill University Reproductive Center, Montreal, QC, Canada
| | - Stefano Polesello
- Department of Obstetrics and Gynecology, McGill University Reproductive Center, Montreal, QC, Canada
| | - W Y Son
- Department of Obstetrics and Gynecology, McGill University Reproductive Center, Montreal, QC, Canada
| | - Togas Tulandi
- Department of Obstetrics and Gynecology, McGill University Reproductive Center, Montreal, QC, Canada
| | - William Buckett
- Department of Obstetrics and Gynecology, McGill University Reproductive Center, Montreal, QC, Canada
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